Author: noorali

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Christmas, Religion, and Health

“Religion is a way of walking, not a way of talking.”

William R. Inge (1868-1957)

Christmas is almost here and that gives me a chance to talk about religion.

I have lived in four continents and I have spent most of my adult life amongst people of different religions. I agree with Robert Burton (1577-1640), who said, “One religion is as true as another.” All religions teach the same virtues – forgiveness, kindness and generosity.

If one religion is as true as another then why do we need so many labels? Benjamin Disraeli (1804-1881) said that sensible men are all of the same religion. And what religion is that? Sensible men never tell!

But the current world atmosphere makes it difficult not to talk about one’s religion. Look at the politicians in this country and the USA. Religious beliefs come up for discussion all the time. Elections are fought and won on what is religiously right. It seems our values and politics are judged on the basis of our religion. There is no end to stereotyping.

What I don’t understand is why it is necessary for a sensible man to talk about his religion in public? Here, I agree with Sean O’Casey (1880-1964), who said “I think we ought to have as great a regard for religion as we can, so as to keep it out of as many things as possible.” To this I would add, let common sense prevail so that society can be just and kind.

Every religion has its share of bigots, zealots and fanatics. This is not something new. It’s been there for centuries. These people promote their brand of religious beliefs which promote divisions and hatred rather than forgiveness, kindness and generosity.

But I believe the vast majority of people (whatever their religion) use religion and spiritualism to promote good health, happiness and brotherhood of man. It is used to achieve peace and tranquility in life.

Sigmund Freud (1856-1939) said, “Life as we find it is too hard for us; it entails too much pain, too many disappointments, and impossible tasks. We cannot do without palliative remedies.” Unfortunately, religion is not what he had in mind when he suggested palliative remedies. In fact, he said that when a man is freed of religion, he has a better chance to live a normal and wholesome life.

Now, some people would agree with that. Since every religion imposes on its followers certain type of discipline. Some religions are more rigid than others. But many people find common sense flexibility more attractive than dogmatic rigidity.

Most sensible people carry on life the way they feel is best for them and their families, in a quite way, without making waves or hurting anybody’s feelings. After all one’s religion should be something very personal. Many people find happiness and comfort in religious activities in a quite way. And that is good. The happier you are, the healthier you feel.

Remember what George Bernard Shaw (1856-1950) said, “There is only one religion, though there are a hundred versions of it.” Let us respect them all so we can do unto others what we like done to us.

Merry Christmas and a safe holiday season.


Thought for Christmas:


At Christmas play and make good cheer,
For Christmas comes but once a year.
Thomas Tusser (1524-1580)

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Staying Healthy

Dear Dr. B: How do I know I am healthy? And how can I stay healthy?

This is a good question for the month of December. This is a month when most people are not worried about their health. It’s a month to shop, eat, drink and be merry. After all Christmas and New Year come only once a year.

But many people use December as a time to reflect on the year gone by and plan for the year to come by. It may be about health or about other matters. It is a good month to remind oneself to get a yearly physical examination and blood tests. And pay a visit to your doctor and ask, “Doc, am I healthy?”

“Yes,” he will say, “you are healthy if you are maintaining a healthy weight, eating right, staying physically active, not smoking, controlling your blood pressure and cholesterol levels, and if you are a diabetic then you should be controlling your blood sugar level.”

This is a bit simplistic answer but you get the point. Many factors determine good health. Maintaining good weight is important. We know that being overweight increases the risk of heart disease, diabetes, high blood pressure and cancer.

But how does one know if a person is of normal weight?

Recently the Canadian Medical Association Journal (CMAJ), published the 2003 Canadian Guidelines for Body Weight Classification in Adults which updates the weight classification system that had been in use since 1988.

The authors of the article say that although the guidelines are helpful, the absence of concrete answers to relevant clinical scenarios weakens their practical application, and they should be applied with caution. After all they are only guidelines. These guidelines should be used in conjunction with clinical findings.

The body weight classification depends on the body mass index (BMI) – kg/m2 . There are many sites on the internet were you can enter your height and weight and your BMI will be calculated for you.

You are considered underweight if your BMI is lower than 18.5 kg/m2 . This could be a marker of malnutrition or may identify people with eating disorders.

If your BMI is between 18.5 and 24.9 kg/m2 then this is considered normal and good weight for most people.

Overweight is defined as a BMI between 25 and 30 kg/m2. This is associated with increased health risks and may lead to health problems in some people. The authors say that many factors beyond BMI influence health risk, such as body fat distribution, physical activity, diet and genetic background.

Obesity is defined as an excessive accumulation of body fat. The BMI of over 30 is considered to be obese. These individuals have increased risk of health problems.

Waist circumference is also important. Healthy waist circumference in a male should be less than 102 cm and for females less than 88 cm.

World Health Organization says that in the most industrialized countries at least one-third of all disease burden is caused by tobacco, alcohol, blood pressure, cholesterol and obesity. So, if we want to stay healthy then we need to tackle these problems.

Healthy eating and maintaining a healthy body weight are the first steps in that direction!

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Heartburn, Barrett’s Esophagus, and Cancer

Dear Dr. B: I have chronic heartburn. I have been told I have Barrett’s esophagus. I believe this is a pre-malignant condition. Should I be having scope tests every year as a method for surveillance and early detection of cancer of the esophagus?

Dear reader: Answer to this question depends on the type of changes seen in the esophagus. There are many unresolved controversies regarding the surveillance and management of this condition. Let us briefly look at the whole subject of Barrett’s esophagus and the current recommendations.

All experts agree that Barrett’s esophagus is a complication of long lasting and usually severe gastro-esophageal reflux disease (GERD) – commonly known as heartburn. This may or may not be associated with a hiatus hernia.

The condition was first described in 1950 by Sir Norman Barrett. His original description has been revised few times. Currently, Barrett’s esophagus implies change in the lining of the esophagus (of any length) from a squamous type to columnar type. This change is only recognized at the time of endoscopy and confirmed by biopsy.

Barrett’s esophagus affects mainly white men, with an average age of 55 years. It occurs in only a small percentage of people with GERD – approximately five to15 percent of patients with inflamed esophagus due to reflux. There is a small but definite increased risk of cancer of the esophagus in people with Barrett’s esophagus.

About 10 percent of patients with Barrett’s esophagus at the time of the initial endoscopic examination have coexistent esophageal cancer. Unfortunately, the 5 year survival rate for patients with esophageal cancer is only 11 percent.

Is it possible to do something to prevent Barrett’s esophagus from turning into esophageal cancer?

Regular endoscopic surveillance and biopsy is recommended for patients with Barrett’s esophagus despite the high cost and inconvenience and the lack of proof that it prolongs survival. Biopsies are done to look for dysplasia.

Dysplasia is a cellular process that occurs in the lining of the Barrett’s esophagus. Presence of dysplasia indicates increased risk of cancer. It is not a foregone conclusion that patients with dysplasia will develop cancer but dysplasia remains the best indicator of cancer risk.

How often one should have scope tests and biopsies? It depends on the presence of dysplasia in the Barrett’s esophagus:
–If the patient has no dysplasia: The frequency for endoscopic biopsy surveillance is annually twice, and then, if no dysplasia is found, every 3 to 5 years. Risk of subsequently developing cancer is quite low.
–If the patient has low grade dysplasia: A surveillance endoscopy with biopsies at six months, one year, and then yearly is recommended.
–If the patient has high grade dysplasia: The management of high grade dysplasia involves repeating the biopsies right after the high grade is discovered to rule out an accompanying cancer. Esophagectomy (surgical removal of the esophagus) is the gold standard of therapy for high grade dysplasia and cancer, but experimental procedures are available.

The treatment for Barrett’s esophagus is, in general, essentially the same as for GERD and heartburn. It is either medical (acid-suppression drugs) or surgical (fundoplication). There is no guarantee that either treatment will result in the disappearance of Barrett’s esophagus or in a reduced cancer risk.

Thought for the week:
“Nothing can be created out of nothing.”
-Lucretius 99-95 BC

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PSA and Prostate Cancer

Dear Dr. B: Recent reports on PSA and prostate cancer have really confused me. Can you please tell me about the tests required for early detection of prostate cancer and where does PSA fit in?

Dear Reader: You are not the only one who is confused. PSA-based screening for prostate cancer has always been confusing and controversial. Even doctors are confused!

I am into my seventh year of writing these columns. And looking back I have written at least five columns on PSA and prostate cancer. And we haven’t heard the last word on it.

Let us look at the recent media attention given to PSA and prostate cancer. An article published in the New England Journal of Medicine (NEJM) asks: What is the prevalence of prostate cancer among men with low prostate-specific antigen (PSA) levels?

Currently, the cut off point for PSA level is 4 ug/L. If the PSA level is 4 ug/L or more then the patient is referred for a biopsy of the prostate gland to check for cancer.

Some experts have argued that this cut off point is high and we may be missing lot of cancers in patient whose levels are lower than 4 ug/L.

The NEJM article reports on the results of PSA levels and prostate biopsy done on 2950 men who completed the seven-year-trial. The study found that the risk of cancer increased with increasing PSA level, from 6.6 per cent for levels of 0.5 ug/L or less to 26.9 per cent for level of 3.1 to 4.0 ug/L.

It has been estimated that by using the current cutoff point at 4 ug/L we will miss up to 82 per cent of cancers in younger men and 65 per cent of those in older men. This finding is the most recent reminder that that PSA measurement is not a good screening test for early detection of prostate cancer.

Is there anything better? Unfortunately, no! It is suggested that monitoring the rate of rise of PSA levels over time may help. For example, if your baseline PSA is 1.0 ug/L and over a period of time it gradually increases then there may be an indication for prostate biopsy. This hypothesis has not yet been validated.

Prostate cancer is the most frequent cancer and the second leading cause of death from cancer in men, exceeded only by lung cancer. In our region, 80 to 90 new cases of prostate cancers are diagnosed each year. And each year 10 to 15 patients die of the disease.

Every man, who lives long enough, will develop prostate cancer. The risk of getting prostate cancer increases rapidly after the age of 50. In fact, by age 75, the risk of getting prostate cancer is 30 times higher than age 50.

So, for early detection tests, what we have is better than nothing. The current tests are digital rectal examination and PSA blood test and they are still available. How often one should undergo these tests also remains controversial. But the best thing is to discuss your risk factors with your doctor and he or she can advise you accordingly.

Thought for the week:

“Success is that old A B C – ability, breaks, and courage.”

-Charles Luckman

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!