May 3 2008 By Kevan Christie
A SICK actor collapsed on stage – at the same time as his character was meant to have a heart attack and die.
Steve Dineen was taken to hospital after he keeled over during the dramatic finale of Mike Leigh’s famous comedy Abigail’s Party.
In the play, lead character Laurence dies of a heart attack in the final minutes and Dineen was moments away from acting out the death.
So when he fell suddenly to the floor, the audience at Musselburgh’s Brunton Theatre thought it was just part of his impressive performance.
But co-star Alice Selwyn noticed Dineen’s struggle was genuine and came out of character to ask for a doctor.
The actor was taken to Edinburgh Royal Infirmary and kept in overnight for tests.
The theatre’s marketing officer, Paul Brunton, said last night: “It was very traumatic at the time because it coincided with the exact moment where Steve’s character was about to have a heart attack.
“It was almost like real life imitating art.
“Thankfully, Steve is going to be OK. We’ve had lots of phone calls from the audience to check on him, which has been nice.”
Theatre spokeswoman Rachel Menzies added: “It had been going fantastically well up until that point, so it was quite a shock.
“When it became clear to some of the other actors that he wasn’t acting any more and that he was in some distress, they asked for the show to be halted.
“The ambulance was here in a matter of minutes.”
May 13, 2008
April 14, 2008
I have eczema. It’s annoying, and sometimes painful, and hard to treat. But it is not nearly this bad.
February 13, 2008
From the AP, via David Williams’ Health Business Blog:
Turns out installing alcohol-based handwashing gel dispensers in hospitals and encouraging staff to use them isn’t enough to prevent infections. … The issue was studied at a hospital in Nebraska, where gel use doubled but infection rates didn’t budge. It’s not surprising to learn that one tactic isn’t sufficient to control infections. Still, whenever I read about the poor record of hospital safety and quality it makes me mad. From the Associated Press:
More gel dispensers were put in the units, and usage rose from 37 percent to 68 percent in one unit and from 38 percent to 69 percent in the other. Compliance for hand washing of any kind in most hospitals is estimated to be about 40 percent, according to experts, although some hospitals do better.
Can you imagine a 40 percent compliance rate in any other business besides health care?
- Pilots going through their pre-flight checklists completely 40 percent of the time?
- Accountants calculating profit and loss correctly 40 percent of the time?
- Hamburger flippers putting all the ingredients on a Whopper 40 percent of the time?
No way. We shouldn’t tolerate it in health care either.
News from the (British) National Health Service (NHS), which is the UK’s universal health care system:
By Laura Donnelly, Health Correspondent
Last Updated: 2:09am GMT 28/01/2008
Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives.
Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.
Fertility treatment and “social” abortions are also on the list of procedures that many doctors say should not be funded by the state.
The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as “outrageous” and “disgraceful”.
About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt.
Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.
Nice to see that in a universal health care system, everyone has equal access to care, and no one is denied care just so the insurance companies can save money.
I’d like to see the presidential candidates comment on this!
January 7, 2008
Ben Smith at Politico.com relates:
Edwards responded sharply to a Clinton aide’s criticism today, intensifying a back-and-forth that began at last night’s debate, after Clinton said Nataline Sarkisyan could be alive if the patients bill of rights, which he’d boasted of championing, had passed.
“The Clinton campaign has no conscience,” Edwards said, after Clinton spokesman Jay Carson said Edwards does no more than “read articles about people who need help and talk about them.”
Well, if that isn’t the clearest case ever of the pot calling the kettle African-American, I don’t know what is. Recall this incident from the 2004 campaign, when Edwards said that the recently-deceased Christopher Reeve could be brought back to life if Bush had supported federal funding for stem cell research!
Edwards said Reeve, who died Sunday, “was a powerful voice for the need to do stem cell research and change the lives of people like him.
“If we do the work that we can do in this country, the work that we will do when John Kerry is president, people like Christopher Reeve will get up out of that wheelchair and walk again,” Edwards said.
Now I understand there is a lot of controversy about what, if any, benefits might result from stem cell research, and how long it might take for those benefits to be realized. But nobody — nobody except John Edwards — ever claimed it would result in resurrections.
But when former heart surgeon and then-Senator Bill Frist called him on it,
Edwards campaign spokesman Mark Kornblau hit back, “Yes, breakthrough research often takes time, but that’s never been a reason to not even try — until George Bush.”
So to summarize: John Edwards blames someone’s death on a policy of his political opponent’s. Hillary Clinton blames someone’s death on a policy of John Edwards. John Edwards claims, based on this fact, that Hillary Clinton “has no conscience.”
Therefore, by John Edwards’ own standard, John Edwards has no conscience.
Either that, or John Edwards is a hypocrite. Which is the more charitable conclusion?
December 12, 2006
As predicted, now researchers are reportedly using stem cells not (just) from embryos, but from born-alive infants killed for their stem cells. This according to the BBC, which (understatement alert!) is not exactly a right-wing news source. (Boldface in the original.)
By Matthew Hill
BBC Health Correspondent
Tuesday, 12 December 2006, 09:34 GMT
Healthy new-born babies may have been killed in Ukraine to feed a flourishing international trade in stem cells, evidence obtained by the BBC suggests.
Disturbing video footage of post-mortem examinations on dismembered tiny bodies raises serious questions about what happened to them.
Ukraine has become the self-styled stem cell capital of the world.
There is a trade in stem cells from aborted foetuses, amid unproven claims they can help fight many diseases.
But now there are claims that stem cells are also being harvested from live babies.
Wall of silence
The BBC has spoken to mothers from the city of Kharkiv who say they gave birth to healthy babies, only to have them taken by maternity staff.
In 2003 the authorities agreed to exhume around 30 bodies of foetuses and full-term babies from a cemetery used by maternity hospital number six.
One campaigner was allowed into the autopsy to gather video evidence. She has given that footage to the BBC and Council of Europe.
In its report, the Council describes a general culture of trafficking of children snatched at birth, and a wall of silence from hospital staff upwards over their fate.
The pictures show organs, including brains, have been stripped – and some bodies dismembered.
A senior British forensic pathologist says he is very concerned to see bodies in pieces – as that is not standard post-mortem practice.
It could possibly be a result of harvesting stem cells from bone marrow.
Hospital number six denies the allegations.
July 24, 2006
I’m checking around to see if anyone I know can verify if this is for real. (Translation: I sent an e-mail to one guy I know who used to do research in this field.) If you have any insights or information, please chime in by posting a comment.
This is from the Herald-Sun of Melbourne, Australia:
By Robyn Riley, July 23, 2006
In a world first, Melbourne scientists have developed a once-a-day pill that they claim may cure Alzheimer’s disease. Human trials of the drug start next month.
The drug — called PBT2 — was developed by a team from the Mental Health Research Institute of Victoria in collaboration with Melbourne-based Prana Biotechnology.
“It is a major breakthrough and very much a Melbourne discovery,” said Prof George Fink, the director of the Mental Health Research Institute.
“Though much depends on the next phase of human clinical trials . . . early results indicate this drug offers hope to people with Alzheimer’s disease,” he said.
The revolutionary drug stops the buildup of a protein called amyloid.
Many scientists accept amyloid is a major cause of Alzheimer’s as the protein is thought to cause the brain to “rust”.
Prof Fink said the drug could significantly prevent Alzheimer’s developing or delay the on-set of the brain disease for many years.
Early clinical testing has confirmed the drug is fast-acting. Levels of amyloid dropped by 60 per cent within 24 hours of a single dose.
It found also that PBT2 suppresses the impairment of memory function.
More human studies begin in Sweden next month and Australians will join a major international trial of the drug next year.
Alzheimer’s is a progressive and fatal brain disease. It is the major form of dementia, a disease that affects one in four Australians over the age of 60.
Prof Fink said the institute was optimistic about the results of clinical trials and said the drug could be on the market within four years.
(Hat tip: Slashdot)
The “John Stossel question” is, how many people will suffer, die, or go beyond the point of help in those four years it takes to get the drug through regulatory hurdles? I’m not saying I’d take the drug on the say-so of a newspaper article, but that seems and awfully long time to test a drug for a disease that can be fatal or completely debilitating within four years, or even less. Especially when you consider that the drug has already passed Phase I clinical trials — that is, it has already been found to be safe.
So if it’s not likely to hurt people, and no other effective treatments are available, what is the problem with making the drug available now, to patients willing to take it without the Phase II trials showing whether it works or not?
July 21, 2006
ORLANDO, Fla. — A 14-year-old who was sucked to the bottom of a hotel hot tub and kept under water for at least seven minutes was likely saved by air his father breathed into his mouth during the ordeal.
June 28, 2006
It seem like the old concept of “donating your body to science” for medical research has taken a whole new turn.
The New England Journal of Medicine just published a paper by a group of researchers at the University of Washington in Seattle studying whether condom use affected the probability of infection with Human Papillomavirus Infection (HPV), in which the researchers essentially asked female virgins to lose their virginity and report on their condom use at the big event, and for the subsequent 2-4 years. Furthermore, they failed to inform participants of all the risks of participating in the study — and in fact never even attempted to obtain consent of any kind, let alone informed consent, from more than half the subjects whose behavior was studied.
I’m sure you don’t believe me — no reasonable person would — so I’m going to quote directly from the article. (Italics in the original, boldface added.)
By the way, I don’t like the mainstream media’s practice of quoting anonymous “researchers” or claiming a study was done by a “university” rather than faculty, staff, or students acting on their own initiative, which is almost always what it is. The researchers have names, so I’m going to name them so they can take credit or blame. They are: Rachel L. Winer, Ph.D., James P. Hughes, Ph.D., Qinghua Feng, Ph.D., Sandra O’Reilly, B.S., Nancy B. Kiviat, M.D., King K. Holmes, M.D., Ph.D., and Laura A. Koutsky, Ph.D. All are from the Departments of Epidemiology, Biostatistics, or Pathology, or the Center for AIDS and STD, University of Washington, Seattle. And the authors state that the works was “Supported in part by grants (RO1-A138383 and T32-AI007140-24) from the National Institute of Allergy and Infectious Diseases.” Which means if you pay taxes in the United States, you paid for this study. The title of the article is “Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women” and it appears in the June 22, 2006 issue of the New England Journal of Medicine, Vol. 354, No. 25, pp. 2645-2654.
Now fasten your seatbelts, this is going to be um, an interesting ride:
Background To evaluate whether the use of male condoms reduces the risk of male-to-female transmission of human papillomavirus (HPV) infection, longitudinal studies explicitly designed to evaluate the temporal relationship between condom use and HPV infection are needed.
Methods We followed 82 female university students who reported their first intercourse with a male partner either during the study period or within two weeks before enrollment. Cervical and vulvovaginal samples for HPV DNA testing and Papanicolaou testing were collected at gynecologic examinations every four months. Every two weeks, women used electronic diaries to record information about their daily sexual behavior. Cox proportional-hazards models were used to evaluate risk factors for HPV infection.
We restricted eligibility to female University of Washington undergraduates who were 18 to 22 years old and who had never had vaginal intercourse or had first had intercourse with one male partner within the previous three months.
Now pay attention — they are later going to change that “within the previous three months” to within the previous two weeks.
In addition, the women had to have a cervix, could not be pregnant, had to be in good general health, and had to be able to provide written informed consent. Since the goal of the study was to enroll a population of healthy women (rather than women presenting to the student health clinic with gynecological problems), between December 2000 and June 2005, we mailed invitational letters to 24,201 women who met the age criterion and who released their names to the registrar.
Let’s restate that: These researchers mailed letters to more than 24,000 female college students asking if they’ve ever had sex, and if not would they like to for a medical study. (And if they’d just started very recently, it wasn’t too late.)
Questions for the peanut gallery: (1) If you were a female college student between the ages of 18 and 22, how would you feel about getting a letter like that. (2) If you had a daughter who was a female college student between the ages of 18 and 22, how would you feel about her university’s registrar releasing her name so she could get a letter like that from her university’s faculty?
Given the restrictive eligibility criteria, we assumed that the number of participants would be low in relation to the number of letters mailed.
Translation: We don’t think much of the morality of our university’s female students.
Well, that might be the translation if the researchers thought that morality and sex were related. I’d bet it never occurred to them to consider that possibility, so they did not actually intend that to be a smear on the female student (er,) body. I don’t know if that makes the claim more or less insensitive.
We also provided informational flyers to contraceptive counselors at the student health clinic. Of the 243 eligible women who responded, 210 agreed to participate (86.4 percent). The protocol was approved by the institutional review board at the University of Washington.
One might conclude from this sentence that what they “assumed” in the previous sentence was in fact correct — that there were only 243 female students out of 24,201 who met the “restrictive eligibility criteria” (never had sex, or at least not until two weeks ago). In other words, that 99% of University of Washington female undergraduates were sexually active more than two weeks ago.
However, we could also give them the benefit of the doubt and assume that some significant percentage of the students either didn’t want to start having sex, even for the sake of “science,” or just had better taste than the researchers. In fact, I think you’d be hard pressed to find any statement that’s true of 99% of any large group of undergraduates.
Later in the report we find this little gem — students were excluded from the study if they didn’t cooperate by losing their virginity:
Excluded from the study were 65 women who reported having had no vaginal intercourse, 3 women who did not record any information in their diaries regarding sexual behavior, and 60 women who reported having first had intercourse more than two weeks before enrollment.
They even have a neat little chart explaining all this.
Normally human research subjects are paid a small stipend for their trouble. I wonder if those enrollees who didn’t have sex still got paid. (If not, the researchers were arguably violating laws against prostitution — they were paying women to have sex.)
Of course, this all sounds very “scientific”:
Marginal Cox proportional-hazards models were used to determine risk factors for HPV infection. Data from diaries were summarized into risk-factor variables during the eight months before HPV testing, since most infections associated with a first partner (before the report of a second partner) occurred within eight months after a woman first had intercourse. Data recorded less than 20 days before a given visit were excluded, because 20 days was the shortest observed interval between the time a woman first had intercourse and the detection of an incident HPV infection in this study. The time to an event was measured from the time a woman first had intercourse to the report of infection with each type of HPV or the last clinic visit, with each woman contributing at-risk time for each of 37 HPV types. Analyses were stratified according to the type of HPV, assuming common relative hazards across HPV types while allowing the baseline hazards to vary. Robust variance estimates were used to account for correlation within subjects. Analyses were restricted to intervals in which intercourse was reported.
Yes, they use fancy terms like “time to an event” and “measured” and — my favorite — “Marginal Cox proportional-hazards models.” (Get your mind out of the gutter — “Cox” refers to the world-famous British statistician, Sir David Cox of Oxford University. And yes, it is a real type of statistical model.)
What sort of data did they collect?
Potential risk factors included the total number of instances of vaginal intercourse (continuous variable), the number of new partners (0, 1, or >1), the frequency of condom use by partners (<5 percent, 5 to 49 percent, 50 to 99 percent, or 100 percent), the partner’s circumcision status (circumcised, uncircumcised, or unknown), and the partner’s number of previous partners (0, .1, or unknown). The frequency of condom use was calculated by dividing the number of condoms used for vaginal intercourse by the number of instances of vaginal intercourse during the eight-month study period. If multiple new partners were reported during an eight-month period, the circumcision status and previous number of partners were summarized.
Now hold that thought for a minute and go back to a statement made earlier:
The protocol was approved by the institutional review board at the University of Washington.
Now this is kind of interesting. It happens to be a federal law (actually a regulation issued by the Department of Health and Human Services) that every institution that does any federally-supported research, and does any research on “human subjects” — that is, any research involving people in any capacity other than as researchers — have an institutional review board (IRB), and that all research projects involving human subjects be submitted to the IRB for approval. The IRB is supposed to make sure that, in the words of the Department of Health and Human Services, “Human Subjects Research Must be Guided by Ethical Principles.”
But whose ethics are they supposed to use?
By the ethics of most religions practiced in the United States, people aren’t supposed to have sex outside of marriage, most 18-22-year-olds aren’t married, and of course they are want data on the number of partners, which has to be greater than one for some significant fraction of of the women to produce statistically valid results. So the researchers are clearly aiming for behavior that a significant fraction of people regard as unethical.
Obviously, then, then don’t mean those ethics.
Perhaps then, they mean more “modern” ethics, by which it’s OK for anyone to have sex with anyone who agrees, as long as they use “protection.” But the whole point is to see if the “protection” works, by seeing the the effects are different for those who use it than for those who don’t. To do this, the researchers depend on some fraction of their subjects having unprotected sex. And it has to be a large enough fraction to generate statistically significant results.
Obviously, they can’t be encouraging condom use any more than they could be encouraging abstinence — either one would ruin their research!
What they mean is, “(a) The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, or (b) other appropriate ethical standards recognized by federal departments and agencies that have adopted the Federal Policy for the Protection of Human Subjects, known as the Common Rule.”
The Belmont Report was written in 1979 by government-appointed commission made up of three medical doctors, two lawyers, two non-physician scientists, a professor of bioethics, a professor of Christian ethics (is that constitutional?), and the then-president of the National Council of Negro Women. The report described three “Basic Ethical Principles”: Respect for Persons, Beneficence, and Justice. And it described three “Applications” of these principles: (1) Informed Consent, (2) Assessment of Risk and Benefits, and (3) Selection of Subjects.
In the section on Informed Consent, the commission stated:
Most codes of research establish specific items for disclosure intended to assure that subjects are given sufficient information. These items generally include: the research procedure, their purposes, risks and anticipated benefits, alternative procedures (where therapy is involved), and a statement offering the subject the opportunity to ask questions and to withdraw at any time from the research. …
Voluntariness. An agreement to participate in research constitutes a valid consent only if voluntarily given. This element of informed consent requires conditions free of coercion and undue influence. Coercion occurs when an overt threat of harm is intentionally presented by one person to another in order to obtain compliance. Undue influence, by contrast, occurs through an offer of an excessive, unwarranted, inappropriate or improper reward or other overture in order to obtain compliance. Also, inducements that would ordinarily be acceptable may become undue influences if the subject is especially vulnerable.
Now one interesting question is to what extent the consent given by the young women involved truly met the requirements above. I’m sure the staff was able to explain their purposes unambiguously. And they probably explained the “research procedure” quite well, if by that one means the procedure for filling out the electronic diaries — if not the procedure for, um, generating the information to put in the electronic diaries. This latter procedure was, by the nature of the requirements for the study, something with which the subjects were, um, necessarily unfamiliar. In fact, some of the “risks and anticipated benefits” were also something with which the subjects were necessarily unfamiliar. Obviously, the risk of HPV infection was there — that was the whole point of the study — and I’m sure the researchers could explain what that entailed, as well as the risks of other sexually transmitted diseases.
But what about the other “risks and anticipated benefits”? Prior to obtaining consent, did the researchers fully inform the subjects as to the emotional risks of engaging in sexual intercourse (a) for the purpose of a study, (b) if not for that purpose alone, then with the study in mind, ( c) with or without a committed relationship, (d) with the commitment level of the relationship formalized or not formalized in any particular way (e.g., marriage), (e) with more than one partner within the time frame of the study? What about the risks of increased emotional trauma when a relationship breaks up, if that relationship involved sexual intercourse? Did they fully inform the subjects of all this? I kind of doubt it.
And what about the “anticipated benefits”? Prior to obtaining consent, did the researchers fully inform their virgin subjects of the physical pleasures of sexual intercourse? What about the emotional pleasures that come from that form of intimacy? (Which, one might argue, turn negative without the appropriate level of commitment.) What about the benefits of parenthood, as opposed to the risks of pregnancy?
An even more interesting question is, did they get informed consent from the “male partners”? The study doesn’t mention that at all. They have copious detail about how the female subjects were recruited and screened, but the “male partners” are only mentioned when they (and their previous partners) are counted, and when it is asked whether they were circumcised. As far as we know, they were not informed of anything by the researchers — the researchers may not have even asked who they were. They female subjects were simply set loose in Seattle to involve unknowing males in a “research study.”
You might laugh, but this is precisely the sort of think the Belmont Commission was meant to address. One of the motivations for appointing the Belmont Commission was the Tuskegee Syphilis Study, in which 600 black men, 399 of whom had syphilis, were “studied” by being given medical care that, unbeknownst to them, did NOT include treatment for their disease. Neither they, nor their wives were informed the had syphilis, and they were “studied” until they died — in part to see how long it would take.
In this case, they aren’t even telling the male partners that they are part of a study. They are collecting personal information about them — such as whether the are circumcised, and the number of previous sexual partners they’ve had — and they are studying them in an environment in which the researchers know they are at risk at least for HPV, not to mention other things, and the are not informed of the risks, they are not informed they are being used for a study, and no consent of any kind, informed or not, has been obtained.
In short, this study is not only unethical from a “traditional values” point of view; it is also unethical from a “secular bioethics” point of view.
The fact that the University of Washington’s IRB was willing to approve this study calls into question whether the entire IRB system is just a bureaucratic rubber stamp for whatever some voyeuristic researchers want to do.
May 31, 2006
Thanks to a reader for alerting me to this story, which is almost too good to be true:
ST. PETERS, Mo. â€” A driver who suffered a heart attack and crashed into a guardrail was saved by a defibrillator salesman and two nurses who happened to be passing by.
The salesman, Steve Earle, was transporting an automated external defibrillator, a device used to shock the heart into a normal rhythm.
This article has some more details, if less dramatic wording:
Four people stopped to help her. Two of them were registered nurses. A third was Steve Earle, who makes a living selling automatic external defibrillators, the devices used to shock a patient’s heart into a regular rhythm.
It was kind of crazy luck that it was me with the device and two nurses that were three of the first four on the scene,” Earle said.
Earle grabbed the defibrillator he uses for demonstrations and rushed to help. Meanwhile another motorist used a trailer hitch to break out the rear passenger window of Holt’s car, unlocked the front passenger door and dragged her to the pavement.
The two nurses – Mary Blome and a woman identified only as Laurie – started cardiopulmonary resuscitation, but Holt wasn’t breathing. Earle and one of the nurses hooked Holt up to the defibrillator and delivered a shock. Holt got a pulse back, and St. Charles County paramedics rushed the woman to the hospital.
She underwent surgery Tuesday to have an automatic internal cardiac defibrillator implanted and is expected to fully recover.
She’s got one built-in now, so she doesn’t have to depend on another defibrillator salesman to happen by if she ever has another heart attack. There’s gratitude for you!
Seriously, though — it’s really good to have one of these things around if you can swing it. It is probably worth having if you run an establishment with large numbers of people — or to have at home if you are have enough of risk of a heart attack, but not enough to get the built-in version. Amazingly, you can buy these things on Amazon.com — here’s a home model, another home model (with free carrying case!), and another model, I guess for when you’re not home. They start at $1,135, which I’m sure is a tenth or a hundredth of what the hospital versions cost a few years ago.
Marty Limpert, spokesman for the St. Charles County Ambulance District, said Tuesday he hopes the $1,400 devices will become as common at places of business as fire extinguishers.
And oh yes — get a fire exthinguisher, too. They’re a heckuva lot cheaper, and they can save your life, too. I have one for the kitchen, one for the room with the fireplace, and one for the car. If I could convince Different Wife, I’d have one for the van, too….
May 23, 2006
David E. Williams writes on the Health Care Business Blog:
A friend in Canada felt so sick that when she went to the hospital on Thursday she told the staff that she felt even worse than she had immediately after her two surgeries. They sent her home with instructions to follow up next Tuesday (tomorrow). By Saturday she felt even worse. Ambulance dispatch told a friend who called to expect an ambulance in 3 hours –the timing based on the perceived severity of the symptoms. The friend took her to the ER instead, where she was promptly taken into the ICU. But it was too late; she is in a coma and will almost certainly succumb to pneumococcal meningitis.
She died because by Canadian standards, she was not sick enough to deserve a place in the hospital.
And lots of people here in the U.S. want us to adopt the Canadian system.
By the way, they are supposed to transplant her kidneys and liver. Someone is going to get some sort of brownie points for acquiring those organs. Would I be too cynical if I said the incentives to save a patient’s life are reduced when one benefits from that patient’s death?
March 29, 2006
Men trying to decide how to have their localized prostate cancer treated may get incomplete or biased advice from both physicians and patient-education materials, a review of the literature suggested.
For example, urologists nearly universally indicate that surgery is the optimal treatment strategy, and radiation oncologists similarly indicate that radiation therapy is optimal, said Scott D. Ramsey, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center here, and colleagues.
This should not be a surpirse. If your only tool is a hammer, every problem looks like a nail.
These doctors are not necessaily recommending their own treatment to feather their own nests; they are just recommending what they know. It is human nature to look at a problem and see how you can solve it, rather than how it is best solved. Plus, it’s natural caution not to recommend things with which one is less familiar.
The lesson is that patients have to take an active role in determining their own medical treatment. Your doctor is your partner in this, not your commanding officer. Before taking drastic treatment, ask the doctor to justify his/her recommendation, find out about other options and ask politely why they aren’t appropriate (maybe they are and the doctor just didn’t think of them; I’ve had this happen), and above all, use your brain.
It doesn’t hurt to have some basic knowlege of statistics, and to be able to read those inserts that come with your prescription drugs.
February 8, 2006
Could it really be that fat doesn’t increase the risk of cancer — or even of heart disease? The answer seems to be Yes — according to a large-scale study reported in three articles in the current Journal of the American Medical Assocation. The Women’s Health Initiative Dietary Modification Trial studied 48,835 (!) post-menopausal women — that’s a huge number of people for a medical study — with 40% on a low-fat diet and 60% eating whatever they wanted — and found no significant effect of the low-fat diet on heart disease (!), breast cancer, or colorectal cancer. JAMA has the full text of the breast cancer article free on its web site; for the others you need a subscription for the full text, but the abstracts of the colorectal cancer and cardiovascular disease are free.
- For cardiovascular disease, there is basically no effect whatsoever from the low-fat diet. LDL cholesterol drops a tiny bit (3 mg/dL) — but there is no effect on heart attacks, strokes, or mortality. And of course, the usual goal of reducing LDL cholesterol is to reduce the change of heart attacks, strokes, and mortality, and this doesn’t accomplish that.
- For breast cancer, there are small reductions in the incidence of cancer (too small to be statistically significant by the usual criterion), but there basically no reduction in mortality. There was, however, a significant reduction in two specific types of tumors, which indicates that fat consumption may have some role in breast cancer even if it doesn’t really affect mortality. Then again, they were measuring so many things it’s likely that something would come out “significant” just by change — kind of like how if you get 100 people to flip 5 coins, there’s a 96% somebody is going to get 5 heads in a row.
- For colorectal cancer, there is basically no effect whatsoever from the low-fat diet. In the low-fat diet group, some kinds of colorectal cancers occurred at higher rates, and some at lower rates. In fact, the overall rate of death due to colorectal cancer was higher in the low-fat diet group — though not high enough to be statistically significant.
The only real caveat is that this study was only of postmenopausal women between the ages of 50 and 79, it might not be the same for men, or for younger women. But it was a study of 48,835 of them, so it’s quite likely the results are valid for at least that group. (Of course, the rates of breast cancer for men are vanishingly small compared to those for women!)
Note also that while this implies it is OK to eat fat — it does not imply that it is OK to be fat. What it basically means is that if you eat the same number of calories but switch some of the calories from fat to other things (protein, carbohydrates) you don’t get any reductions in cardiovascular disease, breast cancer, or colorectal cancer. However, it doesn’t mean you wouldn’t benefit from reducing fat and not replacing it with something else; that is, reducing your total caloric intake. To put it another way, the study shows that the composition of your calories doesn’t matter, but the total number of calories still might.
For an interesting article on the impact of the study, and for a more non-technical explanation of the results, see this article by Gina Kolata in the New York Times.
I normally don’t find science articles in the general media to be very good, or even true, but Gina Kolata has always seemed to me to be one of the few science reporters who actually knows some science. (Her book on the 1918 flu pandemic is excellent, and is a great read for someone who wants to understand what’s going on with the avian flu that might or might not break out.)
Having read both her article, and the JAMA articles, for once I think the newspaper got a science story basically right.
The lead authors of two of the three articles were originally trained in mathematics and statistics, not medicine. Remember when you were sitting in some math class wondering what that stuff was good for? Well, now you know!
January 5, 2006
When I first heard that Ariel Sharon had had a second stroke after the “mini-strokes” last month, and that the second was a hemorrhagic stroke, my first thought was that they’d put him on anticoagulants as a result of the mini-strokes, and they caused the second one.
Now, it seems that some doctors are saying the same thing. (I should have posted this two days ago; I’d have looked like a genius. But, a lot of good that would have done Sharon…)
You see, there are two kinds of strokes — and they are pretty much the opposite in terms of what happens and what causes them. An ischemic stroke is when a blood clot lodges in a artery in the brain, cutting off the supply of blood to the part of brain supplied by that artery. It’s basically the same as a heart attack, only the artery being blocked is in the brain rather than the heart. A mini-stroke is what they call a “transient ischemic attack” — a small clot that either dissolves by itself rather quickly, or blocks an artery that’s so minor the brain can sort of work around the damage. A hemorrhagic stroke — AKA, a cerebral hemorrhage — is the opposite — it’s when a blood vessel in the brain bursts and blood starts spilling all over the place, coming into contact with brain tissue it isn’t supposed be in contact with, and also causing pressure, since there’s not much room for swelling inside a hard container like the skull.
So, these two are opposites — an ischemic stroke is not enough blood where it’s supposed to be, and a hemorrhagic stroke is too much blood where it’s not supposed to be.
The main treatment for an ischemic stroke is to give anticoagulant drugs — drugs that dissolve clots, and prevent new clots from forming. If you’ve heard of that drug (tPA) that can stop a stroke, but only if is given within 3 hours of a stroke — well, that’s a drug that can dissolve blood clots. If it dissolves them fast enough, the severity of brain damage cause by the stroke can be reduced or maybe even eliminated. Someone who has an ischemic stroke — either a “mini-stroke” or a full-blown one — is normally put on milder anticoagulant drugs, such as warfarin (CoumadinÂ®) for an extended period after the stroke, and perhaps indefinitely, to prevent a subsequent stroke. Warfarin works by inhibiting the blood from clotting.
And here’s the problem: Warfarin works on all your blood, so it slows clot formation all the time — not just when it would cause a stroke, but all the time. One of the effects of warfarin and other anticoagulants is that when you start to bleed (say, from a paper cut), you bleed longer since it takes longer for your blood to clot. And if you happen to start to bleed inside your brain, anticoagulants will prevent that bleeding from stopping, too.
In short, the same drugs that cure or prevent ischemic strokes can actually cause hemorrhagic strokes, or at least make them much, much, worse. And this isn’t really a side effect as such — anticoagulants make hemorrhagic strokes for the exact same reason that they cure, reduce, or prevent ischemic strokes.
People often wonder why people are not given tPA right away with they show up in the emergency room showing stroke symptoms. After all, could it hurt? Yes, it could — both kinds of strokes have similar or identical symptoms, so they have to do an MRI or CT scan or otherwise try to figure out whether the person is having a ischemic stroke or a hemorrhagic one — while if it’s ischemic, tPA could save the patient’s life, if it’s hemorrhagic, tPA could kill the patient or otherwise make the stoke a lot worse. And they have to do it very quickly, since tPA works much better when given sooner, and it loses its effectiveness rapidly after about three hours.
I’m not second-guessing the doctors here. I believe it’s standard practice to give anticoagulants to everyone who has an ischemic stroke unless there’s a known good reason not to, under the theory that if a person had one, they are susceptible and could have another. So, they probably did the right thing given the information they had at the time. I don’t know how common it is for the same person to be susceptible to both kinds of strokes, or if there’s any way to tell, or if it’s possible they misdiagnosed the events of last week. Perhaps a doctor reading this might be willing to leave a comment to clarify some of this.
Disclaimer: I am not a physician, and I don’t even play one on TV. Don’t take any of this as medical advice. If you think any of this applies to you, consult an actual medical doctor, not me. I do not guarantee that anything said about is true. I mean, I think it is, but I’m not a doctor so I might make a mistake, and I’m not licensed to guarantee it anyway.
December 29, 2005
I find it quite curious and fascinating (in a morbid sort of way) that the same side of the political aisle that is so eager to “get the government out of the bedroom” when it comes to things like abortion and homosexuality, is so eager to set up a government-run and government-paid-for health care system, which will put government into not only your bedroom, but your kitchen, living room, and anywhere else you go.
As Coyote Blog puts it, it’s a “Health Care Care Trojan Horse“:
I get email and comments from time to time that my language deriding government’s intervention into every aspect of our lives is overblown and exaggerated. My answer: Oh yeah, well how about this:
Mike Huckabee, the Governor of Arkansas, now requires annual fat reports. These are sent to the parents of every single child aged between 5 and 17; a response, he says, to â€œan absolutely epidemic issue that we could not ignoreâ€ in the 1,139 schools for which he is responsible.
As I have argued many times in the past, a large part of the blame for these initiatives is public funding of health care. Beyond the efficiency and choice arguments, I have tried to point out that publicly funded health care is a Trojan horse for a number of truly intrusive nanny-state government controls of our lives.
When health care is paid for by public funds, politicians only need to argue that some behavior affects health, and therefore increases the state’s health care costs, to justify regulating the crap out of that behavior. Already, states have essentially nationalized the cigarette industry based on this argument.
And later he writes:
The logic is that by paying for your health care, the government can argue it has a financial interest in your not eating fatty foods, not smoking, wearing a bike helmet, exercising, etc, decisions that would otherwise only affect the individual themself.
For those who often accuse me of exaggerated paranoia when it comes to government intervention, check out this from the UK:
People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs following a decision by a Government agency yesterday. The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the “self-inflicted” nature of an illness should be taken into account.
Sorry, but I told you so. What’s next? Is an unwanted pregnancy “self-inflicted”? How about an STD from unprotected sex?
Well, there’s a way to get the Left’s attention…
December 21, 2005
Almost a year ago, I posted a story about how some states were considering taxing Botox injections and other cosmetic procedures.
My point at the time was that taxing something like that is not really a very good way to generate tax revenue, since anyone who can afford to get Botox can also afford not to get Botox. It’s similar to the case in 1990 when Congress imposed a 10% tax on luxury yachts — and instead of raising money, they caused unemployment, when yacht sales dropped 90% and yacht-building workers were laid off.
Now, the Sacramento Bee is reporting that doctors and “patient advocates” in California are raising another issue:
More than three dozen consumers, businesses and health groups sent that message to the [California] Board of Equalization this month after the state agency raised the idea of a sales tax on the popular wrinkle treatment.
In letters to the Sacramento-based board, Californians argued that medicines like Botox should never be taxed because such a move might open the door to taxes on other drugs and even medical procedures.
“Even a healthy individual like me can see the problems inherent in looking to medicines as a way to raise sales tax revenue,” wrote Kimberly Jenkins, a Woodland resident who said she is against a Botox tax.
“There’s no guarantee that a person whose election depends on getting the budget under control is going to make sound decisions about what medicines to tax,” added Jenkins.
(And how, exactly, is that different from taxes on anything else? )
That request came after state tax auditors started asking dermatologists why they hadn’t charged sales tax on Botox treatments for cosmetic purposes since 2002, the year the substance was approved by the Food and Drug Administration for cosmetic treatments.
Doctors argued that prescription medicines were exempt from sales tax, but auditors pointed to state regulations specifying that the exemption applies only if medicines are used to treat “disease,” not to erase wrinkles for cosmetic purposes.
A lobbyist for the physicians raised concerns about tax auditors peering at confidential patient files, asking what expertise the auditors had to decide which treatment was cosmetic and which was medical.
“I don’t believe legislators are better able than doctors to decide which prescription medicines are necessary,” Villarreal wrote. “We Californians are already paying very high taxes, and certainly some of the most expensive health care costs in the country.”
(If that last argument is right, what business do legislators have telling us which medicines are legal? How do they know that, say, Vioxx is too dangerous but Celebrex isn’t? What, because they created an FDA run by doctors and scientists? Well, they also created a Board of Equalization which, in theory, can hire whatever experts they want.)
Sales of the drug have exploded and have come close to hitting $1 billion a year since the FDA authorized its use for cosmetic treatments three years ago. While that could make a nice tax revenue generator for the Golden State, it also could affect sales of the product.
(A rare correct use of economics in a news story! Though it would have been nice to explain it so people without a college course in economics would know why it could affect sales of the product. I bet a lot of this reporter’s colleagues don’t know!)
November 24, 2005
It seems that Mifeprex (the “abortion pill” also known as “RU-486″ and “mifepristone”) has been killing women. No, not just the fetal women (and men) it was designed to kill, but the women who take it. As the New York Times reports (emphasis added):
[F]our women in this country who died after taking an abortion pill suffered from a rare and highly lethal bacterial infection, a finding that is leading to new scrutiny of the drug’s safety.
Since all four deaths occurred in California, an unusual clustering, the Food and Drug Administration quietly tested to see if abortion pills distributed in California were somehow contaminated. They were not.
Stumped, officials from the F.D.A. and the federal Centers for Disease Control and Prevention have decided to convene a scientific meeting early next year to discuss this medical mystery, according to two drug agency officials who spoke on the condition of anonymity because of the sensitivity of the topic.
Among other issues, the experts hope to explore whether the abortion pill, called Mifeprex or RU-486, somehow makes patients vulnerable to an infection with Clostridium sordellii, the lethal bacteria. If so, they will explore how such an infection “could be more easily diagnosed and even prevented,” one official said.
Monty Patterson, whose daughter Holly died on Sept. 17, 2003, less than a month after her 18th birthday, said he believed that Mifeprex inhibits the immune system, making women more vulnerable to bacteria.
Mr. Patterson’s campaign against Mifeprex helped persuade the family of at least one other woman who died to have tissue samples tested for the presence of the rare bacteria, he said.
“I believe this drug should be taken off the market,” Mr. Patterson said.
For now, there is no indication that the F.D.A. is considering restricting access to the drug. Indeed, it has advised doctors against giving antibiotics as a precaution to prevent the rare infections since antibiotic therapy carries its own risks.
Mifeprex has been used in more than 500,000 medical abortions in the United States since its approval in September 2000. The risks of death from infection after using the pill are similar to the risks after surgical abortion or childbirth, said Dr. Steven Galson, director of the F.D.A.’s center for drugs.
Warnings about the drug’s possible link with Clostridium sordellii were placed on Mifeprex’s label in July, and the drug agency without announcement updated this information on its Web site on Nov. 4 after it discovered that all of the deaths involved the lethal bacteria.
Ms. Patterson died seven days after taking Mifeprex. She lived in Livermore, Calif.
On Dec. 29, 2003, Vivian Tran, 22, of Costa Mesa, Calif., died six days after taking Mifeprex.
On Jan. 14, 2004, Chanelle Bryant, 22, of Pasadena, Calif., died six days after taking Mifeprex. And on May 24, 2005, Oriane Shevin, 34, of Los Angeles died five days after taking Mifeprex.
In each case, Clostridium sordellii infected the women’s uteruses, flourished and then entered their bloodstreams. The bacterium can cause nausea, vomiting, diarrhea and weakness but may not induce fever, so victims often fail to realize how sick they are until it is too late and succumb to toxic shock. Antibiotics are often ineffective once an infection has flourished because even in death, the bacteria release toxins.
The families of Ms. Patterson, Ms. Tran and Ms. Bryant have all filed suit against Danco, claiming the company failed to warn patients of the drug’s dangers.
A woman who died in Canada after taking Mifeprex during clinical testing in 2001 also suffered from a Clostridium sordellii infection. …
Wendy Wright, executive vice president of Concerned Women for America, a conservative group, said that the latest news about deaths involving Mifeprex proved that the drug was unsafe. Ms. Wright also speculated that more women were dying after using the drug but that their deaths were going unreported.
“I’m pleased that the F.D.A. is taking a serious look at this,” she said, “and hope that they will no longer allow this drug to be available to cause the deaths of more women.”
Dr. Scott J. Spear, chairman of the national medical committee of the Planned Parenthood Federation of America, the nation’s largest provider of abortions, said there was no evidence that the vaginal administration of misoprostol increased the risks of bacterial infections.
No, four dead women is “no evidence” when a political drug is involved. It only took three deaths to get Vioxx off the market, and that was a drug given to millions more people, mostly older people who have a greater risk of death than 18- to 22-year-old women, even in the absense of any drug. And there is no known mechanism by which Vioxx can cause death either.
One might ask, if there’s a problem with Mifeprex, why didn’t the FDA find it in testing? The reason is, Mifeprex was exempted from the usual standards the FDA uses to approve drugs. First, on his third day in office, President Clinton issued an executive order directing the Secretary of Health and Human Services to allow the importation of the drug for personal use, and to “promptly” “promote” the manufacture of the drug in the United States:
I direct that you immediately take steps to rescind Import Alert
66-47 [which barred the importation of unapproved RU-486].
In addition, I direct that you promptly assess initiatives by which the Department of Health and Human Services can promote the testing, licensing, and manufacturing in the United States of RU-486 or other antiprogestins.
Of course, we all “know” it was pure coincidence that the FDA gave its preliminary approval (subject to resolving labelling issues) in September 1996, during a presidential campaign, and final approval in September 2000, during the next presidential campaign.
You might think that the National Organization for Women might be interested in investigating the safety of this drug that kills only women. But you would be wrong — they are focusing their FDA-lobbying efforts on preventing women from exercising their right to control their own bodies. (See my previous post on that topic.)
September 20, 2005
The Mail on Sunday in London and the Sun News in Ottawa both report that doctors in New Orleans killed their patients with overdoses of morphine because they “were going to die anyway” from either their diseases, the hurricane, or some combination thereof. One doctor was quoted as saying, ” “If the first dose was not enough, I gave a double dose … This was not murder, this was compassion. They would have been dead within hours, if not days.”
Several medical-doctor bloggers have checked in the good reasons to doubt this story, both based on its alleged source (a utility manager, who did not work at a hospital), and its general plausibility: Orac, Kevin, M.D., and Diana Kroi.
September 13, 2005
Leon Kass has resigned his position as the chairman of the President’s Council on Bioethics. I will miss his leadership. Kass is one of the great thinkers in contemporary bioethics and a writer of intense talent whose prose reads like poetry. As chairman of the President’s Council on Bioethics, he did a sterling job stimulating profound conversations about the most controversial biotechnology issues of the day. He even forged much consensus among the Council members in several reports, which must at times have seemed to him like herding cats. Contrary to some previous bioethics commissions I could mention, Kass refused to “stack the deck” by appointing only council members who shared one worldview. Thus, the Council, while unanimously rejecting reproductive cloning, divided bitterly about the propriety of human therapeutic cloning in its first report, Human Cloning and Human Dignity.
Because Kass is our premier apologist for the belief that human life has intrinsic dignity and value, which cuts sharply against the grain of the bioethics movement that views such thinking as irrational and discriminatory against animals (speciesism), he was subjected to intense vituperation and calumny. I responded to these attacks in the National Review Online.
Leon Kass is one of the wisest public figures there is. He is also a thorn in the side to those who believe that science is incompatible with traditional values; he has an M.D. and a Ph.D. in biochemistry, but unlike some people he somehow manages to understand that for all its achievements, science is not a source of moral values. Lots of people understand that, but anti-traditionalists call them ignorant of science. They can’t do that with an accomplished scientist, and it seems to annoy the heck out of them.
August 25, 2005
I sit facing my computer, and words fail me. I have just witnessed one of the most tragic and traumatic events of my life.
A Jewish young man died in my arms tonight. His sin? Being Jewish in Jerusalem.
At about 8:25 this evening, we got a call from the MDA dispatcher about a stabbing on David Street – the Arab shuk leading from Jaffa Gate to the Kotel. I immediately left my apartment and sped over to the chaotic scene not far from there on a Hatzolah ambu-cycle.
Upon arrival, a horrible sight greeted me. A young Jewish man, lying in a pool of his own blood, with a 15″ knife sticking out of his stomach. After being at many bombings, car accidents and other traumatic events, this scene had the distinction of being the worst one I have ever seen.
His skin a very pale color, and his eyes half open, I reached him. The only people around were police officers, who didn’t really know what to do. The young Jewish man was not breathing, and he had no pulse.
This is the nightmare of any EMT. Alone, as the only person with medical training at the scene, there is not much you can do. Many tasks need to be done, and many people are needed to do them. Starting CPR, connecting oxygen, starting numerous IV’s due to massive blood loss …
What was the young man’s crime? What did he do wrong? To us, the residents of the Old City, these answers are clear. The Arabs want us out of Israel — out of Jerusalem.
The terrorism will continue — and will get much worse in Jerusalem. One thing I can tell you — we won’t run. We will stand firm, and remain here until one side wins — us or them. The battle is for the soul of the Land of Israel — let no one think otherwise.
The full article is here.
Note that the Gaza withdrawal was supposed to end this sort of thing. The Oslo accords were also supposed to end this sort of thing. When will they realize that there is no diplomatic solution to terrorism? The inherent nature of terrorism is that the diplomats can disclaim any responsibility for it, so by its very nature there can be no diplomatic or negotiated end to it.