Meditation, when used as a health tool, can significantly increase an individual’s sense of well-being, while simultaneously reducing stress.  Abundant research has shown that meditation can lower blood pressure, ease chronic pain, reduce stress and depression, improve concentration, and even boost the immune system.  All of this from the basic practice of sitting and quieting the mind.  There are so many external stressors in today’s society that finding a way to slow down and focus the mind will do wonders for the body.

Charles L. Raison, MD is the clinical director of the Mind-Body program at Emery University School of Medicine in Atlanta and has participated in a study on just how meditation can improve physical and emotional responses to stress.  What he has found is that stress reduction is the key component of the health benefits of meditation.  No matter who the patient is they will benefit from stress reduction because it will enable their minds and bodies to better handle any health issues that may be present.  Even if the only concern is an inability to sleep, meditation can help with that too.

Stress is a contributor to all major modern killers like cancer.  When you think about it, it is actually quite hard to have a disease that does not include or create stress in some way.  In severe cases, stress can even be a cause of the ailment.  Finding a way to minimize or remove stress altogether can only be of great benefit to the entirety of a person’s health.

Many people view meditative practices as hippy dippy techniques, and don’t give them adequate credit for their proven positive impact on overall health.  Many are under the impression that sitting with legs crossed fingertips touching saying “ohm” is the only way to practice meditation, when in reality the only requirement of the practice is to narrow your mental focus and still the body.  This does not necessarily require a specific posture, although some are known to be more effective than others.  You can find alternative ways to achieve the same end.  Some popular, less demanding methods include counting breaths, staring at a candle, or sitting quietly – the only real challenge is finding a way that works for you.

It feels like common sense that taking ten or twenty minutes out of your day to sit quietly, breathing deeply is a great way to unwind and relax, but so many people are unable or unaware of the benefits of meditation.  Call it mediation, call it sitting, call it quiet time; taking a moment to focus your energy and calm the mind will reduce stress, promote well-being, and help bring you back into the present which is all your ever have anyway.  People that live in the present experience a greater sense of well-being, and are much less prone to stress. Try for yourself and experience the health benefits of medication personally.

About the author: Jenni Sunde is a freelance fashion writer and pop culture junkie. Jenni specializes in all things lifestyle-related. From home and design to health and beauty. With her love of art and all things beautiful, she delights in sharing her sense of style from her life to your computer monitor. Her title pegs her as an editor at a website that specializes in providing people with a car insurance quote, but her passion leads her into writing with a little more substance and a lot more heart.

I work in the State of Washington, where the laws regarding medical marijuana are pretty liberal.  I have only recommended marijuana once to a patient, and I believe it helped her die more comfortably with her end-stage pancreatic cancer.  Her nausea seemed diminished in her last few days.

 In general when patients ask me about medical marijuana I just tell them that I do not prescribe it.  Essentially every patient who has asked me is already using marijuana.  I essentially never have chemotherapy patients, end stage cancer patients, or others who need short term use.  I only see patients with longterm anxiety, pain, or other conditions who are already overusing prescription opiates or benzodiazapines who hope marijuana will be of help.  I feel like most of the time I am being asked is to give users a legal out in case they are arrested.   I have mixed feelings about casual or recreational marijuana use.  I believe it can be a big problem for regular users, and am not willing to facilitate its use as of this time. I do look forward to more data, and am keeping an open mind.  Read on to see the Psychiatric News article. 

At least one addiction psychiatrist says the question of legalizing marijuana for medical uses cannot be disentangled from the larger social context in which marijuana is widely used—addictively by many—for recreational purposes.

To say “that the use of [cannabis] should be prevented by a prohibitive tax loses sight of the fact that future investigation may show that there are substantial medical uses for Cannabis.”

So stated William C. Woodward, M.D., J.D., legislative counsel to the AMA, in testimony in 1937 before the House Ways and Means Committee on the“ Marijuana Taxation Bill,” which would have taxed physicians who prescribed—and pharmacies that dispensed—cannabis.

(The bill passed, and in 1942 “cannabis” was officially removed from the U.S. Pharmacopeia.)

Seventy years after Woodward’s testimony, whether research has proven“ substantial medical uses” for cannabis—either smoked in the form of the marijuana plant or taken in some other form—still appears to be a matter of passionate debate.

Thirteen states have passed laws to make marijuana more accessible for medical use. Many physicians and patients cite anecdotal evidence of the efficacy of cannabis for chemotherapy-related nausea, AIDS-related wasting, neuropathic pain, and other conditions; and a body of randomized controlled trials exists—mostly with relatively small samples and short follow-up times—documenting the benefits of cannabis for discrete conditions.

The American College of Physicians, among other groups, has called for reclassification of marijuana under the Controlled Substances Act from a Schedule I drug—under which it is deemed to have high abuse potential and no proven medical uses—to another schedule that would make it more available to researchers and clinicians.

On the opposing side are many physicians, including psychiatrists and addiction specialists, who say that research on cannabis, especially its long-term effects, is not sufficient to warrant rescheduling; that legalization would lead to greater abuse—by nonpatients in the general population, if not by patients; and that the medical community should proceed with great caution before declaring marijuana “safe.”

At the meeting of the AMA’s House of Delegates last November, a resolution to advocate for rescheduling marijuana was the subject of unusually lengthy and passionate debate, only to be sent to the AMA’s Council on Science and Public Health for a report back to the House and the AMA Board of Trustees (Psychiatric News, January 2).

Council chair and past APA President Carolyn Robinowitz, M.D., said she could not comment on the issue prior to the council’s deliberations except that “there seem to be more opinions than data.”

She said, “The council will look at the available evidence and consider it carefully, and present—to the extent that it is possible—an evidence-based report to the house.”

Studies Indicate Some Acute Benefit

To Sunil Aggarwal, Ph.D., the verdict is already in.

Aggarwal is a third-year medical student at the University of Washington School of Medicine and a fellow in the Medical Scientist Training Program. His doctoral dissertation, titled “The Medical Geography of Cannabinoid Botanicals in Washington State: Access, Delivery, and Distress,” discussed the successful use of medical marijuana or cannabinoid botanicals by 176 chronically and critically ill patients in Washington state.

(The term “cannabinoids” refers to any of the substances that are structurally related to tetrahydrocannabinol, or THC, the psychoactive ingredient in marijuana.)

At the AMA meeting, Aggarwal spoke to the Section Council on Psychiatry and asserted that since 2001—when the House of Delegates last voted to retain the Schedule I status of marijuana pending the outcome of research—at least 10 randomized, controlled trials had been completed on the use of cannabis for chronic neuropathic pain of multiple etiologies, appetite and weight loss in HIV/AIDS, spasticity in multiple sclerosis, and severe nausea.

In each of these studies, researchers used a federal-government supply of marijuana grown in Mississippi.

Aggarwal told psychiatrists at the meeting that the total body of literature on the subject shows “that cannabinoids, of which cannabis contains roughly 100 … have activity at the body’s cannabinoid receptors and have many distinct pharmacologic properties, including analgesic, antiemetic, antispasmodic, antioxidative, neuroprotective, antidepressant, anxiolytic, and anti-inflammatory properties, as well as glial cell modulation and tumor growth regulation.”

The 10 randomized controlled trials published since 2001 have relatively small numbers—four had sample sizes of under 20 subjects, and the largest had 62. And all were looking only at acute effects.

A meta-analysis of studies looking at longer-term effects published in the July 2003 Journal of the International Neuropsychological Society found that few studies on nonacute neurocognitive effects met current research standards, but the studies that do exist suggest neurocognitive risks may be minimal.

“Our results indicate that there might be decrements in the ability to learn and remember new information in chronic users, whereas other cognitive abilities are unaffected,” the analysis concluded.“ However, from a neurocognitive standpoint, the small magnitude of these effect sizes suggests that if cannabis compounds are found to have therapeutic value, they may have an acceptable margin of safety under the more limited conditions of exposure that would likely obtain in a medical setting.”

But for addiction psychiatrists like Stuart Gitlow, M.D., M.P.H., the question is far from resolved. “Do the benefits outweigh the risks?” he asked in an interview with Psychiatric News.“ We don’t have anything in the literature to suggest that the answer is yes. None of the damage that has been shown to result from marijuana use is evident in a short-term observation.”

Gitlow said he is not opposed to marijuana’s being used individually in discrete situations, such as end-of-life care. But the question of legalizing marijuana for medical uses, he said, cannot be disentangled from the larger social context in which marijuana is widely used—addictively by many—for recreational purposes.

He added, “At the individual level, there may not be a problem, but when you look at it from a population basis, it’s a different story. We know from experience that when opioids, stimulants, and sedatives are present in the home, they frequently find their way to people who aren’t prescribed the drug.”

Making Marijuana Accessible for Research

Yet the individual cases can be emotionally compelling. Said Aggarawal,“ If you see someone suffering from neuropathic pain and there is no opioid that is helping, but you know that cannabinoids have a unique therapeutic effect on this type of pain, are you going to let the person suffer because his neighbor uses marijuana recreationally to enhance listening to music? Morally, I fall on the side of treating.”

On the question of whether legalization of marijuana for medical uses would increase potential for drug abuse, a 1999 Institute of Medicine (IOM) report (see IOM Report Still Sets Standard on Medical Marijuana) is agnostic.“ [P]resent data on drug use progression neither support nor refute the suggestion that medical availability would increase drug abuse,” the IOM report concluded.

The report also noted, “This question is beyond the issues normally considered for medical uses of drugs and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids.”

Perhaps the most enduring conclusion from the IOM report is the need for more research—the one point on which everyone agrees. Gitlow said he looks for some provision to make marijuana accessible to researchers without changing the schedule status for the general population.

“We need controlled trials for an extended period of time, because many of the effects are not going to show up in an eight-week trial,” Gitlow said. “Ideally, this would be research in a controlled setting without making the drug accessible to the public at large. The first step is therefore to figure out the marijuana ingredient providing benefit and then determine a safe method of dosing that ingredient. We can’t jump to the end of the process without first going through the necessary intermediate steps.”

An abstract of “Nonacute (Residual) Side Effects of Cannabis Use: A Meta-Analytic Study” is posted at<www.ncbi.nlm.nih.gov/pubmed/12901774>.▪

Important to note is that simvastatin, another generic statin, and several brand name statins lower LDL cholesterol by closer to 50%, and in order to get to their goal LDL (sorry about this link, it is very detailed and complicated, it’s probably better to just ask your physician what your LDL goal should be)  many patients will need a more potent statin than pravastatin or Red Yeast Rice.  

Of note some Red Yeast Rice extracts that are cultivated with the mold Monascus purpureus contain lovastatin (the first statin marketed in the US).

Tuesday, January 19, 2010

Why I am So Over Dr. Oz

The newest media Doc on the block is Dr. Mehmet Oz. When he was first seen on Oprah, he seemed engaging and answered some interesting questions in a real and professional way. The audience loved his blue scrubs and boyish clean cut open style.

That was then.

Let’s face it…the media spotlight seems to corrupt even the best physicians. Dr. Oz now has his own show and website and production company. That is a pretty big infrastructure to maintain and we know that the public is fickle. So what does he do?

His “Real-Age” website got 27 million people to sign up and take a health quiz. That information was sold to pharmaceutical companies who used the direct emails for marketing. Real-Age also sends the participants a series of emails about conditions they may (or may not) have and drugs they can use to treat it, based on their answers to the on-line health quiz, sponsored by drug companies of course.

He does pieces on “men’s health” and tells men to do male breast checks once a month. No research I have read would support this advice. On his website he says “By the time women reach their 20th birthday, they are at risk for developing osteoporosis”. Really? An upcoming show asks “Can you climax from intercourse?” Gee, is this a health question that needs an answer by an expert?

With his busy production schedule, book tour and daily talk show on Sirius XM radio, can Dr. Oz be spending much time as the director of the Cardiovascular Institute and Complementary Medicine Program at New York Presbyterian Hospital? Do you think I could get an appointment with him?

His website shows how I can be on the show. Maybe that is how patients get their questions answered. I know I could get tickets for the show and find out if I am”Getting old too fast” (Yes!) or “Do your parents need to lose weight”. (No!)

His website deals with topics like “What his erection is telling you” and “Dangerous health secrets men keep”. Could what his erection is telling you be a dangerous health secret?

Enough Dr. Oz. Please stop embarrassing our profession. See a patient with atrial fibrillation and do something important with your skills.

Dr. Oz, why the goofy business shoes with scrubs?

For ideas on ways to possibly improve memory and brain function, especially in old age, see this article.     Ginkgo doesn’t work: Are there better ways to save your brain? Unfortunately most of them require more effort than swallowing a couple pills.   All drugs have potential side effects.   What we all probably need to do is manage our diet and exercise to improve our lipid type and try to prevent diabetes.