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On St. Paul, the Birth of Mozart, and Discovery of CETP

Monday Musings
Volume III, No. 3/107
by: Assad Meymandi, MD, PhD, DLFAPA*

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Conversion of Saul to Saint Paul. The Birth of Mozart. Discovery of CETP.

This week three important events take place. I will elaborate in the order of importance.

Event I

The Feast of the Conversion of Saul to Saint Paul the Apostle:

Many biblical scholars and historians of impeccable credentials including Eusebius of Pamphili, Saint Jerome, Saint Augustine of Hippo, Saint Ambrose who converted Saint Augustine of Hippo form pagan pursuits and Manichean beliefs to Christianity in 386, and baptized him on Easter morning 387, and Pope Gregory, have written and attested that the conversion of Saul to Paul took place on January 25. Among more modern historians, I recommend a comprehensive and magnificent book published in 1747 by Oxford Press written by the most formidable historian of early Christian era, Lloyd George Lyttleton (1708-1773). The book uses earlier references to lay down the cornerstone of this historic event, namely conversion of Saul to Paul on this date. Saul was a Pharisee with a precise/dry life style, demanding, draconian, exact and unforgiving. Every “t” had to be crossed and every “i” had to be dotted. He lived a life of exactitude with no love and no joy. Paul on the other hand brought the message of hope, faith, love, charity and forgiveness. The two people, Saul and Paul, were extremely opposite in orientation and life style. In many Christian churches including the Roman Catholic, Eastern Orthodox, Oriental Orthodox, Anglican and Lutheran churches, January 25, is celebrated recounting the conversion. The feast is at the conclusion of the “Week of Prayer for Christian Unity and International Christian Ecumenism” which began in 1908. The feast is an octave (an eight-day observance, not a musical octave!) spanning from January 18 (observed in Anglican and Lutheran tradition as the Confession of Peter, to January 25.

Here is the collect for the occasion.

“O God, who taught the whole world
through the preaching of the blessed Apostle Paul,
draw us, we pray, nearer to you
through the example of him whose conversion we celebrate today,
and so make us witnesses to your truth in the world.”

Event II

The birth of Johann Chrysostom Wolfgang Amadeus Gottlieb Mozart:

257 years ago, on January 27, 1756: God wanted to show his mere mortal children, like you and me, what He could do with music. He chose a special child, Mozart to demonstrate the complex sublimity and eloquence of music. Mozart composed more than 623 incomparable pieces in all genre of music, from symphony to opera, to chamber music, etc., in his short life of 35 years. We devoted the December 16, Mozart’s mortal anniversary “Monday Musings” to the miracle of Mozart. If you do not have it, please e-mail us and it will be sent to you.

Event III

A New Discovery in Health Care. A Plug for Prevention:

Like any other human endeavor, in medicine, we have hype, hyperbole, hysteria and high drama. Charlatans from every corner claim to use their powder on food to make you burn calories and lose weight. Full page ads for miracle treatment of back pain in both skinny and fat people. It should be known to all obese people who suffer from back pain that taking off one pound of body fat takes five pound off the aching back. Incidentally, in my view, doctors advertising in news media, both print and electronic, violate Oslerian ethical mandate of medicine. It is very distasteful. It is more than distasteful. It is really disgraceful. Medicine is not a commodity. Medicine is not a business. Medicine is a calling. Medicine is a priesthood, and we, as doctors, are privileged to be handpicked servants to help our patients (not clients, not heath consumers) for which we should be grateful.

However, there are some medical discoveries reported in peer reviewed journals that are époque making and worthy of note. The recent discovery of Cholesteryl Ester Transfer Protein (CETP) or Evacetrapid is one. A bit of explanation is in order. In America, cardiovascular diseases are the biggest killers followed by cancer. For over a half of century scientists have implicated excess circulating cholesterol, especially low density cholesterol or “bad” cholesterol is responsible for occlusion of coronary arteries, leading to heart attack. We have produced a class of drugs call Statins that lower the bad cholesterol and increase the good. However, Statins have undesirable side effects. The side effects include muscle and joint pain and muscle damage. In some cases Statins have been known to cause lysis or eating away of muscles called rhabdomyolysis. Other side effects of Statins are liver damage, kidney failure and fatigue/depression. Liver damage caused by Statins occurs by increasing production of digestive enzymes. Other serious side effects may be low libido and pancreatitis. I see quite a few patients with neurological side effects, such as memory loss, depression and sometimes more serious neurologic conditions.

Back to CETP: A very important paper published in Journal of American Medical Association (JAMA) describes a new chemical that assists cholesterol lowering drugs or Statins to become more effective and biologically efficient. the name of the agent is Cholesteryl Ester Transfer Protein (CETP) Inhibitor. It is potentially capable of replacing use of Statins altogether doing away with Statins’ side effects. But the best life style is prevention, proper diet; exercise and discipline of what one puts in one’s mouth are the ultimate answer to good health. Medicine does have its genuine miracles. In America, a pill taking culture, we have been brain washed that for every ill there is a pill. A pill to sleep, a pill to stay awake, a pill to focus and concentrate, a pill to cure erectile dysfunction, a pill to cure irregularity, a pill to regulate too much regularity. A pill to cure depressed mood, a pill to tone down elevated mood. Aram Khachaturian or Leonard Bernstein could have done well to compose a piece of music like Saber Dance or Candid to express our ominous pill taking culture. I submit that we should pay more attention to prevention. With 80% Americans ranging from fat to very obese and morbidly obese, no wonder we have so many cardiovascular deaths, diabetes, musculoskeletal, that is back and joint problems. I believe we must invest in prevention and have a major national program of awareness to seriously address health issues most caused by fatness. One of the things that I think is most discouraging is to see so many doctors and nurses (health care providers) who are obese. This is truly an ugly and unacceptable site. Instead of putting something in our mouths, we must learn to take something away from our mouths..

Surely, here we are celebrating the discovery a chemical that will potentially help millions. But the main message is to celebrate prevention. We have had luminous achievements in this field. Salk vaccine against polio is a good example. 2011 was the first year no polio was reported in India with a population of one billion. Malaria is on its way to extinction, same as some 25 other infectious diseases including the big killer small pox. To take responsibility for one’s health is not only a civic, but a moral responsibility. Tobacco, alcohol and obesity kill without discrimination.

*The writer is a Distinguished Life Fellow American Psychiatric Association, Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill. He is the Founding Editor and Editor in chief, Wake County Physician Magazine(1995-2012)

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On Money, Ills and Love

Monday Musings for Jan 14, 2013
Volume III. No. 106

Rumi Image

Printing Money, Homelessness, Mental Illness and Love
by Assad Meymandi, MD, PhD, DLFAPA*

Stories about fake bills being printed and circulated appear in the newspapers frequently. Such was the story in N&O, January 5, 2013. One wonders if printing money is fraudulent, bearing grave consequences of long prison term, why nobody arrests the US administration, US Congress, Federal Reserve, US Treasury Department, and for that matter the World Monetary Fund. They print money in the trillions with no accountability or responsibility. Why do they not get arrested and prosecuted?

Homelessness

Thomasi McDonald’s piece in January 11, N&O, carved out and dissected the psychobiography of a group of citizens, the homeless, our fellow humans, with a sharp and precise psychological scalpel. The piece is worthy of a Pulitzer. As a psychiatrist, the hours I spend with clinic patients afflicted with addiction and mental illness, I see so many who would swap their freedom for prison’s board and room. We know that 90% of prison and jail population are afflicted with mental illness. It is a shame that in our society the best place to get any help for the mentally ill is the prison. We do need to repair our broken down system of mental health care. And finally:

Love according to Mowlana Jalal-Din Mohammad Balkhi Rumi

Translated by learned colleague Majid Naiini

From love, bitter becomes sweet,
From love, thorns become flowers,
From love, vinegar becomes wine,
From love, fire becomes light,
From love, devil becomes angel,
From love, sorrow becomes joy,
From love, sickness becomes health,
From love, fury becomes mercy,
From love, dead becomes alive,

I sincerely wish that we all follow Rumi’s grand teachings and for 2013,

Set a fire in your heart from love,
Burn all ill thoughts & statements.
God of love stayed and everything else left,
Be happy, oh fierce love, the burner of all our ills.

*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill. He is Emeritus, Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012)

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Contemplation On Several Current Topics

“Monday Musings” for Monday October 15, 2012

Volume 2.  No. 37/89

Contemplation On Several Current Topics  

By Assad Meymandi, MD, PhD, DLFAPA*

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Alcohol and College Sports

While prohibition is often counterproductive, I believe the answer to binging, abuse and unreasonable use of alcohol is education. The answer also lies in curtailing greed and hunger for money. The university leaders ought to cut out advertising of beer from all TV sports. It is sheer greed to have alcohol products sponsoring sports events, and it is sheer hypocrisy for university leaders to tolerate this practice because it produces revenue for their institutions. Ban alcohol ads from all television sports.

Medical Care in America

The fairly comprehensive article “Prescription for Addiction”, WSJ, (Sat/Sun Oct 6-7) was commendable.  Our healthcare establishment is dysfunctional.  American medicine is expensive.  Nearly 20% of Gross Domestic Product (GDP) is spent on health care.  US medicine is deluged with waste, duplication and overuse.  Patients with no medical home use the most expensive form of medical care, the emergency rooms, and get repeated and often unnecessary scans for every symptoms they present.  I do not blame the emergency room (ER) physicians because they are hounded by malpractice threats.  Over-testing and over-treatment are norms in America.   In my daily practice, I see many patients with brown bags full of medications prescribed by different physicians, ERs, and clinics, each medication prescribed for a symptom, many for treatment of pain.  The patients are often given many other medications that actually cause depression feeding into the pain cycle.  In our culture, we medicalize our social problems and turn to MDs for chemicals for solution which only complicates the problem. We should be aware of iatrogenic addiction, as your article suggests.

On another matter, While my heart goes out to the Kathryn Gullo and her family (news story, N&O, September 11, 2012), I admire her intelligence, intuition and courage to stand up to the healthcare establishment and demand what the additional information the requested MRI would provide to help her baby.  There is no question that American medicine is deluged with waste, duplication and overuse.  Patients with no medical home, use the most expensive form of medicine, emergency rooms,  and get repeated and often unnecessary scans for every symptoms they present.  I do not blame the ER physicians because they are hounded by malpractice threats.  I also, commend the N&O for running another story in the same issue “ Stop testing healthy women for ovarian cancer” which further illustrates over-testing and over-treatment.   Although early detection and prevention are the best form of medical practice, they do not justify overuse and abuse of medical diagnostic tests and procedures.  Kathryn Gullo is right, before you agree to a test, insist upon  knowing what additional information the test provides to help bring solution to

Iatrogenic Addiction

The essay by my learned colleague, Dr. Dan Blazer, “Substance Abuse Disorder in Later Life”, Psychiatric News, August 17, 2012, was most welcome.   I wish to add one more often neglected etiology: iatrogenic.  In their busy practices, colleagues with little time to spend with their patients, seem to prescribe a pill for every symptom.  In my practice, I frequently see patients come in with large brown bags of pills prescribed by one or more physicians.  Often the drug-drug interactions and side effects of prescribed medications go unnoticed.  Addiction to prescribed medications should be addressed seriously in any strategy to combat substance abuse.

 Preemies

The heartwarming story of Royce Jones (June 12) compels me to inform his parents that Johannes Kepler (1571-1630) was born prematurely.  Kepler was obsessed with measurement.  His obsession made him calculate his own gestational period to the minute, 224 days, 9 hours, 53 minutes.  So, don’t fret, Royce’s mama may have given birth to a Kepler.

*The writer is a Distinguished Life Fellow American Psychiatric Association, Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill.  He is the Founding Editor and Editor in chief, Wake County Physician Magazine (1995-2012)

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