Why is there so much over-prescribing of medicine and why is there so much unnecessary medicine?

"You did ask why “perfectly healthy” patients with osteopenia are given medications like Fosamax.

From a primary care perspective, many relatively healthy patients are placed on preventative medications if they have even the slightest indication and no obvious contraindications because

1.) This is what primary care physicians do these days.
2.) It’s expensive for the patient but costs the doctor nothing.
3.) Many of our patients EXPECT us to do something when there is an abnormal test.
4.)We try to do everything to reduce the risk of a lawsuit (defensive medicine)."

(Cynical comments in correspondence with a US-based Dr)
________________________________
Gary Moller comments:
While I love modern emergency medicine, I am much less a fan of medicine's role in the management of the diseases of modern living, including those associated with ageing. I think medicine's track record is appalling. I think our impressive life expectancies have little to do with modern medicine as one sees practiced in surgeries and hospitals and more to do with wonderful public health measures such as sewage and water projects and road and industrial safety programmes.

I would not like to be a Dr nowadays; especially one in the USA. It is a thankless task and has nothing to do with the practice of medicine and more to do with bland processes that may, by chance, have a positive health outcome. This Dr's comments pretty much sum up how a Dr is between a rock and a hard place - they must choose the path of least risk and that means following the trail of "Best Practice Medicine" and ensuring that the patient leaves the consulting room with a script for a prescription drug or further tests. So long as they stick to best practice guidelines, the chances of being sued are minimal even if the patient is severely maimed by that practice.

A further constraint on the practice of good medicine is the fees structure. Good medicine requires time - up to an hour per patient. The way medical practices are structured, a Dr must process patients at the rate of about one patient per 15 minutes at the longest. If not, the practice is in financial trouble. The sad fact is that 10-15 minutes are just long enough for a quick chat and examination and just enough time to enter the details in the computer and to print out a prescrtiption script. This simply adds up to poor medicine. Sadly, this is the status quo and the solutions are not easy. Nor are they cheap and we would sure need a lot more doctors. But; then again, would we? If Drs spent more time with their patients and practiced real medicine, we might all be healthier; needing fewer visits to the Dr, less need for surgery and less need for drugs that often debilitate and finally kill!

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Kiwis Hand Hygiene Habits And Attitudes Worrying

Monday, 17 April 2006, 1:27 pm
Press Release: TNS Research 16 April 2006

Kiwis Hand Hygiene Habits And Attitudes Worrying Given Threat Of Viral Pandemic

New research indicates that New Zealanders are not cleaning their hands well enough to stop the spread of disease.

Gary Moller comments:
This is hardly a surprise, since the teaching and practice of hand washing during childhood is a farce. If people do not have this essential habit in place during their formative years, it is unlikely that it ever will be. The sad fact is that childcare facilities and schools are physically and financially unable to provide proper hand washing training for children.

Here is what I have written about hand washing in the past. Go to this PDF, download it and then click on the link to "I wash my hands - Yeah right!" Enjoy the read

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A fresh warning about the dangers of cortisone injections

I continue to receive inquiries from people who have had cortisone injections to treat injuries to joints, tendons and ligaments, or have recommended that they undergo such treatment. This type of treatment remains disturbingly common and the consequences can be catastrophic.

Read my article here about the dangers of cortisone injections and here.

Photo: Example of chemical excision by cortisone injection causing permanent damage to an important tendon (In this case, tibialis posterior). Only one injection is required to cripple the recipient.

Cortisone is a form of chemical excision. It kills living cells, dissolving living tissue, killing off everything it has contact with. While the relief from pain may be immediate and lasting, the adverse consequences may not appear for weeks or months or even years later. The consequences may be the catastrophic snapping of a tendon or muscle, loss of protective ligaments or the loss of protective cushioning tissue, such as that found in the heel pad. While many people get away without apparent long term consequences, I can tell you that many people definitely are not so fortunate.

Why is it that cortisone continues to be used to widely and for so many different musculoskeletal problems?

• It is cheap, quick and easy and can be done in any medical consulting room
• Relief from pain is instant and it tends to lastJust 1-4 injections seem to do the job which is usually much better and quicker than one would get than other therapies like physio
• If there are any catastrophic consequences, the association with the cortisone injections may never be known and the injecting Dr will never be any the wiser

When a Dr tells you the "risk is 1/1000" bear in mind that this estimation may be based on worthless stats that do not take account the dozens and dozens of unreported adverse side effects that run parallel to each reported case!

If you have an injury that fails to respond to rest and/or medical treatment, or are bothered by chronic pain and treatment with cortisone has been recommended, you are welcome to write to me and I will do my best to assist with helping you with deciding on what is the best course of action to take.

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How much do drugs companies influence your doctor's treatment decisions?

"Approximately US$19 billion is spent annually by drug companies for marketing to doctors. Tens of thousands of sales representatives descend on doctors' offices every day. Patients in doctors' waiting rooms are often outnumbered by drug reps (typically young, female, attractive).

Drug companies write the package inserts of all drugs, carefully including the information they choose and omitting information they want to avoid.

Drug companies underwrite a large percentage of continuing education courses for doctors. In doing so, they make sure that the speakers represent the company view.

Drug companies design studies that are meant to produce favorable results and then publish the studies in medical journals. Studies with unfavorable results are not published.

Drug reps typically bring stacks of studies, all favorable, which impress doctors, who no longer have the time or motivation to search the medical literature themselves.

Drug reps do not include independent studies with less favorable conclusions. Many doctors never see these."
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Gary Moller comments:
What this article did not mention is the fact that drugs companies also invest millions in successfully influencing politicians and bureaucrats. For shocking evidence of the extent of this political lobbying in the USA, go here.

Back in the days when I hired physical education graduates straight from university to work in our rehabilitation programmes it was common for the attractive ones to be recruited within a year or so by our opposition: the drugs companies. Their new job over on the Dark Side was to promote drugs to doctors like blood pressure and cholesterol lowering pills. What is described that happens in the USA happens in NZ. Sadly, NZ allows the advertising of pharmaceutical drugs direct to the consumer using media like television.

Side effects of drugs medication is always underplayed, as is the reporting of any ill effects which consequently distorts official statistics to give the impression of a drug appearing to be much safer than it really is.

If a doctor is even aware of effective alternative treatments for conditions like weak bones, arthritis and high blood pressure these usually receive very low priority treatment that is little more than lip service, or else completely dismissed as a waste of a patient's time and money. I am still astonished at how often a doctor dismisses out of hand a therapy like glucosamine for arthritis despite the wealth of research evidence in its favour.

When a drug is prescribed for a condition like blood pressure this may be done on the basis of a handful of potentially flawed tests of blood pressure done in the artificial envirnoment of a medical clinic. The drug is then dished out with advice along the lines of; "Try this and we will see how it goes". Unless the medication is being closely monitored through the person's day, such as with a blood pressure machine, then the prescribing of this potentially harmful medication sure is a hazardous hit and miss exercise! Would you run a business without having accurate measures of key performance indicators? Of course not and why should your health be any different when ingesting potentially hazardous drugs?

Maybe it is not in the interests of the prescriber or the manufacturer to monitor these drugs properly because it might be discovered more often than not that they are not very good at doing what they are supposed to do and may even be doing more harm than good!

Read more!

Link

Should I allow my injured child to have an Xray or a CT Scan?

"Let's play a new game: Its called Fry Teddy"

Fact: Repeated doses of x-rays from x-ray imaging do increase your risk of developing cancer. The most potent is CT scans, one session of which carries a 1/1,000 risk of developing cancer. The risk is greatest by far with children who have rapidly dividing cells (DNA is most vulnerable to damage during the process of cell division - mitosis).

If your child is injured, such as from a fall, a CT Scan may be ordered as a matter of course to assist with making an accurate diagnosis. An accurate diagnosis is most important, especially if internal injury to the abdomen or brain is suspected. However; those regions of the body are the last places one would ever want to irradiate, especially of a child.

I have written about this before and am writing about it again because the use of the CT Scan continues to be routine in this country and my questioning of doctors and radiologists shows an appalling level of ignorance and lack of any concern about the known health risks of CT Scans. This continues despite the facts and the availability of excellent alternatives.

You can curb the risk from excessive radiation by insisting on using other imaging methods that do not involve radiation these include MRI and ultrasound.

If you are asked to consent to your child undergoing a CT SCan, my advice to you is to refuse to allow it. Insist on readily available alternatives and do not allow yourself to be fobbed off by excuses about availability or extra cost, or flippant comments about how miniscule the risks are - this is your child's long term health that you are dealing with here!

Please read my earlier articles about this most important health issue.
Here and
Here is the original.

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Treat the whole person and not the disease

"Gary
My Vit D was 63 - which is the lower end of the scale.??
Mum's was 41.
Dr said he has no idea what is wrong with my calf, never struck it before. Have had little pain for over a week now, then Wednesday I felt my calf ' clinch' again and it has ached ever since. I was aware of it as soon as I woke up this morning too. No walk. Tried to get appt with Dr today so he could see what it is like when sore, no go. Tried to get appt with physio, no go. She must have realised that I was close to tears as she rung back and said if there was a cancellation she would fit me in. Told me not to walk meanwhile. Seeing her on Monday. Really really depressed and fed up now!"
Anon
_________________________________________
Gary Moller comments:
The modern health system is failing many people because it is based on an inapproriate medical-financial model that treats all diseases as it would an infection or a broken bone.

This woman has been struggling for years with all kinds of health problems, aches and pains, depression and very gradually getting worse. It took several months for us to get the vitamin D test completed and the results are revealing. Cause for concern while also being very good news. Bear in mind that these vitamin D results are her seasonal peak, having been taken towards the end of summer. They will now begin to plummet with winter setting in. Bad news unless corrective action is taken.
Optimum for vtamin D is 120+ especially if one is struggling with illness. Low vitamin D is a factor in depression and muscle and joint pain.

Ongoing physiotherapy, anti-depressants, pain killers and anti-inflammatories are largely a waste of time for her because none of these deal with the root causes of her pain which are to do with lifestyle factors that have been in place and have been doing their damage for decades.

She should also be referred for counselling because she could do with this as support and the Dr can not provide this service during appointments that are just 15 minutes duration. The problem is that a referral to counselling is costly to the patient and this may be a further source of stress. With 99% of the national health $$ tied up in pharmaceutical and surgical based healthcare, there is little funding or investment in these ancillary services.

This lovely person needs to make significant longterm changes to diet and lifestyle, including the way she exercises and she needs to get out in the sun more (without burning of course!). Sadly, the medical system, as it is, is very limited in what it can do to help.

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Is it iliotibial band syndrome - or is it Wobbly wheels syndrome?

"Hi Gary
I did my first marathon in July last year and had very tight ITB bands afterwards. I had a few weeks off then starting running again. When I did my first few runs I developed a shooting pain around my knee. I have been for physio treatment on and off and had a big break from running but I’ve just tried starting back again and the knee pain has come back. It is where my ITB band joins my knee on the outside of my left leg. Do you have any suggestions/advice on how to overcome this injury so I can get back to running again.

Photo: Here is an example of useless therapy in action - Get the cart after the horse please: This patient needs to improve nutritional status first before any kind of physical therapy can be expected to give lasting benefit.

_____________________________________
Gary Moller comments:
Further discussion with this 30'ish very active woman revealed that this injury is just one of a whole succession of injuries over the last few years, all of which have been pushed, prodded, massaged, manipulated or exercised in various way, including the near mandatory fitting of the dreaded orthotics. I have concluded that she is suffering "Wobbly Wheels Syndrome" (WWS). "

I clicked to WWS several years ago because I kept getting inquiries like this: "Gary, I get a week into exercising in the gym and my knee flares up. I rest for a couple of weeks, and go see the physio several times and then my hip goes and then its the knee again. Then its my back and and then my doctor tells me I have blood pressure! I feel as if my body is falling apart. Am I just getting old? Should I just give up and go buy a rocking chair?"

No, it is not really about getting old and this person does not need the rocking chair - But his wheels and other part are getting loose and worn. Time to put the body into the Body Workshop for some major tender loving care.

WWS has little to do with getting old. I think it is a case of the body getting exhausted and depleted. The body needs to recharge its batteries. This means a physical and emotional rest from the rush of modern life and a diet with some supplements to restore depleted stocks.

The therapy that I usually recommend for conditions like recurrent iliotibial band pain, glandular fever or high blood pressure is a combination of corrective exercises, rest, sun and nutrition. This may include advising the person to take a lenghty holiday in the sun in a place like the peaceful and isolated Cook Islands and living on the locally grown fruits and vegetables. This advice works without fail. Their injury and health problems resolve within a few weeks and the person is able to resume exercise later on with energy and enthusiasm and without recurrence of health or injury issues.

I have thought often about setting up a health resort in a place like the Cooks as an alternative to the costly, wasteful and mostly ineffective medical treatment that goes on for conditions like cardiovascular disease, obesity, depression and anxiety, chronic fatigue and arthritis (to name a few). Unfortunately, all the health money has been sucked up by these wasteful therapies, leaving little over for the therapies that actually work.

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Gastric Bypass Horrors

Hi Gary,

Well after 16 weeks my XXXX still has problems from his gastric bypass! The stomach still hasn't healed and his body is rejecting the naso-esophageal feeding tube. He's vomiting most nights and looks like shit!

But he has lost 80kg (or more) from the virtual starvation regime he has been on, so guess that's what they're going to do? He's been told that in the long run it was a success (well.. he has lost the weight...) so now they're going to reverse the procedure. That means another complicated operation and so naturally he's very depressed and more than a little afraid.

He still has a now somewhat deflated spare tire hanging around his waist so will probably need further "body sculpture" surgery to fix that.

He would have achieved the same result if he had not had the surgery and simply drunk the milkshakes he's been squirting up his nose and left it at that.

We are actually concerned about his chances of suviving another operation in his current condition.

Isn't medical science great!

Cheers,

Anonymous
____________________________
Gary Moller comments:
Well, it seems that the pre-holiday hype by the weight-loss surgeons worked and they had at least one taker looking for a "new me" for the New Year.

In my last occupation I got to see a regular procession of failures of routine surgery. For these people that "one in ten thousand" failure rate was 100%. Here in NZ the victim ends up carrying the can. It is very difficult and very costly to sue and the assistance from Accident Compensation is measley to the point of being a miserable insult.

In this case, it would appear there is leakage occuring at one of the points where the stomach and intestine have been severed and joined. The tube is feeding a liquid meal (A poor version of my Super Smoothie) into the gut past the point of leakage. The operation has been a failure and the plan to surgically reverse the procedure is fraught with risk. This poor man is already in a malnourished and weakened state and his friends have every right to fear for his survival.

Read my earlier posting about this kind of mostly unnecessary surgery that is receives so much taxpayer funding. This botched operation has probably cost well over $30k and rising by the day. The reversal will be another $20k. If only there was public funding for a team approach for closely supervised lifestyle, diet and exercise weight loss programmes, similar to what we see on TV reality programmes.

We hear littel about these failures - about 3,000 dead per year in NZ.

In this case, the poor recipient will eventually be chalked up as a success, although with complications. After all - he lost weight didn't he? Let's hope the success is not because he makes a good looking corpse in a regular-size coffin!

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Warfarin linked with brain bleeds

"Warfarin is often prescribed to prevent blood clotting and help combat the most common type of stroke, known as ischemic stroke. However, warfarin itself has been linked to intracerebral brain hemorrhage, another type of stroke caused by ruptured blood vessels and subsequent bleeding in the brain." (Click on the title for the full article).
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Gary Moller comments:
As with most medicines, the full extent of adverse side effects goes largely unnoticed. This is because there is usually no direct link between taking a drug and the adversity.

For example (A real one), a dentist may be conducting a routine tooth extraction to be horrified to find that a chunk of dead jaw bone comes out with the tooth! Of course this means the patient is in real trouble. The condition is called osteonecrosis for which there is no effective treatment. Tests are completed, specialists are consulted and there is no reason for this happening in a 50'ish patient. The only suspiscion the dentist has is that the patient has been taking Warfarin (rat poison) for a decade for a heart condition; but the association is dismissed by the experts.

Here is my take on what is happening: The Warfarin is causing micro-bleeding into the bone of the jaw. Why it shows mostly in the jaw is because the jaw is constantly stressed by the action of chewing on the teeth, thus causing the micro bleeds. Bone is very sensitive to bleeding - the delicate bone cells die off similar to what happens when taking biphosphenates that cause "Fossy Jaw".

My experience is that the majority of people I come across who have been placed on Warfarin need not be on it and non drugs strategies should first have been explored and exhausted.

If for example a patient has atrial fibrilations that may increase risk of a clot that might settle in the brain, how about a course of:

• Fish oil plus vitamin E to stabilise the heart electrical activity and condition the blood to reduce clotting risk
• A multi mineral with magnesium and calcium that relax the heart, nerves and stabilise blood pressure
• A course to learn to breathe properly using the diaphragm and thus stabilise body PH - over-breathing is known to cause heart irregularities that can be so severe as to be mistaken for a heart attack
• Sunbathing to increase vitmamin D levels to at least 120 nmol - low vit D is associated with heart disease (Have you had a blood test for your own vitamin D yet?)

Should these fail to brig about a resolution after about 21 days then the option of medication can be considered.

Read more!

Link

Heart Attack – One runner’s story

“Hi Gary,
I had a 'health challenge' over 11 years ago' at 43. I was lucky to survive the initial episode. Had my wife not decided to have an extra few minutes sleep-in one Saturday morning, she would have been in the shower and I most probably would not have survived it. Some CPR, (not perfect - but just enough before the ambulance guys arrived) helped and a helicopter lift off the flat roof of our house and I was in hospital within the golden 1hr.
I never had any warning symptoms. I had run everyday for 5 & 1/2 years. Was 5th in my club's xc champs masters grade the weekend before when club was strong with masters. The anaesthetist said I had the best set of lungs he had seen. Probably the fitness was also a factor in me surviving.
Of course there have been other runners who did not have my luck in similar circumstances, a number come to mind.”
____________________________
Comment by Gary:
Heart attack can strike the unwary without warning - sometimes while still quite young. The very fit are far from immune and the fitness itself may lull the person into a false sense of security.

Often, there is prior warning that may go on for as long as several days; however, this can be so subtle to be ignored, or easily mistaken for something else, like a touch of the flu or a pulled chest muscle, a strained shoulder, or just a feeling of being a “little under the weather”.

One of your best tools for assessing the health of your heart and circulation is using a digital blood pressure and heart rate monitor. A set of unusual readings of blood pressure and/or heart rate, as compared to your regular norms may be your first and best warning that not all is well - that it is time to seek medical assistance. This could be as simple as a quick phone call made to your doctor.

See your doctor while you are healthy: Have regular health checks, including blood profiles. The fit person who thinks they have a heart like a sturdy Diesel engine and a “good diet” is liable to neglect these with the result that an underlying disorder like excessive cholesterol levels or heart defect may go undetected for many years. Men are the worst when it comes to these matters, including ignoring the obvious hints of a poor family history.

Arrange for you, your family and friends to undertake training in basic CPR (cardio pulmonary resuscitation). The one thing for sure is this life-saving skill will be called upon when least expected.

As is nicely illustrated in this letter modern emergency medicine is a wonderful life saver.

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Dry Mouth Advice

DRY MOUTH By Gabe Mirkin, M.D.
"Dry mouth can be caused by infections, nerve damage and drugs such as blood pressure medication like clonidine, Prilosec and other ulcer medications, antihistamines, stimulants such as amphetamines and intestinal medication called atropine. It can be associated with a type of arthritis.

Lack of saliva causes mouth and neck pain, infections, difficulty talking and sleeping, dental cavities, and difficulty swallowing because saliva lubricates the food and allows it to pass down your throat. Since the mouth is normally full of germs that belong there, it is very difficult to culture a bacteria that causes dry mouth, but some people are cured by taking the antibiotics metronidazole and clarithromycin for a couple of weeks. If that doesn't cure you, you may have to take a 5mg pilocarpine pill four times a day, but they can cause sweating, nausea, running nose, chills, dizziness and frequent urination.

You can also try a machine called Salitron made by Biosonics in Pennsylvania. It uses an electrical probe in your mouth to stimulate the salivary glands to produce saliva. "
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Gary Moller comments:
I thought you might be interested in this article by Dr Mirkin. While the advice might be spot on for treating medical conditioins like Sjogren's, it is not suitable for the majority of people with this problem. Adding more medicine to the pile pills is potentially dangerous and few people can afford extortionately over-priced medical machines. Dry mouth is a potentially serious conditioin that can lead to:

• Severe tooth decay, bad breath and gum disease
• These infections are assoiated with cardiovascular disease
• Diseases of the digestive tract
• Malnutrition
  

Here is my advice:

• If you are on medication that might be causing dry mouth, talk to your Dr and ask if it is absolutely necessary and ask about alternatives.
• If you have digestive problems, high blood pressure or feeling depressed, for example, and you are taking medication there are usually very good lifestyle and nutrition alternatives to medication that has side effects like dry mouth.
  
• If you are a mouth breather, then you need to get to the root cause of this which may be anything from a nasal obstruction, allergy or being over-weight
• Cut out stimulants, including tea, coffee and chocolate
  
• Drink plenty of fresh water so that urination is regular, like every couple of waking hours
  
• Get on a nutrient rich wholefoods diet and cut out sugars and refined flours, artificail sweeteners, colourings and flavourings
  
• Take a multi mineral with magnesium, like Calcium Complete, a selection of omega oils and a natural B Complex that support proper functioning of the nervous system
• Go to sleep and awake the same time every day
  
• Exercise outdoors daily to stimulate mind and body
• Sip fresh fresh cool water frequently and swill and gargle it about the mouth
• Brush and floss morning and evening and see a good dentist regularly
  
• Chew gum, eat apples and other fruit to stimulate the production of saliva and massage the gums
  

Read more!

Link

Depression link with chronic cough

"Among people suffering from chronic cough, more than half have symptoms of depression, new research shows. The good news is that the depression seems to lift as the cough improves."
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Gary Moller comments:
Duuh? Did we miss something? Ok, so I am looking awful and coughing all over the place, grossing other people out. That's depressing.

So, what do we do? Place the person on antidepressants and antibiotics - one or both? Do we take a cough suppressant? This is leading medicine down the wrong path of treating the symptoms and not the cause. Symptoms are being treated to treat symptoms.

While a course of antibiotics may be necessary to get on top of any infection; to really get to the heart of the matter of conditions like chronic chest infections and depression, we need to investigate and deal with the real underlying causes. In doing so, we might find any of the following at work:

• Vitamin D deficient which is linked with chronic respirattory infections and depression
• Malnutrition related to a junk diet that usually goes hand in hand with feeling depressed
• Poor living conditions
• Abuse of drugs including cigarettes, marijuana, prescription drugs and alcohol
• Sleep disturbances
• Chronic stress - financial problems, a lousy marriage or job, no job, no goals, too many committments, out of control kids etc

To not deal with these by means other than drugging is to leave the wolf at the door waiting for the next opportunity to strike.

Read more!

Link

Medical students feel unready to practise safely

" Senior medical students lack confidence in their abilities and some believe they have insufficient knowledge to practise safely, a survey shows.
The survey, published in the latest New Zealand Medical Journal, found that just over half of fourth and fifth-year Auckland University students questioned had doubts about their level of knowledge.
Only one-third of the 156 students surveyed felt their knowledge of anatomy was sufficient to practise safely and fewer than 20 per cent felt they knew enough about pharmacology."
_______________________________

Gary Moller comments:
As per usual, I have a different take on this "disturbing" study: This is very good news. If the level of confidence was higher, I would be really worried. A doctor never knows everything, skills as routine as listeningto a phlemy chest take years to perfect and it is probably not until 10 or so years of full-time practice that one can be confident that a medical practitioner is really hitting his or her straps.The worst person a patient can encounter, next to a doddery old fool who has not kept up with the play, is a young graduate who thinks he or she knows everything from Day One.

Fortunately, nowadays, the vast majority of medical graduates are in some kind of supervised setup and this includes the inexperienced general practitioner who was often quite isolated from immediate professional support. All but a few General Practitioners now work in group practices.Medical and drugs mistakes kill at least 3,000 New Zealanders per year. Many more survive; but must live with the ongoing consequences. Don't be one of them. Don't be an unwitting medical experiment:

• Always seek treatment by a doctor with 10 or more years experience See a doctor with training in your area of need: If you have a knee injury, don't go to a doctor who is interested in gynaecology; see a doctor with post-graduate training in sports medicine
• Stay away from hospital emergency rooms if you can - the lengthy wait is not healthy and the odds are you will encounter a trainee doctor when you are eventually seen to.
• If you are sure the problem can wait, then do so and go see your regular doctor at the earliest you can get in.
• Not sure about waiting? then ring your doctor and seek his or her advice. Ring even if its after hours, you will get the after hours duty doctor.
• If your inner voice is expressing doubts about the diagnosis or the course of treatment, do not hesitate to ask for a second opinion before proceeding.
• If the need for treatment is not urgent; always ask about alternatives, like waiting a while, or alternative therapies like exercise, nutrition, massage, or even a relaxing holiday on a sunny tropical atoll.

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Herniated Disk Improves With Either Surgical or Nonsurgical Treatment

"Patients with herniated disks had improved outcomes during 2 years whether treated surgically or nonsurgically, according to the results of a randomized trial with an accompanying observational cohort reported in the November 22/29 issue of JAMA.

"these findings suggest that in most cases there is no clear reason to advocate strongly for surgery apart from patient preference. For the patient with emotional, family, and economic resources to handle mild or moderate sciatica, surgery may have little to offer."

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Gary Moller comments:

The terrible suffering and restriction on that severe back pain causes can probably never fully appreciated by others more fortunate.

With modern imaging techniques, detailed pictures can be obtained showing herniated discs and other mechanical abnormalities. Modern keyhole microsurgery makes the surgical solution increasingly attractive. But is it really that more effective than a decent physical therapy programme and the progress made by Mother Nature herself over time? This study, and many others over many years, show little extra benefit in most cases of going down the surgical track.

In most cases surgery must still be supported by months of progressive exercise to regain as close to full strength and mobility. This is more or less the same path as the non-surgical treatment approach anyway. Over the long term, there is little to separate the two paths in terms of final destination. I know that from experience of working in back rehabiliation for about 15 years.

If you are suffering back pain; unless you are losing sensation and function, then my advice is to take your time with deciding whether or not to take the surgical path to recovery.

Get the imaging done by MRI or ultrasound (DO NOT allow your internal organs to be irradiated by a cancer producing CT Scan). Discuss the results and the need for surgery with your specialist. Before making a final decision, if surgeryt is recommended, take the results of the imaging away with you and consult a range of back experts who have been in practice for at least 10 years - a physiotherapist, chiropractor, osteopath, various doctors and don't forget the Chinese therapist with the incomprehensible qualifications. If you undergo any treatment with any of them, do not allow any procedure to continue if you feel uncomfortable - tell the therapist to stop and discuss your concerns. Sometimes a regime as simple as a proper exercise programme, massage, stretching and a few key nutritional supplements can give gradual and lasting relief.

All surgery involves an element of risk. The outcome is never assured. The big worry nowadays is hospital based infections. Ask your Dr what the post-operation infection rate is in the hospital you are being referred to. If he/she does not know, you should insist on finding out. Hospitals prefer to keep this kind of information quiet for obvious reasons. Your Dr should know and so should you.

If you have back pain or a friend or relative who is suffering, a good present for the Xmas stocking is my book on Back Pain. You are always welcome to write in with your questions and concerns.

Read more!

Link

Pfizer ends development of "blockbuster" cholesterol drug after excessive patient deaths

"I'm convinced that it works," said Dr. Norman Lasser, director of preventive cardiology at the University of Medicine and Dentistry of New Jersey in Newark.

Study: Drug Lifts Good Cholesterol Level
April 8, 2004

Oops! I think he spoke too soon:

Pharmaceutical giant Pfizer announced that it has ended a clinical trial for the highly anticipated cholesterol drug torcetrapib -- which raises levels of "healthy" HDL cholesterol -- after a high number of patients participating in the trial died or experienced cardiovascular problems.
Pfizer, the world's largest drug firm, was informed over the weekend that an independent board monitoring a study of torcetrapib found that 82 patients out of 7,500 who were taking the drug had died. Fifty-one patients out of 7,500 in the same study who were taking Lipitor -- Pfizer's best-selling cholesterol drug -- also died, though the company said it was not concerned over Lipitor's safety.

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Gary Moller comments:

Chemically tinkering with the way the body does its job and expecting a favourable health outcome is a long shot. Its just another attempt to suck more money out of you via your body.

If you are on Lipitor, or similar cholesterol lowering drugs, talk to your Dr about natural alternatives. If you suffer any joint or muscle pain or feel weak, then go talk to your Dr right away.

Doing it naturally (before the Therapeutic Goods Authority gets in the way)

If you want to improve your good cholesterol naturally, try taking a quality natural vitamin B complex that contains niacin, boost your vitamin D by exposing your skin to sunlight, take cod liver oil during winter or if not going out in the sun often; take flax seed oil and fish oil daily, and use olive oil in your cooking. Reduce your intake of dairy, refined grains and sugars. Exercise briskly each day and go for a long walk along bush trails for up to 3 hours in the weekends, preferably without eating anything. Drink fresh water.

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The Myth of Osteoporosis - Book Review

It is the NZ Osteoporosis Foundation’s claim that 56% of all women over the age of 60 will have an osteoporotic fracture in their lifetime. If that is the case then where are all these people and fractures? They are very dodgy stats, grossly inflated, and based on things like small changes in vertebral shape, the inclusion of all fractures including accidents in the age groups. Amazingly, there has never been an assessment of fracture rates in NZ – these stats are based on an epidemiological study done in Dubbo NSW. People are being frightened into questionable bone mineral denisty tests and, ultimately, onto preventive medications that are of questionable effectiveness and safety.

New Zealand author and health researcher, Gillian Sanson, is now a recognised international expert on osteoporosis. Gillian began her journey of discovery when routine bone density tests revealed a disturbing rate of low bone mineral density in her family, yet no there was no unusual occurence of fractures in her family. How could this be?

Her book, "The Myth of Osteoporosis", is written for the lay person. She asks and offers answers to many pertinent questions such as: "Where are all those post-meonpausal women with osteoporotic fractures?" "Are we being conned?" I wonder. And,"Are bone mineral density tests accurate; or are they causing anxiety where there is little or no cause for concern?" "Do osteoporosis drugs do more harm than good?" "Why; despite our huge consumption of dairy foods, is osteoporosis such an issue?"

I believe that the drugging of millions of women worldwide with biphosphenate drugs may become one of the worst medical scandals in history and this book confirms that something may be amiss. Gillian Sanson is onto something. Why terrorise and drug millions of women when the jury is still out about the safety and effectiveness of these drugs? Besides: There are already more effective and safe interventions like exercise, sunlight and nutrition.

This book is compelling reading and I recommend it as compulsory reading for all women who are the primary target of what is a money making machine of immense proportions, persuasion and of doubtful benefit.

For more information about osteoporosis and related health issues and to order the book go here.

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Therapeutic Products and Medicines Bill being rammed through Parliament

"I am sad to have to inform you that on the 5th December 2006, at 9 a.m., Annette King tabled the ‘Therapeutic Products and Medicines Bill’ in Parliament. The 494-page bill will have its first reading on Tuesday 12th December, at about 3.30 p.m.

This bill will undermine our sovereignty and our democracy, and restrict our access to natural supplements by regulating them as pharmaceuticals through a heavy handed Australian-based Australia New Zealand Therapeutic Products Agency (ANZTPA).

Despite overwhelming opposition, the government is bulldozing ahead with its plans to set up a Trans Tasman regulator.

New Zealand First, having promised publicly that it would never support a Trans Tasman agency that included dietary supplements, has reneged on its promise, and will now support the legislation, along with the government and United Future, through to Select Committee.

The proposed agency is designed to suit large multinational corporations, but will wipe our small New Zealand dietary supplements manufacturers. It will regulate dietary supplements as if they were drugs; impose an inappropriate, pharmaceutical model for low risk healthcare products, and result in increasing pharmaceutical control of natural health products.

If it goes ahead, small natural health businesses will go to the wall as a result of excessive compliance costs.

There will be reduced consumer choice as many ingredients will not be available in the future Some traditional remedies that have been safely used for centuries, such as Chinese herbs and Ayuvedic medicine, will become illegal in a few years time." Sue Kedgely, Green Party MP

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Gary Moller comments:

This is a deliberate action by the pharmaceutical industry to knobble one of the leading threats to their domination of the health system and its billions of dollars which mostly go into the coffers of big business. They are getting away with it.

If you have not realised this yet: Governments serves big business first and the little people who elected them a far off second.

The current medical model only works well with emergency medicine. People are realising this and have been voting with their feet and their wallets by seeking out natural therapies via nutrition and lifestyle measures that empower, rather than disempower and create dependency.

Death by medicine now kills many more New Zealanders than road smashes. This is a huge scandal that still receives little media attention. Most of these deaths are preventable - by prescribing good nutrition, exercise and lifestyle interventions instead of grossly expensive poisons that eventually kill or maim the recipient.

New Zealanders will pay a lot more for their vitamin C and flax seed oil. Many products will no longer be available, or only via a costly prescription. Those who most need them; pensioners, the ill and the injured will no longer be able to afford the cost (Most already struggle with current costs!).

Fish oil or rat poison? At present you have a choice. Lets keep it that way. Write or visit your MP and express your outrage - NOW!

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The 21 day rule for medical treatments

The 21 day rule
I often come across people including athletes who have been undergoing a form of treatment for months; sometimes longer. It raises the question: "How long should one undergo a course of treatment before calling it quits?" As a general rule of thumb, I recommend applying the "21 day rule".

If you are undergoing any form of treatment or therapy be it physical therapy or medicine, apply the 21 day rule.

If, after 21 days of consistent application of the therapy, there has not been a significant improvement in your condition and at a rate or level above what would normally be expected if things were left up to Mother Nature herself, then you need to review what is being done. Far too often, ineffective therapies are continued with long after when their use should have been critically reviewed, modified or ceased altogether. Progress is often erroneously attributed to the treatment or medicine when it is really just the natural healing processes that should be getting the credit.

Nutritional and lifestyle strategies, including exercise, to improve fitness, healing and health can be extremely subtle in effect. These enhance and support, rather than replace or inhibit normal body physiology. Sometimes no obvious benefit is ever demonstrated by exercise, eating well and supplementing where the need exists, other than looking good and feeling great over the long term. Give these strategies at least 3 months to take effect.

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Was it worth it?

Here is an excerpt from a person who has been taking Fosamax: "After about 6 months I experienced gradually worse joint pain that changed me from healthy and athletic to almost crippled. I can barely walk up a stairs one stair at a time and leaning on the railing. Pain and weakness in my knees and hips, both sides is the main problem.

My bone density has increased, but who would want to live this way? I've gone from hiking and biking to practically needing a wheelchair. I've had to move because I couldn't do the stairs to my second floor apartment. I went off it after about a year and I'm desperately hoping my joint function will return. It hasn't improved yet after 1 month off the drug."
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Gary Moller Comments:
As I said in an earlier article, I predict that these anti-osteoporosis drugs are going to be the largest and worst medical scandal in history. While they may increase bone mineral density in the first few years, they are nothing short of being a slow poison. It is disurbing that the 1/2 life of this drug is about 10 years.

Keep informed of this scandal as it develops by going here and then bookmarking this page.

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Having surgery - which doctor is best?

Any surgery, no matter how minor, carries a degree of risk. In fact, the most appalling medical balls-up I have ever encountered happened during an operation to remove a small mole from the cheek of a fit young man. After spending a year or so in an old people's nursing home as a near vegetable, he finally died the most agonising of deaths.

Choose your surgeon carefully - you can't trade in your body if something goes wrong!

• Choose a Dr who is at the peak of his/her professional powers: between 35 and 60 years of age is a good rule of thumb. Stay away from the brilliant young ones and the doddery old ones who are long past retirement.
• Be wary of the foreign trained Dr. I recall a Dr friend telling me of his concern when he noticed a foreign trained colleague taking a quick look through a text book prior to undertaking a potentially risky procedure!
• Get a specialist surgeon and not a general one. If it is a knee op, then get a surgeon that specialises in these; if it is a back op, then go to a back specialist
• Be wary of the latest technique: if the surgeon has not done at least 50 of these "new" procedures, don't volunteer to be a Training Dummy.
• Be wary of having it done in a training hospital: the specialist might be tempted to go on an ego trip in front of the students while poking about your insides; worse still, one of the students might be allowed to "have a go" on you.
• Private is not necessarily the best. The same surgeons that operate in the public system often work privately. Private hospitals may not be properly equipped for emergencies, relying on emergency transfer to the better equipped public hospital. This is what happened to the man with the mole, with the subsequent delays causing irreparable harm.

Find out the following:

• Is there a problem with antibiotic resistant drugs in the hospital at which the surgery is planned? These awful bugs are a growing problem in hospitals, despite attempts to keep this quiet. Choose a hospital that is certified free of these bugs.
• Who is the surgeon with the lowest failure rate? Ask people who have had the procedure. Speak to therapists like physiotherapists, occupational therapists, osteopaths and chiropractors about who they think is best for a particular procedure. If you can get it out of them; ask who to avoid.

Take your time. Take your time!

Is the operation really necessary? Are you being recruited as un-witting high profit contract padding? Here is NZ much orthopaedic surgery is unnecessary; but happens because of the Government contract purchasing of millions and millions of dollars worth of surgery for hips, knees etc. These production line contracts are made all the more profitable when the more costly "necessary" ones are padded out by the many operations that need never happen and which would be better managed by non-surgical methods.

If the answer is that it can wait, then why not wait? Procedures improve, new ones are developed and, surprise - surprise! Things often get better of their own accord. Especially if you have been following my exercise, nutrition and lifestyle advice.

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White Coat Syndrome

If getting checked at the doctor's office makes you nervous, then you may be relieved to learn that you are not alone and it even has its own term: "White coat syndrome". For this reason you should be wary of the results that may indicate that your BP is on the high side. If there is any suggestion of the need to go on medication, insist on self-monitoring your BP at home through the day over a few weeks using a digital BP monitor such as those that can be purchased through www.myotec.co.nz

The doctor's office measurement of your blood pressure is a snapshot which can be misleading and may lead to unnecessary medication. BP fluctuates during a 24-hour period. BP peaks during the daytime hours, and can vary with work and activity. It can also surge during stressful events. For some people, this includes when a doctor or practice nurse applies the BP cuff.

If your BP is elevated, there are nutrtional and dietary measures you can experiment with; but bear in mind that these take time to kick into gear. You must be patient and medication may need to be taken during the interim to protect your cardiovascular health if BP is excessively high.

For a personal consultation about your personal health and fitness, contact Gary Moller.

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Death By Medicine

Gary, Your quote,"The treatment was a success but the patient died" brings to mind my friend Tess who this applies to partly!
Her obitury would read "The treatment was NEVER a success AND the patient died.

From a 59 year old lady who was active, riding a bicycle, making beautiful craft work soft toys. designing and doing tapestries and knitting she over 5 years became a sad, depressed lady with overwhelming bad health.
She had gall bladder disease but the medical report was misplaced and after 6 mths of recurring attacks it was finally removed via key hole surgery. During that time, her attacks of disabling pain were managed with pethidine injections, which a Dr told me she became addicted to.
From then on things went wrong. Her legs became ulcerated and swollen as did face and neck. they said she had Cushings syndrome. she couldn't walk and became diabetic requiring daily insulin injections and finally died.
The treatment didn't seem to help so they just kept on adding to it.
During the last months of her life she was having 11 different medications daily (22tablets total)
and 10units of insulin daily.
Officially she died from Cushings.
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Gary Moller comments:
I am sorry to hear of your friend's passing and can understand your concern with the treatment she received.

While she officially died of Cushings, every indication is that she really died from the consequences of medical bungling, the complications from surgery gone wrong and over medication.

Cushing's syndrome occurs when the body's tissues are exposed to excessive levels of cortisol for long periods of time. Many people suffer the symptoms of Cushing's syndrome because they take glucocorticoid hormones such as prednisone which she was taking large doses of over a protracted period of time.

Pancreatitis, leading to diabetes is a complication of keyhole surgery to remove the gall bladder. Such surgery should only be attempted by a specialist in the procedure.

The 12 medications that she was on is a nightmare of potential interactions and adverse reactions (I have seen the list).

Here in NZ it has been claimed that medical error, including adverse reactions to drugs, claims over 3,000 lives per year making this the 3rd leading cause of death after heart disease and cancer. That the very distant 4th placeholder (Road smashes) gets so much attention while medical error receives so little, is a mystery to me and bordering on being downright scandalous.

With the ageing population and the increasing medicalisation of the healthy, I predict it will not be long before medical error becomes the leading cause of preventable death in the developed world.

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Praise be to emergency medicine

Some readers may have the impression that I am anti-medicine. I certainly am not.

I am a rabid fan of emergency medicine. That is the kind of medicine that you see on popular television programmes like ER (I hardly ever watch it, btw). It wasn't too long ago that a broken thigh bone was close to a death sentence, as was a stroke, heart attack, full body burns or a hard whack on the head. Plastic surgery repairs the most horrific damage and disfigurement.

Last year a not so elderly relative suffered a heart attack in the middle of the night. I have no doubt she would be dead if it were not for the remarkable skills of the doctors and the modern technology of emergency medicine. This is when the powerful anti-clotting drugs and the rest worked their wonders to rescue a life from the brink of oblivion.

What I am not impressed with is the vain and wasteful attempts to then apply the same medical model to prevention of diseases that are largely the result of lifestyle, diet and natural ageing. The very same drugs that are used to resuscitate and stabilise are simply not appropriate for long term use.

So, if we take my relation: She is now on a cocktail of powerful chemicals. Despite all the expenditure on rescuing her, nothing at all has been done to modify those lifestyle, diet and exercise factors that contributed to the heart attack in the first place. Other than the prescriptions and the occasional GP followup, she is as good as forgotten. Until the next one.

One could also validly argue that these very prescription medicines that have been prescribed for prevention actually get in the way of introducing effective prevention measures that are health based.

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Some fatty acids better than electronics at preventing sudden death

ST. PAUL, Minn., Aug. 29 (UPI) -- U.S. scientists say omega-3 fatty acids might prevent more sudden deaths than defibrillators in homes and public places or even implanted defibrillators.
Researchers at Regions Hospital in St. Paul, Minn., compared such preventive strategies in a computer-simulated community of 100,000 people that resembled the population of Olmsted County, Minn., in 2000.
By raising omega-3 fatty acids levels among the cyber-Olmsted citizens, Dr. Thomas Kottke and colleagues were able to lower overall death rates in the simulated population by 6.4 percent.
By contrast, automated external defibrillators, or AEDs, reduced death rates by 0.8 percent, and implanted defibrillators, ICDs, reduced deaths by 3.3 percent.
People can raise their omega-3 levels by eating fish or taking supplements.
Kottle said the research suggests raising omega-3 fatty acids "would have about eight times the impact of distributing AEDs and two times the impact of implanting ICDs."
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Gary Moller comments:
What continues to amaze me is how little traction these studies have on prescribing practices.

It was not that long ago that we considered food to be a rather passive contributor to health (Not sure if this is the best way to describe this, but it'll have to do). We now know that certain foods or food derivatives have powerful preventive and therapeutic effects.

So, for example, if a person has elevated risk of a heart attack or stroke, it makes sense to deliberately boost their intake of healthy oils that we know have important protective effects on the heart muscle and the circulation. (Of course, we would do a few other preventive measures as well).

Example: reducing risk of a blood clot; if, as the evidence is crying out, the omega oils have powerful stabilising effects on the blood, why would anyone ever want to prescribe an expensive and toxic medication that is based on rat poison?

Is it because, like vitamin D (derived from sunlight), these oils are cheap and freely available?

To me the choice for prevention is a no-brainer - who would ever want to cart around a bulky electronic defribulator!

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Wizard Of ID

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Confusion between pathology and symptoms

When it comes to medical treatment, the most common failing I see is the confusion between the true cause (pathology) and the symptoms of an ailment. This is most frequently the case when medicines are prescribed for conditions like heart and circulation disease, depression, overweight, osteoporosis and sexual dysfunction.

A medical professional from overseas recently sent me the following animated parody that illustrates this common treatment failing in an amusing but powerful way.

Click here and enjoy the presentation! The town of allopath

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Essential reading: Imaging X-rays Cause Cancer

Imaging X-rays Cause Cancer

"Let's play a new game: Its called Fry Teddy"

Go here for a PDF summary of the BEIR VII report on this most important subject.

http://fermat.nap.edu/execsumm_pdf/11340.pdf

The report was issued by the National Academy of Sciences in the fall of 2005. The National Academy of Sciences is the largest scientific body in the world. The focus of their report was the part that ionizing radiation plays in the development of cancer. The benchmark that they came up with is that an x-ray exposure of 10 mSieverts (mSv; units that radiation dose is measured in), which is roughly equivalent to the radiation a patient is exposed to with a CT study of the chest or a CT study of the abdomen, produces cancer in 1 per 1000 patients.

Read the following quotation by imaging expert Dr Richard C. Semelka, MD:

“The indisputable fact, and in my opinion rendered truly indisputable by the BEIR VII report, is that medical x-rays cause cancer. BEIR VII also emphasizes that there may be no safe lower limit.^[1] This statement taken as said has the potential to cause considerable alarm, so my intuitive modification is that perhaps below the dose of a standard body CT, which is approximately 10 mSieverts (mSv; units that radiation dose is measured in), there is likely negligible if any risk for an individual test.

However, even 1 body CT scan (1 CT scan of only 1 of the following regions: the chest region, the abdominal region, or the pelvic region) carries with it some element of risk. The risk that BEIR VII reports is 1 in 1000 chance of developing cancer from a 10 mSv radiation dose. In my prior report, I described what is written on the US Food and Drug Administration Web site, which is a 1 chance in 2000 of developing cancer from a dose of 10 mSv. The BEIR VII report doubles that risk. The risk in children is even higher, with a reported chance of 1 in 550 of developing cancer.”

Read this extract carefully about what the Dr Semelka says about medical x-rays:

“In general, BEIR VII supports previously reported risk estimates for cancer and leukaemia, but the availability of new and more extensive data have strengthened confidence in these estimates. A comprehensive review of available biological and biophysical data supports a "linear-no-threshold" (LNT) risk model that the risk of cancer proceeds in a linear fashion at lower doses without a threshold and that the smallest dose has the potential to cause a small increase in risk to humans.”

Note that there is no safe lower threshold – cancer risk is linear.

The following is a table of the standard reported dose of radiation for various common imaging procedures:

Table: Average Radiation Doses Associated With Common Imaging Studies

Diagnostic Examination	Effective Dose (mSv)
X-rays
Chest (PA film)	0.02
Head	0.07
Cervical spine	0.3
Thoracic spine	1.4
Lumbar spine	1.8
Abdomen	0.53
Pelvis/hip	0.83
Limbs/joints	0.06
Upper GI	3.6
Lower GI	6.4
Screening mammogram	0.13
CT
Head	2.0
Abdomen	10.0
Chest	20-40
Pulmonary angiography	20-40
PET - CT	25

You can see from this table that many people are easily getting far too much radiation; especially from CT scans and when one takes account the number of x-ray studies that one may receive throughout a lifetime, including dental x-rays.

There is too much damaging radiation in my opinion and the experts now agree.

Patients who are receiving multiple CT scans and more x-rays from other sources are getting dosages that far exceed what would appear reasonable risk.

It is the patients and their families who end up carrying the can for the consequences. By the time any cancers rear their ugly heads, the institutions and the individuals who first ordered the radiation will probably be long gone. Who pays? Ultimately, it is the patient and their families.

Here is what Dr Semelka recommends to patients”

“I believe it is your right to know that radiation exposure from medical x-rays, in particular procedures utilizing high x-ray doses (eg, CT, PET, PET-CT), may result in cancer, and it is your right to request an alternative procedure when that alternative procedure generates comparable diagnostic information. Providers should know which alternative imaging modalities provide comparable information for the medical indication that you have. It is your right, based on the Hippocratic oath that all physicians have taken, that you undergo the safest test that has sufficient diagnostic accuracy to evaluate your condition. I recommend that you refer your provider to the BEIR VII report regarding radiation hazards, and Abdominal Pelvic MRI regarding how to perform and interpret MRI studies -- if the capabilities of MRI are questioned. Liver exams are one study in particular that should almost always be done with MRI.”

Concluding advice:
Always question the need for imaging x-rays, no matter the reason and to avoid CT scans altogether – be the imaging for a dental exam, a suspected fractured foot or to find the source of abdominal pain. In most cases, there is a good alternative. Where there is not, insist on the lowest possible exposure in order to get the job done and always insist on a protective lead shield to protect the rest of your body from radiation scatter.

Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII-Phase 2. 2005. Available at: http://books.nap.edu/catalog/11340.html

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Hospital Dumps 1,800 Patients off Waiting Lists

The Hawke's Bay District Health Board has unanimously approved a move that would see 1,800 people cut from its waiting lists. They will have to go back to their GPs with no hope of surgery in the foreseeable future. Board CEO Chris Clarke says the hospital cannot keep up with the rising demand for its services. 12/04/2006NewstalkZB

Gary Moller comments:
This news is hardly a surprise and something we are all going to have to get used to as our populations age and the positionally challenged youthful generations begin to get old and suffer diseases of old age, such as diabetes, osteoporosis and CHD, in their 30's and 40's. The current medical model simply can not cope with the tsunami of ill health.

When I was doing my studies in rehabiliation through the Otago School of Medicine, our lecturers frequently referred to the "dreaded specialist appointment". This appointment was dreaded by rehabilitation health professionals because it signaled that nothing would, or could, happen with a patient while waiting to see a specialist. Of course, this appointment would be several months out and it usually would take more than a few further appointments before anything of substance would happen.

A typical interaction between a therapist and a patient goes a bit like this:

Therapist: "I would like to start you with a gentle exercise programme to begin strengthening your lower back"
Patient: "I am not allowed to do anything like that until I have seen my orthopaedic specialist about my suspected prolapsed disc".

Nothing happens and any opportunity for early and active intervention is lost because a lesser expert cannot pre-empt the specialist that is yet to be consulted. This is very frustrating.

What we know is people on waiting lists do not get better; the rule of thumb is that they deteriorate. Adding to the problem; if a person is unable to work, due to a health problem, the chances of getting them back into productive employment plummets with each week they are laid up. After about 3 months, the odds of getting this person back into employment are looking pretty grim.

I have written about this growing problem many times and published a substantial discussion paper that offers one piece to the jigsaw, as far as solutions are concerned. You can read it here.

Resorting to dumping people off waiting lists is not the solution; although it might help a little over the short term by enabling some kind of intervention to begin, instead of having the patient sit around doing nothing and getting worse. Sadly, general practitioners, who are now being asked to deal with these dumped patients, are poorly equipped to offer lasting solutions to ailments that are mostly the result of ageing, combined with the effects of poor lifestyle and nutrition choices.

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