A study to investigate vitamin E’s ability to protect men against prostate cancer was funded in part by the National Cancer Institute and the National Center for Complementary and Alternative Medicine (National Institutes of Health). The study started in 2001, and involved 35,533 healthy men over age 50 from 427 study sites in the United States, Canada, and Puerto Rico. The results originally reported in 2008 found there was no significant reduction in prostate cancer with Vitamin E supplementation. But the investigators saw a trend toward a higher rate of prostate cancer, and decided to continue following the men after the study ended. The data collected by the study up to July 5, 2011 disclosed a 17% higher incidence of prostate cancer in the men who had taken 400 IU of vitamin E daily. Quite unexpectedly, it was found that not only did vitamin E fail to reduce the risk of prostate cancer, but it actually increased the risk.

A recent report of another study was published in the October 10, 2011 issue of the Archives of Internal Medicine. This study involved 38,772 women between the ages of 55 and 69 years, with an average age of 61.6 years at the beginning of the investigation. As was expected, most of the vitamin supplements studied were not associated with a reduced total mortality rate. But unexpectedly, vitamin B6 , folic acid, iron, magnesium, and zinc were associated with a 3% to 6% increased risk of death, and copper was associated with an 18% increased risk of death, when compared to corresponding nonuse. Some medical doctors/commentators have suggested that this study adds “to the growing evidence” demonstrating that certain supplements can be harmful. They further state that, “Those supplements do not replace or add to the benefits of eating fruits and vegetables and may cause unwanted health consequences.”

Another report recently published in the Journal of Clinical Endocrinology & Metabolism brings to light some examples of mislabeling and mis-formulation of vitamin supplements made in the United States. A 58 year old man had been complaining for several weeks of fatigue, excessive thirst, excess urination, and poor mental focus. For two months, he had been taking a vitamin D3 supplement. When the supplement was tested, it was discovered that each capsule contained 186,400 IU of vitamin D3 instead of the 1,600 IU stated on the label. In addition, the instructions on the label mistakenly recommended 10 capsules a day, instead of one. In excess of a thousand times more vitamin D3 than what the manufacturer stated on the label was ingested daily for two months, and it took a year for the vitamin D levels in the body to normalize and for the symptoms to disappear.

Gary Null, Ph.D refers to himself as “America’s leading health and nutrition expert,” markets dietary supplements, and operates health food stores in New York City. In 2010, Mr. Null claimed he was nearly killed by one of his own supplements. He sued the manufacturer with whom he had contracted to produce the supplement, claiming that it contained 1,000 times the labeled dose of vitamin D, caused him kidney damage, severe pain, and led to the hospitalization of six consumers also poisoned by the excessive dose of vitamin D. The Los Angeles Times wrote about Mr. Null’s lawsuit, and noted that it was common for dietary supplements to contain doses “wildly different than those indicated on their label” as a result of weak regulation of the industry.

Most physicians will suggest that a well balanced diet is the surest path to a healthier lifestyle. Before consuming any over the counter vitamin supplements talk to your family physician. If you start taking vitamins and have symptoms or feel that something is not quite right, stop taking them until your doctor eliminates the supplement as the cause.

It’s beginning to look like medical science is catching up with what mom knew all along. Eat your fruits and vegetables.

Most politicians are hypocrites. What they say and what they do are rarely the same. Florida Governor Rick Scott has proven himself to be a true politician, tailoring his message to whatever audience he stands before. He kept a campaign promise and sold (below market value) the State’s Beech King Air and Cessna Citation aircraft as soon as he took office. Prior to his election, and obviously playing on the negative public sentiment created when the CEO's of the Big Three auto makers traveled to DC by company aircraft to request government bailout money, Scott promised that if elected, he would get rid of the airplanes. He preached to the voters that business aircraft are, plain and simple, a waste of money (See my January 14, 2011 Blog). All this anti-aircraft rhetoric from a man who built his Columbia/HCA empire (which became the largest, private for-profit health care company in the US) using his personal Gulfstream jet for business travel (which he still uses). Clearly, Governor Scott knows the utility, and time and cost savings, of travel by business aircraft. And now the icing on the hypocritical cake. On Dec 5, 2011 I attended the opening of Brazilian aircraft manufacturer Embraer’s Global Customer Center at the Melbourne, Florida airport. Anyone in the world who is buying an Embraer business jet will come to this state of the art facility to choose the details of their aircraft. Embraer, a world leader in the manufacture of business jets, also opened its first aircraft assembly facility in the US at the Melbourne, Florida airport earlier this year. Embraer's $50 million, 150,000 square foot high tech facility will employ hundreds of skilled workers. Fortunately, Embraer made its committment to Florida before Scott became governor. Governor Scott attended the opening, and talked about how wonderful it is that Embraer is building business jets in Florida, and how wonderful it is that the Global Customer Center is in Florida, and how wonderful it is that Embraer plans future expansion, and how he hopes they sell lots of business jets. For a Governor who campaigned on a promise to get rid of the State's business aircraft as wasteful and carried out the promise, Governor Hypocrite has proven how skillful he is at tailoring his message to what he believes his audience wants to hear. Yes, Governor, business aviation creates jobs, pumps money into the economy, and saves business travelers time and money. Embraer builds some of the best business jets, and as a result Florida will benefit.

Airline travel is truly one of the safest, most efficient, and fun forms of transportation. Even with the airport security screenings we must endure, no other form of public transportation can get us to our destination faster. However, you should be aware of a relatively rare but potentially hazardous event that has been known to occur on some flights. It is manifested by the appearance of what has been described as light smoke, vapor, or mist, and an odor in the passenger cabin. It is sometimes quickly dissipated, and sometimes it lasts a long time. Although there is a controversy over whether this can damage your health, a recent court decision has found that there is a causal connection between breathing this contaminated cabin air and specific health problems which then follow.

The problem arises when turbine oil leaks from a jet engine, or from an auxiliary power unit (APU), and is “pyrolized” by the very hot operating temperature. The oil contains a very small amount of an anti-wear compound, tricresyl phosphate (TCP), which is known to be toxic to humans. Pyrolizing is similar to vaporizing, and when the oil leak occurs in the part of the engine or APU that is used to provide the cabin air we breathe, the result may appear as a cloud of smoke, or vapor, or mist which contains TCP. This occurrence is often referred to as a “fume event.”

Those who have reported fume events also report the immediate onset of symptoms which include coughing, a burning throat, sore eyes, and headache. Sometimes all the symptoms never resolve, and a diagnosis of Reactive Airways Dysfunction Syndrome (RADS), a form of asthma, is common. RADS is a permanent condition that can be managed, but not cured. The coughing never goes away.

It is impossible to determine how many fume events actually have occurred on airline flights. The Federal Aviation Administration (FAA) maintains a database of Service Difficulty Reports (SDR’s), which are maintenance incidents self-reported by the airlines and other aircraft operators. However, the data is considered to be incomplete, even by the FAA. By some estimates, as much as 90% of reportable maintenance incidents are not reported. A search of the SDR database for the period January 1, 2008 through June 30, 2011 shows 149 reported events of smoke in the cabin resulting from engine or APU oil-related issues.

If you are traveling on an airline flight and experience a fume event, you should consider asking a flight attendant for supplemental breathing oxygen, especially if the toxic vapors do not dissipate quickly. Make a formal report of the event to the airline, and seek medical attention as soon as practical.

According to a study reported in Anesthesiology (April, 2009), the journal of the American Society of Anesthesiologists, between 1999 and 2005 there were 2,211 anesthesia-related deaths in the United States. Of those deaths, almost half (47%) were the result of general anesthesia overdose.

On May 18, 2010, CNN published the story of a woman who woke up in the middle of major surgery. The first thing she heard was “Cut deeper, pull harder.” Although the general anesthesia she had received was insufficient to keep her unconscious, it kept her from screaming or even moving a finger. According to a study reported by the Mayo Clinic, about 1 or 2 people in every 1000 may wake up while under general anesthesia, which is known as “anesthesia awareness”. Although in most cases the person does not feel pain, some people do experience excruciating pain and develop long-term psychological problems.

Clearly, anyone who is about to undergo a surgical procedure under general anesthesia has good reason to question the anesthesiologist in advance of surgery, and to ask how the appropriate drug and its dosage will be determined in order to assure good quality anesthesia without the risk of an overdose. Too much anesthetic can result in death, temporary mental impairment, or permanent brain damage, and too little can result in anesthesia awareness. Unfortunately for us, the administering of general anesthesia appears to be as much an imprecise art as it is a science.

The word “anesthesia” can be defined as “loss of sensation or awareness”. Every day, thousands of people undergo surgery with the safe, effective use of anesthesia. Local anesthesia numbs a small part of the body, usually by injections or ointments. Regional anesthesia is the use of a local anesthetic to numb a larger part of the body by injecting the local anesthetic drugs near the nerve bundle affecting the desired area, with the effect of interrupting the signals between that area and the brain. Sometimes referred to as “blocks,” the most common regional anesthetics are epidural and spinal. General anesthesia is the inducing of a state of controlled unconsciousness accompanied by the absence of pain, the paralysis of the entire body, and loss of memory. During general anesthesia, drugs are injected into a vein or gases may be breathed into the lungs. Interestingly, the precise mechanism of general anesthesia is not yet fully understood, and research to understand it is ongoing.

General anesthesia is more than simply putting the patient to sleep. The loss of consciousness experienced in sleep, compared to the loss of consciousness induced by general anesthesia, is significantly different. When we fall asleep, our consciousness fades and we enter sleep cycles. These cycles are classified as either REM (rapid eye movement) sleep, when remembered dreams occur, or non-REM sleep, during which the sleeper may be drowsy and lose consciousness, or may even be in deep sleep, but dreams are more like short flashes and are usually not remembered. The sleeper passes through several stages during a typical sleep and several transitions between REM and non-REM sleep occur. When we sleep, our brain is in its most active state, organizing knowledge and memories.

On the operating table, the brain uses less oxygen and is less active. The general anesthesia applied before surgery needs to guarantee not only the loss of consciousness, but also sedation, immobility, the loss of memory, and the absence of pain. Since general anesthesia inhibits the parts of the brain which are required for REM sleep, anesthetized subjects do not have REM sleep and usually do not remember dreams. While sleep can be reversed by shaking or loud noises, general anesthesia is reversed only by eliminating the anesthetic drugs.

Traditionally, anesthesiologists are trained to monitor vital signs -- the patient’s oxygenation (concentration of oxygen in the blood and inspired gas), ventilation (breathing), circulation (EKG, blood pressure, and heart rate) and temperature – in order to assess the depth and effectiveness of general anesthesia. By continuously monitoring the patient’s vital signs, together with the anesthesiologist’s clinical experience and judgment, the anesthesiologist determines if a correct amount of anesthetic is being administered to safely keep the patient unconscious. According to Barry L. Friedberg, MD, a Board Certified anesthesiologist who has been quoted in medical journals and anesthesia textbooks, and who has lectured on the subject to surgeons and anesthesiologists in the United States, Canada, Mexico, the Dominican Republic, Israel and Venezuela, anesthesiologists would be able to determine a more exact general anesthesia dosage if they would use a device known as a brain function monitor to more accurately monitor consciousness.

“The brain is the target for anesthesia. It’s critical for the brain to be measured with a brain activity monitor; however, most anesthesiologists are not doing this”, says Dr. Friedberg. “Brain monitoring doesn’t replace vital signs monitoring, but vital signs monitoring can’t give you the information that the brain monitor does,” he says. “Anesthesiologists were trained like I was years ago to believe that heart rate and blood pressure changes are a clue to what goes on inside the brain, but to make sure you give enough you always have to overmedicate by 20 to 30 percent. Using a brain monitor, of course, this type of practice becomes superfluous because it turns out that heart rate and blood pressure changes have almost nothing to do whatsoever with what’s going on in your brain.” “It’s a [$25.00 disposable] sensor that sits on the forehead and plugs into a computer and the computer generates a number from 0 to 100 that allows you to measure the individual response of each patient, so instead of a one size fits most you get a this size is your size for your operation today.” “Without a brain monitor, anesthesiology is not an exact science. With a brain monitor, each patient becomes an open book test instead of a mystery to be solved.” Dr. Friedberg emphasizes he does not make money by spreading this message, he does not have a financial interest in the monitor manufacturers, and he does not have an axe to grind with the drug companies. “We should focus on caring for patients, and understanding the long term risks of overmedicating patients while in surgery. We should be using every tool available to keep them healthy and reduce unnecessary risks through the entire treatment process.” “Nobody should have general anesthesia without a brain monitor. Most people don’t realize that if they don’t ask specifically, the anesthesiologist is not going to use it.”

Currently there are brain monitors available in almost half the operating rooms in the United States. Brain function monitoring technology is widely studied and widely accepted, and is supported by more than 3,300 published studies. The technology has been used on more than 34 million patients around the world, and is utilized in more than 80% of the top ranked US hospitals (according to US News and World Report ranking). However, there is controversy about the effectiveness of the use of brain function monitors.

Some studies claim there is no benefit in using brain function monitoring to prevent anesthesia awareness. Other studies suggest that the decision to use a brain function monitor should be made on a case-by-case basis by the anesthesiologist for selected patients, such as patients undergoing trauma surgery or cesarean section who cannot tolerate a deep anesthetic. Providing a lighter than normal anesthetic to at-risk patients may be a necessary step taken by the anesthesiologist. Advocates like Dr. Friedberg say brain monitoring is essential to ensure the patient achieves the appropriate level of anesthesia. Nevertheless, the American Society of Anesthesiologists foresees brain activity monitoring as a standard of care in the administration of general anesthesia.

Twin Cities-Bound Passengers Stranded on Tarmac at JFK For 6 Hours

“It was a nightmare,” said one passenger. “I pleaded with an airline representative to let the passengers off until we could depart,” said the pilot.

Passengers Stranded Overnight on the Tarmac

“I felt imprisoned for five and a half hours; I wish I would have been cogent enough to go to a flight attendant and say we need to go into the terminal for chairs, light, food and drink,” said a passenger.

Passengers Stranded on a Plane Are Really Stuck

Passengers on a flight to Cancun wait eight and a half hours to take off, then the flight is canceled.

We all know that traveling by the airlines is the fastest and most efficient way to get where we want to go, but occasionally things can and do go wrong. Airline passengers become poorly treated captives when a departing flight sits on the tarmac and does not depart, or an arriving flight sits on the tarmac and does not deplane. Until recently, the traveling public had no way to hold the airlines accountable. Take heart, weary travelers, help is on the horizon.

Recognizing that airline passengers have rights (an astounding revelation), the Department of Transportation has published new rules entitled, “Enhanced Protection for Airline Passengers” (14 CFR Part 259). The stated purpose of the new rules “is to mitigate hardships for airline passengers during lengthy tarmac delays and otherwise to bolster air carriers’ accountability to consumers.” The rules become effective April 30, 2010, and provide in part:

· For domestic flights, airlines must not permit an aircraft to remain on the tarmac for more than three hours unless there is a safety or security related reason. For international flights, the airline sets the number of hours itself.

· For all flights, airlines must provide adequate food and water no later than 2 hours after the aircraft leaves the gate (departure) or touches down (arrival) if the aircraft remains on the tarmac, unless there is a safety or security related reason.

· For all flights, airlines must provide adequate lavatory facilities and medical attention if needed, while the aircraft remains on the tarmac.

Failure to comply with the new rules is deemed to be an unfair and deceptive trade practice that is subject to enforcement by the Department of Transportation.

From a passenger’s perspective, the new rules provide a welcome relief. Perhaps predictably, the airlines claim the new rules are inconsistent with the goal of completing as many flights as possible. James May, president and CEO of the Air Transport Association, which represents the major U.S. airlines, issued a statement in response to the new rules, claiming there will be more canceled flights and greater passenger inconvenience if aircraft have to return to the gates within a three hour window or face significant fines. After April 30, 2010, we will find out if the new rules are a blessing or a curse to airline passengers.

Although it has been more than 100 years since the Wright brothers opened the door to heavier than air powered flight, some people still board the most technologically advanced airliners with a fear that they may never return.

Everyday life is full of risks, whether it is crossing the street in traffic or driving to work. How we manage those risks will determine our “survivability”. If we cross the street only at a crosswalk and only when the sign tells us to cross, and if we drive at the speed limit and come to a complete stop at every stop sign, the risk is low and survivability is high. If we cross in the middle of the street in heavy traffic, and if we drive 10 mph above the speed limit and coast through stop signs, the risk is higher and survivability is lower, but we have made a conscious decision that the level of risk is acceptable. Travel by air involves the same concept of risk management, with one difference – the passengers have no control over the risk. As airline passengers, we are trusting complete strangers to manage the risk for us. Perhaps it is this lack of control that causes some passengers to approach airline travel with more fear and trepidation than an impending root canal.

The airlines must manage what are arguably the most severe travel risks. If the airlines screw up, the consequences can be disastrous and deadly. Let’s take a look at the types of risks the airlines must manage.

Pilot Error: Every pilot must meet strict knowledge and skill requirements before the Federal Aviation Administration (FAA) will issue him/her a pilot’s license. Additionally, before a pilot is deemed qualified by the FAA to fly the type of aircraft operated by the airlines, he/she must acquire a “type rating” from the FAA in that aircraft, which requires a further demonstration of knowledge and skill. In addition to the FAA requirements, which are minimum requirements for the pilot to act as “pilot in command” of the aircraft, each airline has significant experience requirements for a pilot to be hired. Once hired by an airline, the pilot must serve an apprenticeship as co-pilot, before being considered for the position of Captain. Even space shuttle commander Robert “Hoot” Gibson, who flew five shuttle missions as a NASA astronaut, had to start as a co-pilot when he retired from NASA and went to work for an airline. But wait, there’ s more. Every airline pilot must undergo periodic flight/simulator checks to assure his/her continued competence. Pilot error is a risk that the airlines manage, so that risk is low.

Mechanical Failure: Every aircraft, airliners included, undergoes FAA mandated periodic inspections. The inspections are based on both flight time and calendar time. Engines and other components have life limits, which means they are periodically replaced. Mechanical failure is a risk that the airlines manage, so that risk is low.

Air Traffic Control System: Our air traffic control system is operated by the FAA. Air traffic controllers have the responsibility to separate air traffic – make sure two aircraft do not collide with each other – and they work in an intense environment. While the airlines have no direct control over the air traffic control system, they have input into the management of the risk because the pilot in command of the aircraft, the Captain of the airliner, is the final authority as to the safe operation of the flight. There has not been a mid-air collision involving an airliner and causing death or injury since 1986. The risk is managed, and the risk is low.

Weather: The technology available to monitor and forecast weather all over the world is so advanced, that weather related accidents are rare today. Severe weather can be avoided by advance planning, and by circumnavigation in flight. However, some weather events, such as clear air turbulence, simply cannot be foreseen. The risk is managed, but the risk is also unforeseeable to a small extent.

Terrorism: It is the author’s opinion that the risk of a terrorist act occurring on a domestic airline flight is very small, but that terrorism is the most significant risk presented to air travelers in this day and age. The risk is managed by the screening of passengers. However, it is the author’s further opinion that passenger screening in the United States (and most other countries) is distressingly inadequate. The gold standard for passenger screening seems to be the so-called “Israeli model.” Although Israel is a declared target of the radical Muslim terrorist world, El Al (the national airline of Israel) has a reputation as the most secure airline in the world. It should be noted that of all the risks that accompany air travel, terrorism is the only one over which the passenger does in fact have some control -- every passenger has a responsibility to report suspicious people and suspicious activity at the airport.

The risks of air travel are well managed by the airlines. According to the U.S. Bureau of Transportation Statistics, every year there are far more fatalities from cars, from trains, and even from recreational boating than from air travel. Keep that in mind the next time you are considering air travel or a root canal.