Saturday, September 28, 2013

Health Risks of Cell Phone Use

On 11/11/2009, I have posted an article titled:
Until now, I still don't own a cell phone and I am not planning to own one in the future.[15-18,22]  Recently, I have read an excellent book written by Dave Wentz and Dr. Myron Wentz:
  • The Healthy Home[2]
which urges me to visit the safety of cell phone use again.


Are We Protected from Dangers?


The answer is a resounding NO. It took 70 years to remove lead from paint and gasoline, and 50 years to establish the link between smoking and cancer and to have warnings printed on packs of cigarettes[2]. Even the ancient Greeks noted that asbestos was harmful, but it took the United States more than 60 years to ban its use after illness were documented.[19]

In [3], it states that:
  • The possible adverse health and environmental effects of dichlorodiphenyltrichloroethane (DDT) exposure through indoor residual spraying (IRS) are not known and pose a real concern.
However, in 2006, the World Health Organization issued a position statement promoting the use of IRS with DDT for malaria vector control in epidemic and endemic areas. And yes, DDT is still in use today even with a recent headline reminding us that:
  • Forty Years Later Banned Pesticide DDT Is Still Killing California Condors[4]
Finally, "Instead of protecting the public health, the FDA has been allowing the drug companies to pay for a seat at a small table where all the rules were written," reported The Seattle Times.[13]


Is Cell Phone Safe?


The short answer is UNKNOWN[14]. But, the scientific evidence is quickly mounting that cell phone use is associated with the development of serious adverse health effects, especially for whose bodies and brains are still developing.[1,7,20,21]

Dr. Lennart Hardell, a cancer expert from University Hospital in Sweden, recently found that among individuals who began using cell phones before they were twenty years old, after a year or more of use, the risk of brain cancer was 5.2 time greater than for the general population.[5]

In 2009, President’s Cancer Panel has published an Annual Report[20] which examines the impact of environmental factors (including EMR/EMF or non-ionizing radiation) on cancer risk. The Panel has warned that:
Some evidence suggests that EMR/EMF may also have deleterious effects on human health with prolonged exposure.
Sources of non-ionizing radiation include electric power lines, radio and television transmissions, radar, cell phones and other wireless communication devices, cell phone towers, microwave ovens, other home appliances, the sun, and artificial tanning devices.
In 2011, IARC ( International Agency for Research on Cancer of WHO) reviewed all the available evidence in relation to RF fields and cancer.[7] Based on the limited association between wireless phones (mobile and cordless phones) and glioma and acoustic neuroma and inadequate evidence for other types of cancers, IARC classified RF fields as a “possible human carcinogen”.

Finally, do you know what cancer Senator Kennedy died of? The answer is Glioma.[8] As a Senator, you bet he was on the cell phone a lot. Is his cancer related to the frequent use of cellular phone? If I were you, that's the question I would ask.

More Health Risks


Though the most common concern is cancer, there are other serious hazards.[2] A 2008 study from the UCLA School of Public Health asked more than 13,000 mothers to complete a questionnaire that included questions about the health and behavioral status of their children at 7 years of age. It also asked whether the mothers had used cell phones during the pregnancy or immediately after the birth. By nearly two-to-one, the children whose mothers reported cell phone use during this critical time demonstrated behavioral difficulties such as hyperactivity around the age they entered school.[9]

Scientists postulate that the human body responds to EMFs[11] as invading pathogens, setting in place a cascade of biochemical reactions that cause the release of damaging free radials, alter the blood-brain barrier,[12] kick-start chronic inflammatory responses and disrupt intercellular communications.

Recommendations


If you are one of the persons that cannot resist the frequent use of cell phones, please heed Dr. Herberman's 10 practical suggestions documented in:
Don't Be So Sure Your Cell Phone Is Safe

Photo Credit

References

  1. Wireless Radiation and Brain Tumor Risks (Travel and Health)
  2. The Healthy Home by Dave Wentz and Dr. Myron Wentz
  3. Dichlorodiphenyltrichloroethane (DDT) for Indoor Residual Spraying in Africa: How Can It Be Used for Malaria Control?
  4. DDT May Still Be Screwing the California Condor
  5. "Mobile Telephones and Health Effects," Australian Radiation Protection and Nuclear Safety Agency, 2009.
  6. L. Hardell and M. Carlberg, "Mobile Phones, Cordless Phones, and the Risk for Brain Tumors," International Journal of Oncology 35 (2009): 5-17.
  7. IARC Classifies Radiofrequency Electromagnetic Fields as Possibly Carcinogenic to Humans
  8. Senator Edward Kennedy Dies From Malignant Glioma - Medscape
  9. H. Divan et al., "Prenatal and Postnatal Exposure to Cell Phone Use and Behavioral Problems in Children," Epidemiology 19 (2008): 523-29.
  10. Don't Be So Sure Your Cell Phone Is Safe (Travel and Health)
  11. Radio Frequency Radiation Emissions of Wireless Communication Devices (Travel and Health)
  12. Blood-Brain Barrier (Travel and Health)
  13. Drugmakers pay to attend FDA advisory panel’s meetings, emails show (The Seattle Times)
    • “Instead of protecting the public health, the FDA has been allowing the drug companies to pay for a seat at a small table where all the rules were written.”
  14. French Health Agency Recommends Children and Vulnerable Groups Reduce Cell Phone Radiation Exposure
    • Limited levels of evidence do point to different biological effects in humans or animals. 
    • In addition, some publications suggest a possible increased risk of brain tumour, over the long term, for heavy users of mobile phones.
  15. Put Down Your Smart Phone and Pick Up Your Heart Phone
  16. Further Benefit of a Kind of Inconvenience for Social Information Systems
  17. A Sightseeing Navigation System without Route Information
    • Inconvenience can force people to use their cognitive mapping more often, which benefits people's brains.  Also, it allows people to explore new territories and open up new possibilities for discovery.
  18. 6 Ways Phones and Tablets Affect Your Health
  19. Asbestos Victims Unite On Mesothelioma Awareness Day (EWG)
  20. 2008–2009 Annual Report (President’s Cancer Panel)
  21. 'Casualty catastrophe' - Cell phones & child brains (Youtube)
  22. Indian prime minister not worried about U.S. hacking because he doesn't have a cell phone or use email
  23. Belgium Boosts Cell Phone Radiation Safeguards (EWG)
    • Belgium recently adopted new cell phone regulations that bar mobile phone models designed for, and marketed to children ages 7 and younger.
  24. Disease risk rises for health care workers exposed to radiation on the job
  25. The Unsettling Rise Of Microwave Syndrome

Thursday, September 26, 2013

Health Risks of Aluminum

Aluminium (Al) is the most widely distributed metal in the environment and is extensively used in daily life that provides easy exposure to human beings. The exposure to this toxic metal occurs through air, food and water[23,25]. However, there is no known physiological role for aluminium within the body—no known diseases are linked to aluminum shortagesand hence this metal may produce adverse physiological effects[7,25,31].

Aluminum causes problems in the body largely by competing with several other elements with similar characteristics.[26]  If you are deficient in such minerals as magnesium, calcium, or iron, then aluminum is always there to take their place inside your cells.  Although the body tries to excrete most of the aluminum it takes in, any excess is deposited in various tissues including bone, brain, liver, heart, spleen, and muscle.  In certain tissues with relatively low turnover—such as the brain—aluminum is difficult to remove once it's in place, resulting in long-term damage.


Aluminum's Toxicity

In different researches, scientists have identified Aluminum's toxicity to human body in various ways:
  1. Al is associated with Alzheimer’s Disease (AD)[2,3-6,12-16,32]
    • Apoptotic pathway is believed to represent an important mechanism for the physiological or pathological neural cell death. 
    • It has been reported that aluminum (Al) can induce apoptosis in neural cells of rodent models and is associated with Alzheimer’s Disease (AD). 
    • Those neurofibrillary tangles associated with Alzheimer's disease contain aluminum. 
  2. Al can induce DNA damage (or Al is genotoxic compound)[2]
    • The available data suggest that Al can induce DNA damage by modifying the structure of chromatin through the induction of reactive oxygen species or by damaging lysosomal membranes and liberating DNase.
    • The study  points toward oxidative stress or liberation of DNase as the major source of DNA damage induced by Al[1].
  3. Al enhances inflammation and decreases mucosal healing[17]
  4. Al may induce anaemia[20-21]
  5. Al particles may cause functional lung disorder[23]
  6. Aluminum chloride may corrode the skin, irritate the mucous membranes in the eyes, and cause perspiration, shortness of breath and coughing[23]
  7. Alum (明礬) increases blood clotting[23]
  8. Al adjuvants may cause Autoimmune/inflammatory syndrome induced by adjuvants (ASIA)[28]
  9. Al has estrogen-like effects
    • The estrogen-like effects of Al salts have led to their classification as a metalloestrogen[10]
    • Aluminium increases estrogen-related gene expression in human breast cancer cells cultured in the laboratory[9,19]
    • Some researchers have expressed concerns that the aluminium in antiperspirants may increase the risk of breast cancer[8,22]

References

  1. Aluminum-Induced Micronuclei and Apoptosis in Human Peripheral-Blood Lymphocytes Treated during Different Phases of the Cell Cycle
  2. Research presented at the Keele Aluminum Conference strengthens aluminum's link to cancer, Alzheimer's disease & more
  3. Virginie Rondeau, Daniel Commenges, Hélène Jacqmin-Gadda and Jean-François Dartigues.  Relation between Aluminum Concentrations in Drinking Water and Alzheimer's Disease: An 8-year Follow-up Study Am. J. Epidemiol. (2000) 152 (1): 59-66. doi: 10.1093/aje/152.1.59
  4. Swegert,C.V., Dave,K.R. and Katyare,S.S. (1999) Effect of aluminium-induced Alzheimer like condition on oxidative energy metabolism in rat liver, brain and heart mitochondria. Mech. Ageing Dev., 112, 27–42.
  5. Tsunoda,M. and Sharma,R.P. (1999) Modulation of tumor necrosis α expression in mouse after exposure to aluminium in drinking water. Arch. Toxicol., 73, 419–426.
  6. Rogers,M.A. and Simon,D.G. (1999) A preliminary study of dietary aluminium intake and risk of Alzheimer's disease. Age Ageing, 28, 205–209.
  7. Aluminium neurotoxicity: neurobehavioural and oxidative aspects. (PubMed)
  8. Exley C, Charles LM, Barr L, Martin C, Polwart A, Darbre PD (2007). "Aluminium in human breast tissue". J. Inorg. Biochem.101 (9): 1344–6
  9. Darbre, P. D. (2006). "Metalloestrogens: an emerging class of inorganic xenoestrogens with potential to add to the oestrogenic burden of the human breast". Journal of Applied Toxicology 26 (3): 191–7. 
  10. Aluminum (Wikipedia)
  11. Yokel RA, Hicks CL, Florence RL (2008). "Aluminum bioavailability from basic sodium aluminum phosphate, an approved food additive emulsifying agent, incorporated in cheese". Food and chemical toxicology 46 (6): 2261–6.
  12. Ferreira PC, Piai Kde A, Takayanagui AM, Segura-Muñoz SI (2008). "Aluminum as a risk factor for Alzheimer's disease". Rev Lat Am Enfermagem 16 (1): 151–7.
  13. Hawkes, Nigel (2006-04-20). "Alzheimers linked to aluminium pollution in tap water". The Times (London).
  14. Aluminum and Alzheimer's disease (PubMed)
  15. Aluminum may mediate Alzheimer’s disease through liver toxicity, with aberrant hepatic synthesis of ceruloplasmin and ATPase7B, the resultant excess free copper causing brain oxidation, beta-amyloid aggregation and Alzheimer disease. (PubMed)
  16. Acute and chronic neurotoxicity of aluminium oxide nanoparticles in mice. (Keele Aluminum Conference)
  17. Aluminium enhances inflammation and decreases mucosal healing in experimental colitis in mice.  (Keele Aluminum Conference)
  18. Hot watery infusion of Hibiscus sabdariffa petals, a potential source of aluminium in the human diet. (Keele Aluminum Conference)
  19. Effect of aluminium on migratory and invasive properties of human breast cancer cells in culture.  (Keele Aluminum Conference)
  20. Aluminium-induced anaemia in haemodialysis patients. (PubMed)
  21. Aluminum-induced anemia. (PubMed)
  22. Antiperspirants, aluminium salts and relationship with breast cancer.  (Keele Aluminum Conference)
  23. Aluminum (Al) and water
  24. Aluminum In Vaccines
  25. You can call me Al (Video; by Chris Exley)
    • Solution: Drinking silicon-rich mineral water, you pee aluminium.
  26. The Healthy Home by Dave Wentz and Dr. Myron Wentz with Donna K. Wallce
  27. The Pros and Cons of Flu Vaccination (Travel and Health)
  28. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA)
  29. Kawahara, Masahiro; Kato-Negishi, Midori (2011). "Link between Aluminum and the Pathogenesis of Alzheimer's Disease: The Integration of the Aluminum and Amyloid Cascade Hypotheses". International Journal of Alzheimer's Disease 2011.
  30. Anti-caking agent in table salt — Sodium aluminosilicate
  31. Aluminum adjuvant linked to Gulf War illness induces motor neuron death in mice.
  32. Elevated brain aluminium and early onset Alzheimer’s disease in an individual occupationally exposed to aluminium: a case report

Wednesday, September 25, 2013

Pros and Cons of Microwave Cooking

Microwave technology, which is part of the radiofrequency (RF) spectrum[11], was first developed by the German military during World War II.  Many people use microwave ovens as a convenient way to thaw, cook and reheat food. However, a number of people have concerns about the effect of microwaves on their health and on the health and safety of their foods.

In this article, we will look at the pros and cons of microwave cooking.

Video 1.  Are Microwaves Safe? (YouTube link)

Pros of Microwave Cooking

  • Great convenience
    • Microwave ovens heat foods quickly and efficiently.
  • Less chance of being seriously burned (e.g., compared to stove)
    • Microwave ovens heat food without getting hot themselves.
    • Food and cookware taken out of a microwave oven are rarely much hotter than 100 °C (212 °F). 
  • Health benefits (vs. baking or frying)
    • The lower temperature of cooking (the boiling point of water) is a significant safety benefit compared to baking in the oven or frying.
      • The formation of carcinogenic tars and char could be almost eliminated.
    • Unlike frying and baking, microwaving does not produce acrylamide[4] in potatoes, however unlike deep-frying, it is of only limited effectiveness in reducing glycoalkaloid (i.e. solanine) levels[6].
    • When food scientists reviewed vitamin and mineral retention in twenty different vegetables, microwaving was found to be an ideal method.
      • As with steaming, the less water and time used to microwave the food, the more nutrients were kept.
Video 2.  Best Cooking Method (YouTube link)


Cons of Microwave Cooking

  • Reheating previously cooked food may not be safe
    • Bacterial contamination may not be repressed if the safe temperature is not reached
  • Some microwave energy may leak from your oven while you are using it[7]
    • In WWII, solders who had gathered around radar units—use microwave technology—to warm themselves where later found to develop illnesses, including cancer.
    • Researches have found that there is possible modification of blood-brain-barrier permeability by mobile phone and other microwave fields[10].
  • Hazard chemicals from container may leach into food
    • Don't use plastic containers in the microwave because it can cause phthalates in the plastic to leach into your food (note that phthalates are what make vinyl soft).
    • The combination of fat, high heat, and plastics may release even more hazard chemicals into your foods.  
      • Use other safer containers made of glass or ceramic.
    • Avoid fast-food packaging and microwave popcorn bags because many are coated with perfluorinated chemicals to keep grease from soaking through.[1]


Recommendations


Until now, we still don't know much about:
  • If electromagnetic fields (EMFs)[11] can alter our cells?
  • If EMFs can alter the integrity of our food?
So, if I were you, I would heed Dr. Weil's advice[9]:
  • "I don't cook vegetables or anything else in the microwave. I usually steam or stir fry vegetables, and I use a microwave only for defrosting or rapid reheating of leftovers."
  • "Don't heat foods in plastic containers or covered by plastic wrap."

References

  1. The Healthy Home by Dave Wentz and Dr. Myron Wentz with Donna K. Wallce
  2. Radio Frequency Radiation Emissions of Wireless Communication Devices (Travel and Health)
  3. Toxins Are Everywhere — I'm Not Kidding (Travel and Health)
  4. Acrylamide
    • Acrylamide are present in dangerous amounts in carbohydrate-rich foods that have been overcooked by frying, grilling, or roasting.
    • A nerve-damaging compound in humans and clear cancer-causing agent in rodents.
  5. Solanine
    • Deep frying potatoes at 170°C (338°F) is known to effectively lower glycoalkaloid levels (because they move into the frying fat), as does boiling (because solanine is water soluble), while microwaving is only somewhat effective, and freeze drying or dehydration has little effect.
  6. Microwave Oven (Wikipedia)
  7. "Microwave Ovens and Food Safety," Health Canada
  8. "High-temperature Cooking and the World's Healthiest Foods," George Mateljan Foundation.
  9. Nuking your nutrients (Dr. Andrew Weil)
  10. Blood-Brain Barrier (Travel and Health)
  11. Radio Frequency Radiation Emissions of Wireless Communication Devices (Travel and Health)
  12. Why Did the Russians Ban an Appliance Found in 90% of American Homes? (good)
  13. The Effects of Radiation Leaking from Microwave Ovens (Dr. Greger)
  14. The Unsettling Rise Of Microwave Syndrome

Sunday, September 15, 2013

Should CPR Be the Default Treatment for All Cardiac Arrests?

Slow, creeping changes gradually transform the structure of our health care system—sometimes for the better, sometimes not. Creep[1] is a word describing a complex phenomenon:
  • The gradual and unmanaged addition of additional treatments/procedures/features in a practice/mission/product.

In this article, we will examine "medical creep." Medical creep[3] happens when doctors practice "outside the box," performing procedures or prescribing treatments for patients in the absence of clear evidence that patients will benefit. Cardiopulmonary resuscitation (CPR),[16] the procedure used to treat patients who suffer cardiac arrest, is an example of medical creep.


How Was Cardiac Arrest Treated before CPR Invention?


Before 1960, the only way to treat cardiac arrest required surgical opening of the chest cavity and manual cardiac massage, whereby the surgeon holds the heart in his hands and squeezes it rhythmically to pump blood to the brain and other vital organs.

However, such "open-chest" cardiac massage was attempted rarely and succeeded even more rarely in those old days.

CPR Invention


Cardiopulmonary resuscitation (CPR) is an emergency procedure, performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest.

In late 1950s, James Elam and Peter Safar conducted research on then-existing basic life support procedures including controlling a person’s breathing airway by tilting back his or her head with an open mouth; and using mouth-to-mouth breathing.  Later Safar combined these with a procedure known as closed-chest cardiac massage to become the basic life support method of CPR[6].

In 1958, William Bennett Kouwenhoven, Guy Knickerbocker, and James Jude at Johns Hopkins University has formalized chest compression techniques.  In 1960, they reported their experience with twenty patients in whom they had used closed-chest cardiac massage.  They successfully resuscitated every one of the first twenty patients they treated, fourteen of whom (70%) survived without brain damage or other ill effects. They concluded that

  • "the method... can be used wherever the emergency arises, whether that is in or out of the hospital."

So the Creep Began


In May 1966 the National Research Council of the National Academy of Sciences convened an ad hoc conference on cardiopulmonary resuscitation. The conference was the direct result of requests from the American National Red Cross and other agencies to establish standardized training and performance standards for CPR. Over 30 national organizations were represented at the conference. Recommendations from this conference were reported in JAMA in 1966.[7]

Soon thereafter, all cardiac arrests in U.S. hospitals or outside the hospital (i.e., mobile ICU ambulances) were treated with these methods. In other words, CPR became—and remains today—the "default" treatment for every person who dies.

What's the Problem?[3]


This is how the CPR resuscitation works. First aid practitioners will:
  • Pump on you chest
  • Put a breathing tube down your throat
  • Squeeze oxygen into your lungs
  • Jab you with needles
  • Electrocute your heart
If you ever witness this method, you can understand just how crazy, and creepy, this can be.

Three things may have contributed to CPR creep:
  1. The Hopkins researchers, in their initial study, treated a very narrow spectrum of patients; most were young, healthy people (including several children) whose hearts had stopped during elective surgery, victims of anesthesia mishaps.
    • We now know that many new treatments, studied in a narrow spectrum of patients, aren't nearly as successful when used in a broader patient population. Ignorance of this "spectrum bias" potentiates creep.
  2. Our failure to understand the difference between efficacy and effectiveness[2].
    • Effectiveness relates to how well a treatment works in the practice of medicine (i.e., in the "real world"), as opposed to efficacy, which measures how well treatment works in clinical trials or laboratory studies (i..e, under the ideal conditions of a research study).
    • The fist study of out-of-hospital CPR in 1967 found that 50% of cardiac arrest victims in Belfast were resuscitated successfully. But when doctors in New York tried to replicate these spectacular results on the streets of lower Manhattan, their "mobile ICU" ambulances were able to save only 6% of cardiac arrest victims.
  3. Mass media promote medical creep too.
    • Episodes of television "doctor shows" like ER, perpetuated spectrum bias about CPR and grossly inflated its effectiveness.
    • Researchers found that 2/3 of all (fictiohnal) cardiac arrests portrayed on ER (and other doctor shows) involved young patients who had suffered rare events like drowning or lightining strikes, rather than old people with heart disease.

The Truth—It's Not So Effective in the Elderly


First of all, old people with heart disease account for 90% of cardiac arrests in real-life settings, including Cook County Hospital where stories of ER were based on.[3]

Secondly, large studies involving only elderly patients have documented CPR survival rates as low as zero and as high as 18%, with up to 1/4 of all survivors suffering permanent brain damage[8-11]. Not mentioning that CPR can lead to:
  • Prolonged suffering
  • Severe neurological damage[12]
  • An undignified death

One geriatrician wrote that 36 of his 40 patients (whose average age was 87) told him that they wanted CPR[3]. This confused him until he found that they did not understand the low likelihood of benefit and the potential downside of CPR. After he had discussed the realities with his patients, 39 of the 40 opposed resuscitation.  To conclude, as recommended in [15], patients who are in the dying phase should not be subjected to “cardiopulmonary resuscitation,” as this constitutes a futile and inappropriate medical treatment.

References

  1. Creep (Wikipedia)
  2. Efficacy (Wikipedia)
  3. One Doctor—Close calls, cold cases, and the mysteries of medicine by Brendan Reilly, M.D.
    • Excellent book, which most of this writing is based on. It has debunked many myths in today's medical practices.
  4. Cardiopulmonary resuscitation (Wikipedia)
  5. Flynn, Ramsey (2011-02-18). "A Dying Dog, a Slow Elevator, and 50 Years of CPR". Hopkins Medicine magazine.
  6. History of cardiopulmonary resuscitation (Wikipedia)
  7. Committee on CPR of the Division of Medical Sciences, National Academy of Sciences-National Research Council, Cardiopulmonary resuscitation, JAMA 1966;198:372-379 and 138-145.
  8. Kim,C., Becker,L., Eisenberg, M.S., 2000.Out-of-hospital cardiac arrest in octogen-arians and nonagenarians. Arch.Intern. Med. 160,3439–3443.
    • Octogenarians and nonagenarians have lower survival to hospital discharge than younger patients, but age is a much weaker predictor of survival than other factors such as initial cardiac rhythm. Decisions regarding resuscitation should not be based on age alone. 
  9. Murphy, D.J., Murray,A.M.,Robinson,B.E.,Campion,E.W.,1989.Outcomes of cardiopulmonary resuscitation in the elderly. Ann. Intern. Med.111,199–205.
    • CPR is rarely effective for elderly patients with cardiopulmonary arrests that are either out-of-hospital, unwitnessed, or associated with asystole or electromechanical dissociation.
  10. Ehlenbach et al., Epidemiologic Study of In-Hospital Cardiopulmonary Resuscitation in the Elderly. New England Journal of Medicine. 2009; 361:22.
  11. Five-year survival of patients after out-of-hospital cardiac arrest depending on age.
  12. Chan P.S., Nallamothu B.K., Krumholz H.M., et al. Long-Term Outcomes in Elderly Survivors of In-Hospital Cardiac Arrest.  N Engl J Med 2013; 368:1019-1026.
    • At hospital discharge, 48.1% of the patients had mild or no neurologic disability, and the rest of the patients had moderate-to-severe disability or were in a coma or vegetative state. 
  13. As Night Draws Nigh (Travel and Health)
    • A writing to commemorate my mother and to describe how I have walked her through the last moments of her life. 
  14. Why Doctors Die Differently (WSJ)
    • During doctors' last moments, they know, that they don't want someone breaking their ribs by performing CPR (which is what happens when CPR is done right).
  15. Ethical decision making in palliative care: cardiopulmonary resuscitation for people who are terminally ill. London: National Council for Hospice and Specialist Palliative Care Services; 2002.
    • Patients who are in the dying phase should not be subjected to “cardiopulmonary resuscitation,” as this constitutes a futile and inappropriate medical treatment.
  16. Cardiopulmonary resuscitation (CPR): First aid (Mayo Clinic)