Clinical

When I was in medical school it was common to get gifts from drug companies. Since many of us had very little money, the gifts were welcome. One company gave me a Littman stethoscope, at the time, the most advanced stethoscope around. The same model costs about $100 now. I was glad to get it, although I can't tell you the name of the company. I forgot the names as quickly as I pocketed their gifts. We all got lots of free samples, too, and they were often things like tranquilizers sent through the mail and left in the magazine bin in my apartment house common mailbox area. Yes, these folks…
I've seen surgeons blow up in the operating room but never saw an operating room blow up. But according to the Wall Street Journal, it's not that rare for them to catch fire and sometimes worse. Operating rooms are full of flammable gases and materials and oxygen. Moreover it isn't just a matter of taking a fire extinguisher off the wall or dumping a pail of water on the patient. There is the little matter of sterile procedures. So I was quite taken aback by a figure given in the article of 650 surgical suite fires each year in the US and maybe four times that number of "almost" fires (e.g.,…
In my younger days I was quite enamored of radiology as a specialty. I published some papers in that area and enjoyed reading x-rays, quite a complex task, requiring the reader to integrate three dimensional anatomy with two dimensional shadows and relate that to physiology, pathology, surgery, medicine and who knows what else. It was interesting and it was fun. The field has changed a lot since those days. For one thing, the pictures are not all two dimensional any more. First CAT scans and the MRIs have made it possible to reconstruct the two dimensional shadows, taken at a bunch of angles…
A study just published in the British Medical Journal (full disclosure: I haven't read it, only seen wire service reports of it, but I have absolute confidence it is true -- or, more accurately, I'd say it accords 100% with my prior beliefs so I'd have no reason to question it), says that US doctors routinely prescribe drugs purely for their placebo effect, believing they have no other substantive efficacy: Almost half of the rheumatologists and internists surveyed said they prescribed pills whose benefits derive from ``positive patient expectations'' two to three times a month, Jon Tilburt…
The health concerns about bisphenol-A (BPA), a component of hard polycarbonate plastic, has been extended once again (see here, here, here for previous posts on BPA). BPA, a ubiquitous contaminant of human bodies, leaches from water and baby bottles, the lining of tin cans, dental sealants and many other sources. BPA also looks a lot like potent hormones, like estradiol and the synthetic estrogenic agent, diethylstilbesterol (DES), the cause of transplacental carcinogenesis in humans. So there have been plausible concerns that BPA might increase the risk of cancer in humans, especially in…
We don't post much about clinical topics here, mainly because we haven't done much practice since our medical training days. I'm primarily a researcher and professor. But every once in a while I see papers on subjects that strike a nostalgic chord from those days and yesterday was one of those once-in-a-whiles. This was a report of a paper (DOI: 10.3748/wjg.14.5282) about what we used to call "gall balls in the gall bag," that is, gall bladder disease from gallstones. My medical school was located at a gigantic hospital with a very famous surgical program. And the chief surgeon there was most…
I was born by Caesarian section at a time when this method of delivery was fairly rare (too long ago to even mention). The reason was placenta praevia. Both my children were C-section births, too, both for good medical reasons. My daughter has now had two C-section deliveries. These data might lead some to think that C-section deliveries is hereditary but not so, unless you consider national residence to be heriditary (which it is but in a non-biological sense). I say this because the overall rate of Caesarian section deliveries is not astoundingly high (more than 25% of all live births in 12…
A recent letter on the worldwide prevalence of head lice in CDC's journal Emerging Infectious Diseases made me nostalgic for the good old days when our two kids were in daycare (they are both adults with children of their own in daycare now). In particular, I got to thinking about the days when I was active as an officer in the American Public Health Association (APHA) and many years made the yearly trek to its large annual meeting. While it's a large meeting, usually over 10,000 with scientific and business sessions spread out over many hotels, there is usually one headquarters venue where…
One of the effects of high gas prices is to encourage people to use bicycles. This also includes the police, where some jurisdictions are taking cops out of cruisers and putting them on foot or on bikes. Bike police (and bicycle messengers, people who use their bikes in crowded urban areas to endanger pedestrians), spend much more time in the saddle than most, other than professional racers and bike fanatics. A new study in the Journal of Sexual Medicine says the continual pressure on thei perineum is causing genital numbness in males. The culprit seems to be the nose on the traditional bike…
A new article in the British scientific journal, The Lancet, suggests that seasonal influenza vaccines may not be effective in preventing community acquired pneumonia in people 65 years old and older. This is the group specially targeted by CDC for vaccination each year and, not coincidentally, an age group that includes me. So I have both a scientific and personal interest in the subject. This isn't new news. We've previously discussed the evidence that shows seasonal vaccines are less effective in the elderly a number of times (see here and here) over the last few years, but the proposition…
We take for it granted that technology can be used to tag objects in various ways, useful and otherwise. The anti-theft devices used on retail clothing stores are a familiar example. Radio Frequency Identification Devices (RFID) are used for this purpose as well as for security access. I have a device like that on my windshield for automatic highway tolls on the turnpike. Hospitals also have a strong interest in keeping track of lots of items like pharmaceuticals, equipment or even ordinary sponges used in surgery. Counting and keeping track of sponges is routine so none are inadvertently…
Many years ago -- about 40 to be exact -- I was working as the only medical doctor in a bioengineering research laboratory in a famous technological university. A lot of what was done there involved speech synthesis (one of the first reading machines for the blind using text to speech recognition) and also some digital image processing. One of my interests was in radiology (the medical specialty of reading x-rays) and I was doing some research in that area. X-rays of the chest were usually taken in threes: the "posterior-anterior" (PA) view (back to front), the lateral (through the side) and…
Second Life is a virtual reality site, superficially similar to some massive multiplayer role playing games one finds on the net (like World of Warcraft). But it's not a game but a social venue. I've tried it out and posted on or mentioned it several times (here, here, here and here). Second Life is a global phenomenon, not just a US one. Now Spanish public health officials are trying it out as a way to reach young people about drugs and sexually transmitted diseases: Real doctors will log on and offer advice to their anonymous patients. What both will see is an image of a consulting room…
You'd think finding that there were some bird flu infections that went undetected would be bad news but it is actually good news. Not tremendous good news but better than no news, and that's unusual in the bird flu world. For some time the absence of mild or inapparent infections has been worrying. It means that the current case fatality ratio of over 60% is the real CFR, not one based on just the most serious cases coming to the attention of the surveillance system. Now scientists gathered in Bangkok at one of the many gatherings of those studying the disease have heard some new data…
I saw a small news article about what seems to me a fairly silly piece in a bulletin called Communicable Diseases Intelligence: Never mind the Tamiflu, authorities should be stockpiling thermometers in preparation for an influenza pandemic, public health specialists say. The much-rehearsed public health measures to contain an outbreak of influenza may fail because they falsely assume that most households have thermometers to allow self monitoring of suspected fever, they write in the bulletin Communicable Diseases Intelligence. For containment to be effective, health workers are expected to…
Another story about a "new" screening test, this one for prostate cancer, the most common cancer in the US. This one looks for a particular combination of variations in five genes. If a man has all five and a family history of prostate cancer then his risk of is increased by a factor of nine. The researchers who have devised the test have also patented it and plan to sell it for $300 bucks a pop. I, for one, am not buying it (literally or figuratively). First some of the details as given by a press report: Almost half of prostate cancer patients carry five genetic variations and a family…
In 2005 the world's bird flu doctors got together and pooled their meager knowledge about the epidemiology and clinical features of this zoonotic disase that has so far infected 350 people and killed 217 of them (latest "official" figures via WHO). In March of 2007 they got together again in Turkey and the New England Journal of Medicine (January 17, 2008 issue) has just published a joint report summarizing their discussion. Helen Branswell sets the stage: The article, a review of data compiled on human cases to date, answers some questions about how the virus affects people. But it also…
There is a determined honey lobby out there touting the health benefits of honey. That's fine with me, as I am not an enemy of honey. On the other hand, honey, while "natural," is not a completely harmless foodstuff, especially for infants. You wouldn't know it reading the spate of news articles on a Penn State study touting the benefits of honey over cough medicine for kids: The study found that a small dose of buckwheat honey given before bedtime provided better relief of nighttime cough and sleep difficulty in children than no treatment or dextromethorphan (DM), a cough suppressant found…
I learned emergency cardiopulmonary resuscitation (CPR) in medical school more than forty years ago and it hasn't changed much until now. It was always hard to do, but now it's half as hard and not as unaesthetic, at least if the results of several studies are taken into account. The problem was that you had to do two things simultaneously: maintain circulation by chest compression (usually pushing on the sternum) and aerate the mechanically circulated blood by artificial respiration (usually mouth to mouth resuscitation). This meant you stopped compression while inflating the lungs, then…