January 7, 2008.
TOP TEN MEDICAL BREAKTHROUGHS OF 2007? VEH!

I almost threw away my Time magazine in disgust after reading about the “Top 10 Medical Breakthroughs of 2007”. These shills couldn’t stop gushing about the wonderful advances our medical science has made this year. Well since 7/10 were directly related to a product created by the Medical Industrial Complex, and two will probably lead to a new and improved “test” that will also be marketed as a product, most of the gushing is going to be in the form of profits for their manufacturers. (BTW the other breakthrough involved chopping on your penis; not sure how to interpret that one). Before you all get giddy with excitement about the wonderful progress that has been made this year in the field of medical treatments, read on and consider an alternative analysis of this year’s accomplishments.

#1 “Circumcision Reduces Risk of HIV”. Well that certainly makes me want to run out and get my genitalia chopped on. How about you? The risk reduction, however, is only 51%. Using a condom pretty much prevents HIV, and whatever change in sensation it is associated with is temporary. Well on the plus side since it looks like the next step is to push it on African males (since they are too primitive to understand how to use condoms?) maybe that’ll make us more culturally sensitive to their customs of genitally circumcising women.

#2 “Test for Metastatic Breast Cancer”. A new test allows doctors to find out if there are cancerous cells in the lymph nodes adjacent to the breast right away rather than having to wait two days. It prevents you from having to come back for a second surgery, but since these surgeries are usually done under local anesthesia, coming back isn’t that big of a deal. And the cancer won’t spread in two days. More hype than hope for this one.

#3 “Human Vaccine Against Bird Flu”. As I wrote in my blog “Bird Flu Drugs are for Bird Brains,” what our bird brain “public health officials” aren’t telling you is that if the bird flu mutates to be transmissible to humans, the vaccine probably won’t work anymore. Remember the bubonic plague? Now that was a medical news story that the media could really sink their teeth into. Hmmm. Seems like they are running out of topics these days.

#4 “Help for Dieters: Alli”. Now this one was my favorite. Help for dieters? Geez. This is just a repackaging of the prescription diet pill Orlistat for over the counter use, a drug which blocks fat absorption and may lead to vitamin deficiency, embarrassing flatulence, or even more embarrassing public losses of bowel control. Here is Gastroenterology 101. The mouth is connected to the stomach and the bowels by means of a tube called the esophagus. What you put in your mouth ends up in your bowels. So if you want to absorb less fat in your bowels, put less in your mouth. BTW no diet pills have been shown to lead to lasting decreases in weight which persist after you stop taking them.

#5 “New Diabetes Genes”. Four new genes were discovered which brought to 10 the number of genes that have been associated with risk for the development of diabetes. Time went on to croon “Eventually, these discoveries will aid experts in pinpointing those at greatest risk for developing type 2 diabetes.” Well let me tell you something, Mr. Medical Reporter Sir. I’ve got a lot better way to predict who is going to develop diabetes: Sit outside a McDonald’s and see who is scarfing down super sized meals there every day, cuz people who eat fast food a couple of times a week or more double their risk of diabetes. And that is a lot more significant than that gene they found.

#6 “No More Periods”. Thanks to a new pill (Lybrel), a birth control pill that gets rid of those messy things entirely. I guess this one comes up #6 cuz it has so many competitors, like physical (rather than merely pharmaceutical) genital mutilation (#1). Why don’t they just take the reproductive organs out of women at birth, and let the whole reproductive process take place in a more scientific environment? Like in Brave New World you could do it free of messy secretions, or even physical contact. Do the ladies want to remove those menstrual messies for themselves or their beaus? Tip to the ladies out there, variety is the spice of life. BTW most pills (except for the progesterone only ones) eliminate ovulation, which can interfere with that sexual attractiveness thing. To wit, a recent study showed that strippers on the pill make less money.

#7 “Relief from Fibromyalgia: Lyrica”. What a wonderful ad for Pfizer. Reading our Time shill you would think that this is the one and only cure for this debilitating disease that affects so many Americans. However the study comparing Lyrica to a placebo for fibromyalgia found that about half of the women taking Lyrica dropped out of the study, usually because they had side effects, a major problem with the drug, or it wasn’t working. In those who finished the study, there was a 10% or 20% reduction in pain symptoms. Not better than other drugs tested for this disease. No big medical breakthrough here. They just happened to be the first to get FDA approval. Cha-ching. Thanks FDA.

#8 “Early Stage Test for Lung Cancer”. The new LC Detect system is a blood test that permits early detection of lung cancer. I’m not doing jumping jacks over this test yet cuz they haven’t actually yet shown that it saves lives, and if they do show it saves lives the effects won’t be that great. You see in many cases once the cancer has developed and spread to the blood stream it is too late anyway. I heard about this great book called The Easy Way to Stop Smoking. I think we should do a clinical trial to compare it to the blood test. I predict that it will be found to be cheaper and more effective than the blood test at saving lives.

#9 “New Source for Stem Cells” Amniotic Fluid Derived Stem Cells (AFS) are seen as “farther along” in development than embryonic stem cells and can be conveniently collected from pregnant women. They are less susceptible to criticism from evangelicals and more likely to lead to research in the US which has been blocked by mutton-headed biblical literalists who want to base our scientific agenda on a document written several thousand years ago by febrile Jews living in the desert (Or so they say. Come to think about it, don’t remember any mention of stem cells in the holy book). Hey there, Sam Brownback and Mike Huckabee, if you are listening, I’ve got an idea. Why don’t you all lead a raid on in vitro fertility clinics and save some of those embryos that were gonna get flushed down the toilet (and which you have so astutely saved from the barbaric onslaught of medical researchers). You can put them in test tubes and raise them to mature humans who can repopulate the Republican Party. I think that is about the only hope you have for the future.

#10 “Benefits of Vitamin D” The article says that a “slew of studies in 2007” showed that Vitamin D not only promotes bone strength, but prevents multiple sclerosis (MS), diabetes, and cancer. Well Vitamin D may affect a measurement of bone strength, but doesn’t prevent clinically significant bone fractures (like hip fracture) related to osteoporosis. MS? This was based on the Nurses Health Study where 187,563 women were followed for 20 years. They found a 33% reduction in MS in women taking supplements compared to those who didn’t. However since only 173 women developed MS, that means that only about 10 or 15 women were “saved” from MS, in other words about 0.03% of women. This is one of the medical breakthroughs of the year? Geez. And I don’t want to take a supplement for 20 years for such a questionable benefit, do you? And since those women who took supplements also probably did other things that were good for their health, it isn’t clear if Vitamin D does anything at all. Cancer? Based on a single study where a total of 50 women got cancer; that means that about 5 women were saved from cancer with Vitamin D supplements Even the experts say that this is a small study and the results are premature. Diabetes? Maybe if you have a Vitamin D deficiency, which is unlikely in the current environment. I am getting depressed going on with this…

Bottom line? Take a walk in the winter sun (Vitamin D), use a love glove, don’t worry about getting messy with your man, eat your fruits and vegetables and cook your own meals. And stop reading that medical miracle crap in the magazines.

 October 17, 2007. 12:47 p.m.
 Welcome Dalai Lama
 
Emory is hosting a visit from the Dalai Lama this week  
(see how they are getting ready) so I thought I would  
say a few words about meditation and its uses for physical and mental health. A meta-analysis  
(where data from all studies are put together) of mindfulness meditation1 found that  
MBSR was a useful adjunctive intervention for patients with a broad range of chronic  
disorders, including patients with cancer, chronic pain, fibromyalgia, and psoriasis.  
 
Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and  
health benefits: A meta-analysis. Journal of Psychosomatic Research. 2004;57:35-43.  
 
MBSR has been shown to be effective in reducing anxiety and panic in patients  
diagnosed with generalized anxiety disorder and panic disorder (maintained at  
three-year follow-up) as well as anxiety in patients with heart disease.  
 
MBSR has also been shown to be effective as an adjunctive intervention in reducing  
psychological distress and depression, as well as health-related quality of life.  
Reported favorable changes in distress (SCL-90-R) have been found to endure  
at three-month follow-up, six-month follow-up, and four-year follow-up.  
 
Miller J, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications  
of a mindfulness-based stress reduction intervention in the treatment of anxiety  
disorders. General Hospital Psychiatry. 1995;17:192-200.  
 
Tacon AM, McComb K, Caldera Y, Randolph P. Mindfulness meditation, anxiety reduction,  
and heart disease: a pilot study. Family & Community Health. 2003;26:25-33.  
 
Finally our research program at Emory seems to be showing good results with  
returning Iraq vets with early signs of PTSD.  
 
So, welcome, Dalai Lama!  
 
 October 15, 2007. 9:00 a.m.
 Fibromyalgia Diagnosis and Treatment.
 
I got a call this morning from someone who had a question about Fibromyalgia (FM),  
having seen my name pop up on the internet, probably because of my participation in a conference  
on FM in 2004 called "Fibromyalgia: The Next Advances” jointly sponsored by Oregon  
Health & Science University and The National Institute of Arthritis and Musculoskeletal  
and Skin Diseases (NIAMSD), part of the National Institute of Health. FM is a complex disorder  
and for those who are interested I recommend looking up the speakers at the conference, who  
represent the leading authorities on the different aspects of the disease.  
 
Population surveys suggest 4.9% of women and 1.6% of men suffer from FM  
Typically, FM patients complain of chronic widespread pain (involving all 4 quadrants of  
the body as well as the axial skeleton), diffuse tenderness, fatigue and sleep disturbance.  
Until fairly recently, it was assumed either that local pathology would eventually explain  
the distress of FM or that the pain was to due to psychological factors alone.  
This view has now largely given way to an understanding of FM symptoms as a clinical  
syndrome in its own right with a complex and multifactorial etiology that is not yet completely understood.  
FM diagnostic criteria require at least 3 months of widespread pain and pain upon  
digital palpation at no fewer than 11 of 18 characteristic tender points.  
There are a number of treatments for FM, all with variable success.  
Controlled studies of Cymbalta (duloxetine) have shown efficacy for FM.  
 

Doug Bremner, MD, is a physician
and researcher in Atlanta GA
and author of Before You Take That Pill:
Why the Drug Industry May be
Bad for Your Health

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