Panaceia or Hygeia

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Archive for August, 2008

AAMC Calls For Strict Limits on Industry Support of Medical Education

Posted by Colin Rose on August 26, 2008

It’s about time!

But I would extend the recommendations to eliminate all industry funding of CME. If doctors can’t pay for their own education who can?

There are many  industry funded chairs at medical schools, like the Novartis Chair at McGill that pays the head of cardiology, that should be eliminated and their endowments returned to the industry donors with interest. Surely, out of the $many millions collected by the cardiology department for various clinical services, McGill can afford to pay a salary to its head.

All online drug funded CME, like this, should also be eliminated.

 

AAMC Calls For Strict Limits on Industry Support of Medical Education.

 

Washington, D.C., June 19, 2008-The AAMC (Association of American Medical Colleges) today urged all medical schools and teaching hospitals to adopt policies that prohibit drug industry gifts and services to physicians, faculty, residents, and students, and to curtail the involvement of industry in continuing medical education activities. The recommendations were part of a new AAMC report, “Industry Funding of Medical Education,” unanimously approved by the association’s Executive Council. In adopting the report, the AAMC’s leadership urged all association members to implement policies and procedures, consistent with the report’s guidelines, by July 1, 2009.

The report was the result of a 14-month effort by an AAMC task force, established in 2006, to examine the benefits and pitfalls associated with industry funding of medical education, and to develop principles, recommendations, and guidelines to help medical schools and teaching hospitals better manage their relationships with industry. The panel was chaired by retired Merck Chairman and CEO Roy Vagelos, M.D., and the vice chair was William Danforth, M.D., former chancellor of Washington University. The task force membership included institutional leaders, faculty, residents, students, CEOs from the pharmaceutical, biotechnology, and medical device industries, ethicists, and public representatives.

“Interactions between industry and academic medicine are vital to public health,” said AAMC President and CEO Darrell G. Kirch, M.D. “But they must be principled partnerships effectively managed to sustain public trust in both partners’ commitment to patient welfare and the improvement of health care. The recommendations outlined in this report provide essential guidance for how medical schools and teaching hospitals can achieve this important goal.”

Mounting scientific evidence indicates that gifts, favors, and other marketing activities, both explicit and implicit, prejudice independent judgment in unconscious ways. In order to minimize the likelihood of biased decisions by academic physicians, establish an influence-free culture for medical students, residents and other trainees, and optimize the benefits inherent in the principled relationships between medical education and industry, the report proposes that academic medical centers:

  • Establish and implement policies that prohibit the acceptance of any gifts from industry by physicians, faculty, students and residents on- or off-site
  • Eliminate the receipt of drug samples or manage their distribution via a centralized process that ensures timely patient access throughout the health care system
  • Restrict access by pharmaceutical representatives to individual physicians by confining visits to nonpatient areas and holding them by appointment only
  • Set up a central continuing medical education (CME) office to receive and coordinate the distribution of industry support for CME activities
  • Strongly discourage participation by faculty in industry-sponsored speakers’ bureaus
  • Prohibit physicians, residents, and students from allowing presentations of any kind to be ghostwritten by industry representatives.

While all medical schools and teaching hospitals do not yet have strong polices governing their interactions with the drug and device industries, many are working to develop them, and a number of academic medical centers have implemented such policies in the past few years, including University of Pittsburgh School of Medicine; University of Pennsylvania School of Medicine; Stanford University School of Medicine; University of California, Davis, School of Medicine; David Geffen School of Medicine at UCLA; and Yale University School of Medicine.

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Food Addiction

Posted by Colin Rose on August 20, 2008

We were delighted to be notified of an upcoming symposium on food addiction. It has finally dawned on the obesity establishment that the pandemic of obesity is caused by the pandemic of food addiction. We have been criticized for even making the suggestion, illustrated in our photo essay on food addiction. Now they must start asking themselves why there is a pandemic of food addiction that began in the early 1980s, coincident with the beginning of the promotion of the cholesterol myth. The most likely explanation is the moral hazard effect of drugs for “treating” the symptoms of self-destructive lifestyles. The population has been indoctrinated in the belief that as long as one takes one’s pills for blood cholesterol, blood sugar and blood pressure, one is free eat anything in any quantity. In this regard, we would hope that the sponsor of the symposium, Merck-Frosst, a peddler of pills for those very symptoms, realizes its culpability in contributing to the problem.

Piazza San Stefano, Venice

Food addiction in children and an adult

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Obesity is not caused by slow metabolism

Posted by Colin Rose on August 20, 2008

A new study reported by the Medical Post further debunks the myth that obese people are genetically predetermined to get fat because they have a “slow metabolism”. This study shows that obese people process food exactly the same way as thin people when they are in a rigidly controlled environment.

Dr. Bessesen says they are “not mentally processing how many calories they are actually consuming.” Indeed in all “diet” trials such as A TO Z and DIRECT in which obese people are given some freedom to choose their food and then report their intake without verification, they can be proven to be lying about their true intake.

Still Dr. Anhalt says, “We need to see if there are targeted gene strategies to identify what keeps thin people thin.” The mirage of a gene for obesity is much more comforting than dealing with addiction to food. Addiction to many substances and activities is the cause of most of the major problems of developed societies. Doctors are not trained to deal with addiction and, by the nature of their training, will look for some panaceia in the form of a drug or operation.

Bench Press

He does not have a slow metabolism

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Metabolism alone doesn’t explain how thin people stay thin 
August 19, 2008 | John Schieszer 

More important factors may be differences in food intake and activity, and the fact that people who gain weight may not truly realize how much they consume

 

SAN FRANCISCO | Metabolism alone may not explain why some people are fat or thin, according to a study presented at this year’s annual Endocrine Society meeting here.

It is unclear how some individuals remain thin in the current obesigenic environment that promotes significant weight gain in the majority of people. However, researchers with the University of Colorado Health Sciences Center in Denver say it is not because thin people have a faster metabolism or metabolize their food differently than obese people.

“The causes of obesity are complicated and likely cannot be solely explained on differences in rates of metabolism,” said Dr. Daniel Bessesen, an endocrinologist and professor of medicine at this institution.

To better understand the causes of obesity, he and his colleagues looked at thin people who say they have trouble gaining weight. They tested the theory that these individudals can overeat without gaining weight because they have a higher metabolic rate and thus burn more calories than people who have a problem with weight gain.

The investigators studied 26 naturally thin people, whom they called “obesity-resistant,” and 23 people who had a least one obese close relative and were called “obesity prone.”

The Colorado researchers hypothesized that energy expenditure and fat oxidation would increase following overfeeding in the obesity-resistant group, protecting them from weight gain.

In both groups the investigators tested metabolic rates at two separate times: once after the subjects ate a normal diet and once after three days of eating 40% more food than their body needed.

The obesity-resistant subjects had a body mass index between 19 and 23, no obese first-degree relatives and had self-described difficulty gaining weight. The obesity-prone individuals had BMIs between 23 and 27 and at least one obese first-degree relative. All the subjects underwent two one-week dietary study periods, with four days of a control run-in diet followed by three days of either continued eucaloric feeding or overfeeding.

The researchers monitored metabolic rates by having all the subjects stay for 24 hours in a room calorimeter. This special room controls air going in and coming out, and allows for the measurement of oxygen and carbon dioxide levels. Burning calories requires a certain amount of oxygen. Therefore, a calorimeter provided an accurate way of measuring daily energy expenditure or calories burned, explained Dr. Bessesen. It also measured how much fat the subjects burned in a day.

All the food in the study was provided by a special metabolic kitchen. The researchers determined energy needs from a 24-hour baseline calorimeter stay and dietary composition was identical in all study periods. The food consisted of 20% protein, 30% fat and 50% carbohydrate.

The researchers found both groups had higher metabolic rates at rest after they overate for three days than when they ate a normal diet. However, the increase was not any greater in the thin subjects. “This suggests that differences in hunger, fullness, food intake and physical activity may be more important factors in why some people are thin,” Dr. Bessesen said.

Unaware of intake
He suggested these findings are important because many thin people think they have a “faster metabolism.” However, Dr. Bessesen said his study shows that is simply a myth. He said primary-care physicians often have a significant number of patients coming in for visits and reporting they are eating less but still gaining weight. But it is more likely that these patients are probably not mentally processing how many calories they are actually consuming.

“Overall, we found no evidence that thin people have a higher metabolic rate on a regular diet or that they burn more energy following a period of overfeeding,” Dr. Bessesen said. “The most important take-home message for clinicians is that people who are tending to gain weight may not be getting accurate information on how much they are eating through biologic mechanisms. So self-monitoring might be an important tool for them, such as keeping food diaries and food records, because they may be eating more than they think.”

Dr. Henry Anhalt, a pediatric endocrinologist in Englewood, N.J., described Dr. Bessesen’s study as an important first step. Until now, he said, most studies have focused on why people become obese and what can be done to prevent obesity. Instead, he hopes more studies like this will look at how normal-weight or thin people avoid obesity in today’s fast-food, “super-size me” culture.

“We need to see if there are targeted gene strategies to identify what keeps thin people thin.”

Posted in diet, obesity | Tagged: , , | 1 Comment »

Michael Phelps’ atherogenic diet

Posted by Colin Rose on August 16, 2008

A gold medal diet?

If Michael Phelps’s diet is really as reported and he continues to eat like this, his risk of atherosclerosis and probably some cancers are elevated. While no detailed nutrient breakdowns are available, one can infer that a large fraction of his calories are coming from saturated fat and refined carbohydrate, nutrient poor calories. The “energy drinks” are liquid candy. He consumes few vegetables and no fruit. His intake is low in fiber, and could be low or borderline in other nutrients. While such a diet may rapidly supply the calories he needs for Olympic gold medals, in the long run his health will suffer. If he thinks he can eat chocolate chip pancakes as long as he exercises enough, he is dead wrong. And what kind of example does he set for the children of the USA and the world? “Hey Mom, I can eat chocolate chip pancakes instead of broccoli, just like Michael Phelps.”

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French fries healthy – no cholesterol

Posted by Colin Rose on August 8, 2008

La Presse reports the latest example of profiting from the cholesterol myth, this time from a restaurant chain famous for its poutine.

Photo by Matt Saunders. A typical plate of Montreal poutine. Can you see the fries buried under the cheese and gravy?

This sign has been seen in many Lafleur outlets in the last few months.


For those who need help with the French, here is a rough translation:

—————————————-

Our fries – an exceptional product

Produced in Quebec, potatoes, whole and fresh

A nutritious and energizing food, an exceptional vegetable, a healthy choice

More iron than a bowl of spinach,

Two times more potassium than a banana,

More fibre than a bowl of oatmeal

As much protein as half a glass of milk

Less calories than a bowl of rice.

Low in fat and salt and with a high concentration of Vitamin C and cooked in canola oil

Canola oil contains a larger amount of good fat than other popular vegetable oils like olive oil.

A source of omega 3 and omega 6 essential for good nutrition and a healthy diet without cholesterol and trans fat.

———————————————

Let’s dissect this diatribe. We would agree that potatoes with the skin, baked or boiled, are nutritious but not particularly exceptional. They certainly don’t deserve the trashing they have gotten from the likes of nutritional morons like Montignac, Atkins or Taube who believe that calories from carbohydrates are poison and that calories from fat or protein are the only good calories. They ignore the fact that one’s brain needs 400 kcal (100 gm) of glucose per day.

Potatoes many contain more iron than a bowl of spinach but have more calories for the same amount of iron. One certainly wouldn’t want to attempt to supply one’s requirement for iron by eating potatoes.

We won’t argue about potassium but one doesn’t put salt on bananas and most servings of French fries, alone or in poutine would come with a lot of salt which tends to negate the benefits of potassium.

The protein in potatoes is not a complete protein, like in animal products, and one wouldn’t want to rely only on potatoes for one’s protein requirement.

One French fry may have less calories than a bowl of rice but a bowl of French fries has a lot more than a bowl of rice.  

Potatoes have very little fat but, when French fried, have a huge amount of fat. There is no such thing as “good” fat. All fat has the same calories, 9 kcal per tablespoon, the most concentrated form of calories. Now there are differences in the fatty acid composition of refined oils from various sources but there are no controlled trials showing these variations have any effect on prevention or treatment of any disease. High profit olive oil and canola oil are “good” because those selling them say they are good.

There are lots of other sources of omega 3 and omega 6 fatty acids. No need to eat French fries.

No vegetable food ever contained cholesterol but so what? Dietary cholesterol is not a problem. But the cholesterol myth has been so well implanted by the drug dealers that grease peddlers, like Lafleur, can use it to sell their junk. I hope Lafleur is paying royalties to Pfizer on every plate of poutine it serves. On the other hand, maybe Pfizer is paying Lafleur and its ilk to flog poutine so that people get obese and get “dyslipidemia” and Pfizer can sell more Lipitor to treat the “dyslipidemia”.

Trans fat is the current politically correct explanation for all the ills of Western civilization including child obesity. It like all kinds of refined fat is totally useless empty calories but there is no evidence that it killed any more people than any other kind of refined fat.

Most importantly, what is nowhere mentioned in the nutritional deception is that the vast majority of the French fries will be served at Lafleur as poutine in which the potatoes become a minor ingredient in the great globs of gravy and high-fat cheese. So Lafleur is really trying to sell more poutine by vastly exaggerating the importance of its only potentially healthy ingredient.

Legal Addictions

The appearance of a typical eater of poutine and a good candidate for a trial of a statin for "treating dyslipidemia"

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