Tagged: medicine

Snake oil?

Clark Stanley's Snake Oil Liniment. Before 1920.

Scientific evidence for popular health supplements depicted visually. The size of the ‘bubble’ for each supplement indicates its relative popularity, as measured by Google hits. Coloration indicates credibility of evidence. Of course, this is just the opinion of one source, but it largely parallels my own impressions from following the literature. (Information is beautiful)

Marburg Fever Survivor Puzzles Scientists

This negative stained transmission electron mi...

“The Marburg virus had never before reached North America, as far as experts know. It is a close relative of Ebola, and the diseases these viruses cause are among the world’s most dreaded, because they can have horrific symptoms and high death rates and are easily transmitted by bodily fluids. There is no vaccine, cure or even specific treatment.

Infectious disease experts had warned for years that someday an infected person might board a plane and carry one of these deadly viruses halfway around the world, potentially exposing countless others along the way. Now it had happened.

But Ms. Barnes survived, and no one else became infected, even though epidemiologists calculated that 260 people — hospital and lab workers, friends and family — had potentially been exposed.” (New York Times )

Uninsured Twice as Likely to Die in ER

“Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study.

The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable.” (Truthdig)

Bending the Rules of Clinical Trials for the Patient’s Sake

Newspaper advertisements seeking patients and ...
Newspaper ad solicits research volunteers

In the current issue of the bioethics journal IRB: Ethics & Human Research, investigators from four different institutions surveyed over 700 clinicians involved in clinical trials and found that 90 percent believed that ignoring certain entry criteria was acceptable if a patient could, in their estimation, benefit from the trial. In addition, over 60 percent of those surveyed also believed that researchers should deviate from study rules if doing so might improve a patient’s care.

While bioethicists and researchers have long suspected that doctors and other clinicians might be committing an occasional protocol infraction, few if any studies have looked at the extent to which such violations occur and how they might compromise research results.” (NYTimes)

I am not a researcher but purely a clinician. I’ve never been in a position to discover whether I would compromise a research protocol to benefit a patient, but I suspect the temptation would be strong (and would limit my ability to deliver good research findings).

Quack remedies spread by virtue of being useless

Photograph of three antique patent medicine bo...

“Eating a vulture won’t clear a bad case of syphilis nor will a drink made of rotting snakes treat leprosy, but these and other bogus medical treatments spread precisely because they don’t work. That’s the counterintuitive finding of a mathematical model of medical quackery.

Ineffective treatments don’t cure an illness, so sufferers demonstrate them to more people than those who recovery quickly after taking real medicines.” (New Scientist)

Fatal Deer Tick Virus Raises Concern

Adult deer tick, Ixodes scapularis.

‘While deer ticks are widely know to be the source of Lyme disease, they are now linked to a death by encephalitis. “We were concerned to find this particular virus in deer ticks which are extremely common,” said Harvard University epidemiologist Sam Telford, who first discovered the virus 12 years ago.’ (WCVB Boston )

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Don’t judge the chemo kid, says Rahul Parikh MD in Salon:

Hodgkin's lymphoma

‘The story of Daniel Hauser, a 13-year-old boy from Minnesota with Hodgkin’s lymphoma, became tabloid fodder overnight. The boy and his mother are on the lam because the mother refuses, because of her beliefs, to authorize chemotherapy treatments for her son. Hodgkin’s lymphoma has a 90 percent cure rate with chemotherapy, and a 95 percent chance of killing a person without it. Chemotherapy will likely save Daniel’s life, and as a pediatrician I wouldn’t hesitate for a moment to recommend it.

But I would also like to turn down the volume on the talk-radio chatter and outraged editorials. That’s because nobody seems to be talking about what it takes to beat Hodgkin’s (or any other cancer). What it takes is a grueling regimen that can indeed give even a dying person pause. In fact, the Hausers didn’t refuse chemotherapy outright. They defied doctors and a judge’s ruling only after Daniel experienced some of its violent effects following one round. If you don’t understand why, listen to my friend, Arun Ponnusamy, 36, who beat acute lymphocytic leukemia. “Surviving cancer is one thing,” he says. “Surviving chemotherapy is another thing entirely.” ‘

via Salon.

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An unusual cause for headache following massive alcohol intake

“Massive alcohol intake usually resolves in a banal headache. We report a case of a patient presenting with acute alcohol intoxication in which the ensuing “hangover” was due to a knife blade deeply retained in the brain parenchyma. This case underlines the unpredictability of retained foreign bodies without a high level of suspicion and a detailed description of the circumstances of admission.” (Emergency Medicine Journal via Mind Hacks)

Predicting Flu With the Aid of (George) Washington

The best way to track the spread of swine flu across the United States in the coming weeks may be to imagine it riding a dollar bill. The routes taken by millions of them are at the core of a computer model at Northwestern University that is predicting the epidemic’s future. Reassuringly, it foresees only about 2,000 cases by the end of this month, mostly in New York, Los Angeles, Miami and Houston.” (New York Times )

Related:

Some ways to track H1N1

This message was passed on David Farber’s IP mailing list:

Students in New York Fall Ill, and Swine Flu Is Suspected

‘Tests show that eight students at a Queens high school are likely to have contracted the human swine flu virus that has struck Mexico and a small number of other people in the United States, health officials in New York City said yesterday. The students were among about 100 at St. Francis Preparatory School in Fresh Meadows who became sick in the last few days, said Dr. Thomas R. Frieden, New York City’s health commissioner.“All the cases were mild, no child was hospitalized, no child was seriously ill,” Dr. Frieden said.’ (New York Times )

A few comments on pandemic influenza

Terry Jones
Terry Jones

“The virus has, as far as we know, not spent much time in humans yet. Once it does, it will begin to adapt itself in unpredictable ways. It may become more virulent, or less virulent. It may develop resistance to the antivirals that are currently effective. Antiviral resistance has been a topic of great concern for at least a couple of years. The current virus is already known to be resistant to both amantadine and rimantadine, though oseltamivir is still effective.

[...]

Some aspects of the current outbreak are, to my mind, cause for great concern.

The acting-director of the CDC has already said: “There are things that we see that suggest that containment is not very likely.” That is a remarkably candid statement. I think it’s very clear that the cat is out of the bag. The question is how bad is it going to be. That’s impossible to tell right now, because we do not know what the virus will look like in the future, after it has had time to mutate and adapt inside humans.

[...]

The new virus has been popping up in various places in the US in the last days. I expect it will go global in the next couple of days, maximum. What’s to stop it? The virus has been isolated in several diverse areas and in many cases is genetically identical. The 1918 virus also popped up, in many cases inexplicably, across the US…

There were 3 waves of the 1918/19 pandemic. The first was in summer of 1918 – very unusual, as influenza normally falls to extremely low rates during summer. Note that the current outbreak is also highly unseasonal.

The 1918 pandemic killed with a very unusual age pattern. Instead of peaks in just the very young and the very old, there was a W shape, with a huge number of young and healthy people who would not normally die from influenza. There are various conjectures as to the cause of this. The current virus is also killing young and healthy adults.

The social breakdown in a pandemic is extraordinary. If you read The Great Pandemic by John Barry, you’ll get some sense of it. America’s Forgotten Pandemic also helps give some idea of what it must have been like.

[...]

The influenza people at the CDC and the other international labs are an amazing team of experts. They’ve been at this game for a very long time and they work extremely hard and generally get a bad rap. It’s no wonder flu is such a political issue, the responsibility is high and the tendency towards opaqueness is understandable. Despite all the expertise though, at bottom you have an extremely complex virus – much of whose behavior is unknown, especially in the case of antigenic shift, especially when it is so young, and especially when you don’t know what nearby mutational opportunities may exist for it in antigenic space – spreading in a vastly more complex environment (our bodies), and with us moving and interacting in odd ways in a complex and extremely interconnected world. It’s a wonder we know as much as we do, but in many ways we don’t know much at all.” — Terry Jones via fluidinfo.

Related:

Ethics of Physicians’ Sexual Relationships with Patients

Medicine

A good introduction to the issue; helps you to understand the strict medical ethical guidelines against intimacy with our patients and even former patients, even when the parties are two consenting adults insistent on the consensual nature of their liaison. The ‘transference‘ to the authority of the physician, the AMA says, makes free choice on the part fo the patient difficult. The situation is even more thorny, the violations more egregious, and the condemnation of the profession more emphatic in my discipline, psychiatry, as you might imagine.

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Disease Mongering or Medicalization

MIAMI - MARCH 22:  Juan Ruiz (L) and Pablo Men...

“The medicalization of many social facets of our lives, multitasking pharmaceuticals and disease mongering are problems we should face head on…” via Sciencebase.

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Lincoln Remains

I have never been there, but this sounds like a fascinating place to visit:

“Between the reopening of Ford Theater, constant comparisons, and the 200th anniversary of his birth, the nation’s spotlight is fully fixated on the United States 16th President, one Abraham Lincoln. Yet through all the Lincoln buzz and excitement, an out-of-the-way museum in Washington D.C. is quietly preparing a different, somewhat more macabre kind of Lincoln exhibit. The National Museum of Health and Medicine owns the bullet that killed the president, casts of his face and hands, fragments of his skull jiggled loose during the autopsy, a lock of hair removed from the wound, the probe used to locate the bullet, and a shirt cuff stained with Lincoln’s blood.

Oddly, we have Lincoln himself to thank for the preserving of these items along with the rest of the wonderful collection at the NMHM. In 1862 Lincoln appointed William Alexander Hammond, a neurologist, to be the 11th Surgeon General of the U.S. Army. The National Museum of Health and Medicine was established that same year under Hammond’s orders. Its mission was to “collect, and to forward to the office of the Surgeon General all specimens of morbid anatomy, surgical or medical, which may be regarded as valuable; together with projectiles and foreign bodies removed, and such other matters as may prove of interest in the study of military medicine or surgery.” …

The museum holds far more than simply war artifacts. One fascinating display at the NMHM is the mummified head and shoulders of a girl who died naturally in the late 1800s and was embalmed using an arsenic-laced formula. While preserved by the arsenic, she was turned a ghostly white. The fetal section is incredibly compelling, with a row of skeletons arranged by height and illustrating different stages of development, to the conjoined twins, to the pathological fetuses, to the incredible Diaphanised fetuses (diaphanisation is a chemical process which stains the skeleton red, while making the flesh transparent). Another curious item is the Trichobezoar, a human hairball, removed from a 12 year old girl who compulsively ate her hair for 6 years. More than anything, Curious Expeditions would like to say while he surely never intended to end up as a part of the museum, we can thank Lincoln for helping create an institution where his remains are evident, both physically and metaphorically.” via Curious Expeditions thanks to julia.

Related?

Head and neck injury risks in heavy metal

A diagram of the forces on the brain in concussion

“Head bangers stuck between rock and a hard bass — Patton and McIntosh 337: a2825 — BMJ (Abstract):

Objective To investigate the risks of mild traumatic brain injury and neck injury associated with head banging, a popular dance form accompanying heavy metal music.

Design Observational studies, focus group, and biomechanical analysis.

Participants Head bangers.

Main outcome measures Head Injury Criterion and Neck Injury Criterion were derived for head banging styles and both popular heavy metal songs and easy listening music controls.

Results An average head banging song has a tempo of about 146 beats per minute, which is predicted to cause mild head injury when the range of motion is greater than 75°. At higher tempos and greater ranges of motion there is a risk of neck injury.

Conclusion To minimise the risk of head and neck injury, head bangers should decrease their range of head and neck motion, head bang to slower tempo songs by replacing heavy metal with adult oriented rock, only head bang to every second beat, or use personal protective equipment.”

via British Medical Journal.

The Cure Was Worse than The Disease

PyridostigminePyridostigmine

“The Gulf War illness was real and was caused by pyridostigmine bromide pills taken by U.S. troops to neutralize the effects of nerve gas attacks and by exposure to neurotoxic insecticides, according to a VA advisory panel.”

via MedPage Today

U.S. Doctors Regularly Prescribe Real Drugs As Placebo Treatments, Study Claims

Prescription placebos used in research and pra...

“Many rheumatologists and general internal medicine physicians in the US say they regularly prescribe ‘placebo treatments’ including active drugs such as sedatives and antibiotics, but rarely admit they are doing so to their patients, according to a study on bmj.com.

The use of placebo treatments in clinical practice has been widely criticised because it is claimed that the practice by its very nature is deceptive and therefore violates patients’ autonomy. But advocates of placebo treatments argue that they could offer effective treatment for many chronic conditions without necessarily deceiving patients. Despite the controversy, to date there has been little data on doctors’ attitudes towards and the use of placebo treatments in the US.” (Science Daily)

The only people bent out of shape by this are those unsophisticated physicians who can believe only in the concrete and materialistic explanations for how they ‘heal’. Most of medicine mobilizes patients’ healing resources through symbolism, ritual and enlistment into a belief system. That’s why I have such a hard time with the (equally concrete) critics of Western allopathic medicine. It is not that they offend me by not believing in what I do, but rather that they undermine the power of belief which is the basis of how physicians heal. In short, most treatment is probably mediated by the placebo response. Patients inherently give up their autonomy by consulting a health professional, and treatment will not work without an element of faith on their part.

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