Saturday, August 3, 2013
This represents my 26th publication of POV: Science for the Union-Bulletin. I find it hard to believe that I’ve been doing this for more than a year. It’s harder yet to know that I’ve wandered through a mixture of topics and can’t be sure what works for you and what doesn’t.
I continue to hope that you enjoy a story now and then, from the thousands that come from my half-century of medical practice. I’ve used my tales from medicine as a way to lure you in. I’ve wanted to get you hooked on a scientific approach to social problems and opportunities to live healthier lives.
I’m testing a new approach that I’ll repeat from time to time. Short comments on a variety of subjects may leave you wanting to know more about one of them. Comments are welcome, in the U-B or on my Facebook page. Google my name. Challenge anything.
What follows is a potpourri, a ragbag of insights from the recent literature:
Item 1: Surgery isn’t any better than physical therapy for torn menisci or arthritis in the knee. The New England Journal of Medicine (NEJM) reported on the six- and 12-month functional statuses of patients assigned to one group or the other. Treatments were done in major centers and there was no significant difference between surgical and physical therapy outcomes. This study has been added to two others that come to essentially the same conclusion.
My editorial: I can’t argue with a surgeon who is convinced that his or her results are better than what the literature reports. Maybe he or she is right, but the data in this article is impressive and the economics present worrisome challenges.
Item 2: Uterine cancer isn’t necessarily uterine cancer. More correctly, it may act like cancer that started somewhere else. DNA and related chemistry drive cancer’s behavior. For example, it is possible that half of all squamous cell lung cancer may respond best to regimens designed to treat other malignancies.
My editorial: Genomic research is driving us toward a change in the way we will think about cancer in the future. The code inside the cell determines outcome more than the organ where the growth begins. We are likely to redefine disease, including cancer, mental illness and others by their chemistry. The process will be slow and bumpy, but the direction seems inevitable. Since 1971, when Nixon declared the war on cancer, we have seen amazing progress in some areas, misdirection in others, and, sadly, a scam here and there. I view it all as part of the human package. What about your opinion?
Item 3: Governmental regulation can favorably impact obesity prevention. One part of the Affordable Care Act, often denigrated as “Obamacare,” requires chain restaurants to post calorie information about its products. A lead article in the May 9 NEJM sets out some well supported ideas. Our children and we are becoming more obese and the rising incidence of diabetes threatens both the physical and economic health of our nation. We know that eating habits, on average, are worse when we eat out than when we stay home. It is possible to move in a healthier direction. The second and third articles in the journal discuss the battle between New York Mayor Bloomberg and the soda pop industry.
My editorial: These issues are critical to the future of our nation, our town, and our children. The easiest way to avoid dealing with them is to pretend they don’t exist or to dismiss the question by linking it to Obamacare or that crazy mayor Bloomberg. Obamacare is a poorly written bit of legislation, because lobbyists left the government incapable of restricting drug profits or refusing to pay for things that don’t work. Medicare is expected to write the check and not negotiate the price. It’s the only way the bill passed. Compromise and common sense are fleeing out the windows of congressional offices. I hold out hope that things will improve. I am being more political than I would like to be, but I feel it necessary to explain myself and to alert readers to my biases.
The next nutritional battleground may be less against calories than a stand against sugars, carnitine or other factors in our diet. We need to understand the enemy before we decide where to build the barricades. If you ask whether labeling has had an effect in your favorite fast-food store, you may get the same answer I did — “A lot of people look at it and some change their orders.” Published data from a Washington think-tank show improved earnings in recent years for fast-food operations that have reduced calories on their menu. If you take a position, you may get some blowback. I have. My plea is to read, learn, decide one way or another, and then put yourself on the front line.
Item 4: You aren’t what you eat, but a good part of your health depends on what ends up in your bloodstream, after your gut works it over. The bacteria in your intestines have shown relationships with obesity, diabetes, liver disease, childhood eczema, irritable bowel disorder, cancer and others. Some links are stronger than others. I have recently written about meat, carnitine, gut bacteria and atherosclerosis. The research has been extensive and goes beyond the carnitine effect. The related terms confuse me at times. Not everyone uses them in the same way. I’ll refer to probiotics as good bacteria, while I allow that good bacteria are not precisely definable. (Pro means something that supports something else.) Prebiotics are things that promote the proliferation of good bacteria. By one definition, these are non-digestible carbohydrates, fibers that act symbiotically with other things, grains, yogurt, bananas, etc., to sustain the things that we think are good for us.
My editorial: These are fascinating issues that represent an area for fruitful study. No pun intended. The subject prickles with caveats. First, there is what I call the “Let’s build a dam” syndrome. A sportsman may want water for his amusement. It provides pure nature, with enhancements. The farmer wants water held back for irrigation on the day he needs it. The homeowner wants it drained dry and ready to accept torrential rains. Whatever we do with the dam or to the chemistry of our bodies — our personal ecosystem — the results will be mixed. Join me on the bandwagon that promotes more fruits, grains, vegetables and exercise, and hope that I’m right. Don’t waste your health and wealth on the next profit-oriented doctor who promotes his secrets on television. Don’t believe any organization that advertises exceptional cure rates. Believe in goodness and evil, but tune up your God-given brain when you enter the marketplace of health products, treatment devices and drugs.
Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at amazon.com and other online book retailers. He can be reached at firstname.lastname@example.org.