1-1banner
 
medpundit
 

 
Commentary on medical news by a practicing physician.
 

 
Google
  • Epocrates MedSearch Drug Lookup




  • MASTER BLOGS





    "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



    email: medpundit-at-ameritech.net

    or if that doesn't work try:

    medpundit-at-en.com



    Medpundit RSS


    Quirky Museums and Fun Stuff


    Who is medpundit?


    Tech Central Station Columns



    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews

    Review


    Medical Blogs

    rangelMD

    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc

    richard[WINTERS]

    code:theWebSocket

    Psychscape

    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It

    medmusings

    SOAP Notes

    Obels

    Cut-to -Cure

    Black Triangle

    CodeBlueBlog

    Medlogs

    Kevin, M.D

    The Lingual Nerve

    Galen's Log

    EchoJournal

    Shrinkette

    Doctor Mental

    Blogborygmi

    JournalClub

    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House

    .PARALLEL UNIVERSES.

    SoundPractice

    Medgadget
    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day

    BioEdge

    The Business Word Inc.

    Point of Law

    In the Pipeline

    Cronaca

    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station

    Blogcritics

    Overlawyered.com

    Quackwatch

    Junkscience

    The Skeptic's Dictionary



    Recommended Reading

    The Doctor Stories by William Carlos Williams


    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn


    Intoxicated by My Illness by Anatole Broyard


    Raising the Dead by Richard Selzer


    Autobiography of a Face by Lucy Grealy


    The Man Who Mistook His Wife for a Hat by Oliver Sacks


    The Sea and Poison by Shusaku Endo


    A Midwife's Tale by Laurel Thatcher Ulrich




    MEDICAL LINKS

    familydoctor.org

    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info

     



    button

    Sunday, August 07, 2005

    From the Land of the Ever Young:: Is the
    placenta going to turn out to be the salvation of mankind? (An argument could be made that it already is, since none of us would be here without it):

    Scientists looking for easier and less-controversial alternatives to stem cells from human embryos said on Friday they found a potential source in placentas saved during childbirth.

    They described primitive cells found in a part of the placenta called the amnion, which they coaxed into forming a variety of cell types and which look very similar to sought-after embryonic stem cells.


    In addition to being researchers at the University of Pittsburgh, the researchers are also shareholders in a company called Stemnion, a biotechnology company that runs the business side of their research. Nothing wrong with that, except that it puts added pressure on them to succeed - or at least give the appearance of succeeding.

    The news reports say that the team got their placenta cells to transform into liver, pancreas, heart, and nerve cells, but the abstract of their paper suggests they merely hypothesize this could happen. (I could be wrong. The paper may go into more detail, but it's only available at a price.) What they did do, according to the abstract and the substance of their interviews, is analyze the contents and gene expression of the cells that make up the inside lining of the amnion, the transparent sac that surrounds the developing baby. (what is sometimes called the caul.)

    What they found is rather fascinating, and certainly has the potential to be a stem cell substitute. They found two genes switched on in the amniotic epithelial cells that heretofor were believed to only be expressed in embryonic stem cells. The first is the utiltarian named octamer-binding protein 4, a protein that plays a key role in controlling the expression of other genes, such as the second gene the researchers found switched on in their epithelial cells - the more imaginatively named nanog. It is this nanog gene, or so science assumes, that is the key to a stem cell's ability to turn into just about any type of tissue cell. It is also the gene that allows the embryonic stem cell to divide in perpetuity, hence its name, derived from Tir Nan Og, the land of the Ever Young in Celtic mythology.

    However, embryonic stem cells have something else going for them that keeps them ever young, an enzyme called telomerase, which repairs a cell's chromosomes as it divides into new cells. Ominously, telomerase, although absent in most adult cells, is also present in cancer cells. It may, in fact, be the key to what turns a normal cell into a cancer cell and sends it into an out of control cycle of propagation, growing and spreading throughout the body. Thus the concern that embryonic stem cells will have the unwanted complication of causing cancer. Amniotic epithelial cells, to their credit, do not have telomerase. They would thus appear to have the best of both worlds - the genes that allow embryonic cells to differentiate into different types of tissue cells, but no association with cancer.

    There's great potential there. In fact, amniotic epithelial cells have already repaired guinea pig ears and transformed into skin. The key word, though, as in all stem cell research, is potential. There is much about the inner workings of our cells that we have yet to discover. We won't truly understand their true potential until we completely understand their biology. Until that day, their therapeutic promise remains just as ephemeral as Tir-Nan-Og.

    UPDATE: Dr. Potato emails from the Phillipines to share another superstition about the caul - that it's associated with a sixth sense. She also shares a ghost story.
     

    posted by Sydney on 8/07/2005 11:20:00 AM 0 comments

    Saturday, August 06, 2005

    Morals: My medical practice and my house happen to be in the same neighborhood. It's what most people would call a nice neighborhood. It's graced by large, wooded lots and single family homes. There's a Catholic primary school at one end of it and a nice public elementary school on the other. My brother once called it a "very Brady Bunch place." And yet, a couple of weeks ago a house around the corner was exposed as a meth lab, and one day last week, I left the office to discover a SWAT team in the parking lot.

    Moral of the Story: The next time you're tempted to think in Brady Bunch stereotypes, remember that Mr. Brady was a deeply unhappy man and Mrs. Brady dated her older son.
     

    posted by Sydney on 8/06/2005 08:07:00 AM 0 comments

    Friday, August 05, 2005

    Wash, Rinse, Repeat: The best method to get rid of lice may be to search and destroy:

    Nigel Hill and his team asked the parents of 126 children aged 2-15 with head louse infestations to use pharmacy-bought insecticide products or the wet combing method, called Bug Busting, after washing the hair with normal shampoo and conditioner.

    Overall, 56 of the children were treated using the Bug Busting method and 70 using over-the-counter delousing products.

    The researchers then checked how many still had head lice two to four days after the volunteers had finished their treatment.

    The cure rate of the Bug Busting method was far higher than that of the chemical treatment - 57% compared to 13%.

    The authors said: "For every two or three people using the Bug Buster kit rather than pediculicides an extra person would be cured."

    However, only one dose of insecticide was used in the study as recommended by manufacturers.


    Here's a wet-combing method taught to me by a nurse: After each pass of the comb through wet hair, rinse the comb by swirling it in a bowl or glass of water. Discard the water and replenish it with fresh when it's cloudy. Repeat until the water no longer gets cloudy when the comb is rinsed. It works, but it's extremely time consuming.
     

    posted by Sydney on 8/05/2005 01:32:00 PM 0 comments

    More MedBlogs: And of course, how could I have forgotten? Grand Rounds is, as usual, excellent.
     
    posted by Sydney on 8/05/2005 01:15:00 PM 0 comments

    Medical Blog Alert: The Journal of Medical Practice has it's own blog - SoundPractice.Net - including podcasts! So, when will JAMA and the New England Journal of Medicine follow suit? (The NEJM already has audio interviews with authors on its website, but no blog.)
     
    posted by Sydney on 8/05/2005 01:02:00 PM 0 comments

    Thursday, August 04, 2005

    A Need for Reform: According to the New York Times the Vioxx trial is getting emotional:

    "The night Bob died, we lost my mom too," Ms. Sherrill told the Texas jury of seven men and five women. "She's very depressed."

    Ms. Sherrill cried repeatedly during her testimony, which lasted about an hour. Some people in the courtroom audience also cried, and the jury appeared to be paying close attention to her.

    ...Ms. Sherrill said that her mother had endured a difficult life before meeting Mr. Ernst in 1997. After divorcing her first husband about 16 years before, Ms. Ernst raised her four children as a single mother, Ms. Sherrill said. During that period, Ms. Ernst rarely dated, devoting her life to her children, and later earning a college degree.

    But when she met Mr. Ernst on a date arranged by another of her daughters, they fell in love almost immediately, Ms. Sherrill said. They married three years later. "She was happy, very happy," Ms. Sherrill said.

    "Had you ever seen her this happy your entire life?" asked Lisa Blue, a lawyer for plaintiffs.

    "No," Ms. Sherrill said. "They were together all the time, doing stuff all the time."

    She added, "He embraced our family and we embraced him," and then began to cry. Mr. Ernst's death devastated Ms. Ernst and she remains severely depressed, Ms. Sherrill said. "It's just hard. Every day is hard."

    When Ms. Blue asked, "How do you think the death of Bob has changed your mother?" Ms. Sherrill sobbed for several seconds.


    Isn't this the part where the attorney for the other side pipes up and objects that this testimony isn't relevant to the case? Surely, the family would be just as devastated by their step-father/husband's death regardless of the cause - wouldn't they? Yes, this case is about monetary compensation, so the suffering of the survivors counts, but shouldn't it be kept separately from the finding of guilt? How about a simple judicial reform that requires a trial to focus on the evidence of whether or not someone is guilty of causing the harm, making the decision of guilty or not guilty, then saving the emotional witnessing for the sentencing?

    If you think this is something that only big corporations need to worry about, think again. Anyone could find themselves the only survivor of an auto accident that wasn't their fault and end up in court facing the same sort of testimony. Call me naive, but I always thought our courts at looked at the facts, not the emotional impact, of a case.

    P.S. Medically speaking, this case is short on evidence that Vioxx killed the man:

    Mr. Ernst's death certificate lists an arrhythmia as his cause of death. Lawyers for Merck say that Vioxx has never been shown to cause arrhythmias, and so Vioxx cannot have caused Mr. Ernst's death.

    But W. Mark Lanier , a lawyer for Mr. Ernst's family, has told the jury that a blood clot caused by Vioxx led to the arrhythmia that killed Mr. Ernst. Even though the autopsy showed no evidence of a blood clot, several witnesses for plaintiffs, including Dr. Maria M. Araneta, the coroner who conducted the autopsy, have backed Mr. Lanier's theory and said that it was more likely than not that Vioxx caused Mr. Ernst's death.



     

    posted by Sydney on 8/04/2005 01:53:00 PM 0 comments

    Milk for Sale: A US company wants to buy and sell breast milk. Seems like production would be a major issue, enough to make it prohibitively expensive, as a spokesman for the UK's National childbirth trust pointed out:

    'There is a need for more mothers to come forward to give their milk, the whole issue needs to be valued more. I can see both sides of the argument.

    'However, I don't think it would work in the UK as it would prove too expensive for hospitals.'


    If it's too expensive for them, it's too expensive for the rest of us. Just because an insurance company might pay for it, doesn't mean we all don't pay for it in the long run.
     
    posted by Sydney on 8/04/2005 09:51:00 AM 0 comments

    Personal Note: One of my patients is in the ICU this morning with a life-threatening condition. When I asked him if he had any questions, he only had one - "Can I golf on Saturday?" The man has priorities.
     
    posted by Sydney on 8/04/2005 09:44:00 AM 0 comments

    Heimlich Maneuvers: The Heimlich maneuver is a proven method for removing objects lodged in the trachea of choking people. But, if you take a course in CPR taught by the American Red Cross, you will notice that they never refer to it as the Heimlich maneuver, but as "abdominal thrusts." Is that because of copyright issues, as a Red Cross instructor recently told my son's Boy scout troop, or bad blood?

    Heimlich does seem to be going off the deep end. There was his dubious foray into malriotherapy for AIDS patients and now he's using the National Enquirer to promote his Heimlich maneuver for drowning victims who are not choking. (See the original article here.) Always be wary of doctors who use the popular media to seel their theories - even if it's a paper of record rather than a supermarket tabloid.

    MORE: Heimlich's son, Peter, has collected all the information you could want on the controversy over the Heimlich maneuver's use in drowning.
     
    posted by Sydney on 8/04/2005 09:09:00 AM 0 comments

    This page is powered by Blogger, the easy way to update your web site.

    Main Page

    Ads

    Home   |   Archives

    Copyright 2006