Douwe Rienstra, MD

Educational Activities

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2005

November 18, 2005 - Astrid Pujari, MD of Virginia-Mason Clinic has studied integrative medicine here and in Europe. She outlined the use of herbs in seniors. The average senior uses five pharmaceuticals a day. She discussed the use of ginkgo, vitamin E, St John's Wort, glucosamine, and other herbs.

In the talk, she carefully outlined all the possble side-effects of these herbs, and most often came to the conclusion that these side-effects precluded their use in patients. She seemed to me to express the general academic medical view that side-effects in pharmaceuticals are unavoidable and generally outweighed by the benefit of the drug, whereas any possible side-effect of a natural substance is unacceptable. She presented as trust-worthy the meta-analysis purporting to show a danger from vitamin E published in the Annals of Internal Medicine on January 4, 2005, a study I find to be breath-takingly flawed.

October 28, 2005- Kevin Beshlian, MD of Virginia-Mason Clinic discussed melaoma. This tumor currently gets a lot of news coverage, because the numbers identified by doctors are increasing rapidly. Currently about 50,000 Americans are diagnosed with melanoma each year, which is in the range of the number of us killed in automobile accidents. The good news is that the death rate from melanoma is holding steady at about 7,000 people per year. The rate of melanoma is going up in over 45 age group, and in men more than women. While the role of sun exposure is still being argued, melanoma is more common in people who live near the equator, especially those who are particularly light-skinned.

One of the more important elements of the annual physical is a head-to-toe skin examination. If you see something on your skin that worries you, don't wait for your annual- see your doctor ASAP.

October 7, 2005 - Kenneth Gross, MD of Virginia-Mason Clinic discussed fatty tissue. Just fifteen years ago, we thought the fat cell did nothing but store energy. Now we know that fat cells also behave like glands. They make molecules that raise blood pressure, promote blood clots, interfere with insulin action, and promote inflammation. People who are overweight are not just suffering from lack of execise; they hurt because their body fat produces signals that promote pain..

Dr Gross reported on a six year study of 60,000 nurses.  Those nurses who watched TV less than ten hours per week and walked briskly an hour per day became obese only a third as frequently as those who watched TV two hours a day or more. They developed diabetes only 43% as much.

September 30, 2005 - Phil VanDerhoef, an attorney, spoke at Virginia-Mason clinic spoke on communication as a foundation for trust in healthcare. One aim is, of course, to prevent lawsuits. He had a larger aim, and he expressed it well. We serve our patients better by paying attention to their needs.  As we meet those needs we need to attend to their human sensibilities.  For too many doctors, this is not a natural thing.

September 16, 2005 - John Ryan, Jr, MD of Virginia-Mason Clinic gave a humorous and informative talk about the vocabulary and language of medicine.

June 10, 2005 - John Guyton, MD of Duke University spoke at the Virginia-Mason Clinic about the influence of diet on cardiovascular risk. Here are a few points from his talk you might find helpful for dealing with weight.

The Ornish diet is largely vegan, and reduced chest pain but not the rate of heart attacks. The Mediterranean diet did not lower cholesterol, but lowered the rate of heart attacks by 60%. This is a better result than any pharmaceutical.

Eat less; you can't completely rely on exercise. But you must exercise to feel good. Don't get complicated, keep it simple.

If you skip breakfast and lunch, you'll probably eat more at supper than you would have eaten all day if you avoided letting yourself become ravenous.

Choose 2 pounds a month as a target to lose, not 50 pounds.

Weigh yourself.

Don't eat for energy; the problem is "energy overload."

Omega-3 fatty acids are helpful.

The South Beach diet is generally a good program.

June 3, 2005 - Harry Geggel, MD, of Virginia-Mason Clinic reviewed laser surgery to improve vision. The procedure originated in Bogata, Columbia about 50 years ago, although lasers replaced scalpel-like cutting tools only in the last decade or so. Newer techniques smoothe the edge of the operated area, eliminating halo and glare. Even when we fix our gaze on something, the brain moves the eye a microscopic amount from side to side and in rotation as well. Newer techniques automatically move the laser to track these microscopic eye movements. Very new techniques, call wavefront technology, have been adopted from astronomical science and allow more precise shaping of the eye surface.  These new techniques are still being improved. The are many technical details that have to go correctly for this surgery to be safe and successful. If I were to have it, I would be very careful about choosing my surgical team.

May 13, 2005 - Paul Mystkowski, MD, of Virginia-Mason clinic reviewed the hormones that are abused by athletes. Growth hormone is one such hormone; it improves muscle mass, but degrades endurance and strength. Testosterone increases muscle mass and muscle strength. It increases red blood cell count, so that more oxygen is carried to the muscles. This increases endurance. Visual perception is improved as well.

With testosterone supplementation, the testicles will shrink because they no longer are being stimulated by the brain, and the breasts will enlarge because excessive testosterone is made into estrogen. Athletes therefore use hormones to increase testicle size, and estrogen blockers to prevent breast enlargement.

The adverse effects of testosterone replacement on health are still unclear. It is clear that competitive sports may never be the same, for new technologies of gene therapy may forever change our athletic abilities.

May 12, 2005 - Bruce Psaty, MD, of the Cardiovascular Health Research Unit at the University of Washington addressed drug safety. The human studes of rofecoxib involved only 3600 were given the drug for over a day, and only 750 received it for over a year. This is typical, as the FDA is looking mainly to see if the benefits outweigh the risks. Congress and the pharmaceutical industry resisted additional funds for safety testing; in March 2003, two/thirds of FDA reviewers believed that safety testing is currently inadequate.

There are numerous examples of pharmaceutical companies designing studies to show benefits and minimize any risks. For Vioxx, there were theoretic reasons to expect that it might increase blood clotting, and therefore stroke and heart attack. The studies were designed to eliminate people at higher risk of heart disease, and lasted only a few weeks- enough time to show a benefit but short enough to minimize risk of heart attack and stroke.

Cerivastatin, a drug for high cholesterol, produced muscle damage over fifty times as often as other statins, yet was marketed for several years despite company knowledge of this knowledge. The company involved showed an almost purposefull ingorance of the problem. In 1998 the company had undeniable evidence that cerivastatin combined with gemfibrizol (another lipid lowering drug), yet in the year 2000 the head of marketing, when advised of the continuing evidence of increased risk, said "promote the hell out of this drug."

Once drugs are approved, the FDA has surprisingly little power to regulate them.

In our January newletter at http://www.rienstraclinic.com/newsletter/2005/2005Jan.html, we pointed out that the pharmaceutical industry provides us with great benefits. We noted that those countries who have used price controls to reduce pharmaceutical prices have severely damaged the industry. This picture, as so much of life, is not black and white. Check out http://suepelletier.typepad.com/daily_capsules/pharma_and_medical_device_industry/ for more details on industry abuses.

April 29, 2005 - Astrid Pujari, MD of the Virginia-Mason Clinic spoke about prevention of cardiovascular disease with omega-3 fatty acids. She pointed out that flax seeed oil is only about 10% converted to the desirable omega-three fatty acids.

She was followed by Cindy Synder, MPH, Registered Dietitian.

They spoke about red rice yeast, which lowers cholesterol. This substance contains natural statins, plant sterols, isoflavones, and other substances that lower cholesterol. They use 1.2 to 2.4 grams per day, divided into three doses. Also for high cholesterol, they recommend policosanol, a wax from the sugar case. It has an anti-coagulant effect similar to 100 milligrams of aspirin a day. They use guggulipid, made from myrrh, at 1 to 3 grams per day. Plant sterols and stanols work best if mixed with fat, so do not work so well when encapsulated. The FDA has approved plant sterols and stanols for over-the-count use to lower cholesterol. The usual dose is a bit less than a teaspoon a day, and the average decrease in cholesterol is about 10%.

We have some years of experience with all these methods.   Sometimes they are effective, sometimes not.  Fortunately we can find out in a couple of months with a blood test.

April 15, 2005 - Christopher Porter, MD, of the Virginia-Mason Clinic discussed prostate cancer.

March 31, 2005 - Jerome Kassirer, MD, former editor of the New England Journal of Medicine, spoke at the University of Washington about how medicine's complicity with big business endangers the medical profession. As an example, he reviews the recent recommendations from the National Cholesterol Education Program, that conluded that we need to use statins even more aggressively than we do now. At the same time, a panel from the University of British Columbia concluded that statins have not been proven to help people who don't have heart disease already. The difference? Maybe it was that no one on the University of British Columbia panel had a financial connection with the pharmaceutical industry, but seven of the nine distinguished participants on the National Cholesterol Education Program panel made money from the pharmaceutical industry.

In his one-hour talk he points out that medical education, medical research, and health care policy making are heavily influenced by the pharmaceutical industry.

Physicians working with industry can produce benefit for society. Surgeons cooperating with industry have give us stents; all new drugs result from academic/industry collaboration, and there are many other examples. What we need, however, is to realize that judgements about medical treatments need to be made by people who have no financial bias and are skilled in data analysis.

He recently wrote a book about this called "On the Take."

March 25, 2005 - Daniel O'Connell, PhD spoke at Virginia-Mason discussed the changes health care organizations are making to improve openness in regard to medical errors.

March 19, 2005 - Thorne Research sponsored an all-day forum on therapeutic nutrition in Seattle.  They discussed issues important in manufacture of nutritional products.  Parris Kidd, PhD reviewed the physiology and biochemistry of bipolar disorder, pointing out that essential fatty acids play a major role in proper function of the membranes of the central nervous system.  Eyal Ron, PhD reviewed the biochemistry of the vascular endothelium, the tissue that lines the blood vessels. This is the tissue that, when damaged, produces plaque and, eventually, heart disease and stroke.  Naturally, nutrients such as antioxidants and arginine improve the health of this tissue.

March 11, 2005 - Craig Nichols, MD from Oregon Health and Science University in Oregon spoke at Virginia-Mason Clinic about testicular cancer. In the 1960's this cancer was fatal 95% of the time. In 1973 a new drug, cisplatin, was employed and increased the cure rate to over 50%.

March 5, 2005 - Virender Sodhi, MD (Ayurveda) in this one-day course reviewed ayurvedic treatments for digestive and inflammatory conditions.

March 4, 2005 - Robin Kroll, MD spoke at the Virginia-Mason clinic about sexual desire disorders in women and the various causes thereof. These include testosterone deficiency, relationship problems, prescription drug side-effects, estrogen deficiency, thyroid disorders, vaginal muscular spasm, metabolic disorders, drug abuse and other less common reasons.

March 3, 2005 - Steffen Gay, MD directs the World Health Organization Collaborating Center for Molecular Biology and Novel Therapeutic Strategies for Rheumatic Diseases. He reviewed in detail the molecular factors involved.

February 25, 2005 - Terry Clemmer, MD, Director of Critical Care medicine at LDS Hospital in Salt Lake City, Utah, spoke at Virginia-Mason clinic about methods to improve quality of care in an intensive care unit. These methods may also work in other areas of medicine as well. These methods involve constant revision of protocols, rapid cycle testing of these protocols, measurement of results, then repetition to improve the process.

February 24, 2005 - Anthony Back, MD of the Seattle Cancer Care Alliance spoke about how to give bad news to patients and their families.

February 18, 2005 - Rosemary Agostini, MD of the Virginia Mason Sports Medicine clinic discussed the "female athlete triad." This a trap some young women athletes fall into, in which weight loss can progress to an eating disorder, or to loss of menstrual flow, and both of these predispose to bone loss. Such women are more prone to osteoporotic fractures and even to weakening of the skeleton which can be lifelong. Sometimes these symptoms are not due to the athletics, but to polycystic ovary syndrome or hypothyroidism. Dr Agostini gave concrete and useful recommendations. Read more at http://www.aafp.org/afp/20000601/3357.html .

February 17, 2005 - David Pisetsky, MD, chief of the Division of Rheumatology and Immunology at Duke University spoke at the University of Washington about newer ideas about the cause and treatment of systemic lupus erythematosis.

January 28, 2005 - Oneil Bains, MD of the Virginia-Mason Clinic spoke about sleep disorders in children. Normal children sleep much more than adults; at age 5 children need up to 12 hours of sleep per 24 hours. Unfortunately, many children today obtain much less sleep, on average two hours less. Many children with bed-wetting, unusual weight gain, behavior or attention-deficit disorder suffer from undiagnosed sleep problems. Children can have sleep apnea with even more subtle symptoms than adults, and benefit from tonsillectomy about 75% of the time.

January 21, 2005 - Ted Gibbons, MD of the Virginia-Mason Clinic spoke about methods we use to predict heart disease. Because only two-thirds of people survive their first heart attack, we prefer to prevent that first one if we can. Risk factors include waist size, weight, detailed cholesterol profile, blood sugar, smoking and exercise status, blood pressure, family history, C-reactive protein, homocysteine, fibrinogen, and kidney function. We have been offering all these tests for several years.

January 14, 2005 - A physician at Virginia-Mason Clinic reviewed the use of hyperbaric oxygen. Using a pressure chamber, physicians can increase the levels of oxygen far higher than ever seen in nature. They can treat serious limb-threatening infections, help with success of limb grafts, treat smoke injuries and carbon monoxide poisoning, treat diving injuries, osteomyelitis and other conditions.