Perlmutter Health Center

A Quarterly Health Update • Summer 1998 • Vol. 3 No. 3

David Perlmutter, MD, FACN

Quotes

"The best cure for hypochondria is to forget about your body and get interested in somebody else's." --- Goodman Ace

"A doctor's reputation is made by the number of eminent men who die under his care." --- George Bernard Shaw

"We shall have to learn to refrain from doing things merely because we know how to do them." --- Theodore Fox

"The animals are not as stupid as one thinks - they have neither doctors nor lawyers." --- L. Docquier

"Never go to a doctor whose office plants have died." --- Erma Bombeck

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Cellular Telephones - More Bad News

As portable cellular telephones become more prolific, reports in medical journals raising questions about the safety of these devices seem to be on the rise as well. Questions have been raised concerning the relationship between the use of portable cellular telephones and the risk of brain cancer with causality being ascribed to a direct carcinogenic effect of the electromagnetic radiation emitted from these devices. While this issue remains to be settled, other dangers are now making their way to the public attention.

In a sobering study appearing in the prestigious New England Journal of Medicine (February, 1997), an article entitled, "Association Between Cellular-Telephone Calls and Motor Vehicle Collisions," published by researchers at the University of Toronto, revealed a striking increased risk of collision in automobile drivers using cellular telephones. The study evaluated 699 drivers over a 14 month period. The risk of experiencing a collision when using a cellular telephone was found to be four times higher than the risk when the telephone was not being used. Interestingly, the risk of collision was just as high in individuals using devices which allowed their hands to be free when compared to those drivers using hand-held units. The only good news is that 39% of the drivers utilized their cellular telephones to call for emergency help following their accidents.

More concern was raised by another article appearing in the New England Journal of Medicine - this one in the May 22, 1997 issue entitled, "Interference with Cardiac Pacemakers by Cellular Telephones." This report described 980 patients with cardiac pacemakers exposed to the radiation emitted from five different types of hand-held cellular telephones. Patients were evaluated with electrocardiograms while using the telephone devices. The results were certainly troubling. Twenty per cent of the evaluations demonstrated measurable interference in pacemaker function from the cellular telephone. In 7.2% of the exposures, patients actually experienced symptoms when the cellular telephone was being used. Symptoms were much more likely to occur when the cellular telephone was held near the pacemaker.

Another potential danger of these devices is blood pressure elevation. In a June 20, 1998 issue of Lancet, an article entitled, "Resting Blood Pressure Increase During Exposure to a Radio-Frequency Electromagnetic Field," evaluated blood pressure in a group of volunteers. These individuals held the cellular telephone in the normal position on the right side of the head. The telephones were operated by remote control so that the test subjects did not know whether or not the phone was actually being used. The study demonstrated very significant results. The authors concluded that exposure of the test subjects to the radiation created by the hand-held cellular telephones for 35 minutes caused an increase in blood pressure of between 5 and 10 mm.

It would certainly be difficult to dispute the convenience and utility of the ever popular hand-held cellular telephone. But despite the vigorous attempts on the part of the manufacturers of these devices to convince us of their absolute safety, medical research continues to raise serious questions concerning their health risks.

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Cholesterol Drugs For Everyone

Without question there is a strong, positive, direct relationship between elevated total cholesterol levels and the risk of coronary heart disease. There is also a direct correlation between levels of low-density lipoprotein cholesterol (LDL) and heart disease risk. The various studies supporting these relationships have long been quoted by those clinicians seeking support for their use of cholesterol lowering drugs to reduce heart attack risk. Now, a study has appeared in a major medical journal indicating that physicians should consider treating people with "average cholesterol levels" with very potent cholesterol lowering drug. This study published in the May 27, 1998 issue of the Journal of the American Medical Association entitled, "Primary Prevention of Acute Coronary Events with Lovastatin in Men and Women with Average Cholesterol Levels," found that indeed, utilizing this drug did reduce the risk of the first acute heart attack in men and women with average total cholesterol and LDL levels with below average levels of HDL (the good cholesterol). Indeed, the data presented in this study of 5,608 men and 997 women was compelling. But let's dig a little deeper. First, although "dietary re-enforcement and other risk factor modification information" was provided to the test subjects, no specific strict dietary intervention was carried out. Further, the subjects were not compared to a group of patients not receiving the medication who were placed on a strict dietary program. Next, the data actually revealed 80 deaths among the participants taking Lovastatin compared to 77 deaths among participants treated with placebo. Lovastatin is a powerful and potentially dangerous drug. Adverse reactions include nausea/vomiting, diarrhea, abdominal pain, constipation, muscle pain, joint pain, headache, dizziness, insomnia, rash, chest pain, blurred vision, and hair loss. Nevertheless, physicians continue to be bombarded by scientific literature advocating the use of quick fix magic bullets to treat various medical conditions. Information provided to physicians concerning the use of cholesterol lowering drugs typically contains information recommending that these drugs be used only after strict dietary measures have failed. Dietary measures have long been known to be significantly effective in lowering cholesterol and reducing cardiac risk.

Finally, the funding for this research report was provided by Merck and Company, Inc. Two of the principle investigators are, in fact, employees of Merck and Company, Inc., and yet the Journal of the American Medical Association chooses to publish this information as if it is somehow unbiased.

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Pharmaceutical Drugs - A Prescription for Danger

In a classic example of the pen being mightier than the sword, the past several decades have witnessed an incredible expansion of the variety of pharmaceutical agents available to physicians for treating our medical maladies. It seems that these days there is a pill for just about every one of our ills. Whether it is high blood pressure, high cholesterol, arthritic joint, or Parkinson's disease, doctors always seem to be able to scribble something on a prescription pad that they believe will help cure or at least improve the problem. Unfortunately, the medical consumer seems to have readily adapted to this paradigm. We blindly accept the recommendations of our treating physicians to take this pill or that without having a good concept of the potential risks involved.

A landmark article was published in the Journal of the American Medical Association on April 15, 1998, entitled, "Incidence of Adverse Drug Reactions in Hospitalized Patients." In this study, researchers evaluated serious and fatal adverse drug reactions in U.S. hospitals during 1994. The study revealed that in 1994, adverse drug reactions accounted for 2, 216,000 serious events, and 106,000 deaths in this country.

These statistics are certainly sobering. The implications of these results are that adverse drug reactions may represent the fourth leading cause of death in this country - far above breast cancer and prostate cancer combined. Further, it is important to understand that this was a study looking at reactions to drugs administered appropriately, which is to say, given in the correct dosages and used in appropriate circumstances.

The following week, the Journal of the American Medical Association in its commentary section, published an article entitled, "Time to Act on Drug Safety." This commentary was no doubt hastened by the profound impact that the adverse drug reactions article had on medical practitioners and medical consumers alike. The authors of the commentary stated, "While the FDA has more than 1,400 employees with principle duties related to approving new drugs, a full-time staff of only 52 monitors the safety of approximately 5,000 brand name, generic, and over-the-counter drugs already in the marketplace." Further, they stated, "The nation needs an office of drug safety with the authority, independence, funds, and legal mandate to undertake all four of the major tasks that define a basic drug safety monitoring program. The funds to pay for this expanded safety program should come from user fees collected from pharmaceutical companies. The drug industry should be no less liable for the cost of its safety regulation than the nuclear industry, which pays for the full costs of the Nuclear Regulatory Commission. Even if the pharmaceutical industry, already the nation's most profitable as measured by return on investment, passes on the whole burden to consumers, the added costs would be small. Just one penny per prescription would yield approximately $24 million for an enhanced drug safety monitoring program….. This investment in drug safety has the potential to save thousands of lives and prevent tens of thousands of serious injuries every year."

In September, 1997, the diet drugs Fenfluramine and Dexfenfluramine were withdrawn when the FDA finally conceded that these drugs were associated with heart valve abnormalities in 31% of the patients tested. Events like these and the article concerning adverse drug reactions described above are certainly bringing to the public awareness the idea that it may be time for us to question the long held belief that the cure for all of our maladies is to be found in pharmaceutical magic bullets. Indeed, in the same issue of the Journal of the American Medical Association in which the commentary on drug safety appeared, an article entitled, "Why Patients Use Alternative Medicine" was published. How appropriate. Coming on the heels of the report of the dangers of pharmaceutical drugs, it doesn't take much imagination to understand why 34% of adults in the United States readily choose to utilize alternative medical techniques. As the authors of this report stated, "Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as the result of being dissatisfied with conventional medicine, but largely because they find these healthcare alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life."

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Timing of Mammography May Prove Critical

There remains much debate as to whether women in the 40-49 year age group should have routine mammography. One of the arguments against this practice is the fact that women in this age group tend to have denser breast tissue. But new research indicates that density of the breast tissue varies greatly during the menstrual cycle - and this may have an impact on the accuracy of mammography.

In a study recently published in the Journal of the National Cancer Institute, an evaluation of mammograms performed on 2,591 pre-menopausal women between 40 and 49 years revealed that women were less likely to have extremely dense breasts during the first two weeks of their menstrual cycle (follicular phase) as compared to weeks three and four (luteal phase). Breast density is known to obscure the accuracy of mammography. Thus, if you are a pre-menopausal woman contemplating mammography, these results would indicate that you should time this mammogram to coincide with the first two weeks of your menstrual cycle.

Related data reveals that there is a substantially reduced accuracy of mammography in women with silicone breast implants. Several studies have clearly demonstrated that mammograms performed in women with silicone breast implants are much less likely to detect early cancers when compared to mammograms of non-augmented breasts.

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Garlic and Antioxidant Activity

Oxygen free radicals are normal by-products of the body's metabolism. Excessive free radicals, however, have been implicated as playing a role in a variety of pathologic conditions including inflammation, atherosclerosis, Alzheimer's disease, Parkinson's disease, and aging. Normally, the body limits the activity of free radicals by utilizing a variety of free radical quenching enzymes as well as antioxidant vitamins. Among the most potent enzymes in the body for limiting free radicals are superoxide dismutase, catalase, and glutathione peroxidase. These enzymes play a critical role in scavenging free radicals and preventing cell injury.

In exciting research performed at the Loma Linda University School of Medicine, investigators evaluated the effectiveness of Aged Garlic Extract® (Kyolic Garlic) in enhancing the activities of these free important antioxidant enzymes. The results of this study published in Nutritional Research, supports the usefulness of Kyolic Garlic in a nutritional program designed to reduce free radical damage. The enhancement of antioxidant enzyme activity by Kyolic Garlic joins a long list of other health benefits of this important nutritional supplement including cholesterol reduction, enhanced memory performance, and improvements in immune function. To learn more about the health benefits of Aged Garlic Extract® (Kyolic Garlic), contact Wakunaga of America at (800) 421-2998.

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Book Review

The Truth About Breast Cancer - A Seven Step Prevention Plan by Joseph Keon, Ph.D.
Parissound Publishing, Mill Valley, CA, i.s.b.n. #0-9648974-7-4

In this issue of The Perlmutter Letter, we break with tradition by presenting a book review of a book soon to be published. Rather than presenting an actual review, the following is the forward from The Truth About Breast Cancer that I was privileged to write.

Imagine waking up to read the morning newspaper and discovering that while you slept, a commercial jet airliner had crashed killing all 130 passengers. The headlines might report, "Tragedy Strikes," and reading further you would be assured to know that the National Transportation Safety Board was already on the scene to determine the cause of this fatal disaster. Indeed, when such an event occurs, nothing can be done for the victims. The vigorous efforts undertaken to discover the cause of the tragedy are pursued in hopes of preventing future similar events.

At present, the annual fatality rate from breast cancer for women in America approximates the number of deaths if this hypothetical air disaster occurred each and every day. But unlike the approach taken by the N.T.S.B. to determine the cause and ultimately prevent air disasters, the focus in America regarding breast cancer remains fixated on treating victims.

Hardly a day goes by that we are not encouraged by the announcement of some new form of breast cancer therapy. Unfortunately, even with our vast array of technical advancements in the 1990's, still one-third of breast cancer victims die from their disease. Remarkably, our cure rates for breast cancer remain about where they were some fifty years ago.

In light of these sobering statistics, it is imperative to recognize the our most well respected peer review medical journals have for decades been publishing high caliber research indicating that preventive medicine may represent our most potent tool for dealing with breast cancer. While headlines are made by the discovery of so-called "breast cancer genes," announcements dealing with risk factors over which we can exercise control receive little fanfare.

The modern western medical paradigm places the healthcare consumer into an entirely passive role. We are conditioned to place our faith in the products of the medical technology and pharmaceutical industries in hopes that "magic bullets" will treat the ever increasing number of maladies of modern society. This is exemplified by the recent announcement of the results of a six year study of the drug Tamoxifen conducted by the National Cancer Institute which did demonstrate a slight reduction of breast cancer risk in non-afflicted women taking this potentially dangerous drug. At the same time, a landmark article was published in the Journal of the American Medical Association entitled, "Dual Effects of Weight and Weight Gain on Breast Cancer Risk" from the Harvard School of Public Health. Likely because this report did not advocate the use of a high-tech procedure or new pharmaceutical intervention, it received very little public attention. Nevertheless, this study did demonstrate a dramatic relationship between weight gain and breast cancer risk. In a study reported in the prestigious New England Journal of Medicine, (May 1, 1997), it was found that in women 45 years or younger, regular exercise reduced breast cancer rate by an astounding 68%. A study published in the journal Lancet, (October 4, 1997), now provides almost irrefutable evidence of the link between a diet rich in phyto-estrogen containing foods like soy and lowered risk of breast cancer. Further studies have now made quite clear the relationship between other modifiable risk factors and the risk of breast cancer including pesticide exposure, alcohol consumption, and estrogen replacement therapy.

This book is about women choosing either to be passive and accept the one in eight risk of developing breast cancer and the subsequent one in three risk of dying from the disease, or being active and making those meaningful and profoundly therapeutic lifestyle changes which modern science has confirmed can have a major impact on reducing breast cancer risk.

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