The difference between remembering and forgetting... Actually written at least a week earlier...

We could erase all of our horrible childhood memories... and recuperate the best we can from specific traumas.  We can also forgive ourselves for how we may have treated people... and the friends we may have denied... or even forgotten that we had forgiven ourselves for something and that something had passed between us that must be healed...  Maybe everything healed socially politically and we accepted the developmental mishaps... and now we are content, healthy and happy... and what is our life is our life and what passed... well that was our life too...  what can you do?  And maybe we don't remember everything... and we find ourselves forgetting little by little.  And, every-once-in-a-while something or someone resurfaces...

or when least expected and least indicated... during the least stressful period of the healthiest possible lifestyle... a heart attack reminds us that maybe something was not understood about us... and the situation...

"Doctor, can you tell me what was left unturned... what is it that I missed?  My acute myocardial infarction is a thing for the elderly... about years of wear-and-tear... since my numbers have been great for a while now..."

"Patient, I'm sorry, but things aren't always what they seem...  It may not have anything more to do than who was pulling on your heart strings...  Sometimes science fails us and we must revert to Tarot or Astrology or Ouija.  Have you thought about contacting your father about why, at the moment of obtaining all he had dreamed for himself, all of that was suddenly removed? He was a man of science, wasn't he?  It seems you inherited more than just FAP/Gardners from him.  You inherited the tendency of losing everything the moment of seemingly obtaining true success with others..."

And what does this have to do with the difference between remembering and forgetting?

Ya know there are many forms of memory and lack there of and related repercussions.

Actually, the idea appeared in my head because I hadn't wished a happy birthday to a friend of mine on the 10th of March (for some reason I've had many female friends born on the 10th).  We were in Sayulita for a week for Margarita's birthday and I intentionally avoided the internet.  The 11th we drove back to Guadalajara.  And my younger sister's birthday, March 12th, I had my acute myocardial infarction (not all heart attacks were created alike)...  Low stress, normal cholesterol, normal triglicerides, 2 weeks of eating purely fish... months of high consumption of ground flaxseeds etc, much aerobic exercise for a year... much floating in the waves for 6 days...... If we could go organic we would...  Peace brother... Peace sister... Love is all we need la la la la la

But in all seriousness...  

Today I decided to ask the friend some questions.  Since if anyone knows the adequate responses, she does.  But, she has her own intense problems and responsibilities...  So, I apologized for missing her birthday that I never miss and explained what was going on... and then worried about how she may have responded to having been oppressed with the question.  That's where the idea entered about the different sides of remembering and forgetting... remembering and forgetting people...

Remembering and forgetting information... events... reasons... why why why... and no how how how...  Do you remember that week in Sayulita?  I only remember the week afterwards!

I spend my days researching/investigating... trying to remember what I knew before the event, although I didn't really take heart disease seriously over the past year... afterall, I was removing all of the risk factors and the signs and numbers...  People considered me the one healthy person here and the man with the answers and the information...  And now they're asking "how is it possible?"

"YOU OF ALL PEOPLE???!!!"

I spend my days researching/investigating... and fatiguing and laying in bed or on the couch... and wondering and worrying... and worrying about what the cardiologist don't understand... and what happens to the body when the pharmaceuticals, in the name of helping, they hinder...  But, the cardiologists aren't "allowed" to worry about that side... since they aren't truly train for thinking about health...  They are just high-tech mechanics...  And, yes, we need all types of mechanics in this world.  But, one must not confuse themselves with chemist or alchemist... and even less-so with healer or GOD...

Acute Myocardial Infarction... normally occurs with the elderly... It's related to the aging of the outside heart tissue...  the outside heart arteries...  Most "epidemiologic" studies focus on age groups above 50 years, although people have had AMIs as early as 25 years...

I stumbled across a study http://www.ncbi.nlm.nih.gov/pubmed/24581071from Purdue University (where my father walked out on his Fullbright Scholarship) that links accumulated childhood misfortune and child abuse to increased risk of AMIs...

Speaking of Bullies in 1982...

trying to jog your memory... the same year Todd had everyone calling me "Poor Boy"... but different school year.  Now we were in 8th grade.  Because Todd's mother wanted Todd to have more time to study for his bar mitzvah the convinced Rabbi Abraham to give Todd my date (June 19th; the day before my birthday) and moved me to November, which was a horrible injustice you can not imagine.  Do you remember the cast on my wrist during my Bar Mitzvah?  Do you wonder why... what happened?  Did I bring it on to myself...

Ok.  One October day in English class, I don't know what had gotten into John Kalmbach's head to start playing as he did.  But, suddenly he started saying out loud, "Ross, what did you say about Mike's mother!?"  Mike Szmanski (neighbor of the Cohns) was a class bully; not the worst one.  But, for some reason he liked to start fights.  Hence, Mike got up from his desk and walked straight up to me... I trying to play calm... and said, "what did you say about my mom?"  I'm sure he said some other words.  But, truthfully, I don't remember other than the important details.  And I said, "Nothing. John's trying start things," and he responded, "I hope not.  Or else!"  and he walked back to his desk and his friends...  And then John does it again, "You've gotta be kidding Ross!  Mike's mother did WHAT?"  This time, Mike returns, pushes my chest and says, "TODAY after school, in back of Rodney Carr's house at 4:30.  You better not chicken out! or I'll have to come find you."  

If I didn't go to fight (and I had never been in a fight before.  I wasn't a fighter.  I didn't know how to fight), I would hear from everyone the following day.  So, I went.  And I broke my hand on his cheek bone... But at first I didn't throw a punch, just blocked his.  And he started to laugh and then snare... because I wasn't throwing punches.  

I didn't call attention to the bullies.  The attended towards me.  I spent my school days trying to avoid them.  Remember Hank Toyes; occasional friend, occasional bully.  Why did he have me as a friend and then, for some reason, pull "older-brother/Sheri pranks" like, pull Ross's hood off his coat and play keep away from Ross in the 4th grade Old York School playground.  And when Ross lost his patience at being used as a joke in Monkey-in-the-middle (one of Sheri's favorite games), Hank decided to show the friends in the circle how he could be like Rocky Balboa...  

But, you would later accuse me of making-up these things or even later on, of bringing them onto me...  Did I bring on dad's death and the Familial Poliposis/Gardners Diseases, and Uncle Stan's violence when my father was dying in Sloan Kettering or Sheri's horrible possessiveness and jealousy of me when I was born...  You're who said, when I was a baby, she would pinch me to make me cry.  Now, what did she do when you weren't observing?  Do you know what she did on the corner with Chris Love waiting for the school bus when I first started going to Old York School with her?  Can you imagine?  She did the same with Barry and then with Craig when Barry left...  She had this incredible need to control and ostracize... me.  

Do you know what growing up with Sheri was like?  You remember what Mrs. what's her name said Sheri did to scare away her daughter (our baby sitter) and Sheri's reasoning.  But, you can't imagine just how abusive Sheri was towards me.  And Sheri says that she doesn't remember anything bad between us...  And everyone believes her.  I must be inventing.  

As if it wasn't bad enough to lose my father suddenly, inherit his disease, have my mother how you were.  Do you remember how you were? Be deathly scared of Uncle Stan who beat the shit out of me when you left us with him while visiting dad before he died... Why would the uncle beat his brother's son when his nephew's father was dying in the hospital? And be picked on in school from age 8 (2nd grade) and ignored by the teachers who allowed the children to ostracize me in class and on the playground...  I complained to you.  And you accused me of inventing...  

Why so much accusation of me inventing?  Was I truly a lier as a child?  Didn't you say that I was a very tranquil/calm toddler?  So, when did I suddenly become a lying bastard?

But, it was something I brought onto myself... like the gang-rape victim...

Accumulative Childhood Misfortune, AMI and a letter to my mother...

the accumulation of childhood misfortune also presents a lasting threat to cardiovascular conditions. Additive measures of childhood misfortune that capture child maltreatment, family structure, and the psychosocial environment have displayed a doseresponse effect: as the number of adversities a child experiences increases, so does the risk of heart disease and CVD risk factors

You found it strange that I found myself thinking about Todd Golub...  Don't you remember how he had the bullies and others call me "POOR BOY!" in 7th grade... When his mother Regina called to beg me to come to Todd's bar mitzvah (the 19th of June), he constantly got on the other phone and taunted me with his "POOR BOY" and the tone he used...  How could his mother have the nerve to continue asking me to attend the bar mitzvah.  Did she not have any idea how that chanting/taunting made me feel?  Why would I want to be next to that horrible person?  Do you not have any idea what it was like walking from one class to another hearing people call me poor boy?  I knew I was a poor boy...  He didn't have to say anything... For years I didn't want to bring friends to our house because we didn't have in the pantry what their parents had and I didn't have toys or games they had...  our furniture and carpets were horrible... And, no, I didn't blame you for that.  It was just a reality of the difference between how was our home and how was theirs.  And I also was greatly aware of the difference of having a living father and not having a living father...  Hank's parents were divorced.  But, there was money from his father.  He had his father visiting with him regularly...  And I know that this doesn't make much a difference in the end... No matter what I do, I will find myself HERE as I am, regardless of my intensions...  Yes, today is a bad day.  And no one can change it.  The damage was done.  And I'm not angry with you.  I don't believe you can escape the resentment...  I think it's something you must live with...  Everyone must take responsibility for why they receive certain slaps...  I won't lie to you.  I can't protect you from yourself.  I get tired and frustrated and I go away in order to be able to live the little I've created that's good in my life... to protect that from the negativity connected with others who, truthfully, never adequately helped construct my healthy life.  And then the heart attack...  And here we are.  communicating.  But, truthfully, I don't know how far this will go... I don't know if I will return to the health I knew of the past year...  I am almost certain I will be a certain form of geriatric at 46-years-old...  if they cause my liver to stop producing cholesterol...  That's what statins do; they destroy the liver enzymes responsible for producing cholesterol...

Did you go down the list of factors of childhood misfortune:

1) Death of Father

2) Female headed Family

3) Poor socio-economic Status

4)Childhood Abuse (uncle stan, Sheri, mother, peers)

5)Instable homelife

6)Insomnia

7)Disease (I was diagnosed at 12 and had my major surgery at 13)

Now, thinking about things you say the family believed or relatives said... What if this article was published in the 70s and you had Mary Beth and Henry read it...  What if you read it?  Wouldn't you all have approached me differently?

If these and other factors so greatly increase the risk of AMI, what other risks did they increase?  And I wouldn't be in a battle with "YOU" since at least 2006 and I wouldn't have found myself dedicating my damn blog to explanations in the hope of everyone suddenly understanding...  

But, now I had the heart attack (although healthy until Beth's birthday).  And now I stumbled across this article...  And now you and I are communicating.  And I know you worry about that day when I stop talking with you again.  Because it seems thats just the way I am.  Although I've ALWAYS warned or tried to explain why things were happening, giving the option of a different response...  But you are just a person... and you can only do so much or understand so much... and you have your own needs... AND YOU CAN'T CHANGE THE PAST...

But, as you see, the past comes back to slap me in the face... to remind me that I can't escape it...  

It's funny, I'm a bastard... I was that way this time when your sister died... since I continued to ignore you and then I wrote very insensitive criticisms of you on my blog... and I could hear everyone calling me a bastard... You called me that when I was a small child... And, later on, when I became aware of the true significance of words, that it's true, I'm A BASTARD... and the study shows that that's where the AMI problems began; with my bastardome... with the death of my father...  and how that mother became when she became a young widow...  

What was life like as a BASTARD and a POOR BOY? 

I don't like going back there... But, we're trying so hard to understand the heart attack, since it makes so little sense within the circumstances... And now the article appeared

Childhood Misfortune and Acute Myocardial Infarction in Adulthood (an excerpt)

As stated in cummulated inequality (CI) theory, childhood is a particularly vulnerable period of the life course since it comprises a significant portion of cognitive, neural, and biological maturation (Maggi, Irwin, Siddiqi, & Hertzman, 2010). Research has demonstrated how childhood insults, such as parental loss, can alter biological functioning and neurological response systems (Luecken, 1998). Many physical ailments in later life still bear the imprint of childhood misfortune, illustrating its far-reaching grasp. Childhood misfortune can later manifest as adult obesity (Greenfield & Marks, 2009), cancer (Morton, Schafer, & Ferraro, 2012), and lung disease (Blackwell et al., 2001). Among the diseases studied in relation to childhood misfortune, the most pervasive in the United States remains CVD.

Investigating how childhood misfortune raises the risk of CVD has generally taken two approaches: analyzing unique or cumulative effects of misfortune. Among the commonly examined types of misfortune, such as Socio-Economic Scale (SES), poor childhood health, and a harsh family environment, many studies treat these as individual CVD risk factors (e.g., Beebe-Dimmer et al., 2004; Blackwell et al., 2001; Luecken, 1998). Although many of these childhood insults have independent effects, the accumulation of childhood misfortune also presents a lasting threat to cardiovascular conditions. Additive measures of childhood misfortune that capture child maltreatment, family structure, and the psychos2ocial environment have displayed a doseresponse effect: as the number of adversities a child experiences increases, so does the risk of heart disease and CVD risk factors (Dong et al., 2004; Felitti et al., 1998; Loucks et al., 2011).

Although many studies link childhood misfortune and CVD, we identified only a few that focused on AMI. O’Rand and Hamil-Luker (2005) have found that adults who experienced poor health, family instability, and low SES during childhood were at increased risk for AMI, and they extended their findings to show that childhood misfortune was more consequential for women than for men (Hamil-Luker & O’Rand, 2007). Whereas O’Rand and Hamil-Luker’s research identified how different clusters of misfortune raise AMI risk, Hallqvist and associates’ (2004) research focused on SES; they found that the life course trajectory of low SES, rooted in childhood, raises AMI risk in adulthood. These three studies paint a compelling picture of the influence of childhood misfortune on the risk of heart attack, but we draw attention to two notable risk factors that have not yet been incorporated in research on the topic.

First, a risk factor that merits attention is family history of heart disease. Previous research shows that having just one first-degree family member with ischemic heart disease doubles the risk of AMI, and the risk elevates further with two or more relatives with heart disease (Bertuzzi, Negri, Tavani, & La Vecchia, 2003). We are unaware, however, of any studies on childhood misfortune and AMI that account for family history of AMI or any type of CVD, potentially leading to an overestimation of the effect of childhood misfortune on AMI. In addition to this confounding relationship, childhood misfortune could also moderate or mediate the relationship between family history of AMI and AMI risk. Regardless of the relationship, we build upon prior literature by incorporating family history of AMI into our analyses.

Second, a growing body of literature has revealed that child maltreatment raises the risk of multiple health problems in adulthood, from ulcers (Springer, 2009) to cancer (Morton et al., 2012). Childhood experiences such as household financial strain or living in a fatherless home may have lasting effects on health, but many studies also point to the long-term effects due to traumatic experiences. Child maltreatment is often a traumatic experience that activates a host of physiological, psychological, and social responses—from secretion of glucocorticoids to social withdrawal. Despite substantial literature suggesting that child maltreatment influences cardiac health, we found only one published study examining the link between child maltreatment and AMI (Fuller-Thomson, Bejan, Hunter, Grundland, & Brennenstuhl, 2012). The authors examined one type of maltreatment—sexual abuse—and reported that it raised the risk of AMI for men but not for women. Most studies of sexual

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abuse and CVD, however, report that women are at greater risk (e.g., Goodwin, & Stein, 2004). The current study does not include measurement of sexual abuse per se, but we are able to capitalize on an extensive battery of questions tapping both physical and emotional abuse. As such, we examine whether AMI risk is related to an overall measure of accumulated misfortune (including maltreatment) or maltreatment as a special type of early misfortune.

Mechanisms of childhood misfortune Many life course scholars contend that childhood misfortune triggers a chain of risks, where one event increases the likelihood of other negative events. Experiencing childhood misfortune may propel an individual toward risky lifestyles and behaviors that lead to poor health. Childhood misfortune has been shown to increase the risk of smoking, alcoholism, drug abuse, and obesity, each of which may mediate the relationship between childhood misfortune and adult health (Brown et al., 2010; Felitti et al., 1998; Greenfield & Marks, 2009).

Felitti and colleagues (1998) developed a conceptual model that includes both health behaviors and psychosocial factors as potential mediators of the childhood-adult health relationship. Applying this model to childhood misfortune and heart disease, Dong et al. (2004) found that both health behaviors and psychological risk factors mediated the relationship, with the latter, psychological risk factors, producing a stronger mediation effect. Therefore, the mechanisms linking childhood experiences to adult AMI may extend beyond the adult health behaviors, social support, and SES trajectories already identified by Hallqvist et al. (2004) and O’Rand and Hamil-Luker (2005). Prior research reveals that anxiety, locus of control, and family strain are potential mechanisms. Previous studies have reported associations between childhood misfortune and risk of anxiety, low locus of control, and familial relationship strain (Irving & Ferraro 2006; Kessler et al., 1997; Loucks et al., 2011). Anxiety, low locus of control, and family strain have also been associated with increased AMI risk (Kubzansky, Cole, Kawachi, Vokonas, & Sparrow, 2006; Rosengren et al., 2004). Bridging together this research, we investigate psychosocial factors of anxiety, locus of control, and family strain as potential mediators that may link childhood misfortune to adult AMI risk.1.

Selection issues Selection processes are also important for the study of AMI. Although AMI is often considered a disease of old age, many AMI studies also identify cases of early onset – as early as 25 years old (e.g., Fang, Alderman, Keenan, & Ayala, 2010). Moreover, a Swedish study of AMI survivors found that approximately one-fourth of adults who had an AMI between the ages of 25 and 55 died within 5 years (Isaksson et al., 2011). In the US, women under the age of 55 have the highest AMI mortality rates (Vaccarino et al., 2009). This type of mortality leads to a selection problem when studying the effects of childhood misfortune on AMI risk in adulthood (people die from an AMI or other causes before they are eligible

1We investigated anxiety instead of depression because Kubzansky et al. (2006) found that anxiety, but not depression, predicted AMI. Moreover, Davidson et al. (2005) contend that the effects of depression on CVD are more reliable when using clinical depression measures rather than self-reported depressive symptoms. The MIDUS only measures self-reported depressive symptoms.

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to be surveyed). This is an important consideration because previous studies of childhood misfortune and adult AMI rely on samples of adults aged 51 and older (Hallqvist et al., 2004; Hamil-Luker & O’Rand, 2007; O’Rand & Hamil-Luker, 2005). By restricting the sample to persons 51 years and older, existing AMI studies may be underestimating the effects of childhood misfortune, especially if those who were faced with early disadvantage and heart trouble did not survive until late middle age. As Vaccarino and colleagues note (1998), limiting samples to older populations can lead to underestimating the prevalence of AMI at younger ages as well as the potential effect of childhood misfortune on AMI risk. To account for those earlier heart attacks, we use an age-heterogeneous sample of adults.

To extend the literature, we propose three hypotheses:

H1 Childhood misfortune is associated with greater risk of AMI.

H2 Health lifestyle factors will mediate the relationship between childhood misfortune and AMI.

H3 Psychosocial factors will mediate the relationship between childhood misfortune and AMI.

The Irony?

Otra peregrinación con Cuñado

sí... Sayulita estuvo buenisima para nosotros... como vino el frente frio... hizo muy comodo para nosotros... Descrubrimos varedas en la jungla que nos llevaron a playas escondidas...   Jueves, creí estaba yo con una reacción alergica a soya en unos chocolates regalado a Margarita por Socorro.  Empeze con dolor en el pecho y más fuerte en la garganta y en la mandibula.  Dije a Margarita que duraria solo media hora... hice 72 largatijas rápidas, 20 llantitas y fuimos a Metropolitano... Se pasó un rato durante la corrida pero volvio antes terminar los 5 kms...  Fuimos a MixUp por unas peliculas y empeze tener nausea.  Pasando por Costco, tuve que pararme para acostarme atras... sentí horrible.  Casi no llegue a la casa.  En la casa tome mi presión; estaba como la tuya 88/50 con ritmo cardiaco a 50...  La sigiente mañana Viernes fui al Chopo.  Recibi los resultados en la tarde... y los leí 100% infarto...  Pudiera haber sido cancer... pero, por el AST alto, para mi, fue claramente un infarto... ni modo...  Llamó Margarita al gastroenterologo quien nos conecto con un cardiologo intervencionista en Sabado quien me dijo acaba de tener un infarto y hicimos una cita en el hospital para la tarde... para hacer una angiograma en que ponen en tú corazon (por el arterio de la muñeca) tinta de yodo para hacer un medio de contraste para ver como están los arterios... Pero, los muy tontos no me preguntaron si tuve una historia de alergias a mariscos... En el medio de procediamiento, tuve una reaccion (cuando estaban ellos aldrentro de mi corazon; estaba yo despierto para dejar de respirar cuando me pidieron) al yodo y mi cuerpo entro en espasmas sin control y mi pulso subio de 68 a 200 y despues perdí conciencia.  Cuando despirte en la habitación no pude ver por unas horas... Estaba yo contestando y mirando con ojos abiertos, per sin ver Margarita o la enfermera...  Y todavia, nos cobraron los $7,500 de medicamentos usados para quitar la reacción...  Imagino, si hubiera muerto por su falla, hubieron cobrado Margarita todavia...

Antes que empezó la reacción, me sorprendio un comentario del cardiologo "sabes? no eres hipertenso... tú presión es normal."  Imagino normalmente los hipertensos tienen una subida de presion cuando están en la mesa de cirujia... Le dije que estaba yo tomando mucha linaza estos días...

¿Que puedo decir?  Como sabes de diabetes y otras pedacimentos de salud, un infarto es un proceso de decadas... tal vez por geneticas... tal vez por demasiado estres prolongado... tal vez por decadas de descuido alimenticio...  Pero, es que mata 50% del población mundial...

En esto momento, no se como planear por un futuro para nadie, ni para mi...  Y que es más triste para mi es que no se como planear para Margarita cuando no estoy... Ha hecho tantísimo ella y merece más...  Pero, desde Jueves, no existe nada de entusiasmo para comprar terrenos...  no es lógico pensar en las escuelas de los niños si pasa algo peor en San Marcos... La idea fue comprar 5 tareas de cafetal en tú nombre que devuelvarias poco a poco (o mucho a mucho)...  Pero, la "intervención" costo lo mismo que planeabamos para ti $107mil... y no se como voy estar en un mes... o si llego a 6 meses... pasan cosas... o tal vez solo es una forma de depresión mia por no ver la salida... para planear buenas fantasias... como poner buena tierra en tú nombre...  Pero, ¿que hacer?

Tal vez no pasa nada mala en San Marcos, aunque es mi feria más pesada que he dicho más que una vez "si una feria me mataria, es San Marcos"...  Tal vez en Mayo nos encontramos entusiasmados... Tal vez recupero mi energia en 2 semanas...  Pero, no se nada.  Es muy temprano.

O demasiado tarde...

A letter to Dr. Jess Madden

I've been in contact with Jess for over a year now.  It was through her website that I finally understood the relationship between apple cider and alcohol that caused the same horrible allergic reaction; that I didn't have an allergy to apples or alcohol... That the connection between the alcohols and the apple cider is Sulfites... what is placed with the apples or the grapes or other fermentable fruits etc to control the formation of molds...  For years I had horrible reactions without understanding what was happening.  It was also through Jess that I understood that the issue of histamines or why some people find themselves taking anti-histamines through their lifetime is because those people lack a certain enzyme in their stomachs to metabolize naturally occuring histamines we obtain in certain amino acids in our diet.  Considering that Jess has battled with Celiac Disease and a constantly increasing array of issues with allergies since childhood and through medical school, I felt she was the most adequate person to ask how to approach the prescription of powerful pharmaceuticals for "reversing" arteriosclerosis and their risks...

Hi Jess, long time no communication.  Everything was going real well with the "diet" (off wheat products for a year now and my digestive tract is much different...  However, I've stumbled across ideas that if a person has problem with gluten, they probably will have problems with zein in corn... I mention this because my wife and I spent December at her family's home and on the road, where we found ourselves eating much corn tortillas and tamales and suddenly I found myself with very similar issues, as if the corn was mixed with wheat...

But, this is NOT why I write you today.  Thursday I had a heart attack... and I ran 3 miles in the middle of it...  Since I thought the pain in my throat and lower jaw was from an alergic reaction to soy in chocolates I ate in the morning (since "high quality" dark chocolate caused immediate headaches and joint pains in January, while I have no problems with pure cocoa beans), I didn't seek a cardiologist until Saturday, after receiving the results of bloodtests I had ordered on Friday that showed high AST and high Lactic Acid in my blood stream.  Saturday evening I had an angiogram done and had two stents placed in two of my heart arteries.  The artery that was blocked was the smallest of the arteries and the cardiologist said that it was too late to change that situation and that it really doesn't make much of a difference.  Towards the end of the placement of the stents, I had an allergic reaction to the Iodine placed in my heart for imaging...  My pulse increased from 68 to 200 and my body went into uncontrolable shivering/spasms... all because no one asked me if I have a history of allergies to clams...  I've eaten long-necked clams 3 times in my life and with the same horrible reaction...  It took them 30 minutes to control the reaction.  In the meanwhile I lost consciousness.  And when I came too afterwards, I couldn't see for a few hours...  Although the mishap was the falt of the doctors or the nurse who didn't ask me if I had alergies to seafood (a reaction to yodo in the image resonance ink supposedly is less than 10%, although this was the first time occurance for my intervention cardiologist), they still charged us for the cost of all of the medicine used to control the reaction.

Considering this mishap or the lack of asking questions before prescribing powerful drugs, I've put on hold taking any of the 4 drugs the cardiologist prescribed me yesterday...  One says, "not to be used if the patient has a history of asthma or respiratory problems"  But, the doctor didn't ask me if I was asthmatic (I was but supposedly ceased being diagnosable... my asthma has been called "Seasonal Asthma" and appears often in response to allergic reactions, like mold spores, dust particals and who knows what else triggers it...)  

Do you know anything about the risks of people using Statins and other drugs for arteriosclerosis who have a tendency towards allergies or who do not metabolize histamines adequately?  

As I'm sure you know, not taking the statins or the blood thinners or the platelet unstickers seems reckless on my part.  Then again, taking whatever drug prescribed by a doctor who I can assure you doesn't truly know all that's behind how those free samples given him by his pharmaceutical rep, also seems extremely reckless.

Ross

How does that Billy Joel song go?

"Oh, but workin’ too hard can give you/A heart attack-ak-ak-ak-ak-ak/You oughta know by now"

And that was the diagnosis two days later...  In a few hours Margarita and I leave for a hospital where the emergency Cardiologist will be placing at least one stent in one of my heart arteries... it all depends what else they find in the imaging...

But, this is what we work for...  Paying for pick-ups accidented and destroyed by other's careless driving... and for extremely expensive "surgeries" due to my very own decades of intentional carelessness... And, yes, I knew... But, I didn't care... until I met Margarita... but at first I didn't believe... and we didn't have the economy for eating healthfully... for years...  

Racing against an invisible clock... tick tock... did you hear that?

...went for blood tests today...  High LDH (Lactic Acid leaving the muscle cells related to Cancer or Hearta Attack) and TGO (AST; a certain type of Amino Acid circulating in the bloodstream due to muscle damage).

Today my BP has remained stable and low 106/66.  Normal for me when I'm not running 6 miles or more per day is more or less around 132-88.  Since last night I have a dull headache and today I have a familiar pain on my lower left side of my back behind the stomach or where the kidney is...  3.5 years ago the gastroenterologist who didn't want to do the upper endoscopy or an ultrasound, although I require them due to my FAP/Gardners and although I was experiencing abdominal pains said that the pain there could be hypertension of the Kidney.  But, the cardiologist to whom he refered me said that hypertension of the Kidney doesn't exist and said it was a muscle pull and prescribed me the pain releaver banned in the U.S. due to high risk of causing heart attacks...  

I bought Aspirin "Protect" for thinning blood little by little... and will return to using fresh turmeric...

...wracking our brains thinking what could be the cause... aside from what I wrote yesterday about long-term accumulated damage due to my decades long lack of respect for my health and discontrol of my diet extremely high in refined carbs...

Causes of what I believe I'm experiencing (Miacardial Infarction) are: Alcohol Abuse, Cigarrete Smoking, Obesity, lack of exercise and heavy stress.  I've never been a "drinker" and the last time I had an alcoholic beverage was a year ago in Sayulita.  We thought about going for a Margarita or a Mojito in Sayulita.  But, in the end (the last night) I said to Margarita "better yet, we stay 'home' and I can prepare a doble Margarita for myself"... And yes, it was a better choice for spending the last night on vacation, in bed with my wife...  I haven't smoked a cigarrette since June 2003 in Xalapa, Veracruz and I was a sporadic smoker.  I'm not obese and, as you read yesterday, I'm not seditary...  But, José destroyed the pick-up we use for transporting our coffee bar and we elected against throwing away $30,000 USD in a new cargo van...  We haven't truly relaxed since the accident on January 10th, and the concerns and calculations about buying a cargo van or seeing if we can rent a truck or find a reliable transportation service falls on my shoulders...  It's a problem.

Racing against an invisible clock...

And I was wondering... I had wondered about my increased consumption of green leafy vegetables high in Vitamin K and the risks posed for those with hypertension, since Vitamin K is necessary for increased clotting...  Kale, Spinach, Swiss Chard, Bok Choy and Romain Lettuce all of which we've greatly increased in our diet since discovering Kale in the Farmers Market in November...  We brought a lot of Spinach, Romaine Lettuce and some Bok Choy to Sayulita, meaning that my diet was especially high in Vitamin K this past week...  But, while wondering, I said to myself, "Most people obtain their Vitamin K from beneficial bacteria in their large intestine... I don't have a large intestine and must have a shortage in Vitamin K...so why not eat these wonderful foods?"  However, now thinking about increased clotting: maybe it was my lack of vitamin K that protected me from that imminent heart attack of which the Cuban Doctor warned me in 2004 in Xalapa... He said I would have a massive one in maximally 3 years... 11 years later...  And, yes, I've felt discomforts in my chest over the past year...  But considering that all of my numbers were normal, I imagined it was my imagination...

Until yesterday...  

Coffee didn't raise my BP.  In fact, Chris Kresser mentioned in his recent article/Podcast, that coffee does not negatively affect the heart.  Infact, he says that it positively affects the heart... depending on the genotype of the person... their sensitivity to caffeine...  

Needless to say, I'm a bit concerned considering that we are approaching the most stressful work of the year; on top of that the accident/transportation issue...

And, no, I won't be visiting a cardiologist... so that he can prescribe medications that don't work at their best and at their worse cause additional chronic issues or at their worst, kill you...  

"and in the end...the love you make is equal to the love you take..."  

We had an incredibly nice time in Sayulita Margarita and I...  

"... sleep pretty darling, do not cry, for I will sing you a lulaby..."

Coffee and Health; response to Chris Kresser's very interesting article

Hi Chris, I really appreciate this piece http://chriskresser.com/all-about-coffee on Coffee consumption and health… not that I disappreciate any of your other pieces. At the moment I’m experiencing a strange hypotension and forced myself to read…

I live in Mexico with my wife Margarita. My father-in-law is both an organic and conventional coffee producer in the mountains of Veracruz. Margarita, a few of my 11 brother and sister in laws, and I travel around the country with a coffee bar in search of a better coffee market for my father-in-law etc… During the 12 years Margarita and I are together, I’ve seen my coffee consumption decrease greatly (and yes, it has much to do with issues of stress and health and much of what you mentioned about the personal state of the person) since I fell in-love with coffee in Puerto Rico and New York City in the 90s…

I’m frequently asked by customers if coffee is bad for you… I generally responded that it is a diarrhetic and that the person must be aware of how much water they are drinking before and after drinking coffee and how much coffee they are drinking, that the caffeine will function as a leaching away of water soluable vitamins and minerals… Then, not long ago, studies came out about coffee high in anti-Oxidents. But, in my studies, I realized that most of the anti-oxidents in coffee are in the flesh of the “coffee cherry” that is discarded in the process of removing the seed (bean)… Years ago my sister and brother-in-law started a business extracting the antioxidents from the discarded flesh of the coffee cherry and invited me to participate in the grassroots part of the process with my in-laws. But, one of their partners took off with the machinery forcing my sister and brother-in-law to file for bankruptcy, ending that project before it started with me… Here in Mexico Nestle ran away with the idea that coffee is an anti-oxidant, promoting their vast line of Nescafes as good pro-health, leaving me (us) with a horribly bad “taste” in our minds connected with the idea that coffee is an anti-oxidant. So, when clients mention anti-oxidants, I respond that it is a big fat lie… We sell wonderful coffee and are trying to help a community “pull itself up from its bootstraps” and we don’t believe in gain by manipulation and lying… As long as coffee doesn’t harm the consumer, that’s fine for us. Granted, if there is a whole slew of new information showing that the actually coffee bean is high in anti-oxidants not destroyed by the roasting process, then that it great too!

A few years ago I read a Canadian study of female coffee drinkers and diabetes that showed the women who consume 6 cups or more of coffee per day have inverse rates of diabetes… I tell my clients about that study. However, my mother-in-law who was born in the cafetal/finca/coffee plantation and who drank coffee all day long instead of water (since the water in Mexico, even in the mountains, tends to be contaminated) was diagnosed with Type II Diabetes. Then again, she gave birth to 13 babies (one died in the first week) which I am certain took a toll on her body… Plus, she lives in a horribly sexist culture where the men believe that the women should eat after the men have eaten (what is left over) even if the women are pregnant… A ton of desnutrition/malnutrition in the coffee ranches; children who grow up with distinct neurological problems/deformaties… that I imagine began in vitro… And lastly, the coffee that my mother-in-law always prepared for the family I called “coffee-tea”… very lightly concentrated light roast coffee that you can drink all day long… and that coffee-tea drunk all day long, like water, she also prepared with a lot of sugar…

There’s something I wish you and your readers and your (and my) fellow country people (“Americans”) would understand about coffee producers when thinking about organic coffee… When I first met Margarita in 2003, her father’s 5 hectares of coffee plants was 100% organic. Years earlier, representatives of Green Mountain Coffee Roasters (#2 buyer of coffee after Starbucks) had visited the community inspiring the coffee growers to convert to organic with the incentive of earning more money and creating stable family economies… Then, suddenly, Green Mountain left Veracruz and didn’t respond to my letters asking about their program, that they mention on their website…talking about Huatusco, Veracruz as one of the projects aiding family farmers… But, that’s clearly not true. And, no, this is not about Green Mountain, but about cultivating organic coffee and who actually gains… If you cultivate organic for a sustainable income in Mexico, you must have a lot of land, since organic coffee produces much less crop than does conventional. Granted, conventional agriculture leaches the soil of its nutrients, requiring a lot of land for rotating the crops… In Mexico, organic toasted coffee does not receive a higher price. So, if you are a small coffee farmer struggling to “pay the bills”, it is much more logical to cultivate conventional coffee… And if you sell unprocessed organic coffee cherries to the middle men who were actually working closely with Green Mountain, “they” were paying you 5 cents more por kilo for that organic coffee… Lets say that they paid you 50 cents per kilo for conventional coffee cherries, meaning that you were being given a 10% increase, although your organic coffee farm produces at least 50% less per year than conventional coffee… So, the appearance of Green Mountain Coffee Roasters, while appearing to be helping the farmer was actually sending them further into poverty… Later on I bumped into a woman who worked in Green Mountain’s publicity department and told her about my in-laws’ ranch and the Green Mountain project there and that they just disappeared… And she told me that Green Mountain only works within countries that guarrantee Fair Prices for the farmers… which explains much about why they suddenly disappeared from Mexico. But, this does not justify Green Mountain’s publicity of their project with my inlaws’ community when, truthfully, the benefit is not seen.

It would be wonderful to find giant organic markets here in the Garden of Eden of Mexico. Truthfully, it is virtually non-existent. Most organic products to be found in Mexico are from the Costco stores and extremely doubtable… It’s wonderful that you the health conscious readers can maintain a 100% organic diet. But, I truly believe that you have no idea just how difficult it is for a farmer, especially organic farmer, to subsist. In Mexico, a pound of conventional coffee sells at $5 USD at the high end, no matter the quality… That’s the price we are selling my father-in-law’s coffee. When I met Margarita 12 years ago, my father-in-law’s anual crop (December-March is the harvest period) 100% organic sold to the middle-man buyer earned him gross $1,500 USD. In order to help the family economy, various of my brothers-in-law worked on construction sites in Mexico City earning the equivalent of $120 USD per week… (This was 2003-2007 in a country that resides in the top 8% of the world’s wealthiest countries). This past year we returned to my father-in-law the equivalent of $8,500 USD for roasted coffee much higher prices than the typical buyer of roasted coffee would pay… and we have 3 of my brothers-in-law working with us 4 months per year at a total pay of $13,461 USD that also includes room, board, transportation, health insurance. We pay my father-in-law in advance for coffee we will use in the future… If you do the math, comparing these earnings with those in the U.S., you will understand why so many Mexicans enter the U.S. “illegally”… And why so many “American” manufacturers put their plants in Mexico… The Swine Flu of 2009 began in the state of Veracruz in the region of the giant Smithfield Foods Pork processing plants (Smithfield Foods is the #1 pork producer and processor in the U.S.) But why must they exist in Mexico? because minimum wage is $5 USD/day and they can break environmental and health laws without legal repercussions…? In the last 6 years, the # of the world’s millionaires decreased a little less than 1% while the # of Mexico’s Millionaires increased 30% But that increased wealth does not filter down in the least bit to those doing the difficult work… Instead, since NAFTA in 1994, there has been an incredible phenomena of Mexican farmers selling their land so that their sons can pay the “coyotes” fees for entering the U.S. “illegally”… I put the word in quotations because the movement of poor mexican farmers to the U.S. was also part of the North American Fair Trade Agreement… but only read between the lines…

Coffee… a great thing for the consumer who can encounter high quality coffee like what my father-in-law produces and what we sell… A bad thing if cultivating it is your main economic option. What would you, the reader, do if you coffee prices doubled because the 70+ coffee cultivating countries decided to offer the coffee farmer a fair price?

You may be thinking that this is a different discussion. But, it really isn’t. I’m reading Chris’s wonderful pieces on health and diet and translating it to my wife, in-laws and friends. But, health, diet and economy can NOT be separated… As you all should know, the international epidemic of obesity/metabolic disorder no longer is about “diseases of affluence” but about “affordable” food… and refined carbs are much less expensive today than true whole grain breads, true brown rice and healthier grains, such as quinoa. My specialty is international cuisine and I would love to offer wheatless, soyless, cornless baked goods etc. But, no one in Mexico would pay the cost for those products; quinoa flour costs 10 times that of processed wheat flour… During the 12 years I’ve been living in Mexico, the value of the Mexican Peso against the U.S. Dollar has gone from 10 pesos/dollar to 16 pesos per dollar… Since much of what is sold in Mexico is imported from the U.S., that means that the price of goods has increased minimally 40%. At the same time, minimum wage here has increased possibly 5% and the state and federal declared price of a kilo of coffee cherries remains the same (increasing when there is a drout or a plague, due to scarecity and immediately decreasing the following year when the plantations have returned to health). Since the farmers aren’t generally well educated (horrible rural school systems), they don’t understand about economics and real value of the Peso or true costs of living etc… But, they do understand that the value of their land increases greatly sold for sending their sons to the U.S. to work, instead of producing coffee or tomatoes or sugar cane…

The Day I Died...

... I woke up in Margarita and my bed in Guadalajara instead of in Sayulita... 7am... walked downstairs and prepared coffee in the Cuisinart, and re"fried" black beans on the stove... Drank a cup of coffee, eat a small bowl of "fried" black beans with raw tomato, raw onions and crumbled feta cheese... before I finished my cup of black coffee, I popped a chocolate truffle in my mouth from the birthday present Socorro gave Margarita last night... I had read the label on the box of truffles as I always do and accepted that it had partially (or not so partially--"they" don't specify) hydrogenated soybean oil (actually "they" specify "vegetable fat" as the first ingredient)...  Vegetable fat is what gives the chocolate (or chocolate bars) their texture and usually, their ability to remain hard (and why they have partially or not so partially hydrogenated vegetable oil, otherwise known as transfats)...  And, of course, soybean oil is the least expensive of the vegetable fats on the market...  What's the issue?  It seems that I have an allergy to soy...  But, when your diet is full of all sorts of crap, you don't so easily detect what is the cause of your malady.  Considering that I've removed basically all of the crap (the fun stuff) from my diet and a chocolate bar may be the only "pastry/desert" I experience in a week, it became very easy to detect reactions...  to wonderful supposedly high quality dark chocolate bars...  Sudden headaches, joint and muscle aches...  

I served myself another cup of coffee and went upstairs to check my correspondence and look at the photos Margarita and I took in Sayulita the past week... But, I immediately stopped drinking the coffee, thinking that maybe one cup was more than enough... because I started feeling bad.  It was like the occasional reactions to Alcohol or Apple Cider (sulphites) I knew since drinking that wonderful apple cider in the parking lot of the Oldwick General Store with Francesca in 1986... Pain in the chest, headache, muscle aches in my back or in my abdomin.  However, this time I wasn't experiencing rapid heart beat and migrain-like headache... my muscle cramps were softer... and this time my greatest pain was in the esophagus rising to the lower back jaw and the molers...  I mentioned to Margarita that I was having an alcohol-like reaction and that it would pass in 30 minutes...  But it didn't pass.  So I layed down in my bed hoping the relaxation would lead to its passing...  And it didn't pass, although I did fall asleep momentarily...  

When I awakened I decided that it did not make a difference if I was sitting at the computer or laying in bed... the pain in the throat would continue... so I want back downstairs and took my BP... it was a bit high...  in the 144/100 range... which I attributed to the sudden change in altitude after being on the coast for a week.  I returned upstairs and proceeded to do a set of 72 quick push-ups and then a set of 20 wheel crunches (if that's what they are called; we call it "the llantita"...)  I imagined that if I was having a prolonged sulphure-like allergic reaction (or a heart attack), I wouldn't be able to do my usual over 60 reps of quick push-ups, and less 20 reps of the llantita... or I would be very fatigued... But, I was able to do them... and took my bp again; it dropped about 10-15 points... but the pains continued.  Margarita said that she was ready to leave for our 5km run when I was ready...  and I hesitated a while... in the end, I made it out to the Metropolitan Park and a cool but very sunny day and took off my shirt... not enough sun on the beach?  Possibly never enough Vitamin D... for lowering BP amongst other things...  I doubted I would be able to withstand the 5km run... because of the continuing pain in my throat and chest, that radiated towards my back, was felt in my lower abdomin and lower back too... and caused a strange coughing like the clearing of my throat.  But, in the end, my legs (like my arms) proved unaffected by the possible reaction to the soybean oil in the truffles and I managed a slow but firm run...  At first, it seemed that the run or the pumping of blood through my body during the first brisk mile removed the pain from my throat and chest.  But, later on it returned as it had been...  Something I imagined I must live with for a while more...  

Margarita and I passed by the local super-mall for looking for some inexpensive videos at Mix-Up music store... and I suddenly felt nauseous... but I let it pass... we were looking for "Ghost", "Dirty Dancing" (part of a ride home conversation yesterday... why? I don't remember) and some Oscar Award winning movies staring Penelope Cruz or written by Almodavar... or not award winning but starring Tom Cruise and Penelope Cruz or the wonderful mouthed Scarlett Johanssen... We didn't find the Tom Cruise, but we did find the Patrick Swayze and Woopie Goldberg and Almodavar and Penelope Cruz and Woody Allen with Scarlett Johanssen...  And "Small Town; Big Gun" that we wanted to see for Margarita's birthday a year ago... but for some reason they always removed from the theater the day we went to see it...  

And then I started feeling woosy again... And then I had to stop the car on the side of Costco and lie down in back...  And because Margarita was anxious to go home to eat (I was also hungry, but now very nauseous and not feeling very capable of driving), I shortened that stint and drove the 20 minutes home in fast traffic the best I could... the last few blocks greatly worried that I would accident... and it seemed that I also was experiencing a sudden bout of diarrhea... and parked as quickly as I could, ran to the bathroom and gave Margarita the keys to the kitchen door... But, really didn't have the energy for going to the bathroom, although it felt like diarrhea...  And the pain in the chest and what felt like irregular heartbeats... and I lay down on the couch for a minute and didn't eat the scrambled eggs Margarita prepared me, although she has the magic touch for scrambled... and I took my BP...  90/56, heart rate around 50... explaining the dizziness/nausea... But only something I knew after mild anesthesia or the wrong ADD medication in '86...  Margarita suggested preparing me coffee with milk and sugar, thinking that I was experiencing a shortage of sugar after the run, although I told her I had eaten that Truffle and a left-over corn tortilla in the morning...  And when I was running 7 miles per day, I didn't experience this...

And went upstairs to sleep...  

Margarita followed me upstairs with the cup of coffee and lay in bed with me, hugging me from behind... I imagine we slept a few minutes... And I went downstairs to eat my cold eggs and cold re"fried" black beans and drink my cup of cold regular coffee... And everything was fine cold... although I felt cold... Mexico was hit by an incredible cold spell that we felt in Sayulita (that made the vacation that much more enjoyable, since there was no hot humidity, although the air was brisk in the strong sunlight... but we didn't experience uncomfortable sweating there and slept wonderfully).  But here it is cold and sunny...  And I'm sitting at the computer with shorts, sandles and a T-shirt...  While eating, my BP had risen a few points, but was still very low for me... Now after writing for a while (writing on the computer greatly raises my BP and why I don't spend so much time writing these years, since it could actually be dangerous for me) and the cup of coffee having taken affect, my BP is at 119/76 with a pulse around 72...  I'm tired, which is normal after exercise... the pain in my chest and my throat (always more pronounced in my throat) has dulled some...  

And maybe it is a form of heart failure... maybe it is just a form of allergic reaction... from the soybean oil... 

I won't be visiting a doctor, nor a hospital...  You should understand why not... 

And if it is an impending heart attack... I was thinking about this with half-closed eyes sitting in the bathroom hours earlier... "what I was doing the day I died..." because, if this is it, no one will know what happened or what was happening... if I don't write this beforehand...  

Heart failure is the result of accumulated damage over many many years of poor eating habits and poor exercise habits... My blood tests could come back perfect today and still could be approaching a heart attack or a stroke from plaques accumulated over the years (arterial plaques are the body's attempt towards repairing damage to the arterial walls... they are similar to the welding of a scrap of iron to a pipe that has a fracture or hole... The arteries aren't returned to new, and the plaque invades some of the space of the blood stream--current...)  There are a lot of things we can do to try and reverse the destruction against our bodies... we can become very healthy in the end... and still suddenly die of a heart attack or a stroke or cancer...  And why the late stage surgeries (which most are) and the medications and the chemotherapy and the radiation therapy DON'T CHANGE ANYTHING FOR THE BETTER...  ask Patrick Swayze and Laura Ziskin and how many others who were NOT saved by the chemotherapy...  Patrick blamed his Pancreatic Cancer on his chain smoking, which he continued until his death.  But, the moving of the cancer from the Pancrease to the Liver to the Stomach to the small intestine was blamed upon the Chemo...  And he only live 20 months after the diagnosis and the surgeries and the radiation and the chemo... and Barbara Walters asked him if he was doing any homeopathy... and he said, "some chinese herbs" which means, "no"...  But, the doctors gained a ton of money and Patrick's family can say to itself (especially his wife now remarried) that they "did all [they] could"...  If you don't spend the money and make him suffer a bit more, you will suffer with horrible doubt and possible recriminations...  But, "if you did all that you could within your means" (making the doctors and pharmaceuticals richer) and he or she dies, at their death you can live at peace with yourself... But if you didn't do all of that, you would suffer for years after he or she died... 

Do you get my jist?

And maybe I'll live to 95 years and not just 45.5... But, I've never felt this before... So, I'm living in doubt... But, I will be damned if I give that false power over my body and economy to doctors and pharmaceuticals who aren't there to help you... nor do they believe they can actually truly help you...  They are not in the healing "business" for many decades now...  The sell you "peace of mind"...  But, only if you didn't know better...  

We all die at any given time...  Most deaths aren't announced... Nor are they like in Hollywood films... giving the spouse time to say goodbye... 

And that's something that worries me...  That she suddenly had the lights turned out on her... and no, the lights weren't turned out on her... it would be much easier...  if the ending was truly the ending... and we could actually move on unscathed...  

And I don't know why I mentioned "Ghost" and felt I must purchase the video if I couldn't find it on Youtube... Instead we found on YouTube the wonderful Spanish/Italian/Bosnian film starring Penelope Cruz and Emile Hirsch "Twice Born" and another very interesting Spanish film starring Penelope Cruz "Open Your Eyes"... Suddenly losing someone very important to you... Who knows? Maybe for the survivors, cancer is the best solution, because they're there dying with you for a while... nothing sudden and shocking...  like an accident or a bombing or an assault or a heart attack... 

Who knows? 

Perigrinación con otro cuñado... o cuando la elefante le da luz a un raton...

... y la raton le da luz a un gatito y despues...

en algún lugar en los mediados de la peregrinación dijo el cuñado numero cuatro...


"Si es estresante, cuando regreso a pensar en lo que hemos pasado para trabajar y llegar al dia de hoy, tambien ver como te esfuerzas por sacar adelante el negocio y manejarlo de manera que lo haces, si es mucho esfuerzo y dedicación.  Como me comentabas en león mucha de la parte para que funcione el negocio es como se trabaja, como se dirije y quien lo maneja (en este caso tú) (y margarita el esmero que le pone) bueno acerca de José si se descuido y parece que es parte del descuido que viene de la generaciones pasadas, unos descuidaron sus hijos, otros sus recursos y otros descuidamos nuestra salud ¿o que es? yo siento que adentro de esto hay un transfondo o igual como dicen me estoy malviajando a otro lado, bueno Ross- espero no causarles mas estres" 

y respondí:

Descuidos... es un problema tamaño de la Luna... y no creo que existe un remedio cerca de adecuado... como dije a [cuñado numero seis] hace cuantas semanas... existen 3 tiempos en el rancho... y no se como explicarlo... Pero, parece que siempre vamos encontrar que se acabo el tiempo... Necesitamos más tiempo... o Necesitamos que se hace más rápido el entendimiento... o necesitamos que tienen más paciencia... y necesitamos que entienden de preparar para el futuro porque un día llegamos al supuesto futuro y no hemos hecho que tuvieramos que haber hecho para estar verdaderamente bien... Ahora estamos en la emergencia del futuro descuidado y tenemos que usar los recursos que fueron para los quien nos siguen... las generaciones no nacidas... Entonces, sin que respiran un gramo de aire, están congelados en el futuro que no logramos hacer para ellos... y no pueden lograr, aunque no fue su decisión de fallar... ¿cuanto tenemos que trabajar para ponerles al tiempo con lo de más del mundo?

Tú madre dijo a tus hermanas "no tienen que hacer que hizo Margarita"... es decir, "No tienen que juntarse con un extranjero como hizo Margarita"... ¿por qué no? si lo quisiera hacerlo una de las tres, ¿que seria la probabilidad de repetirla? Y, de verdad, ¿que fue el verdadera mensaje les dio a ellas tú madre?

Y no tiene la culpa tú madre... estaba participando en el gran descuido o la gran tragedia... pero, ¿tragedia para quien si todos la eligieron en una forma o otra la gran tragedia?

Es para los niños quien no fueron dada la oportunidad de eligir una otra experiencia... Es una tragedia para el niño despertando como adulto grande y viendo con todas las ganas de encontrar la otra salida, que no tiene las herramientas ni las invitaciones, ni la preparación ni la educación para responder bien a las invitaciones...

Behind the Veil: Conflicts of Interest and Fraud in Medical Research

by CHRIS KRESSER 

If you want to read the very interesting and informative comments at the end of this piece:  http://chriskresser.com/behind-the-veil-conflicts-of-interest-and-fraud-in-medical-research


Recent reports have revealed that conflicts of interest and research fraud are rarely reported in the scientific literature or announced to the general public, which raises questions about the integrity of clinical trials and the reliability of public agencies like the FDA and CDC.

A couple of weeks ago I wrote an article called Why Are Scientists and the Public So Often at Odds? I described the frequent disconnect between scientists and the general public on controversial issues like nutrition, vaccination, climate change, and genetically-modified foods.

In that article, argued that both the general public and scientists were to blame for the disconnect. In some cases the public does act out of ignorance, whether intentionally or unintentionally; in other cases, scientists have ignored the very real limitations and problems with the research they rely on to reach consensus.


Why conflicts of interest and fraud harm the public’s trust of medical research.

In this article, I’m going to discuss two other reasons that the public mistrusts scientific research: fraud, and conflicts of interest.
Fraud in Medical Research: “Out of Sight, Out of Mind, and Out of the Peer-Reviewed Literature”

A large part of the subtitle above comes directly from a paper published in JAMA Internal Medicine, authored by Charles Seife. (1) In short, Seife discovered that clinical trial data determined to be fraudulent or mishandled by the FDA is rarely excluded from research studies published in scientific journals.

One of the FDA’s roles in the drug approval process is to inspect clinical trial sites to determine whether these sites are complying with FDA regulations. A typical inspection might involve auditing the records of the site, verifying that investigators adhered to the trial protocol, and comparing an investigator’s notes in hospital records with data reported to the study sponsor to ensure that there aren’t any discrepancies.

If there is a violation, the FDA classifies it in one of two ways: Voluntary action indicated (VAI) means the inspectors have found violations, but the problems aren’t serious enough to require sanction. Official action indicated (OAI) means that the inspectors have found violations significant enough to warrant official action.

Siefe and his assistants used the Freedom of Information Act to request information from the FDA, and supplemented that data with Google searches of the FDA database. They found 57 clinical trials that were directly linked to an OAI inspection.

The misconduct identified by the FDA in these cases included:
Falsification or submission of false information
Underreporting of adverse events
Failure to follow the investigational plan or other violations of protocol
Inadequate record keeping
Failure to protect the rights, safety, and welfare of patients
Use of experimental compounds in patients not enrolled in trials
Failure to supervise clinical investigations properly

The 57 trials Seife identified were in turn linked to 78 research articles published in the peer-reviewed scientific literature. 96 percent of these articles failed to mention the violations identified by the FDA inspection—despite the fact that in the majority of cases the inspection was completed at least 6 months before the article was published.

Doctors, researchers, and other health professionals rely on scientific studies to establish treatment protocols and public health policies. If the data in some of these studies are fraudulent, but the doctors and researchers have no way of knowing that, the decisions they make may be unsound and even put people at unnecessary risk.

I’d like to make the significance of these omissions even more clear by sharing a couple of examples mentioned in Seife’s paper.

One case involved a researcher who falsified lab test results to hide a patient’s impaired kidney and liver function in a trial comparing two chemotherapy regimens. The first dose of the regimen proved to be fatal to this patient, and the researcher was sentenced to 71 months in prison. Despite this episode being described in both FDA and court documents, not one of the studies in the peer-reviewed literature associated with the chemotherapy trial have any mention of the falsification, fraud, or homicide.

Another case involved a clinical site in China participating in a large trial of apixaban, an anticoagulant (i.e. anti-clotting) drug. The FDA determined that this trial site had altered patient records and falsified data. If the data from this site had been excluded, the mortality benefit for the drug would have disappeared. In other words, the “proof” that this drug saved lives was dependent on this fraudulent data. Yet none of this discussion appears in the scientific literature. In fact, studies since 2011 have consistently relied on the full data set (including the fraudulent data from the China trial site), and this was even true for an article published nearly 18 months after the fraud was discovered.

How can such egregious cases of fraud and misconduct go unreported in the scientific literature and in the media? The answer is almost hard to believe. The FDA does not notify journals when a site participating in a clinical trial receives an OAI inspection, nor does it typically make any announcement which would alert the media and general public to the issues it identified.

What’s more, the documents the FDA produces about these OAI inspections are heavily redacted, which makes it extremely difficult even for researchers like Seife who’ve invoked the Freedom of Information Act to determine which published clinical trials are tainted by misconduct. The FDA redacts these documents because it considers the identity of the drug company involved in the trial to be “confidential commercial information” that it is bound to protect.

In other words, the FDA appears to believe that it’s more important to protect private, commercial interests than it is to protect public health.

Seife’s says as much in the conclusion of his paper:

However, failing to notify the medical or scientific communities about allegations of serious research misconduct in clinical trials is incompatible with the FDA’s mission to protect the public health. Such allegations are relevant to include in the peer-reviewed literature on which physicians and other medical researchers rely to help them choose treatments that they offer to patients and other research participants.

The issues highlighted here raise serious concerns not only about the trustworthiness of the data in clinical trials and published research, but the reliability and motives of the agencies tasked with protecting public health.

Which takes us to the second reason that public mistrust of scientific research is sometimes well-founded: conflicts of interest.
Conflicts of Interest in Research Are Common—and Often Unreported

In my article about the disconnect between scientists and the public, I mentioned that two-thirds of medical research is sponsored by drug companies, and industry-sponsored trials are more likely to report favorable results for drugs because of biased reporting, biased interpretation, or both. (2) This is a well-established phenomenon, and it has been explored in both the media and the scientific literature:
Can the Source of Funding for Medical Research Affect the Results? (Scientific American)
Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients (a book authored by Ben Goldacre)
How Pharmaceutical Industry Funding Affects Trial Outcomes (Social Science & Medicine)
Pharmaceutical Industry Sponsorship and Research Outcome and Quality: Systematic Review (British Medical Journal)
Association Between Industry Funding and Statistically Significant Pro-Industry Findings in Medical and Surgical Randomized Trials (Canadian Medical Association Journal)

Is it really a big surprise that the source of funding influences study results? After all, as Upton Sinclair famously said, “It’s difficult to get a man to understand something, when his salary is dependent upon him not understanding it.” The time-honored saying “don’t bite the hand that feeds you” also applies here.

Unfortunately, just as research misconduct and fraud is often not reported, conflicts of interest in academic research are rarely disclosed. According to a 2009 reportissued by the Department of Health and Human Services, very few universities make required reports to the government about the financial conflicts of interest of their researchers—and even when they are reported, the universities rarely require those researchers to eliminate or reduce these conflicts.

In fact, 90 percent of universities relied solely on the researchers themselves to decide whether to report their potential conflicts of interest, and half of universities don’t even ask their faculty to disclose the amount of money or stock they make from drug or device makers.

This isn’t likely to change anytime soon, according to Eric G. Campbell, an associate professor at Harvard Medical School that was quoted in this New York Times article covering the report. He said that “universities had no interest in putting real limits on the incomes of their star researchers for fear that those researchers would leave for institutions with fewer restrictions.”

But conflicts of interest aren’t just a problem in academia; they’re also a problem on expert advisory panels that influence public health policy. For example, back in 2008 Dr. John Briffa linked to a web page disclosing the conflicts of interest in members of the National Cholesterol Education Program, a government organization that creates the official blood cholesterol target values for the U.S..

Are you ready for this? 8 out of the 9 doctors on the panel had direct ties to statin drug manufacturers. Here’s the complete list, excerpted from a post written by Dr. Stephan Guyenet in 2008 (the companies in bold are statin manufacturers):

Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, andAstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline.

Dr. Cleeman has no financial relationships to disclose.

Dr. Bairey Merz has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-Myers Squibb Medical Imaging; she has received a research grant fromMerck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.

Dr. Brewer has received honoraria from AstraZeneca, Pfizer, Lipid Sciences,Merck, Merck/Schering-Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis.

Dr. Clark has received honoraria for educational presentations from Abbott,AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol-Myers Squibb,Merck, and Pfizer.

Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca,Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, andPfizer.

Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS-Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca.

Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson.

Dr. Stone has received honoraria for educational lectures from Abbott,AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough,Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant.

Another 2009 report, also from the Department of Health and Human Services, revealed similar issues with expert panels that advise the Centers for Disease Control (CDC) on vaccine safety. The report found that 64 percent of experts who served on advisory panels in 2007 to evaluate vaccines for flu and cervical cancer had potential conflicts of interest that were never identified or resolved. The report also revealed that the CDC failed nearly every time to ensure that experts adequately disclosed that they were being paid by vaccine manufacturers.

Can you see how these conflicts of interest might be a problem, when the advisory committees mentioned above strongly influence the sales of both statin drugs ($30 billion a year) and vaccines ($20 billion a year)?

Sadly, these financial relationships between experts who influence or formulate guidelines and drug companies whose drugs are being considered are not the exception, they’re the rule. A study published in JAMA shows that 59 percent of the experts participating in guideline creation have such financial ties. (3)

Another related problem is the “revolving door” between public agencies like the CDC and FDA or institutions like the U.S. Congress, and pharmaceutical companies. A year after leaving her position as the director of the CDC in 2009, Dr. Julie Gerberding took a position as president of Merck Vaccines. Another former CDC employee, Dr. Thomas Verstraeten, took a position with GlaxoSmithKline (a vaccine manufacturer) while he was still involved in completing a major study on the possible negative side effects of thimerosal (a mercury-containing compound used in some vaccines) at the CDC. Finally, over half of the lobbyists employed by the pharmaceutical industry in 2008 had worked in Congress or another branch of the federal government, and 35 had been former members of Congress. (4)

These conflicts of interest do not necessarily lead to fraud or misconduct. There are surely many honest and unbiased researchers and physicians investigating controversial topics like cholesterol targets and statin drugs, vaccines, and genetically-modified foods. However, studies have confirmed what common sense and an understanding of human nature would also suggest: conflicts of interest can and do influence both individuals and institutions. For example, the financial interests of researchers are positively associated with outcomes favorable to the sponsor in medical studies, and research institutions can be influenced by industry sponsorships such as grants, endowed chairs, and other gifts. (5, 6, 7, 8)
Concluding thoughts

My purpose here is not to attack the credibility of scientific research as a whole, or scientists as a group. But science is a human endeavor, and like all human endeavors, it is subject to the vagaries of human ethics and behavior. There is good science, and bad science; there is honest science, and dishonest science.

If you’ve been following my work for several years, you’ll know that my blog used to be called “The Healthy Skeptic”. I called it that because I believe that skepticism is healthy when it comes to science. Yet all too often I see this skepticism being applied in a biased or inconsistent manner.

For example, I’ve noticed that some people who are indignant about conflicts of interest in government agencies responsible for bank bailouts or among experts responsible for establishing blood cholesterol targets are completely unwilling to consider how similar conflicts might affect research on, say, vaccines or genetically-modified foods.

I’ve also encountered people who are skeptical of any challenge to the status quo, but don’t apply their skepticism with the same rigor to the the status quo itself. On the other side of the coin are those that accept unconventional or alternative ideas (regardless of whether there is evidence to support them), and tend to reject anything that could be remotely construed as conventional or mainstream.

Someday, perhaps we’ll be able to extricate the financial interests of Big Pharma from the behavior of medical scientists and regulatory agencies. Until then, our responsibility—whether we are clinicians, patients, researchers, or members of the media—is to acknowledge the influence these relationships may have on scientific research, and take that influence into account when considering controversial issues—especially when large amounts of money are at stake.

Now I’d like to hear from you. Were you aware that research misconduct rarely gets reported on in the media or scientific literature? Are you surprised by the extent to which conflicts of interest are present on advisory panels responsible for creating guidelines? How do you feel about this subject after reading this article? Let us know in the comments section.