Apr
27
2019

Mayo Clinic Could Become A Health Care Model

I watched the movie “Mayo Clinic: Faith-Hope-Science”, which suggested that the Mayo Clinic could become a health care model. The movie aired originally on Sept. 25, 2018. It is a fascinating presentation of the history of the Mayo Clinic.

Historical facts

The Mayo Clinic is well known for its surgeries. In the beginning there were only 3 surgeons, Dr. William Worrall Mayo and his two sons, Dr. Will and Dr. Charlie. In 1904 alone they performed more than 3000 surgeries at St. Mary’s Hospital. Today 255 Mayo Clinic surgeons do more than 76,000 surgical procedures for patients.

The original Mayo Clinic was built in Rochester (Minnesota). Later two more Mayo Clinics were added, in Jacksonville (Florida) and Phoenix (Arizona). Here is a link that shows more historic facts.

Involvement in Wars

The Mayo Clinic provided medical care during WWI, WWII and during the Korean War. Management of the Mayo Clinic decided to erect portable clinics close to the battlefields. Treatments for the injured soldiers were free.

Mayo Clinic Involved in Research

From early on in the development of the Mayo Clinic research played an important part. Now there are three Mayo Clinics, each with their own research facilities. There is a campus of a Medical School connected with the Rochester Mayo Clinic. The Medical School puts emphasis on medical research.

Organization of the Mayo Clinic

The organization of the Mayo clinic was initially based on a handshake between the Sisters of Saint Francis who provided nursing skills and the medical staff that provided diagnoses, surgeries and investigations. The movie reported that the handshake philosophy lasted for over 100 years, but eventually the administration came up with a formalized agreement.

A few peculiarities are worth noting.

Doctors on salaries

All doctors working for the Mayo Clinic are on salary. This is in stark contrast to the rest of the medical system in the US. The US medical system is a fee-for-service system. The problem is that fee-for-service clinics rush patients through their appointments. In the past one patient was seen on average every 15 minutes, then every 10 minutes, and now often there are only 7 minute time slots. The more patients a doctor sees in an hour, the more money he/she makes. With a complicated patient at the Mayo Clinic a doctor may take 2 yours to see such a patient. It makes no difference in term of salary to the doctor, but the quality of care and thoroughness of examining a patient can make a huge difference.

Proton therapy made affordable

When proton therapy was first introduced in the Mayo Clinic for cancer therapy, patients could not afford the higher costs of proton therapy versus conventional radio beam therapy. The Mayo Clinic resolved this problem simply by charging the same cost for both procedures. This way the doctor decided, which approach was more appropriate for a particular patient, but there was no financial hardship as a result of this decision.

When poor people cannot afford health care

Another peculiarity evolved when it became apparent that some very poor people could not afford the treatment. The nurses and the doctors consulted about this problem and decided that nobody should suffer diseases because of financial hardship. The minority of these patients received free treatments from the Mayo Clinic. To correct for the difference the administration was charging the well-to-do people a little bit more. Over the years the Mayo Clinic had made enough profit that they could expand and build bigger clinics. There are now three Mayo Clinics, namely in Arizona, Florida and Minnesota.

Other health care jurisdictions

I have worked in the Canadian health care system for 16 years as a general practitioner. Like in the US this is based on a fee-for-service system. Subsequently I worked as a Medical Advisor for the Workers’ Compensation Board of British Columbia (“WorkSafeBC”). This was a salaried position. The advantage of being in general practice is that you are in charge of your practice. You can decide how many hours in a day you work and how many patients you will see on average in an hour. Because of the fee-for-service remuneration from the government this determines your annual income. It also determines your income tax status, so that the take-home pay may not be that much larger than the take-home pay as a salaried physician.

The system in Germany is similar. Most patients have coverage by the regular insurance company (AOK patients). But there is a two tier system, where private patients have insurance coverage by a private insurance carrier, called DKV. They experience a different treatment. Unlike the AOK patients (fee-for-service) there is no rush when the doctor examines a private patient. The doctor takes a lot more time to see a private patient and is more thorough with the examination. The remuneration for the private DKV patients is 3 to 4-times as much as for an AOK patient.

Mayo Clinic could become a health care model for the US

The Mayo Clinic has been in existence for 150 years. It has achieved the highest level of care in the US and many physicians refer their difficult to diagnose patients to this clinic. It seems that financially the clinic is also on solid grounds.

Could this system be transferred to the US health care system at large? Several points have to be considered regarding this.

Health care should be administered by each state separately

Health care is administered by each of the separate states. But federally the United States Department of Health & Human Services (HHS), also known as the Health Department should be responsible for health care in the US. This means that there has to be consultation between the Federal and the state level.

Biggest problem to convince all practicing physicians to be on salary

The biggest problem would be to convince that all of the practicing physicians should be on salary. For centuries patients paid for physicians’ services by using a “fee for service” payment schedule. For physicians this is the gold standard. They perceive the payment for their services as independent from the government. They have a deep distrust whether the government will treat them fairly. Another complicating factor are very high liability insurance payments, and medical lawsuits are common. How can a physician afford sky-high insurance rates? It is only possible with an agreement that pays a fair salary to all physicians. This will stabilize the healthcare system.

Escalating drug costs curtailed by generic drugs

Regarding the escalating costs of brand name medicines a solution is to allow generic drugs. They are chemically identical to brand name drugs. They are often 1/3 or ½ the cost of brand name drugs. Many non-US countries have used generic drugs for many years with no problems. But in the US pharmaceutical companies that produce brand name drugs have maligned generic drugs. They call generic drugs to be inferior.

Provisions need to be made to cover poorer people

Provisions for poorer people allow them to not have to suffer from untreated illnesses. The Healthcare Plan can take care of this in a similar fashion as the Mayo Clinic did. The health care premiums to be paid by every citizen in the US would be dependent on what your annual income is. People in higher income groups would pay a slightly higher premium than low- income people or middle-income people. Special provisions would apply to cover healthcare costs for people in training who do not yet have an adequate income. But essentially everybody would pay something into the health care plan. This way there would be enough funding for the health care system.

Will all the players accept that the Mayo Clinic could become a health care model?

Whether or not the US public at large would ever accept this proposal, all of the physicians and all of the major players of the health care industry remains to be seen. It would contain the healthcare costs and would cover every US citizen for healthcare expenses.

Mayo Clinic Could Become A Health Care Model

Mayo Clinic Could Become A Health Care Model

Conclusion

The Mayo Clinic has provided 150 years of healthcare coverage and provided excellent medical service. There is no reason why this type of system would not work for the general public. Healthcare coverage would be provided for everyone, regardless of their income. The high-income group would pay more than the middle income and those with low incomes. But everybody would receive the same healthcare service. Physicians would be on salary. Drugs would be largely generic drugs, but would also be trademark drugs, if no generic drugs are yet available.

100% enrolment ensures full funding of healthcare plan

By having 100% enrolment into the healthcare plan there would be no shortage of funding as healthcare costs average out when everybody -young and old people, rich and poor -are all included. It would require negotiations of the United States Department of Health & Human Services (HHS), backed up by the president and including the health departments of all of the states in the US. The Mayo Clinic succeeded achieving all of this within the US. Why should the US at large not be able to copy that system in all of the states?

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Dec
23
2017

Birth Control Pill Increases The Risk Of Breast Cancer

A recent study showed that the birth control pill increases the risk of breast cancer. This publication did research on 1.8 million of women of Denmark who took various forms of contemporary birth control pills (BCP). They were under the age of 50 and the observation of the participants continued for about 11 years.

Risks for breast cancer

When a woman took the BCP for less than one year, the risk of developing breast cancer was 9% higher compared to controls. But this rate increased even more to 38% after the use of the BCP for over 10 years. Women who had used progestin only intrauterine devices had a risk of 21% to develop breast cancer. It did not make a difference whether the BCP was a mix of estrogen and progestin or progestin. Researchers expressed the risk in the following fashion:

  • Less than one-year exposure to BCP: a 1.09-fold risk to develop breast cancer
  • Over 10-years use of BCP: a 1.38% risk to develop breast cancer
  • IUD with progestin in uterus: a 1.21% risk to develop breast cancer

Strokes and Heart attacks from the BCP

At the 86th Annual Meeting of the Endocrine Society in New Orleans/Louisiana a Canadian delegation presented this data. They had done a meta-analysis of 14 trials regarding side effects of the birth control pill (BCP). These women had taken the BCP on a prolonged basis (Ref. 1). The researchers monitored the risk of heart attacks and strokes. They found an association with the prolonged use of the low dose estrogen BCP. Researchers examined all of the studies between 1980 and October of 2002. 14 independent studies qualified for the meta-analysis.

Metaanalysis of BCP caused heart attacks and strokes

The strength of such a meta-analysis lies in the pooling of data and the fact that the data comes from a much larger patient population, which generally makes the results more reliable. Dr. J. Baillargeon from the Centre Hospitalier Universitaire in Sherbrooke, Quebec/Canada, stated that they found a

  • 85-fold risk for developing heart attacks with long-term use of the BCP and at the same time there was a risk of
  • 54-fold of hemorrhagic strokes with long-term use of the low-dose BCP.

It is important that women who contemplate going on the BCP know not only about the dangers of developing breast cancer, but also about the dangers of heart attacks and hemorrhagic strokes.

Lessons learnt from the Women’s Health Initiative

The Women’s Health Initiative in 2002 showed that women who were on Premarin and progestin for hormone replacement in menopause came down with breast cancer, heart attacks, stroke, and thromboembolic events. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127562/

They were using the synthetic hormones, namely conjugated equine estrogen and medroxyprogesterone acetate. The reason these women had to suffer these side effects was because their physicians insisted on using “pure hormones that a drug company had manufactured”. But these synthetic hormones were not pure hormones; they were hormones adulterated with side chains so that pharmaceutical companies could patent them.

Misfit of synthetic hormones with hormone receptors

These side chains made the synthetic hormones not fit the body’s hormone receptors. And this is the reason why the synthetic hormones created chaos in the body with breast cancer, strokes and heart attacks. In essence the mix of conjugated equine estrogen and the medroxyprogesterone were functioning like estrogens. So, there was an overdose of estrogenic hormones when taking these hormones and this use resulted in the development of breast cancer, heart attacks and strokes. The BCP is very similar to these hormones that are in the medication for hormone replacement therapy in menopause, but the hormone dosage in the BCP is much lower.

Other high-risk settings for women taking the BCP

There are other higher risk subpopulations of women who should avoid the BCP:

  • Had 1st degree relative with breast cancer on one breast :5-fold relative risk ; there is a genetic reason for breast cancer here
  • 1st degree relative with breast cancer on both breasts : 9.5-fold relative risk ; genetic risk more obvious.
  • No relative, but patient had history of breast cancer : 4-fold relative risk ;
  • First child born later than 30 years of age : 1.9-fold relative risk ; in comparison with a woman who has her first child prior to age 20
  • If woman consumes 3 oz. of alcohol per day : 2-fold risk; in comparison with woman not using alcohol or BCP
  • Prior radiation for Hodgkin’s disease (age 10 to 19) : 10- to 75-fold risk; radiation exposure during time of breast development leads to an enormous risk ratio about 15 years later

Mechanism of the BCP

The BCP or OC (oral contraception) utilizes the fact that ovulation (=release of a fertile egg) requires a complex interaction between hormones to occur. The gonadotropin hormones LH and FSH from the pituitary gland must stimulate the ovaries. The right mixture of estrogen and progesterone from the ovaries achieves this. Without that proper hormonal interaction ovulation will not take place leading to an infertile cycle. With contraception scientists were able to suppress ovulation for as long as patients are taking the birth control pill regularly. By giving a small amount of estrogen and progesterone like substance (called “progestin”) in the oral contraceptive form (the birth control pill) ovulation stops, the lining of the uterine cavity becomes stable through estrogen, and the mucous plug in the cervical canal thickens, making it much more difficult for sperm to enter.

Estrogen dominance from the BCP

The Women’s Health Initiative has taught physicians a tough lesson: you cannot mess with nature’s hormones or else you create a risk of strokes (41%), heart attacks (29% more), blood clots (twice as many), breast cancer (26% more), colorectal cancer (37% more) and the patient will have a higher risk for Alzheimer’s disease (76% more often). This was a trial involving over 16,000 postmenopausal women.

Although the hormones used in these women were slightly different in concentration, structurally they were very similar to the ones used for birth control purposes. What nature seems to tell us is that you cannot mess with hormone receptors, or you set up the body for one of the diseases mentioned.

Hormonal disruption

The truth is that the combination of  synthetic estrogen-like and progesterone-like substances  in the BCP are not bio-identical hormones. They suppress ovulation, which means they are creating progesterone deficiency in the woman who takes these synthetic hormones. The end result is that physicians create estrogen dominance in these women, which according to Dr. Lee is the reason for the above listed complications (Ref.2).

It makes more sense to use less invasive alternatives for birth control methods instead of the BCP. A well-fitted IUD (inserted by a gynecologist) is a good alternative. This will not create havoc with the woman’s hormones and will not create infertility after contraception is no longer needed. Bio-identical progesterone replacement using creams is being used to rebalance the original hormones when the BCP is discontinued.

Birth Control Pill Increases The Risk Of Breast Cancer

Birth Control Pill Increases The Risk Of Breast Cancer

Conclusion

The birth control pill (BCP) is a popular form of contraception. But there are significant risks of breast cancer, heart attacks and strokes associated with its use. According to the previous literature the risk of complications associated with the BCP was between 1.3- and 1.6-fold. The present study with smaller concentrations of hormones in the more modern BCP still showed a risk of 1.38-fold regarding breast cancer. It did not mention heart attacks and strokes as additional risk factors. The Danish study was supported by a grant from the Novo Nordisk Foundation. Novo Nordisk is a major producer of BCP’s in Europe and in the world. It would be in their interest to minimize the risks associated with the BCP. Any woman using the BCP should use it only as long as she really needs it. Ultimately she would be better advised to use alternatives like IUD’s and condoms.

References

  1. https://www.askdrray.com/birth-control-pill-increases-strokes-and-heart-attacks/
  2. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. Page 360 to 374 explains xenohormones.

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Jan
09
2016

Safety Of CT Scans And X-Rays

In the December 2015 issue of the LifeExtension Magazine Mr. William Faloon provided an interesting editorial that discussed the safety of CT scans and X-rays. Physicians often order CT scans to decrease their medico-legal risks or because they own part of the CT scan equipment.

Various publications give estimates of unnecessary CT scans in the order of 30% to 50%.

Brief history of X-ray machine inventions         

Wilhelm Conrad Roentgen, a German physicist was investigating electromagnetic wave lengths and detected electromagnetic waves in the range of X-rays. He won the first Nobel Prize in Physics in 1901 for his achievement.

Marie Curie

Marie Curie and her husband were experimenting with X-rays producing machines and developed the prototype of an X-ray machine that could be used for diagnostic purposes to visualize broken bones or the typical findings of pneumonia or tuberculosis on chest X-rays.

Thomas Edison

Thomas Edison was fascinated by this type of work and invented the fluoroscopy X-ray machine where the doctor could get instant feedback by watching on a screen when a needle was inserted. A helper, Clarence Dally who worked in Edison’s lab developed radiation sickness from X-ray overdoses and died. This haunted Edison for the rest of his life and he quit experimenting with X-rays.

CT scan 

The CT scan was invented in the 1980’s and was immediately used for difficult to diagnose clinical cases. The manufacturer of CT equipment did not advertise that the dosage of one abdominal CT scan was about 400-times stronger than that of a simple lung X-ray. This means that the danger of developing cancer as a late complication due to a CT scan also had a 400-fold higher risk. High sensitivity CT scans using lower X-ray doses have been invented, but they are not always available. It is simpler for the technician to keep the X-ray dose at the higher dosage setting than adjust the CT scanner to the body mass index of patients. A child should not receive the dosage of an adult, but again it is simpler to keep the CT dosage dial in the same setting. This is an unnecessary X-ray overexposure for the patient.

History of cancer complications from radiation

When Mrs. Curie was experimenting with X-rays and radioactive elements she was not aware of the potentially deadly effects of radiation. She died in 1934 at the age of only 67 of aplastic leukemia from unprotected exposure to radiation.

Unfortunately there were many radiation disasters throughout history. This made it clear that X-rays can cause cancer years after the original exposure.

The nuclear bombs of Nagasaki and Hiroshima are ugly reminders how ionizing radiation affects people in terms of getting cancer even years after the initial exposure.

The Chernobyl disaster exposed a lot of people not only in the Chernobyl area (the present state of the Ukraine), but also in Belorussia.

The latest experience comes from the Fukushima disaster in Japan, where authorities initially were slow to respond. Now they have a regular screening in place that identifies youngsters at risk for developing cancers and leukemia.

What all of these disasters have taught medical researchers is that cancerous transformation of tissues can occur even decades after prior exposure. At present there is no safe test that will predict with certainty when a cancer will develop.

Radiation exposure from various X-ray procedures

Because cases of cancer depend on the dosage used for diagnostic purposes, I am going to list dosages for common X-ray procedures, compared to a chest X-ray (modified according to article in the December 2015 LifeExtension Magazine):

Diagnostic             Effective dose (mSv)             Number of Chest               Time to reach dose from                                                          

procedure                                                               X-rays needed to                background radiation

                                                                               get equivalent dose

Chest X-ray                        0.02                                              1                                                 2.4 days

(PA film)

Skull X-ray                           0.1                                               5                                                 12 days

Lower back                          1.5                                             75                                                182 days

Kidney X-rays                      3                                               150                                                 1.0 year

Stomach and

intestine exam                      6                                               300                                                 2.0 years

Colon exam (Barium)           8                                               400                                                  2.7 years

CT scan head                       2                                               100                                                 243 days

CT scan abdomen                8                                               400                                                  2.7 years

You see from this overview that a CT scan generally has a higher X-ray dosage than a plain X-ray, but internal organ X-rays (stomach/intestine and colon X-rays) also use a high dosage of X-rays.

Balance the patient’s need for an X-ray with the risk from it

A CT scan has the ability to image soft tissues, bone and blood vessels, which makes it a useful tool to depict bone fractures, distinguish between hemorrhagic and ischemic stroke and visualize an abscess in the soft tissue. On the other hand there are real concerns about radiation exposure and possible cancer development years after the tests have been done. With any medical procedure physicians have no problems accepting a risk versus benefit analysis. However radiation history showed that physicians were totally oblivious to the possibility of radiation being able to cause cancers until only recently. In the aftermaths of Hiroshima and Nagasaki it became clear that even decades after exposure physicians found new cancer cases among people who had exposure to radiation in the past.

Thyroid cancers in adults often due to radiation exposure in childhood

Most recently with children and adults exposed to radiation from Fukushima it is clear that thyroid cancers are much more frequent in exposed children and adults than in non-exposed controls.

Long-term cancer risk associated with CT scans

Researchers compared over 680,000 children and adults born in the 1980’s. Their physician ordered at least one CT scan. The examiners matched this with a similar large group who never experienced any exposure to a CT scan (Ref.1). The ones who had their CT scan in childhood had a risk of 24% to develop any kind of cancer. If the same person had more than one CT scan the cancer risk was even higher: 35% higher in the first 4 years of exposure; 25% higher at 4 to 9 years and 14% higher still at 10 to 14 years. A group who had their first CT scan exposure 15 years or more ago still had a 24% risk of developing cancer compared to controls who never had a CT scan.

What kind of cancers CT scans cause
What type of cancers did they get? It is a vary varied list: solid tumors in the digestive tract, urinary tract, brain, ovary/uterus, skin and thyroid; among blood cancers they got leukemia and lymphomas. There were also numerous varieties of other other cancers.

Consequences of this data for clinical studies of patients

If follows from this:

  1. If another study is available that can show an abscess, then an ultrasound that does not utilize ionizing radiation would be a superior test to use!
  2. An MRI scan of the brain is superior in stroke patients to distinguish between hemorrhagic and ischemic stroke than a CT scan.
  3. Plain X-rays with less radiation exposure than CT scans often show bone fractures well enough for the orthopedic surgeon to be able to say whether or not a surgical intervention is necessary or conventional management with casts is sufficient. As can be seen from the table above there is 20-fold less X-ray exposure than with a CT scan.

Protection from ionizing radiation

In the fall-out of Chernobyl and Fukushima researchers have gone back to some fundamental observations. There are certain supplements that show cancer protection.

Four plant-derived remedies are useful in fighting radiation damage from CT scans or X-rays.

Blueberries or blueberry extract

Blueberries or blueberry extract has been shown to repair DNA damage from radiation.

Ginkgo biloba

A well-known botanical, ginkgo biloba,  is capable of scavenging free radicals (reactive oxygen species) produced by radiation. Ginkgo biloba can reduce abnormal chromosomes by 60% in individuals who had previously experienced exposure to radiation compared to controls who had not received treatment. During the Chernobyl disaster blood samples from Armenian workers who cleaned up the nuclear reactor had 17.9 abnormal chromosomes per 100 cells; after 120mg of ginkgo biloba for 2 months the cells with chromosome damage showed reduction to 5.7 per 100 cells. These benefits persisted for 7 months, but after 1 year 33% of workers had abnormal chromosomes again.

Lemon balm extract

In the meat industry llemon balm extract is used  to keep meat from oxidizing. There are three stabilizing functions of lemon balm regarding ionizing radiation: it boosts the levels of an enzyme called superoxide dismutase, which is an essential component of the body’s system to protect itself from ionizing radiation. The second effect of lemon balm is to stabilize lipid cell membranes, which prevents direct cell damage following radiation. The third effect of lemon balm is protection of DNA similar to blueberries. In one study radiation technologists were given 1.5 grams/100ml of lemon balm tea twice daily for 30 days. Judging by various cell markers these radiation technicians experienced between 10% and 61% of lower radiation damage on their cells.

Spirulina extract

Spirulina extract stimulates white cell, monocyte and red cell production following exposure to radiation. Research has shown that 4 grams of Spirulina per day for 21 days following the Chernobyl nuclear plant explosion given to youngsters normalized their blood values and they survived. Other research has shown that Spirulina stimulates the granulocyte macrophage colony-stimulating factor (GM-CSF), which stimulates bone marrow precursor cells, the precursors of immune cells.

Safety Of CT Scans And X-Rays

Safety Of CT Scans And X-Rays

Conclusion

The medical profession belittled radiation damage, until the landmark study of 2013 emerged and showed the the consequences described above. Now there is no question that the radiation dosage of CT scans is responsible for the causation of cancer. The decision to order a CT scan requires caution. The physician needs to take into consideration the seriousness of the patient’s condition. Next the benefit of what CT scan findings would show and the risk that this CT scan will impose on the patient needs balance. Alternative non-ionizing tests such, as ultrasounds and MRI scans should be considered.

Minimizing damage from anticipated CT scan

If a CT scan is unavoidable, the physician should tell the patient to take the following. Blueberries, Ginkgo biloba, lemon balm and Spirulina. It is administered at least 5 days before and 5 days after the CT scan. This will minimize the ionizing radiation effect on the body’s tissues. The overall effect is that it will reduce the risk of developing cancer later. It is important for the patient to be informed. Anybody who is told that he or she needs a CT scan needs to talk to the doctor. Don’t be afraid to ask questions about alternative investigation techniques.

References

Ref. 1: Mathews JD et al. “Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians.” BMJ. 2013; 346:f2360.

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