Prestigious Heart Surgeon’s Confession Reveals the Truth About Heart Disease


Statin Drugs

A physician’s word is often taken very seriously and with little skepticism. An opinion from one or two doctors, when made in a professional office or hospital, can persuade a worried patient to take drugs with complex side-effects, or even undergo traumatic treatments such as radiation and chemotherapy. Yet, when the same doctors, with years of experience and thousands of satisfied customers, give an opinion that questions a therapy established by mainstream medicine, the mainstream media calls them irresponsible, or quacks, or even criminals.

Many doctors are highly admirable people, bu they are still human beings. They all make mistakes, they all learn from them, but the really good ones are willing to admit to them.

Dr. Dwight Lundell

Dr. Dwight Lundell

Which brings us to Dr. Dwight Lundell. He’s an experienced heart surgeon and retired Chief of Staff and Chief of Surgery at Banner Heart Hospital in Mesa, Arizona. Not so long ago, Dr. Lundell made the following statement of confession:

We physicians with all our training, knowledge and authority often acquire a rather large ego that tends to make it difficult to admit we are wrong. So, here it is. I freely admit to being wrong. As a heart surgeon with 25 years experience, having performed over 5,000 open-heart surgeries, today is my day to right the wrong with medical and scientific fact.

I trained for many years with other prominent physicians labeled “opinion makers.” Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol. The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice. It Is Not Working!

These recommendations are no longer scientifically or morally defensible.”

Not surprisingly, Lundell’s statement regarding the medical establishment’s approach to treating heart disease caused a ripple in the medical industry. It challenged the validity of statins – commonly known ascholesterol-lowering medications – such as Lipitor, Crestor, Zocor, and others.

The reason Lundell’s statement created such a buzz is because statins are big business. In the United States alone, about 25% of the population takes statin medications. They cost from as little as $53 per month to more than $600. Pfizer’s Lipitor went on sale in 1997 and its lifetime sales have surpassed $125 billion. AstraZeneca’s Crestor was the top-selling statin in 2013, generating $5.2 billion in revenue that year alone. The statin industry is estimated at around $30 billion in sales per year. Nevertheless, in the United States, more die each year of heart disease than ever before.

Lundell went on to say:

“The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated. The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.

I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing the body to respond continuously and appropriately with inflammation. While we savor the tantalizing taste of a sweet roll, our bodies respond alarmingly as if a foreign invader arrived declaring war. Foods loaded with sugars and simple carbohydrates, or processed with omega-6 oils for long shelf life have been the mainstay of the American diet for six decades. These foods have been slowly poisoning everyone.”

Simply, it is the foods that are baked or soaked in soybean oil and ones that are processed for long shelf-life that are creating an extreme imbalance of omega-6 and omega-3 fats in people’s bodies. Lundell estimates the ratio of imbalance “ranges from 15:1 to as high as 30:1 in favor of omega-6.” A healthy ratio is closer to 3:1.

But what makes Lundell’s statements controversial is that cholesterol does not cause heart disease…which makes statin drugs superfluous. And he suggests a treatment to heart disease that doesn’t make Big Pharma any money:

“Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.

Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today. The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers. What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.”

It probably comes as no surprise that Lundell has been portrayed as a quack by the mainstream medical establishment. The main argument to back up his “quackery” was that his medical license was revoked in 2008…although the man was already retired and had no plans to return to the surgery room. He was not called a quack when he was performing surgeries, but once he took his 25 years of practice and discerned what he believes is the cause of heart disease, it was then that he was attacked by his peers. Which brings up the question if Lundell came onto the American Medical Association’s radar as he was working on and promoting his book, The Cure for Heart Disease, which was published in 2007.

Millions of dollars are made from heart disease treatment and statin medications. This established industry does not want anyone to interfere. Lundell said it himself, “Deviations from these recommendations were considered heresy and could quite possibly result in malpractice.” And it sure is easier to discredit a retired heart surgeon and chief of surgery with 25 years of experience if you revoke his license.

Does Aspirin Reduce the Risk of Developing Acute Respiratory Distress Syndrome?


Effect of Aspirin on Development of ARDS in At-Risk Patients Presenting to the Emergency Department: The LIPS-A Randomized Clinical Trial

Kor DJ, Carter RE, Park PK, et al; US Critical Illness and Injury Trials Group: Lung Injury Prevention with Aspirin Study Group (USCIITG: LIPS-A)
JAMA. 2016 May 15. [Epub ahead of print]

Summary

Acute respiratory distress syndrome (ARDS) is among the most common and feared respiratory conditions in critically ill patients.[1] ARDS is a form of acute inflammatory lung injury, most often due to sepsis, severe trauma, aspiration, pancreatitis and other systemic injuries, and inflammatory disorders.[2]

Although we do not yet have effective drug therapies for ARDS, much attention has focused on prevention of ARDS. The authors of this study sought to follow up prior observations studies suggesting a role for aspirin in preventing ARDS,[3-5] to determine whether aspirin may prevent the development of ARDS if given early in patients at moderate to high risk.[6]

In the study, 400 emergency department patients at risk for ARDS (Lung Injury Prediction Score ≥ 4) were randomly assigned to receive treatment with aspirin (325 mg initial dose and 81 mg daily for 7 days) or placebo.[7] ARDS developed in 10.3% of patients receiving aspiring and 8.7% of those receiving placebo (P=.53), and there were no differences between groups in terms of mortality or length of stay in the hospital or intensive care unit. The authors concluded that aspirin is ineffective for preventing ARDS.

Viewpoint

The difficulty in treating ARDS has led to increased interest in prevention as a more effective strategy. Although this is appealing and clinically important, the same challenges that have led to failed ARDS trials (heterogeneous causes of ARDS, sufficient understanding of disease pathogenesis, and other factors) is equally problematic for studies of prevention.

In this case, there was a growing body of literature about the role of platelets in ARDS and the association between aspirin therapy and either lower rates of ARDS or improved outcomes.[3-5] It was reasonable to pursue the possibility that something as simple as aspirin could prevent this severe, life-threatening condition. Unfortunately, aspirin therapy neither prevented ARDS nor demonstrated efficacy for any other measurable outcome, aside from a change in interleukin 2 values at day 1.

Fluoroquinolones Not First Line: FDA Advisory Reinforces Standard Practice in Ambulatory Care


Hello. This is Paul Auwaerter, with Medscape Infectious Diseases and the Johns Hopkins University School of Medicine. The US Food and Drug Administration (FDA) recently announced[1] that it will upgrade its package warnings on fluoroquinolones to include instructions that they should not be used for routine respiratory tract infections or uncomplicated urinary tract infections unless there is no suitable alternative agent.

Why these warnings are being reinforced at this point rests on several foundational issues. When I was a medical student the late 1980s, fluoroquinolones were embraced as “wonder drugs.” We had ciprofloxacin, which offered oral treatment for Pseudomonas aeruginosa and was thought to be effective for Staphylococcus aureus, even in deep bone infections. Over time, these drugs have been widely embraced with new additions, such as levofloxacin and moxifloxacin. But a number of other drugs (eg, trovafloxacin, lomefloxacin, and others) have fallen to the wayside, deservedly, because of serious toxicities.

It seems to be true, however, that the fluoroquinolones remain broadly prescribed both by primary care practitioners and in hospital settings and skilled nursing facilities. Studies looking at the use of fluoroquinolones in ambulatory settings for uncomplicated urinary tract and respiratory infections show that over the past few years there has been little diminishment in the use of fluoroquinolones.[2] Because of their wide use and adoption, we are experiencing problems such as pathogen resistance. The fluoroquinolones are no longer recommended for gonorrhea because of widespread resistance. They are no longer recommended for routine first-line treatment of uncomplicated cystitis because of increased resistance of Escherichia coli to this class of drugs.[3]

Another issue is that, over the years, the remaining fluoroquinolones have been associated with adverse effects, including increased risk for Clostridium difficile infection (compared with many other antibiotics), tendinopathy, arthropathy, QT prolongation, retinal issues, and central and peripheral nervous system toxicities.[4] These adverse effects have been reported, although perhaps not thoroughly vetted through careful analysis. However, the FDA now feels that owing to potential irreversible or permanent side effects, these drugs should not be used for first-line treatment.

Many infectious diseases practitioners, out of concern about antibiotic resistance, have been broadly beating the drum for many years that these drugs should not be used in office settings and practices for mundane and pedestrian upper respiratory tract infections such as bronchitis or sinusitis, or for urinary tract infections.

So why are these drugs still so widely used? There is a perception (and perhaps a reality) that the fluoroquinolones are still quite safe. I have never seen a case of peripheral neuropathy although I have certainly seen C difficile infection, tendinopathy, and arthropathy. Obviously as drugs are getting more attention and being looked at in terms of adverse effects, it does not make sense to prescribe these drugs, which have quite broad-spectrum activity, to treat conditions that could be treated with a narrower-spectrum and more targeted drug.
The FDA is upgrading its warnings about these drugs in spite of what practitioners are seeing. The diminished use of these broad-spectrum antibiotics for certain conditions is a worthy goal and probably will benefit patient care, either by avoiding the use of antibiotics altogether if appropriate, or targeting antibiotics, as recommended in guidance on sinusitis, bronchitis, exacerbations of bronchitis, and urinary tract infections.

Low Salt Is Bad for Heart Health


The leading cause of heart attacks and stroke in the U.S. is high blood pressure. Recommendations from the American Heart Association (AHA) and other policy makers have been to reduce salt intake in order to control your blood pressure. However, research has not supported this recommendation for everyone.1

Consuming Salt

Consuming Salt

Story at-a-glance

  • In a controversial study, researchers identified a higher heart risk if you either eat too much or not enough salt
  • Although the amount of salt is important, it is the ratio between salt and potassium that is of greatest importance to your heart health and lowering your stroke risk
  • You can shift your potassium and sodium balance with your lifestyle and food choices

Salt is an ionic compound made of two groups of oppositely charged ions, namely sodium and chloride. Table salt is made of one metal ion (sodium) and one non-metal ion (chloride). Your body needs both ions to function and can produce neither, so you must get them from your food.

However, not all salts are created equally. Refined table salt is almost all pure sodium chloride and 39 percent sodium. The rest are man-made chemicals.

Iodine is often added to refined salt in a public health preventive measure against iodine deficiency. A lack of iodine is the leading cause of hypothyroidism, mental retardation, autism, depression and anxiety.2

Unprocessed salt, such as pink Himalayan salt, is 84 percent sodium chloride and 37 percent pure sodium. The remainder is naturally occurring trace minerals your body also needs, including phosphorus and vanadium.3

Dangers of Restricting Your Salt Too Much

In a controversial study4,5,6,7 published in the Lancet medical journal, results supported a mid-range salt intake to protect your heart and your health. While high-salt diets are not healthy for your body, it turns out that low-salt diets are dangerous as well.

According to the Centers for Disease Control and Prevention (CDC), the average American eats approximately 3,400 milligrams (mg) of salt each day.8 This is higher than the 1,500 mg per day that the AHA recommends, but within range of the results of this study.9

Associate professor of clinical epidemiology and lead researcher, Andrew Mente, Ph.D. finds that, “Having neither too high nor too low levels of sodium is optimal for health.”10

Mente and his colleagues analyzed four different studies covering 49 countries and using over 113,000 participants. Each study was structured in the same manner, estimating salt intake from a single-morning urine sample and then following the participant’s health status for several years.

The results demonstrated that whether you suffer from high blood pressure or not,low salt intake was linked to a greater risk of heart attack, stroke and death.11 The data does highlight the need to lower salt intake if you suffer from high blood pressure, but not to levels currently recommended.

Instead, the study demonstrates that eating a moderate amount of salt, near to 3,000 mg per day, was associated with the best health. Salt intake levels that were high or low carried the same risk of high blood pressure, cardiovascular disease (CVD) and stroke.

Results indicated a low-salt diet could increase your risk of heart attack by 26 percent if you don’t suffer from high blood pressure, and 34 percent higher risk if you do.

Arguments Against the Study Results

Although controversial, the results of the study have been supported by the results of other studies12,13

A second study evaluated over 100,000 individuals and found those who consumed between 3,000 and 6,000 mg per day were at the lowest risk of health conditions, and those who ate more than 6,000 or less than 3,000 were at the highest risk.

The AHA has been critical of the study published in the Lancet, citing a reliance on incorrect sodium levels in the study.14 The claim was spot urine testing could not adequately measure salt intake in participants over the length of the study.

However, 24-hour urine collections have been standard in research studies to measure salt intake in the past.15,16 Research has also demonstrated the accuracy of spot urine testing to adequately measure the amount of sodium intake.17,18

Critics also object to the assumption by researchers that salt intake was consistent over the course of the study for each individual based on spot testing.

However, in both studies, participants numbered over 100,000 individuals, making the risk of the participant having an abnormally high or low salt intake for testing day relatively minor.

Imbalanced Sodium to Potassium Ratio Is the Most Important Risk Factor

One teaspoon of refined table salt contains 2,300 mg of sodium. According to the AHA, an excess of sodium in your body may cause you to retain water, putting an extra burden on your heart, blood vessels and kidneys.

Past recommendations have assumed that in some people this may lead to high blood pressure.19  But, sodium is just one-half of the ratio needed to keep your body healthy. The second half of the equation is potassium.

Your body is a complex organism, relying on the interactions and relationships between several factors. Your sodium level is important, but the ratio between sodium and potassium is even more important.

The main finding in one study showed the sodium-to-potassium ratio was more strongly associated with blood pressure changes than were either sodium or potassium individually.20

Our modern diet is high in foods containing large amounts of salt and low in potassium-rich real foods, such as vegetables. This electrolyte mismatch has significant effects on your body and your cardiovascular health.

Research has shown that women who eat a higher amount of potassium-rich food also have a lower risk of cardiovascular disease and stroke, as well as all other causes of mortality, especially women who were not hypertensive.21

The protective effects of potassium are associated with the actions of nitric oxide release, which increases the relaxation of your arterial system and lowers blood pressure.22

Impact of Your Sodium to Potassium Ratio

The separate roles of sodium and potassium, and their relationship to heart health, have been studied over the years. Researchers have also evaluated the relationship between a combination of sodium and potassium and heart health.

In findings published in the Journal of the American Medical Association (JAMA), researchers determined that your sodium-potassium ratio is associated with a higher risk of cardiovascular disease (CVD) and all causes of mortality.23

Several studies have suggested that the ratio of sodium to potassium is a more important risk factor for hypertension and CVD than either of the risk factors alone.24,25,26

Data from over 12,000 individuals participating in the 3rd National Health and Nutrition Examination found higher sodium was associated with an increased risk of death, while a higher potassium level was associated with a lower rate of death from any cause.27

An imbalance of potassium in your body is linked to more than just CVD and stroke risk. A low potassium level is also a contributing factor in the development of:

Kidney stones Memory loss Cataracts Osteoporosis
Ulcers Stomach cancer Rheumatoid arthritis Erectile dysfunction
Hair loss Depression Fatigue Muscle weakness

The Best Way to Balance Your Sodium and Potassium

Low potassium levels are related to low intake of potassium-rich foods, but also to losing potassium from other conditions, such as:28

Long-term antibiotic use Diarrhea and vomiting Laxative use
Chronic kidney disease Diuretics Eating disorders
Low magnesium levels Profuse sweating

The best way to balance your sodium and potassium ratio is to increase your intake of foods rich in potassium, while maintaining a moderate amount of sodium intake. However, it’s important to look at all the nutrients foods rich in potassium will provide.

For instance, white potatoes are high in potassium but also high in carbohydrates, raising the risk of spiking your insulin levels. So loading up on white potatoes to balance your sodium to potassium ratio would not be in your best interest. Whole foods naturally high in potassium and low in sodium include:29,30

White beans Spinach Sweet potatoes
Broccoli Cantaloupe Cherry tomatoes
Blackberries Oranges Red Grapefruit
Plums Prunes Raisins
Bananas Artichokes Lima beans
Acorn squash Nuts and seeds Apricots
Avocado Garlic Bee pollen

Choose Your Salt Wisely

Your body needs salt to regulate blood pressure, help your brain communicate with your muscles and support the function of your adrenal glands. However, it isn’t the processed table salt your body needs to perform optimally.

Instead, I recommend pink Himalayan salt. This salt is higher in potassium than any of the other natural, unprocessed salts, helping you to maintain a balanced potassium-salt ratio. The salt is very flavorful and tastes delicious on your food. You’ll find that you’ll need less than you do of table salt, but you’ll get more flavor and more mineral content.

It isn’t just the additional minerals in Himalayan salt that makes it a better choice, but rather the lack of processing. Table salt undergoes considerable processing, and chemicals detrimental to your health are added. Table salt is what’s used in canned and processed foods, which is yet another reason why they’re best avoided.

I recommend eating as much real food as possible, using Himalayan salt to taste, and to increase your potassium by including ample amounts of potassium-rich foods. When ordering at a restaurant, ask your food be prepared without salt, and that your vegetables be steamed. Many restaurants now offer sea salt at the table, but if they don’t you can always bring your own from home.

Salad dressings and sauces can be served on the side so you can limit the amount you use. If your food comes to the table too salty, send it back. Avoid fast food restaurants where you can easily reach your daily intake of sodium in one meal.

In an effort to reduce salt intake, the State of New York has passed a National Salt Reduction Initiative, requiring all chain restaurants to add a warning icon next to foods on their menu containing more than 2,300 mg of salt.31 When you do eat foods high in salt, be sure to watch your diet the rest of the day and include real foods high in potassium to balance your salt-to-potassium ratio.

Optimize Your Salt to Potassium Ratio for Good Health

Interestingly, the idea that too little salt might not be good for you is not new. In an article published in the New England Journal of Medicine in 1985, the authors evaluated the dietary intake of our Paleolithic ancestors to find they naturally consumed about 11,000 mg of potassium and 700 mg of sodium.32 Today that ratio is reversed where the daily potassium intake averages 2,500 mg and sodium 3,400 mg.

This imbalance may explain why high-sodium diets affect some people more negatively than others. Another study from 2011 found that people who ate too much sodium and too little potassium had a greater risk of CVD and stroke.33

Remember, the more you can move toward a diet of whole organic foods the healthier you’ll be — whether it’s veggies, meat, dairy products, or salt. Given that salt is absolutely essential to good health, I recommend switching to a pure, unrefined salt like Himalayan crystal salt.

Sunscreens: The Ugly Truth


For decades, doctors and the media have recommended you apply sunscreen before going outside.

According to the American Academy of Dermatology (AAD), everyone should use sunscreen for protection from the sun’s ultraviolet rays, believed to be the trigger for skin cancer and the precursor to wrinkles and premature aging.1

is sunscreen safe

Story at-a-glance

  • Rates for melanoma skin cancers began to climb in the 1970s, rising 200 percent between 1975 and 2013
  • Although sunscreen is recommended to reduce skin aging and your risk of skin cancer, many products have just the opposite effect as they filter only UVB and not the more dangerous UVA
  • Some sunscreens use chemicals that may increase your risk of skin cancer and may contain hormone disrupters. Your best sun protection comes from hats, sunglasses, clothing, zinc oxide and astaxanthin

However, the recommendations don’t include the kind of sunscreen that is effective, nor do the recommendations advise you how to use the sun effectively to protectyourself from skin cancer and improve your vitamin D level, which has significant health benefits, including a lowered risk of melanoma.

To date, the U.S. Food and Drug Administration (FDA) does not have regulations governing advertising and claims for sunscreen.2 In 2011, the FDA banned the use of terms on sunscreen making inflated claims, such as “all day protection” and “sweat-” or “waterproof.”

The Environmental Working Group (EWG) recently released their 2016 list of best and worst sunscreens3 based on criteria such as level of protection and safety of the product, to guide your use of sunscreens this season.

Just remember, companies can change their ingredients, so always read the labels of the products you purchase.

Are Sunscreens the Right Way to Prevent Sunburn and Skin Cancer?

Despite the availability of sunscreen products and media coverage about using sun protection, the number of people suffering from malignant melanoma of the skin continues to rise each year. The number of new cases of skin cancer per 100,000 people has risen from 7.9 in 1975 to 24 people in 2013.4

This represents a consistent average 3 percent rise each year in newly diagnosed cases and a 200 percent rise from 1975 to 2013.

Ultraviolet radiation reaches the earth as UVA and UVB light, and has been classified as a human carcinogen by the National Toxicology Program (NTP).5 UVA is generally considered to be less carcinogenic than UVB.

Because it was believed UVB light was more dangerous, sunscreen products were first developed to filter UVB and not UVA. However, recent research has demonstrated UVA radiation actually plays an important role in the development of malignant melanoma, the most aggressive form of skin cancer.

According to estimates, more than 144,000 Americans will be diagnosed with melanoma in 2016, with five-year survival rates starting at 98 percent if the cancer has not reached the lymph nodes, 63 percent for regional cancer and dropping to 17 percent for distant-stage melanoma.6

A number of studies demonstrate sunscreen reduces the number of new squamous cell skin cancers, but has no effect on basal cell and may actually contribute to the development of the more aggressive malignant melanoma.7

There is some evidence that non-melanoma and easily treated skin cancers are related to cumulative exposure to the sun. However, that is not the case with malignant melanoma, linked with significant sunburns.8

The American Cancer Society recommends sunscreen should be used as a filter, and not a reason to stay longer in the sun. For extended outings, they recommend other methods of sun protection, even when properly using sunscreen, such as hats, sunglasses, clothing and shade.9

The Good, the Bad and the Ugly

Surveys from the AAD have demonstrated that many are not aware of how to use the sunscreen effectively.10 However, even when used correctly, not all sunscreen products contain what’s advertised on the bottle.

In one test, researchers evaluated the SPF value of 65 different products to find 43 percent had less SPF than promised on the label.11

Sunscreen also blocks your body’s ability to manufacture vitamin D, although several studies have demonstrated that most people don’t use adequate amounts of sunscreen to negatively affect their vitamin D levels.12,13,14,15 Still, this certainly is a concern, especially if you wear sunscreen all the time.

In such a case, you may want to consider getting your vitamin D level tested, and if below the clinically relevant level of 40 nanograms per milliliter, you’d be wise to consider a vitamin D supplement. Still, supplements cannot provide the identical benefits of sensible sun exposure.

The amount of sunscreen needed to protect your skin from burning also increases the amount of toxic chemicals you use.

Even studies from the Centers for Disease Control and Prevention (CDC), demonstrate 97 percent of people living in the U.S. are contaminated with a toxic ingredient widely used in sunscreens, called oxybenzone.16

Oxybenzone is commonly found in sunscreens and other personal care products. EWG identified nearly 600 different sunscreen products containing oxybenzone.

Mothers with high levels of the chemical have a higher risk of giving birth to low birthweight babies, a critical risk factor linked to cardiovascular disease, diabetes, hypertension and other diseases.17

What Do the Numbers Really Mean?

Sunscreens may also give you a false sense of security. Many consumers believe the higher the SPF number, the greater the protection against UV radiation. However, as mentioned earlier, most sunscreens protect against UVB but don’t have adequate protection against UVA radiation.

Both UVA and UVB can cause tanning and burning, although UVB does so far more rapidly. UVA, however, penetrates the skin more deeply than UVB, and may be a much more important factor in photoaging, wrinkles and skin cancers.

An SPF of 30 will theoretically filter 97 percent of the UVB rays for two hours.18 Theoretically, a higher SPF will block more of the sun’s UVB rays, but no sunscreen will block 100 percent.

The problem is, if you’re not experiencing skin reddening, you may be tempted to prolong the time you stay in the sun. This raises your risk of overexposure, which is the real danger with sun exposure.

Sunscreens with a higher SPF also require more chemicals to achieve the intended result. Many pose a health risk when they are absorbed through the skin, potentially causing tissue damage and disrupting your hormonal balance.

Because you don’t experience better protection with higher SPF numbers, it’s usually best to stick with SPF 30 if you choose to use sunscreen.

How They Work

In order for sunscreens to be effective, you must apply large amounts over all exposed areas of your skin. This means the product should not trigger skin allergies and must provide good protection against UV radiation. It also should NOT be absorbed into your skin, as the most effective sunscreen acts as a topical barrier.

Sunscreens work based on one of two mechanisms. Older products sat on the top of your skin, causing UV rays to bounce off. Most contained zinc oxide or titanium dioxide.

The second type uses chemical filters to block UV radiation. Many of those include octisalate, oxybenzone, avobenzone, homosalate, octinoxate and octocrylene.19

Several of these chemicals are hormone disruptors that have been shown to alter reproductive ability, delay puberty, alter estrous cycles in mice, reduce sperm counts in animal studies, and alter thyroid function.

Other chemicals, such as retinyl palmitate, may actually increase your risk of developing skin cancer. This product is a form of vitamin A that may speed the development of tumors and lesions when exposed to sunlight.

Manufacturers sometimes add it to products to slow skin aging.20 However, that only holds true in the absence of sun exposure.

Mechanical sunscreens, including zinc oxide, have proven over years of use to be a safe and effective means of blocking both UVA and UVB light.21

In light of recent media coverage, some companies are using zinc oxide to block UV radiation, while attempting to meet the desire of their consumers for products that don’t leave a thick film on the skin.

Nanotechnology and What It Does

To reduce the thick film, manufacturers are reducing the size of the molecules. This nanotechnology has several different effects. The particles are so small they may be absorbed into your skin. Some studies have found significant negative health effects from the absorption of nanoparticles.22 While excellent as a drug delivery system, it is questionable for use in sunscreen.23

Reducing the size of the zinc oxide particles improves the UVB protection but reduces the UVA protection, one of the important benefits of using zinc oxide as a sunscreen.24 Zinc oxide is beneficial because it remains stable in heat, but as a nanoparticle, the problems with toxicity probably outweigh the benefits to sun protection.

Toxicity of zinc oxide nanoparticles, after systemic distribution, may affect your lungs, liver, kidneys, stomach, pancreas, spleen, heart and brain.25 Findings have also demonstrated that aging has a synergistic effect with zinc oxide nanoparticles on systemic inflammation and neurotoxicity, affecting your brain and neurological system. In other words, the older you are, the higher your risk of neurotoxicity from zinc oxide nanoparticle absorption.

Is Sunscreen a Scam?

Until around 1950, melanoma was rarely diagnosed. The numbers didn’t rise until the late 1960s, just after “tanning lotion” was introduced on the market. The idea behind the lotion was the longer you could stay in the sun without burning, the more likely you would tan.

The standard explanation for the rare diagnosis of melanoma prior to the 1970s was that Americans started sunbathing in earnest in the 1950s. However, any image of the beaches from the 1930s and earlier would demonstrate that people enjoyed the sun and ocean long before the 1950s. The higher the rates of melanoma diagnosed per year, the greater the call to use sunscreen.

Interestingly, the prognosis or outcome of a diagnosis of melanoma may be linked to your levels of vitamin D. In a ground-breaking study, researchers demonstrated a link between levels of vitamin D and outcomes in individuals diagnosed with melanoma, after adjusting for C-reactive protein levels.26

Prior studies demonstrated a link between C-reactive proteins and poor outcomes after diagnosis with melanoma. This study looked at the association between vitamin D, an inflammatory response, and C-reactive proteins in a sample of over 1,000 patients. An investigation of several biomarkers suggested increasing vitamin D may improve five-year survival rates.

From the Inside Out

You can boost your internal ability to offset UVA and UVB radiation through the nutrients you eat each day. Antioxidants found in colorful fruits and veggies have been shown to have protective effects, but the real “superstar” is the fat-soluble carotenoid astaxanthin, which is what gives krill, salmon, and flamingos their pink color.27

Astaxanthin is produced by the microalgae Haematococcus pluvialis when its water supply dries up, forcing it to protect itself from ultraviolet radiation. It is this “radiation shield” mechanism that helps explain how astaxanthin can help protect you from similar radiation.

When you consume this pigment, you are essentially creating your own “internal sunscreen.” Research has confirmed it’s a potent UVB absorber that helps reduce DNA damage. It’s actually one of the most potent antioxidants known, acting against inflammation, oxidative stress and free radical damage throughout your body.

Each of these functions improves the ability of your skin to handle sun without burning, while giving your body the best advantage to manufacturing vitamin D. This is not a free pass to spending all day in the sun without physical protection, such as hat and long-sleeved clothing, but it does give you a healthier option than using chemicals to filter UV radiation.

Your Best and Worst Sunscreen Choices

Your safest and best choice for sunscreen protection is zinc oxide. Avoid nano versions however, to circumvent potential toxicity. Unfortunately, it can be challenging to find a product without other chemically based sunscreen filters. To help you choose the product best for your family, EWG performs an annual sunscreen evaluation based on effectiveness and safety.

Sixty brands received the EWG’s low-hazard ingredient list ranking this year. Their report published the best and worst choices for children, but only the best choices for adults.28,29,30 Here’s a sampling of the best and worst:

Best for Adults and Children

Adults Children
All Good Sport Sunscreen, SPF 33 Adorable Baby Sunscreen Lotion, SPF 30+
All Terrain TerraSport Sunscreen Lotion, SPF 30 All Good Kid’s Sunscreen, SPF 33
Babo Botanicals Clear Zinc Sunscreen Lotion, Fragrance Free, SPF 30 All Terrain KidSport Sunscreen Lotion, SPF 30
Badger Sunscreen Cream and Lotion, SPF 25, 30, and 35 ATTITUDE Little Ones 100% Mineral Sunscreen, Fragrance Free, SPF 30
Bare Belly Organics Face Stick Sunscreen, SPF 34 Badger Kids Sunscreen Cream, SPF 30
Burt’s Bees Baby Bee Sunscreen Stick, SPF 30 BabyHampton beach*bum sunscreen, SPF 30
Goddess Garden Facial Natural Sunscreen, SPF 30 Bare Belly Organics Baby Sunscreen, SPF 30
Kabana Organic Skincare Green Screen D Sunscreen, Original, SPF 35 Belly Buttons & Babies Sunscreen Lotion, SPF 30
Nature’s Gate Sport Vegan Sunscreen, SPF 50 Blue Lizard Australian Sunscreen, Baby, SPF 30+
The Honest Company Sunscreen Stick, SPF 30 BurnOut Kids Physical Sunscreen, SPF 35
Tropical Sands Sunscreen, SPF 15, 30, and 50 California Baby Super Sensitive Sunscreen, SPF 30+

Worst for Children

Banana Boat Kids Max Protect & Play Sunscreen Lotion, SPF 100 Coppertone Water Babies Sunscreen Stick, SPF 55 Coppertone Sunscreen Continuous Spray, Kids, SPF 70 Coppertone Sunscreen Lotion Kids, SPF 70+
Coppertone Foaming Lotion Sunscreen Kids Wacky Foam, SPF 70+ Coppertone Water Babies Sunscreen Lotion, SPF 70+ CVS Baby Sunstick Sunscreen, SPF 55 CVS Kids Wet & Dry Sunscreen Spray, SPF 70+
Equate Kids Sunscreen Stick, SPF 55 Hampton Sun Continuous Mist Sunscreen For Kids, SPF 70 Neutrogena Wet Skin Kids Sunscreen Spray, SPF 70+ Neutrogena Wet Skin Kids Sunscreen Stick, SPF 70+
Up & Up Kids Sunscreen Stick, SPF 55

Bariatric surgery reduces all-cause mortality in obesity


Patients with obesity who do not undergo bariatric surgery have a higher all-cause mortality rate than those who undergo bariatric surgery, according to study findings presented at the European Obesity Summit.

Christina E. Persson, MPH, a PhD candidate in the department of molecular and clinical medicine at Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues evaluated data from the Swedish Patient Registry for patients who visited a hospital with a principal diagnosis of obesity between 2000 and 2011 to determine the overall mortality in participants with obesity who did and did not undergo bariatric surgery. There were 48,693 participants aged 18 to 74 years; 22,581 underwent bariatric surgery (92.8% gastric bypass). Mean follow-up was 5.4 years for the surgical group and 5.5 years for the nonsurgical group.

The nonsurgical group had a higher mortality rate (4.21%; 7.7 deaths/1,000 person-years) compared with the surgical group (1.11%; 2.1 deaths/1,000 person-years). Compared with the nonsurgical group, overall mortality decreased by 57% in the surgical group (age-adjusted HR = 0.43; 95% CI, 0.37-0.5).

Cardiovascular disease was the most common cause of death in the nonsurgical group, followed by cancer. External causes of mortality (ie, accidents and suicide) were the most common cause of death in the surgical group, followed by CVD and cancer. Although external causes were the main causes of death in the surgical group, the incidences remained lower than those in the nonsurgical group.

“The implication is that we can see a reduced morality in the surgical obese compared to the nonsurgical obese, and that these differences lie mainly in CVD and cancer, which goes in line with previous studies,” Persson toldEndocrine Today. “Although it is well known that severe obesity carries many adverse health effects, and that bariatric surgery reverses many of these, we need to know much more about those who do not undergo surgery. What are the barriers? How can people who do not opt for surgery be helped?” – by Amber Cox

A Stolen Life: The ‘Civilization’ of a Child


“Train up a child in the way he shall go and when he is old he will not depart from it.” ~ Salomon proverb

Knock on any door and inside will be found those responsible for the stolen lives of children. Instead of being protective of the child’s destiny, those caretakers are following the same protocol that was done to them as children. They are training up the child so that it will forever reflect the civility of the present culture. Used here, civility means psychological clones.

A Stolen Life - The 'Civilization' of a Child

Parents who maintain their socially-given identity cannot be the true guardians of the child. The true destiny of the children is to be the possessors of their own pristine awareness and to respond to life’s challenges from that state. The guardian’s role is to guard by first protecting the child from those who feel it is their duty to mold (clone) the child into the image liken onto themselves; to provide the space where completeness can come to fruition.

The true nature of the adult child will reject all ideologies because belief is not reflective of its prime directive. Mind (the aberration of the memory-senses complex) has deceived the guardians into believing what their true role is. Mind needs the patriotic spirit(energy) that will fight to protect the status-quo. The guardians are presently interrupting the child’s completeness process. Their role is to see that there is no disruption of the child’s energy flow.

From childhood to adulthood the chances of the child reaching its flowering (completeness) is extremely rare. The fragrance from such a being would be considered as un-acceptable. The adulthood of such a being would see itself as a stranger in a foreign land. Societies believe they function at their finest with clones and drones and not with those showing independence.

The government and other social institutions have at their root the same directive, to influence the direction in which the energy (the Force) is already moving. So long as the energy remains un-divided, it cannot be used by any outside source. It remains under the direction of Intelligence (the mysterious expression of all that exists). However, when the energy is fragmented, it no longer is capable of understanding that which is self-evident. The divisive (fallen) state is the cause of all chaos, confusion and delusion.

Presently our energy is not whole. That divisiveness is responsible for our being in a state of limbo. On the one hand we are captors of mind and on the other hand there is no possibility of being the carriers of life’s pristine expressions. In ancient writings this conundrum is spoken of as “no man’s land, the drifting between heaven (Intelligence) and hell” (mind as chaos, confusion and delusion.

Clarity will again reign in our lives when through the apperception of Intelligence there is a pristine witnessing of our daily life’s responses. So long as we remain mind fixated and not pristine awareness centered, we are doomed to endlessly repeating our lives at the residency of doubt, despair and hopelessness.

Mind is a cradle snatcher that is constantly seeking energy for its present and future glorification. It does this by implementing into the child’s memory cells false images that are not compatible to its true identity.

When the prime directive is fully operative, we become Nature’s newest addition into the family of species. We human beings are unique among other life forms, we carry the seed of a prime directive that makes it possible to not depend on the physical environment for its responses to life’s challenges. Animals and other species depend solely on the physical environment (and its challenges) for their growth and survival.

With the arrival of human beings, instinct was no longer the only means to fulfill life’s expressions. With our arrival in the universe Nature made a quantum leap and for the first time severed the thread of mechanicalness. As the first of its kind, we represent Nature’s complete cycle. We are the direct responders to life’s challenges. We are the universe’s Alpha and Omega. Our birth heritage is to no longer live under the laws of mechanicalness but rather to follow the Intelligence through the sensitivity of awareness. Freedom does not mean doing the will of mind but rather to express our gift of not having to function robotically. There is only one energy operating in all life forms. Our life is different, not better.

A Stolen Life - The 'Civilization' of a Child - Edison quote on education

Because of an un-intended dysfunction, we became side-tracked from our completeness. To get on track again Nature needs the assistance of the guardins to again bring the cycle to comleteness. The success of Nature’s grand experiment remains with those responsible for the child’s care. The confrontation is now between good (pristine awareness) and evil (mind) both of which are battling for the soul (whole energy) of the child. As far as Nature is concerned, all its creations are perfect and so it does not interfere into the adjustment process. It is up to us to get it right and if not, Nature will eventually reject us. Through the pristine listening and guidance of apperceptive discernments flowing from Intelligence, we have the ability to transform from our present state.

Mind’s survival depends on its certainty that is a reality and not an aberration of its imagination. Mind can doubt many things, it cannot doubt its own existence. The ability that it can do is mind’s false belief of its power. Mind’s desires cannot be fulfilled without the energy of existence. So that it can endlessly pursue its hopes and dreams, mind has deviously seduced us into believing that we, as pristine consciousness, are mind. Our semi-hypnotic state is sustained by the hoaxer of all hoaxes, mind.

The moment we accepted the role as charlatan, we were instantly cast out of the garden of choice-less (effortless) living, to our present state where false beliefs (given by others) are accepted as the norm. From that tainted pool are spewn forth the mis-guided responses that are perceived as our daily relationships.

What is presently functioning are endless imaginary images believing themselves to be independent autonomous entities. We are not many, we are one (pristine awareness). Our prime directive is to serve as life’s pristine expression. Our flawless disign gives us the ability to end the flow of energy to our captor (mind).

Through the process of apperceptive discernment we will realize how and why our life has been stolen. Knowing that you know the truth shall set you free, the first step (pristine witnessing) is also the last step in the resurrection (bringing to attention or use again) process. Life expressing itself through Intelligence is the meaning of life.

That meaning, that life is my wish for you.

Eating Black Raspberries Significantly Lowers Cardiovascular Disease


An extract found in black raspberries can significantly lower arterial stiffness, a key measure of cardiovascular disease, according to data from a Korean study. 

Black raspberry (Rubus occidentalis) has long been used in traditional alternative medicine in Korea because of its potential to improve vascular function. Previous research has shown that Black raspberries are highly effective in preventing colorectal tumors and esophageal cancer. Now, current findings establish a link between the consumption of this fruit and circulating endothelial progenitor cells (EPCs), which help repair and regenerate damaged arteries.

Eating Black Raspberries Significantly Lowers Cardiovascular Disease

The Korean Trials

Researchers from Korea University Anam Hospital (Seoul) and Gochang Black Raspberry Research Institute (Korea) carried out the trial.

The results of a randomised controlled trial saw two groups of patients with metabolic syndrome receive either 750 mg/day of black raspberry extract or a placebo for 12 weeks.

Here, blood pressure, degree of vascular stiffness, circulating number of EPCs and various markers of inflammation were recorded at the start of the study and at a 12-week follow-up.

The team of researchers from Korea University Anam Hospital and Gochang Black Raspberry Research Institute in South Korea found vascular stiffness values were significantly decreased in the black raspberry group compared to the placebo group (–5% vs. 3%).

In addition, EPCs at the 12-week follow-up were significantly higher in the black raspberry group compared to the placebo group (19 microlitres vs. –28micro-L).

Indicators of inflammation, such as interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF), were significantly greater in the black raspberry group compared to the placebo group (–0.5 picogram per millilitre vs. –0.1 pg/ml, and –5.4 pg/ml vs. –0.8 pg/ml, respectively).

Adiponectin levels, a hormone involved in regulating metabolic processes, were significantly higher in the black raspberry group when compared to the baseline (2.9 micro-g/ml vs.– 0.2 micro-g/ml).

“The use of black raspberry significantly lowered the augmentation index and increased circulating EPCs, thereby improving CV risks in patients with metabolic syndrome during the 12-week follow-up,”

Black Raspberry Benefits

The health benefits of anthocyanidins such as those found in purple potatoes and its derivatives have been well-documented and add to an ever growing body of science to support the potential heart health benefits of black raspberries, with the bioactives proposed to be anthocyanins, flavonols, resveratrol, ellagitannin and tannins.

Check out this comparison graph that uses ORAC (a way of measuring antioxidant capacity) of different caneberries fromOregon State University Food Science:

Eating Black Raspberries - Graph

Antioxidant compounds of black raspberry, in particular are effective in reducing blood pressure.

Black raspberry has long been used in traditional alternative medicine in Korea because of its potential to improve vascular function.

These components have already been well-documented for their anti-inflammatory, antioxidative and anti-atherosclerotic effects.

Studies have shown antioxidant compounds of black raspberry, in particular as especially effective in reducing blood pressure and improving arterial stiffness.

Some studies have demonstrated black raspberries improve blood pressure, lipid profiles and vascular function.

The researchers pointed towards the fruit’s flavonoid content as primarily responsible for the improvement of vascular function in the subjects.

Flavonoids are known to increase bioavailability of nitric oxide (NO) and the enzyme endothelial nitric oxide synthase (eNOS), two known factors that contribute to the relaxation of coronary arteries.

Anthocyanins too were highlighted as factors that possess an anti-inflammatory and antioxidant capacity, further improving vascular function by up-regulating NO and eNOS.

Meanwhile, the researchers hypothesised that the degree of vascular stiffness was lessened due to the increased circulating number of EPCs.

EPCs are believed to home into the injury site to replicate endothelial cells and activate the endogenous repair system.

“The number of circulating EPCs inversely correlates with CV risk factors, suggesting that the circulating number of EPCs is lower in patients with CV diseases,” the study noted.

“Increases in circulating EPCs during the 12-week follow-up in this study suggest rapid restoration to the damaged endothelium, thereby contributing to the improvement of arterial stiffness and the augmentation index.”

Sugar-sweetened beverages dominant source of free sugar for young children


Among young British children, 40% of daily free sugar intake comes from sugar-sweetened beverages, including fruit juices and smoothies, according to study findings presented at the European Obesity Summit in Gothenburg, Sweden.

“Primary school children are consuming, on average, around four times more than the recommended maximum levels of sugar in their diet each day,”Peymane Adab, MD, professor of public health at the University of Birmingham Institute of Applied Health Research, told Endocrine Today. “The main sources of free sugar intake are drinks, including carbonated and sugar-sweetened beverages (25% of total intake), but also fruit juices and smoothies with no added sugar (15% of total intake). The other major source of sugar intake was desserts, including cakes, puddings and sweetened yogurt.”

Peymane Adab

Peymane Adab

Adab and Kiya Hurley, a research assistant and PhD student at the Institute of Applied Health Research at the University of Birmingham, analyzed data from the WAVES study, a cluster-randomized obesity prevention intervention trial in primary schools in the United Kingdom (n = 1,085). Researchers assessed dietary intake with the Child and Diet Evaluation Tool (CADET), a 24-hour food check-off list; CADET foods were matched to the U.K. National Diet and Nutrition Survey database. Nutrient compositions were drawn from McCance and Widdowson’s nutrient database for total sugar intake information. Researchers applied the ratios of intrinsic sugars to free sugars from the diet and nutrition survey to the total sugar values in the McCance and Widdowson’s database; a value for free sugar was generated for each CADET food and a weighted average produced for each category.

The researchers found that mean daily intake of free sugars was 74.6 g, or 17.4% of energy intake. Of the free sugar consumed, 25% was from “fizzy drinks, squash and fruit drinks,” and 15% came from fruit juice and smoothies. Other free sugar consumption was attributed to chocolate, sweets, toffees and mints (10%), cakes, buns and sponge puddings (8%), and from yogurt and fromage frais (7%).

Kiya Hurley

Kiya Hurley

The maximum daily recommendation for free sugar intake for children is 19 g, according to Public Health England.

“High sugar intake is a major contributor to the growing epidemic of childhood obesity,” Adab said. “Unless this pattern of consumption is changed, children are at risk of the emotional, social and health consequences associated with obesity in childhood, and higher risk of cardiometabolic disease and cancers in adulthood.”

Adab said parents should encourage water and milk as the main beverages for children, and limit other drinks and desserts to “occasional treats.” – by Regina Schaffer

The Art of Medicine: Seven Skills That Promote Mastery


With a little practice, these seven vital skills can become a natural part of your patient consultations.

Despite enormous advances in the science of medicine, the interpersonal encounter between patient and physician remains a keystone of medical care. Considerable research has explored various aspects of this relationship, including physician-patient communication, difficult patient interactions, and what physicians find meaningful in their work. These interpersonal aspects of the healing enterprise can be considered the art of medicine.

Most research into the art of medicine has tended to focus on theory instead of specifying how doctors should act. So, in teaching family medicine residents over the years, I have reviewed the literature and delineated seven behaviors that foster more consistent practice of the art of medicine. I call these behaviors “The Magnificent Seven.”

THE MAGNIFICENT SEVEN

  1. Take a moment to focus before entering the consultation room.
  2. Establish a connection with the patient by developing rapport and agreeing on an agenda.
  3. Assess the patient’s response to illness and suffering.
  4. Communicate to foster healing.
  5. Use the power of touch.
  6. Laugh a little.
  7. Show some empathy.

1. Focus on the patient. Before entering the consultation room, take a moment to personally prepare for the encounter. This will set the stage for all that is to follow. Become aware of what is going on in your body, whether you are feeling rushed or tense or are still thinking about the previous patient. If so, take a deep breath and let go of that tension or preoccupation so that you do not carry it into the next encounter.

Then, think about the patient you are about to see. What do you know about him or her? Where are you in terms of developing your relationship? What would you like to learn about this person that you don’t already know? What is the topic of the encounter, if known, and how might that drive what needs to be accomplished during the consultation? Becoming mindful of these details outside the consultation room is a precursor to being mindful inside the consultation room.

2. Establish a connection with the patient. Use the first few minutes of the consultation to connect with the patient – before opening the electronic health record. Connection occurs on at least two levels: interpersonal and intellectual. Interpersonal contact is aimed at developing rapport and generally begins by incorporating a short, non-medical social interaction to open the interview. This is a good time to get to know a bit more about the patient. A good tactic is to refer to something mentioned in earlier consultations as a way to reinforce the continuity of your relationship, such as “How is your son doing?” or “How is your garden coming along?” When the patient answers, simply observe and listen, and you’ll often find clues about his or her emotional state. Other aspects of interpersonal connection involve the effective use of attending behaviors that show you are listening, such as furthering responses (“uhhuh”), eye contact, and open body language. Spending a small amount of time socializing with and listening to the patient is worth the investment, as it has been shown to yield higher patient satisfaction than spending more time with the patient.1

The intellectual aspect of connection involves taking time to assure the patient that you are interested in addressing what is important to the two of you. This also signals that you are transitioning from the social/rapport-building aspects of the interview to the medical aspects. Ideally, in a team-driven environment, your staff and patient would negotiate an agenda before you even walk in the room. If that hasn’t taken place, you can quickly negotiate an agenda by sharing your understanding of the reason for the visit and then inquiring whether there are other issues the patient wishes to discuss today. If the patient responds affirmatively, continue to ask until the patient identifies no further issues for discussion, and then inquire as to whether the patient needs any refills or forms completed. Having surfaced the patients’ concerns, prioritize them and negotiate a workable agenda for the time available. If necessary, ask the patient to schedule another appointment to address the remaining issues (see “Agenda-setting algorithm”). Setting an agenda adds negligible time to the consultation, promotes greater patient satisfaction, and makes patients less likely to raise concerns when you are trying to close the visit.24

In setting the agenda, it may help to understand that patients visit their doctor for five basic reasons:5 1) They may have trouble tolerating some aspect of their disease; 2) They may be anxious that their symptoms foretell dire consequences; 3) They may have problems in life that present as symptoms, such as tension headaches; 4) They may appoint for administrative reasons, such as a work release; or 5) They may need preventive services. Patients can present with more than one of these concerns (e.g., they may have pain they consider intolerable and are anxious about what it means). Understanding the reason or reasons for the visit ensures that you address the heart of why the patient is seeing you.

AGENDA-SETTING ALGORITHM

 Download in PDF format

3. Assess the patient’s response to illness and suffering. The diagnosis and treatment of a patient’s illness is a core clinical function, but it is also important to assess the patient’s response to their illness and suffering. Patients commonly share clues about their illness experience, which you can explore with a modest time investment. Listen for what the patient tells you he or she can no longer take for granted – e.g., “It’s hard getting up the stairs, Doc” or “I just can’t make it through the workday anymore without a nap” – and express curiosity about that. This can uncover significant clinical information and is associated with a better resolution of patient concerns.6,7

Patient suffering is more than just physical pain. It is “the state of severe distress associated with events that threaten the intactness of the person.”8 In other words, it affects their personhood. To assess a patient’s suffering, ask questions such as, “How is your illness affecting you personally?” “How do you find comfort when you are suffering?” and “Despite your suffering, do you feel hopeful about your future?” Some patients are able to find meaning in their suffering or express a sense of hope, even if their condition is incurable, while others may feel despair and withdraw into their suffering.9 These latter patients will require more care, attention, and relationship building, and your management plan will be more effective if it addresses ways for them to find comfort in the face of illness and suffering.

4. Communicate to foster healing. Renowned psychologist Carl Rogers suggested that those who counsel patients need to display three things in their communication:10

  • Congruence (being authentic and letting the patient experience who you really are, instead of putting on a facade),
  • Acceptance (showing that you value the person even if you don’t agree with his or her actions),
  • Understanding (relating and being sensitive to what the patient is experiencing).

Rogers’ research indicated that individuals exposed to a relationship with high degrees of these qualities grew in their potential.

Patients who have problems of living (such as domestic problems, socioeconomic challenges, or emotional issues) that present as medical problems can be particularly difficult to communicate with and are often labeled “problem patients.” Managing them will require you to use two skills that can be uncomfortable. The first is relational immediacy, that is, the ability to communicate about a dynamic or behavior that is happening in the present moment of the encounter (e.g., “I feel like we’re misunderstanding one another” or “I’m feeling frustrated, and I’m sensing that you are too. Can we start over?”).

The other skill you’ll need involves confrontation. This is one of the most powerful actions you can take to support another’s growth because it focuses on areas that the individual may need to change. However, confrontation can trigger volatile, defensive reactions. Useful tactics are to introduce your concern with a positive observation to help the patient absorb some of the shock of your confrontation and then use curiosity or wonderment to express your concern. For example, “I can tell that you love your family very much and you want them to have a happy home life. But I wonder if hiding your depression from them might have the opposite effect of creating distance in your relationship and keeping you from getting the support you really need?”

5. Use the power of touch. A general rule is to always touch the part that hurts, but never touch the part that hurts first. A warm handshake or a pat on the shoulder can often help calm distraught patients, and touch may have health-enhancing benefits as well. For example, massage can strengthen immune function11 and gentle touch has been shown to reduce pain responses to heel stick in premature infants.12

Of course, reactions to touch may be unpredictable with patients who have been physically abused and associate touch with exploitation or pain, patients who are psychiatrically or developmentally challenged, and patients who are seductive. You can still use touch with these patients, but proceed with some caution. Also, be culturally sensitive. If you sense that a patient is uncomfortable with touch because of his or her culture or beliefs, be sure to explain what the physical examination will entail before you begin and, in some cases, ask permission to proceed.

6. Laugh a little. Medicine is a serious business, and doctors are seriously busy people. But if you’re too serious or too busy to recognize humor in your workday, then you and your patients are missing out on something powerful. Humor can be helpful in establishing rapport, relieving anxiety, communicating messages and caring, enhancing healing, and providing an acceptable outlet for anger and frustration.13 It has generally favorable physiological effects but, like any other tool, should be used appropriately. Humor carries less risk if it is gently self-deprecating, is externally focused (not directed at the patient), is not used as the sole means of communication, is grounded in empathy, and is reciprocal.

When using humor, remember that there are three types of people: those without a sense of humor, those who enjoy humor, and those who generate humor. If you sense the patient lacks a sense of humor, forego this recommendation; humor will only make the patient angry. If you lack a sense of humor, forego this recommendation; you won’t be funny. For everyone else, be discerning but please give yourself license to laugh a little.

7. Show some empathy. As discussed earlier, psychologist Carl Rogers included understanding, or empathy, as an important ingredient in communication. I’ve put empathy in its own category, however, because I believe it is so vital but so seldom practiced. Rogers described it as sensing the patient’s world “as if it were your own, without ever losing the ‘as if’ quality.”10 This attempt to understand the patient’s experience not only helps to establish a caring relationship but also can affect physiology. For example, patients with highly empathetic physicians have been shown to have better glycemic control and LDL levels and cold symptoms that last two fewer days than those of patients whose physicians are less empathetic.14,15

Being empathetic usually involves making an explicit comment concerning the patient’s feelings or experience. Saying “I’m sorry,” while sympathetic and often appropriate, is not empathetic because it references your feelings, not the patient’s. Examples of empathetic remarks are, “That must be very frustrating” (feeling) or “The stairs are really becoming a struggle for you” (experience). Empathy can be coupled with expressions of sympathy: “I’m sorry for your loss. I can’t imagine how devastating this must be.”

Making a mental note to be explicitly empathetic is important because medical training and medical culture can sometimes erode empathy. For example, you may have learned over the years to consider subjective information as suspect or to disconnect from a patient’s experience to ensure technical proficiency during an unpleasant or painful procedure. Being explicitly empathetic is important because “empathy withers with silence.”16 Patients cannot know whether you have grasped their experience and understand them as individuals unless you state what you understand. By being explicit in your understanding, you communicate your receptiveness to the patients’ concern, which may encourage the sharing of more personal, clinically important information.

The benefits

Although no empirical tests have verified the thesis that using these seven strategies will enhance your practice of the art of medicine, the behaviors recommended are based on empirical data. They incorporate a patient-centered approach to communicating with patients, which has been shown to improve health outcomes, increase patient satisfaction, and decrease malpractice liability.17

But using these activities may have an added benefit: In an environment in which physicians are becoming increasingly disillusioned and burnt out, utilizing “The Magnificent Seven” may help you deepen your relationships with patients. In so doing, you may uncover those changes in perspective, connections with patients, and experiences of making a difference in another’s life that bring meaning to your work.18

The science of medicine has wrought miracles in the prevention, diagnosis, and treatment of disease. But the art of medicine remains the medium through which illness and suffering are relieved and becomes paramount when biomedicine runs its course and has little to offer the patient. By practicing the art of the consultation, you just might rediscover and nourish the altruistic motivations that called you to be a healer.