Category Archive 'Medicine'
18 Mar 2017
Sir Samuel Luke Fildes KCVO RA, The Doctor, 1891, Tate Gallery.
In 1949, Fildes’ painting “The Doctor” (1891) was used by the American Medical Association in a campaign against a proposal for nationalized medical care put forth by President Harry S. Truman. The image was used in posters and brochures along with the slogan, “Keep Politics Out of this Picture.” 65,000 posters of The Doctor were distributed, which helped to raise public skepticism of the nationalized health care campaign. In 2008, the AMA was no longer defending the sanctity of the doctor-patient relationship and the independence of the Medical Profession, but was instead supporting Obamacare and the nationalization of health care.
Dr. Publius, at Ricochet, explains how all this happened.
For the medical profession, there is one ethical obligation that surpasses all others. It is the very obligation that defines a classic profession, and once it is abandoned, members of that so-called profession no longer have any claim whatsoever to any of the special regard, respect, perquisites, or considerations that commonly accrue to true professionals in our society.
Physicians have referred to this obligation as the doctor-patient relationship. Like the lawyer-client relationship and the clergy-parishioner relationship, the doctor-patient relationship is supposed to be a sacred, protected, fiduciary one, in which the patient can feel safe in disclosing private information they may not even willingly tell their spouses, and in return the doctor agrees not only to keep that information private, but also to act on that information in such a way that furthers and optimizes the individual patient’s own best medical interests, without regard to which actions or recommendations might be to the doctor’s interests — or to society’s.
The abandonment of this sacred, fiduciary obligation (honored by physicians for over 2000 years) cannot be blamed on Obamacare. It was formally abandoned years before most of us had ever heard of Mr. Obama. The doctor-patient relationship, never as pure in practice as it was in concept, began to significantly erode in the 1990s. This, of course, was the heyday of for-profit HMOs, when the insurers used extreme coercion to make certain that doctors learned who their real customers were. Doctors who did not place the payers first had their reimbursements slashed, and often found themselves excluded from panels, and therefore from access to patients. In a surprisingly short time doctors by the thousands were signing “gag clauses,” in which they agreed to withhold from patients certain information that might be adverse to the interests of the HMOs.
It would be wrong to say that doctors did not mind these things. It troubled many of them deeply. Indeed, by the turn of the millennium many members of the profession were feeling, and occasionally publicly expressing, tremendous guilt for having had to abandon their chief ethical obligation to their patients, in order to continue practicing medicine.
Faced with an ethical dilemma which was increasingly difficult for them to tolerate, an outcry arose from within the medical profession demanding that their leadership take up the problem, and do something about it. Most doctors had in mind some sort of organized action by which the profession would attempt to reclaim its ethical grounding. And so, conferences were convened, debates (of a sort) engaged in, and at last, action taken.
What doctors in the trenches failed to realize was that the physicians who dedicate their careers to leading professional organizations are almost always Progressives, because this is what Progressives do. So the action that was finally taken was the official adoption of a new set of medical ethics, which was published in 2002: “Medical Professionalism in the New Millennium: A Physician Charter. “(Annals of Internal Medicine, February 5, 2002). This document described a new ethical precept which was to be formally adopted by the medical profession. That new precept was, of course, “Social Justice.” Under the precept of social justice, doctors, in making medical decisions at the bedside, suddenly became obligated to take the equitable distribution of healthcare resources into account. Covert rationing at the bedside at the behest of payers (who presumably knew more about equitable distribution of resources than individual physicians did), was not only acceptable, and not only a positive good, but an ethical requirement.
During the intervening years this new charter of medical ethics was indeed formally adopted by virtually every medical professional organization in the world.
Adding social justice to the ethical obligations of physicians or course did nothing to ease the discrepancy between the needs the patient and the needs of the payer. But its addition at least assuaged some of the guilt of some of the doctors who chose not to think too deeply about it.
This modernized, progressive version of medical ethics was not the result of Obamacare, but it has served Obamacare well. It was a matter of mere moments before doctors noticed that it would behoove them to shift their efforts from making the insurers happy to making the government happy.
Today, when a doctor makes a medical recommendation to a patient, that patient can no longer be confident that the recommendation is truly the one the doctor believes is best for him or her. For it may instead simply represent what the doctor has decided the patient deserves, given his/her needs in relation to the needs of all the other patients in the Accountable Care Organization, the state, the country, or the world.
21 Jan 2016
I grew up in Shenandoah, so I know McAdoo.
I came across a classic Coal Region survival story yesterday, out of McAdoo, just south of Hazleton.
Justin Smith, 26, of McAdoo is what doctors are calling a medical miracle.
He was found nearly frozen to death on the side of the road about one year ago.
On Monday, he got the opportunity to thank everyone who helped him survive after spending nearly 12 hours out in the cold.
“I got done with work that day and we were going to the fire hall to hang out, having a couple drinks with some people, and I wanted to go home around 10 o’clock,” said Smith.
On that cold night last February, Justin Smith walked out of the Treskow fire hall, but never made it home.
His father Don found him the next day on the side of Treskow Road.
“I looked over and there was Justin laying there and he was laying face up there like this,” said Don Smith. ” He was blue. His face he was lifeless. I checked for a pulse. I checked for a heartbeat. There was nothing.”
“The coroner was on scene. The state police were on scene. They were doing essentially a death investigation,” said Dr. Gerald Coleman.
But Dr. Coleman, an emergency department physician at Lehigh Valley Hospital in Hazleton, refused to pronounce Justin dead when his body was that cold.
“Our mind is supposed to run the show, not our hearts because if your heart runs the show, you can run into some problems. I just kind of threw that to the wind and said, ‘No, not today,’” said Dr. Coleman.
A team in Hazleton performed CPR on Justin for two hours.
He was then transferred to Lehigh Valley Hospital Cedar Crest near Allentown where doctors used what’s called an ECMO machine to warm up Justin’s blood.
Doctors say flying Justin to Lehigh Valley’s Hospital near Allentown was a miracle in itself. They had to beat a snowstorm and do compressions on him the entire way.
“We knew we needed a big, big miracle,” Justin’s mom Sissy Smith said.
“When you have very low temperature, it can preserve the brain and other organ functions,” said Dr. James Wu of the Lehigh Valley Health Network.
Doctors said as Justin warmed up, his heart started beating.
Weeks went by before he actually woke up and realized where he was.
“It’s like I woke up from a dream, but it wasn’t a dream,” Justin said.
“When you look at the science of what happened to Justin, it was really hard to imagine that anyone on Earth could survive this,” said Dr. John Castaldo of the Lehigh Valley Health Network.
Now he’s back to his family he loves, golf, and school.
Justin lost his pinkies and all of his toes, but doctors call him a medical miracle.
31 Mar 2015
Bald’s Leechbook, British Library (Royal 12 D xvii)).
Scientists recently experimented with a recipe from Bald’s Leechbook aka Medicinale Anglicum an Old English medical text probably compiled in the ninth-century and found that a compound recommended for a common eye infection worked just as well as the modern antibiotic used to treat Methicillin-resistant Staphylococcus aureus (MRSA).
The project was born when a microbiologist at the University of Nottingham, UK, got talking to an Anglo Saxon scholar. They decided to test a recipe from an Old English medical compendium called Bald’s Leechbook, housed in the British Library. …
Sourcing authentic ingredients was a major challenge, says Freya Harrison, the microbiologist. They had to hope for the best with the leeks and garlic because modern crop varieties are likely to be quite different to ancient ones – even those branded as heritage. For the wine they used an organic vintage from a historic English vineyard.
As “brass vessels” would be hard to sterilise – and expensive – they used glass bottles with squares of brass sheet immersed in the mixture. Bullocks gall was easy, though, as cow’s bile salts are sold as a supplement for people who have had their gall bladders removed.
After nine days of stewing, the potion had killed all the soil bacteria introduced by the leek and garlic. “It was self-sterilising,” says Harrison. “That was the first inkling that this crazy idea just might have some use.”
A side effect was that it made the lab smell of garlic. “It was not unpleasant,” says Harrison. “It’s all edible stuff. Everyone thought we were making lunch.”
The potion was tested on scraps of skin taken from mice infected with methicillin-resistant Staphylococcus aureus. This is an antibiotic-resistant version of the bacteria that causes styes, more commonly known as the hospital superbug MRSA. The potion killed 90 per cent of the bacteria. Vancomycin, the antibiotic generally used for MRSA, killed about the same proportion when it was added to the skin scraps. …
It wouldn’t be the first modern drug to be derived from ancient manuscripts – the widely used antimalarial drug artemisinin was discovered by scouring historical Chinese medical texts.
04 Oct 2014
hierarchical aestheticism: Goes mad and dies from a brain tumor; suffers more than a century of lies about it being due to syphilis.
Friedrich Nietzsche, the philosopher thought to have died of syphilis caught from prostitutes, was in fact the victim of a posthumous smear campaign by anti-Nazis, according to new research.
A study of medical records has found that, far from suffering a sexually-transmitted disease which drove him mad, Nietzsche almost certainly died of brain cancer.
The doctor who has carried out the study claims that the universally-accepted story of Nietzsche having caught syphilis from prostitutes was actually concocted after the Second World War by Wilhelm Lange-Eichbaum, an academic who was one of Nietzsche’s most vociferous critics. It was then adopted as fact by intellectuals who were keen to demolish the reputation of Nietzsche, whose idea of a “Superman” was used to underpin Nazism.
The new research was carried out by Dr Leonard Sax, the director of the Montgomery Centre for Research in Child Development in Maryland, America. Dr Sax made his discovery after studying accounts of Nietzsche’s collapse with dementia in 1889.
18 Jul 2014
Carl Zimmerman‘s article at Ars Technica offers a useful precis.
Why do 40 percent of Caucasians have Type A, while only 27 percent of Asians do? Where do different blood types come from, and what do they do?
To get some answers, I went to the experts—to hematologists, geneticists, evolutionary biologists, virologists, and nutrition scientists. In 1900, the Austrian physician Karl Landsteiner first discovered blood types, winning the Nobel Prize for his research in 1930. Since then, scientists have developed ever more powerful tools for probing the biology of blood types. They’ve found some intriguing clues about blood types—tracing their deep ancestry, for example, and detecting influences of blood types on our health. And yet I found that in many ways, blood types remain strangely mysterious. Scientists have yet to come up with a good explanation for their very existence.
“Isn’t it amazing?” says Ajit Varki, a biologist at the University of California at San Diego, “Almost a hundred years after the Nobel Prize was awarded for this discovery, we still don’t know exactly what they’re for.”
I’m Type O, RH positive myself.
23 Aug 2012
The New York Times has a scary and intriguing medical detective story.
The ambulance sped up to the red brick federal research hospital on June 13, 2011, and paramedics rushed a gravely ill 43-year-old woman straight to intensive care. She had a rare lung disease and was gasping for breath. And, just hours before, the hospital learned she had been infected with a deadly strain of bacteria resistant to nearly all antibiotics.
The hospital employed the most stringent and severe form of isolation, but soon the bacterium, Klebsiella pneumoniae, was spreading through the hospital. Seventeen patients got it, and six of them died. Had they been infected by the woman? And, if so, how did the bacteria escape strict controls in one of the nation’s most sophisticated hospitals, the Clinical Center of the National Institutes of Health in Bethesda, Md.?
What followed was a medical detective story that involved the rare use of rapid genetic sequencing to map the entire genome of a bacterium as it spread and to use that information to detect its origins and trace its route.
Read the whole thing.
Hat tip to Stephen Frankel.
26 Jun 2012
Celebrating its 200th anniversary, the New England Journal of Medicine takes a look back, comparing causes of death in 1811, 1900, and 2010.
We have more heart disease and cancer, and seem to less frequently expire due to spontaneous combustion or the impact of a cannon ball. Fears of racial suicide and belief in the progress of eugenics are not what they were in 1912.
Hat tip to Sarah Kliff.
08 May 2012
Atul Gawande shares a great story of the pre-anaesthesia age, in the New England Journal of Medicine.
The limits of patients’ tolerance for pain forced surgeons to choose slashing speed over precision. With either the flap method or the circular method, amputation could be accomplished in less than a minute, though the subsequent ligation of the severed blood vessels and suturing of the muscle and skin over the stump sometimes required 20 or 30 minutes when performed by less experienced surgeons. No matter how swiftly the amputation was performed, however, the suffering that patients experienced was terrible. …
Before anesthesia, the sounds of patients thrashing and screaming filled operating rooms. So, from the first use of surgical anesthesia, observers were struck by the stillness and silence. In London, [Robert] Liston called ether anesthesia a “Yankee dodge” — having seen fads such as hypnotism come and go — but he tried it nonetheless, performing the first amputation with the use of anesthesia, in a 36-year-old butler with a septic knee, 2 months after the publication of Bigelow’s report. As the historian Richard Hollingham recounts, from the case records, a rubber tube was connected to a flask of ether gas, and the patient was told to breathe through it for 2 or 3 minutes. He became motionless and quiet. Throughout the procedure, he did not make a sound or even grimace. “When are you going to begin?” asked the patient a few moments later. He had felt nothing. “This Yankee dodge beats mesmerism hollow,” Liston exclaimed.
It would take a little while for surgeons to discover that the use of anesthesia allowed them time to be meticulous. Despite the advantages of anesthesia, Liston, like many other surgeons, proceeded in his usual lightning-quick and bloody way. Spectators in the operating-theater gallery would still get out their pocket watches to time him. The butler’s operation, for instance, took an astonishing 25 seconds from incision to wound closure. (Liston operated so fast that he once accidentally amputated an assistant’s fingers along with a patient’s leg, according to Hollingham. The patient and the assistant both died of sepsis, and a spectator reportedly died of shock, resulting in the only known procedure with a 300% mortality.
In his surgical exuberance, Liston apparently had cut through the coat tails of a distinguished visitor, who thought he’d been stabbed in the vitals and proceeded to die of fright.
14 Mar 2012
Run Google image searches on: “Penile Fracture” and “Peyronie’s disease.” I’m not posting pictures.
Jeff Winkler had a rather unusual, and incredibly unpleasant to even contemplate, accident.
With my one kidney, the Meckel’s diverticulum was unable to dissipate a blood clot causing aortic arrhythmia, which led to the ruptured penile corpus fracture and Peyronie’s disease. It was a freak accident.
29 Feb 2012
Science Daily reports that the count of blood group proteins has been increased for the first time in more than a decade by two more, raising the count from 30 to 32.
You probably know your blood type: A, B, AB or O. You may even know if you’re Rhesus positive or negative. But how about the Langereis blood type? Or the Junior blood type? Positive or negative? Most people have never even heard of these.
Yet this knowledge could be “a matter of life and death,” says University of Vermont biologist Bryan Ballif.
While blood transfusion problems due to Langereis and Junior blood types are rare worldwide, several ethnic populations are at risk, Ballif notes. “More than 50,000 Japanese are thought to be Junior negative and may encounter blood transfusion problems or mother-fetus incompatibility,” he writes.
But the molecular basis of these two blood types has remained a mystery — until now.
In the February issue of Nature Genetics, Ballif and his colleagues report on their discovery of two proteins on red blood cells responsible for these lesser-known blood types.
Ballif identified the two molecules as specialized transport proteins named ABCB6 and ABCG2.
“Only 30 proteins have previously been identified as responsible for a basic blood type,” Ballif notes, “but the count now reaches 32.”
The last new blood group proteins to be discovered were nearly a decade ago, Ballif says, “so it’s pretty remarkable to have two identified this year.”
22 Aug 2011
If anyone had any doubts that Chronic Fatigue Syndrome is essentially just a medical term for a confirmed habit of whining and malingering, this news item from Britain’s Guardian describing activists’ attacks on doctors questioning or investigating CFS demonstrates the existence of the sort of political constituency which genuine illnesses just do not have.
The full extent of the campaign of intimidation, attacks and death threats made against scientists by activists who claim researchers are suppressing the real cause of chronic fatigue syndrome is revealed today by the Observer. According to the police, the militants are now considered to be as dangerous and uncompromising as animal rights extremists.
One researcher told the Observer that a woman protester who had turned up at one of his lectures was found to be carrying a knife. Another scientist had to abandon a collaboration with American doctors after being told she risked being shot, while another was punched in the street. All said they had received death threats and vitriolic abuse.
In addition, activists – who attack scientists who suggest the syndrome has any kind of psychological association – have bombarded researchers with freedom of information requests, made rounds of complaints to university ethical committees about scientists’ behaviour, and sent letters falsely alleging that individual scientists are in the pay of drug and insurance companies.
“I published a study which these extremists did not like and was subjected to a staggering volley of horrible abuse,” said Professor Myra McClure, head of infectious diseases at Imperial College London. “One man wrote he was having pleasure imagining that he was watching me drown. He sent that every day for months.”
Chronic fatigue syndrome – also known as myalgic encephalomyelitis (ME) – is common and debilitating. A recent BMJ (formerly the British Medical Journal) feature suggested that as many as one in 250 people in the UK suffers from it. Patients are sometimes unable to move and become bedridden, occasionally having to be fed through a tube. For more than 20 years, scientists have struggled to find the cause, with some pointing to physiological reasons, in particular viral infections, while others have argued that psychological problems are involved.
It is the latter group that has become the subject of extremists’ attacks. The antagonists hate any suggestion of a psychological component and insist it is due to external causes, in particular viruses. In the case of McClure, her “crime” was to publish a paper indicating that early studies linking the syndrome to the virus XMRV were wrong and the result of laboratory contamination. So furious was the reaction that she had to withdraw from a US collaboration because she was warned she might be shot.
A similar hate campaign was triggered by a study published in the Lancet earlier this year. It suggested that a psychological technique known as cognitive behavioural therapy could help some sufferers. This produced furious attacks on the scientists involved, including Michael Sharpe, professor of psychological medicine at Oxford University. He had already been stalked by one woman who was subsequently found to be carrying a knife at one of his lectures.
“The tragedy is that this tiny group of activists are driving young scientists from working in the field,” said Sharpe. “In the end, these campaigns are only going to harm patients.”
22 Apr 2011
Wired describes a newly published scientific paper offering a new form of human taxonomic classification. This development offers promise of assistance in treating gastrointestinal diseases and obesity and in more specifically personalizing medical treatment in general.
In much the same way that every person has one of eight common blood types, each of us may contain one of several possible bacterial communities, suggests new research. …
In the latest study [Published Apr. 21 in Nature], [Mani] Arumugam, fellow EMBL bionformaticist Peer Bork and dozens of other researchers sequenced every gene they could find in fecal samples from 22 people from Denmark, France, Italy and Spain. Then they searched the data for patterns, looking to see if certain arrangements of bacteria tended to be found in certain people.
The search returned three distinctive “enterotypes,” or bacterial communities dominated by a distinct genus — Bacteroides, Prevotella or Ruminococcus — each of which is found with a particular community of bacteria (see picture above).
“One analogy that people draw — I don’t know how accurate it is yet — is blood type,” said Arumugam. “It’s not exactly the same. Blood types don’t change, but we don’t know if enterotypes do.”
Further analysis of microbiomes from 13 Japanese and four Americans returned the same three clusters, suggesting the patterns are widespread and unconnected to ethnicity, age or gender. With such a limited sample size, however, containing no microbiomes from South Asia, Africa, South America and Australia, it remains to be seen whether other enterotypes exist.
Beyond identifying the enterotypes, “anything we say now will be a hypothesis,” said Arumugam. In terms of function, each of the enterotype-defining genera has been linked to nutrient-processing preferences — Bacteroides to carbohydrates, Prevotella to proteins called mucins, or Ruminococcus to mucins and sugars — but far more may be going on.
“Exactly what they are doing in there is still to be explored,” said Arumugam.
20 Feb 2008
The Telegraph, 2/4, reported that in Britain Islamic rules are having an impact on medical procedures. One wonders: Do National Health Service patients get to refuse the services of Muslim doctors and surgeons?
Muslim medical students are refusing to obey hygiene rules brought in to stop the spread of deadly superbugs, because they say it is against their religion.
Women training in several hospitals in England have raised objections to removing their arm coverings in theatre and to rolling up their sleeves when washing their hands, because it is regarded as immodest in Islam. …
Universities and NHS trusts fear many more will refuse to co-operate with new Department of Health guidance, introduced this month, which stipulates that all doctors must be “bare below the elbow”.
The measure is deemed necessary to stop the spread of infections such as MRSA and Clostridium difficile, which have killed hundreds.
Minutes of a clinical academics’ meeting at Liverpool University revealed that female Muslim students at Alder Hey children’s hospital had objected to rolling up their sleeves to wear gowns.
Similar concerns have been raised at Leicester University. Minutes from a medical school committee said that “a number of Muslim females had difficulty in complying with the procedures to roll up sleeves to the elbow for appropriate handwashing”.
Sheffield University also reported a case of a Muslim medic who refused to “scrub” as this left her forearms exposed.
Documents from Birmingham University reveal that some students would prefer to quit the course rather than expose their arms, and warn that it could leave trusts open to legal action. …
But the Islamic Medical Association insisted that covering all the body in public, except the face and hands, was a basic tenet of Islam.
“No practising Muslim woman – doctor, medical student, nurse or patient – should be forced to bare her arms below the elbow,” it said.
17 Sep 2007
A stopped clock is right twice a day, and even the New York Times occasionally publishes an intelligent article.
In this week’s Sunday Magazine, Gary Taubes offers some much-needed skepticism about the omniscience of the kind of research whose results we continually hear trumpeted in the media.
Mr. Taubes’s reflections could readily be extended to other areas, particularly to climate studies.
Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem.
… hypotheses begin their transformation into public-health recommendations only after they’ve received the requisite support from a field of research known as epidemiology. This science evolved over the last 250 years to make sense of epidemics — hence the name — and infectious diseases. Since the 1950s, it has been used to identify, or at least to try to identify, the causes of the common chronic diseases that befall us, particularly heart disease and cancer. In the process, the perception of what epidemiologic research can legitimately accomplish — by the public, the press and perhaps by many epidemiologists themselves — may have run far ahead of the reality. …
The goal of the endeavor is to tell those of us who are otherwise in fine health how to remain healthy longer. But this advice comes with the expectation that any prescription given — whether diet or drug or a change in lifestyle — will indeed prevent disease rather than be the agent of our disability or untimely death. With that presumption, how unambiguous does the evidence have to be before any advice is offered?
The catch with observational studies…, no matter how well designed and how many tens of thousands of subjects they might include, is that they have a fundamental limitation. They can distinguish associations between two events — that women who take H.R.T. have less heart disease, for instance, than women who don’t. But they cannot inherently determine causation — the conclusion that one event causes the other; that H.R.T. protects against heart disease. As a result, observational studies can only provide what researchers call hypothesis-generating evidence — what a defense attorney would call circumstantial evidence.