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.”

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.

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…

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.”

May 8, 2017

Salt Isn’t Doing What We Thought

An entertaining article in The New York Times explains that, according to studies on Russian Cosmonauts, a high salt diet makes us hungry, not thirsty. Salt also helps us burn fat and produce our own water, thereby also increasing urine output, just like camels in the desert.

April 26, 2017

And How Long Will You Be Staying, Doctor?

A family physician writes in The New England Journal of Medicine about being asked, again and again, “And how long will you be staying, Doctor?”

“Caring for entire families helps me understand my community. I know that a patient is stressed because her son struggles with alcoholism: I’ve admitted him several times with pancreatitis. I know another patient can’t focus on her diabetes because she is still grieving her mother’s death: for years she wheeled her mother into my clinic for monthly appointments. When a teenager returns from a first year at college and asks for birth control, I remember her mother crying in my office months earlier, overwhelmed with pride and worry at having her first baby move so far away.
The patients weary of explaining all this — their tragedies, triumphs, and transformations — to a new face every few years, no matter how bright or kind that new face is. Seven years in, I understand why my patients would be disappointed if I left. As their doctor, I would be, too.”

April 25, 2017

Babylon: Smartphone App, Smarter than Doctors?

Babylon is announcing an investment of £50m to build what it claims will be the world’s most advanced artificial intelligence healthcare platform.

Its chief executive Ali Parsa says it will put expert health advice in the hands of smartphone users around the world. “Our scientists have little doubt that our AI will soon diagnose and predict personal health better than doctors,” he says.

But he is quick to stress that this will be a help to doctors, rather than a replacement: “No machine can put its hand on your shoulder and say trust me I’m going to take care of you.”

Babylon puts a doctor in the machine_95767717_502f750c-0cbc-48fe-9e44-462e538cc6a6.jpgBritish firm Babylon promises to build the perfect doctor using machine learning.
(From the BBC)

April 22, 2017

Can Trazodone Stop Dementia?

Two drugs, one old and one new, appear to stop the progression of prion disease in mice. This suggests that the old antidepressant-turned-sleeping pill trazodone could do the same for humans:

“Thus, in prion-diseased mice, both trazodone and dibenzoylmethane treatment restored memory deficits, abrogated development of neurological signs, prevented neurodegeneration and significantly prolonged survival. In tauopathy-frontotemporal dementia mice, both drugs were neuroprotective, rescued memory deficits and reduced hippocampal atrophy. Further, trazodone reduced p-tau burden. These compounds therefore represent potential new disease-modifying treatments for dementia. Trazodone in particular, a licensed drug, should now be tested in clinical trials in patients.”

April 15, 2017

A Doctor’s Healing Presence

This week’s Saturday Essay in The New York Times is about the relationship between a woman with ALS and her Syrian doctor:

“I knew I was lucky. Motor neuron disease is incurable and most people who have it die within a year or two, maybe five. But I was still alive. Soldiering on.

So when my doctor said I was fine, he meant he had discovered nothing new and alarming during this exam. I was holding steady. I wasn’t fine but I wasn’t dying, either.

We met every three months. The regularity of these appointments, and the close monitoring that the schedule suggested, should have terrified me. Instead, it made me feel safe. As time passed, I realized it wasn’t just the monitoring that brought me comfort but the doctor himself.”