Saturday, July 12, 2008

Some Random Thoughts on Longevity [102]

Friends ,

Medical science is by necessity quite dry .Claims of superiority of new drugs ,new techniques need to be validated by trials ,preferably double blinded[ given and compared with a blank called a 'placebo'] to both doctors and patients .A double blind prospective study means the doctor do not know whether he is giving the blank or the drug under study to his patient as they are similar looking and just labelled for instance drug A and B .At the end of study the code is broken and we look for statistical significance in the total patients response to the treatment .To acheive significance difference oftentimes the sampling population need to be big in number .Drug or new medical devices prospective studies are expensive affairs .

In the West there are national bodies that oversee such claims and the most famous is the Federal Drug Authority , in America . There are similar bodies in Europe as well .The third world countries usually follow whatever are accepted as truth by these bodies .Though oftentimes 'political' [European drugs and new devices take longer time and more fund to get an FDA approval than American products] what is 'validated' and passed by FDA is most time accepted as 'gospel truth' and oftentimes the share value of whatever company producing the drugs or devices skyrocketed .A lacklustre short comment from FDA can mean 'near bankruptcy' as shares plummet downward .

Luckily there are no drugs or devices related to the issue of longevity .In a way 'unlucky' because otherwise longevity could be bought easily in a 'pill' or 'capsule' over the counter .Longevity in the main ,mean a certain protracted life style , a certain mindset , an definitely a certain life long philosophical leaning .Some drugs though have been implicated but they are all well known ,well established drugs ,'long gone' beyond the crutches and monopoly of megabillion dollar American or European owned pharmaceutical companies .

Those few big players are MSD ,Roche ,Pfizer ,Bristol Myers ,Novarties and a couple others .Just imagine ,the new drugs Tarceva or Iressa ,the new kids on the block , targeted therapy , for treating adenocarcinoma of the lung cost cost a whooping RM $ 300 a tablet ,9000 RM a month to be taken indefinitely . My mum in law is undergoing this therapy ,insyaallah she would have a period of 'honeymoon' before the cancer cells get the better of the new drugs and become resistant .This is typical of cancers .

A respectable and reliable drug eluting stent , for example ,by the time plumbers like me deploy them in your hearts , will cost you around 7k a piece ,and if you need 3 stents that is 21k in just 'stainless steel' or cobalt chromium hardware .And mind you if you have ischaemic heart disease or lung cancer you do not talk of longevity , you are talking of survival ! I am not giving you guys figures to frighten you guys but really to impress that at the end of the day , prevention is better than cure .Longevity is about doing the right things so that you do not end up having those' fatty streaks' in your systemic circulations at relatively young age as those unfortunate young American boys of the 60's .They died from Viet Cong's bullets of course but the postmortem findings gave us important lessons in premature aging .

Preventive steps may be too late for us now that we are well beyond our 20's ,not spring chicken anymore ,so some may say , enjoy and be merry ! But if one just look at the smoking habit [ a definite no no for longevity ], it is even useful to stop at whatever age you may be ,even in your fifties .You still derive significant benefit . Your lung capacity immediately improve ,and even mortality statistics from a cardiovascular event dip a little . Of course you may not end up like the Okinawans .

What the Okinawans ,Sardinians from Oviddo ,or that small group from Costa Rica or the 7th Day Adventists from Loma Linda go through in the daily life , mental and physical may actually have strong bearing on 'prevention' which lead to longevity .It may not just be what they do but in actual fact , the answer may be in what they do not do ! Only God knows , but we can make intelligent conclusions and guess .

Nonetheless longevity is big business .Huge .Science as I contend earlier is dry and boring .Pseudo science is however big business !Multi billion dollar business !My Kuala Terengganu colleague Dr Sulaiman Abdullah ,an enthusiast and occasional practitioner ,in my earlier meeting with him talk about the goings on in Longevity : GH therapy ,low dose insulin injections ,megadoses of vitamins and vitamin derivatives ,ozone therapy ,chelation therapy ,colonic washouts !!! ,etc etc .Desperate people do desperate things ,even colonic washouts ! How simplistic ! I do not blame them because all of us want to live long ,youthful lives and if we can just sign it via our cheque books, the better ! .

In the realm of 'health and pseudo health' ,'the more one has to pay the better the results would be ' .If that 'lingzi ,the special herb from China ,now even planted in Malaysia cost RM $ 100 a month , no it may not work .But if it is not for sale ,only given as a state gift from Mr Chairman Deng Sio Peng to Prime Minister Dr M and thus is priceless.But for you ,since you are special we will sell for RM $1500 per kg . Special price for a valued customer.Suddenly in your mind you could feel younger on the 1st day of taking .Placebo effect is about pricing , pricing and pricing ! The more expensive the better . Similarly if you need to check into a Swiss spa for a rejuvenation therapy,pay upfront RM 25k ,get special IV therapy of 'you know what' [ young calf protein etc etc] , your mind say from day one that you feel special .That is placebo effect for you .They say fools are born everyday ,I am not surprised .

Ozone therapy ? No I am afraid it does not work except make a big dent in your pocket ." But Dr Nik ,I can swear even our present PM ,Pok Lah has been seen at so and so's clinic getting his regular ozone dose ??" .My friend that is precisely why we are having a lot of hiccough now !

Growth hormone therapy ?.At one time the 'in thing' in downtown KL ."Dr M is so active ,so youthful , I am sure Doc ,he is also on GH" .Expensive ,big money .Had made many general practitioners and 'unscrupulous' specialists able to upgrade their 3 series to BMW 7 series !Not shown to work .Thereis this fear as well that GH therapy for longevity and as a fountain for youth and energy may 'energies' certain cells in the body to become cancerous .No ,growth hormone replacement has got it's role in many situations but not for longevity .It does not work .Fullstop .

Testosterone therapy ?With increasing age there is a physiological drop in the level of testosterone in males .Expected .Young upwardly mobile female executives in the West ,to be as competitive as their male counterparts ,have been known to coerce their doctors to give them periodic injections of depot testosterone .The additional excess male hormone make them more aggressive and more ccompetitive . Good luck to them . We have to pity them for having to live in such social millieu .Testosterone therapy for longevity . No studies or papers so far can point to it's usefulness .The fear is in older men ,may lead to increase incidence of liver and prostate malignancies or at least aggravate a latent or quiescent liver or prostate malignancy .No value in longevity .

Low dose insulin therapy for longevity .The rationale seem steeped in science ie with the intended effect of bringing down endogenous insulin production and keeping blood sugar at sub normal level .But basic science is not that simple.Yet there are people who do this .We are all looking for short cut .

Mega doses of vitamins or vitamin derivatives ? Dr Sulaiman told me some people are taking not 1 or 2 grams of vitamin C ,but 10 grams !Until their stomach burns! So much for wanting to live longer !The short answer is also no .No studies or papers or evidence so far pointing to it's usefulness .Most of my patients ask me about vitamins because this is the commonest, affordable to the masses concoction .Yes , vitamins are good for you if you think your diet is not balance enough .Usually I will have to spend another 10 minutes to discuss vitamins .So my usual S.O.P is :"If it cost you less than RM $50 a month ,go ahead .It is good for you " .You guys may not believe me one young upwardly mobile Chinese businessman ,a one time patient of mine spent RM $1500 per month on all sort of vitamins he bought from multi level companies .He stopped seeing me because I ask him I would like to have his address so that I can send someone to collect his urine daily so that we can set up a vitamin factory !

" Everything seem not to work Doc ! What works?"
[ To be continued ]

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