Dietary Supplements: Warnings and Recommendations

Consumer Reports has an article in their latest issue, September 2010, called Dangerous Supplements. Since they almost always do a fine job of evaluating products, I was interested.

A bit of history concerning this interest of mine. I had been disturbed by what looked like too much unnecessary regulation of over the counter products. I had started taking red yeast rice at the recommendation of my primary care provider as an alternative to taking a prescription statin drug to lower my cholesterol. Her patients had had success with this product with fewer side effects than with prescription statin drugs.

After purchasing it online and being on it for a few months, my cholesterol dropped and was in the normal range for the first time in many years. I was delighted as was my PCP. Then, at the next blood check, my cholesterol started going back up. After some checking, we concluded that it was probably because the company manufacturing the red yeast rice had been forced to remove its effective statin-like ingredient. It seemed to me at the time that this was about profits and control rather than safety, and I was not at all happy, especially since I was being monitored closely to make sure there were no problems.

In a case like this, it is easy to have a knee-jerk reaction of anger, not look at all sides of the question, and generalize from one experience. Consumer Reports points out that there are products that have caused damage and require regulation.

As for the article, it looks at both dangerous supplements and at other supplements worth considering.

First comes the list of the dangerous ‘dirty dozen’: Aconite, Bitter Orange, Chaparral, Colloidal Silver, Coltsfoot, Comfrey, Country Mallow, Germanium, Greater Celandine, Kava, Lobelia, and Yohimbe. In the magazine, there is a chart that gives more detail about the uses, dangers, and other comments about each.

Next are their supplements to consider. These have apparently been shown to likely be safe for most people and possibly or likely to be effective for certain conditions.
Calcium, Cranberry, Fish Oil, Glucosamine Sulfate, Lactase, Lactobacillus, Psyllium, Pygeum, SAM-e, St. John’s Wort, and Vitamin D. Again, the article gives more details about each of these supplements.

I plan to to print the names of both on an index card to keep on hand while browsing through vitamin catalogs or at the drug store when considering a purchase.

Also rated in the article were multivitamins. They found most of the products to be of decent quality and to contain the ingredients in the amounts stated on the containers. They were also found to dissolve properly so that they could be absorbed into the system. The overriding message, however, was that most people do not need or benefit from multivitamins unless they are suffering from severe nutritional deficiencies. The irony is that it may look like there are benefits to taking them because the very people who are healthiest are often the ones who take them. It is easy to see how this would skew study results.

One thing I have learned is that all of this information needs regular revisiting and reevaluation. We can only work with our best current information and then be willing to discard it when new and solid research comes to the fore. And rather than jumping at every news item that touts another miracle product, there needs to be time for sifting and evaluating carefully with the help of sources such as CR and others.

Honor My Wishes

Almost everyone we know right now is dealing with elder care and end of life issues. One resource that we (Robin and Miriam) have both used in the past is called The Five Wishes. It is accepted as a legal document in the majority of U.S. states.
www.agingwithdignity.org/
Here is an excerpt from the website that describes the document.
"Five Wishes is an easy to use legal document that lets adults of all ages plan how they want to be cared for in case they become seriously ill.... Five Wishes helps you express how you want to be treated if you are seriously ill and unable to speak for yourself."

Since we live in Washington State, we have been looking at more local resources. One excellent all-volunteer organization is called Honor My Wishes. They are committed to raising public awareness about end of life issues. They promote discussions on health care choices and help in organizing important legal, financial and funeral planning information. Their main tool is a personal planning binder.
The binder and/or a Health Care Power of Attorney & Directive form for WA State are available for free download (although donations are appreciated) from the forms section of their website: www.HonorMyWishes.org

How much radiation exposure do you get every year?

We were wondering how much radiation exposure we get each year from various sources, including medical tests.
We came across a website of the American Nuclear Society which featured an 'interactive dose chart.'
They indicate that the average dose per person from all sources of radiation is about 360 mrems (millirems) per year.
Fill in your individual data, and it will come up with your annual dosage of radiation as well as the amount you get from each individual type of exposure.
Here is the link: http://www.ans.org/pi/resources/dosechart/

We noticed that cell phone usage was not included and found a website of the Environmental Working Group (EWG), a non-profit organization that provides public information in order to protect public health and the environment. Among other things, their site provides information about various cell phones and their radiation outputs.
According to the EWG site, "cell phone radiation differs from the high-energy waves of X-rays and some nuclear waste emissions. Its lower energy 'non-ionizing' waves penetrate deeper into the body but lack the energy to break apart molecules.... More research is needed to pinpoint the ways that cell phone radiation could damage the body."
Here is the link to their website: http://www.ewg.org/cellphoneradiation/faq

The Pressures on Doctors for Profits

You have to watch this short clip from a video called Health, Money, and Fear, produced by an emergency room (ER) doctor.
Chapter 6 is about the pressures on doctors to maximize profits.
Go to: www.ourailinghealthcare.com , then Play Chapters, and select Chapter 6.

ER doctors describe the pressures placed on them to produce more of what are called RVUs or units of billable activity. They are encouraged to order expensive diagnostic tests like CT scans or MRIs in order to bring in the big bucks and, at the same time, reduce their risk of liability.

Because a business model has replaced the earlier patient care model, doctors now find themselves in a bind. Should they approach the care of their patients with tests and procedures which are quick and add lots of RVUs and money OR should they focus, instead, on patient education about exercise and diet which takes much more time but yields little in the way of billable hours?

More on Canadian Health Care

Robin wanted to look at the fear that some have about Canada's 'socialized' health care system. She found a useful article by Rhonda Hackett from June 2009 in The Denver Post addressing myths about Canadian health care. http://www.denverpost.com/opinion/ci_12523427
Hackett is a Canadian who has been living in the U.S. for the past 17 years.

Here are 3 of the myths and some of the arguments she brings to bear in debunking them.

1. The Myth: Canada is a socialized health care system in which doctors work for the government.
The Reality: Doctors work in the private sector - most are self-employed - while their pay comes from a public source.

2. The Myth: There are long waits for care, and this compromises access to care.
The Reality: There are no waits for urgent or primary care in Canada. There are some waits for specialists' care and longer waits for elective surgery.

3. The Myth: Canada's health care system is a cumbersome bureaucracy.
The Reality: In the U.S. 31% of every dollar spent on health care goes to paperwork, overhead, CEO salaries, and profits. Canada operates with just a 1% overhead.

We attended a health care reform forum this week

We attended a health care reform forum this week. One of our local chiropractors has been hosting a series of what he calls transformational dialogues, and this was one of them. Nice idea. Rather than a battle between supporters and opponents of health care reform, the focus was on encouraging a thoughtful discussion about the important questions that need to be asked. Dr. Craig posed questions for the panel which included doctors, nurses, anthropologists and a health care policy advisor.

A few of the issues raised included: health care as a right vs. a privilege, how to reduce health care costs, how much profit should be involved in health care, and what drives the intense feelings on both sides of the issue.

Here are a few points that were made in addressing these issues:

• Canada spends half of what we do. We are ranked #37 and Canada is #3.


• A study in the New England Journal of Medicine of 6000 physicians representing every specialty reported 63% in favor of a strong public option, an additional 10% in favor of single payer. 


• In the 60s, the American Medical Association (AMA) fought hard against Medicare. The AMA represents only 25% of physicians. 


• Pharmaceutical companies spend only 13% of their money on research. They rely a great deal on government funded research.


• Only two countries in the world allow advertising of medications on television - the U.S. and New Zealand.

The Chaos of Health Care Reform

Well folks, it has been quite a ride since we last visited our blog and the issue of health care reform. The process of "discussion" of options and plans has been chaotic and downright nasty. We are interested here in looking at the big picture. In the course of traveling that route, we have come across some very thoughtful articles that address various pieces of the puzzle. One of those pieces is the cost of health care and how to control it.

One article that we especially like is called 'The Cost Conundrum' by Atul Gawande. It appeared in the New Yorker in June 2009.

Here's the link. http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

The author looks at the costs of health care in the U.S. He searches for the places that spend the most money on health care as well as those that spend the least. McAllen, Texas turns out to be one of the most expensive towns in the U.S. for health care. He also looks at models like the Mayo Clinic, which operate in various parts of the country, and Grand Junction, Colorado, a community which provides high-quality health care at substantially lower cost.

What accounts for the differences? After a great deal of digging, interviewing and comparing, he points to one particular issue and dividing principle. Rather than trying to maximize profits for the practitioners, the leading doctors and the hospital systems in the lower-cost places have found ways to reduce or eliminate incentives to spend more for the sake of maximizing profits. They also take collective responsibility for improving over-all patient care.

There you have it - one piece of the big puzzle. It is not easy to change an underlying philosophy and approach to patient care, but it has clearly happened successfully in some places and could be replicated and save lots of money without compromising quality of care.