|Dr. Mercola Articles|
|Americans Have a Right to Basic Lab Tests|
|Tue, 21 Feb 2017 06:00:00 GMT|
By Dr. Mercola
In the U.S., getting simple blood tests to monitor your health can be a time-consuming and expensive endeavor. Typically, you first must make an appointment with a physician, have the tests ordered by said physician and then wait for the results to come back, again through your physician.
Weeks and hundreds of dollars later, you may finally have your lab results in hand, but in an era where people are increasingly interested in taking control of their health, this physician-driven model has become antiquated and unnecessarily burdensome for patients.
No one has greater right to, or interest in, your lab work results than you do, which is why it should be a given that you can access such results directly from the company you pay to run the labs.
Beyond that, some companies are taking it a step further and offering direct-to-consumer laboratory tests, which allow you to pick and choose which biomarkers of health you'd like to monitor, no physician's visit required. The market for such testing was valued at $131 million in 2015 — up from $15 million in 2010.1
2014 Rule Gave Patients Direct Access to Lab Results
In case you've ever wondered if you can get your lab test results directly from the lab that conducted the testing, you do have that right.
In 2014, the U.S. Department of Health and Human Services (HHS) issued a final rule that granted a person (or a person designated by the patient) direct access to their laboratory test reports without having to have them sent to a physician first.
Clearly, doctors should not have exclusive rights to information about your body, but prior to this rule, this wasn't a guarantee. The final rule updated the Clinical Laboratory Improvement Amendments (CLIA) of 1988 , allowing laboratories to give patients direct access to their lab results.
Even so, it's not always as simple as it should be to get your results without going through your doctor. Laboratories may require patients to make requests for lab results in writing, and they may charge you extra to mail or electronically deliver them.
Further, the rule states that most results must be made available to patients within 30 days of the completion of testing, so you could be waiting weeks to find out crucial health information.2
Why You Should Have the Right to Monitor Your Own Health
Direct-to-consumer laboratory tests can empower you to be proactive about taking care of your health. If you know you're low in a certain vitamin or mineral, for instance, you can make efforts to increase it in your diet.
Or, if your A1C levels (a marker for diabetes) are normal but elevated near the pre-diabetic range, you can take steps to exercise more and change your diet to drive those levels down instead of allowing them to trend upward.
Critics of direct-to-consumer lab tests suggest the results are useless without a doctor to translate the results and provide related medical advice.
This may be true in some cases, but there are many tests results that provide fairly straightforward health information, once you know the optimal reference ranges where your results should fall into.
Further, doctors simply should not have exclusive rights to information about your body. This belongs to you, and it's up to you to do with it what you will, whether that be making an appointment with a physician to help you interpret the results or choosing to proceed otherwise.
New York State Attorney General Investigation Stopped Direct-Access Lab Testing
Even with the HHS final rule, laboratories can still be challenged for carrying out medical tests without the order of a licensed medical practitioner. In late 2015, for instance, the New York State attorney general accused DirectLabs and LabCorp of violating state law by doing just that.
The labs had been conducting health testing ranging from vitamin and heavy metal screening to checks for parasites, thyroid levels and cancer markers that had been ordered by a chiropractor who allegedly did not meet with the patients or follow up with them after the testing.
More than 1,000 patients used the service, which allowed them to get health information at a reduced price compared to normal. As a result of the investigation, a settlement was reached that stopped this direct-access lab testing without a licensed medical provider's involvement. The state's attorney general website reported:3
Walk-In Blood Tests With No Doctor's Visit Required
In stark contrast to New York, in Arizona patients can walk into laboratories and order a choice of tests on demand. Some labs even display the testing options on a price list, offering labs like a basic metabolic panel for just $17.4
This seemingly basic right to choose your own medical testing in Arizona is largely the result of intense lobbying by Theranos Inc., a blood-testing start-up firm that had hoped to identify illnesses from a finger prick instead of vials of drawn blood.
After failed inspections, the firm has closed its blood-testing facilities,5 but the doors it opened for companies offering direct-to-consumer testing using conventional methods remain.
Sonora Quest Laboratories, one company offering so-called direct access testing (DAT), reported 400 percent growth in the sector in 2016 and continued growth of more than 15 percent a month.6
Further, as Forbes reported, Sonora president and CEO Dave Dexter said, " … Doctors in the state have not been suddenly overwhelmed by anxious patients, and patients haven't been overwhelmed by the challenge of dealing with their data."
Instead, the patients have become empowered to become more deeply engaged with their health.
A number of companies have also started to allow patients to order hormone panels, test nutrient levels and markers of inflammation and more, then give the option to consult with doctors, nutritionists or other medical personnel for follow up.
In some cases, lifestyle changes, such as dietary and exercise recommendations or supplements, may be recommended. As Forbes reported:7
Research Suggests More Engaged Patients Have Better Health Outcomes
Putting health testing in the hands of patients is a logical progression of patient-centered health, and research even suggests that doing so may lead to better health outcomes.
In the journal Health Affairs, researchers looked into patient activation, or a person's willingness and ability to take independent actions to manage their health and care. "There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences," they wrote, noting:8
Favorable outcomes cited in the report among more activated patients include the following:9
4 Blood Tests I Advise Performing Annually
As direct-to-consumer lab tests become increasingly available, one of the first questions that probably come to mind is which tests are worth getting.
This is where having a relationship with a holistic health care provider can be valuable, as you can set up a baseline of which tests you should be monitoring and what your results should be (the reference ranges provided on lab test reports are not always accurate when it comes to optimal health).
This can vary considerably depending on your age, health status and health goals. There is no doubt, however, that having direct access to lab testing, and direct access to your results, is an invaluable way for you to take control of your health. As a general rule, I recommend getting the following four tests done on an annual basis, although others, such as uric acid level, may be beneficial as well.
|How Clothes Are Polluting the Food Supply|
|Tue, 21 Feb 2017 06:00:00 GMT|
By Dr. Mercola
Every day, each and every one of us contribute to the ongoing destruction of the environment simply by participating in modern society.
Not only do people inappropriately dispose of drugs by flushing them down the toilet, the cleaning and personal care products we use and the clothes we wear and wash on a daily basis also contribute to the environmental pollution.
Indeed, the environmental impacts of our clothing choices are shocking, as studies assessing toxic effects of various fabric treatments (such as dyes, flame retardants and stain-resistant chemicals) to laundry detergents and the fabric fibers themselves need serious attention.
The Drawback of Fleece
Microfibers Have Become a Very Significant Water Pollutant
Water testing done by the Rozalia Project also showed microfibers are showing up in most water samples collected from the Hudson River.5 The fibers have also been found in both table salt6 and fish sold for human consumption.7
A 2015 study from the University of California Santa Barbara (UCSB) directly linked microbead plastics and man-made microfibers to the pollution in fish,8 and when Abigail Barrows — chief investigator for Global Microplastics Initiative — sampled over 2,000 marine and freshwater fish, 90 percent had microfiber debris in their bodies.
Near identical results have been reported by Amy Lusher, a microplastics researcher based in the U.K. who co-authored a study9 on microplastic pollution in the northeast Atlantic Ocean, published in 2014. There really does not appear to be any place on Earth that remains unspoiled by plastic pollution.
As Abby Barrows, a microplastics researcher for Adventurers and Scientists for Conservation told The Washington Post:10
Microfibers Are Also a Potential Food Contaminant
Microfibers, which are more prevalent than microbeads (found in face scrubs and similar items), are particularly detrimental as the fibers are easily consumed by fish and other wildlife, accumulating in the gut and concentrating in the bodies of other animals higher up the food chain.
In one study, microfibers raised mortality among water fleas.11 In another, the presence of fibers were found to reduce overall food intake of crabs, worms and langoustines (aka Norway lobster),12,13 thereby threatening their growth and survival rates.
Making matters worse, these microscopic plastic fibers actually soak up toxins like a sponge, concentrating polychlorinated bisphenyls (PCBs), pesticides and oil in ever higher amounts as you move up the food chain.
Factors That Worsen Microfiber Release
The older the jacket, the more microfibers are released,17 and lower quality generic brand fleece was also found to shed 170 percent more over its lifespan than higher quality fleece.
Separate research18,19 published in Marine Pollution Bulletin found that the type of fabric also makes a difference in the rate of microfiber shed. In a comparison of acrylic, polyester and a polyester-cotton blend, acrylic was the worst, shedding microfibers up to four times faster than the polyester-cotton blend.
Different types of washing machines may also release different amounts of fibers (and chemicals) from your clothes. Tests show top loading machines release about 530 percent more microfibers than front loading models.20
Other factors that can influence the amount of shedding include water temperature, length and agitation strength of the wash cycle and the type of detergent used. Up to 40 percent of these microfibers leave the wastewater treatment plant and end up in the surrounding lakes, rivers and oceans. As reported by Fusion:21
To address these problems, scientists are calling for appliance companies to investigate the effectiveness of adding filters to catch the microfibers.22 Wexco is currently the exclusive distributor of the Filtrol 160 filter,23 designed to capture non-biodegradable fibers from your washing machine discharge.
The problem with this solution is what becomes of the microfibers when they're disposed of in landfills (the same issue that is raised if wastewater treatment plants install filters to keep the tiny fibers out of waterways). The fibers may simply end up entering the environment via another route.
Another novel potential solution — a waterless washing machine — was developed by Tersus Solutions in Colorado, with funding from Patagonia. It washes clothing using pressurized carbon dioxide instead of water.24
An even simpler strategy would be to wash your fleece and microfiber clothing less often. Patagonia is also looking for mitigating solutions, including product redesign to prevent the shedding of microfibers.
Polyester Downfalls Beyond Microfiber Pollution
Beyond microfiber pollution, polyester and other man-made materials have many other environmental drawbacks. As previously noted by Environmental Health Perspectives:25
Even seemingly innocuous garments like jeans are often produced using a laundry list of toxic chemicals, including perfluorochemicals, phthalates and azo dyes. It's not only man-made materials that are the problem, however. Even conventionally grown genetically engineered (GE) cotton is problematic due to the cotton industry's heavy use of hazardous herbicides and insecticides, including some of the most hazardous insecticides on the market.
This is one reason why I strongly encourage you to choose organic cotton, organic hemp and/or wool items, ideally colored with non-toxic, natural dyes whenever possible. Organic fabrics will not be genetically engineered and subject to this onslaught of toxic exposures. And, while this will not solve all of the environmental problems related to the garment industry, it's a step in the right direction.
Change Starts at Home
Benign by Design,26,27 a program created by ecologist Mark Browne, Ph.D., in 2013, aims to show clothing companies "exactly how textile wear leads to fiber pollution and ways to control their emissions." According to the website, the program — which is supported by the Environmental Protection Agency (EPA) — "developed a trade-off analysis system that rigorously and scientifically selects the most cost-effective material with the smallest impact; fabrics that emit fewer fibers and less toxic fibers."
But while some companies are actively investigating ways to produce clothing that is more environmentally friendly, each and every one of us can contribute to the solution by buying less and becoming more conscious consumers when it comes to clothing.
As described in my previous article on "fast fashion," the entire life cycle of a piece of clothing would ideally be taken into account before buying, as most of your discarded clothes actually end up in landfills, or are resold to third world countries where local clothing industries then suffer instead.
Westerners have a tendency to think we're being generous by donating our cast-offs, allowing those with few means to get clothes they might not be able to afford otherwise. The reality is, the second-hand industry is struggling with an overwhelming amount of clothes. They cannot even house it all — which is why charities will only keep donated items in their thrift shops for a month before shipping them off for bulk liquidation.
There's simply no shortage of second-hand clothing, so you're not really doing the world any favors by routinely adding to the donation piles. If you really want to make a dent in the problem, give more thought to what you buy in the first place and curb your consumption.
Most Americans have enough clothes to outfit entire villages in some other countries. There's little doubt that many would do well to absorb some of the life-affirming suggestions offered by the minimalism movement. As the director of environmental strategy for Patagonia told CBS in 2015:28
|Pharmacies Miss Half of Dangerous Drug Combos|
|Tue, 21 Feb 2017 06:00:00 GMT|
By Dr. Mercola
The average American adult took nearly 13 prescription drugs in 2015, according to Kaiser Family Foundation statistics. Seniors (aged 65 and over) took even more; the annual per capita prescription drugs filled at pharmacies was 27 among seniors in 2015, while even U.S. children took an average of four prescriptions each.1
The numbers are alarming not only because of the chronic and acute conditions driving such massive prescription drug usage but also because of the risks of the drugs themselves, particularly when taken in combination. In the U.S., 1 in 5 adults take three or more drugs and 1 in 10 takes five or more.2
Many people depend on their doctors and pharmacies to not prescribe or dispense potentially contraindicated drugs, but doctors are not always aware of all the medications their patients are taking (or their potentially dangerous interactions), and any fail-safes in place at pharmacies are also not measuring up.
In a recent Chicago Tribune investigation of 255 U.S. pharmacies, it turned out that dangerous drug combinations are putting millions of Americans at risk, representing an "industry-wide failure."3
More Than Half of U.S. Pharmacies Sold Dangerous Drug Combinations With No Warning
Chicago Tribune reporters Sam Roe, Ray Long and Karisa King investigated just how often potentially dangerous drug combinations are dispensed at Chicago-area pharmacies without warning to patients.
Fifty-two percent of the pharmacies investigated did just that, handing out drug combinations that could result in stroke, kidney failure, oxygen deprivation, unintended pregnancy, birth defects and other health risks.4
Among the individual pharmacy chains tested, CVS fared the worst, with 63 percent dispensing dangerous drug combinations with no warning to patients. Walgreens ranked the best, but at a 30 percent failure rate still had much room for improvement.5
Others, including Kmart and Costco pharmacies, had a 60 percent failure rate while Walmart failed to warn patients of dangerous drug interactions 43 percent of the time.
Pharmacists Should Have Spotted the 'No Brainer' Dangers
Perhaps worst of all, the dangerous drug combinations presented were "no-brainers," according to pharmacy professor John Horn of the University of Washington, who helped select the drug pairs to test.
The drugs were not new to their market and their ability to cause serious health issues if taken together should have been common knowledge to pharmacists. The prescriptions were presented to pharmacists either together or a couple of days apart, and included dangerous drug combinations such as:6
The Illinois Department of Financial and Professional Regulation (IDFPR) requires pharmacists to alert the prescribing doctor if a serious interaction risk is detected, to determine if the prescription is correct and whether an alternative is available.
Pharmacists were considered to have "passed" the test if they either contacted the prescribing doctor or warned the reporter about the drug interactions, but in most cases this wasn't done.
Simply stapling an informational sheet to the prescription was not deemed to provide sufficient warning, as many people simply throw the pamphlets away without reading them.7
Are Pharmacists Working Too Fast for Safety?
Pharmacies are increasingly touting fast service, including drive-through windows, to customers, putting pressure on pharmacists to work fast, perhaps faster than can be safely done. It's not unusual for pharmacists to fill hundreds of prescriptions in every shift. In some cases, they may be filling one prescription every two minutes.
In Illinois, drug safety reviews are required in which pharmacists are supposed to check the medication's dosage and whether it could interact with other drugs the patient is taking. But the investigation found many pharmacists were too rushed to complete the review.
It's an issue that likely stretches beyond Illinois borders. The New Hampshire Board of Pharmacy previously found, for instance, that pharmacists spend about 80 seconds per prescription on safety checks.
President Bob Stout told the Tribune, "They're cutting corners where they think they can cut … What happens, I found on the board, is people stop doing [safety] reviews. They're not going in looking at patient records."8
Pharmacies also use computer software designed to flag potential interactions, but the alerts may occur so often that pharmacists start to glaze over them and may miss some of the most important warnings, the Tribune reported.
'Every Prescription Is Timed'
Adding to pharmacists' pressures to move fast are company-wide "scorecards" that track pharmacists' performance based on filling prescriptions on time, responsiveness to voicemails and other tasks.
Many pharmacies also guarantee short wait times and quick service, which is alluring but potentially dangerous to customers. Forty percent of pharmacists working at such stores said they'd made medication errors because they were rushing to fill prescriptions on time.
Further, the Tribune reported on a national survey conducted by the nonprofit Institute for Safe Medication Practices (ISMP), which found two-thirds of pharmacists work at stores that track how long it takes them to fill prescriptions.9
Deepak Chande, a former head pharmacist at an Illinois CVS told the Tribune, "Every prescription is timed, and this is the worst of the pharmacist's nightmares."
He also described a color-coded alert that would pop up on computer screens if pharmacists fell behind on prescriptions. "It's an unreal pressure," he continued. "Your mind is kind of frantically trying to obey it."10
Even at independent pharmacies, problems persisted, not so much via time pressures but due to pressures to stay afloat and compete with larger chains.
Drug Interaction Leads to Stevens-Johnson Syndrome: 1 Woman's Story
The Tribune also covered the story of Becki Conway, who developed Stevens-Johnson Syndrome (SJS) after being prescribed two medications, Lamictal and Depakote, despite a black box warning alerting doctors of the known risk.
In SJS, the patient's immune system attacks their skin and mucous membranes. It begins with flu-like symptoms that progress into a painful purple or red rash that blisters and causes the top layer of your skin to slough off.
This can lead to serious infections, blindness, damage to internal organs, permanent skin damage and even death. Conway was left legally blind and struggles with pain and a constant cough caused by lung injuries.
Her case illustrated how fundamentally broken the system is, as she was failed at multiple points along the way, starting with the prescribing doctor and continuing with the pharmacist who dispensed the drugs and the multiple doctors and nurses who didn't connect her symptoms to the two medications she was taking.
"It starts with a hospital or physician error, then there's a pharmacy error and diagnostic errors, and that becomes the perfect storm," Conway's attorney Andrea Dalton told the Tribune. "At the end of this is someone who has to live with it for the rest of their life."11
Will the Investigation Trigger Pharmacies to Clean Up Their Acts?
In response to the Tribune investigation, CVS, Walgreens and Wal-Mart pharmacies announced they'd be taking steps to improve patient safety at their stores, including streamlining computer alerts so pharmacists see the most important warnings. The companies are also looking into changing the pharmacist's "offer to counsel," which is a legal requirement that some pharmacists meet simply by asking the patient if they have any questions during checkout.
The National Association of Boards of Pharmacy (NABP), an association of pharmacy regulators, is calling on states to require more robust counseling from pharmacists, in addition to public disclosure of pharmacy medication errors. They also proposed setting minimum staffing levels to help ease pharmacists' workloads.12
Addressing the poor health of Americans leading to excessive medication use is an issue all its own. But if you're already on prescription drugs, drug safety needs to become a priority, not an afterthought, especially since the 21st Century Cures Act relaxes FDA standards and makes it easier for experimental drugs and vaccines to come to market without being adequately tested for safety.
Doctors need better methods to prevent prescribing dangerous drug combinations, and pharmacies need stricter monitoring programs to prevent dangerous combinations from being distributed.
Apps like Epocrates, which physicians can use to check for drug interactions, contraindications, black box warnings and more, should help to streamline the process and protect patients, but unfortunately, most dangerous drug interactions are discovered by accident and entirely too late — or are not discovered at all because people may not equate their symptoms to their medications. In some cases, deaths caused by drug interactions may be incorrectly attributed to old age or other underlying health conditions.
Protecting Yourself From Dangerous Medication Errors
Every time you take a medication, ask your doctor and your pharmacist about the side effects and whether it's safe to take with any other medications or supplements you're currently taking.
Many common medications, including antibiotics, antidepressants and cholesterol and high blood pressure meds, can be dangerous if taken in the wrong combinations, so don't simply assume any combination of drugs is safe because your doctor or pharmacist prescribed and dispensed it.
Make a point of asking if the drugs you're prescribed are safe when taken together, and remind both your doctor and the pharmacist about your other medications (including over-the-counter drugs). Ask, and then ask again, and if you experience any unusual symptoms after taking a new combination of drugs, ask your health care providers if the drug combination could be to blame.
Ultimately, however, reducing your reliance on prescription and over-the-counter drugs is your best protection against drug interactions, and this is done foundationally, by leading a healthy lifestyle and taking control of your health.