Commentary on medical news by a practicing physician.
"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
A California man who once tested positive for the virus that causes AIDS has learned the diagnosis made eight years ago was mistaken and he was never infected.
...The error may have occurred because Malone arrived at the clinic in 1996 with lab results from a testing firm showing he had HIV, said Karen Pridmore, spokeswoman for the VA's Northern California Health Care System.
The clinic performed its own HIV test on Malone to confirm the first set of results and it came back negative, but that information was never shared with the patient, Pridmore said.
Always confirm those outside tests. And always follow-up on the test results.
posted by sydney smith on 8/30/2004 08:24:46 AM
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Wonderful Chocolate: Good news for chocolate lovers. A little bit of chocolate appears to improve arterial blood flow:
The scientists, who presented their work Sunday at Europe's most important cardiology conference, gave 3.5 ounces of either dark, bittersweet, chocolate or fake chocolate to 17 healthy volunteers.
On another day, the volunteers were switched. They had no chocolate outside of the study, and investigators did not know what each volunteer ate during the study.
An ultrasound was taken of each volunteer's upper arm to see the functioning of the endothelial cells in the main artery. The cells accomplish their goal of controlling the stiffness of the blood vessel by secreting several active substances that regulate the flexibility of the vessel and influence clot formation.
'During the chocolate session, endothelial function was improved, whereas during the placebo day there were no such changes,' the study concluded. 'The favorable effects of dark chocolate lasted for three hours at least.'
The fact that it improves blood flow for a few hours in an arm doesn't necessarily mean that eating chocolate prevents heart attacks, but those of who like chocolate can feel a little less guilty about eating it.
posted by sydney smith on 8/30/2004 08:16:29 AM
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Vioxx and Hearts: What to make of the news last week that Vioxx causes heart attacks? Hard to say. The study was released in France, at a conference. The only figures available are those from press releases, so it's impossible to evaluate the claims that Vioxx users had three times the risk of heart disease as Celebrex users. (Three times what? 0.1 or 10?)
It's also impossible to inspect the data for confounding variables. Was there something about the Vioxx users that was different than the Celebrex users? Were they heavier, more likely to smoke, older? The fact that they were all on twice the normal dose of Vioxx suggests that perhaps they had arthritis pain that was not responding to traditional doses or therapies. With all of the recent evidence pointing to the role of inflammation in coronary artery disease, might the inflammation from their arthrititis be playing a role?
Too early to tell. But full disclosure of the data would be extremely helpful.
posted by sydney smith on 8/30/2004 08:07:25 AM
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Saturday, August 28, 2004
Rounding In Absentia: Making hospital rounds via robot. But, except for driving time, how exactly does this save time? And how does the robot do a physical exam?
And at least one person says robot care might be OK for surgeons, but not for primary care doctors:
Early was amused – and satisfied – with the doctor's wireless visit, calling the experience a "fun thing," adding, "You can still see your doctor, and talk to him."
Trish Early said it might bother her to visit with her primary care doctor via robot but not the urologist in the hospital following surgery.
"We don't know Dr. Ellison that well," she said. "All I want him to do is to get the job done and keep my husband alive."
posted by sydney smith on 8/28/2004 10:27:50 PM
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Stem Cells: I meant to link to this sooner, but for those who are interested in learning the basics of stem cell research, from the science to the politics to the ethics, the much-maligned President's Council on Bioethics has the most extensive and comprehensive collection of information. The main site includes links to their full report as well as transcripts of their discussions and debates and testimony.
The report is especially good, as are most of their reports. They present both sides of the debate and are quite solid in their summaries of the science. And they're written in readable language. The Council deserves far more credit than they generally receive for examining the issues in an even-handed manner. Not to mention making their process so transparent.
posted by sydney smith on 8/28/2004 10:16:08 PM
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Dying Ombudsman: Evidently, people in Ohio are dying horrible, painful, deaths. How else to explain the existence of the Ohio Compassionate Care Task Force or its recommendation that the state appoint a pain ombudsman:
Ohio should create a program to help dying patients and those with chronic pain enjoy the best quality of life possible.
...Dr. Warren Wheeler, the task force co-chairman, said a program for a pain and palliative care ombudsman in the Ohio Department of Health could educate health-care providers and patients about the importance of proper pain management -- something that doesn't always happen.
....An ombudsman could help by giving patients and their caregivers information about available services and then assisting in getting the care covered by health insurers, the report stated.
Just as importantly, Wheeler said, an ombudsman program could ensure that future doctors, nurses and pharmacists learn how to effectively manage pain.
In a perfect world, there would be no pain. Can an ombudsman give us a perfect world?
posted by sydney smith on 8/28/2004 09:56:36 PM
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Friday, August 27, 2004
The Not-So-Talented Mr. Kerry: Evidence of a conscience surfaces:
When Kerry is asked about the nightmares that haunted his sleep for years after he returned from Vietnam, he shrugs. "I don't think I've had a nightmare in a long time," he says. But then Heinz begins to mimic Kerry having a Vietnam nightmare.
"Down! Down, down!" she yells, patting her hands down on her auburn hair.
"I haven't gotten slapped yet," she says. "But there were times when I thought I might get throttled."
Kerry quivers his right foot and steers the discussion to the counseling programs he has supported for Vietnam veterans. Asked if he has been in therapy himself, he non-answers. "It doesn't bother me anymore, I just go back to sleep."
Heinz presses him. "Not therapy for the dreams, therapy for the angst," she says, and looks quizzically at him, awaiting an answer. Kerry shakes his head "No."
Maybe my first theory was right after all. Which brings up the next question. If Kerry is that ashamed of any angst the trauma of war may have caused him, why would he make his service in that war the centerpiece of his campaign? Does that not show a stunning lack of judgement and of insight? (via this article from The American Thinker.)
(Also posted as an update to the original post on August 22, below.)
ASIDE: I'm not so sure having a parasomnia would disqualify someone from the Presidency as long as it was successfully treated or they were able to successfully deal with it. (Stealing cat naps now and then, for instance.) But the story of the dreams is disturbing. It suggests he hasn't gotten over that angst yet. Do we want someone in the White House who might go to flash-back mode in the face of another September 11? (It also explains all those bravado pastimes - windsurfing, skysailing, snowboarding, power biking, shooting doves,etc. A man who hasn't come to terms with his anxieties usually feels as if he has to constantly prove himself.)
posted by sydney smith on 8/27/2004 04:46:10 PM
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Blaming the Media: South Bass Island, a Lake Erie island known as the "Key West of the Midwest," and completely dependent on summer tourism, is in economic trouble because of an outbreak of diarrhea in visitors. There's no clear cause, although the intestinal bacteria, E. coli, has been found in some wells:
Four more public wells and a handful of private wells have tested positive for E. coli bacteria, but health officials still don't know if tainted water is what sickened any of the 1,020 people who went to South Bass Island, then complained of gastrointestinal illness.
But so far, none of the sick visitors have been diagnosed with E. coli:
Nineteen people have submitted stool samples that tested positive for diarrhea-causing agents: Campylobacter (14), norovirus (3), salmonella (1) and Giardia (1).
There doesn't seem to any one thing causing the problem, and only a small percentage of visitors were sick enough to require a doctor's care:
Nancy Osborn, county health commissioner, said that 95 percent of the people who have complained of sickness were tourists; 84 percent had diarrhea; 53 percent experienced vomiting and nearly 4 percent visited a hospital emergency room or hospital. The ill range in age from 7 months to 83 years old.
The only thing they had in common was that they visited the island. However, many people visit that island in the summer. Hundreds of thousands, if not millions, usually only for a day or two. It's more likely that the reported illnesses are illnesses that would have happened whether or not they'd gone to South Bass.
Meanwhile, the residents blame the media for their misfortune:
This week, Mayor Bernard McCann began to offer a new twist on the classic words of Admiral Oliver Hazard Perry, whose 352-foot-tall granite monument towers over the island.
After a key naval victory in the War of 1812, Perry declared: ``We have met the enemy and they are ours.'' In the mayor's view, he has met the current enemy and they are the media.
...Some tourists are angry, too.
``I think you people (the media) blow everything way out of proportion,'' said an agitated Renae Morse, eating lunch at Mossbachs restaurant in the heart of town. A resident of Pittsburgh, she was in the third day of her Put-in-Bay debut.
``This is nothing but a party town. Who doesn't get sick after a night of drinking? Every kid in the world wants to call in and get their name on the list in case there's a lawsuit. I think you're only hurting the local businesses.
I'd go there this weekend, with the kids, if I weren't on call. Sounds like a great opportunity for nice quiet bike rides and picnics without the usual obnoxiously loud drunks. But I'm not sure I'd drink the water.
posted by sydney smith on 8/27/2004 08:27:13 AM
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Anticipating Influenza: Manufacturers are trying to make more influenza vaccine this year to avoid the shortages encountered last year. But one manufacturer has run into some problems:
Chiron Corp., which makes nearly half the country's flu shots, announced Thursday some batches of the Fluvirin flu vaccine made in its England factory were found to be contaminated.
About 50 million shots will be examined for safety before they are released, which could mean a delay of shipment until early October. The company reports eight of 60 batches tested so far have failed to meet Chiron's sterility specifications.
About 1 million shots have already been shipped to distributors but have not yet reached doctors and clinics, Chiron officials said, because flu shots are not being administered this time of year. The 4 million doses in the eight contaminated batches will be destroyed.
...A second major manufacturer, Aventis, said it was ahead of schedule in producing more than 50 million doses for use this season.
The overall goal is 100 million doses by October or November, so 4 million is a drop in the bucket. Hopefully the delay won't put a crimp in the supply.
posted by sydney smith on 8/27/2004 08:11:19 AM
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Thursday, August 26, 2004
Seeing Things: One of my patients told me today that after being quite blind for several years she was suddenly seeing flowers and birds. She was also seeing kings and castles. In her living room. She's not crazy. She has Charles Bonnet Syndrome. (And if it weren't for Google and the wonder that's the internet, I would never have figured it out.) You can read more about it here.
posted by sydney smith on 8/26/2004 10:59:53 PM
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Sign This... Just about every doctor has had the experience of a patient bringing a form in to the office to be signed that is essentially a medical excuse for non-medical reasons.
"I've been summoned for jury duty, but if you sign this, I won't have to go."
"I haven't paid my gas bill for two months, but if you sign this, the gas company will give me a reprieve."
"I bought plane tickets for a trip I've decided I don't want to take, but if you sign this, the airline will refund my money."
"I missed two days of work because I was at Lollapalooza, but if you sign this I won't get in trouble with the boss. (Does it help that I spent most of the time vomiting drunk?)"
"I hate looking for parking spaces at the mall, but if you sign this, I can easily find a parking space right up close."
So it's no suprise that combat surgeons would encounter the same sort of behavior in their practices.
posted by sydney smith on 8/26/2004 10:29:30 PM
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Wednesday, August 25, 2004
Indoor Air Pollution and Asthma: More evidence that being too clean can cause asthma in children:
Air fresheners, furniture polish and household cleaners may increase the risk of asthma in young children, a study has found. Those exposed to fumes from common domestic products were up to four times more likely to develop asthma than those who were not.
Outdoor pollution from vehicle exhausts is known to exacerbate asthma in susceptible individuals but it seems that staying inside offers little respite. Evidence is growing that indoor pollution caused by household products and appliances may have similar effects..
posted by sydney smith on 8/25/2004 10:04:59 PM
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Cancer Shedding: Those who want to be screened for colon cancer but don't want to have an endoscopic procedure to do it, currently have to have their stools checked for blood. The drawback to that is that there's a high rate of false positives. But researchers are looking for ways to detect shedding cancer cells in the stool. There have already been some tests that depend on genetic identificaiton of cancer cells. Here's one that identifies a chemical produced by tumors. If it pans out, it could lead to fewer needless colonoscopies.
posted by sydney smith on 8/25/2004 09:57:52 PM
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Environmental pressure swings may cause air leaks as a result of transpulmonary pressure changes across areas of trapped gas in the distal lung. This is the first report of music as a specific form of air pressure change causing pneumothorax (five episodes in four patients). ..... we speculate that repetitive pressure changes in the high energy-low frequency range of the sound exposures is more likely to be responsible.
I've heard of loud music damaging ears, but this is the first I've heard of it collapsing lungs.
posted by sydney smith on 8/25/2004 09:48:06 PM
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UPDATE: Michael Fumento says that Gina Kolata is wrong about adult stem cells:
How incredible that Gina Kolata would write of adult stem cells that, "There are no ethical issues in studying these cells, but the problem is in putting them to work to treat diseases. So far, no one has succeeded. ("Stem Cells: Hope and Setbacks", August 26.) In fact, the first success with marrow stem cell transplants was almost 50 years ago. Today almost 80 diseases can be treated or outright cured with these cells that are found not just in adults, as she wrote, but in umbilical cords. (See: this.) Insofar as Ms. Kolata is one of the nation's top science reporters, it stretches the imagination to think this is anything but yet another media effort to try to raise the perceived value of embryonic stem cells, which have yet to treat a single human disease, by ignoring the true value of the alternatives.
posted by sydney smith on 8/24/2004 10:14:55 PM
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Boomer Culture:Menopause, the Musical. Can't wait until the boomers reach the age of constipation and sleepless nights.
posted by sydney smith on 8/24/2004 09:14:33 PM
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The Smallest of the Small: The smallest baby ever to survive ( 280g, 25 cm length) is now 14 years old. How's she doing? A letter to the editor (subscription required) to the New England Journal of Medicine says just great:
At two years of age, our patient had a Mental Development Index score of 86 (normal range, 84 to 116) on the Bayley Scales of Infant Development and was walking independently. Toilet training took place at three years of age. At five years of age, her visual acuity was 20/200 (in the right eye) and 20/100 (in the left) and was corrected with eyeglasses. Her only hospitalization was at four years of age, for pneumonia. She continues to have reactive airway disease. She started kindergarten at six years of age. A workup for failure to thrive and short stature at three and nine years of age, respectively, revealed no abnormalities. Menarche occurred at 13 years of age. She attends a regular school and has a cumulative grade-point average of 3.70 (of a possible 4.00) for the previous eight years. Since her birth, she has gained an average of 1.8 kg in weight and 9.7 cm in height annually. The 50th percentile for weight and height for girls at the age of 14 years are 50 kg and 163 cm, respectively. Despite her present weight of 25.4 kg and height of 136.5 cm, no psychosocial maladaptations have been reported. The results of her high-school entrance examinations were in the 83rd percentile nationally.
posted by sydney smith on 8/24/2004 09:13:49 PM
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When Biology Trumps Genetics:These men began life looking exactly the same. Until nature intervened.
posted by sydney smith on 8/24/2004 09:12:30 PM
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Sunday, August 22, 2004
The Talented Mr. Kerry: I used to think that John Kerry's constant reference to his Vietnam service was akin to an accident victim who can't stop talking about the accident. Have you ever met anyone who miraculously lived through a horrible accident? One in which their car is left a mangled tangle and yet somehow they walk away with only a few minor scratches and sprains? I have. I've met quite a few. And each and every one of them brings up the story of their accident at every given chance. Many of them even carry around a photograph of the wreckage and show it, over and over again, just as Kerry reportedly does with his Vietnam home movies. It's a way to deal with the shock of a sudden, mortality-confronting catastrophic event - and perhaps a way of giving constant thanks to God for unexpected favors. And with each retelling, the car goes a little bit faster, the escape grows a little more narrow, just as Kerry now admittedly has embellished his own story.
It used to make sense, this theory. After all, Kerry was in some very heated combat situations, including one in which he chased down an armed enemy - and killed him. One on one. That had to be traumatic.
But then, amid all the Swiftboat Vet controversy, a different picture of Kerry began to emerge. Pictures like this, and this and this. (And don't forget this.) These are not portraits of a man traumatized by war. These are portraits of a man without a conscience.
When Kerry is asked about the nightmares that haunted his sleep for years after he returned from Vietnam, he shrugs. "I don't think I've had a nightmare in a long time," he says. But then Heinz begins to mimic Kerry having a Vietnam nightmare.
"Down! Down, down!" she yells, patting her hands down on her auburn hair.
"I haven't gotten slapped yet," she says. "But there were times when I thought I might get throttled."
Kerry quivers his right foot and steers the discussion to the counseling programs he has supported for Vietnam veterans. Asked if he has been in therapy himself, he non-answers. "It doesn't bother me anymore, I just go back to sleep."
Heinz presses him. "Not therapy for the dreams, therapy for the angst," she says, and looks quizzically at him, awaiting an answer. Kerry shakes his head "No."
Maybe my first theory was right after all. Which brings up the next question. If Kerry is that ashamed of any angst the trauma of war may have caused him, why would he make his service in that war the centerpiece of his campaign? Does that not show a stunning lack of judgement and of insight? (via this article from The American Thinker.)
UPDATE II: John Ray thinks the second theory is more plausible.
posted by sydney smith on 8/22/2004 06:13:33 PM
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