immediate experience, short-term result, acid blocker, proton pump inhibitor, osteoporosis, gastric polyps, Richard C. Semelka MD

The Science of the Immediate Experience

The Science of the Immediate Experience

I read hundreds of medical articles each year. Scientists are not noted for their ability to spin exciting tales or weave words into an engaging and entertaining tapestry. Their approach is that of Dragnet’s Joe Friday: “Just give us the facts, ma’am. All we need are the facts.” It is unusual to run across a phrase that is noteworthy.

I was therefore pleasantly surprised when, in an article written by Richard C. Semelka, MD, I discovered an insightful new phrase that described the thought process of most physicians. Dr. Semelka is a professor of radiology at the University of North Carolina at Chapel Hill. In attempting to explain why radiologists (x-ray specialists) are not more concerned about the possibility that a CT or PET scan may trigger cancer in the patient receiving the study, Dr. Semelka observes that physicians are heavily influenced by what he calls “the science of the immediate experience”.

Dr. Semelka suggests that physicians are conditioned to look to the science of the immediate result through their personal experiences. He gives the example of mixing two chemicals in a college chemistry experiment and seeing an immediate change in their color or consistency. Having seen the result of the experiment appear immediately, it is natural to conclude that the effects of other reactions will also be readily apparent. Dr. Semelka writes:

“When we as radiologists perform a CT scan on a patient, the patient lies down on the table, undergoes the scan, gets up and is perfectly fine (unless there has been a contrast reaction or subcutaneous contrast misinjection), and then leaves and waits to hear back from the ordering provider about the results of the study. There is no skin heating, no burning, no skin reddening, and no hair exfoliation, which are features that we are familiar with as representing x-ray overdoses as experienced in the past. So, fundamentally, our primordial brains reject the concept that we are doing harm, because of our appreciation of the science of the immediate experience.”

The “science of the immediate experience” reassures the physician that all is well, that no harm has been done. Nevertheless, studies have demonstrated that the risk of developing cancer as the direct result of exposure to radiation from a single CT scan of the chest, abdomen, or pelvis is 1 in 1000.

The percentage of cat scans that result in cancer is so low, and the date at which those cancers present so far removed from the immediate experience that few physicians or patients ever make the connection. Still, for the one person in 1000 who develops cancer as a result of having undergone the procedure, the long term experience can be devastatingly different than the immediate experience at the time the test is performed.

Dr. Semelka pleads with physicians to be certain that the CT scan is necessary, that there is not a good alternative. In many instances equivalent or superior information can be obtained through the use of magnetic resonance imaging (MRI), which has not been shown to trigger cellular changes that can ultimately develop into cancer. He offers excellent advice. Even if a procedure or treatment provides good information or addresses the challenge effectively it should not be employed if a safer alternative exists.

Dr. Semelka’s phrase, “the science of the immediate experience”, resonated with me. It captures the essence of medicine as it is practiced in America today. It explains the excellence of critical care and trauma centers where the results of the actions taken are immediately visible. At the same time it spells out why diseases that come on gradually or cannot be cured within a matter of days or weeks are handled so poorly. It also sheds light on medicine’s disdain for measures that support the body’s ability to heal itself and medicine’s love of toxic chemicals and surgical procedures that effect an immediate change in the patient’s condition.

In many instances, the risks of a procedure are small and the appearance of any consequences is delayed. This allows physicians and patients alike to blissfully treat illnesses as if therapeutic risks and consequences did not exist. If the risk was high and a deleterious effect was immediately apparent the treatment would not be used. For example, a leg amputation would effectively treat an ingrown toenail, but the incidence of a devastating outcome (the loss of a leg) would be 100 % and the consequences of the procedure would be apparent immediately. As a result, leg amputation is never employed and alternatives are sought.

Unfortunately, safer alternatives are rarely sought when no immediate consequence of the treatment is experienced. During the late 1950s and early 1960s x-ray radiation was a popular treatment for acne. It was also employed for the treatment of enlarged tonsils, ringworm, and goiter (an enlarged thyroid gland). It has since been learned that x-ray exposure of the thyroid gland significantly increases the likelihood that thyroid cancer will occur within 10 to 40 years. No one would consider using x-rays to treat benign conditions of the head and neck today, but the lesson has not been learned. Even when there are reasons to suspect that treatments may cause undesirable future consequences physicians continue to prescribe them, stubbornly refusing to acknowledge that a potential for harm exists and consistently explaining away any findings that support the suggestion that a risk exists.

The widespread use of potent acid-blocking drugs is an example of relying upon the science of the immediate experience. There are instances in which these drugs can be life saving, such as Zollinger-Ellison syndrome, in which abnormally high levels of hydrochloric acid are produced. Zollinger-Ellison syndrome is quite rare, occurring with a frequency of one in a million people in the United States. Since acid-blocking drugs are among the most widely prescribed agents in the United States, it is obvious that they are being used for less serious conditions, such as indigestion.

If an individual complains of heartburn, indigestion, upper abdominal pain, or any of a number of other abdominal or chest symptoms it is almost guaranteed that he or she will be given a prescription for an acid blocking drug. The drug will cause acid production to fall within minutes. The immediate experience of the individual is relief of pain or burning, which leads the patient and the physician to believe that something wonderful has been accomplished.

When the drug is stopped, however, the body responds with what is called “rebound hyperacidity” – an overproduction of stomach acid by the cells that have been suppressed. This often results in symptoms that are as severe as they were before the drug was begun. The immediate experience leads the patient and the physician to believe that the drug is still needed. Since rebound hyperacidity can persist for up to two months, very few people who begin an acid blocking drug are ever able to stop taking it.

The immediate experience of acid blocking drugs in relief of heartburn and in its return when the drug is stopped is so compelling that physicians now prescribe the drugs without regard for any future consequences. Unfortunately, long term use of the drugs is proving to be a very dangerous practice.

I have written in the past about how physicians and medical researchers in the United States ignore the design of the body and mechanisms of disease, choosing instead to rely upon the results of short term studies to determine the benefits and risks of the treatments they prescribe (Evidence-Based Medicine and the Death of Logic, June 2004). This promotes a medical culture that is driven by the immediate experience.

The widespread use of acid-blocking drugs is a prime example of the folly of relying upon the science of the immediate experience. Although a short-term study published in 2000 reported that acid-blocking drugs did not adversely affect mineral absorption I advised my readers that the body could not absorb minerals effectively without the presence of stomach acid. In 2005 the American Journal of Medicine reported that calcium absorption was reduced by an average of 44 percent in women taking acid-blocking drugs. In 2006 the Journal of the American Medical Association published a report on long-term use of acid-blocking drugs and the risk of hip fracture.

The article reported that the risk of hip fracture increased by a factor of 1.22 after one year of continuous acid blockade. The risk increased by a factor of 1.41 after two years, by 1.54 after three years, and by 1.54 after four years of acid-blocking drug use. Since osteoporosis develops slowly it is likely that the reported increase in hip fracture from one to four years of acid blockade is the tip of the iceberg. The risk of osteoporosis from use of the drugs will almost certainly prove to be much greater over time.

Pre-release animal studies showed a significant increase in malignant tumors of the stomach in those given the drugs. This is not surprising, since the natural history of a condition of low stomach acid (hypochlorhydria) is an inflammation in the cells of the stomach and a subsequent increase in gastric tumors.

The mechanism by which low stomach acid leads to stomach cancer is well-documented. When acid production is compromised the body responds by increasing the production of gastrin, a major hormone responsible for regulating the production of stomach acid. The high gastrin levels trigger an enlargement of cells in the stomach called enterochromaffin-like (ECL) cells. Continued stimulation of ECL cells leads to the development of malignant tumors called carcinoids. The tumors that were commonly seen in animals given the drugs in pre-release studies were carcinoids.

It seems foolhardy to expect high levels of gastrin to produce a different result when they become elevated due to the presence of a drug than when they become elevated for other reasons, but the science of the immediate experience was quick to allay any fears of drug caused stomach cancer. Writing in the journal Gut in 1990 a group of British physicians proclaimed that while elevated gastrin levels related to the use of acid blocking drugs increases the size and number of ECL cells in animals it does not do so in humans. A 1998 research paper stated that there was no evidence of dysplasia (pre-cancerous changes) in the stomachs of individuals taking acid-blocking drugs. A 2001 study reported that the drugs did not increase the risk of stomach polyps (non-cancerous growths). A year later, however, the presence of gastric polyps in persons on acid-blocking therapy was reported. Reassurance was given that although genetic mutations were found in the polyps, no dysplasia was seen.

A 2005 study, however, noted pre-cancerous changes in some polyps associated with acid-blocking drug use. Nevertheless, the study concluded that the risk of dysplasia with long-term use of acid-blocking drugs is “negligible”. As I write this article in March 2008 the World Journal of Gastroenterology has just published an article titled Proton Pump Inhibitors and an Emerging Epidemic of Gastric Fundic Gland Polyposis. The authors, from the University of British Columbia make the following statements:

"Fundic gland polyps are now commonly recognized during endoscopy . . . In recent years, it has become evident that increasing numbers of these polyps are being detected during endoscopic studies, particularly in patients treated with proton pump inhibitors for prolonged periods. In some, dysplastic changes in these polyps have also been reported."

In less than seven years the science of the immediate experience has gone from reporting that acid-blocking drugs do not cause stomach polyps to acknowledging an “epidemic” of drug-associated stomach polyps. In less than three years it has progressed from a position that the risk of dysplasia in the polyps is “negligible” to a recognition that dysplastic changes do occur.

The progression is not surprising. Cancer develops in stages, and it typically does so over a period of decades, not a period of months or years. Genetic mutation is one of the first stages, but when genetic mutations were noted in 2001 physicians were advised that they were of no consequence. Over time, genetic mutation leads to cellular changes that are referred to as dysplasia. Dysplasia is now being reported. It is not out of the realm of possibility that an article reporting an epidemic of proton pump induced stomach cancers will appear within the next ten years.

While the statement that ECL cells increase in number and size in response to inhibition of stomach acid in animals but not in humans can no longer be made, physicians still refuse to accept the possibility that carcinoid tumors, which are common in animals on the drugs, will appear in humans. A woman recently informed me that when she expressed concerns that continued use of the acid-blocking drug her physician had prescribed could lead to stomach cancer the physician responded, “Only if you’re a rat!”

Physicians are not the only group that is unduly influenced by the science of the immediate experience. It is just as easy for non-physicians to fall victim to the deception. I recently received an e-mail message from an individual who had stopped taking a comprehensive nutritional support because it didn’t give him a “punch”. After a couple of months he felt significantly older than he had while taking the product (Lifetime) and he had therefore decided to start taking it once again.

I suspect he noted a difference in his vitality after stopping the supplement because he is at an age when the body’s need for daily support becomes more apparent. It is quite likely that if he were younger he would not have noted any significant change in his condition when he stopped taking the nutrients. The absence of a significant change in one’s sense of well-being on a short term basis is not an indication that the nutrients are not required, however.

Disease doesn’t just happen. With the exception of infectious diseases, which often cause a person to recognize that he or she is sick within hours or days of exposure, most diseases develop slowly. In most cases, a disease process has been present for years before the affected individual becomes aware of its presence. The heart attack that occurs at age 63 is initiated in the person’s twenties, when plaque initially begins to develop in coronary arteries. A skin cancer that is discovered at the age of 48 has usually been in development since the occurrence of a teenage sunburn. An arthritic knee that requires replacement at age 57 has typically been slowly deteriorating for several decades.

It is even possible for infectious diseases to be present for long periods of time before they become apparent. It is estimated that most people who find that they have hepatitis C were infected at least 10 years earlier. An individual who is infected with the HIV virus may feel perfectly fine for several years before the first disease symptom presents.

The science of the immediate experience is the greatest obstacle that must be overcome if you wish to optimize your chances of living a long and healthy life. I rarely see an individual who says, “I feel great, and I’d like to know what I should due to continue to feel this way.” When I do, I am ecstatic, because I know that individual is unlikely experience 85 to 90 percent of the health challenges that would have presented had he or she not taken a proactive approach to health.

It is more common to see an individual in consultation who has noticed a symptom or who has recently been diagnosed as having a disease. I am always pleased to have an opportunity to outline a program that will allow the body to intervene and begin the process of restoring health early in the disease process. The sooner the body is given the supports it needs to address a disease process the greater the likelihood that it will be able to do so successfully.

The rule, unfortunately, is that I will be consulted about ways to support the body’s healing mechanisms only when a disease is well advanced and after all attempts to control the disease surgically and pharmaceutically have failed. I approach such challenges with hope, for I have seen instances in which disease progression has been reversed even when it is far advanced.

Nevertheless, the chances of success are markedly diminished when a cancer has metastasized (spread from its original location), when the heart muscle is so scarred from heart attacks that it cannot pump effectively, and when all of the cartilage in a joint has been lost.

The science of the immediate experience is an impostor and a deceiver. Only by studying the body’s design and the mechanisms of disease development and aging can one determine what steps to take to reverse disease development and achieve lasting health. Providing information on how to effectively support the body’s innate ability to restore and maintain health has been and continues to be the focus of the Health By Design wellness letter.

© 2008 Wellness Clubs of

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