Medicine for People!

June 2003

Contents

• Healthcare Privacy - Your Civil Rights at Stake
• Natural Menopause
• What's New in Medicine?

Healthcare Privacy - Your Civil Rights at Stake

Have you read your health insurer's privacy policy? You may be surprised by what you find there.

The Health Insurance Portability and Accountability Act (HIPAA), passed by Congress in 1996, is supposed to protect your medical privacy. However, disturbing new rules were recently instated to make electronic transfer of medical information easier. For previous coverage of the rules see our August 2002 Newsletter.

With these new rules in place, Kitsap Physician Service's privacy policy states it may give your personal health information to the Department of Health and Human Services or to law enforcement officials. Each time information is shared, there is greater opportunity for a leak in the net. Unfortunately, databases are compromised with some frequency. (For an example of such compromise see HIPAAdvisory News.)

What does that mean to you as patient? Say for example you are a woman who tells her doctor she has a family history of breast cancer. Perhaps this information finds its way onto an insurance company database. Later, if you want to switch jobs or insurance companies, you could have trouble getting reinsured. Say you have an STD and work in the church office. Could that innocent line on a form (HIV test - $36) come to your employer's notice? Say you are gay and your employer is a homophobe. Could your personal health information jeopardize your job?

Perhaps you think that your right to sue protects you from such potential abuses. Think again. The new legislation denies you the right to sue. Instead the government "may' assess a penalty on the offending health care provider or other organization.

What can you do to protect your privacy? Delete portions of any "privacy agreement" you don't agree with. If there is something you don't want in your records, don't tell your doctor. Or, tell him or her what kind of information it is and ask if you can give it without it getting into your medical record. See our privacy policy.

Natural Menopause

Following last summer's big study showing that hormone replacement therapy increases the risk of breast cancer, thousands of menopausal women stopped taking hormones cold turkey. Perhaps their combined hot flashes account for last summer's searing heat wave!

Now that we are all more aware of the potential side effects of HRT (hormone replacement therapy), many women are looking for other answers. Unfortunately, there is no one all-purpose pill you can take for hot flashes, night sweats, vaginal dryness, bone loss, loss of libido and other concerns of the menopausal transition. Each woman is different. Some sail through menopause; others suffer symptoms for years. The good news is there are several approaches to ease the symptoms and increase vitality and enjoyment of life.

Black Cohosh
Many of our patients find black cohosh (Cimifuga racemosa) banishes or at least reduces hot flashes. Phytopharmica's brand Remifemin was the first very effective brand of black cohosh, so popular in fact that it was bought by the pharmaceutical giant GlaxoSmithKline and marketed worldwide. Another good brand is Vitanica, produced by Tori Hudson, ND, an outstanding naturopathic women's health specialist. If hot flashes disturb you, and you haven't tried black cohosh, buy a good brand and try it. Most of the time, that will be all you need.

Vitamin E
Some women find relief from hot flashes by taking vitamin E at a dose of 1200 to 1500 units daily. Most vitamin E capsules are d-alpha-tocopherol, which is bioavailable and potent. We believe mixed tocopherols, which contain alpha-, delta-, and gamma-tocopherol are safer, especially in higher doses, because they more accurately mimic the vitamin E we obtain from our food. Too much alpha-tocopherol in supplement form may crowd out the delta- and gamma- forms, leading to as yet undetected problems.

Soy Products
Soy products may help reduce hot flashes. Perhaps you have also heard that soy products can be harmful. Researchers have discovered substances in soy products called phytates that can chelate minerals and lead to deficiency. These phytates are not all bad; they also have an anti-cancer effect. Since all the facts are not yet in, here's what we suggest: take your soy the way people do in Asia. They consume fermented soy products such as tempeh and miso. The process of fermentation reduces the phytate concentration. Evidence is developing that fermented soy products reduce the risk of heart and blood vessel disease as well. (Tofu, by the way, is not a fermented soy product. It is not toxic either - moderation is the key.)

Bone loss
If you are concerned about osteoporosis, discuss preventive measures with your health care provider. Estrogen has been shown to prevent bone loss, but natural treatments such as vitamin D and ipriflavone are also available. Ipriflavone is synthesized from a flavonoid in soy called daidzein. Most studies show that it increases bone strength in women with osteoporosis. The Journal of the AMA published a study in which ipriflavone did not appear to increase bone strength, and also lowered white blood cell counts (reversibly) in some women. My experience is that some women respond to ipriflavone, some don't. We've not seen the white blood cell count decrease.

Libido
If your libido is down, you may benefit from male hormone replacement. See our Website for more info.

Vaginal Dryness
If you have vaginal dryness, you may want to try a prescription vaginal hormone cream.

Natural Hormones
Finally, remember that last summer's study reported on horse estrogen and synthetic progesterone. For years we have been among those who believed that natural forms of these hormones are safer, and we have a great deal of experience with natural hormone replacement therapy. If nothing else works, I think it is safer to take a hormone and get some sleep. Comfortable sleep restores your health. Nighttime sleep keeps you awake at the wheel of your car during the day.

There are ways to assess a woman's individual risk from estrogen, and we can give you several methods to lower these risks.

Remember, whatever decision you make, you can change it later as you and your physiology evolve.

For an overview of hormone replacement and related issues see our Website. When the latest big study on hormone replacement came out, we updated our information in our July 2002 Newsletter. For a similar view, with some references, check out American Association for Health Freedom

What's New in Medicine
Ever watch a three-ring circus? Hard to keep track of what was going on in all three rings, yes? Medicine is like that. Right now, I have the newest pharmacology text open on my dining room table, a pile of medical journals in my study room, and a list of upcoming conferences on my schedule. If you want to see what medical courses I've been attending and what I think about them, check our Website.

Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington. Edited by Carolyn Latteier.

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