Friday, January 19, 2018

This Won't Hurt A Bit - Medical podcast

Imagine a podcast that mixes current medical stories with opinion from experts about medicine, science and what it means to be human. Imagine beautifully created stories about medical history and the characters that created the world we live in today. Imagine hearing pieces that highlight the wonder and tragedy of being human. Imagine if this show was created by some of the most famous, experienced and talented physicians and podcasters in the world...imagine no more…

Simple blood test detects eight different kinds of cancer - Nature

A single blood test could one day be used to detect a variety of cancers, results from a preliminary trial suggest.

The past few years have seen a bevy of experimental tests called liquid biopsies that hold the promise of detecting and tracking tumours from a simple blood draw. Many of these tests are designed to detect a single kind of cancer by spotting tumour-associated mutations in DNA sequences found floating freely in the blood.

The latest study, published on 18 January in Science1, is unusual in that it tests not only for these DNA mutations, but also for aberrant levels of certain proteins, in an effort to detect eight different cancers. The test was able to detect disease in about 70% of more than 1,000 people who had already been diagnosed with cancer.

The researchers hope that their work could eventually lead to a test that is simpler and cheaper than the intensive sequencing involved in some other liquid biopsies. "They end up with performance that is similar to other approaches, but with what looks to be a much more cost-effective approach," says Nitzan Rosenfeld, a cancer researcher at the University of Cambridge, UK.

Many groups in academia and industry have focused on using liquid biopsies to track cancer progression and to guide physicians as they formulate a treatment plan.

But oncologist Nickolas Papadopoulos at the Johns Hopkins Kimmel Cancer Center in Baltimore, Maryland, and his colleagues wanted to develop a test that could detect cancers early, when they are easier to treat.

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Tuesday, January 16, 2018

So You Might Actually Not Be Allergic to Penicillin - Daily Beast

If you say that you're allergic to penicillin— a narrow-spectrum antibiotic that, for many bacterial infections, is still considered to be a "wonder drug"—your doctor won't prescribe it. Once you write it on those forms in the waiting room, or tell your pharmacist, "penicillin allergy" becomes part of your permanent medical record.

Yet a growing body of evidence suggests that most people who say they're allergic to penicillin are, well, wrong. In a recent study published in Journal of Allergy & Clinical Immunology, nearly 90 percent of patients who had "penicillin allergy" listed on their medical charts were found to actually have no such allergy at all.

"There's this problem— what you could consider an epidemic—of people labeled with unverified penicillin allergy. It's the number one drug allergy that's listed in patients' records," Dr. Dave Kahn, a professor at the University of Texas Southwestern Medical Center and co-author of the study, told The Daily Beast. Over one in 10—up to 15 percent—of Americans has a reported penicillin allergy. That's more than the number of adults in the U.S. who have hay fever (7.8 percent), and the number of children under age three who have food allergies (8.0 percent).

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Wednesday, January 10, 2018

You’re Sick. Whose Fault Is That? - The New York Times

On my pediatrics rotation in medical school, several residents told me they worked with children in part because they sometimes found themselves judging adults: Did they do drugs? Were they fat? Why did they drink so much?

The idea that Americans should take personal responsibility for their health has recently received renewed attention. Vice President Mike Pence has argued for "bringing freedom and individual responsibility back to American health care."

Mick Mulvaney, director of the Office of Management and Budget, expressed a more punitive view, saying, "That doesn't mean we should take care of the person who sits at home, eats poorly, and gets diabetes."

The call for personal responsibility is not new, nor just conservative. Barack Obama said, "We've got to have the American people doing something about their own care."

Many Americans think it's O.K. to ask people with unhealthy lifestyles to pay higher insurance premiums and deductibles. Efforts to inject more personal responsibility into health care, however, have not consistently been shown to lower costs, improve outcomes or save lives. Effectiveness — or lack of it — is often in the eye of the partisan beholder.

What does it actually mean to take personal responsibility for health?

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Friday, January 5, 2018

How to Counter the Circus of Pseudoscience - The New York Times

Maybe one day, once I have decades of experience as a doctor and further training in my area of specialization, I will be able to speak about health matters with the tone of authority of the average naturopath.

That was the thought that crossed my mind recently while I waded through the online world of alternative-health practitioners, wellness bloggers, whole-food chefs and Gwyneth Paltrow.

I did not seek it out at first; it came to me through a social-media algorithm. Facebook offered up a video advertisement from a "female hormonal health specialist" with her own "practice." Not an endocrinologist but a naturopath. She lectured with confidence on thyroid testing, though much of what she said was wrong. And down the internet rabbit hole I went.

One traditional view of the medical profession is that doctors are commanding and authoritarian, even arrogant. Though some individuals fit that description, in fact, the profession is built on doubt.

Most doctors, especially the good ones, are acutely aware of the limits of their knowledge. I have learned from those much more experienced and qualified than me that humility is something to be cultivated over time, not lost.

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A Doctor With a Phone and a Mission - The New York Times

More than 200,000 people seek addiction treatment on the phone or online every month. Few of them realize that their pleas for help are a valuable commodity — one that is quietly fought over by those angling to turn a distress signal into cash.

Addicts represent big money to treatment centers, which are happy to pay a middleman $50 for a "lead" on a patient who might generate $40,000 or more in insurance claims in a matter of months. That is why television ads offering help to addicts air constantly nationwide.

But lead generators, or lead gens, aren't necessarily the ideal path to rehab clinics — as Dr. Alan Goodwin, an inquisitive psychologist in Palm Beach, Fla., accidentally discovered earlier this year. That discovery led him on a monthslong personal mission to try to understand the ethically murky business of customer acquisition in the treatment world.

It started when Dr. Goodwin, who works as an education and health care consultant, phoned a local substance abuse awareness coalition with a question about the format of a presentation he was to make. Instead of the organization, he got a recording saying the number had been disconnected — but before he could hang up, the message continued.

"We can help you find an alternative addiction specialist," the recording said, according to Dr. Goodwin. "Please stay on the line while we look."

The medical group's phone number, he quickly realized, had been hijacked by a drug-treatment referral service.

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Thursday, December 28, 2017

How Big Tech Is Going After Your Health Care - The New York Times

When Daniel Poston, a second-year medical student in Manhattan, opened the App Store on his iPhone a couple of weeks ago, he was astonished to see an app for a new heart study prominently featured.

People often learn about new research studies through in-person conversations with their doctors. But not only did this study, run by Stanford University, use a smartphone to recruit consumers, it was financed by Apple. And it involved using an app on the Apple Watch to try to identify irregular heart rhythms.

Intrigued, Mr. Poston, who already owned an Apple Watch, registered for the heart study right away. Then he took to Twitter to encourage others to do likewise — suggesting that it was part of a breakthrough in health care.

"It's not inconceivable, by the time I graduate from medical school," Mr. Poston said, "that the entire practice of medicine can be revolutionized by technology."

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Freed From the iPhone, the Apple Watch Finds a Medical Purpose - The New York Times

In the last months of Steve Jobs's life, the Apple co-founder fought cancer while managing diabetes.

Because he hated pricking his finger to draw blood, Mr. Jobs authorized an Apple research team to develop a noninvasive glucose reader with technology that could potentially be incorporated into a wristwatch, according to people familiar with the events, who asked not to be identified because they were not authorized to speak on behalf of the company.

It was one of many medical applications that Apple considered for the Apple Watch, which debuted in 2015. Yet because many of the health features proved unreliable or required too many compromises in the watch's size or battery life, Apple ended up positioning the device for activity tracking and notifications instead.

Now, the Apple Watch is finding a medical purpose after all.

In September, Apple announced that the Apple Watch would no longer need to be tethered to a smartphone and would become more of a stand-alone device. Since then, a wave of device manufacturers have tapped into the watch's new features like cellular connectivity to develop medical accessories — such as an electrocardiogram for monitoring heart activity — so people can manage chronic conditions straight from their wrist.

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Saturday, December 9, 2017

Pills get overprescribed as people age but there can be bad side effects for seniors - The Washington Post

Consider it America's other prescription drug epidemic.

For decades, experts have warned that older Americans are taking too many unnecessary drugs, often prescribed by multiple doctors, for dubious or unknown reasons. Researchers estimate that 25 percent of people ages 65 to 69 take at least five prescription drugs to treat chronic conditions, a figure that jumps to nearly 46 percent for those between 70 and 79. Doctors say it is not uncommon to encounter patients taking more than 20 drugs to treat acid reflux, heart disease, depression or insomnia or other disorders.

Unlike the overuse of opioid painkillers, the polypharmacy problem has attracted little attention, even though its hazards are well documented. But some doctors are working to reverse the trend.

At least 15 percent of seniors seeking care annually from doctors or hospitals have suffered a medication problem; in half of these cases, the problem is believed to be potentially preventable. Studies have linked polypharmacy to unnecessary death.Older patients, who have greater difficulty metabolizing medicines, are more likely to suffer dizziness, confusion and falls. And the side effects of drugs are frequently misinterpreted as a new problem, triggering more prescriptions, a process known as a prescribing cascade.

The glide path to overuse can be gradual: A patient taking a drug to lower blood pressure develops swollen ankles, so a doctor prescribes a diuretic. The diuretic causes a potassium deficiency, resulting in a medicine to treat low potassium. But that triggers nausea, which is treated with another drug, which causes confusion, which in turn is treated with more medication.

For many patients, problems arise when they are discharged from the hospital on a host of new medications, layered on top of old ones.

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Monday, December 4, 2017

New Recognition for Chronic Fatigue - The New York Times

Having recently endured more than a month of post-concussion fatigue, I can't imagine how people with so-called chronic fatigue syndrome navigate through life with disabling fatigue that seemingly knows no end. Especially those who are erroneously told things like "It's all in your head," "Maybe you should see a psychiatrist," or "You'd have a lot more energy if only you'd get more exercise."

After years of treating the syndrome as a psychological disorder, leading health organizations now recognize that it is a serious, long-term illness possibly caused by a disruption in how the immune system responds to infection or stress. It shares many characteristics with autoimmune diseases like rheumatoid arthritis but without apparent signs of tissue damage.

Accordingly, doctors now typically refer to it as myalgic encephalomyelitis, meaning brain and spinal cord inflammation with muscle pain, and in scientific papers it is often written as ME/CFS. At the same time, a major shift is underway as far as how the medical profession is being advised to approach treatment.

The longstanding advice to "exercise your way out of it" is now recognized as not only ineffective but counterproductive. It usually only makes matters worse, as even the mildest activity, like brushing your teeth, can lead to a debilitating fatigue, the core symptom of the disease. Both the Centers for Disease Control and Prevention in the United States and the National Institute for Health and Care Excellence in Britain are formulating revised guidelines for managing an ailment characterized by six or more months — and sometimes years — of incapacitating fatigue, joint pain and cognitive problems.

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