Although the research on what constitutes the best form of stretching is all over the place, most experts would agree that good / normal ranges of motion in all anatomical areas are important.  So it shouldn't come as a shock that we know from peer-review that exercise is beneficial for those with Cancer.  Last month the journal Scientific Reports published a study called Stretching Reduces Tumor Growth in a Mouse Breast Cancer Model, which concluded...

There is growing interest in developing non-pharmacological treatments that could boost natural defenses against cancer and contribute to primary and secondary cancer prevention. Recent studies have shown that gentle daily stretching for 10 minutes can reduce local connective tissue inflammation and fibrosis. Mechanical factors within the stroma can influence the tumor microenvironment. 66 female mice underwent bilateral injection of primary mouse mammary tumor cells into the third mammary fat pad. Mice were then randomized to stretch vs. no stretch, and treated for 10 minutes once a day, for four weeks. Tumor volume at end-point was 52% smaller in the stretch group, compared to the no-stretch group in the absence of any other treatment. Cytotoxic immune responses were activated and levels of Specialized Pro-Resolving Mediators (SPM's) were elevated in the stretch group. These results suggest a link between immune exhaustion, inflammation resolution and tumor growth. Stretching is a gentle, non-pharmacological intervention that could become an important component of cancer treatment and prevention.

Did you catch the magnitude of what these authors said?  In the 'breast cancer' subjects, a measly ten minutes of stretching a day was enough to not only increase specific immune compounds that target cancer cells, it decreased levels of programmed death receptor-1 (PD-1), a major marker of immune system exhaustion (WARNING: CAUTION MUST ALWAYS BE USED WHEN "BOOSTING" THE IMMUNE SYSTEM).  If you look at my post called FASCIA AND CANCER, you'll see how FIBROSIS / SCAR TISSUE in the stromal connective tissues acts sort of like a perverse scaffolding, allowing cancer to take root and "connect" to your tissue bed, tapping into your blood supply and nutrition source in the process, while giving it a pattern to grow on.  Think of it as though your tissues are being hijacked.

We've known for quite some time that CANCER is included in the same class of diseases as Cardiovascular Disease, Diabetes, Arthritis, and numerous others.  What's the common denominator?  You already know the answer --- INFLAMMATION.  Furthermore, we know from the numerous posts I've provided you in THIS POST that inflammation, by its very nature, ends up causing some degree of fibrosis, 100% of the time.  Never forget that despite the name of the disease (see list under the "inflammation" link above), one way or another, fibrosis is at the root and is considered our nation's number one cause of death (HERE) --- a fact that is unfortunately lost not only on average people, but on most of the medical community as well.

The area of cancer research that consistently draws the most attention is BREAST CANCER.  Ten days ago DR. HELENE LANGEVIN did a talk at Harvard's Osher Center Integrative Medicine on her lab's experiment looking at the effects of stretching on breast cancer, as seen in a mouse model.   Dr. Langevin (she's a neurologist) is one of the growing number of scientists talking about the FASCIAL CONNECTION IN ALL DISEASES as being much larger than anyone could previously have dreamed.  How else do you explain tumors in stretched subjects being less than half the size of the tumors in unstretched subjects?  None of this is shocking if you read my recent post called CANCER'S RELATIONSHIP TO THICKENED, STIFF, AND DENSE TISSUE.

Think about it like this.  Even if you decide to treat your Cancer conventionally, how cool is it to know that you can add simple things like an ANTI-INFLAMMATORY DIET (especially effective once you understand the "WARBURG EFFECT"), STRETCHING / YOGA, REBOUNDING (trampolining), GROUNDING, and others to your whatever else you're doing.  What do these have in common? The fact that they are all based on reducing the amount of inflammation in the body.  For more ideas on reducing inflammation, take a look at this MUCH MORE COMPREHENSIVE POST.  If you are interested in hearing Dr. Langevin talk about this study, I'm providing you the video below.  Oh; and be sure to show us some love on FACEBOOK if you appreciate our work here!

CANCER.  It's a word no one wants to hear.  But contrary to what the medical community is currently saying (IT'S MOSTLY DUE TO BLIND CHANCE) there are things you can do to help prevent it; one of the first being the need to understand DR. OTTO WARBURG'S work --- work that while originally done in the 1920's and 30's, has seen a recent revival within the scientific community.  Warburg won 1931's Nobel Prize for Medicine by figuring out that cancer "eats" by fermenting sugar.  Because FASCIA is the most abundant connective tissue in the body, we can't be surprised at the FASCIA / CANCER CONNECTION either.  But the connections don't stop there.  Another consequence of LIVING THE HIGH CARB LIFESTYLE is the accumulation of AGES (Advance Glycation Endproducts), one of the chief characteristics being that they cause abnormally cross-linked and stiffened soft tissues (organs included). And now we have another piece of the puzzle thanks to a very cool collaboration between researchers from University of Notre Dame's Department of Aerospace and Mechanical Engineering and their Cancer Research Institute.

The study (Stromal Cell-Laden 3D Hydrogel Microwell Arrays as Tumor Microenvironment Model for Studying Stiffness Dependent Stromal Cell-Cancer Interactions), from July's issue of Biomaterials showed that when it comes to BREAST CANCER, the stiffness of the ECM (extracellular matrix --- the substances secreted by surrounding cells to provide both structural and biochemical support to a particular tissue) matters.  INFLAMMATION always leads to fibrosis / scar tissue (HERE), and as shocking as it may seem to the average person, the thickened ECM found in fibrotic tissue is the number one cause of death on the planet (HERE & HERE).  I've also shown you that thickened or "densified" connective tissues (fascia in particular) are a serious problems as well (HERE and HERE), whose consequences go far beyond chronic pain (HERE).  With this as our backdrop, let's take a look at the study's abstract.

"Tumor properties such as growth and metastasis are dramatically dependent on the tumor microenvironment. However, the diversity of the tumor microenvironment including the stiffness and the composition of the extracellular matrix (ECM), as well as the involvement of stromal cells, makes it extremely difficult to establish proper models for studying tumor growth and metastasis.  Our results showed that, tumor spheroids closely interacted with the pre-adipocyte stromal cells encapsulated within the microwell array, influencing their differentiation and maturation degree in a stiffness related manner. They inhibited adipogenesis in high stiffness tissue constructs that were at breast cancer stiffness range, while the inhibition effect diminished in the low stiffness tissue constructs that were at normal human breast tissue range. Furthermore, the 3D structure of tumor spheroids was shown to be important for the inhibition of the adipogenesis, as conditioned media from monolayer culture of cancer cells did not show any significant effect. These results show, for the first time in literature, that stromal-cancer interactions are highly dependent on ECM stiffness."

Hold on and I'll show you what's going on here.  The team, lead by Dr Pinar Zorlutuna (a professor in ND's Department of Aerospace and Mechanical Engineering and the Harper Cancer Research Institute), created a sort of scaffolding system for cells to grown on, which had a "tuneable stiffness" so that the authors could grow their cell cultures at both normal stiffness as well as the stiffness of cancer (hundreds of times stiffer).  The breast, which is made up mostly of ADIPOSE (fat), COLLAGEN, and EPITHELIAL CELLS, is known to develop cancer mostly in the epithelial layer.  It's a well-known fact that cancer cells are stiff and dense compared to surrounding tissues, but in this study the reverse was also true --- that stiffer tissue led to increased cancer growth.  In other words, stiff, dense tissue fueled cancer.  In the study's press release, Dr. Z stated, "If you have a stiffer environment, the cancer cell can do more manipulation of its immediate microenvironment."

Why should you care?  Because when it comes to diet we know at least a couple relevant facts.  Firstly, as I already mentioned, sugar and junk carbs cause tissue to become less elastic and thicker.  Secondly, the kind of fats you consume is of critical importance as well.  For instance, the primary property that makes TRANS FATS so dangerous is the fact that they create stupid cell membranes (see link).  Instead of cell membranes that are supple and wavy, Trans Fats make them rigid and inflexible, with the end result being an intimate relationship to any number of diseases and chronic pain syndromes.  Not surprisingly, obesity has been heavily linked to cancer as well (HERE, HERE, HERE, and HERE).  If you want to learn about which fats to eat and which to avoid, HERE and HERE are the links. 

And for those of you struggling with chronic health issues, including problems with your weight, Gut Health, chronic pain, or any number of others, I've given you some tools to start addressing the underlying causes (HERE).  If you find our site interesting and know of people who could benefit from the free information, reaching those you love and care about most is as easy as dropping them a link or liking, sharing, or following on FACEBOOK.

"If you haven't gotten this message already, you should heed it now: The benefits of screening for breast cancer are limited.  We should be doing fewer screening mammograms, not more."  Doctor H. Gilbert Welch from yesterday's issue of the L.A. Times (When Screening is Bad for a Woman's Health)

Dr. Welch is what I would refer to as a sharp guy.  He graduated from Harvard in 1976, and from medical school four years later.  Then in 1990, he got his Masters in Public Health from the University of Washington. He currently spends some of his time working as an internist for the VA and the rest working as a medical professor at the Dartmouth Institute for Health Policy and Clinical Research.  His specialty? 

"For the past two decades, Dr. Welch’s research has focused on the problems created by medicine's efforts to detect disease early: physicians test too often, treat too aggressively and tell too many people that they are sick. Much of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, lung, breast and prostate cancer."

I have written about these very 'problems' on any number of occasions.  It's why rituals like ANNUAL PHYSICALS, yearly PROSTATE SCREENINGS, and regular MAMMOGRAMS are no longer considered to be the 'standard of care'.  It all has to do with something known as "OVERDIAGNOSIS & OVERTREATMENT"   In fact, over the past decade, Dr. Welch has written three different books on this subject.

"His first book, 'Should I be Tested For Cancer? Maybe Not and Here's Why' was written while he was a Visiting Scientist at the International Agency for Research on Cancer and was one of the six "best books" listed by Malcolm Gladwell in 'The Week'. He has recently published two more books, 'Overdiagnosed: Making People Sick in the Pursuit of Health' and 'Less Medicine, More Health: Seven Assumptions that Drive Too Much Medical Care'."

Just yesterday, Dr. Welch wrote an article for the LA Times called When Screening is Bad for a Woman's Health.  It's mostly about the various newer forms of BREAST CANCER DETECTION.  We are all familiar with Mammography, but there are any number of new technologies that are far better at detecting Breast Cancer early.  Some of these include....

"Three-D mammography is promoted as finding 40% more breast cancer than conventional screening. The addition of ultrasound finds 50% more breast cancer than conventional screening. Adding an MRI doubles the amount of breast cancer found. And this year Mayo Clinic researchers reported finding almost four times more breast cancer using molecular breast imaging."

These technologies do exactly what they are designed and advertised to do --- detect small Breast Cancers, earlier.    Sounds great doesn't it?  It's the logical extension of the message ("Early Detection Saves Lives") that has been pounded into our skulls since we were in grade school.  Unfortunately, it's simply not true.

"Looking harder isn't the right way to combat breast cancer. What do get when we look harder? More false alarms and more overdiagnosis — with no obvious change in what we really care about: breast cancer deaths."

The gist of the article is that not only is finding early cancer rarely beneficial, using new technologies to find CANCER even earlier is worse yet.  If you want to understand why, I would suggest you either read the links in this post, or better yet, take a look at DR. WELCH'S ARTICLE in the Times.  Or, just to show you that this concept is nothing new, you could look at an article that Welch wrote for the New England Journal of Medicine (Advances in Diagnostic Imaging and Overestimations of Disease Prevalence and the Benefits of Therapy) just over 22 years ago --- clear back in 1993.  I included the opening paragraph below.

"Over the past two decades a vast new armamentarium of diagnostic techniques has revolutionized the practice of medicine. The entire human body can now be imaged in exquisite anatomical detail. Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography routinely “section” patients into slices less than a centimeter thick. Abnormalities can be detected well before they produce any clinical signs or symptoms. Undoubtedly, these technological advances have enhanced the physician's potential for understanding disease and treating patients.  Unfortunately, these technological advances also create confusion that may ultimately be harmful to patients."

If you recall, the first rule of medicine --- part of the Hippocratic Oath that all physicians take upon graduation --- is "Do No Harm".   Clearly, this issue being brought up by Dr. Welch is just the tip of the iceberg as far as the practice of medicine causing harm is concerned.  If you really want to get a picture of what's going on in American medicine, I would suggest you look at two short posts (HERE and HERE).

For many years, I have been educating my patients about something known in the medical community as "OVERDIAGNOSIS & OVERTREATMENT" (this used to be called "False Positive" tests).  During those same years, the medical community has ignored their own research and continued to beat the "Early Detection" drum --- despite the fact that they've recently seen recommendations for "ANNUAL EXAMS" and MOST MRI'S go the way of the way of the Dodo Bird and coal-fired steam engine. The problem is, most physicians continue to push outdated tests on their patients --- tests that are no longer considered to be Standards of Care in their respective fields (HERE).  Nowhere has this SCHIZOPHRENIC DICHOTOMY been more apparent than with Mammograms (HERE) --- particularly after the latest study in a long line of similar studies  --- at least three decades worth.

The brand new issue of one of the journals put out by the American Medical Association (JAMA Internal Medicine) carried a study done at Harvard University and called Breast Cancer Screening, Incidence, and Mortality Across US Counties.   The study involved, "16 million women 40 years or older who resided in 547 counties reporting to the Surveillance, Epidemiology, and End Results cancer registries during the year 2000. Of these women, 53,207 were diagnosed with breast cancer that year and followed up for the next 10 years."  The powers that be were wanting to know whether or not having a mammogram in the two years prior to a Breast Cancer diagnosis had any effect on the outcome.  To put it another way, they were wondering if mammograms helped prevent deaths caused by BREAST CANCER. 

What they found was that mammography only increased the pysicians's ability to find larger tumors slightly.  However, it increased the discovery of smaller tumors by 25%.  On the surface, this sounds good --- maybe even wonderful.  But here's the rub.  The authors concluded that, "the clearest result of mammography screening is the diagnosis of additional small cancers. Furthermore, there is no concomitant decline in the detection of larger cancers, which might explain the absence of any significant difference in the overall rate of death from the disease. Together, these findings suggest widespread overdiagnosis."  

Think about this for a moment.  Even though mammograms are catching many more cases of Breast Cancer than not having mammograms, the death rate remains unaffected.  How can this be?  It all has to do with understanding the term "Overdiagnosis".  Overdiagnosis is explained in the first paragraph of the March, 2015 issue of the British Medical Journal (The Challenge of Overdiagnosis Begins With its Definition). 

"The implicit social contract underpinning healthcare is that it will reduce illness and preventable death and improve quality of life. But sometimes these promises are not delivered. Sometimes health services take people who don’t need intervention, subject them to tests, label them as sick or at risk, provide unnecessary treatments, tell them to live differently, or insist on monitoring them regularly. These interventions don’t improve things for people; they produce complications or illness, reduce quality of life, or even cause premature death. Active health intervention is not always a good thing: it can be “too much medicine,” or produce what is often called overdiagnosis.   Although the concept of overdiagnosis has been described in the literature for nearly 50 years in relation to cancer screening, it was Welch and colleagues’ 2011 book, Overdiagnosed: Making People Sick in the Pursuit of Health, that popularized the term.  Overdiagnosis is now an acknowledged problem for patients, clinicians, researchers, and policymakers; it is discussed in journals, and at specialist conferences, and addressed through policy and practice initiatives."

Webster's makes things easier, defining Overdiagnosis as, "the diagnosis of a condition or disease more often than it is actually present."  Although this might not sound like a big deal, we know that medical treatment --- especially when it comes to treating CANCER (or "Overtreating" as the case may be) --- CAN BE QUITE HARSH.  The goal is to use Chemo and Radiation to kill the Cancer; hopefully before it kills you first; often bringing patients to the brink of death.  Unfortunately, we are seeing that many more people than we are led to believe cross that brink (HERE). 

When we factor Overdiagnosis and the subsequent Overtreatment into the equation, we see that annual mammograms for the general population are a wash --- something the authors of this study admitted (see the quote at the top of the page).  "There are increasing concerns that screening unintentionally leads to overdiagnosis by identifying small, indolent, or regressive breast tumors that would not otherwise become clinically apparent [relevant]."  The end result is that as many people die of Overtreatment, as are saved by early detection.  Like I said, a wash.

Whether or not you chose to have mammograms done on a regular basis is your business.  There are, however, any number of things you can do to prevent Cancer from happening in the first place --- or DEAL WITH IT EFFECTIVELY if it does.  Firstly, don't take Antibiotics, as they have been linked to higher rates of Cancer (HERE).  Secondly, avoid XENOHORMONES (or HERE) like the plague they are.  And thirdly, change your diet and lifestyle.  Not sure where to start?  Try THIS APPROACH.  It may keep you from becoming another casualty of EVIDENCE-BASED MEDICINE.

No profession is more jam-packed, stuffed, wedged, and crammed full of "SACRED COWS" than the practice of medicine.  There's the issue of VACCINES, there are ANTIBIOTICS, there are STATIN DRUGS, there is EVIDENCE-BASED MEDICINE, NON-CELIAC GLUTEN SENSITIVITY, DIETARY FAT, ANNUAL PHYSICALS, etc, etc, etc.  And that's just for starters. And when it comes to BREAST CANCER, I have actually shown you a couple different times that mammograms are not everything they have been cracked up to be (HERE and HERE).  Now we find out that double-mastectomy falls into the same category.

Women who are diagnosed with Breast Cancer in one breast, frequently opt for the removal of both breasts as a preventative measure.  I understand the thought process and emotions that lead to this decision, but is the decision based on good science?  Let's look at a study that was published in the latest issue of JAMA (Journal of the American Medical Association) that came out yesterday (Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011).

A joint study between Stanford University, USC, the Cancer Institute, the California Department of Health Services, and the CDC, looked at almost 200,000 California women who had been diagnosed with unilateral (one-sided) breast cancer.  These women were followed for an average of approximately 7.5 years post-surgery.  Here are a few quotes that I pulled out of this study word-for-word (emphasis mine).

A myth is defined as "an idea or story that is believed by many people but that is not true".  A sacred cow is, "someone or something that has been accepted or respected for a long time, and that people are afraid or unwilling to criticize or question".   Believe me when I tell you that there's a whole herd of myths and sacred cows running wild in the Medical Community.  Tackling them is not always easy; and as crazy as it may seem, can be painfully controversial.   Some of these scared cows include things like....

• OSTEOPOROSIS DRUGS PREVENT FRACTURES:  The truth is, Osteoporosis Drugs cause fractures.  I have been warning people of this fact for over a decade (HERE).  Fortunately, the powers that be are starting to admit this on a small level.

• HIGH CHOLESTEROL IS THE CHIEF CAUSE OF HEART ATTACKS:  The underlying culprit in the vast majority of Heart Disease is INFLAMMATION and not CHOLESTEROL.  This is one of the reasons why you do not want to be on STATIN DRUGS.

• VACCINES ARE SAFE:  Whether we are talking about FLU SHOTS or VACCINES in general, they are anything but safe.  Sure they prevent acute diseases.  The problem is, here in America we have been trading acute illnesses for chronic, long-term NEURO-DEGENERATIVE DISEASES, AUTISM, AUTOIMMUNITY, CANCER, and ENDOCRINE PROBLEMS, for decades.

• DOCTORS DON'T PERFORM TESTS OR PRESCRIBE DRUGS THAT YOU DON'T ACTUALLY NEED:  Really?  Although I could show you dozens upon dozens of examples, just look at these two topics and try and convince me otherwise (HERE & HERE).

• ANTIBIOTICS KEEP OUR NATION HEALTHY:  Although ANTIBIOTICS undoubtedly have the ability to save lives, their overuse has been a major causal factor in POOR GUT HEALTH (including LEAKY GUT SYNDROME and IBS) as well as a whole host of AUTOIMMUNE DISEASES and DYSBIOSIS.

• AS LONG AS I DON'T HAVE DIABETES, MY BLOOD SUGAR IS FINE:  HERE and HERE are solid proof that "Uncontrolled Blood Sugar" (even if your numbers are in the 'normal' range) is one of our nation's foundational health problems.
  

• ANTI-DEPRESSION DRUGS ARE SAFE AND EFFECTIVE:  Because so many of you reading this post are on ANTI-DEPRESSION DRUGS, it would behoove you to click on the link and spend just a little bit of time reading before accusing me of speaking out of turn.

• ANNUAL PHYSICALS ARE A CRITICAL PART OF GOOD HEALTH:  This is simply not true.  Why not?  Because of something you are going to learn a great deal about today ---- way too much over-treatment due to "False Positives".  More on this topic to come.
  

• EVIDENCE-BASED MEDICINE IS A WONDERFUL WAY TO PRACTICE MEDICINE:  EVIDENCE-BASED MEDICINE is the way doctors are currently forced to practice medicine by our bureaucracy-loving government.  If you believe that this is improving your quality of care, you may want to click on the link.

Here's the thing folks; I could have included dozens of other examples of medical myths and sacred cows.  If you want to read more about them, they're all over my site.  But time is short.  We need to get back to our question at hand.  Is mammography a life saving diagnostic tool that leads to early detection of BREAST CANCER, and ultimately saves women's lives, or is it not?  Let's cut straight to the chase.

A mammogram is an X-ray of the breast used to detect tumors earlier than they would otherwise be detected through things like physician breast examinations.  For years, there have been people raising a red flag concerning our nation's extensive use and recommendations for mammography.  In fact, worries about lifetime radiation exposure and "False Positives" have led to some recent changes in the way mammograms are to be used to screen for Breast Cancer.  According to the the U.S. Preventive Services Task Force (The USPSTF --- a group of experts meeting under the umbrella of the Department of Health and Human Services)..........

• Routine mammograms should begin at age 50 instead of 40.  They should also end at age 74.

• Women should receive a mammogram every other year instead of every year.

• Based on the most current peer-reviewed scientific literature, self-examination of the breasts (something that has been heavily promoted for decades) has little or no value.

Wow! Self-breast exams have, "little or no value".  How can that be?  These sacred cows hurt when they step on your toes.  The biggest reason for the failures of self-breast exams and regular mammography screenings has to do with something called "False Positives".  Let's take a couple of minutes to unwrap this terminology and figure out why mammograms aren't what we've been led to believe they are, and why several recent studies actually show higher death rates for women who follow routine mammography schedules as opposed to women who don't get mammography at all.

According to a study published in this month's issue of BMJ (The British Medical Journal), Canadian researchers who started following a group of almost 90,000 women 25 years ago have come to some interesting conclusions concerning mammography and Breast Cancer.  The women were divided into two groups ---- those who had annual mammography and those who had no mammography at all.  Listen to the author's conclusions at the end of the 25 years.  "Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy [chemo / radiation] for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed...."  The study's lead author, Dr. Anthony B. Miller (M.D.), Professor Emeritus of the University of Toronto's School of Public Health clarified what they meant by going on to say that, "At the end of the screening period, an excess of 142 breast cancers occurred in the mammography arm compared with the control arm.... This implies that 22% (106 of 484) of the screen-detected cancers in the mammography arm were overdiagnosed". 

In simple English, this means that 22% of those diagnosed with CANCER did not actually have Cancer.  I would assume that most, if not all of these women then fell into the category of "Overtreated"  In fact, there were researchers from around the world (Dr. Mette Kalager, MD, of the University of Oslo in Norway was one of the most renowned) who looked at the study and said that since the type of Breast Cancer called "ductal carcinoma in situ" that accounts for 25% of all Breast Cancers was not included in the study, the numbers would actually be worse than Miller's group determined --- significantly worse.   Gulp.  Dr. Kalager's team published an editorial in the same issue of BMJ titled, "Too Much Mammography".  But not everyone agreed with these findings.

Two doctor's groups lost their collective minds over Miller's study --- The American College of Radiology (ACR) and the Society of Breast Imaging (SBI).  They issued a joint statement accusing Miller and his colleagues of all sorts of underhanded and dirty tricks, as well as using shoddy research techniques and outdated equipment.  In a statement issued by Miller that addressed every issue brought up by these two groups, he said that his team's study was undoubtedly "unwelcome to this highly financially conflicted group, but which will be of substantial interest to policy makers in considering the future of screening for breast cancer."  Wow!  Financial conflict-of-interest in medicine?  You don't say.  If you have a couple of minutes sometime, breeze through a few of our numerous articles on EVIDENCE-BASED MEDICINE to get a small taste of what Miller is up against as he takes on this sacred cow.  The crazy thing about this research is that like Dr. Wender told us at the very top of the page, it's not really new information.

The November, 2012 issue of the New England Journal of Medicine published a study called, "Effects of Three Decades of Screening Mammography on Breast-Cancer Incidence".  What were the conclusions of this thirty year study that looked crunched governmental statistics for the entire United States?  Are you sitting down?  The authors stated that, "we estimated that breast cancer was overdiagnosed (i.e., tumors were detected on screening that would never have led to clinical symptoms) in 1.3 million U.S. women in the past 30 years. We estimated that in 2008 alone, breast cancer was overdiagnosed in more than 70,000 women; this accounted for 31% of all breast cancers diagnosed.  Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer. Although it is not certain which women have been affected, the imbalance suggests that there is substantial overdiagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer." 

If you get out your calculator and do the math, this study showed a whopping 93% "False Positive" rate.  Re-read that and let the magnitude of what it is implying about our current model of diagnosing and treating Breast Cancer sink in for a moment.  And the final bite-in-the-butt for those of you keeping score at home is that they did not even include the Breast Cancers that were thought to have been caused by the ongoing HRT (Hormonal Replacement Therapy) fiasco (HERE), which would have made the numbers even worse.  But that's not all.  This study only dealt with False Positives.  What about the "False Negatives"?  Listen to what our government's NIH website has to say on this topic.  "Assuming an average sensitivity of 80%, mammograms will miss approximately 20% of the breast cancers that are present at the time of screening (false-negatives)".  93% False Positives plus 20% False Negatives adds up to 113% --- an impossibility.  Let's just say that the False Positives are over 50% (the government admitted in the quote from the very top of the post that, "most abnormal mammograms are false-positives"). Throw in the False Negatives and the absolute best you could hope for was 30% accuracy.  Could be why  recent studies are leading some doctors to conclude that women who get regular mammograms have a better chance of dying of Breast Cancer than those who do not get mammograms at all.

A recent book by Peter Gøtzsche (Mammography Screening: Truth, Lies, and Controversy) goes on to cite incidence after incidence after incidence of this phenomenon.  And just like I told you would happen when ANNUAL PHYSICALS showed the same problem (colossal numbers of False Positives), the medical community howled.  False Positives are exactly as the name implies, diagnostic test results that come back positive when they really are not.  In other words, the test says you have Cancer, and either you don't have Cancer, or you have a slow-growing non-invasive form of cancer that would never present a problem in your natural lifetime.  The same phenomenon of False Positives is why regular PROSTATE CANCER SCREENINGS were deep-sixed several years ago (I have always thought that a "False Positive" test ultimately killed a dear neighbor of ours (HERE).  Having spoken with several MD's about this issue of False Positives, I can assure you that the problem is real and it is serious. 

Patients who are not aware of this information are sitting ducks to be cajoled into doing things they do not want to do (I spoke of the same thing going on with appendicitis in THIS recent post on CT Scans --- a scenario that happened to our family three years ago).  I have included a sample conversation from the average doctor's office to help you understand the situation.   PATIENT:  But doctor Smith, I really don't want to have that mammogram.  I read on the internet that they aren't all they've been cracked up to be.   DR. SMITH:  I'm sorry Mrs. Jones, but if you don't agree to get the test, you'll have to find another doctor.  And really; you should stop putting so much faith in articles you find on the internet.  You know you can't trust any of that stuff anyway.  Especially if it comes from Dr. Schierling's site.  Trust me instead.  I'm a doctor.  This scenario is playing out all over the United States.  The bottom line is that if you are a female who is concerned about Breast Cancer, whether for yourself, your daughters, or grand-daughters, you need to educate yourself.  In my humble opinion, the best thing you can do is to stop the process before it starts ---- after all, this is what the word "Prevention" really means.

How do you prevent Breast Cancer?  You would prevent it the same way you would try to prevent any Cancer --- or for that matter, practically any disease period (HERE).  One of the very first things you need to do is to understand the relationship between Estrogen and Female Cancers.  From there you can begin learning about something called "ESTROGEN DOMINANCE".   Another important step in this puzzle would be figuring out how to resolve Estrogen Dominance before it begins fueling cellular mutations of the breast (HERE).   As always, never take my word for anything.  The internet has placed huge amounts of valuable information at your finger tips.  Like I stated earlier, knowledge is power.  Empower yourself and your family by learning more about Breast Cancer and the ways to stop it dead in its tracks before it ever has a chance to gain a hold in your life.

Do you like swimming?  Although I don't enjoy swimming laps or anything like that, I can spend days on end swimming / snorkeling / boating on the CURRENT RIVER.  Now; take just a moment and imagine that each and every day of your life, you are swimming in a sea of artificial estrogen --- the female sex hormones.  Unfortunately, this is what is happening with many Americans --- both male and female.  There is estrogen in the foods we eat (estrogen is the hormone farmers give cattle to make them fat).  It's in the scents we wear (perfumes, colognes), as well as the soaps and shampoos we clean ourselves with.  It's in the foods we eat (soy is one of the worst offenders), the pesticides / herbicides that we spray our food supply with, as well as the containers we put the leftovers in (plastic baggies, plastic containers).  It's in the gasoline we spill on our clothes as we fill up, and the cleaners we use to get them clean (and let's not forget the dryer sheets).  Estrogen is even 'out gassed' from the carpets, furniture, and materials used in our houses --- particularly true if you happen to live in a mobile home.  The truth is, artificial estrogens are everywhere --- and I do mean everywhere.  Fail to understand this, and you could wind up on the MEDICAL MERRY GO ROUND.

We will get to the reasons that this is such a big health concern in a moment, but I want to first talk for a moment about where this flood of estrogen-like chemicals (Xenohormones / Xenoestrogens) is coming from.  A simple way to think of this is by likening the relationship between estrogen and xenoestrogen, to the relationship between Gluten and Gluten Cross-reactors. Over the past several decades, GLUTEN (Wheat Protein) has, for a NUMBER OF DIFFERENT REASONS, been technologically altered until it is a very different product than the Gluten our forefathers consumed.  Because of this, many people have Immune System reactions to it, and are considered to be "sensitive" to it.

Because your body recognizes various substances according to their molecular shape (example below), foods that have a close enough molecular structure / shape to Gluten will be recognized by certain people's bodies as Gluten ---- even though it is not Gluten.  One of the more common of these is coffee.  This phenomenon is known as GLUTEN CROSS-REACTIVITY.  It's almost like a skeleton key that fits in any number of different locks.  Unfortunately, the very same principle can be seen with certain synthetic or petro-chemicals as well --- particularly a chemical called Benzene.

Estrogen is chemical compound made up of six-sided rings.  Benzene is a very simple six sided ring.  When you look at the two side by side, you can begin to see how the body could be fooled.  This is particularly scary considering that Benzene is known to be one of the most toxic, widely used chemicals on the planet.  When you smell glue, paint, gasoline, detergent, automobile exhaust, cigarette smoke (50% of America's exposure comes from cigarette smoke), or almost anything else with a chemical or artifical smell (even a pleasant chemical smell), you are likely inhaling Benzene.  Benzene has been associated with a wide array of illnesses and cancers, as well as being a known "ENDOCRINE SYSTEM DISRUPTOR".  When you 'disrupt' the ENDOCRINE SYSTEM, there can be hell to pay in practically every different system in your body.  Remember this when you look at the list below.

Estrogen Dominance describes the state of women who have too much estrogen in their system in relationship to the amount of Progesterone they have.  This means that Estrogen Dominance is not necessarily predicated on having too much estrogen (although that is the most common scenario), but in having a ratio of estrogen to progesterone that is out of kilter.  Truth be known, even women with low levels of estrogen can suffer from Estrogen Dominance if there is not enough Progesterone present in their bodies to balance it out.   When you read the list below, I want you to notice that the symptoms of Estrogen Dominance are ridiculously common here in America.  In fact, many experts estimate that as many as 1 in 2 women (and an untold number of men) suffer from the effects of this all too common, but poorly understood health problem.  Here are a few of the more common signs / symptoms of Estrogen Dominance.

• Accelerated Aging
• ALLERGIES / CHRONIC SINUSITIS and other INFLAMMATORY CONDITIONS
  
• AUTOIMMUNITY, including THYROID
  
• Breast Cancer/ Breast Tenderness
• Cervical Cancer
• Chronic Fatigue / Adrenal Fatigue (FIBROMYALGIA) / Brain Fog / Memory Loss
  
• DIMINISHED LIBIDO
  
• DEPRESSION / Anxiety/ Rage / Mood Swings
  
• Early Onset of Puberty (this is truly out of control in numerous countries around the world)
  
• Endometriosis / Uterine Cancer/ Fibroids
  
• HEADACHES / MIGRAINES
  
• BLOOD SUGAR DYSREGULATION problems, including HYPOGLYCEMIA / SUGAR AND CARB ADDICTION
  
• INFERTILITY / PCOS
  
• OSTEOPOROSIS
  
• SYMPATHETIC DOMINANCE
  
• Weight Gain --- particularly ABDOMINAL OBESITY / Bloating
  
• Many Others

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The first rule of thumb is to stay as far away as possible from Xenoestrogens.  Unless you are living in the Alaskan wilderness in a homeade log cabin you built yourself, this will be all but impossible.  Xenoestrogens are literally everywhere.  But, with a little bit of knowledge, you have the ability to significantly limit their effects on you and your family.  First, you must realize that anything that is made from petroleum, or anything that has an artificial or chemical smell (even if it is a "good" smell) is very likely to be a Xeno-estrogen.  Secondly, whether it is real estrogen, artificial estrogen, or substances that simply mimic estrogen (the 'Xeno' family, you need to avoid excess estrogen whenever possible.   Again, be aware that the hormones given to beef cattle to make them gain weight are synthetic estrogens.  Other things you can do include.... (this list is by no means comprehensive).

• DON'T HEAT PLASTIC SUBSTANCES, RUBBER, OR CELLOPHANE-LIKE WRAPPERS IN YOUR MICROWAVE OVEN:

• BEWARE OF COMMERCIALLY RAISED MEAT OR POULTRY PRODUCTS:

• USE SOMETHING OTHER THAN "THE PILL":
  

• BEWARE OF PERFUMES, SCENTS, AND VIRTUALLY ALL BEAUTY PRODUCTS:

• BEWARE OF HOUSEHOLD CLEANING PRODUCTS THAT HAVE "NICE" SMELLS:

• AVOID HERBICIDES AND PESTICIDES:

• AVOID PHTHALATES & METHYL PARABEN:

• KNOW YOUR SUNSCREENS:    Five specific chemicals to avoid here include benzophenone-3, homosalate, 4-methyl-benzylidene camphor (4-MBC), octyl-methoxycinnamate and octyl-dimethyl-PABA.
• REMEMBER THAT SUGAR TURNS MEN INTO WOMEN AND WOMEN INTO MEN (HERE)
  

Let me throw you one more 'bone' in your fight against Xenoestrogens.  For decades, soy has been promoted as a this fantastic "health food" --- a "super food" if you will.  Unfortunately, this is a complete and total myth. Nothing could be farther from the truth.  You should never consume soy unless the soy has been fermented.  Why?  Because soy is a Phyto-Estrogen (plant-based Estrogen).  For more information, you can read Dr. Tim O'Shea's paper called The Magic Bean.

Beyond simple avoidance of Estrogen and Xenoestrogens, there are some other things you can do if you believe you are suffering from Estrogen Dominance.  Finding a Functional Medicine practitioner can be helpful, but there are some things you can do for yourself in the meantime.  The first thing I would suggest is to follow some GENERIC RECOMMENDATIONS that are true for almost anything that ails you.  Now let's tackle some of the recommendations specifically for use by the Estrogen Dominant person.

• STUDY THE ISSUE:  As I have always said, knowledge is power.  Do not blindly listen to any doctor --- including myself.  Several hours of studying this issue on the internet, and you will likely know more about this common problem than your doctor.  Speaking of your doctor; don't be surprised if you get a deer-in-the-headlights look or eye-roll if you mention 'Estrogen Dominance' in their presence.  There are lots and lots of great websites on this topic.  Beware of sites whose sole goal is to sell you something.  There are many good sites with information concerning specific foods to add to or remove from your diet, or specific chemical products to really watch out for.  After you have studied, sit down and create a written outline of how you are going to tackle your Estrogen Dominance.  Wouldn't hurt you to have an accountability partner as well.  Odds are, you know several women (and probably some men) with this problem.

• MAKE SURE YOU ARE GETTING LOTS OF FIBER:  When my family juices, I usually eat the pulp on my lunchtime salad.  Fiber is critical for dealing with Estrogen Dominance because it binds to the Estrogen and facilitates your ability to excrete it from the body ---- instead of reabsorbing it over and over again.  Word of warning here:  DO NOT buy into the myth that Whole Grains are a good source of fiber (I personally prefer ground Flax Seeds, although some will tell you to steer clear).  If you are dealing with very many of the symptoms of Estrogen Dominance, you can almost assure yourself that you are GLUTEN SENSITIVE as well.  This not only means that you are almost surely dairy-sensitive also, but that you are probably AUTOIMMUNE on top of everything else.  Again, the PALEO DIET is the best way to deal with this entire scenario.
  

• DETOX YOUR LIVER:  When it comes to Estrogen Dominance, dealing with your liver is critical.  This is because your liver is the organ that essentially filters / removes / breaks down excess Estrogen in your body so that you can get rid of it.  One of the best resources for learning about liver detox is Dr. Sandra Cabot (MD) of Australia.  You can also read a SHORT ARTICLE I wrote on the subject.
  

• TAKE THE CORRECT SUPPLEMENTS:  The link I left you under "Generic" above is going to give you some of the generic supplements you'll need to take for inflammation (the two biggies are PFGO for INFLAMMATION, and PROBIOTICS for GUT HEALTH).  However, there is at least one other supplement that I would highly recommend taking specifically for Estrogen Dominance.    Vitex / Chaste Tree is one of the best and most popular supplements for this problem, although there are a slew of others; all different from each other depending on who you read.  The truth is, the supplements are not nearly as important as is your diet.
  

• RELAXATION TECHNIQUES AND DEEP BREATHING:  Exercise will get you breathing hard.  However, once you read the next section on Breast Cancer, you will see why good breathing habits / PROPER OXYGENATION are absolutely critical for properly dealing with Estrogen Dominance.
  

Progesterone Creams have long been used to improve the ratio of Progesterone to Estrogen, thus, diminishing the effects of Estrogen Dominance.  For many women, these work like magic.  Although I have previously given the nod to over-the-counter Progesterone Creams for women suffering from a variety of Estrogen Dominance-related symptoms (even at times suggesting them to patients), as of 2011, I no longer do so.  Although these products can certainly (temporarily) relieve the symptoms of Estrogen Dominance, Dr. Kharrazian showed us research saying that Progesterone tends to be broken down by your liver into ----- you guessed it ---- estrogen.  From there it is stored in the fat cells.  The end result of this cycle is increasing Estrogen Dominance!  But unfortunately, that's not where it ends.

Did you notice the last bullet point on the first list above?  It is 'Weight Gain'.  Let me tell you why this presents such a dilemma when it comes to Estrogen Dominance.  Not only does estrogen cause weight gain via an increase in fatty tissue (this is why beef farmers give "hormones" to their cattle), but the real bite-in-the-hind end that few people talk about is the fact that fat cells, right along with the ovaries, actually manufacture ---- correct again ----- estrogen. 

The statistics on American Breast Cancer reflect everything you have learned thus far concerning Estrogen, Xenohormones, and Estrogen Dominance.  According to MedlinePlus (a service of the National Library of Medicine and the National Institutes of Health), one in eight American women will get Breast Cancer at some point in their lives.  And each year, nearly 40,000 of them die. 

There is an overwhelming amount of information on Breast Cancer online.  The truth is, if you want to make yourself an expert on the subject (if you are at risk, you should), there is so much information online that you could never possibly wade through it all.  I am going to keep this section brief by spending only two or three paragraphs talking about the Estrogen / Breast Cancer link.

Because the majority (over 3/4) of Breast Cancers in America are fueled by Estrogen), your lifetime exposure to Estrogen, whether natural, synthetic, or pseudo (Xenoestrogens) play a huge part in determining whether or not you will get Breast Cancer over the course of your lifetime --- or whether or not you will relapse after taking the "cure".  This is why women take drugs like Tamoxifen and Femara to "block" Estrogen for several years after successful treatment of their CANCER. 

All Cancers, including cancer of the breast, tend to develop in similar fashion.  Firstly, the body becomes oxygen deprived, toxic, and acidic --- usually due to a poor diet.  The breast tends to act as a magnet for Cancer because of the close proximity of glandular tissue (the milk glands are highly responsive to estrogen) to fat cells (fat cells tend to accumulate toxins).  As the cells in the glandular tissue of the breast struggle to survive in this increasingly acidic and poorly oxygenated environment, they begin to mutate.  This allows them to produce energy from SUGAR (fermentation), instead of using oxygen.  The whole process continues to feed itself as well as increasing the rate of cell replication (already a problem in Cancer --- read the articles in the link from the preceding paragraph on "Sugar Feeds Cancer").

Although I do not claim for one moment to be any sort of expert on Cancer, I do know that the vast majority of disease processes START IN SIMILAR FASHION.  Who would I trust to take care of me if I had Cancer?  That's an easy one to answer.  One of the most brilliant minds on the subject is Dr. Kevin Connors of Minneapolis, Minnesota.  He is on the cutting edge of Functional Neurology / Functional Medicine.  Hopefully you will never need his expertise in this area.

Over the course of a woman's lifetime, she has a 12% chance (1 in 8) that she will develop an invasive form of BREAST CANCER.  This chance doubles if she has a close relative who has been diagnosed.  BREAST CANCER is the second most common form of cancer in American women, and of all American women diagnosed with cancer, almost 1/3 of it is of the breast.  According to BreastCancer.org, this year there will be just shy of a quarter million American women diagnosed with Invasive Breast Cancer, and another 65,000 diagnosed with non-invasive Breast Cancer.  About 40,000 of these will die.  Currently, there are almost 3 million living American women who have had or currently have Breast Cancer.

One of the many treatments for breast cancer involves removing the breast (MASTECTOMY).   It should be noted that some studies say that incidence of mastectomies are increasing in America, while other studies say they are falling.  Regardless of who you believe, approximately 40% of those diagnosed with Breast Cancer will undergo a mastectomy.  Although this procedure goes off without a hitch for the majority of women, a large percentage end up with chronic post-surgical pain.  In fact, this problem is common enough that it has its own name (Post-Mastectomy Pain Syndrome or PMPS).  

Google "Mastectomy Chronic Pain" and you'll get nearly 70,000 hits.  This is not surprising considering such a large percentage of women undergoing mastectomy end up with PMPS, which is defined as having, "pain located in the area of the surgery or same-side arm, present at least 4 days per week and with an average intensity of at least 3 on a scale from 0 to 10".  Here are some statements made by the medical profession concerning PMPS.

Although recent advances in the diagnostic and surgical procedures have reduced the frequency of the more invasive surgical procedures, there still is a considerable risk of developing PMPS after treatment of breast cancer.  Department of Surgery, Odense University Hospital as published in the August 2008 issue of the British Journal of Cancer.

Post-Mastectomy Pain, also known as post-mastectomy pain syndrome (PMPS), is a type of chronic postoperative pain. PMPS is pain that persists after a mastectomy or other type of breast surgery is performed. Procedures that may lead to post-mastectomy pain include total mastectomy, partial mastectomy, lumpectomy and even breast reconstruction.  From the website of the American Chronic Pain Association.

Current literature illustrates that PMPS has an alarmingly high incidence (20-57%, but has been reported as high as 82% in one study). Despite various strategies of prevention or therapy, PMPS often persists for many years for those patients who are diagnosed with this syndrome (greater than 50% of patients still report pain at an average 9-year post-op follow-up).  The national burden from this often unrecognized but commonly occurring condition is staggering.  From a study done at University of Buffalo (NY) and published in the April 2013 issue of The Journal of Pain.

Although I could have included dozens more quotes, this last study, published a mere 6 months ago, is truly a shocker.  Although the authors did not do any specific research themselves, they did a literature review of nearly 30 studies on the topic.  At a three year follow-up, fully half of women who underwent mastectomy were dealing with PMPS.  Furthermore, they stated that almost 1 in 5 women who have undergone mastectomy, have NEUROGENIC PAIN a decade after the fact.  There are an estimated 1.2 million women in the U.S. who deal with PMPS.  The financial burden for PMPS is thought to be in the 2.5 billion dollar a year range, which does not include loss of workplace productivity, family and social costs, or counseling costs.

What is the mechanism for PMPS?  This is the $64,000 question.  The standard line is that it is caused by surgical damage to the nerves in the breast, chest, and underarm area.  Many researchers believe that neuromas (abnormal nerve tissue growth) are a large factor as well.  Could anyone be missing the connection to FASCIAL ADHESIONS?  In order to understand PMPS as well as many of the CHRONIC PAIN SYNDROMES that people present to my clinic with, you must first have a working knowledge of Scar Tissue itself, and what it means to be "TETHERED".

SCAR TISSUE is normal tissue that has been physically deranged (click on the link for lots of pictures).  In other words, tissue that should be aligned all nice and neatly like well-combed hair, becomes matted, tangled, and twisted into a restricted clump due to the surgery ---- sort of like a hairball.  Not only is Scar Tissue extremely immobile and restrictive, it is up to 1,000 times more pain-sensitive than normal tissue.  Couple this with the fact that you cannot see FASCIA on MRI, and you set the table for Chronic Pain's "PERFECT STORM".  This is true whether one is having a complete mastectomy, or reconstruction / implants.  Read the quote below from Roni Caryn Rabin in the May 20, 2013 issue of the New York Times.

For decades, women were lied to about HRT (Hormone Replacement Therapy) and the link to cancer.  Not surprisingly, they were told that HRT would prevent various kinds of female cancers.  When the truth began coming out around the turn of the century (Y2K), Breast Cancer rates began falling.  One of the biggest studies on this topic, The Women's Health Initiative, was published in 2002.   The results of this study were so adamantly against HRT that over the course of the next year, the Breast Cancer rate in America dropped by a whopping 7% (HRT). 

Although there have been other similar studies published on this topic, BIG PHARMA, under the guise of the medical community, keeps churning out studies saying that HRT and Breast Cancer are not related.  In fact, a brand new study said that while HRT with multiple hormones is counterproductive, straight estrogen is a long-term cancer preventative.  Be very cautious about trusting studies like this.  Don't take any doctor's word for anything (self included).  Do your own research to find out what is best for you and your family.  HERE is a starting point, followed by THIS.

According to a brand new Norwegian medical study, Routine Mammograms cause, "substantial amount of overdiagnosis" of nonfatal breast cancer (a common problem with ALL CANCERS).  According to Mette Kalager and colleagues of Harvard School of Public Health, the screenings found large numbers of cancers that would not have become clinically significant during the woman's lifetime.  Their research was published in the April 3 issue of Annals of Internal Medicine.

Mammograms increase the incidence of diagnosed cancer in the following two ways.

• By detecting tumors earlier than they would have been otherwise found.
• By detecting tumors that would never have been clinically apparent in the woman's life.

The first scenario is what Mammography is all about --- it's what we think of when we think of Mammograms and "early diagnosis".  However, in the second scenario is problematic because the researchers stated that, "the woman would be diagnosed and treated with no possible survival benefit."  This is not a new problem.  It is the very reason that routine PSA tests for Prostate Cancer have been abandoned (HERE and HERE).  But how big a problem is this phenomenon in the area of Breast Cancer?  The researchers showed previous studies showed that over diagnosis (the second bullet above) that were as high as 54% (gulp).

Seven years ago, Norwegian women ages 50 to 69, were allowed to have a mammogram every other year using public health data from their government-run health system, Kalager and colleagues and his team looked at the statistics.  They determined that Norway's over-diagnosis rate was a whopping one in four (25%).  After looking at the data in a different manner, they still estimated the over-diagonisis to be as high as 20%.

When the rate of breast cancer diagnosis is added to the rate of breast cancer over-diagnosis (and the subsequent over-treatment, and mortality / morbidity associated with this process), their stats showed that one breast cancer death per 2,500 women was prevented.

This led experts Drs. Joann Elmore, MD, of the University of Washington, and Suzanne Fletcher, MD, of Harvard Medical School to publish their own research in the very same journal.  These two well-respected breast cancer experts wrote in the Annals of Internal Medicine that, "Evaluating strategies for observing change in some lesions over time instead of recommending an immediate biopsy has been suggested.  Unless serious efforts are made to reduce the frequency of overdiagnosis, the problem will probably increase."

As a side note to this issue, our own State Department's website on Norwegian travel states that, "Healthcare in Norway is very expensive and healthcare providers sometimes require payment at time of service."  Norway's tax rate is approaching 50% of their GDP.   They are one of the many nations that the AHA (Obamacare) is being modeled after.