Category: Drugs and Alternatives

  • Is There Any Wonder That People Become Confused?

    Dr. Myatt is currently deep in research for an upcoming paper on an increasingly common modern disease, hepatitis C. In this research she reviews hundreds of papers and references and studies – some of them big name scientific studies, some of them anecdotal reports, some of them promoting natural therapies, many more promoting allopathic Big Pharma drug offerings.

    There is a lot of misinformation out there – much of it promulgated by Big Pharma and Big Medicine who really don’t have a workable solution for hepatitis C, but don’t want to give any ground to the possibility that there might be natural alternatives to their often-toxic drug treatments.

    As an example, Dr. Myatt came across this article in the government’s National Library of Medicine PubMed service – the place where your allopathic doctor goes for his information (if your doctor bothers to research at all). This study was published under the heading of "Hepatology" (the study of diseases of the liver) and titled Herbal product use by persons enrolled in the hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial.

    I’ll include the text of the abstract at the end of this article, but here is the short course:

    • The authors / researchers looked at the herb silymarin (milk thistle) use by hepatitis C patients
    • The authors / researchers found that no beneficial effect of silymarin was found on hepatitis C virus (HCV) RNA levels
    • The authors / researchers conclude that only a well-designed prospective study can determine whether silymarin provides benefit to persons with chronic hepatitis C

    Whew! Heady stuff! Almost anyone quickly reading this brief abstract would be compelled to conclude that milk thistle has virtually no benefit or place in the treatment of hepatitis C. But wait – let’s read the authors words a little more carefully for when we do we begin to recognize a classic example of obfuscation and doublespeak:

    Univariate analysis showed significantly fewer liver-related symptoms and better quality-of-life parameters in users than nonusers, but after reanalysis adjusted for covariates of age, race, education, alcohol consumption, exercise, body mass index, and smoking, only fatigue, nausea, liver pain, anorexia, muscle and joint pain, and general health remained significantly better in silymarin users. In conclusion, silymarin users had similar alanine aminotransferase and HCV levels to those of nonusers but fewer symptoms and somewhat better quality-of-life indices.

    Translation please? Here it is…

    "We found that milk thistle helped patients feel better – so we re-worked the analysis to try to juggle the numbers the way we wanted them to be, and even after working hard to show otherwise we had to admit that it looks like milk thistle has a beneficial effect in hepatitis C patients"

    At no time, in the 2000 years or so of the recorded use of milk thistle has anyone ever claimed it to be an "anti-viral" herb. Immune enhancing, yes. Liver protective, yes. But not antiviral. So why look for an antiviral effect? Perhaps so that they could then say that "it doesn’t work"?

    Folks, if these results had been obtained with a prescription drug Big Pharma would be shouting it from the very rooftops and pressing for it to be added to drinking water like their favorite toxin fluoride. It would be in the nightly news and on the front pages of major newspapers. But it’s just a lowly and unpatentable and unprofitable natural herb that must be discredited at any cost – even if that "cost" is scientific and medical honesty. Even if that "cost" is the quality of life enjoyed by hepatitis C sufferers.

     

    Here is the full text of the abstract – judge for yourself:

    Herbal product use by persons enrolled in the hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial.

    Authors: Seeff LB, Curto TM, Szabo G, Everson GT, Bonkovsky HL, Dienstag JL, Shiffman ML, Lindsay KL, Lok AS, Di Bisceglie AM, Lee WM, Ghany MG; HALT-C Trial Group.

    Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.

    Herbal products, used for centuries in Far Eastern countries, are gaining popularity in western countries. Surveys indicate that persons with chronic hepatitis C (CHC) often use herbals, especially silymarin (milk thistle extract), hoping to improve the modest response to antiviral therapy and reduce side effects. The Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial, involving persons with advanced CHC, nonresponders to prior antiviral therapy but still willing to participate in long-term pegylated interferon treatment, offered the opportunity to examine the use and potential effects of silymarin. Among 1145 study participants, 56% had never taken herbals, 21% admitted past use, and 23% were using them at enrollment. Silymarin constituted 72% of 60 herbals used at enrollment. Among all participants, 67% had never used silymarin, 16% used it in the past, and 17% used it at baseline. Silymarin use varied widely among the 10 participating study centers; men were more frequent users than women, as were non-Hispanic whites than African Americans and Hispanics. Silymarin use correlated strongly with higher education. No beneficial effect of silymarin was found on serum alanine aminotransferase or hepatitis C virus (HCV) RNA levels. Univariate analysis showed significantly fewer liver-related symptoms and better quality-of-life parameters in users than nonusers, but after reanalysis adjusted for covariates of age, race, education, alcohol consumption, exercise, body mass index, and smoking, only fatigue, nausea, liver pain, anorexia, muscle and joint pain, and general health remained significantly better in silymarin users. In conclusion, silymarin users had similar alanine aminotransferase and HCV levels to those of nonusers but fewer symptoms and somewhat better quality-of-life indices. Because its use among these HALT-C participants was self-motivated and uncontrolled, however, only a well-designed prospective study can determine whether silymarin provides benefit to persons with chronic hepatitis C.

    PMID: 18157835 [PubMed – indexed for MEDLINE]

  • Sulfa Vs. Sulfites Vs. Sulfur Allergies – Confusing Terminology

    Sulfa Vs. Sulfites Vs. Sulfur Allergies – Confusing Terminology

    By Dr. Myatt

    Someone wrote and asked me about Alpha-lipoic acid, to wit:

    "I have had a life long allergic reaction to sulpha – it crystallizes in my urine, making urination difficult. I just started taking ALA as an aide for glaucoma. I am 60 yrs. old.

    I understand that ALA is supha based. How should I proceed?

    Thank you,

    Sal"

    Hey Sal, there should be no problem with alpha lipoic acid, and “sulfa” (a drug) does not cause allergic reactions because of the sulfur content. Here’s the scoop.

    Sulfur (chemical symbol: S) is a naturally occurring non-metallic element that comprises 0.25% of the human body. It is the 8th most prevalent element in the body. (A)

    Elements found in the human body at their approximate amounts:

    • Oxygen (65%)
    • Carbon (18%)
    • Hydrogen (10%)
    • Nitrogen (3%)
    • Calcium (1.5%)
    • Phosphorus (1.0%)
    • Potassium (0.35%)
    • Sulfur (0.25%)
    • Sodium (0.15%)
    • Magnesium (0.05%)
    • Copper, Zinc, Selenium, Molybdenum, Fluorine, Chlorine, Iodine, Manganese, Cobalt, Iron (0.70%)
    • Lithium, Strontium, Aluminum, Silicon, Lead, Vanadium, Arsenic, Bromine (trace amounts)

    Sulfur is an essential mineral, meaning that the body MUST have it. Sulfur is found in two amino acids, cysteine and methionine. Methionine is an essential amino acid. (B)

    Sulfur is a component of many proteins, vitamins and hormones. Sulfur-containing compounds in humans include methionine, cysteine, homocysteine, cystathione, S-adenosylmethionine (SAMe), taurine, thiamin, biotin, alpha-lipoic acid (ALA), coenzyme A, glutathione (GSH), chondroitin sulfate, glucosamine sulfate, fibrinogen, heparin, metallothionein, and inorganic sulfate. (C)

    There is no such thing as a sulfur allergy, just as there is no such thing as an allergy to oxygen , carbon or calcium, all of which also occur in the human body in high amounts. Anyone who was truly allergic to sulfur would be dead!

    Sulfate (SO4) is a molecule which contains sulfur and oxygen. It occurs in nature and is found in most natural water including rain water. It is also the form of sulfur most commonly used to fertilize plants. (D) Sulfate may have a laxative effect that can lead to dehydration, especially in infants. Adults become “acclimatized” to high sulfate levels. (E).The current U.S. EPA national Secondary Maximum Contaminant Level for sulfate, is 250 mg/L (U.S. EPA, 1990).

    Sulfite (SO3) is another molecule that contains sulfur. Sulfite is used on foods and some wines as antioxidants, and can cause asthmatic reactions. Sulfites are rare in medications.

    Sulfites are used as preservatives on vegetables, especially vegetables in salad bars. This is probably the most common source of sulfite allergy reactions.

    Sulfa drugs (sulfonamide class of antibiotics), contain sulfur but allergies and other reactions are not from the sulfur per se. Rather, the complex sulfonamine molecule can form proteins that are allergenic in some individuals. The sulfur atom is NOT the allergenic agent and being allergic to sulfa drugs does NOT imply having an allergy to sulfur.

    Sulfa antibiotics include Septra®, Bactrim® and Pediazole®.

    Go ahead, Sal, and take alpha-lipoic acid without concern for your history of sulfa drug allergy. And be sure to look for more in-depth information about proven treatments for glaucoma coming up in the next edition of HealthBeat News.

    In Health,

    Dr. Myatt

    References

    (A): Reference: H. A. Harper, V. W. Rodwell, P. A. Mayes, Review of Physiological Chemistry, 16th ed., Lange Medical Publications, Los Altos, California 1977.

    B.) Reeds PJ. "Dispensable and indispensable amino acids for humans." J. Nutr. 130 (7): 1835S–40S, 2000.

    C.) Parcell Stephen. Sulfur in Human Nutrition

    and Applications in Medicine. Alternative Medicine Review Volume 7, Number 1 2002.

    D.) Sulfate -vs- Elemental Sulfur Part I: There Is A Difference. Educational brochure by Agri-Facts ™

    E.) Wilkes University Center for Environmental Quality,

    Environmental Engineering and Earth Sciences.

    “Sulfates and Hydrogen SulfideThat Rotten Egg / Sulfur Smell

    Sulfate Reducing Bacteria “(SRB).

  • Cancer Research – A Super Fraud?

    Nurse Mark note: We have long warned of the effect that Big Medicine and Big Pharma have on such organizations as those purporting to be seeking a "Cure for Cancer". Indeed, we have gone as far as to say that the "War on Cancer" has been lost. This well-written and well-researched article provides some interesting insight. It is very true that there is nothing so noble that it cannot be perverted for profit by these mighty chemical, pharmaceutical, and medical cartels.

    Cancer Research – A Super Fraud?

    by Robert Ryan, B.Sc.

    "Everyone should know that most cancer research is largely a fraud and that the major cancer research organisations are derelict in their duties to the people who support them." – Linus Pauling PhD (Two-time Nobel Prize winner).

    Have you ever wondered why, despite the billions of dollars spent on cancer research over many decades, and the constant promise of a cure which is forever "just around the corner", cancer continues to increase?

    Cancer Is Increasing

    Once quite rare, cancer is now the second major cause of death in Western countries such as Australia, the U.S.A. and the United Kingdom. In the early 1940s cancer accounted for 12% of Australian deaths. (1) By 1992 this figure had climbed to 25.9% of Australian deaths. (2) The increasing trend of cancer deaths and incidence is typical of most Western nations. It has been said that this increase in cancer is just due to the fact that people now live longer than their ancestors did, and that therefore the increase of cancer is merely due to the fact that more people are living to be older and thereby have a greater chance of contracting cancer. However, this argument is disproved by the fact that cancer is also increasing in younger age groups, as well as by the findings of numerous population studies which have linked various life-style factors of particular cultures to the particular forms of cancer that are predominant there.

    The Orthodox "War on Cancer" Has Failed

    "My overall assessment is that the national cancer programme must be judged a qualified failure" Dr. John Bailer, who spent 20 years on the staff of the U.S. National Cancer Institute and was editor of its journal. (3) Dr. Bailer also says: "The five year survival statistics of the American Cancer Society are very misleading. They now count things that are not cancer, and, because we are able to diagnose at an earlier stage of the disease, patients falsely appear to live longer. Our whole cancer research in the past 20 years has been a total failure. More people over 30 are dying from cancer than ever before . . . More women with mild or benign diseases are being included in statistics and reported as being ‘cured’. When government officials point to survival figures and say they are winning the war against cancer they are using those survival rates improperly."

    A 1986 report in the New England Journal of Medicine assessed progress against cancer in the United States during the years 1950 to 1982. Despite progress against some rare forms of cancer, which account for 1 to 2 per cent of total deaths caused by the disease, the report found that the overall death rate had increased substantially since 1950: "The main conclusion we draw is that some 35 years of intense effort focussed largely on improving treatment must be judged a qualified failure." The report further concluded that ". . . we are losing the war against cancer" and argued for a shift in emphasis towards prevention if there is to be substantial progress. (4)

    Most Cancer IS Preventable

    According to the International Agency for Research in Cancer "…80-90 per cent of human cancer is determined environmentally and thus theoretically avoidable." (5) Environmental causes of cancer include lifestyle factors such as smoking, a diet high in animal products and low in fresh fruit & vegetables, excessive exposure to sunlight, food additives, alcohol, workplace hazards, pollution, electromagnetic radiation, and even certain pharmaceutical drugs and medical procedures. But unfortunately, as expressed by medical historian Hans Ruesch, "Despite the general recognition that 85 per cent of all cancers is caused by environmental influences, less than 10 per cent of the (U.S.) National Cancer Institute budget is given to environmental causes. And despite the recognition that the majority of environmental causes are linked to nutrition, less than 1 per cent of the National Cancer Institute budget is devoted to nutrition studies. And even that small amount had to be forced on the Institute by a special amendment of the National Cancer Act in 1974." (6)

    Prevention – Not Profitable to Industry

    According to Dr. Robert Sharpe, " . . . in our culture treating disease is enormously profitable, preventing it is not. In 1985 the U.S., Western Europe and Japanese market in cancer therapies was estimated at over 3.2 billion pounds with the ‘market’ showing a steady annual rise of 10 per cent over the past five years. Preventing the disease benefits no one except the patient. Just as the drug industry thrives on the ‘pill for every ill’ mentality, so many of the leading medical charities are financially sustained by the dream of a miracle cure, just around the corner." (7)

    Desired: A State of No Cure?

    In fact, some analysts consider that the cancer industry is sustained by a policy of deliberately facing in the wrong direction. For instance, in the late 1970s, after studying the policies, activities, and assets of the major U.S. cancer institutions, the investigative reporters Robert Houston and Gary Null concluded that these institutions had become self-perpetuating organisations whose survival depended on the state of no cure. They wrote, "a solution to cancer would mean the termination of research programs, the obsolescence of skills, the end of dreams of personal glory, triumph over cancer would dry up contributions to self-perpetuating charities and cut off funding from Congress, it would mortally threaten the present clinical establishments by rendering obsolete the expensive surgical, radiological and chemotherapeutic treatments in which so much money, training and equipment is invested. Such fear, however unconscious, may result in resistance and hostility to alternative approaches in proportion as they are therapeutically promising. The new therapy must be disbelieved, denied, discouraged and disallowed at all costs, regardless of actual testing results, and preferably without any testing at all. As we shall see, this pattern has in actuality occurred repeatedly, and almost consistently." (8) Indeed, many people around the world consider that they have been cured by therapies which were ‘blacklisted’ by the major cancer organisations.

    Does this mean that ALL of the people who work in the cancer research industry are consciously part of a conspiracy to hold back a cure for cancer? Author G.Edward Griffin explains ". . . let’s face it, these people die from cancer like everybody else. . . [I]t’s obvious that these people are not consciously holding back a control for cancer. It does mean, however, that the [pharmaceutical-chemical] cartel’s medical monopoly has created a climate of bias in our educational system, in which scientific truth often is sacrificed to vested interests . . . [I]f the money is coming from drug companies, or indirectly from drug companies, the impetus is in the direction of drug research. That doesn’t mean somebody blew the whistle and said "hey, don’t research nutrition!" It just means that nobody is financing nutrition research. So it is a bias where scientific truth often is obscured by vested interest." (9) This point is similarly expressed by Dr. Sydney Singer: "Researchers are like prostitutes. They work for grant money. If there is no money for the projects they are personally interested in, they go where there is money. Their incomes come directly from their grants, not from the universities. And they want to please the granting source to get more grants in the future. Their careers depend on it." (10)

    Money Spent on Fraudulent Research?

    A large portion of money donated to cancer research by the public is spent on animal research which has, since its inception, been widely condemned as a waste of time and resources. For instance, consider the 1981 Congressional Testimony by Dr. Irwin Bross, former director of the Sloan-Kettering, the largest cancer research institute in the world, and then Director of Biostatistics at Roswell Park Memorial Institute for Cancer Research, Bufallo, NY: "The uselessness of most of the animal model studies is less well known. For example, the discovery of chemotherapeutic agents for the treatment of human cancer is widely-heralded as a triumph due to use of animal model systems. However, here again, these exaggerated claims are coming from or are endorsed by the same people who get the federal dollars for animal research. There is little, if any, factual evidence that would support these claims. Indeed, while conflicting animal results have often delayed and hampered advances in the war on cancer, they have never produced a single substantial advance either in the prevention or treatment of human cancer. For instance, practically all of the chemotherapeutic agents which are of value in the treatment of human cancer were found in a clinical context rather than in animal studies." (11)

    In fact, many substances which cause cancer in humans are marketed as "safe" on the basis of animal tests. As expressed by Dr. Werner Hartinger of Germany, in regard to cancer-causing products of the pharmaceutical-petro-chemical industry, "Their constant consumption is legalised on the basis of misleading animal experiments . . . which seduce the consumer into a false sense of security." (12)

    Imagine What Could Be Achieved

    The next time you are asked to donate to a cancer organisation, bear in mind that your money will be used to sustain an industry which has been deemed by many eminent scientists as a qualified failure and by others, as a complete fraud. If you would like to make a difference, inform these organisations that you won’t donate to them until they change their approach to one which is focussed on prevention and study of the human condition. We have the power to change things by making their present approach unprofitable. It is only through our charitable donations and taxes that these institutions survive on their present unproductive path.

    Return to the Top


    Copyright 1997 by the Campaign Against Fraudulent Medical Research, www.pnc.com.au/~cafmr

    This article may be copied or distributed, provided the copyright and disclaimer messages are clearly attached.

    Disclaimer: This article is presented for educational purposes only and is not intended as a substitute for professional or medical advice. CAFMR disclaims all liability to any person arising directly or indirectly from the use of the information provided.


    References:
    1. d’Espaignet, E.T. et al., Trends in Australian Mortality 1921-1988, Australian Government Publishing Service (AGPS), Canberra, 1991, p. 33
    2. Australian Bureau of Statistics, Causes of Death, Australia 1992, ABS, Canberra, 1993, p.1
    3. Dr. Bailer, speaking at the Annual Meeting of the American Association for the Advancement of Science in May 1985, as quoted in Bette Overall, Animal Research Takes Lives – Humans and Animals BOTH Suffer, NZAVS, 1993, p.132
    4. Robert Sharpe, The Cruel Deception, Thorsons Publishing Group, Wellingborough, U.K. 1988, p.47
    5. Robert Sharpe, op. cit. 1988, p.47
    6. Hans Ruesch, Naked Empress – the Great Medical Fraud, CIVIS, Massagno/Lugano, Switzerland, 1992, p.77
    7. Robert Sharpe, op. cit. 1988, p.65
    8. as quoted in Hans Ruesch, op.cit. 1992, p.65-66
    9. Edward Griffin, The Politics of Cancer, (audio cassette) American Media, 1975 available from CAFMR $14.
    10. Sydney Singer, Medical Demystification (M.D.) Report, Vol.1 No.1 p.5., Medical Demystification Crusade, 1992, CA, U.S.A.
    11. Irwin Bross, as quoted in Robert Sharpe, op.cit., 1988 p.179
    12. Dr. Werner Hartinger, in a speech given at the 2nd International Scientific Congress of the Doctors in Britain Against Animal Experiments (D.B.A.E.), London, 24 Sept. 1992.
  • I Feel A cold Coming On – Better Get An Antibiotic!

    By Nurse Mark

    There is no doubt or question that one of the medical miracles of the 20th century is the antibiotic – for antibiotics have truly saved lives in the face of overwhelming infections.

    Unfortunately, antibiotics are their own worst enemy too – for they are easily overused and inappropriately used, and that use diminishes their power and value as a life-saving drug. Part of the problem is human nature: we tend to take our health for granted when we feel well, and when we are ill and feeling miserable it is easy to believe that ours is the most severe of infections, requiring the most powerful of drugs – surely mother nature can be no match for this illness!

    (more…)

  • Pregnancy Risks With Flax?

    By Nurse Mark

    There is no natural substance so good that it cannot be overdone!

    And there is no substance, natural or otherwise that cannot have an alarming article written about it based on someone’s reading of a tangentially related research study!

    We get letters… frequently they are from folks who have seen some alarming little tidbit in some article or other and they are now suddenly worried – understandably so, since they are taking the substance that is in question in the cautionary article.

    Here is the note we received:

    Hi there,  My daughter just sent me the link below to an article about flax seed.  I am curious as to your thoughts on what this writer expresses.  Birgitta

    http://www.thenourishinggourmet.com/2009/03/flax-seed-and-oil-phytoestrogens-phytic-acid-and-pregnancy-risks.html

    something to keep in mind, especially with the oil. I’m still going to make the bread and eat it, but I don’t think the
    amount of ground flax in there is high enough to make me nervous.

    And here is Dr. Myatt’s reply:

    Hi Birgitta:

    We’ve talked about flax and phytoestrogens before, but here’s the short course.

    LOTS of foods have mild estrogenic properties, most of which are protective against stronger estrogens in the environment. And lots of foods have some anti-nutrients. Soy is one of the worst.

    At recommended doses these are really "non issues."

    Also, there are a long list of things not to do when pregnant; pregnancy is an entire different metabolic circumstance than non-pregnant. Heck, in natural medicine we often use a tablespoon or two of castor oil to stimulate contractions, but yes, any oils might start labor.

    All in all, there’s nothing new in this article and nothing that contradicts the way in which I advise people to use flax.

    In Health,
    Dr. Myatt

    Like Dr. Myatt, I reviewed the article – a nice article, but one that looks to be written by a layperson. This person has read a single study from Canada (not a country that is especially friendly toward natural solutions over pharmacology) which offers a rather alarming headline – as seen here:

    Pregnant women consuming flaxseed oil have high risk of premature birth

    Université de Montréal study looks at the dangers of some natural products

    A study has found that the risks of a premature birth quadruple if flaxseed oil is consumed in the last two trimesters of pregnancy. The research was conducted by Professor Anick Bérard of the Université de Montréal’s Faculty of Pharmacy and the Sainte-Justine Hospital Research Center and Master’s student Krystel Moussally.

    In Canada, 50 percent of pregnant women take prescription medication. Yet many of them prefer to use natural health products during the pregnancy. "We believe these products to be safe because they are natural. But in reality, they are chemical products and we don’t know many of the risks and benefits of these products contrarily to medication," says Bérard.

    Bérard and Moussally set out to conduct one of the largest studies ever undertaken on by analyzing data from 3354 Quebec women. The first part of the research established that close to 10 percent of women between 1998 and 2003 used natural health products during their pregnancy. Before and after pregnancy they were respectively 15 and 14 percent to use these products. The increase means that about a third of women consuming natural health products stopped during the pregnancy.

    The most consumed natural health products by pregnant women are chamomile (19 percent), green tea (17 percent), peppered mint (12 percent), and flaxseed oil (12 percent). Bérard and Moussally correlated these products to premature births and only one product had a very strong correlation: flaxseed oil.

    "In the general population, the average rate of premature births is 2 to 3 percent. But for women consuming flaxseed oil in their last two trimesters that number jumps up to 12 percent," says Bérard. "It’s an enormous risk."

    The correlation existed only with flaxseed oil, yet women consuming the actual seed were unaffected. Even if more studies must be undertaken to verify these results, Bérard recommends caution when it comes to consuming flaxseed oil.

    If we read this article carefully we see that the researcher (who is not a doctor but rather a "professor") looks to have a bit of a bias against natural products to begin with. We then see that amounts of flax oil consumed by the subjects of this study are not given and that the risks are increased for those taking this unknown amount during the last few weeks of pregnancy. Finally, there is the somewhat grudging admission that this effect was seen in women consuming this unknown amount of flax oil – and not those using flax seed.

    So, I am left to wonder if this effect is the same effect that might be seen with the consumption of any amount of any oil during the late stages of pregnancy. As Dr. Myatt mentioned in her note to Birgitta a couple of tablespoons of castor oil is a time-honored natural way of stimulating the contractions of labor – and  a dose of oil taken too early could possibly stimulate the premature labor of the researchers headline…

    The bottom line?

    There are two: All things in moderation. And, pregnancy changes the rules – proceed with caution and with the assistance of a good holistic / naturopathic physician to ensure a happy and healthy outcome for all!