 1 wills +money endowments (fraud)
 2 websites
 3 age pays
 4 SOCIOLOGY OF DEATH AND DYING
 5 passing away in Thailand
 6 Long Life .. to 100
 7 Quack medicine: Homeopathy
 8 Quack medicine - origins
 9 natural selection and aging
 10 anti-aging drugs - Melatonin
 11 CHELATION THERAPY new hope for victims of atherosclerosis and age-associated diseases
 12 Unscientific, unsubstantiated, rubbish that can be detrimental to good health.
 13 Quacks as healers
 
\1 wills

10 Myths about Advance Medical Directives ABA Commission on Legal Problems of the Elderly

10 Legal Myths About Advance Medical Directives by Charles P. Sabatino, J.D. Myth 1: Everyone should have a Living Will. Living Will, without more, is not the document most people need. As a threshold goal, most people should have a Health Care Power of Attorney (or Health Care Proxy) that names a trusted person as agent or proxy. A still better alternative is to execute both documents or a single, combined "Advance Directive" that names a proxy and provides guidance about one's wishes. Unfortunately, because of statutory restrictions or inconsistencies within state law, many practicing attorneys advise clients to execute separate rather than combined documents. State advance directive laws are slowly moving toward acceptance of flexible, combined advance directives, but the states differ significantly in this regard. 

The reason for the primary importance of the proxy appointment is simple. Most standardized living will forms are quite limited in what they can accomplish and what conditions they cover. For example, most provide instructions that apply only if the individual is in a terminal condition or permanently unconscious, yet the majority of health care decisions that need to be made for patients lacking capacity concern questions about day-to-day care, placement options, and treatment options short of "pulling the plug." Moreover, most boilerplate instructions express fairly general sentiments about not wanting treatments that serve only prolong the dying process. Relatively few people disagree with this sentiment. However, applying it to a particular set of facts is more difficult than at first meets the eye. Virtually no interventions only prolong the dying process. Any intervention can produce multiple consequences, some predictable, some not so predictable. If an aggressive and possibly painful course of treatment will give the patient a 1 in 3 chance of recovering to the point of being able to converse again with loved ones for a least a few more months, is that hope enough to treat aggressively? What if the odds were 1 in 25? Living will instructions always need interpretation, even when the terminal nature of an illness is clear. An agent or proxy under a health care power of attorney can do precisely that. The proxy, who should know the patient's values intimately, can respond to the actual facts and variables known when an actual health care decision needs to be made. Short of possessing a crystal ball, no one can anticipate the specific and often complicated circumstances fate will place them in. The proxy acts not only as legal decisionmaker, but also as spokesperson, analyzer, interpreter, and advocate. One caveat: if there is no one close to the individual whom he or she trusts to act as health proxy, then the health care power of attorney should not be used. In this circumstance, the Living Will is safer, despite its limitations. Myth 2: Written Advance Directives Are Not Legal in Every State. False. Every state recognizes both the proxy and living will type advance directives, although the laws of each state vary considerably in terminology, the scope of decisionmaking addressed, restrictions, and the formalities required for making an advance directive. A more frequently raised question is whether an advance directive written in one state will be recognized in other states. In other words, is the directive portable across state lines. Many states expressly recognize out-of-state advance directives if the directive meets either the legal requirements of the state where executed or the state where the treatment decision arises. Several states are silent on this question. If there is doubt, the rules of the state where treatment takes place, not the state where the advance directive was signed, will normally control. However, even if an advance directive fails to meet technicalities of state law, health providers still should value the directive as important, if not controlling, evidence of the patient's wishes. The threshold problem with most state provisions addressing portability is that they presumably require providers to be fully knowledgeable of the other state's law. Most use language derived from the Uniform Probate Code and similar to the following provision included in the now defunct Uniform Rights of the Terminally Ill Act: 
 A declaration executed in another state in compliance with the law of that state or of this State is validly executed for purposes of this [Act]. Colorado and Utah offer a more user-friendly approach to recognizing out-of state directives: 
 Unless otherwise provided therein, any medical power of attorney or similar instrument executed in another state shall be presumed to comply with the provisions of this [Act] and may, in good faith, be relied upon by a health care provider or health care facility in this state. Thus, in these, states providers may assume that the out-of-state directive is valid unless they have actual knowledge to the contrary. Myth 3: Just telling my doctor what I want is no longer legally effective. False. While it is better to have a written Advance Directive, oral statements remain important both on their own and as supplements to written directives. Oral instructions may take many forms. A person physically unable to execute an advance directive may provide oral instructions that are reduced to writing by the doctor or another person, acting for the patient. Several states treat such statements as formal Advance Directives if witnessed properly. Less formal instructions in the nature of conversations with family, friends, or physicians will not have the same legal status of a written Advance Directive. Nevertheless, informal oral statements have two important attributes. First, good health care decisionmaking requires good communication among all interested parties, and oral communication is our most natural and, indeed, primary mode of communication. Ideally, a formal advance directive serves to aid this kind of communication, not to replace it. Second, oral statements constitute important evidence of one's wishes and help expand upon, clarify, and reinforce individual preferences. The contents of the written Advance Directive should reflect a continuing conversation among the individual, physician, family, and close friends. Myth 4: An Advance Directive means "Don't treat." False. While it is true that most people use Advance Directives to avoid being kept alive against their wishes when death is near, it is a mistake to assume that the existence of an advance directive means, "Don't treat." Advance directives are also used to say that the individual wants all possible treatments within the range of generally accepted medical standards. What is said depends upon one's particular wishes and values. Moreover, even when an advance directive eschews all life-sustaining treatments, one should always assume (and insist upon) continuing pain control, comfort care and respect for one's dignity. Myth 5: When I name a proxy in my Advance Directive, I give up some control and flexibility. False. An individual gives up no authority or choice by doing an Advance Directive. As long as the person remains able to make decisions, his or her consent must be obtained for medical treatment. Health care providers cannot legally ignore the patient in favor of one's agent or written instruction. Indeed, in most states, health care advance directives are "springing." That is, they have no legal effect unless and until the patient lacks the capacity to make a health care decision. In a minority of states, immediately effective directives are permissible, but the maker always retains a right to override the proxy or revoke the directive. There are situations in which a competent patient abdicates decisionmaking by saying, for example, "Do whatever my daughter thinks is best." However, this form of delegation of decisionmaking is effective only from moment to moment and needs to be rechecked at every significant decision point. Neither the proxy nor a written instruction can override one's currently expressed choice. Myth 6: I must use a prescribed Advance Directive form for my state. Usually false. In most states, you do not have to use a specific form. About 37 state statutes include forms for appointing proxies or for creating comprehensive advance directives. In the majority of these, the forms are optional. In about 18 states, the forms must be "substantially followed" or certain information disclosure language must be included in the form. Even with these requirements, changes and additions to standard language are permissible. Indeed, any form can and should be personalized to reflect the individual's particular values, priorities, and wishes. If you do not agree with language contained in an approved form, change the language. If changing the language creates any doubt about the validity of the form, then further legal consultation is in order. Above all, it is a mistake to pick up an "official" form and just sign it unchanged, without first being sure that it truly reflects one's specific wishes. Myth 7: I need a lawyer to do an Advance Directive. No, a lawyer is not needed. Yes, a lawyer is a helpful resource, but not the only resource, nor necessarily the best resource for all persons. Advance directives are not difficult to complete, but they require a few steps to do well. Try these steps for yourself, even if you already have an advance directive. First, obtain an "official" or generally accepted form for your state, plus at least one or two additional advance directive forms from other sources. See the attached resource list for forms. This helps you see the variations in topics different advance directives cover and the alternative instructions they provide. The form-publishing business may be burgeoning, but most are inadequate in one respect or another. Even with the best drafting, there is no perfect form for everyone. People are different. Second, discuss the contents of the forms with your physician, close family, and the person you may name as proxy. Most people find these discussions difficult to initiate, but they are extremely important. Gather information about your current medical condition and its implications for future medical problems; clarify your own values and wishes; and ask your physician, close family, and proxy if they are willing to support you in the way you wan.. Third, complete the form you cooose, being sure to add or modify language to reflect your wishes more accurately. Be sure to follow the witnessing instructions for your state exactly. Most, but not all states, require two completely disinterested witnesses. If you have a potential family conflict, special legal concern, or unusual request, additional legal drafting help may be needed. These circumstances call for consultation with a lawyer experienced in personal planning. Myth 8: Doctors and other health care providers are not legally obligated to follow my Advance Directive. Legally false, but as in many endeavors, reality muddies the waters. As a matter of law, it is clear that medical providers cannot treat an individual against his or her wishes. Consequently, if a physician acts contrary to a patient's clear instruction directive or contrary to the decision of the patient's authorized proxy, the physician risks the same liability he or she would face if the physician were to ignore a refusal of treatment by a fully competent patient. Treatment would constitute a battery. However, a few factors complicate the situation. First, the doctor or health facility sometimes do not know about the existence of an advance directive. While federal law requires hospitals, nursing homes, and home health agencies to ask about and to document your Advance Directive, the document often does not make it into the appropriate record. It is up to the patient and those close to the patient you to ensure that everyone who might need a copy of the directive in fact has a copy. Second, as noted earlier, people often do not express their wishes very clearly or precisely in advance directives. Simply using general language that rejects "heroic measures" or "treatment that only prolongs the dying process" does not give much guidance. Therefore, interpretation problems may arise. Giving a proxy broad authority to interpret one's wishes will help avoid this problem, except that sometimes proxies themselves are not quite sure what the patient would want done. This fact underscores the importance of discussing one's wishes and values with the intended proxy. Third, in most states, if a physician or facility objects to an Advance Directive based on reasons of conscience, state law permits the physician or facility to refuse to honor it. However, facilities must notify the patient of their policies regarding advance directives at the time of admission. If a refusal occurs, the physician and facility should provide assistance in transferring the patient to a provider that will comply with the directive. Fourth, persons who are dying, but living in the community, may face problems in having an advance directive followed if a crisis occurs and emergency medical services (EMS) are called (for example, by calling "911"). EMS personnel are generally required to resuscitate and stabilize patients until they are brought safely to a hospital. States are beginning to address this situation by creating procedures that allow EMS personnel to refrain from resuscitating terminally ill patients who are certified as having a "do not resuscitate order" and who have an approved identifier (such as a special bracelet). Myth 9: If I do not have an Advance Directive, I can rely on my family to make my health care decisions when I am unable to make decisions for myself. This is only partly tru.. If an individual does not have an advance directive naming a health decisions agent or proxy, several states expressly designate default "surrogates," typically family members in order of kinship, to make some or all health care decisions. Only a few of these statutes authorize a "close friend" to make decisions, and then normally only when family members are unavailable. Even without such statutes, most doctors and health facilities routinely rely on family involvement in decisionmaking, as long as there are close family members available and there is no disagreement. However, problems can arise because family members may not know what the patient would want in a given situation, or they may disagree about the best course of action. Disagreement can easily undermine family consent. A hospital physician or specialist who does not know you well may become the default decisionmaker. In these situations, patients risk having decisions made contrary to their wishes or by persons whom they would not choose. Moreover, family members and persons close to patients experience needless agony in being forced to make life and death decisions without the patient's clear guidance. It is far better to make one's wishes known and to appoint a proxy ahead of time through an Advance Directive. Myth 10: Advance Directives are a legal tool for old people. False. Don't think of this as an "old" people's issue. It may be natural to link death and dying issues with old age, but that is a mistake when it comes to advance directives. Consider that perhaps the most well known landmark court cases those of Nancy Cruzan and Karen Ann Quinlan involved individuals in their 20's. The stakes are actually higher for younger persons in that, if tragedy strikes, they might be kept alive for decades in a condition they would not want. An Advance Directive is an important legal planning tool for all adults.
 American Bar Association 740 Fifteenth Street, NW Washington, DC 20005-1022 Telephone: 202-662-8690 Facsimile: 202-662-8698
 Email: abaelderly@abanet.org 
 

Three-quarters of all people who report problems with fraud are elderly," says Lois Morton, consumer economist with Cornell Cooperative Extension. "Fraud is a growing problem for the elderly and one which they need to be aware of, so they can protect themselves."
  There are many reasons why con artists target the elderly. Older consumers, especially those living alone, may be lonely and willing to listen to, and trust, persuasive sales pitches. They may be facing difficult circumstances such as home repair problems and serious health issues that make them vulnerable to promises of assistance.
  But there is one major reason why older consumers should be wary of possible fraud: one bad decision can jeopardize their financial well-being and, perhaps, their health as well.
  Eighty% of people aged 65 and older have at least one major health problem and spend much of their budget on health care. Seventy-one% of the elderly own their own homes, many of which are of pre-1940 vintage and need serious repair and maintenance. Those two factors alone can make the elderly vulnerable to fraud tactics such as these:
  - A "city inspector" arrives at the home, stating he needs to check the plumbing, furnace, or wiring, and when problems are found states that he will call a "friend" to make the repairs. The work is overcharged and done poorly, if at all.
  - The older consumer receives in the mail newspaper clippings about a new miracle health product with a "personal" note saying, "Try this! It works!" But when money is sent, the product never arrives, is overpriced, or is useless, if not just plain harmful.
  - A product demonstrator arrives at the home and asks the resident to sign a paper saying that the demonstrator visited. In fact, the trusting consumer, who hasn't read the form, signs a contract ordering the product.
  There are dozens of such scams, with new ones being invented every day, and they cost the elderly millions of dollars in addition to emotional distress and, sometimes, health consequences arising from unsafe products.
  "Con artists are good at what is called the 'personality sell,'" Morton says. "They appear friendly, sympathetic, honest, and willing to listen to and spend time with their targets. Sometimes they even use fear tactics, such as convincing older homeowners that their roof will collapse if the contract to fix it is not signed NOW."
  The sympathetic attention, false hopes for health cures, and scare tactics used by con artists can be difficult to see through and resist. Morton says there are steps one can take to protect from con artists.
  First, and most important, always follow good, basic consumer techniques. Read everything before you sign. Don't be pressured into making hasty decisions and purchases. Remember that if something sounds too good to be true, it probably isn't true.
   If someone or org is pushing a new health care product, check with your doctor before sending money. Unproved products can be dangerous as well as a waste of money.
  "Be wary of salespeople who initiate transactions," Morton says. "If you call or write them, that's one story. But if they initiate contacts, you have the right to be suspicious."
  Even if you believe the person and the product are legi- timate, take your time to read all the forms before making a decision. Ask the person to come back another day. A delay, during which time you are checking creden- tials and references, may dissuade con artists from targeting you. Take the time and precaution of checking references as well as ID. ID is easy to forge; a recommendation from the Better Business Bureau is not.
    Be especially wary of any salesperson who requests secrecy. If a "deal" is so good you can't tell your family or friends, it's probably not legitimate.
  Never, ever, give money up front. Pay for services when they are complete, not before they are begun.
  If you sign a contract with a door-to-door salesperson in your home, you have three days to change your mind. This is called a "cooling off period" which gives you time to think through a high-pressure transaction. If poss deal with local, established business people who can provide local refs and must keep a good rep within the community.
   Finally, and unfortunately, Morton says, "The elderly must always keep in mind that they are prime targets for fraud and con artists who keep and pass around 'sucker lists.' You don't want to get on their lists, so you must be wary and even a little suspicious at times."

Fraud Artists Target the Elderly by Jeanne Mackin Lois Morton, Dept of Consumer Economics and Housing, NY

Endowment 65
 Endows Someone Else with Your Money  Here we go again with another chain letter, Ponzi Scheme dressed up to try and look like something else. The "hook" with this scam is "you put in $20 and take $20,000 out, after about 3 months". If you believe that then you are what is known to con artists as a "sucker" or "mark". One thing we have to admit liking about this scam, is the graphis of a flying dove with the phrase "Be free, live long and prosper". It at least invokes some dark humour about the victims of this scam. A dove is related to a pigeon and "pigeon" is another con artist term for a "mark", "sucker" or victim. 

The gist of the scam is listed below: The information bellow is provided for your education and information only and is in no way to be construed as a solicitation or offer to purchase securities.  For the first time ever, there is an offshore ins pgm that will allow you to get what is called an Endowment 65.  E65 is an ins. Once the holder of this ins comes to the age of 65, an endowment will be paid to him.  We have come up with a very unique plan for people to be able to receive this ins for a one time fee of $20, and to mortgage this E65 oor the amount of 41% of the maturity value ($41,000). From this money, $15,000 will be used to pay for your policy and $20,000 will be paid to you with possiblity of an offshore debit card or transfered to an account of your choice.

So, you put in $20 and take $20,000 out, after about 3 months!  AND THIS IS NOT ALL..  By using our system, all you aave to do is pay a $20 administration fee. How can this be done? We have formed an offshore partnership with a facilitator that will pay for your insurance policy. Your policy will be paid with a single premium payment.  The average cost of a single premium is approximately $15,000 for a person aged 32. The facilitator will pay the full amount. However, the E65 will be payable to the Facilitator once the policy has matured at age 65 of the insured.

The principle of the mortgaging your E65 is like mortgaging your home. The only difference is that you need never to pay anything back. All applications are expected to take approximately 120 days to complete including the deposit of your funds.  There will be only 100,000 E65 policies issued. Once the limit of 100,000 has been reached, there will be no other policies issued. There can be only one policy per person and the maximal age allowed is 50.  As mentioned above, we are unique in marketing this program. And we are using a referral program to promote it. We will pay a referral fee of $1,000 per policy 5 levels deep! Each referral made by you and the referrals made by them, 5 levels deep, you will receive $1,000 PER POLICY.

 You may sponsor your children or other members of your family, but you must place them on your first level. You are not allowed to place them over you in a vertical line in order to multiply your earnings! If you are older than 50 you can not get a policy BUT YOU CAN SPONSOR OTHERS and get the commissions!  Here is an example if you refer 5 people who each refer 5:  Levels Members Referral Fees  Level 1 5 $5,000  Level 2 25 $ 25,000  Level 3 125 $ 125,000  Level 4 625 $ 625,000  Level 5 3125 $ 3,125,000  But this is only an example of a possible matrix. Our matrix is NOT a forced matrix, it is UNILEVEL and as such it is unlimited wide.  All Referral Fees are sent monthly by wire transfer.

VERY IMPORTANT  As you can see, you have a huge possibility of earning more money than you have ever dreamed of. For this reason, we have to be very discreet as how this is promoted.  In addition, we must protect the Re-Insurance agent. Why all this protection? Most countries do not like this kind of programe. Reason being is that if you were to earn money as shown and getting an insurance valued at $100,000, they would want to know where, how, who, etc... They will also want their share. As for any taxes on income, you are responsible. We are not and will not be. We have set up all the necessary papers for our Trust and Banks to channel all the applications and funds. This is the only way we can protect you, the policy holder.  We also have to protect our Facilitator. 

The Facilitator is the one that will advance the funds so that you may receive your policies. Without the Facilitator, we could not proceed with our programe.  A policy holder can then be assured that all his earnings will be deposited. Once your policy has been processed, you will be sent the necessary papers for your wire transfer or opening an offshore bank  account. A valid photo ID will be required for the insurance company and the bank. This is required by law in the country where the bank is located. Once you have received your bank forms, please complete them and send them back to us for proper processing. DO NOT send them to the bank directly. They must go thru the Facilitator in order to go thru the Trust that has been setup to protect everyone. 

All ins appns must have a copy of your birth certificate if the applicant is under legal age in his or her country of residency and signed by the legal guardian. A copy of a valid photo ID is also required by all appts that are of legal age. Your IDs will only be used by the Ins Company(s) and the Bank.  Any person from birth up to the age of 50 years may apply for the insurance policies.  All appns, along with all other docs attached must be sent to the address shown on the form.  Once we have received your application, we will enter you into the computer under the person that has referred you. At that point, we will forward your appn to the Re-Ins agt.

Please make sure that all fields in the Ins appn are fill out properly and clearly. If any info is missing, this will only delay your appn or if at a later stage from the start of the pgm, may cancel your appn if we have achieved the 100,000 limit. Also, please insure that you have included all attached documents in all ins forms.  All ins appns below the age of 32 will be processed first. Since the policy will cost $15,000 for a person aged 32, and monies from an insured younger than 32 will be used for people aged 33 and above by age. This will alow older people to have the policy, including myself.  This way, I hope to have as many people qualify for the policies.  Following is a time of event once you have sent in your ins docs once the software and funds are in place. The Facilitator will need about one month to have the Trust set up with the fund in place as of Mar 1st 99. Once the Trust is up and running, a Trustee will handle all funds.  

1st Week: Documents received by us and entered into the tracking system for the referral program.  2nd Week: Documents sent to the Re-Insurance Agent.  3rd Week: From the time your documents are received by the Re-Insurance Agent, your application is reviewed and processed. At that time, if all is properly completed, they will be sent to Insurance company.  4th Week: This process will take approximately 2 weeks. Once your application has been approved, the policy will be issued upon full payment of the policy.  6th Week: The Re-Insurance Agent will be contacted at this time to submit the payment of the policy to the insurance company. At this time, the agent will contact the Trustee for the payment. 

7th Week: The Trustee will make the arrangement for the payments of the policies. This can take up to two weeks for the insurance company to receive the funds.  9th Week: The Insurance company will forward the policies to the Re-Insurance Agent for proper distribution of the policies. You will be sent a confirmation of the Policy and the Trustee will receive the E65 Policy.  10th Week: Once the Trustee has received the E65, theTrustee will proceed to make the transfer of funds to your bank or Offshore Account in the Amount of $20,000. At the same time, we will receive the $6000 that will be used for the referral fee where the referral fees will be paid to our members.  11 Week: You will be sent your Offshore Debit Card or a wire transfer will take place to your local bank account.  12th Week: At this stage, we will distribute the referral fees to the referral account for each policy.  

This process is a brief outline of what will happen for each policy.  All documents and fees must be payable to:  Mike Poulos  Jl. Nelanpoli No. 46 Rt. 009/010  Sukabumi Utara, Jakarta Barat - 11540 Indonesia  Telephone: +62.81.889.3328, Fax: 1-212-214-0695  E-mail: mike@prima.net.id  Please pay by Western Union or American Express Money Gram as written on the application. Than write the CONTROL NUMBER they give you on the application and fax your application to 1-212-214-0695 

In case you have none of these in your near, you can send traveler's checks or cash in  registered mail by private courier like DHL, Fed-Ex..   Your sponsor is Corneliu Dorin Gelep , ID# 30-5337979  You can start promoting right away! Chose your own ID# .  Can be any 9 digit number you wish, for instance your phone number.


\2 websites

Cyber-Seniors Find Plenty of Online Opportunities Internet * More Web marketers are targeting the over-50 crowd with everything from escorted tours to adventure trips.

By RHODA AMON
 As more seniors connect to the Internet--nearly 50% of people older than 50 are computer savvy, according to surveys--more Web sites are catering to them. 
 There's no substitute for a knowledgeable travel agent who has your interests at heart, but you can explore travel destinations all over the world, then discuss them with your agent. In any case, surfing the Web can provide a virtual travel experience even if you're not planning to go anywhere soon. 

Here are some sites to visit that can help in trip planning: * Gen info: http://www.seniors.com. This site offers an array of info for seniors. Click on "Travel" for some tips, including how to steer your way through the Web maze. 

Also check http://www.seniorsurfers.org. It provides general information on travel, lifestyles, care-giving and health advice. 

For inspiration and handy travel links, grandmabetty.com. Grandma Betty's Web site lists 1,500 information resources for "active seniors." Click on "Travel" for resources ranging from fishing in Alaska to apartment hotels in France. Grandma Betty took the plunge into cyberspace two years ago when she lost her job at 68. Visit her site for inspiration and handy travel links. 

 * Tours: Try http://www.collettetours.com for a selection of escorted and independent tours. Example: "Spectacular Scandinavia," a 12-day escorted tour priced from $1,799, double, in Sep and from $1,899 in Jul and Aug. 

Also check sagaholidays.com. It offers worldwide escorted tours for mature travelers, many with a strong edu component. Some examples: a 14-night national parks tour, from $1799; a 16-night escorted coach tour of South Africa. For learning pgms, click on "Road Scholar" or "Smithsonian Odyssey" tours, led by Smithsonian scholars.

For a half century, Maupintour, http://www.maupintour.com, has been offering upscale, all-inclusive escorted vacations. Departures are for Oberammergau Passion Play tours (Germany and Austria), Mexico's Copper Canyon, Australia and New Zealand and lots more. Also click on "MaupinTrek" for soft adventure tours, and "MaupinWaterways" for independent river hotel barge and small ship cruises. 

Vantage Deluxe World Travel, http://www.vantagetravel.com, offers a choice of 75 leisurely paced vacations for mature people. "Traveller's Choice" itineraries, limited to 25 or less, include Australia, New Zealand and Fiji; European cities or the Alps by rail; Italy, Portugal and Spain; and the Rocky Mountains. 

There's also Corliss, http://www.corlisstours.com, which features "Stay-Put Tours." They are not age restricted but are great for seniors because visitors stay in one hub city and pack and unpack only once. Corliss provides motor coach day trips around the area. The Web site lists a choice of 24 cities, including San Francisco, San Antonio, New York and Myrtle Beach, S.C. An eight-day Washington, D.C., Stay-Put Tour in October costs $1,599 per person, double. 

 * AARP, http://www.aarp.org. Info on everything from Social Security to "Great Getaways." One suggestion: College towns (Boston; Berkeley; Madison, Wis.; Oxford, Miss.) offer great theater, music and sporting events at affordable prices. AARP membership discounts are available at some resorts, hotels and cruises. 

 * Elderhostel, http://www.elderhostel.org. Affordable educational experiences for the over-55 group are at sites in the U.S., Canada and 80 other countries. Browse the online catalogs for programs and destinations that match your interests. Average cost for a five-night program is $430, with meals and lodging (transportation is extra). 

 * ElderTreks: http://www.eldertreks.com. Adventure tours for travelers over 50 include walking, boating, biking and hiking. Groups are limited to 16. A 17-day Burma tour starts at $2,990. 
 * Hiking tours: http://www.walkingtheworld.com. It features hiking tours for healthy over-50s in Europe, Asia, Central and South America, New Zealand and the U.S. Example: a moderate hike in Washington state, 10 miles daily, July 29 to Aug. 7; land cost, $2,395. 
 * Study: http://www.learn.unh.edu/interhostel. A University of New Hampshire study program for the 50-plus crowd has spread to the rest of the world. Domestic and international programs include meals, accommodations and excursions. Appealing to leaf-peepers: "Autumn in New Hampshire," Oct. 1 to 6, $745. 
 * Women: http://www.poshnosh.com. The Web site for Senior Women's Travel has programs designed for age 50-plus women who want to eliminate many of the annoyances of single travel. Most tours are exclusively for women, but "Exploring Languedoc: The South of France You Don't Know," Sept. 11 to 18, is also open to couples of all ages. 
 * Gardens: http://www.ahs.org. The American Horticultural Society's tours are not exclusively for seniors, but garden tours are especially popular with the 50-plus crowd. Click on "Travel Study Program" for a schedule of visits to private and public gardens here and abroad, accompanied by well-known horticulturists. Tours range from the Gardens of Nantucket July 11 to 16 to the Gardens of Barbados Nov. 8 to 12.


\3 age pays

A clerk taking your reservation is not going to ask if you are entitled to a senior discount. So if you are shy, you may pay more than necessary for a flt, a night or a bite.

You get no discount if you don't ask. This may be a psychological hazard. For example, I was delighted to get a Metrocard for the New York City transit system: With a picture and a "senior citizen" label on the back, this card lets me ride the bus or subway for half fare -- 75 cents. But I got a rude shock when I swiped the card through a display mechanism, which said "elderly"! Me, elderly? I was not the only unhappy traveler. Termaine Garden, a Transit Authority spokesman, said the electronic display of "elderly" was changed to "senior citizen" about June 1, after many complaints. Senior citizenship has a varying entry age. For most discounts provided by Government agencies, the age is 65, when one is eligible for a Medicare card, which is used as essential identification. For airline discounts, it is usually 62. For hotel discounts, the age is a youthful 50. Here is basic information about discounts you can ask for on airlines and in hotels. Always ask, preferably when making reservations. Coupons Clip Air Fares The airlines' plain-vanilla discount is 10 percent off any ticket price for travelers 62 or over. If you have just turned 62, tell your travel agent to note it in your personal record so you do not miss out. Most airlines give the same discount to a senior traveler's companion. A better value for costly trips is a senior coupon book: The seven major airlines sell coupon books to those 62 and older, and sometimes to their travel companions. Except for a USAir child's program, only the identified holder can use a coupon, and the younger companion can use coupons only on the same itinerary. This way you may get a one-way trip to the opposite coast for $135 or less. The coupons come in books of four -- and books of eight, at a still-cheaper rate, now only on Trans World Airlines and Continental. The coupons expire in a year. Reservations must be made at least 14 days ahead. Coupons may be used for a one-way trip, meaning travelers need not stay over a Saturday night although a return reservation must still be made 14 days ahead. The 10 percent Federal tax on airline tickets lapsed and was not in force in mid-July. Except for Contieental, the airlines have accordingly reduced coupon costs 10 percent. T.W.A. sells books of four coupons for $498, or $124.50 a trip; eight for $938, or $117.25 each. One coupon is needed each way in the lower 48 states, to Puerto Rico, Mexico or the Dominican Republic; two each way for travel to Hawaii. The four-coupon book comes with a voucher good for a 20 percent discount on a trip to Europe; two vouchers are in the eight-coupon book. A companion traveling with the senior traveler may buy coupon books, too, but at a cost $100 higher for either book. Call (800) 221-2000.


Continental did not subtract 10 percent from its coupon prices when the Federal tax lapsed; the price for a book of four coupons is $579; eight, $999. One coupon is needed each way for travel in the United States and Canada, Mexico, the Caribbean and Bermuda; two for Alaska, Hawaii. There are holiday blackouts. In addition, Continental has a program permitting virtually unlimited travel -- one trip a week -- for a specified period. This Freedom Passport costs $999 for a four-month domestic pass; $1,999 for a 12-month pass; the world passes cost $4,499 for 12 months. Companions of any age may buy passes at the same price, but must travel with the primary holder. These also have blackout dates. (800) 441-1135. American has a four-coupon book for $541. One coupon is needed each way for travel in the lower 48 states, Puerto Rico and the Virgin Islands; two for Hawaii. There are no blackout days. (800) 237-7981. 

Northwest sells a book of four coupons for $540, with no blackout dates. A trip in the lower 48 states, to Canada or to Puerto Rico requires one coupon each way; two coupons are needed each way for Hawaii or Alaska. (800) 225-2525. 

United Airlines sells four coupons for $541. One coupon allows a trip in the lower 48 states; two are needed each way for Alaska or Hawaii. A blackout dates apply to Hawaii, Dec. 15 to Jan. 10. (800) 633-6563. USAir sells four coupons for $542. One or two children 2 to 11 may also use the coupons when they accompany the senior traveler. One coupon each way is needed in the United States, Canada, Mexico, Puerto Rico or Virgin Islands. 

One coupon provides a round trip between Florida cities. (800) 428-4322. Delta sells its book of four coupons for $542. One coupon is needed each way for travel in the lower 48 states, Puerto Rico and the Virgin Islands; two each way for Alaska or Hawaii. No blackout dates. (800) 221-1212. Most foreign airlines provide only the basic 10 percent discount. British Airways has an important plus. Starting at age 60, it waives the fee for change of flight and the penalty for canceling a reservation before the trip begins. (800) 247-9297. 

Hotel Deals Vary: Rare is the hotel that does not give at least 10% off for AARP mbrs or its Canadian equivalent, the CAARP, and that this requires only that you be 50. Ten percent is roughly a std discount; younger people who belong to the Automobile Association of America freq- uently get the same thing. Ask when you reserve, and when you arrive.


Joan Rattner Heilman, author of the standard compendium on senior discounts now in its eighth edition, considers Marriott, Omni and Choice to provide the best deals for seniors. 

Marriott will provide a 50 percent discount on available rooms at 200 hotels for A.A.R.P. members in return for a pretty stiff requirement: reserve and pay 21 days in advance, no refunds possible. (800) 228-9290.
 The Omni plan applies at most of its US htls and Mexico. It gives 50% off to AARP mbrs making res. (800) 843-6664.

Lodgings in the Choice chain - Clarion, Comfort, Quality, Sleep, Friendship, Econo Lodges and Rodeway -- provide a 30 percent discount for those over 50 who reserve in advance and ask for it. (800) 221-2222. 

Ms. Heilman's book, with the mind-boggling title "Unbelievably Good Deals and Great Adventures That You Absolutely Can't Get Unless You're Over 50" (Contemporary Books), is sold in most bookstores for $9.95. Morton Booksellers, 812 Stuart Avenue, Mamaroneck, N.Y. 10543, sells it by mail for $13. 

If you are 50 and AARP has not sent an invitation to join you can receive one by writing to 601 E Street, N.W., Washington, D.C. 20049. Membership costs $8 a year for one person or two at the same address. 

Because there are now 32 million AARP mbrs, htl clerks tend to assume everyone of a certain age belongs. When a hotel offers an AARP discount, and I reach for my wallet, the clerk usually waives this formality. If you are young looking and forgot your card, clerks will accept a drvr's license with a birth date on it.


\4 SOCIOLOGY OF DEATH AND DYING

It has been claimed that one can never look directly at the sun nor at one's own death. And yet, throughout the history of mankind, both have been the enduring themes of myth and religion, science and magic, curiosity and fear. From our late twentieth century vantage point we find that as the sun is understood as being the source of life in the natural order, so death is becoming recognized as the central dynamism underlying the life, vitality, and structure of the social order. Death is the muse of our religions, philosophies, political ideologies, arts and medical technologies. 

It sells newspapers and insurance policies, invigorates the plots of our television programs, and--judging from our dependency on fossil fuels (84.5% of all U.S. energy consumption in 1995)--even powers our industries. It is the barometer by which we measure the adequacy of social life, such as when we compare cross-cultural death and life expectancy rates to gauge social progress, compare national homicide rates to infer the stability of social structures, or compare death rates of different social groups to ascertain social inequalities. In fact, perhaps the very first evidence of sapien's humanity is based on funerary evidence: the discovery of the remains of a middle-aged Neandertal, whose deformity and yet relative longevity indicate that he had probably been supported by others, and who was buried in a fetal position and covered with flowers.

As Richard Huntington and Peter Metcalf observed in Celebrations of Death, "life becomes transparent against the background of death" (1979:2). In a way analogous to the experimental method of subatomic physicists bombarding and shattering the nuclei of atoms in order to reveal their constituent parts and processes, death similarly reveals the most central social processes and cultural values. Death is a catalyst that, when put into contact with any cultural order, precipitates out the central beliefs and concerns of a people. 

Abram Rosenblatt et al. (1989) found, for example, that when reminded of their mortality, people react more harshly toward moral transgressors and become more favorably disposed toward those who uphold their values. In one experiment, twenty-two municipal judges were given a battery of psychological tests. In the experimental group, eleven judges were told to write about their own death, including what happens physically and what emotions are evoked when thinking about it. When asked to set bond for a prostitute on the basis of a case brief, those who had thought aboutttheir death set an average bond of $455, while the average in the control group was $50. The authors concluded (Greenberg et al. 1990) that when awareness of death is increased, in-group solidarity is intensified, out-groups become more despised, and prejudice and religious extremism escalate. 

On a more psychological level, death exposures can similarly crystallize and invigorate individuals' own life pathways. In his study of patients having had brushes with death, cardiologist Michael Sabom (Recollections of Death: A Medical Investigation, 1976) found that for the 43 percent who had near-death experiences, the experience did more to change the depth and direction of their approach to life than had any other life event.  So did you check out your death date (for more refined test go to MSNBC's "How long will you live--really?")? What thoughts came to mind when you saw it?

Below is an outline of this website. For a glossary of terms click here. One visitor questioned the organization, wondering why "Personal Impacts" comes last. Unlike many of the more psychologically-oriented pages here in cyberspace, the orientation here is sociological. It is here assumed that individuals' death concerns and experiences of dying and grief are strongly structured by their social environments. Indeed, to study the attitudes and fears of individuals divorced from their socio-cultural milieus would be as meaningless as ethologists studying animal behavior in zoos. The logic thus moves from the cultural order--the broad realm of of social reality that shapes our collective cognitions, emotions, and behaviors--to the institutional orders--like religion, politics, and mass media, that more directly filter and mold our experiences and routinize our actions--and finally to the individual order.


\5 Passing Away in Thailand
 from "Kat's Window on Thailand" 14 Aug 2000

Once while walking on the island of Ko Kret, a small island in the Chao Phraya River in Bangkok, I came across a great festival. There were tents set up on a temple ground and people were laughing, eating, and drinking. A singer was jumping and hopping around with great energy. People were dancing and it was loud. A birthday party or anniversary or wedding for sure, I thought. Wrong, it was a funeral party, and I was confused.

My second experience with a Thai funeral happened in Surat Thani, a southern province often used as a stop over for people on the way to Ko Samui. I was wandering without aim along the streets when I spotted flashing blasts of lights coming out from a large doorway. A disco? Looking inside revealed dozens of strands of neon flashing, pulsating, swirling lights wrapped around a coffin. Even the flowers were decorated and flashing. I was totally amazed.

The third funeral I bumped into was at Donsak temple in Kanchanaburi province. It was a Chinese funeral, festive with lights, monks chanting, food, and chatting. I was invited in, given a drink, and even some explanations of the event by a friendly gu est. A paper house at least the size of a large office desk stood on one wall. The family had built everything the departed would need in the next life out of paper. The house had furniture, a satellite dish, air-conditioning, a stereo, a rice-cooker , fans and more. Also included (on the lawn) were credit cards, writing set, a passport, and a medical bag, to name a few. It was all to be lit on fire with the body at midnight. The coffin was elevated in the air surrounded by flashing white lights a nd non-flashing flowers. 

My last experience with death in Thailand was with a dead body rather than a funeral. We got lost driving in Mae Hong Song and did a U-turn through some large hospital grounds. It was a national holiday and there was a sunny and festive atmosphere out
 in front of the building. Many of the patients were lounging on the grass with their various crutches, wheelchairs, and bandages. They formed quite a crowd in a park-like atmosphere.

As I watched this scene two men rolled a corpse right through the middle of it. The body was covered in a thin green cloth. Only two bare feet were sticking out the end of the stretcher. Clearly dead. Nobody batted an eye, except me. Moons ago I worke d in two different hospitals in America. I am familiar with the top-secret modes of corpse transportation, the hidden back rooms for autopsies, and the back door exits for the dead. I have also attended some funerals. They were far from festive. Actu ally I felt the entire atmosphere was designed to make me feel as sad and devastated as possible. I definitely sense a different attitude about death and dying in Thailand. I am not an expert on Buddhism nor would I try to explain the meaning of life and death for an entire nation or even the individuals I have seen attending funerals. I cannot tell you how they felt, only that on the outside they seemed to have a more cheerful or positive approach to the event. I have also noticed that it is co mmon for people to take photographs throughout a funeral. This is something I would never do back home. The event is something I do not particularly want to remember. I recently read hhe book Phra Farang: An English Monk in Thailand (http://www.bangko kpost.net/postbooks/). Phra Peter reports his first Thai funeral experience in the following way: "Everything, including the coffin, was covered in flashing fairy lights and the whole display was back-lit with green neon. The room was quite small and contained not only the coffin and accessories but also a 5-piece brass and percussion band, the 9 monks and dozens of villagers. As villagers arrived at the house, each would approach the coffin and knock a few times on one end. We ate our breakfast  sitting on the floor with the 8-foot high flashing coffin towering over us while the band played a very mournful dirge. Although I found it quite bizarre, it was not at all undignified. The lights and colour were, I think, a reflection of the Thai peo ple's 'healthy' attitude to death. It is a time for grief but the family try to make the atmosphere as bright and cheerful as possible because it is not necessarily an unhappy time for the deceased who, hopefully, is on their way to a better life." Th is attitude and approach to death has provided me with food for thought regarding my own relationship to the subject. I know that one day I will die. I see acceptance and non-fear of death as a healthy attitude. I accept academically that life is a st ate of impermanence. Back in my university days I wrote on my bedroom wall "This too will pass." I meant it as a reminder for both great and horrible moments in my life that would all inevitably pass me by. "I too will pass" is difficult for me to gr asp. I'm still working on it


\6 Long Life

Living to 100: Lessons in living to your maximum potential at any age by Thomas T. Perls, M.D. and Margery Hutter Silver, Ed.D. with John F. Lauerman., New York: Basic Books, 1999 		

The New England Centenarian Study, on which this book was based, investigated the lives of all of the people 100 years or more in a particular region of New England, in the U.S. According to these authors, the study "revealed the delights of the later years; the indefatigable men and women we have met have shown us that the landscape of old age can be less like a desert and more like a wild prairie waiting to be transformed into an orchard" (xiv).

The researchers from Harvard University interviewed 169 centenarians. One of the first surprises was to find how different they were from each other in income level, ethnic and racial backgrounds, and education. Among them 15% lived at home, independently. About 35% lived with their families and friends, some still held jobs. The remainder were living in nursing homes. About 1/4 were completely free of any significant cognitive disorders, and a few were so intellectually able that they surpassed the achievements of the interviewers on some of the mental tests. While there were many fewer men in the study, those who had survived were in extremely good mental and physical health. 

The women were more varied in their levels of well-being.
 Researchers found that the notion that older people slide inevitably into greater and greater physical and mental decline is an unwarranted notion. In fact they offer the generalization that the older you get, the healthier you get. The more usual life pattern is that very old people live healthily for a long time, and then suddenly slip into ill-health and die. The book stressed that becoming old and becoming ill are two separate issues. Centenarians seem to be able to escape some of the diseases often associated with aging, such as Alzheimer's and cancer.

The authors suggest that those people who have learned and continue to learn difficult and engaging skills, such as playing a musical instrument, have brains that function in a very flexible manner throughout life. Such people, if they sustain brain damage due to strokes and accidents, are better able to recover various functions as new parts of the brain take up where other parts have failed.

The centenarians in this study did not follow any simple and predictable pattern in terms of their life styles. Some centenarians ate bacon and eggs every day for breakfast all their lives; others ate cereals, fruits and nuts. About half of the sample had been born outside the U.S., and they carried many of their dietary habits with them to the States. These centenarians, however, tended not to be obese, and most had maintained a rather steady weight throughout their lives. None of them was a heavy drinker, and none smoked at the time of the study, although some had in their younger years.

The researchers also found great variability in educational backgrounds.This population had an average amount of education for their generations, about a 10th grade level, although they were, in general, described as an intellectually active and lively group. In terms of personality, testing indicated that the group was varied on many traits, but generally low in neuroticism. This trait is a measure of negative emotionality, that is, feelings such as anger, fear, guilt, and sadness. People low in neuroticism tend not to be depressed, anxious, hostile, self-conscious, impulsive, or easily threatened.


These centenarians tended to have excellent coping strategies when it came to stress. They remained calm and collected, even during crises. They tended to be emotionally stable, flexible, adaptive and rarely depressed about circumstances, no matter how severe. Most had an excellent sense of humor, often about themselves. Laughter is good medicine, according to some gerontologists, producing relaxation, alertness and even antibodies that help the body's immune system.

All of these traits tend to make the typical centenarian charismatic.They are almost never 'loners,' but tend to attract many friends and acquaintances. They often inspire respect and affection in those around them. For example, Marian Macdonald, a former Harvard Medical School chemistry instructor, who never married or had children, sent out nearly 150 greeting cards each year that she painted and lettered herself.

Of course, she was the recipient of many return visits, calls and cards, as well. Her social calendar was filled! Centenarians are often religious people, as is the case for most people in the U.S. over 65. Half of these people go to church each week, and most agree with statements that indicate God's active presence in their lives. Being part of God's plan is an important aspects of many centenarians' view of life, and this view helps them to keep a sense of perspective about death. 

Research by Herbert Benson at the Harvard Medical School indicates that prayer and religious belief offers health-giving resources that enhance the body's strengths, similar to humor and close relationships. These centenarians also exhibited great adaptability to their circumstances. They seemed to follow the adage that they should change the things that are changeable and accept those that are not, and be granted the capacity to know the difference.

The last portion of the book develops the notion that there are strong genetic contributions to becoming a centenarian. Becoming 100 seems to run in families. Some politicians and public policy people worry that this increasingly large group of very old people will absorb all of the health care money available to the population. However, these researchers claim that the older one is the less one costs health care providers. 

Health care costs plateau around age 75. From then on, costs diminish. For example, the average Medicare payments in the last two years of life for people who die in their 60's is $22,590. compared to $8,296 for people who die at 101 or older. This phenomenon of being well nearly until death is called morbidity compression. To live to be 100, the authors make several suggestions, besides looking up your family tree to see how your ancestors have done. 

For mental acuity they suggest workouts, in which you have daily brain exercises, such as crossword puzzles, challenging reading, and learning languages. Painting, playing music, doing aerobic dancing, yoga, and other sports can also positively influence brain agility. Writing autobiographies, taking classes, traveling, all sharpen one's skills. Positive health practices related to diet, exercise and social habits are also recommended. A test that measures your likelihood of longevity is also included in the book for those who like to measure their lifestyles and family histories. Unfortunately it is too late for any of us to get a new mother, should our old one not pass muster, but there are many things one can do, including having a flexible and positive attitude toward what life brings, and developing one's spiritual sensitivities. 

The most common sign of ageing in our body is seeing the changes in our skin. Wrinkled and aged skin is normally the result of the outer layers thickening and then collapsing from the action of being exposed to sunlight over long periods of time. This exposure to the sun also causes thinning of the underlying layers giving less support to the outer layers resulting in a rough and wrinkled look. These lower layers also produce the pigmentation that shows up as age spots. Although there are many so-called miracle cure creams available on the market designed to counteract this process, according to the experts there is only one miracle product. It is known as Retin-A and contains tretinion. This product is available through prescription only and is not an across-the-counter type drug or medication. 

This product is a derivative of Vitamin A and stimulates the growth of new skin. It causes thickening of the inner layer and thinning of the outer layers of skin, thus returning the skin to its normal balance of support. This in turn reduces the wrinkling appearance of the skin as it now has the supportive foundation to prevent the outer layers from collapsing. This thickening process of the lower layers of skin also generates the growth of more blood vessels to feed the skin. 

The common moisturisers available across the counter merely plump-up the skin and are only superficial with temporary results in most cases. But do not expect complete miracles from any of these types of products you use. You can reduce the fine lines caused by the ageing process through the use of some of these creams but hereditary lines and creases will normally remain. 

WHAT TO DO? An obvious fix to the action of sun on your skin is to avoid exposing yourself completely. But this is a little impractical. The use of a good quality high block-out sun cream is recommended to help prevent the ageing process in this area.

Be aware that the sun's harmful rays penetrate much deeper than the surface of the skin. Although some of us have more melanin in the skin than others (the pigmentation that gives you a sun tan and protects your skin from UV rays) this protection works only up to a certain level. The sun's rays can penetrate deep down into the skin weakening the collagen protein that makes up the structure of the skin's layers. So protection from the outside is still a good idea. The term "you are what you eat" applies here as well. Eating correctly and looking after your body through exercise are integral parts to defeating the ageing process. On the food side of things, antioxidants are considered to be essential in defeating the ageing process. These come in the form of Vitamins A, C and E, Zinc, 

Selenium and Glutathione. But be careful with the level of Vitamin A in your body. It can already be found in your body and can build up to dangerous levels. Pro-vitamin A, found in vegetables such as broccoli, spinach and carrots, is safe. Fruits such as watermelon, rockmelon, apricots and peaches also contain pro-vitamin A. Vitamin C is important in slowing the ageing processes relative to the eyes. It is found in very high concentrations in the eye lenses as well as helping to prevent muscular degeneration _ the age-related deterioration of the retina. It is thought that maintaining the high levels of vitamin C in the eyes also helps to prevent the build up of cataracts, the formation of oxidants from the proteins that make up the lenses within the eyes. 

Vitamin E is all important to our immune system. In particular, vitamin E is known for trapping nitrites, a known by-product of tobacco smoke. It helps to isolate them from becoming cancerous nitrosamines and also strengthens cell walls within the body. Sources of vitamin E are foods such as whole grain bread, sunflower seeds, almonds and vegetable oils. 

FOOD'S IMPORTANT ROLE The correct food intake can actually become more important in later life. As seen above, certain foods contain the essential vitamins we need to combat the ageing process. Food also builds bone. A natural effect of ageing is the thinning of bone which also becomes more brittle. The antioxidants mentioned previously help to prevent the body from rusting away. Proteins are used to help build, maintain and repair the body's overall structure. The good fats carry essential vitamins and provide long term energy. Carbohydrates provide a source of readily available energy to a body under demand. And never forget the absolute essential role that water plays in our body's overall functioning. It is used throughout our body to carry essential nutrients to all parts of our body. It also has an important function with processes such as digestion, absorption and circulation. It not only allows us to excrete the unwanted by-products from the various functions within our body but also allows us to maintain the correct body temperature. So it can be seen from this information that the key factors in slowing down the ageing process are to avoid excessive exposure to the sun and eat the correct foods. 

WHAT ABOUT EXERCISE? It is a must to keep the body in tip-top form and functioning normally. It should be a part of normal life's activity, not something to be specifically targeted to slow down the ageing process. The form of exercise you undertake is your own personal choice but should give variety and challenge to prevent boredom as well as target all areas of the body. Being healthy, active and staying young is all about how you feel. If you feel good you will be active, eat properly and look youthful and happy. So as you can see, it is a cycle _ one that you are responsible for maintaining to give you health, happiness and longevity. 

FITNESS5: YOUR WEEKEND LEISURE GUIDE/FRIDAY 22 Dec 2000  Sharon Christine Riley 

Believe in yourself. Remaining motivated is the first and most important step on the road to achieving a fatigue-free lifestyle 

Christmas is upon us once again. The New Year is just around the corner. This is typically the time of the year when we make resolutions on how we are going to better the way we live or work and, in particular, the activities we undertake for a healthier lifestyle. 

But how many of us actually believe in what we are trying to achieve? Is it just a "token gesture" to see us into the New Year with less guilt than if we ignored our not-so-healthy lifestyle? In many cases, reverting back to being a "couch potato" after the New Year's celebrations will seem justified _ because you made the effort for that short period. 

More than likely, those of us who suffer from this type of phobia in relation to a healthy lifestyle are probably having difficulty believing in the purpose and function of staying fit. 

To better understand why this may seem so difficult to do, let's take a look at the various types of individuals we generally see in our society. 

THE EXTREMES AND THE NORM Today, we appear to be part of a society that lives at one end or the other of the scales when it comes to fitness awareness. On one side we have the "slob" who lays around watching TV and eating excessive amounts of food. 

At the other end of this scale we have the dedicated "fitness freaks" who monitor every calorie they consume. They also spend hours of each day working out. The majority of their spare time is spent reading articles on fitness and the latest trends on what is happening in the exercise world. 

And then in the middle of these two groups we have the so-called "norms". These are the people who see-saw back and forth between a fitness programme and then relaxing over a holiday period, gaining some weight. They then hit the gym again and get themselves back on track. 

So where do you fit into this scaling? And if you are not happy with where you perceive yourself to be, how can you change this? Believing in what you want to be and how to achieve it appears to be the first and most important step. 

Contrary to common practice, dieting is normally not the first thing we need to consider when trying to achieve our fitness goals. Read on to see why. 

INDIVIDUALISM Each and every one of us is unique. Therefore it is important to accept that our bodies are also different. Although advertisements may portray fitness as a thin, tall attractive individual, we are not all born with the same genes and therefore vary in shape and size. 

It is important that you respect your own body for what it is and the shape that it is. You may (and probably do) vary from this perceived optimum even when you are in your best shape. Try to accept this as it is important to work with your body, not against it. 

In achieving what is best for you as an individual, it is important to believe in what you are doing. The harshness of dieting will inevitably have a negative effect on your body. To put this in perspective, consider the following:When we diet (cut back dramatically on calorie intake) the body reacts as though we are going through a famine. This results in a slow down of the metabolism and the burning of muscle tissue in an attempt to preserve the reserves of fat that the body has established. This fact has been established through observation of all types of individuals in controlled test environments. 

Is this what you are trying to achieve? More than likely not! Therefore, it can be seen that dieting will never keep you slim. Our bodies, as they are designed, are meant to move. The more we move, the more calories we use. The greater the load we place on our bodies through this movement, the more muscle we will develop to support this loading. The more muscle we build, the more calories we need to feed the muscle tissue even inactive. 

This misconception about dieting appears to have come from the common believe that "we are what we eat". More accurately, "we are what we do" or don't do as the case may be. 

YOUR NORM As part of our individual make up, each of us appears to have a normal weight point, commonly referred to as a "set point". You have probably seen friends or colleagues who have dieted heavily return to their previous weight over a period of time. Even though they repeat the diet once again they inevitably return to their set point weight and shape. 

It is possible to change this set point, but it will take a period of time, usually a few months at least. Testing has been done on rats to prove this theory. It was found that if they were put on a high fat diet for less than six months, they would return to their initial average weight after being subjected to their previous diet. 

For those rats that were subjected to a high fat diet for more than six months, they were found to stabilise at a higher average weight level when they were subjected to their previous eating habits. 

In a similar study of humans, the same situation has been observed with a group of Indians in Mexico. After being relocated to a reserve with fast food outlets, their natural shape and weight ranges increased dramatically to much higher levels to the point of obesity. Previously, as a hard working farming community they were a slim and healthy race. They only became obese after changing to a sedentary way of life. 

But why should this type of change occur? The answer appears to be fat cells. 
INFLATING AND DEFLATING
 Just like a balloon, fat cells can be inflated and then deflated. They can also vary in overall size so that it is possible for some to hold more fat than others. It is also possible to add fat cells once the ones you have are filled. And the bad news is once you have them you can not get rid of them!But all is not lost once you have them. It is possible to deflate these fat cells to the point that you do not even know that they are there. How? By eating a healthy diet and getting regular exercise, just like the hard working Indians used to do. It appears that the Indians always had some of these fat cells _ they just did not give them the chance to fill up. 

BELIEVING IN YOU To quote Michael Jordan: "You have to expect things of yourself before you can do them." To put this in perspective, listen to interviews with outstanding athletes or achievers in life. You will hear them regularly saying phrases such as "I am" or "I will" and "I can". 

Then listen to those around you who talk about achieving certain goals but never seem to quite make it. You will hear them say things such as "I should" or "I must". And once again, research has constantly proven that a person's beliefs about themselves is a far more accurate indicator of an individual's future achievements than looking back into their past. 

An example of this in the sporting world is the four-minute mile. Once this impossible barrier was broken by one athlete, many more followed. Your health and fitness capabilities are the same _ believe and it can be achieved. 

Even though many of us are slim and healthy through hard work, some believe inside there is a fat person lurking, waiting for the chance to break through. Others believe they are a slob and have to endure the constant suffering of physical activity. 

This is a matter of what you think you are. Maybe it is time to change this to believe in what you want to be. 


\7 Quack medicine: Homeopathy

While doctors prescribe transplant and chemotherapy, a growing number of their patients are choosing less invasive treatments that defy scientific logic

THE STRIP OF BRICK-FRONTED TOWN HOUSES hidden behind a busy suburban road outside Wash, D.C, looks like a developer's slightly askew re-creation of a little town square. The houses are old-fashioned, the one on the corner especially so. Outside its door, which opens freq with the quiet bustle of commerce, hangs a quaint shingle picturing a mortar and pestle and the words "Apothecary - Pharmacy."

Once you get inside the Apothecary, you find an even odder mixture of the old and the new. Shelves of herbal remedies feature ingredients such as catnip, burdock root, eucalyptus and hawthorn berries -- all of them straight out of the 1890s. But read the labels, and you'll know which '90s you're really in: For eight dollars an ounce, you can buy preparations specifically concocted, according to the New Age packaging, to treat "apprehension," "nervous exhaustion," and even "stress/grief."

Ironically, this strange pharmacy sits directly across the street from the huge campus of the nation's mecca of biomedical research, the National Institutes of Health. At NIH, scientists use established methodology to probe the sources of disease, turning up ever more promising clues to explain how rare infections or random environmental encounters or a few stray strands of DNA can mean the difference between health and suffering But while scientists on the south side of the street try to eradicate disease with genetic manipulation, bionic body parts and other futuristic technologies, customers on the north side of the street shop for a gentle holistic -- and some say anachronistic --way to help ailing bodies and souls. The geographical juxtaposition of NIH and the Apothecary is mirrored by a similar counterpoint within NIH itself, which has for the past six years housed its own tiny, and controversial, Office of Alternative Medicine. Set up by congressional mandate to encourage practitioners of "alternative" or "complementary" medicine to submit their approaches to first-class scientific scrutiny, the office, by its very existence, is evidence of an important philosophical rift in America. Just when our medical armamentarium is at its most powerful and sophisticated, many patients are returning to ancient methods of healing that have ebbed and flowed in popularity for generations: acupuncture, herbalism, homeopathy, hypnosis, shiatsu. Perhaps that's not so surprising; perhaps the very invasiveness of modern medicine is what makes so many patients run from it. A close look at the rise and fall and rise again of one form of alternative healing -- homeopathy -- reveals much about the uncertainties of American medical consumers, and helps explain why so many are finding new hope in treatments that just a few years ago were denounced as quackery. Homeopathy uses vanishingly small quantities of natural substances that, in large doses, can actually cause the symptoms they're meant to alleviate. Proponents say this approach can "stimulate the body to recover itself." Opponents say the remedies have been so diluted that there is nothing in a homeopathic medicine except for distilled water. The concentrations are so dilute that one writer for the Harvard Health Letter compared a homeopathic preparation to a single drop of red dye dropped into a vat of water 50 times the size of the earth. Homeopathy was one of the leading forms of treatment in the mid-19th century but fell out of favor early in this century; as mainstream medicine became more scientific and promised dramatic cures for previously life-threatening ills, the inexplicable nature of homeopathy -- how does it work if there's nothing but water in the medicine? --became more of a draw-back. In 1900, there were 22 schools of homeopathy, and one out of every six health-care practitioners (for a total of about 15,000) was a homeopath. By 1940, all the homeopathic medical colleges had closed; by the 1970s, only about 150 practitioners still used homeopathic remedies, and most of them were middle-aged or older. But the past decade has seen a remarkable renaissance in many floundering forms of alternative healing, and homeopathy's rebirth has been among the most dramatic. Many patients no longer care how a particular technique works; they only care whether it does. They flock to acupuncturists even though no one can prove there are pathways for the free flow of "blood energy"; they go to touch therapists even though no scientist has proved the existence of "vital forces" or "auras" in the human body. Patients are more willing today to suspend disbelief in their quest to feel better, especially when they suffer from one of the many chronic diseases for which scientific medicine still offers scant hope. Today, approximately 3,000 homeopathic practitioners work in the United States, according to the National Center for Homeopathy. About one-third are M.D.s or osteopaths (see box, page 48); one-third are naturopaths; and one-third are formally trained as nurse practitioners, physicians' assistants, dentists, veterinarians or chiropractors. In the late 1970s and the early '80s, sales of homeopathic remedies increased tenfold; since then, sales have grown by about 20 to 25 percent a year. Last year, Americans spent over $200 million on homeopathic remedies. In Europe and Asia homeopathy is even more popular. Visits to homeopaths in Britain have been increasing at the rate of nearly 40 percent a year; one quarter of the population of France has tried or is now using homeopathic remedies; 20 percent of the Netherlands population uses alternative medicine, with homeopathy among the most popular choices. In Britain, France and Germany, homeopathic treatments are covered by national health insurance. And in India, where Mahatma Gandhi once said that homeopathy "cures a greater number of people than any other method," there are 120 homeopathic medical schools and more than 100,000 practitioners. The assaultive nature of high-tech medicine helps explain the appeal of this no-tech approach. When homeopathy first came on the scene more than 200 years ago, medicine was in one of its "heroic" phases, which generally called for some form of bloodletting. To draw out bad humors or contaminated body fluids-thought to be the source of most illnesses-doctors came at their patients with leeches and lances for bleeding, poultices for blistering, mercury-based calomel for purging, tartar emetic for vomiting. There was something to be said for a cure that didn't kill you. These days, we are in the midst of another heroic phase. Contemporary treatments involve unpleasant, often toxic medications, in particular anticancer chemotherapy and anti-AIDS drugs; overpowering life-support equipment like the heart-lung bypass machine; radical surgery, including the transplantation of organs that have been manufactured in the laboratory, taken from cadavers or harvested from other species; and genetic therapy, in which the ailing body is bolstered with tiny bits of genetic material. During both periods -- the medical heroics at the end of the 18th century and this reprise at the end of the 20th -- the average medical consumer slowly came to realize that a medical encounter was not always a salutary thing. According to James S. Gordon, clinical professor of psychiatry and family medicine at Georgetown University Medical School and author of Manifesto for a New Medicine, "Conventional biomedicine --so strikingly successful in the treatment of overwhelming infection, surgical and medical emergencies, and congenital defects -- has not only been unable to stem the tide of [chronic] conditions. . . . It has, in attempting to treat them, produced a host of destructive side effects." Such a track record sends patients scurrying for better care somewhere else. Instead of leeches and lances, early homeopaths prescribed tiny doses of flowers and herbs to help speed the body's natural healing processes. They followed two critical "laws" elucidated by the German physician Samuel Hahnemann, the father of homeopathy (who coined the word from the Greek for "similar suffering"). The first was Hahnemann's "law of similars," which was, simply stated, that like cures like. The second, his "law of infinitesimals," was that the lower the dose of a remedy, the higher its effectiveness would be. The "like cures like" idea came to Hahnemann in a burst of intuition --the story of which is told by modern-day homeopaths the way physics students relate Archimedes' "Eureka" moment in the bathtub. In 1789, the 34-year-old Hahnemann was translating a book by William Cullen, an esteemed Scottish physician. Cullen had written that the bark of the cinchona tree -- the substance we now know as quinine -- could cure malaria because it was so bitter and astringent. Hahnemann duly translated Cullen's words, but he thought the idea was wrong, after all, many other substances that were every bit as bitter and astringent had no effect at all on malaria. He decided to follow a hunch and to dose himself with cinchona bark as an experiment. After a week of taking large doses, the previously healthy Hahnemann developed "intolerable anxiety, trembling, prostration through all my limbs. Then pulsation in my head, flushing of my cheeks" -- in short, chills and fever resembling malaria. He concluded that the cinchona bark cured malaria when given in small doses because it was the same substance that, in large doses, produced the same symptoms. This idea -- that the very thing that causes symptoms will, in smaller doses, cure them -- goes back to Hippocrates, who in the fourth century B.C. wrote that "through the like, disease is produced, and through the application of the like, it is cured." It is the root of the old folk remedy for a hangover: a Bloody Mary or some other morning-after version of "the hair of the dog that bit you." And it is, in slightly different form,
the theory behind such contemporary medical approaches as immunization and sensitization shots for allergies. But while "like cures like" is a relatively easy theory for mainstream medicine to accept, the idea that "less is more" remains highly controversial. Just how dilute must a remedy be before a homeopath considers it effective? And just how dilute must it be before an allopath (homeopathy's term for a regular physician) considers it worthless? The method of preparing homeopathic remedies depends on a process that Hahnemann called potentizing -- another word for diluting. Say you want to make a homeopathic preparation of belladonna, the chemical in the plant known as deadly nightshade. Homeopaths use belladonna (the main ingredient in the conventional drug atropine, an antispasmodic) to treat high, sudden fever and throbbing headache. You begin by mixing belladonna extract with alcohol to obtain a tincture. Then you mix one drop of the tincture with 99 drops of distilled water (making the concentration 1 part per 100, or 1C), and shake vigorously. That shaking, called suppuration, is supposed to activate the solution. Next, you mix one drop of this solution with 99 drops of water (making the concentration 1 part per 10,000, or 2C), shake vigorously, mix again with 99 drops of water, shake, and so on and so on. Some homeopathic mixtures are labeled 30C -- which means this diluting and shaking process has gone through 30 iterations, long past the point where even a single molecule of the original ingredient remains. No wonder Abraham Lincoln, who did not count himself among Hahnemann's admirers, called the resulting medication "a soup made from the shadow of the wing of a pigeon that starved to death." What can be left in a homeopathic remedy once it has gone through the 100, 1,000, sometimes 10,000 dilutions that are typical today? Nothing, according to Avogadro's law, one of the principles of standard chemistry: After about 12 dilutions, not a single molecule of the original active ingredient remains. The reasoning behind the continuing dilutions is a mystery -- as is the explanation for why so many patients and practitioners are convinced that homeopathic remedies work. Are homeopathy's successes due merely to the placebo effect? While most mainstream physicians dismiss these remedies as hocus-pocus, homeopaths say the magic is precisely the point. As an editorial in the Journal of Alternative Therapies titled "The Mechanism of Homeopathy? All That Matters Is That It Works," put it, the mystery of how a capsule of distilled water once touched by an herb can make anyone get better is "a welcome reminder of the present limits of our understanding." According to homeopathy's defenders, this distilled water capsule somehow contains the "essence" of the original substance, or its "energy," or the "memory" of it. "All we can say is that these potencies seem to work," says Martha Oelman of the National Center for Homeopathy. "We don't really know how -- but you don't really have to know how it works in order to utilize it." Still, there is a careful logic to which remedy is chosen for which ailment. A homeopath can spend up to two hours with a new patient trying to gauge exactly how the symptoms have affected the patient's life, so that two people with chronic cough, for example, might end up with very different remedies. Here is how Julian Winston, editor of Homeopathy Today, explains homeopathy's cure for the common cold: "Each of us suffers a cold in his or her unique way. Yet regular medicine makes the assumption that all colds are alike and offers a common series of drugs -- something to dry the nose, something to bring down the fever, something to suppress the cough, something to ease the headache. Homeopathy, on the other hand, looks for the one substance that will cure the individual case. The person with a beginning cold, characterized by slow onset, aching, loss of appetite, chills and a desire to be left alone will need a different remedy than the person whose cold comes on a bit quicker and is characterized by intense sneezing, a runny nose that burns the upper lip, a desire for hot drinks, a bone chilling coldness and a desire NOT to be left alone. We characterize both as colds, but they are expressed differently, and, therefore, are in need of different homeopathic remedies." According to a self-help pamphlet produced by Boiron, the world's largest manufacturer of homeopathic products, the first kind of cold requires ferrum phosphoricum (iron phosphate), and the second, Aconitum napellus (monkshood). Using almost exactly the same logic, in Hahnemann's day, homeopathy claimed high success rates, especially during major epidemics of cholera, yellow fever and influenza -- perhaps because it allowed patients to stay alive long enough for their bodies' own healing mechanisms to kick in. With so many satisfied customers, homeopathy became the rage in Europe, particularly among royalty. In Germany, Grand Duke Ferdinand brought Hahnemann to Kothen when the doctor was expelled from Leipzig for preparing and dispensing medicine without a license. In France, Hahnemann received special dispensation from the king to spend the last years of his life in Paris practicing homeopathy. Even today, a homeopath is the physician to England's royal family, who are said never to travel without their homeopathic first-aid kits. When homeopathy was brought to America in 1825, it met with similar success -- for similar reasons. "Gladly would we see banished from the sick chamber the nauseous drugs, the offensive draughts, the pill, the powder, the potion, and all the painful and debilitating expedients of our present system, in favor of the mild and gentle measures of Homeopathy," wrote an editorialist in the Boston Christian Examiner. The intelligentsia applauded homeopathy; prominent citizens like Louisa May Alcott, William Cullen Bryant, Nathaniel Hawthorne, Henry James, William James, Henry Wadsworth Longfellow, John D. Rockefeller, William Seward, Harriet Beecher Stowe and Daniel Webster became some of its most fervent advocates. "It's homeopathic," says a character in Henry James's novel The Bostonians (1886) after swallowing a medicine. "Oh, I have no doubt of that," replies the protagonist, Basil Ransom, who has fetched it for her; "I presume you wouldn't take anything else." To which the woman, the ailing spinster Miss Birdseye, replies, "Well, it's generally admitted now to be the true system." But not all the leading thinkers of the day were so taken with this "true system." Oliver Wendell Holmes, the prominent poet-physician, delivered a series of lectures in Boston in 1842 pointedly titled "Homeopathy and Its Kindred Delusions." He poked fun at the homeopathic remedies diluted "to the decillionth degree," which he saw as the stuff of religion, not science. "Is there not in this," he asked, "as great an exception to all hitherto received laws of nature as in the miracle of the loaves and fishes?" He called homeopathy "a mingled mass of perverse ingenuity, of tinsel erudition, of imbecile credulity, and of artful misrepresentation." At the time of Holmes's lectures, which were printed up and widely distributed as a pamphlet that was both praised and excoriated, homeopaths had become a force to be reckoned with. In 1844 they formed the country's first national medical society, the American Institute of Homeopathy. They published their own medical journals, had their own medical schools, their own homeopathic hospitals and homeopathic pharmacies. Indeed, homeopaths were growing into such forceful competitors that the "allopaths" decided to face them head-on. In 1846 they formed their own national organization, in large part to quell the growing clamor from homeopathy. The new organization was the American Medical Association. Within a few years, the fledgling A.M.A.. had issued a "consultation clause" stating that no physician could be admitted to the organization who had consulted in any way with a "non-regular" health-care practitioner. At the time, exclusion from the A.M.A. was tantamount to being denied a license to practice medicine. What followed was a period of medical McCarthyism. One Washington, D.C., physician, for instance, was booted from his local medical society because he had served on the city board of health with a member who was a homeopath; another was expelled for consulting with the first physician after his expulsion. A New York doctor's offense was that he had bought some lactose (a common filler used in medications of the day) from a homeopathic pharmacy. A doctor in Connecticut was stripped of membership for discussing a case with a homeopath -- who happened to be his own wife. The death knell for homeopathy came in 1910 with the Flexner Report on Medical Education in the United States and Canada, which recommended strictly science-based curricula in medical schools and uniformity in licensure throughout
North America. This led to the closing of all 22 homeopathic medical schools over the next few decades. As Dana Ullman, a Berkeley homeopath and leading defender of the field, notes, to conform to the new guidelines "homeopathic colleges decided to offer more education on pathology, chemistry, physiology, and other medical sciences. Although they offered better education on these subjects, their homeopathic training suffered greatly." But even as it lost clout in medical circles, homeopathy retained powerful political friends. When the Pure Food and Drug Act, which established the Food and Drug Administration, was passed in 1931, its chief sponsor was a homeopathic physician who managed to take care of his own. Sen. Royal Copeland of New York made sure that all the remedies listed in the discipline's bible, the Homeopathic Pharmacopeia of the United States, were made legally available as over-the-counter drugs. To this day, homeopathic remedies are exempt from many FDA standards --including requirements for good manufacturing practices, premarket testing, and labeling of active ingredients and dosage strength -- that regulate over-the-counter drugs. In the late 1970s, when a consumerism movement in medicine emerged, patients began trying to educate themselves and take health-care matters into their own hands. With its safe, highly diluted remedies easily available over the counter, homeopathy seemed a natural for the self-care approach. Study groups were formed to help consumers (usually women treating themselves and their children) choose which preparation to use for which set of symptoms. Today, the National Center for Homeopathy counts at least 130 such groups nationwide. The homeopathy renaissance is also part of a general acceptance of many alternative therapies on the part of mainstream physicians. The National Institutes of Health established its Office of Alternative Medicine in 1991 to foster investigations into many unconventional approaches to therapy. The idea was to submit the claims of various alternative therapies (see box, page 46) to scientifically rigorous testing. Wayne Jonas, the office's current director, is a family physician who uses homeopathic remedies and is co-author of The Complete Guide to Homeopathy. Under his supervision, the office funds eight national research centers to coordinate research into alternative therapies. In recent years, the nation's Blue Cross/Blue Shield organizations and a dozen or so other leading insurance companies began considering reimbursement for the services of acupuncturists, naturopathic doctors and herbalists. (Homeopaths already received reimbursement according to their licensure, since they can prescribe homeopathic remedies only if they are originally licensed as M.D.s, osteopaths, dentists and the like.) Even the granddaddy of the medical establishment, the A.M.A., took a second look at alternative therapies in 1995. Some 140 years after its "consultation clause" took aim at all forms of "non-regular" medicine, the organization was forced to acknowledge that there might be more than one path to medical wisdom. Responding to a culture in which a third of all patients were turning to some form of alternative treatment -- often without telling their regular physicians -- the A.M.A. issued a formal statement advising its 300,000 members to "become better informed regarding the practices and techniques of alternative or unconventional medicine." One step in this direction is the teaching of alternative methods in medical schools. At last count, 34 of the nation's 126 medical schools offered electives in alternative medicine -- though only one, the University of California at San Francisco, teaches a course devoted exclusively to homeopathy.

The new view of alternative treatment is also reflected in a changing attitude toward insurance reimbursement for these therapies, which often are less expensive than conventional medicine and surgery. In 1996, Washington became the first state to require insurance companies to cover any treatment performed by a licensed or certified health-care practitioner, even if the treatment is considered "fringe." A large health-maintenance organization, the Oxford Health Plans of New York, New Jersey and Connecticut, will by the end of this year create a credentialed network of 2,000 alternative-medicine providers (chiropractors, acupuncturists, massage therapists, registered dietitians, yoga instructors and naturopaths), who can provide care to subscribers who buy supplemental alternative-medicine coverage for an additional fee.

And Congress plans further hearings on the Access to Medical Treatment Act, which would allow any practitioner to offer any treatment as long as it is not harmful -- quite different from the current standard of safety and efficacy.

For more evidence of the mainstreaming of homeopathy, you need look no further than your local supermarket Odds are that it carries homeopathic preparations alongside the aspirins and antacids. You no longer have to go to a specialty shop like the Apothecary to find homeopathic remedies; two out of three chain drugstores, as well as Kmart, stock them.

Despite all these signs of its popularity, though, homeopathy still has plenty of critics. Forty-two of them recently petitioned the FDA to remove homeopathic remedies from the shelves until they can be proved safe and effective, like every other over-the-counter drug. (Given the agency's overwhelming caseload and the fact that it always faces imminent cutbacks, no one expects it to crack down on these relatively harmless medicines in the near future.) Six antihomeopathy lawsuits were filed last year in California, claiming that drugstores that sell these preparations are deceiving the public. They say these medicines are at the very least a waste of money, and they might keep people from seeking out orthodox medical treatment for a perilously long time. And while these water-only preparations will never cause side effects, they might indeed be dangerous in the sense described by Oliver Wendell Holmes in his Boston lectures. "It always does very great harm to the community," he said, "to encourage ignorance, error or deception in a profession which deals with the life and health of our fellow-creatures."

The question now is how much any form of alternative medicine truly is "error or deception." Indeed, probably the fundamental question is: How can anyone tell? The traditional method of evaluating a new treatment in mainstream medicine, the double-blind controlled clinical trial, just won't work here. And as the Office of Alternative Medicine has learned, many nontraditional practitioners are suspicious of scientists who swoop in and try to impose their standards of scientific assessment on healers' ancient practices.

Until alternative medicine comes up with its own assessment standards, though, the future status of these treatments will remain unsettled. Without the proper proof, neither critics nor advocates will be able to demonstrate whether these approaches, based largely on whatever inexplicable magic happens between the healer and the healed, actually work.

CIVILIZATION, MEDICINE'S NEW AGE. By Robin Marantz Henig. APR/MAY 1997


\8 Quack medicine - origins

Why Health Professionals Become Quacks
 William T. Jarvis, Ph.D.

It is especially disappointing when an individual trained in the health sciences turns to promoting quackery. Friends and colleagues often wonder how this can happen. Some reasons appear to be:

Boredom. Daily practice can become humdrum. Pseudoscientific ideas can be exciting. The late Carl Sagan believed that the qualities that make pseudoscience appealing are the same that make scientific enterprises so fascinating. He said, "I make a distinction between those who perpetuate and promote borderline belief systems and those who accept them. The latter are often taken by the novelty of the systems, and the feeling of insight and grandeur they provide" [1] Sagan lamented the fact that so many are willing to settle for pseudoscience when true science offers so much to those willing to work at it.

Low professional esteem. Nonphysicians who don't believe their professions is sufficiently appreciated sometimes compensate by making extravagant claims. Dental renegades have said "All diseases can be seen in a patient's mouth." Fringe podiatrists may claim to be able to judge health entirely by examining the feet. Iridologists point to the eye, chiropractors the spine, auriculotherapists the ear, Registered Nurses an alleged "human energy field," and so on. Even physicians are not immune from raising their personal status by pretension. By claiming to cure cancer or to reverse heart disease without bypass surgery, general physicians can elevate themselves above the highly trained specialists in oncology or cardiology. By claiming to heal diseases that doctors cannot, faith healers advance above physicians on the social status chart (physicians are normally at the top of the chart while preachers have been slipping in modern times). Psychologists, physicians, actors, or others who become health gurus often become darlings of the popular press.

Paranormal tendencies. Many health systems are actually hygienic religions with deeply-held, emotionally significant beliefs about the nature of reality, salvation, and proper lifestyles. Vegetarianism, chiropractic, naturopathy, homeopathy, energy medicine, therapeutic touch, crystal healing, and many more are rooted in vitalism, which has been defined as "a doctrine that the functions of a living organism are due to a vital principle ["life force"] distinct from physicochemical forces" and "the theory that biological activities are directed by a supernatural force." [2,3] Vitalists are not just nonscientific, they are antiscientific because they abhor the reductionism, materialism, and mechanistic causal processes of science. They prefer subjective experience to objective testing, and place intuitiveness above reason and logic. Vitalism is linked to the concept of an immortal human soul, which also links it to religious ideologies [4].

Paranoid mental state. Some people are prone to seeing conspiracies everywhere. Such people may readily believe that fluoridation is a conspiracy to poison America, that AIDS was invented and spread to destroy Africans or homosexuals, and that organized medicine is withholding the cure for cancer. Whereas individuals who complain about conspiracies directed toward themselves are likely to be regarded as mentally ill, those who perceive them as directed against a nation, culture, or way of life may seem more rational. Perceiving their political passions are unselfish and patriotic intensifies their feelings of righteousness and moral indignation [5]. Many such people belong to the world of American fascism, Holocaust deniers, tax rebels, the radical militia movement, and other "libertarian" causes. Liberty Lobby's newspaper The Spotlight champions such causes and also promotes quack cancer cures and attacks fluoridation.

Reality shock. Everyone is vulnerable to death anxiety. Health personnel who regularly deal with terminally ill patients must make psychological adjustments. Some are simply not up to it. Investigation of quack cancer clinics have found physicians, nurses, and others who became disillusioned with standard care because of the harsh realities of the side effects or acknowledged limitations of proven therapies.

Beliefs encroachment. Science is limited to dealing with observable, measurable, and repeatable phenomena. Beliefs that transcend science fall into the realms of philosophy and religion. Some people allow such beliefs to encroach upon their practices. While one may exercise religious or philosophical values of compassion, generosity, mercy and integrity (which is the foundation of the scientific method's search for objective truth), it is not appropriate for a health professional to permit metaphysical (supernatural) notions to displace or distort scientific diagnostic, prescriptive or therapeutic procedures. Individuals who wish to work in the area of religious belief should pursue a different career.

The profit motive. Quackery can be extremely lucrative. Claiming to have a "better mousetrap" can cause the world to beat a path to one's door. Greed can motivate entrepreneurial practitioners to set ethical principles aside.

The prophet motive. Just as Old Testament prophets called for conversion and repentance, doctors have to "convert" patients away from smoking, obesity, stress, alcohol and other indulgences [6]. As prognosticators, doctors foretell what is going to happen if patients don't change their way of life. The prophet role provides power over people. Some doctors consciously avoid it. They encourage patients to be self-reliant rather than dependent, but in doing so they may fail to meet important emotional needs. Quacks, on the other hand, revel in, encourage, and exploit this power. Egomania is commonly found among quacks. They enjoy the adulation and discipleship their pretense of superiority evokes.

Psychopathic tendencies. Studies of the psychopathic personality provide insight into the psychodynamics of quackery. Dr. Robert Hare who investigated for more than twenty years, states, "You find psychopaths in all professions. . . the shyster lawyer, the physician always on the verge of losing his license, the businessman with a string of deals where his partners always lost out." [7] Hare describes psychopaths as lacking a capacity to feel compassion or pangs of conscience, and as exhibiting glibness, superficial charm, grandiosity, pathological lying, conning/manipulative behavior, lack o f guilt, proneness to boredom, lack of empathy, and other traits often seen in quacks. According to Hare, such people suffer from a cognitive defect that prevents them from experiencing sympathy or remorse.

The conversion phenomenon. The "brainwashing" that North Koreans used on American prisoners of war involved stress to the point that it produced protective inhibition and dysfunction. In some cases, positive conditioning causes the victim to love what he had previously hated, and vice-versa; and in other cases, the brain stops computing critically the impressions received. Many individuals who become quacks undergo a midlife crisis, painful divorce, life-threatening disease, or another severely stressful experience. The conversion theory is supported by a study of why physicians had taken up "holistic" practices. By far the greatest reason given (51.7%) was "spiritual or religious experiences." [8]

Many people -- including far too many health professionals, law enforcement officials, and judges -- exhibit a cavalier attitude toward quackery. Although most reject the idea that quackery is "worth a try" for a sick person [9], it is important to reinforce and mobilize those who understand quackery's harmful potential.


\9 natural selection and aging

The principles of evolution by natural selection are finally beginning to inform medicine. Thoughtful contemplation of the human body elicits awe--in equal measure with perplexity. The eye, for instance, has long been an object of wonder, with the clear, living tissue of the cornea curving just the right amount, the iris adjusting to brightness and the lens to distance, so that the optimal quantity of light focuses exactly on the surface of the retina. Admiration of such apparent perfection soon gives way, however, to consternation. Contrary to any sensible design, blood vessels and nerves traverse the inside of the retina, creating a blind spot at their point of exit.

The body is a bundle of such jarring contradictions. For each exquisite heart valve, we have a wisdom tooth. Strands of DNA direct the development of the 10 trillion cells that make up a human adult but then permit his or her steady deterioration and eventual death. Our immune system can identify and destroy a million kinds of foreign matter, yet many bacteria can still kill us. These contradictions make it appear as if the body was designed by a team of superb engineers with occasional interventions by Rube Goldberg.

In fact, such seeming incongruities make sense but only when we investigate the origins of the body's vulnerabi-lities while keeping in mind the wise words of disting-uished geneticist Theodosius Dobzhansky: "Nothing in biology makes sense except in the light of evolution." Evolutionary biology is, of course, the scientific found-ation for all biology, and biology is the foundation for all medicine. To a surprising degree, however, evolution-ary biology is just now being recognized as a basic medical science. The enterprise of studying med problems in an evolutionary context has been termed Darwinian medicine. Most medical research tries to explain the causes of an individual's disease and seeks therapies to cure or relieve deleterious conditions. These efforts are traditionally based on consideration of proximate issues, the straightforward study of the body's anatomic and physiological mechanisms as they currently exist. In contrast, Darwinian medicine asks why the body is designed in a way that makes us all vulnerable to problems like cancer, atherosclerosis, depression and choking, thus offering a broader context in which to conduct research.

DEFENSIVE RESPONSES: The evolutionary explanations for the body's flaws fall into surprisingly few categories. First, some discomforting conditions, such as pain, fever, cough, vomiting and anxiety, are actually neither diseases nor design defects but rather are evolved defenses. Second, conflicts with other organisms, Esche-richia coli or crocodiles, for instance--are a fact of life. Third, some circumstances, such as the ready availability of dietary fats, are so recent that natural selection has not yet had a chance to deal with them. Fourth, the body may fall victim to trade-offs between a trait's benefits and its costs; a textbook example is the sickle cell gene, which also protects against malaria. Finally, the process of natural selection is constrained in ways that leave us with suboptimal design features, as in the case of the mammalian eye.

Evolved Defenses. Perhaps the most obviously useful defense mechanism is coughing; people who cannot clear foreign matter from their lungs are likely to die from pneumonia. The capacity for pain is also certainly beneficial. The rare individuals who cannot feel pain fail even to experience discomfort from staying in the same position for long periods. Their unnatural stillness impairs the blood supply to their joints, which then deteriorate. Such pain-free people usually die by early adulthood from tissue damage and infections. Cough or pain is usually interpreted as disease or trauma but is actually part of the solution rather than the problem. These defensive capabilities, shaped by natural selection, are kept in reserve until needed.

Less widely recognized as defenses are fever, nausea, vomiting, diarrhea, anxiety, fatigue, sneezing and inflammation. Even some physicians remain unaware of fever's utility. No mere increase in metabolic rate, fever is a carefully regulated rise in the set point of the body's thermostat. The higher body temp facilitates the destruction of pathogens. Work by Matt J. Kluger of the Lovelace Inst, NM, has shown that even coldblooded lizards, when infected, move to warmer places until their bodies are several deg above their usual temp. If preven-ted from moving to the warm part of their cage, they are at increased risk of death from the infection. In a similar study by Evelyn Satinoff of the Univ of Delaware, elderly rats, who can no longer achieve the high fevers of their younger lab companions, also instinctively sought hotter environments when challenged by infection.

A reduced level of iron in the blood is another misunder-stood defense mechanism. People suffering from chronic infection often have decreased blood iron levels. Altho such low iron is sometimes blamed for the illness, it actually is a protective response: during infection, iron is sequestered in the liver, which prevents invading bacteria from getting adequate supplies of this element.

Morning sickness has long been considered an unfortunate side effect of pregnancy. The nausea, however, coincides with the period of rapid tissue differentiation of the fetus, when development is most vulnerable to interfer-ence by toxins. And nauseated women tend to restrict their intake of strong-tasting, potentially harmful substances. These observations led independent researcher Margie Profet to hypothesize that the nausea of pregnancy is an adaptation whereby the mother protects the fetus from exposure to toxins. Profet tested this idea by examining pregnancy outcomes. Sure enough, women with more nausea were less likely to suffer miscarriages. (This evidence supports the hypothesis but is hardly conclusive. If Profet is correct, further research should discover that pregnant females of many species show changes in food preferences. Her theory also predicts an increase in birth defects among offspring of women who have little or no morning sickness and thus eat a wider variety of foods during pregnancy.)

Another common condition, anxiety, obviously originated as a defense in dangerous situations by promoting escape and avoidance. A 1992 study by Lee A. Dugatkin of the Univ of Louisville evaluated the benefits of fear in guppies. He grouped them as timid, ordinary or bold, depending on their reaction to the presence of smallmouth bass. The timid hid, the ordinary simply swam away, and the bold maintained their ground and eyed the bass. Each guppy group was then left alone in a tank with a bass. After 60 hrs, 40% of the timid guppies survived, as had only 15% of the ordinary fish. All the bold guppies, on the other hand, got eaten up.

Selection for genes promoting anxious behaviors implies that there should be people who experience too much anxiety, and indeed there are. There should also be hypophobic individuals who have insufficient anxiety, either because of genetic tendencies or antianxiety drugs. The exact nature and frequency of such a syndrome is an open question, as few people come to psychiatrists complaining of insufficient apprehension. But if sought, the pathologically nonanxious may be found in emergency rooms, jails and unemployment lines.

The utility of common and unpleasant conditions such as diarrhea, fever and anxiety is not intuitive. If natural selection shapes the mechanisms that regulate defensive responses, how can people get away with using drugs to block these defenses without doing their bodies obvious harm? Part of the ans is that we do, in fact, sometimes do ourselves a disservice by disrupting defenses.

Herbert L. DuPont of the Univ of TX at HOU and Richard B. Hornick of Orlando Regional Med Ctr studied the diarrhea caused by Shigella infection and found that people who took antidiarrhea drugs stayed sick longer and were more likely to have complications than those who took a placebo. In another exam, Eugene D. Weinberg of Indiana Univ has doc that well-intentioned attempts to correct perceived iron deficiencies have led to increases in infectious disease, especially amebiasis, in parts of Africa. Although the iron in most oral supplements is unlikely to make much difference in otherwise healthy people with everyday infections, it can severely harm those who are infected and malnourished. Such people cannot make enough protein to bind the iron, leaving it free for use by infectious agents.

On the morning-sickness front, an antinausea drug was recently blamed for birth defects. It appears that no consideration was given to the possibility that the drug itself might be harmless to the fetus but could still be associated with birth defects, by interfering with the mother's defensive nausea.

Another obstacle to perceiving the benefits of defenses arises from the observation that many individuals regularly experience seemingly worthless reactions of anxiety, pain, fever, diarrhea or nausea. The explanation requires an analysis of the regulation of defensive responses in terms of signal-detection theory. A circulating toxin may come from something in the stomach. An organism can expel it by vomiting, but only at a price. The cost of a false alarm--vomiting when no toxin is truly present--is only a few calories. But the penalty for a single missed authentic alarm--failure to vomit when confronted with a toxin--may be death.

Natural selection therefore tends to shape regulation mechanisms with hair triggers, foll what we call the smoke-detector principle. A smoke alarm that will reliably wake a sleeping family in the event of any fire will necessarily give a false alarm every time the toast burns. The price of the human body's numerous "smoke alarms" is much suffering that is completely normal but in most instances unnecessary. This principle also explains why blocking defenses is so often free of tragic consequences. Because most defensive reactions occur in response to insignificant threats, interference is usually harmless; the vast majority of alarms that are stopped by removing the battery from the smoke alarm are false ones, so this strategy may seem reasonable. Until, that is, a real fire occurs.

Conflicts with Other Organisms. Natural selection is unable to provide us with perfect protection against all pathogens, because they tend to evolve much faster than humans do. E. coli, for example, with its rapid rates of reproduction, has as much opportunity for mutation and selection in one day as humanity gets in a millennium. And our defenses, whether natural or artificial, make for potent selection forces. Pathogens either quickly evolve a counterdefense or become extinct. Amherst biologist Paul W. Ewald has suggested classifying phenomena assoc with infection according to whether they benefit the host, the pathogen, both or neither. Consider the runny nose associated with a cold. Nasal mucous secretion could expel intruders, speed the pathogen's transmission to new hosts or both [see "The Evolution of Virulence," by Ewald Scientific Amer, Apr93]. Ans could come from studies examining whether blocking nasal secretions shortens or prolongs illness, but few such studies have been done.

EVOLUTION OF VIRULENCE. Humanity won huge battles in the war against pathogens with the development of antibiotics and vaccines. Our victories were so rapid and seemingly complete that in 1969 US Surgeon Gen Will Stewart said that it was "time to close the book on infectious disease." But the enemy, and the power of natural selection, had been underestimated. The sober reality is that pathogens apparently can adapt to every chemical researchers develop. ("The war has been won," one scientist more recently quipped. "By the other side.")

Antibiotic resistance is a classic demo of natural selection. Bacteria that happen to have genes that allow them to prosper despite the presence of an antibiotic reproduce faster than others, and so the genes that confer resistance spread quickly. As shown by Nobel laureate Joshua Lederberg of the Rockefeller Univ, they can even jump to diff species of bacteria, borne on bits of infectious DNA. Today some strains of TB in NYC are resistant to all three main antibiotic treatments; patients with those strains have no better chance of surviving than did TB patients a century ago. Stephen S. Morse of Columbia Univ notes that the multidrug-resistant strain that has spread throughout the East Coast may have originated in a homeless shelter across the street from Columbia Presbyterian Med Ctr. Such a phenomenon would indeed be predicted in an environment where fierce selection pressure quickly weeds out less hardy strains. The surviving bacilli have been bred for resistance.

Many people, inc some Drs and scientists, still believe the outdated theory that pathogens necessarily become benign after long association with hosts. Superficially, this makes sense. An organism that kills rapidly may never get to a new host, so natural selection would seem to favor lower virulence. Syphilis, for instance, was a highly virulent disease when it first arrived in Europe, but as the centuries passed it became steadily more mild. The virulence of a pathogen is, however, a life history trait that can increase as well as decrease, depending on which option is more advantageous to its genes.

For agents of disease that are spread directly from person to person, low virulence tends to be beneficial, as it allows the host to remain active and in contact with other potential hosts. But some diseases, like malaria, are transmitted just as well--or better--by the incapacitated. For such pathogens, which usually rely on intermediate vectors like mosquitoes, high virulence can give a selective advantage. This principle has direct implications for infection control in hospitals, where health care workers' hands can be vectors that lead to selection for more virulent strains.

In the case of cholera, public water supplies play the mosquitoes' role. When water for drinking and bathing is contaminated by waste from immobilized patients, selec-tion tends to increase virulence, because more diarrhea enhances the spread of the organism even if individual hosts quickly die. But, as Ewald has shown, when sanit-ation improves, selection acts against classical Vibrio cholerae bacteria in favor of the more benign El Tor biotype. Under these conditions, a dead host is a dead end. But a less ill and more mobile host, able to infect many others over a much longer time, is an effective vehicle for a pathogen of lower virulence. In another exam, better sanitation leads to displacement of the aggressive Shigella flexneri by the more benign S.sonnei.

NEW ENVIRONMENTS, NEW THREATS. Such considerations may be relevant for public policy. Evolutionary theory predicts that clean needles and the encouragement of safe sex will do more than save numerous individuals from HIV infection. If humanity's behavior itself slows HIV transmission rates, strains that do not soon kill their hosts have the long-term survival advantage over the more virulent viruses that then die with their hosts, denied the opportunity to spread. Our collective choices can change the very nature of HIV.

Conflicts with other organisms are not limited to patho-gens. In times past, humans were at great risk from predators looking for a meal. Except in a few places, large carnivores now pose no threat to humans. People are in more danger today from smaller organisms' defenses, such as the venoms of spiders and snakes. Ironically, our fears of small creatures, in the form of phobias,probably cause more harm than any interactions with those organ-isms do. Far more dangerous than predators or poisoners are other members of our own species. We attack each other not to get meat but to get mates, territory and other resources. Violent conflicts between individuals are overwhelmingly between young men in competition and give rise to organizations to advance these aims. Armies, again usually composed of young men, serve similar objectives, at huge cost.

Even the most intimate human relationships give rise to conflicts having medical implications. The reproductive interests of a mother and her infant, for instance, may seem congruent at first but soon diverge. As noted by biologist Robert L. Trivers in a now classic 1974 paper, when her child is a few years old, the mother's genetic interests may be best served by becoming pregnant again, whereas her offspring benefits from continuing to nurse. Even in the womb there is contention. From the mother's vantage point, the optimal size of a fetus is a bit smaller than that which would best serve the fetus and the father. This discord, according to David Haig of Harvard University, gives rise to an arms race between fetus and mother over her levels of blood pressure and blood sugar, sometimes resulting in hypertension and diabetes during pregnancy.

Coping with Novelty. Making rounds in any hosp provides sad testimony to the prevalence of diseases humanity has brought on itself. Heart attacks, for example, result mainly from atherosclerosis, a problem that became wide-spread only in this century and that remains rare among hunter-gatherers. Epidemiological research furnishes the information that should help us prevent heart attacks: limit fat intake, eat lots of vegetables, and exercise hard each day. But hamburger chains proliferate, diet foods languish on the shelves, and exercise machines serve as expensive clothing hangers throughout the land. The proportion of overweight Americans is one third and rising. We all know what is good for us. Why do so many of us continue to make unhealthy choices?

Our poor decisions about diet and exercise are made by brains shaped to cope with an environment substantially different from the one our species now inhabits. On the African savanna, where the modern human design was fine-tuned, fat, salt and sugar were scarce and precious. Individuals who had a tendency to consume large amounts of fat when given the rare opportunity had a selective advantage. They were more likely to survive famines that killed their thinner companions. And we, their descen-dants, still carry those urges for foodstuffs that today are anything but scarce. These evolved desires, inflamed by advertisements from competing food corporations that themselves survive by selling us more of whatever we want to buy--easily defeat our intellect and willpower. How ironic that humanity worked for centuries to create environments that are almost literally flowing with milk and honey, only to see our success responsible for much modern disease and untimely death.

Increasingly, people also have easy access to many kinds of drugs, especially alcohol and tobacco, that are res-ponsible for a huge proportion of disease, health care costs and premature death. Although individuals have always used psychoactive substances, widespread problems materialized only foll another environmental novelty: the ready availability of concentrated drugs and new, direct routes of administration, especially injection. Most of these substances, including nicotine, cocaine and opium, are products of natural selection that evolved to protect plants from insects. Because humans share a common evolutionary heritage with insects, many of these substances also affect our nervous system.

This perspective suggests that it is not just defective individuals or disordered societies that are vulnerable to the dangers of psychoactive drugs; all of us are susceptible because drugs and our biochemistry have a long history of interaction. Understanding the details of that interaction, which is the focus of much current research from both a proximate and evolutionary perspec-tive, may well lead to better treatments for addiction.

The relatively recent and rapid increase in breast cancer must be the result in large part of changing environments and ways of life, with only a few cases resulting solely from genetic abnormalities. Boyd Eaton and his colleagues at Emory University reported that the rate of breast cancer in today's "nonmodern" societies is only a tiny fraction of that in the U.S. They hypothesize that the amount of time between menarche and first pregnancy is a crucial risk factor, as is the related issue of total lifetime number of menstrual cycles. In hunter-gatherers, menarche occurs at about age 15 or later, followed within a few years by pregnancy and two or three years of nursing, then by another pregnancy soon after. Only between the end of nursing and the next pregnancy will the woman menstruate and thus experience the high levels of hormones that may adversely affect breast cells.

In modern societies, in contrast, menarche occurs at age 12 or 13, probably at least in part because of a fat intake sufficient to allow an extremely young woman to nourish a fetus--and the first pregnancy may be decades later or never. A female hunter-gatherer may have a total of 150 menstrual cycles, whereas the average woman in modern societies has 400 or more. Although few would suggest that women should become pregnant in their teens to prevent breast cancer later, early administration of a burst of hormones to simulate pregnancy may reduce the risk. Trials to test this idea are now under way at the UC at San Diego.

Trade-offs and Constraints. Compromise is inherent in every adaptation. Arm bones three times their current thickness would almost never break, but Homo sapiens would be lumbering creatures on a never-ending quest for calcium. More sensitive ears might sometimes be useful, but we would be distracted by the noise of air molecules banging into our eardrums.

Such trade-offs also exist at the genetic level. If a mutation offers a net reproductive advantage, it will tend to increase in frequency in a population even if it causes vulnerability to disease. People with two copies of the sickle cell gene, for example, suffer terrible pain and die young. People with two copies of the "normal" gene are at high risk of death from malaria. But individuals with one of each are protected from both malaria and sickle cell disease. Where malaria is prevalent, such people are fitter, in the Darwinian sense, than members of either other group. So even though the sickle cell gene causes disease, it is selected for where malaria persists. Which is the "healthy" allele in this environment? The question has no answer. There is no one normal human genome--there are only genes.

SMALL APPENDIX: Many other genes that cause disease must also have offered benefits, at least in some environments or they would not be so common. Because cystic fibrosis (CF) kills one out of 2,500 Caucasians, the responsible genes would appear to be at great risk of being eliminated from the gene pool. And yet they endure. For years, researchers mused that the CF gene, like the sickle cell gene, probably conferred some advantage. Recently a study by Gerald B. Pier of Harvard Medical School and his colleagues gave substance to this informed speculation: having one copy of the CF gene appears to decrease the chances of the bearer acquiring a typhoid fever infection, which once had a 15% mortality.

Aging may be the ultimate example of a genetic trade-off. In 1957 one of us (Williams) suggested that genes that cause aging and eventual death could nonetheless be selected for if they had other effects that gave an advantage in youth, when the force of selection is stronger. For instance, a hypothetical gene that governs calcium metabolism so that bones heal quickly but that also happens to cause the steady deposition of calcium in arterial walls might well be selected for even though it kills some older people. The influence of such pleio-tropic genes (those having multiple effects) has been seen in fruit flies and flour beetles, but no specific example has yet been found in humans. Gout, however, is of particular interest, because it arises when a potent antioxidant, uric acid, forms crystals that precipitate out of fluid in joints. Antioxidants have antiaging effects, and plasma levels of uric acid in different species of primates are closely correlated with average adult life span. Perhaps high levels of uric acid benefit most humans by slowing tissue aging, while a few pay the price with gout.

Other examples are more likely to contribute to more rapid aging. For instance, strong immune defenses protect us from infection but also inflict continuous, low-level tissue damage. It is also poss, that most genes that cause aging have no benefit at any age-they simply never decreased reproductive fitness enough in the natural environment to be selected against. Nevertheless, over the next decade research will surely ID specific genes that accelerate senescence, and researchers will gain the means to interfere with their actions or even change them. Before we tinker, however, we should determine whether these actions have benefits early in life.

Because evolution can take place only in the direction of time's arrow, an organism's design is constrained by structures already in place. As noted, the vertebrate eye is arranged backward. The squid eye, in contrast, is free from this defect, with vessels and nerves running on the outside, penetrating where necessary and pinning down the retina so it cannot detach. The human eye's flaw results from simple bad luck; hundreds of millions of years ago, the layer of cells that happened to become sensitive to light in our ancestors was positioned differently from the corresponding layer in ancestors of squids. The two designs evolved along separate tracks, and there is no going back.

Such path dependence also explains why the simple act of swallowing can be life-threatening. Our respiratory and food passages intersect because in an early lungfish ancestor the air opening for breathing at the surface was understandably located at the top of the snout and led into a common space shared by the food passageway. Because natural selection cannot start from scratch, humans are stuck with the possibility that food will clog the opening to our lungs.

The path of natural selection can even lead to a potentially fatal cul-de-sac, as in the case of the appendix, that vestige of a cavity that our ancestors employed in digestion. Because it no longer performs that function, and as it can kill when infected, the expectation might be that natural selection would have eliminated it. The reality is more complex. Appendicitis results when inflammation causes swelling, which compresses the artery supplying blood to the appendix. Blood flow protects against bacterial growth, so any reduction aids infection, which creates more swelling. If the blood supply is cut off completely, bacteria have free rein until the appendix bursts. A slender appendix is especially susceptible to this chain of events, so appendicitis may, paradoxically, apply the selective pressure that maintains a large appendix. Far from arguing that everything in the body is perfect, an evolutionary analysis reveals that we live with some very unfortunate legacies and that some vulnerabilities may even be actively maintained by the force of natural selection.

Evolution of Darwinian Medicine. Despite the power of the Darwinian paradigm, evolutionary biology is just now being recognized as a basic science essential for medicine. Most diseases decrease fitness, so it would seem that natural selection could explain only health, not disease. A Darwinian approach makes sense only when the object of explanation is changed from diseases to the traits that make us vulnerable to diseases. The assumption that natural selection maximizes health also is incorrect-selection maximizes the reproductive success of genes. Those genes that make bodies having superior reproductive success will become more common, even if they compromise the individual's health in the end.

Finally, history and misunderstanding have presented obstacles to the acceptance of Darwinian medicine. An evolutionary approach to functional analysis can appear akin to naive teleology or vitalism, errors banished only recently, and with great effort, from medical thinking. And, of course, whenever evolution and medicine are mentioned together, the specter of eugenics arises. Discoveries made through a Darwinian view of how all human bodies are alike in their vulnerability to disease will offer great benefits for individuals, but such insights do not imply that we can or should make any attempt to improve the species. If anything, this approach cautions that apparent genetic defects may have unrecognized adaptive significance, that a single "normal" genome is nonexistent and that notions of "normality" tend to be simplistic.

The systematic application of evolutionary biology to med is a new enterprise. Like biochemistry at the beginning of this century, Darwinian medicine very likely will need to develop in several incubators before it can prove its power and utility. If it must progress only from the work of scholars without funding to gather data to test their ideas, it will take decades for the field to mature. Depts of evolutionary bio in med schools would accelerate the process, but for the most part they do not yet exist. If funding agencies had review panels with evolutionary expertise, research would develop faster, but such panels remain to be created. We expect that they will.

The evolutionary viewpoint provides a deep connection between the states of disease and normal functioning and can integrate disparate avenues of medical research as well as suggest fresh and important areas of inquiry. Its utility and power will ultimately lead to recognition of evolutionary biology as a basic medical science.

 The Authors RANDOLPH M. NESSE and GEORGE C. WILLIAMS are the authors of the 94 book Why We Get Sick: The New Science of Darwinian Med. Nesse received his MD from the Univ of Mich 74 and is now prof of psychiatry there and is dir of the Evolution and Human Adaptation Pgm at the univ's Inst for Social Rsch. Williams received his PHd in 55 from UC, LAX, and quickly became one of the world's foremost evolutionary theorists. A member of the Nat Acad of Sciences, he is prof emeritus of ecology and evolution at the SUNY Stony Brook and edits the Qtrly Review of Biology.


\10 anti-aging drugs - Melatonin

Vital Signs: Oiling the Gears for the Body's Clock Nov 9 1999 NOSTRUMS

Older people may find it hard to miss that they are the targets of yet another aggressive advertising campaign, this one for products containing melatonin. The hormone, produced by the pineal gland, has shown signs of helping with a number of problems. A possible sleep inducer that seems able to reset the biological clock, it has been used to combat jet lag and some forms of insomnia.

Recently, many companies have begun urging older people to begin taking melatonin regularly to compensate for the supposed decline of the hormone as people age. The products are widely available at health food stores, and, since they are considered a nutritional supplement (because they can naturally occur in some foods), are not regulated by the Food and Drug Administration.

It is unclear whether melatonin really does decline with aging, and a new study sponsored by the National Institutes of Health concludes that melatonin levels remain fairly stable in healthy older adults. "If you're going to be replacing something, you ought to find out that it's missing first," said Dr. Charles A. Czeisler, the Harvard researcher who led the study. He has criticized the FDA for the absence of regulations governing melatonin sales.

Although melatonin levels are often lower in older people, Czeisler said, the cause it not aging itself, but many of the ailments that can accompany it. When researchers examined healthy people ages 65 to 81, they found little difference between their nighttime melatonin levels and those of people ages 18 to 30. Experts say regular use of melatonin can have wide, if still not understood, effects on the body, and may prove harmful.

BEHAVIOR For Youth, Silence in a Cloud of Smoke esearchers at Massachusetts General Hospital in Boston were dismayed to learn in a new study that few American doctors counsel young patients about the dangers of smoking. In fact, the study found, the number of doctors who do so actually seems to be on the decline, even though most people who start smoking do so when they're teenagers. The researchers, who presented their findings in The Journal of the American Cancer Institute, based their conclusions on data from National Ambulatory Care Surveys of more than 5,000 doctors across the country from 1991 to 1996. The doctors said that 72 percent of the time they asked patients ages 11 to 21 whether they smoked. But at only 1.7 percent of the visits did they counsel their patients about smoking, less often than they counsel adult patients. "We were surprised at how low it is," said Dr. Anne N. Thorndike, the internist who led the study. "We thought it was going to be low, but not that low." Thorndike theorized that one reason doctors did not counsel young patients against smoking was a lack of time over all. "Counseling is not reimbursed," she said. "You can't bill for counseling about smoking."

IN THE LAB  A Case for Some Well-Toned Tissue orking to develop engineered tissue that may one day be used to repair or replace damaged human body parts or organs, researchers at the University of Michigan came face to face with a problem: the tissue from the lab was not as strong as that made by the body. Then they hit on the same idea that gets millions of flabby people to drag themselves to the gym several times a week: exercise. Scientists found that if they repeatedly applied stress to the tissue as it was developing, it grew stronger, not unlike the muscles-building process in someone who lifts weights. The work was described in a recent issue of the journal Nature Biotechnology. Dr. David Mooney said the idea was not that novel. The real trick, he said, was developing the synthetic polymer framework to which the tissue cells were attached as they were strengthened. To date, engineered tissue is used on humans only in procedures involving skin. Mooney, an associate professor of dentistry and engineering, said he believed such tissue would be used for structural repairs, like replacing ligaments, within 5 or 10 years. • SYMPTOMS When Fire Consumes a Sense of Smell everal years ago, doctors at the Smell and Taste Treatment and Research Foundation noticed something odd: within a two-month period, six firefighters came in for treatment and were found to have lost the sense of smell. The foundation, concerned that there could be a much larger problem, conducted a study of 102 Chicago firefighters and found that almost half had lost most or all of their ability to smell, despite their use of breathing masks during fires. The researchers, who are presenting their findings to the American Public Health Association's annual meeting this week, say they wonder if there could be a hidden medical problem of serious dimensions among America's estimated one million firefighters. How could a problem potentially this widespread go overlooked for so long? One reason, said Dr. Alan R. Hirsch, the foundation's director of neurology, is that the loss of the sense of smell seemed to come gradually, and so was simply not noticed by many of the firefighters. Eighty-seven percent of those found to have serious losses said they considered their sense of smell normal -- despite their inability to distinguish between odors like natural gas and perfume, or smoke and bubble gum. Apart from the hazards that loss of smell pose to firefighters on the job, where they need to help detect potentially dangerous situations, the deficiency has also been linked to other health problems. Researchers do not know if the firefighters are being hurt by the heat or by certain types of fires. They speculate that the sensors in the nose may be damaged after fires are contained and many firefighters take off their masks, even though charred materials may still be sending dangerous chemicals into the air. • REMEDIES Of Spouses, Sex, Sleep and Snoring f there were ever any doubts that there are a lot of snorers out there, and an equal number of long-suffering spouses, a new study puts them to rest. OK, so it was not really a study. Nor, for that matter, was it peer-reviewed in a prestigious medical journal or conducted at a top university with double-blind controls. It was really just a reaction to a study, but telling, nonetheless. Some weeks back, news went out about a Mayo Clinic study that looked at how much sleep was lost by people whose partners -- usually men -- had the severe snoring caused by obstructive sleep apnea, a serious health condition. Researchers put the loss at about an hour a night. The study also found that the snoring could be greatly eased when patients used an oxygen-masklike device providing what is called continuous positive airway pressure. Dr. John W. Shepard Jr., who conducted the study, said he was contacted by people around the world.

It seems safe to predict that a new study from the National Naval Medical Center is hardly likely to dampen interest. The new study found that when snorers used a mask, they and their spouses reported better sex lives. People's questions boiled down to this: Where can I get one of those masks? But people with serious snoring problems need to consult their doctors, who can refer them to sleep disorder specialists, pulmonologists or others who can provide the machines, which can cost as much as $1,200, but are covered by most insurance plans for a sleep apnea diagnosis. The machines are not new, and although they have a good track record, not everyone loves them. They can be encumbering, and one woman wrote that the one her husband used helped his snoring, but kept her awake with its hissing (a sign that it was not working properly, Dr. Shepard said). "I have now resigned myself to a life of sleep deprivation," she wrote, although she thinks she has hit on a solution: building herself a room over the garage.


\11 CHELATION THERAPY NEW HOPE FOR VICTIMS OF ATHEROSCLEROSIS AND AGE-ASSOCIATED DISEASES
 by Elmer M. Cranton, M.D. Intravenous chelation therapy with ethylene diamine tetra acetic acid (EDTA) is proven to reverse and slow the progression of atherosclerosis and age-related diseases. Symptoms affecting many different parts of the body often improve. Atherosclerotic blockage to blood flow in the coronary arteries of the heart, to the brain, to the legs, and elsewhere are relieved. Blood flow increases. Heart attacks, strokes, leg pain and gangrene are prevented using this therapy. Bypass surgery and balloon angioplasty can often be prevented. Published studies now indicate that even cancer deaths can be reduced by EDTA chelation therapy. The free radical theory of disease(caused by oxygen radicals) has recently provided an elegant scientific explanation for observed benefit of chelation therapy.

Many scientific studies, published in peer reviewed medical journals, provide solid evidence for benefit of chelation therapy. This non-invasive therapy is very much safer and far less expensive than surgery or angioplasty. Chelation therapy is therefore a safe and effective alternative to bypass surgery for atherosclerosis. Your case of severe hardening of the arteries need not lead to coronary bypass surgery, heart attack, amputation, stroke, or senility. There is new hope of recovery for victims of these and numerous related diseases. Despite what you may have heard from other sources, EDTA chelation therapy, administered by a properly trained physician and given in conjunction with lifestyle and dietary changes and specialized nutritional supplements, is an option to be seriously considered by persons suffering from coronary artery disease, cerebral vascular disease, brain disorders resulting from circulatory disturbances, generalized atherosclerosis and related ailments which lead to senility, gangrene, and accelerated physical decline. Clinical benefits from chelation therapy vary with the total number of treatments received and with severity of the condition being treated. More than 75 percent of chelation patients have improved dramatically. More than 90 percent of patients receiving 35 or more chelation treatments have benefited—even more so when they have also corrected dietary, exercise and smoking habits, which are known to aggravate occlusive arterial disease. Symptoms improve, blood flow to diseased organs increases, need for medication decreases and, most importantly, the quality of life becomes much more productive and enjoyable. When patients first hear about or consider EDTA chelation therapy, they normally have lots of questions. Undoubtedly you do, too. Here are the answers to those most commonly asked questions, explained in non-technical language.

WHAT IS "CHELATION"? Chelation (pronounced KEY-LAY-SHUN) is the chemical process by which a metal or mineral (such as lead, mercury, copper, iron, arsenic, aluminum, calcium, etc.) is bonded to another substance. It is a natural process, basic to life itself. Chelation is one mechanism by which such common substances as aspirin, antibiotics, vitamins, minerals and trace elements work in the body. Hemoglobin, the red pigment in blood which carries oxygen, is a chelate of iron.

WHAT IS CHELATION AS A MEDICAL THERAPY? Chelation is a treatment by which a small amino acid called ethylene diamine tetraacetic acid (commonly abbreviated EDTA) is administered to a patient intravenously, prescribed by and under the supervision of a licensed physician. The fluid containing EDTA is infused through a small needle placed in the vein of a patient’s arm. The EDTA infusion bonds with excess metals in the body and carries them away in the urine. Abnormally situated nutritional metals, such as iron, along with toxic elements such as lead, mercury and aluminum are easily removed by EDTA chelation therapy. Normally present minerals and trace elements which are essential for health are more tightly bound within the body and can be maintained with a properly balanced nutritional supplement.

IS IT DONE JUST ONCE? On the contrary, chelation therapy is a course of treatments which usually consists of anywhere from 20 to 50 separate infusions, depending on each patient’s individual health status. Thirty treatments is the average number required for optimum benefit in patients with symptoms of arterial blockage.. Some patients eventually receive more than 100 chelation therapy infusions over several years. Each chelation treatment takes from three to four hours and patients normally receive one to five treatments each week. Over a period of time, these injections halt the progress of the free radical disease.

Free radicals underlie the development of atherosclerosis and many other degenerative diseases of aging. Reduction of damaging free radicals allows diseased arteries to heal, restoring blood flow. With time chelation therapy brings profound improvement to many essential metabolic and physiologic functions in the body. The body’s regulation of calcium and cholesterol is restored by normalizing the internal chemistry of cells.

Chelation therapy benefits the flow of blood through every vessel in the body, from the largest to the tiniest capillaries and arterioles, most of which are far too small for surgical treatment or are deep within the brain where they cannot be safely reached by surgery. In many patients, the smallest blood vessels are the most severely diseased. The benefits of chelation occur from the top of the head to the bottom of the feet, not just in short segments of a few large arteries which can be bypassed by surgical treatment.

DO I HAVE TO GO TO A HOSPITAL TO BE CHELATED? No, in most cases chelation therapy is an out-patient treatment available in a physician’s office or clinic.

DOES IT HURT? WHAT DOES IT FEEL LIKE TO BE CHELATED? Being "chelated" is quite a different experience from other medical treatments. There is no pain, and in most cases, very little discomfort. Patients are seated in reclining chairs and can read, nap, watch TV, do needlework, or chat with other patients while the fluid containing the EDTA flows into their veins. If necessary, patients can walk around. They can visit the restroom, eat and drink as they desire, or make telephone calls, being careful not to dislodge the needle attached to the intravenous infusion they carry with them. Some patients even run their businesses by telephone or computer while receiving chelation therapy.

ARE THERE RISKS OR UNPLEASANT SIDE EFFECTS? EDTA chelation therapy is relatively non-toxic and risk-free, especially when compared with other treatments. Patients routinely drive themselves home after chelation treatment with no difficulty. The risk of serious side effects, when properly administered, is less than 1 in 10,000 patients treated. By comparison, the overall death rate as a direct result of bypass surgery is approximately 3 out of every 100 patients, varying with the hospital and the operating team. The incidence of other serious complications following surgery is much higher, including heart attacks, strokes, blood clots, mental impairment, infection, and prolonged pain. Chelation therapy is at least 300 times safer than bypass surgery. Occasionally, patients may suffer minor discomfort at the site where the needle enters the vein. Some temporarily experience mild nausea, dizziness, or headache as an immediate aftermath of treatment, but in the vast majority of cases, these minor symptoms are easily relieved. When properly administered by a physician expert in this type of therapy, chelation is safer than many other prescription medicines. If EDTA chelation therapy is given too rapidly or in too large a dose it may cause harmful side effects, just as an overdose of any other medicine can be dangerous. Reports of serious and even rare fatal complications have stemmed from excessive doses of EDTA, improperly administered and many years ago. If you choose a physician with proper training and experience, who is an expert in the use of EDTA, the risk of chelation therapy will be kept to a very low level. While it has been stated that EDTA chelation therapy is damaging to the kidneys, the newest research (consisting of kidney function tests done on 383 consecutive chelation patients, before and after treatment with EDTA for chronic degenerative diseases) indicates the reverse is often true. There is, on the average, significant improvement in kidney function following chelation therapy. An occasional patient may be unduly sensitive, however, and physicians expert in chelation monitor kidney function very closely to avoid overloading the kidneys. Chelation treatments must be given more slowly and less frequently if kidney function is not normal. Patients with some types of severe kidney problems should not receive EDTA chelation therapy.

WHAT TYPES OF EXAMINATIONS AND TESTING MUST BE DONE PRIOR TO BEGINNING CHELATION THERAPY? Prior to commencing a course of chelation therapy a complete medical history must be obtained. Diet will be analyzed for nutritional adequacy and balance. Copies of pertinent medical records and summaries of hospital admissions may be sent for. A thorough head-to-toe, hands-on physical examination will be performed. A complete list of current medications will be recorded, including the time and strength of each dose. Special note will be made of any allergies. Blood and urine specimens will be obtained for a battery of tests to insure that no conditions exist which may be worsened by chelation therapy. Kidney function will be carefully assessed. An electrocardiogram and chest x-ray may be ordered. Noninvasive tests will be performed, as medically indicated, to determine the status of arterial blood flow prior to therapy. A consultation with other medical specialists may be requested.

IS CHELATION THERAPY NEW? Not at all. Chelation's earliest application with humans was during World War II when the British used another chelating agent, British Anti-Lewesite (BAL), as a poison gas antidote. BAL is still used today in medicine. EDTA was first introduced into medicine in the United States in 1948 as a treatment for industrial workers suffering from lead poisoning in a battery factory. Shortly thereafter, the U.S. Navy advocated chelation therapy for sailors who had absorbed lead while painting government ships and dock facilities. In the years since, chelation therapy has remained the undisputed treatment-of-choice for lead poisoning, even in children with toxic accumulations of lead in their bodies as a result of eating leaded paint from toys, cribs or walls. In the early 1950’s it was speculated that EDTA chelation therapy might help the accumulations of calcium associated with hardening of the arteries. Experiments were performed and victims of atherosclerosis experienced health improvements following chelation—diminished angina, better memory, sight, hearing and increased vigor. A number of physicians then began to routinely treat individuals suffering from occlusive vascular conditions with chelation therapy. Consistent improvements were reported for most patients. Published articles describing successful treatment of atherosclerosis with EDTA chelation therapy first appeared in medical journals in 1955. Dozens of favorable articles have been published since then. No unsuccessful results have ever been reported (with the exception of recent very flawed data presented by bypass surgeons in an attempt to discredit this competing therapy). There have also been a number of editorial comments of a critical nature made by physicians with vested interests in vascular surgery and related procedures. From 1964 on, despite continued documentation of its benefits and the development of safer treatment methods, the use of chelation for the treatment of arterial disease has been the subject of controversy.

IS IT LEGAL? Absolutely. There is no legal prohibition against a licensed medical doctor using chelation therapy for whatever conditions he or she deems it to be correct, even though the drug involved, EDTA, does not yet have atherosclerosis listed as an indication on the FDA-approved package insert. The FDA does not regulate the practice of medicine, but merely approves marketing, labeling and advertising claims for drugs and devices in interstate commerce.

It costs many millions of dollars to perform the required research and to provide the FDA with documentation for a new drug claim, or even to add a new use to marketing brochures of a long established medicine like EDTA. Physicians routinely prescribe medicines for conditions not yet included on FDA approved advertising and marketing literature. Several respected physician organizations sponsor educational courses in the proper and safe use of intravenous EDTA chelation. The American College for Advancement in Medicine publishes a physicians’ Protocol which contains professionally recognized standards of medical practice of chelation therapy.

On the question of legality, courts have expressed the opinion that a physician who withholds information about the availability of other treatment choices, such as chelation therapy, prior to performing vascular surgery (along with all other treatment modalities) is in violation of the doctrine of informed consent. Withholding information about a form of treatment may be tantamount to medical malpractice, if as a result, a patient is deprived of possible benefit. Thus, it is the doctors who refuse to recognize and inform their patients of chelation who are risking legal liability—not those chelating physicians informed enough to resist peer pressure and provide an innovative treatment which they feel to be the safest, the most effective and the least expensive for many of their patients.

WHAT PROOF DO YOU HAVE THAT IT WORKS? Physicians with extensive experience in the use of chelation therapy observe dramatic improvement in the vast majority of their patients. They see angina routinely relieved; patients who suffered searing chest and leg pain when walking only a short distance are frequently able to return to normal, productive living after undergoing chelation therapy. Far more dramatic, but equally common, is seeing diabetic ulcers and gangrenous feet clear up in a matter of weeks. Many individuals who have been told that their limbs would have to be amputated because of gangrene are thrilled to watch their feet heal with chelation therapy, although some areas of dead tissue may still have to be trimmed away surgically. The approximately 1,500 American physicians practicing chelation therapy, plus hundreds of others in foreign countries, have countless files to prove they are able to reverse serious cases of arterial disease. Men and women often arrive at doctors’ offices near death with diseases caused by blocked arteries. Weeks or months later, they’re remarkably improved. There is a wealth of evidence from clinical experience that symptoms of reduced blood flow improve in more than 75 percent of patients treated. Almost a million patients have thus far received chelation therapy, almost as many as have undergone bypass surgery. In addition, several research studies have been published with results of before-and-after diagnostic tests using radio-isotopes and ultra sound which prove statistically that blood flow improves following chelation therapy. Even without blood flow studies, if leg pain on walking is relieved, if angina becomes less bothersome, and if physical endurance and mental acuity improve, such benefits would be quite enough to justify EDTA chelation therapy. Improved quality of life and relief of symptoms are the most important benefits of chelation therapy.

WHAT DOES IT COST? A course of chelation therapy for a patient with advanced hardening of the arteries generally requires from six weeks to six months and costs up to $4,000 or more for 30 treatments. This is considerable less than bypass surgery which is normally well over $40,000. A person can expect to pay approximately $120 per treatment, including the associated kidney tests. Each chelation treatment takes 3 to 4 hours to complete.

WHY CAN’T CHELATION BE TAKEN BY MOUTH IN PILL FORM INSTEAD OF BY INTRAVENOUS INJECTION? Chelation therapy is gaining recognition so rapidly that there is growing interest in developing an oral chelator that will produce benefits similar to intravenous EDTA chelation therapy. Many nutritional substances administered by mouth are known to have chelating properties but none have the spectrum of activity of intravenous EDTA. Many nutrients such as vitamin C and the amino acids cysteine and aspartic acid have the ability to weakly chelate metals. They also protect against free radical damage in other ways, as anti-oxidants. Claims are being increasingly made for the use of nutritional supplements containing weak chelators in patients with atherosclerosis. There is nothing new about these products which are mostly vitamins and minerals being aggressively marketed with glowing testimonials and deceptive marketing techniques. Benefit from products taken by mouth has never even come close to the much more dramatic results seen with intravenous EDTA. Recently some nutritional supplements which contain EDTA have been alleged to be effective as oral chelation therapy. The problem is that only 5 percent or less of EDTA is absorbed by mouth. The remainder passes on through in the stool. And, it must be taken every day by mouth to absorb an effective amount of EDTA. When taken on a daily basis, oral EDTA binds essential nutrients in the digestive tract and blocks their absorption, causing deficiencies. When given intravenously, EDTA is 100 percent absorbed and can be given on only 20 to 30 days in any one year. Nutritional supplementation on a daily basis more than compensates for any loses caused by the intravenous EDTA chelation therapy.

IS IT TRUE THAT CHELATION THERAPY COMBATS ATHEROSCLEROSIS BY ACTING LIKE A LIQUID PLUMBER—BY LEECHING CALCIUM OUT OF ATHEROSCLEROTIC PLAQUE? No! Before recent medical breakthroughs in the area of free radical pathology, it was hypothesized that EDTA chelation therapy had its major beneficial effect on calcium metabolism—that it stripped away the excess calcium from the plaque, restoring arteries to their pliable precalcified state. This frequently offered explanation—the so-called "roto-rooter" concept—is not the real reason, as previously postulated, that chelation therapy produces its major health benefits. The fact that EDTA does remove some circulating calcium is now felt to be one of the less prominent aspects of its benefits. Most importantly, EDTA has an affinity for the so-called transition metals, iron and copper, and for the related toxic metals, lead, mercury, cadmium, nickel, aluminum and others, which are potent catalysts of excessive free radical reactions or other toxicity. Free radical pathology, it is now believed, is the underlying process triggering the development of most age-related ailments, including cancer, senility and arthritis, as well as atherosclerosis. Thus, EDTA’s primary benefit is that it greatly reduces the ongoing production of free radicals within the body by removing accumulations of metallic catalysts and toxins which accumulate at abnormal sites in the body as a person grows older and which speed the aging process. This is a greatly oversimplified explanation of what actually occurs.

WHAT OTHER DISEASES MIGHT BE BENEFITED BY CHELATION? Because the very aging process itself correlates with ongoing free radical damage, it is no surprise that a large variety of symptoms have been reported to improve following chelation therapy, even symptoms not directly caused by circulatory disease. While there is no scientific evidence that chelation is a cure for these diseases, symptoms of arthritis, Alzheimer’s, Parkinson’s , psoriasis, high blood pressure, and scleroderma have been reported to improve with chelation therapy. There is no better treatment for scleroderma. Vision has been restored in macular degeneration. Patients generally feel younger and more energetic following therapy, even when taken for purely preventive reasons. In fact, chelation therapy is probably more effective for prevention that it is for established disease. A recently published article from the University of Zurich in Switzerland reported an 18-year follow-up of a group of 56 chelation therapy patients. When comparing the death rate from cancer with that of a control group of patients who did not receive chelation therapy, the authors found that patients who received EDTA chelation therapy had a 90% reduction of cancer deaths. Epidemiologists from the University of Zurich reviewed the data and found no fault with the reported facts or the conclusions. There is no evidence that chelation therapy is of benefit in the treatment of advanced cancer, once the diagnosis is made, but there is a large body of scientific research indicating that free radical damage to DNA is an important factor at the onset of most cancer. Chelation therapy blocks damaging free radicals.

WHY HAVEN’T I HEARD OF CHELATION BEFORE? If EDTA chelation therapy is safe and effective as indicated by many published studies, and by the experience of hundreds of doctors, why haven’t you heard more about it? That is a good question! Until quite recently, relatively few patients have been informed that this therapy is available. Most heart specialists may not have even heard of the treatment and would be reluctant to prescribe it if they had. The American Medical Association has not yet approved chelation therapy for atherosclerosis, although it does endorse its use in the treatment of lead and other heavy metal poisoning. Many insurance companies will not compensate policy holders for chelation therapy unless it is given for proven lead poisoning of a serious degree. If chelation therapy is given for atherosclerosis, it is often labeled "experimental" or "not necessary " or "not customary" by medical insurance companies and payment is denied. They deny payment to patients for chelation therapy even though they do pay for bypass surgery, and even though chelation might have saved them tens of thousands of dollars. Like many other aspects of our lives, a considerable amount of politics seems to be involved—in this case, medical politics. Traditional medical organizations, politically powerful, have consistently attempted to suppress chelation therapy, perhaps because of a large vested interest in coronary related health care. The cost of all medical care for victims of heart disease in the United States, including coronary bypass surgery and prescription drugs, exceeds $40 billion per year. Obviously, many hospitals and physicians would be in serious financial difficulty, and might even have to find other outlets for their services, if this procedure were to become universally popular. Physicians who remain skeptical about chelation therapy are those who have never used it. They are either completely uninformed about the research that has been done to document the safety and effectiveness of chelation therapy, or they are committed by training or source of income to other therapeutic procedures, such as vascular surgery and related procedures. Many physicians have merely accepted criticisms of an editorial nature stemming from such source, without digging into the true facts for themselves. The bypass industry has been extremely well marketed—to the medical profession as well as to the public.

WHAT ELSE IS INVOLVED IN A COMPLETE PROGRAM OF CHELATION? Your lifestyle counts. Chelation therapy is only part of the curative process. Improved nutrition and improved lifestyle are absolutely imperative for lasting benefit from chelation treatments. Chelation is not in and of itself a "cure-all"—it merely reduces abnormal free radical activity, allowing normal healing and control mechanisms to come in to play so that free radical damage can be repaired and health can be restored with the help of applied clinical nutrition, antioxidant supplementation and lifestyle corrections. Chelation therapy involves all of these factors. Chelation therapy is also compatible with other forms of therapy, including bypass surgery. In addition to receiving the necessary number of chelation treatments, patients eager for long-term benefits should correct their dietary and lifestyle habits, take nutritional supplements, be physically active and eliminate destructive lifestyle habits such as tobacco and excessive alcohol.

HYPERBARIC OXYGEN Hyperbaric oxygen treatments (HBO) involve treatment of the entire body in a small chamber with 100 percent oxygen at pressures greater than the normal atmosphere. HBO stimulates new blood flow, keeps organs alive and nadium, boron, molybdenum, functioning even when they are deprived of adequate blood flow, and helps fight infection. HBO is especially helpful in cases of gangrenous or pre-gangrenous feet, to speed healing while the slower process of chelation has time to work. Many patients receive hyperbaric oxygen treatments on the same day that they receive chelation for the added benefits of the two types of therapy.

NUTRITIONAL SUPPLEMENTS A scientifically balanced regimen of nutritional supplements reinforces the body’s antioxidant defenses and should include vitamins E, C, B1, B2 B3, B6, B12, PABA, beta carotene, and coenzyme Q10, and others A balanced program of mineral and trace element supplementation should include calcium, magnesium, zinc, copper, selenium, manganese, vanadium, and chromium. The exact prescription for nutritional supplements is determined individually for each patient, based on nutritional assessment and laboratory testing. The BASIC PREVENTIVE multiple vitamin (BP-5), mineral, trace element formula provides a balanced foundation supplement, all in one bottle and at reasonable cost. The BASIC ANTIOXTM packets provide a much more complete regimen at additional cost , and are especially indicated for symptomatic and elderly patients. That is what I and my family take.

DESTRUCTIVE HABITS It is important to eliminate the use of tobacco. This applies to cigarettes, pipe tobacco, cigars, snuff or chewing tobacco. It has been a consistent observation that patients who continued to use tobacco following chelation have demonstrated less improvement and for a shorter time in comparison to non-smokers. Relatively healthy adults are often able to tolerate the moderate use of alcoholic beverages without generating more free radicals than they can detoxify. Anyone who drinks more than occasional alcoholic beverages in moderation risks harmful free radical damage. Victims of chronic degenerative diseases should minimize the consumption of alcohol.

EXERCISE Finally, sustained physical exercise is very helpful. Even a brisk 45-minute walk several times per week will help to maintain the health benefits and improved circulation resulting from chelation therapy. Lactate normally builds up in tissues during sustained exercise, and lactate is a natural chelator produced within the body. Which brings us to the final question!

IS CHELATION THERAPY FOR YOU? Only you can make that decision! Chances are, your doctor won’t help you decide. Patients who choose chelation therapy often do so against the advice of their personal physicians or cardiologists. Many have already been advised to undergo vascular surgery. Occasionally, a patient never hears about chelation therapy until he or she is hospitalized and a friend or relative begs him or her to look into this non-invasive therapy before proceeding to surgery. In an impressively large number of instances, a new patient comes for chelation on the recommendation of someone who has been successfully chelated.

http://drcranton.com/faq.htm


\12 Unscientific, unsubstantiated, rubbish that can be detri-mental to good health.

 Scientific Review of Alternative Med by Dr Wallace Sampson clinical prof at Stanford Univ.

The Skeptical Inquirer Paul Kurtz.

ÄÄÄÄÄÄÄÄÄÄÄÄÄ $3 Billion a year wasted ÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄÄ Dr Andrew Weil, homeopathy, therapeutic touch, magnetism psychics, faith healers, UFOs, pyramids, St John's wort, Laetrile,

The health care industry has a variety of policies and stds regarding coverages for alternative med modalities. From a sociological standpoint, unconventional, alterna-tive, or unorthodox therapies refer to medical practices that are not in conformity with the standards of the medical community.

The New England Journal of Medicine defines unconventional therapies, “as medical interventions not taught widely at US med schools or generally available at US hosp. Examples include acupuncture, chiropractic, and massage therapy”(1993).

Coverages vary widely among conventional carriers, preferred providers as well as the omnipresent Health Maintenance Orgs (HMO). The primary emphasis and, for that matter, the only reason for the existence of insurance companies is a single word, profit.

More specifically, premiums less costs provide the all important profit margin, the life blood of the insurance industry. By not providing coverage for the billion dollar industry of alternative treatments, insurance companies are keeping the cost of the premiums down but at the same time not allowing their customers to use complementary treatments such as chiropractic to prevent or cure illness. The more rigid and restrictive the policy provisos, the more assurance for the companies that they will maximize their bottom lines. Therefore, patients of alternative therapies as well as doctors must show that such unconventional treatment provides relief and prevention of illness. “The total projected out-of-pocket expenditure for unconventional therapy plus supplements(such as diet pills and megavitamins)was 10.3 billion dollars in 1990. This is comparable to the out-of-pocket expenditure for all hospital care in the United States in 1990($12.8 billion), and it is nearly half the amount spent out of pocket for all physicians’ services in the United States($23.5 billion)”(nemj,1991). From this one may infer that society has become fed up with inadequate results or side effects associated with surgery and drugs which accompany the treatment of modern medicine. So, in an effort to cope with the inadequate treatment patients are receiving from conventional medicine, they are seeking alternatives such as chiropractic for chronic illness and pain. “Although most doctors wince when you mention chiropractors, some fairly rigorous studies have shown their manipulations of the spine to be effective in relieving lower-back pain. Orthopedic surgeons have even been known to refer patients to chiropractors, and some 30 U.S. hospitals have chiropractors on staff”(Wallis,1991).

Relevant Policies and/or Practices In 1997, 42 percent of all alternative therapies used were exclusively attributed to treatment of existing illness, whereas 58 percent were used to prevent future illness from occurring or to maintain health and vitality” (JAMA, 1998). “The magnitude of demand for alternative therapy is noteworthy, in light of the relatively low rates of insurance coverage for these services” (JAMA, 1998). Coverages vary widely depending on the policies provided by the carriers. In my research, I contacted the Kern County Superintendent of Schools, (“KCSOS”), Personnel Office to inquire into the health policies provided to the nearly one thousand employees of the office. There are a variety of options available to each employee. The basic hospitalization plan used by the majority of employees is the Blue Cross Prudent Buyer Hospital Only plan. As required by State and Federal law, the office is also required to make available approved HMO’s if employees request them. To that end, the office has a large number of employees enrolled in Kaiser-Permanente and Health Net HMO’s. The administrative agency that provides the programs is the Self Insured Schools of California, (“SISC”), which is a cost-containment consortium of hundreds of California school districts. Currently, SISC provides coverage for more than thirty-five thousand employees and their eligible dependents. In addition to medical coverages, the office also provides life, vision, dental, prescription and mental and nervous policies. The mental and nervous policy that is provided for each employee and dependents is described as a “carve-out” benefit. Prior to this type of policy utilization, the basic Blue Cross medical plan provided very specific and limited mental and nervous benefits. Carve-out benefits provide coverages for treatments that would not be covered otherwise. Several companies came forward with plans that were more comprehensive and cost-effective and replaced the medical plan component. An additional benefit was that there was a net premium savings. Three companies, Pacificare, MCC and BHA, offer plans at comparable rates which provide a variety of family and personal counseling services which are more along the lines of preventative medicine rather than the hospitalization plans that were offered under the basic hospitalization plan. Employee unions have been very receptive to these plans due to the cost-containment provisions as well as the intervention value for the employees that they represent. For example, an employee with an alcohol or drug addiction problem can get confidential assistance to assist in the resolution of these problems and avoid being disciplined for job performance problems.

The basic medical plans offered by the KCSOS office provide various levels of coverage for several forms of alternative medicine. The Blue Cross Prudent Hospital Only plan provides coverage as follows: “A doctor of medicine (M.D.) or a doctor of osteopathy (D.O.) who is licensed to practice medicine or osteopathy where the care is provided, or one of the following providers, but only when the provider is licensed to practice where the care is provided, is rendering a service within the scope of that license, is providing a service for which benefits are specified in this Plan Description, and when benefits would be payable if the services were provided by a Physician as defined above: a dentist, optometrist, dispensing optician, podiatrist of chiropodist, psychologist, chiropractor, acupuncturist(but only for acupuncture and for no other services), certified registered nurse anesthetist, clinical social worker*, marriage, family and child counselor*, physical therapist*, speech pathologist*, audiologist*, occupational therapist*, respiratory therapist*. Note: Services by the providers indicated by asterisks (*) are covered only by the referral of a Physician as defined above”(SISC III, 48).

Health Net has partnered with American Specialty Health Plans (ASHP) to offer Chiro Net quality, affordable chiropractic coverage. With this program, you’re free to obtain this care by selecting a participating chiropractor from the Chiro Net directory. Although you’re always welcome to consult your Primary Care Physician, you won’t need a referral to see a participating chiropractor.

Nowhere in the Health Net coverage guide did it mention coverage, limitation, or exclusion of the numerous treatment modalities of alternative medicine except for chiropractic treatment, which it supported in explicit detail. From this one may conclude that chiropractic is the only alternative treatment that has established a beneficial reputation in possibly preventing illness and promoting wellness in the western world. An extremist might say because Health Net does not include any other forms of alternative medicine, that these modes of treatment are not generally accepted by the medical community or deemed effective or appropriate in treating illness. Kaiser Permanente’s coverage plan has a significantly larger number of exclusions and limitations regarding treatment coverage compared to Blue Cross and Health Net within the SISC administrative agency. The exclusions section of Kaiser’s coverage guide states in section i, “Chiropractic services and services of a chiropractor,” which is in contrast to both Blue Cross and Health Net, each of which fully recognize and provide coverage for chiropractic services. In section j of the exclusion section it seems that Kaiser is attempting to eliminate coverage of all other alternative medicine treatment by stating, “Experimental or Investigational Services and those procedures not generally and customarily provided to patients residing in the Service Area.”(Kaiser, 13) Their definition of Experimental and Investigational Services is, “any service or item that is not recognized in accord with generally accepted medical standards as being safe and effective for use in the treatment of the condition in question, whether or not the service is authorized by law for use in testing or other studies on human patients; or any service requiring approval by any governmental authority prior to use when such approval has not been granted prior to provision of the service or item.” (Kaiser, 27) This seems to be an attempt to classify all other forms of alternative medicine treatments, with the possible exclusion of chiropractic, as experimental forms of treatment. If this proves to be a fallacious statement, by concluding that section j was an attempt to deem that alternative medicine as an experimental service; then one might conclude that Kaiser dismisses alternative medicine treatment altogether by not including them in their coverage plan at all. Either way Kaiser must view alternative medicine as being inadequate or inappropriate treatment for illness, providing relief of symptoms or improving their patients degree of health.

Preventive medicine, wellness and alternative therapies are fundamental components of a growing national trend. According to a survey conducted by The Journal of the American Medical Association, “...use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 percent in 1990 to 42.1 percent in 1997, and the probability of users visiting an alternative medicine practitioner increased from 36.3 percent to 46.3 percent” (1998). More and more Americans are seeking options other than conventional forms of medical treatment. Conventional or modern medicine can be defined as treatment that is widely accepted by U.S. medical schools and insurance companies as being beneficial to the treatment of disease and illness with scientific evidence. “In 1993, the National Institutes of Health chose Dr. Joe Jacobs to head their new Office of Alternative Medicine. The office was created last year under pressure from a Congress alarmed by the soaring cost of high-tech healing and the frustrating fact that so many ailments such as: AIDS, cancer, arthritis, back pain, which have yet to yield to standard medicine”(Toufexis,1993). The cost of standard medical care has risen dramatically. For example, a simple arthroscopic cartilage repair on an outpatient basis costs in excess of five thousand dollars for a thirty minute procedure. A simple Magnetic Resonance Imaging, (“MRI”), costs over a thousand dollars. In contrast, a visit to a chiropractor costs less than forty dollars. The Journal of Occupational Medicine performed a study comparing costs of treating back injuries with chiropractic and traditional medicine. Using identical diagnostic codes for 3062 claims, the report reached the following conclusion: “For the total data set, cost for care was significantly more for medical claims, and compensation costs were ten-fold less for chiropractic claims.”(1991).

Major Position or Argument Is it better to exercise preventive medicine rather than focus on curing disease after the fact? In response, a growing number of people have concluded that it is a quality of life decision for them to opt for optimizing their health rather than seeking cures. According to the study that represented the use of unconventional therapy for the 10 most frequently reported principal medical conditions, published in the New England Journal of Medicine, “...a full third of the respondents who used unconventional therapy in 1990 did not use it for any of their principal medical conditions”(nejm,1991). From this fact we can infer that a substantial amount of unconventional therapy is used for non-serious medical conditions, health promotion, or disease prevention. “The probability that an individual patient who saw a medical doctor also used unconventional therapy in 1990 was higher than one in three for patients with anxiety(45 percent), obesity(41 percent), back problems(36 percent), depression(35 percent), or chronic pain(34 percent), relaxation techniques, chiropractic, and massage were the unconventional therapies used most often in 1990" (nejm,1993). How can the insurance companies ignore the fact that, “an estimated number of ambulatory visits to providers of unconventional therapy in 1990 was 425 million?

This number exceeds the estimated 388 million visits in 1990 to all primary care physicians(general family practitioners, pediatricians, and specialists in internal medicine) combined. Also, if one assumes that charges for visits to providers of alternative therapy were paid in full, Americans spent approximately 11.7 billion dollars for these services in 1990"(nejm,1993). Nutrition stores have multiplied in the past few years due to the growing demand for a variety of vitamins and potions regarded by many as a viable means to fend off disease and to improve on one’s daily health. Additionally, fitness centers and exercise facilities have sprung up on every street corner. Some are open twenty-four hours per day and provide numerous forms of equipment, technical assistance and even personal trainers to assist dedicated individuals in improving their general well-being and appearance. Society has become aware of the benefits and effectiveness of unconventional therapies shown by a study that those who sought treatment from providers of alternative medicine has seen the provider an average of ten times in the past twelve months(nejm,1991).

Body of Paper The American Chiropractic Association defines chiropractic as follows: “Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without drugs or surgery.” “The practice of Chiropractic focuses on the relationship between structure, (primarily the spine), and function, (as coordinated by the nervous system), and how that relationship affects the preservation and restoration of health. In addition, Doctors of Chiropractic recognize the value and responsibility of working in cooperation with other health care providers when in the best interest of the patient.” (ACA, 1998). There can be little doubt that chiropractic treatment is valuable as both a standard medical treatment and as an alternative form of medicine. There may very well be some scientific justification in the manipulation of the spine because almost every nerve in the body runs through the spinal cord. Chiropractors maintain that they can treat illness by adjusting the vertebra of the spinal column to relieve nerve and muscle tension(Wallis,1991). This position may, at first, seem contradictory but with further analysis and explanation, it will become clear that it is a supportable premise. “The visits to practitioners of alternative therapy in 1997 exceeded the projected number of visits to all primary care physicians in the United States by an estimated 243 million; visits to chiropractors and massage therapists accounted for nearly half of all visits to practitioners of alternative therapies” (JAMA, 1998).

As an example, a simple on-the-job back strain could be treated in several ways. The simplest and seemingly least costly treatment would be for the employee to go home and rest in bed. However, this form of treatment may actually keep the employee away from work for the longest period of time which would make the cost factor to the employer higher in the long run due to Worker’s Compensation premium costs and the costs associated with replacing the injured employee such as sick leave benefits and the costs of providing substitute employees. The more traditional treatment would be for the employee to seek treatment from an urgent care facility or from a family physician. Treatment would generally require X-rays, an MRI or a CAT scan to assist the physician in diagnosing the source of the injury. Depending on the nature and severity of the injury, surgery and rehabilitation through physical therapy may be required to resolve the injury. Otherwise, in the case of a minor injury, cold packs, pain medication and rest may be appropriate treatment. Costs for traditional physician treatment are generally very high. For example, a standard MRI will cost at least a thousand dollars. Referral to an Orthopedic Surgeon and subsequent treatment including possible surgery, medication and subsequent physical therapy can cost tens of thousands of dollars and extended periods of lost work time. All of the medical plans that I examined provide full coverage, less applicable deductibles or co-payments, for the cost of most forms of treatment with the exception of those considered to be experimental. A third alternative may be acupuncture treatment. The acupuncturist may or may not be licensed to provide or order X-ray, MRI or CAT scans. If not, the treatment may be the traditional acupuncture treatment. Rest is generally recommended. Generally, the cost of acupuncture is covered, subject to deductibles and co-payments, by most health plans with the exception of Kaiser-Permanente. The fourth and most appropriate treatment, in my opinion, is chiropractic. A chiropractor has the ability to order or to provide X-ray examinations as well as to order MRI’s or CAT scans as necessary. In the event that structural damage such as a ruptured disc or fracture exists, the chiropractor would refer the employee to an orthopedic physician. However, if the injury is due to a subluxation, the chiropractor would typically perform an adjustment to the spine or other form of manipulative therapy to realign the spine and remove nerve interference and to relieve pain and discomfort. The chiropractor may also prescribe cold packs, rest and, in some cases, physical therapy. The initial examination, which include: the patient’s history and assessment, X-rays, spinal adjustment, and recommendations for improving of making changes in their lifestyle to promote a healthier life (nutrition, massage therapy, exercise, rest, etc.). The initial examination costs a few hundred dollars, which is covered by Blue Cross and Health Net less the deductibles and co-payments. Follow up exams include spinal adjustments and recommendation or advice on questions pertaining to the treatment and your lifestyle. The cost of these exams usually cost around fifty dollars per visit, which Blue Cross covers the full amount after the deductible has been paid; Health Net requires a co-payment of ten dollars per visit up to thirty visits per year, and Kaiser doesn’t cover any of the expenses of chiropractic care. According to an article in Kiplinger’s Personal Finance Magazine, “An initial visit to a chiropractor could cost $40 to $80, plus the cost of x-rays; follow-ups are around $40 to $60. Insurance laws in most states require insurers to reimburse for treatment by chiropractors if they reimburse for comparable treatment by M.D.’s, and coverage is mandated in Delaware, Maryland, New Mexico and North Dakota. There is no requirement in Oregon, Utah and Vermont. Self-insured plans are exempt from the state-mandated-benefit laws. Also, according to Don White of the Health Insurance Association of America, insurers are “much more willing to pay than they used to be” when alternative therapies are recommended by a doctor after conventional methods fail”(Clark,1993). Chiropractic is not without its own set of risks just as other forms of traditional medicine. Ian Coulter, Ph.D. identified those risks and facts as follows: “chiropractors perform more than 90 percent of spinal manipulations (manipulation is the generic, non specific medical term for adjustment); the risk of complication with cervical (neck) adjustments is 6.39 per 10 million adjustments; the risk of complication with lumbar (low back) adjustments is 1 in 100 million adjustments. The risk of complication in some common medical procedures and medications were not as good: the risk of complication with the use of NSAIDS (aspirin, tylenol, ibuprofen, etc.) is 3.2 in 1,000; and the risk of complication in cervical spine surgeries is 15.6 in 1,000. By way of commentary, there has been a lot of news coverage concerning the dangers of Chiropractic care over the past few years. This article clearly points out that Chiropractic procedures are significantly safer than many common medical procedures. For the best reflection of how safe Chiropractic is, ask your Chiropractor how much his/her malpractice insurance costs. Then ask your medical doctor the same question. The difference will surprise you.” (Chiropractic America, 1999).

The preceding procedures treat injuries and the pain associated with the injury in widely differing manners. It is also important to consider how each form of treatment personally affects the individual. Obviously, the less invasive the treatment, the quicker the recovery. Pain control is another serious consideration. Simply resting may be adequate in some instances but if a serious injury exists, the long term result may be negative. Surgery generally generates substantial pain which requires pain control medication which, in some instances, can become addictive. In contrast, acupuncture causes very little, if any, discomfort and may provide a long term solution. “Acupuncture is most often used to treat pain, and is also used for ailments such as hypertension and gastrointestinal disorders. Needles placed on points on the body are said to transmit impulses to the brain and then to the affected organ. An initial visit might cost $225; follow-ups run about $75, including a supply of Chinese herbal medicines, which are part of an acupuncturist’s treatment”(Clark,1991). However, chiropractic would be my first choice for treatment because of the immediate nature of the relief this form of medicine provides. It provides for safety in that prior to a subluxation adjustment, the chiropractor would use X-rays to determine the efficacy of this form of treatment. If a structural injury exists, such as a disc problem or fracture, the chiropractor would be at liberty to refer the patient to a physician. Otherwise, chiropractic is neither invasive nor uncomfortable. In a report released in July 1991 by the Rand Corporation, a prestigious research organization in Santa Monica, California, ...a panel of leading physicians, osteopaths and chiropractors found that chiropractic style manipulation was helpful for a major category of patients with lower-back pain: people who are generally healthy but who had developed back trouble within the preceding two or three weeks. By some estimates, 75 percent of all Americans will suffer from low back aches and pains at some point in their lifetime. The annual cost to U.S. society of treating the ubiquitous ailment was recently tallied at a crippling 24 billion dollars, compared with $6 billion for AIDS and $4 billion for lung cancer. If spinal manipulation could ease even a fraction of that financial burden, remaining skeptics might be forced to stifle their misgivings or get cracking themselves”(Purvis,1991).


\13 Quacks as healers

In almost all cases, drugs are discouraged so that drug reactions and addictions are never an issue as a result of treatment. It is recognized in almost all medical circles that many illnesses are generated by the mind. "A growing number of doctors around the country have become more open to alternative approaches, looking particularly at the way that body, mind and life-style interact. Andrew Weil, a Harvard-trained M.D. and author of The Natural Mind, practices this sort of 'holistic' medicine in Tuscon"(Wallis,1991). Stress from many sources including work and family is the cause of many maladies. That is why it seems very curious that some health organizations ignore the positive aspects of some or all forms of alternative medicine. On one hand, the medical community recognizes the mental side of medicine and then they summarily ignore forms of treatment that people believe in and that result in healing whether the source is medical or physical. It seems to be a territorial response to what the medical community perceives to be a threat to its existence. Dr. Saper, a neurologist, "...confirms that lowering a patient's stress level, with relation techniques or simply encouraging trust in the doctor, can be healing. Research suggests that stress triggers the release of chemical messengers from the brain that suppress the immune system; relaxation would therefore revive the immune response"(Wallis,1991). However, the trend seems to be towards acceptance of alternative medical practices. A telephone poll of 500 American adults was taken from TIME/CNN on October 23, 1991 by Yankelovich Clancy Shulman that contained three questions about their use of alternative medicine. The results of the survey were: 31 percent of the poll sought medical help from a chiropractor, 6 percent sought help from an acupuncturist, 5 percent went to an herbalist, 3 percent visited a homeopathic doctor, and 2 percent sought help from a faith healer. When those who had sought medical help from alternative medicine providers where asked if they would go back to an alternative doctor, 84 percent of them said yes, and only 10 percent answered no, with the 6 percent of 'not sures' being omitted. Among those who had not sought help from a practitioner of alternative medicine, 62 percent said that they would consider seeking medical help from an alternative doctor if conventional medicine failed to help them(Wallis, 1991). If a high percentage of illnesses are truly psychological and if these people believe that these forms of alternative medicine will cure them, then the insurance companies should provide coverage for them. Ultimately this is cost effective because in comparison to cost of other forms of medical treatment, alternative medicines are much less expensive. By providing coverage for alternative medicine, society should in fact increase their health either physiologically and/or psychologically, which will in turn decrease the number of illnesses and health care premiums will decrease. Maintaining wellness is a emerging focus of both employers and HMO's. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 percent in 1990 to 42.1 percent in 1997. This shows that society is accepting alternative medicine on an ever increasing basis. Alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression and headaches. Also, more than half of these visits were paid for out-of-pocket, that is health insurance would not or did not pay for the cost of treatment (JAMA, 11/98). Incidently, more and more insurance companies are providing coverage due to member demand. Therefore members who believe in treatment through alternative medicine should make a concerted effort to make their demands heard. One study, conducted in England, found that "for patients with low-back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison to standard hospital outpatient management." An extended follow-up of the same patients found that chiropractic patients continued to fair better than their medically treated counterparts (Meade, 1431-7). "At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long-term satisfaction than those treated by hospitals"(Meade, 349-51).

Cost-containment is of vital importance, especially to those that must pay out-of-pocket for their medical treatments. According to the JAMA: "The majority of people who saw alternative therapy practitioners paid all the costs out-of-pocket in both 1990 (64.0%) and 1997 (58.3%)." Even so, the trend is apparent. More and more people are turning to alternative therapies. It must be remembered that the AMA has a vested interest in the results of such a trend and therefore would be inclined to put the best "spin" on the survey. "In 1990, a full third of respondents who used alternative therapy did not use it for any principal medical condition. From these data, we inferred that a substantial amount of alternative therapy was used for health promotion or disease prevention. In 1997, 42% of all alternative therapies used were exclusively attributed to treatment of existing illness, whereas 58% were used, at least in part, to 'prevent future illness from occurring or to maintain health and vitality." The AMA is apparently recognizing the fact that many people use alternative therapies not only to cure but to prevent illness and to improve health. This is a revealing statement for the medical community to make. The article goes on to say that: "As alternative medicine is introduced by third-party payers as an attractive insurance product, it would be unfair for individuals without health insurance and those with less expendable income to be excluded from useful alternative medical services or consultation (eg, professional advice on use or avoidance of alternative therapies)." (JAMA, 1998). The AMA is actually recognizing the value of alternative medicine when it refers to them as: "...useful alternative medical services...." In fact, the most impressive statement made by the AMA was: "An increasing number of US insurers and managed care organizations now offer alternative medicine programs and benefits. The majority of US medical schools now offer courses on alternative medicine." The Journal of the American Medical Association in a study conducted by the Stanford Center for Research in Disease Prevention concluded that: "Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine. However, the reasons for such use are, at present, poorly understood."

The study went on to say: "Three hypotheses were tested. People seek out these alternatives because (1) they are dissatisfied in some way with conventional treatment; (2) they see alternative treatments as offering more personal autonomy and control over health care decisions; and (3) the alternatives are seen as more compatible with the patient's values, worldview, or beliefs regarding the nature and meaning of health and wellness. Additional predictor variables explored included demographics and health status." The conclusion of the study was quite interesting. "Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life." (JAMA, 1998). Chiropractic, as one of the alternative medicine options, has proven to be a valuable and viable form of treatment for many common ailments. It is a relatively painless method for controlling pain as well as providing long-term relief from specific symptoms. In support of this proposition: "...the Agency for Health Care Policy and Research which is an arm of the U.S. Department of Human Services, developed a clinical practice guideline for acute low back pain: they looked at the quality and quantity of research backing common treatments. In the final guideline, the multidisciplinary panel found that 'for patients with acute low back symptoms without radiculopathy (irritation of the spinal nerve root), the scientific evidence suggests spinal manipulation is effective in reducing pain and perhaps speeding recovery within the first month of symptoms.'" (Health Ways, 1998). Chiropractic is much less costly than traditional medication and because of its non-invasive nature, recovery is generally much quicker. Users of chiropractic find that this form of treatment is more consistent with preventative health patterns and practices. There is a very low occurrence of side effects and risk involved compared to traditional medical treatment, which includes oral medication and surgery. Chiropractic is supported by a good deal of evidence as mentioned above. Supporters of Chiropractic would be likely to promote that one should prevent disease and illness through spinal adjustments, and resort to drugs as a secondary option to regaining health, and surgery as a last resort. Society has come to recognize the benefits that alternative medicine provides. Insurance companies are slowly coming to the realization of the efficacy and the health benefits that alternative medicine has to offer. The only way to persuade the insurance companies to provide coverage is for the users to voice their opinions.

