COOK
FOR YOUR DNA
My
good friend Gordon with his wife recently visited La Habana, my current home.
We had known each other since our days as Junior Doctors at Repat Hospital in
Melbourne, which we recollect as the golden days of our training for the real
life Medicine. Gordon has gone on to become to practice the art of medicine,
taking into consideration, the aspirations and abilities of the people to whom
he ministers, successfully I may say, watching the outcome of patients.
One
thing we both shared from the beginning was our dislike for rules and
regulations in the practice of medicine imposed by professors and peons of the
industry, with their illogical algorithms and constructed numbers as gate keepers
for treatment. Many years later, many of these algorithms, evidence based treatments
belly flop and the professors move on to other computer generated models, we
plod on, dealing with every day people, in my case, the poor of the United
States, the marginalized Native People of that continent.
We
had long discussions about health of the society in general, and I was able to
share with him some new information from Israel about nutrition and microbiome
and level headed dietary advice in the midst of the jungle of experts in all
sorts of fields. Australia did take a lead in defining Glycemic Index by
defining the increase in blood sugar of a thousand different edibles that one
comes across on a daily basis, but they forgot one important aspect: The
Patient. In our lifetime, the demography of Australia had changed and as the
Israeli research shows, a slice of bread may result in blood sugar excursions
which is not consistent from person to person and that without knowing the
microbiome of the person, it is hard to give nutritional advice. During his
years of practice to a stable population in a Melbourne suburb, Gordon had made
many discoveries which in the future may be scientifically proven but certainly
intuitive and in tune with the explanatory models of the patients.
He
had always been like this. I remember many years ago his attempts to get the
management of Qantas, the national airlines of Australia, at that time an
International player in aviation, to give passages to doctors on their long haul
flights to Europe, but turned down. I had been called many times by the flight
attendants to look at people who do not well traveling and should not be
traveling in cramped conditions in the economy class but could offer some
comfort and alleviate the suffering. I couldn’t help but chuckle when I read
that ANA the popular airline of Japan with a wide outreach to other continents
has introduced a concept of ANA doctor on board and would allow qualified
practitioners to register as ANA doctor on board while traveling, to be called
upon in case of need.
Gordon
is a man ahead of his time when it comes to health care delivery to his
patients, because he is unbound from conventions of Australian medical systems
and the egoistic, self-fulfilling, and often unnecessary arrogant attitudes of
the doctors at the Consultant levels. I am a GP, he would announce proudly.
While
talking about the laboratory abnormalities with no current evident explanations
among the American Indians (such as high alkaline phosphatase which is an
enzyme in the liver, bone and guts; lower to non-measurable levels of CPK, an
enzyme in the muscle), Gordon talked about Melanoma in Australia, a very
prevalent cancer among its population, coming in at number 4. But Australians of
darker skin colour are spared of this high prevalence and Australians of Asian ancestry
tend to have a lower incidence. Darker skin does protect us from the UV radiation,
associated with the Melanoma formation. Discussing these matters, accompanied
by the excellent Mojito at the roof top bar facing the ocean in La Habana, I
told him of a study done in Cuba where genetic mapping was able to point out
the racial admixture from the past, to such a degree that most people who
looked white had some black or Amerindian ancestry and most people who looked
black had a fair bit of European genetic presence.
Right
now, we treat patients as if they are a number and that studies done on people
who are different from them in looks, socioeconomic status and race, are doled
out as if we expect to get good results from it. The failure of modern medicine
in USA or Europe or Australia to control chronic diseases to any great degree
or prevent diseases and its complications over the years show that one medicine
does not fit all and that we need to individualize our treatment, taking into
consideration the explanatory model of the patient, the socioeconomic status
and the current and future expectations of the patient and in fact a patient
oriented rather than a disease oriented medical care.
We
could reel off diseases which affected people of pure European or mixed European
ancestry much more than Africans or Asians, such as Type 1 Diabetes, many of
the autoimmune disorders and the higher than normal prevalence of metabolic
diseases and mortality from Diabetes and Cardiovascular diseases from
immigrants from South Asian region or origin. Malaysians or Cambodians don’t too
well in Australia the statistics say, of course it does matter whether you are
a Chinese Cambodian or a Khmer Cambodian!
On
top of it all is the widely accepted, and slowly recognized metabolic
explanation that Diabetes and Cardiovascular and cerebrovascular and
degenerative diseases are inflammatory in nature and that the microbiomes may
have a causative role in them.
So
we could easily put out a pamphlet and jovially dedicate to our fun times at
Repat Hospital... The Repat doctors medicine for your DNA... We laughed out
loud to the amazement of the usually ebullient Cubans present at the roof top
bar as the sun was setting over the US embassy into the sea...
If you wish we can
give you a couple of articles to show you how relevant was our laughter laden
conversations were in La Habana, the moveable feast of a city. (The first
article was published after our conversation in La Habana took place)
Here is one about
Asian Americans, first of all, they are a heterogeneous group. For example,
migrants to Australia from South India are racially different from those from
the North. In South East Asia, the Chinese are the healthiest (perhaps also the
wealthiest, which may have something to do with it). People who have undergone
trauma, such as the Khmer under Khmer Rouge have epigenetic changes that give
rise to illnesses.
The
Burden of Cancer in Asian Americans: A Report of National Mortality Trends by
Asian Ethnicity
Caroline A. Thompson, Scarlett Lin Gomez, Katherine
G. Hastings, Kristopher Kapphahn, Peter Yu, Salma Shariff-Marco, Ami
S. Bhatt, Heather A. Wakelee, Manali I. Patel, Mark R. Cullen and Latha
P. Palaniappan
DOI: 10.1158/1055-9965.EPI-16-0167 Published October 2016
Abstract
Background: Asian Americans (AA) are the fastest growing U.S.
population, and when properly distinguished by their ethnic origins, exhibit
substantial heterogeneity in socioeconomic status, health behaviors, and health
outcomes. Cancer is the second leading cause of death in the United States, yet
trends and current patterns in the mortality burden of cancer among AA ethnic
groups have not been documented.
Methods: We report age-adjusted rates, standardized mortality ratios,
and modeled trends in cancer-related mortality in the following AA ethnicities:
Asian Indians, Chinese, Filipinos, Japanese, Koreans, and Vietnamese, from 2003
to 2011, with non-Hispanic whites (NHW) as the reference population.
Results: For most cancer sites, AAs had lower cancer mortality than
NHWs; however, mortality patterns were heterogeneous across AA ethnicities.
Stomach and liver cancer mortality was very high, particularly among Chinese, Koreans,
and Vietnamese, for whom these two cancer types combined accounted for 15% to
25% of cancer deaths, but less than 5% of cancer deaths in NHWs. In AA women,
lung cancer was a leading cause of death, but (unlike males and NHW females)
rates did not decline over the study period.
Conclusions: Ethnicity-specific analyses are critical to understanding
the national burden of cancer among the heterogeneous AA population.
Impact: Our findings
highlight the need for disaggregated reporting of cancer statistics in AAs and
warrant consideration of tailored screening programs for liver and gastric
cancers. Cancer Epidemiol Biomarkers Prev; 25(10); 1371–82. ©2016 AACR.
One could sense that
Gordon is a genuinely caring practitioner of our art of medicine. He has all
the qualities which has been catalogued for the “hard working doctors” who may
have forgotten the human elements while caring for the diseased. (Pun intended)
Published in Cardiology
December 2015
FRIDAY, Dec. 11, 2015 (HealthDay News) -- Seven behaviors should
be implemented to improve the art of medicine, which can help improve
relationships with patients, according to an article published in Family
Practice Management.
Thomas R. Egnew, Ed.D. from the University of Washington School
of Medicine in Seattle, reviewed the literature and delineated seven behaviors
that promote more consistent practice of the interpersonal aspects of medicine.
Egnew describes seven behaviors that include focusing
on the patient, ideally taking a moment to prepare before entering the office,
and establishing a connection with the patient, preferably before opening the
electronic medical record in the first few minutes of the consultation. Other
tips include assessing the patient's response to illness and suffering, use of
communication to foster healing, use of the power of touch, use of humor and
laughter, and showing empathy.
Anyone who knows Gordon will readily admit that he possesses those
qualities in good measure!
