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From the Townsend Letter
January 2008


briefed by Jule Klotter

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Controlling MRSA
Barry M. Farr, MD, MSc says, in a 2006 editorial, that isolation of contaminated patients is the key to preventing the spread of Methicillin-Resistant Staphylococcus Aureus (MRSA). Vigilant handwashing programs alone do not stop the spread of infection, which is transmitted via direct contact with contaminated objects or infected people. Staphylococcus aureus is a bacterium that commonly inhabits the skin of healthy people. Antibiotic-resistant strains of this bacterium caused an estimated 94,360 severe infections in the US during 2005, resulting in around 18,500 deaths, according to the Centers for Disease Control (CDC). About 85% of all invasive MRSA infections have been associated with exposure to a hospital or clinic. However, strains of community-associated MRSA are now being found in hospitals. To reduce the risk of infection, the CDC tells the public to wash hands frequently, cover open sores/wounds with bandages, and avoid sharing razors, towels, or other equipment likely to transfer the bacteria from skin to skin.

Thousands of US hospitals have implemented hand hygiene protocols that follow CDC recommendations since 2002; but few hospitals, relying on those measures alone, have seen a significant reduction in MRSA cases. However, actively screening for MRSA and using contact isolation measures with contagious patients does decrease the number of severe infections. Dr. Farr refers to a 2005 study at Brigham and Women's Hospital intensive care unit in Boston, Massachusetts. The researchers reported at the 43rd Annual Meeting of Infectious Diseases Society that alcohol handrubs and a motivational campaign that increased hand hygiene compliance to 80% had no effect on the MRSA bacteremia rate, but active detection and isolation of all colonized patients reduced MRSA bacteremia by 75%. Dr. Farr says that hospitals in Northern Europe and Western Australia that use active detection and isolation have "consistently and convincingly controlled [nosocomial MRSA infection rate] to very low levels for decades."

Farr BM. Doing the right thing (and figuring out what that is). Infect Contrl Hosp Epidemiol. 2006;27:999-1003.

Health Costs
The US uses a corporate system of health insurance to cover medical costs. Without good insurance coverage, necessary hospital care can bankrupt families. In the wake of rising health care costs and federal inaction, some states have embarked on their own reform measures to make health insurance accessible to all their citizens. An estimated 47 million people in the US lacked insurance coverage in 2006, according to the Census Bureau. Every year between 2000 and 2006, health insurance premiums increased more than twice as fast as workers' salaries, according to the Health Research and Educational Trust and the Kaiser Family Foundation. The average yearly insurance cost for a family enrolled in a preferred provider organization (PPO) was $11,090 in 2005, most of which was paid by employers.

Maine was the first state to aim for universal health care. Maine set up a subsidized insurance plan called DirigoChoice. But the reform plan has stalled due to several factors, including a large number of seasonal and part-time workers and small family businesses that cannot afford premiums. Governor Baldacci has proposed reforms to the initial law that include having the state administer DirigoChoice instead of having the state's major insurer Anthem Blue Cross sell it, making DirigoChoice more affordable for small businesses, setting up more Medicaid cost controls, and covering high-risk patients under a separate insurance fund. The governor also wants health insurance to become mandatory, instead of voluntary.

Learning from Maine's mistakes, Massachusetts passed a bill in April 2006 that made health insurance, like car insurance, mandatory. Individuals and families who do not have insurance will lose their individual state income tax exemption and incur other penalties. The bill relaxed its strictures on insurance policy guidelines so that new, less expensive, private policies (some of which are state-subsidized) are now available. These plans are required to include prescription drug coverage. (I have not seen any reports that they include CAM practices.) In lieu of a regular insurance policy, residents are permitted to buy catastrophic coverage with a high-deductible plan or a Health Savings Account (HAS). Those who cannot afford coverage can get a waiver and thereby avoid penalty fees. California's proposed health care plan is similar to that in Massachusetts. California, however, has a far high number of uninsured residents: about 20% of the population (7.2 million) compared to 7.2% (460,000) in Massachusetts. At this point, no one knows how many of the uninsured can afford one of the plans or if either state will be able to fund coverage for those who cannot.

These state plans address the cost of health insurance but do not address the deeper problems of health care expense caused by over-testing due to practitioner fears of being sued, the drive for the newest technology (which often does not live up to the hype), and the emphasis on acute care instead of primary preventive care. Quad/raphics, a large US printing company, cut its employee health care costs by providing in-house primary care clinics. These clinics focus on health outcomes and patient satisfaction rather than on the number of patients a doctor sees. The company also negotiated with nearby hospitals and specialists for a lower price for its employees, thus cutting out the middle man – insurance companies.

The US has the highest total health care expenditure per person – $6,096 (Intl$, 2004), according to the World Health Organization (www.who/int/countries/en/), yet many of its health outcomes are consistently lower than other industrialized nations. Britain, Canada, and France, three of the countries featured in Michael Moore's Sicko, have different types of systems and better outcomes. Britain's system, like the US Veterans Administration, is socialized. The government runs the hospitals and hires the staff. Britain's total cost per capita was $2560 (Intl$) in 2004, but its health outcomes in terms of infant mortality and lifespan are better than in the US. Canada has a single-payer system. The government pays health care providers and hospitals, based on negotiated fees. Doctors have private practices, and hospitals are either nonprofit or government-owned. This system works like the US Medicare system. Canada spends $3,173 (Intl$, 2004) per person.

France's funding of health care is more complex, but the country's system ranked first in the WHO's 2000 ratings of health performance. In France, both medical practices and hospitals are privately owned. Nonprofit, regulated "sickness" funds pay health care bills, using a negotiated fee structure. Compulsory payroll contributions from employers and employees finance these funds, which cover about 75% of all medical bills. Government, patients, and supplemental insurance cover the rest of the charges. This system costs $3,040 (Intl$, 2004) per capita, about half the price of US care.

Alliance for Health Reform. The uninsured and rising health costs (Issue Brief). January 2006.
Abelson R. Mandatory coverage is easier said than done. The New York Times. June 11, 2007. Available at: Accessed October 7, 2007.
Armstrong D. Number of uninsured in US increases. CQ Today. August 28, 2007. Available at: Accessed October 12, 2007.
Belluck P. As health plan falters, Maine explores changes. The New York Times. April 30, 2007. Available at: Accessed May 23, 2007.
Fahrenthold DA. Mass. bill requires health coverage. The Washington Post. April 5, 2006; A1.
Fuhrmans V. One cure for high health costs: in-house clinics at companies. The Wall Street Journal. February 11, 2005; A1, A8.
Gov. Schwarzenegger Tackles California's Broken Health Care System Proposes Comprehensive Plan to Help All Californians (Press Release). January 8, 2007. Available at: Accessed October 1, 2007.
Krasner J. Calif.'s healthcare plan looks familiar. The Boston Globe. January 11, 2007. Available at: Accessed October 1, 2007.
Moffit RE, Owcharenko N. Understanding key parts of the Massachusetts health plan. The Heritage Foundation web memo. April 20, 2006. Available at: Accessed October 1, 2007.
Van Gelder S, Pibel D. Health care options at a glance. YES! Magazine. Fall 2006. Available at: Accessed August 16, 2007.

Genetic Tests, FDA, and Warfarin
The US Food and Drug Administration has updated prescribing information for warfarin (Coumadin) to include a recommendation for a lower dose in people with certain genetic factors. Warfarin, especially at the beginning of therapy, produces a high number of adverse drug events, second only to insulin. Too large a dose can cause serious bleeding, and too low a dose can result in blood clots. Variations in gene CYP2CP cause warfarin to break down more slowly, causing it to buildup in the body and increase the likelihood of hemorrhage. Another gene, VKORC1, affects the processing of vitamin K. Warfarin interferes with vitamin K to produce its anti-clotting effect. Variations in this gene can also increase a person's risk of bleeding.

The FDA's decision to highlight the effect of genetic makeup on dosing has met with criticism. At this time, practitioners do not have specific dosing guidelines for genetic variations. No clinical trials have studied the risk of bleeding in patients who receive traditional dosing compared to those who undergo genetic testing. The FDA is funding research to produce dosing guidelines for these genetic variations. In the meantime, some worry that practitioners who do not use genetic tests, referenced on the product's label, will be sued by patients who have adverse drug reactions. Warfarin genetic tests cost between $300 and $500, according to The Wall Street Journal. Medicare will pay for the tests, but many insurers do not. Another concern is that doctors who use the tests will relax their oversight of a patient's condition.

The FDA and industry are pushing pharmacogenomics, the use of genetics to predict a person's response to a drug. Warfarin is the first widely used drug to employ genetic testing. The antidepressant Prozac, the bronchodilator albuterol, and the diabetes medication metformin may be among the next drugs to have genetic screening tests.

Mathews AW. In milestone, FDA pushes genetic tests tied to drug. The Wall Street Journal. August 16, 2007; A1. Available at: Accessed August, 17, 2007. (Jan. 2008: Older than 90 days. You must now pay for article through
US Food and Drug Administration. FDA approves updated warfarin (coumadin) prescribing information. Available at: Accessed September 26, 2007.
Warfarin (Coumadin) and DNA. Available at: Accessed September 26, 2007.

EAV and Holistic Medicine
Washington State practitioners who use EAV (Electroacupuncture, according to Voll) equipment have attracted unwanted attention from the state's Department of Health and Medical "Quality" Assurance Commission (M"Q"Ac, pronounced "M-quack"). EAV, also known as electrodermal testing (EDS) or meridian stress analysis (MSA), uses an ohmmeter to measure the electrical resistance and conductivity of specific acupuncture points on the skin. Dr. Reinholt Voll, MD discovered a Universal Baseline measurement of 50, which indicates an energetically healthy meridian regardless of gender, age, or race. Readings significantly above the baseline indicate inflammation. Readings below 30 indicate low energy and possible deterioration. EAV gives holistic practitioners a non-invasive tool for assessing a patient's overall health. Although EAV procedures have not undergone FDA approval, the devices themselves are registered with the agency as Skin Conductance Meters.

Jonathan V. Wright, MD began using EAV in 1986, when he took part in a three-month comparison of EAV screening to traditional needlestick testing in children with allergies and sensitivities. He found, "EAV was clearly superior in both methods and results. It was also more humane, less time-consuming, and less expensive." ICON Health & Fitness, Inc., which makes home exercise equipment, now includes EAV screening in its self-funded medical plan. The company performed an outcome study using the BioEnergetic Stress Test (BEST) System, a MSA device produced by BioMeridian Corporation. Douglas Younker, ICON's Human Resources Director, said that information gained through meridian stress analysis led to a significant reduction in symptoms and high satisfaction among the participants and that $10.40 was saved for every dollar spent.

Despite evidence of EAV's benefits, Washington State's M"Q"AC has targeted professionals who use the device. Dr. Geoffrey Ames' medical license was suspended for five years because he demonstrated EAV equipment to a patient. He can practice medicine as long as he does not use EAV. Dr. Wright says that M"Q"AC sent him "a preliminary investigation letter," partly because his website advertises "Sensitivity Screening via non-invasive measures" (EAV screening). Reports in Dr. Wright's newsletter about the crackdown on holistic practitioners have caused Washington citizens to appeal to state legislators. Groups such as WaCHOICE are urging legislators to pass a bill that prevents state agencies from targeting health care practitioners whose practices deviate from conventional care, especially when patients are not harmed. The bill cleared the Senate but failed to pass in the House. The bill will be re-introduced in 2008. In addition, M"Q"AC has lost credibility. A September 2007 performance audit of M"Q"AC, requested by Governor Christine Gregoire, found serious flaws and inconsistencies in the agency's procedures, documentation, and disciplinary actions.

EAV Discussions. Available at: Accessed September 26, 2007.
ICON Health & Fitness, Inc. Healthcare study: The use of meridian stress assessment. March 22, 2000. Available at: Accessed October 8, 2007.
WACHOICE. Serious flaws unearthed in state performance audit. September 6, 2007. Available at: Accessed September 26, 2007.
Wright JV. Challenges facing holistic medicine. Nutrition & Healing. June 2007. Available at: challenge.php. Accessed October 25, 2007.
Wright JV. State tries to ban accurate and pain-free sensitivity testing. Nutrition & Healing. September 2006; 6-7.
Wright JV. You made a difference. July 2007. Available at: challenge.php. Accessed October 25, 2007.

In the hope of encouraging improvements in health care quality, Medicare, state Medicaid programs, and other health plans are testing pay-4-performance (P4P). P4P rewards hospitals and doctors with more money as the quality and efficiency of their care improve and penalizes those that fall below a set standard. Changing from the current pay-for-service paradigm that sets a fee for each service rendered to pay-for-quality is challenging and may not truly improve health care quality overall. For example, the same high-performing doctors in Atlanta, Georgia, profit from P4P year after year without other doctors showing much improvement. Some also wonder how to fund pay increases for high-performing providers
P4P brings up many questions. What is high-quality care? How do you measure it? Many P4P programs rely on evidence-based information – that is, medical knowledge that has been tested in clinical trials. (A majority of tests and treatments are not evidence-based, according to this definition.) How do you document (and charge for) evidence-based care that recommends "watchful waiting" when current fee-for-service insurance codes encourage the use of tests and treatment? What if a doctor does not prescribe the evidence-based drug for heart failure because a patient is allergic to it? Would that doctor be penalized for not following the evidence-based recommendation? Rewarding evidence-based care rather than patient outcomes has another drawback; it discourages doctors from trying to improve care by following empirical evidence, ad-hoc experimentation, and their own insights. As cystic fibrosis expert Warren Warwick told surgeon Atul Gawande, "National clinical guidelines for care are…a record of the past, and little more – they should have an expiration date."

Basing P4P on patient outcomes has its own problems. Most doctors do not have the resources or technology needed to document patient outcomes. Moreover, patients do not, or financially cannot, always follow their doctor's advice. Should doctors who service poorer populations be penalized because their patients do not have money for evidence-based medical care and good nutrition? Donald Berwick, founder of the Institute for Healthcare Improvement, questions the wisdom of using P4P at the practitioner level: "..I don't think we're going to get to the heart of the problem in American medicine by paying doctors to try harder….We've got to support the culture, clinical care, and underlying system that make healing, not scoring, the objective." He warns, "The problem with pay-for-performance is not that it doesn't mold behavior. The problem is that it does mold behavior. You get exactly what you're paying for, which might not, in the end, when you're finally on your deathbed, be exactly what you wish you'd gotten."

Alliance for Health Reform. Pay-for-Performance: A promising start. February 2006.
Landro L. To get doctors to do better, health plans try cash bonuses. The Wall Street Journal. September 17, 2004: A1, A12.
Nonpayment for noncompliance. AAPS News (Association for American Physicians and Surgeons). September 2006; 62 (9): 1.
Galvin R. A deficiency of will and ambition: A conversation with Donald Berwick. Health Affairs. January 12, 2005. Available at: Accessed October 26, 2007.
Gawande A. Annals of medicine: The bell curve. The New Yorker. November 23, 2004. Available at: Accessed October 26, 2007.

Viral Bacteriophages
The FDA approved a mixture of six lytic bacteriophages for use on hot dogs, cold cuts, and deli meats in August 2006. Bacteriophages are viruses that target a specific bacterium to use as a breeding ground. Lytic phages multiply until the bacterial membrane bursts apart, releasing endotoxins (produced by the bacterium in self-defense) and a new population of bacteriophages. Bacterial endotoxins can cause a Herxheimer response (fever, rigors, rashes, and worsening of symptoms). The FDA-approved mixture is designed to kill Listeria monocytogenes, a bacterium that causes food poisoning in about 2,500 people each year. Food labels do not list the viral spray, made by Intralytix, Inc., in a product's contents.

After the discovery of bacteriophages in the early 1900s, researchers sought phages that would target and destroy infectious bacteria. Unlike broad-spectrum antibiotics, phages discriminate in their destruction of bacteria; they only go after the strain that they use for breeding. Consequently, effective phage therapy depends upon a precise match between phage and bacterium. Although bacteria may evolve a defense against the phage(s), phages themselves also evolve, overcoming the defense – something antibiotics can never do. Doctors in Georgia, Russian, and other East European countries tend to use combinations of phages to treat bacterial infections. Serious antibiotic-resistant infections, like MRSA, have caused renewed interest in phage therapy among Western scientists.

Therapeutic use of phages, however, is not the same as liberal use of bacteriophages in the food supply. Instead of eating a meat product contaminated with Listeria, consumers will be ingesting endotoxins that can also cause illness. In addition, the product will contain large amounts of viral bacteriophages. Theoretically, these phages should target only Listeria. Some critics, however, point out that even these lytic phages, which use bacterial DNA simply to make copies of themselves, can take on random pieces of the bacteria genome. Although generalized transduction is rare, critics question the safety of ingesting these bacteriophages along with genetically engineered food products. All genetically modified organism (GMO) food contains viral promoter genes. Unlike chemical reactions, the interaction between microbes is dynamic and highly unpredictable. If you don't want to become part of the latest FDA-sanctioned experiment, avoid deli meats.

Intralytix, Inc. Frequently asked questions. Available at: Accessed October 1, 2007.
Phage therapy. Available at: Accessed October 1, 2007.
Richards BJ. FDA approves viral adulteration of our food supply. The Free Press. September 22, 2006.
Thiel K. Old dogma, new tricks – 21st Century phage therapy. Nature Biotechnology. January 2004;31-36.
Virus in our food supply. Available at: Accessed October 1, 2007.

Improving Health Care Quality
When Cincinnati Children's Hospital called in Donald Berwick to help improve its cystic fibrosis (CF) program, Berwick ran into a wall. Berwick founded the Institute for Healthcare Improvement, a small, nonprofit organization that provides multimillion-dollar grants to hospitals that agree to implement his ideas for improving medicine. Berwick believes that health care quality stems from regularly updated, open disclosures of measurable performance factors: "…everything from complication rates to how often a drug ordered for a patient is delivered correctly and on time." Such openness, he believes, gives patients' well-being precedence over a hospital's or doctor's reputation.

Under his guidance, the Cincinnati cystic fibrosis medical staff revealed to its patients' parents all the information it had about how its program compared to other CF programs in the US. Parents were dismayed to learn that Cincinnati's CF care was "at best, an average program," according to an article for The New Yorker by surgeon Atul Gawande. But they were impressed by the staff's openness and desire to improve care. The program's director set up several committees, each of which included at least one parent, to generate ideas for improvement. To learn what made the top-rated programs the best, one group wanted to visit the sites. Unfortunately, the Cystic Fibrosis Foundation would not release the names of the top centers. When Berwick called the foundation's executive vice-president, he learned that centers give the foundation data on their programs with the expectation of confidentiality. After much internal debate, the foundation finally gave Cincinnati doctors the names of the top five centers. Cincinnati was then able to learn from the best in the US.

Don Berwick believes that "if we are genuinely curious about how the best achieve their results…[those methods] will spread." But improvement in health care quality has not spread as quickly as he would like. In a 2005 interview with Robert Galvin, Berwick blames hospital executives and boards for not providing leadership for change. Executives are too often "devoted to maintaining the status quo," and hospital boards tend to accede to the wishes of doctors and managers. Berwick hopes that change will result by educating the public to demand more effective, efficient care. He is particularly concerned about the US love of technology: "We have a learning disability in this country with respect to the differences between technologies that really do help and technologies that are only adding money to the margins of the companies that make them….One of the drivers of low value in health care today is the continuous entrance of new technologies, devices, and drugs that add no value to care." Patients and practitioners need truthful, easily accessible information about effective practices so that they can differentiate between high-value and low-value treatments. I suspect that another component necessary for improvement in health care quality is giving doctors more time for education and communication with patients. How can patients and doctors build a relationship of openness and trust in a seven-minute consult?

Galvin R. A deficiency of will and ambition: A conversation with Donald Berwick. Health Affairs. January 12, 2005. Available at: Accessed October 26, 2007.
Gawande A. Annals of medicine: The bell curve. The New Yorker. November 23, 2004. Available at Accessed October 26, 2007.

Acid-Alkaline Balance & pH
One of the key features of body terrain is acid-alkaline balance. Although blood pH lies within a narrow, slightly alkaline pH of 7.35-7.45, pH differs in various parts of the body. (A pH of 7.0 is neutral. A pH above 7.0 is alkaline; below is acidic.) Chemical reactions and enzyme activity occur more readily at a specific pH. In addition, David L. McMillin at the Edgar Cayce research organization, Meridian Institute, cites several studies that show some viruses, including those that cause colds and flu, need a slightly acidic intracellular environment to infect cells. Researchers have also shown that many antibiotics and therapeutic substances are more effective in an alkaline environment. As an example, McMillin refers to berberine sulfate, an antibacterial alkaloid in goldenseal. "At a pH of 8 (alkaline)," he explains, "its antimicrobial activity in vitro is about two to four times greater than at 7.0 (neutral). At an acid pH of 6.0, the antimicrobial activity is only one-fourth as strong as at a neutral pH." In addition to affecting the body's ability to fight infection, the correct pH promotes toxin elimination.

The body works hard to maintain the crucial alkaline pH in the bloodstream. Several organs help regulate acid-alkaline balance. Lungs remove carbon dioxide (an acidifier) from the blood. Kidneys release extra hydrogen atoms into the urine and retain extra sodium when the blood becomes too acidic. When the blood is too alkaline, the kidneys retain hydrogen and excrete sodium. If the blood becomes "extremely acidic," the kidneys excrete hydrogen in the form of ammonium ions (alkaline), according to Virginia Worthington, ScD. Buffers within the blood itself also help regulate pH.

Balancing blood pH is an ongoing process. Stress, environmental pollution, too little or too much exercise, dehydration, infection, smoking, and alcohol make the terrain more acidic. Digestion and the foods we eat also affect acid-alkaline balance. "Normally, after eating, there are transient changes in blood pH, known as the acid and alkaline tides, that correspond to the stomach and pancreatic secretions," Virginia Worthington explains. "Usually the pH of the blood quickly returns to normal. However, if digestive secretions are out of balance, then the whole body can be affected."

Many natural health practitioners encourage people to follow a diet that includes 80% alkaline-forming foods (primarily fruits and vegetables) and 20% acid-forming foods (meats, sugar, caffeine, beans, dairy, and grains) in order to keep body terrain on the alkaline side. Weston Price, DDS, who studied traditional diets of people around the world during the 1920s and 1930s, questioned that advice. He found that people who followed their traditional diets had fewer cavities, better skeletal formation, and better health. These diets were higher in acid ash food than in alkaline ash foods. Dr. Price was more interested in mineral content of both alkaline- and acid-forming foods. "It is my belief that much harm has been done through the misconception that acidity and alkalinity were something apart from minerals and other elements," he said in 1934.

Natural medicine encourages the measurement of urine and saliva pH as a way to assess acid-alkaline balance. A diet that is high in alkaline-forming foods tends to raise urine pH (make it more alkaline). However, Gabriel Cousins, author of Conscious Eating, reportedly said "that about 30% of the people [he] counseled nutritionally responded the exact opposite way. In other words, the fruits and vegetables made them more acidic," according to an article posted at Differences in digestion, metabolism, and genetics may account for such variations.

Urine pH can vary from 4.5-8.0. Most information that I found recommended measuring urine pH at set times throughout the day, beginning with a pre-breakfast (fasting) measurement. Interpreting the results can be tricky since I found conflicting information. Enzymedica, whose information is similar to many other sites on urine pH, says: "The optimal urine pH is between 6 and 7 on the pH scale. If your average [for a day] is below six, you are too acidic. If your average is above seven you are too alkaline." In contrast, Donald Feeney, DC says that a urine pH of 5.5-5.8 indicates that the body has enough alkalizing minerals to handle dietary acids. A pH of 6.8-8.0 (alkaline) is actually a sign that the body is saturated with dietary acid. (Remember the kidneys excrete ammonium ions when the body is extremely acidic.) Dr. Feeney says, "The more protein in the kidney fluid, the more ammonia is produced, and the higher the pH goes." His article is posted at the American Chiropractic Association Council on Nutrition's website.

Views about salivary pH also differ. The Enzymedica article says, "Most authors agree that the pH of saliva is an indicator of alkaline reserve and the condition of the pH of the cells….The healthy pH of saliva tested first thing in the morning or on an empty stomach is between 6.2 and 7.2." Dr. Feeney says that saliva pH can show whether emotional factors rather than diet is affecting acid-alkaline balance. A consistent saliva pH of 6.2-7.0, first thing in the morning, would indicate that "the patient's emotions are not overwhelming their physiology." A saliva pH of 7.2 to 8.0 (alkaline), however, indicates that the alkaline reserve is nearing depletion: "This person's body is moving toward total exhaustion," Dr. Feeney writes. "You must take caution not to make too many changes in their diet or lifestyle too quickly." Reducing stress, exercising moderately, and eating in a relaxed setting along with dietary changes should help rebalance the system.

I wish researching practitioners with differing views would get together to determine a clear interpretation for urine and saliva pH measurements among different ethnic and metabolic types. At-home pH monitoring would be a simple, non-invasive, inexpensive way for people to monitor acid-alkaline balance if everyone could agree on the meaning of the results.

Feeney D. Saliva & urine pH evaluation. Available at: (3KB .pdf) Accessed October 11, 2007.
The importance of proper pH. Available at: (49KB .pdf) Accessed October 1, 2007.
McMillin DL. Diet and urinary pH: A preliminary study and brief discussion of relevance to infectious disease. Available at: Accessed October 10, 2007.
Minich DM, Bland JS. Acid-alkaline balance: Role in chronic disease and detoxification. Alternative Therapies. Jul/Aug 2007; 13(4):62-65.
Price WA. Acid-base balance of diets which produce immunity to dental caries among the South Sea islanders and other primitive races. Available at: Accessed Oct. 10, 2007.
Tomoda A. Variation of urinary pH and bicarbonate concentrations of students in metropolitan and rural areas of Japan. Archives of Environmental Health. Nov-Dec 1995. Available at: Accessed October 10, 2007. (Jan. 2008: CNET bought Looksmart in November. Archives of Environmental Health is apparently not covered anymore. Link incorrect.)
Worthington V. Acid-alkaline balance and your health. Available at: Accessed October 10, 2007.

Fighting Pathogens with Silver
Before antibiotics, doctors used silver preparations to fight bacteria, fungi, and viruses, according to an article by Jonathan V. Wright, MD. Unlike antibiotics, ionic silver produces several effects that help the body fight pathogens. In sufficient concentrations, silver ions can break open a pathogen's cellular membrane, making the contents vulnerable to white blood cell activity. Silver also seems to inhibit enzymes common to microorganisms but not found in mammalian tissue cells. Colloidal silver, a suspension of ultra-fine, electrically charged (ionic) silver particles in water, increases the production of white and red blood cells after an initial decrease. In addition to increasing the number of leukocytes, silver raises their "phagocytic index" – the cells' ability to kill and digest pathogens by boosting the cells' production of hydrogen peroxide. Silver's effect on immune cells was first observed in the early 1900s.

"The smaller the size of the silver particle, the more likely it is to kill germs," Dr. Wright says in his September 2006 newsletter. Argentyn 23™, made by Natural-Immunogenics Corporation, is a hypoallergenic preparation with 23 parts per million of 0.8 nanometers-size silver particles. (A nanometer is one-billionth of a meter.) The small particle size means quick absorption and reduced likelihood of reaching and destroying necessary bacteria that live in the intestinal tract. An intravenous preparation known as "UPOSH" (ultraparticulate uniform picoscalar silver hydrosol) contains the same concentration and size of silver particles as Argentyn 23™. Sovereign Silver, an over-the-counter preparation with ten parts per million of the 0.8-nanometer-size silver is available in health food stores.

Dr. Wright says that silver absorbs best on an empty stomach. He recommends one teaspoon (5 cc) of Argentyn 23™ (or two teaspoons of Sovereign Silver) every 15 to 60 minutes, seven or more times a day, at the first sign of infection. Some people have experienced a Jarisch-Herxheimer reaction when microorganisms die off more quickly than the body's clean-up system can handle. Signs of Jarisch-Herxheimer include headaches, joint pain, nausea, flu-like symptoms, rashes, and malaise. Fever, vomiting, and diarrhea are also possible. If such a reaction does occur, Dr. Wright says to stop taking the silver for 24 to 48 hours and then start at a lower dose.

Allergy Research Group. Argentyn 23TM. January 2006. Available at: (50KB .pdf) Accessed October 25, 2007.
Klotter J. Colloidal silver. Townsend Letter. April 2007:47-48.
Wright JV. Stop super-germs in their tracks with one powerful silver bullet. Nutrition & Healing. September 2006: 1-3,8.


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