Monthly Archives: May 2010

The Age Old Salt Controversy

Part One:

Part Two:

The two articles enclosed are realistic commentaries, pertaining to the ingestion of salt.
The conclusions stated, with which I concur completely, indicate that salt is essential in our diet for the maintenance of good health. Restriction of the use of salt can lead to physiological imbalances and accomplishes little of merit.

Salt is a vital ingredient in the maintenance of the body’s physiological functions. Specifically, it is integral to the maintenance of hydration and electrolyte balance. It has always been my presumption that unless one has significant renal or cardiac dysfunction, the liberal if not excessive use of salt is totally safe and probably essential.

The normal ingestion of fluids will invariably eliminate any excess that may remain. Without question, the restriction of salt in the diet creates more problems than it cures.

Many physicians advise salt-free regimens without adequate reflection. This trend is sometimes based on the commercial aspects of marketing salt-free products. In addition, the confusion that exists with regard to the treatment of hypertension is a significant factor. Hypertension is generally associated with an increase in age and is sometimes necessary in order to permit adequate arterial perfusion of the peripheral areas of the body including the brain. Focusing on the removal of stress in the environment undoubtedly is the best anti-hypertensive therapy available.

It must also be understood that most individuals’ blood pressures are highly labile, depending on circumstances. At rest, blood pressures generally return to normal, whereas in the stressful atmosphere of the physician’s office for example, they are invariably and inordinately elevated. Frequently, anti-hypertensives are prescribed on the basis of the prevalent, almost hysterical approach to what may be termed the “temporary” elevation of blood pressure and over the past decade particularly, this has become somewhat ingrained in routine medical practice.

Many patients monitor their blood pressures with devices purchased at their local drug store (some of which are highly inaccurate) many times each day and develop an obsession with the readings, resulting in a self-fulfilling prophecy. They may then consult a specialist who may prescribe an additional anti-hypertensive drug, resulting in the inappropriate management of hypertension, whether real or imaginary.

The controversy over salt utilization and the ingrained treatment of hypertension is not that dissimilar to the recent H1N1 crisis. These matters should provoke independent thought and one should be cautioned against the literature promulgated by pharmaceutical companies and governments. “Do not believe everything you may hear or read”; instead cultivate the ability to research widely and interpret correctly.

Whereas inoculation for polio and the other childhood diseases is extremely important, flu vaccination programs have a checkered history at best. Personally, I have never submitted to a flu shot and have been fortunate enough to avoid contracting these multiple disease entities, despite interacting daily with people who are infected and sometimes seriously ill. These contacts strengthen the immune system, much like inoculation.

It was interesting to note that during our recent flu epidemic, when the vaccine was unavailable to the public, panic reigned supreme. Stimulated by the media, the poorly informed clamored for the vaccine incessantly; once it became widely available, the demand evaporated instantly.

Medical fashion varies from one decade to the next as is well-illustrated by the history of the treatment of tonsillitis leading to almost routine tonsillectomies and once upon a time appendectomies were performed to prevent appendicitis. Today, fortunately these trends have fallen by the wayside.

Over the past hundred years, the management of psychiatric patients almost invariably resulted in long-term institutionalization. Beginning in the forties the advent of psychotherapy became the elitist approach. From an economic perspective however, it was problematic to apply this form of therapy widely.

Over the past twenty years, psychiatrists have found it easy to utilize psychomimetic drugs, as patient response can sometimes be dramatic and appears to be beneficial on a short-term basis. This trend, hopefully appears to be nearing its end as the complications engendered by this widely utilized and poorly monitored method are becoming better recognized.

Finally, rest assured that it is totally appropriate to use salt as required and no undue restriction is necessary, except in extreme circumstances.

Fred Kahn, MD FRCS(C)

Amputating Costs

(Globe and Mail Editorial Section)

Medicare has been called the Pac-Man that survives by eating all other social programs. The $128-billion system consumes about 40 per cent of provincial program spending. And yet it is so ingrained in the Canadian identity that it seems untouchable.

It is refreshing, then, that several health leaders have put out a report called “Bending the Health Care Cost Curve,” which provides ways to eradicate waste. It’s about time. The report has suggestions so obviously necessary, it seems shocking to see them in print.

Take the case of wound care, a decidedly unglamorous medical problem but a costly one: If hospitals, nursing homes and home care followed best practices in dealing with these pressure ulcers, venous leg ulcers and diabetic foot ulcers, they could save as least $100-million in Ontario alone in preventable amputations, infections, repeat visits and hospitalizations.

For home visits, nurses are paid on a per-visit basis, not based on whether the wound has healed or the treatment is working – something they want to change.

“What we want to move to is an outcome-based payment process that actually looks at a course of treatment,” said Margaret Mottershead, chief executive officer of the Ontario Association of Community Care Access Centres, an author of the report. “And you will be paid for the treatment and the outcome, rather than on a one-off that gives you no guarantee every time you do a visit that you are actually improving the outcome or fixing the problem or helping the wound heal.”

Other suggestions including reducing medical mistakes, allowing palliative-care patients to die at home and finding alternatives for patients who are waiting in hospital for nursing-home beds.

The report from the trio of groups, including the Ontario Hospital Association and the Ontario Federation of Community Mental Health and Addiction Programs, comes at a welcome time, particularly as the province tries to rein in costs.

But tough economic times should not be the impetus to make change: providing the best patient care should be.

Why are these common-sense solutions, which are best for patients, not being widely implemented today?

The health-care system is complex and even the brightest minds struggle to manage it. It is built around process, so change is never dramatic, but incremental.

It has also been a recession-proof business with no consequences to those who do a job inefficiently. Pay-for-performance measures exist to some degree, but not enough to spawn widespread change.

What is missing in health care are quality, accountability and value for money. Canadians do not need another royal commission to tell them that; they have been hearing it for almost two decades.

Medicare need a champion, a strong arm that can make transformative change. Without it, the system is doomed to become increasingly inefficient, unmanageable, and like Pac-Man, virtually obsolete.


The article enclosed, titled “Amputating Costs” was published in The Globe and Mail on April 16, 2010. It is timely and written with considerable comprehension of the facts. Moreover, it clearly defines the problems encountered in wound healing, so often leading to amputation. It stresses inefficiencies that serve only to increase the costs of treatment, along with a total disregard of the outcomes.

Managed health care, in essence, imposes relatively rigid parameters which have long been outdated. Personally, I would be embarrassed to treat a wound that did not heal in a timely fashion. Yet, the present system incentivizes prolonged and ineffective care, all too frequently, leading to negative results.

At Meditech over the past decade, we have been aware of the inadequacies of the present conventional approach to wound healing. This sector has therefore become one of the more compelling targets in our efforts to bring about change.

We have always questioned the prevalent methods applied in wound healing that are almost universally enforced.

At the same time, we have developed methodologies that are highly effective in this area.

To illustrate –

• Instead of using bandages of various descriptions, we treat the wounds with open exposure permitting access to the oxygen in the atmosphere.

• Instead of antibiotics, we use saline compresses which have no adverse reactions, are potent bactericidals and are inexpensive.

• Instead of surgical debridement, we use dilute hydrogen peroxide to remove non-viable tissue.

• When available, we also utilize hyperbaric chamber therapy.

The basic approach of our treatment platform is Laser Therapy customized for the individual patient. With this method, the need for analgesics is rapidly eliminated.

We fully endorse the treatment of wounds with an outcome based on resolution and agree that remuneration should be based on clinical results.

In closing, I make one final statement – “bring on the wounds and we will heal them!”

Fred Kahn, MD, FRCS(C)