Sunday, November 22, 2015

Turmeric is More Powerful and Effective Than 14 Drugs
Turmeric is one of the most thoroughly researched plants in existence today.  Its medicinal properties and components (primarily curcumin) have been the subject of over 5600 peer-reviewed and published biomedical studies.   In fact, our 5-year long research project on this sacred plant has revealed over 600 potential preventive and therapeutic applications, as well as 175 distinct beneficial physiological effects.

2. Turmeric: Cholesterol/Steroids

Given the sheer density of research performed on this remarkable spice, it is no wonder that a growing number of studies have concluded that it compares favorably to a variety of conventional medications, including:
Lipitor/Atorvastatin(cholesterol medication):
A 2008 study published in the journal Drugs in R&D found that a standardized preparation of curcuminoids from Turmeric compared favorably to the drug atorvastatin (trade name Lipitor) on endothelial dysfunction, the underlying pathology of the blood vessels that drives atherosclerosis, in association with reductions in inflammation and oxidative stress in type 2 diabetic patients. [i]  [For addition curcumin and ‘high cholesterol’ research – 8 abstracts]
Corticosteroids (steroid medications):
A 1999 study published in the journal Phytotherapy Research found that the primary polyphenol in turmeric, the saffron colored pigment known as curcumin, compared favorably to steroids in the management of chronic anterior uveitis, an inflammatory eye disease.[ii]  A 2008 study published in Critical Care Medicine found that curcumin compared favorably to the corticosteroid drug dexamethasone in the animal model as an alternative therapy for protecting lung transplantation-associated injury by down-regulating inflammatory genes.[iii] An earlier 2003 study published in Cancer Letters found the same drug also compared favorably to dexamethasone in a lung ischaemia-repurfusion injury model.[iv]  [for additional curcumin and inflammation research – 52 abstracts]
3. Turmeric: Antidepressant/Blood Thinner
Prozac/Fluoxetine & Imipramine  (antidepressants):
A 2011 study published in the journalActa Poloniae Pharmaceutica found that curcumin compared favorably to both drugs in reducing depressive behavior in an animal model.[v] [for additional curcumin and depression research – 5 abstracts]
Aspirin (blood thinner):
A 1986 in vitro and ex vivo study published in the journal Arzneimittel for schung found that curcumin has anti-platelet and prostacyclin modulating effects compared to aspirin, indicating it may have value in patients prone to vascular thrombosis and requiring anti-arthritis therapy.[vi]  [for additional curcumin and anti-platelet research]
4. Turmeric: Anti-inflammatory/Chemotherapy
Anti-inflammatory Drugs:
A 2004 study published in the journal Oncogene found that curcumin (as well as resveratrol) were effective alternatives to the drugs aspirin, ibuprofen, sulindac, phenylbutazone, naproxen, indomethacin, diclofenac, dexamethasone, celecoxib, and tamoxifen in exerting anti-inflammatory and anti-proliferative activity against tumor cells.[vii] [for additional curcumin and anti-proliferative research – 15 abstracts]
Oxaliplatin (chemotherapy drug):
A 2007 study published in the International Journal of Cancer found that curcumin compares favorably with oxaliplatin as an antiproliferative agenet in colorectal cell lines.[viii] [for additional curcumin and colorectal cancer research – 52 abstracts]

5. Turmeric: Diabetes

Metformin (diabetes drug):
A 2009 study published in the journal Biochemitry and Biophysical Research Community explored how curcumin might be valuable in treating diabetes, finding that it activates AMPK (which increases glucose uptake) and suppresses gluconeogenic gene expression  (which suppresses glucose production in the liver) in hepatoma cells. Interestingly, they found curcumin to be 500 times to 100,000 times (in the form known as tetrahydrocurcuminoids(THC)) more potent than metformin in activating AMPK and its downstream target acetyl-CoA carboxylase (ACC). [ix]
6. Turmeric Studied as Cancer Treatment
Another way in which turmeric and its components reveal their remarkable therapeutic properties is in research on drug resistant- and multi-drug resistant cancers.  We have two sections on our site dedicated to researching natural and integrative therapies on these topics, and while there are dozens of substances with demonstrable efficacy against these chemotherapy- and radiation-resistant cancers, curcumin tops both lists:
·                 Cancers: Drug Resistant
·                 Cancers: Multi-Drug Resistant
We have found no less than 54 studies indicating that curcumin can induce cell death or sensitize drug-resistant cancer cell lines to conventional treatment.[x]
We have identified 27 studies on curcumin’s ability to either induce cell death or sensitize multi-drug resistant cancer cell lines to conventional treatment.[xi]
Considering how strong a track record turmeric (curcumin) has, having been used as both food and medicine in a wide range of cultures, for thousands of years, a strong argument can be made for using curcumin as a drug alternative or adjuvant in cancer treatment.
Or, better yet, use certified organic (non-irradiated) turmeric in lower culinary doses on a daily basis so that heroic doses won’t be necessary later in life after a serious disease sets in.  Nourishing yourself, rather than self-medicating with ‘nutraceuticals,’ should be the goal of a healthy diet.  [learn more at Sayer Ji’s new collaborative project EATomology]
The entire database of 1,585 ncbi-hyperlinked turmeric abstracts can be downloaded as a PDF at the GMI Downloadable Turmeric Document page, and acquired either as a retail item or with 200 GMI-tokens, for those of you who are already are members and receive them automatically each month.   Turmeric (Theracurmin) is the Wonder Drug of "ALL TIME"

Sunday, November 15, 2015

Industry Insider Speaks Out About the HAZARDS of Industrialized Agriculture

Industry Insider Speaks Out About the Hazards of Industrialized Agriculture

November 15, 2015 |  

By Dr. Mercola
It's been eight years since bird flu was a concern in the United States, but now it's back again, and it's particularly integrated into confined animal feeding operations (CAFOs).
Dr. John Ikerd, who has a PhD in Agricultural Economics, is an industrial agriculture insider, making him a rare voice to speak out against the conventional model.
He grew up on a dairy farm, and also gained experience working for Wilson & Co. — at that time, the fourth largest meat packing company in the country — and Kansas City stockyards.
After obtaining his PhD, he worked as an extension livestock marketing specialist and an agricultural economist, spending the first 15 years of his academic career promoting industrial agriculture, which includes large-scale CAFO’s.

Financial Crisis Revealed Fundamental Flaws in Big Ag Model

It wasn't until the financial crisis hit farmers in the 1980s that he began to reconsider what he'd been taught, and what he'd been teaching farmers.
As it turned out, the farmers who were hit the hardest by the recession were the ones who had diligently followed the advice of Dr. Ikerd and other industry experts.
"'Get big or get out' was this idea of industrialization to get larger and larger. Many farmers followed our advice during the 1970s [and] borrowed heavily in order to expand their operations," Dr. Ikerd says.
"When the 1980s came along, farmers were caught with huge debts at record-high interest rates, and they simply couldn't pay off the loans. By that time, I'd moved to the University of Georgia, and I was head of the Department of Extension Agricultural Economics.
It was the responsibility of my department to go out and work with these farmers who were losing their farms. We tried to figure out some way they could make the farm profitable; if not profitable, then maybe they could get out of agriculture while they still had some equity left.
Or at least we tried to talk them out of killing themselves... There were more than a few farm suicides around the country among the farmers faced with the prospect of losing their farms. It was a pretty intense situation...
I said, 'Look, there's something fundamentally wrong with this. I didn't get all this education and all this experience, so that I could create a system where these farmers would end up going broke.'"
He began to realize that in order for some farmers to continue to grow and get increasingly bigger, it meant that other farmers had to be forced out of business, and this had a number of unrecognized consequences.
"I said, 'Look, that kind of agriculture is not good for farmers.' Then, I began to look around, and I could see that it wasn't good for the rural communities that depended upon those farms.
There are places in North Missouri, for example, that lost 20 percent of their total county population during those periods of time because the family farmers couldn't make a living on the land, and those rural communities depended on those family farmers for businesses."
Now, with the advent of an increasing number of serious disease pandemics, the flaws of the "bigger is better" model has become even more evident...

How CAFOs Promote Disease Epidemics

The first bird flu pandemic was launched upon the American public in 2005, with repeats in 2006, 2007, and again in 2008, followed by the threat of a swine flu pandemic in 2009. I actually wrote a book about the initial bird flu scare, which became a New York Times bestseller, called The Great Bird Flu Hoax.
At one time, they warned two million people could potentially die from this disease. Yet to this day, I'm not aware of anyone in the US ever dying from bird flu. It has however become a serious threat to CAFOs.
“The reason I was giving you that background is I think what we’re seeing right now is inherent within this system of agricultural production,” Dr. Ikerd says. “What we’re seeing in terms of the bird flu is a consequence of concentrating hundreds of thousands of birds in these [space-wise] small operations.”
Prior to CAFOs, when a virus would emerge, some small farms would lose part or all of their flock, but the numbers would be limited. It wouldn't turn into a massive epidemic where millions of birds are affected and the disease spreads like wildfire across the entire country.
"The background in terms of the industrialization of agriculture, in my opinion, is very directly related to what we're talking about here in terms of the spread of the bird flu," Dr. Ikerd says.
"In 2013 and 2014, we had the Porcine Epidemic Diarrhea virus (PEDv). Seven million pigs dead in that case, and that virus spread through these large-scale confined animal feeding operations in much the same way we saw with the bird flu.
[Then there's] the honeybee colony collapse... I can tell you what the problem is... it's the industrialization of the pollination industry... packing hives up on trailer trucks and hauling them across the country.
It’s the specialization, standardization, and consolidation into larger and larger units. That’s the reason we’re having these outbreaks and will continue to have these outbreaks.”

How CAFOs Profit from Livestock Pandemics

The bird flu reemerged with a vengeance in CAFOs last year. In Iowa, 70 different CAFOs lost a total of 29 million chickens, turkeys, and ducks. Minnesota lost 8.3 million birds, mostly turkeys. The US Department of Agriculture (USDA) estimates a total of 45 million birds were lost, with an economic impact totaling $1 billion.
"The USDA came in to prop up these industrial operations with the allocation of 413 million dollars, [which is] what I call the bail-out fee for the failed CAFO industry. That would be about nine dollars per bird of taxpayers' money to subsidize [CAFOs].
Basically, we're subsidizing these specialized operations. We know there's inherent risk when you go to the specialization and standardization. Diversity is the means by which we manage risk in agriculture, in business, or anywhere else.
But when you go to these specialized operations, you're taking away the diversity, and inherently, you're involved in a much riskier operation when you're just producing one commodity or one phase of production like egg production. We're paying the cost of the increased risk that's associated with the specialization of these large operations."
During the PEDv pandemic, an estimated seven million pigs were lost, and the economic impact was estimated at $350 million. In that case, the US government allocated $11 million dollars to cover CAFO losses. However, the price of pork also went up, so the CAFOs actually profited from the pandemic and the loss of all these pigs.
"This is inherent within this system. That's the point I'm getting at," Dr. Ikerd says. "The bird flu outbreak is just a symptom of a much larger problem that goes across pigs, cattle, honeybees, and crops. We have a failed system of agriculture production in this country."

Virtually All Agricultural Programs Subsidize CAFOs

According to Dr. Ikerd, virtually every program that has come out of the USDA during his career has in one way or another subsidized specialized, standardized, and consolidated production. Consumers ultimately pay the cost of the risks inherent with these types of operations. We also pay for subsidized credit that allows farmers to expand their operations.
“I think it was all intended well. When I was out here talking to farmers about specialized, standardized, “get bigger or get out,” I really thought it was for the basic good of the consuming public, because what we were told, and what we believed, was that we were going to make good, safe, and wholesome food affordable for everyone. We were going to bring down the cost of agriculture production. It would bring down food costs to the point where everyone could have access to enough wholesome foods to support a healthy, active lifestyle. But we didn’t do that.”
Today, we have a higher percentage of people who are food insecure or go hungry in the US than we had in the 1960s, before widespread industrialization started. About 15 percent of Americans are now classified as being food insecure. More than 20 percent of American children live in food insecure homes.
So while the industrialization of agriculture lowered production costs, and to some extent made certain foods (read processed foods) less expensive, the system has completely failed to secure food for all. Forty percent of the US corn crop in the last several years has in fact gone toward producing ethanol rather than producing food for hungry people.
As Dr. Ikerd notes, "that's the part of that industrial agricultural system that's driven by the economic bottom line — the system I promoted. I look back now and I see the flaws in that system, but it took me a while to realize that not only was this system not good for the animals, for the farmers, for the land, and for the whole community; it wasn't even good for consumers. The problems we're creating pose real public health risks for the consumer."

Diversification and Decentralization Is the Solution

Sustainable agriculture is the answer to these and many other related problems. While it may not be the easiest solution, implementation wise, it's the best and most logical solution in the long term. Sustainable agriculture balances the need to produce food to be economically viable and efficient with a need to take care of the land, and support rural communities and society as a whole.
Dr. Ikerd became involved in the sustainable agriculture movement in the late 1980s, the most visible part of which is the growth of organic food production. In terms of sales, organic foods grew at a rate of 20 percent per year during the 1990s, up to the Great Recession of 2008.
Today, organic food sales are growing at a rate of more than 10 percent annually, yet as a whole, it still represents less than five percent of the total food sales. More recently, the local food movement has been the most dramatic development in the food economy. There's been a quadrupling of the number of farmers' markets in the last 20 years, and CSAs have grown from practically nothing to about 12,000 to 14,000.
"I think we're in the process of creating a fundamentally new and different food system," Dr. Ikerd says. Part of this is the creation of local food networks the USDA calls "food hubs." At present, there are more than 300 food hubs across the US, where farmers sell to local customers.
"I think what we're seeing here is the evolution of the change in the food system. I really think that it's inevitable, because this industrial food system is simply not sustainable. It's not ecologically sound. It's not socially responsible. And over the long run, it can't be economically viable," he says.
Some people question whether sustainable or organic agriculture would be economically viable, or whether that might make food insecurity even worse by raising food prices too high. According to Dr. Ikerd, while transitioning over to a more sustainable type of food system may eventually result in farm cost increases of eight to 12 percent, the actual price you pay for the food would only rise about two percent.
“What we have to look at here is that currently, only about 20 percent of what we pay for food at the grocery store is at the farm level. In other words, you can have a significant increase in the cost of production at the farm level withouthaving a major impact on the consumer level. For example, it would cost you 10 percent more to produce [sustainable food] at the farm level, and the farm level is only 20 percent of the total value. That’s only a two percent increase in [retail] food cost.
We need to keep in mind that we're not talking about something that's totally out of the realm of possibility here. We can certainly raise birds in a competitive way in the smaller operations. How much smaller do we have to get in order to get away from the problems? I think part of it is bringing poultry into a more diverse operation that has other operations on the same farm.
Other things are going on so you don’t end up with mountains of poultry manure that you have to get rid of. You end up with poultry manure that’s just adequate to fertilize your pasture where you’re raising beef cattle on grass, for example. Or you’re raising hogs on pasture. Or you’re growing other kinds of crops. We need to move to more diversified operation.”

Agroecology and Other Sustainable Agriculture Systems

Contrary to popular belief, around 70 percent of the global population is fed by food produced by small independent farms operating at subsistence level, not by industrial agriculture. On those small independent farms, production can be doubled, tripled, or even quadrupled, without replicating an industrial system. The most popular system right now, according to Dr. Ikerd, is called agroecology.
It's a diversified farming system where you build up the fertility of the soil, and you manage crops and livestock in an integrative system. This not only allows you to maintain the fertility of the soil, it also helps you manage pests and curtail diseases. Diversification inherently means reduced risk across the board. Permacultures and biodynamic farming are also popping up, especially in Eastern countries. In China and Japan, they call it nature farming. All of these are different approaches that fall under sustainable agriculture.
"There are at least five major UN reports that have come out in the last few years that are saying that industrial agriculture is not the answer to feeding the growing global population. They're increasingly moving toward supporting agroecology, sustainable agriculture, permaculture, and natural farming – these alternative systems of production," Dr. Ikerd says.
"It's just propaganda in this country that says we have to have industrial agriculture. We don't need it to feed the people here. We can certainly make a transition to an agriculture that costs us 10 to 15 percent more [at the farm level], and it wouldn't be a major shock.
In fact, when we decided to have corn ethanol in this country – and we put 40 percent of our corn crop into ethanol rather than feed for livestock – the cost of food went up by about as much as it would have gone up over the long run if we're to make a total transition to sustainable agriculture. In the past 20 years, food costs have gone up faster in this country than the overall inflation rates. All the propaganda about industrialization of agriculture being necessary to provide food for people; to keep food cost down and so on — it hasn't, and it hasn't for the past 20 years."

CAFOs Should Be Treated Like Any Other Factory Industry

With respect to what could be done to improve CAFOs (either that, or speed up their conversion to more sustainable operations), Dr. Ikerd suggests treating them as if they were any other factory industry. They're not like traditional agriculture, they're not diversified like a family farm, so why are they being treated like one?
CAFOs need to be held accountable for the pollution they create, the public health problems they bring, and they need to have regulations in place to address the fair treatment of workers and animals — just like any other factory enterprise. Moreover, if their subsidized risk protections were removed, they would no longer be able to compete with diversified, independent family farms. All of this would likely prompt CAFOs to be broken up into smaller, more diversified pieces.
"We just need to recognize that these are industrial operations, and we're going to run into the same kind of problems as we run in with any other industrial operations. We need to have worker protection and animal protection. We need to have public health assessments. We need environmental regulations. We need to regulate these factory farms for what they are: they're factories," he says.

Working with Nature Is the Best Way to Assure Abundance

The key to creating a sustainable agriculture is to work in harmony with nature, and to realize that every act ripples through the whole system. This interdependence can be effectively harnessed, allowing mutually beneficial relationships among diverse elements to do a lot of the work that conventional agriculture have to use chemicals and other unnatural interventions to achieve.
As Dr. Ikerd notes, nature can be tremendously supportive and productive. If you rebuild the natural health and productivity of the soil, then nature and sunlight will bring forth their bounty. Good sustainable farmers can create yields that are just as high as the average or even better than average commercial farmers. But it takes a lot of understanding of what's going on in the soil, how to integrate crops and livestock systems with the soil, and how to manage pests to maintain soil fertility.
"There's also potential for high economic returns in the future," Dr. Ikerd says. "Because in the future, those people who are able to think, create, and understand how to work with nature, those are going to be the people in high demand when this industrial food system eventually collapses.
These are new occupations. I think many of the people who are going to create this new agriculture, in many cases, are not going to be the existing farmers who are locked in with this industrial mindset, but the people who have a different way of thinking and who when we get out here on the land will use that way of thinking."

Together, We Can Steer Agriculture Toward Safer, More Sustainable Systems

According to a recent Hartman Report,1 which surveys consumer preferences, about one-third of American consumers are looking for something fundamentally different from what they're getting in their local grocery store. This includes GMO-free, organic, hormone-free, antibiotic-free, and pesticide-free foods, and they're willing to pay premium prices for foods they consider to be safer and healthier for their families and for the environment.
"One thing, as an economist, that I continue to point out is that focusing solely on the economic bottom line, which is what I used to tell farmers to do, is what got us in to this system that we are in today. A sustainable system has to be economically viable, but that doesn't mean that you're maximizing profits...
But it does mean you’re making enough money. It provides you with the quality of life that you want, but you’re doing it in such a way that it’s humane to the animals, that protects the environment, that doesn’t threaten the public health, and that’s contributing to the quality of life in your community and society as a whole. It’s bringing all of those things together.”
You can find a variety of papers written by Ikerd on related subjects on his personal website, and on hisUniversity of Missouri website.

Healthy Food Resources

You can help steer the agricultural industry toward safer, more sustainable systems by supporting your local farmers and choosing fresh, local produce over "cheap" conventional varieties commonly sold in larger grocery chains. You can also slash your food bill by focusing on locally grown foods that are in season, typically a bargain at that time of year, or by growing some of your own. Remember to choose organic, grass-fed/pasture-raised beef, poultry, and dairy, in addition to organic produce.
While many grocery stores now carry organic foods, it’s preferable to source yours from local growers whenever possible, as much of the organic food sold in grocery stores is imported. If you live in the US, the following organizations can help you locate farm-fresh foods in the vicinity of your home:
Weston Price Foundation: Weston Price has local chapters in most states, and many of them are connected with buying clubs in which you can purchase organic foods, including grass-fed raw dairy products such as milk and butter.
Local Harvest: This site will help you find farmers' markets, family farms, and other sources of sustainably grown food in your area.
Farmers' Markets: A national listing of farmers' markets.
Eat Well Guide: Wholesome Food from Healthy Animals: The Eat Well Guide is a free online directory of sustainably raised meat, poultry, dairy, and eggs from farms, stores, restaurants, inns and hotels, and online outlets in the United States and Canada.
Community Involved in Sustaining Agriculture (CISA): CISA is dedicated to sustainable agriculture and small farms.
FoodRoutes: The FoodRoutes "Find Good Food" map can help you connect with local farmers to find the freshest, tastiest food possible. On their interactive map, you can find listings for local farmers, CSAs, and markets near you.

Wednesday, November 11, 2015

Astounding Number of Medical Procedures Have No Benefit, Even Harm - JAMA Study

Astounding Number of Medical Procedures Have No Benefit, Even Harm - JAMA Study

Astounding Number of Medical Treatments Have No Benefit, Even Harm - JAMA Study
What if millions of medical diagnoses, procedures, and treatments were based on, at best, questionable scientific evidence, but still performed daily, the world over, in the name of saving patients lives or reducing their suffering? A new JAMA review indicates this may be exactly what is happening. 
A concerning new review published in the Journal of the American Medical Association online ahead of print on the topic of overuse of medical care, i.e., health care for which "risk of harm exceeds its potential for benefit," finds that many commonly employed medical procedures, to which millions are subjected to each year, are based on questionable if not also, in some cases, non-existent evidence. 
According to the review, which was co-authored by researchers from some of the country's most esteemed medical institutions, medical overuse can also be defined as a health care practice that patients would forego consenting to if fully informed. They elaborate further on the definition of medical overuse: 
[Medical] Overuse encompasses overdiagnosis, which occurs when "individuals are diagnosed with conditions that will never cause symptoms," and overtreatment, which is treatment targeting overdiagnosed disease or from which there is minimal or no benefit."
Clearly, when information is lacking or withheld concerning the true risks and benefits of a medical procedure, the principle of informed consent is violated. And this is, no doubt, a far too common occurrence in today's medical landscape where market forces rather than scientific evidence drive the medical consensus that determines the standard of care. In fact, there is reason to believe that the published biomedical literature is so corrupted by industry influence, and publication bias, that the entire ivory tower of 'Evidence-Based Medicine,' which Kelly Brogan, MD, recently described as a House of Cards, is actually based on nothing more than a coin's flip worth of certainty.
But there is also the far more insidious problem of the misclassification and/or misunderstanding of disease which can mislead researchers, health care professionals, and their patients into performing and undergoing harmful procedures without anyone realizing the harmful and sometimes deadly consequences they have wrought.
For example, over the past eight years, we have identified what is essentially a vast, submerged iceberg of overdiagnosed and overtreated medical conditions, with the worst examples being common forms of breast, prostate, thyroid, and ovarian cancer. It was not until 2013 that the issue broke wide open, when a National Cancer Institute commissioned expert panel acknowledged that early-stage or 'stage zero' breast (DCIS) and prostate (HGPIN) "cancers" are actually benign or indolent lesions of epithelial origin and should never have been, and should never be, termed "carcinomas." Essentially, the NCI report revealed that millions have been wrongly diagnosed and treated for breast and prostate cancers over the past few decades that they never had. In the case of DCIS, about 1.3 million U.S. women were subjected to some combination of either mastectomy, lumpectomy, radiation, and chemotherapy over the past 30 years, even though their screen-detected condition had no symptoms, and left untreated would likely never have caused them any harm. And this does not even account for the radiobiological harms caused by x-ray mammography, which may have planted the seeds of malignancy into the healthy breasts of millions of women in the name of "prevention through early detection." 
No Evidence Backing Millions of Diagnoses & Treatments, JAMA Review Finds
The new study, titled "Update on Medical Practices That Should Be Questioned in 2015," reviewed 910 articles published in 2014, of which 440 directly addressed medical overuse. 104 of these were selected as "most relevant," with the 10 most influential articles selected by author consensus, and forming the basis for their 10-topic critique, which is divided into three sections: overdiagnosis, overtreatment, and methods to avoid medical overuse.


  • Asymptomatic Carotid Stenosis: Colloquially known as "blocked or restricted arteries in the neck," carotid artery stenosis often presents with no symptoms (asymptomatic), and yet is routinely treated with carotid angioplasty and stenting (placing a balloon or stent within the artery to open it) or surgical endarterectomy (removal of the inner lining of the artery and obstructive deposits found there) as "precautionary measures." The review referenced a systematic review and meta-analysis by the US Preventive Services Task Force that found no studies providing data on whether screening for carotid stenosis reduced stroke. What was found is that carotid ultrasonography screening leads to many false-positives; a finding that I believe, contributes to increased morbidity and mortality in screened populations. 
  • Screening Pelvic Examinations Are Inaccurate in Asymptomatic Women and Are Associated With Harms That Exceed Clinical Benefits. Pelvic examination is often included in annual preventive visits for women and usually consists of both visual examination and the insertion of the hand and instruments like a speculum in the vagina. This soft-tissue evaluation includes the upper genital tracts, as well as urethra, bladder, and rectum. Amazingly, a cited review found no studies assessing the effect of pelvic examinations on morbidity or mortality from cancers (including ovarian cancers) or benign gynecological conditions. Moreover, it was found that the harms of screening include "discomfort, anxiety, psychological effects, embarrassment, and unnecessary procedures, including surgery (1.4% [29 of 2000] of women in one study)."  The review opined strongly about the study implications: "Do not perform screening pelvic examinations. Clinicians should educate female patients about the low value of the examination. This review informed a new guideline from the American College of Physicians recommending against routine pelvic examinations for screening asymptomatic women." Given the lack of evidence supporting pelvic examinations, could the practice be considered just another form of the violation of women by medical care providers, not unlike unnecessary C-sections?
ct scan
  • Head Computed Tomography Is Often Ordered but Is Rarely HelpfulComputer tomography uses ionizing radiation and sometimes a contrasting agent in diagnosis, both of which have significant potential to cause adverse health effects. Often CT scans produce incidental, and clinically unimportant findings, and will lead to additional CT scans being ordered. The review concluded, "A second head CT scan rarely affects patient management. Clinicians should be judicious in ordering multiple CT scans in the same patient." Consider also, that a study published in the NEJM in 2007 estimated that .4% of all cancers in the US may be attributable to CT scans!
  • Thyroid Cancer Is Massively Overdiagnosed, Leading to Concrete Harms: In the past 30 years, there has been a global increase in the implementation of thyroid cancer screening programs which have lead to dramatically increased rates of diagnosis of "thyroid cancer,"mostly due to papillary carcinomas, which are non-fatal.  Thyroid cancer mortality rates remained the same throughout this period, a clear indication of overdiagnosis, i.e. the thyroid lesions were non-cancerous insofar as they would have never caused harm if left untreated. The review cited a new study that reviewed the 15-fold increase in thyroid cancer in South Korean, from 1993 to 2011, concluding that, "Overdiagnosis of thyroid cancer is extremely common. The harms associated with this overtreatment include lifelong thyroid replacement, hypoparathyroidism, and vocal cord paralysis." Learn more by reading my article, "Thyroid Cancer Epidemic Caused by Misinformation, Not Cancer."


  • There Is No Benefit to Paracetamol or Acetaminophen for Acute Low Back Pain: Low back pain is one of the most common reasons why people seek medical attention, and acetaminophen/paracetamol (Tylenol) one of the most common treatments, but the study pointed out that in the first large double-blind RCT of Tylenol for back pain in patients without serious spinal pathology, the drug was not observed to be more beneficial the placebo group. The review concluded: "There is no benefit to acetaminophen or paracetamol use for acute back pain. Reassurance with advice on likely resolution may be the primary treatment for acute low back pain." Also, consider that Tylenol has recently been found to have psychiatric adverse effects, such as the dulling of emotions, and is one of the most toxic chemicals to the liver known.  
  • Postoperative Opioid Use Continues Past the Postoperative Period: Opioid drugs are often used for post-operative pain control. The review referenced a study that found 3% of patients continue to take opioid prescriptions beyond 90 days after the procedure. The review opined: "Clinicians should diligently reassess patients receiving postoperative opioids to ensure that these medications are used safely and appropriately because opioid overuse is associated with obvious psychological and physical harm. Given the millions of patients undergoing surgery each year, it is essential that postoperative opioid use does not become a gateway to long-term opioid use."
  • The Harms of Perioperative Aspirin Outweigh the Benefits in Patients Undergoing Noncardiac Surgery: Aspirin use is common in the period before and after non-cardiac surgeries, even though its role in cardiovascular complications is not fully understood. According to a randomized, blinded trial comparing 200 mg/d of aspirin with a placebo during the 30-day periooperative peroid in 10,010 patients undergoing noncardiac surgery, one third of whom had vascular disease, that when the primary outcome of death or nonfatal heart attack were evaluated, there was no difference between groups (although the frequency of major bleeding was higher in the aspirin group). The study's implications were described: "Do not treat patients undergoing noncardiac surgery with aspirin during the perioperative period unless they have had stent implantation in the past year because harms may occur and there is no benefit. In patients with an indication for aspirin independent of surgery, restart aspirin use after the perioperative period, although optimal timing is not clear." Learn more about aspirin's harmful nature by reading, "The Evidence Against Aspirin and For Natural Alternatives."
  • Renal Artery Revascularization for Renal Artery Stenosis (RAS) Has No Clinical Benefit: a common occurrence in aging population are vascular disease including stenosis of the renal artery. A meta-analysis of 8 studies on the topic found renal artery stenting in combination with medical therapy was not superior to medical therapy alone in reducing mortality, congestive heart failure, stroke, or worsening renal function. The implications of this research were summarized as follows: "Do not perform renal artery revascularization in patients with clinically relevant RAS. Furthermore, testing for RAS has little benefit. Consistent randomized evidence shows that optimizing medical therapy is the best approach to management of hypertension and chronic kidney disease, with or without RAS."
  • Medications to Raise High-Density Lipoprotein Cholesterol Level Do Not Improve Cardiovascular Outcomes: There is some evidence that low HDL-C levels are associated with an increase risk of cardiovascular events. A meta-analysis of drug interventions for raising HDL< which included niacin, fibrates, and cholesteryl ester transfer protein inhibitors, found none of these drug classes improved cardiovascular morltaity, all-cause mortality, or stroke compared with controls.  The study's implications were summarized as follows: "In patients with low HDL-C levels who are treated with statins, there is no clinical benefit to HDL-C–targeted therapies."

Methods to Avoid Overuse

  • Most Diagnoses Are Based on History and Physical Examination, and Conservative Management Is Valuable: There are 400 million annual office visits in the U.S. alone. At least 50% of the time, people go to see their doctor for physical symptoms (a symptom-based paradigm). In juxtaposition, the era of screening has lead many physicians to take a disease-based view, diagnosing patients without symptoms with problems because of suspicious laboratory findings or lesions (a disease-based paradigm). The review discovered that about one-third of patient symptoms don't match up with identifiable disease, and that "Approximately 73% (range, 56%-94%) of diagnoses are based on the history and an additional 4% to 17% on the physical examination. There is considerable overlap between physical and psychological symptoms, and approximately 75% (range, 71%-79%) of symptoms improved in weeks to months." They stated their finding's implications as follows: "Be cautious in using diagnostic tests to identify disease without high pretest probability because most disease can be diagnosed with a thoughtful history and skillful physical examination. Clinicians managing patient symptoms without obvious cause should be aware that physical and psychological symptoms co-occur, should recognize that most symptoms resolve within a few weeks to months, and should consider that serious causes of symptoms rarely emerge during long-term follow-up."
The review concluded that based on research emerging in 2014 alone, there are a diverse number of practices from various areas of medicine that indicate medical overuse is rampant, where the harms of diagnosis or treatment clearly outweigh the benefits.
They commented further on the implications of their research:
Published literature documenting overuse may benefit patients and populations if it stimulates decisions to avoid overused diagnostics and therapeutics. It is difficult to stop using commonly used tests and treatments.20 Explicit recognition that practices shown to be ineffective often continue to be performed has resulted in a focus on methods of deadoption or deimplemention. These approaches incorporate strategies from behavioral economics, such as framing patient discussions around what is available and having guarded enthusiasm about new medical care that is at risk for later being deadopted because of ineffectiveness.20 Health care professionals are well suited to improve these practices at multiple steps when providing patient care, as described by Kroenke.19
Clinicians and patients share the consequences and responsibility for medical overuse. With improved awareness, caution around new tests and treatments, and deimplementation of ineffective practices, there should be improvement in patient outcomes, safety, and satisfaction along with reductions in health care spending. With thoughtful questioning, many current practices that seem logical but are without evidence may be reconsidered and incorporated into a less dogmatic and more patient-centered approach to care.
Reviews like this indicate that many of the most commonly accepted and proffered procedures in modern medicine may be causing more harm than good. Perhaps we need to heed the sage advice of Samuel Shem, who once wrote: "The delivery of good medical care is to do as much nothing as possible." To learn more, read my recent article on the topic, "Good Medicine: Do As Much Nothing As Possible."
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