Petroglyphs and Paleo: Inspiration for Essential Beginnings

Honestly, my opinion about nutritional supplements has evolved dramatically. Historically, the value of prenatal vitamins for women is well recognized and uncontested. For example, calcium keeps mom’s bones healthy as developing fetuses borrow mom’s calcium for their own bones. And iron prevents the anemia of pregnancy. Folic acid clearly prevents neural disorders and birth defects in children. No doubt, prenatal vitamins for women make sense.

Do Vitamins Treat Cancer?

However, with heart disease or cancer, the story is quite different. In 1998, the government set out to test herbal and other alternative health remedies to find the ones that work for cancer and other diseases. After spending $2.5 billion, the disappointing answer was that none of them help prevent or treat these diseases. As noted here several years ago, vitamins got an “F” for cancer. To top this off, newer data from just last month suggests that excess vitamins supplements may actually lead to an earlier death. Now what’s a guy to do?

Do Vitamins Help Men Conceive?

Thankfully, what is more encouraging is the value of antioxidant supplements for male infertility. In 2011, An august research group in England published a Cochrane Review that analyzed 34 studies of 3876 infertile couples using assisted reproduction to conceive. The meta-analysis found that the partners of men taking antioxidant supplements were 4-fold more likely to get pregnant and 4-fold more likely to give birth than couples in which the male partner was not taking supplements.

The Idea of a Male Prenatal Vitamin

This study changed my worldview to the following:

1. A large chunk of male infertility (maybe half) is due to what’s called “oxidative stress.”
2. Antioxidants are a good defense against oxidative stress.
3. The best antioxidants are found in the diet, and the Paleo diet appears to be the best.
4. Most men have terrible, antioxidant-poor, diets
5. If men ate more fruits and vegetables, maybe fertility would improve.
6. Barring this, men should view antioxidant supplements as prenatal vitamins.

The Essential Beginning

Motivated by this epiphany, I and several trusted colleagues, including fertility physicians and nutritionists, set forth to create a male prenatal supplement that would be better than eating airport food for fertility. We wanted it to be made in California and support the local economy, be certified-organic, and to reflect the latest findings in antioxidant research. It would contain vitamins, minerals and organics with high bioavailability, instead of just putting stuff on a label without regard to whether or not it is absorbed well by the body, like most other supplements. We wanted it to be available online, to avoid the middleman markup, and to be reasonably priced.

After a year of pretty intense work, it has arrived. It is called XY (your chromosomes, get it?). And not only that, we continued our research and developed an entire fertility product line for women all the way from pre-conception through breast-feeding with XX (women’s prenatal), Z (pregnant prenatal) and Z+ (post-natal and breast feeding).

Do all men need a male prenatal? Probably not, because as I said, nothing replaces a healthy antioxidant diet. But if you are like most of us, creatures of habit eating airport food and busting our chops to put food on the table daily, it is to you that I dedicate Essential Beginnings, XY.

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2. The Ins and Outs of Male Fertility Kits
3. A Year Without Answers II
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A humanizing force: The book in my white coat

“Doctor, could you speak to me in plain English, please?!”

I rarely hear this in my men’s health practice. It’s likely because I am aware that Medspeak, or the language of medicine, is a second tongue, and a very foreign one to boot.

The Language of Medicine

There are 750 muscles, 206 bones, 428 named nerves and 60,000 miles of named and unnamed arteries and veins in the adult human body. Add to this all known body organs and physiological and molecular pathways and it becomes clear that the first two years of medical school involves learning 20,000 new vocabulary words, the equivalent of an entirely new language. Suddenly, sweating becomes diaphoresis, vomiting becomes emesis and red becomes erythematous. Throw in normal physiology and disease states in the second two years of medical school, and you have another 20,000 word vocabulary lesson. For some reason, patients now ambulate, visualize, articulate and masticate when the rest of us walk, see, talk and chew. That’s two whole languages to be learned in 4 years.

The Beauty of Medspeak

The vocabulary of medicine can be elegant, efficient and sound oh-so beautiful with all those Latin words. There is something poetic and mellifluous about the word “vestigial” which is a leftover structure with no current function, like the appendix. Another example: I recently hurt my thumb after my 7-year old daughter’s ace tetherball serve. Presenting my black and blue thumb to my favorite orthopedic surgeon, he said: “A minor bruise to your flexor pollicis longus and brevis muscles.” Just sort of rolls off your tongue. Felt better already.

The Vagaries of Medspeak

But Medspeak can also dehumanize. In the field of men’s health, I hear the words “idiopathic epididymitis” all the time. That’s eleven syllables of Medspeak in just 2 words. Sounds impressive but what does it really mean? How’s this: “unexplained scrotal pain that is not due to cancer or other badness.” When put in front of another word, “essential” also means unexplained. Admittedly, Medspeak can make even the vague and unknown sound official.

When commenting on written Medspeak, the late author-doctor Michael Crichton wrote: “I don’t agree… that medical writing is inept. I argue that it is actually a highly skilled, calculated attempt to confuse the reader.” Agreed. When used excessively or carelessly, it is dehumanizing and can change the moment and direction of a patient’s life.

While I was a resident at the University of Pennsylvania years ago, a college friend who trained with me gave me a small book of poems to carry around. I opened it during those rare, quiet moments that can happen while on call. The book was by William Carlos Williams, a noted doctor-poet. Dr. Williams fully understood the two edged sword of Medspeak when he noted: “It is not what you say that matters but the manner in which you say it; there lies the secret of the ages.”

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Diet like you emptied your piggy bank as a kid…

“You tell me I need to lose weight. How do I do it, Doc?”
“My dear patient, it’s simple: treat your body like a bank account, but one that you should empty. Put less in and take more out.”

Obesity in America

You’ve heard the rumors; here are the facts: The United States is one of the most obese nations in the world, with 31% of Americans currently overweight. Not only that, obesity rates have tripled in the past 3 decades. The most disturbing statistic about all of this is that obese children are leading the way.

The Best Recipe for Weight Loss

Believe it or not, Americans are very motivated to lose weight. In fact, they spend $42 billion annually on weight loss foods, products, and services. Any Joe can name a half a dozen diet plans that populate the American psyche: Atkins, Pritiken, Ornish, Zone, South Beach, Jenny Craig and Weight Watchers to name a few. But do they really work?

A great study was published recently in one of medicine’s most prestigious journals that showed that no particular diet plan works better than any other to help you lose weight. In a Harvard study, 811 overweight adults were assigned to one of four diet programs that each varied carbohydrate, fat and protein content. After two years, each group had lost — and regained — about the same amount of weight regardless of the diet. I say regained because a few months off of the diet, most returned to their usual eating habits. So, despite the different diets, the same results were achieved. Conclusion: popular diet plans are largely ineffective.

Calorie and food group restricted diets are complex, stressful and lead to disappointment when goals aren’t met. Not only that, the math gets too complicated and it makes meals stressful instead of enjoyable. There must be a better way.

Five Easy Ways to Empty Your Bank Account

Give this approach a try. Knowing that the cause of obesity is relatively simple in that weight gain occurs when caloric intake exceeds caloric expenditure, try treating your body like a bank account that you want to empty and keep empty:

1. Eat less but keep it simple. Eat what you like, but first cut out snacks between meals. Then cut out dessert after dinner a couple of times a week. Then cut down on the size of one meal each day. A great way to put less into the bank account.

2. Eat food that requires work. It takes time to consume celery or an apple and requires chewing. The more you chew, the more you decrease hunger.

3. Replace energy drinks with water. Energy drinks have way too many unfilling calories.

4. Although you exercise for your heart, and you at to lose weight, exercise is a great way to help empty the bank account. Go for a 20-minute walk after lunch.

5. Get more sleep: Poor or too little sleep impairs hormones (ghrelin and leptin) that regulate hunger (gherlin) and satisfaction (leptin). Less sleep means less satisfaction with food and more uncontrolled hunger. Try to sleep 30 minutes more nightly than you do now.

I explained this recipe for weight control to a banker one day in the office and he listened intently. He then went home, made a series of small changes in his diet and lifestyle as suggested here. Being the typical number-oriented male that he is, he brought a plot of his weight over the next 4 months to show me. He had lost 30 pounds; about 1-2 pounds a week, and felt great. No fancy diet plan. Just plain ol’ economics: buy low and sell high.

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Blueberries: the #1 antioxidant fruit.

Once in a great moon, something comes around that changes the way you think about things. Galileo’s dismissal of the earth-centered universe, the invention of electricity and the desktop computer are but a few of these. Upon reading a recent meta-analysis of antioxidant supplements for male infertility, did my world-view change? Not really. But I did take notice.

What is a Meta-analysis?

A meta-analysis is a 100 year old statistical term used to describe a certain way of combining evidence that, when viewed separately, is relatively unconvincing. Meta-analyses seek to more powerfully estimate an effect or outcome than might be possible from a bunch of smaller studies, especially if there are differences in their design and execution. A big problem with meta-analyses is that their quality depends on the data that they analyze, and garbage in means garbage out. Not to bore you further, but this type of analysis has become very trendy in medicine lately as a way to figure out where truth rests at the moment on a particular subject.

Antioxidants and Male Infertility

Antioxidants have been the rage in the literature for years as cancer preventing and anti aging agents. In more recent studies in which placebo (sugar pill) controls were used, however, they haven’t looked so sharp. Like with cancer or aging, oxidants are thought to be a fundamental cause of male infertility as they clearly damage DNA, reduce sperm motility and otherwise render sperm dysfunctional. And these effects cannot be good for male fertility. In fact, many think that as much as half of male infertility is due to oxidative stress. But the role of antioxidants such as the water-soluble vitamins A, C and E, metals such as selenium and zine, and the natural antioxidants found in blueberries (anthocyanins), tomatoes (lycopene), other fruits, vegetables, nuts and tea (theaflavins) have not been found to reliably improve sperm quality or male fertility in small studies. Hence, in comes the meta-analysis to the rescue.

The Antioxidant Meta-analysis

This Cochrane review analyzed 34 randomized, controlled trials (2876 couples) in which male partners of infertile couples were given antioxidant supplements (or placebo) while their partners underwent assisted reproduction (no all natural conceptions here). Any type or dose of antioxidant was included and pregnancy and sperm outcomes tracked. In general, the studies that were reviewed weren’t stellar stuff, but the meta-analysis showed a 4 fold higher rate of live births among antioxidant users (based on 3 studies and 20 births). There was also a 4 fold higher rate of conceptions in the antioxidant group (15 studies, 96 pregnancies total). Finally, the meta-analysis suggested that there were significant improvements in both sperm concentration (from 7 studies) and motility (from 10 studies) with antioxidants, although this was much weaker than the pregnancy data.

The Turek Clinic World View of Antioxidants and Male Infertility

My belief in antioxidant supplements for male fertility comes from simple reasoning:

1. Oxidants hurt cells.
2. Sperm are cells.
3. Antioxidants can protect cells from the oxidant-induced damage.
4. Antioxidants can therefore help decrease oxidative damage to sperm.

Along with the following observations, there comes a conclusion:

1. Probably the best antioxidants are found in the diet
2. Most men have terrible, antioxidant-poor diets
3. If men ate more fruits and vegetables, maybe fertility would improve
4. Barring this change in diet, men should view antioxidant supplements similar to the way women view “prenatal” vitamins, and take them.

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Freed from the confines of the solitary.

He called me from rural northern California and the phone conversation went something like this:

“Er… hello. I…I was wondering if you could help me.”
“Sure, sir, how can I help you?”
“Well…I’m single and haven’t dated in 20 years, but would really like to.”
“I’m not so sure that I am the one to ask on matters like that!”
(Laughs nervously) “I just haven’t had the nerve to date anyone.”
“If you are worried about your erections, I can certainly help with that.”
“No…no…it’s more that I’m worried that they will find out…” (goes quiet)
“Find out what, if I may ask?”
“Well, that I only have one ball left” said the Solitary Man.

And so it goes. A man is his mid-40’s diagnosed with testicular cancer in his 20’s and cured by removal of his right testicle. And now, after leading a solitary life for 25 years, he wants his sex life back. Surely, losing a testicle wouldn’t affect a man that much.

An unusual story? Not at all. In 1996, I led the study team that investigated the safety of using a newly designed testicular implant in boys and men who had never had, or had lost, a testicle. At this time, the FDA required extensive safety data on all new implants because of the cancer scare associated with leaking breast implants in the past. That same scare led to the pulling of all kinds of implants off the market, including a tried and true testis implant that had a perfect track record. Several years later, collaborating with 14 university medical centers nationwide, I published the research that showed that the new testis implant was entirely safe and it became the first (and still only) FDA-approved implant to replace this organ.

Proving that it was safe is only half the story though. It was also effective, very effective. What does that mean? For the study, we had men complete validated psychological questionnaires, termed “instruments,” that addressed confidence, self-esteem and body image before and after implant placement. We asked questions that no one had ever asked these men before. And what we learned was impressive: Men felt better about themselves, were more confident, and felt whole again. And these gains translated into real changes in their lives, both socially and professionally.

I recently placed the testicle implant that I had designed and studied into The Solitary Man. I put it right where his original testicle was before it was removed and placed it in less than an hour. He went home the same day and I saw him again 3 weeks after the procedure.

If it weren’t for the Pendelton wool shirt and boot jeans, I might not have recognized him; he was a changed man. He had a grin from ear to ear, a deep sparkle in his eye and a new bounce in his step. I asked him how he was doing and he responded, almost wet eyed: “I’m dating again.” Miracle? No. Magic? Yes.

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JFK supported teaching us to fish to eat for a lifetime

What’s 4000 years old and still alive and kicking? Traditional Chinese medicine. It’s a form of complimentary or alternative medicine that should be better integrated into our modern medicine healthcare toolbox in the future to keep America’s reproductive age men healthy.

Why do I say this? Because I like to face facts. Currently, alternative medicine is used by about 48% of the U.S. population in general and by about 30% of male infertility patients. That means that just as many men are using alternative medicine than Western medicine.

Why is complimentary medicine gaining traction in America? For a variety of reasons, not the least of which is because of a perceived dissatisfaction with the doctor-patient relationship. It simply takes too long to see a doctor. And when the visit actually materializes, it lasts about as long as a cat on a hot tin roof. To me, this is a quiet but strong statement about how Western medicine is simply not meeting the needs of modern men.

Complimentary and alternative medicine includes acupuncture, homeopathy, massage, aromatherapy, reflexology and herbal medicine as well as combinations of these employed in traditional Chinese medicine. Although their approaches may differ, alternative medicine is generally perceived as having natural effectiveness, being safe and non-invasive, and addressing the holistic and spiritual dimensions of healing and treatment.  Most importantly for men, it is philosophically “patient-centered” rather than provider-centered which leads to a more positive patient-practitioner relationship.

Understanding men as men (and not women or children) is a key first step in drawing them back into an enabling and therapeutic healthcare experience. It involves playing to their strengths and not their weaknesses. You know, the old empowerment idea. As trite as the old Chinese proverb is, complimentary and alternative medicine, unlike most of Western medicine, provides a better opportunity to teach men how to fish so that they can eat for a lifetime rather than give them fish so that they can eat for a day. It’s the much-needed secret sauce to men’s health.

True, traditional Chinese medicine and most other forms of alternative medicine lack the spirit of scientific inquiry, being based almost entirely on anecdotes and stories rather than controlled experiments. But scientific medicine has generally ignored the powerful mind-body interaction so crucial for true health wellness. So, although the language of each approach is different, they really share the same goals. With this belief, I have taken the steps that I can to help this integration happen on a national level.

Men are looking for more than what Western medicine offers—the facts are clear. We in healthcare need to respond to this need and offer a taste of the secret sauce during those precious few moments when men ask for more.

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How many of these are chasing you?

Whenever I mention to the media that “stress” is bad for male fertility and men’s health in general, they show images of snarling, bumper-to-bumper traffic with heat shimmering off of the asphalt. Sure, that works for stress. But that is not the half of it.

Being stuck in traffic is a form of acute stress, similar to being told that your check bounced, you missed your deadline, or you’re late for that important business meeting for which you planned so hard. Going back 100,000 years, this is same stress associated with being chased by a rogue wooly mammoth. Either way, modern or ancient, the human body responds the same way: by stimulating adrenaline and activating the sympathetic (“fight or flight”) nervous system. Blood is directed to where it is needed most—the heart and muscles–and not to the penis. And the result is loss of sex drive, erections, and lower testosterone levels. Not a great state of affairs for general or sexual health. This response also explains why so many men who are fine with recreational sex hit the skids performance-wise during “scheduled sex” needed for baby making.

More worrisome than the effect of acute stress on health is that of long term or chronic stress. Although more subtle than acute stress, it is far more pervasive in our lives. Do you travel 50,000 air miles or more annually across time zones? Do you change shifts at work? Travel stress and changing work hours (circadian stress) are forms of chronic stress. Do you worry about your finances (financial stress) or workout too much (physical stress)? Is there someone seriously ill in the family or is your love life tanking (emotional stress)? Remember, your body is a very primitive organism and responds the same way to all forms of stress, with the “fight or flight” reaction, ready to run from the wooly mammoth.

So what are the consequences of chronic stress? Well, for both sexes, sex is the first casualty. Intimacy is a close second. Stress hormones lower testosterone production and, as a consequence, sex drive falls. Testosterone is also an important vitamin for mood, muscle mass, male fertility, kidney and bone function and these can also suffer. And must I mention one of the best-studied areas of stress: that of Type A personalities having the shortest “shelf life” on this earth? Is this you? Take the test and find out.

Even more novel is the latest news that humans (like animals) have “clock genes” that control daily, sleep-wake or circadian rhythms. And when these rhythms are upset, as with stress, cancer development is promoted.

My advice: Assess how many wooly mammoths are chasing you, even the small ones. Then, begin a regimen of stress reduction using regular exercise, acupuncture, yoga or massage to get that body of yours tired and relaxed.  In the words of Lily Tomlin “For fast-acting relief, try slowing down.”

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Spoon bending power to heal.

Can prayer heal? Does touch matter in medicine? Long considered a nonrational part of Western medicine, these “lighter side” topics are now receiving close attention and study.

I am reminded about distant healing on the anniversary of the death of a medical school classmate and friend Dr. Elisabeth Targ. As a psychiatrist, daughter of a parapsychologist and niece of chess champion Bobby Fischer, she was not only bright, but also a bit paranormal herself. As a child, she played hide-and-seek with friends and would attempt to use clairvoyance to find them. She was also expected to call out her Christmas presents before opening them. As a trained scientist, she performed some of the best studies showing the effect of prayer or “distant healing” on extending the survival of AIDS and breast cancer patients.

In her study of how prayer can heal, Dr. Targ used scientific methods to determine whether “intention” from others 1500 miles away could help treat medical ills. In small studies of AIDS patients before current treatments were developed, she showed that they could live longer and spend less time in the hospital with distant healing. Her papers are in no way definitive and are highly criticized, but to date remain the best and most scientific attempts the world has seen in the last 150 years to define the potential of faith to heal.

What made Elisabeth Targ a unique force in her field is that she refused to speculate about how or why distant healing works. She had a simple goal: to define the existence (or not) of the effect. Her boyfriend, Mark Comings, however is more daring in this regard. A theoretical physicist, he suggested that if we actually live in an eight-dimensional universe instead of the accepted three dimensions, then we might be more interconnected than we currently understand, and this could explain how a healer in Santa Fe could influence a patient in San Francisco. Sadly, Elisabeth died at age 41 years of a brain tumor. Ironically, it was the same kind of tumor that she was studying with distant healing treatment.

What about the role of touch in medicine? Clearly, patients who visit doctors for terrifyingly short visits feel that the visit is incomplete without a physical exam. The doctor’s visit is just not the same as that with your accountant, lawyer or financial advisor. The laying on of hands is a special part of the medical relationship and has been for millennia. In fact, there is good science to show that the physical exam is not as good at disease detection as a good patient history. What needs more study is what makes touch so special, almost medicinal, in the doctor’s office. Can it cure disease? I wish that my friend Dr. Targ were around for this one. She might be able to help us decide whether, in the words of Diane Ackerman: “touch seems to be as essential as sunlight.” My view as a men’s health specialist is that if it has the potential to heal, then use it, regardless of whether we understand why or how it works.

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A man looking for his mojo.

Do you know why Sigmund Freud, esteemed psychoanalyst, had a vasectomy when he was 67 years old? How about William Butler Yeats, the famed writer, having his vasectomy at 69 years of age. Were they that sexually active and worried about conceiving? God bless them if this is true!

Hardly. Believe it or not, vasectomies were done in the roaring twenties and thirties in Austria by an endocrinologist named Steinach for physical and mental rejuvenation. “It revived my creative power,” wrote Yeats in 1937. This may be true as Yeats wrote a crop of poems during this period that rank with his best work. At that time, a vasectomy was considered the “holy grail” of perpetual youth. Steinach felt that by blocking sperm flow, male hormone production in the testis would improve.

The idea of hormonal rejuvenation really started in earnest with an acclaimed endocrinologist named Brown-Sequard who in 1889 injected himself with testicular extracts from rats and dogs. This led to the trend of “organotherapy” in which all sorts of animal organs were injected for every conceivable human illness. Sound familiar at all? It also led to serious and productive experimental research on the function of glands in the body.

The rejuvenating vasectomy was not an isolated claim to fame by Eugen Steinach from Vienna. He was nominated for a Nobel Prize six times for innovative studies that showed that male or female development depended almost entirely on the sex glands and their secretions. Give this theory a pinch of salt to incorporate modern genetics and is it true enough today.

What went wrong with Steinbach’s vasectomy idea was that he believed that narrow biologic principles could be used to treat the wide and complex condition of human sexuality. The funny thing is, almost 100 years later, we are still trying to figure out how to stay young forever.

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It doesn't get any better than this!

Legend has it that surfing began in the Hawaiian Islands hundreds of years ago. In the late 1800’s, it was introduced to the U.S. mainland by way of southern California. Duke Kahanamoku, an Olympic star in swimming from Hawaii, helped popularize the sport by traveling internationally and demonstrating his surfing style. He is credited with surfing the longest wave ever in 1917, at a break called Outside Castles in Waikiki. The 1000 meter long wave that he surfed is a record that has yet to be broken.

Surfing became known in the Santa Cruz area, at the northern edge of Monterey Bay, began in the early 1930’s, 30 years before the epic surfing movie “Endless Summer” was released. Even today, Santa Cruz is known throughout the world as a mecca for peeling point breaks, and is certainly one of the best surf spots in California.

I love surfing Santa Cruz waters. To me, it is really the pinnacle of pristine California coastal beaches, a place where you can still hear the driving surf guitar of Dick Dale and feel the relaxed atmosphere of surf living. Pelicans, sea otters and often dolphins join you as you play in the water. Just magic.

I surfed Pleasure Point this weekend with an old friend on two windless days. Warm, waist- to head-high surf launched from a southern swell beginning in New Zealand and entering Monterey bay in perfectly peeling corduroy sets. Poetry.

In my other life as a surgeon, a craft like many others, I have learned to appreciate and enjoy the smallest details in life. For details matter in surgery, let this be clear. But they are not the ends, only the means, to a much larger whole that they constitute. Witness the healing and restoration of patients after complex microsurgery.

Surfing is also rich with details. The size, pitch and break of the swell, the aura of the murmuring ocean and breaking tide. The contour, rail, and rocker of the hand shaped board, and the trim of the body on board as it silently cuts through water.  Like surgery, surfing reaches an almost spiritual realm not only through the sensations conveyed by innumerable associated details, but also through the sublime and intoxicating feeling that, at least for a moment, one is in control of life.

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Synthetic cells: true science or fashion vinyl?

Believe it or not, science has now claimed to have made “synthetic life.” Life created from non-living substances. J Craig Venter and colleagues, after a decade of work, produced a man-made version of the entire DNA content (genome) of a bacteria (adding in a couple of harmless “watermarks” to track it) and inserted it into the shell of another bacteria after removing its DNA. And, lo and behold, the artificial genome starting making proteins and the man-made bacteria began to replicate.

You may remember Craig Venter as the man in corporate biotech a decade back who challenged the U.S. government in a race to completely encode the entire human genome. The Human Genome Project was completed in 2003 and jointly announced. This is a beautiful thing but Venter wanted to “own” and patent the human genome and charge others for using it as a resource whereas the U.S. government insisted that it be made publicly available, which it is.

Is this really synthetic life? No. Essentially, Venter performed the equivalent of gutting a computer and then entirely reprogramming it. Is this an important scientific achievement? Absolutely, a tour de force, since technology has been limiting this work for years. Recently, however, there has been a 100-fold increase in the length of genetic material that can be manufactured from raw chemicals in the lab. Without a doubt, science has been dreaming about this kind of work for three decades and recombinant DNA technology is an early product of this movement.

So, an entirely “artificial cell” was not produced by Venter, as the control station was man-made, but the rest of the cell was not. My only hope is that this is not just another “pleather” (plastic and leather) product in our lives. As Lily Tomlin said: “[even] vinyl leopard skin is becoming an endangered synthetic.” On the contrary, this work may have advance science sufficiently to begin the manufacture of designer cells, good or bad, that can clean up oil spills, dynamite and waste water, dispose of nuclear waste and deliver antibiotics, chemotherapy, testosterone or Viagra to hard to reach but important areas of the body.

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Can we be DNA barcoded like a soup can in a grocery store?

How many of you would take a blood test to learn exactly how long you will live? How about whether or not you will become demented? Since the Human Genome Project ended, the genes and mutations associated with a vast array of diseases are being discovered daily and it is pretty easy to just put them on “chip” and make them available to the public.

Don’t get me wrong; gene testing already has already improved our lives. Such tests can clarify a diagnosis and better direct care, while others allow families to avoid having children with life-threatening or disabling conditions. They can be used to prevent disease before it happens, as with monitoring and removal of colon growths among those who have a gene for familial polyposis, and can diagnose common iron-storage diseases early enough to treat them and prevent them from becoming fatal. They can also help to positively identify murderers two decades after the crime.

One real problem is that many commercialized gene tests are targeted to healthy people who might be at high risk because of a strong family medical history for a disorder. Unfortunately, because of how complex we are as biological organisms, the tests give only a “probability” for developing the disorder. That means that some people who carry a mutation may never develop the disease. Another limitation is the possibility of laboratory errors. What this means is that the tests are not perfect and could be wrong.

And what happens to your job prospects and health (or life) insurance rates when it is learned through genetic testing that you might develop a significant disease? Well…nothing. Because of the federal GINA Law (Genetic Information Nondiscrimination Act) passed in May 2008, insurance companies and employers cannot discriminate on the basis of information derived from genetic tests. So, genetics has now been added to the list of characteristics first embodied by the Civil Rights Act of 1964, that states that U.S. employers cannot discriminate according to race, color, national origin, sex, or religion. And this is good.

So, go ahead and take the “23 and Me” “DeCode” or “Navigenics” genomic screens if you so desire. Get to know your DNA barcode. Maybe you will get an idea of what may be around the corner for you. And maybe, just maybe, you will take better care of yourself knowing more about your genes. Just understand that many in the medical community feel that uncertainties surrounding test results, the current lack of available treatment options, the tests’ potential for provoking anxiety and social stigmatization could outweigh the benefits of testing. You know the saying: “Too much information…”

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Miles and Microsurgery: it doesn't get any better.

For as long we have pounded drums and plucked strings, listening to music has affected people’s sense of well-being, lifting and consoling their spirits, inducing calm and tranquility, or the trance of dance. I have listened to the sounds of classical jazz during microsurgery operations throughout my professional career as a surgeon. Coltrane, Miles, Evans, Djavan, Caetano Veloso and all the greats sweetly waft in the operating suite and overcome the din of devices within the room. Does music in the operating room lead to less wasted and more fluid surgical motion, and therefore faster procedures and better patient outcomes? Who knows. But as the background makes the painting, the music may make the maestro.

A recent study suggests that listening to music in surgery may also benefit patients. Maybe this is why oral surgeons and dentists offer earphones and video glasses to their patients. Anything is better than listening to the whine of the drill during a root canal. The effect of music on cortical, limbic or higher brain centers has previously been studied in patients undergoing brain surgery. These centers control feeling, thoughts and memory. In this recent research, a neurosurgeon studied the effect of different kinds of music on deeper portions of the brain, located in the thalamus. This region is responsible for sensation, motor function, consciousness, sleep and alertness. This study of music and Parkinson’s patients is quite different from what Oliver Sacks describes in his book Musicophilia, in which music therapy is used to increase the mobility and responsiveness of Parkinson’s patients.

According to this new study in awake patients undergoing surgery for Parkinson disease, music slowed the neuronal firings deep within the brain. As a consequence, patients became physically more relaxed, calm and even slept during their surgery. And pure melodic music appeared to be the most soothing to most patients.

So music in the operating room may make more sense than we think. In addition to helping the surgeon with his surgery, it may reduce patient anxiety. This in turn, could shorten operative times, reduce the need for anesthetic medication, and lead to quicker patient recovery and shorter hospital stays. In a word, more music, less pills.

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Amber waves of grain, the stuff of our Neolithic ancestors

At some point as we evolved, well after the Neolithic period, we started thinking that there must be a better way to get nutrients, something faster and more efficient, than through the food we have eaten for tens of thousands of years. Our fantasy of the future was encapsulated with TV shows like The Jetsons and Star Trek, where roast chickens and earl grey tea were produced by the touch of a button. Nowadays, grocery stores offer fruit smoothies, breakfast bars, energy drinks and microwave pizzas, so we can fuel up quickly and efficiently. Why sit down when you can eat while running? We take vitamins with the idea that we can rectify any potential deficiencies and even prevent illness, with the swallow of a pill. How simple, how easy, how efficient.

As a society, we are in love with “nutriceutical” supplements. About half of all adults take a multivitamin everyday and it is estimated that $75 billion worldwide is spent annually on nutriceuticals. And nonvitamin and nonmineral natural product use is so prevalent in the U.S. (40% of Americans) that the National Institutes of Health has even commissioned a new branch devoted entirely to the pursuit of complementary and alternative medicine research. This effort will undoubtedly unleash the true potential of alternative medicine. But let’s drill down on vitamins for a minute. What does the evidence really show? Well, it appears that taking vitamin supplements may not as beneficial as previously thought. Several major studies have now shown that vitamin supplements do little to prevent cancer and heart disease, while other studies report that vitamins and antioxidant supplements may actually increase cancer rates. One study concluded that folic acid supplements actually increased rates of precancerous colon polyps, and another study linked beta-carotene to higher lung cancer rates. Are vitamins then, failing us as supplements?

No one discounts the necessity of vitamins for our body’s function. Indeed, many diseases are associated with a deficiency in one or another vitamin. But we do place rather high expectations on vitamins. It’s rather narrow-minded of us to tout only a few particular nutrients in food and assign them letters of the alphabet, when many others may be just as essential to our primitive bodies, yet are unfamiliar to us intellectually. Vitamins do not exist in a void, but are part of a complex mixture of substances called food that is the real stuff of life. If anything, the fact that vitamins are getting an F in cancer prevention suggests that the way that they are absorbed in a pill is not the same as the way we extract them from whole foods that we eat.

My patients frequently ask me what supplements they should take to enhance their sexual health or fertility. The truth is that because sexual health is so thoroughly intertwined with overall health, I emphasize a whole-body approach. I don’t recommend a specific course of supplements, but antioxidants may have some value. If they wish to take a supplement, they may, but the important thing is that they get all nutrients necessary for their bodies to function optimally. The real solution to this is a well-balanced diet low in fat and sugar, emphasizing whole grains, fruits, and vegetables. That said, I do realize how resistant many people can be to changing their diet. If a patient feels they must take a supplement to compensate for poor eating habits, I steer them towards whole food supplements that contain a larger and more complex spectrum of nutrients than that found in traditional multivitamins. In all honesty however, I firmly believe in carrots from the earth and apples from trees, just like our Neolithic ancestors did.

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