Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the Established Populations for Epidemiologic Studies of the Elderly

KG Losonczy, TB Harris and RJ Havlik

American Journal of Clinical Nutrition, Vol 64, 190-196

We examined vitamin E and vitamin C supplement use in relation to mortality risk and whether vitamin C enhanced the effects of vitamin E in 11,178 persons aged 67-105 y who participated in the Established Populations for Epidemiologic Studies of the Elderly in 1984-1993. Participants were asked to report all nonprescription drugs currently used, including vitamin supplements. Persons were defined as users of these supplements if they reported individual vitamin E and/or vitamin C use, not part of a multivitamin. During the follow-up period there were 3490 deaths. Use of vitamin E reduced the risk of all-cause mortality [relative risk (RR) = 0.66; 95% CI: 0.53, 0.83] and risk of coronary disease mortality (RR = 0.53; 95% CI: 0.34, 0.84). Use of vitamin E at two points in time was also associated with reduced risk of total mortality compared with that in persons who did not use any vitamin supplements. Effects were strongest for coronary heart disease mortality (RR = 0.37; 95% CI: 0.15, 0.90). The RR for cancer mortality was 0.41 (95% CI: 0.15, 1.08). Simultaneous use of vitamins E and C was associated with a lower risk of total mortality (RR = 0.58; 95% CI: 0.42, 0.79) and coronary mortality (RR = 0.47; 95% CI: 0.25, 0.87). Adjustment for alcohol use, smoking history, aspirin use, and medical conditions did not substantially alter these findings. These findings are consistent with those for younger persons and suggest protective effects of vitamin E supplements in the elderly.

ARE VITAMIN AND MINERAL DEFICIENCIES A MAJOR CANCER RISK?

Bruce N. Ames & Patricia Wakimoto

Nature Reviews Cancer 2, 694 -704 (2002)

Diet is estimated to contribute to about one-third of preventable cancers — about the same amount as smoking. Inadequate intake of essential vitamins and minerals might explain the epidemiological findings that people who eat only small amounts of fruits and vegetables have an increased risk of developing cancer. Recent experimental evidence indicates that vitamin and mineral deficiencies can lead to DNA damage. Optimizing vitamin and mineral intake by encouraging dietary change, multivitamin and mineral supplements, and fortifying foods might therefore prevent cancer and other chronic diseases.

Bruce Ames has been one of the leading researchers in carcinogenesis for decades and is a professor of Biochemistry and Molecular Biology, University of California, Berkeley and a senior scientist at the Children’s Hospital Oakland Research Institute. Research interests in his lab include genetic toxicology, micronutrient deficiencies and DNA damage, and mitochondrial decay in ageing. He developed the test for detecting mutagens, and is a member of the National Academy of Sciences. Among numerous other honors, he is the past recipient of the Japan Prize and the US National Medal of Science. His 460 scientific papers have resulted in him being one of the few hundred most-cited scientists.

He has also shown that vitamin therapies can help over 50 genetic diseases. See:

High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms1–3.

Bruce N Ames, Ilan Elson-Schwab, and Eli A Silver

Am J Clin Nutr 2002;75:616–58.

BIOCOMPATIBLE ELECTRIC CURRENT ATTENUATES HIV-I INFECTIVITY

William D. Lyman, Irwin R.Merkatz

William C. Hatch and Steven C. Kaali

Departments of Pathology,

and Obstetrics & Gynecology

Albert Einstein. College of Medicine

SUMMARY

In this report, we present the results of double-blinded studies on the use of direct electric current to alter the infectivity o£ HIV-1 for susceptible cells in vitro. Two lymphoblastoid cell lines (H9 and CEM-SS) were exposed to aliquots of the RT strain of HIV-1 treated with direct current. Results of these studies show that virus treated with currents from 50 to 100 microamperes (ìA) has a significantly reduced infectivity for susceptible cells.

These experimental currents were equal to 3.85 and 7.7.ìÁ/mm2 current densities respectively. The reduction of infectivity was dependent upon, the total electric charge (ìA x min) passing through the chamber to which the virus was exposed. Viral infectivity was determined by two independent measures: a syncytium-formation assay which can be used to quantify the production of infectious particles; and. a reverse transcriptase assay which is an index of viral protein production. Additional experiments demonstrated that the currents employed were biocompatible. Uninfected H9 cells were exposed to the same conditions used for the viral aliquots.

There was no significant change in the percentage of viable uninfected cells exposed to any of the currents tested. Therefore, because biocompatible direct electric current attenuates the infectivity of cell-free virus, this treatment may allow development of new strategies to prevent transmission of HIV-1 through either treating the general blood supply or developing alternative barrier contraceptive devices. Additionally, biocompatible electric. current may be applicable for the direct treatment of AIDS patients by utilizing either extracorporeal systems or self contained indwelling electrodes. Lastly, because the virus is being attenuated, electric current may also render treated HIV-1 suitable for vaccine development.

Recently, a member of [email protected] asked about treating Giardia. This is a nasty parasite that requires careful clinical technique with a frequency device.

Last April, I treated residual Giardia infection with:

7755 6787 5758 4797

These were frequencies for a specific strain and frequencies may vary for other infections. If you have the right frequencies, treating for 10 minutes at each frequency for a specific area of the body where the infection is located should do the job. For systemic infections, repeated treatments and plate zapping will be required (see below).

Giardia is particularly adept at moving throughout the body and finding a place where it can survive, particularly in hip muscles. I have treated several Colorado athletes with residual Giardia infections in the hip muscles that were impeding their athletic performance in Triathlons. Almost everyone in Colorado is exposed to Giardia through the mountain streams.

I often use plate zapping to focus the energy on specific tissues by taking a microscopic slide of the tissue and putting in the circuit. This can be done easily with an FSCAN by laying the slide on the imprinter which comes with the FSCAN. On my EM6C plasma device, the same effect can be achieved by placing the slide between the plasma tube and the treatment area.

You can also use microscopic slides of Giardia adults, two larva stages, and egg to focus energy transfer directly to the organisms.

Parasites like Giardia have four stages in their life cycle. You must eliminate all four stages simultaneously or reinfection will occur. The four frequencies are for the four stages.

There is almost a complete exchange of gases between nasal passages and sinuses while humming in one exhalation vs. 4% without humming. If you have sinus problems, you should do a lot of humming. Chanting your mantra might do the same trick.

Humming Greatly Increases Nasal Nitric Oxide

Eddie Weitzberg and Jon O. N. Lundberg

Department of Anesthesiology and Intensive Care, Karolinska Hospital, and Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 144-145, (2002)

The paranasal sinuses are major producers of nitric oxide (NO). We hypothesized that oscillating airflow produced by humming would enhance sinus ventilation and thereby increase nasal NO levels. Ten healthy subjects took part in the study. Nasal NO was measured with a chemiluminescence technique during humming and quiet single-breath exhalations at a fixed flow rate. NO increased 15-fold during humming compared with quiet exhalation. In a two-compartment model of the nose and sinus, oscillating airflow caused a dramatic increase in gas exchange between the cavities. Obstruction of the sinus ostium is a central event in the pathogenesis of sinusitis. Nasal NO measurements during humming may be a useful noninvasive test of sinus NO production and ostial patency. In addition, any therapeutic effects of the improved sinus ventilation caused by humming should be investigated.

Errors That Kill Medical Patients

Medical errors are killing tens of thousands of Americans each year and harming countless more, so it has been a salutary trend that many medical, academic and business groups have been developing ways to reduce the dangers. But now a survey of practicing physicians has revealed disheartening evidence that the doctors themselves may be the biggest obstacle to effective reform.

Three years ago the Institute of Medicine estimated that 44,000 to 98,000 patients die each year because of medical mistakes — more than are killed annually by automobile accidents. The numbers seemed so staggering that many medical practitioners thought them inflated. But the survey of physicians, published in The New England Journal of Medicine last week, has offered corroborating evidence that, whatever the number of deaths might be, there are an awful lot of medical mistakes causing an awful lot of damage.

The survey, conducted by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation, examined the views of more than 800 American doctors and 1,200 other adults. Fully 35 percent of the doctors said that either they or members of their families had experienced medical errors in the course of being treated, and most said the errors had “serious health consequences,” such as death, long-term disability or severe pain. Three in ten had seen an error that caused serious harm to patients outside their families in the past year.

The critical issue, of course, is how to prevent harm, and here the survey found troubling attitudes. Although studies have demonstrated that various technological and procedural changes can cut the error rates in hospitals, the practicing physicians were lukewarm toward many reforms. Only a third of the physicians, for example, consider that reducing the work hours of young doctors in training to avoid fatigue is a “very effective” strategy to cut errors.

Less than a quarter of the doctors think it would be very effective to use computers instead of paper forms to order drugs or to include pharmacists on hospital rounds, two approaches that have been shown to reduce medication errors in hospitals. Nor were they enthusiastic about using only specially trained physicians on intensive care wards, or about limiting high-risk medical procedures to hospitals that do a lot of them, despite evidence that expertise and frequent practice are key ingredients in successful medicine.

With the evidence growing ever stronger that medical errors are a danger to many patients, it is disturbing to find such retrograde attitudes among physicians. Reform can succeed only if the medical profession gets behind changes that expert groups and plain common sense suggest could significantly reduce the harm caused by medical errors.

Views of Practicing Physicians and the Public on Medical Errors

Robert J. Blendon, Sc.D., Catherine M. DesRoches, Dr.P.H., Mollyann Brodie, Ph.D., John M. Benson, M.A., Allison B. Rosen, M.D., M.P.H., Eric Schneider, M.D., M.Sc., Drew E. Altman, Ph.D., Kinga Zapert, Ph.D., Melissa J. Herrmann, M.A., and Annie E. Steffenson, M.P.H.

Volume 347:1933-1940 December 12, 2002 Number 24

ABSTRACT

Background In response to the report by the Institute of Medicine on medical errors, national groups have recommended actions to reduce the occurrence of preventable medical errors. What is not known is the level of support for these proposed changes among practicing physicians and the public.

Methods We conducted parallel national surveys of 831 practicing physicians, who responded to mailed questionnaires, and 1207 members of the public, who were interviewed by telephone after selection with the use of random-digit dialing. Respondents were asked about the causes of and solutions to the problem of preventable medical errors and, on the basis of a clinical vignette, were asked what the consequences of an error should be.

Results Many physicians (35 percent) and members of the public (42 percent) reported errors in their own or a family member’s care, but neither group viewed medical errors as one of the most important problems in health care today. A majority of both groups believed that the number of in-hospital deaths due to preventable errors is lower than that reported by the Institute of Medicine. Physicians and the public disagreed on many of the underlying causes of errors and on effective strategies for reducing errors. Neither group believed that moving patients to high-volume centers would be a very effective strategy. The public and many physicians supported the use of sanctions against individual health professionals perceived as responsible for serious errors.

Conclusions Though substantial proportions of the public and practicing physicians report that they have had personal experience with medical errors, neither group has the sense of urgency expressed by many national organizations. To advance their agenda, national groups need to convince physicians, in particular, that the current proposals for reducing errors will be very effective.

MENLO PARK, Calif., Dec. 11 /PRNewswire/ – Some 42% of the public and more than one-third of U.S. doctors say they or their family members have experienced medical errors in the course of receiving medical care, with significant percentages reporting serious consequences, according to a new survey by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation.

However, implementing the actions recommended by experts on medical errors may not be easy. Despite widespread personal experience, neither the public nor physicians name medical errors as a top problem facing health care and medicine today. Physicians and the public also disagree about many proposed solutions.

The Harvard and Kaiser researchers discuss their findings in a New England Journal of Medicine article being published on December 12, 2002. The nationwide survey examined the views of 831 physicians in April-July 2002 and 1,207 adults in April-June 2002.

“One of the striking findings of this study is that physicians disagree with national experts on the effectiveness of many of the proposed solutions to the problem of medical errors,” said Robert Blendon, Sc.D., professor of Health Policy at the Harvard School of Public Health.

“This survey provides strong documentation that medical errors represent a problem that affects a significant number of people,” said Drew Altman, Ph.D., president and CEO of the Kaiser Family Foundation. “The fact that so many physicians report personal experiences with errors corroborates what we heard from the public,” Altman added.

Experience with Medical Errors

Both physicians and the public were read a common definition of a medical error early in the survey. Subsequently, 35% of physicians and 42% of the public reported experiencing a medical error in their own care or that of a family member at some point in their life; 18% of physicians and 24% of the public said an error caused “serious health consequences” such as death (reported by 7% of physicians and 10% of the public), long-term disability (6% and 11%, respectively) or severe pain (11% and 16%, respectively).

Three in 10 (29%) of all doctors said that in their role as a physician they had seen a medical error that resulted in serious harm to a patient in the last year, and a majority of those who had seen an error said it is “very likely” (15%) or “somewhat likely” (45%) that they would see a similar one at the same institution in the next year.

Not Viewed As A Top Problem Facing Health and Medicine

Doctors and the public agree that as many as half of the deaths due to medical errors could have been prevented, but neither group listed medical errors among the top “problems facing health care and medicine in the country today.” Only 5% of physicians and 6% of the public identified medical errors as a top concern.

Instead, when asked to name in an open-ended question the top problems facing health care and medicine today physicians identified malpractice insurance costs and lawsuits (29%), health care costs (27%), and problems with insurance companies and health plans (22%). The public cited the cost of health care (38%) and cost of prescription drugs (31%) as the top problems facing health care and medicine.

Preventing Medical Errors?

Doctors and the public differ in their views of the most effective ways of reducing medical errors. Much of the public agreed that nine of the 16 offered proposals could be very effective, but a majority of practicing physicians saw just two proposals as very effective: requiring hospitals to develop systems to avoid medical errors (55%) and increasing the number of hospital nurses (51%).

Physicians and the public disagree substantially in their views on some of the key proposals:

— Seven in 10 of the public (71%) said requiring hospitals to report

errors to a state agency would be very effective, compared with 23% of

physicians.

— A majority of the public (62%) said reports of serious errors should be

released publicly; just 14% of physicians agreed, with most doctors

(86%) saying hospital reports should remain confidential.

— Half of the public (50%), but only 3% of physicians, said that

suspending the licenses of health professionals who make medical errors

would be a very effective solution for reducing errors.

— Two-thirds of the public said it would be very effective to reduce the

work hours of physicians in training (66%) compared to 33% of

physicians.

Although few physicians said that more malpractice suits could be effective in preventing individual errors, a majority believes that surgeons who make errors with serious consequences should be subject to lawsuits.

Gap Between Medical Error Experts and Views of Physicians and the Public

Physicians and the public do not necessarily agree with the views of experts regarding the effectiveness of certain approaches to reducing errors. For example, less than a majority of both physicians and the public believes that limiting certain high-risk procedures to high volume centers (40% of physicians, 45% of public), increasing use of computerized medical records (19% and 46%, respectively), or use of computers in ordering of medical tests and drugs (23% and 45%, respectively) would be very effective solutions.

Furthermore, about one-third of physicians (34%) agree that another key proposal of experts — using only physicians trained in intensive care medicine in hospital ICUs — would be very effective.

Causes of Medical Error

Physicians said the leading causes of errors are a shortage of nurses (53%) and overwork, stress or fatigue of health professionals (50%). A majority of the public identified seven causes; the top four they cited are physicians not having enough time with patients (72%); overwork, stress or fatigue of health professionals (70%), health professionals not working together or communicating as a team (67%) and a shortage of nurses (65%).

About seven in 10 physicians thought an error would be more likely at a hospital that does fewer procedures. The public was less sure, with about half saying that an error would be more likely at a low-volume center and the other half saying that errors would be more likely at a high-volume center (23%) or that volume would make no difference (26%).

Methodology

The Harvard School of Public Health and Henry J. Kaiser Family Foundation’s Medical Errors: Practicing Physician and Public Views is based on two surveys, one of physicians and one of the public, both designed and analyzed by a team of researchers from Harvard School of Public Health and the Kaiser Family Foundation.

Physician Survey

The fieldwork for the survey of physicians was conducted April 24-July 22, 2002 by mail or online with 831 physicians by Harris Interactive, Inc. The sample was drawn from the national list of physicians provided by Medical Marketing Service, Inc. This list includes both American Medical Association members and non-members and is updated weekly. The margin of sampling error was +/-3.5 percentage points.

General public sample

The survey of the public was conducted by telephone April 11- June 11, 2002 with a nationally representative sample of 1,207 adults 18 years and older. The fieldwork for the survey was conducted in Spanish and English by ICR/International Communications Research. The margin of sampling error was +/-2.6 percentage points.

Please note that for both surveys sampling error may be larger for other subgroups and that sampling error is only one of many potential sources of error in these or any other public opinion poll.

This site is based on the assumption that 50% of hospital visits can be prevented by exercise and nutrition, 35% by alternative medicine, and 10% by electronic medicine. The remaining 5% deserve careful attention because your odds of dying in a poorly rated hospital are more than twice the odds of dying in a highly rated hospital for serious conditions. See a recent article in Advances for Health Information Executives. I’m partial to this journal because they rated me one of the 15 most influential people in healthcare IT in 2000. At least someone thinks that people follow my recommendations. But I digress …

HealthGrades posts ratings for many conditions for most hospitals. Five stars is good. One star is bad. The chart above shows that survival is much higher in good hospitals vs. bad hospitals. You can drill down on the HealthGrades web site and see that a good hospital, like Massachusetts General, is highly compliant with the LeapFrog Group’s recommendations for patient safety.

The Washington Post is really focusing in on the lack of progress dealing with medical error in the U.S. Whether it is the Catholic Church or corporate America, the deeper you look, the worse it gets.

A Medical Enron

Washington Post Editorial; Monday, December 9, 2002; Page A22

“The sources of error are various. Surgeons mix up patients’ X-rays or look at them the wrong way up; as a result, they operate on the wrong patient or the wrong body part. Doctors and health workers fail to follow basic hygiene procedures such as washing hands or changing gloves; the consequent infections account for thousands of deaths a year. The largest single source of error stems from faulty drug prescriptions. One recent study found that one in five doses of medicine dispensed to patients involved an error. Either the wrong drug was given, or the wrong dose, or it was given at the wrong time.

“These various errors reflect the arrogance of the medical priesthood. Even though doctors themselves have produced studies showing how fatigue erodes worker competence, they persist in thinking that it’s normal for junior members of their profession to put in more than 100 hours of work a week. Even though every other profession has embraced computers’ ability to enhance human performance, doctors persist in scribbling prescriptions in illegible handwriting rather than punching them into a computer that might alert them if the dose is wrong. Studies of hospital infections find that junior workers are most likely to wash their hands properly. It is doctors who are most likely to forget this chore.”

One of the many newsletters I scan each month is Dr. Williams “Alternatives for the Health Conscious Individual.” In the July 2002 issue he mentions an editorial in Circulation by Dr. Leaf of Massachusetts General Hospital on the “Lyon Diet Heart Study.” Results of this study were published years ago and showed that one teaspoon of cold pressed flax seed oil per day resulted in a 70% reduction in deaths from heart disease in the study group, more than any result from any previous cholesterol study ever published.

Dietary Prevention of Coronary Heart Disease: The Lyon Diet Heart Study (Editorial)

Alexander Leaf, MD

Circulation. 1999;99:733-735

Dr. Leaf comments: “This issue of Circulation contains an article that I believe deserves special attention from cardiologists and physicians. It reports the 46-month mean follow-up findings on the original report of the study on “Mediterranean -linolenic acid–rich diet in secondary prevention of coronary heart disease,” the so-called Lyon Diet Heart Study. This study was undertaken because of the interest of the investigators in explaining the very much lower mortality from cardiovascular disease, mainly coronary heart disease, in the countries bordering the Mediterranean compared with that in northern Europe. The initial report was published in Lancet in 1994 after the study was terminated by its Scientific and Ethics Committee at 27 months mean follow-up time of what had been planned as a 5-year study, because the benefits in the experimental group at that time were so favorable. Despite the striking findings in the first report of a 70% reduction in all-cause mortality due to a reduction in coronary heart disease (CHD) mortality and comparable large reductions in nonfatal sequelae, I have encountered few cardiologists here who are aware of that study.”

There are few cardiologists at one of the world’s leading medical centers who are even familiar with the study! I don’t want to be too critical of busy physicians because Dr. Halamka, CIO of CareGroup, is also responsible for information technology for the Harvard Medical School. Every day he searches the internet and finds 40,000 new pages of information to post for medical students. This is more pages than most physicians read in a lifetime of medical practice.

What this means, is that an intelligent person must research the medical literature for pertinent information and bring this information to their physician and use the physician as a consultant. We don’t expect our lawyers to understand our business and we are at great risk if we expect our physician to fully comprehend our health status. That is just the way it is, and anyone who says otherwise is just not reading the medical literature.

To their great credit, the American Heart Association freely publishes the full text of their journal, Circulation. Check out the article on the Lyon Diet Heart Study update.

Another key point that Dr. Williams points out, is that if you are using aspirin, ibuprofen, acetaminophen, or other COX-2-inhibiting medications and getting some pain relief benefit, you are probably treating the symptom, not the disease. Since aspirin and like medications work by inhibiting the effects of eicosanoids from omega-6 fats, you need to increase you intake of omega-3 oils from flaxseed, or better yet, pharmaceutical grade fish oil. Flax seed oil or fish oil pushes the omega-3/omega-6 oil balance in your body in a positive direction. Continually treating your headache or arthritis with the drugs mentioned above could set you up for a heart attack. There a much better ways to eliminate aches and pains by curing the underlying condition.