kottke.org posts about medicine
Doctors and researchers are investigating the source of a new disease caused by aerosolized pig brains.
Their working hypothesis is that the harvesting technique — known as “blowing brains” on the floor — produces aerosols of brain matter. Once inhaled, the material prompts the immune system to produce antibodies that attack the pig brain compounds, but apparently also attack the body’s own nerve tissue because it is so similar.
(via frontal cortex)
Dr. Jay Parkinson M.D. emailed in to tell me about his new medical practice in Williamsburg. He’s got no office (housecalls only), takes appointment requests via SMS, email, or IM, handles some follow-ups over video chat, and specializes in the 18-40 age group without traditional health insurance. The goal, states Parkinson, is to “mix the service of an old-time, small town doctor with the latest technology to keep you and your bank account healthy”.
To give you an idea of how the practice operates, here’s a recap of his first day on the job:
Yesterday went quite well and I was very happy with the amount of money I kept out of the hands of companies that attempt to take advantage of how difficult it is to find prices for medications and healthcare services. For example, the first patient I saw needed a medication that Walgreens offered for $60. I called my tried and true Williamsburg mom-and-pop pharmacy only a few blocks from Walgreens and talked to Arthur the Pharmacist who said he sells it for $15. “Thanks Arthur.” “No thank you Jay.” The way it should be done.
My second patient was getting a certain medication for years every month by mail from Walgreens that costs $63 per month. I knew where she could get the same medication for $42 a month. I just saved her $252 per year. After she made her $200 down payment on my services via PayPal, her monthly fee for my services is now only $17 a month. But I just saved her $21 a month on her monthly mail order medication. She’s essentially getting the rest of the year of my services for free. Not bad.
Sounds fantastic. If only every doctor was this much of an advocate for his patients.
P.S. Parkinson also happens to be a heck of a photographer (@ Flickr). Some photos NSFW. I linked to this interview about his photography between him and Joerg Colberg last May.
Update: The WSJ Health blog has a short interview with Parkinson, followed by a lengthy comment thread.
Oscar the cat lives at the Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. According to an article in the New England Journal of Medicine, Oscar possesses a peculiar talent…he knows when the residents there are going to die and curls up with them for comfort before they pass.
Making his way back up the hallway, Oscar arrives at Room 313. The door is open, and he proceeds inside. Mrs. K. is resting peacefully in her bed, her breathing steady but shallow. She is surrounded by photographs of her grandchildren and one from her wedding day. Despite these keepsakes, she is alone. Oscar jumps onto her bed and again sniffs the air. He pauses to consider the situation, and then turns around twice before curling up beside Mrs. K.
One hour passes. Oscar waits. A nurse walks into the room to check on her patient. She pauses to note Oscar’s presence. Concerned, she hurriedly leaves the room and returns to her desk. She grabs Mrs. K.’s chart off the medical-records rack and begins to make phone calls.
Within a half hour the family starts to arrive. Chairs are brought into the room, where the relatives begin their vigil. The priest is called to deliver last rites. And still, Oscar has not budged, instead purring and gently nuzzling Mrs. K. A young grandson asks his mother, “What is the cat doing here?” The mother, fighting back tears, tells him, “He is here to help Grandma get to heaven.” Thirty minutes later, Mrs. K. takes her last earthly breath. With this, Oscar sits up, looks around, then departs the room so quietly that the grieving family barely notices.
For some, the hospital is a place to go to get sick, not to get healthy. At the Veterans Affairs hospital in Pittsburgh, they’re cutting down on diseases passing from patient to patient by testing arriving patients for drug-resistant bacteria, more careful use of equipment, and careful isolation of the most sick. A surgical unit in the hospital has cut their infection rate by 78% since 2001.
A company called Lifeforce has received FDA approval to store white blood cells for people as a “back-up copy of your immune system”. The idea is that those pre-diseased cells could be reproduced in the lab and infused back into your body when needed to fight off infection or deal with the aftermath of chemotherapy.
How doctors make their decisions is being studied in the hopes of making medical care better. “Doctors can also make mistakes when their judgments about a patient are unconsciously influenced by the symptoms and illnesses of patients they have just seen. Many common infections tend to occur in epidemics, afflicting large numbers of people in a single community at the same time; after a doctor sees six patients with, say, the flu, it is common to assume that the seventh patient who complains of similar symptoms is suffering from the same disease.”
The Ghost Map is a book about:
- a bacterium
- the human body
- a geographical map
- a man
- a working friendship
- a household
- a city government
- a neighborhood
- a waste management system1
- an epidemic
- a city
- human civilization
You hooked yet? Well, you should be. As the narrative unfolds around the 1854 London cholera epidemic, author Steven Johnson weaves all of these social, geographical, and biological structures/webs/networks into a scientific parable for the contemporary world. The book is at its best when it zooms among these different scales in a Powers of Ten-like fashion (something Johnson calls The Long Zoom), demonstrating the interplay between them: the way the geography of a neighborhood affected the spread of a virus, how ideas spreading within a social context are like an epidemic, or the comparison between the organism of the city and the geography of a bacterial colony within the human colon. None of this is surprising if you’ve read anything about emergence, complexity, or social scale invariance, but Johnson effectively demonstrates how tightly coupled the development of (as well as our understanding of) viral epidemics and large cities were across all of these scales.
The other main theme I saw in the book is how inherently messy science is. Unlike many biographies, The Ghost Map doesn’t try to tie everything up into a nice little package to make a better story. The cholera epidemic and its resolution was sloppy; there was no aha! moment where everyone involved understood what was going on and knew what had to be done. But the scientific method applied by John Snow to the situation was solid and as more evidence became available over the years, his theory of and solution to cholera epidemics were revealed as actual fact. Johnson reminds us that that’s how science works most of the time; science is a process, not a set of facts and theories. During the recent debate in the US over evolution and intelligent design, I felt a reluctance on the part of scientists to admit to this messiness because it would give an opening to their detractors: “haha, so you admit you don’t know what’s going on at all!” Which is unfortunate, because science is powerful in its nuance and rough edges (in some ways, science is what happens at the margins) in helping us understand ourselves and the world we live in.
[1] Had Mark Kurlansky written this book, it would have been called “Shit: How Human Effluence Changed the World”. ↩
Atul Gawande on the rise in Cesarean deliveries in the US, which soon may become safer than natural childbirth: “We are losing our connection to yet another natural process of life. And we are seeing the waning of the art of childbirth. The skill required to bring a child in trouble safely through a vaginal delivery, however unevenly distributed, has been nurtured over centuries. In the medical mainstream, it will soon be lost.”
The hygiene hypothesis of allergies “argues that exposure to more natural environments such as farms early in life helps train the body to respond appropriately to harmless microbes and pollen”. Could also be called the “let your kids eat dirt hypothesis”. Somewhat related story: my dad had allergies when he was a kid but then got stung by a bunch of bees one day and boom, no more allergies.
President of the Oglala Sioux Tribe on the Pine Ridge Reservation, Cecilia Fire Thunder, says:
I will personally establish a Planned Parenthood clinic on my own land which is within the boundaries of the Pine Ridge Reservation where the State of South Dakota has absolutely no jurisdiction.
(via bb)
Michael Crichton on the sad state of patents in the US, particularly those related to medicine. “Any doctor who reads a patient’s test results and even thinks of vitamin deficiency infringes the [homocysteine/B-12] patent. A federal circuit court held that mere thinking violates the patent.”
So, it’s day five of my cold[1]. Last night, I was down to only two out of my five senses. My sense of taste and smell left the scene sometime on Saturday. On Sunday, I had salad and fruit for lunch because I figured if I can’t taste anything, I might as well eat healthy. Trying to smell or taste strongly aromatic substances like wine or scented shower gel produces a sensation not unlike that of tasting or smelling something, except there’s no smell or taste. It’s the weirdest thing…I don’t even know how to properly describe it. It’s like there’s a ghost of a taste and when I think too hard about trying to really taste it, it’s gone. It’ll be a relief when I finally decongest and can enjoy food again[2].
And then yesterday while driving, we went from sea level up to around 600 ft of elevation, which caused the pressure to build up in my head enough to affect my hearing. By 4pm, everything was kind muffled and I was asking Meg speak up repeatedly. I could just barely hear the hum of the highway under the car. Last night at dinner, I couldn’t taste anything, smell anything, hear anything, and my voice was so gravelly from my cold (and probably way too loud from overcompensating for the hearing loss) that listening to me was probably not very pleasant. My ears finally popped somewhat this morning and I can hear ok again, but smell and taste are still missing. Come back, guys, I miss you!
Update: Here’s an article by Jason Feifer from the Washington Post about his investigation into his poor senses of taste and smell. (thx, mim)
[1] After a bit of research this AM, I’ve determined that what I have is a cold and not the flu.
[2] I remember reading a book or article once that mentioned a person who lost their sense of taste and when it would briefly return, that person would drop whatever they were doing and go eat a great meal. Anyone know where that story is from?
In the five years since the sequencing of the human genome, “much of the data have little immediately useful meaning, and the research has produced only a trickle of medicine”. And where medical science has failed, hucksters have filled the gap.
Gelf Magazine says “a new study uses shoddy stats to hold the movie industry responsible for society’s poor health choice”. “But even if we disregard the fact that people don’t necessarily take their public-health cues from films like Scary Movie and Rambo: First Blood Part II, the study has serious flaws that undermine even its tenuous claim on our attention”.
Among laparoscopic surgeons, those who have played video games in the past are significantly faster and less error-prone in a surgical training exercise than those who have never gamed. Even better were those who are current gamers…they realized 30% gains in speed and accuracy over their non-gaming counterparts.
Laurie sends along an account of the week she spent in a psych ward. She says she’s “trying to publicize it in order to remove some of the stigma of mental illness”. Reminds me of Heather’s accounts of her psych ward stay last year.
Making sense of the appendix, the one in your body, not the one in books. “Perhaps the appendix lifted the odds that our ancestors could resist childhood diseases and live to childbearing years.”
The science of Lance Armstrong. Between 1992 and 1999, he increased his muscle efficiency by 8 percent, a gain previously thought to be impossible.
I was somewhat disappointed in the 2003 edition of this collection, especially after enjoying so much the last three editions. Perhaps Oliver Sacks and I disagree on what makes science writing good. The two best articles were 1491 by Charles Mann about what the Americas were like before Columbus landed and the effect of the European arrival:
In North America, Indian torches had their biggest impact on the Midwestern prairie, much or most of which was created and maintained by fire. Millennia of exuberant burning shaped the plains into vast buffalo farms. When Indian societies disintegrated, forest invaded savannah in Wisconsin, Illinois, Kansas, Nebraska, and the Texas Hill Country. Is it possible that the Indians changed the Americas more than the invading Europeans did? “The answer is probably yes for most regions for the next 250 years or so” after Columbus, William Denevan wrote, “and for some regions right up to the present time.”
and Atul Gawande’s The Learning Curve, an article on how doctors need to learn on the job (while potentially making costly mistakes) in order to become more effective overall:
In medicine, there has long been a conflict betwenn the imperative to give patients the best possible care and the need to provide novices with expericne. Residencies attempt to mitigate potential harm through supervision and graduated responsibility. And there is reason to think that patients actually benefit from teaching. But there is no avoiding those first few unsteady times a young physician tries to put in a central line, removes a breast cancer, or sew together two segments of colon. No matter how many protections are in place, on average these cases go less well with the novice than with someone experienced.
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