"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
Serendipty: The flu vaccine shortage has been a bonanza for Kimberly-Clark's new anti-viral Kleenex, which is flying off shelves.
The Kleenex has a specially treated middle layer, containing citric acid and sodium lauryl sulfate, but as one microbiologist points out, just having the chemicals there doesn't necessarily make the tissue an effective virus killer :
"But let's say you have a large amount of mucus coming out of your nose, it is virtually impossible for the amount of citric acid and sodium lauryl sulfate in a tissue to diffuse through that and effectively kill all the virus in a particular sample."
In addition, the tissue must be wadded up rather carefully with the mucus inside before it is tossed in the trash can. Stuffing it back into a pocket is liable to spread the virus.
Also, for successful germ control, no mucus can touch the cold sufferer's hands. If it does, the virus can be easily transferred to a new victim either directly or indirectly. "So the concept is good, but the execution may allow for a limited effectiveness,"
The company claims that 99.9% of cold and flu viruses -- specifically rhinoviruses type 1A and 2, influenza A and influenza B and respiratory syncytial virus -- that are trapped in the treated tissue will be killed within 15 minutes.
A 99.9% kill rate seems pretty optimistic. Especially for the large boluses of mucous that come out of most people's noses when they blow them. posted by Sydney on
12/03/2004 08:46:00 AM
0 comments
Preparedness Update: Are we prepared for a bioterrorism attack? No. We've got stockpiles of supplies, but no way to distribute them. That should come as no surprise to anyone who has tried to get a flu vaccine this year. If distribution plans had been in place, the flow of vaccine from the manufacturer to the CDC to local public health departments and then to the high risk public should have been smooth. It wasn't, and hasn't been. Instead, we've had heads of local public and state public health departments stating publicly they have no idea if and when they'll get flu vaccine, and we've had elderly people standing in long lines at grocery stores and pharmacies to get vaccines.
Part of the problem may be understaffing, but a larger problem is that those who have been made responsible for bioterrorism response plans seem to have a mental block when it comes to taking the threat seriously. They're more concerned about familiar threats, such as influenza and antibiotic-resisitant bacteria:
...."I'm not downplaying five deaths from anthrax," Gensheimer said, "but we have 38,000 people dying of influenza each year."
Even in cases where vaccines and antibiotics are available, the supply of these medications is unreliable. "There have been shortages of several antibiotics," said Gensheimer. "It's a symptom of the whole system. We really are vulnerable."
"And people still don't have any clue what we're talking about when we say 'influenza pandemic,' " said Olson. The Spanish Flu of 1918-19 killed at least 25 million people worldwide in just those two years — more than died in World War I.
"The U.S. does not have a robust infrastructure for developing antibiotics — they're viewed as low-priced commodities," said Olson, "increasing reliance on off-shore manufacturers. The fact is we don't have the ability to ramp up to produce these drugs."
Not to downplay the here and now of those problems, but bioterrorism is a very real threat that we must take equally seriously. And while it's beyond the ken of public health departments to improve drug research or vaccine manufacturing methods, it certainly is within their ken to have distribution plans in place and tested, and to have the staff hired to implement them. (Or, at the very least, to have enlisted volunteers from the local medical community to help implement them.)
In many areas, mine included, efforts at bioterrorism preparedness have been non-existent. There needs to be a full accounting from each state and local health department to the federal government of how those bioterrorism preparedness funds were spent. And then, there needs to be some accountability.
The CDC and HHS have proven themselves inferior to the task of coordinating nationwide bioterrorism preparedness. Perhaps Tom Ridge's replacement at Homeland Security will be up to it. posted by Sydney on
12/02/2004 08:14:00 AM
0 comments
TennCare Update: Tennessee's experiment in universal health insurance coverage is still in limbo. The governor hasn't announced its complete elimination, but he has instructed its administrators to take steps to return to traditional Medicaid coverage.
Attempts at reforming rather than killing TennCare have been stalled by an advocacy group called The Tennessee Justice Center. Turns out, the attorneys at the Justice Center are making a killing on their lawsuits, all at the expense of TennCare:
The Tennessee Justice Center has received millions of dollars in court-ordered payments from TennCare, but the executive director of the nonprofit legal advocacy group says that isn't the motivation behind its legal challenges.
...In all, Tennessee has spent $11.3 million since 1998 to defend against class-action lawsuits from the center, paying both consultants and the public advocacy group's legal fees when they repeatedly defeat state attorneys in court, records show.
Sen. David Fowler, R-Signal Mountain and a member of the TennCare Oversight Committee, said the state has no choice but to pay the legal fees if a judge orders it.
``It's unfortunate that money is being spent on legal services rather than citizen services,'' Fowler said. ``But if the Justice Center wants to sue, we have to defend.''
All that money, and they're still running at a deficit. Maybe they need to cut their salaries.
Acknowledging Responsibility: From an editorial in today's New England Journal of Medicine (full text requires subscription):
Knowing that the media are primed and poised to focus on what we publish only increases the responsibilities of medical journals to maintain rigorous peer review and critical examination of how researchers interpret their findings. The media and the public see publication in peer-reviewed journals as validation of the research. Diligent reviewers and careful editors can identify mistakes, provide balance, and restrain overinterpretation. At this journal we go to great lengths to provide accompanying commentary from experts who can offer critical perspective and qualification. We urge the news media to try to do the same. Ironically, physicians tend to blame the journal when the media publicizes and misinterprets a research report.
Investigators see attention in the media as a valuable professional opportunity, as do their academic institutions, their funding sources (both public and private), and even their specialty societies, not to mention the pharmaceutical and medical-device industries. For private companies, publication and a positive press have cash value, which only further increases the need for peer-reviewed journals to remain critical and for policies such as ours that ensure that editors remain free of financial ties to those whose work they publish. Journals and those who write for them should be judged by the most critical standards of the medical profession, which has a memory that endures long after the flashes in the news media have faded.
They pat themselves a little too much on the back, but at least it's a start. Here's to the hope that future issues of the Journal will embrace an editorial policy of restraining statistical and rhetorical excesses in the papers they publish. It's not enough to provide accompanying commentary. The media and the public don't read those. They must also actually function as editors to the papers they publish and not fear telling an author, no matter how respected they are, that their analysis is flawed or their claims excessive. Once a paper gets published, it becomes gospel. The time to exercise editorial responsibility is before publication, not after. posted by Sydney on
12/02/2004 07:24:00 AM
0 comments
Redefining Normal: While Proctor & Gamble strives to redefine normal sexual appetites, some plastic surgeons and gynecologists seek to redefine normal genital anatomy. They're convincing women that they need surgery to make their genitals fit into skimpy bathing suits or to look like porn actresses, where evidently smaller is better. But other doctors, and porn producers, say that's bunk:
Some plastic surgeons, who note that there is no such thing as "normal" female genitals, are scratching their heads.
"It doesn't make a lot of sense to me, to be honest," said Dr. Young, of the American Society of Plastic Surgeons, who said he does a small number of labiaplasties in his practice in St. Louis. "I try to discourage most patients."
Even people in the pornographic film industry say there is no universal standard of beauty for genitals and that, in any event, men fantasize about the woman, not any one body part.
Mark Kernes, a senior editor with the trade magazine Adult Video News, said, "I really don't think most men care."
I think it's fair to say I've seen more than my fair share of women's genitalia, and it's true. There really is no "normal." They're as varied as any other part of the body - lips, eyes, ears, noses. Goodness. If the porn industry doesn't recognize a standard of beauty in that area, why should anyone else? posted by Sydney on
12/01/2004 08:40:00 AM
0 comments
Fast Tracking: The FDA has a testosterone patch that's supposed to increase women's libido on a fast track path, and its maker is calling in favors to get it approved quickly:
The Procter & Gamble Co., which is applying for approval of its Intrinsa testosterone patch from the Food and Drug Administration panel, confirmed yesterday that it has asked a medical society that it backs financially to recommend approval.
Although the patch has been granted 'fast track' consideration by FDA, some critics have said that side effects have not been sufficiently studied.
A New York University psychologist said that the patch is being 'treated like a female Viagra,' even though it causes a fairly drastic change in a woman's hormonal balance.
Why on earth would the FDA fast track a lifestyle drug? A drug for a terminal illness or a lethal infection, yes. But a drug that increases sexual appetites? Please. There's no reason to rush this to market without sufficiently exploring its side effects. Not to mention making sure its benefits are real and not a placebo effect.
And that bit about requesting that the finanically-beholden International Society for the Study of Women's Sexual Health lobby for its approval is just appalling. And to think that some drug company executives blame general practitioners for too early and indiscriminate mass use of new drugs. Right.
Proctor & Gamble have even created a disorder for their new product: HSDD, or "hypoactive sexual desire disorder." And how, pray tell, do we determine what is classified as hypoactive? Human sexuality runs a broad gamut. It's impossible to classify into normal and abnormal, except at the extremes. Just as it is with any other type of appetite. posted by Sydney on
12/01/2004 08:33:00 AM
0 comments
Against All Odds: Imagine, you're pushing 60, your youngest child is 44, you're divorced, and you've had your tubes tied years ago. And then, you discover you're pregnant with twins. What are the chances of that? Pretty slim, actually. The story doesn't quote any of the woman's doctors, so it could just be a hoax.
When I was a resident we had a woman who came into the hospital every couple of months or so claiming she was in labor with twins. Usually she'd show up in the emergency room and would be whisked up to labor and delivery. If the people working that night had never encountered her, they'd put on the fetal monitors and then get all worked up when they couldn't find a fetal heart beat. Then an emergency ultrasound would find no babies, and off she'd go to psychiatry.
I'd take this story with a whopping grain of salt.
UPDATE: From a reader:
I once had a patient who had, due to surgery,one tube and one ovary, on opposite sides of the pelvis. She'd been told by lots of doctors, me being the final one, that she'd never get pregnant.
Of course, she did; every year after that she gleefully sent me a birthday card--the little boy's birthday, that is. One of the happiest deliveries I ever had, back when I did OB.
Of course, this kind of thing can happen. But I'm still suspicious of the woman's story. Especially since there's nothing but her word to back it up. A comment from her doctor would make it more believable.
Federal and state investigators yesterday continued unraveling the mystery involving four Florida residents who appear to have contracted potentially deadly botulism poisoning possibly linked to anti-wrinkle injections at a Fort Lauderdale clinic.
....McComb, 47, and his employee Alma Hall were in serious condition at the Bayonne Medical Center in Bayonne, N.J., and breathing on ventilators, according to the Sun-Sentinel. It was unclear why the two were in New Jersey. The other two patients, also on ventilators, were at Palm Beach Gardens Medical Center in Florida.
...It is not known whether the four received Botox, another FDA-approved product or a counterfeit substance.
A hospital in the Netherlands -- the first nation to permit euthanasia -- recently proposed guidelines for mercy killings of terminally ill newborns, and then made a startling revelation: It has already begun carrying out such procedures, which include administering a lethal dose of sedatives.
Of course, the Netherlands isn't really the first nation to permit euthanasia. Germany, 1939:
The killing was usually arranged by the director of the institution or by another doctor working under him, frequently by innuendo rather than specific order. It was generally done by means of luminal tablets dissolved in liquid, such as tea, given to the child to drink. This sedative was given repeatedly - often in the morning and at night - over two or three days, until the child lapsed into continuous sleep. The luminal dose could be increased until the child went into coma and died. For children who had difficulty drinking, luminal was sometimes injected.
....Hans F. went on to tell how severely impaired the children were..."Those who were cleared for killing had prescribed for them much higher doses of luminal....Those children who were spastic,....had cerebral polio,....were idiots.....were unable to speak or to walk. And as one says today, allright, give them a sedative because they have been screaming. And with these sedatives...the child sleeps. If one does not know what is going on, he is sleeping. One really has to be let in on it to know that... he really is being killed and not sedated.
Initially limited to "mercy killings" at the behest of parents, Germany's child euthanasia program expanded within a few years to become automatic for babies deemed unlikely to live worthwhile lives - those with congenital deformities, cerebral palsy, Down's syndrome, microcephaly, hydrocephalous, and "serious hereditary diseases." Those categories soon expanded to older children and teenagers with the same conditions, and others - borderline mental impairments, juvenile delinquents, and of course, Jewish children, the ultimate "serious hereditary disease" of the day.
The Netherlands may not be in any immediate danger of descending from infant euthanasia to ethnic euthanasia, but once a society convinces itself that one type of life is not worth living, it's all too easy to convince itself that another type is equally unworthy. It's all just a matter of opinion. Today the unhealthy infant, tomorrow the hated minority. posted by Sydney on
12/01/2004 06:43:00 AM
0 comments
Tuesday, November 30, 2004
Ukrainian Medical Mystery Update: Former Congressman and Ukrainian election observer, Bob Schaffer, tells NRO Online that Ukrainian opposition leader Viktor Yushchenko was poisoned by biological agents:
I've known Yushchenko for many years and could barely recognize him when I saw him this time. Not until he spoke and I recognized his voice did I believe I was looking at the same man his face being so disfigured by the poisoning. No common virus could have done such a thing. In fact, his medical analysis indicates he had been simultaneously exposed to as many as five unlikely viruses.
HIV Vaccine: The BioEthics blog points to a Nature study that shows promise for an HIV vaccine. For some reason, they assume that Republicans and fundamentalist Protestants would oppose such a vaccine. Chalk it up to prejudice.
But the vaccine does has some practical problems. It doesn't prevent disease, it only suppresses it, much as the current drugs do. The advantage is that it would be a once a year shot instead of a daily regimen of several pills. But, making it is cumbersome, and likely very costly:
To make a dose of vaccine, the French doctors extract from each HIV-infected patient a sample of dendritic cells -- starfish-shaped white blood cells that play a special role in the human immune system. They also take a sample of the virus from the infected blood of each patient.
In the laboratory, they separately grow uninfected dendritic cells and a batch of the virus itself. The virus is eventually killed and mixed in with the dendritic cells, whose special function then becomes vital.
The dendritic cells consume the virus, breaking it into pieces and displaying the parts on their surfaces like grisly trophies.
Doctors then inject the dendritic cells back into each patient.
If it pans out, but turns out to be very expensive, would it be worth replacing the current anti-viral drug regimens that have also been very successful? posted by Sydney on
11/30/2004 08:00:00 AM
0 comments
HIV Vaccine: The BioEthics blog points to a Nature study that shows promise for an HIV vaccine. For some reason, they assume that Republicans and fundamentalist Protestants would oppose such a vaccine. Chalk it up to prejudice.
But the vaccine does has some practical problems. It doesn't prevent disease, it only suppresses it, much as the current drugs do. The advantage is that it would be a once a year shot instead of a daily regimen of several pills. But, making it is cumbersome, and likely very costly:
To make a dose of vaccine, the French doctors extract from each HIV-infected patient a sample of dendritic cells -- starfish-shaped white blood cells that play a special role in the human immune system. They also take a sample of the virus from the infected blood of each patient.
In the laboratory, they separately grow uninfected dendritic cells and a batch of the virus itself. The virus is eventually killed and mixed in with the dendritic cells, whose special function then becomes vital.
The dendritic cells consume the virus, breaking it into pieces and displaying the parts on their surfaces like grisly trophies.
Doctors then inject the dendritic cells back into each patient.
If it pans out, but turns out to be very expensive, would it be worth replacing the current anti-viral drug regimens that have also been very successful? posted by Sydney on
11/30/2004 07:56:00 AM
0 comments
When Frayde Leventhal, 83, fell last year, her doctor sent her in for a brain scan. 'I thought I was getting Alzheimer's,' said the resident of Palm Springs, Fla. But the brain scan showed she'd suffered a minor stroke.
Her doctor called and told her to stop taking Vioxx. She says she hasn't been the same since her stroke: 'I sure don't play golf anymore.'
Merck will soon be getting a call from her son, Jim Leventhal, 56, one of Colorado's top malpractice attorneys.
But was it the Vioxx? His mom was 83. The risk of stroke goes up dramatically with age. In one study in Japan, the rate of strokes found on autopsy in people over 60 was as high as 32%. And in another population based study from Japan, researchers found the rate of asymptomatic strokes to be as high as 19% in those over 80. Chances are pretty good that it was Mrs. Leventhal's age that caused her stroke, and not her Vioxx. But then, you can't sue mother nature. posted by Sydney on
11/30/2004 07:21:00 AM
0 comments
Men Who Cry Bird: The World Health Organization is warning that the bird flu could kill millions:
BIRD flu is far more lethal than the SARS virus that struck Asia last year and could unleash a pandemic that could kill up to 50 million people, the World Health Organisation said yesterday.
...While SARS had a mortality rate of about 15 per cent, the deadly H5N1 strain of bird flu kills up to a third of the people it infects.
H5N1 is now able to latch itself on to more hosts, Mr Omi said.
The virus has killed 32 people in Thailand and Vietnam this year.
If it were extremely contagious and lethal, wouldn't it have killed more people in Thailand and Vietnam? But then, the threat isn't what the virus does now, it's what it might do in the future, which is difficult to predict.
But, if it does mutate into a highly contagious, lethal virus, a simple salt water nose spray may help slow the spread:
Inhaling a simple saltwater spray could help prevent the spread of disease-causing germs, a small study suggests.
....Edwards's team suspects the spray treatment increases surface tension in the fluid lining our airways, producing larger droplets that are less likely to stay airborne.
They acknowledged the study included few high-producers and further research is needed on the topic.
Nevertheless, the team said the findings may help to control an influenza pandemic..
The Sad Case of Dr. K: The sad story of an obstetrician who did everything right, except predict that there would be complications, and yet still lost his malpractice suit.
He delivered a baby vaginally because there were no indications that a C-section was necessary. But, towards the end of the delivery, the baby's shoulder got stuck in the vaginal canal. This unpredictable complication turns a routine delivery into an extremely difficult one. If it weren't for things like this, anyone could deliver babies for a living. In fact, it's because of complications like this that most of us are glad to have skilled obstetricians around to deliver our babies. Sometimes, during the process of delivery, the nerves passing through the babies shoulder get damaged, resulting in paralysis of the arm.
This is what happened to Dr. Kearney, the obstetrician in the article. He successfully delivered the baby, but it had a paralyzed arm, and for that he had to pay. (Plus, he let a moment of sympathy get the better of him and said something to the mother that she took as an apology.) The irony is, that if things were allowed to proceed on their own, with no intervention by the doctor, the results would likely be fatal for both mother and child.
Scientists have identified the first direct link between stress and aging, a finding that could explain why intense, long-term emotional strain can make people get sick and grow old before their time.
Chronic stress appears to hasten the shriveling of the tips of the bundles of genes inside cells, which shortens their life span and speeds the body's deterioration, according to a small, first-of-its-kind study involving mothers caring for chronically ill children.
If the findings are confirmed, they could provide the first explanation on a cellular level for the well-documented association between psychological stress and increased risk of physical disease, as well as the common perception that unrelenting emotional pressure accelerates the aging process.
The article doesn't say if the study controlled for such factors as sleep deprivation, which could certainly play a role in the physical effects of stress on the body. It's during sleep that our bodies repair and rejuvinate themselves, and mothers with chronically ill children would certainly be expected to get less sleep on average than mothers with healthy children.
posted by Sydney on
11/29/2004 10:57:00 PM
0 comments
Colds and Flu: Tend to work through your minor illnesses? It might be better to take a day off and recuperate. (No data available, so it's impossible to say how accurate the study's findings are. The fact that they plan to broadcast the findings on the BBC rather than publish them in a peer-reviewed journal raises red flags of caution.) posted by Sydney on
11/29/2004 08:00:00 AM
0 comments
Finding Their Voice: Those who stood by silently while John Kerry made embryonic stem cell research one of the rallying cries of his campaign, now speak up:
As California moves to begin a lushly financed program of embryonic stem cell research, medical ethicists and other skeptics are concerned that the $3 billion that state voters approved for the endeavor could become a bonanza for private profiteers.
Critics say the ballot measure that passed by a wide margin on Nov. 2 contains inadequate safeguards to ensure public oversight of the financial allocations and guarantee public benefit from any medical breakthroughs. They also worry that the promise of stem cell studies has been oversold to the public and say the money might better be directed to more mature medical technologies. (emphasis mine)
Funny, I don't remember the New York Times running this kind of story during the campaign, when Kerry was promising to spend money on embryonic stem cell research, and Edwards was insinuating that the current administration policies were killing people, or at least preventing them from walking. posted by Sydney on
11/29/2004 07:55:00 AM
0 comments
Promising Hearts: An interesting study appeared in Nature on Thanksgiving. The study found that a protein that plays a key role in skin healing, thymosin beta 4, also helped heal injured mouse hearts:
In the experiment, researchers at the University of Texas Southwestern Medical Center in Dallas induced heart attacks in 58 mice by constricting blood flow in a major artery leading to the left ventricle, or the heart's primary pumping chamber.
Half of the mice were injected with a dose of thymosin beta 4, while the rest received a placebo. Forty-five mice survived the procedure and their progress was monitored over a four-week period.
After a month, the mice treated with thymosin showed a 60 to 100 per cent improvement in their hearts' ability to contract and pump blood. That's at least twice the improvement of the other mice, the Texas team reported.
The biggest gains in heart function occurred within one to three days of their 'attacks,' they said, while the other mice tended to get worse.
The thymosin-treated mice also showed far less scar tissue in their hearts, indicating the treatment prevented death of heart muscle cells when they were deprived of oxygen, while levels of other protective immune molecules were increased.
They're planning a clinical study that will involve giving the protein to heart attack patients en route to the hospital. posted by Sydney on
11/29/2004 07:46:00 AM
0 comments
Public Health Sundays: Catholic churches in Massachussetts are advising parishioners to forego parts of the mass to avoid the flu:
Leaders of the Roman Catholic Church in Boston and Springfield issued advisories to parishioners in recent weeks telling them that if they have the flu or a cold, they should forgo a handshake of fellowship as well as sipping from the Communion cup during Mass.
Bishop Timothy A. McDonnell of the Catholic Diocese of Springfield went even further, suggesting that parishioners who are sick for any reason ''can excuse themselves from Sunday worship out of respect for their fellow worshipers."
...As a sign of fellowship and peace, Catholics routinely exchange a handshake during Mass, and Communion consists of both a wafer and wine sipped from a chalice. The United States Conference of Catholic Bishops has periodically issued recommendations on how to prevent disease transmission, urging the ill to avoid drinking from the Communion cup if they fear they could spread illness to other worshipers. But the latest guidance from the Massachusetts dioceses reflects the increased level of concern this flu season.
The Roman Catholic Diocese of Burlington is the only one in the country that has formally asked priests to refrain from using the communion chalice and parishioners to avoid the usual handshake, hug or kiss when they make the sign of peace during Mass until the end of flu season, the United States Conference of Catholic Bishops says.
..."The bishop didn't want to make people feel out of place if they did not want to offer their hand. And we're concerned that if a good flu epidemic is going, it would be very hard to deal with," said Gloria Gibson, director of communications for the diocese. "I think a lot of people are afraid of the cup and holding hands for prayer or shaking for the sign of peace because people are in there sneezing."
I know a woman who refuses to shake the hand of anyone near her who has sneezed or coughed or blown their nose during the mass, and she tells them exactly why, too. She also, needless to say, never drinks from the chalice.
posted by Sydney on
11/29/2004 07:40:00 AM
0 comments
Sunday, November 28, 2004
Ukrainian Medical Mystery: Ukrainian opposition leader Victor Yushchenko is suffering from a mysterious malady. No one seems to know what caused it, or if they do, they aren't telling. Theories of poisoning and biological weapons exposure have been bandied about.
