Acupuncture May Help Depression



A new study finds acupuncture to be highly effective in treating depression.


 

ACUPUNCTURE MAY HELP DEPRESSION

At least 1 in 10 Americans have been afflicted with major depression at some point in their lives, and some studies suggest that as many as 1 in 5 Americans have experienced significant depression before.  At any given time, an estimated 7 percent of adults in the United States are suffering from major depression.  (For reasons that are not entirely clear, women are twice as likely as men to be diagnosed with major depression.)  In view its very high incidence, it is not surprising that major depression is the leading cause of disability in the U.S. for people between the ages of 15 and 44.

There are a variety of potentially effective therapies available for depression including, primarily, cognitive therapy (i.e., meeting with a therapist for counseling) and antidepressant medications.  However, in view of the limited coverage made available for cognitive therapy by health insurers, there has been an increasing reliance upon antidepressant medications in the U.S. for many years.  While many of these medications can significantly reduce the signs and symptoms of major depression, they are often associated with significant side effects, and as many as half of all patients with severe chronic depression will fail to respond to most such medications.

A newly published prospective randomized controlled study from England suggests that acupuncture may be as effective as cognitive therapy and antidepressant medications as a treatment for depression.  This study appears in the online journal PLOS Medicine.

In this study, 755 patients with documented chronic major depression were randomized to one of three different treatment groups: acupuncture, cognitive therapy (counseling), and “usual care alone.”  (The latter group, which also included the use of antidepressant medications, served as the “control group” for this clinical study.)  All patient volunteers were subsequently reassessed with validated diagnostic tests throughout the 12-month course of this clinical study.

On average, the patient volunteers who participated in this clinical trial underwent 10 acupuncture sessions and 9 counseling sessions.  Compared to “usual care,” there was a statistically significant decrease in depression-associated symptoms in both the acupuncture and the counseling groups at 3 months and at 6 months after the start of this clinical study (by 12 months, however, the patients in the “usual care” group had improved to a level comparable to the acupuncture and counseling groups).  To summarize, acupuncture and counseling were each found to be highly effective in reducing the severity of depression-associated symptoms in patients with moderate-to-severe depression, and both were actually found to be more effective than the “usual care” (including antidepressant medications) received by the control group of patient volunteers at 3 months and at 6 months. 

This small study suggests a potential role for acupuncture in the treatment of major depression, and should stimulate additional research in this, and other, non-pharmacologic therapies for depression, particularly given the minimal risks associated with acupuncture in otherwise healthy patients.  However, if you are already taking antidepressant medications, and you are interested in trying acupuncture as a treatment for depression, please do not stop taking your medications without your doctor’s approval, as doing so could result in a worsening of your depression!

 

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According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, more than 3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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Psychiatric Illnesses May Involve Changes in Only Two Genes



A new study shows that changes in only two genes may account for most psychiatric illnesses.


 

PSYCHIATRIC ILLNESSES MAY INVOLVE CHANGES IN ONLY TWO GENES

As most regular readers of Weekly Health Update know, I rarely discuss psychiatric research studies here, as most behavioral studies are based upon lower level research methodologies, and many of these studies also take inadequate safeguards, in my view, to eliminate inherent biases. However, every now and then, a psychiatric study comes along that catches my attention, and merits further discussion.

Currently, psychiatric diagnoses are based upon clinical symptoms that are organized into diagnostic groups contained in the “bible” of Psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, or “DSM.” Because specific psychiatric diagnoses are based almost entirely on the subjective observation of signs and symptoms of mental illness, rather than objective test results, there is enormous potential for misdiagnosis. Moreover, many psychiatric diagnoses are associated with overlapping clusters of symptoms, which further increases the likelihood of misdiagnosis (and inappropriate treatment).

A new research study, which appears in the current issue of the journal The Lancet, strongly suggests that several common mental health disorders long thought to be unrelated to each other may, in fact, share a common biological basis, at least in some patients. The striking findings of this novel genetic study may dramatically change the way that psychiatrists diagnose and manage patients with psychiatric illnesses.

In this landmark study, 33,332 patients with psychiatric illnesses and 27,888 healthy control subjects underwent sequencing of their entire complement of DNA (“genome”), looking for genetic variations known as single-nucleotide polymorphisms (SNPs). (These common variations in the individual “letters” of our genetic code are responsible for many of the differences that exist among us, including hair color, eye color, and other variations, or traits, that can be readily observed.) The researchers then used very complex genetic analysis tools to search for SNPs that appeared to be linked, specifically, to the diagnosis of 5 different psychiatric illnesses in this large population of research subjects.

The results of this landmark study go a long way towards explaining the inaccuracies and inconsistencies commonly associated with the clinical diagnosis of psychiatric illnesses based upon DSM diagnostic criteria. Another very important result of this study is that it provides a potential explanation for the actual genetic and biological basis for at least some cases of common psychiatric illnesses.

Based upon the enormous amount of genetic information collected in this study, SNPs at four specific genetic sites were found to be strongly associated with the following 5 common psychiatric illnesses: autism spectrum disorder, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (depression), and schizophrenia. What was especially fascinating was the finding that genetic variations at these four sites involved just two genes, both of which are associated with calcium channels that act like microscopic gates that allow calcium to move into or out of cells.

It is difficult to overstate the importance of this study’s findings. For perhaps the first time, there is now genetic and biological data linking the 5 most common major psychiatric illnesses to specific locations in just two genes, which argues against the current clinical view that each of these illnesses are completely unrelated to each other. Indeed, the finding that variations in only two genes may account for these 5 common psychiatric illnesses is hugely significant, as is the finding that these two genes, which are involved in the construction of calcium channels, may play a fundamental role in the development of these seemingly unrelated illnesses.

The findings of this pivotal study will, hopefully, help psychiatrists to move away from the current subjective, and often arbitrary, methods of clinically diagnosing and treating psychiatric illnesses, and move towards making diagnoses based upon objective gene-based (“molecular”) and biological findings. Moreover, reaching a clearer understanding of the biological mechanisms underlying these common psychiatric illnesses may also lead to innovative new treatment options for patients with mental health illnesses.

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com Top 100 New Book Releases in Cancer” list.

 

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Dr. Wascher’s latest video:

Dark as Night, Part 1

Dark as Night, Part 1

Dark as Night, Part 1


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, more than 2.6 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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American Surgeons in Crisis: Implications for Healthcare






 

A new study finds that more than half of surgeons are experiencing work-home conflicts that threaten their personal and professional wellbeing.


 

AMERICAN SURGEONS IN CRISIS:  IMPLICATIONS FOR HEALTHCARE

As I have discussed in previous columns (The Silent Epidemic of Surgeon Burnout and DepressionEpidemic of Alcohol Abuse Among Surgeons), there are quiet and evolving, and disturbing, developments within the community of American surgeons, and these developments may portend of significant potential future problems for surgeons, and for patients who require surgical care.  Now, a newly published research study, which appears in the current issue of the Archives of Surgery, further suggests that the epidemic of surgeon burnout and depression is indeed real, and has serious potential implications for both surgeons and their patients.

In this study, 7,197 active surgeons were surveyed, electronically, by the American College of Surgeons, using questions from validated surveys that assess for career burnout, depression, quality of life, alcohol use, and other measures of satisfaction with both personal and professional life attributes.

When asked if they had experienced any significant conflicts between their “work lives” and their “home lives” within the previous three weeks, an astounding 53 percent of the queried surgeons replied, “Yes.”  Thus, more than half of all surgeons who participated in this confidential survey reported substantial and distressing conflicts between their professional lives and their home lives within the preceding three weeks.

When the study’s authors analyzed the personal and professional factors that were most closely associated with “work-home conflicts,” and with both personal and professional dissatisfaction, a clearer picture emerged.  For example, the number of hours worked per week, having children, the surgeon’s gender, and the type of surgical practice were all closely linked with work-home conflicts, and with lower levels of personal and professional satisfaction.  For example, surgeons who practiced at Veterans Administration hospitals were 91 percent more likely to report work-home conflicts when compared to surgeons in private practice, while surgeons who practiced at an academic medical center were 19 percent more likely to report such conflicts when compared to private practice surgeons.  Not surprisingly, having children at home was associated with a 65 percent greater likelihood of work-home conflict when compared to surgeons without children at home.  Working more hours per week and being younger were also factors associated with a higher likelihood of work-home conflict, as was being a female surgeon (i.e., when compared to male surgeons).  Surgeon specialty was also significantly linked to work-home conflicts and overall lower satisfaction levels, with broadly practicing general surgeons being twice as likely to report work-home conflicts as surgeons in other specialties (e.g., breast surgeons, heart surgeons, neurosurgeons, and other subspecialist surgeons).

The high level of work-home conflicts identified among surgeons is an issue of great concern to all of us, as such conflicts were significantly associated with career burnout, exhaustion, decreased quality of life, depression, relationship difficulties, alcohol abuse, and overall career dissatisfaction by scientifically validated surveys.  Surgeons reporting recent work-home conflicts were also substantially less likely to recommend surgery as a career option to their children.

In addition to higher levels of burnout, depression, alcohol abuse, relationship difficulties, and career dissatisfaction, surgeons who reported recent work-home conflicts were also 77 percent more likely to be planning to reduce their clinical work hours, and71 percent more likely to be planning to leave their surgical practices for reasons other than planned retirement.

At a time when the demand for some types of surgical care is already outstripping the supply of experienced, competent surgeons in many areas of the country, the findings of this study are cause for considerable concern.  For example, looking into the near future, our population is aging, and many acute and chronic diseases that require surgical treatment are more common in elderly patients.  Therefore, there is real concern that an increasingly burned-out surgeon workforce, and a declining interest in the more challenging surgical specialties (like general surgery) by today’s medical students, will someday soon leave the United States with an inadequate number of experienced surgeons to meet our nation’s healthcare needs.

All of the above noted adverse factors within the American surgeon community, once again, raise the concern that adequate levels of surgical care may not be available in the not too distant future if significant changes in surgical training and surgical practice are not considered and implemented, particularly in the workhorse specialty of general surgery.  The surgical community has been, admittedly, slow to appreciate or embrace generational changes in perceptions about work-life balance, and has only grudgingly (and recently) acquiesced to external pressures to treat its surgeons-in-training in a more considerate and supportive manner, compared to the conditions that surgery interns and residents toiled under during my era of training, as well as previous generations of surgical trainees.  (When I was a surgical intern, in the late 1980s, there were no limitations on the number of hours that interns and residents were expected to work in the hospital, including the number of nights spent on call for emergencies within the hospital, and it was not uncommon for us to spend 100 to 120 hours inside the hospital each and every week.)  Regardless of how more senior surgeons feel about it, it must be acknowledged that the current generation of medical students and young surgeons, both male and female, are much more concerned about work-life balance, and overall quality of life issues, than was typical for my generation of surgeons.

On a brighter note, the American College of Surgeons’ sponsorship of this research study, and others like it, suggests that the older generation of surgeons who currently serve as senior leaders and mentors for young surgeons and surgical trainees may, finally, be coming to grips with the rather dramatic shift in attitudes and priorities among their young charges. Hopefully, it is not too late to make meaningful structural changes in surgical training and surgical practice conditions before there are widespread adverse public health consequences to the ongoing crisis among the community of surgeons in the United States….

 

A Cancer Prevention Guide for the Human Race is now available in both printed and digital formats from all major bookstores.  Get your copy now, and begin living an evidence-based cancer prevention lifestyle!


Dr. Wascher’s latest video:

Dark as Night, Part 1


Dark as Night, Part 1

Dark as Night, Part 1


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 





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Chronic Anxiety and Depression Significantly Increase the Risk of Early Death




 

A large new study suggests that chronic anxiety and depression are associated with a higher risk of premature death than was previously appreciated.


 

 

CHRONIC ANXIETY AND DEPRESSION SIGNIFICANTLY INCREASE THE RISK OF EARLY DEATH

As I discuss in my bestselling book, A Cancer Prevention Guide for the Human Race, most previous research studies have suggested only rather weak links between chronic stress and cancer risk, although there is some data linking chronic depression with breast cancer risk.  However, in view of the increasing number of people around the world who are currently experiencing chronic anxiety and depression during these economically and geopolitically troubled times, the findings of a new public health study that psychological distress significantly increases the risk of premature death from serious illnesses, including cancer, is concerning.  This new study appears in the current issue of the British Medical Journal.

Altogether, 68,222 adults in Great Britain were followed for an average of more than 8 years within the prospectively conducted Health Survey for England study.  All of these study participants were clinically free of serious physical illness when they first joined this very large public health study.  All of the participants in this study were assessed for psychological stress using a validated assessment questionnaire, which was administered in their homes by research staff.  Subsequently, the incidence of serious physical illnesses during the course of this study was then correlated with the degree of measured psychological distress.  The rather dramatic findings of this large prospective public health study illustrate the magnitude of the impact of chronic, severe stress on our bodies, including the risk of premature death due to stress-associated physical illnesses.

After adjusting for preexisting serious physical illnesses, lifestyle-associated risk factors for serious illnesses, and socioeconomic factors known to be linked to chronic, serious illnesses, this study still identified a highly significant increase in the risk of premature death associated with the extent of psychological distress among volunteers in this very large study.  When the “psychological distress score” was compared with death rates, having a score of 1 to 3 (compared to a score of “0,” which reflects no evidence of psychological distress) was associated with a 20 percent increase in the risk of premature death.  A psychological stress score of 4 to 6 was associated with a 43 percent increase in the risk of early death, while a distress score of 7 to 12 was associated with a whopping 94 percent increase in the risk of premature death when compared to study volunteers who were without evidence of any significant psychological distress!

Upon further analysis, death due to cardiovascular disease and other non-cancer causes increased significantly, and proportionally, with each increase in the psychological distress score.  Cancer-associated deaths also increased with rising psychological distress scores, although this association was only observed among volunteers with significantly elevated distress scores.  However, for non-cancer causes of death, the risk of premature death was significantly elevated with evenmild increases in psychological distress.

The potential impact of this study’s findings are highly significant, as they not only reveal a “dose-dependent” relationship between stress levels and the risk of premature death from serious physical illnesses, but the sheer magnitude of the impact of high levels of chronic anxiety and depression on the risk of premature death is much higher, potentially, than has been observed in previous and much smaller studies.

Although this study was not designed to identify the biological mechanisms whereby prolonged periods of increased psychological distress lead to early death, numerous prior studies have shown that chronic depression and anxiety can directly activate an inflammatory response in humans which, in turn, is known to increase the risk of cardiovascular disease, infection, and cancer, as well as other chronic, serious illnesses.  It is also well known that chronic anxiety and chronic depression increase the likelihood of unhealthy behaviors that have also been linked to serious, chronic illnesses, including smoking, excess alcohol or other drug intake, unhealthy diets, and lack of exercise, in addition to other unhealthy behaviors.  What is especially unique about this new study (other than its sheer size), however, is that the researchers were able to identify and adjust for preexisting unhealthy behaviors among the study’s volunteers when they analyzed the study’s data, which increases the likelihood that the adverse effects of chronic anxiety and depression on the risk of premature death observed in this research study are actually a direct result of psychological distress rather than unhealthy lifestyle choices.

If you are experiencing high levels of chronic stress, and if you are frequently anxious or depressed, then please seek help from your personal physician or a mental health professional.  If you are thinking of harming yourself, or someone else, then please seek immediate help.  These are very trying times for many people, and the ongoing worldwide challenges that have provoked such high levels of stress do not appear likely to disappear any time soon.  Knowing that so many other people around the world are also feeling worried and chronically stressed can make each of us feel less alone in our distress.  However, sometimes the awareness that others are experiencing similar levels of distress is, by itself, not enough to ease our anxiety or depression.  So, if you are struggling with anxiety or depression, and especially if you are feeling alone and isolated at the same time, then please seek the help and support of others.  In the vast majority of cases, feelings of hopelessness or helplessness will eventually pass when you get help and support during dark times in your life.


 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 




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Depression After Childhood Abuse May Be Linked To A Specific Gene







 

A new study suggests that a variant of a recently discovered gene may double the risk of lifelong depression after childhood abuse.


 

 

CHRONIC DEPRESSION AFTER CHILDHOOD ABUSE MAY BE LINKED TO A NEW GENE

The age-old debate about “nature versus nurture” has become increasingly complicated as we continue to learn more about the impact of individual genes on our risk for various illnesses.  While it has become widely accepted that specific genetic patterns may predispose some of us to a very high risk of certain physical illnesses, such as cancer and cardiovascular disease, the potential linkage between specific genes and the risk of mental illness has been less clear.  At the same time, however, it has long been known that some mental health disorders, including depression, anxiety disorder, panic disorder, bipolar disorder, and schizophrenia, tend to run in families, which suggests that there may be at least some genetic component to these illnesses.

Over the past 5 years, fundamental new research has begun to suggest that certain genes may indeed be associated with an increased risk of specific mental illnesses.  However, most mental health experts believe that having a specific form of a gene linked to mental illness does not, by itself, mean that an affected individual faces a 100 percent risk of developing a mental illness.  Getting back to that “nature versus nurture” debate once again, it appears that having a genetic variant associated with a specific mental health illness probably predisposes an affected person to develop that particular mental health disorder, but does not guarantee that this will happen.  More specifically, an individual person’s experiences and environment during early life (i.e., the “nurture”) appear to have a significant impact on whether or not genes associated with an increased risk of mental illness (i.e., the “nature”) will actually lead to the development of mental illness.

Now, a newly published clinical study provides strong evidence that a specific form of a single gene can significantly increase the likelihood of major depression in adults following physical abuse during childhood, while another variant of this same gene appears to decrease the risk of chronic depression in similarly abused adults.  This intriguing research study appears in the current issue of the Archives of General Psychiatry.

This new research study was inspired by previous research with laboratory animals that identified a network of neurons in the brain that use chemicals called endocannabinoids to communicate with each other.  (If the word “endocannabinoid” sounds vaguely familiar, it is because these naturally occurring neurotransmitters in the brain also have counterparts in the plant world, most notably in cannabis, or marijuana, plants!)  Previous research has also suggested that the endocannabinoid system in the brain may play an important role in adaptation to stress, including the moderation of our mood following stressful events.

In this new study, two groups of patient-volunteers were included.  The first group consisted of 1,041 young adult female twins in the United States, while the second group consisted of 1,428 Australian adults known to be addicted to heroin. (An additional 506 Australian volunteers without heroin addiction participated in this study as the control group for the heroin-addicted volunteers.)  The presence of depression, and in particular, depression with anhedonia (a term that indicates the inability to enjoy experiences that most of us find pleasurable), was assessed among all of these patient-volunteers.  The absence or presence of a history of physical abuse, by a parent or caregiver, during childhood was also evaluated.  Testing of the gene which codes for the human endocannabinoid receptor in the brain was performed on all of these research volunteers, as well.

The findings of this study were highly significant.  Not surprisingly, the study volunteers who reported having experienced significant childhood physical abuse had a much higher incidence of depression when compared to those volunteers who did not experience physical abuse as children.  Among the volunteers who had experienced significant physical abuse during childhood, a single, specific variant of the endocannabinoid receptor gene appeared to be highly protective against anhedonic depression when compared to volunteers who possessed the more common variant of this gene.  Specifically, only 29 percent of abused volunteers with this less common variant of the endocannabinoid receptor gene experienced anhedonic symptoms, while 57 percent of the previously abused volunteers with the most common form of this same gene were found to have symptoms of anhedonic depression.

The findings of this study strongly suggest that certain naturally occurring variants of specific genes may either increase or decrease the risk of mental illness (and in the case of this clinical study, major depression with anhedonia) following stressful experiences earlier in life.  Not only do this study’s findings suggest a method of screening patients who might be at significantly increased risk for major depression following stressful events in their early lives, but the linkage of a specific gene within the brain’s endocannabinoid system with depression following traumatic childhood experiences may someday allow for a more effective treatment for post-traumatic major depression, using medications targeted at the specific genetic variation that leads to this increased risk of depression following childhood trauma.


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 











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Epidemic of Alcohol Abuse Among Surgeons





A new study indicates that chronic alcohol abuse among surgeons is far more common than among the general population.


 

 

EPIDEMIC OF ALCOHOL ABUSE AMONG SURGEONS

In a previous column (Surgeon Performance and Alcohol), I reviewed a clinical research study that revealed just how significantly alcohol intake degrades surgical skills among surgeons, even well into the day following alcohol intake.  In another recent column, I examined a study that revealed a disturbingly high rate of burnout and depression among American surgeons (Surgeon Burnout and Depression).  This week, I will present a newly published clinical study that, once again, raises serious concerns about the health and wellbeing of many surgeons in the United States.

In a study that appears in the current issue of the Archives of Surgery, more than 7,000 surgeons in the United States agreed to participate in a confidential assessment of alcohol abuse and alcohol dependence among members of the American College of Surgeons.  Validated surveys and tests were administered to these surgeon-volunteers, and the resulting data was analyzed.

Based upon the results of the Alcohol Use Disorders Identification Test, 15 percent of the responding surgeons, overall, were identified as meeting the criteria for either chronic alcohol abuse or alcohol dependence.  Further evaluation of the data collected in this study revealed that 14 percent of the participating male surgeons met the criteria for chronic abuse of alcohol or alcohol dependency, while 26 percent of the corresponding female surgeons met these same worrisome criteria.  Moreover, surgeons who reported having committed a major medical or surgical error within the previous 3 months were 45 percent more likely to abuse alcohol, or to be dependent upon alcohol, when compared to surgeons who did not report any recent errors.  Similarly, surgeons who reported feeling burned out in their professional lives were 25 percent more likely to be problem drinkers when compared to surgeons who did not report professional burnout.  Finally, surgeons who reported symptoms consistent with depression were nearly 50 percent more likely to abuse alcohol than surgeons who did not report feeling depressed.

Interestingly, surgeons were less likely to have alcohol abuse and dependency problems if they were older, male, or had children.  (Approximately 11 percent of adult males in the general population are thought to have chronic alcohol abuse problems, while only about 5 percent of adult females in the general population appear to abuse alcohol on a regular basis.)

The findings of this study, once again, indicate a disturbingly high rate of substance abuse among American surgeons; and this is the first study to show that female surgeons, unlike women in the general population, are twice as likely as their male counterparts to regularly abuse alcohol.  Taken together with previous studies showing very high rates of depression and career burnout among surgeons in the United States, the findings of this latest study are rather worrisome.  (Previous studies have also linked an increased likelihood of medical and surgical errors to surgeons who are depressed, and who abuse alcohol and other drugs.)

I should also note that only 29 percent of the surgeons who were contacted agreed to participate in this confidential study.  Because this participation rate is much lower than what is typically seen in most survey-based research studies, it raises the important question as to whether or not the rate of alcohol abuse and alcohol dependency might actually be considerably higher among surgeons, in general, than what is reflected in this study.  Indeed, most statistics experts believe that a very common reason for nonparticipation in survey-based studies is a reluctance to divulge negative information about oneself.  Moreover, even people who elect to participate in survey-based studies often “fudge” their responses in ways that tend to underestimate their bad habits and other self-perceived shortcomings.  Therefore, it is entirely possible that the incidence of chronic alcohol abuse and alcohol dependency among surgeons may be even higher than what was reported in this study….

 

As I have observed in previous columns, surgeons who abuse alcohol, or other drugs, are more likely to be associated with medical errors and worse patient outcomes.  However, the stigma of reporting oneself as having an alcohol, or other drug, problem is so great in the medical profession that impaired surgeons (as with other physicians) are generally extremely reluctant to admit that they have an alcohol or drug problem.  Most medical boards still require physicians to indicate whether or not they have a history of drug or alcohol abuse on licensure applications, and the medical profession, in general, still seems to be in a state of denial regarding the unusually high incidence of drug and alcohol abuse among physicians when compared to the general public.  It also goes without saying that the potential consequences of being operated upon by an impaired surgeon can be catastrophic to both patients and their loved ones, and, therefore, the still prevailing “head in the sand” approach to identifying, and rehabilitating, impaired physicians would not appear to serve the public interest very well, in my view.

 

While the vast majority of surgeons are passionately devoted to providing the best possible care to their patients, and would therefore not engage in personal behaviors that might potentially endanger their patients, it is becoming increasingly clear that a sizable percentage of surgeons in the United States are seriously impaired by burnout, depression and other mental health illnesses, and by alcohol and drug abuse.  Therefore, a better system of screening out surgical trainees who are predisposed to these serious health problems should be considered, while, at the same time, medical authorities at the state and federal levels should make it easier, and less threatening, for currently impaired physicians and surgeons to reach out for help without fearing that they will be punished or professionally sanctioned as a result.  I, therefore, applaud the American College of Surgeons for sponsoring and publishing this important study as a preliminary step forward in this direction.


 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a lighthearted perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 








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Effective New Treatment for Chronic Pain

Welcome to Weekly Health Update



New research shows that behavioral therapy combined with an exercise program may be the most effective treatment for chronic pain.


 

 

EFFECTIVE NEW TREATMENT FOR CHRONIC PAIN

According to the American Academy of Pain Medicine, chronic pain afflicts nearly 1 out of every 3 American men, women and children, and is associated with an estimated cost to society of $560 to $635 billion per year.  While there are many causes of chronic pain, they all share a common trait in that almost all types of chronic pain are associated with significant physical and psychological disability in afflicted patients.

Unlike acute pain (like the pain that follows a fresh cut on your hand, or spraining your ankle, for example), which subsides very quickly, chronic pain usually does not improve on its own.  Moreover, while you may hop around and shout out a few choice words after smashing your thumb with a hammer, the acute pain caused by a poorly aimed hammer usually does not leave a person feeling depressed or completely disabled like chronic pain so often does.  Over time, as chronic pain persists, the area in the brain (the limbic system) that attaches emotional content or value to our experiences and sensations becomes increasingly involved with interpreting the chronic barrage of pain sensations from damaged nerves or chronic inflammation, which leaves many chronic pain sufferers debilitated, and often depressed.  Because of the biological complexity of chronic pain, when compared to acute pain, it can be very difficult to effectively treat this lingering form of pain.  Patients suffering with chronic pain frequently find their symptoms both physically and emotionally disabling, and medications commonly used to treat acute pain are often ineffective in managing chronic pain.  As I have noted, depression is a common feature of chronic pain, and often requires treatment with antidepressant medications and behavioral therapy in addition to treating the original cause (or causes) of a patient’s pain.

Now, a newly published prospective randomized clinical research study offers new hope for the estimated 116 million Americans who suffer from chronic pain.  This study, which appears in the current issue of the Archives of Internal Medicine, randomized 442 patients with chronic pain to receive one of the following interventions for a period of 6 months:  (1) telephone-based behavioral therapy, (2) a graded, step-wise exercise program, (3) a combination of both telephone-based therapy and a graded exercise program, or (4) standard treatment for chronic pain.  All of the study volunteers were assessed at the time that they entered into the study, 6 months later, and again at 9 months.

The results of this innovative study were quite interesting.  Following 6 months of standard chronic pain management, only 8 percent of the study volunteers randomized to this intervention group noticed any significant improvement in their symptoms, and this result was unchanged 9 months after the start of this clinical study.  Among the patients who underwent 6 months of telephone-based behavior therapy, 33 percent felt that their chronic pain was improved at 9 months.  After 6 months of treatment, 35 percent of the patients who participated in a graduated exercise program felt improved, although this effect decreased over time, with 24 percent of this group of patients reporting improvement in their chronic pain symptoms at 9 months.  Finally, the combined therapy group (behavioral therapy and exercise) experienced the greatest improvement in their symptoms, compared to the other treatment groups, with 37 percent of patients in this group reporting significant improvement at both 6 months and 9 months.

This study represents an extremely important advance in the management of chronic pain, a condition that is highly resistant to most conventional therapies and medications.  As a cancer physician who regularly treats cancer patients with chronic pain, I am not surprised by the extremely poor response of patients to conventional chronic pain management approaches in this study.  While the 37 percent positive response rate noted in this study to combination therapy may seem like a rather poor result, chronic pain syndromes are so difficult to effectively treat that this study’s 37 percent response rate is actually extremely impressive.  Based upon the results of this important study, behavioral therapy combined with exercise therapy appears to be the most effective and long-lasting treatment approach for patients with chronic pain.  At the same time, the dismal response rate associated with standard chronic pain management approaches, as noted in this study, should cause pain management specialists to seriously reevaluate current methods of treating patients with chronic pain.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity



Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 





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Deep Brain Stimulation May Help Severe, Refractory Depression

Welcome to Weekly Health Update




DEEP BRAIN STIMULATION MAY HELP SEVERE, REFRACTORY DEPRESSION

Depression is both a common and a potentially very serious mental health disorder.  According to the Centers for Disease Control (CDC), nearly 10 percent of the adult population in the United States can currently be classified as having active depression, and approximately 4 percent of the population currently meets criteria for severe, major depression.

The incidence of depression varies considerably between different groups of people.  For example, women are 70 percent more likely than men to experience depression.  Although depressed women are more likely than men to attempt suicide, men are far more likely to be successful in their suicide attempts.  Other high risk groups include people between the ages of 45 and 64 years, people from ethnic minority groups, people with less than a high school education, people who are divorced and who have not remarried, the unemployed, and those without health insurance.  (Clearly, in view of the still ongoing recession in the United States, the number of people in several of these high-risk categories has increased significantly over the past four years.)

There are multiple effective therapies available or depression, including antidepressant medications, psychotherapy, and electroconvulsive therapy (ECT).  More recently, transcranial magnetic stimulation, vagus nerve stimulation, and other experimental treatments have been evaluated in patients with depression that fails to respond to conventional therapies.  Another recently developed experimental therapy for severe, refractory depression is deep brain stimulation (DBS).  In small pilot studies, small numbers of patients with severe depression, and who have failed every other form of depression treatment (including ECT), have had surgically implanted electrodes placed into their brains, followed by electrical stimulation of their brains through these deep brain electrodes.  While it is too soon to conclude that DBS is both safe and effective in the management of severe, refractory depression, a new prospective clinical research study suggests that DBS may, indeed, produce significant remissions in refractory major depression.  This newly published study appears in the current issue of theArchives of General Psychiatry.

In this small but innovative clinical trial, 10 patients with major depression and 7 patients with bipolar disorder underwent surgical implantation of deep brain stimulation electrodes into both hemispheres of the brain.  Initially, all patients underwent simulated (“sham”) DBS, without the patients’ knowledge.  (This sham stimulation was done to test whether or not the patients’ expectation of benefit, or a true potential benefit simply from having the electrodes surgically placed, might have influenced their depression independent of actually stimulating their brains.)  Following 4 weeks of sham stimulation, all patients then initially received 24 weeks of actual DBS.  Following this period of actual DBS, active stimulation of the deep brain electrodes was then temporarily stopped.  (Once again, this discontinuation of active DBS was not revealed to the patients.)  These patient volunteers were then treated with DBS and monitored for up to 2 years.

In this group of patients who had previously failed, literally, all other forms of conventional therapy for their severe depression, DBS was associated with complete remission of depression in 18 percent (3) of the patients, and a significant improvement in depressive symptoms was observed in 41 percent (7) of the patients after 24 weeks of active DBS.  After 2 years of active DBS, 12 patients remained in the study, and 92 percent (11) of these patients experienced significant improvement in their depressive symptoms, including 58 percent (7) who experienced a complete remission of their depression!

The findings of this small prospective, controlled clinical research study are both dramatic and important, and for several reasons.  First of all, the clinically significant improvement seen in almost all of these patients is extraordinary in view of the severity of their depression and the completely refractory nature of their depressive symptoms.  Secondly this study included several patients with bipolar disorder, a disease which is characterized by alternating episodes of mania (a state of extreme mental and physical hyperactivity) and depression.  (Earlier studies of DBS had suggested that this treatment might not be as effective in patients with bipolar disorder, and might also lead to an increased risk of episodes of mania.  However, in this small pilot study, DBS was as effective in treating the symptoms of depression in patients with bipolar disorder as it was in patients with depression alone.  Moreover, DBS did not appear to increase the likelihood of episodes of mania in patients with bipolar disorder.)

 

Depression is a common mental health disorder, and severe cases of depression can leave patients feeling miserable and hopeless.  In especially severe cases, depressed patients may be unable to function in their daily personal or professional lives.  For some unfortunate patients with depression, suicide or accidental causes of death may also end their lives prematurely.  Based upon the findings of this small, preliminary clinical study, DBS may be a safe and effective treatment option for patients with chronic, severe, and refractory depression.

 

If you are depressed, and you are having thoughts about harming yourself (or harming someone else), please immediately contact your mental health provider, a suicide hotline, your personal physician, a close and trusted friend or relative, or your clergy person.  Even during times when you feel like there is no hope that life will get better for you, it almost always will get better if you get some help.

 


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 




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Physicians and Mental Illness

Welcome to Weekly Health Update




New research confirms that physicians frequently suffer from mental illness, and are more reluctant than non-physicians to seek help.



PHYSICIANS AND MENTAL ILLNESS

While physicians are less likely than the general population to die from heart disease or cancer, we doctors are significantly more likely to die from suicide than our lay brothers and sisters.  Indeed, a very troubling statistic is that suicide is the second most common cause of death among medical students (accidents are the number one cause of death).

Multiple studies have shown that physicians are at greater risk of developing significant mental health problems when compared to the general population, including depression and bipolar disorder.  Physicians also have higher rates of alcoholism, and other forms of substance abuse, when compared to the general public.  Although the potential reasons behind this higher incidence of mental illness among physicians continue to be debated, most experts agree that doctors with mental health problems are notoriously reluctant to seek help.  They often do not recognize that they are ill, in the first place; and when they do become aware that they are not well, they are less likely than non-physicians to seek professional help.  Moreover, there are still tremendous stigmas associated with mental illness among health care professionals, causing many impaired physicians to avoid reaching out for help.  As if these adverse factors that discourage physicians from seeking help are not already bad enough, most state medical boards require physicians to disclose whether or not they have ever been diagnosed or treated for a mental illness (or substance abuse) as a precondition for initial licensure or renewal of an existing medical license.  (In many cases, disclosing a prior or current history of mental illness, even if the physician is receiving appropriate treatment, can result in very negative professional and financial consequences for physicians who disclose their history of depression or other mental health problems.)

 

 

In view of these disturbing statistics regarding physicians and mental illness, I find the results of a newly published clinical research study to be quite revealing (and disturbing).  In this study, 108 physicians were asked to confidentially complete a 56-item questionnaire that assessed their distress levels and their willingness to accept various forms of assistance for their feelings of severe distress.  This study appears in the current issue of the Archives of Surgery.

Within the preceding year, fully 79 percent of the surveyed physicians had experienced either a serious adverse patient event or a traumatic personal event that left them feeling very distressed.

When asked about their willingness to seek support or assistance regarding stressful issues in their lives, 72 percent of the doctors indicated that they would be willing to seek help for legal problems, while 67 percent would do so after being involved in a serious medical error.  Another 67 percent of the physicians were willing to seek help for substance abuse issues, while 62 percent were open to seeking medical help for physical illness.  Tellingly, only half (50 percent) of the physicians indicated that they would seek help for mental illness, and an equally small number also indicated that they would be open to assistance regarding serious interpersonal conflicts at work.

When asked about barriers to seeking help, 89 percent of the doctors indicated that they did not have time to get help with the causes of their distress, while 69 percent also responded that they were either uncertain about how to get help or that they had experienced difficulty in obtaining assistance.  A total of 68 percent of the physicians also cited lack of confidentiality, a potentially negative impact on their career, and the stigma associated with seeking help as barriers.

Regarding the most likely sources of support that they would be willing to seek, 88 percent expressed a preference for their physician colleagues, while only 48 percent were willing to be seen by mental health professionals, and only 29 percent were open to participating in employee assistance programs.

 

 

The findings of this study are hardly surprising.   The prevalence of major distress and mental health issues among physicians continues to be very high, relative to the general population.  At the same time, only half of the physicians participating in this study indicated a willingness to seek help for mental health problems.  Similarly, only half of these doctors would be willing to seek help for serious interpersonal difficulties (a common marker for certain psychological and personality disorders) in the workplace.  Among the most often cited reasons for not seeking help were “lack of time” and uncertainty about how to obtain help.  Additionally, the physicians who participated in this confidential study expressed serious concerns regarding confidentiality, the potential for negative career impact, and the perceived stigma associated with asking for help for mental health issues.

 

 

From my own experience as a physician over the past 23 years, I can honestly say that these disturbing statistics and findings regarding physician stress, distress, and mental health problems are, if anything, most likely understated.  Within the medical profession, it is no secret that the true incidence of depression, bipolar disorder, personality disorders, interpersonal strife, marital duress, domestic abuse, and divorce is very high among physicians, in comparison to the general population.  Ironically, and unfortunately, however, as bad as the stigma associated with mental illness is in the general public, it is even more severe within the medical profession.

Over the years, I have known numerous physicians with various forms of mental illness and personality disorders, and I cannot recall a single one of them ever voluntarily reaching out to mental health professionals for help.  Sadly, in view of the strong aversion on the part of physicians with mental illness towards seeking help from mental health professionals,  proactive and progressive steps to eliminate the perceived stigma of mental health problems within the medical profession, as well as removing the potentially punitive sanctions that many physicians would otherwise be subjected to if they sought professional help, will be necessary before troubled or impaired physicians can begin to feel free to seek help and support for the problems that torment them.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-Million,Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 




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The Silent Epidemic of Surgeon Burnout and Depression

 

Welcome to Weekly Health Update



“A critical weekly review of important new research findings for health-conscious readers”


THE SILENT EPIDEMIC OF SURGEON

BURNOUT AND DEPRESSION

Here in the United States, we face momentous, and as yet unclear, changes in the delivery of health care.  Approximately 46 million Americans lack any health insurance at this time, and tens of millions of others have grossly inadequate health insurance.  Therefore, many millions of Americans are just one major illness away from a financial catastrophe.

In addition to the huge dilemma of how we go about making health care more efficient and more affordable for everyone, the United States, like most countries around the world, is in the midst of a dramatic shift in the average age of its population.  As the graying of America continues (not to mention the ongoing epidemic of obesity across all age ranges, as well), the growing need for high quality, comprehensive health care will continue to present major challenges to our health care system here, and in many other countries around the world.

When I graduated from medical school in 1988, health care experts were predicting a huge surplus of physicians in this country, and in response to this concern, medical schools around the United States began cutting back their class sizes, and a de facto moratorium on opening new medical schools was initiated.  Fast forward to 2010, and it has since become apparent that these dire predictions of an impending physician glut were absolutely incorrect.  As our population grows older, and more diverse, the demand for physicians is increasingly in danger of outstripping the projected supply of doctors, including surgeons.

Aging patients have a higher incidence of illnesses and injuries that require the expertise of surgeons, and general surgeons in particular.  Broadly trained and experienced general surgeons are the primary care doctors, and the workhorses, of the surgical world, and they manage an astonishing array of diseases and injuries.  Unfortunately, and for a variety of reasons, comprehensive general surgeons are slowly withering in numbers, while the demand for their skills only continues to increase.  Generational attitude shifts among recently graduating physicians have seen young new doctors gravitate towards less demanding “boutique” specialties, and away from the more challenging surgical specialties (like general surgery).  Even among those young doctors who still elect to pursue residency training in general surgery, more than two-thirds will go on to train and practice in more restricted subspecialty surgery areas.  (Disclaimer:  As a surgical oncologist, I am one of those subspecialty surgeons.  However, I still include a great deal of general surgery care in my practice, and I continue to take general surgery call in our medical center.)  Another factor that discourages potential general surgeons is the enormous debt load that most newly minted doctors graduate from medical school with, and the resultant pressure that they feel to train in specialties that do not require the additional 5 to 10 years of training that general surgeons must complete.  (Increasingly, new medical school graduates are, instead, seeking out specialties that are more financially lucrative, and require shorter durations of residency training, than general surgery.) 

Yet another adverse factor that has harmed the recruitment of new general surgeons is the ongoing and progressive fragmentation of traditional general surgery practice into other subspecialty domains.   For young doctors who are attracted to the diverse and clinically challenging sort of surgical practice that has historically made general surgery a highly desirable profession, the increasing practice restrictions imposed upon general surgeons have removed a major incentive to undergo the many years of training necessary to become a comprehensive general surgeon

Against the backdrop of these and other pressures that continue to dwindle the ranks of broadly trained and practicing general surgeons (as well as other critical core surgical specialists), the issue of surgeon burnout has only recently started to receive its due attention.  The comprehensive practice of general surgery, and other demanding surgical specialties, can be grueling and exhausting, particularly in the private practice setting where declining reimbursements compel surgeons to work ever longer hours to maintain their income and lifestyle.  (Future threatened cuts in reimbursements to surgeons will likely only further exacerbate surgeon workload problems, and eventual surgeon shortages, as new health care reform initiatives begin to roll out in the coming years.)

A newly published research study, which appears in the current issue of the Journal of the American College of Surgeons, reveals a very disturbing picture of burnout, exhaustion, and depression among surgeons, and the potentially adverse consequences of distressed surgeons on patient outcomes.

In this study, nearly 8,000 surgeon members of the American College of Surgeons responded to a detailed survey, which included self-assessments of their practice details, a validated depression screening tool, and validated assessments of both burnout and overall quality of life.  The results of these surgeon surveys were, in a word, depressing.

Among the surgeons who reported working less than 60 hours per week, 30 percent described themselves as burned-out with their profession.  Among surgeons who worked 60 to 80 hours per week, 44 percent felt burned-out, and among those surgeons who put more than 80 hours per week, 50 percent experienced significant feelings of burnout.  In addition to the number of hours spent in clinical practice per week, the number of nights spent performing overnight surgery call was a highly significant predictor of surgeon burnout.  These two surgeon workload factors were also highly statistically significantly linked to clinical depression, difficulties in finding a reasonable home-work balance, and increased conflicts at both home and at work.  Additionally, the rates of both personal emotional exhaustion and feelings of depersonalization towards patients were directly associated with working more than 80 hours per week, and with performing 2 or more night calls per week.

Excessive hours spent in clinical practice, as well as performing 2 or more overnight calls per week, also correlated with a significant increase in the number of self-reported medical and surgical errors committed by exhausted and burned-out surgeons.  Nearly 11 percent of surgeons who worked more than 80 hours per week admitted to committing medical or surgical errors, compared to about 7 percent of surgeons who worked less than 60 hours per week.

Surgeons who either worked more than 80 hours per week, or who took more than 2 night calls per week, were also significantly more likely to express regret regarding their choice of specialty, and more likely to indicate that they would not choose to become surgeons if they had an opportunity to choose their specialty all over again.

The results of this survey of surgeons across the United States have been generally confirmed by other similar studies, recently.  These disturbing findings, as reported by surgeons themselves, paints a picture of a large population of highly essential physician specialists who are, increasingly, feeling burned-out, depressed, emotionally exhausted, regretful of their career choices, and progressively more prone to both depersonalizing their relationships with their patients and to committing more medical and surgical errors.  In short, my chosen profession appears to be a profession that is, frankly, approaching a state of crisis.

Because of these enormous (and growing) pressures and stresses that are being experienced by many surgeons, including general surgeons, many public health experts are viewing the current and future surgical workforce with considerable consternation.  As more and more surgeons hang up their white coats and put away their scalpels early in their careers, and as more and more newly graduated doctors shy away from the more demanding surgical specialties, our country appears to be headed for a potentially catastrophic mismatch between the demands of an aging population for surgical care and the diminishing pool of physicians who are willing to shoulder the heavy responsibilities, and significant stresses, of surgical practice.

It is my hope that the governmental agencies responsible for implementing current and future health reforms will pay close attention to this study, and others like it.  If hard-working surgeons cannot sustain reasonable income levels (against the decades of grueling training required, and the hundreds of thousands of dollars in educational loans that most young doctors acquire) without working themselves into a state of exhaustion, burnout, and divorce, the ranks of general surgeons, and other core surgical specialists, will continue to become thinner and thinner.  Ultimately, if things do not change, and soon, you and I might find it difficult to obtain access to high quality surgical care, particularly for emergency illnesses and injuries…. 

 

 

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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


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