medicine

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When human lives are at stake, there is simply no room for emotional decisions based on pseudo-science.  But since when does anybody listen to anything I have to say?

Individuals are being removed from organ transplant lists because they are users of medical marijuana.  Most recently, a staffer at a dispensary that is kind enough to refer people to me for medical marijuana prescriptions told me about a 30ish young man who is in renal kidney failure.  He’s been taken off the list because –you guessed it – he is a user of medical marijuana.  I’m afraid it’s more common that I’d like to admit. Read more on Denied a Kidney Transplant for Taking Legally Prescribed Medicine?…

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In this life, everything should be as simple as it is, but not simpler.  That includes this questionnaire study about marijuana as an exit” drug for substance abuse.    This article hit a nerve because there are issues here I have come up against before.  And I mean “against.”  I don’t mean to say it isn’t “good science;” it is. I’m talking about the emotional resistance to the idea that detoxifying from a medication can be comfortable, painless, and effective.  I see this coming like I see the sun rising in the morning, because I have been to this place. A few years ago, I found myself in an informal banquet room across the parking lot from a hotel type establishment in a touristy part of San Diego.  There was a woman rep from the drug company, Hythiam.  She wasn’t an ex beauty queen like most reps, but a fairly credentialed therapist who actually knew what she was talking about.  My husband was there with me; a younger, chubbier, and more naïve me – therefore, less authoritative.

These Hythiem/Prometa folks had a great schedule of IVs that removed physiological cravings for various substances of abuse, including methamphetamine.  Basically, they use safe and older type drugs intravenously for a lovely pharmacological intervention.  The cravings stop, and the person does not “need” to use the drug. Neither they nor I was stupid and naive enough to think that was all you had to do.  Aftercare was important and I was ready to jump in.  They recommended vitamins — I recommended lots of vitamins, high dose, and chelated to cross the blood-brain barrier. But these addicted folks needed “prosthetic lives.”  When all you can muster goes to satisfying a craving or a need, there are not many hours left in the day for work or relationships.  I helped with this, too. Some people had problems, but they were mostly because of the psychosocial void left when they did not go for drugs, and their inability to fill it.  I worked my damnedest with these folks; and like the company, was eager to be accepted into the addiction community. There was this reception, and they had invited people from every substance abuse program in town.  I was there and ready to go to bat as the only physician who had experience with these folks locally. Two people showed up.  One was an older, fatherly type. The other was a young sidekick who was presumably learning from him.  This older guy said something that rings in my ears now. “You got to earn your sobriety.” Read more on Time to Stop Judging and Start Healing…

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I’ve got to admit, I must have already been living in the world of alternative medicine by the time the FDA approved Xyrem.  As far as I can figure, it’s exactly the same as the street drug GHB.  Us pharmacology types call this gamma hydroxybutyric acid.  In a stable salt form that people can take as a prescription drug, it can also be called sodium oxybate.  Among other sets of cognoscenti with whom I would usually not hang out — read “on the street” — it is known as various other things that those initials can stand for such as Georgia Home Boyor Grievous Bodily Harm,” a lovely term from old British law.  There have been a couple of high profile American cases where Xyrem was used as a date-rape drug.  The FDA has warned against taking dietary supplements that contain it.  It’s the very same chemical as GHB.  It is also an FDA approved prescription drug. Read more on Topic: Xyrem and Doctors…

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The medicating of Americans for mental illness has continued to grow over the last decade.  And while that’s not exactly a news flash, I have seen no approach as fresh as the one taken by the folks at CrazyMeds”.

They are not doctors.  They are presumably patients or potential patients, then, just as some doctors are or should be.  Their approach is so fresh that I am amazed to notice the grain of truth in it.  This is the same way I felt when I visited the Psychiatry Kills” Museum in Los Angeles, operated by the Scientology folks.  They had a distorted view, but I saw where they were coming from. Read more on Psychotropic Drugs, According to their Users…

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Drug company lobbyists still rule this country, even under a president who promised us something different.  I am sorry it took me so long to find out about the threats and deals made by the White House to get drug companies on board with Obama’s healthcare overhaul.  Apparently, it was released by Republicans at the end of May. Read more on Even Obama is Ruled by Drug Companies…

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I recently got hold of a copy of Dr. Atkins’ Vita-Nutrient Solution; a book by the same Robert C. Atkins, M.D. who invented the “Atkins Diet” –mainly known as the low-carb diet.  I was impressed by his general erudition and review of the literature.  He had even visited with various luminaries of alternative medicine.  Here was a guy who was capable of writing a pretty complete vitamin and mineral prescription for almost any chronic illness that was part of an internal medicine practice.

In a section titled “My Own Transformation,” he tells how, when he was devoted to mainstream medicine, he found a diet that worked for him and for most folks.  He had found it in the Journal of the American Medical Association, which is perhaps the most mainstream medical journal that exists.  He wrote his first book about that diet.  He was shocked when a consensus panel from the American Medical Association was critical. After all, he had been relying on medical literature which had been reviewed by peers and validated in every way that academics respect and deserve when they have done work.  He started questioning these professional “edicts” and found himself squarely in the world of nutrition-based therapeutics. I have believed for a long time that most psychiatric disorders, maybe all, are the result of a genetically transmitted limitation of the ability to metabolize nutrients.  There is plenty of evidence for this. Read more on Yes, Virginia — Cannabis IS Medicine…

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It is very hard for straightforward and presumably honest medical researchers to give us much of anything objective about something that has been labeled “alternative medicine”.  Maybe there should only be two kinds of medicine.  Good and not good; helpful and not helpful. I was minding my own business – well, as much as ever — when I found an article about chelation as a preventative for heart disease.  It basically says that chelation seems to “work”.  But it also seems that some people are ashamed to find this out and don’t want too many people to take advantage of this as a treatment option.  This makes about as much sense as most of what I have read recently about medical research, but I do have one way to put it in context. I have spoken at some alternative medicine meetings where I have proselytized about the effectiveness of high dose vitamins — chelated, to pass the blood-brain barrier.  I have been told that I would be skewered by colleagues.  Colleagues never seem to have much worried about what I have to say.  As a matter of fact, the world seems to have a pretty bad track record as far as listening to what I say. Read more on Chelation As Preventive Therapy for Heart Disease…

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The psychological ability to adjust to chronic medical illness is an area where there has been very little study.  Lately, I find myself working mostly with this population of people.  I’m noticing that some adjust very well and some do it very poorly.  It depends on a lot of factors.

The situation is clearest when the illness we’re talking about is back or neck pain.  Back pain, more than neck pain, has been clearly correlated to the presence of major depression.  If a person walks into the office crying and says they’re having trouble controlling what’s going on, it’s a pretty sure bet we’re dealing with depression.

Most back pain patients aren’t prepared for the kinds of life adjustments they are required to make.  Generally, many will need to switch from a job that has involved lifting or other physical work to a job that is more sedentary.  Quite honestly, most back pain patients are in no way prepared to do this.  Mostly, this is because anything that is sedentary is going to require a higher level of education.  Most of the folks I’m seeing are not highly educated, so the back pain leads to incapacity. Read more on Adjusting to Medical Illness…

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By every measure, America is hanging onto its first world status by a thread.  And even that is arguable.  We have been in slow decline toward third world status for the last 30 years.  And nothing speaks to this reality more than this country’s poverty rates. It is sad that poverty is measured in percentages and indices that are debatable at best.  As in many news stories, an effort is made to personalize — to render concrete — these elusive numbers.  The happiness of the person who found free fruit but could not afford it at Walmart, cited at the end of the article, is a touching story. These are the stories of real poor folks, who have seen me as patients, in rural northern California. Folks like the married couple, both of whom were on active army duty in both Iraq and Afghanistan.  They left their kids with their parents while they served.  They wanted to continue serving, but were informed they could not because of “military cutbacks.”  They asked for job direction from VA counselors who were no help, and finally both found minimum wage jobs.  Their new wages combined total less than 1/4 of their military salaries, but they still make too much to qualify for insurance.  They own some land — from the family – where they are living with their children in their parents’ houses.  They are wondering how they are going to pay for their children’s medical care. Like the young man who has impacted wisdom teeth and back pain from a serious accident at a saw mill.  Something ran amok and tons of wood fell on his back. He cannot pay for either dental care or an operation on his back.  His family has chipped in for medical marijuana.  He has no idea of how to do anything except stay home, in pain, depressed, and stoned. Or there’s the older woman on oxygen who cannot lift her tank and has a bag of pills she cannot lift either.  She needs me to hold her hand while she limps with great pain into my office.  She has a broken hip but until she is old enough for Medicare — a year or so — mostly her friends shop for her and bring her everything she needs.  What she really needs is an operation on her hip but has no idea how to pay for it.  I tell her to ask her doctor for some kind of a device to assist ambulation.  She says a cane is not enough and nobody will pay for a walker; certainly not for a wheelchair. Some people think Obamacare might help but have no idea what to do until then.  I have seen unemployed young people who are glad they are still on their parents’ health insurance. The kinds of things I am seeing are the kind of things that missionaries see in third world counties.  I know some physicians who have been discouraged from that kind of work, simply because people need basic food and shelter before they can be cured or managed.  From what the people above tell me, they do not seem to have these things, either. Hanging on by a thread to our first world status?  No.  The thread has broken and we are third world. Now.

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In the National World War II museum, it is easy and even triumphant and pride-generating to look back and see some of the scientific advances made during World War II.  There’s no doubt that science is advancing.  But I wonder if our ethics can keep pace.

I am fairly proud of Teflon.  And synthetic cortisone is widely used and may have saved plenty of lives. It’s a steroid that knocks down the action of the immune system.  When a medical substance becomes cheaper and easier to use and known to the public, then it runs a real danger of getting overused.  Most concern about overuse is focused on illegal steroids taken by athletes.  Nevertheless, everything that can be helpful and fast may make things worse. One example would be the over-prescribing of steroids to kids with allergies.

Penicillin had been invented before WWII, but its use did not become widespread until WWII.  Of course, it took people awhile to find out about the ability of bacteria to develop resistances to antibiotics.  This has led to newer and stronger antibiotics, which would not be the worst thing in the world. Unfortunately, the excessive use of antibiotics has led to untreatable infections, such as methicilline-resistant strep and an untreatable strain of tuberculosis. Read more on Science and War (and Ethics)…