I Drink to Your Good Health

I Drink to Your Good Health
How can I forget those sick, disabled, wounded warriors of World War 2 and Korea at Walter Reed General Hospital, the premier military hospital in the country? Depressed and agitated, into themselves, they had little desire to engage with their friends, family, nurses and doctors. It was a time when the only sedatives were barbiturates, which would make them soporific. The only pain relievers were opiates, which were addictive. There were none of today’s antidepressants. But they would brighten up before dinnertime when one to two ounces of an amazing elixir – Old Methuselah, a “medicinal” whiskey – was prescribed. The veil of isolation was lifted.

There are public health physicians and healthcare providers who have spent little time treating patients. As a result, they have limited understanding and insight into the mood lifting and health benefit properties of alcohol consumed in moderation. They tend to focus, sometimes exclusively, on statistics and on vehicle accidents and other hazards caused by consumption of excessive amounts of alcohol. These hazards, which we all are against, are well known. Of course one should not drink and drive! But lost on or undervalued by these individuals, who one might assume have never attended a holiday party or consumed a glass of beer, wine or spirits, is the ambiance and camaraderie of today’s cocktail hour and its ability to promote dialogue and relaxation.

Consumption of alcohol in moderation is part, and should be recognized as part, of our social norm. Admittedly, there is no way to quantify the satisfaction and relaxation enjoyed by individuals at social occasions. On the other hand, abuse of alcohol is quantifiable and that is where physicians must speak with one voice. Those of us who see, care for and counsel patients every day have the responsibility for educating the public as to the dangers of alcohol abuse. We need to explain what constitutes a “standard” drink in terms of alcohol content, regardless of the type of beverage: a five ounce glass of wine, or a 12 ounce bottle of beer, or one and one-half ounces of 80 proof spirits all contain the same amount of alcohol. And we need to explain that moderate consumption of alcohol means no more than two drinks per day for men and one drink per day for women.

So how can moderate consumption of alcohol be beneficial to your health? This begins with the basic mood relaxing and stress relieving effects for many. Beyond that, however, today there is a huge volume of literature published in peer reviewed journals on the benefits of alcohol in specific disease states. These include:
• less cardiovascular disease;
• stabilization of diabetes mellitus and its insulin requirements;
• decreased incidence of rheumatoid arthritis in patients who consume alcohol in moderation;
• less peripheral vascular disease;
• less cerebrovascular disease and dementia.

As a practicing physician, to those who do not drink I would never recommend consuming alcohol beverages to achieve health benefits. But for those who do drink, consumption in moderation is well known to provide health benefits which cannot be ignored.
So as you raise a glass during this holiday season and toast to everyone’s good health in the coming year, remember that consumption of alcohol, in moderation, can have a role in making those best wishes come true. I’ll drink to that!

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Presidential Candidate Health and Disability

Presidential Candidate Health and Disability November 30, 2014
Raymond Scalettar, M.D., DSc.

As the 2016 presidential campaign begins, we are again confronted with serious issues relating to the health of potential candidates. This is not something that can be dismissed as peripheral to political issues or philosophies. The enormous responsibilities of the President of the United States require a comprehensive discussion of the health of the candidates.

The history of our country reveals how little has been paid to this issue in the past. An inner circle may know of the medical problems of the candidate, which may never be discussed publicly. The media has not always been forthright about the presidential candidates’ health. This may be due to journalistic ethics that there will be no medical revelations without permission. Similarly, healthcare professionals who care for their candidate patients cannot violate fundamental ethical issues of privacy. Their confidential medical information is protected by HIPAA, just as any citizen. The public, therefore, knows only what the candidate chooses to release.

Here are some examples of the limitations placed on the public’s knowledge of the candidates’ medical history. The public did not know of the Addison’s disease of President John F. Kennedy prior to his election. This is a condition which is treatable but nevertheless potentially fatal. Although the public knew of Franklin Roosevelt’s poliomyelitis, its severity and his limitations were concealed. John McCain in 2008 revealed records of the melanoma of his face that required extensive reconstructive surgery.
However, detailed pathological reports were unavailable. On the other hand, Bob Dole’s World War II wounds and severe disability were well-known and easily visible to the public.

In an aging population, physical disabilities are no surprise. Certainly a presidential staff can assist a physically impaired president. In contradistinction, when we deal with behavior, mental health disorders and substance abuse, we must have better insight into our presidential candidates emotional state than we have had in the past. We have seen leaders of countries whose conduct has wreaked tremendous devastation on our world. Is it possible that in the United States we may elect a President with bizarre behavior who may make reckless decisions which cannot be countermanded? Fortunately, these problems have not occurred although there may have been concerns. Examples of potential problems in our leaders relating to substance abuse, dementia and mind altering procedures or drugs are as follows: Former President George Herbert Walker Bush has stated that he is not an alcoholic but acknowledges he no longer consumes alcohol and that there was a time that he drank too much. Ronald Reagan’s Alzheimer’s appears to have begun after his presidency. Presidential candidate George McGovern made a controversial decision to remove Senator Thomas Eagleton as a vice presidential candidate in 1972 when he learned Eagleton had received electroshock therapy for depression.

The 1960 presidential campaign had two formidable opponents: John Fitzgerald Kennedy and Richard Milhous Nixon, both of whom were destined to be presidents. As I reported in the Journal of the American Medical Association on June 1,1984, volume 251 number 21 (JAMA), the then Vice President of the United States, Richard Nixon, sustained an injury and potential life-threatening infection which significantly impaired his campaign. At the time of his hospitalization for treatment of a septic arthritis, there was full disclosure of his illness and treatment.

What effect knowledge of President Kennedy’s Addison’s disease would have had on his election is unknown. Nevertheless, I contend that candidates for the highest elective position of United States should provide full disclosure of their medical history. As stated in the JAMA article, the public should know the physical and mental health of the candidates and whether they are “physically dependent on alcohol, barbiturates, tranquilizers, amphetamines or any other mind altering drugs or medications that impair intellectual judgment.”

The JAMA commentary article concludes as follows:

“We must know as much as possible about the health and well-being of candidates for major offices. Failure to have this information could result in the election of a candidate who is physically and emotionally unqualified for high public office. Similarly, the acute illness or even death of a presidential candidate could result in the election of a candidate who is less popular with the electorate but who wins by default because of his or her opponent’s bad fortune.”

I believe it is a fundamental prerequisite for all candidates for the Presidency of the United States to fully disclose their medical history.

Practicing Medicine without a License

November 29, 2014

He may have been a fine physician at one time. But now he works for an insurance company. He is a medical director. It appears his job is to deflect, intervene, delay and obfuscate the approval of expensive procedures. When a patient was denied approval for a procedure that was deemed necessary, I had to speak to him directly to gain approval. The patient had a history of head and neck trauma and was having severe headaches. An MRI of the head and neck was inconclusive as to the diagnosis. A board-certified radiologist of many years’ experience recommended an MRA of the head to make certain there was no vascular damage such as a dissection.

My staff and I contacted the company for approval as recommended. After 15 minutes of shunted calls from peon clerk, up the impersonal administrative telephone chain, finally brought us to the Wizard, the Medical Director. Upon explaining to him the problem, he enumerated the steps “I would have to do” to gain his approval. I told him that his decision not to approve in the face of the recommendations, was practicing medicine and indeed, without a license! I explained that I had already performed my duty and it would now be a matter for my patient to immediately complain to the state insurance commissioner. Whereupon, the Wizard without hesitation approved the procedure! He opined to my administrator as he read her the approval number: “He is not a very cooperative physician!”

Socioeconomics of healthcare;