Writing, writing, writing. However, at least recently, it has been rather enjoyable. Like you might hurriedly turn the page of a good novel to see what is going to happen next, so I write The Genotype Diet -often rushing home after karate class or some other engagement just to get back to work and see what might organically follow what I had previously written. It may (or may not) surprise you when you read it, since it turns the entire field of nutrigenomics upside-down, substituting a low-technology, DIY approach for any and all of the high tech glossy stuff that passes for the field nowadays.

Now, I have no gripe with labs and lab testing, but as John Bastyr used to say almost three decades ago when one of us student clinicians would pony up with the latest sophisticated panel, "That's nice, but tests don't get anybody better."

A while back a lawyer friend showed me a very old cartoon of a cow, with one man holding the tail and another holding the horns. The guy holding the tail was labeled "plaintiff" and the guy holding the horns was labeled "defendant". In between, milking the cow, was a third guy, labeled "attorney".

Labs are sort of like that. The doctor looks intelligent and busy, the patient feels that something important is happening. But in reality, nine times out of ten, the only real winner is the lab. I'm constantly amazed at the reams of testing information that typically accompanies a new patient, and how often these tests would appear to have had no basis for being ordered in the first place. Wouldn't the patient have been better off getting a new sweater or some slacks rather than to be left with a photostat of some normal lab values --which most of the time no one bothers to explain to them anyway-- or to have paid good money for spurious or even questionable testing?

Also guys, c'mon, dump the normal test results from a decade ago. Although they may mean something to you, a normal lab result older than about six months is just about worthless to your doctor and forcing him or her to peruse them is apt to just cause something important to be missed. It's nice that your urine was healthy in 1986, but frankly, we're not very interested in that.

You'd think alternative doctors would be less seduced by fancy-pants testing but it seems to me that they are often more likely to order them. Perhaps it is some sort of insecurity, or a desire to look "doctorly". On the allopathic front, how many tests are ordered just so that if things come to some sort of litigation, one's proverbial gluteus maximus is covered. Of course the fact that Big Brother Insurance pays for it all adds to the carnival atmosphere.

I met a new patient recently who had reams of tests including the two most recent which showed a gradually increasing white cell count. However, apparently nobody had paid any attention to this. At first I thought it could be some sort of low grade infection, since she was a B non-secretor. But over the course of the interview she referred several times to a twinge on the right side of the abdomen, which made me think of perhaps a low grade appendicitis flare up. Nine times out of ten these resolve with a change in diet and supportive care, and right then and there nothing more needed to be done, so I just advised her to look for signs of an escalating problem, such as fever or severe cramps, and move on them.

Frankly, I think the over-reliance on obtuse lab testing erodes the doctor-patient relationship. Most patients would do better with a dose of reality, especially when it comes to an appreciation of their limitations.