Dr. H on food, medicine and life

I'm pleased to announce that we're starting something new. In the wake of the huge interest generated by my "hip blog", we're debuting a new section of drhoffman.com: A personal blog in which I will hold forth on essentially whatever is on my mind on a given week. This part of the website will be totally informal, raw, and unadulterated.

I think you'll find the new blog a welcome complement to the articles on health topics that I write for other parts of the website. Blogging will give me "quick turnaround" to express my thoughts on items of interest in the news, health breakthroughs, conferences I attend, or things that we're doing at the Hoffman Center.

Who knows: There might even be a movie, play, music or TV show review interspersed, or even some sports!

And don't forget to e-mail us your questions at drhoffman.@wor710.com to provide grist for the mill!

Be sure to check back here frequently for timely updates, and bookmark your web browser to make this page a favorite!

Dr. Hoffman

Unfortunately, the WSJ didn't see fit to publish my letter, so I'm reproducing it in its entirety below

Letter to the Editor WSJ Re: Bookshelf by Scott Gottlieb "Herbal Legends" Trick or Treatment, by Simon Singh and Edzard Ernst, M.D.

August 19, 2008

I was disappointed to read Dr. Scott Gottlieb's uncritical review of Trick or Treatment. This book appears to be the latest in the genre that debunks alternative medicine written, not by actual practitioners of natural therapies, but by "authorities" with a Quackbuster agenda.

It is disingenuous to allude to the infrequent harms associated with alternative medicine when it is well-documented that hundreds of thousands of Americans die in hospitals each year from adverse reactions to FDA-approved drugs properly administered by licensed medical professionals, and untold millions of Americans have adverse reactions to FDA-approved drugs.

Evidence-based studies tell us that antibiotics make little difference in treating bronchitis, sinusitis, and childhood ear infections. Aggressive strategies to control diabetes with drugs control blood sugar but yield little benefit in mortality. Today's hallowed drugs and heroic interventions are too often quickly relegated to medicine's junk heap.

No wonder that Americans turn to alternatives, which are not, as Singh and Ernst dismissively allege, just well-administered placebos. Moreover, studies show that most consumers of complementary medicine do not dangerously eschew conventional treatments--they simply want to access the best of both worlds.

Natural therapies are notoriously difficult to validate in traditional study settings. While Dr. Gottlieb states "the evidence of clinical trials is largely ignored when it comes to alternative medicine," are multi-modal interventions involving diet, supplements, physical manipulation, and lifestyle amenable to the randomized double-blind placebo controlled model engendered by drug trials? Medicine's slavish adherence to inappropriate evidence criteria could impede acceptance of much that is valuable in the altmed armamentarium.

It is unfortunate that, at the very historical moment when our costly, ineffective, and side-effect laden medical system threatens to founder, ideologues like Singh and Ernst are foreclosing what well might be conventional medicine's best option for avoiding meltdown: incorporating safer, low-tech, relatively cheap therapies, and empowering patients toward enlightened self-care.

Ronald L. Hoffman, MD New York, NY

Merck has been aggressively marketing this new vaccine for Human Papilloma Virus, even lobbying state legislatures to mandate the vaccine for all girls age 9 and above (I guess that's when they think girls start to become sexually active these days!).

The theory is that we can eradicate the scourge of cervical cancer by innoculating ALL girls against HPV, the main cause of pre-cancerous transformation in cervical cells. The argument is even being made that, while we're vaccinating our young girls, we might as well give shots to the boys, because, after all, they can be carry the virus and sexually transmit the disease.

But this effort to add yet another required vaccination to the long list to which our kids are subjected is fraught with drawbacks--and perils.

Not the least of which is the unwillingness of some parents to acknowledge that their adolescent girls will imminently engage in sexual activity. When proposed government mandates take effect, ALL girls will get the vaccine, regardless of whether theyıre having sex. In the government's cynical view, there's no telling when your little girl will become active, hence the attempt to vaccinate young grade school girls. Imagine the pre-teen discussions this will prompt at Brownie troop meetings or in cafeteria lines!

The vaccines are expensive, costing around $360 for the 3-shot series (no wonder Merck is pushing this!). Side effects range from sore arms, and low-grade fever and malaise to paralysis and death in a few tragic cases.

The New England Journal's editorial is entitled "Human Papillomavirus Vaccination--Reasons for Caution." Their main point is that the vaccine program is a big experiment with our kids as guinea pigs. While the vaccine does prevent SOME forms of HPV, incredibly there are NO long-term studies that show it actually reduces the incidence of cervical cancer--the prime rationale for the expensive and potentially hazardous universal vaccination campaign. This is terrible science!

Why should a vaccine that's been shown in experiments to prevent HPV infection NOT help to prevent cervical cancer? The Journal article points to several reasons:

1) Just like the flu vaccine, the HPV vaccine is only effective against certain strains, but not all, of the disease-causing virus. Sure, we could modify the vaccine every year to head-off new or resistant strains of HPV, but that's exactly what we try to do with the flu shot, sometimes with poor results.

2) One of the consequences of the vaccine campaign might be to make women (and men) less careful about unprotected intercourse, thus actually increasing the risk of cervical cancer due to resistant HPV or chlamydia, another suspected trigger of cervical cancer risk. Increased unwanted pregnancy, other sexually-transmitted diseases, and even HIV might be the unintended consequences.

3) Similarly, falsely reassured that they are "bullet-proof", some vaccinated women might skip annual PAP smears, which clearly ARE helpful in catching cervical cancer before it spreads.

4) Since the vaccine is new, it's unclear how long it confers protection. Ten years? Twenty? Are there variations in women's immune systems that make the vaccine "take" longer in some women, and wear out in others? We simply don't know!

5) Are there other, as yet unrevealed consequences of the Gardisil vaccine? Might it have suppressive effects on immunity--since we know that normal exposure to infections entrains healthy immune systems to respond better to infections and cancer? Again, unknown territory.

6) Is the cost of the vaccination program justified? Surely, some would argue, if we could save even just a few lives, aggressive measures are justified--no? But what if a national program to "eradicate" HPV were to cost--let's just say--$18 billion (do the math--that's the cost of vaccinating just one generation of 50 million young girls and boys!)? Wouldn't it be more prudent and cost-effective to embark on a national campaign to provide PAP smears (average cost $100) to all eligible women?

Folks, this is nuts! Even the usually complicit New England Journal of Medicine is saying hold on:

"With so many essential questions still unanswered, there is good reason to be cautious about introducing large-scale vaccination programs. Instead, we should concentrate on finding answers through research rather than base consequential and costly decisions on yet unproven assumptions."

Right on, New England Journal!

As we waited by the checkout register, I watched the cashier scan the dozens of grocery items we were buying. It was all done by computer, effortlessly, efficiently.

Then a thought occurred to me: All the nutritional information for each product has been compiled somewhere: its caloric value, carb, sugar, fat, protein and fiber content, even the vitamin/mineral breakdown, and probably even its ORAC value, preservative and artificial ingredient content, even levels of hazardous mercury. Perhaps there's even a way to compute nutrient density, a reasonable proxy for foods' nutritional value.

So . . . theoretically at least, it would be possible for the grocery store to provide each departing shopper with, not just the price total for their day's purchase, but also with its caloric value, and the nutritional composition of the food they're buying.

Suppose then, that the purchases could be linked to voluntary demographic data about the characteristics of the purchasers and their family: family size and composition, activity levels, height and weight of individual family members. Maybe, even, an anthropometric measurement portal through which each shopper could pass and record height, weight and body composition and metabolic rate!

There might even be a special "Aoooogah" klaxon that would sound when the shopper exceeded the reasonable caloric allocation for, say a family of four with few metabolic demands because of a sedentary lifestyle!

Exhortative messages might be given to shoppers like: "We notice that you have purchased 21,347 calories of food today. At this rate, the average family of four should subsist for at least four days. If your family consumes all this food in three days or less, we suggest that you either (a) increase your household's metabolic rate with a concerted program of exercise for all family members, or (b) delete some or all of the following items from today's shopping list: soda, cookies, candy bars, M & M's, pretzels, chips, and/or frozen pizza.

Now taking this one step further, a totalitarian government of the future might decide to harness this technology to impose healthy guidelines on its recalcitrant citizens. Wait, this isn't so far-fetched, even social democratic Japan has enacted new regulations to assure a fit, non-obese population--employees now are required to queue up at work to be weighed and to have their waist-lines measured. The reason: health care entitlements are going through the roof, and the government has a stake in curtailing medical expenditures associated with diseases of excess. Can't happen here? Teachers tell me that they are now required to calculate the BMI's of their students and make a report to parents when they exceed a certain threshold!

Such a government regime might install software at the checkout counter that actually prevents citizens from exceeding nutritional guidelines. Over-consumers would literally be flagged down at the cash register, and prevented from committing dietary malfeasance. How might the ingenious shoppers of the future circumvent the new nanny states' tyranny?

Overweight shoppers desirous of obtaining their sugary snacks would be reduced to the stratagem used by generations of high school kids trying to pay winos a few bucks to obtain booze for them.

Someone who has expended their caloric quotient for the week, languishing unhappily in front of the PriceChopper display window, would go up to someone of healthy weight and body composition--say, a competitive cyclist stopping off at the market to buy some broccolini and a bottle of Evian--and enlist them to sneak out a box of contraband Oreos.

Just like environmentally-compliant utilities selling carbon credits, healthy consumers could sell "junk" credits to gastronomes trying to circumvent the calorie controls imposed by the food police. A lively junk-trading market might emerge on the internet of the future--with abstainers saving up fat and sugar credits and engaging in spirited arbitrage.

Anyway, interesting speculation to idle away a few leisure minutes while on vacation. Don't worry, it'll NEVER happen. Markets would never accede to alerting customers to the nutritional perils of the food they're buying. Look how long it took to get them to list hydrogenated fat. They fought tooth and nail, and to this day, the disclosures remain misleading.

Now, the Iron Man comprises a marathon run, but only as the dessert, after a main course of a 2 1/2 mile swim, followed by an incredible 112 mile bike ride.

By contrast, the Olympic distance triathlon that will be featured in the Beijing Olympics comprises a one mile swim, a 25 mile bike ride, and a six mile run. That's the event that I've done several times.

On race day, we were woken up at the crack of dawn by inspiring rock music emanating from the bandstand at the race start on the other side of Mirror Lake. Family members and friends had gathered to support the race of David Cowan, age 31.

The starting cannon roared, and the swimmers churned the water like a school of piranhas jockeying for position on the fresh water lake. In the days before the race, I had plied the swim course, and found it one of the smoothest most delightful swim experiences of my life, after remorselessly orbiting in chlorinated pools and in choppy ocean waters.

After two circuits, contestants transitioned to their bikes, but the sky opened up with a punishing downpour that lasted the entire race. Incredibly, David maintained his pace, and as he passed our cottage a couple of times we tried to buoy his soggy spirits, but he appeared undaunted and flashed us the V sign.

Incredibly, the oldest contestant was a 71 year old who has done 31 Iron Man competitions so far. Many competitors are in their 50's. Professionals complete the three segments in just over eight hours, and David did it in eleven and change, a very respectable time, and a personal best.

The course remains open from the 7:00 AM start time until midnight, allowing a few stragglers to cross the finish line to applause after an amazing 17 hours of non-stop exertion. We saw a female contestant stumble toward the finish line on rubbery legs, fall to the ground twice, and amidst roaring cheers from the crowd, get up again and propel herself forward across the line.

The sport went from a freak aberration for hammerheads to such incredible popularity that race entries sell out on the internet within minutes of opening up. There are dozens of events world-wide, and athletes frequently travel thousands of miles to compete.

For my part, I found the athletes inspiring. While I'll never do a full Iron man, I think of their incredible determination whenever I feel "gassed" while running, biking or swimming. I tasted the hills of Lake Placid on an abbreviated bike ride on part of the race course, ran around Mirror Lake for a fraction of the marathon distance, and swam the lake. And the next time I get caught in a summer rain shower without an umbrella, I'll remember those intrepid contestants going a whole day in a downpour wearing nothing but sleeveless spandex jerseys, and I'll just shrug it off.

So whatever your personal Iron Man is, whether it's committing to a 20 minute mall walk three times a week, or trying a fifteen mile bike ride, or running on the treadmill for a couple of miles while listening to a podcast of Health Talk, be inspired and BRING IT!

First, I found out that the word "Adirondack" is a name given to the local Indians by other, neighboring tribes of ancient Native Americans. Translated, it means "bark eater," and the moniker was coined in recognition of local tribes' tendency to subsist on tree bark during the annual winter-spring famine. In commemoration of this, there is a Bark Eaters Inn northeast of Lake Placid.

And you thought you were being virtuous having that whole wheat bagel for breakfast! It took a lot of chewing to release the meager carbohydrate content of the tree bark--talk about low glycemic index foods! That's some real fiber!

There's more from a nutritional perspective: Jacques Cartier was the first intrepid explorer to visit the region in 1535. When he and his men were threatened with scurvy, local Indian guides told them to make tea from the arbor vitae plant, a common decorative that adorns many suburban driveways and perimeters. It turns out that arbor vitae is rich in vitamin C and polyphenols, like the French maritime pine, the source of modern pycnogenol. Hence the name arbor vitae, which means "tree of life."

WARNING: Don't try this at home. I read this in a history book, and haven't field-tested brewing tea out of my landscaping, and the neighbors would freak if I started gnawing my prized paper birches.

Additionally, one of the major impetuses to settlement of the Adirondacks during the "Gilded Age" (1875 to 1910) was health. The AIDS of the nineteenth century was tuberculosis, with even less prospect for cure. A doctor named E. L. Trudeau (hopefully no relation to modern scam-artist Kevin Trudeau) discovered that a couple of patients with terminal TB seemed to get better when transferred from the grimy cities to the open air of the Adirondack Mountains.

This set off a wave of health tourism to the pristine country. Health resorts and sanitariums sprang up around Saranec Lake, which enjoyed a brief economic boom around the turn of the century. Special rail lines were built to bring urban refugees up to the mountains.

Patients would typically recline for hours in Adirondack chairs on the verandas of stately hotels. They would talk, read newspapers and books, play cards, and dine on nutritious food in giant communal dining halls. Their main occupation was to inhale as much fresh, pine-scented air as possible, sometimes for weeks and months at a time. No one knew precisely how this was supposed to help them.

Now we know that one of the key benefits of getting out of the dark, polluted cities and into the sunlight was boosting levels of vitamin D, since ultraviolet light exposure triggers D synthesis by the skin. And new studies suggest that D enhances immunity overall, in particular resistance to the tuberculosis bacillus.

In fact, ancient archaeological digs in Turkey provide a clue to this phenomenon. Researchers report that Turkey was one of early man's first migration destinations after our origins on the sunny African savannah. Turkey is colder, more mountainous, and further from the equator than the African cradle of mankind.

Human remains discovered in Africa are free of evidence of TB infection. By contrast, bones from the Anatolian plateau show evidence of ancient tuberculosis. The suggestion: early man migrated from Africa to Asia Minor, put on furs, huddled in shelters against the cold, had fewer high UV index days, made less vitamin D, and developed a nasty propensity to one of the earliest diseases of "civilization," since humans originally evolved to walk naked in the tropical sun.

At any rate, a handful of TB sufferers got a reprieve in the fresh air of the Adirondacks, but many fared no better--maybe it was the modest Victorian clothes they always concealed their skin with.

It took an additional century for the therapeutic benefits of vitamin D to be appreciated. Now we can test levels of D and administer concentrated vitamin D supplements, and no less importantly, we can administer powerful combinations of drugs to reliably vanquish the ancient scourge of TB. Today, we just have to worry about cancer, heart disease, diabetes, autoimmune diseases, and osteoporosis, modern plagues which vitamin D could help to eradicate.

New guidelines posted yesterday by the American Academy of Pediatrics promise a bonanza for the failing pharmaceutical industry (Today, Merck, faced with unexpected resistance to its much vaunted Gardasil vaccine to prevent pre-pubescent girls from getting HPV infections, was down-graded by stock analysts).

Pediatric statins are the worst idea since those chocolate cigarettes they used to give us as kids!

Tara Parker Pope reports in the July 8, 2008 NY Times: "While some doctors applauded the idea, others were incredulous . . . 'To be frank, I'm embarrassed for the AAP today,' said Dr. Lawrence Rosen of Hackensack University Medical Center in New Jersey, vice chairman of an academy panel on traditional and alternative medicine. He added: 'Treatment with medications in the absence of any clear data? I hope they're ready for the public backlash'."

The new guidelines call for kids to be screened, as early as two where family history warrants, but no later than ten years of age. Low-fat diets are to be implemented "with two per cent milk" for kids with high cholesterol. But most controversial are the recommendations that call for powerful cholesterol reducing drugs to be used in the following cases:

Kids with LDL cholesterol greater than 190. But that's not all.

Kids with LDL cholesterol greater than 160 if any other risk factors are present like overweight, high blood pressure, family history of heart disease, or cigarette smoking [Junior's hooked on Camels, so make sure you put Zocor in his lunchbox!]

ALL children with diabetes whose LDL is greater than 130!

These ham-handed guidelines will insure that millions of kids are enrolled as lab rats in an experiment of unprecedented proportions!

While statins can help a limited number of older people with demonstrable cardiovascular disease, their use to prevent disease in otherwise healthy individuals is a total EXTRAPOLATION (Translation: a wild leap of faith). They seem to work best in people with high calcium scores or angina, after a heart attack, bypass or stent, and in middle aged men.

NO research shows they work in children, and it would take fifty years of careful study in thousands or even millions of kids to prove they provide one iota of benefit.

Cholesterol is actually essential for the developing brain. The brain is largely composed of cholesterol. Even in adults, a connection has been demonstrated between higher cholesterol--especially HDL--and better brain function. Whatıs bad for the ticker is good for the brain. Children's brains are rapidly growing and forming new nerve connections, and limiting cholesterol, either via an ultra-restrictive low-fat diet or through artificial cholesterol blockade might have unforeseeable effects on brain development.

Additionally, cholesterol is the building block for all the body's sex hormones: testosterone, estrogen, progesterone, DHEA, and even the adrenal hormone stress hormone, cortisol. Imagine the potential effects of limiting the availability of these on a child's normal maturation!

Not to mention the wide variety of statin side effects already recognized in adults that might take new, troubling forms in immature bodies: liver problems, muscle pains, mood and sleep problems, and memory deficits, to mention just a few of the more common ones.

And, since statins deplete CoEnzyme Q 10, which has a wide gamut of functions in cells, why aren't AAP pediatricians calling for universal prophylactic administration of supplemental CoQ 10 to those hapless children who will be exposed to statins' onslaught on their immature bodies? One of the theories behind susceptibility to autism is that it's a mitochondrial disease, and that's what Co Q 10 specifically governs.

Don't get me wrong--we should care about our kids risk of future disease--they're the future of our country, and unfortunately, of our stressed-to-the-breaking point health care system. High cholesterols should be just one of many warning signs that kids need corrective action, but not with drugs of unproven efficacy and safety. Meanwhile, kids with obesity, sedentary lifestyles and early tendency toward high blood pressure and diabetes should be targeted with boot-camp programs for risk reduction. I'd rather see public monies be expended on decisive lifestyle turnaround targeting kids (and their enabling parents), rather than creating a huge, unaffordable new drug entitlement so eight year olds can get statins.

The AAP pediatricians who promulgated these guidelines are either fat-heads ( a compliment, really, since the brain needs fat and cholesterol!), or else they themselves are suffering from statin-induced encephalopathy. At this early juncture, efforts to disclose that they are on the take from drug companies have yielded no obvious signs of unsavory ties, but just wait. Following the money trail recently revealed huge conflicts of interest on the part of researchers promoting powerful drugs for children with the newly-minted diagnosis of "childhood bipolar disease".

The new cholesterol guidelines and statin recommendations for kids are just typical of the paint-by numbers, mechanistic approach we take to medicine today.