Saturday, May 28, 2016
In other words: Green and Jones have refused to write a medical beach read. It's a courageous choice but one that will most likely limit sales. That's too bad, because the book is a model for how to communicate science to the public, an antidote to the breathless hype and simplistic headlines that too often dominate popular scientific discourse.
The medical beach read is a straightforward genre. Like its fictional counterpart, there are clear villains: grains, toxins, malevolent corporations, the mainstream medical establishment. There are heroes: good fats, natural foods, everyday people who refuse to be sheeple, maverick doctors who write books that go against the grain. The archetypal plot is uncomplicated: For too long we have neglected the dietary root cause of our suffering, and things have never been worse than they are today. Fortunately, there's always a happy ending, and it's usually as simple as eating (or not eating) certain foods.
Medical beach reads sell like crazy because they are easy, empowering page-turners. Each chapter promises secret scientific knowledge in terms that any person can understand. The knowledge is profound, conclusive, revolutionary, and extraordinary. There's invariably a map to the holy grail of effortless weight loss. And like advertisements, the books are written for you. ("If the thought of your brain suffering over a bowl of savory pasta or plate of sweet French toast seems far-fetched, brace yourself," warns Grain Brain.)
But science is not fiction, and medical beach reads are not harmless dramas. They encourage a view of scientific knowledge as propelled by sporadic revolutions rather than incremental advancement; great scientists as lone truthseekers rather than contributors to a communal endeavor. The drama is not a fantasy: It is real, it is religious, and readers are made to believe that they are confronting a clear choice between salvation and damnation.
Gluten Exposed avoids these pitfalls with the humility and honesty that ought to be standard in any discussion of contentious medical research. The book offers expert, up-to-date summaries of the scientific consensus (or lack thereof) on gluten, grains, the gut, the microbiome, and theories about how these come together in healthy and unhealthy people. What exactly is the truth about gluten? It turns out that with the exception of celiac sufferers, who can't ever eat it, we're just not sure—though it certainly isn't as bad as popular health gurus might have you believe. Every chapter emphasizes this complexity. The mechanism of irritable bowel syndrome is "poorly understood." There is "conflicting data" on the effects of a gluten-free diet. The relationship between autism and gluten-containing grains "must be studied further."
Wednesday, May 25, 2016
Seemingly overnight, treatment of men with early-stage prostate cancer has undergone a sea change. Five years ago, nearly all opted for surgery or radiation; now, nearly half are choosing no treatment at all.
The approach is called active surveillance. It means their cancers are left alone but regularly monitored to be sure they are not growing. Just 10 percent to 15 percent of early-stage prostate cancer patients were being treated by active surveillance several years ago. Now, national data from three independent sources consistently finds that 40 percent to 50 percent of them are making that choice.
In recent years, major research organizations have begun to recommend active surveillance, which for years had been promoted mostly by academic urologists in major medical centers, but not by urologists in private practice, who treat most men. In 2011, the National Institutes of Health held a consensus conference that concluded that it should be the preferred course for men with small and innocuous-looking tumors. Last year, the American Society of Clinical Oncology issued guidelines with the same advice.
The data includes a large new national registry established by the American Urological Association involving 15,000 men nearly all treated by urologists in private practice through 2015; a national registry of 45 mostly private urology practices; and a Michigan registry of mostly private urology practices. In addition, preliminary 2016 data from the urology association indicates that the numbers are growing, with even more than 50 percent of patients choosing active surveillance.
Saturday, May 21, 2016
To see Rafael, you pay one peso to get your number and then 20 more pesos once you make it into his room. That's roughly $1.25 — a good deal, compared with a $200 reiki session in Manhattan.
Working in central Mexico this year, I've met many healers and shamans: the one who runs sweat lodges in his front yard, the one who can detect water underground with sticks, the one who swung a pendulum in front of me and announced that I only 45 percent love myself.
I watched one shaman give another shaman a hairless puppy in a cardboard box. I met one who is celibate and another who prayed for three wives and another who's romantically involved with his therapist and another who cures illness with bees.
One looked at my palm and told me that my heart was broken. I've watched several wrap red cloth around their heads and cough out bad spirits. I've smelled a lot of burning sage. I've heard assessments of my aura. Once, when I had a bad cold, a shaman snapped my picture with his iPhone and showed me the dark entity hovering over my shoulder.
But none of those people are pilgrimage destinations. Only Rafael, according to his regulars, sees 8,000 to 12,000 people a month.
Friday, May 20, 2016
Under instructions from U.K. Prime Minister David Cameron, economist Jim O'Neill has spent the last two years looking into the problem of drug-resistant infections—bacteria and other microbes that have become impervious to antibiotics. In that time, he estimates that a million people have died from such infections. By 2050, he thinks that ten million will die every year.
O'Neill is most famous for another prediction—that by 2050, the combined economies of Brazil, Russia, India, and China (BRIC), would eclipse those of the world's current richest countries. A former chairman of Goldman Sachs with no scientific training, he was an unorthodox choice to lead an international commission on drug-resistant infections. He was also an inspired one. The problem of drug-resistant microbes isn't just about biology and chemistry; it's an economic problem at heart, a catastrophic and long-bubbling mismatch between supply and demand. It's the result of the many incentives for misusing our drugs, and the dearth of incentives for developing new ones.
Wednesday, May 18, 2016
The concept of using "good" bacteria to improve health may feel like a recent idea, but it was first put forward by Ilya Metchnikoff, a Russian scientist born in 1845 who thought the colon was a "vestigial cesspool" and hypothesized that the friendly microbes in yogurt might help improve the population of the bacteria in your gut.2 A century after his death, consumers are snapping up the products based on his idea. According to the National Health Interview Survey, 3.9 million U.S. adults reported using probiotics or prebiotics in 2012, the most recent year for which data is available. That was almost 3 million more than in 2007, so it's safe to assume that even more people are taking them now. Sales of probiotics worldwide passed $32 billion in 2013 and are likely to reach $52 billion by 2020, according to Grand View Research.
It's the third day of this week's series on gut science. We've written about whether gut science is biased, why we're so obsessed with constipation, and we've made a video about what poop can tell us about our health — and there's more to come later in the week.
But there is still so much we don't know about whether and how the probiotic products now on the shelves — which most commonly contain bacteria from the Lactobacillus and Bifidobacterium genera — can improve health.3 Probiotic supplements (and to a lesser extent, prebiotics) have been studied for a host of ailments, including digestive problems, allergic disorders, obesity, dental problems, the common cold, high cholesterol and gestational diabetes. But there's limited evidence that they work for any but a handful of conditions. The probiotic craze has gotten ahead of the science.
European doctors wouldn’t let him play soccer anymore. U.S. specialists had a different opinion. - The Washington Post
In 2015, at age 21, he had posted a half-dozen goals during IFK Norrkoping's first Swedish championship in 23 years, raising his two-season total to 16. Last fall, he scored for Sierra Leone's national team in a World Cup qualifier.
The muscle-packed striker, from the hard-luck shadows of Freetown's international airport, was on the rise.
And then in February, as Norrkoping was preparing for a campaign that would include its first appearance in Europe's premier continental competition since 1963, medical test results arrived: Kamara was told he had a congenital heart defect.
Norrkoping shut him down. UEFA, the governing body that administers such tests for participation in the Champions League, wouldn't allow him to play.
"Is this true," Kamara recalled asking himself, "or am I dreaming?"
Less than three months later, the striker is back on the field, cleared by two U.S. cardiologists – one aligned with D.C. United, the other with MLS – who reviewed his case and tested him further.
Yes, they concluded, Kamara did have a deviation of the coronary artery, as the test results in Sweden had uncovered. Medical teams on either side of the Atlantic, however, had differing opinions of the severity of the condition and whether he could resume playing soccer.
Norrkoping released an ominous statement in February, saying Kamara was at a "high risk of sudden cardiac death during maximum exertion."
The American doctors disagreed.
"Under the condition he has, he's fit to play," Allen Taylor, United's team cardiologist and chief of cardiology at Washington's MedStar Heart and Vascular Institute, said in an interview.
Many ill people with a legitimate need for drugs like oxycodone and other narcotics known as opioid analgesics cannot get them and are suffering and dying in pain, according to health officials, doctors and patients' rights advocates.
In Russia, India and Mexico, many doctors are reluctant to prescribe these painkillers, fearful of possible prosecution or other legal problems, even if they believe the prescriptions are justified.
In Kenya, health officials only recently authorized the production of morphine, one of the most effective drugs for pain relief, after criticism that it was available in only seven of the country's 250 public hospitals. In Morocco, the advocacy group Human Rights Watch reported in February, only a small fraction of physicians are permitted to prescribe opioid analgesics, which the country's law on controlled substances identifies as poisons.
And in most poor and middle-income countries, these drugs are restricted and often unavailable, even for patients with terminal cancer, AIDS or grievous war wounds.
The reasons include an absence of medical training, onerous regulations, costs, a focus on eliminating illicit drug use and, in some cultures, a stoic acceptance of pain without complaint. The problem has been amplified, public health experts say, by the stigmatization of the drugs, partly from fear of what has happened in the United States, where opioid misuse is a growing cause of death.
Reinforcing this view has been publicity about high-profile users like Prince, the pop star who died last month at his Minnesota mansion as friends sought help from an addiction specialist to treat what was apparently a dependence on opioid painkillers.
"While clearly there are issues with some prescribing practices, there's also clearly a risk to vilifying these medicines," said Diederik Lohman, associate director of the health and human rights division at Human Rights Watch.
In some countries, Mr. Lohman said, "a clerical error in a morphine prescription" can lead to criminal inquiries. "The fear associated with prescribing a medicine under strict scrutiny makes physicians afraid," he said.
Tuesday, May 17, 2016
Colette turned out to be completely fine. A doctor ran her finger under the tap, stuck a Band-Aid on her pinky, and sent the family home.
A week later, something else showed up at home: a $629 hospital bill for the Band-Aid and its placement on Colette's finger.
His insurance had negotiated the price down to $440.30, the amount Bird — who was still in his deductible — was expected to pay. "My first thought was, how could this possibly cost $629?" Bird told me when we spoke in April. "So I wrote the hospital a letter, expecting them to say, yeah, that's a bit excessive, and lower the price."
That didn't happen. The hospital sent him back a long letter explaining why it would stick with the price. The fees, the hospital's leadership responded, were justified — and it ultimately sent his unpaid bill to a debt collection agency.
Bird sent me all his correspondence with the hospital, which I ran by medical billing experts. His experience provides a unique window into how emergency health care billing works in the United States, and how easy it is for customers to end with a surprise bill for a relatively small service — like a Band-Aid on a child's finger.