Blog - Georgia Hormones

The Menopausal Vagina Monologues

9/9/2018

The Menopausal Vagina Monologues

Read NY Times Article

This article discusses menopausal vaginal dryness, its effects on menopausal women and treatment options.

One of the most important points is that the problem is treatable. Because the onset of symptoms is gradual, woman may not realize that the cause could be lack of estrogen. Unlike hot flashes, which may resolve with time, the lack of estrogen causes vaginal symptoms to gradually worsen with time.

Many women may experience:

Discomfort or pain with sex
Increased yeast or urine infections
Vaginal dryness and discomfort

Despite the uncomfortable symptoms, women may hesitate to bring these issues up with their doctors. At Georgia Hormones, we understand the problem and know of many hormonal and non-hormonal solutions.

Don’t suffer silently. We can help.

Hormone Levels Likely Influence a Women’s Risk of Alzheimer’s, But How?

8/15/2018

Read NPR Article

Often, patients send articles to get my viewpoint. I recently received an article written for NPR, Hormone Levels Likely Influence a Woman’s Risk of Alzheimer’s, But How?

This is a typical case of researchers conducting statistical studies without looking at the already known science behind the numbers. The article was also trying to reduce a complex issue into a simple one.

Some of the main points from the article:

Women that started menstruation at an early age were less likely to develop dementia. This actually surprised me. The age at the first period is influenced by body fat — heavier girls tend to begin their periods earlier. If a woman continues to stay overweight throughout her life (which is associated with higher insulin levels), she is more likely to get dementia.

Women that experienced late menopause were less likely to develop dementia. It is my experience that healthier, trimmer women who regularly exercise, tend to go through menopause later (some as late as their mid-50’s). These women, not surprisingly, should have less arteriosclerosis in the arteries inside their brains, and less dementia.

Women who gave birth to more than one child were less likely to develop dementia. Having more children requires fertility. Higher carbohydrate consumption raises insulin levels, which actually increases arteriosclerosis and also interferes with ovulation, as in Poly Cystic Ovary Syndrome. Less healthy women tend to have fewer children.

The article lumped together different influences. Different situations can result in a woman having higher estrogen levels. Some situations can make Alzheimer's less likely while others make it more likely.

They also discuss that hormone replacement fell out of favor about a decade ago. Although they don’t refer to it specifically, they are talking about the Women’s Health Initiative Study, (see my article about the WHI study). In the WHI, most of the women were over 60 years old at the start of therapy and they were given a high dose of estrogen, by mouth. Lower doses of estrogen, given through the skin using creams, gels and patches do not cause blood clotting and do not raise the rates of heart attack or stroke.

In the WHI study, only Provera was used (which is not real progesterone; it's medroxyprogesterone acetate). Only the Provera users experienced higher rates of breast cancer, not the estrogen only group.

Menopause at age 45 or younger seemed to increase the risk of dementia by 28%. My question: Did these women receive any hormone replacement, and if so, what kind? Often, early menopause is triggered by surgical removal of the ovaries. The problem that caused the removal of the ovaries might also be a problem that causes dementia. For women under 45 whose periods ended spontaneously, it is usually attributed to an autoimmune disease. This may influence the onset of Alzheimer’s as well.

In summary: Simply looking at statistical relationships is interesting but does not provide much value for the individual. These are complex problems. One really has to unravel what is the cause and what is effect. Number crunching large groups of people does not explain which individual unique conditions lead to which specific problems.

If You Order Genetic Testing, The Results Could Be Wrong!

7/11/2018

Read NYT article

Recently, the Science section of the New York Times published an interesting article, The Limits of Online Genetic Tests. It discusses a lack of rigor that often leads to false results about mutations.

Dr. Joshua Clayton decided to order a set of tests from 23andMe, a popular genetic testing company. He also sent the results to Promethease, which offers a more in-depth analysis for genetic mutations that cause disease. When Dr. Clayton’s report came back, he was informed that he carried a gene for Lynch syndrome. People who carry the mutation are much more likely to be diagnosed with a special type of bowel cancer (as well as other cancers).

After getting over the initial shock of the diagnosis, he consulted an expert in Lynch syndrome. His sample was sent to a medically approved lab and the results clearly indicated he DID NOT have Lynch syndrome. There have been reports of others who sent DNA samples to several different commercial companies for ancestry evaluation and received radically different results.

The companies say that these reports are just for entertainment and not for medical diagnosis. Just because no one is regulating these companies doesn’t mean they are not responsible for incorrect reports.

I do not encourage my patients to get these amateur genetic tests. For one thing, they can lead to unnecessary stress and additional medical testing. For another, they could lead to problems getting life, disability, long term care or even health insurance if Obamacare is eliminated. And the results may actually be wrong.

In addition, many of these genetic tests are new and doctors don’t always know what to do with the results. Many women that are BRCA positive are submitting to preventative surgeries on their breasts and female organs without clear data on their benefits and risks.

As with most things,
Let the Buyer Beware!

A Polite Silence on Sex Raises Women’s Costs

6/12/2018

Read NYT article

Additional thoughts from Dr. Goldman:
This is an important article found in the Business Day section of the New York Times, June 4 edition. It talks about the startling rise in the cost of pharmaceutical drugs — this time focusing on products helping replenish vaginal moisture in menopausal women.

It is a good article, as it points out the back channel deals involving drug companies, pharmacy benefit managers and insurers — they are ALL making extra money while increasing the costs to insurance payers and patients.

The lead off product in the discussion is Vagifem. Over the last five years costs have steadily risen and is currently over $200/month. Vagifem is a very low dose, 10mcg/vaginal tablet made of bioidentical estradiol. They are taken twice a week, totaling eight tablets monthly. Patches (also replaced twice a week), range from 25mcg/day up to 100mcg/day. This dose, although quite effective in improving vaginal moisture, is too low to significantly raise the blood levels of estradiol. I know because I have many patients on Vagifem and I measure their blood levels.

The point of the article discusses the huge increase in the cost of estrogen products (just in the last few years). Estradiol is a body part and cannot be patented. It is only the delivery system that can hold a patent. Recently, Vagifem’s patent ran out (it has been on the market for well over a decade). Now there are generic competitors, but despite that, the price just keeps going up.

This story is not just about Vagifem. Estrace vaginal cream has been around for decades. In the last few years the price doubled, then redoubled and is now approximately $372 per tube. An exorbitant price, despite the fact that it is now also off patent — yet the generics are similarly priced. A compounding pharmacy could produce similar products for around $60/tube. Unfortunately, the Times article does not discuss what a compounding pharmacy could supply.

Nothing is going to stop this outrageous robbery until the American public holds businesses and Congress accountable. This is almost exclusively an American problem. The same medications are much less costly in other parts of the world. It is illegal for medications to be purchased from other countries and brought into the USA. That law could be changed.

President Trump Says He Will Lower Drug Prices???

5/18/2018

Read NYT Article

On Friday, May 11, 2018, President Donald Trump announced a plan to provide Americans relief from high prescription drug costs. That’s not what is happening at all! President Trump is protecting the same players that he says he is attacking.

In response to the announcement, the stock of pharmaceutical companies, insurance companies, drug supply chains and middlemen have INCREASED. If this new plan of President Trump’s passes, the cost of Medicare Part D will go up, not down.

If President Trump really wanted to lower drug costs, he should start by doing three things:

1. Allow Americans and American corporations to buy FDA approved medications from wherever they are sold (at local prices), and bring them into the United States.

Currently, it is illegal. The price of many U.S. medications can be ten to twenty times the price they are sold for in other countries. For example: menopausal estrogen replacement patches are approximately $120/month in the U.S. From the same manufacturer, they sell for 17 euros or about $20/month. The birth control Mirena IUD, sells for $100 in Europe versus $950 in the U.S. Cancer drugs are highly expensive in the U.S. as well.

2. Ban all prescription drug advertising in the public media. This is already the case in most parts of the world.

Americans have no idea how the financial aspects of U.S. healthcare really operate. For most of the 20th century it was illegal for prescription medications to be advertised to the public. Ronald Reagan changed that. He allowed prescription drug ads for freedom of speech reasons. This allowed the pharmaceutical industry to control the news. The news contains mostly drug ads, never revealing the real story of American medical care. Aside from the U.S., only New Zealand allows drug advertisements to the public.

We knew for a long time about the problems with smoking and health. Yet no progress was made in reducing smoking until cigarette ads were banned from the public media in 1968 — a year that had one of the highest smoking rates in America. Finally, the news media began spreading the truth about cigarettes and sickness.

3. Allow Medicare, all insurance companies and consumer groups to bargain with pharmaceutical industries for better pricing.

Right from the start of Medicare Part D (the drug plan initiated under President George W. Bush), Medicare was forced to pay full retail price for all medications. They were forbidden from negotiating better prices. Medicare Part D became a big boon for the pharmaceutical industry and a huge cost to U.S. taxpayers. Drug prices massively rose at a time when inflation was very low. This was a big driver of the rising costs of health insurance.

Drug companies claim they need the higher profits to pay for research. This is not true. Most basic research is paid for by the federal government. The drug companies then buy up the patents and sell the medications for huge profits.

These are not all of the changes needed, but minimally, they should be a necessary start. President Trump has proposed some other minor changes but it is still not correcting the cause of our huge price increases.

How to Stop Eating Sugar

4/10/2018

How to Stop Eating Sugar

Read NY Times article

Additional thoughts from Dr. Goldman:
The author, David Leonhardt, is not a doctor and usually writes editorials relating to politics and economics. In the article, he states that "he is not sure about diet sodas being harmful." I AM SURE that diet sodas are harmful and cause weight gain!

Breakfast is discussed a lot, as it is easy to consume high sugar amounts. Take a look at the below photo of a typical breakfast for me: veggies, hummus and shrimp. I take my supplements before eating and don’t experience any vitamin “burp up.” Eggs or other protein could be substituted for the shrimp. Any vegetable (cooked or uncooked) will do.

Dr. Bob Goldman's sample breakfast

Many TV ads for diet sodas promote taglines such as, “One calorie but still tastes great.” The message never endorses diet sodas as part of a weight loss plan or a healthy diet.

That is because they cause weight gain.

There are taste buds in the intestine near the pancreas. Artificial sweeteners found in diet sodas stimulate these taste buds and in response the pancreas makes more insulin. The insulin drives sugar from the blood into fat stores. The brain sees the sugar levels go down and the person is driven to want more sugar.

Tests have shown that after three months, lab rats who drank Diet Coke, weighed 50% more than control lab rats drinking water!

Diet soda can pouring out sugar

Don’t be fooled by
the term “diet” soda

Chile Takes on Junk Food and Obesity

2/14/2018

Chile Takes on Junk Food & Obesity

Read NY Times article

Like the United States, Chile is seeing a huge rise in obesity along with related diseases such as diabetes, heart disease, joint problems and cancer. After twenty years of debate, Chile’s new president, Michelle Bachelet, a pediatrician, is doing something about it.

The new laws do not ban the sale of snack foods containing high sugar, salt, fat and calories. But they now require black warning labels to appear on the front of the packages — they also prohibit the sale of these unhealthy products in schools. Advertising aimed at children has been discontinued. Even Tony the Tiger is banned from Frosted Flakes boxes and Chester the Cheetah has been removed from all Cheetos packaging (I always hated the Cheetos Cheetah. He teaches children bad manners including smearing yellow Cheetos dust onto other people's clothing).

Over the last several decades, Americans went from consuming a few pounds of sugar each year to ingesting approximately 150 pounds annually! The move from white sugar produced from sugar cane to high fructose corn syrup markedly lowered the price of sugar — and with lower prices, portion size and total sugar consumption grew. Chile has also added an 18% tax on high sugar beverages. They are still much cheaper than before the advent of corn sugar sweeteners. Mayor Bloomberg tried to do this in New York City and failed.

In 1981, Pepsi and Coke both made the change to using corn sugar. Soda became so cheap that McDonald’s moved their soda dispenser from behind the counter to inside the dining area. It was cheaper to allow a customer to drink unlimited soft drinks than to pay an employee to fill empty cups. Instead of tracking soda consumption, management would simply track the number of cups used.

In the 1970s, most people in the world were thin. There are still areas where food is in short supply, but mostly these are areas where war or fallen governments prevent the distribution of food. American produced sugar is so cheap that huge regions of the planet now have high obesity and diabetes rates. Diabetes was virtually unknown in China a few decades ago — now it is a rising epidemic.

Like many businesses, the food industry has undergone consolidation, resulting in a few huge companies controlling most of the trade. They can (and do) lavish money on politicians worldwide, and lobby heavily to protect their business.

Sadly, one of the responses of the food industry in Chile has been to remove sugar and replace it with artificial sweeteners. Those chemicals raise insulin levels, just like sugar and have many of the same bad effects on health. In lab experiments, rats given Diet Coke weighed 50% more than water drinking controlled rats after just three months!

As individuals, we all have the power to change our food choices. But, as a society, it helps a great deal if consumers can clearly see which foods are unhealthy. It is especially effective if these labels are plainly visible to children. We also need to remove unhealthy snacks from schools and forbid harmful food advertising directed at children.

The rise in food related disease takes many years. As with smoking, deaths occur four to six decades after the habit begins. If the U.S. launched a program to reduce consumption of sugar, processed carbohydrates, salt and unhealthy fats, it could take over thirty years to document some major improvement in health statistics.

Cigarette consumption peaked in 1968 when advertising was banned. Lung cancer deaths continued to rise and peaked in 1998. In order not to die of lung cancer, a smoker would need to quit smoking thirty years before they would otherwise die of the disease. People don’t suddenly get a heart attack at sixty or seventy — they have been gradually accumulating the problem for decades.

By changing the detrimental advertising sales patterns of processed foods, it will mostly benefit our children when they become mature adults. The earlier we start, the sooner the changes can begin.

I congratulate the people of Chile for their courageous step and wish them good health. If only the American people were to take such a step.

Why Are They Frightening American Women?

12/14/2017

Many Modern Contraceptives Still
Linked to Breast Cancer, Study Finds
NY Times, 12/7/2017

Read NY Times article

You can’t just read the headlines. You have to dig into the details of the story.

When I saw this headline, I was curious and skeptical. Birth control pills have been around for over fifty years. They have been studied many times and they are associated with slight or no increase in breast cancer. They have the benefit of reducing endometriosis, endometrial cancer and ovarian cancer. They give women control over their reproductive lives. Mostly, the benefits outweigh the risks. What do they mean “STILL” linked to breast cancer? Any linkage to breast cancer has been weak at most.

The study was done in Denmark where everyone is part of the national health service. So basically the whole population is the study group. Novo Nordisk, a drug company, conducted the study.

The study indicated that for every 100,000 women not on birth control, 55 women per year were diagnosed with breast cancer. For every 100,000 women using birth control, 68 women were diagnosed annually with breast cancer. Women who had used Progestin Implants and the Mirena IUD had the same numbers as the women who took oral contraceptives.

The article stated that the longer a woman is on the birth control, the higher the risk of her developing breast cancer. It has been known for decades that women who have more children and breastfeed have lower risks of becoming diagnosed with breast cancer. I suspect women who take contraception for many years probably experience fewer pregnancies, births and breastfeeding. These small differences could simply be due to women having fewer babies and not based on the contraceptive method itself. In studies conducted in the 1960s, Irish nuns had higher rates of breast cancer than Irish women who had many children. I am assuming the nuns were not on birth control.

Another issue supporting this idea is that the results were the same for all of the birth control methods used. If synthetic hormones were the problem, the results should have varied with different methods and doses. The implants and IUD are progestin only, with no estrogen. The IUDs have only a tiny amount of progestin which acts on the uterus directly. I have tested the hormone levels of many women on the Mirena IUD and concluded that the IUD had minimal effect on the woman’s own hormone production.

Women with estrogen/progesterone receptor positive breast cancers have only a 15% mortality rate. 85% never die of their breast cancer. This means that any additional number of women actually dying of breast cancer would be quite small. Some women also die from pregnancy complications. If women become frightened of using these birth control methods, they are at an increased risk of the consequences for any unintended babies or undesired pregnancies.

Just because there is a “statistically” significant difference between two groups does not mean that the difference is meaningful for the women involved. If you buy two lottery tickets instead of one, it is true that you double the opportunity to win. But if that means you go from one chance in a billion to two chances in a billion, your odds haven’t changed in a meaningful way.

Novo Nordisk is a global healthcare company that focuses on diabetes care. Why did they fund this study? Is there some marketing reason why they want to frighten women away from using contraception?

I am not arguing with statistics or the numbers in the study. I just find the conclusions and suggested actions to be questionable.

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

11/20/2017

An American Sickness How Healthcare Became Big Business and How You Can Take It Back

At the recommendation of one of my patients, I have recently read An American Sickness, by Elisabeth Rosenthal, MD. Dr. Rosenthal is a Harvard trained physician and also worked as a medical reporter for the New York Times.

Ironically, some of the information pointed out in Dr. Rosenthal's book are stories I have been telling my patients for years. It is not about how to stay healthy or how to stay out of the medical system. This book is about the business of American medicine. It is intended to give the layman understanding of the financial aspects of our medical system and what an individual can do in self defense. Dr. Rosenthal also provides ideas of what people should demand from their senators and representatives. No one in Washington (of either party), seems to be working for the public. They are working for the many big financial players in a 3 trillion dollars a year business that makes up nearly 20% of the entire U.S. economy.

Dr. Rosenthal discusses why Americans pay so much more for their medical care than it costs in any other developed country. It is meticulous in its history about where we were years ago and how we arrived at the current state of affairs.

The book also includes the development of American health insurance companies, why insurance is so costly, and why it is beneficial to insurance company profits for medical costs to go up and up, but not down.

Also discussed is the growth of the pharmaceutical industry and legislation that has led to huge increases in the cost of medications. Dr. Rosenthal points out why our prices are so much higher than anywhere else on the planet. She also discusses why drug advertising was only relatively recently permitted in the U.S. Only the U.S. and New Zealand permit pharmaceutical ads to the public.

Hospital costs and billing practices are examined and why hospital bills are so incomprehensible and how they became so high.

Other topics cover what drives some physicians to choose medical procedures and practices that maximize their income and patient’s costs. Even the location of where procedures are performed can have huge effects on pricing!

She also discusses the pharmacy business and how they increase drug costs for the patients. Rarely do Americans shop for medications like they would for many other products.

Most importantly, Dr. Rosenthal gives instructions and reference materials for patients to help get control of their own medical costs.

I am not sure that Dr. Rosenthal understands deeply the flaws in the medical education system and how doctors are being taught to treat patients. She does not discuss how the professors of medicine are now tied in deeply with the pharmaceutical and equipment industries. Still, this book is very well documented and would be an eye opener, not only for most lay people but even for most medical professionals.

I highly recommend it.

Cancer's Invasion Equation

10/10/2017

We Can Detect Tumors
Earlier Than Ever Before.
Can we predict whether they’re going to be dangerous?

By Siddhartha Mukherjee (September 11, 2017, The New Yorker)

Additional thoughts from Dr. Goldman:

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
William Osler, MD 1849-1919

William Osler, MD, was one of the founders of American Medicine at Johns Hopkins, and his quote seems particularly appropriate after reviewing the September 2017 article in The New Yorker. The subject is about cancer, its diagnosis, treatment and what doctors are really doing for their patients.

Mukherjee mentions Occam’s razor twice in the article. Occam’s principle states that among competing hypotheses, the one with the fewest assumptions should be selected. Simple answers are better than complicated ones. This has been a driving principle of science for the last few centuries, but I think the tide is changing. Over the last fifty years of following the advances in science and medicine, it is amazing to me how many things have swung from the simple to the complex.

The science of evolution of our solar system grows more complex every year. Copernicus made things much simpler by proposing that the sun was at the center of the solar system, not earth. It was all simple clockwork. Jupiter is now thought to have started out further from the sun then it is now — to have actually moved much closer to the sun, scattering small objects (and even planets) out into space, and then moved back to where it now resides. No one theorized this complex movement fifty years ago.

Research involved with the AIDS epidemic showed that the immune system is far more complex and has many more moving and changing parts than anyone had dreamed. In the 1970s there was a simple idea — if we could detect cancer earlier and declare war on it, we could save a lot of lives. Unfortunately, that has not worked out. Screening programs for breast, prostate, thyroid cancer and melanoma have resulted in a huge increase in the number of patients treated with almost no reduction in the death rates from these diseases.

On page two, Dr. Daniel Hayes talks about breast cancer and says, “Only some fraction of the patients who receive toxic chemotherapy will really benefit from it, but we don’t know which fraction. And so, unable to say whether any particular patient will benefit, we have no choice but to overtreat.” I disagree. Dr. Hayes and his patients do have a choice. The number of patients that benefit may be as low as 3%. The other 97% will develop damage from chemotherapy treatments and will either live or die anyway, but will not have received any benefit. Mukerjee does not address money in the article, but the entire medical system is making a huge amount by implementing these testing programs and therapies. Whenever a more careful consideration of screening and therapy programs is suggested, the medical companies scream bloody murder about restricting medical care, and could result in a large amount of dying patients.

Mark Twain was known to have said, “It is difficult for a man to see the truth when his income depends on not seeing the truth.”

In the article, the theory of the spread of cancer is discussed and states, “This theory would form the intellectual basis for William Halsted’s “radical mastectomy.” Halsted and William Osler were colleagues at Johns Hopkins. A study published in 1971 proved that radical mastectomy had the same breast cancer death rates versus simply removing the lump and giving local radiation. There was no added benefit for performing the more radical surgery. Radical mastectomy rates plummeted in the 1970s but are now rising again, with no proof it saves lives. Numerous surgeons have told me that many of their patients insist on getting the mastectomies. That may be true, but surgeons could still refuse to perform a surgery that may cause more harm than benefit. I am sure they could convince a patient that no benefit would be gained by removing their breasts — but that may not be in the best interest of the surgeon. There are also more lawsuits for patients dying after too little treatment than too much.

On page four, Mukherjee talks about a meeting he had with Gilbert Welch, MD. I have read Welch’s book, Overdiagnosis, and I highly recommend it. Welch talks about a thyroid cancer screening program in South Korea that resulted in a huge increase in thyroid cancer diagnosis and treatment but no reduction in cancer deaths. The basic reason is that, as with breast and prostate cancer, a lot of people have slow moving tumors that would never kill them. The screening uncovers many more tumors that would otherwise remain hidden. On the other hand, when the screening program finds aggressive tumors, it is often already too late. They may have already sent metastasis all over the body. Even when the thyroid, breast or prostate is removed, it may already be too late to prevent the cancer spreading. The distant disease may still be hidden, but it is already there.

Again, quoting Dr. Daniel Hayes, he says, “The early detection of breast cancer via mammograms saves women’s lives although the benefit is modest.” He doesn’t say how modest. In fact, the total death rate for breast cancer continues to rise. In 1975, 70,000 women were diagnosed and treated for breast cancer – average deaths were about 35,000. In recent years, around 285,000 women are treated yearly for new breast cancer diagnosis and the deaths are around 39,000 a year. It may have seemed like a good idea to set up these screening programs to make more cancer diagnoses. As it turns out, this has resulted in a huge increase in patients being treated for breast, prostate, and thyroid cancers as well as melanoma type skin cancer. The death rates, despite so many more patients undergoing major treatments, has remained about the same. Mukherjee says, “ For Welch, the fact that diagnoses of thyroid cancer or prostate cancer could soar without a corresponding effect on mortality rates was a warning, a little knowledge had turned out to be a dangerous thing.”

The solution is much more likely to be in a holistic approach that involves the patient and their resistance to the spread of cancer, rather than just focusing on the cancer itself. Cancer researcher D.W. Smithers is quoted, “Cancer is no more a disease of cells than a traffic jam is a disease of cars.” This is where Occam’s razor comes in again. Oncologists, like everyone else, want simple solutions. They don’t want to multiply the factors that they have to consider.

More is not necessarily better. On page eight, Mukherjee says, “We err toward risk aversion, even at the cost of bodily damage; we don’t learn what would happen if we did nothing.” He was counseling one of his patients that had undergone a hysterectomy — when her newly removed uterus was examined, doctors found a rare, malignant sarcoma lodged in the tissue — a tumor so small that it could not be detected on any of her preoperative scans. Both her gynecologist and surgeon had recommended an aggressive procedure to remove the ovaries and surrounding tissue. Mukerjee explained that her circumstances were completely different, as the tumor was detected incidentally, with no signs or symptoms of the cancer (and was contained in the uterus, which no longer inhabited her body). She looked at me as if I were mad and asked, “Would you sit and do nothing if someone found this tumor in you?” She decided to go ahead with the surgery.” I have been in this position myself. It is very difficult to say no to a therapy that is proposed. There is an ad for Houston’s MD Anderson Cancer Hospital that says, “They will never give up on your cancer.” Maybe many of their patients would be better off with less therapy, rather than more.

In conclusion, Mukherjee states, “It would return us to the true meaning of Holistic: to take the body, the organism, its anatomy, its physiology -- this infuriatingly intricate web -- as a whole. Such an approach would help us understand the phenomenon in all its vexing diversity; it would help us understand when you have cancer and when cancer has you. It would encourage doctors to ask not just what you have but what you are.” I started medical school in 1967— everyone in my class would know that Dr. Mukherjee was simply paraphrasing William Osler. Treating this particular individual patient was important in the late 1800s but seems to have been forgotten in 2017. Mukherjee doesn't seem to know that he is just resurrecting an old idea from Osler.

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
William Osler, MD 1849-1919

weebly reliable statistics

weebly reliable statistics