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What Is The Most Important Quality In A Physician?


Article Source: Health And Fitness Journal

Medical errors are estimated to be the third leading cause of death in America’s hospitals. Though some of these errors are beyond physician control, many are the direct result of physician action and inaction. I spend a lot of time thinking about how to reduce these errors and I (like many of my peers) lose sleep over the mistakes I witness.

When you ask patients what quality is most important in a physician, they often answer, “empathy.” I think that’s close, but not quite right. I know many “nice” and “supportive” doctors who have poor clinical judgment. When it comes to excellent care quality, one personality trait stands out to me – something that we don’t spend much time thinking about:

Curiosity.

A physician with a curious mind doesn’t necessarily know all the answers. He may not be the “smartest” graduate of his medical school.  But he is a great detective, and doesn’t rest until problems are solved. This particular quality isn’t nurtured in a system that rewards partial work ups, rapid patient turnover, and rushed documentation. But some doctors retain their intellectual curiosity about their patients – and to the extent that they do, I believe they can significantly reduce medical errors.

Many of the preventable adverse events I have witnessed (outside of procedure-based errors) began with warning signs that were ignored. Examples include abnormal lab tests that were not followed up in a timely manner, medication side effects that went unrecognized, copy errors in drug lists, and subtle changes in the physical exam that were presumed insignificant. All of these signs trigger the curious mind to seek out answers in time to head off problems before they evolve into real dangers.

Of course, there are other qualities that make a physician excellent – wisdom, experience, kindness, and a grounding in evidence-based practice come to mind. But without an engaged mind fueled by genuine curiosity, it’s hard to retain the vigilance required for continued good outcomes.

Curiosity may have killed a cat or two, but I’ve seen it save a large number of patients!

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Raw Milk versus Pasteurized—Which Is Safer?


Article Source: Health And Fitness Journal

By Dr. Mercola

The United States lags far behind many other nations when it comes to food safety and nutritional recommendations, and this is perhaps particularly true when it comes to raw milk.

The fact is, large dairy farmers operating under the factory farm model simply cannot produce raw milk safe for human consumption.

They’re too large, and therefore end up being hotbeds for pathogenic contamination. They also cannot provide enough open pasture for tens of thousands of cows to continually graze on.

Cleanliness and pasture are critical parameters for producing healthy milk fit for raw consumption. So really, the war on raw milk boils down to control—controlling the competition, which is selling a superior product. It’s NOT an issue of safety at all.

In fact, several studies have demonstrated the superior safety of raw milk compared to pasteurized, yet the vilification of raw milk continues unabated—science and statistics be damned…

Europeans Can Buy Raw Milk from Vending Machines

In sharp contrast to the US, some European nations sell raw milk in vending machines! And contrary to popular (American) belief, the bodies are NOT piling up as a result. As reported by Modern Farmer:1

“Europe’s embrace of raw milk vending machines isn’t new. Such daring dispensers of unpasteurized dairy can be found in France, Croatia, Switzerland, Austria, the Netherlands and, as one map2 shows, all over the place in Italy.”

The safety measures are remarkably simple. If the temperature of the milk rises above the regulated level, the machine will stop dispensing milk, and the farmer is notified via text message. The milk spout is sterilized by a UV light between each purchase.

In the US, several states have outright banned the sale of raw milk for fear of contaminated milk despite the fact that, statistically, such fears are completely and udderly unfounded (pun intended).

Research by Dr. Ted Beals, MD,3 featured in the summer 2011 issue of Wise Traditions, the quarterly journal of the Weston A. Price Foundation, shows that you are actually about 35,000 times more likely to get sick from other foods than you are from raw milk!

Pasteurized Dairy and Processed Foods Top the List of ‘Most Dangerous’

The vast majority of foodborne illnesses in the US are linked to factory farmed and highly processed foods, not raw foods. For example, late last year, Chobani Greek yogurt was recalled following reports of gastrointestinal illness.4 The yogurt, which is pasteurized and not raw, was found to be contaminated with a fungus called Murcor circinelloides.

In 2011, Cargill recalled a whopping 36 million pounds of ground turkey.5 An antibiotic-resistant strain of Salmonella in the meat ended up causing 107 illnesses and one death.

An investigation revealed that this strain of Salmonella had been found four times over the course of one year, yet the US Department of Agriculture (USDA), took no action against the producer. And, from the time the first illness was reported and the recall took effect, five months passed, allowing over a hundred more people to become ill from the contaminated meat.

A major part of the problem is that, despite being in charge of food safety oversight of meat and poultry, the USDA does not have the authority to take action against a meat or poultry producer—even if the permissible limits of pathogenic contamination are repeatedly exceeded.

Clearly, this does not bode well for food safety. As explained in a previous Food Safety News article discussing this case:6

“For example, take ground turkey. When USDA tests for Salmonella, they take individual 1-pound samples on 52 consecutive days of production. Sometimes it takes a year to complete a set — and the establishment gets a heads up that a sample is going to be taken!

In addition, if 26 or fewer are positive, the sample set passes. If more than 26 are positive, the sample set fails.

Basically, these are like open book exams — not pop quizzes — where a 50 percent is still passing! And even when a sample set fails, USDA does another set of testing. And they keep doing testing until a set passes.”

What this means is that if 50 percent of the samples are contaminated with disease-causing bacteria, it’s deemed “safe.” But if it hits 51 percent, it’s tagged as “unsafe.” And testing simply continues until illness is reported. What sense does this make?

Yet anytime the lack of food safety is discussed, the focus is suddenly turned to raw milk! It’s almost as though US agencies are using raw milk as a scapegoat to keep you from looking at the real problem, which is that factory farms produce inherently unsafe foods. It’s like a propaganda machine sleight of hand maneuver…

CDC Stance on Raw Milk—As Biased as It Gets

Mark McAfee, CEO of Organic Pastures Dairy and an internationally recognized expert in raw milk production and safety, has on numerous occasions tried to set the record straight with US authorities, to no avail. In a 2012 letter to the Centers for Disease Control and Prevention (CDC), he writes:7

“As a grade A producer of retailed-approved raw milk in California, I find your raw milk page filled with highly erroneous and very misleading information… In California, we have legal retail-approved raw milk in 400 stores consumed by 75,000 consumers each week. This retail legal raw milk is tested and state inspected and far exceeds pasteurized milk product standards without any heat or processing.

It is clean raw milk from a single source dairy. There have been no deaths from raw milk in California in 37 years. Two years ago, I submitted a FOIA request to the CDC to request data on the two deaths that the CDC database claims were from raw milk. The data I received back from the CDC showed that in fact there had been no death from raw milk at all.

The two deaths had been from illegal Mexican bath tub cheese and not raw milk from any place in America. Why does the CDC persist in publishing this erroneous information? …The last people to die from milk died from pasteurized milk at Whittier farms in 2007, not from raw milk.”

While both the US Food and Drug Administration (FDA) and the CDC warn that raw milk can carry disease-causing bacteria, they completely overlook the fact that these bacteria are the result of industrial farming practices that lead to diseased animals, which may then in turn produce contaminated milk.

They make no distinction whatsoever between disease-riddled factory farmed milk and the milk from clean, healthy, grass-fed cows. This is indeed a key issue, as raw milk from a confined animal feeding operation (CAFO) IS dangerous and must be pasteurized in order to be fit to drink, whereas raw milk from cows raised on pasture IS NOT dangerous and DOES NOT need pasteurization. The source of the milk makes all the difference when it comes to raw milk.

What the CDC Doesn’t Tell You About Raw Milk Is Worth Knowing…

The CDC also fails to inform visitors in its website that legal raw milk producers oftentimes adhere to stricter safety standards than CAFOs do. California, specifically, has its own special set of standards for raw milk for human consumption, in which farmers must meet or exceed pasteurized milk standards, without pasteurizing.

Instead of giving you the facts, the CDC lists raw milk as one of the riskiest foods in America, without any real proof to back up such a proclamation. The American Academy of Pediatrics (AAP) has even called for a complete ban on raw milk because it is so “dangerous.” But on what do they base their assumptions? On the CDC’s unproven opinion? If safety was truly the issue, then pasteurized dairy would be banned, as that’s what’s causing the most disease.

So you’ve got to ask yourself, is this really about our personal safety or the safety of the milk industry? Eating directly from the farm is prohibited by industry so they can control our food supply. They make it very difficult for farmers to sell directly to us, whether dairy products or meat products. They claim this is done for our safety, but it’s really just a plot to control our food system.

“The FDA does not mention raw milk on their top 10 most risky foods in America list,” McAfee notes. “Pasteurized ice cream and pasteurized cheeses make the top 10 risky foods list… According to the Cornell study performed on CDC data, there were 1,100 illnesses caused by raw milk between 1973 and 2009. There were 422,000 illnesses caused by pasteurized milk. No deaths from raw milk and at least 50 deaths from pasteurized milk or pasteurized cheese—the CDC left out the 29 or more people that died from the pasteurized Jalisco cheese listeria incident in 1985.”

Raw Milk Has Many Health Benefits

The CDC, as McAfee notes, is absolutely riddled with bias. While most of it is obvious, some of the bias is hidden by the way the CDC counts its statistics. For example, it counts outbreaks rather than the number of people affected by the outbreak. In one outbreak caused by pasteurized milk, 200,000 people fell ill! Yet it’s only counted as one incident. Its website also makes no mention whatsoever to studies showing how raw organic milk differs, nutritionally, from CAFO milk, and how it improves health. For example, raw milk is:

Loaded with healthy bacteria that are good for your gastrointestinal tract High in omega-3 and low omega-6, which is the beneficial ratio between these two essential fats
Full of more than 60 digestive enzymes, growth factors, and immunoglobulins (antibodies). These enzymes are destroyed during pasteurization, making pasteurized milk much harder to digest Loaded with vitamins (A, B, C, D, E, and K) in highly bioavailable forms, and a very balanced blend of minerals (calcium, magnesium, phosphorus, and iron) whose absorption is enhanced by live Lactobacilli
Rich in conjugated linoleic acid (CLA), which fights cancer and boosts metabolism Rich in healthy unoxidized cholesterol
Rich in beneficial raw fats, amino acids, and proteins in a highly bioavailable form, all 100 percent digestible It also contains phosphatase, an enzyme that aids and assists in the absorption of calcium in your bones, and lipase enzyme, which helps to hydrolyze and absorb fats

Pasteurizing milk, on the other hand, destroys enzymes, diminishes vitamins, denatures fragile milk proteins, destroys vitamin B12 and vitamin B6, kills beneficial bacteria, and actually promotes pathogens.

Max Kane’s Self-Healing Is a Testament to the Power of Raw Dairy

In the video above, I interview Max Kane, a local raw dairy farmer from whom our office purchases a variety of raw dairy products from. Max was diagnosed with Crohn’s disease at the age of 10. Through years of study, he eventually healed himself through nutrition and lifestyle changes. He now consumes only 100 percent raw, 100 percent organic, and 100 percent pasture-raised dairy products. Raw dairy makes up about 50 percent of his diet.

“The cream is perhaps the most important part of the milk because the cream is where all the energy is that’s needed to digest the milk protein casein,” he explains. “That’s why it’s important to consume full-fat dairy products instead of non-fat or skim dairy products. The cream is also responsible for regulating the sugar absorption into your blood. It decreases the likelihood of insulin spikes. The cream naturally floats to the top of the milk, and it can be skimmed right off the top. Traditionally, people would use the cream line as a visual aid to help them assess the quality of the milk…

Homogenization [is] an industry process that fractionates the cream molecule, the fat molecule, into small little pieces. This was done for the purpose of making the cream line non-detectable to the human eye… That’s how they standardized the milk, by taking away the viewable quality assessment from the consumer, and ultimately left the consumer with no real visual way to assess the quality and the value of the milk.”

The quality of grass-fed milk, butter, and yogurt can easily be ascertained by its color. The carotenoids in the plants cows eat on pasture gives grass-fed products a more yellow-orange cast. When cows are raised on dried grass or hay, opposed to fresh-growing grass, you end up with a whiter product, which is an indication of reduced carotenoid and antioxidant content. Raw milk yogurt is also very thick and creamy, compared to pasteurized commercial varieties. The same goes for pastured eggs, which can be ascertained by their deep orange yolk. CAFO chickens, which never go outdoors, and are fed grains rather than bugs and insects, produce eggs with pale yellow yolks.

ABOUT Max Kane – Max Kane was diagnosed with Crohn’s disease at the age of 10, and through years of study, healed himself through nutrition and lifestyle changes. 100% of his dairy products and over 50% of his other foods are purchased directly from farms. When it comes to dairy, he only consumes 100% raw, 100% organic, 100% grass-fed. Dairy makes up about 50% of his diet. After realizing the healing power of fresh farm foods, Kane teamed up with Amagisoft to create FarmMatch.com.

ABOUT FarmMatch It’s free to create an account, but no account is required to use the system.

FarmMatch is built over the Google mapping system and makes local food searchable worldwide, making it easy to find a local farmer. Not only are specific farm products searchable, but products are searchable by quality standards as well… 100% grass-fed, non-GMO, etc. You can connect with farmers and buy online as well. The order management system is consumer funded. Buyers pay a $2.95 fee when placing an order or can opt into a $3.95/month plan that allows unlimited ordering with no $2.95 fees. Through these small affordable consumer fees, FarmMatch delivers a state-of-the-art software suit to every small scale farmer at no charge to the farmer. The FarmMatch business model not only helps individual small farmers, but it also lifts the entire local food movement as a whole.

Join the Fight for Food Freedom

The fight over raw milk stands as a symbol of the much larger fight for food freedom. Who gets to decide what you eat? You? Or the FDA? If the FDA and other government agencies are allowed to impose their view of “safe food” on consumers, raw milk won’t be the only thing lost—all food will be pasteurized, irradiated, and genetically engineered. The effort to reclaim our right to buy and consume raw milk is leading the way for everyone who wants to be able to obtain the food of their choice from the source of their choice. So please, get involved! I urge you to get involved with the following action plan to protect your right to choose your own foods:

  1. Get informed: Visit www.farmtoconsumer.org or click here to sign up for action alerts. To review the raw milk laws in your state, see the Farm-to-Consumer.org’s Raw Milk Nation page.
  2. Join the fight for your rights: The Farm-to-Consumer Legal Defense Fund (FTCLDF) is the only organization of its kind. This 501(c)(4) nonprofit organization provides a legal defense for farmers who are being pursued by the government for distributing foods directly to consumers. Your donations, although not tax deductible, will be used to support the litigation, legislative, and lobbying efforts of the FTCLDF.
  3. Support your local farmers: Getting your raw milk from a local organic farm or co-op is one of the best ways to ensure you’re getting high-quality milk. You can locate a raw milk source near you at the Campaign for Real Milk Website. California residents can find raw milk retailers by using the store locator available at www.OrganicPastures.com.


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Why It’s So Tempting To Over-screen: A Personal Perspective


Article Source: Health And Fitness Journal

Health screening is part of good preventive care, though over-screening can lead to increased costs, and potential patient harm. Healthcare professional societies have recently developed excellent public service announcements describing the dangers of over-testing, and new research suggests that though additional medical interventions are associated with increased patient satisfaction, they also lead (ironically) to higher mortality rates.

And so, in a system attempting to shift to a “less is more” model of healthcare, why is resistance so strong? When the USPSTF recommended against the need for annual, screening mammograms in healthy women (without a family history of breast cancer) between the ages of 40-49, the outcry was deafening. Every professional society and patient advocacy group rallied against the recommendation, and generally not much has changed in the breast cancer screening world. I myself tried to follow the USPSTF guidelines – and opted out of a screening mammogram for two full years past 40. And then I met a charming radiologist at a women’s medical conference who nearly burst into tears when I told her that I hadn’t had a mammogram. Her lobbying for me to “just make sure I was ok” was so passionate that I simply could no longer resist the urge to get screened.

I knew going into the test that there was a reasonably high chance of a false positive result which could cause me unnecessary anxiety. That being said, I was still emotionally unprepared for the radiologists’ announcement that the mammogram was “abnormal” and that a follow up ultrasound needed to be scheduled. I must admit that I did squirm until I had more information. In the end, the “abnormality” proved to be simple “dense breast tissue” and I was pleased to have at least dodged an unnecessary biopsy or lumpectomy. Did my screening do me any good? No, and some psychological harm. A net/net negative but without long term sequelae.

My next personal wrestling match with screening tests was the colonoscopy. I was seeing a gastroenterologist for some GI complaints, and we weren’t 5 minutes into our conversation before he recommended a colonoscopy. I argued that I was too young for a screening colonoscopy (I was 42 and they are recommended starting at age 50), and therefore was doubtful that anything too helpful would be found with the test. My suggestion was that a careful history and some blood testing might be the first place to start. My gastroenterologist acquiesced reluctantly.

As it turns out the blood testing was non-diagnostic and my symptoms persisted so I agreed to the colonoscopy. In this case I felt it was reasonable to do it since it was for diagnostic (not screening) purposes. I was quite certain that it would reveal nothing – or perhaps a false positive followed by anxiety, like my mammogram.

What it did show was some polyps that had a 50% chance of becoming malignant colon cancer in the next 10 years. I was shocked. If I had waited until I was 50 to start screening, I could have missed my cure window. The uneasiness about screening guidelines began to sink in. As a physician I had done my best to apply screening guidelines to myself and resist the urge to over-test, even with a healthy dose of natural curiosity. Yet I failed to resist screening, and in fact, my life was possibly saved by a test that was not supposed to be on my preventive health radar for another 8 years.

Screening tests are recommended for those who are most likely to benefit, and physicians and patients alike are encouraged to avoid unnecessary testing. But there are always a few people outside the “most likely to benefit” pool whose lives could be saved with screening, and the urge to make sure that’s not you – or your patient – is incredibly strong. I’m not sure if that’s human nature, or American culture. But a quick review of Hollywood blockbuster plots (where tens of thousands of lives are regularly sacrificed to save one princess/protagonist/hero from the aliens/monsters/zombies) testifies to our desperately irrational tendencies.

I am now biased towards over-testing, because my emotional relief at dodging a bullet is stronger than my cerebral desire to adhere to population-based recommendations. Knowing this, I will still try to avoid the temptation to over-test and over-treat my patients. But if they so much as hint that they’d like an early colonoscopy – I will cave.

Does that make me a bad doctor?

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