Last week at the eHealth Developers Summit, I made the point that nutrition and exercise can eliminate 50% of disease, alternative medicine another 35%, and electronic frequency instruments at least another 10%. Hospitals admissions and clinic visits could be reduced by 95%. It takes knowledge, committment, and ability to change behaviors. This is a very good number, because Brent Lowensohn, Director of IT Advanced Technologies at Kaiser Foundation Health Plan and Hospitals, predicts a 15-fold increase in clinic visits over the next decade due to aging baby boomers, a problem that the current health system cannot possibly handle (see MIT Media Lab Future of Health Technology Summit).

A senior staff member of the Kellogg Foundation asked me for examples to support my argument and I gave a few. To my surprise, I returned home and found a recent New England Journal article showing that a 7% decrease in body weight and 150 minutes of exercise per week reduced the incidence of type 2 diabetes by 58%. The best drugs could do was a 31% reduction and this does not take into account the negative side effects of drugs or the positive side effects of lower weight and exercise on everything else except type 2 diabetes.

Alas, people continue to argue about the impact of nutrition and exercise as they did with smoking years ago. The smoking argument has largely stopped now that R.J. Reynolds was fined $144.9B in July 2000, and Phillip Morris was fined $28B last month (see today’s New York Time business section). But I digress, let’s look at the New England Journal of Medicine on diabetes.

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group.

Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA.

BACKGROUND: Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors–elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle–are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.

METHODS: We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.

RESULTS: The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.

CONCLUSIONS: Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.

I take flaxseed oil and cottage cheese regularly as a cancer preventative based on the excellent results that Dr. Budwig reported in Germany over 50 years ago. She is an excellent example of a researcher whose information has been repressed by vested interests. Of course, the beauty of good research is that anyone can replicate it any time they want, so the truth comes out eventually. Duke University scientists have replicated her work. Some complain that Duke researchers did not cite Dr. Budwig properly.

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Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features.

Urology 2001 Jul;58(1):47-52

Demark-Wahnefried W, Price DT, Polascik TJ, Robertson CN, Anderson EE, Paulson DF, Walther PJ, Gannon M, Vollmer RT. Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina, USA.

OBJECTIVES: Dietary fat and fiber affect hormonal levels and may influence cancer progression. Flaxseed is a rich source of lignan and omega-3 fatty acids and may thwart prostate cancer. The potential effects of flaxseed may be enhanced with concomitant fat restriction. We undertook a pilot study to explore whether a flaxseed-supplemented, fat-restricted diet could affect the biomarkers of prostatic neoplasia.

METHODS: Twenty-five patients with prostate cancer who were awaiting prostatectomy were instructed on a low-fat (20% of kilocalories or less), flaxseed-supplemented (30 g/day) diet. The baseline and follow-up levels of prostate-specific antigen, testosterone, free androgen index, and total serum cholesterol were determined. The tumors of diet-treated patients were compared with those of historic cases (matched by age, race, prostate-specific antigen level at diagnosis, and biopsy Gleason sum) with respect to apoptosis (terminal deoxynucleotidyl transferase [TdT]-mediated dUTP-biotin nick end-labeling [TUNEL]) and proliferation (MIB-1).

RESULTS: The average duration on the diet was 34 days (range 21 to 77), during which time significant decreases were observed in total serum cholesterol (201 +/- 39 mg/dL to 174 +/- 42 mg/dL), total testosterone (422 +/- 122 ng/dL to 360 +/- 128 ng/dL), and free androgen index (36.3% +/- 18.9% to 29.3% +/- 16.8%) (all P <0.05). The baseline and follow-up levels of prostate-specific antigen were 8.1 +/- 5.2 ng/mL and 8.5 +/- 7.7 ng/mL, respectively, for the entire sample (P = 0.58); however, among men with Gleason sums of 6 or less (n = 19), the PSA values were 7.1 +/- 3.9 ng/mL and 6.4 +/- 4.1 ng/mL (P = 0.10). The mean proliferation index was 7.4 +/- 7.8 for the historic controls versus 5.0 +/- 4.9 for the diet-treated patients (P = 0.05). The distribution of the apoptotic indexes differed significantly (P = 0.01) between groups, with most historic controls exhibiting TUNEL categorical scores of 0; diet-treated patients largely exhibited scores of 1. Both the proliferation rate and apoptosis were significantly associated with the number of days on the diet (P = 0.049 and P = 0.017, respectively). CONCLUSIONS: These pilot data suggest that a flaxseed-supplemented, fat-restricted diet may affect prostate cancer biology and associated biomarkers. Further study is needed to determine the benefit of this dietary regimen as either a complementary or preventive therapy.

Medical error is the third leading cause of death in the United States and the medication error component is the 4th leading cause of death. This is largely caused by systemic problems in the management of our healthcare system and lack of deployment of available information technologies. I have been doing presentations at major conferences for years on medical error pointing out that poor financial performance (due to lack of automation) leads to nursing shortages which directly leads to patient death. This week, the Journal of the American Medical Association published the numbers. Every additional patient for a nurse increases the risk of death for all patients by 7%.

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Douglas M. Sloane, PhD; Julie Sochalski, PhD, RN; Jeffrey H. Silber, MD, PhD

JAMA. 2002;288:1987-1993

Context: The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.

Objective: To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.

Design, Setting, and Participants: Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.

Main Outcome Measures: Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.

Results: After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.

Conclusions: In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.

Nature Science Update: Superbug Strikes Again
“A drug-resistant superbug has resurfaced, doctors announced today, leaving researchers scrabbling for the next line of antibiotic defence. The rogue Staphylococcus aureus bacteria, identified in the foot ulcer of a Pennsylvania patient, are resistant to vancomycin, one of the last lines of antibiotic defence. More cases were widely anticipated after reports of the first such strain earlier this year. Today’s announcement coincided with confirmation of the case by the US Centers for Disease Control and Prevention in Atlanta, Georgia.”

When antibiotics fail, these bugs can be dealt with using a frequency generator such as the FSCAN or F100, or by a rife plasma tube device such as the EM6C. They typically cover a spectrum of frequencies that must be treated at 1HZ increments through the entire spectrum. Misuse of antibiotics has caused these pathogens to generate a broad spectrum of strains. For resistant strains, virtually any conventional treatment affects only part of the spectrum and the infection regrows no matter what you treat it with.

Most people are lightly infected with these organisms. Using a microscopic slide of the organism, I identified the frequency for the pathogen and tested postive for hosting a strain of the organism. I then treated myself for a couple of minutes to get rid of it. Serious infections require more extended treatment across a wide band of frequencies.

© 2002 Kenneth Todar University of Wisconsin-Madison Department of Bacteriology
Pathogenesis of S. aureus infections
“Staphylococcus aureus causes a variety of suppurative (pus-forming) infections and toxinoses in humans. It causes superficial skin lesions such as boils, styes and furuncles; more serious infections such as pneumonia, mastitis, phlebitis, meningitis, and urinary tract infections; and deep-seated infections, such as osteomyelitis and endocarditis. S. aureus is a major cause of hospital acquired (nosocomial) infection of surgical wounds and infections associated with indwelling medical devices. S. aureus causes food poisoning by releasing enterotoxins into food, and toxic shock syndrome by release of pyrogenic exotoxins into the blood stream.”

CDC Fact Sheet
Eight cases of infection caused by vancomycin-intermediate Staphylococcus aureus (VISA) have been detected in the United States (Michigan, New Jersey, New York, and Illinois, Minnesota, Nevada, Maryland, Ohio. Some of the VISA infections developed in persons with previous infections with methicillin-resistant Staphylococcus aureus (MRSA). Normally, vancomycin is the most reliable and effective drug for treating MRSA. The appearance of Staphylococcus aureus with reduced susceptibility to vancomycin is concerning. The patients with VISA infections were chronically ill and probably developed their VISA infection in a healthcare setting. No spread to family members, household contacts, other patients, or healthcare workers was detected.

Sequencing the Genome
The Sanger Institute has been funded to sequence the 2.8 Mb genomes of two strains of Staphylococcus aureus in collaboration with Prof. Tim Foster of the Department of Microbiology, Trinity College, Dublin, Prof. Brian Spratt of the Department of Infectious Disease Epidemiology, Imperial College School of Medicine, Mark Enright of the Department of Biology and Biochemistry, University of Bath, and Dr. Nicholas Day and Dr. Sharon Peacock of the John Radcliffe Hospital, Oxford.

FDA Bacteriological Analytical Manual
Staphylococcus aureus is highly vulnerable to destruction by heat treatment and nearly all sanitizing agents. Thus, the presence of this bacterium or its enterotoxins in processed foods or on food processing equipment is generally an indication of poor sanitation. S. aureus can cause severe food poisoning. It has been identified as the causative agent in many food poisoning outbreaks and is probably responsible for even more cases in individuals and family groups than the records show.

FDA Bad Bug Book
Foods that are frequently incriminated in staphylococcal food poisoning include meat and meat products; poultry and egg products; salads such as egg, tuna, chicken, potato, and macaroni; bakery products such as cream-filled pastries, cream pies, and chocolate eclairs; sandwich fillings; and milk and dairy products. Foods that require considerable handling during preparation and that are kept at slightly elevated temperatures after preparation are frequently involved in staphylococcal food poisoning.
Staphylococci exist in air, dust, sewage, water, milk, and food or on food equipment, environmental surfaces, humans, and animals. Humans and animals are the primary reservoirs. Staphylococci are present in the nasal passages and throats and on the hair and skin of 50 percent or more of healthy individuals. This incidence is even higher for those who associate with or who come in contact with sick individuals and hospital environments. Although food handlers are usually the main source of food contamination in food poisoning outbreaks, equipment and environmental surfaces can also be sources of contamination with S. aureus. Human intoxication is caused by ingesting enterotoxins produced in food by some strains of S. aureus, usually because the food has not been kept hot enough (60°C, 140°F, or above) or cold enough (7.2°C, 45°F, or below).

Medication error rates in hospitals are well known to be the fourth leading cause of death in the United States. Outpatient errors are probably much higher than inpatient errors, although little data exists for outpatient studies in the literature. I have argued for years that the number of unnecessary deaths is increasing every year from medication error because more drugs are given and they have more dramatic impact on the patients physical system. This combined with nursing shortages and underfunding of information techologies to prevent these errors have doubled the rate of medication error from 1996 to 2000 in the study below.



Prescribing Errors Involving Medication Dosage Forms

Timothy S. Lesar, Pharm D

Journal of General Internal Medicine, Volume 17 Issue 8 Page 579 – August 2002

CONTEXT: Prescribing errors involving medication dose formulations have been reported to occur frequently in hospitals. No systematic evaluations of the characteristics of errors related to medication dosage formulation have been performed.

OBJECTIVE: To quantify the characteristics, frequency, and potential adverse patient effects of prescribing errors involving medication dosage forms .

DESIGN: Evaluation of all detected medication prescribing errors involving or related to medication dosage forms in a 631-bed tertiary care teaching hospital.

MAIN OUTCOME MEASURES: Type, frequency, and potential for adverse effects of prescribing errors involving or related to medication dosage forms.

RESULTS: A total of 1,115 clinically significant prescribing errors involving medication dosage forms were detected during the 60-month study period. The annual number of detected errors increased throughout the study period. Detailed analysis of the 402 errors detected during the last 16 months of the study demonstrated the most common errors to be: failure to specify controlled release formulation (total of 280 cases; 69.7%) both when prescribing using the brand name (148 cases; 36.8%) and when prescribing using the generic name (132 cases; 32.8%); and prescribing controlled delivery formulations to be administered per tube (48 cases; 11.9%). The potential for adverse patient outcome was rated as potentially “fatal or severe” in 3 cases (0.7%), and “serious” in 49 cases (12.2%). Errors most commonly involved cardiovascular agents (208 cases; 51.7%).

CONCLUSIONS: Hospitalized patients are at risk for adverse outcomes due to prescribing errors related to inappropriate use of medication dosage forms. This information should be considered in the development of strategies to prevent adverse patient outcomes resulting from such errors.

I was an Air Force fighter pilot for 11 years and experienced the loss of many of my fellow pilots in Vietnam and elsewhere. A serious aircraft incident was almost always the result of several errors in a sequence which compounded one another. Almost never does a single error cause a major catastrophe. The same is true in medicine.

The Wrong Patient

Mark R. Chassin, MD, MPP, MPH; and Elise C. Becher, MD, MA*

Ann Intern Med. 2002;136:826-833.

Among all types of medical errors, cases in which the wrong patient undergoes an invasive procedure are sufficiently distressing to warrant special attention. Nevertheless, institutions underreport such procedures, and the medical literature contains no discussions about them. This article examines the case of a patient who was mistakenly taken for another patient’s invasive electrophysiology procedure. After reviewing the case and the results of the institution’s “root-cause analysis,” the discussants discovered at least 17 distinct errors, no single one of which could have caused this adverse event by itself. The discussants illustrate how these specific “active” errors interacted with a few underlying “latent conditions” (system weaknesses) to cause harm. The most remediable of these were absent or misused protocols for patient identification and informed consent, systematically faulty exchange of information among caregivers, and poorly functioning teams.

Many people working with electromagnetic frequency devices, whether Rife or FSCAN devices, know that growth of cancer cells is selectively inhibited by the right frequencies. Dr. Lai and his research group, at the University of Washington, has demonstrated this in cell culture with a Clark Zapper which only puts out a single frequency.

Low-intensity electric current-induced effects on human lymphocytes and leukemia cells

Narendra P. Singh and Henry Lai

Department of Bioengineering

University of Washington

Seattle, WA

USA

The purpose of this study is to investigate whether low-intensity current affects cells in culture. Two types of human cells: white blood cells (lymphocytes) and leukemia cells (molt-4 cells), were studied. A low-intensity time-varying electric current (0.14 milliamp) generated by the Clark Zapper was applied to cell cultures via two platinum electrodes for 2 hrs at 37o C. Cell counts were made at different times after electric current application. Results show that the current had no significant effect on human white blood cells up to 24 hrs after exposure, whereas it significantly inhibited the growth of leukemia cells. At 24 hrs after exposure, concentration of leukemia cells exposed to the electric current was only 58% of that of non-exposed leukemia cells. These data suggest that the electric current can selectively inhibit the growth of leukemia cells and does not significantly affect normal cells. A manuscript describing these results is in preparation for publication. In addition, the same electric current exposure (0.14 milliamp, 2 hrs at 37oC) was applied to E. coli bacteria cultures. No significant effect of the current was observed in E. coli cultures at 24 hrs after exposure.

Further research should investigate whether this selective electric current-induced growth inhibition also occurs in other types of cancer cells. The critical current parameters and mechanism of this effect should also be investigated.

Medication Errors Observed in 36 Health Care Facilities

Kenneth N. Barker, PhD; Elizabeth A. Flynn, PhD; Ginette A. Pepper, PhD; David W. Bates, MD, MSc; Robert L. Mikeal, PhD

Arch Intern Med. 2002;162:1897-1903

Background: Medication errors are a national concern.

Objective: To identify the prevalence of medication errors (doses administered differently than ordered).

Design: A prospective cohort study.

Setting: Hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations, nonaccredited hospitals, and skilled nursing facilities in Georgia and Colorado.

Participants: A stratified random sample of 36 institutions. Twenty-six declined, with random replacement. Medication doses given (or omitted) during at least 1 medication pass during a 1- to 4-day period by nurses on high medication–volume nursing units. The target sample was 50 day-shift doses per nursing unit or until all doses for that medication pass were administered.

Methods: Medication errors were witnessed by observation, and verified by a research pharmacist (E.A.F.). Clinical significance was judged by an expert panel of physicians.

Main Outcome Measure: Medication errors reaching patients.

Results: In the 36 institutions, 19% of the doses (605/3216) were in error. The most frequent errors by category were wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). Seven percent of the errors were judged potential adverse drug events. There was no significant difference between error rates in the 3 settings (P = .82) or by size (P = .39). Error rates were higher in Colorado than in Georgia (P = .04)

Conclusions: Medication errors were common (nearly 1 of every 5 doses in the typical hospital and skilled nursing facility). The percentage of errors rated potentially harmful was 7%, or more than 40 per day in a typical 300-patient facility. The problem of defective medication administration systems, although varied, is widespread.

Gearin-Tosh, Michael. Living Proof: A Medical Mutiny. Scribner, 2002.

Gearin-Tosh, a tutor at St. Catherine’s College, Oxford, was diagnosed with myeloma (cancer of the bone marrow) and told that if he did not begin chemotherapy immediately, he would be dead in less than a year. The recommended treatment, while probably extending his life somewhat, would not cure the condition. A second specialist confirmed the original prognosis, but the author rejected the proposed treatment after a former Oxford pupil consulted a cancer statistician who warned, “If your friend touches chemotherapy, he’s a goner.” Interwoven with engaging anecdotes from his professional life, Gearin-Tosh details his research into the world of alternative medicine…

“Michael Gearin-Tosh is a wonderful writer. He deals with the most important concepts. And he is indeed Living Proof. All physicians should read this book. Many of us are looking for more effective chemotherapeutic agents, biological intervention, etc., but the role of the ‘unorthodox’ therapies in his own experience and Carmen Wheatley’s case report on him–which is particularly well done–deserve scientific scrutiny and study.” Robert A. Kyle, M.D., Mayo Clinic, Rochester, Minnesota

I’m doing background research on claims by Dr. Sears in his Zone Diet books on the benefits of fish oil. I’ve found that pharmeceutical fish oil produces dramatic effects within a few days on a number of levels. This article discusses why its inflammation suppressive effects help suppress cancer and how this affect depends on individual genes.



The ability of fish oil to suppress tumor necrosis factor production by peripheral blood mononuclear cells in healthy men is associated with polymorphisms in genes that influence tumor necrosis factor production1,2,3

Robert F Grimble, W Martin Howell, Gillian O’Reilly, Stephen J Turner, Olivera Markovic, Sharon Hirrell, J Malcolm East and Philip C Calder

American Journal of Clinical Nutrition, Vol. 76, No. 2, 454-459, August 2002

Background: Tumor necrosis factor (TNF-) mediates inflammation. High TNF- production has adverse effects during disease. Polymorphisms in the TNF- and lymphotoxin genes influence TNF- production. Fish oil suppresses TNF- production and has variable antiinflammatory effects on disease.

Objective: We examined the relation between TNF- and lymphotoxin genotypes and the ability of dietary fish oil to suppress TNF- production by peripheral blood mononuclear cells (PBMCs) in healthy men.

Design: Polymorphisms in the TNF- (TNF*1 and TNF*2) and lymphotoxin (TNFB*1 and TNFB*2) genes were determined in 111 healthy young men. TNF- production by endotoxin-stimulated PBMCs was measured before and 12 wk after dietary supplementation with fish oil (6 g/d).

Results: Homozygosity for TNFB*2 was 2.5 times more frequent in the highest than in the lowest tertile of inherent TNF- production. The percentage of subjects in whom fish oil suppressed TNF- production was lowest (22%) in the lowest tertile and doubled with each ascending tertile. In the highest and lowest tertiles, mean TNF- production decreased by 43% (P < 0.05) and increased by 160% (P < 0.05), respectively. In the lowest tertile of TNF- production, only TNFB*1/TNFB*2 heterozygous subjects were responsive to the suppressive effect of fish oil. In the middle tertile, this genotype was 6 times more frequent than the other lymphotoxin genotypes among responsive individuals. In the highest tertile, responsiveness to fish oil appeared unrelated to lymphotoxin genotype. Conclusion: The ability of fish oil to decrease TNF- production is influenced by inherent TNF- production and by polymorphisms in the TNF- and lymphotoxin genes.