Monday evening, 500 or so residents of Covina, California gathered at the Royal Oak Intermediate School to discuss the horrific Christmas Eve slayings committed by Bruce Pardo.  Pardo, dressed as Santa Claus, walked into a family gathering at his ex-in-laws’ home, shooting a 9-year-old girl in the face and then killing nine other people.  Before escaping and committing suicide himself, he burned the house to the ground.

According to police, Pardo had hoped to kill other people, too, including his mother, his wife’s divorce attorney and the attorney’s family.  They believe he had been planning the carnage since June — perhaps even earlier.

Because of Pardo, 13 young people are orphans.  Still others are without one of their parents.

What makes a man, who appeared to others to be quirky, but friendly, commit such an atrocity?  How is it possible that the same person who had participated in a seemingly rational way in divorce proceedings could have done so with mayhem on his mind?  How could he have wished the owner of his favorite coffee shop—the Montrose Bakery and Café—a merry Christmas just several hours before the slayings?

We know some of the stresses Pardo was facing.  He had lost his job.  His marriage had dissolved in the wake of his wife having learned he had abandoned a son she knew nothing about, a son left brain-damaged by nearly drowning while Pardo was to be watching him.  Perhaps Pardo felt lingering guilt and grief over that tragedy.

Yet, in my 16 years as a psychiatrist, I have met hundreds of men and women who have shouldered equal or greater psychological burdens without their circumstances triggering violence of any kind.  I have been privileged to see many of them face the loss of children, homes, marriages or their own health by looking inside themselves for strength — and finding it.

Pardo apparently had no such reserves of character upon which to draw, no hope for the future, no empathy left for others.  He seems to fit into that category of men I have met in my work as a forensic psychiatrist who, faced with painful changes over which they lacked control, came to see their life stories — including the people in them — as ending, done with … over.  It is as if they were collecting scripts from actors in a play that was going badly and being shut down.  Then the curtain fell.

For Bruce Pardo, I can theorize (even without interviewing him), there had to be a deep-seeded belief — perhaps an unconscious one — that loss of control or perceived abandonment had always meant chaos and terror.  There may have been unavoidable suffering in his own life as a child, suffering he could do nothing to prevent, suffering that left him, long into his adult life, with a child’s intense brand of terror at being powerless.  There can be no consoling such a “man” when events — even those of his own making — seem to be rendering him isolated, subject to forces (like job loss and divorce decrees) he cannot bend to his infantile will, impotent.

Those feelings of impotence, I believe, may have been the ones turned upside-down and inside-out in the months leading to the Christmas Eve carnage in Covina.  They may have been the ones that became fuel for a pathological and sinister plot that, in his own twisted mind, turned Bruce Pardo, for one terrible night, into the strongest man on earth, wielding the power of life and death over others, as though the frailties in his own psyche could somehow be camouflaged, even beyond his own recognition, by a storm of bullets and shield of flame.

I’ve been concerned for a long time about the tendency that my patients have to mix their medications with over-the-counter treatments and herbs. This is not a safe or wise approach, though most of the time, no major side effects occur.

Just this week, a patient called me to say she had a cold and wondered if she could take a common over-the-counter cold medication. On the surface it seems like an easy question with an automatic “yes” answer — except for one thing. She was taking the kind of antidepressant medication that can raise blood pressure, and the cold medicine she had in mind contains Sudafed, which can also raise BP. So my answer was actually “no.” More importantly, I felt glad she thought to ask me the question, as too many patients don’t think they need to discuss over-the-counter aspirin, Tylenol, or cold medicines with their doctors.

According to a new study in the Journal of the American Medical Association, approximately 2.2 million or 1 in 25 older adults, are at risk for potential major drug-drug interaction. Men are at greater risk than women. The study looked at close to 3 thousand people aged 57 to 85.     

The problem often occurred because of mixing prescription drugs with over-the-counter drugs and dietary supplements, which also contain active chemicals. Frequent problems involved mixing Coumadin (a blood thinner) with aspirin or garlic (which also thin blood), or mixing a cholesterol-lowering statin with dietary niacin (lowers cholesterol and can effect the liver). Aspirin, when taken with gingko, can also increase the risk of bleeding. Certain blood pressure medicines (lisinopril) can raise potassium, and many patients were also taking potassium at the same time (for use with diuretics). Unfortunately, these different and potentially conflicting drugs are often prescribed by different doctors, and there is no one who has the entire list or is coordinating care.
     
Here is my take:

1. This study brings home the point that physicians need to be in the loop on ALL medications their patients are taking, including over-the-counter pills and supplements.

2. Doctors need to address this with each and every patient and to go over potential interactions.

3. Elderly patients have SLOWER metabolisms, so the risk of a major complication from medicines competing with each other to be removed by the liver or kidney is much greater.

4. The Institute for Safe Medication Practices has an excellent Website which goes over medications at high risk for misuse as well at the latest news. They have recently launched a new website for the consumer, www.consumermedsafety.org, which is very accessible and user friendly.

5. Any concerns raised by reading this information, should NOT lead to automatically stopping medications that may be important, but rather should lead to a clarifying consultation with your physician.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth about the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

Almost as soon as the Times Square ball drops and the confetti is scattered, many people start making resolutions to improve their health and lives. In fact, according to ABC News, 45 percent of Americans vow to lose weight as the New Year approaches. Losing weight after the holidays doesn’t have to be difficult, and with the right plan you can accomplish your goal weight. Here are some tips to get you on the right track.

1. Set realistic goals.

Write down where you would like to be with your weight in 1 month, 3 months, 6 months, and then 1 year. You gradually gained the weight over several months and even years, so always remember that you’re in this for the long haul. It’s a marathon, not a sprint, and with this mind set you will be able to create new healthy habits which will ultimately turn your “diet” into a truly healthy lifestyle.

2. Fill up on fiber and protein.

Make sure every meal is a combination of fiber and protein.  Fiber and protein are the two nutrients that take the longest to digest.  It is this perfect combination of foods that keeps your serum glucose levels consistant, leading to improved energy throughout the day.  In addition, since fiber has zero calories per gram, and protein has 4 calories per gram, you are guaranteed the least caloric intake with the most food itake.  Eating small, frequent meals helps to stabilize blood sugar and keep energy levels consistent.  In addition, it helps to prevent you from becoming ravenous at night which leads to poor food choices and less portion control, and eventually leading to overeating. For lunch, have a big salad filled with vegetables and lean protein, and as a snack, have an apple with a piece of string cheese or peanut butter. These meals will keep you stay satiated throughout your days.

3. Don’t skip breakfast.

Most mornings, we barely glance at the kitchen because we’re either in a rush or would rather sleep until noon.  Other people skip breakfast thinking they’re saving on calories, but by mid-morning, that person is starved — leading them to be ravenous throughout the day. Recent research shows that eating breakfast can actually help you shed pounds by jump-starting your metabolism for the day. A breakfast consisting of fiber and protein is the ultimate combination because these nutrients will fill you up on the fewest calories.  Some delicious and satisfying breakfast options include a high fiber cereal (5 grams or more) with skim milk and berries or an egg white omlette with veggies and a slice of whole wheat toast.

4. Lose weight with water.

Water is essential for everybody, and it is also the key to losing weight. Drinking eight 8-ounce glasses of water each day is essential for losing weight. Not only is drinking water important for all bodily functions, but it keeps you hydrated and helps fight fatigue — a symptom that tends to lead to overeating.  If you haven’t been drinking enough water, your body has developed a pattern of storing water. This water retention equals unwanted pounds.  If plain water is too boring for you, add a slice of lemon or lime or a sugar-free flavor packet.

5. Eat more fruits and veggies.

By simply adding more produce to your diet, you may find that you begin eating less and thereby lose weight without making any additional dietary changes. Filling up on fiber-rich vegetables and fruit add bulk and satiety to your diet without excess calories. Plus, you’ll get the extra health benefits of crucial vitamins and minerals.  Some fiber-rich choices include broccoli, cauliflower, artichokes, heart of palm, apples, berries and pears.

6. Snack on pistachios.

In a recent study done at Eastern Illinois University, researchers confirmed that people are more influenced by perception then hunger. When a group of people were given the same amount of pistachios, shelled and unshelled, they ate 45 percent less nuts when they had to open them. This small study shows that by making small changes such as choosing in-shelled pistachios, which slow down consumption time, one can curb calorie intake dramatically. Pistachios also contain the highest amount of fiber compared to most other nuts, as well as heart healthy mono-unsaturated fats, which have been shown to lower cholesterol. 

7. Keep a food journal.

Writing down what you eat can double your weight loss, according to a new study of nearly 1,700 dieters from Kaiser Permanente’s Center for Health Research. Those who documented their food, drinks and exercise everyday lost twice as much over six months as people who did so occasionally or not at all (average difference: 20 pounds compared with 10). Journaling makes you accountable and aware of subconscious eating that packs on the pounds.

Tanya Zuckerbrot, MS, RD, is a nutritionist and founder of Skinnyandthecity.com.  She is also the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com.

During the 1960s, psychologist Stanley Milgram set out to study how obedient human beings can be to authority.  Three months after the start of the trial of Nazi war criminal Adolf Eichmann in Jerusalem, he set up an experiment designed to determine whether ordinary people could be coaxed to inflict suffering on innocent people simply because they were ordered to do so. 

In the now-famous Milgram experiment, volunteers were told by an “experimentor” that they were participating in a study about learning.  Each individual believed he or she was the “teacher,” administering electric shocks to another volunteer in a separate room each time that person failed to answer a question correctly about word pairs.  In one version of the study, the “learners” mentioned having heart conditions. 

As the learner made more and more mistakes, the shocks were increased.  If the teacher hesitated, the experimentor stated that the experiment had to continue.

In fact, only the “teachers” giving the shocks were being studied.  The learners were researchers, too.  No real electric shocks were being administered, though the learners — who were good actors —screamed as the teachers really dialed up the electricity.

Heart conditions or not, about two-thirds of the study volunteers continued to deliver electric shocks to their students, even when they were told to deliver the maximum 450 volts — enough to cause permanent injury or even death.

Milgram had proven that average individuals presented with rules and an authority figure to enforce them (the experimentor), would hurt other innocent people they had never met.

Now, some 45 years later, psychology professor Jerry Burger at Santa Clara University has confirmed Milgram’s findings.  In a modified version of the Milgram experiment (with somewhat lower voltages, but plenty of “learner” suffering), volunteers remained willing to torture their students for wrong answers, as long as they were consistently told to do so by an “experimentor.”  In fact, about 70 percent of the volunteers were willing to keep delivering shocks until the highest voltage level was reached (this time, 150 volts).

The Burger experiment has caused a stir in the psychology research community because of concerns that volunteers were not informed that the experiment was a “sham.”  Although the Burger team tried to screen out those who might be incapacitated by guilt after participating, or who might become depressed, there’s really no way to know if they might be harmed by the experience of “hurting” another person so badly.

That ethical debate is likely to rage on for some time.  But the data isn’t being challenged:  Most human beings are willing to inflict terrible pain on innocent people they have never met when an authority figure consistently tells them to do so.  What does that say about us?  What does it predict about the potential for genocides and other calamities in the future?

I believe it tells us one very important thing about our view of decency and morality.  Our notion that there are evil people and good people among us is too simplistic.  A majority of us can lose our moral bearings and do the bidding of evil by ceding our own personal autonomy to that of someone who instructs us, with authority, to harm our fellow man.  This fault line between good and evil cuts through the hearts of the majority of us, not a rare and select group. 

This explains much about the behavior of street gangs and terrorist cells and cults and nations with strongmen with their sights set on the destruction of others.  When a group — even a whole country — is in the grip of a charismatic leader giving consistent and forceful instructions on what must be done, the population is likely to get in line and do it.  It doesn’t make every citizen of the nation the devil.  It doesn’t necessarily mean the country is filled with people who are, at heart, morally different than we are.  But it does mean that they can be passive instruments of untold suffering.

In this world, at this time, in our species, the field of psychology tells us it will depend on those with a clear vision and a strong voice and absolute resolve to protect the rights of others and oppose the forces of destructiveness sure to gather in the coming years.  Our safety and security and capacity for goodness all require strong leaders to stand firm for the very best in us, and stand even firmer against the worst in any of us.

I am a primary care doctor. Today I saw a young woman who was afraid she might have appendicitis. I thought enough of the possibility to order a CT of the abdomen — which was negative — but I did not admit her to the hospital. She got better, and chances are the problem was due to a virus.

With primary care doctors rapidly becoming extinct, I think it is worth pointing out that if I didn’t exist, this young woman might have been admitted to the hospital for a few days, and possibly faced an unnecessary operation — at the very least it would have been a big expense to our health care system.

With only 2 percent of medical school graduating classes going into primary care medicine these days, and with 50 percent of primary care providers in a recent study saying they would quit if they could, I think it is worth considering what we could do about the shortage of well-motivated primary care doctors going forward — since we are the quarterbacks of any well-maintained health care system.

Here are some of my ideas:

• Subsidize education for primary care physicians on a state and national level with a payback of several years. As opposed to the National Health Service, which was disbanded in the 1980s, this service will inject primary care docs into urban and suburban centers with the goal of introducing a preventative strategy that can then be adopted by trained nurse practitioners and physician assistants.
• Reimbursements should favor primary care visits, and de-incentivize overuse of specialists and their procedures — especially tests (like EMG) or elective procedures (like cosmetic surgery), which do not lead to crucial treatments.
• Reimbursements (including Medicare and Medicaid) should reward preventative strategies such as weight loss and smoking cessation.
• With primary care physicians more in charge and more accessible, it might then make sense to increase insurance copays and deductibles, which would make patients hesitate before overusing their health insurance (studies show that most ER visits are currently from the insured, often for minor complaints).
• A new infusion of primary care doctors would help emphasize the principle that physicians and patients should be in charge of health care, rather than insurance companies. This could improve efficiency and decrease costs. Insurance is intended to be “just in case” rather than the primary controlling payer for all health costs. Insurance should carry over state-to-state, and insurance companies should be liable for forced medical errors — especially when they refuse to cover tests. Records should gradually be converted to electronic medical records, to improve efficiency.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth about the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

Today I want to talk about some of the most promising medical breakthroughs that we could see in the New Year.

Over the next couple of weeks, I’m going to be looking at different diseases — but for now, I want to concentrate on heart disease. Heart disease continues to be the leading cause of death for both men and women in the U.S., and even though new drugs to reduce cholesterol and diagnostic tools, such as the Ultrafast CT scan to predict coronary artery disease, have made a tremendous difference in mortality — more work needs to be done.

So, here are three new exciting possibilities for 2009:

Percutaneous valve replacement
A valve replacement procedure is currently a major surgery where the chest is opened up to repair or replace diseased heart valves. But new technology could introduce the replacement of these valves through blood vessels, and without the need for major surgery. This would reduce the possibility of complications, side effects and recovery time after surgery.

Safer drugs
Coumadin is a blood thinner that millions of Americans take everyday — and it is especially popular among those who have had heart surgery. This medication is a strong anticoagulant, meaning it reduces the formation of blood clots, but it has many side effects. Newer drugs will improve efficacy and reduce side effects.
Semi-artificial hearts
Small, mechanical pumps that can be placed in the heart prevent it from failing may extend the lives of patients on the transplant waiting list, and in many cases, may even void the need for heart transplantation in the future.

In my next blog I’ll be talking about new breakthroughs in cancer treatment and Alzheimer’s disease. I know the present feels overwhelming, but the future, at least in medicine, looks very bright.

A new study published in the December issue of the Journal of Allergy and Clinical Immunology (JACI) found a higher likelihood of anaphylaxis, or severe and/or life-threatening allergic reactions than previously reported.

In the study, Wyatt W. Decker, MD, Chief of Emergency Medicine at the Mayo Clinic in Rochester, Minnesota, reported that the incidence rate of food-allergic reactions increased significantly from 1990 to 2000. Researchers reported about a 10 percent increase in cases of life-threatening allergic reactions over the 10-year period of the study. 

Children ages 0 to 19 are at the highest risk for these severe reactions. Based on the new study, it’s estimated that food allergies cause 50,000 emergency room visits per year, with overall cases approaching 150,000 annually.

“This study shows anaphylaxis affects significantly more people, many of whom are children, than previously reported,” said Anne Muñoz-Furlong, Founder and CEO of the Food Allergy & Anaphylaxis Network (FAAN). 

Increased prevalence of peanut and tree nut allergy

Almost every day I am asked by patients, colleagues and the media why there are so many new cases of food allergies — particularly, nuts and peanuts. The prevalence of peanut allergy in the U.S. has been estimated to affect as many as 6 million people. The incidence of peanut allergy is said to have doubled in American children in the five years between 1998 and 2003.

Since there is no treatment or cure for food allergies, avoidance and education are the most important methods of reducing risk. Another important strategy is to become a “label detective.” To better understand food labels, carry a “food allergy identification card” (especially when eating outside of the home), and be prepared to treat severe allergic reactions when they occur. 

For more information on food allergy, contact FAAN at (800) 929-4040 or visit www.foodallergy.org.  In addition, see a board certified allergist for testing, and if you or a family member has food allergies, ask for a food allergy action plan!  

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine. He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology. No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Dear Yvonne,
For Christmas this year, I want to give my gal one of those sexual empowerment courses she’s always talking about taking  with her girlfriends. Which one do you think would be best as far as boosting her sexual self-confidence?
—Hank

Dear Hank,
Hands down — she should try belly dancing. It’s a form of self-expression that builds body image, self-esteem, and sexual self-confidence. She’s celebrating herself and her gifts — making a statement about her passion and pride. Belly dancing concentrates her body’s energy into her abdominal and pelvic areas — areas of great sexual and creative energy — helping her to bring out her sensual, inner sex goddess. Plus, belly dancing has many (health) benefits that are going to make for better sex, like improved coordination, flexibility, posture, and muscle tone.

Dr. Yvonne Kristín Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, “Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots.”

Dear Yvonne,
I’m really self-conscious about my butt. I know that half the battle of being comfortable with it in bed is working on my mental self. In the meantime, what sexual positions should I try to divert my partner’s attention from my rear?
—Rose

Dear Rose,
Before answering this, I have to point out that most guys get off on seeing their lover’s derriere — and love the jiggling effect that occurs as a result of his thrusting. That said, being on top is a great way for the lady to draw attention away from her buttocks. In most cases, a man’s entire attention is devoted to her breasts when she’s riding him. Being on top is always a favorite among ladies because it provides a great deal of clitoral stimulation and allows them to be much more orgasmic.  Plus, many love being in control of not only the depth of penetration and the speed and angle of his penis, but find the power dynamic of being in charge exhilarating as well. 

Dr. Yvonne Kristín Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, “Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots.”

Nearly 50 million Americans have high cholesterol. There are two kinds of cholesterol: HDL (high-density lipoprotein) and LDL (low-density lipoprotein). HDL is often called the “good” kind of cholesterol because it helps remove unwanted cholesterol from the body. LDL is the “bad” cholesterol made up primarily of fat, and is a particular risk factor for heart disease. So when setting out to lower your cholesterol, you need to know your HDL number, your LDL number, and your total cholesterol number.

This  chart will provide you with some helpful information:

High levels of cholesterol in the blood increase your chances of developing heart disease. In an effort to lower your cholesterol and reduce your risk, you must increase your fiber intake. Clinical studies show that a heart-healthy diet that is low-fat and includes lots of fruits, vegetables and whole grain products that contain fiber can lower blood cholesterol. Fiber, among its other benefits, seems to bind up cholesterol allowing it to be eliminated from your body. If enough is removed it can lower cholesterol by 10-15 percent.

Many studies have shown that fiber can slow the liver’s manufacture of cholesterol, as well as modify LDL particles to make them larger and less dense. Researchers believe that small, dense LDL particles pose a bigger health threat.

The American Dietetic Association recommends that Americans eat 20-35 grams of fiber per day. Here are some fiber-filled foods to help lower cholesterol:

•   Oat/oat bran/whole-wheat products
•   Dried beans and peas
•   Nuts
•   Barley
•   Flax seed
•   Fruits such as apples and pears
•   Vegetables such as carrots and broccoli
The key to improve overall health is not only dieting, but making physical activity a part of your daily routine. Regular physical activity is key to keeping your cholesterol low. Aerobic exercise may improve insulin sensitivity, HDL, and triglyceride levels, and may reduce your heart risk. People who exercise and control their diet appear to be more successful in long-term lifestyle modifications that improve their heart risk profile.
 
Tanya Zuckerbrot, MS, RD is a nutritionist and the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com.