Category Archives: How to

Problems with our Health Care System:  HOSPITALS by Greg Feinsinger MD

In his book “Mistreated,” Robert Pearl, M.D. talks about the four “legacy players,” that resist needed change in our dysfunctional, expensive healthcare system—because they benefit financially from the status quo. These entities are hospitals, medical insurance companies, physician specialty societies, and the pharmaceutical/medical device industry.

Last year, Elisabeth Rosenthal, M.D., wrote the book “An American Sickness, How Healthcare Became Big Business and How You Can Take It Back.”  She writes about how in the last 25 years “healthcare, the caring endeavor, became healthcare, the highly profitable industry,” and about how “our politicians have proven themselves either unwilling or unable to rein in the increasingly outrageous costs faced by patients.”

In regard to hospitals, Dr. Rosenthal notes that “from 1997 to 2012, the cost of hospital services grew 149 percent, while the cost of physician services grew 55 percent. The average hospital cost per day in the United States was $4,300 in 2013, more than three times the cost in Australia and about ten times the cost in Spain.” Following are a few of Dr. Rosenthal’s thoughts on how hospitals contribute to the high cost of medical care in this country:

  • Based on advice from consultants, hospitals– including nonprofits– boost charges as much as they can on whatever they can, including operating room time, oxygen therapy and drugs (note that usually hospitals won’t let you take your own medications during your admission). We all have experienced—or known others who have—outrageous hospital charges, such as $48 for putting an oximeter on a patient’s finger for a few seconds to check pulse rate and oxygen saturation (the device costs less than $50 at Walmart, is reusable, and lasts for years)–or $17 for an acetaminophen tablet which costs well under a penny.
  • In a section of the chapter on hospitals titled “closing departments: make money or die,” Dr. Rosen notes that “hospitals…enhanced their most profitable offerings:  orthopedics, cardiac care, a stroke center (revenue from expensive scans), and cancer care (revenue from infusions)” while closing departments that aren’t very profitable, even if they benefit patients.
  • In talking about “the emergence of hospital-hotels,” Dr. Rosenthal notes that 25 years ago rooms with four beds were common, but now single rooms are the norm, even though “there is little medical justification and many insurers won’t cover them.” A health economist quoted by Dr. Rosenthal says hospitals are “like Four Seasons Hotels, with valet parking and chandeliers.” (The book doesn’t mention fireplaces in the rooms, probably because readers wouldn’t believe that such a hospital exists).
  • Many hospital CEOs are paid exorbitant salaries, even if the hospitals they manage are nonprofit. “An American Sickness” notes that “in most cities the highest-paid nonprofit executive by far runs the local hospital.”
  • Putting an E.R. patient on observation status while getting tests to determine the diagnosis and need for admission made sense in the past, before modern diagnostics such as CT scanning became available. Many hospitals now abuse the system: Rosenthal explains that “the easy money for Medicare patients is not in inpatient admissions. Medicare pays a bundled rate for those. But outpatient care has no similar limits–the till is open for testing.”
  • Many hospitals, especially community hospitals, are nonprofit, which allows them to receive huge tax benefits. They hire consultants and accountants to figure out how they can maintain their nonprofit status while doing the minimal amount of required charity and community benefit work.

At the end of her book Dr. Rosenthal has a section that lists the following sites you can use to vet hospitals in your area:

  • New York Times Pricing Calculator: nytimes.com/interactive/2013/05/08/business/how-much-hospitals-charge.html. This tells you how much a particular hospital charges for various procedures, the Medicare hospital payment for admissions for conditions such as pneumonia, and how much more than the Medicare rate the hospital typically bills patients.
  • The Leapfrog Group: leapfroggroup.org/ratings-reports.  This rates hospitals on several quality measures.
  • Hospital Compare: medicare.gov/hospitalcompare/compare.html. This site is run by Medicare and rates hospitals on quality measures including those related to particular procedures.
  • Propublica Nonprofit Explorer (https;//propublica.org/nonprofits) and Guidestar (guidestar.org) “allow you to download an IRS Form 990 for most hospitals.” For a nonprofit such as Valley View Hospital, these sites include the compensation of the hospital’s highest-paid executives and doctors, what they claim as charitable work, and what the profit was every year.

Signs that the Medical Establishment may be Starting to get Healthy Eating by Greg Feinsinger M.D.

In the 1940s Dr. Walter Kempner proved that severe hypertension could be reversed by diet. Over 25 years ago Dr. Dean Ornish, and later Dr. Caldwell Esselstyn, proved that our biggest killer—heart disease—can be reversed by plant-based, whole food nutrition with avoidance of salt, sugar and added oil. But unfortunately, the medical field is bound by tradition; doctors are paid well to do procedures but not for counseling; and physician training and practice are unduly influenced by the pharmaceutical and food industries. As a result, the power of food to prevent and reverse disease has been neglected by traditional medicine.

Finally, there are some hopeful signs that this may be changing. Dr. Kim Williams, who was recently the president of the American Collage of Cardiology, decided to go plant-based a few years ago, after reviewing several different diets. When people asked him why, he said “I don’t mind dying so much, but I don’t want it to be my fault.”

The American Heart Association publishes the respected medical journal “Circulation.”  In the June 5th issue there is an article titled “Medical Nutrition Education, Training and Competencies to Advance Guideline-Based Diet Counseling by Physicians.”  The article notes that “training physicians to provide diet and nutrition counseling as well as developing collaborative care models to deliver nutrition advice will reduce the health and economic burden of atherosclerotic cardiovascular disease to a degree not previously recognized.” It goes on to note that “despite evidence that physicians are willing to undertake this task and are as credible sources of diet information, they engage patients in diet counseling at less than desirable rates and cite insufficient nutrition knowledge and training as barriers to carrying out this role…These data align with ongoing evidence of large and persistent gaps in medical nutrition education and training in the United States…”

The American Family Physician journal is getting on board as well. The June 1st edition contained an article titled “Diets for Health:  Goals and Guidelines,” which reviewed the pros and cons of various diets that are touted as being healthy. The article points out that plant proteins are preferable, and cites the health benefits of fruits and vegetables, legumes (beans, lentils, chick peas), whole grains, healthy fats and spices. In a high-lighted box titled “What is New on This Topic:  Diets For Health,” the article notes:

  • Large, prospective cohort studies show that vegetarian diets reduce the risk of coronary heart disease and type 2 diabetes mellitus, and that vegan diets offer additional benefits for obesity, hypertension, type 2 diabetes, and cardiovascular disease.”
  • “Eating nuts, including peanuts, is associated with decreased cardiovascular disease and mortality, lower body weight, and lower diabetes risk.
  • “In a prospective cohort study, consumption of artificially sweetened beverages increased the risk of type 2 diabetes…”

Of course, Drs. Esselstyn, Fuhrman, Greger, McDougall, Barnard and others have been telling us these things for years—this information really isn’t new. What’s new is that the medical establishment is finally listening.

At my 50th medical school reunion in Denver last month, graduating medical students told me they still aren’t being taught much about nutrition or prevention. But maybe this will finally change, and in the near future medical students will learn that health isn’t all about pills and procedure—that inexpensive, low-tech lifestyle changes can prevent and reverse many of the chronic, costly diseases that afflict so many Americans.

 

How to Avoid Blood Cancers by Greg Feinsinger M.D.

There are basically 3 types of blood cancer: leukemia, lymphoma and myeloma.

  • Leukemia involves propagation of mutant white blood cells in the bone marrow. Normal white blood cells fight infection but leukemia cells lose this function. Furthermore, they crowd out normal red and other types of white blood cells in the bone marrow. Around 52 thousand cases of leukemia occur in the U.S. annually, and 24 thousand people die from it.
  • Lymphoma involves mutation and propagation of another type of white blood cell—lymphocytes. The most common type is non-Hodgkin’s lymphoma, of which there are 70 thousand cases diagnosed in the U.S. every year, with about 19 thousand deaths.
  • Myeloma involves plasma cells—white blood cells that produce antibodies. Some 24 thousand Americans are diagnosed with myeloma every year, resulting in 11 thousand deaths.

Treatment of blood cancers has variable results, with the greatest success being childhood leukemia, which now has a 90 percent ten-year survival rate. As with other diseases, prevention is best. In his book “How Not to Die,” Dr. Michael Greger reviews foods associated with decreased blood cancer risk. As discussed in the last several columns, what we eat don’t eat can lower the risk of many types of cancer. Dr. Greger says that studies have shown that “the greatest protection appeared to be against blood cancers.”

  • Sulforaphane* is a strong cancer-fighting micronutrient present in cruciferous vegetables—arugula, bok choy, broccoli, brussels sprouts, cabbage, cauliflower, collard greens, horseradish, kale, mustard greens, radishes, turnip greens, and watercress. Sulforaphane kills human leukemia cells in the lab, and studies have shown that high daily dietary cruciferous intake decreases the risk of lymphoma.
  • In a Mayo Clinic study, people who ate 5 or more servings of green, leafy vegetables a week had a 50 percent lower incidence of lymphoma compared with those eating less than 1 serving a week.
  • There is preliminary evidence that turmeric can slow or stop pre-myeloma changes in humans.
  • Acai berries have been shown in the lab to be effective against leukemia cells, although studies proving that they prevent leukemia in living humans have not been done yet. Of course, Big Food jumped on the favorable lab evidence—beware of “superfood” supplements and shakes, which have not been proven to have any benefit.

Dr. Greger also cites certain foods that increase the risk of blood cancers:

  • People who grow up on poultry farms and workers in the poultry industry are at higher risk for blood cancers. Eating poultry regularly also increases risk. The cause is thought to be certain viruses that cause cancer in poultry and probably in humans (we don’t know for sure yet).
  • Exposure to cattle and pigs has been associated with non-Hodgkin’s lymphoma, and eating them may prove to increase risk of lymphoma although again, we don’t know for sure yet.

*In order for sulforaphane to be released from cruciferous vegetables, an enzyme called mycrosinase is necessary, and this enzyme is inactivated by cooking. One strategy you can use is to eat some raw cruciferous veggies, such as cauliflower or broccoli, before you eat cooked cruciferous veggies—that way microsinase is available to release the sulforaphanes in the cooked veggies. A second strategy is to chop or blend cruciferous veggies at least 40 minutes before you cook them, which allows mycrosinase to do its job. A third strategy is to add mustard or horseradish to cooked cruciferous veggies (mustard greens and seeds, and horseradish, come from cruciferous vegetables and contain mycronase). Frozen cruciferous vegetables are flash-heated prior to freezing, to prolong shelf life—so frozen cruciferous vegetables need to be considered “cooked.”

How to Avoid and Survive Breast Cancer (by Greg Feinsinger M.D.)

Breast cancer is the most common cancer in American women, after skin cancer. Every year about 230,000 women in this country are diagnosed with breast cancer, and 40,000 die from it. Mammograms and self-breast exams supposedly lead to early detection, but in reality, this is “late detection” because breast cancer has been present for years—up to 4 decades– by the time it is diagnosed. Some of the 2-billion cells in our bodies are always mutating. We evolved to eat plants, and plants contain micro-nutrients that destroy these mutant cells before they propagate– animal products lack this ability.

Caldwell Esselstyn, M.D. is one of the two doctors (Dr. Ornish was the other) who proved that plant-based, whole food nutrition with no salt, sugar or added oil reverses heart disease.  Dr. Esselstyn, now in his 80s, started out as a surgeon at the Cleveland Clinic decades ago. He was operating on young women who presented with breast cancer, and the treatment back then was radical mastectomy—a very disfiguring operation. Dr. Esselstyn started looking for a way to prevent breast cancer and found out that populations who ate a plant-based diet had an extremely low rate of breast cancer.

If you are a woman and want to do everything you can to prevent breast cancer, read the chapter on breast cancer in Dr. Greger’s book “How Not to Die,” and search breast cancer on his website NutritionFacts.org. If you are a breast cancer survivor, read “The Cancer Survivor’s Guide, Foods That Help You Fight Back!” by Neal Barnard, M.D. Following are some of the points made in these two books:

  • In 2014 the World Health Organization upgraded its classification of alcohol to “a definitive human breast carcinogen.”  The culprit is acetaldehyde, a toxic breakdown product of alcohol. Dr. Greger notes that the skin of grapes used to make red wine contains a compound that “may help cancel out some of the cancer-causing effects of the alcohol.”
  • Melatonin, the “sleep hormone,” appears to have a protective effect against breast cancer. Melatonin levels are lowered by bright lights including computer and TV screens during pre-bedtime hours and by eating meat (for unknown reasons). Eating vegetables raises melatonin levels (again, for unknown reasons).
  • Excess estrogen increases breast cancer risk, and women need to be hesitant about taking post-menopausal hormones (“bio-identical hormones” have not been proven to be any safer). Body fat produces estrogen, and therefore people who are overweight are at increased risk for breast cancer.
  • Diets high in saturated fat from added oil (coconut oil has the most), meat, dairy products and eggs increase breast cancer risk.
  • Regular exercise such as brisk walking for an hour a day lowers the percentage of body fat, and for that and other reasons exercise lowers breast cancer risk.
  • Heterocyclic amines (HCAs) are carcinogens produced by cooking beef, pork and other meat—and fish and poultry– at high temperatures, such as roasting, pan frying, grilling and baking. According to Dr. Greger, PhIP,  “one of the most abundant HCAs in cooked meat, was found to have potent estrogen-like effects, fueling human breast-cancer cell growth.”
  • Lignans are phytoestrogens that “dampen the effects of the body’s own estrogen” according to Dr. Greger. Lignans are particularly plentiful in flaxseeds, and are also found in berries, whole grains and dark, leafy greens. Flaxseed has even been shown to reduce breast cancer tumor growth. Antibiotics kill health-promoting gut bacteria which are important in activating lignans.
  • According to Dr. Greger, some studies have shown a link between high cholesterol levels and breast cancer risk, thought to be due to our bodies “using cholesterol to make estrogen or to shore up tumor membranes to help the cancer migrate and invade more tissue.” Using statins to lower cholesterol does not decrease breast cancer risk.
  • Fiber, which is found only in plant foods, helps remove estrogen via the GI tract and lowers breast cancer risk. For every 20 grams of fiber intake per day, there was a 15 percent lower risk of breast cancer in several studies.
  • Apple peels contain a compound that activates a breast tumor-suppressor gene.
  • Cancerous stem cells may be why breast cancer can sometimes recur years after apparently successful treatment. Sulforaphane, a component of cruciferous vegetables (e.g. broccoli, cabbage, kale, cauliflower), “suppresses the ability of breast cancer stem cells to form tumors” according to Dr. Greger. Cooking destroys the enzyme that activates sulforaphane so some cruciferous vegetables should be eaten raw (or eat some raw ones before eating cooked cruciferous vegetables).
  • Soybeans contain weak phytoestrogens (phyto = plant) called isoflavones, which attach to estrogen receptors in breast tissue, preventing stronger estrogens from attaching, thereby lowering breast cancer risk. It is thought that high soy intake is why the incidence of breast cancer is low in Asian women. If you are a breast cancer survivor, you should know that according to Dr. Greger, “women diagnosed with breast cancer who ate the most soy lived significantly longer and had a significantly lower risk of breast cancer recurrence.”