Although we can, of course, never draw conclusions from a couple of weeks, the recent heat seems to be melting any remaining illusions about global warming. As the temperatures have dropped to normal, my keyboard has cooled enough to write again.

The medical meetings I attended in May and June gave me lots of good ideas. Many of which I’ve begun applying in patient care, many more I am still digesting. It is easy to run with every “latest thing”, losing sight of the bigger picture. On the other hand, the usual problem in medicine is rejecting everything unfamiliar as worthless. Everything, that is, except the new drugs pushed by the charming drug company representative. As you know I prefer more natural approaches, and so tend to stay away from those marketing exposures.

Best, Michael Carlston, M.D.
www.carlstonmd.com 
707-545-1554

Two impressive reminders of the toxicity of prescription drugs hit the media recently. The popular press picked up on the new report from the Institute of Medicine that drug errors (dosage or name confusion) kill 1.5 million Americans a year. The AMA medical news reported on the growing recognition that unused prescription drugs are a form of toxic waste in the environment, due to ill effects on nonhuman life. Furthermore, we don’t know how to properly dispose of old medications.

So the bottom line on the second issue is that it’s a problem, but we don’t know what to do about it. The obvious solution to both of these problems is to do your part to leave those medicines in the big bottles at the pharmacy where they can be safely watched. When you really really need them you will know where to find them.

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Living in Sonoma County is wonderful in many ways. One aspect of my professional life here is not so great. That is the lack of understanding of drug addiction. Alcohol is the biggest layer in drug addiction. It seems to be difficult for people to accept that alcohol, just like marijuana, prescription drugs, etc, are not always evil or good. While using just about anything medicinal can cause some physical damage, it is the pattern of use which reflects addictive behavior. It should not surprise anyone that alcohol is the most important “gateway” drug. The gateway leads to addiction.

Two groups of researchers recently looked at the long-term effects of using alcohol in childhood. One group learned that those who used alcohol before age 14 were five times more likely to become alcoholics at some time in their lives. While such early use of alcohol and long-term alcohol addiction could both be the result of personal or family problems, another study points to alcohol as a directly causative factor. Those researchers found that teenagers exposed to alcohol might permanently damage the parts of the brain responsible for controlling impulses, learning and decision-making.

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Despite my semi- optimistic assessment in a recent newsletter, it appears that we have new grounds for pessimism. In case you didn’t read it, I wrote that the fact that the numbers of cases had not been rising as expected looked like a good sign that perhaps very few of those exposed to Mad Cow tainted products had received a sufficient dose of prions to develop illness. Tracking a similar disease in the South Pacific over 50 years, researchers learned that the average time from exposure to symptom appears was 39-56 years. Given the fact that Mad Cow disease involves transference from one species to another, we expect that it should take longer for the average Mad Cow case. There is a significant amount of guesswork involved and maybe the length of time will be reassuring to some. Certainly what this new information does do is to remind us of our relative ignorance.

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One of the most exciting areas in medicine is all that we are learning about biomarkers. Biomarkers are chemicals in the blood which give us subtle information about diseases and treatment response.

For example, osteoporosis is a big problem complicated by the fact that the best test (DEXA bone density) is not as predictive of fractures as we’d like, can only be checked every couple of years and requires radiation. Two years is a LONG time to wait to find out if what you are doing is working. I am routinely now using biomarkers to evaluate therapy in patients over months instead of years.

UCLA researchers have discovered that a pattern of biomarkers allowed them to diagnosis ovarian cancer with 100% accuracy in a small study. This is very big news because the tests we currently have (CA-125, ultrasound, physical exam, etc) are very unreliable and it appears that discovering the disease earlier would greatly increase a woman’s chance of successful recovery. The testing device has been patented and, if all goes well, could be available in doctors’ offices by late 2007.

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