Favorite Five from Recent Medical Journals
Profound Statements from the Former Editor of the
Journal of the American Medical
Seven Ways to Reduce Unnecessary Medical Costs -- Right
Now!* by George Lundberg, MD.
Paraphrases of his seven points:
Substitute intensive medical care for bypass surgery.
Substitute intensive medical care for angioplasty.
Stop PSA testing for prostate cancer. Stop surgery for
Stop mammograms for women under 50 and sharply curtail
use of all mammograms.
Reduce use of expensive tests (CT and MRI).
Stop administering chemotherapeutic false hope for
Stop prolonging dying with false hopes, bravado, and
According to Dr. Lundberg billions of dollars would be
saved, and changing current practices would also reduce
immeasurable human suffering.
1982 to 1999 - Editor in Chief of JAMA
Editorial responsibility for its 39
medical journals, American
Medical News, and various Internet
of the American Society of Clinical Pathologists
2002 to 2009: Editor in Chief of both Medscape
General Medicine and CBS
Academic appointments (professor):
Northwestern and Harvard
Consulting Professor, Health Research
Stanford Medical School, Los Gatos,
powerful quotes from this article:
that there are still many ethical and professional American
physicians and many intelligent American patients who are
capable of, in an alliance of patients and physicians, doing
‘the right things.’ Their combined clout is being
underestimated in the current debate on healthcare reform.”
of economic incentives to provide care that is unnecessary,
unproven, or even known to be ineffective encourages many
physicians to make the lucrative choice. Hospitals and
especially academic medical centers are also motivated to
profit from many expensive procedures.”
many physicians, their patients, and their institutions
suddenly now change these established behaviors? Patriotism,
recognition of new science, stewardship, and the economic
survival of the America we love. No legislation is necessary
to effect these huge savings.”
medical centers should take the lead, rather than continuing
to teach new doctors to ‘take the money and run.’”
George Lundberg, MD has just been added to my list of heroes
and mentors. He is one more professional person with the
courage to stand up and tell the truth. His voice is loud
and cannot be ignored. If he can be heard then he can help
stop the rivers of money that flow into the bank accounts of
doctors, hospitals, device manufacturers, and insurance
companies at the expense of patients.
have the great fortune of hearing him speak at our next
Advanced Study Weekend, February 19 to 21, 2010. (Two other
truth-tellers, Neal Barnard, MD and Dean Ornish, MD, will
also be speaking that weekend.)
add these seven ways to reduce costs:
all doctors and dietitians to teach a starch-based diet.
Earnestly promote clean habits and exercise.
baby formula by prescription only.
the sale of all oral diabetic medications.
elevated blood pressure only after it is sustained for
months at 160/100 mmHg or
Use a simple diuretic, chlorthalidone, when blood pressure
needs to be
(to no less than 140/90 mmHg with medication).
use of statins to people at high risk of heart disease—not
simply to treat
conservative treatments for major organ cancers (lumpectomy,
no routine surgery, no routine radiation, etc.)
article has been removed from Medscape since the original
publication on August 24, 2009. The author does not know the
reason for its removal. You can still read the article, “How
to Rein in Medical Costs, RIGHT NOW,” in its entirety at the
Institute and at this
Treatment" IS Better for Prostate Cancer
of localized prostate cancer following conservative
by Grace Lu-Yao published in the September 9, 2009 issue of
the Journal of the American Medical Association
10-year outcomes following conservative management,
men with a
life expectancy of less than 10 years may wish to
active surveillance or watchful waiting protocol
as an alternative to immediate attempted
curative therapy (radiation and/or radical surgery).”1
The study followed 14,516 men diagnosed between 1992 and
2002 and found a 10-year overall survival of 94% for men
with localized prostate cancer managed conservatively. Most
importantly, these results are better than the 90% survival
rate in a similar population of men who were treated with
radical prostatectomy in a Scandinavian study.2
Urologists commonly use this Scandinavian study to recommend
radical surgery to men. However, this study involved less
than 700 men divided into two treatment groups and had an
absolute survival advantage for surgery over “watchful
waiting” at 10 years of only 5.3%.
Once diagnosed with prostate cancer you are given three
choices of therapy for the disease localized to the
prostate: Radical surgery, radiation, or to do nothing.
“Doing nothing” is also called “watchful waiting.” Doctors
like to refer to this as “active surveillance.” Since
surgery and radiation have not been shown to save lives,
active surveillance means “doing nothing” until the cancer
returns or the PSA rises higher, and then doing treatments
that would have not saved lives in the first place.
Approximately 10% of middle-aged men are
found to have a positive PSA test. Approximately a quarter
of these men have prostate cancer on biopsy.
lifetime risk of being diagnosed with prostate cancer is
while the risk of dying of this disease
is only about 3%. Conservative management (no
surgery or radiation) is used in only about 10% of
patients—the rest get radiation and surgery, with common
debilitating effects of impotence and incontinence.
proven otherwise, conservative therapy is the right choice,
even for men with disease that appears to be aggressive. A
recent study of 50 men showed very good outcomes for men
with a prostate cancer given a Gleason score of 7.3
None of the men died of prostate cancer over the 6 years of
study. There is no reliable evidence to support
recommendations for radical treatments, surgery or
radiation, for men of any age or with any Gleason score.4
(Gleason score is an imprecise grading system used by
pathologists to help determine prognosis.) Unfortunately
most doctors are afraid to practice evidence-based medicine
and to do the right thing. If a metastatic prostate cancer
is discovered after opting for watchful waiting, then there
is danger for the doctor—especially in the litigious
environment of the United States—of a malpractice claim of
medical negligence. Because of these fear-based medical
practices, millions of people are harmed unnecessarily.
GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, Barry
MJ, Zietman A, O'Leary M, Walker-Corkery E, Yao SL. Outcomes
of localized prostate cancer following conservative
2009 Sep 16;302(11):1202-9.
2) Bill-Axelson A, Holmberg L, Ruutu M,
Häggman M, Andersson SO, Bratell S, Spångberg A, Busch C,
Nordling S, Garmo H, Palmgren J, Adami HO, Norlén BJ,
Johansson JE; Scandinavian Prostate Cancer Group Study No.
4. Radical prostatectomy versus watchful waiting in early
prostate cancer. N Engl J Med.
2005 May 12;352(19):1977-84.
3) van den
Bergh RC, Roemeling S, Roobol MJ, Aus G, Hugosson J,
Rannikko AS, Tammela TL, Bangma CH, Schröder FH. Gleason
score 7 screen-detected prostate cancers initially managed
expectantly: outcomes in 50 men.
4) Wilt TJ,
MacDonald R, Rutks I, Shamliyan TA, Taylor BC, Kane RL.
Systematic review: comparative effectiveness and harms of
treatments for clinically localized prostate cancer. Ann
Intern Med. 2008 Mar 18;148(6):435-48.
Vegetarians Make Plenty of Essential Fats (DHA)
by Thomas Sanders in the
August-September 2009 issue of the journal
Leukotrienes and Essential Fatty Acids
concluded, “…the relatively lower intake of
linoleic acid and the presence of preformed DHA (fish) in
the diet of omnivores explain the relatively higher
proportion of DHA in blood and tissue lipids compared with
vegetarians. In the absence of convincing evidence for the
deleterious effects resulting from the lack of DHA from the
diet of vegetarians, it must be concluded that needs for
omega-3 fatty acids can be met by dietary ALA (alpha
linolenic acid).”1 ALA is made by plants.
Your well-meaning friends and family may insist you eat fish
in order to get enough of the essential fat DHA for the sake
of your brain. The two fatty acids (fats) that are essential
for human health are the omega-3 alpha, linolenic acid
(18:3n-3; ALA) and the omega-6, linoleic acid (18:2n-6; LA).
Only plants can synthesize these two fats. No animal or fish
can make these fats, but they can be stored in their bodies.
These essential fats are converted in animals, including
fish, to longer chain derivatives, such as DHA and EPA.
DHA, which stands for docosahexaenoic acid, is a type of fat
found abundant in the membranes of the retinas of the eyes
and the brain. DHA is naturally found in human breast milk,
and preformed dietary sources for adults include fatty fish.
The human body has no difficulty converting the
plant-derived omega-3 fat, ALA, into DHA or other omega-3
fatty acids, in the liver, thus supplying our needs even
during gestation and infancy.2
solid science you can put your friends’ worries at ease—as a
non-fish-eater you will be just fine. And you’ll also avoid
all that toxic mercury and help restore our oceans.
TA. DHA status of vegetarians.
Essent Fatty Acids.
Langdon JH. Has an aquatic diet been necessary
for hominin brain evolution and functional development?
Br J Nutr. 2006 Jul;96(1):7-17.
Cholesterol-lowering Statins Weaken Muscles and Cause Falls
Therapy, muscle function and falls risk in
community-dwelling older older adults
by D. Scott, published in QJM, monthly journal of the
Association of Physicians, found “Statin
use may exacerbate muscle performance declines and falls
risk associated with aging without a concomitant decrease in
muscle mass, and this effect may be reversible with
cessation.” A common side-effect of statin therapy is
skeletal muscle damage (myopathy), which sometimes includes
muscle pain (myalgia) and weakness. Enzymes released from
the muscles (creatine kinase) may or may not rise in the
blood in association with this damage.
In this study, a total of 774 (48% female)
participants were studied over 2.6 years. The average age
was 62.0 (range 51–80 years). No differences in effects were
found among different kinds of statins. Stopping statin use
was associated with improvement.
This paper describes subtler, easily overlooked, harms from
cholesterol-lowering statins—muscle weakness and falls. We
commonly hear of the rare but severe form of muscle damage,
rhabdomyolysis, which can occasionally result in
death. About 1% to 5% of people on these medications
experience muscle inflammation and pain (myositis). A recent
study, with electron microscopy and biochemical approaches,
examined the muscle tissues of patients on statins. They
found muscle cell damage in over 70% of people on statins,
even when they had no complaints of pain.2
and least expensive way to lower cholesterol levels is to
eat a low-fat, no-cholesterol diet, like the McDougall Diet.
Typically people experience a 20 to 60 mg/dL reduction in
total cholesterol in seven days on blood tests—along with
many other benefits from their change in diet. I do not
statin drugs in otherwise healthy people because
benefits, in terms of reduced heart attacks and death, are
not apparent. I do prescribe
statins in patients with a high risk of a future heart
attack or stroke (for example, a person with a history of a
previous heart attack, angioplasty, or bypass surgery). For
these few people in need of medication my goal is to reduce
their total cholesterol below 150 mg/dL with the foundation
of their care always being the McDougall Diet, strictly
1) Scott D, Blizzard L, Fell J, Jones G.
Statin therapy, muscle function and falls risk in
community-dwelling older adults.
Draeger A, Monastyrskaya K, Mohaupt M, Hoppeler H,
Savolainen H, Allemann C, Babiychuk EB. Statin therapy
induces ultrastructural damage in skeletal muscle in
patients without myalgia. J Pathol. 2006
Osteoporosis Drugs May Cause Esophageal Cancer
Reports of esophageal
cancer with oral bisphosphonate use
by Diane K. Wysowski, Ph.D. from the Food and
Drug Administration in the January 2009 issue of the New
England Journal of Medicine found that, “Between the
time of the initial marketing of
alendronate (Fosamax) in October 1995 through
mid-May 2008, the Food and
Drug Administration (FDA) received reports of
23 patients in
the United States receiving a diagnosis of
with alendronate (Fosamax, Merck) as the
suspect drug (in 21
patients) or the concomitant drug (in 2
patients).” The median time from
alendronate use to diagnosis was 2.1 years.
Thirty-one patients from Europe and Japan were reported as
received a diagnosis of esophageal cancer
after using alendronate
(the suspect drug in 21 of the patients).”1
Several critics with ties to the drug industry responded to
this potential risk in the April 2009 issue of the Journal.2
The first warning in the Physician’s Desk Reference
FOSAMAX, like other bisphosphonates, may
cause local irritation of the upper gastrointestinal mucosa.
Esophageal adverse experiences, such as esophagitis,
esophageal ulcers and esophageal erosions, occasionally with
bleeding and rarely followed by esophageal stricture or
perforation, have been reported in patients receiving
treatment with FOSAMAX. Patients are instructed to sit up or
stand up for 30 minutes after taking this medication in
order to help prevent esophageal damage…
Bisphosphonates, which include
Actonel, Boniva, and Zometa,
are dangerous drugs with few actual benefits for the
prevention of osteoporosis-related fractures—I
will not prescribe them. They have been shown to cause
delay in fracture healing (non-union of fractures), death of
bone (jaw necrosis),
bone, joint, and muscle pain in women, and damage to the
esophagus. There has also been concern that they may cause
heart damage (atrial fibrillation).
Eating the rich Western diet, especially the
consumption of animal proteins and associated dietary acids,
causes osteoporosis. These acids must be neutralized after
ingestion. The bones are the primary buffering system of the
body. They dissolve to release alkaline materials. At the
same time, changes take place in the kidneys from animal
proteins and acids allowing the bone materials to pass out
of the body into the urine where these precious materials
are lost. There is every reason to believe that osteoporosis
is not only preventable by following an alkaline-rich,
starch-based diet, but also reversible. My patients have
shown improvements in their bone mineral density (BMD) after
changing to the McDougall Diet. Exercise is also helpful.
1) Wysowski DK. Reports of esophageal cancer
with oral bisphosphonate use. N
Engl J Med. 2009 Jan 1;360(1):89-90.
N Engl J Med. 2009 Apr 23;360(17):1789-90.
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