Thursday, June 13, 2024

Breast Cancer Incidence on Long Island: Environmental Impact

 A report by: Dr. Noelle Cutter (Molloy University) and Ben Honigsfeld

Breast cancer is a current health concern, affecting millions of women globally.  In 2023, it was the leading cause of death due to cancer in the United States (ref). While genetic factors and lifestyle choices play significant roles in its development, emerging evidence suggests that environmental exposures also contribute to breast cancer incidence rates. Long Island, New York, has garnered attention due to its elevated breast cancer rates compared to national averages, prompting investigations into the potential environmental factors driving this phenomenon. 

Whether environmental contaminants increase breast cancer risk among women on Long Island, NY, is unknown. In the early 1990s, breast cancer advocates petitioned the United States Congress to investigate the high rates of breast cancer on Long Island in the state of New York (1992-1996 117.8 per 100,000 in Nassau County, 113.6 in Suffolk county vs national average (NYS Cancer Registry, 2023). The resulting law led to the Long Island Breast Cancer Study Project (LIBCSP)--more than ten collaborative research projects designed to study the possible causes of this increased incidence of cancer. This project reported that there was no evidence that environmental exposures were responsible (ref, LIBCSP). However, the rate of BC on Long Island remains high compared to other regions in the United States (2016-2020 Nassau 145.9 and Suffolk 139.9) (NYS Cancer Registry, 2023). and has led to speculation that environmental risk factors remain an important cause of breast cancer. 

ENDOCRINE-DISRUPTING CHEMICALS (EDCS):
Endocrine-disrupting chemicals (EDCs) are natural or human-made chemicals that may mimic, block, or interfere with the body’s hormones, which are part of the endocrine system. These chemicals are associated with a wide array of health issues, including cancers (Safe, 2000). Endocrine disruptors are found in many everyday products, including some cosmetics, food and beverage packaging, toys, carpet, and pesticides. Some chemicals that act as flame retardants may also be endocrine disruptors. Long Island’s environment is full of potential sources of EDCs, which have been linked to an increase in breast cancer development. 

A study by Soto et al. (2015) highlighted the presence of EDCs such as bisphenol A (BPA) and phthalates in everyday consumer products, including plastics and personal care items. These chemicals can interfere with hormonal signaling pathways, such as the estrogen, androgen, and growth factor signaling pathways. EDCs such as BPA, phthalates, and certain pesticides can mimic estrogen's action by binding to estrogen receptors (ERs) and activating estrogen-responsive genes and turning on downstream transcription factors which are involved in pathways associated with many cancers, including breast cancer. The Androgen Signaling Pathway can also be impacted by EPCs.  Androgens, such as testosterone, play crucial roles in the development and maintenance of male reproductive tissues and secondary sexual characteristics. EDCs can disrupt androgen signaling by interfering with androgen receptor (AR) activation or inhibiting androgen synthesis. This disruption can impact reproductive health, development, and hormone-sensitive tissues in both males and females (Akdag et al., 2016). 

Additionally, the Growth Hormone/Insulin-like Growth Factor (GH/IGF) Signaling Pathways are critical regulators of growth, development, and metabolism. EDCs like polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) can interfere with GH/IGF signaling pathways, affecting cellular proliferation, differentiation, and apoptosis. Disruption of these pathways by EDCs may contribute to altered growth patterns and increased susceptibility to cancer and potentially increasing breast cancer risk. Moreover, Long Island's proximity to industrial sites and agricultural areas raises concerns about exposure to these environmental EDCs with studies suggesting a possible association between pesticide exposure and breast cancer incidence (Engel et al., 2017). Contact with these chemicals may occur through air, diet, skin, and water.


AIR & WATER POLLUTION:
Long Island's densely populated urban areas are susceptible to high levels of air pollution, including particulate matter and volatile organic compounds (VOCs), which have been implicated in breast cancer development (Hystad et al., 2013). Additionally, concerns have been raised about groundwater contamination from industrial activities and pesticide runoff from agricultural lands. A case control study investigating pesticide use on Long Island identified that women using higher amounts of pesticide in and around their homes had a greater than 30% increase in risk of developing breast cancer. In addition, use of most individual and combined lawn and garden pesticides examined by the study identified a consistent elevation in breast cancer risk (Teitelbaum et al., 2007). 

However, the lack of dose-response relationship and conflict of the LIBCSP study results indicates the need for additional research. In addition to pesticides, a major source of contamination is due to the Navy-Grumman groundwater plume. Beginning operation in the 1930s, the 600 acre Northrop Grumman-Bethpage Facility and Naval Weapons Industrial Reserve plant site was utilized for military industry and research until 1996 (DOJ, 2022). During this time, Northrop Grumman’s activities lead to the contamination of the soil and groundwater with volatile organic compounds, polychlorinated biphenyls, metals, and many others (NYSDOH, 2022). These contaminants were first detected in the 1970s, allowing for decades of unopposed groundwater, soil and air contamination. 

Furthermore, the New York Department of Health estimates that groundwater contamination reaches up to 750 feet deep, and stretches over 3800 acres (NYSDOH, 2022). This dumping took place on land now surrounded by residential neighborhoods, thus posing a major hazard to the community. As of March 2024, buried contaminants are still being discovered, with additional potential sources still expected to be present (DEC, 2024). 

There was also detection of similar contaminants at the Naval Weapons Industrial Reserve Plant in Calverton in eastern Long Island, which resulted in closure of all wells on the contaminated property in 2012 (NYSDOH, 2022). Amongst the contaminants identified as part of the Northrop-Grumman plume, concerns have been raised regarding 1,4 dioxane in particular, a solvent stabilizer rated by the EPA as a likely human carcinogen. In an evaluation of 4,400 water sources across the country, the EPA identified Long Island as having among the highest levels of 1,4 dioxane (EPA, 2021). In response, the Yale Superfund Research Center has initiated a series of 4 projects to measure the exposure to 1,4 dioxane and connection to adverse biological effects (Kim & Fortner, N.D.). 

In addition to spillage from Northrop-Grumman, the Hooker Chemical & Plastics Corp./Ruco Polymer Corp plant formerly located in Hicksville was discovered to have contaminated the groundwater with vinyl chloride, trichloroethylene, barium, cadmium, organic acids, and other compounds due to dumping practices. These activities were discovered in 1984 after several decades of operation, and groundwater cleanup is still underway (EPA, N.D.). Unfortunately, It is clear that Long Island has suffered decades of hazardous waste exposure through soil, water, and air. 

A study by Gammon et al. (2002) found an association between residential proximity to hazardous waste sites and increased breast cancer risk among Long Island women, highlighting the potential role of environmental pollutants in driving breast cancer incidence rates. Besides cancer, environmental pollution has also been linked to increased rates of cardiovascular, reproductive, neurological, gastrointestinal, respiratory, and developmental disorders among other complications (Shetty et al. 2023).

RADIATION EXPOSURE:
Long Island's history of nuclear facilities and radioactive waste sites raises concerns about radiation exposure and its impact on breast cancer risk. Namely, the Shoreham Nuclear Power Plant, decommissioned in 1994 before becoming fully operational due to public safety concerns. During the breakdown process, 5 million pounds of radioactive waste via 353 truckloads, as well as water barges to remove 560 irradiated fuel assemblies was required (NYT, 1994). In Upton, Suffolk County, Brookhaven National Laboratory experienced a tritium leak in 1998, leading to tritium in the groundwater above the state and federal drinking levels (Brookhaven Bulletin, 1998). This culminated in a shutdown of the High Flux Beam Reactor (ANS, 2022). The extent and harm of the leak remains a point of controversy, and has been designated as a superfund site by the EPA and is under periodic 5-year review (EPA, 2024). 

Irradiated surfaces were treated and the area remains at normal background levels according to state officials . While medical imaging and radiation therapy contribute to some extent, historical exposure to ionizing radiation from nuclear facilities may have long-term health consequences. A study by Boice et al. (2012) suggested an increased risk of breast cancer among individuals exposed to low-dose ionizing radiation, emphasizing the importance of monitoring and mitigating radiation hazards in the environment. The effects of ionizing radiation on the destabilization of DNA have been well documented, with research particularly emphasizing double strand breakage, and generation of reactive oxygen and nitrogen species (Helm & Rudel, 2020). 

(Click image for full view)

Furthermore, ionizing radiation has been found to cause epigenetic alterations, including alterations in DNA methylation and histone acetylation (Pogribny, 2019). with regards to breast cancer specifically, no association was found with high levels of UV radiation and overall breast cancer incidence (Gregoire et al., 2022) However, ionizing radiation has been demonstrated to increase the incidence of breast cancer in women in a dose-dependent manner, especially when the exposure occurs at a young age (Helm & Rudel, 2020).

Addressing the environmental impact on breast cancer incidence requires a collaborative effort involving community engagement, advocacy, and policy interventions. Clearly, more research is needed to ascertain the environmental impact on the increased incidence of breast cancer on Long Island.  By leveraging scientific research, community engagement, and policy advocacy, Long Island can work towards reducing breast cancer incidence rates and improving the overall health and well-being of its residents. 

References: https://prevention101.org/refs_6-13-2024-N.Cutter.html


CONTRIBUTORS

DR. NOELLE CUTTER is a professor of biology, ironman finisher, and advocate for dense breast screening.  United with an expanding research team dedicated to collecting data on women with dense breasts and screening options for these patients, her initiative aims to investigate and gather conclusive information about dense breasts in specific groups- including age, body mass index, and amount of physical activity and the underlying diagnostics of breast cancer tumors. This research program is under a partnership with Molloy College and Dr. Robert Bard, expert diagnostic cancer imaging specialist in NYC and other colleagues from the NY Cancer Resource Alliance. 

BENJAMIN HONIGSFELD began his interest in cancer research as part of the Advanced Science Research program in high school. Since then, Benjamin has contributed to research and publications regarding ovarian cancer, medulloblastoma, and brownfield site remediation, earning awards at LISEF, and MACUB. Benjamin is currently a third year medical student at Ben-Gurion University of the Negev and co-president of the internal medicine interest group.





ALSO SEE:

CHANGES IN BREAST CANCER CARE IN NEW YORK DURING THE COVID-19 PANDEMIC   By:  Alexandra Fiederlein | Cheyenne Rosado | Noelle Cutter

Breast cancer is the second most common malignancy among women in the United States. As such, the COVID-19 pandemic has caused medical facilities to change their methods of operation since March of 2020, including changes in diagnosis and treatment plans. New York (NY) has an unusually high incidence of breast cancer. This study analyzed the effects of the COVID-19 pandemic on breast cancer care (BCC) in NY. Women in NY that were diagnosed with or in remission for breast cancer were asked to take an online, anonymous survey regarding their BCC experience. For patients in treatment, 26% of women wished they had greater emotional support or had a family member included in their appointments. 39% of women do not feel they are receiving as good of care as before, while 31% feel they are receiving the same level of care. Additionally, 41% of women feel they received the same level of care over telemedicine. 

Our data show a negative correlation between the quality of care received during the pandemic and the wish for more emotional support and inclusion of supportive members in the care process (nonsignificant). There was less of a negative correlation between the quality of telemedicine care received during the pandemic and the wish for more emotional support and inclusion of supportive members in the care process (nonsignificant). This indicates that most women lacking emotional support reported worse BCC experiences, and telemedicine use was not as troublesome to patients as the lack of emotional support. Most women in treatment and in remission reported negative feelings like fear when asked about their BCC experiences. Our data show the importance of emotional support for breast cancer patients and those in remission during the COVID-19 pandemic. Our work could also provide clinicians with the knowledge necessary on how breast cancer care should be handled in an evolving pandemic such as COVID-19.

 

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Wednesday, February 14, 2024

The REAL Cause and Effect of ENVIRONMENTAL TOXINS

 Source: ECOSMART NEWS  Vol 2-2024

 By: Dr. Roberta Kline / Women’s Health Digest – Editor

The role of environmental toxins in a wide variety of health issues is a huge public health crisis that is not receiving the attention it needs. While it is well known that making healthy diet and lifestyle choices can significantly improve health outcomes, this is only one part of the equation. Putting the burden of responsibility solely on the individual is no longer effective when their greater environment is full of toxic threats they cannot see or control. 










HOW BIG IS THE PROBLEM REALLY?

The reality is that we are exposed to numerous toxins over the course of our lives – starting even before birth. Over the last 50 years, more than 87,000 chemicals have been approved for commercial use. Yet only about 1% (about 1,000 chemicals) have been actually evaluated for health risk. Half of those have been found to have some risk of causing cancer by the WHO: 120 as known carcinogens, 81 as probably carcinogens, and 299 as possible carcinogens. [1] 

Here in the U.S. we have lagged behind. To date, the EPA has only banned 9 chemicals, and the National Toxicology Program has identified 27 chemical substances as carcinogens. [2] Clearly, there is much more work to do.

Neither of these addresses the increasing burden of a newer class of chemicals called endocrine disruptors. Classic carcinogens cause cancer through cell damage and mutations. Endocrine disruptors operate differently, mimicking hormones and causing subtle but significant alterations in our biological communication system. [1] Often there is synergy between the effects of these different types of chemicals, making it difficult to show direct cause-and-effect for health risks. 

A recent update by the EPA revealed that less than half of the 87,000 identified chemicals are currently in commercial use). [3] That may sound promising, but it is estimated that many more chemicals are present in our everyday environment, including pharmaceuticals and byproducts of degradation. On top of this, most monitoring protocols only report on a small number of these. Thus, while it is impossible to state the exact burden of toxins accurately, it is clear that this is a significant problem.

A COMPLEX INTERACTION
Not everyone who is exposed to environmental chemicals will develop disease or cancer. The outcome for each individual is the result of a complex interplay of their genetic predispositions, epigenetics, and environmental exposures over their lifetime. We all have biological processes to clear many different chemical substances from our bodies. How well these systems function can be affected by many factors, including genetics and epigenetics, along with a person’s health and nutrition status, exposure level, and even stress. The more suboptimal these are, the higher a person’s risk for consequences to their health from environmental toxins.

By looking at larger trends, it is possible to get different perspectives on how these risks manifest. The role of Social Determinants of Health (SDoH) is the focus of many health initiatives, including the CDC’s Healthy People 2030. People who are of lower economic status are exposed to more toxic environments, often accompanied by fewer resources to offset them. [4]

Image source: Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved 2.8.2024 from https://health.gov/healthypeople/objectives-and-data/social-determinants-health


The role of these factors included in SDoH cannot be underestimated. In fact, research has shown them to be significant independent risk factors for many health issues. One of the most shocking insights is that a person’s zip code can reveal more than their genetics. [5] A large part of this is the disparity in exposure to environmental toxins, access to healthy food, health care services, and life stressors.


BEYOND LOCAL
Environmental pollution is not just a local issue. Once chemicals enter the local environment, they are difficult to contain, so they often pollute multiple aspects of the environment – often as far away as other continents or even deep in atmospheric space. 

One of the most obvious sources comes from our insatiable appetite for more goods, and the manufacturing plants that make them continue to dump chemicals into the surrounding air, soil, and water. Consumer products themselves contain a variety of chemicals. Computers, smartphones, and other communication devices are central to our everyday lives, and yet processes from extracting raw materials to manufacturing leave their toxic footprint. Plastics are omnipresent, and their outsized role in the long-term environmental dangers is becoming quite clear. Our need for transportation, utilities to heat, cool, and light our homes and offices, and even our medications, medical supplies, and treatments all contribute. Current large-scale agricultural and food distribution practices play a role as well. 

Clearly, many of the products created make our lives better. But how we think about them - and the actual cost of producing them - has to change.


NATURAL DISASTERS INCREASINGLY PLAY A ROLE

It’s not just these obvious sources that are contaminating our environment. Natural disasters produce their own share of toxins, directly and indirectly. Toxins that normally aren’t released into the environment directly can pose new threats when natural disasters overwhelm current measures. For example, today’s fires release toxins as materials burn, whether these materials are those found in nature or those that are manufactured. Floods cause sewage and industrial or agricultural waste to enter  waterways and groundwater systems. As these natural disasters these become increasingly more frequent and more devastating, we’ll need new ways of addressing their impact.

Image source: G. Muir, D. C., Getzinger, G. J., McBride, M., & Ferguson, P. L. (2023). How Many Chemicals in Commerce Have Been Analyzed in Environmental Media? A 50 Year Bibliometric Analysis. Environmental Science & Technology, 57(25), 9119-9129. https://doi.org/10.1021/acs.est.2c09353


INVISIBLE ENEMY
A stealthy adversary, environmental toxins are often invisible, and the diseases they cause are not often immediate. Rather, they often alter a person’s biology so that illness develops over time. This makes it difficult to connect with the abstract concept of their risk. Additionally, many toxins individually may not have such potent effects, but collectively the risk is magnified. Thus, the risk from our exposure to multiple toxins over many years can be much greater than the risk of a single or short-term exposure to a single toxin. 

The current level of scientific and clinical knowledge is more than enough to demonstrate the ongoing risks to health and the role of a wide array of environmental toxins in devastating diseases, including cancer. We have been contaminating our food, water, and air for centuries. But with a sharp increase in new chemicals being developed over the past 30 years, it is now accelerating at a breakneck pace. 

It is impossible to rid our world of every environmental toxin, and inconceivable that we could ever go back to a world where no chemicals will be utilized to create the goods and services we need. So the way forward is to reimagine the future to alter how we support modern lifestyle needs in a way that also supports a healthy environment for all.



CHANGE REQUIRES FUNDAMENTAL SHIFT
Change is possible, but it is not easy nor is it fast. Just look at the slow progress since the passage of the Toxic Substances Control Act (TSCA) in 1976. With all existing chemicals being deemed “safe for use” and grandfathered in, it was only designed for evaluating new chemicals. And yet, only about 20% of new chemicals were reviewed, with the remaining 80% allowed to go to market without any oversight. 

It was only in 2016 that this legislation was updated in an effort to address these shortcomings. The EPA has since completed its initial evaluation of all chemicals in its database, finding that only about half of the 87,000 listed chemicals were still in commercial use. But safety data is still unknown for most of these, and the next task is to start addressing this large void. [6] 

Altering course demands a shift in societal values that will support critical evaluation of current practices, and the will to enact significant modifications in public and private policies operating under an old paradigm. Many may need to be completely overhauled at a high short-term monetary cost. But this short-term cost will be more than offset by long-term savings in environmental toxin-related health services and the cost of premature loss of health and life. 

Creating this paradigm shift will require extensive education and advocacy to communicate the existing research and knowledge about risks and potential solutions and put them into action. We must also prioritize ongoing research and development to address this crisis with practical solutions on both a local and global scale. 


REFERENCES

1) Cohen, L., & Jefferies, A. (2019). Environmental exposures and cancer: Using the precautionary principle. Ecancermedicalscience, 13. https://doi.org/10.3332/ecancer.2019.ed91 

2) https://www.cancer.gov/about-cancer/causes-prevention/risk/substances

3) https://www.epa.gov/newsreleases/epa-releases-first-major-update-chemicals-list-40-years

4) https://health.gov/healthypeople/priority-areas/social-determinants-health

5) Graham GN. Why Your ZIP Code Matters More Than Your Genetic Code: Promoting Healthy Outcomes from Mother to Child. Breastfeed Med. 2016 Oct;11:396-7. doi: 10.1089/bfm.2016.0113. Epub 2016 Aug 11. PMID: 27513279

6) https://www.epa.gov/reviewing-new-chemicals-under-toxic-substances-control-act-tsca/statistics-new-chemicals-review


AUTHOR:

DR. ROBERTA KLINE is a life-long advocate for women's health.  She is a board-certified ObGyn physician and an Integrative Personalized Medicine & Functional Genomics specialist. She is a recognized published author and educator whose mission is to change how we approach health by combining cutting-edge science with heart-centered care. In 2023, she was recognized by the AngioFoundation for her educational achievements and her contribution to the development of the national Earlier Detection initiative, the Coalition of Cancer Resources and the establishment of the Women’s Health Collaborative (a global alliance of women's health advocates). Today, Dr. Kline continues to forge new partnerships in support of underdiagnosed and underserved women with her educational programs for medical conferences such as the Endometriosis Foundation of America.


WEBSITES:

www.WomensHealthDigest.org

www.Pevention101.org

www.RobertaKlineMD.com

www.AngioFoundation.org

This feature article is originally published in EcoSmart News 




LONG ISLAND CANCER- THEN AND NOW by: Robert L. Bard, MD

Since the early 1940’s, Long Island became riddled with countless cases of toxic waste and hazardous dump sites contaminating groundwater and wells with volatile organic chemicals and carcinogens.  Much of this was known as the Bethpage Plume thanks in part to the Grumman manufacturing plant, Naval Weapons Industrial Reserve plant and Hooker Chemical/Ruco Polymer site.  Record levels of radioactive materials such as chromium and radium continue to plague its drinking water today despite decades of cleanup efforts and water treatment plant upgrades.  Scientists have speculated a direct connection between Long Island’s reportedly high rate of breast cancer (alongside other cancers) over the national average and this cancer plume.

In 1985, a major study of Long Island patients in the NY State Journal of Medicine showed over 90% of the suspect calcifications that showed up in mammograms were proven benign after surgical biopsy, resulting in unnecessary treatments that nowadays are avoidable.  Unfortunately, the increase in inflammation in the breast which was causing the calcification was what instigated the greater risk of developing actual breast cancer. The current 2018 American College of Radiology statistics state that women with dense breasts are 500% more likely to develop benign, or malignant tumors than women without dense or lumpy breasts.

To address this overdiagnosis, they started using the MRI to detect breast cancer in the 1990’s- but this too showed inconsistent levels of inaccurate readings as far as things that looked suspicious and looked like breast cancer- similar to Dr. Leis’ negative mammogram readings.   By the advancement of the new 3D ultrasound systems, we were able to find and discern a true cancer from a cyst, or one of these benign post-inflammatory reactions mimicking a cancer on the MRI and the mammogram.

Some women (with diabetes as one example) tend to have inflammation that forms lumpy areas in the breast which causes scarring - scarring that can give a false reading and actually feels like a breast cancer.  Scenarios like these tend to trick the less experienced diagnostician or older technologies into false reports.   Since the introduction of the Doppler blood flow technology, we are able to see the entire cancer vessels and actually gives you a road map to the tumor. The 3D technology allows you to look at the map and measure how many cancer vessels there are. In patients who are taking non-traditional treatment or on immune or chemotherapies, you can see if the number of cancerous vessels are larger, which means the treatment is failing. Or, if it goes from five blood vessels down to one tumor vessel- an indication that the treatment is working.

WHY GO DOPPLER?
There are other ways of looking at blood flow in tumors. CAT scans and CT radiation imaging was spectacular at finding breast cancer except the radiation dose was so high that patients were developing lung cancer from it. Also, claustrophobic people couldn't fit into the CT or the MRI tube. MRI also uses the blood flow technology but some people are allergic to the contrast from the CT or the MRI. We also learned that the MRI contrast is depositing now in the brain, causing other problems that we're just being aware of. 

The Doppler Sonogram is technically instantaneous. You put the probe on the breast, find the area, pinpoint it, press a button and seconds later you have the map showing the types of vessels, the location of the  vessels. You have a program on the computer to give you a vessel density measurement which shows how aggressive this is. Instead of the genetic markers, which are very popular, showing how aggressive a tumor will be, this is a visual way in seconds that's being used worldwide to show cancer vessel aggression. Tumor aggression by blood flow evaluation is used worldwide in nuclear medicine, CT  scans and MRI technology, however, the simplest way is the non invasive 3D Doppler breast procedure.


Additional References:
1) Local clustering in breast, lung and colorectal cancer in Long Island, New York

2) Breast Cancer Incidence- Nassau County, 2005-2009

3) 3-D Doppler Ultrasound Helps Identify Breast Cancer

4) Doppler ultrasound scoring to predict chemotherapeutic response in advanced breast cancer


 



Tuesday, December 12, 2023

GILDA'S CLUB WESTCHESTER BRAND UPGRADE


12/7/2023- After more than twenty-two years of dedicated service to the Westchester, NY area, Gilda’s Club Westchester will now reach more individuals and families impacted by cancer under the new name, Cancer Support Community Greater NY & CT at Gilda’s Club.  The mission and essential work of the organization is not changing; in fact, as the new name suggests, providing cancer support to the community is at the core of CSCNYCT’s mission. CSCNYCT‘s scope has expanded beyond Westchester and Rockland Counties in NY and Fairfield County in Connecticut to include the five boroughs of NYC, Long Island, Orange, Putnam, Dutchess, Ulster, and Sullivan Counties in New York and Fairfield, New Haven, and Litchfield Counties in Connecticut.

According to Sarah Sedo, Executive Director of CSCNYCT,  “CSCNYCT is committed to providing FREE cancer support services to more individuals than ever before. Our programs are available in English and Spanish, in-person and virtually. We understand the impact that a cancer diagnosis has on someone and when you join our community, we hope you feel the sense that you are not alone in your journey - there are others who can relate and through that shared experience, the stress, anxiety, and negativity associated with cancer can be lessened.”

Named for comedienne Gilda Radner, an iconic member of the first cast of Saturday Night Live who died of ovarian cancer, the first Gilda’s Club opened in NYC in 1995 with the goal of providing free cancer support services to anyone impacted by cancer – adults, teens, children, and families. The White Plains location, which was established in 2001, is now part of a network of 190 partner locations in the US and beyond that form the largest professionally led nonprofit network of cancer support worldwide, the Cancer Support Community.

The mission of CSCNYCT is to uplift and strengthen people impacted by cancer by providing support, fostering compassionate communities, and breaking down barriers to care. Program offerings include five components, or pillars of support:  emotional support (including support groups and counseling services); education (lectures, workshops, and panel discussions); healthy lifestyle classes (exercise and mind/body/spirit offerings); social and networking opportunities; and resources and referrals. Programs are designed to support cancer patients, their caregivers, their children, and families, and those who have lost someone to cancer. All services are provided free of charge, and insurance is not required.  Services are provided without regard to immigration status or documentation.

 

To contact CSCNYCT, please call 914.644.8844 or www.cancersupportcommunitynyct.org.

 “It is incredibly important for Cancer Support Community Greater NY & CT at Gilda’s Club (formerly Gilda’s Club Westchester) to collaborate with community partners to empower cancer patients and their families. Opportunities to join with other cancer-focused individuals and organizations, such as those provided by the NYCRA Powermeet virtual conferences, enable us to learn from one another, consider new ways to advocate for those impacted by cancer, and join forces to launch important initiatives.” - Ms. Debbie Vincent, Director of Outreach and Clinical Partnerships at Cancer Support Community Greater NY & CT @ Gilda's Club

 

 

 

 

Saturday, November 18, 2023

DR. ROBERT BARD PRESENTS @ VIENNA INFLAMMATORY SKIN DISEASE CONFERENCE

click to enlarge
November 15‐18, 2023‐ Dr. Robert Bard's graphic presentation was showcased in the 5th ISDS  Inflammatory  Skin  Disease Summit 2023 in Vienna, AU.  Dr. Bard's current review on the "ABSCOPAL  EFFECTS  OF  IMAGE  GUIDED  PULSED  BIOENERGY TREATMENT"  presents  his  findings  about  the  adjuvant treatment  effects  of  the  latest  in  non‐invasive  therapeutic solutions  such  as  pulsed  electromagnetic  therapy  irradiation (PEMF) and its potential in cell regenerative effects.  Dr. Bard’s poster  was  accepted  on  October  15  as  one  of  the  top  279 scientific contributors worldwide offering the most compelling discoveries and current reports. 


FROM THE ISDS EVENT: (source: isds2023.org/program/)
The “5th Inflammatory Skin Disease Summit: The Translational Revolution” (is) a unique and dynamic symposium, being held in Vienna, Austria, at the “Aula der Wissenschaften” on November 15-18, 2023.  After four very successful meetings in Vienna and in New York City in 2014, 2016, 2018 and 2021, we have again taken upon the task of organizing such an important in-person meeting, in order to continue this path of therapeutic revolution and extend to other inflammatory skin diseases. We want to discuss new concepts and new developments in the field of inflammatory skin diseases and to devise and explore new therapeutic strategies. For the last meetings, we had been able to attract true leaders in their fields, with more than 600 participants from all over the world at the last meetings in New York (2021) and Vienna (2018). We have now established this conference on an every two-year basis."

According to a project manager from Mondial Congress & Events, "we are the biggest Professional Congress Organizer in Austria (PCO)... We have been working for ISDS and supported the organizing committee with the organization/logistics since the first edition in 2014. The community of ISDS is growing each year and. This year we are excited to welcome the community to our hometown." She added that this ISDS event had "more than 600 people registered, 33 Oral abstract presentations and 44 faculty speakers and a poster exhibition of over 279 abstracts have been accepted this year"

A LEGACY OF RESEARCH & EDUCATION
Since  the  inception  of  his  profound  career  in  cancer  research  and  advanced diagnostic  imaging  (1974),  Dr.  Bard  has  been  a  staunch  supporter  of  non‐invasive imaging technologies that has proven to offer significant quantitative biometrics for a wide range of clinical uses. He has authored an expansive list of medical texts and articles in medical journals about cancer imaging and reports about technological innovations. Moreover, he remains active  throughout his unending career by having presented in over 200 medical summits, symposiums and conferences both domestic and in Europe. From pre and post‐op scanning, clinical  research  validation  and  2nd  opinion  scans,  Dr.  Bard's  mission  as  a medical educator is to mobilize more effective strategies in pathology reporting and  data  gathering  through  the  use  of  ultrasound  functions.   He  is  globally recognized  in  conferences  and  throughout  the  medical  media  for  his informative  presentations  and  published  textbooks  on  diagnostic  imaging science‐ including his highly referenced IMAGE GUIDED PROCEDURES series. 

REAL‐TIME IMAGE GUIDED TREATMENTS: “SCAN AND TREAT”
Dr. Bard employs  the use of 3D Doppler Sonogram and elastography imaging  to collect biometric data and  to record  the  efficacy  of  therapeutic  solutions.    This  includes  an  array  of  information  including  the  quantifiable measurement  of  blood  flow,  muscle  contractions  and  the  temporal measurement  of  the  treatment’s  effects  on  inflammation.  For  this  specific presentation,  the  technology  called  PEMF  (Pulsed  Electromagnetic  Field) technologist  Patrick  Ziemer,  founder  of  Aurawell  PEMF  to  support  this dermatological study by donating various product models to Dr. Bard’s research center.  “We recognize the value of Dr. Bard’s findings for the continuance and advancement of PEMF research… and certainly proving (clinically) that PEMF can affect the outcome and care of inflammatory skin disorders through imaging is a medical milestone for the non‐invasive and alternative health movements.”  



PATRICK ZIEMER: CRUSADER IN NON‐INVASIVE THERAPY MOVEMENT 
AURA  Wellness  PEMF  is  a  major  sponsor  of  Dr.  Bard’s  latest presentation  and  a  contributor  to  PEMF  innovations  for  his research.  Mr Ziemer himself is part of the ISDS Vienna Conference exhibitor lineup on November 15‐18.  With an extensive history in the development of PEMF science, Pat Ziemer started in 2002, co‐developing  and  promoting  the  therapeutic  use  of  PEMF  in  the equine society and expanded to high‐power applications in 2007.  

His  PEMF  devices  have  shown  to  improve  horses’  circulation, increasing  blood  oxygen,  lymphatic  stimulation,  relaxing muscle spasms,  enhancing  muscle  tone,  and  increasing  the  range  of motion in high performance horses.  In 2020, Mr. Ziemer’s PEMF officially made its way to human patients at the launch of AURA Wellness (brand)‐ carrying a professional grade, high voltage PEMF model  while  helping  advance  tremendous  research  and development toward the application of for‐human prototypes.  

RESEARCH & VALIDATION
It is noted that Dr. Bard continues to conduct pilot studies and publishing efficacy studies with PEMF devices (and other non‐invasive modalities)‐ including the latest models donated by AURA WELLNESS.  Dr. Bard’s research and publishing  programs  include  exploratory  testing  for  Pulsed  Bioenergy  solutions  for  enlarged  prostate (hyperplasia), dense breast tissue, endometrial symptoms, inflammatory skin disorders, urinary incontinence and an array of other health issues.  His work is under AngioResearch (501c3) and the recently launched Integrative Health Research Center in NYC.

Monday, July 17, 2023

ANGIOFOUNDATION & NATIONAL FIREFIGHTERS HEALTH ADVOCACY ORG SPONSORS RESPONDER-TECH PROGRAM



In an ongoing battle for advocacy and supportive resources for national rescue members, Dr. Robert Bard, (associate producer and co-publisher of health educational programs for first responder safety and the "Get Checked NOW!" program)  recently launched "ResponderTech Reviews".  Thanks in part to F.A.C.E.S. dir. of operations Lennard Gettz and CEO, Capt. Chris Conner (of the Bedford (TX) Fire Dept), the launch of this educational programming is inspired by its sister program -HealthTechReporter.com, reporting on non-invasive innovations that support functional medicine and "deserves recognition for their mark in alternative therapeutics".   Under collaboration with Responder Resilience producer David Dachinger, spotlighting technologies that "affect the lives of our rescuers is relevant news and is priceless information for our audiences".   ResponderTech Reviews profiles the evolution of of our community and earmarks the latest developments that shape the way we bring care to the caregivers from the field.

More than a product showcase, IPHA's diagnostic specialist Dr. Bard will report on medically validated testing of healing devices through the use of his diagnostic imaging.  Dr. Bard employs the same Before and After scans used in clinical trials and case studies that offer quantitative understanding of a device's efficacy during the treatment process. This comparative interpretation aims to show the body's reaction to therapeutic solutions.

EPISODE 1: Some of the upcoming episodes of ResponderTech episodes will highlight functional health game-changers in DECON and detoxification techniques, EMS portable diagnostic scanning, advancements in PEMF devices, Infrared therapeutics, burn solutions and so much more.  Check out our latest clip, featuring Captain Carrie Preusse of the Minneapolis FD and her use of PEMF technology. As a high ranking member of her firehouse, "Capt. Carrie" shares the many potential injuries that happen 'on the job' and her discovery of Pulsed Electromagnetic Therapy offers major pain relief to keep her going at peak performance.

STAY TUNED!



NEWS: MEDICAL ASSOCIATION BOOSTS NATIONAL PRESENCE FOR FIRST RESPONDER PODCAST

12/11/2022- The AngioFoundation (501c3) announced its official sponsorship of the RESPONDER RESILIENCE PODCAST.  This recent funding boost (alongside a lineup of new corporate and foundation sponsors) aimed at advancing the programming of the responder-media initiative's national footprint.

Since its inception in the fall of 2021, the podcast's popularity in the fire, law enforcement and other responder groups maintained a steady growth, continuing to bring in some of the most respected and recognized guests from the rescue service.  This steady rise in subscribers led the show to reach over 60 memorable episodes and a respectable set of subscribers in the public sector. In its 3rd season, Responder Resilience earned national recognition thanks in part to another AngioFoundation partner-- F.A.C.E.S. (Firefighters Against Cancer & Exposures). 

The alliance originally began in 2018 when the org's executive founder Dr. Robert L. Bard joined a medical collaboration with the 9/11 CancerScan -an early detection advocacy program for ground zero rescue responders.  Retired firefighter and cancer survivor Dave Dachinger was elected as a technical advisor of the project, spotlighting the health initiative called "Get Checked Now!".

On October 17, 2021, leading board members of the AngioFoundation spoke as guests on one of the early episodes of the Responder Resilience video podcast (Season 1, Episode 6) where Dr. Bard and executive director Dr. Lennard Gettz presented clinical reviews about the identified toxins and carcinogenic particulates from the many types of fire calls - otherwise called "BEING SALTY". They discussed clinical findings about today's "plastic fires", 9/11 illnesses, and they also covered a review on modern non-invasive diagnostics including image-guided biopsies and targeted therapies. This episode raised significant viewership in the fire service and earned new audiences within the cancer communities- thanks to the podcast's online re-distribution channels and social media boosting. 

In Nov. 2021, F.A.C.E.S. and Responder Resilience teamed up on a special project broadcasting their November meeting of the NY Fire Bell Club at the NYC Fire Museum (See Video) which catapulted a major event in 5/2022 at the FDNY Fire Academy in Randall’s Island (NY). An official ceremony was held for the 699 first responders of the 1975 NY Telephone Exchange Fire (Feb. 27, 1975) with the Memorial Wall and Plaque Dedication Ceremony. Dr. Bard took the podium as an honoring speaker and presented the highest foundation award to advocate and survivor Ret. FF. Dan J. Noonan.


PSA: Public Service Announcement- F.A.C.E.S. Foundation


As a public educational service, Mr. Dachinger attracted fundamental supporters and program partners including podcast co-hosts clinical psychologist Dr. Stacy Raymond and licensed social worker Bonnie Rumilly. AngioFoundation program executive and F.A.C.E.S. director Dr. Gettz also joined the efforts to support the podcast's branding, distribution and outreach development.  "Now more than ever, streamlining our public media with sound educational content and dedicated awareness is paramount.  Using the benefits of the web to bring front-row access to the insight of our local heroes is empowerment for us all… on so many levels.  Lessons learned from  active members of the rescue service carries great value when it comes to uniting our community," states Dr. Bard.

THE ANGIOFOUNDATION was established in 2001 as public trust in support of medical research and educational programs relating to noninvasive cancer diagnostic solutions. Over the years, the foundation championed public advocacy efforts through new alliances with public health initiatives like the FIRST RESPONDERS CANCER RESOURCE, BRAIN INJURY DETECTION, THE PAIN HEALERS COALITION and the WOMEN'S DIAGNOSTIC NETWORK. The AngioFoundation's sponsorship is a national endorsement of the podcast within the medical community. The attention gained from this is expected to bring in new support from other supporters of rescuers' health and safety groups as well as other foundations who encourage prevention and early detection.

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Thursday, June 29, 2023

2023 IPHA SPOTLIGHT: NATHAN INTRATOR & NEUROSTEER

MEETING INNOVATORS OF BRAIN HEALTH (part 1)

By: Marilyn Abrahamson

Since December 2022, I've been privileged to be part of a distinguished group of professionals known as the Brain Health Collaborative. As the associate director, I've had the honor of meeting and learning from many of the remarkable individuals within our ranks.

On June 14, 2023, I had the pleasure of meeting Dr. Nathan Intrator, the visionary CEO of Neurosteer Inc., a groundbreaking company he established in 2015. Dr. Intrator's expertise lies in mathematics, particularly in signal processing, and his fascination with the human brain led him to write his doctoral dissertation on the subject of neuroplasticity.

Neurosteer’s FDA cleared platform represents a remarkable advancement in the form of a user-friendly, portable brain activity monitor that utilizes EEG technology to measure various aspects of brain function, including engagement, attention, emotional state and cognitive load. As a professional devoted to brain health, I am perpetually seeking answers to the most pressing questions about brain training and how to optimize its benefits. That is why Dr. Intrator's work captivated me, and I eagerly seized the opportunity to meet and interview him.

During our conversation, Dr. Intrator illuminated the multitude of future applications for Neurosteer (subject to additional FDA clearances) in both the diagnosis and treatment of neurodegenerative conditions such as epilepsy, Parkinson's disease, and Alzheimer's. Remarkably, this is achieved using a small patch on the forehead with just a single EEG channel. Recent pilot studies have shown that Neurosteer can provide enable preclinical diagnoses of Parkinson's disease, Alzheimer's, and other neurodegenerative conditions before symptoms manifest.

Dr. Intrator also revealed that Neurosteer has shown promising results in the detection of dopamine depletion in Parkinson's disease at an early stage, facilitating early intervention. Studies are underway to explore its role in detecting  epilepsy, Lewy body dementia, frontotemporal dementia, essential tremor, and more. In hospital intensive care units, Neurosteer is being evaluated for assessing comatose patients, gauging their level of consciousness, depth of sedation, seizure activity, and other vital factors.

Regarding Alzheimer's disease, Dr. Intrator emphasized that Neurosteer has shown connectivity changes in the pre-symptomatic presence of amyloid accumulation. Early detection is crucial as it enables intervention that can delay or prevent cognitive decline associated with Alzheimer's and other forms of dementia. In the absence of pharmaceutical solutions for memory disorders like Alzheimer's, identifying the condition early empowers patients to take control of their lifestyle choices, and adopt habits that promote a healthy brain. Armed with this information, lives can be transformed if patients possess the motivation and discipline to embrace these choices.




Tune Your Brain with Wearables, Not Drugs | Nathan Intrator | TEDxWhiteCity: Can we monitor the brain just like we monitor other organs, using a portable and easy to use device? Nathan Intrator, a brain researcher and computer scientist, is currently developing one such monitor that can provide detailed information about cognitive and emotional brain activity. It can be used to improve health and wellness and for a variety of  lifestyle applications.

Nathan Intrator is the neuroscience startup leader of a revolutionary cloud-based platform that uses advanced brain signal processing and big data analytics to manage brain health and human wellness. An international scholar in neural computation, he delves into the undiscovered grey area of our brain.  His latest startup, Neurosteer, uses advanced brain signal processing and big data analytics to perform continuous, mobile monitoring and management of brain health. Neurosteer's mission is to become the standard method for ubiquitous brain activity interpretation and neuro-feedback. Real-time, detailed brain state analysis will be seamlessly integrated into a wide range of medical, neuro-marketing, lifestyle and gaming applications. In his belief communication technologies that didn’t exist 5 years ago can be leveraged to improve brain function in novel and fun ways, as well as improve the life style of individuals with brain disabilities. 

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx


Moreover, Neurosteer also offers support for those seeking to enhance their brain health and overall wellness, whether they currently experience cognitive decline, exhibit clinical biomarkers, or exist in a preclinical stage with early cognitive symptoms. The hope is that by identifying pathology before symptoms arise, more individuals will be motivated to take charge of their lives, prioritize brain health, and nurture their overall well-being.

Additionally, Neurosteer possesses therapeutic capabilities through neurofeedback, for example, by detecting elevated resting brain activity levels in seniors predisposed to cognitive decline before noticeable symptoms manifest. Through neurofeedback training, individuals can learn to lower their resting brain activity levels. This is studied in monks from the Dalai Lama's community, demonstrating the efficacy of this approach, wherein neurofeedback facilitates a meditative state that has reparative effects on the brain.

Dr. Intrator's groundbreaking vision of an affordable wearable device, to provide diagnostic assessment and therapeutic modalities for neurodegenerative conditions like Parkinson's, Alzheimer's, and other forms of dementia, is on the verge of becoming a remarkable reality. With Neurosteer leading the charge, we find ourselves at the threshold of a transformative era, where individuals will have the power to reclaim control over their cognitive well-being, offering them the gift of brain health.


AUTHOR:

MARILYN ABRAHAMSON, MA, CCC-SLP : As a Brain Health Education Specialist at Ceresti Health, Marilyn offers initiatives that supports education and empowerment of family caregivers. She also writes for and edits the Ceresti’s monthly newsletter and produces all brain health education and brain-health coaching programs for caregivers.  Marilyn's prior work is as a NJ Licensed Speech-Language Pathologist since 1987 and is an Amen Clinics Certified Brain Health Coach. 
She is also the cofounder of BrainThrive Consulting, and creator of the Long Live Your Brain program. www.longliveyourbrain.com







COGNITION TESTING & CONCUSSION METRICS THROUGH OPTICSCAN

INTRODUCTION
A new research study is underway at the Bard Diagnostic Imaging Center in NYC. Dr. Robert Bard and a local research team combines the latest biometric scanning advantages of transcranial DOPPLER imaging,  hemodynamic ULTRASOUND scanning (of the retinal, basilary and temporal arteries) and the integration of BIOFEEDBACK technology for a special research study. This neuro-scan review establishes (1) a cross-comparative study  between the technologies and (2) a multi-modality screening & monitoring protocol to record post-concussion and neurodegenerative disorders.

One of several major foci for this project is to explore the development of a diagnostic paradigm in the detection of post concussion symptoms including the growing reports of Chronic Traumatic Encephalopathy/CTE, identified from head concussions in military service and high impact sports.  Since 2018, Dr. Bard has been collaborating with neurologists and pain management specialists to assess the rampant growth of this progressive brain condition.  

STUDY 1: INTRACRANIAL PRESSURE
Case studies with a presumptive degenerative neuromuscular disease or amyotrophic lateral sclerosis are now being examined through a non-invasive investigation of the eye.   We can observe increased intracranial pressure, which may reflect in changes in the optic nerve diameter.  

[Fig. 1]  Scan of the eye (L) with a Doppler ultrasound probe shows the optic nerve diameter of five millimeters compared to the usually symmetric right almost eight millimeters. This suggests increased intracranial pressure or optic nerve tumor indicating a blood flow measure of the right anterior cerebral artery circulation that supplies the retina (approximately 60cm/s) blood flow.  [Fig. 2] The left vessel shows a decreased pressure of approximately 45cm/s as shown by the decreased height of the blood flow graph at the bottom. These quantitative diagnostic technologies are non-invasive allowing close clinical follow-up treatment in diseases affecting the eye related to brain trauma or degenerative neuromuscular disorders.


STUDY 2: POST-CONCUSSIVE / RETINAL ARTERIOVENOUS IMAGING
Concussion literature notes a funduscopic exam of the retinal arterial-venous width showing ASYMMETRY is indicative of possible trauma. This is a potential response of the autonomic nervous systems microcirculatory hemodynamics that are optically useful in validating the treatment progress. [L Image] Normal retinal artery vein width ratio is 1 to 2.  [R image] artery 0.9 mm (red)  vein 2.3mm (blue)  signifying possible increased intracranial pressure. Hemodynamic Doppler study of abnormal retinal vessels allows real time evaluation of the cerebral circulation measuring the anterior cerebral artery (ACA) with physiologic flow parameters.   















STUDY 3: WHIPLASH
Hemodynamic changes from whiplash may injure the vessels supplying the brain.  [Image L] High resolution scan of traumatized carotid artery showing turbulent flow (dark blue) and normal outer wall (red) ruling out arterial wall rupture.  [Image R] blood flow in the vertebral artery shows less flow disturbance (scattered blue) and no evidence of thrombosis which is a common cause of posttraumatic symptoms including speech and gait abnormalities


Now that more radiologists are using Doppler blood flow to examine eye disease, including systemic diseases (including diabetes, brain tumors, heart disease, sickle cell disease, etc.) that affect the eye, we are hopeful that the ophthalmologic and neurological communities will start using this noninvasive technology as well to improve noninvasive and more rapid treatment of potential eye disorders, such as cancers of the eye, diabetes and glaucoma.  Another future use will be to correlate the effect of decreased vascular pulsation in the production of cerebrospinal fluid that is removed by the cleansing glymphatic system is postulated as a contributing factor in degenerative neuromuscular disease.    
 








RECOGNIZING BRAIN HEALTH & ADDICTION
By: Dr. Leslie Valle-Montoya
It is well documented that tobacco increases the risk of different cancers such as lung, liver, and colorectal.  According to the National Health Interview Survey data from 2020, 47.1 million adults in the United States reported currently using tobacco products with 79.6 % of those being cigarette smokers [1].  If cigarette smoking continues to be one of the leading causes of preventable disease and deaths, why is cessation not easier to attain?  First, we must recognize the science behind nicotine addiction and its withdrawal effects.  Addiction is recognized to be a brain disease. Overcoming an addiction, whether it’s prescription pain pills, sugar, alcohol, nicotine or anything else, cessation is harder to exercise when the “pathways” or pleasure circuits of the brain have chronically been overstimulated.   (See complete article)





RELATED STORIES:

"GETTING MY LIFE BACK FROM CHRONIC FATIGUE SYNDROME"  2/15/2022- Mrs. Suzanne Wheeler of Minneapolis, Minnesota is celebrated as IPHA NEWS' Researcher of the Month.  After years of suffering a life-altering disorder that currently continues to challenge the scientific community of its root causes, Mrs. Wheeler explored “outside the conventional box” of opioid prescriptions, uncovering alternative solutions that got her back on her feet and joining life again.  Invoking CHANGE against all odds by diligently searching for what’s beyond the convenient takes courage and conviction.  It is this level of academic strength and strategic leadership that comprises the Alternative Health and Wellness community. (see full feature on Mrs. Wheeler's PEMF review)

10/25/2022- HEALING, STRESS AND THE PARASYMPATHETIC SYSTEM:  Analyzing STRESS & ANXIETY from a holistic point of view means identifying the body’s interconnected systems (ie. circulatory, cardiovascular, nervous, lymphatic, endocrine etc.) and its many touch points for stimulation.   This analysis should also offer a comprehensive breakdown of the body's HEALING capacity- which includes our hormones, digestive system, immune system, brain, heart-- all the way down to our cells and mitochondria.   Stress is part of life, and comes in many forms including physical, emotional, mental and environmental. Foods we eat, unhealthy relationships, difficulties at work, toxins in our environment, even poor posture or lack of sunshine can all create stress on our bodies. (See complete report by: Dr. Roberta Kline)


HOW TO FIND THE RIGHT SPECIALIST FOR YOU: Whether you're searching for a primary care physician or a cosmetic specialist, shopping for any doctor can be quite a challenge. Ingredients for finding a professional that you can trust with your life rely heaviest on their reputation, expertise and qualifications found under smart research methods. REFERRALS: As medical professionals are now heavily participating in commercial marketing platforms (such as broadcast and podcast commercials, youtube videos, social media promotion and public relations campaigns), the most favored influencer about any practitioner is still word of mouth. At least starting with a recommendation from a friend, colleague or family member, getting positive feedback about a practitioner through others' experience is a great place to begin. (see complete report)

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 https://healthresourcedigest.blogspot.com/2023/02/addiction-2023-battle-rages-on.html

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