Wednesday, July 8, 2009

Gain Weight, Lose Brain Cells

Well, heck, as if getting wrinkles wasn't bad enough, turns out that if you gain weight after menopause, you lose gray matter--that's brain cells. Now, either that explains any and all of my mental problems OOORRRRR, it goes to show how much more remarkably intelligent I will be when I lose weight! Hum.

Here is the excerpt. For more information, visit Dr. Daniel Amens' website. He is a remarkable doctor, if you haven't discovered him yet, now is the time!

Gain Weight, Lose Gray Matter

As if we needed more proof that gaining weight is bad for our health. Now there’s evidence showing that an increase in weight can decrease the size of your brain.

Researchers at the University of Pittsburgh, Pennsylvania, used brain imaging to examine the effects of increases in body mass index (BMI) on 48 otherwise healthy postmenopausal women. They found that women whose BMI went up following menopause were more likely to have a reduction in gray matter volume.

When it comes to the brain, size matters. A smaller brain means reduced brain function, which can affect every aspect of your life — your relationships, your career, and your mood.

For women going through menopause, it’s especially important to eat a brain-healthy diet to prevent those extra pounds.

Wednesday, July 1, 2009

I just found out that eating too much sugar will give you wrinkles. Well, now you tell me, after I have been having a serious love affair with everything sugar and white, for the past five years. Check the above link and confirm this for yourself. No wonder I have aged so fast!! Damn. I am pissed. Sugar has been my drug of choice for these so many years on purpose. I figured sugar is better than alcohol. Better than a psych hospital. Damn. Now I have to give it up. You have no idea how unhappy I am.

What this article says is that sugar in the body undergoes glycation, a process much like browning meat in a pan. YUCKOLA!

Here is the quote:

Sugar triggers a natural process called glycation, which is the same chemical reaction that turns meat brown when you cook it. The sugars bind with tissues to form harmful molecules, called advanced glycation end products (ironically known as AGEs), which damage elastin and collagen -- two substances your skin needs to stay supple and elastic. AGEs also damage the kidneys, brain and other essential organs.

Tell me, what other habit can I develop instead of sugar and high carbs to be my drug of choice? Exercise. Pahleeze. I can exercise alright. But it's not quick and easy. Not like grabbing a bag of chips or oreos! I may write a health blog, but I like my vices. Darn. Now, I gotta change. We'll see if I actually do it! Smile!

Saturday, May 30, 2009

Hormones and Addictions: A Landmark Find

Hormones and Addictions: A Landmark Find

Ya'll, this is from Dr. Amen. Bottom line get a saliva test from your wholistic doctor to test all your hormone levels. Get them corrected, and you will no longer have addiction cravings. Good Luck! Susan

Dr. Rick Sponaugle is a friend and colleague. He wrote the following article for the American Association of Anti-Aging Medicine (A4M) on hormones and additions and sent it to me this morning. It is such a wonderful piece I asked him if I could reprint it here for you. Please read this. Ihope it opens your mind as it has mine.

Anti-aging/Longevity Medicine Reduces the Prevalence of Alcoholism and Drug Addiction

The utility of hormonal replacement therapy and other proactive longevity medicine practiced by A4M physicians not only improves the quality of life in patients, it also prevents unnecessary depression, anxiety and insomnia disorders all of which cause subsequent addiction.

Florida Detox and Wellness Institute in Tarpon Springs, Florida, has successfully treated over 5000 addicted patients since our inception in 1998. While most “treatment” centers continue to ignore the scientific and biochemical basis for addiction, we have successfully proven that over ninety percent of addicted patients self-medicate with drugs and alcohol in their attempt to balance their brain chemistry and “feel more normal”.

Normalizing brain chemistry with medication, bio-identical hormone replacement and nutraceutical supplementation balances brain activity and negates the patient’s craving for and self medication with alcohol and drugs. Patients utilize drugs and alcohol either to stimulate under-active brain regions or relax over-active brain systems. The aberrant electrical activity in the addicted patient’s brain is typically caused by inherited or acquired biochemical and hormonal deficiencies.

Our physicians utilize modern brain science derived from neuro-imaging studies and A4M wellness/anti-aging medicine to restore balance of biochemical deficiencies and their subsequent electrical dysfunction. This scientific approach allows us to more effectively diagnose and subsequently treat the “true cause” of drug and alcohol craving.

Due to the limited scope of this article, we cannot discuss all addiction etiology as is related to hormonal and nutritional deficiencies or environmental toxins such as pesticides, black mold and Lyme’s disease. All mentioned can cause dysfunction of neurotransmitter [glutamate, histamine, dopamine and serotonin] activity and subsequent addiction. We will address two very common causes of addiction which are fortunately prevented when patients receive quality anti-aging medical treatment.

The average age of menopause in American women is 51 years; however, female progesterone levels begin to decline approximately eight years prior to estrogen. When progesterone production declines in middle age females, they begin to experience new found anxiety and insomnia. Retrospective studies at Florida Detox and Wellness Institute have demonstrated that the “progesterone drop out” phenomenon is a common etiology of alcohol and drug abuse, with causation in over forty percent of our addicted middle age females.

The biochemical explanation is that allopregnanolone, a metabolite of progesterone, enhances GABA-A receptivity. When females experience a loss in GABA-A receptivity via diminished progesterone levels, they can develop excess electrical activity in both the central and peripheral nervous system. Their newfound anxiety and insomnia disorders precipitate subsequent addiction issues.

These progesterone deficient females will begin to utilize alcohol for it’sGABA-A receptor activation. The woman who historically drank only a glass of wine with dinner will insidiously progress over a few years to two bottles of wine per night as the wine has now become “medication.”

She may be courageous enough to visit a physician, however, if the physician has limited knowledge regarding hormonal replacement therapy, he/she will not appreciate the gravity of the patient’s situation. The doctor will practice “symptom medicine” and readily prescribe her addicting medication such as Xanax or Klonopin instead of investigating hormonal imbalance.

Another common scenario observed at Florida Detox is that the progesterone deficient female will begin to abuse Vicodin or Oxycontin because the calcium channel blockade effect of the opiate will down regulate the increased “brain voltage” derived from the lost GABA-A receptivity. Unfortunately, when she chooses this option, she will eventually develop Mu receptor tolerance, begin increasing her 24 hour opiate dose and subsequently develop hypothalamic-pituitary-ovarian axis suppression further exacerbating her original hormonal deficiency.

A 2009 Florida Detox study found that 100 percent, thirty of thirty females, ages 21-29 years old who were prescribed 80 mg methadone per 24 day were suffering “flat line” ovarian output. Testosterone, Progesterone and Estradiol were pathetically at menopausal levels.

Measurement of LH and FSH in these females revealed suppression to pre-puberty levels demonstrating the severity of methadone induced hypothalamic-pituitary dysfunction. This pituitary suppression derived from chronic consumption of opiate pain medication frequently causes coincident hypothyroidism in both females and males with greater prevalence in females.

Fortunately, when progesterone levels are restored using bio-identical progesterone, the anxiety and insomnia disorders subside as does “craving” for GABA-ergic drugs like alcohol and Xanax; nor do these progesterone treated females need the calcium channel blockade effect of Vicodin/Oxycontin to “turn down the “excess brain voltage.”

It is paramount for pediatricians to become more astute regarding the principles of A4M medicine as much addiction can be prevented in adolescent females.

Susan is a 21 year old female who presented to Florida Detox in May, 2006. When admitted to our detox unit, she was consuming two liters of vodka per day, 1,000 mg of Oxycontin per day and 20 mg of Xanax per day.

She and her mother, Mary, had chosen Florida Detox because our website discussed what appeared to be a more scientific approach to addiction treatment. Susan had already completed and failed eight 28 day “talk therapy” programs from Arizona to New York, each costing over thirty thousand dollars. The only diagnosis Susan had received from all of the previous treatment centers was drug addict, alcoholic and while undergoing severe withdrawal symptoms was diagnosed with personality disorder.

Susan began drinking at age12 initially raiding her parents liquor cabinet. By age 14 she was admitted to her first 28 day “treatment program.” In high school Susan was introduced to Xanax and “Oxy’s”, both of which “calmed” her anxious brain without the unfavorable gastrointestinal symptoms she experienced with alcohol.

Upon reviewing Susan’s history, I discovered a pertinent chronological correlation. Susan had begun her menses at age 12, the same age at which she allegedly began to drink alcohol “to calm her nerves.”

Her menses was always much heavier than her friends and it usually lasted seven days. Susan bled so severely that she was anemic throughout high school and periodically required intravenous infusions of iron. Her menses was also extremely painful, unlike her best friends. She had seen several different gynecologists and pediatricians none of which discussed or measured hormones.

Susan’s symptoms were classic for unequal ovarian output from the very onset of her menses, that in which the production of progesterone lags that of estrogen. Anxiety disorders in America have equal prevalence in males and females up to age 13 after which females experience two to three fold the incidence of anxiety verses their male counterparts. The causation of such can not be solely attributed to adolescent peaked interest and interaction with the male gender; my wife might challenge this statement.

The balancing GABA-ergic effect of progesterone is more critical when estrogen function is activated than when both estrogen and progesterone are at pre-puberty levels.

When Susan’s progesterone deficiency was appropriately treated along with the multiple hormonal and nutritional deficiencies caused by nine years of alcohol and drug abuse, her craving for both drugs and alcohol stopped. Susan has been drug and alcohol free for almost three years.

Susan and her family suffered years of unnecessary psychological and financial trauma because her gynecologists, psychiatrists and addictionologists were not trained in A4M medicine. As more pediatricians, gynecologists and family physicians enroll in A4M, the future Susans will not be robbed of their youth.

Another hormonal deficiency that frequently serves as the etiology of alcoholism and drug addiction in females is estradiol deficiency. Estradiol enhances serotonin receptivity in the female brain. While the literature states that “normal” estradiol levels fluctuate during the menstrual cycle between15 pg/dl and 315 pg/dl, estradiol levels below 60 pg/dl cause compromised serotonin receptivity. Furthermore, estradiol has monoamine oxidase inhibitor activity and therefore increases both serotonin and dopamine levels in the brain.

These biochemical findings facilitate understanding of the common symptamatology associated with premenstrual syndrome, post partum depression, and the midlife onset of psychological issues such as depression, anxiety and insomnia in females. It becomes then obvious that untreated estradiol deficiency plays a pivotal role in causation of new onset addiction issues in middle age females.

The increased anxiety associated with suboptimal serotonin activity has so eloquently been elucidated by my esteemed colleague and good friend, Daniel Amen, M.D., the founder and medical director of the Amen Clinics.

Through SPECT brain imaging, Dr. Amen has demonstrated that patients with suboptimal serotonin activity, whether inherited or acquired suffer from excess activity in two different regions of the brain, the limbic system or “emotional center” and the anterior cingulate gyrus, normally considered the brain’s gear shifter.

Furthermore, normal serotonin activity inhibits the release of the excitatory neurotransmitter, norepinephrine, from the locus cereleus. When serotonin receptivity is compromised by estradiol deficiency, female patients can develop excessive sympathetic tone in both the central and peripheral nervous systems which further exacerbates anxiety and insomnia disorders. As with the anxiety and insomnia produced by progesterone deficiency, females with estradiol deficiency often medicate their overactive brain regions with alcohol, benzodiazepines or opiate pain medication.

Linda is a 45 year old school teacher from Atlanta who presented to Florida Detox and Wellness Institute in July of 2007 with a history of new onset alcoholism, approximately three years, claiming she developed anxiety for the first time in her life at age forty two.

Neurotransmitter assessment excluded biochemical causes of anxiety such as serotonin deficiency, norepinephrine excess, dopamine excess, glutamate excess or GABA deficiency, Her histamine levels were excessive which is common in alcoholic patients secondary to alcohol induced systemic Candidiasis and leaky gut syndrome.

This monoamine histamine, like dopamine, can when in excess, produce increased “electrical voltage” in the brain causing subsequent anxiety. But, was it the original cause of Linda’s self-medication with alcohol or did it develop because of the alcoholism?

Amen brain questionnaires were negative for the typical anxiety profile seen with low serotonin activity, but, positive for a more typical profile of “generalized anxiety” often seen in patients with excess histamine or progesterone deficiency. Hormonal evaluation revealed adequate estradiol and testosterone levels, however, progesterone levels were post menopausal.

Following medical detoxification, Linda’s progesterone levels were restored, her GI tract was detoxified of yeast, her leaky gut was treated with an herbal glutamine mixture and histamine reduction was accomplished via SAMe, high dose vitamin C and Vitamin B6, pyridoxine.Following this treatment regimen, Linda reported that her anxiety had abated and she had no more alcohol craving.

Linda remained alcohol free for one year when she suddenly began experiencing a combination of depression and anxiety which precipitated a short relapse to alcohol. Fortunately, Linda returned to Florida after just two weeks of drinking and did not require an inpatient medical detoxification.

Linda’s new evaluation revealed normal neurotransmitters levels including serotonin, however, she now had developed menopausal estradiol levels and her Amen brain questionnaires revealed a classic low serotonin anxiety and depression profile, one that the Amen Clinic defines as laden with excessive worry and continuous rumination over negative things.

Even though Linda had maintained normal serotonin production, she had now lost serotonin receptivity with her estradiol drop out and she began to suffer a different type of anxiety from that she had previously experienced when her progesterone production had ceased.

Linda responded well to bio-identical estradiol enhancement and 5-hydroxy tryptophan, a serotonin precursor. We have now referred her to an anti-aging doctor in the Atlanta area.

Severe depression can be precipitated by the diminished MAO inhibitor effect and subsequent reduction of brain dopamine levels that accompanies estradiol “drop out.” Reduced brain dopamine can have a negative effect on cognition, but often of more importance, can decrease activation of our nucleus accumbens or “pleasure/hunger center” which is dopamine driven.

Specifically, it’s the activation of the D2 dopamine receptor in the nucleus accumbens that gives us pleasure, satiety and motivation. A 2006 University of Virginia PET SCAN study comparing D2 dopamine activity, before and after, eating, orgasm and cocaine consumption revealed that D2 dopamine activity was temporarily elevated three times normal with eating, ten times normal with orgasm and one hundred times normal with cocaine.

Nicotine’s effect on D2 activity was not evaluated in this particular study, however, a 2003 NIDA [National Institute of Drug Addiction] study demonstrated that nicotine was more dopaminergic than heroin and cocaine and preferred by rhesus monkeys over cocaine and heroin.

Clinical studies at Florida Detox validate that the diminished dopamine activity that accompanies midlife estrogen drop out, frequently precipitates self medication with any drug that temporarily releases dopamine from the vesicles [brain cell storage units] to the brain neuron synapse, the area between two brain cells.

Drugs of choice are food, nicotine, alcohol, opioid pain pills and marijuana. Other drugs that block synaptic re-uptake of dopamine such as methamphetamine and cocaine are less commonly utilized in this particular female population.

In summary, this article is written with the intent to further validate the importance of expanding the reach of A4M education to all physicians by elucidating yet another dimension of human suffering, drug and alcohol addiction, that can be prevented with the implementation of quality anti-aging and longevity medicine.

Marvin Rick Sponaugle MD
Founder and Medical Director, Florida Detox and Wellness Institute
Board Certified Anesthesiology and Addiction Medicine
This entry was written by Dr. Amen, posted on March 4, 2009 at 4:28 pm, filed under Blog. Bookmark the permalink. Follow any comments here with the RSS feed for this post. Post a comment or leave a trackback: Trackback URL.

Friday, April 24, 2009

BPA update

from Dr. Douglas' email digest today:

Scientists uniting to attack FDA inaction on BPA

Dear Friend,

The tide that's been turning against the dangerous chemical additive Bisphenol A (BPA) has officially become a tsunami. Not long ago, I told you that state senators had prompted major manufacturers of plastic baby bottles to discontinue the use of the substance. And now the scientific community has finally taken a stand against BPA and called the FDA on the carpet for the federal agency's repeated claims that BPA is safe.

Fifty-eight scientists from all over the world and from nearly every scientific discipline are currently working at on a soon-to-be released "consensus statement" that will attack the FDA's stance on BPA.

What makes this hazardous material so dangerous is its ubiquity – it's been used in the making of shatterproof plastics and food containers for over 50 years.

BPA is a chemical estrogen that seeps into the foods and drinks that are often found in containers made from these plastics - like baby formula, for example. And that's how it spreads into humans. It's been linked to all manner of hideous maladies: liver problems, brain disorder, heart disease, hormonal disruption, diabetes, and more. BPA can cause young kids to retain toxins in their bodies for abnormally long periods.

In all, over 130 studies in the last decade have connected the development of serious health issues with BPA. Recent studies have shown that it doesn't take much BPA to start having a negative impact on health – even doses lower than the FDA's standards can be harmful.

Developmental biologist Laura Vandenberg of Tufts University says that the dangers of BPA are "becoming undeniable."

"The FDA's standard for safety is reasonable certainty," Vandenberg says. "It is no longer reasonable to say that BPA is safe."

The penny seems to have dropped on the issue of BPA for pretty much the rest of the planet. There are efforts by elements within the U.S. and Canadian governments to officially ban the use of the material.

Yet the FDA still insists it's safe. It's truly one of the more pig-headed stances you're likely to find in a government agency – and remember, this is the U.S. government we're talking about … that's a pretty long history of pig-headedness.

This stance on the safety of BPA is based on two studies that were funded by the American Chemistry Council (ACC) – an organization made up of the leaders of the very companies that profit from the manufacture of this dangerous chemical. Most people would think that a pro-BPA study paid for by the makers of BPA would be somewhat biased. Alas, the FDA is not like most people. Not sane people anyway.

In fact, Rochelle Tyl, who authored BOTH the ACC studies backing up the safety of BPA, admitted that the report on which the FDA based its decision-making shouldn't be taken at face value. The ContraCostaTimes reported that Tyl admitted that "there were errors and inconsistencies in the 2008 report that the FDA used as the foundation for its findings." And she did this in front of the very international consortium that's working on a statement condemning the FDA's stance.

It doesn't get much more convincing than that. I wonder why she was telling the consortium this, and not the FDA…

Monday, March 30, 2009

Bisphenol A

Friends, just got this in my email from W C Douglass. I didn't even realize this was this much of a problem. Heck, my husband has diabetes. That link, and all those drinks out of hard plastic bottles makes me wonder... here is the article.

State attorney general gets deadly BPA out of bottles

Dear Friend,

I'm happy to announce a big win in the battle against BPA. Six of the largest makers of baby bottles have vowed to stop selling bottles made with the chemical known as Bisphenol A, thanks to one crusading attorney general.

By now, you should be well aware of the evils of BPA. I've warned you about it several times over the last 18 months, cataloging for you the growing list of potential health dangers that have been linked to the stuff (including, most recently, diabetes). Manufacturers have used BPA for more than half a century to make hard, shatterproof plastics.

Unfortunately, BPA can seep into the foods and drinks that are often contained in containers made from these plastics – like baby formula, for example.

Believe it or not, this move to remove BPA from baby bottles was actually prompted by politicians from Connecticut and New Jersey, who personally wrote to the bottle makers and asked that they cease use of the chemical.

"The evidence seems to clear and emphatic and unequivocal to simply permit this stuff to go into children on a massive scale," said Connecticut Attorney General Richard Blumenthal, adding that "there's no reason for it because substitutes are available."

I'm not usually one to hand out plaudits to politicians. But Attorney General Blumenthal is deserving of a standing ovation. I can appreciate what an uphill struggle he faced.

Shannon Jenest, a spokesperson for Philps Avent, the top seller of plastic baby bottles, said the company made a "business decision to move out of BPA." Of course it was a business decision! You didn't think they'd do it for the health of the consumers, did you?

The fact is, U.S. consumers like you have been putting tremendous pressure on retailers to stop selling BPA-made bottles, which hits them right where it hurts – right in the bottom line.

"Babies R Us was banning [BPA], Target was going to, CVS was going to, and so the distribution channels were lessening and lessening," Jenest says.

As you might expect, the FDA is still in BPA's corner. And the American Chemistry Council even had the nerve to release a statement of their continued support of the FDA's position that BPA levels are safe.

But thankfully Blumenthal is unfazed. He's now working to rally the support of other state attorneys general throughout the U.S. to ban the use of BPA in the manufacture of infant formula cans. And after that, he wants it out of ALL food and beverage containers.

Saturday, January 17, 2009

Pharmacuetical Companies' lobby Washington

This is nothing new. But you might not know it. I didn't. Page 198, of Dr. Angell's book, THE TRUTH ABOUT DRUG COMPANIES, first sentence, first paragraph reads: "The pharmaceutical industry hss by far the largest lobby in Washington--and that's saying something." She adds, "In 2002, it employed 675 lobbyists (more than one for each member of Congress)--many drawn from 138 Washington lobbying firms--at a cost of over 91 million.

And you wonder why your pharmaceuticals are priced so high?

And you presume your congressman isn't influenced by all this money and verbiage?

Thursday, January 15, 2009

Surgery Checklist Saves Lives

A little story first: a long time ago, (almost 30 years now), a then young, single mother worked as a receptionist in human resources at a large city suburban hospital. Occasionally, nurses would come through to tend to personnel business, and needing a safe ear, just vent about work to this receptionist. One day, a surgical nurse came through and told the receptionist that the worst part of her job was working with a drunk surgeon, trying hard to keep the count of surgical supplies going into and out of the body correct, trying to make sure he (there were only he surgeons back then at this hospital) did his job decently, yet still not offending him so that he couldn't complain to her bosses and have her fired.

Of course, I was that young, single mother receptionist.

She added, and I am passing this bit of advice on to you, that anytime you have surgery, make sure you do NOT take any drug to make you looney before you go into the surgical suite. STAY LUCID! She emphasized that. When you are in the surgical suite, ask to talk to your doctor. Then whisper. This forces his face to come near yours so that you can smell what is on his breath. If he doesn't come near, WARNING bells should sound an alarm in your soul. Forget medical protocol, forget doctor as the authority figure, and grab the man's shirt and pull him near to you so you can get a good whiff.

What is the worst that can happen? If you smell alcohol coverup, baby you shout loud, demand off the table, all IV's off, etc, and, now in this day and age, demand a blood alcohol level, and threaten a lawsuit of the hospital so that they will follow through. If you smell nothing, so what? This well paid man changes his clothes and your life is safe!

Now, to the Yahoo study.

Study: Basic checklist saves lives during surgery.

By MIKE STOBBE, AP Medical Writer Mike Stobbe, Ap Medical Writer – Wed Jan 14, 5:57 pm ET
Surgical checklist can cut complications and save lives: WHO AFP/File – Doctors perform heart surgery. Potentially life-threatening complications from surgery can be cut by …

ATLANTA – Scrawl on the patient with a permanent marker to show where the surgeon should cut. Ask the person's name to make sure you have the right patient. Count sponges to make sure you didn't leave any inside the body. Doctors worldwide who followed a checklist of steps like these cut the death rate from surgery almost in half and complications by more than a third in a large international study of how to avoid blatant operating room mistakes.

The results — most dramatic in developing countries — startled the researchers.

"I was blown away," said Dr. Atul Gawande, a Harvard surgeon and medical journalist who led the study, published in Thursday's New England Journal of Medicine.

U.S. hospitals have been required since 2004 to take some of these precautions. But the 19-item checklist used in the study was far more detailed than what is required or what many institutions do.

The researchers estimated that implementing the longer checklist in all U.S. operating rooms would save at least $15 billion a year.

"Most of these things happen most of the time for most patients, but we need to make it so that all these things happen all the time for all patients, because each slip represents an opportunity for harm," said Dr. Alex Haynes of the Harvard School of Public Health, one of the study's authors.

The checklist was developed by the World Health Organization and includes measures such as these:

• Before the patient is given anesthesia, make sure the part of the body to be operated on is marked, and make sure everyone on the surgical team knows if the patient has an allergy.

• Before the surgeons cut, make sure everyone in the operating room knows one another and what their roles will be during the operation, and confirm that all the needed X-rays and scan images are in the room.

• After surgery, check that all the needles, sponges and instruments are accounted for.

That checklist was tested in 2007-08 in eight cities around the world: Seattle; Toronto; London; New Delhi; Auckland, New Zealand; Amman, Jordan; Manila, Philippines; and Ifakara, Tanzania. (Heart and pediatric cases were excluded.)

Before the checklist was introduced, 1.5 percent of patients in a comparison group died within 30 days of surgery at the eight hospitals. Afterward, the rate dropped to 0.8 percent — a 47 percent decrease.

The biggest decreases were in developing countries, with the combined death rate for Jordan, India, Tanzania and the Philippines falling 52 percent. There was no significant difference in deaths in the wealthiest countries.

Overall, major complications dropped from 11 percent to 7 percent. Again, the biggest decreases were in the lower-income countries.

"What we're seeing is the benefits of good team work and coordinated care," Haynes said.

The results were so dramatic that Dr. Peter Pronovost, a Johns Hopkins University doctor who proved in a highly influential study a few years ago that checklists could cut infection rates from intravenous tubes, said he was skeptical of the findings.

One possible flaw, he said, is that "you had people who bought into the system collecting their own data."

The researchers acknowledged it is possible that the results were partly because people perform better when they know they're being watched.

However, the 19-point checklist is already being adopted. Ireland, Jordan, the Philippines and Britain have recently established nationwide programs to have the checklist used in all operating rooms.

In the U.S., the Joint Commission, which accredits most hospitals and sets standards for them, said it is considering adopting more of the steps. The agency already requires three of them, including marking the incision site and pausing before surgery to make sure everything is in place.

At least one patient in the study at the University of Washington Medical Center in Seattle welcomed the checklist.

Darrell McDonald, 63, had a hernia operation in March. A longtime bush pilot in Alaska, he followed a checklist before every takeoff, including checking the controls and walking around the propeller-driven plane "to make sure nothing is getting ready to fall off."

So McDonald was fine with his doctor writing on his body where the incision would be. He had no problems with repeated inquiries about who he was and why he was there. He applauded measures such as a poster-size checklist hanging from an IV pole in the operating room.

"It eliminates the little bit that could possibly go wrong," he said.