Plan…C?

The U.S. Secretary of Health, Kathleen Sebelius, just overruled the FDA and decided to keep morning-after contraception (“Plan B”) accessible to girls younger than 17 by prescription only.  The FDA had recommended, in a split vote, to make the agent available over-the-counter.

This is simply the latest chapter on a long-simmering controversy, and one on which I have opined before.  There are plenty of opinions swirling in cyberspace about Secretary Sebelius’ decision- so I won’t belabor that.  Reposted below from 2009 is a blog I wrote addressing some of the historical controversy- all clearly still relevant.  My opinion on the right course is as it was in 2009.

 

Preventive Medicine Column

April 24, 2009

plan b for Plan B

 

Last week, in accord with a ruling by a federal judge, the FDA lowered the age requirement for over-the-counter access to Plan B – morning after contraception- from 18 to 17.  And thus Plan B, conceived in controversy, gestates in controversy still!

In 2005, the controversy was whether to make this last-ditch defense against unintended pregnancy available over the counter (OTC) to anyone.  At that time, the product- essentially a concentrated dose of the hormones used in oral contraceptives that prevents implantation, and thus pregnancy, if taken within 72 hrs of intercourse- was available by prescription only.  Making Plan B available OTC was recommended by a scientific advisory committee to the FDA, the agency’s regulatory staff, and the head of the agency’s drug center.

But instead, the FDA Commissioner at that time announced that a decision on Plan B would be postponed indefinitely while the agency wrestled with the unprecedented policy implications.  The real story, however, was all about political contamination of what should have been science-based action.

Dr. Susan Wood, who was assistant FDA commissioner and director of the agency’s office of women’s health at that time, resigned in protest over the agency’s handling of the Plan B issue.  Dr. Wood contended that abortion politics, rather than science, were behind FDA decisions regarding Plan B, which was self-evident to anyone paying attention.

We have come a long way since.  Eventually, Plan B was made available over the counter, but to women 18 and older.  With the official lowering of the age restriction to 17 last week, Plan B re-entered the news, and re-ignited controversy.

Age, in fact, was always the centerpiece of the Plan B controversy, or at least the pseudo-controversy used to stall any action.  The FDA acknowledged in 2005 that OTC Plan B was appropriate for those over age 17, but not for anyone younger.  The contention then was that it could not be made available over the counter at all without the risk that younger girls would buy it.

But that reasoning would suggest that cigarettes and alcohol should be sold by prescription only, since they, too, come with an age restriction!  Yet both are, of course, sold ‘over the counter.’   The notion that placing an age restriction on an OTC product had “unprecedented policy implications” was eventually exposed as the nonsense it always was.

But that left us with age-restricted access to Plan B, and still does- just a lower cut point as of last week.  Whether Plan B should have any age limit is a debatable issue in its own right.  Personally, I don’t think so.  Don’t get me wrong- I am not advocating sexual licentiousness.  As the father of five, four of whom are young women and teenage girls, I find my views on juvenile sexual activity to be quite conservative!

But it seems self-evident to me that if and when an injudicious sexual encounter does take place, compounding it with a safely preventable, unwanted pregnancy –or an abortion- makes little sense.  Plan B is quite safe, and fairly effective, having been used by millions of women in the US and Europe.  Once a girl is old enough to decide to have sex, however ill advised her decision may be, then it seems to me she is old enough to buy and take Plan B.  The more portentous of these two decisions is the former, not the latter.

Make no mistake, Plan B is NOT an early abortion.  Immediately after intercourse, there may not even be an egg, let alone a fertilized egg, in the fallopian tube.  But even if there is, prior to implantation, there is no embryo.  This is contraception, just applied a bit late.  Earlier contraception is better for many reasons, the most significant of which is that the right kind protects not only against pregnancy, but also against sexually transmitted diseases, including HIV.  Plan B does not.  That’s exactly why it IS plan B, and not plan A.

Plan A is either abstinence from sex, or the use of barrier contraception (e.g., condoms) that can safely prevent both pregnancy and sexually transmitted disease.  Plan B is just what it should be; a contingency plan when better options are no longer available.  Plan B is far from ideal, but once it becomes a relevant consideration, the other options are decidedly less so.

There is, as one would expect, conservative opposition to making plan B available to 17-year-olds.  The principal argument I have found is that young girls will rely on it as their preferred form of contraception.

While I can generally see the merits on both sides of such arguments, and am respectful of the range in perspectives on ethical matters, I really think this opposition is feeble.  It defies reason to think that girls will be sufficiently well informed about Plan B to rely on it for contraception, yet not informed of its clear limitations relative to the better methods of Plan A.  Pharmacies that sell Plan B also sell condoms, and at lower cost.

The considerable research on the topic of teen sex indicates that informing young people about sex and its consequences, and empowering them to avoid those consequences, are associated with lower, not higher, rates of sexual activity.  Any messaging associated with the marketing of Plan B should be an opportunity to highlight the hazards of unprotected sex.

Which makes a strong case for Plan A.  I support Plan A for the prevention of unwanted pregnancies among teenage girls.

But when the chance for Plan A has come and gone, I support the availability of Plan B to any girl old enough to have made the decision that makes contraception a relevant issue in the first place.  In moving to plan b for Plan B, the FDA has done the right thing.  Better still would be the removal of an age restriction altogether.  I guess that will be plan c.

 

 

-fin

Dr. David L. Katz; www.davidkatzmd.com

 

 

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Vice Versa… (responding to the October snow storm aftermath in verse)

After the storm…

…something insists I fill the space

with words

 

an epitaph                       a eulogy

 

for death

 

has spread a table

in my yard              mauled

the magnolia              left beaten

 

branches bent           in  disregarded

prayer              needing only

 

a handful more of days

 

to have shed

its leaves    but  the sky                bled

October

 

snow

 

defiled the pine

mangled the weeping cherry             left

the larch in tatters          everything

 

that mattered in the wealth

of summer

spent…

 

…after the storm

 

up and down

the road the chain saw

squeals                the way is littered with

 

what was

 

summer’s robes             autumn’s

 

hope of glory

 

a gory battlefield           fodder

for a winter

flame…

 

It is not philosophy I seek              but

question

 

with whose voice

the spring will speak       and whisper

 

of a tempered wind     and what becomes

of summer’s song           with only empty

 

space where trees belong      will only

 

silence greet

the dawn…

 

…after the storm?

 

-Susan A. Katz

November 13, 2011

 

(And in response…)

solace

 

-seeking it, after the storm (CT; October, 2011)

mangled limbs and

battered boughs would

seem to denigrate all vows and leave

us where all trust is

spent on antecedents of

Lament.

for we are wont to

gaze on high at figurines

of branch on sky-

now broken, martyred

torn asunder.

Solace?  lies not

up, but under.

where humble roots hug

humbler dirt-

in vacant spaces trees

once stood

no such embrace,

there is no wood.

Deplore the scene of waste

and spoil; but at its

feet some comfort lies interred.

But for the fall

of former

trees from grace, a want

of soil may be inferred.

-fin

 

11/14/11

DLK

 

 

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IOM Report On Nutrition Guidance: The Good, The Bad, & the Ugly

A committee commissioned by the Institute of Medicine, with backing by the CDC, the FDA, and the USDA, just released its report on front-of-pack nutrition guidance.  The recommendations are good in that they may help prevent the food industry from doing bad.  The recommendations are bad if they forestall the progress and implementation of superior approaches. And the recommendations are downright ugly in that…well, we’ll get to that.

 

The IOM began work on this issue in earnest, at the request of federal agencies, in the immediate aftermath of what can only be called the ‘Smart Choices debacle.’

 

Smart Choices was a front-of-pack nutrition guidance system developed by food industry elements, which famously reached the conclusion that Froot Loops was a ‘smart choice’ for breakfast.  That, among other things, invited some federal wrath, and the threat of punitive action by Congress, state attorneys general, or both- and the system was decommissioned.  Food manufacturers had other front-of-pack systems prior, and have developed others since.  Food industry elements, through the Food Marketing Institute and the Grocery Manufacturers Association, have recently rallied around ‘Nutrition Keys’- which shifts back-of-pack information to the front.

 

Even as the food industry has attempted to regroup after Smart Choices, the IOM work on developing recommendations for consistent front-of-pack guidance has proceeded.

 

The report just issued is lengthy.  Its bulk alone, and its many citations, might suggest it is more definitive than it actually is.  The IOM committee charged with this task, and its consultants, conducted no new research- not even consumer focus groups.  They cite prior literature with which all directly concerned with this field were already familiar.  The large aggregation of studies cited attest to the fact that decisive evidence to indicate what nutrition guidance system is ‘best’ has not yet been gathered.  And thus the very report in which the IOM committee issues its recommendation makes clear that the recommendations are simply the opinion of a small group of people- not based on directly relevant data.

 

The committee’s recommendations are, in essence, to note calories on the front of packs, and to provide a scale to indicate the relative quantity of added sugar, sodium, saturated fat, and trans fat.  It is not clear whether all of these nutrients will be bundled together into that scale, or whether each will be scaled separately.  They suggest a numerical scale, ranging from 0 to 3.

 

Starting with the fact that this recommendation is based on nothing other than opinion, let’s consider what’s potentially good, potentially bad, and potentially ugly about it.

 

The Good:
The strength of the recommendation resides in its potential to constrain and unify the current efforts by food manufacturers to call out nutritional properties of their products to consumers.  I fully respect that the business of business is business, and have no problem with food companies working to sell their food!  But it is for that very reason that they should NOT be the ones to decide how to highlight nutritional quality- because they will inevitably accentuate the positive.  Food sellers deciding how to inform consumers about nutritional quality is a classic case of the fox guarding the hen house, and results in feather-flying fiascos like Smart Choices.

 

The IOM recommendations tell manufacturers what is expected- and while compliance with the expectations is voluntary, the heavy hand of regulation looms if compliance is poor.  So the IOM report does promise to rein in the diverse efforts of food sellers to tell consumers a cherry-picked version of the truth about nutrition that is more about promoting sales than providing insights.  That’s good.

 

The Bad:

 

As already noted, the new recommendations are not the product of new research.  They are simply a new opinion of a new group based on a limited assessment of the research to date.

 

The group seemed to ignore the fact that the information they are proposing to put on the front of the pack is already on the back-of-pack in every case.  Do we truly think that the fundamental limitation to consumers’ ability to judge relative nutritional quality is their inability to turn the box around?

 

The group also seemed to ignore that a long history of efforts based on highlighting just negative nutrients have resulted in very poor food choices indeed.  Warned against an excess of dietary fat, the public followed front-of-pack messages about ‘low fat’ to such questionable choices as SnackWell cookies.  While accounting for several nutrients at a time may make similar missteps a bit less likely, there is much missed by simply noting what ‘bad’ stuff is or isn’t in a food.

 

Whether or not the new recommendations are proposing a 0 to 3 scale for each of several nutrients, or the several nutrients bundled together, a 0 to 3 scale is…bad.  It is bad because the average supermarket offers some 50,000 food items, and the US food supply offers a staggering variety of products, in the neighborhood of 800,000!  These products range from marshmallows, jellybeans, and fried pork rinds- to spinach and kale.  In between is everything from orange juice, kiwis, cauliflower, potatoes, salmon, chicken, beef, pizza, milk, and margarine- to milk chocolate, dark chocolate, avocado, walnuts, olives, and blue cheese salad dressing.

 

A 0 to 3 scale, one nutrient at a time, or several bundled together, risks truly massive compression of such diversity.  If thresholds for points on such a scale are placed reasonably high, to safeguard health, an enormous percentage of processed foods will all get the same low score.  When a large number of products get the same score, the system in question is providing no guidance when choosing among such products!

 

Conversely, if the threshold for scaling is placed low enough so that a reasonable percentage of processed foods can ‘register’ on the same scale as broccoli or spinach, then the ability to make distinctions at the high end of the scale is lost- and products that are only moderately nutritious become indistinguishable from products that are really excellent.

 

There is no basis whatsoever in evidence for expressing the quality of nutrition for a supply of hundreds of thousands of foods across the limited expanse of 4 points.  We don’t get miles-per-gallon fuel efficiency ratings that way.  We don’t get wine quality scores that way.  We don’t score the SAT that way.  Whenever there is a wide variation in a measure, a scale suitable to express it clearly and simply, but reliably, is warranted- and routinely used.  Efforts to date to express nutritional quality on a scale with just several values result in over 70% of all items in the supermarket getting the same score- meaning, 7 times out of 10, such a system fails to help you make a choice.

 

There is another problem as well with so compressed a scale.  One item at the very bottom of the nutritional quality barrel will get a 0 it well and truly deserves.  Another will be much better, and nearly –but not quite- good enough to get a 1.  It, too, will get a 0- and the difference will be invisible.  Another item may barely qualify for a 3- and look exactly comparable to, say, spinach- which is monumentally overqualified for that same 3!  Again, a great deal of ‘lumping’ that conspires against the informed point-of-purchase choices such a system is supposed to empower.

 

Also bad is the fact that the IOM report is not directly linked to real-world evidence about what nutrition guidance systems can actually influence consumer choices for the better.  And even more important, the committee apparently did not consider whether the nutrition guidance system actually translates into ‘better’ food choices!  The only true way to measure ‘better’ food choices is to show that they correlate with better health outcomes- since that is what the definition of ‘nutritious’ derives from: foods that are health-promoting, and ‘good’ for us.  Absent evidence that food ‘scoring’ for nutrition correlates with health outcomes, it is unsubstantiated opinion that a given scale reliably measures nutritional quality at all.  Such evidence of the link between nutritional quality measurement and health outcomes has been published- but the IOM report, quite surprisingly, ignores the issue entirely.  This is clearly bad.

 

 

The Ugly:
But none of what’s bad cited above rises to the level of truly ‘ugly.’

 

To get to truly ugly, we have to look at what ISN’T in the IOM recommendations!  Fiber is not in the recommendations.  Omega-3 oils are not in the recommendations.  Antioxidant nutrients are not in the recommendations.  Monounsaturated oils are not in the recommendations.  Calcium is not in the recommendations.   In fact, no beneficial nutrient, or nutrient property, is considered at all.

 

There is no historical evidence that a nutritional guidance system based on ‘negative’ properties only is useful.  The nutrition facts panel that is the mainstay of this space, developed during the tenure of Dr. David Kessler as FDA Commissioner, very explicitly includes positive and negative nutrients, and establishes a standard that should not be casually tossed aside.

 

Imagine trying to sum up the health of a person with a short list of ‘negative’ characteristics only.  If you knew someone didn’t use tobacco, didn’t use illicit drugs, didn’t run out into traffic without looking first, and wasn’t an alcoholic- do you feel confident in your ability to say whether or not this person is actually healthy?  I’m an expert in doing so, and I certainly don’t- nor would any other short list of just negative traits allow me to do so.  A comprehensive blending of both negative and positive traits, however, reliably does- and is the cornerstone of both all medical assessment, and the standardized Health Risk Appraisal.

 

Trying to sum up overall nutritional quality by looking only at a short list of negative considerations is silly to the point of…ugly.

 

How ugly?  Well, such a system would presumably have to give its highest commendation to a food that was free of all bad properties under consideration.  Among the ranks of foods free of calories, added sugar, sodium, saturated fat, and trans fat- diet soda springs to mind.  A system that recognizes diet soda as a ‘perfect’ food is…very ugly indeed.

 

And it is equally ugly in reverse.  Walnuts are wonderfully nutritious- but contain a bit of saturated fat, and quite a lot of calories.  Avocado is highly nutritious, but also high in calories.  Nut butters are very nutritious, but high in calories.  Milk, unlike diet soda, contains sodium, calories, and if not fat-free, varying amounts of saturated fat.   If the IOM intended to encourage diet soda intake as opposed to intake of milk, that’s…ugly.

 

In Conclusion:

 

An IOM committee recommendation based on no new research, but just the opinion of one small group of advisors, is at best questionable- particularly when it is at odds with the conclusions reached by other groups of those at least as highly qualified.

 

But whether the report proves to be of net benefit or harm to the public health will depend on how it is used.  It will be good if used to prevent potentially harmful distortions that arise when the food sellers generate their own nutrition standards.  It will be bad if it interferes with judgments in the court of public opinion about far more comprehensive approaches developed by independent entities committed to public health.  And if it propagates the perception that high-calorie walnuts and almonds and avocado and yogurt are less good than 0-calorie diet sodas…it will take ugly to a whole new place.

 

-fin

 

Dr. David L. Katz; www.davidkatzmd.com

www.turnthetidefoundation.org

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Can Your Multivitamin Kill You?

You have likely heard about a recent study, involving roughly 40,000 women over the age of 60, in which daily use of a multivitamin- and several other nutrient supplements- was associated with a higher rate of death.  Along with the mix of shock, consternation, and disappointment is the very practical question: could a multivitamin kill you?

 

Almost certainly not!  The current study- like others before it that have hinted at much the same association- is absolutely NOT cause for panic.   For each such study, there is another showing no real harm.  That vial of (now menacing) multivitamins in your medicine cabinet doesn’t mean you need to fast track the preparation of your will & testament.

 

For starters, the study now making headlines, and the similar studies preceding it, are observational.  A large group of people is simply followed and assessed over time, and the associations between what they do, and what happens to them, are analyzed.

 

In the current case, routine use of a multivitamin was associated with roughly a 2% greater chance of dying over a 20-year span for women over age 60.  So, for starters, a 2% increased risk of dying over 20 years is not exactly cause for panic- especially when one considers that dying in our early 80s is not entirely unexpected or untimely.

 

But even more important, these women were not assigned to a multivitamin or placebo; they made up their own minds.  Some chose to take nutrient supplements, some did not.  How did these two groups differ?  Like all good observational studies, this one attempted to account for obvious differences- in education, income, smoking status, general dietary pattern, and so on- but the only honest answer is: we don’t know!  We can’t possibly know all the ways women who opt to take nutrient supplements differ from those who don’t.  (That, by the way, is why randomized trials can be so important; they reliably correct for this limitation of observational studies.)

 

So, for instance: what if women more concerned about a family history of chronic disease were the ones to take supplements?  What if women who were less confident in their ability to eat fruits and vegetables daily were the ones to take supplements?  What if women who were just more anxious and pessimistic about their health were the ones to take supplements?  Independent of all other factors, pessimism increases mortality, and optimism decreases it.

 

We don’t know that any of these ‘what ifs’ was true; but if any one of these, or another like them, was true, it might be the reason for the (minimally) higher death rate among supplement users, rather than the supplements per se.

 

But, the fact of the matter is that several large studies now suggest possible harm attached to the use of multivitamins and certain other supplements (including some B vitamins, and iron).  Since we never had any clear evidence of benefit from multivitamin use, and since the ‘at least it couldn’t hurt’ rationale for using multis as an insurance policy is clearly not valid- the day of the conventional multinutrient supplement is over.  I used to take a multi, and no longer do; I used to recommend them to patients, and no longer do.

 

How could a mix of nutrients known to be essential cause harm?  When we extract nutrients from their context in food, we are ‘guessing’ about preparation, dose, and combination.  Errors in any of these could lead to trouble.

 

Imagine, for example, that you had all the essential construction material you needed to build a house- but in the wrong proportion.  Too many roofing shingle,s but too little lumber.  Or perhaps the beams were too short for the dimensions of the roof.   We use nutrients to build cells and proteins and hormones every day, and having the right ‘stuff’ but in the wrong form or supply could make a mess of things.

 

Or, consider a musical analogy.  You love a jazz ensemble; a rock band; and a symphony orchestra.  Imagine the sax player from the one, the guitarist from the other, and the cellist from the third each playing her own music, all at the same time.  Noise!  Lovely on their own, a mess when combined badly.

 

This could be the case with how we have approached nutrient supplementation.  Frankly, I don’t know for sure- nobody does- but the potential for real, if modest, harm is plausible.

 

So what do we do now?

 

For one thing, we should recall that all along, the best-case scenario was ‘supplement,’ not substitute.  There is no substitute for eating well, and that deserves our dedicated commitment.

 

At this point, unless you are likely to have a serious deficiency in overall nutrient intake- or unless you have a specific indication for taking a multivitamin, such as pregnancy or the intent of pregnancy- use of a multivitamin seems ill advised.  You need a good reason to do it; ‘what the heck’ is no longer sufficient.

 

Judicious use of select supplements still makes sense.  We have convincing evidence of known or likely benefit from supplemental omega-3 oils and vitamin D for most men and women, and calcium for most women.  For the most part, other supplements should be used for a specific reason, and with input from someone with genuine expertise.  As an example, B12 supplementation is warranted for most vegans, and for all older adults with pernicious anemia.  Let’s not toss out the baby with the bathwater!

 

Another intriguing consideration is the use of whole food based supplements (for example).  Such products are ‘humble’ in the sense that they don’t presume to know how to combine nutrients- they let nature do it.  They simply compress the nutrients from healthful foods into pill form so that those who don’t eat quite as they should – including children- can fill in the gaps.  We need more science to prove the benefits of such supplements, but the approach makes sense to me, and may prove to be the new-age answer to the multivitamin/mineral supplement.

 

Independent of other factors, a multivitamin is very, very unlikely to kill anyone.  If there is risk attached to the use of such supplements, it is very small.  But there may be some risk- and there is no reliable indication of benefit.

 

That’s really all we need to know to conclude it’s probably time for us to kill the multivitamin.

 

-fin

 

Dr. David L. Katz; www.davidkatzmd.com

www.turnthetidefoundation.org

 

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PSA: Yea, or nay?

I support the recommendation of the US Preventive Services Task Force against routine use of the PSA test to screen for prostate cancer.  For the reasons why, see: “PSA

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My ‘Academy’ Award!

The 2011 annual meeting of the American Dietetic Association- FNCE (Food & Nutrition Conference and Expo) opened 2 days ago in San Diego.  At the opening session, the in-coming president announced that after 100 years, the Association was changing its name to the ‘Academy of Nutrition and Dietetics.’

I am in San Diego at the conference because I was this year’s recipient of the Lenna Frances Cooper Memorial Lectureship/Award.  I delivered the lecture yesterday morning, addressing an audience of some 2,000 attendees.

Reactions to the name change are mixed, as one might expect after 100 years of familiarity.  So I opened my lecture by commenting that the single most important implication of the change was immediately apparent to me: I had been upgraded to an ‘academy’ award!

The content of my talk emphasized the need to see and address the ‘big picture’ in our efforts to combat and reverse trends in obesity, diabetes, and other chronic disease.  I made use, as I routinely do, of a levee-building metaphor to characterize the task at hand.

For those in the audience – and everyone else- here are links to  some of the sandbags in question, in the hope that many of you will be in the mood to help build the levee!  It will take a village…

http://www.turnthetidefoundation.org/programs.htm

http://www.nuval.com/

http://www.rediclinic.com/weighforward/

http://www.mindstreamacademy.com/

 

 

 

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September 11th: Reflecting Back, Looking Ahead

We are ten years out from the September 11th that changed so much, and remembrance of it prevails throughout the land, as well it should.  With so much reflection devoted to the topic, it is tempting to devote this column to something else.  But frankly, September 11th is what’s on my mind.

And there is, I think, a unique contribution to our collective reflections on this seminal calamity from the realm of preventive medicine, and holistic care.  In holistic care, we always consider both mind and body, and how the two relate.  In preventive medicine, we focus on vulnerability- and the risks that lie ahead.

The particular contribution has to do with mind, body, time, and distance- and the way these factors relate to the effects of toxicity and trauma.

There is a well known expression that “time heals all wounds.”  Partly that’s wishful thinking.  Partly, it is a truism when enough time is involved, but if so, ten years is certainly not enough.  We are not “healed” of 9/11, and I suspect most of us not only know we never will be- but don’t even want to be.  It is something of a sacred burden we all share to hold on to the pain of that day.  We will- as we all pledge- never forget.

But we can confess that we carry with us only some of the pain of that day, and the days that followed immediately.  Time does attenuate mental and psychological trauma, and treat if not fully heal those wounds.   Most of us are, I suspect, in relative shallows now- ten years later- compared to the depths of anger, sadness, and fear we felt in 2001.

So for wounds of the mind, time is indeed somewhat therapeutic.  In contrast, distance provides little defense.   Of course, those directly caught up in the events of 9/11 experienced trauma- both physical and psychological- the rest of us can only begin to understand.  But for all the rest of us, it didn’t really matter whether we were ten miles away, or 100, or 1000.  Distance provides no real protection against tragedy, terror, and dread.

But while time is therapeutic and distance somewhat irrelevant for wounds of the mind and spirit, the opposite is true for wounds of the body.

For most physical traumas related to toxins, distance is a powerful defense.  The density of airborne toxins will drop off with distance from the source.  While even a tiny exposure to a carcinogen can cause cancer, it is far less likely to than a larger exposure under most circumstances.

For some dangerous exposures, such as radiation and electromagnetic energy, distance is, literally, of exponential importance.  The strength of an energy field is inversely related to the square of the distance from its source.  In plainer English: every time you move Z distance away from the source of an energy field, your exposure falls by ZxZ.  A little bit of distance between you and such a field can mean a whole lot of defense against its harmful effects.  Consequently, first responders at Ground Zero were subject to toxic effects that those living nearby in lower Manhattan were largely spared.

But time, in contrast, does not offer protection here.  Time certainly can heal large and superficial wounds.  But it is the smallest and deepest of wounds- wounds at the cellular and sub-cellular level- that are most apt to ensue from toxic exposures.   Exposure to radiation, other energy fields, and some chemicals does its most important damage to our chromosomes and genes.  Aberrations here can translate into overt medical maladies, such as cancer, very slowly, as the genetic abnormality leads to an abnormal cell, then an abnormal cluster of cells, and only eventually, a mass of abnormal cells.  For some cancers, this process plays out over decades.

This means, alas, that we have yet to see the full toll of 9/11 among first responders, even ten years out.  All relevant resources should be made available to address the burden of illness shouldered by these brave souls who rushed toward the very thing most of us with just average courage would flee.

An anniversary is generally a time for looking back.  But this anniversary warrants consideration of traumas to spirit, and cell alike- and requires that we also look ahead.  The full medical toll of that infamous day has, regrettably, yet to be tallied.

 

-fin

 

Dr. David L. Katz; www.davidkatzmd.com

www.turnthetidefoundation.org

 

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Getting to ‘YOU-Centered’ Medical Decisions, with Help from Your Inner Statistician

I have recently contributed two blogs about medical decision-making to the Huffington Post.  Read in sequence, this one, and this one, are intended to help get you from ‘test-centered’ medical evaluation, to ‘you-centered’ evaluation- which is much better.

There is- sorry!- a little algebra involved in the explanation.  But very little, I promise.  I’m sure you can handle it, no matter how high school algebra may have made you wince.  And the ROI- better medical care- is well worth the modest effort.  Here’s hoping you find the posts…illuminating.

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