January 7, 2018

Medicines are Bad for You

Every day, as I print the mandated medication information about a new prescription from my EMR, I end up saying something like:

“When you go to the health food store, all their pills and supplements are good for you, but everything I prescribe has side effects. It’s an uneven playing field.”

Some patients squirm uncomfortably as I continue.

“FDA regulated medications have to list known side effects, even if only one percent of people get them. Would you buy a car if you got a piece of paper that said you could burn to a crisp of the gas tank exploded in a rear end collision or get crushed if you got T-boned by a logging truck or suffocate if he car slid down an embankment and into the Atlantic?”

Usually that gets some recognition.

“It’s just so the pharmaceutical companies can’t get sued if someone comes to harm, because they have been warned. It’s like the man who successfully sued a lawn mower manufacturer for not warning against using it at eye level as a hedge trimmer – a twig flew in his eye that way and he lost his vision.”

Then I get nods and mumbles, but how much nocebo or placebo effect am I getting when I have to present my remedies in his fashion?

I read an article today about how pseudoscience is presenting itself with greater conviction than real science, how alternative practitioners seem unfettered by the doubts of real scholars (the Dunning-Kruger effect), and how now the alternative practitioners are immensely more dogmatic and authoritarian than science based medical professionals.

“One traditional view of the medical profession is that doctors are commanding and authoritarian, even arrogant. Though some individuals fit that description, in fact, the profession is built on doubt.

Most doctors, especially the good ones, are acutely aware of the limits of their knowledge. I have learned from those much more experienced and qualified than me that humility is something to be cultivated over time, not lost.

Our field is built around trying to prove ourselves wrong. In hospitals we hold morbidity and mortality meetings trying to show where we have failed, what we need to change, how we can do better. Our hospital work is audited to identify where we fell short of our ideals. Through scientific research we try to disprove the effectiveness of treatments. Our failings are exposed from the inside.”

January 1, 2018

Pacemaker no Contraindication for MRI

The New England Journal of Medicine reports that 1,500 patients with older pacemakers previously thought unsafe for MRIs underwent such studies without complications. And I always thought that was a no-brainer to even consider…

http://www.nejm.org/doi/full/10.1056/NEJMoa1604267#t=abstract

December 19, 2017

Odor can diagnose and even predict Parkinson’s disease

A retired nurse first smelled it in her then 35 year old husband. Scientists have now isolated the molecules.

Scientists sniff out Parkinson’s disease smellp05rcrcq.jpgThe breakthrough, inspired by Joy Milne’s sense of smell, could lead to the first diagnostic test.
Disclaimer: The BBC is not responsible for the content of this email, and anything written in this email does not necessarily reflect the BBC’s views or opinions. Please note that neither the email address nor name of the sender have been verified.

December 12, 2017

Spinal drug injection arrests Huntington’s Disease

The defect that causes the neurodegenerative disease Huntington’s has been corrected in patients for the first time, the BBC has learned.

Huntington’s breakthrough may stop disease_99155050_img_2496.jpgScientists say it could be the biggest breakthrough in neurodegenerative diseases for 50 years.
Disclaimer: The BBC is not responsible for the content of this email, and anything written in this email does not necessarily reflect the BBC’s views or opinions. Please note that neither the email address nor name of the sender have been verified.

December 10, 2017

Race in the Age of Personalized Medicine

On one hand, it may seem that physicians should consider their patients’ racial background when making diagnostic or treatment considerations. For example, certain blood pressure medications work better than others in African-American patients. But on the other hand, not only are racial boundaries fluid; features we have thought of as racial are often not. For example, sickle cell trait is more common in the Greek town of Orchomenos than it is among African-Americans.

Today’s The New York Times has an interesting essay about the need to go deeper and move beyond racial thinking when it comes to genetics, but to perhaps keep racial awareness when it comes to considering social or cultural risk factors for disease.

“Science seeks to categorize nature, to sort it into discrete groupings to better understand it. That is one way to comprehend the race concept: as an honest scientific attempt at understanding human variation. The problem is, the concept is imprecise. It has repeatedly slid toward pseudoscience and has become a major divider of humanity. Now, at a time when we desperately need ways to come together, there are scientists — intellectual descendants of the very people who helped give us the race concept — who want to retire it.”

December 8, 2017

Ramblings in The Lancet

The Brits seem to have more of a sense of history and our place in it than we do here in the New World. I was reminded of that as my attention was drawn to a piece called “Icarus” in this week’s The Lancet:

“Technology is often treated like it has a soul, and will itself make us better or make our lives easier; but technology is always a relationship between people, expressed in steel and wire. People worked far harder, in more dangerous conditions, after the Industrial Revolution than before. Even now, in the sweatshops of Asia and Africa, it is hard to argue that technology saves labour; nor, looking at offices in London and New York, is technology primarily intended for that purpose.

Medicine, too, is a relationship between people. Modern medicine relies on an engineering metaphor: the patient is essentially inert, and the pill or operation does something to him; so we are very good at procedures where the patient actually is largely inert (sewing a leg back on, taking an appendix out) and often very bad when the patient has a will, a spirit, or a compensatory physiological function. After a few words from the patient, we complete his story with a standard fairy tale. My wife hates me…I am lonely…My hands feel funny turn into Addison’s disease, or depression, or shingles; I think I want to die now turns into ticket number 52, building C, 9:15 am. A relationship between people has become a relationship between systems—or within a system, with the doctor and the patient as characters in an endless drama that is always the same.

Health care has increasingly become a commodity, and the greater amount goes to those who can pay. This might mean that tents of folk healing spring up around the hospital towers. Folk healing can be ramshackle but is likely to be, at least in places, informal and flexible, reflecting a relationship between acquaintances rather than the set targets of impersonal organisations. It may allow people to discuss what they mean by being healthy, and how to get there; although they will still live in the shadow of the corporation’s and state’s definitions of health; and folk healers are not guaranteed to be kinder than their official counterparts.”

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33092-1/fulltext

September 15, 2017

Life is the best education for a GP

PULSE, the British General Practitioner website has an amusing article by Dr. Zoe Norris, titled “Life is the best education for a GP”. I agree wholeheartedly.

Some examples:

1) Sit up all night with a child who has acute otitis media until their ear drum perforates.

2) Have at least two acute admissions: one that turns out to be nothing (trapped wind is a good one), and one that results in a hospital stay of at least 48 hours.

3) Try one dose of everything you prescribe.

4) Have at least one unpleasant examination.

5) Breastfeed. And bottle feed. Preferably with a normal baby who doesn’t know how to do either, while you are horribly sleep deprived.

6) Take a course of antibiotics without missing a dose. You can’t, can you?

7) Have headlice. And scabies. Then try to treat them.

8) Have constipation. And piles. Check what you are prescribing actually works – your patients will love you forever.

http://www.pulsetoday.co.uk/views/dr-zoe-norris/life-is-the-best-education-for-a-gp/20035263.article

September 9, 2017

Drug Patents Safer with Tribes than Offshore

Allergan’s Restasis eye drop patent has been sold to a Native American tribe. Generic drug makers therefore cannot challenge Allergan, because the patent now belongs to an entity that is very difficult to sue – Tribes are sovereign and US law doesn’t apply. Allergan will now be leasing the rights from the Tribe and paying handsome royalties. Almost like moving the rights offshore, but easier…

https://www.bloomberg.com/news/articles/2017-09-08/allergan-makes-deal-with-native-american-tribe-over-drug-patents

July 23, 2017

Friendly Dogs and Human Genetics

The reason dogs are friendlier than wolves appears to be a genetic one, according to an article in The New York Times:

“A group of scientists from Princeton, Oregon State University and other institutions combined behavioral and genetic studies of 16 dogs and eight captive, socialized wolves to pin down changes in two genes on a region of one chromosome that were associated with hyperfriendliness in dogs. The two genes, GTF2I and GTF2IRD1, are also associated with Williams-Beuren syndrome in humans.”

I found this interesting, because of my general love for dogs and my heartfelt memories of the three extremely affable beagles I have lived with over the years. Also, I know a boy, now in his early teens, with Williams Syndrome. I wrote about him in my first year of blogging in a peace called “All God’s Children”:

“Joey didn’t reach his developmental milestones; his eyes didn’t seem right and he had an unusual, broad grin, which he always flashed. By age two he was diagnosed with Williams Syndrome, a rare genetic disorder that affects one in 7,500 newborns.

Joey, in typical fashion for Williams Syndrome children, is extremely gregarious, even with strangers. He is a favorite with the nurses. He isn’t potty trained, cannot make three word sentences, and cannot make age-appropriate drawings.

His parents elected to give him the 4-6 year-old shots yesterday, and he protested loudly. Immediately afterward, he wanted to kiss the nurses.”

My 2008 piece concludes:

“We must all remember that our children are only loaned to us. We have a natural desire to see them grow up to be healthy and happy, and more often than not I think we hope they will be a lot like us. Our task and privilege as their parents is to see them for who they are, and help them reach their potential.

A youngster with Down’s or Williams Syndrome can be more capable of receiving and returning the love of their parents than a child without genetic challenges, and a healthy child can be killed in a freak accident in the matter of seconds. The wisest parents cannot protect their children from making their own mistakes, and even the elderly often have to grieve the loss of a child.”

June 25, 2017

Could an Alzheimer’s gene make you smarter, and a sickle cell gene make you healthier?

I just read a fascinating article in The New York Times about how genes we think of as bad sometimes do good things too:

“Consider the border between Finland and Russia, where there’s a sharp gradient in the prevalence of autoimmune disorders like celiac disease and Type 1 diabetes. As I’ve pointed out before, these conditions have become worrisomely common in Finland in recent decades, but are between one-fifth and one-sixth as common on the Russian side, despite the fact that the Russians are just as genetically predisposed to developing them.

What protects the Russians from their own genetic inheritance? Or better phrased, what makes the Finns vulnerable?

Finnish scientists think that exposure to a particular community of microbes — one that more resembles the microbiota of our less hygienic past — prevents the diseases from emerging in Russia. That’s important because at least some of the gene variants associated with autoimmune disease are probably useful; they most likely helped us battle infections in the past.

So instead of rewriting our genetic code, a better approach might be to change the interplay between our genes and environment — in this case by altering the microbes we encounter.”

https://www.nytimes.com/2017/06/17/opinion/sunday/crispr-upside-of-bad-genes.html?smprod=nytcore-ipad&smid=nytcore-ipad-share