Category Archives: Doctors

How to Reduce Surgical Deaths By 47%

When I left standard general practice back in 2000 I recognized that the family doctor was going to be making way for the Nurses.

The growing reality is that government can’t afford to pay for doctors – nurses are much cheaper.

BUT … I also recognized that nurses – as heretical as it sounds – are probably better for the patient’s health too.

Doctor’s, as well meaning as they generally are, can be dangerous cowboys.

Nurses don’t have the mindset of doctors. They have been trained much more in the way Dr Atul Gawande recommends in this video below.

Hopefully we are seeing the rise of a ‘new medicine’ in the seeds of this talk.

[Note: the surgical part starts at 13:00, but the whole video is well worth watching.]

How Much To Pay For Running Shoes?

If you are truly trying to do the best by your feet, surely you would choose the best shoes when you are pounding the ground, or the court, or the treadmill. Wouldn’t you?

But what is ‘the best’?

And then, how much does it cost?

Well most of the opinion suggests you want a shoe that supports, and is specifically fitted for, your foot.

I believed this, until I read the books by Pete Egoscue which explained it quite simply.

If a shoe that supports your foot does its job then it replaces support that your muscles are meant to be providing.

Sure it may be more comfortable at the start, but in the long run it allows your own foot support to wilt away, leaving you MORE prone to problems than when you began.

Pete’s recommendation: wear at little shoe as possible, and get your foot aligned properly from head to toe. (For the first steps on how to do this see “Where is Your Pain?” at Pete’s website www.Egoscue.com or order his book Pain-Free.)

But that’s all nice theory.

Where is the research proof?

Well with all the money spent on shoes by consumers, health experts and shoe manufacturers, there should be a few good studies to turn to, right?

Sorry. Wrong.

In their recently published study in the British Journal of Sports Medicine, “Is your prescription of distance running shoes evidence-based?” Dr Chris Richards, and his 2 co-authors reported that…

“Since the 1980s, distance running shoes with thick, heavily cushioned heels and features to control how much the heel rolls in, have been consistently recommended to runners who want to avoid injury,” Dr Richards said.

“We did not identify a single study that has attempted to measure the effect of this shoe type on either injury rates or performance.”

In fact Dr Richards is being kind in his paper. This is objective science after all.

The media loved this story.

“Sports shoes a sham: research”

“Running down myths on jogging shoes”

“Don’t do it: pricey running shoes not worth it, study finds”

But on a blog of his called “Barefoot versus the shoe” Dr Richards is more frank when he went directly to shoe companies to ask them for the evidence. His subsequent post is titled, “Is there a running shoe mafia?”

I have been busily contacting all the major shoe companies asking them to direct me to the evidence that their distance running shoes either prevent injuries or improve performance.

The most entertaining responses so far have been from Mizuno and Puma who both claimed that whether or not their running shoes prevent injuries or improve performance was a trade secret.

Refusing to tell consumers whether or not your product works is certainly a unique marketing ploy!

Unfortunately I would have to say hiding information it is NOT a unique marketing ploy.

I would say it is an extremely consistent and pervasive marketing ploy thoughout all health products and services in particular.

The end results of Dr Richard’s enquiries?

Number of major running shoe manufacturers contacted= 18
Number who have responded= 11
Number who have provided evidence that their running shoes decrease injury rates= 0
(Number of legal threats= 0)

Here is how Dr Richard sums up the published research on the lack of any studies on the health impacts of running shoes.

He says there are only two possible conclusions…

…1) the studies have not been done or 2) their results have been suppressed because they show that modern running shoes are either of no benefit or are in fact harmful. Only the shoe manufacturers know which of these is true.

We can only hope that an entire generation of runners have not been the unwitting victims of unethical corporate behaviour.

We have consistently seen how large corporations behave when their profits are threatened by the truth. Big Tobacco, the pharmaceutical industry and asbestos manufacturers come to mind as poignant examples.

Will the multinationals who perpetuate and feed on the myth of the modern running shoe be next?

Couldn’t have put it better myself.

My self help suggestion is to walk in bare feet as often as you can, and buy shoes that you are prepared to throw away when they start to get old. Continuing to use a worn shoe simply aggravates any misalignments you already have.

Or, if you want something more sophisticated check out this post here. Just the pictures of feet that have never had shoes on are amazing.

-Dr Martin Russell

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Phentermine For Weight Loss – My Story

As I was cleaning out some of my old medical files I came across a couple of letters from 1998 about the weight loss drug phentermine.

Back in 1998 I was reading the material of a medical organisation called MaLAM, which monitors and lobbies pharmaceutical companies on their advertising.

Always a fascinating read, but this time they had sent a letter to 3M Pharmaceuticals with questions about their Duromine brand of phentermine.

Phentermine has been around as a weight loss medication since the 1959, and is only recommended for short-term use eg 3 months at most.

The first question was the kicker…

“1. Does 3M have any evidence that the short-term of [sic] Duromine leads to long-term reduction in weight, total morbidity and total mortality?”

ie does Duromine work?

And 3M’s reply…

“…there is no evidence in the medical literature or from 3M studies suggesting that long term reduction in weight, total morbidity and total mortality can be expected from the use of short term adjunctive appetite suppression with phentermine.”

Hmm.

So did 3M just say phentermine is useless?

That’s how I read it.

This letter was the moment I stopped using the currently available medications for weight loss.

That left me with only lifestyle options to offer my patients and I’ve written before about my issues with exercise and dieting.

But today in 2009 maybe something has changed for phentermine in the past 10 years.

Nup.

Wikipedia still says, “Since the drug was approved in 1959 there have been almost no clinical studies performed. The most recent study was in 1990…” ie well before this 1998 letter.

Sad. Really sad.

Go read my Amazon review if you want an alternative.

-Dr Martin Russell

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Serious Illness And Trauma – Support For The Carers

In my original 7 years of training to be a medical doctor there were gaps.

Some of those gaps I have filled. I spent time with Aboriginal people in rural Australia. I assessed elderly and frail people for admission to Aged Care facilities (aka Nursing Homes.) I also spent time working in a hospital Palliative Care unit caring mostly for people dying of cancer, but also Multiple Sclerosis and other illnesses. Then I took up as a family doctor which covers all areas of medicine, including visiting patients (aka people) in their own homes. Ooh wow.

In all this I still never got the sense of what it was actually like to be a relative, friend or carer of someone who is seriously ill or hospitalized.

Medicine never taught me this.

I still don’t have much experience in this area. (Un?)fortunately most of those around me have remained healthy and well.

This is a gap in the training of most doctors and nurses.

This is one area where the medical system isn’t going to help you very much.

It’s hard to help yourself when there are very few people to turn to for expertise.

However I saw a story on TV about a guy who does know a bit more about this, Dale Elliott (www.DaleElliott.com), who is now a sit-down/stand-up comedian, professional speaker, and the first paraplegic skydiver in Australasia.

Dale’s story is that at age 26 he broke his spine and lost the use of his legs coming off a motorbike. But it was only after his short 2-month stay in hospital that he discovered how many issues there had been for his colleagues, friends, and family while he was concentrating on getting well.

He took this experience and turned it into a self help tool for carers of people with serious illnesses and trauma.

It is called ‘I’m Thinking Of You’.

Since its launch in 2007 the site has attracted TV attention as well as private and corporate recognition. It has cost over $300,000 to setup, and over a thousand “Care Zones” have been created. Much more is to come.

If you know a carer who supporting someone ill in hospital or rehabilitation then have them check out this site to support them and take a big hassle off their already full plate…

www.ImThinkingOfYou.com.au (don’t worry about the .au – this site is used worldwide – 30% from the US alone.)

-Dr Martin Russell

The LAP-BAND Solution

No, this is not my line.

The LAP-BAND Solution: A Partnership in Weight Loss” is the title of a book by Australian surgeon Dr Paul O’Brien which I read with interest when one of my patients found it in a library and showed it to me.

Since the start of 2007 I have been doing public talks on the myths and facts about weight loss.

The key question I ask people at those talks is this…

What would you advise someone who wanted to lose a SIGNIFICANT amount of weight LONG-TERM?

By which I mean, what actually works to lose >10% of bodyweight for >5 years.

People will come back with all sorts of answers.

I’d love to be able to say it was some sort of psychological intervention, but I can’t (more on this later.)

The fact is that the only research-PROVEN answer is an operation.

There are a few types of stomach operations for weight loss, also known as bariatric surgery, but to my mind they fall into two camps; ones that irreversibly rearrange the gut in some way, and ones that leave your insides intact and put in some sort of stomach banding instead.

The commonest operation of the first type is called gastric bypass surgery, and it is popular in the US.

The most well-known of the gastric banding type is LAP-BANDing (TM), and it is the most popular in Australia.

In “The LAP-BAND SolutionDr Paul O’Brien is described as one of the originators of this device, and has extensive experience in academic, research, and professional areas of obesity and bariatric surgery.

The book therefore promised to be an authoratitive text, and also very pro-LAP BAND(TM). It was both of these.

It is also fairly readable which is a nice bonus too.

The best bit about finding people who have one solution to a problem, is to listen to what they say about other suggested solutions. They will tend to be scathing.

Here’s what Paul O’Brien says about drugs…

The long-term efficacy is poor and the long-term safety is unknown … the average weight loss after 1 year of orilistat [Xenical] is about 7 lb (3 kg) and for sibutramine [Meridia or Reductil] is 10 lb (4.5 kg) … these results are just not good enough.

Here’s what he has to say about weight loss by dieting and lifestyle modification…

The commercial weight-loss centers have made fortunes by promising excellent weight loss through various twists on the “lifestyle” methods, and their constant advertisements always show the classic “before and after” pictures. Invariably, the “äfter” picture is only a few months after. They do not show the “after” pictures at 5 years.

A recent comprehensive review of all the high-quality scientific studies of the options for weight control has found that there is no evidence of a durable effect from any current lifestyle intervention methods for obesity.

The only problem with this statement is that the review he refers to is in fact from 1997. Not exactly ‘recent’ in my opinion.

Still, the last 11 years haven’t proven any better studies that I am aware of either.

[The approach I recommend has not been proven in the research, and since there is no pill or expensive program, ie no money in it, I very much doubt the required multi-year studies will ever be done.]

However, my patient was already losing weight without surgery.

She gave the book to me for an entirely different reason.

She pointed out that the book talks about patients with a LAP-BAND(TM) learning to eat in an entirely different way – a way that mimics many (but not all) of the things I recommend in my non-surgical, non-dieting approach.

This is really interesting.

What if surgery is merely an extreme way to change someone’s eating behaviors?

I don’t think that is all of the effect, but I certainly think it is some of it, and maybe all of the long-term lasting results.

Why would I say this?

Because I have worked with people who lost weight with surgery, but then gained much of it back again. Their results didn’t last, and I then teach them the additional changes.

Every method of weight loss reports some successes.

Some of people even keep the weight off long-term.

A few become celebrities (eg Biggest Loser winners) and their new life then depends upon keeping the weight off. That might help as motivation.

But I think there are another group of people who discover a few other tips and habits that give them the success they need – effortlessly.

I think they discover, albeit accidentally, the non-dieting method that naturally thin people live unconsciously and automatically.

If you are over-weight enough to qualify for surgery, then it certainly is worth pursuing. In the US you might need to push to get access to LAP-BAND(TM) because apparently insurance companies are still trying to avoid paying for this, but I agree with Dr O’Brien that it is a better option than gastric surgery, if for no other reason than it is entirely reversible.

But also know that you can make many of the same changes without surgery, and all for free!

Here’s how.

Enter your name and email address for the blog notification list at the top of the page here, and you will be sent a complete audio of all the steps I suggest.

[If you are in my home town of Adelaide, then you can get the Adelaidean-only emails with the same audio here instead.]

-Dr Martin Russell

Exercise And Weight Loss… The Final Nail?

The problem with studying exercise for weight loss is that you can’t really disguise the exercise.

If exercise came in a pill you could do it.

You could get a big group of people and randomly give half the pill with exercise in it, and the other half a dummy, sugar pill that looks, smells, tastes etc just the same (aka a ‘placebo’.)

This is the scientific way to test whether pills works for weight loss.

But what about exercise?

It’s a bit hard to have a ‘dummy, sugar pill’ for physical activity. The sweating and heart-pumping bit sort of gives it away.

What this means is that for exercise for weight loss there is no way to do the gold-standard of a “double-blind, placebo-controlled” study.

Is this a problem?

Oh my wordy, YES!

Time after time it has been shown that the psychological power of medicines is a huge part of their overall effectiveness.

But is this specifically a problem for exercise and weight loss?

Well I only know of one good study that covers that question.

The researchers didn’t invent a dummy, sugar pill, but they did the next best thing as Ben Goldacre at Bad Science reports

Alia Crum and Ellen Langer from Harvard psychology department took 84 female hotel attendants in 7 hotels. They were cleaning an average of 15 rooms a day, each requiring half an hour of walking, bending, pushing, lifting, and carrying.

These women were clearly getting a lot of good exercise, but they didn’t believe it: 66.6% of them reported not exercising regularly, and 36.8% said they didn’t get any exercise at all.

The study abstract reports that one group of the hotel attendants was…

…told that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon General’s recommendations for an active lifestyle. Examples of how their work was exercise were provided.

Subjects in the control group were not given this information.

Although actual behavior did not change, 4 weeks after the intervention, the informed group perceived themselves to be getting significantly more exercise than before.

As a result, compared with the control group, they [the hotel attendants who were told that their cleaning job was in fact ‘exercise’] showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index.

These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.

Now here is the really interesting bit.

HOW MUCH weight did people lose in 4 weeks merely by being thinking they were exercising?

These details are from PsyBlog

The average weight of those in the intervention group reduced from 145.5 lbs to 143.72 lbs. Over the same period the control group showed no significant change. For those of you working metric-style that’s 66.14 kg down to 65.33 kg.

That’s weight loss of almost 2 pounds, just under 1 kilogram, in just 4 weeks.

Not bad huh, for doing nothing extra?

So here’s the kicker.

Doesn’t that sound scarily similar to the 1 kilogram or 2.5 pounds in 12+ weeks that is the ENTIRE benefit of exercise anyway?!!!

[If you didn’t know this was all exercise does, see my previous post with the scientific evidence.]

Exercise, if done for weight loss alone, has suddenly become not just a minor factor, but instead an utter waste of time!

Could this really be the final nail in the exercise / weight loss coffin?

Massive industries of gyms, fitness equipment manufacturers, personal trainers etc etc hope it’s not true.

But what is there left that could resurrect exercise as a real weight loss tool?

If any one knows, I’m all ears.

-Dr Martin Russell

Exercise For Weight Loss

There is so much misinformation around about the benefits of exercise, particularly in regard to weight loss.

But let’s use a bit of common sense, shall we?

When we get active ie exercise, we use up energy.

If you don’t eat more calories, then this energy has to come from your body stores ie from fat.

So exercising more will burn off fat, and you will lose weight.

Simple, isn’t it?

NO!!!

Common sense has failed you and everyone else who pushes this line of thinking.

Don’t kill the messenger. I’m just passing on the researched reality.

Exercise has a pitifully small weight loss advantage.

Mild to moderate exercise removes an average of less than 3 pounds / 1 kilogram.

Vigorous exercise produces barely any more weight loss at 4 pounds or 1.5 kilograms.

That’s all!

Now that isn’t to say exercise doesn’t have other important. It does.

Exercise tones up your muscles, improves your heart, is a more effective mood enhancer than anti-depressants, helps you live longer, among other benefits. Pretty important if you ask me.

It’s just that exercise isn’t all it’s cracked up to be for losing weight.

This totally non-commonsense finding is systematically proven by a review of all the best literature on exercise put together by the most authoritative research collation body in the world, the Cochrane Collaboration. They are not sponsored by medical companies so they are uniquely independent reviewers.

The header of their “Exercise for overweight or obesity” review does indeed say…

We found that exercise has a positive effect on body weight

But buried lower down in the sleep-inducing technical details they admit how miserably small the weight loss is…

When compared with no treatment, exercise resulted in small weight losses across studies. Exercise combined with diet resulted in a greater weight reduction than diet alone (WMD – 1.0 kg; 95% confidence interval (CI) -1.3 to -0.7). Increasing exercise intensity increased the magnitude of weight loss (WMD – 1.5 kg; 95% CI -2.3 to -0.7).

The small weight loss is the same whether you exercise for 6 weeks, 12 weeks, 6 months or 12 months!

Not only that but no matter what type of exercise it is, the results are still unerringly the same.

You can check out the full study here.

In summary.

When someone, a gym instructor, a personal trainer, a friend, a health adviser, or even a medical authority, tells you that exercise will help you lose weight, I invite you to challenge them.

Ask them how much weight they think exercise will help you lose and watch them ignore your question, squirm, or outright invent stuff.

If they disagree with the study above then have them send their research proof to me. No one has yet.

Bust the myth-making.

Truth is that yes, on average, exercise will lose you weight. Just not much.

-Dr Martin Russell

Doctors And Empathy

Have you heard the joke?

When is the time to get empathy from a doctor?

Before they’ve gone to medical school.

Boom. Boom.

Well actually it’s not a joke at all. It’s a researched fact, and not a very funny fact either.

Evidence has been building that shows a steady decline in empathy in doctors as they go through their medical training. The latest one came out just last month…

http://www.ama-assn.org/amednews/2008/03/24/prsb0324.htm

It is quite staggering.

Empathy is the ability to feel and respond to what someone else is experiencing.

Doctors are most empathic when they have first been chosen for medical school.

From this point on their ability to be empathic declines. Even once they become registrars it continues to fall away.

I’m not yet aware of research that shows when this trend stops, or begins to reverse. Perhaps at some point it does.

Not surprisingly females on average have more empathy than males, but it makes little difference in medical school.

The proportional drop during training is the same.

Except for alcoholism, some prescription drug addictions, and completed suicide (presumably they have better knowledge about how to succeed if they attempt it) doctors are generally healthier than the average population.

So for self help, empathy may not be very necessary.

But if you want empathy from a doctor you might have to hunt a bit more than you would expect. No joke.

-Dr Martin Russell

How To Get Better Results From Treatment

Fake pills and treatments are such wonderful things.

They work roughly 30% of the time, on almost anything.

With the technical term of ‘placebos’ they are the gold standard treatment against which every other treatment is measured.

And the whole field is shrouded in mystery.

Why do blue placebos make people more sleepy, while red placebos keep people more awake?

How can fake pills work even when you know there is no active ingredient in them?

How can they work no matter what level of intelligence you do or don’t have?

Well it’s still largely guesswork, because we don’t know why or how they work but they certainly do. Study after study has shown the effectiveness of variations of placebos.

Here is one more thing that has been recently uncovered about placebos – they work better if they cost more!

Dr. Ariely, a behavioral economist at MIT’s Media Lab, and his colleagues had two groups of people receive electrical shocks to their wrists.

They were told this was for a research into a new painkiller called Velodone.

When they were given the medication one group was told the price of the medication was $2.50 a pill and others were told the cost was discounted to just 10 cents a pill.

Those who got the “more expensive” pill had significantly better pain reduction than those who thought they were getting the discounted version.

This is actually important.

Drug companies often bring out drugs that besides being new, are often more expensive too. How much of the patient’s results is simply based on the added expense, rather than having a better chemical.

Also, this effect may indeed make brand-name medications more powerful than generic brands.

So one way to get better results from your treatment is to pay more for it.

As a side note, Dr Dan Ariely has a book just published about these and other psycho-illogical phenomena. It’s called “Predictably Irrational: The Hidden Forces That Shape Our Decisions”.

My main thought is whether people who buy the more expensive hardcover version will rate the book better than those who buy the cheaper paperback.

It wouldn’t surprise me, or Dan I suspect, in the least.

-Dr Martin Russell