Monthly Archives: May 2015

Great Women in Medicine Rachel Carson

This is an important article which everyone interested in health should read.

Great Women in Medicine Rachel Carson

Rachel Carson SIlent SpringGreat Women in Medicine Rachel Carson

by Jeffrey Dach MD

Although Rachel Carson was a marine biologist, I believe she deserves recognition as one of the “Great Women In Medicine” .  I will explain why.

Her landmark book, “Silent Spring”, is credited with motivating the government to create the Environmental Protection Agency in 1970 and the banning of DDT in 1972, both of which had enormous health benefits for the population.  (1)(2)(3)(4)(5)(28)

Left Image: Rachel Carson Courtesy of Wikimedia Commons

The title “Silent Spring”, refers to the mass extermination of the bird population from indiscriminate spraying of DDT over the fields.  The songbirds died from eating DDT laden insects.

Rachel Carson died from breast cancer in 1964 and was posthumously awarded the Presidential Medal of Freedom by Jimmy Carter in 1980. The Post Office in Rachel Carson’s home town, Springdale, Pennsylvania, was named in her honor on May 27, 2008.

Silent Spring CoverThe History of DDT and the Chemical Industry

The post-war era of the nineteen forties and fifties saw massive expansion of manufacture and sale of chemical pesticides such as DDT.   These chemical agents were considered safe, and DDT was indiscriminately sprayed from passing trucks and planes onto agricultural fields and residential areas.

Above Left Image Silent Spring,Book Cover by Rachel Carson, 1962.

At the same time, there was hysteria arising from the polio epidemic, and the media falsely spread the misguided notion that using DDT to kill insects somehow prevented the spread of polio.  DDT can not prevent polio.  See this 1946 newsreel documenting the misguided spraying of DDT in San Antonio Texas ordered by Heath Dept. director Mr.Crittenden, May, 1946 in an ill-fated attempt to wipe out polio. Many other cities joined in, like Rockford, Illinois, and Paterson, New Jersey.

The Power of the Mass Media

The mass media and government in league with the chemical industry lulled the complacent population into a sheep-like acceptance of these poisons.   See video below:

Fighting the Chemical Industry

Rachel Carson bravely took on the entire Chemical Industry who fought back by hiring their own “experts”, goons with scientific credentials, to attack her work.  The attacks back fired, providing even more media attention to her work and the health dangers of pesticides.

Magnified Effects Moving Up the Food Chain

Silent Spring Noisy SummerRachel Carson brought to public attention the fact that pesticides sprayed on our food supply move right up the food chain to us humans where they build up in the tissues of the body causing hormonal disruption, toxic effects on the nervous system and increased cancer risk.(28)

One should notice that the chemical structure of DDT is very similar to DES (Diethylstilbestrol), a synthetic estrogen which was banned because it causes cervical cancer in the daughters of women given DES during pregnancy. (11) (12) (12a) (13)

DDT was banned in 1972, and DES was banned in 1971. The Silent Spring Institute continues the legacy of Rachel Carson, and has focused on chemicals in the environment which cause breast cancer as hormonal disruptors and neurotoxins. (14)


Above Image: Activist and author Rachel Carson, whose book “Silent Spring” led to a study of pesticides, testifies before a Senate Government Operations Subcommittee in Washington, D.C. on June 4, 1963. Carson urged Congress to curb the sale of chemical pesticides and aerial spraying. (AP Photo)

The Breast Cancer-Pesticide Link

In 2007,  178,480 women were diagnosed with breast cancer and 40,460 women died of breast cancer in the US. (6)(7)(8).  Considerable study has been devoted to proving a link between pesticides and breast cancer. Could there be such a link ? (31,32)

Pesticides Banned in Israel and Breast Cancer Rates Fall.

The answer is yes. The pesticide-breast cancer link was clearly shown in research from Israel which linked three pesticides found in dairy products to increased cancer in mice. After a public outcry in 1978, the Israeli government was forced to ban the three pesticides, Benzene Hexachloride, DDT, and Lindane .

After the banning of these pesticides in Israel, breast cancer mortality rates (which had increased every year for 25 years), dropped nearly 8 per cent for all age groups and dropped more than a thirty-three percent for women ages 25-34 in 1986. (9) (10)

Endocrine Disruptors

Thanks to efforts made by Rachel Carson, the Silent Spring Institute, and others, the EPA has banned the following endocrine disruptor chemicals: PCBs, chlordane, DDT, aldrin, dieldrin, endrin, heptachlor, kepone, toxaphene, and 2,4,5-T . (15)

Rachel Carson’s work reminds us to avoid these toxic chemicals and hormone disruptors. By doing so, we may reduce the risk of breast cancer, and neurodevelopmental abnormalities in children. (28)

Watch this inspiring video documentary on Rachel Carson:

Our Stolen Future

Other scientists such as Theo Colborn have continued Rachel Carson line of investigation with the book, Our Stolen Future,  which describes in detailed scientific terms the effect of endocrine disruptor chemicals on the developing fetus of animals in the wild as well as in us humans. (16) (17) (18)

One example from Theo Colborn’s book describes infertility caused by pesticides in Florida Alligators, attributed to DDT and other pesticides dumped into the Everglades and detected in the egg shells. (19) (20)

Endocrine Disruptor Chemical BPA Causes PCOS

A major cause of infertility is PCOS, Poly Cystic Ovary Syndrome.  PCOS has been linked to neonatal exposure to the endocrine disruptor chemical BPA (Bisphenol-A) causing the the increasing epidemic of PCOS affecting 10-20% of the female population. In experimental animals, neonatal exposure to BPA (Bisphenol-A) results in a PCOS-like syndrome.  In addition, there is elevated BPA levels in PCOS patients.  For more on this see my  article: PCOS, BPA and Endocrine Disruptors.

Ten Ways to Reduce Your Exposure to Chemicals and Decrease Cancer Risk (19)

1. Use glass containers instead of plastic containers.

2. Avoid dry cleaning services.  The smell of dry cleaning comes from residues of perchloroethylene (PERC).

3. Avoid Pthalates, endocrine disrupting compounds that have been associated with cancer, impaired fertility, and male birth defects. Pthalates are found in hundreds of products including shampoo, lotion, perfume, cosmetics, vinyl and plastics, including toys.

5. Go Organic to reduce your exposure to pesticides.

6. Down the Drain.  Never put cleaning solvents, pesticides, paint thinners, automobile oil, or gas down a drain.  These pollute the environment.

7. Vacuum cleaners?. Vacuums with HEPA filters are best to avoid recycling dust back into the air.

8. Flame Retardants ? Look for furniture without PBDEs. PBDEs  flame retardants in polyurethane foam They are endocrine disruptors that affect thyroid hormones.

9. Use organic gardening and lawn care.

10. City Hall.  Encourage your city or town to use  natural/non-toxic solvents in public buildings, schools, and organic practices for green spaces.

 Our Breast Cancer Prevention Program:

Iodine testing and supplementation is the cornerstone of our breast cancer prevention program as discussed in previous articles. (20)

In addition to Iodine, we also include I3C (Indole-3 carbinol) and DIM (Di-Indole Methane).  These are broccoli extracts available as nutritional supplements which have beneficial effects on estrogen metabolism. (21) (22) (23) (24) (25)

Without boring you with the biochemistry, suffice it to say that the the breakdown and elimination of estrogen by the liver is beneficially diverted towards the 16 hydroxy pathway to estriol and away from the 2 hydroxy pathway which requires a methylation reaction. The net result is a decrease in breast cancer risk with the use of DIM.

DDT and Malaria Eradication

Although DDT agricultural use was banned in 1972, its use against mosquito-born malaria disease was never banned and continues to present day in various third world countries. In 2006, the World Health Organization promoted indoor residential DDT  spraying for malaria control in epidemic and endemic areas.(33)  Malaria eradication by controlling the mosquito population is a high priority for society and has enormous health benefits.  DDT and other chemical agents have been enormously helpful.  This cannot be doubted.  However these chemical agents must be used with care to avoid human toxicity, and to prevent development of insect resistance through over-use.(33)


Rachel Carson deserves to be included in the list of “Great Women in Medicine”.   The medical profession is entrusted with guarding the health of the community.  When the time came to warn about indiscriminate spraying of DDT on agricultural and residential areas, where was the medical profession? They were nowhere to be found. They were silent and complicit in this great cover-up.   Instead, leading the battle was one small, frail woman who stood up against the powerful interests of the chemical industry.  That small voice of truth and reason was Rachel Carson.

Articles with Related Interest:

PCOS,BPA and Endocrine Disruptors

Is Your Baby Toxic from Environmental Pollution?

Risk Factors for Breast Cancer, Wrong Again

Breast Cancer Prevention with Iodine Supplementation Part One

Iodine Prevents and Treats Breast Cancer Part Two

Iodine Treats Breast Cancer, Overwhelming Evidence

How to work out how much food you should eat

2 February 2015, 3.13pm AEDT

Health Check: how to work out how much food you should eat

Dietary guidelines broadly recommend a daily intake of 10,000 kilojoules (2,400 calories) for men and 8,000 kilojoules (1,900 calories) for women. But what do these figures mean in the context of the number…

Daily kilojoule requirements are based on many variables, and no two people are the same across all of these parameters. Sarah Horrigan/Flickr, CC BY-NC

Dietary guidelines broadly recommend a daily intake of 10,000 kilojoules (2,400 calories) for men and 8,000 kilojoules (1,900 calories) for women. But what do these figures mean in the context of the number of kilojoules or calories you personally need to consume to attain and maintain a healthy body weight?

I’m going to stick with kilojoules in this article because kilojoules – not calories – are the metric unit for measuring energy, just as kilograms – not pounds – are the metric unit for measuring body weight.

Daily kilojoule requirements are based on many variables, and no two people are the same across all of these parameters. It makes sense then that if we all followed the same prescriptions for kilojoule intake, some of us would gain weight while others might lose some. That’s because any excess or deficit between the number of kilojoules you consume and the number your body uses results in weight gain or loss.

So how can you know what you need to maintain your energy balance? There are two options: the mathematical approach, which requires kilojoule counting, and the instinctive approach, which involves “listening” to your body (my personal preference).

Both approaches take some trial and error.

The mathematical approach

One way to estimate how many kilojoules you need is to use an online calculator that takes into account major factors regulating energy requirements. These include your sex, weight, age and activity levels. Some calculators also take height into account.

Such calculators are based on prediction equations that estimate true energy requirements – as measured in a laboratory – from readily available parameters.

Processed foods make it harder for the body’s automatic weight-management system to do its job. Michael Johnson/Flickr, CC BY

While some prediction equations may be slightly better than others, none of them can tell you exactly how many kilojoules you need to consume to maintain your weight. That’s because no prediction equation can take your genetic make-up, which may impact how fast or slow you churn through kilojoules, into account.

Nor can they account for things like whether you have more or less lean mass or fat on your body than the average adult. Or that you may have spent the last few months on a weight-reducing diet that has dropped the amount of energy you need to maintain your weight by a few thousand kilojoules per day.

Despite these limitations, once you have a ballpark figure of your energy requirements, you can roughly work out how much you need to eat and drink based on the kilojoule content of the foods and beverages you consume.

For this you will need a comprehensive kilojoule counter (I recommend CalorieKing, which has extensive data bases for Australia and the United States) and a way to track your food and beverage intake throughout the day (MyFitnessPal comes highly recommended). Numerous other programs and apps are available for both.

The instinctive approach

We also have the ability to maintain a healthy body weight without any regard for kilojoule counting; the human body is endowed with a remarkable system that enables us to attain and maintain an optimum weight instinctively.

Eating minimally processed food is best for using your body’s appetite signals to control weight. Ron Dauphin/Flickr, CC BY-NC

This system works by controlling your appetite. When your body needs more kilojoules, you may feel hungrier more often. And you may need to eat and drink a greater number of kilojoules in order to feel satisfied.

When your body needs fewer kilojoules, you may not feel hungry enough to eat all the meals and snacks you normally eat in a day. When you do eat, it may take much less than usual to satisfy your hunger.

Provided you heed your body’s appetite signals by eating when you are hungry – and only when you are hungry – and eating enough to feel satisfied but not too full, then you will be able to attain and maintain an optimum body weight.

Sounds simple, doesn’t it? It is when you eat a diet of foods that are close to the form they appear in nature – that is, food that’s minimally processed.

Processed foods, which have many added ingredients such as fat and sugar to make them palatable, make it harder for the body’s automatic weight-management system to do its job. That’s because diets high in fat, or high in fat and sugar, change the balance of natural chemicals in the brain that control this system.

Using trial and error to get there

If your clothes are getting tighter, then you’re consuming more kilojoules than your body needs. bark/Flickr, CC BY

Regardless of how you estimate the amount you need to eat, the current obesogenic environment prevailing in most countries, which pushes us to gain weight, means you will need to use some trial and error to determine exactly how much to eat.

If you are gaining weight, or you find your clothes are getting tighter, then you’re consuming more kilojoules than your body needs, period.

To prevent further weight gain, you need either to cut your energy intake or to increase the number of kilojoules you burn via physical activity – or both. Do this by becoming mindful of the kilojoule content of the foods and drinks you consume. Drinks are particularly important, especially alcohol, because they sneak into your day and may not be accounted for.

Or you need to keep a written hunger-and-satiety diary to ensure you’re eating only when hungry and only until you feel satisfied. And that your food choices are as close to natural as possible.

In today’s obesogenic world, attaining or maintaining a healthy body weight doesn’t just happen naturally for most people. It usually requires conscious attentiveness to how much and what you’re eating. The good news is that you can do this using external signals such as kilojoule counting, or via your body’s own internal signals.

If you live in the Sydney metropolitan area and would like to find out about participating in weight-management trials involving mathematical or instinctive approaches to eating, please e-mail or click here for more information

Synthetic Hormones Lose in Court.

I often get women telling me that when they visited their GP/specialist, she/he got very angry with them when told they were on BHRT. The Dr told them that BHRT is not FDA approved, is made up by unregistered compounding chemists with no proper controls, and that these hormones are dangerous and cause cancer and so on. Besides this being incorrect, I then have to spend considerable time explaining the evidence and research into BHRT. I would rather spend this time helping that person with their problems . I can understand the confusion patients suffer, when a doctor or specialist they like and trust tells them this – what are they to believe? I do my best with this web-site to give you a balanced view, and the information you need to be able to answer these attacks on BHRT. At the moment over 50% of all American women on menopausal hormones are using bioidentical HRT, in spite of the efforts of their doctors to dissuade them from doing so. (see my blog of last week). They can’t all be wrong. The article below further explains what is happening. Just by the way, while the pharmaceutical companies have been frequently sued over their flawed products which have harmed them, I cannot find anyone suing their doctors for using BHRT. Further, in direct comparison of synthetic HRT vs BHRT, every study has shown BHRT to be safer and leading to a better quality of life. In Australia “Prempro” goes under the name “Premia” and is a combination of Premarin and Provera, and variants of that name.

Synthetic Hormones Lose in Court

Court CaseSynthetic Hormones Lose in Court

Pfizer-Wyeth Loses Big Case

Prempro Causes Breast Cancer

112 Million in Punitive Damages

by Jeffrey Dach MD

A 112 million dollar punitive award is a very loud statement.  It states that the jury was outraged by the “wanton and reckless”conduct by Wyeth.  112 Million Dollars in punitive damages was awarded to two breast cancer victims who took Wyeth’s synthetic hormone, Prempro, all the while thinking it safe. The jury was outraged that Wyeth ignored and suppressed evidence that Prempro causes breast cancer.  Wyeth paid consultants and ghostwriters of medical journal articles to play down concerns about breast cancer, and declined to study known risks. Once again, company profit was placed ahead of patient safety. This is the tip of the iceberg, as another ten thousand cases are waiting for their day in court.

Women’s Health Initiative Bombshell

Years ago, a bombshell appeared in the medical literature, and massive numbers of women switched from Prempro to safer bio-identical hormones. This was the 2002 WHI study which showed that PremPro causes breast cancer. This massive shift away from synthetic Prempro reduced breast cancer rates by 10,000 fewer cases per year. (NEJM Volume 356:1670-1674 April 19, 2007 Number 16)

The American Public Hoodwinked

progesteroneLeft image : Natural Progesterone   

This Prempro court case teaches us an important lesson. When a “Bad Drug” like Prempro gets FDA approval and placed on the market, what happens?  The public is hoodwinked, and the drug company profits handsomely. The wheels of justice turn slowly.  After 65 years and thousands of victims, our court system has finally ended a bad drug, in this case, a synthetic hormone called Prempro.
MedroxyprogesteroneAltered PremPro

Left image show how to chemically alter a natural bioidentical hormone by adding  chemical groups. This is done in order to obtain a patent on the new chemical structure which protects profits for the drug company. This is a bad idea because any alteration of a hormone creates a MONSTER.  Left image medroxyprogesterone.

Another Important Lesson – Don’t Use Synthetic Hormones

Another important lesson from this case is that synthetic hormones like Prempro, which are chemically altered versions of human hormones, are all “Monster Hormones” which should never have been approved by the FDA in the first place. Any alteration in a chemical structure of a hormone creates a Monster, and in the case of Prempro, the result is increased cancer and heart disease.

Breast CancerChanged Chemical Structure Results in Monster Hormones

The drug companies changed the chemical structure of human hormones to obtain patent protection and maximize profits. Human bioidentical hormones cannot be patented because they are found naturally in the human body, therefore they are not profitable for the drug companies.  Left Image : Bright spot represents  breast cancer on PET mammogram combined imaging.

Just Another Round in the Medical Information War

Drug companies routinely use their influence to control information in the mainstream media and the medical journals. They downplay adverse side effects of their products in order to maximize profits. This is merely part of the Medical Information War played out in the media every day.

Bioidentical Hormones Are Safe and Effective

This case highlights another important lesson. While the chemically altered synthetic hormones like Prempro are dangerous, the original version from nature, called Bioidentical hormones are safe, effective and beneficial for health.

Addendum June 19 2012 from Bloomberg News:

June 19 (Bloomberg) by Jef Feeley — Pfizer Inc. has paid $896 million to resolve about 60 percent of the cases alleging its menopause drugs caused cancer in women.  Pfizer has now settled about 6,000 lawsuits that claim Prempro and other hormone-replacement drugs caused breast cancer, and it has set aside an additional $330 million to resolve the remaining 4,000 suits, according to a filing with the U.S. Securities and Exchange Commission.

The reserve means New York-based Pfizer has committed more than $1.2 billion to resolving claims that its Wyeth and Pharmacia & Upjohn units failed to properly warn women about the menopause drugs’ health risk. Based on the May 10 filing, the company is paying an average of about $150,000 a case.

New Attack on BioIdentical Hormones by Drug Industry

phyllis greenberger huffington postBioIdentical Hormones Attacked Again

Article in Huffington Post by SWHR.

Just when things have calmed down, the Drug Industry opens a new salvo in its war against bioidentical hormones, perceived as unfairly stealing market share from their flaghip hormone pill, Prempro, a synthetic chemical currently in litigation for causing cancer and heart disease.

This time the attack appeared in the Huffington Post, with anarticle by Phyllis Greenberger, CEO of Society for Women’s Health Research, an industry sponsored mouthpiece which funnels money from the drug industry to doctors for research grants, speaking engagements, meetings and even gala celebrations. Upper left image courtesy of Huffington Post, Phyllis Greenberger,and SWHR.

Psycho_Alfred Hitchcock_Vivian_LeighHot Flash and Cold Cash by Alicia Mundy

A 2003 expose by journalist Alicia Mundy in the Washington Monthly spills the beans on the Society for Women’s Health Research (SWHR).  Here is a quote from Alicia Mundy’s 2003 article:

We do know the companies that sit on the (SWHR) society’s 40-member “corporate advisory board,” created since Greenberger took over. They include Eli Lilly, Johnson & Johnson, Merck, Pfizer, and Wyeth–all of which market popular women’s drugs. 

Serving Your Corporate Master

Although I am grateful to Phyllis Grenberger for giving me a topic to write about, I must confess astonishment with such a twisted and distorted collection of untruths, and deception nonsense all in one place.    Apparently, having the drug industry as one’s corporate master requires regurgitation of old marketing propaganda, even if it doesn’t make any sense.  Even to the most casual observer, this Huffing Post piece is a blatant attempt to discredit bioidentical hormones using fallacies, innuendo, and misinformtion.  Much of this material was covered in my previous book, Bioidentical Hormones 101.

 Let’s Take A Look At the Huff Post Article

The author,  Phyllis Greenberger M.S.W.,  states, “Bioidentical Hormones are not FDA approved.”

This is blatantly incorrect. There are twenty or so FDA approved bioidentical hormone preparations widely available at corner drug stores. Here are a few examples: Vivelle-Dot, Estrace, Climara, Prometrium, Androgel, etc.

The author Phyllis Greenberger states: “Bioidentical Hormones made by compounding pharmacies are Non-FDA approved.

This is misleading and deceptive.  Compounding pharmacies are regulated at the state level, and do not fall under FDA jurisdiction. So, of course compounding is not FDA approved. No FDA approval is required or even desired. Your local hospital pharmacy is a compounding pharmacy that makes up life-saving medication such as IV antibiotics with no FDA oversight or approval. The FDA approval process is designed for manufacturer capsules and tablets, and is impractical and unnecessary for compounded medications prepared to order by hand. Are we going to reject IV antibiotics from the hospital pharmacy because these are non-FDA approved compounded medication? Of course not. Compounding is here to stay.

66 Cases of Endometrial Cancer on Prempro

The author, Phyllis Greenberger brings up a 2007 report of three cases of endometrial cancer in women on bioidentical hormones, implying that synthetic PremPro prevents endometrial cancer wheras biodentical hormones do not.  This is a blatant lie.  Prempro contains a synthetic progestin which reduces the incidence of endometrial cancer.  However, this is not reduced to zero. The author conveniently neglected to mention the 66 cases of endometrial cancer in Prempro treated reported in the Women’s Health Initiative Study.  Dr. Rowan T. Chlebowski reported on the WHI data after 13.2 years of follow-up.  He said there were 66 endometrial cancers among women given PremPro (premarin and medroxyprogesterone).  There were 95 cases of endometrial cancer in the placebo group.

A “Bad Drug”  in Litigation ?

One easy way to determine if you are dealing with a “bad drug” is to ask the question:  Is this drug in litigation ?  For Prempro and synthetic “FDA approved” women’s hormones, the answer is yes, Prempro has been in litigation for years now.  Pfizer, the company that bought Wyeth, has paid almost a billion dollars to settle 6,000 lawsuits by women who claimed the drug caused their breast cancer.  This information should have been included, yet was conveniently omitted from the Huffington Post article by Phyllis Greenberger.

Abandoning Synthetic Hormones

The Women’s Health Initiative (WHI) study was terminated early in 2002, because the data showed increased risk of breast cancer and heart disease in the synthetic hormone treated group given Prempro. This information prompted intelligent women to abandon synthetic hormones. Instead they switched to bioidentical hormones, same as estrogen and progesterone produced by the ovary.  The massive switch to bioidentical hormones produced an immediate decline in breast cancer rates of about nine per cent.(9,10)  Left image: Abandoning the Sinking Ship courtesy of wikimedia commons.

Wake up From the Synthetic Hormone Nightmare

It is time to awaken from the nightmare of synthetic hormones, known for decades to cause cancer and heart disease. The drug industry can spin, and deceive us with misinformation and propaganda, however, the truth is clearly seen. Synthetic hormones remain monsters that should be avoided. Sadly, nowhere in this Huffington Post article was this important message stated.

Is It OK To Eat Food That Fell On The Floor?

Is It OK To Eat Food That Fell On The Floor?
Published: 11/2/2014

The “five-second rule” – that it’s OK to eat what’s been dropped on the floor within five seconds – has been around a long time. It has been studied scientifically, testing different foods dropped on contaminated surfaces and left for five seconds. Surfaces ranged from ceramic tiles to wood floors and nylon carpeting, and foods included sticky candies known as “gummi bears,” bologna, bread and cookies (hardly foods you will find on my Anti-Inflammatory Food Pyramid). Regardless of food and surface type, all food that came in contact with contaminated floors quickly picked up the dirt and bacteria it landed on. Contaminants tended to favor the carpet more than the hard surfaces, and the longer the food was in contact, the more bacteria it picked up, which lends some credence to the five-second rule.

Odds are that you won’t get sick if you invoke the five-second rule, and exposure to ordinary dirt and germs may strengthen the immune system and reduce the risk chronic illnesses. Although, sometimes it takes just a few strains of certain infectious diseases to get sick, so you should use common sense with what fallen food you eat – avoid anything that fell on a hospital or sickroom floor, other surfaces likely to harbor really dangerous organisms such as uncooked meat juices, and any surface that is visibly dirty – it’s not worth it.

It’s your choice: how to plan for a better death

7 October 2014, 6.35am AEDT

It’s your choice: how to plan for a better death

Have you thought about how you would want to be treated if you cannot make your own decisions? You may be unconscious after car accident, you may be so ill you cannot communicate, or you may be dying and…

We all have the legal right to refuse health care. Warren Goldswain

Have you thought about how you would want to be treated if you cannot make your own decisions?

You may be unconscious after car accident, you may be so ill you cannot communicate, or you may be dying and cannot convey your wishes. Would you want to be kept alive on life support if there is no hope of recovery?

If you are 93 with advanced dementia, would you want to be resuscitated and die in intensive care on life support? Or would you rather be at home, in your own bed, with those who you care about nearby?

Thinking ahead about how we would like to be cared for if we can no longer make our own decisions is called advance care planning. It’s a simple idea, but one most of us find difficult to do.

Advance care planning is about having a conversation with those close to you so they understand your values. It’s important to record those wishes and decisions on a document so it can be referred to when you cannot make those decisions. It’s also important to decide who you would want to make your decisions when you cannot.

These documents are usually called advance care plans, or if they are legal documents they are called advance care directives.

An advance care directive is a formal document recognized under common law or under specific legislation, in which the person can record their preferences about their future care and/or appoint a substitute decision-maker, who will make the decisions guided by the person’s wishes.

(This does not usually include financial decisions which are covered by another legal document called an Enduring Power of Attorney.)

How do they work?

An advance care directive is written by you, the person, while you have the capacity to make decisions. It’s based on the ethical principle of autonomy and self-determination: you have the right to make the decisions about health care treatments in advance.

We all have the legal right to refuse health care. An advance care directive extends this right if we should lose the ability to make decisions.

These documents and/or the substitute decision-maker inform doctors and health professionals about the person’s wishes. Doctors can then decide on the most appropriate treatment based on what the person would have wanted. Doctors write the treatment decisions in a clinical care plan informed by the person’s advance care directive.

Doctors can’t treat patients without consent. TheTun/Shutterstock

Doctors cannot treat patients without consent, except in an emergency. This is both a legal and ethical principle.

But what if the patient cannot give consent and has not completed an advance care directive or had a conversation with those close to them?

A doctor then has to decide what is best for the individual and consult with family members who may be too distraught to help with difficult treatment decisions. The result may not be what that person would have wanted.

If a patient suddenly dies or deteriorates in hospital the automatic response is to start cardiopulmonary resuscitation (CPR) unless there is clear documentation not to resuscitate. There is now evidence that resuscitation is unlikely to be successful if the person is older, frail or is already dying, yet often patients are subject to this very invasive treatment without their consent.

Consider this scenario. Mrs Smith, aged 92, was in hospital dying of terminal cancer. When she stopped breathing, a “code blue” was called and the emergency team commenced CPR. This involved breaking her ribs. She was admitted to the intensive care unit, where after two days she was allowed to die.

If Mrs Smith had been consulted earlier or completed an advance care directive, she would not have been resuscitated but kept comfortable and cared for while she died.

So, who should make an advance care directive?

We all should have this conversation with those close to us. It is not only about end-of-life care, but anytime that we cannot make our own decisions. The conversation can include organ donation.

Advance care directives are particularly relevant as we get older. As Hal Swerissen and Stephen Duckett note in their report Dying Well, 70% of Australian want to die at home but only 14% do. The majority of people die in a hospital or an aged care facility where they are more likely to receive aggressive treatments aimed at keeping people alive.

However, young people can also suddenly become ill, or receive a traumatic brain injury, so it is something all adults should consider.

Different laws and terminology

The first advance care directive legislation, the Natural Death Act was passed in California in 1976 as a result of a young woman in a coma (persistent vegetative state) who was kept alive on the new life-support technology. The doctors decided she had no hope of recovery but refused to turn the machines off.

Her parents were extremely distressed to see their unresponsive daughter kept alive against, what they believed, would have been her wish. They took the case to court which decided to turn off life-support.

South Australia passed similar “living will” legislation in 1983 giving people the legal right to refuse unwanted treatment in advance.

The majority of Australians die in a hospital or an aged care facility. Tomasz Romski/Shutterstock

Now all Australian states and territories have laws and advance care directive documents. All the laws differ and the terminology lacks consistency. This creates confusion which can be a barrier for people wanting to complete an advance care directive.

However, the principles are the same. People have the right to refuse health care while they have capacity. They also have the right to refuse health care after they lose capacity by appointing a substitute decision-maker and/or recording their wishes in advance on the document appropriate for that jurisdiction.

In 2011, the Australian Health Ministers Advisory Council agreed to a national policy framework on advance care directives. This recommends consistent terminology and mutual recognition across state boundaries. In 2013 South Australia passed a new Advance Care Directives Act based on this framework.

Advance care directive documents in SA have now been simplified and include decisions about future health care, end-of-life care, living arrangements and other personal matters, as well as appoint one or more substitute decision makers. Making the process easier is a welcome move and the advance care directives legislation provides a model for other states and territories to follow.

Advance care directives are not about euthanasia nor about demanding treatment. They are about respecting your wishes when you are unable communicate.

Making decisions in advance is a very simple idea, but it is actually quite complex involving the law, medicine and human relationships. To create an advance care directive, you need to:

  1. have the conversation
  2. decide who you want as a decision-maker
  3. complete the relevant document
  4. give those close to you copies.

It’s a great investment for your future.

Also see : Plan your end of life on my website. And following posts:

Death and Dying.  May 20

Waking the dead? Some things you should know about dying. SEP 26

Heroic Measures. JUL 7

Bioidentical Hormones for Safety and Efficacy

This is an interesting article which clearly states the principles and facts behind the use of BHRT. I am still amazed how many doctors still using the synthetic hormones, and that all the specialists I know use synthetic HRT. This will change in the future, mark my words. Dr McWherter’s experience of breast cancer rates on BHRT mimics my own. I am surprised at how few breast cancers have occurred in women I have treated over the last 20 years.

Bioidentical Hormones for Safety and Efficacy. By Dr Jeffrey Dach

The use of synthetic female hormones will go   down in history as one of the worst failed medical experiments of all time.  The most widely prescribed estrogen called Premarin doesn’t come from humans.  It comes from pregnant horse urine.  The most widely prescribed synthetic progesterone called Provera is a chemical which is not normally found in the human body or anywhere else in the animal or plant kingdom.  After 30 years in medical practice, I have been astounded by the fact that our medical system uses these synthetic hormones.  However, if you consider the financial implications, this is not surprising. Current law prohibits patent protection for the manufacture of natural substances like human estrogen and human progesterone. However, the Synthetic versions can be patented and therefore profitable.

Bio-Identical Hormones:

Bio-Identical hormones are inexpensive and these are the ones found in the human body.  They are readily available from compounding pharmacies.   The medical literature confuses the definition of Synthetic and Bio-Identical Hormones and doesnt understand the difference.  That is why the large medical studies on hormones such as the Womens Health Initiative have used only synthetic hormones which have patent protection.  The WHI study was published in the July 2002 issue of JAMA.

The WHI study shows increased Cancer and Heart Disease from Synthetic Hormones:

The first arm of the WHI study was halted early because of increased breast cancer in the Synthetic Hormone group.  The culprit was found to be the Synthetic Progesterone, Provera, which also causes coronary vasospasm, heart disease and stroke.  A less well known study, published in JAMA 2004, was  the second arm of the WHI study, which used Horse Estrogen (Premarin) alone.  This study actually found less breast cancer in the Premarin treated group.  However, the oral estrogen pill was causing blood clots and strokes (similar to the birth control pills) and this study was also halted early. Out of 5,300 patients, there were 124 cases of breast cancer per year in the placebo group (dummy pill) and only 94 cases in the Premarin treated group.

A Clinical Study showing Safety of Bio-Identical Hormones:

The French Cohort Study showed no increased risk of breast cancer from Bio-identical hormones in 3,000 women.

Dr. Joseph F. McWherter conducted a clinical study involving 2,300 women on his Bio-Identical Hormone Program over a five year period.  He reports only one case of breast cancer under his care over five years.  Compare this to the 124 cases of breast cancer expected each year from the Womens Health Initiative study, and it is clear that Dr McWherters patients had a dramatic reduction in breast cancer.  This excellent result can be credited to the Breast Cancer Prevention Program outlined in his book.

Dr. McWherter’s Breast Cancer Prevention Program:

Dr. Joseph McWherter’s Program uses trans-dermal triple estrogen cream (Tri-Est) applied to the skin.  This avoids the blood clots and strokes found with the pill form.  He also uses bio-identical progesterone.  His breast cancer prevention program consists of a nutritional supplement containing a broccoli extract called DIM, CalciumD-Glucarate and Red Wine Extract, all of which influence estrogen metabolism beneficially.  Also included is an Iodine supplement (which reduces the incidence of breast cancer in many medical research studies), an Omega-3-fatty acid supplement (fish oil) and a high quality daily multivitamin/mineral supplement.  Regarding the vitamin supplement, Dr. McWherter gives high levels of folate (800 mcg) and high levels of vitamin D (combined with vitamin D blood testing to avoid toxicity).  The full program can be found in his book or web site.  By the way, the iodine supplement not only prevents breast cancer, it also completely reverses fibrocystic breast disease, a common painful breast condition.

Good sleep gets harder as we age, but mindfulness could help

I have come back to this theme of sleep 0ver 10 times in various blogs over the last 2 years. This is because it is so important for our good health and well-being. Without a good sleep we will not function as well as we should.
26 February 2015, 6.32am AEDT

Good sleep gets harder as we age, but mindfulness could help

By learning to become more aware of present-moment experiences, we learn not to react to thoughts and worries that can interfere with sleep.

Older adults have less deep sleep than younger people and it’s more easily interrupted. Image Point Fr/Shutterstock

Getting a good night’s sleep can be challenging, especially as we age. About half of all older adults report sleeping difficulties. This can make them more likely to experience physical or mental health conditions, memory problems, and falls, due to poor balance.

Older adults also have less deep sleep than younger people and their sleep is more easily interrupted.

As we age, our body clock or “circadian rhythms” change. We have a less consistent pattern of feeling sleepy and awake. We also feel sleepy earlier in the evenings and wake up earlier in the mornings.

Medical conditions commonly experienced in later life, and the medication used to treat, them can also interfere with sleep.

Treatments for sleeping difficulties include medication for short-term relief and psychological treatments such as cognitive behaviour therapy (CBT). CBT helps people to change unhelpful thoughts and behaviours that contribute to poor sleep.

While CBT is very effective for clinically diagnosed insomnia, not everyone with milder sleeping difficulties needs such an intensive treatment. For some people, sleep quality can be improved by learning relaxation to reduce physical tension and worry.

Another approach that is showing promise for improving sleep is to learn mindfulness.

What is mindfulness?

Mindfulness involves deliberately focusing on what we are experiencing, thinking or feeling in the present moment, without negatively judging our experiences. We can learn mindfulness by becoming more aware of where we are focusing our attention.

Mindfulness is the opposite to absentmindedness or being on “auto pilot”, like when you read a book and realise you haven’t paid attention to what was written on the last few pages because you were distracted by planning tomorrow’s activities.

Mindfulness involves focusing on your sensations in the present moment, and letting worrying thoughts pass by. Halfpoint/Shutterstock

Mindfulness also involves deliberately focusing on things we don’t normally pay much attention to. You may have experienced mindfulness when you’ve listened intently to a favourite piece of music and deliberately turned your attention to the sound of just one instrument.

How can mindfulness help sleep?

The findings of a recently published research study, led by David Black from the University of Southern California, suggest that practising mindfulness might be particularly helpful for improving sleep quality in adults aged 55 years or older with mild sleeping difficulties.

The mindfulness program involved taking part in six two-hour group classes and between five and 20 minutes a day of home practice.

The researchers found that adults who completed a structured mindfulness program showed greater improvements in sleep quality than adults who completed a program that taught them good “sleep hygiene” habits.

Counter-intuitively, the way that mindfulness may influence sleep is not directly through relaxation, because mindfulness is about waking the body up and becoming more aware. By learning to become more aware of present-moment experiences, we learn not to react to thoughts and worries that can interfere with sleep.

We still don’t know exactly how much and what type of mindfulness practice is needed before a person notices improvements to their sleep. But research suggests that regular practice activates the parts of the brain that help us experience our environment through our senses rather than through thoughts and worries.

Tips for practising mindfulness

Practise mindfulness regularly, in a quiet place where you won’t be interrupted. It’s best to learn mindfulness outside of the bedroom because to learn the skill, you first need to learn to pay more attention to your present-moment experiences rather than to go to sleep.

Tai chi is one way to practise mindfulness. Garry Knight/Flickr, CC BY

There are a number of ways to start to practising mindfulness:

  • Listen to a mindfulness meditation CD, MP4 audio or a mindfulness app
  • Take part in activities that encourage mindfulness, such as yoga, pilates, walking, tai chi or running
  • Undertake daily activities, such as cleaning your teeth or washing the dishes, in a mindful way by focusing on the experience of doing the activity
  • Enjoy the experience of eating in a mindful way by using all of your senses and keeping your attention on the food.

Try not to pressure yourself to get the hang of mindfulness straight away. The goal of mindfulness it to not judge your experiences. If you notice your attention straying you can gently bring your attention to what you are focusing on, such as your breath.


See Articles on my blogs :

How much sleep do we need?

How a bee sting saved my life: poison as medicine

© Victoria Jenkins

How a bee sting saved my life: poison as medicine

Ellie Lobel was ready to die. Then she was attacked by bees. Christie Wilcox hears how venom can be a saviour.

24 March 2015

“I moved to California to die.”

Ellie Lobel was 27 when she was bitten by a tick and contracted Lyme disease. And she was not yet 45 when she decided to give up fighting for survival.

Caused by corkscrew-shaped bacteria called Borrelia burgdorferi, which enter the body through the bite of a tick, Lyme disease is diagnosed in around 300,000 people every year in the United States. It kills almost none of these people, and is by and large curable – if caught in time. If doctors correctly identify the cause of the illness early on, antibiotics can wipe out the bacteria quickly before they spread through the heart, joints and nervous system.

But back in the spring of 1996, Ellie didn’t know to look for the characteristic bull’s-eye rash when she was bitten – she thought it was just a weird spider bite. Then came three months with flu-like symptoms and horrible pains that moved around the body. Ellie was a fit, active woman with three kids, but her body did not know how to handle this new invader. She was incapacitated. “It was all I could do to get my head up off the pillow,” Ellie remembers.

Her first doctor told her it was just a virus, and it would run its course. So did the next. As time wore on, Ellie went to doctor after doctor, each giving her a different diagnosis. Multiple sclerosis. Lupus. Rheumatoid arthritis. Fibromyalgia. None of them realised she was infected with Borrelia until more than a year after she contracted the disease – and by then, it was far too late. Lyme bacteria are exceptionally good at adapting, with some evidence that they may be capable of dodging both the immune system and the arsenal of antibiotics currently available. Borrelia are able to live all over the body, including the brain, leading to neurological symptoms. And even with antibiotic treatment, 10–20 per cent of patients don’t get better right away. There are testimonies of symptoms persisting – sometimes even resurfacing decades after the initial infection – though the exact cause of such post-treatment Lyme disease syndrome is a topic of debate among Lyme scientists.

“I just kept doing this treatment and that treatment,” says Ellie. Her condition was constantly worsening. She describes being stuck in bed or a wheelchair, not being able to think clearly, feeling like she’d lost her short-term memory and not feeling “smart” anymore. Ellie kept fighting, with every antibiotic, every pharmaceutical, every holistic treatment she could find. “With some things I would get better for a little while, and then I would just relapse right back into this horrible Lyme nightmare. And with every relapse it got worse.”

After fifteen years, she gave up.

“Nothing was working any more, and nobody had any answers for me,” she says. “Doctors couldn’t help me. I was spending all this cash and was going broke, and when I got my last test results back and all my counts were just horrible, I knew right then and there that this was the end.”

“I had outlived so many other people already,” she says, having lost friends from Lyme support groups, including some who just couldn’t take the suffering any more. “I didn’t care if I was going to see my next birthday. It’s just enough. I was ready to call it a life and be done with it.”

So she packed up everything and moved to California to die. And she almost did.

Less than a week after moving, Ellie was attacked by a swarm of Africanised bees.

Ellie was in California for three days before her attack. “I wanted to get some fresh air and feel the sun on my face and hear the birds sing. I knew that I was going to die in the next three months or four months. Just laying there in bed all crumpled up… It was kind of depressing.”

At this point, Ellie was struggling to stand on her own. She had a caregiver on hand to help her shuffle along the rural roads by her place in Wildomar, the place where she had chosen to die.

She was just standing near a broken wall and a tree when the first bee appeared, she remembers, “just hitting me in the head”. “All of a sudden – boom! – bees everywhere.”

Her caregiver ran. But Ellie couldn’t run – she couldn’t even walk. “They were in my hair, in my head, all I heard was this crazy buzzing in my ears. I thought: wow, this is it. I’m just going to die right here.”

Ellie, like 1–7 per cent of the world’s population, is severely allergic to bees. When she was two, a sting put her into anaphylaxis, a severe reaction of the body’s immune system that can include swelling, nausea and narrowing of the airways. She nearly died. She stopped breathing and had to be revived by defibrillation. Her mother drilled a fear of bees into her to ensure she never ended up in the same dire situation again. So when the bees descended, Ellie was sure that this was the end, a few months earlier than expected.

Bees – and some other species in the order Hymenoptera, such as ants and wasps – are armed with a potent sting that many of us are all too aware of. This is their venom, and it’s a mixture of many compounds. Perhaps the most important is a tiny 26-amino-acid peptide called melittin, which constitutes more than half of the venom of honey bees and is found in a number of other bees and wasps. This little compound is responsible for the burning pain associated with bee stings. It tricks our bodies into thinking that they are quite literally on fire.

When we experience high temperatures, our cells release inflammatory compounds that activate a special kind of channel, TRPV1, in sensory neurons. This ultimately causes the neurons to send a signal to the brain that we’re burning. Melittin subversively makes TRPV1 channels open by activating other enzymes that act just like those inflammatory compounds.

Jellyfish and other creatures also possess TRPV1-activating compounds in their venoms. The endpoint is the same: intense, burning pain.

“I could feel the first five or ten or fifteen but after that… All you hear is this overwhelming buzzing, and you feel them hitting your head, hitting your face, hitting your neck,” says Ellie.

“I just went limp. I put my hands up and covered my face because I didn’t want them stinging me in the eyes… The next thing I know, the bees are gone.”

When the bees finally dissipated, her caregiver tried to take her to the hospital, but Ellie refused to go. “This is God’s way of putting me out of my misery even sooner,” she told him. “I’m just going to accept this.”

“I locked myself in my room and told him to come collect the body tomorrow.”

But Ellie didn’t die. Not that day, and not three to four months later.

“I just can’t believe that was three years ago, and I just can’t believe where I am now,” she tells me. “I had all my blood work done. Everything. We tested everything. I’m so healthy.”

She believes the bees, and their venom, saved her life.


Venom 1

Venom 1

© Victoria Jenkins

The idea that the same venom toxins that cause harm may also be used to heal is not new. Bee venom has been used as a treatment in East Asia since at least the second century BCE. In Chinese traditional medicine, scorpion venom is recognised as a powerful medicine, used to treat everything from eczema to epilepsy. Mithradates VI of Pontus, a formidable enemy of Rome (and also an infamous toxinologist), was said to have been saved from a potentially fatal wound on the battlefield by using steppe viper venom to stop the bleeding.

“Over millions of years, these little chemical engineers have developed a diversity of molecules that target different parts of our nervous system,” says Ken Winkel, Director of the Australian Venom Research Unit at the University of Melbourne. “This idea of applying these potent nerve toxins to somehow interrupt a nervous disease has been there for a long time. But we haven’t known enough to safely and effectively do that.”

Despite the wealth of history, the practical application of venoms in modern therapeutics has been minimal. That is, until the past ten years or so, according to Glenn King at the University of Queensland in Brisbane, Australia. In 1997, when Ellie was bouncing around from doctor to doctor, King was teasing apart the components of the venom from the Australian funnel-web, a deadly spider. He’s now at the forefront of venom drug discovery.

King’s group was the first to put funnel-web venom through a separation method called high-performance liquid chromatography (HPLC), which can separate out different components in a mixture based on properties like size or charge. “I was just blown away,” he says. “This is an absolute pharmacological goldmine that nobody’s really looked at. Clearly hundreds and hundreds of different peptides.”

Over the course of the 20th century, suggested venom treatments for a range of diseases have appeared in scientific and medical literature. Venoms have been shown to fight cancer, kill bacteria, and even serve as potent painkillers – though many have only gone as far as animal tests. At the time of writing, just six had been approved by the US Food and Drug Administration for medical use (one other – Baltrodibin, adapted from the venom of the Lancehead snake – is not FDA approved, but is available outside the US for treatment of bleeding during operations).

The more we learn about the venoms that cause such awful damage, the more we realise, medically speaking, how useful they can be. Like the melittin in bee venom.

Melittin does not only cause pain. In the right doses, it punches holes in cells’ protective membranes, causing the cells to explode. At low doses, melittin associates with the membranes, activating lipid-cutting enzymes that mimic the inflammation caused by heat. But at higher concentrations, and under the right conditions, melittin molecules group together into rings creating large pores in membranes, weakening a cell’s protective barrier and causing the entire cell to swell and pop like a balloon.

Because of this, melittin is a potent antimicrobial, fighting off a variety of bacteria and fungi with ease. And scientists are hoping to capitalise on this action to fight diseases like HIV, cancer, arthritis and multiple sclerosis.

For example, researchers at the Washington University School of Medicine in St Louis, Missouri, have found that melittin can tear open HIV’s protective cell membrane without harming human cells. This envelope-busting method also stops the virus from having a chance to evolve resistance. “We are attacking an inherent physical property of HIV,” Joshua L Hood, the lead author of the study, said in a press statement. “Theoretically, there isn’t any way for the virus to adapt to that. The virus has to have a protective coat.” Initially envisioned as a prophylactic vaginal gel, the hope is that melittin-loaded nanoparticles could someday be injected into the bloodstream, clearing the infection.


Venom 2

Venom 2

© Victoria Jenkins

Ellie is the first to admit that her tale sounds a little tall. “If someone were to have come to me and say, ‘Hey, I’ll sting you with some bees, and you’ll get better’, I would have said, ‘Absolutely not! You’re crazy in your head!’” But she has no doubts now.

After the attack, Ellie watched the clock, waiting for anaphylaxis to set in, but it didn’t. Instead, three hours later, her body was racked with pains. A scientist by education before Lyme took its toll, Ellie thinks that these weren’t a part of an allergic response, but instead indicated a Jarisch–Herxheimer reaction – her body was being flooded with toxins from dying bacteria. The same kind of thing can happen when a person is cured from a bad case of syphilis. A theory is that certain bacterial species go down swinging, releasing nasty compounds that cause fever, rash and other symptoms.

For three days, she was in pain. Then, she wasn’t.

“I had been living in this… I call it a brown-out because it’s like you’re walking around in a half-coma all the time with the inflammation of your brain from the Lyme. My brain just came right out of that fog. I thought: I can actually think clearly for the first time in years.”

With a now-clear head, Ellie started wondering what had happened. So she did what anyone else would do: Google it. Disappointingly, her searches turned up very little. But she did find one small 1997 study by scientists at the Rocky Mountain Laboratories in Montana, who’d found that melittin killed Borrelia. Exposing cell cultures to purified melittin, they reported that the compound completely inhibited Borrelia growth. When they looked more closely, they saw that shortly after melittin was added, the bacteria were effectively paralysed, unable to move as their outer membranes were under attack. Soon after, those membranes began to fall apart, killing the bacteria.

Convinced by her experience and the limited research she found, Ellie decided to try apitherapy, the therapeutic use of materials derived from bees.

Her bees live in a “bee condo” in her apartment. She doesn’t raise them herself; instead, she mail orders, receiving a package once a week. To perform the apitherapy, she uses tweezers to grab a bee and press it gently where she wants to be stung. “Sometimes I have to tap them on the tush a little bit,” she says, “but they’re usually pretty willing to sting you.”

She started on a regimen of ten stings a day, three days a week: Monday, Wednesday, Friday. Three years and several thousand stings later, Ellie seems to have recovered miraculously. Slowly, she has reduced the number of stings and their frequency – just three stings in the past eight months, she tells me (and one of those she tried in response to swelling from a broken bone, rather than Lyme-related symptoms). She keeps the bees around just in case, but for the past year before I talked to her, she’d mostly done just fine without them.


Modern science has slowly begun to take apart venoms piece by piece to understand how they do the things they do, both terrible and tremendous. We now know that most venoms are complex cocktails of compounds, with dozens to hundreds of different proteins, peptides and other molecules to be found in every one. The cocktails vary between species and can even vary within them, by age, location or diet. Each compound has a different task that allows the venom to work with maximum efficiency – many parts moving together to immobilise, induce pain, or do whatever it is that the animal needs its venom for.

The fact that venoms are mixtures of specifically targeted toxins rather than single toxins is exactly what makes them such rich sources of potential drugs – that’s all a drug is, really, a compound that has a desired effect on our bodies. The more specific the drug’s action, the better, as that means fewer side-effects.

“It was in the 2000s that people started saying well, actually, [venoms] are really complex molecular libraries, and we should start screening them against specific therapeutic targets as a source of drugs,” says King.

Of the seven venom-derived pharmaceuticals on the international market, the most successful, captopril, was derived from a peptide found in the venom of the Brazilian viper (Bothrops jararaca). This venom has been known for centuries for its potent blood-thinning ability – one tribe are said to have coated their arrow tips in it to inflict maximum damage – and the drug has made its parent company more than a billion dollars and become a common treatment for hypertension.

Bryan Fry, a colleague of Glenn King’s at the University of Queensland and one of the world’s most prolific venom researchers, says the captopril family and its derivatives still command a market worth billions of dollars a year. Not bad for something developed in 1970s. “It’s not only been one of the top twenty drugs of all time,” he says, “it’s been one of the most persistent outside of maybe aspirin.”

And it’s not just captopril. Fry points to exenatide, a molecule found in the venom of a lizard, the gila monster, and the newest venom-derived pharmaceutical on the US market. Known by the brand name Byetta, this has the potential to treat type 2 diabetes, stimulating the body to release insulin and slow the overproduction of sugar, helping reverse the hormonal changes caused by the disease.

Rare cases like Ellie’s are a reminder of the potent potential of venoms. But turning folk knowledge into pharmaceuticals can be a long and arduous process. “It could take as long as ten years from the time you find it and patent it,” says King. “And for every one that you get through, ten fail.”


Venom 3

Venom 3

© Victoria Jenkins

Since the 1997 study, no one had looked further into bee venom as a potential cure for Lyme disease, until Ellie.

Ellie now runs a business selling bee-derived beauty products called BeeVinity, inspired after, she says, noticing how good her skin looked as she underwent apitherapy. “I thought, ‘Well, people aren’t going to want to get stung with bees just to look good.’”

Ellie has partnered with a bee farm that uses a special electrified glass plate to extract venom. As the bees walk across the plate on the way to and from their hive, harmless currents stimulate the bees to release venom from their abdomens, leaving teeny little droplets on the glass, which are later collected. Ellie says it takes 10,000 bees crossing that plate to get 1 gram of venom (other sources, such as the Food and Agriculture Organization of the UN, quote 1 million stings per gram of venom), but “those bees are not harmed”.

For her, it is more than just a way to make a living: it’s “an amazing blessing”. Proceeds from her creams and other products support bee preservation initiatives, as well as Lyme disease research. In addition, she sends some of the venom she purchases – which, due to the cost of the no-harm extraction method she uses, she says is “more expensive than gold” – to Eva Sapi, Associate Professor of Biology and Environmental Science at the University of New Haven, who studies Lyme disease.

Sapi’s research into the venom’s effects on Lyme bacteria is ongoing and as yet unpublished, though she told me the results from preliminary work done by one of her students look “very promising”. Borrelia bacteria can shift between different forms in the body, which is part of what makes them so hard to kill. Sapi has found that other antibiotics don’t actually kill the bacteria but just push them into another form that is more dormant. As soon as you stop the antibiotics, the Borrelia bounce back. Her lab is testing different bee venoms on all forms of the bacteria, and so far, the melittin venom seems effective.

The next step is to test whether melittin alone is responsible, or whether there are other important venom components. “We also want to see, using high-resolution images, what exactly happens when bee venom hits Borrelia,” Sapi told me.

She stresses that much more data is needed before any clinical use can be considered. “Before jumping into the human studies, I would like to see some animal studies,” she says. “It’s still a venom.” And they still don’t really know why the venom works for Ellie, not least because the exact cause of post-treatment Lyme disease symptoms remains unknown. “Is it effective for her because it’s killing Borrelia, or is it effective because it stimulates the immune system?” asks Sapi. It’s still a mystery.

There’s a long way to go for bee venom and melittin. And it takes a lot of work – and money – to turn a discovery into a safe, working medicine. But labs like King’s are starting to tap the pharmaceutical potential that lies in the full diversity of venomous species. And King, for one, believes that scientists are entering a new era of drug discovery.

In the past, venoms have been investigated because of their known effects on humans. Such investigations required both knowledge of the venom’s clinical effects and large volumes of venom, so until now only large species, like snakes, with easily extracted venoms have been studied in any depth. But that’s changing. Technological advances allow for more efficient venom extraction as well as new ways to study smaller amounts of venom. The preliminary tests for pharmaceuticals can now start with nothing more than a genetic sequence. “We can now genomically look at the toxins in these animals without having to actually even purify the venom,” says King, “and that changes everything.” Ken Winkel thinks venomous animals will be excellent drug resources for devastating neurological diseases, as so many of their venoms target our nervous system. “We really don’t have great drugs in this area,” he says, “and we have these little factories that have a plethora of compounds…”

No one knows exactly how many venomous species there are on this planet. There are venomous jellyfish, venomous snails, venomous insects, even venomous primates. With that, however, comes a race against time of our own making. Species are going extinct every year, and up to a third may go extinct from climate change alone.

“When people ask me what’s the best way to convince people to preserve nature, your weakest argument is to talk about how beautiful and wonderful it is,” says Bryan Fry. Instead, he says, we need to emphasise the untapped potential that these species represent. “It’s a resource, it’s money. So conservation through commercialisation is really the only sane approach.”

Ellie couldn’t agree more. “We need to do a lot more research on these venoms,” she tells me emphatically, “and really take a look at what’s in nature that’s going to help us.”

Vaginal estrogen for genitourinary syndrome of menopause: A systematic review

Vaginal problems are very common in menopausal women. Most suffer in silence unnecessarily. HRT helps, but sometimes a vaginal cream is needed. It helps the bladder as well, as a bonus. Read the evidence.

Vaginal estrogen for genitourinary syndrome of menopause: A systematic review
Obstetrics and Gynecology, 12/05/2014  Evidence Based Medicine  Review Article

Rahn DD, et al. – In this study, authors want to comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines. All commercially available vaginal estrogens effectively relieve common vulvovaginal atrophy–related complaints and have additional utility in patients with urinary urgency, frequency or nocturia, SUI and UUI, and recurrent UTIs. Nonhormonal moisturizers are a beneficial alternative for those with few or minor atrophy–related symptoms and in patients at risk for estrogen–related neoplasia.


  • MEDLINE and Cochrane databases were searched from inception to April 2013.
  • Authors included randomized controlled trials and prospective comparative studies.
  • Interventions and comparators included all commercially available vaginal estrogen products.
  • Placebo, no treatment, systemic estrogen (all routes), and nonhormonal moisturizers and lubricants were included as comparators.
  • Authors double–screened 1,805 s, identifying 44 eligible studies.
  • Discrepancies were adjudicated by a third reviewer.
  • Studies were individually and collectively assessed for methodologic quality and strength of evidence.


  • Studies were extracted for participant, intervention, comparator, and outcomes data, including patient–reported atrophy symptoms (eg, vaginal dryness, dyspareunia, dysuria, urgency, frequency, recurrent urinary tract infection (UTI), and urinary incontinence), objective signs of atrophy, urodynamic measures, endometrial effects, serum estradiol changes, and adverse events.
  • Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI).
  • Urinary tract infection rates decreased.
  • The various estrogen preparations had similar efficacy and safety; serum estradiol levels remained within postmenopausal norms for all except high–dose conjugated equine estrogen cream.
  • Endometrial hyperplasia and adenocarcinoma were extremely rare among those receiving vaginal estrogen.
  • Comparing vaginal estrogen with nonhormonal moisturizers, patients with two or more symptoms of vulvovaginal atrophy were substantially more improved using vaginal estrogens, but those with one or minor complaints had similar symptom resolution with either estrogen or nonhormonal moisturizer.

Krill oil marketing: a case study of Australia’s broken regulations

The evidence is very strong for the benefits of omega-3 in depression, arthritis (big doses – 9-12 gms/day) and probably heart. However, krill is much more expensive and no better – only marketed better. See the Australian Rheumatology web-site patient information sheet on Fish oil
6 February 2015, 6.37am AEDT

Krill oil marketing: a case study of Australia’s broken regulations

Two out of three Australians regularly use complementary medicines, which constitute a A$3.5 billion domestic market. But the industry’s marketing strategies are a source of ongoing controversy and pose…

Complementary medicines such as krill oil don’t always have the science to back up their claims. Jo Christian Oterhals/Flickr, CC BY-NC-ND

Two out of three Australians regularly use complementary medicines, which constitute a A$3.5 billion domestic market. But the industry’s marketing strategies are a source of ongoing controversy and pose a significant challenge for regulators.

Products containing krill oil provide a good example of the kinds of extravagant claims made by supplement manufacturers. The oil is derived from a tiny, shrimp-like crustacean and, like fish oil, contains omega-3 fatty acids.

Company claims include krill oil’s capacity to “relieve arthritic symptoms [of osteoarthritis and rheumatoid arthritis] within a short period of 7 to 14 days”, as well as its “superior absorption” and the curiously ambiguous “9x [strength]” of the less expensive fish oil. Such claims are found on product packs and manufacturers’ websites, as well as the websites of third-party stockists.

Few companies provide links to research supporting such claims. What research does exist is not easily accessible to most consumers, who, at any rate, can rarely assess its validity.

Claims and science

The widely used claim that krill oil relieves the symptoms of arthritis within seven to 14 days appears to be based on a small 2007 study. The research focused on one specific formulation of krill oil, produced by a Canadian company. Possible conflicts of interest, including the source of funding for the study, are notably absent from the paper.

The study recruited 90 people with a confirmed diagnosis of one or more of cardiovascular disease, rheumatoid arthritis (ten people) and osteoarthritis (30 people). They were compared to placebo groups of 12 and 26. Three patients pulled out of the trial before completion, and 12 didn’t have a diagnosis of either osteoarthritis or rheumatoid arthritis.

While some results at seven and 14 days were deemed statistically significant, the meager number of people involved raises questions about the clinical significance of its conclusions.

Snake oil for what ails you? Speedy fixes sound great, but don’t be taken in by claims on labels. Tim & Selena Middleton/Flickr, CC BY
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Regardless of this and other details of the report that suggest only people with very severe cases of illness were included, the findings of this early and isolated study can, at best, be considered preliminary. And a search of a comprehensive research database found no evidence that the results had been replicated independently.

The claim of krill oil having “superior absorption” is also dubious and not supported by research evidence. A 2014 review of krill oil absorption actually concluded there was no evidence for krill oil being more easily absorbed by the human body.

Regulatory challenges

Companies that market complementary medicines in Australia are legally required to comply with standards set by the Therapeutic Goods Administration (TGA). These standards relate to both the quality of the product and advertising claims.

But manufacturers self-certify their compliance with TGA requirements. Limited, as well as poorly targeted, post-market surveillance of complementary products means they can contravene standards without fear of reprisal. Then there’s the lack of effective penalties to deter companies from breaching TGA regulations.

In May 2013, the Therapeutic Products Advertising Complaint Resolution Panel determined claims such as “9x stronger” and “reduce[s] pain, stiffness and inflammation caused by arthritis, within a short period of 7 to 14 days” breached a number of sections of the Therapeutic Goods Advertising Code 2007.

It said such statements:

ought to be supported by a wide body of scientific evidence involving a number of independent studies.

But the claims continue to be made, even by companies asked to withdraw them.

Numerous reports over the last decade have recommended that the lack of effective penalties for offending companies be redressed. But it seems unlikely any changes will be implemented any time soon as both the industry and government support a deregulation agenda.

Meanwhile, consumers continue to be ripped off by products that cannot deliver on the promises they make.