It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen-that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
People don’t know how to die anymore…advances in technology and medicine have lulled us into believing we can fix anything that’s wrong with our bodies, pain and expense be damned. And sometimes we can and do, and it’s that “what if” that makes it so difficult when thinking about what to do.
The first report of a zolpidem [aka Ambien] awakening came from South Africa, in 1999. A patient named Louis Viljoen, who, three years before, was declared vegetative after he was hit by a truck, had taken to clawing at his mattress during the night. Thinking he was suffering from insomnia, his family doctor suggested zolpidem to help him sleep. But 20 minutes after his mother ground the tablet up and fed it to him through a straw, Viljoen began to stir. His eyes, which normally wandered the room, vacant and unfocused, flickered with the light of consciousness. And then he began to talk (his first words were “Hello, Mummy”), and move (he could control his limbs and facial muscles). A few hours later he became unresponsive. But the next day, and for many days after that, zolpidem revived him, a few hours at a time.
Here was a case worthy of Hollywood: three years was well past the point at which doctors would expect any sort of spontaneous recovery. Viljoen awoke with the ability to speak in complete sentences. Not only did he recognize his mother, but he also recognized the voices of people who had spoken to him only when he was apparently vegetative. He remembered nothing of the mysterious realm he kept receding back into. When doctors asked him what it was like to slip away, he said he felt no changes at all. But he could recall conversations from the previous day’s awakening, along with bits and pieces of his former life: his favorite rugby team, specific matches he attended, players that he rooted for and against. As time passed, his cognition improved. He could laugh at jokes, and his awakenings stretched from a few hours to entire days. Eventually, he no longer needed zolpidem.
Sour candy is sour because of the acidity level. The Minnesota Dental Association has compiled a chart listing several popular sour candies, all of which are acidic enough to cause tooth enamel loss and some of which are almost as acidic as battery acid! Here’s part of the chart:
Update: I meant to add that the ph scale is logarithmic (like the Richter scale) so that a pH of 3.0 is 10 times more acidic than a pH of 4.0. That means that even the pH 1.6 & 1.8 candies on the list aren’t quite battery acid, but it also means that a pH 2.0 candy has 100x more acidity than is required to cause enamel loss, not just 2x.
This is good news in the fight against malaria, which kills almost 800,000 people annually (that’s a San Francisco, every single year).
An experimental vaccine from GlaxoSmithKline halved the risk of African children getting malaria in a major clinical trial, making it likely to become the world’s first shot against the deadly disease.
Final-stage trial data released on Tuesday showed it gave protection against clinical and severe malaria in five- to 17-month-olds in Africa, where the mosquito-borne disease kills hundreds of thousands of children a year.
“These data bring us to the cusp of having the world’s first malaria vaccine,” said Andrew Witty, chief executive of the British drugmaker that developed the vaccine along with the nonprofit PATH Malaria Vaccine Initiative (MVI).
While hailing an unprecedented achievement, Witty, malaria scientists and global health experts stressed that the vaccine, known as RTS,S or Mosquirix, was no quick fix for eradicating malaria. The new shot is less effective against the disease than other vaccines are against common infections such as polio and measles.
GlaxoSmithKline has previously stated that they will sell the vaccine for cost + a 5% markup that will be put back into tropical disease research.
Scientists have developed a spray gun that sprays the burn victim’s own skin cells onto the affected area heals them within a matter of days, not weeks or months.
The guy doesn’t even look like he got burned. (via @delfuego)
Internet sensation Amit Gupta was recently diagnosed with leukemia and needs a bone marrow transplant. Problem is that he needs a transplant from someone of South Asian descent.
To aid him in his fight, Amit is going to need a bone marrow transfusion. Unlike blood transfusions, finding a genetic match for bone marrow that his body will accept is no easy task. The national bone marrow registry has 9.5 million records on file, yet the chances of someone from South Asian descent of finding a match are only 1 in 20,000.
This is where we come in. We’re going to destroy those odds.
How? By finding and registering as many people of South Asian descent as we possibly can.
Tests are easy — a simple swab of the cheek. If someone is determined to be a match, that person would have to be willing to undergo an outpatient procedure in which marrow is extracted from bones in the back by a special needle. It’s not a fun procedure, but it’s not dangerous either. And doing it could save a life.
This crazy-experimental therapy uses a modified HIV virus to attack cancer cells in humans. Only three people have tried this therapy for chronic lymphocytic leukemia; two are in complete remission and one showed improvement.
Doctors removed a billion of his T-cells — a type of white blood cell that fights viruses and tumors — and gave them new genes that would program the cells to attack his cancer. Then the altered cells were dripped back into Mr. Ludwig’s veins.
At first, nothing happened. But after 10 days, hell broke loose in his hospital room. He began shaking with chills. His temperature shot up. His blood pressure shot down. He became so ill that doctors moved him into intensive care and warned that he might die. His family gathered at the hospital, fearing the worst.
A few weeks later, the fevers were gone. And so was the leukemia.
There was no trace of it anywhere — no leukemic cells in his blood or bone marrow, no more bulging lymph nodes on his CT scan. His doctors calculated that the treatment had killed off two pounds of cancer cells.
A year later, Mr. Ludwig is still in complete remission. Before, there were days when he could barely get out of bed; now, he plays golf and does yard work.
The team begins by injecting a solution containing carefully chosen nanoparticles into the skin. This leaves no visible mark, but the nanoparticles will fluoresce when exposed to a target molecule, such as sodium or glucose. A modified iPhone then tracks changes in the level of fluorescence, which indicates the amount of sodium or glucose present. Clark presented this work at the BioMethods Boston conference at Harvard Medical School last week.
The tattoos were originally designed as a way around the finger-prick bloodletting that is the standard technique for measuring glucose levels in those with diabetes. But Clark says they could be used to track many things besides glucose and sodium, offering a simpler, less painful, and more accurate way for many people to track many important biomarkers.
Dudley Clendinen has ALS, aka Lou Gehrig’s disease, and has a short time to live. Which is fine by him; he’s got a plan.
There is no meaningful treatment. No cure. There is one medication, Rilutek, which might make a few months’ difference. It retails for about $14,000 a year. That doesn’t seem worthwhile to me. If I let this run the whole course, with all the human, medical, technological and loving support I will start to need just months from now, it will leave me, in 5 or 8 or 12 or more years, a conscious but motionless, mute, withered, incontinent mummy of my former self. Maintained by feeding and waste tubes, breathing and suctioning machines.
No, thank you. I hate being a drag. I don’t think I’ll stick around for the back half of Lou.
I think it’s important to say that. We obsess in this country about how to eat and dress and drink, about finding a job and a mate. About having sex and children. About how to live. But we don’t talk about how to die. We act as if facing death weren’t one of life’s greatest, most absorbing thrills and challenges. Believe me, it is. This is not dull. But we have to be able to see doctors and machines, medical and insurance systems, family and friends and religions as informative - not governing - in order to be free.
And that’s the point. This is not about one particular disease or even about Death. It’s about Life, when you know there’s not much left. That is the weird blessing of Lou. There is no escape, and nothing much to do. It’s liberating.
Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions. Forty per cent of coronary-disease patients and sixty per cent of asthma patients receive incomplete or inappropriate care. And half of major surgical complications are avoidable with existing knowledge. It’s like no one’s in charge-because no one is. The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.
When former NFL player Dave Duerson shot and killed himself the other day, he aimed for his chest and not his head because he wanted his brain to be in one piece and therefore available for study for signs of chronic traumatic encephalopathy, which may have led to Duerson’s suicide in the first place.
Players who began their careers knowing the likely costs to their knees and shoulders are only now learning about the cognitive risks, too. After years of denying or discrediting evidence of football’s impact on the brain — from C.T.E. in deceased players to an increasing number of retirees found to have dementia or other memory-related disease — the N.F.L. has spent the last year addressing the issue, mostly through changes in concussion management and playing rules.
Duerson sent text messages to his family before he shot himself specifically requesting that his brain be examined for damage, two people aware of the messages said. Another person close to Duerson, who spoke on the condition of anonymity, said that Duerson had commented to him in recent months that he might have C.T.E., an incurable disease linked to depression, impaired impulse control and cognitive decline.
You may have seen a reference to this last week, but the New Yorker just posted the full text of Atul Gawande’s latest article on their site. The article is about efforts to lower healthcare costs by focusing on the patients who use (and often misuse) healthcare the most. Like many of Gawande’s other articles, this is a must-read.
“Let’s do the E.R.-visit game,” he went on. “This is a fun one.” He sorted the patients by number of visits, much as Jeff Brenner had done for Camden. In this employed population, the No. 1 patient was a twenty-five-year-old woman. In the past ten months, she’d had twenty-nine E.R. visits, fifty-one doctor’s office visits, and a hospital admission.
“I can actually drill into these claims,” he said, squinting at the screen. “All these claims here are migraine, migraine, migraine, migraine, headache, headache, headache.” For a twenty-five-year-old with her profile, he said, medical payments for the previous ten months would be expected to total twenty-eight hundred dollars. Her actual payments came to more than fifty-two thousand dollars — for “headaches.”
Was she a drug seeker? He pulled up her prescription profile, looking for narcotic prescriptions. Instead, he found prescriptions for insulin (she was apparently diabetic) and imipramine, an anti-migraine treatment. Gunn was struck by how faithfully she filled her prescriptions. She hadn’t missed a single renewal — “which is actually interesting,” he said. That’s not what you usually find at the extreme of the cost curve.
The story now became clear to him. She suffered from terrible migraines. She took her medicine, but it wasn’t working. When the headaches got bad, she’d go to the emergency room or to urgent care. The doctors would do CT and MRI scans, satisfy themselves that she didn’t have a brain tumor or an aneurysm, give her a narcotic injection to stop the headache temporarily, maybe renew her imipramine prescription, and send her home, only to have her return a couple of weeks later and see whoever the next doctor on duty was. She wasn’t getting what she needed for adequate migraine care — a primary physician taking her in hand, trying different medications in a systematic way, and figuring out how to better keep her headaches at bay.
As if there was actually more evidence needed that vaccines don’t cause autism, the 1998 British study that linked autism to childhood vaccines was recently discovered to be an elaborate fraud. Not just incorrect, a fraud.
An investigation published by the British medical journal BMJ concludes the study’s author, Dr. Andrew Wakefield, misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study — and that there was “no doubt” Wakefield was responsible.
“It’s one thing to have a bad study, a study full of error, and for the authors then to admit that they made errors,” Fiona Godlee, BMJ’s editor-in-chief, told CNN. “But in this case, we have a very different picture of what seems to be a deliberate attempt to create an impression that there was a link by falsifying the data.”
Doctors who carried out a stem cell transplant on an HIV-infected man with leukaemia in 2007 say they now believe the man to have been cured of HIV infection as a result of the treatment, which introduced stem cells which happened to be resistant to HIV infection.
The man received bone marrow from a donor who had natural resistance to HIV infection; this was due to a genetic profile which led to the CCR5 co-receptor being absent from his cells. The most common variety of HIV uses CCR5 as its ‘docking station’, attaching to it in order to enter and infect CD4 cells, and people with this mutation are almost completely protected against infection.
With the current popularity of the craft cocktail bar, massive ice cubes, and vigorous cocktail shaking techniques, comes the risk of injury.
“When they’re shaking a drink, it’s very similar to the motion of a pitcher, or a tennis serve or throwing a football,” said Lisa Raymond-Tolan, an occupational therapist in New York. “It’s the same motion, back and forth, back and forth, rotating up high. You have a heavy weight at the end of the arm, out in the air. It’s not just the shoulder. It’s the wrist as well.”
One of the bartenders at Varnish, Chris Bostick, shook his cocktails so vigorously that he ripped out the screws that had been inserted in his clavicle after a snowboarding injury. He was sidelined for weeks.
Maybe instead of Tommy John surgery, they’ll start calling it Johnny Walker surgery.
In the New Yorker, Michael Specter reports on tuberculosis, the world’s deadliest infectious disease — worldwide, more than 5000 people die from it every day. In India, misdiagnosis and improper treatment result in tens of thousands of unnecessary deaths a month and even new genetic screening machines might not help matters.
Since late 2009, the hospital has had one unique asset: a piece of equipment called a P.C.R., which can multiply tiny samples of DNA and analyze them. The device is not as fast as the GeneXpert, but it can examine the genetics of virtually any organism, including tuberculosis. The hospital’s machine, which was purchased with money from a government research grant, has never been used. “The hospital has had this for months,” Mannan said. “But nobody knows how it works.” We were standing at the door of the virology lab, where the new P.C.R. Cobas TaqMan 48, made by Roche and sold for roughly fifty thousand dollars, was resting on a shelf, still wrapped in its shipping material.
How could that be? I was staring at a machine that could alter, even save, the lives of scores of the people who were sitting nearby in the gathering heat. Mannan said nothing, though his anger was palpable.
[…] “It’s a nice lab,” Mannan said when we left. “Beautiful, actually. But if the doctors used it properly that would interfere with their private practice.”
I asked what he meant.
“It is simple,” he said. “If patients are treated at the hospital, they won’t need to pay for anything else.”
So with those foreskins, or more accurately, the fibroblasts from the cells of the foreskin, collagen can be lab-created, and where do you put collagen? On your face! Penis wrinkle cream, anyone? Oprah’s beloved SkinMedica product? Yup! Foreskins! One foreskin can be used for decades to grow thousands of fibroblasts.
The debate is essentially over and the final word is in: vaccines do not cause autism. The results of a rigorous study conducted over several years were just announced and they confirmed the results of several past studies.
Basically, the final two groups that were studied consisted of 256 children with ASD [autism spectrum disorders] and 752 matched controls. One very interesting aspect that looks as though it were almost certainly placed into the experimental design based on concerns of anti-vaccine advocates like Sallie Bernard is a group of children who underwent regression. Basically, the study examined whether there was a correlation between ASD and TCV [thimerosal-containing vaccines, i.e. mercury-containing vaccines] exposure. It also examined two subsets of ASD, autistic disorder (AD) and ASD with regression, looking for any indication whether TCVs were associated with any of them. Regression was defined as:
“the subset of case-children with ASD who reported loss of previously acquired language skills after acquisition.”
Also, when adding up total thimerosal exposure, the investigators also included any thimerosal exposure that might have come prenatally from maternal receipt of flu vaccines during pregnancy, as well as immunoglobulins, tetanus toxoids, and diphtheria-tetanus. In other words, investigators tried to factor in all the various ideas for how TCVs might contribute to autism when designing this study.
So what did the investigators find? I think you probably know the answer to that question. They found nothing. Nada. Zip. There wasn’t even a hint of a correlation between TCV exposure and either ASD, AD, or ASD with regression:
“There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83-1.51) for prenatal exposure, 0.88 (0.62-1.26) for exposure from birth to 1 month, 0.60 (0.36-0.99) for exposure from birth to 7 months, and 0.60 (0.32- 0.97) for exposure from birth to 20 months.”
The last result is a bit of an anomaly in that it implies that exposure to TCVs from birth to 1 month and birth to 7 months actually protects against ASD. The authors quite rightly comment on this result thusly:
“In the covariate adjusted models, we found that an increase in ethylmercury exposure in 2 of the 4 exposure time periods evaluated was associated with decreased risk of each of the 3 ASD outcomes. We are not aware of a biological mechanism that would lead to this result.”
So get your kids (and yourselves) vaccinated and save them & their playmates from this whooping cough bullshit, which is actually killing actual kids and not, you know, magically infecting them with autism. Vaccination is one of the greatest human discoveries ever — yes, Kanye, OF ALL TIME — has saved countless lives, and has made countless more lives significantly better. So: Buck. Up.
Electromagnetic waves resonate on a half-wavelength antenna to create a standing wave with a peak at the middle of the antenna and a node at each end, just as when a string stretched between two points is plucked at the center. In the U.S. bed frames and box springs are made of metal, and the length of a bed is exactly half the wavelength of FM and TV transmissions that have been broadcasting since the late 1940s.
(thx, anna)
Update: So, you know when you run across something about some current scientific theory or hypothesis on a blog or in a magazine or newspaper or even in a scientific journal, there’s a fair chance that whatever the article says is misleading, misstated, or even incorrect. That’s just how it is and if you didn’t know, now you do. Take this stuff with a grain of salt. It’s why I use phrases like “suspected cause” instead of something like “box springs and FM radio proven to cause cancer”.
I don’t post things like this because I think they’re right, I post them because I think they are interesting. The geometry of TV signals and box springs causing cancer on the left sides of people’s bodies in Western countries…that’s a clever bit of hypothesizing, right or wrong.
In this case, an organization I know nothing about (Vetenskap och Folkbildning from Sweden) says that Olle Johansson, one of the researchers who came up with the box spring hypothesis, is a quack. In fact, he was “Misleader of the year” in 2004. What does this mean in terms of his work on box springs and cancer? I have no idea. All I know is that on one side you’ve got Olle Johansson, Scientific American, and the peer-reviewed journal (Pathophysiology) in which Johansson’s hypothesis was published. And on the other side, there’s Vetenskap och Folkbildning, a number of commenters on the SciAm post, and a bunch of people in my inbox. Who’s right? Who knows. It’s a fine opportunity to remain skeptical. (thx, tom)
SuperBetter is a superhero-themed game that turns getting better in multi-player adventure. It’s designed to help anyone recovering from an injury, or coping with a chronic condition, get better, sooner - with more fun, and with less pain and misery, along the way.
The game starts with five missions. You’re encouraged to do at least one mission a day, so that you’ve successfully completed them all in less than a week. Of course, you can move through them even faster if you feel up to it.
McGonigal recently gave a short talk about SuperBetter:
and has plans to make a SuperBetter game guide so that anyone can play. (via mr)
A recent medical innovation holds out the promise that this might be the first generation of transsexuals who can live inconspicuously. About three years ago, physicians in the U.S. started treating transgender children with puberty blockers, drugs originally intended to halt precocious puberty. The blockers put teens in a state of suspended development. They prevent boys from growing facial and body hair and an Adam’s apple, or developing a deep voice or any of the other physical characteristics that a male-to-female transsexual would later spend tens of thousands of dollars to reverse. They allow girls to grow taller, and prevent them from getting breasts or a period.
The gel or thin film contains a peptide known as MSH, or melanocyte-stimulating hormone. Previous experiments, reported in the Proceedings of the National Academy of Sciences, showed that MSH encourages bone regeneration.
Bone and teeth are fairly similar, so the French scientists reasoned that if the MSH were applied to teeth, it should help healing as well.
To test their theory, the French scientists applied either a film or gel, both of which contained MSH, to cavity-filled mice teeth. After about one month, the cavities had disappeared, said Benkirane-Jessel.
Scientists are working on two fronts toward a cure for AIDS: 1) neutralizing HIV in the human body so that regular medication is unnecessary, and 2) eradicating all traces of HIV in the body.
Human immune-system stem cells are transplanted into pups bred from these mice when they are two days old, and over the next few months, those cells mature and diversify into a working immune system. Then the mice are infected with HIV, which attacks the immune cells. But before transplanting the original human cells, the researchers introduce an enzyme that interferes with the gene for a protein the virus needs to stage the attack. This modification makes a small percentage of the mature immune cells highly resistant to HIV, and because the virus kills the cells it can infect, the modified cells are the only ones that survive over time. Thus, the HIV soon runs out of targets. If this strategy works, the virus will quickly become harmless and the mice will effectively be cured.
Half the words you now routinely use you did not know existed when you started: words like arterial-blood gas, nasogastric tube, microarray, logistic regression, NMDA receptor, velluvial matrix.
O.K., I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.
Since I graduated from medical school, my family and friends have had their share of medical issues, just as you and your family will. And, inevitably, they turn to the medical graduate in the house for advice and explanation.
I remember one time when a friend came with a question. “You’re a doctor now,” he said. “So tell me: where exactly is the solar plexus?”
I was stumped. The information was not anywhere in the textbooks.
This is a good example of how the very ubiquity of vitamin C made it hard to identify. Though scurvy was always associated with a lack of greens, fresh meat contains adequate amounts of vitamin C, with particularly high concentrations in the organ meats that explorers considered a delicacy. Eat a bear liver every few weeks and scurvy will be the least of your problems.
But unless you already understand and believe in the vitamin model of nutrition, the notion of a trace substance that exists both in fresh limes and bear kidneys, but is absent from a cask of lime juice because you happened to prepare it in a copper vessel, begins to sound pretty contrived.
To start with, only simple tissues, such as skin, muscle and short stretches of blood vessels, will be made, says Keith Murphy, Organovo’s chief executive, and these will be for research purposes. Mr Murphy says, however, that the company expects that within five years, once clinical trials are complete, the printers will produce blood vessels for use as grafts in bypass surgery. With more research it should be possible to produce bigger, more complex body parts. Because the machines have the ability to make branched tubes, the technology could, for example, be used to create the networks of blood vessels needed to sustain larger printed organs, like kidneys, livers and hearts.
Some scientists have developed a promising method for targeting and destroying individual cancer cells without harming the tissue around them. Tiny (like nano tiny) gold-plated iron-nickel discs are attached to cancer-seeking antibodies. The antibodies attach themselves to the cancer cells and when an alternating magnetic field is applied, the metal nano-discs vibrate and literally shake the cancer cells to death.
Since the antibodies are attracted only to brain cancer cells, the process leaves surrounding healthy cells unharmed. This makes them unlike traditional cancer treatment methods, such as chemotherapy and radiation, which negatively affect both cancer and normal healthy cells.
In 1961, surgeon Leonid Rogozov was the only physician stationed on an isolated 12-man Soviet base in Antarctica when he developed appendicitis. He had to remove his appendix himself.
“I didn’t permit myself to think about anything other than the task at hand. It was necessary to steel myself, steel myself firmly and grit my teeth. In the event that I lost consciousness, I’d given Sasha Artemev a syringe and shown him how to give me an injection. I chose a position half sitting. I explained to Zinovy Teplinsky how to hold the mirror. My poor assistants! At the last minute I looked over at them: they stood there in their surgical whites, whiter than white themselves. I was scared too. But when I picked up the needle with the novocaine and gave myself the first injection, somehow I automatically switched into operating mode, and from that point on I didn’t notice anything else.
To ensure it had enough eggs to meet pandemic-level demand, the government invested more than $44 million in the program over five years; more than 35 farms are now involved in this feathered Manhattan Project. No signs advertise the farms’ involvement in the program, and visits from the outside world are discouraged. The government won’t disclose where the farms are located, and the farmers are told to keep quiet about their work — not even the neighbors are to know.
These don’t exactly sound like free-range operations:
After nine months of service, [the chickens] are typically euthanized because they can no longer lay “optimal eggs,” Mr. Robinson said. “They’ve served their government,” he said.
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