Harvey S. Mishner MD
Here are two articles that were just published. They make no sense to me. See what you think. The first, from Health Outcomes Res Med. 2012:e3-e10: This paper tells us that longer waiting times and shorter office visits really make patients mad and unhappy with their doctors. Now, this seems to be common sense and reasonable. Why waste grant money on something as obvious as this? Well, let’s look at the next article from Arch Intern Med online (2-13-12): This study says that higher patient satisfaction is associated with more hospitalizations, greater healthcare and prescription costs and a higher mortality risk (dying!).So the authors conclusion was that the more pleased the patient is, the more likely he is to die when compared to the dissatisfied patient.
(Laughter is the BEST medicine!)
Here are excerpts from a review on vitamins and supplements from the Archives of Internal Medicine.I reprinted it without any editing.Americans pay $27,000,000,000/year in vitamins and supplements!Best Evidence Review of Dietary Supplements and Mortality Rates in Older WomenMursu J, Robien K, Harnack LJ, Park K, Jacobs Jr DR. Dietary supplements and mortality rate in older women. Arch Intern Med.2011;171:1625-1633.
Dietary supplements are widely used by older adults, even though the effectiveness of these supplements in preventing illness is questionable. But can dietary supplements actually promote a higher risk for death? A new study suggests that the answer is yes for some of the most common supplements. This Best Evidence Review describes the findings of this study and puts these results in context.BackgroundVitamins and dietary supplements play an important role in the health and health care of many adults, and the business of supplements constitutes a multibillion-dollar industry worldwide. Based on the Third National Health and Nutrition Examination Survey, 40% of men and 50% of women older than 60 years of age consume at least 1 vitamin or mineral supplement. A national survey by the US Food and Drug Administration found that 73% of US adults were found to use dietary supplements in 2002, providing annual sale costs in 2005 of over $20 billion.[2,3]The widespread use of dietary supplements is not supported by practice guidelines. The US Preventive Services Task Force (USPSTF) states that there is insufficient evidence to recommend for or against the use of vitamins A, C, E, or multivitamins with folic acid or antioxidants. Specifically, the USPSTF cites concerns regarding the balance of benefits vs harms of these supplements. The American Medical Association recommends supplements specifically for seniors who have generalized decreased food intake, while the American Dietetic Association advises low-dose multivitamin and mineral supplements depending on individualized dietary assessment. The American Heart Association emphasizes healthy eating patterns rather than supplementation with specific nutrients.These recommendations against the routine use of supplements are grounded in good evidence. A Cochrane intervention review of 77 randomized controlled trials with 232,550 participants found no evidence to recommend antioxidant supplementation for primary or secondary prevention of mortality. Moreover, there is the possibility of harm related to the use of some supplements. For example, the Alpha-Tocopherol Beta-Carotene Cancer Prevention Trial demonstrated that beta-carotene supplements increased the risk for lung cancer among male smokers.CommentaryThe principal limitation of the current study was its observational nature, which leaves open the possibility of confounding by indication. Specifically, there is the possibility that women with higher risks for mortality or who developed serious chronic illnesses as they grew older had a wider use of supplements.Nonetheless, it is worth remembering that women who used supplements had superior health characteristics compared with nonusers. Therefore, supplement users should have experienced a lower risk for death overall. While it is plausible that some women started taking multiple supplements when confronted with news of a severe illness, such as cancer, it is hard to imagine that this practice alone was common enough to tip the scales toward a higher overall risk for mortality associated with the use of supplements.One of the more fascinating findings in this very interesting study is the higher risk for mortality associated with the use of iron supplements. Higher levels of serum iron and transferrin saturation have been associated with a lower risk for mortality.[9,10] However, another study found that men with a serum ferritin level of 200 mcg/L or more experienced more than a twofold increased risk for myocardial infarction. Finally, both increased serum iron levels and higher transferrin saturation have been associated with an increased risk for death due to cancer. Of course, in this study, women with existing anemia due to any number of chronic serious medical conditions, such as cancer or chronic kidney disease, could have been told to take iron supplements by their physician, and these illnesses might account for their higher mortality. In any case, it appears that the role of iron among adults without iron deficiency is controversial, and there is little data from clinical trials to suggest a benefit to the routine use of iron supplementation among adults.An additional interesting finding in the current study is the effect of calcium, but not vitamin D, supplements in reducing the risk for mortality. This is another controversial area because calcium supplements have been implicated in promoting a higher risk for myocardial infarction among women. However, in the Women's Health Initiative trial, the use of calcium plus vitamin D reduced the risk for some types of cancer without an overall effect on the risk for mortality.The findings from the current study offer several lessons to physicians. First, physicians need to pay close attention to nonprescription therapies used by patients. These treatments are routinely omitted from the history of many patients, but the current study suggests that physicians make such errors at the peril of their patients.Physicians should be a trusted resource for patients interested in dietary supplements. We can help balance self-treatment practices that might be effective against those that appear harmful or excessive. The findings of the current study should be sobering for the most ardent supporters of supplements, and patients need to understand the potential risks inherent in the treatment choices they make.Clinical Pearls • Nearly half of older adults routinely use dietary supplements, with higher rates of use among women compared with men. • The routine use of many dietary supplements is discouraged in practice guidelines. • The use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc, and copper was associated with a higher risk for mortality among older women in the current study. • Conversely, calcium supplements were associated with a lower risk for mortality. (I am not so sure about this statement!) • Physicians need to analyze nonprescription therapies used by patients and warn them of potential harms associated with the use of supplements.
Does your Cholesterol or Blood Pressure medicine interact with Grapefruit?It does if you take Zocor (simvastatin), Lipitor or certain BP medications.This looks promising, but make sure you are getting the RIGHT product.(Eating grapefruit regardless of when you take certain medications can cause serious muscular side effects)
If you love grapefruit, but can’t eat it because of its dangerous interaction with some prescription medications, there is hope.Scientists at the University of Florida have created a hybrid grapefruit that has the same citrus taste, but without the furanocoumarin compound that can be unsafe when combined with blood pressure and heart medications.“There are certain relatives of grapefruit that we call pummelo, some of which are very, very low or have no furanocoumarins in them at all,” said Fred Gmitter, a citrus geneticist at UF.As an added bonus – the new grapefruit is seedless.The hybrid grapefruit is described in the Journal of the American Society for Horticultural Science.
We all know that DIABETES increases risks of heart disease, strokes, kidney failure and blindness......but have you heard of this one? “Type 2 diabetes mellitus and colorectal cancer: Meta-analysis on sex-specific differences ?European Journal of Cancer, 09/25/2011 Evidence Based MedicineKramer HU et al. – In both men and women, risk estimates from case–control studies were slightly higher than those from cohort studies. Overall, type 2 diabetes mellitus (T2DM) is associated with a moderate increase in colorectal cancer (CRC) risk in both men and women“ At our office, we are more than just a place to get medicine when you are sick. We like to teach and practice wellness. The word “doctor” literally means teacher. We firmly believe in preventive medicine. That is why we employ nutritionists, life coaches, fitness trainers, physical therapist and massage therapists.
www.kaizentotalwellness.com (941)556-7788www.drmishner.com (941)747-2090
According to a study in the Journal of The American Medical Association (JAMA), when primary care doctors are plentiful, health care not only gets better, but costs go down. Dartmouth Medical School found lower death rates and fewer hospitalizations when patients had their health care provided by qualified physicians in an office setting. There is a DIFFERENCE between GENERAL PRACTITIONERS, FAMILY DOCTORS and INTERNAL MEDICINE SPECIALISTS. We are trained to treat more complex patients and are very skilled at co-coordinating care amongst different specialties.Unfortunately, Internal Medicine doctors will become extinct in the near future since many medical school students opt for higher paying specialties. According to Medical Economics, 50% of small (5 or less physician) practices will close in the next 5 years. CORPORATE and HOSPITAL controlled health care will rule the future. Goodbye Dr. Welby. Hello Wall Street. Medical costs will continue to skyrocket.JAMA. 2011;2096-2104 (May 28,2011)
Alpha-lipoic acid is an antioxidant that is made by the body and is found in every cell, where it helps turn glucose into energy.(Alpha-lipoic acid is not the same as alpha linolenic acid, which is an omega-3 fatty useful in heart health.) ALA has been shown to reduce blood sugar and a recent study showed that it markedly reduced weight gain in rodents. Before trying this supplement, please be aware that it may interact with diabetes medicine to lower blood sugar too much and can also interfere with thyroid hormone production. Please consult your doctor before taking this.
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