nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Tuesday, July 28, 2009

FAT KIDS, MORE MICE, AND THE MARKET FOR GUT BACTERIA

The analysis of healthcare reform has lurched into action over the last week; analysts are doing a much better job than I can, so I’m not going to concentrate on it.  However, if you’re interested here are a couple of reports:

  1. FactCheck.org is an organization that checks the facts that politicians and advocates put out.  They kick everybody in the rear:  McCain, Palin, Obama, DNC, RNC ….  You can survey the website to validate the broad brush they paint.  Here is their analysis of the President’s claims for healthcare and its reform:  http://www.factcheck.org/politics/obamas_health_care_news_conference.html.

 

  1. The article referenced below discusses some of the statements made in the medical journals over the last few years by the doctors who are key advisors to the President.  One of them is the brother of the White House Chief of Staff, who said the following in Lancet (Jan 31):

 

“Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years"

 

So much for the “no rationing” claims.  As a doctor, I find this kinda’ chilling:  http://www.nypost.com/seven/07242009/postopinion/opedcolumnists/deadly_doctors_180941.htm.

 

Back to some less dismal stuff:

 

Scientists produce live mice from induced pluripotent stem cells.

NBC Nightly News (7/23, story 8, 2:25, Williams) reported that there is a mouse in China that goes by the name Tiny, and what makes it and "26 others unique is that researchers cloned him -- not from embryonic stem cells, but from another mouse's skin cells."

        Although "some of the mice...had 'abnormalities,'" the AP (7/24, Borenstein) reports, they were able to produce "second and third generations that included hundreds of mice with no noticeable abnormalities." The authors conceded that the "process isn't very efficient; many attempts were needed to get stem cell generated births."

 

Doc D:  Aren’t there enough rodents in the world already?  But, note that this was done with skin stem cells, not embryonic skin cells.  Another example of how the embryonic stem cell research issue was just a political canard.

 

Studies challenge conventional wisdom on juvenile obesity trends.

The Wall Street Journal (7/22, Bialik) reports, "Evidence for the expanding epidemic of childhood obesity is thinning. Nutritionists, health advocates, and media reports have been sounding the alarm about a rise in childhood obesity, which could lead to diabetes, heart disease and other problems." Now, new research "from half a dozen countries suggest that rates have held steady over the past five to 10 years, albeit at levels much higher than in the 1960s and 1970s." Still, the reasons for the leveling off in the US, Australia, France, Switzerland, Sweden, and New Zealand "remain shrouded in mystery." The CDC's figures for the US found that "obesity rates among children hovered at about 16 percent between 2002 and 2006," a plateau that came as "a surprise to William Dietz, director of the CDC's division of nutrition, physical activity, and obesity, who notes that prominent anti-obesity-awareness campaigns have only been around for a few years."

 

Doc D:  While “leveling off” in obesity isn’t what I would call a correction, it may be that a physiological limit is being reached.  Also, obesity could be leveling off because there are only so many times you can do the “arm curl” from your plate to your mouth in a 24 hour period.  Duh…  Benjamin Disraeli said something to the effect that by the time the populace becomes aware of a crisis requiring a response, the problem is already beginning to experience a correction due to natural processes.  I wonder how many millions we will spend to investigate this common sense issue.  Feed your kids sensibly, make sure they exercise, and forget the rest.

 

 

Author discusses gut bacteria's potential role in human health.

In a New York Times (7/21) blog, Olivia Judson writes, "The typical human is home to a vast array of microbes," but "only now, with the revolution in biotechnology...we're able to do detailed studies of which microbes are there, which genes they have, and what they're doing." The bacteria in the digestive tract intrigue Judson. "Many of these appear to be true symbionts" that "play crucial roles in digesting food and modulating the immune system." Currently, "a huge effort is...underway to see whether differences in gut bacteria are responsible for differences in health." The gut "microbiome" may contain over "100 times more genes than the human genome," and while "humans are extremely similar to one another at the level of the genome, the microbiome appears to differ markedly from one person to the next."

 

Doc D:  The industry is already madly putting out expensive macrobiotic supplements and foods, despite a lack of evidence—yet—that they do anything.  It’s almost impossible to do meaningful research on the complex interaction of a “vast number of microbes.”  These products are being sold with no well-conducted studies and under the sobriquet of being “natural”, when most aren’t.  All of these microbes come in your regular food anyway, and there’s no evidence to suggest that getting them separately is any better.  Don’t waste your money—yet.

 

 

Study shows experimental AIDS drug decreased virus to undetectable levels in most patients.

Bloomberg News (7/22, Bennett) reports, "GlaxoSmithKline PLC's experimental AIDS drug," called S/GSK1349572, "reduced the virus as much as 500-fold without the signs of resistance linked to treatments from Merck & Co. and Gilead Sciences Inc., a study showed." Data from the first human trial presented at the International AIDS Society's conference in Cape Town, South Africa, showed the drug "decreased the virus to undetectable levels in 70 percent" of the 35 patients in the study. In addition, none of the patients "showed signs of drug resistance," and the researchers "didn't detect genetic mutations associated with resistance to Merck's Isentress [raltegravir] and Gilead's Elvitegravir [GS-9137] either."

 

Doc D:  We need to watch this one.  If this drug doesn’t promote resistance to other effective drugs, it will really be something.  The problem so far with HIV disease treatment has been having to chase after resistance that develops to every drug we use.

 

 

FDA approves seasonal flu vaccine.

USA Today (7/21, Sternberg) reports, "The Food and Drug Administration approved a seasonal flu vaccine on Monday, in plenty of time to protect people against the three standard flu strains expected to spread this fall." However, the FDA warned that "the seasonal vaccine will not guard against a fourth, potentially more dangerous, strain spreading worldwide." The swine flu "has caused more than 40,000 cases and 260 deaths in the USA and its territories." The CDC "recommends flu vaccine for children and young people 6 months to 19 years of age; pregnant women; people 50 and older; people with chronic diseases; people in long-term care facilities; and those who live with, or care for, those most susceptible to flu and its complications.

 

Doc D:  This is IMPORTANT.  Note that the vaccine doesn’t protect against the new H1N1…but that doesn’t mean you don’t need to take it.  These standard seasonal flu viruses will be around, causing disease.  So, get your shot in the Fall.  The vaccine for the new strain won’t be available until October at the earliest.  Human trials are just beginning:  even if successful, it takes a long time to grow the virus in quantity.  The new illness is turning out to be about as serious as all the others, no more, but viruses can mutate once they get out in the population, so, stand by…

 

Let me say this again:  TAKE THE REGULAR FLU SHOT AND THE NEW ONE WHEN IT COMES OUT.  (they could be combined, we’ll see..)

 

 

Some doctors requiring patients to sign contracts prohibiting online physician reviews.

The Washington Post (7/21, Boodman) reports, "In the past five years more than 40 websites...have begun reviewing physicians, providing information about one of the more difficult and important decisions consumers make routinely." But, "as these sites proliferate -- a reflection of the hunger for information about doctors in an era where patients are expected to make sophisticated decisions about their care -- questions about their usefulness, accuracy, and fairness are intensifying." As a result, some physicians are now "requiring patients to sign broad agreements that prohibit online postings or commentary in any media outlet 'without prior written consent.'" Critics claim these documents are "gag orders," arguing that "they are both unethical and unenforceable." Still, physicians increasingly "view them as an appropriate response to sites that not only ask detailed questions...but also permit comments that may be untrue."

 

Doc D:  What is good medical care?  For most patients I’ve come in contact with, it’s “getting what you need when you need it.”  That seems to make good sense, but it’s a little vague.  Consider this:  I’m a doctor, you have a tough time getting a quick appointment because I’m very busy, and I am personally somewhat unsympathetic.  My office is clean and hygienic, my staff are professional and courteous, but businesslike.  BUT, my diagnostic process, which you really can’t judge:  why I’m doing the things I’m doing and asking the questions I’m asking—they may seem to make no sense to you—uncovers some elements of your illness, particular to you, that few doctors would have discovered. Therefore, I prescribe a different treatment, which works for you because of your unique findings, despite the fact that it’s not the standard way to do this.  And, finally, you get better faster than you would have otherwise.  Or, maybe you don’t, for reasons that have nothing to do with the treatment…maybe it’s just the illness’s fault (the most common cause of poor outcomes).  Some months back, I recommended a book titled “How Doctors Think.”  It’s a worthwhile read, to get inside the head of someone who’s trying to help you using knowledge you probably don’t have.

 

Is this quality medical care?  I think so, but I don’t know how it will be reflected on Angie’s List.  Will it be “couldn’t get an appointment” and “nobody seemed to care”?  It depends on personal perceptions of customer service.  When I see a doctor, the things I focus on are the ones I listed above, because it means they are focusing on what I want from healthcare.  I don’t care about the magazines or chairs in the waiting room, and I don’t care…much…about the doctor’s personality—as long as we can get the job done between me, the patient, and him/her, the doctor.  I’m conflicted about this, but if online physician reviews consciously accept that their focus is customer service rather than medical competence, then they’re OK. 

 

 

Medical quote of the DayThis is more related to healthcare reform economics, but still a good quote from a Nobel Prize winner. 

“Government is one means through which we can try to compensate for ‘market failure,’ try to use our resources more effectively to produce the amount of clean air, water, and land that we are willing to pay for.  Unfortunately, the very factors that produce market failure also make it difficult for government to achieve a satisfactory solution…. Attempts to use government to correct market failure have often simply substituted government failure for market failure.”  --Milton and Rose Friedman, Free to Choose, 1979.

 

 

Fraud Alert:    1.   There’s a fascinating story about how acupuncture got its start in the US back in the 1970’s here:  http://www.sciencebasedmedicine.org/?p=131.  Like the “Spouse Abuse during Superbowl” phenomenon, it appears that there was a no basis in fact for the claim.  Instead it was assumed that President Nixon’s physician had his appendix operation under acupuncture while traveling in China… in fact he had a standard spinal block.  The author goes on to pursue the sociology of how acupuncture became a fad, which has since been controversial and has often failed in controlled studies to accomplish organic anesthesia.  He tries to make the case that this fascination with an unproven procedure led to the further interest in herbals and supplements that we are experiencing today.  I’m not so sure you can link up the two, but it’s a fun story to read.

 

Doc D

Opinions are entirely my own.  Quotations and excerpts are from Kaiser Daily Health Policy Report ( © Kaiser Family Foundation), PND News Briefs – Texas Edition ( © 2008, Physician's News Digest, Inc.), AMA Morning Rounds (© U S News Custom Briefings), and other sources in the public domain.  As always, you may share this column, with appropriate attribution (here and in the text) included.  Please do not forward my email address.

 

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