HADCORP NEWS: July 21, 2008

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HADCORP NEWS: July 21, 2008

Leading Story

Fluoride Still in the News: Risks Noted for Kidney Patients, Children, Seniors

By Lee son and Gail Mc-Tune

Topanga Messenger

Topanga,CA,USA

The National Kidney Foundation (NKF) recently withdrew its longstanding support for fluoridation of public water supplies. Although scientists have long raised concerns about the risks of fluoridation to public health, especially in susceptible populations, including infants, seniors and those suffering from chronic renal diseases, the NKF had allied itself since at least 1981 with the American Dental Association (ADA), which listed the NKF on its website as an organization that "recognize the Public Health Benefits of Community Water Fluoridation for Preventing Dental Decay." In a position paper issued in 1981, and relying on scientific data from the 1970s, the NFK also stated there was "insufficient evidence at this time" to recommend the use of fluoride-free water for those with kidney disease.

In a new position paper, dated April 15, 2008, the NKF reversed its previous stance, and the foundation's name has since been removed the list of fluoridation-endorsing organizations on the ADA website. However, the NKF issued no press release and its new position paper did not come to media attention until early June.

According to the new paper, the NKF was moved to reexamine its stance on fluoridation by a number of factors, among them a challenge by an attorney who intimated suit might be filed on behalf of renal patients who had relied on what he characterized as the foundation's "outmoded" advice that fluoridation was safe. But perhaps most compelling were the March 2006 report of the National Research Council (NRC) on fluoridation and a recently published review by Kidney Health Australia, strongly suggesting that NKF's position on fluoridation was obsolete.

The NKF's new position paper emphasizes the NRC's finding that "a potentially susceptible subpopulation comprises individuals with renal impairments who retain more fluoride than healthy people do." The NKF paper also takes note of the multiple vehicles, including foods, beverages, drugs, toothpastes (which contain 1,000-fold more fluoride than drinking water), as well as fluoridated drinking water, through which fluoride is ingested; the fact that many of these products are not labeled for fluoride content, making it impossible to monitor the fluoride dosage actually being received by renal patients and others; and the scientific research documenting the health risks of fluoride, among them, dental and skeletal fluorosis, weakening of the bones, and an increased rate of fractures. The NKF observes that the worst of these risks appears to be associated with intake of fluoride at levels as much as four times higher than those commonly used in the

fluoridation of public drinking water. However, the NKF report notes that those in the advanced stages of chronic kidney disease (CKD)–stages 4, 5 and 5D–"retain more fluoride than healthy individuals,"; in fact, their "[f]luoride blood levels are approximately 4-fold higher" than those of the general populace. "

It has long been acknowledged that fluoridated water cannot be used in dialysis, which sustains the lives of patients in renal failure.

However, the NKF paper reports instances of severe illnesses and even several deaths following water system and hospital equipment accidents which allowed the introduction of fluoridated water into the dialysis process–including one in polis in 1979 in which "approximately 1,000 gallons of 22 percent hydrofluorosilic were accidentally added to the ... public water system."

As a result, the new position paper concludes, "The 1981 NKF position paper on fluoridation is outdated. The paper is withdrawn and will no longer be circulated...." The new paper also states definitively: "The NKF has no position on the optimal fluoridation of water. The oral health of people with CKD is certainly of interest to the NKF, but balancing the overall benefits and risks of fluoride exposure is the primary concern." The foundation goes on to recommend additional research on fluoride toxicity, and specifically advises: "Individuals with CKD should be notified of the potential risk of fluoride exposure by providing information on the NKF website including a link to the report in brief of the NRC and the Kidney Health Australia position paper."

Kidney patients are not the only ones at risk from fluoride exposure, say many scientists. Infants and young children are another susceptible population. "[H]uman breast milk has about 1/100th the level of fluoride that so-called optimally fluoridated water has.... f Mother Nature had intended for human beings to get fluoride at that level, the human breast would have accommodated it," says J. Hirzy, a chemist and fluoride expert at the American University in Washington, D.C.

"It is now the consensus view of the dental research community that fluoride's primary benefit to teeth comes from topical application to the exterior of teeth, not from ingestion through the water supply," adds Connett, project director of the Fluoride Action Network.

Connett continues, "Since … the risks are primarily from ingestion … adding fluoride to the nation's water–and thereby to the bulk of the nation's processed food–increases public ingestion of fluoride."

Phyllis Mullenix, Ph.D., a neurotoxicologist, former head of the toxicology department at the Forsyth Dental Center, a world renowned dental center associated with Harvard Medical School, and currently a research associate in psychiatry at the Children's Hospital Medical Center in Boston, reported impacts on the central nervous system that flagged fluoride as having the potential to cause motor dysfunction, IQ deficits, and learning disabilities in humans. In a study published in the Journal of Neurotoxicology and Teratology, Mullenix showed that fluoride crosses the blood-brain barrier in baby rats, which–depending on when they were exposed to fluoride dosages similar to what human children receive–exhibited hyper and hypo-activity.

In two other studies published in 1999, the same journal noted that some children exceed the total daily fluoride ingestion simply by using toothpaste alone. (Commercially packaged toothpastes contain warnings not to swallow.) The second study found that more than 50 percent of infants are currently formula-fed at one month of age, and, because of the fluoride in the formula, they "are likely to be continuously exposed to high intakes of it for nine or 10 months."

Fluoride is also contained in most of our nation's processed and packaged infant foods and beverages, including "healthy choices," such as many fruits and vegetables sprayed with pesticides containing fluoride. For example, non-organic grapes and raisins are among the highest fluoride-containing foods eaten by children. Some sodas are also made with fluoridated water. As early as 1996, the Journal of the American Dental Association presented data suggesting that young children who drink substantial quantities of juice "should not receive dietary fluoride supplements, since they might be at increased risk of developing dental fluorosis." Another ADA article from 1997, found high-fluoride-content chicken in infant food.

More recently, a 2001 study by Oregon State University showed that foods made with mechanically separated chicken contribute to fluoride intake, reporting that infant foods had the highest amounts of fluoride. The study concluded that "a single serving of chicken sticks alone provides roughly half of a child's upper limit of safety for fluoride."

Parents may be surprised to learn that the substances used to fluoridate their water is a waste material, hydroflusilic acid, taken from the smokestack pollution scrubbers used in the phosphate fertilizer industry. Hydrofluosilicic acid is classified as a hazardous industrial waste.

Those wishing to avoid the potential health risks associated with fluoride may want to consider feeding their children organic foods, including organic baby foods now carried by many markets. Filtering water is a bigger obstacle–most common household water filters do not screen out fluorides. Reverse osmosis water filters are required to remove or substantially reduce fluorides in the water supply, and such filters often waste as much as two-thirds of the water being processed. If choosing fluoridated tooth paste, be certain that your children use only small, pea-sized amounts and do not allow them to swallow it.

For more information, check out the following websites: Fluoride Action Network, www.fluoridealert.org; Citizens For Safe Drinking Water, www.keepers-of-the-well.org; Scientists, Doctors and Researchers Warn of Fluoride Dangers, www.nofluoride.com.

PLASTIC SURGERY

Nip tuck holiday or medical lottery?

Mon, 21 Jul 2008 6:37p.m. 3 News NZ

Auckland, New Zealand

A scrap is going on in the plastic surgery world. Local surgeons, versus a medical tourism company that runs nip-tuck tours to Asia.

"Beautiful You Holidays" is giving away $15,000 worth of surgery in Malaysia. Plastic surgeons say that is unethical and it trivialises the risks of surgery.

So is it quality surgery at an affordable price, or a medical lottery which puts your health at risk? The debate over nip tuck holidays, or medical tourism, has been going strong for years with no sign of it going away.

In the latest instalment, a new medical tourism company is promoting itself with a giveaway, a surgical makeover worth up to $15,000 in Malaysia.

It has raised the ire of the local plastic surgeons who say it is unethical and it trivialises the importance of surgery.

The company says it is not doing anything illegal and that the surgeons are only upset because they are being undercut.

“Its a marketing tool, but also for me you know its very rewarding thing, its nice to see people get something that they couldn't have the surgery because maybe they couldn't afford it,” says Lorraine Reinsfield of beautiful You Holidays.

It all sounds very appealing, the sunshine, shopping and surgery, with two recovery weeks in a five star hotel.

But our local plastic surgeons see it differently.

“It just degrades surgery assuming it is a simple thing that you duck out earn a prize rather like having your hair or your nails done. There are very serious implications if the wrong operation is done or it is inappropriately or its inappropriate operation for that person,” says Colin Calcinai from the Association of Plastic Surgeons.

Colin Calcinai says it is unethical for doctors or surgeons to offer a prize or inducement to any patient, a stance mirrored by the New Zealand Medical Council.

But does that apply to surgery done overseas?

We contacted the Department of Internal Affairs which keeps an eye on sales promotions schemes like this to see if they contravene the gambling act. It said the way the competition is being run is not against the law and neither is the prize being offered illegal.

Lorraine Reinsfield believes the real reason surgeons are upset is because they might lose some business.

“I think the people who go to Malaysia can not afford the price that they are charging here and if they are upset about that then they should bring their prices down,” says Lorraine.

“There is no question that it will be cheaper to have surgery in Asia full stop, because the whole cost structure is cheaper, in Asia there are no regulations that they have to conform to, for example, they pay their workers next to nothing so they can build hospitals for next nothing and charge next to nothing,” says surgeon Colin Calcinai.

This is why the industry in Malaysia is growing by 30 percent a year.

It has caught the eye of the British. Part of the promotional pack Lorraine and Liz hand out includes UK TV shows following clients to Kuala Lumpur.

But these are the success stories, surgeons here say they see the mistakes.

“In terms of people travelling to have surgery yes there are certainly cases that have come back to new zealand having had surgery abroad with significant problems and then my members are obliged to pick up the pieces,” says Colin.

Malaysia hit the headlines last year - when a New Zealand woman died there after obesity related surgery.

It was organised by a different medical tourism company called Gorgeous Getaways, but the whole industry has felt the effects.

Liz Talifero recently met with the Malaysian Health Minister because the government there is considering some industry regulation.

“Unfortunately there is no guarantee and there is no guarantee when the person arrives back in New Zealand with complications,” Colin says.

But that may not stop people entering, Lorraine Reinsfeld's competition runs all year. But she already has plenty of people wanting a new body for free.

BIG PHARMA

Big Pharma freebies for docs seen driving up health care cost

Published: July 20, 2008

By Mason Staff writer

USA

BOSTON — Free meals, conferences and pens and note pads emblazoned with the names of the latest prescription drugs are some of the goodies Big Pharma companies lavish on doctors to get their products prescribed.

With Massachusetts spending enough on health care to pay for almost three Big Digs, those freebies are under scrutiny as part of a sweeping effort to rein in soaring health care costs that was passed last week by Beacon Hill lawmakers.

A 2006 report by the Boston University School of Public Health estimates the cost of health care at $62.6 billion a year — the cost of 2.8 Big Digs at $22 billion each.

Rising costs threaten to undermine the state's landmark health care law, which requires considerable state subsidies, as Massachusetts moves toward its goal of insuring all its residents.

Carlat, a Newburyport psychiatrist, said the House fumbled a chance for real savings last week when it didn't approve a ban on gifts to doctors.

"It's all part of the puzzle of trying to contain costs," Carlat said. "Allowing drug company reps to shower even small gifts has an effect. It encourages doctors to prescribe new and more expensive drugs."

The method is subtle, said Carlat, who does not accept gifts from drug company representatives.

"The psychology is not that you're given a pen or clock and then say, 'I'm going to return this favor,'" Carlat said. "It's the visits, the lunches they bring into your office, the gradual process of buttering up a prospect. It's about a friendly relationship with your drug rep. You want to reciprocate."

The cozy, boundary-bending relations go back to medical school.

Raser, a doctor at Greater Lawrence Family Health Center who graduated from Dartmouth Medical School in 2006, recalls daily lunch conferences at the school sponsored by pharmaceutical companies.

"There's clearly an influence, even the smaller gifts," said Raser, who also does not accept drug company gifts. "I consider the pharma companies sophisticated. They wouldn't spend millions of dollars (on doctors) if it didn't profit to give those kind of gifts."

The House bill passed last week would ask drug companies to adopt a voluntary code of conduct limiting gift-giving to doctors, something Senate leaders say they'll support.

Rep. Walrath, D-Stow, said lawmakers backed away from an outright ban following a June biotech conference in San Diego. There, drug and life sciences company executives protested the ban, proposed in February by Senate President Therese Murray.

Walrath said pharmaceutical companies argued that a full ban would deprive doctors of valuable information in one-on-one meetings with drug company reps.

Alan Sager, director of the Health Reform Program at Boston University's School of Public Health, said banning gifts to doctors won't do much — and there are bigger issues.

Health care costs are out of control because the way health care is delivered is broken, he said. Patients go to specialists when a primary care physician is more appropriate. And if they did want to see an internist, good luck. Massachusetts has a glut of specialists and a shortage of generalists.

The bill lawmakers passed doesn't address any of that, he said.

"This bill will not save serious money," Sager said. "It doesn't attack the sources of the real problems in substantial ways."

The bill would require that doctors adopt electronic medical records by 2015. Hospitals would have to report infections patients acquired to the state. It also includes a program to help doctors repay loans so they can focus on areas where specialists are in short supply, such as family practice and obstetrics.

And a commission would devise regulations for treating patients. The state would reward doctors and hospitals that focused on preventative care and less on expensive high-tech gadgets, similar to the way it regulated care in the 1970s and 1980s.

But Motta, a Gloucester cardiologist who is the president-elect of the Massachusetts Medical Society, doesn't want to see a total ban on gifts.

He said the Senate version of the health care cost bill went too far, banning drug samples that he dispenses to help indigent patients or those who need a dose or two to tide them over. He also accepts educational material on how to use drugs, which he reviews first, then pasess along to patients.

Motta said he complies with American Medical Association guidelines on receiving gifts, which ask doctors not to accept any gift of value that does not help patients. "As long as it benefits the patient, there should be no problem," Motta said.

That means drug reps better come to his office with peer-reviewed articles, not drug company propaganda or lavish gifts.

Motta does accept trinkets like pens and memo pads, which he says don't influence doctors.

"If you're talking about a fancy paperweight or a clock for the wall, that crosses the line," Motta said.

Health Care for All research director Rosman said he's disappointed the gift ban will not make the final bill. But he said the measure will help corral runaway costs.

"We're encouraged," Rosman said. "It has the potential for leading to transformative changes."

"It's not going to be quick or easy," Rosman said. "These things take time."

Time may not be on the side of the state or the nation.

In Massachusetts, employers are balking at Gov. Deval 's proposal to have businesses shoulder more of the cost of expanded health care access. And exploding health care costs have made their way into the presidential race. U.S. Sen. Barack Obama supports moving the nation toward universal health care.

Pushed aside following the Clinton administration's disastrous venture into health care reform, health care costs may be the biggest issue facing Americans.

"It's going to be the major problem the country has to wrestle with," Motta said. "We'll either solve it in the next year or two or health care will be in deep trouble."

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