"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
Beware the Baracuda: Think twice before eating the shark or barracuda fillets, especially if they were caught off oil rigs. They might bear ciguatera fish poisoning:
The condition is caused by eating fish containing toxins produced by the dinoflagellate Gambierdiscus toxicus, a one-celled plantlike organism that grows on algae in tropical waters worldwide. Because these toxins are lipid soluble, they accumulate through the food chain as carnivorous fish consume contaminated herbivorous reef fish; toxin concentrations are highest in large, predatory fish such as barracuda, grouper, amberjack, snapper, and shark. Because fish caught in ciguatera-endemic areas are shipped nationwide, ciguatera fish poisoning can occur anywhere in the United States.
What does it do? Besides causing vomiting and diarrhea, it makes the hot feel cold and the cold feel hot. That must be a strange, strange feeling. posted by Sydney on
10/07/2006 10:40:00 PM
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When asked what choices they would make if they could complete their education again, only 37.6% indicated they would choose primary care. Over one-third (33.8%) indicated they would choose a surgical or diagnostic specialty, while 28.6% indicated they would not choose to go into medicine at all.
This is sad. No wonder the number of medical students entering primary care is down. If the doctors they meet in the course of their training are so obviously unhappy, you can't expect them to chose the field. posted by Sydney on
10/07/2006 10:04:00 PM
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Misunderestimating the U.S.: That shameful infant mortality rate of ours, which is so often used as a stick with which to beat us into admitting we are an inferior nation, turns out to owe much to preterm infant deaths - even more so than previously thought:
Callaghan and other researchers examined birth and death certificates for about 28,000 U.S. infants that died in 2002.
About 4,600 of those - or 17 percent - were attributed only to preterm birth. But the researchers also grouped in more than 5,700 other deaths that were attributed to preterm-related conditions including respiratory distress syndrome, brain hemorrhage and maternal complications such as premature rupture of membranes.
In that counting, nearly 9,600 births - or 34 percent - could be classified as preterm, Callaghan said.
The researchers believe that figure is conservative and likely underestimates the true picture.
Experts have generally understood the burden of preterm birth on infant deaths, but the new study sorts out the data and provides specific numbers, said Carol Hogue, an Emory University professor of maternal and child health.
The Eyes are Upon You: Sometimes, when a new patient comes to the office asking for drugs of potential abuse, you get a feeling that they aren't legitimate, but have no way of proving it. They may say they're visitng family and pulled their back out while lifting the suitcase, or that their insurance changed and they had to find a new doctor, and doggone it, they're out of their prescription amphetamine for their adult ADD. It's hard to deny them their request based on a gut feeling that they're lying. Short of saying, "Sorry, I think you're lying," which, of course, opens a whole 'nother can of worms, the doctor is stuck. In Ohio, that situation will soon have a new out:
About 2,300 retail and mail-order pharmacies that sell to Ohio patients will be required to electronically report prescription sales twice a month to create the database, which has the ability to store 30 million to 35 million prescriptions.
Doctors and pharmacists then will be able to get a report via the Internet to see if patients are visiting multiple physicians and pharmacies to obtain the same types of drugs - commonly called doctor shopping. And law enforcement will be more easily able to uncover criminal activity.
I recently discovered that one of my suspected liars was indeed lying when her insurance company sent me a profile showing she had been going to other doctors in my neighborhood every two weeks for the same drug. I began to suspect her when she stopped by two weeks after her initial visit and said she needed her Adderall refilled two weeks early because she was going to Myrtle Beach and wouldn't be in town when it ran out. I told her she didn't need to worry about treating attention deficit disorder while lying on a beach. It would be OK if she missed a few doses. It would have been nice to be able to look her up during her initial visit when she requested refills to begin with.
Now that they have their database, will they ease up on letting doctors send prescriptions to the pharmacy electronically? posted by Sydney on
10/04/2006 07:38:00 PM
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Breastfeeding Wars: Ann Althouse notes a story that isn't critical of breastfeeding, but just doesn't affirm one of it's theoretical benefits, and gets slammed in her comments section. What is it about breastfeeding that brings out the worst in people? One of her commenters has the answer:
All of these parenting issues, not just breastfeeding, seem to bring out the cattiness. I suppose it's because most of us feel a little insecure about what we're doing and so we get defensive if someone makes a different choice. Breastfeeding is probably just the most noticeable because it is more visible than some other parenting choices.
(And yes, I'm breastfeeding as I type this. The current baby is 1 and I can now use both hands while he eats! Do I get a prize for that???)
Yes, you do!!! For you won't refuse to speak on the phone to the doctor you just paged because you are breastfeeding the baby. (An especially annoying thing for the doctor if she just happens to be breastfeeding while returning your call.) posted by Sydney on
10/04/2006 05:49:00 PM
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Young Hearts: A study in today's Journal of the American Medical Association suggests we should be doing EKG's on young athletes. That's pretty radical. The conventional wisdom has been that EKG's are not good screening tools. They provide good information when people are having symptoms - passing out, chest pain, paliptations, but as predictive tools they are lousy. So what is it about this study that changes that?
The study looked at athletes in the Veneto region of Italy, ages 12-35, from the years 1979 to 2004. The region has an ethnically homogenous population of 4,379,900. In 1982, Italy began requiring that EKG's be performed on all young people as part of their pre-participation sports exams. The Italian guidelines povide clear rules for what constitutes a positive screen in a young athlete:
Family History
Close relative(s) with premature myocardial infarction or sudden death at <50 years Family history of cardiomyopathy, coronary artery disease, Marfan syndrome, long QT syndrome, severe arrhythmias, or other disabling cardiovascular diseases
Personal History Syncope or near-syncope Exertional chest pain or discomfort Shortness of breath or fatigue out of proportion to the degree of physical effort Palpitations or irregular heartbeat
Physical Examination
Musculoskeletal and ocular features suggestive of Marfan syndrome Diminished and delayed femoral artery pulses Mid- or end-systolic clicks Abnormal second heart sound (single or widely split and fixed with respiration) Heart murmurs (systolic grade ?2/6 and any diastolic) Irregular heart rhythm Brachial blood pressure ?140/90 mm Hg on more than 1 reading
Electrocardiogram
Left atrial enlargement: negative portion of the P wave in lead V1 ? 0.1 mV in depth and ?0.04 s in duration Right atrial enlargement: peaked P wave in leads II and III or V1 ? 0.25 mV in amplitude Frontal-plane QRS axis deviation: right ?+120° or left –30° to –90° Increased voltage: amplitude of R or S wave in a standard lead ?2 mV, S wave in lead V1 or V2 ?3 mV, or R wave in lead V5 or V6 ? 3 mV Abnormal Q waves ?0.04 s in duration or ?25% of the height of the ensuing R wave, or QS pattern in ?2 leads Right or left bundle-branch block with QRS duration ?0.12 s R or R' wave in lead V1 ? 0.5 mV in amplitude and R:S ratio ?1 ST-segment depression or T-wave flattening or inversion in ?2 leads Prolongation of heart rate corrected QT interval >0.44 s in men and >0.46 in women Premature ventricular beats or more severe ventricular arrhythmia Supraventricular tachycardia, atrial flutter, or atrial fibrillation Ventricular preexcitation: short PR interval (<0.12 s) with or without delta wave First-degree (PR ?0.21 s, not shortening with hyperventilation), second-degree, or third-degree atrioventricular block
It also happens that since 1979, the medical establishment in the Veneto area has been studying the hearts of dead athletes in great detail:
Since 1979, all fatalities occurring in young people aged 35 years or younger in the Veneto region have been collected and investigated in the setting of a prospective clinicopathological study. The medical centers participating in this research project constituted an active network that served 94.4% of the population and permitted an accurate monitoring of fatal events occurring in this well-defined geographic area. (Participating centers are listed at the end of this article.) Regional newspapers were also systematically used at the coordinating center (The Institute of Pathological Anatomy, University of Padua, Padua, Italy) for daily monitoring of articles on sudden death in young people that occurred in the Veneto region, either sports-related or sports-unrelated.
Athletes and nonathletes who died a sudden death were examined postmortem by the local pathologist or medical examiner at each collaborative medical center to rule out extracardiac causes of death by routine autopsy. The entire heart was subsequently forwarded to the Institute of Pathological Anatomy for detailed morphological assessment, including macroscopic examination and histopatogic study of coronary arteries, ventricular myocardium, and the specialized conduction system as reported in detail elsewhere.... Clinical history, athletic activity, and the circumstances surrounding the cardiac arrest were investigated in each athlete who had a sudden death. According to the 1995 World Health Organization classification,1 cardiomyopathies included dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy.
The researchers looked at the incidence and causes of sudden death in young athletes before the 1982 screening guidelines, early in their implementation, and later, when they were standard of care. The incidence rates did go down during those successive years.
The authors claim this decline is due to the ECG portion of the pre-sports physicals, but there's no data to confirm that. The history and physical portion, may be just as important, and may be providing the real benefit. It also may be why here in the States, our rates of sudden cardiac death in young athletes are the same as in Italy, even though we don't routinely perform EKG's (we only recommend EKG's if the history or physical suggest a problem):
An accompanying editorial raised questions about the study, noting that the sudden cardiac death rate before Italy’s screening program was high compared to rates found in other studies. And the lowest annual death rate achieved after screening was similar to the U.S. rate for high school and college athletes from 1983-93.
The editorial also noted that different heart conditions are the most frequent cause of exercise-related sudden death in the two countries.
“I think we have to be very cautious,” said editorial co-author Dr. Paul Thompson of the University of Connecticut. “You can actually cause problems by screening. There are a lot of abnormalities out there that, if left alone, won’t actually do harm, and screening could lead to people getting procedures done that aren’t necessary.”
He added: “There’s a large medical-industrial complex willing to embrace screening, and they just happen to sell the tools used for screening.”
Drs. Gaetano Thiene and Domenico Corrado, co-authors of the Italian study, said their country’s higher mortality rates can be explained by the older age and higher proportion of men compared to the U.S. athletes. posted by Sydney on
10/04/2006 07:26:00 AM
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Making Lemonade: The winners of this year's Nobel Prize in medicine took an experiment gone wrong and turned it into success:
To produce the proteins used in cellular processes, the necessary DNA gene is copied onto a strand of genetic material known as messenger RNA, whose job is to carry the information from the nucleus into the main body of the cell. There, it is used as a template to make a specific protein.
Messenger RNA normally exists as a single strand, unlike the usual double-stranded helix of DNA.
Other researchers had observed that injecting extra messenger RNA into cells either did nothing or, paradoxically, actually inhibited protein production.
Researchers trying to enhance the red color of petunias, for example, inserted the messenger RNA for the red pigment. To their astonishment, petals came out white.
Fire and Mello explained how this occurred. They found that the protein-making ability was silenced when researchers inadvertently added a double-stranded form of RNA that was present as a contaminant when the RNA was synthesized in the laboratory.
Working with the humble nematode Caenorhabditis elegans, Fire and Mello showed that when double-stranded RNA bearing the gene for a specific protein was injected into a cell, it sparked a kind of housekeeping, in which the messenger RNA for the same gene was chopped up and destroyed.
Soldiers on operations say they would rather receive a more serious injury and go to the top American military hospital in Ramstein, Germany, than end up in a NHS hospital.
They now half jokingly refer to getting "a Boche rather than a Blighty" in reference to the wounds that would send them home. Ramstein has an outstanding unit for brain surgery, and neurological intensive care beds in Britain are in short supply. "The blokes see it that if you are unlucky you get wounded and go to the UK at the mercy of the NHS, but if you get a head wound you get sent to Ramstein in Germany where the US has an outstanding medical facility," said an officer serving in Afghanistan.
Would they really rather get shot in the head than go to the NHS? Or is it that wry British humor that's so often lost on us here in the States? posted by Sydney on
10/02/2006 08:50:00 PM
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....the legal system in the way my trial practice professor had explained it to me more than a quarter century before -- that trial isn't about finding the truth or doing justice. It's just one of the ways to resolve a dispute. And mediation is its alternative.
I've always thought of our justice system as a way to get the truth of a matter. And I'm sure most of us think of it as a means for justice. How else to explain all those activist lawsuits? There must be some lawyers who see at as a sword of justice rather than just dispute resolution, no? posted by Sydney on
10/01/2006 05:59:00 PM
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