An Apple A Day

If you have been reading my thoughts for some time, you know that I am not a big advocate of mammograms. I really wish they would do the job they are supposed to do, but they just don’t.

Another study appeared recently, documenting the unpleasant consequences of well-intentioned mammographic screening. It is not the first study highlighting a dilemma that would be much more comfortable to deny. Years ago two large studies, including nearly one half million women, found that mammograms often found breast cancers that spontaneously disappeared, and that breast self exam did not reduce deaths from breast cancer. Much of the medical community and society at large have tried, pretty successfully, to ignore those powerful findings.

The principle author (H. Gilbert Welch) is someone I respect highly, partly because he thinks so clearly and critically about the application of research in clinical practice. Like me, he is trained in Family Medicine in addition to his research bona fides, so he always considers the “bottom line” outcomes. In the past I have recommend one or another of his books because they contain such clear discussions of the vitally important but infinitely confusing matter of using research to make health care decisions. The concepts he explains so well confused just about every medical student, resident and practicing physician I have worked with through my career. It is no surprise then, that his review of mammography data created a white-hot firestorm of controversy. You can read a simple discussion of the study and its implications in an editorial he wrote- http://www.nytimes.com/2012/11/22/opinion/cancer-survivor-or-victim-of-overdiagnosis.html

The essential findings of the study, reviewing the impact of three decades of mammographic screening in America, were:

• Mammograms did not lower the rate of widespread, life-threatening breast cancer
• Improved breast cancer survivor rates are the result of more effective treatment, not screening
• 1/3 of the diagnoses of cancer by mammogram were needless, consequently -
• 1.3 million women have undergone treatment for breast cancers that would never have caused harm

Unneeded treatment causes significant harm. The Hippocratic Oath begins with the admonition, “First, do no harm”. The obvious conclusion is that we need to find better ways to determine which cancers need to be treated and which do not.

The reaction of much of the medical community has been highly emotional. It has not been reasoned and scientific, like we pretend to be. I admit that I have enjoyed the controversy for a few reasons. Welch’s points are valid, but carry frightening implications about our ignorance. Maybe it is because I was already aware of our ignorance in this way (as well as in some many others), that I see mostly good in the controversy. It is another blow against erroneous assumptions. Sometimes it is necessary stir things up. Personally, having had decades of experience as a lightning-rod for narrow-minded criticism, it is nice to see someone else saying the right thing, accepting that it will be unpopular. I dedicated my medical textbook on homeopathy “to those with the courage to ask questions”, both because it is a rare quality in medicine and because it is essential to fundamental progress.

The universal assumption has been that cancers must be treated, or they will kill you. We have so much data, on so many cancers, refuting this facile falsity, that there is no excuse for sticking our heads in the sand. We urgently need to recognize our previous ignorance and move forward to answer the vital question of when treatment for cancer is needed and for whom.

Many medications are available only by prescription (unless you own a computer or travel to another country). That is because of the risks that accompany their use. When drugs become available we tend to believe that availability is some sort of certification that they are safe, and weak compared to prescription meds. Not true.

Recent news that daily use of aspirin lowers the risk of a number of cancers (especially esophagus, colon, rectum and lung) is another example of apparently wonderful information that is not, if you know enough. Seems great, doesn’t it? Take a safe drug and prevent some very nasty diseases. Shouldn’t I be taking it anyway, because it prevents heart attacks and strokes?

Here comes the buzz kill. Other studies, larger and more carefully designed, have not found this effect. Also, studies have found that taking aspirin does not prevent a first heart attack or stroke, as we had thought it would. It might be a good idea for that purpose in some middle-aged individuals, and probably is for those who have already had a heart attack or stroke. Finally, recent data shows that daily aspirin doubles the risk of macular degeneration, already one of the most common causes of age-related blindness.

Aspirin used to be routinely given to infants with fever. Then we learned that this could lead to (potentially fatal) Reyes Syndrome. I have never liked using it in this circumstance, because fever is generated by the body in its effort to make itself an unpleasant place for bacteria and viruses to live. Squashing the fever squashes the immune response and, as research shows, prolongs illness.

Ibuprofen, (aka ADVIL, MOTRIN, MUPRIN, RUFEN) seems like a good choice to so many. Inflammation is “bad”, so anti-inflammatory is then good.

Ibuprofen is the leading cause of impaired kidney function in the US. Years ago a kidney specialist told me she would not see a new patient for kidney trouble until the patient had been off ibuprofen entirely for at least a month, because dropping the kidney-imparing ibuprofen fixed 75% of the patients sent to her.

Ibuprofen markedly increases the risk of the most serious problem commonly seen in marathon runners. Their kidneys slow down from the exertion. Taking ibuprofen makes it worse. Their sodium drops and they can die. Not good.

Many athletes take ibuprofen before engaging in their sport. Ironically, ibuprofen increases damage to muscles and soft tissue because “inflammation” is one aspect of the healing process. At the medical meeting of physicians working with endurance athletes before the Marine Corps Marathon last fall, I was delighted to find myself in the company of others who shared my dislike for ibuprofen. We discussed its harms at length, as well as the muscle damaging effects of statin drugs. I loved it.

Is Tylenol, the “safer choice”. Not really. Starting from the very beginning of my medical training I spent a great deal of time working as an Emergency Room Physician. One of my first ER shifts I took care of a teenaged girl who was upset and, crying out for help, took an overdose of Tylenol, believing it was safer than aspirin. By the time she arrived in the ER, she had changed her mind and was feeling fine. She did not realize that, although , in the coming days her life was at risk due to the delayed, liver toxicity of acetaminophen/tylenol.

Following the recognition of the link between aspirin and Reye’s Syndrome, everyone switched to Tylenol. Now many think that the rise in childhood asthma, which began at the same time, is not a coincidence.

Remember, there is no “free lunch” biologically or otherwise. The best medication is no medication. Taking care of yourself, minding the essential health habits, will do far more to help you live well and happily than any medication. There is a place for drugs but they are only pharmacological band aids.

This video talk is exceptional. You will find it interesting and surprising. The presentation style is very cool and the information is accurate, overlooked and extremely important.

Dear Patients

I am sorry that this email has to be so long. My sadness that it is necessary is, of course, far greater. Also, please do review this material carefully, as I am unable to respond to the very large volume of emails and phone calls that we have been receiving. Reviewing my previous email/blog posting might also be helpful. If you have further questions regarding your own health, please call the office and schedule an appointment.

I understand the instinctive fear so many of you are experiencing. The trauma suffered by the Japanese is nearly unimaginable. If you have the means, I hope you have made some donation to the American Red Cross or some other humanitarian organization on behalf of the Japanese.

Despite this nightmare, at our distance the radiation released is very unlikely to pose any significant health risks. The Chernobyl disaster (25 years ago next month) is the standard against which all are compared. For perspective, Chernobyl effects extended about 1,000 miles, and the great majority of ill effects were limited to a few hundred miles. Santa Rosa is approximately 4,600 miles from these plants. As the winds are driving the air across northeast towards Alaska and then down into Canada first, we are effectively even further away. Chernobyl was the worst nuclear reactor disaster of all time because of the combination of a large explosion (much larger than anything in Japan so far), as well as the volume and nature of radioactive material released.

I gained much of my earliest experience as a physician explaining health issues to other doctors, the media and the public thirty years ago, when I started speaking on “The Medical Consequences of Nuclear Waste Storage”. The point of my effort was to act on my concerns about the long term safety and security threats created by nuclear power. The range of responses taught me a lot about how people respond to controversial information that they did not want to hear. One caller on a radio show was upset because I was “scaring old people”. Another suggested that I crawl back into my “cave on Fantasy Island”. The Chief of Staff at a hospital where I lectured proposed launching nuclear waste on rockets to the sun, somehow ignoring the fact that rocket failures happen regularly and scattering plutonium over thousands of miles was a really, really bad idea. The funniest might have been the front page newspaper story which began quoting “Dr. Michael Carlston, age 26″, immediately proving my naivete and inevitable ignorance.

The work I did speaking on this topic was on behalf of Physicians for Social Responsibility. I founded a chapter in Minneapolis-St Paul and was the first local chair. This organization has advocated in opposition to nuclear power and weapons since 1961. Today some PSR experts held a very useful press conference, with information beyond what I have found elsewhere. You can access it at:
http://www.hastingsgroupmedia.com/031611radiationhealthexposure.mp3

Sadly, the impacts of the tragic situation in Japan are widening. In addition to the severe challenges they face with rescues, medical care and basic survival needs for at least one half million displaced people, the collapse of infrastructure has made it impossible for authorities to gain control over all of their damaged reactors. After expanding the quarantine area and warning of radiation releases endangering the local population, the company withdrew operators from the reactors for their safety, unfortunately ending the vital efforts to prevent worse damage than has already occurred. In addition, after encountering clouds of radiation, US ships and airplanes moved further off the Japanese coast, with some relocating to the other side of the island, away from the prevailing winds. This is all extremely bad for the Japanese people, and possibly the Chinese, if the winds shift. As there is plutonium on the site and the half life of plutonium is ridiculously long (24,000 years) the present crisis is not only a short-term issue. Some of you might recall the line in the old song that went “plutonium is forever”.

One type of radiation being released into the environment at the Japanese site at a rate equivalent to 400 chest Xrays/hour. That kind of radiation is deadly to people on and near the site, but can have absolutely no effect on us. Particulate forms of radiation (including radioactive iodine, strontium and cesium) are the forms that are carried on the wind. A tiny particle of radioactive material, inhaled, swallowed or entering your body through broken skin, would hardly budge a geiger counter, but would increase your risk of cancer markedly, especially if it were an element that remained radioactive for a long time.

Radiation impacts are always the most severe on young children, infants and babies developing in their mother’s womb. In contrast, the consensus is that the proven thyroid-protective effects of potassium iodide are outweighed by its adverse effects on adults over age 40, except when exposed to doses those nearby the reactors might experience. Age, type of radiation, amount of radiation and your health conditions are all factors to consider.

My recommendations:

DO THE THINGS YOU SHOULD ALWAYS DO TO BE HEALTHY
There is nothing specific you can do to prevent all possible adverse effects of radiation, except to avoid exposure. General measures may seem wimpy but they are actually the most important, as they are the best overall protective measures you can take. If you are deficient in iodine, you are prone to absorbing any iodine including the radioactive version

Fluids
Exercise
Eat well (especially leafy greens, sea vegetables and fish)
Avoid the things that make you sick
One special point here is that radioactive iodine loses its radioactivity over weeks. Consequently, plants and animals in areas inundated by fallout will incorporate radioactive iodine and then expose people eating them (including milk products). BTW, radioactive iodine levels are 10 times higher in goat and sheep milk products than in cows milk.

Strontium accumulates in the same manner and is radioactive for decades not weeks.
Sleep
Supplements - calcium blocks many radioactive minerals including the radioactive form of strontium with its half life of 29 yrs.

Specific supplementation
At this time, I am not personally taking or planning to take potassium iodide. I may take some ginseng and certainly will, as always, take calcium, my MVM and do my best to follow excellent health habits.

Herbs - Siberian ginseng has been shown to reduce damage caused by radiation.

VITANOX Is a combination of green tea, turmeric, rosemary leaf and grape seed I use for various conditions including radiation exposures. As a compromise, you can also (and with greater enjoyment) consume somewhat more nominal doses of some of these in your diet

Potassium iodide
To remind you of what I have written previously-
Potassium iodide is only useful for protecting the thyroid gland. It also disturbs the thyroid, and so should not be used carelessly. The last time I saw a patient whose thyroid function was impaired, seemingly by taking a slightly increased amount of iodine (600 mcg vs the 100,000 mcg in most anti-radiation pills), was yesterday. Adverse effects from high doses of iodine DO occur. The high dose, protective approach is effective when started at the beginning of exposure. There has not been any radiation spread to the US, and it is likely that there will not be at a level likely to cause any health effects.

The young are the most vulnerable, with the developing fetus and newborns the most extremely vulnerable, AND most vulnerable to ill effects of potassium iodide.

If you are over 40, and living in N California, I do not recommend taking it at this time based upon my understanding of the worst possible outcomes arising from the Japanese nuclear crisis. Although I have had potassium iodide on hand at my home for many years, I do not anticipate taking any of it with this incident. The exposure simply does not warrant doing so. I may take Siberian Ginseng and VITANOX as well as my usual calcium.

Again, I feel most strongly that the right approach as far as iodine is to take the RDA of iodine (100-150 mcg for people of all ages). There is evidence that the thyroid damage (including cancer) caused by Chernobyl, was compounded by chronic iodine deficiency. If you have not been taking a supplement with such a level of iodine, avoiding iodized salt, not consuming sea food, and have no thyroid disease, taking a bit more for a couple of weeks would be wise and not harmful. How much is that? For adults a maximum of 1-2,000 mcg (ie 1-2 mg), scaled down for children by age (200 mcg in the youngest). You really should start taking a MVM with an appropriate level of iodine for many long-term health reasons.

Decisions about whom to dose and when are related to level of radiation exposure. When there is a major exposure as the Japanese face, the decision is very clear. Unfortunately, radiation dosage units are very confusing because they mean different things. One measurement you have probably never heard of (Gray units) are the best guideline for thyroid protection, as it indicates how much radiation the thyroid has absorbed. An expert was quoted on the LA Times online site today stating that iodide is recommended at a 50 rad exposure. We do not use rads any more but actually the equivalence should be 5 rads for children or 500 rads for adults. Quite confusing. To simply things

Detectable radioactive iodine (5 cGy) - treat children only
Up to 1 month of age: 16 mg
1 month to 3 yrs of age: 32 mg
3 - 18 yrs: 65 mg (if 150 lbs+ take full adult dose 130 mg)

Higher levels (10 cGy)
Adults to age 40: 130 mg

Levels 100 times higher (500 cGy)
Adults over age 40: 130 mg

I would extremely cautious about continuing these doses more than a week.

At higher exposure levels the preventive iodine dose for children does not increase.

PREGNANT women and newborn babies are very vulnerable to radioactive iodine AND high doses of preventive iodine. These individuals should take one dose with the guidance of a physician (never more than two), and shelter away from exposures (ie, stay indoors). The reason for this is the high risk of killing off the newborns thyroid with high doses of iodine, leading to congenital hypothyroidism (also known as cretinism).

Remember that people who have thyroid disease or an allergy to iodine should not take high doses of iodine.

Instructions on how to make iodide palatable to children
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072254.htm

http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072248.htm

General INFO on potassium iodide
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072265.htm

Best
Michael Carlston, M.D.
www.carlstonmd.com

We are bathed in all kinds of invisible energies. From cosmic rays to radio waves, we have no choice in the matter. Well, we do have some choice, but not much.

In the 1960′s my father was a computer whiz. He deliberately flunked out of college so that he could leave and join the Navy. There he learned much of what there was to know about electronics. Despite his higher educational choice, he was very smart and soon became the guy who’d fly off to the Pentagon to fix the computers they used for war games and firing nuclear missiles from ships. In part due to his influence, I grew up passionately immersed in the sciences, including computers. While I was notorious for my endless questions, the possibility of unintentional harm, questioning the reassuring understanding of the experts, had yet to enter my consciousness.

My first awareness of the sea of electromagnetic radiation we swim in came from a sixth grade take-your-child-to-work day. I do not remember much about that day, excepting one particular room. Some of the most sensitive work they did at this company was performed inside a room that had to be insulated from electromagnetic radiation. The room was unlike any other I have been in or seen at any time in my life. The room was made of copper and surrounded by wire coils constructed to block EMR. The strangest part of the experience was that inside this metallic echoing room it seemed surprisingly and strikingly peaceful and “quiet”. I was just 10 years old and blindly in love with science and technology. It was startling, unexpected and, as I became more questioning over the years, disturbingly laden with potential concerns.

EMR is another of the ways in which we have profoundly changed our environment in recent decades. It is not terribly surprising then, that we are more than a bit ignorant as to the impacts of the changes. For years research evidence has bounced back and forth on the ill effects of cell phones on our brains. Most of that concern has been whether cell phones increase the risk of cancer.

The results of medical research are usually considered dubious if the outcome is unexpected, particularly if those results challenge fundamental scientific “understanding”. There are MANY ironies in this. First, the reason we follow scientific methods is precisely to overcome our biases. Why then do we disbelieve our own results? Second, third, fourth and fifth (ad infinitum), scientific discoveries proving that we were previously totally wrong are common. That is how science advances. That is why we do science.

We now have clear evidence that cell phone radiation does in fact alter brain metabolism. A study of 47 individuals was published in the Journal of the American Medical Association a week ago showing a 7% increase in the metabolism of glucose (the brain’s energy source) in the parts of the brain closest to the cell phone antenna.

The study did not show that this caused cancer or was harmful in any way. Actually there is evidence that electromagnetic radiation to the brain can cure otherwise incurable depression, so this cell phone jazz could be positive. I think the odds are against that. Certainly now, the evidence of a measurable biological affect should help us stifle our biases pooh poohing this issue. It should also make you think a bit about your own EMR radiation exposures from cell phones, etc.

I suggest reading the book, DISCONNECT, by Devra Davis as food for thought. She is a serious researcher formerly at Johns Hopkins and the National Cancer Institutes. Another of her books, THE SECRET HISTORY OF THE WAR ON CANCER, despite it sensationalist title, is an excellent source of information on environmental causes of cancer. DISCONNECT is not as good, but still worth your time.