In the late 1930s, Charles Bradley, the director of a home for "troublesome" children in Rhode Island, had a problem. The field of neuroscience was still in its infancy, and one of the few techniques available to allow psychiatrists like Bradley to ponder the role of the brain in emotional disorders was a procedure that required replacing a volume of cerebrospinal fluid in the patient's skull with air. This painstaking process allowed any irregularities to stand out clearly in X-ray images, but many patients suffered excruciating headaches that lasted for weeks afterward.
Meanwhile, a pharmaceutical company called Smith, Kline & French was facing a different sort of problem. The firm had recently acquired the rights to sell a powerful stimulant then called "benzedrine sulfate" and was trying to create a market for it. Toward that end, the company made quantities of the drug available at no cost to doctors who volunteered to run studies on it. Bradley was a firm believer that struggling children needed more than a handful of pills to get better; they also needed psychosocial therapy and the calming and supportive environment that he provided at the home. But he took up the company's offer, hoping that the drug might eliminate his patients' headaches.
It did not. But the Benzedrine did have an effect that was right in line with Smith, Kline & French's aspirations for its new product: The drug seemed to boost the children's eagerness to learn in the classroom while making them more amenable to following the rules. The drug seemed to calm the children's mood swings, allowing them to become, in the words of their therapists, more "attentive" and "serious," able to complete their schoolwork and behave. Bradley was amazed that Benzedrine, a forerunner of Ritalin and Adderall, was such a great normalizer, turning typically hard-to-manage kids into models of complicity and decorum. But even after marveling at the effects of the drug, he maintained that medication should be considered for children only in addition to other forms of therapy.
Bradley's research was ignored for a couple of decades as psychoanalysis became dominant in the United States. But his discoveries laid the foundation for one of the most aggressive marketing campaigns in history, which succeeded not only in helping to transform the nascent drug industry into the multinational juggernaut known as Big Pharma, but in convincing parents, physicians and public health officials that 15 percent of American schoolchildren are sick enough that they would require powerful medication just to get through the day.
More ...
http://www.nytimes.com/2016/08/28/books/review/adhd-nation-alan-schwarz.html
Saturday, August 27, 2016
Thursday, August 25, 2016
Doctors Learn Improv to Improve Bedside Manner - The Atlantic
There is something about the ER—especially the night shift—that thrives on spontaneity.
It's just past 2 a.m. I meet him for the first time in a hallway stretcher—one step past the waiting room and any number of hours before he inherits a bed with privacy. The patient is a 50-something Caucasian man with salt-and-pepper hair, battered glasses, a three-day beard, and an air of frustration. He wants to know why—why the long wait, why he's constantly in pain, and why we can't immediately comply with his request for narcotics.
I start to gather information as we are trained to do. I utter some version of "what brings you into the ER today?" I carry on with more questions, registering each answer on my mental checklist.
"Look, I really don't want to be here right now," he says with defeat.
I pause.
I tuck away my pen and paper—and with them, my persistence.
"You know, to be honest, I wouldn't mind being at home in my own bed right now either," I offer.
More ...
http://www.theatlantic.com/education/archive/2016/08/what-improv-can-teach-tomorrows-doctors/497177/?
It's just past 2 a.m. I meet him for the first time in a hallway stretcher—one step past the waiting room and any number of hours before he inherits a bed with privacy. The patient is a 50-something Caucasian man with salt-and-pepper hair, battered glasses, a three-day beard, and an air of frustration. He wants to know why—why the long wait, why he's constantly in pain, and why we can't immediately comply with his request for narcotics.
I start to gather information as we are trained to do. I utter some version of "what brings you into the ER today?" I carry on with more questions, registering each answer on my mental checklist.
"Look, I really don't want to be here right now," he says with defeat.
I pause.
I tuck away my pen and paper—and with them, my persistence.
"You know, to be honest, I wouldn't mind being at home in my own bed right now either," I offer.
More ...
http://www.theatlantic.com/education/archive/2016/08/what-improv-can-teach-tomorrows-doctors/497177/?
Precision Test For Breast Cancer Treatment Remains Imprecise : Shots - Health News : NPR
A major study about the best way to treat early-stage breast cancer reveals that "precision medicine" doesn't provide unambiguous answers about how to choose the best therapy.
"Precision doesn't mean certainty," says David Hunter, a professor of cancer prevention at Harvard's T.H. Chan School of Public Health.
That point is illustrated in a large study published Wednesday in the New England Journal of Medicine, involving decisions about chemotherapy.
As is true for many cancers, breast cancer responds best to treatment when it is caught early, before it has spread throughout the body. Dr. Fatima Cardoso, the study's lead author and a breast cancer specialist at the Champalimaud Clinical Center in Lisbon, Portugal, says that creates a conundrum for doctors and patients alike.
Because it's the only opportunity to cure the cancer, "when in doubt we tend to treat" women with early-stage breast cancer, she told Shots. "So we know that we overtreat the patients with early breast cancer."
That means that women could end up undergoing chemotherapy even if it wouldn't really improve their survival odds.
Hoping to refine those treatment decisions, Cardoso helped organize a huge study throughout Europe to see whether a commercially available genetic test called MammaPrint could help reduce that overtreatment. More than 6,600 women participated at 112 institutions in nine nations.
Scientists identified women with breast cancer whose physical exams suggested they were at relatively high risk for having the cancer return eventually after surgery, but who seemed to be at low risk of recurrence based on the genetic test results.
They were invited to participate in the study, which would randomly assign them to have chemotherapy or not. "You know that chemotherapy is a treatment that scares people, so overall and for the majority of patients, it was not difficult to convince them," Cardoso says.
The genomic test, which studies 70 distinct features of a tumor, did a pretty good job of predicting who was at low risk for recurrence of breast cancer and could therefore avoid the pain, discomfort and risks of chemotherapy. (The test, priced at $4,200, is covered by some insurance in the United States.)
The scientists found that 46 percent of women who were deemed to be at high risk of recurrence based on physical symptoms could actually skip chemotherapy with little consequence to their long-term survival.
More ...
http://www.npr.org/sections/health-shots/2016/08/24/491213713/study-of-breast-cancer-treatment-reveals-paradox-of-precision-medicine
"Precision doesn't mean certainty," says David Hunter, a professor of cancer prevention at Harvard's T.H. Chan School of Public Health.
That point is illustrated in a large study published Wednesday in the New England Journal of Medicine, involving decisions about chemotherapy.
As is true for many cancers, breast cancer responds best to treatment when it is caught early, before it has spread throughout the body. Dr. Fatima Cardoso, the study's lead author and a breast cancer specialist at the Champalimaud Clinical Center in Lisbon, Portugal, says that creates a conundrum for doctors and patients alike.
Because it's the only opportunity to cure the cancer, "when in doubt we tend to treat" women with early-stage breast cancer, she told Shots. "So we know that we overtreat the patients with early breast cancer."
That means that women could end up undergoing chemotherapy even if it wouldn't really improve their survival odds.
Hoping to refine those treatment decisions, Cardoso helped organize a huge study throughout Europe to see whether a commercially available genetic test called MammaPrint could help reduce that overtreatment. More than 6,600 women participated at 112 institutions in nine nations.
Scientists identified women with breast cancer whose physical exams suggested they were at relatively high risk for having the cancer return eventually after surgery, but who seemed to be at low risk of recurrence based on the genetic test results.
They were invited to participate in the study, which would randomly assign them to have chemotherapy or not. "You know that chemotherapy is a treatment that scares people, so overall and for the majority of patients, it was not difficult to convince them," Cardoso says.
The genomic test, which studies 70 distinct features of a tumor, did a pretty good job of predicting who was at low risk for recurrence of breast cancer and could therefore avoid the pain, discomfort and risks of chemotherapy. (The test, priced at $4,200, is covered by some insurance in the United States.)
The scientists found that 46 percent of women who were deemed to be at high risk of recurrence based on physical symptoms could actually skip chemotherapy with little consequence to their long-term survival.
More ...
http://www.npr.org/sections/health-shots/2016/08/24/491213713/study-of-breast-cancer-treatment-reveals-paradox-of-precision-medicine
Wednesday, August 24, 2016
NYTimes: The Life-Changing Magic of Choosing the Right Hospital
There's an exceedingly simple way to get better health care: Choose a better hospital. A recent study shows that many patients have already done so, driving up the market shares of higher-quality hospitals.
A great deal of the decrease in deaths from heart attacks over the past two decades can be attributed to specific medical technologies like stents and drugs that break open arterial blood clots. But a study by health economists at Harvard, M.I.T., Columbia and the University of Chicago showed that heart attack survival gains from patients selecting better hospitals were significant, about half as large as those from breakthrough technologies.
That's a big improvement for nothing more than driving a bit farther to a higher-quality hospital.
More ...
http://www.nytimes.com/2016/08/23/upshot/the-life-changing-magic-of-choosing-the-right-hospital.html?
A great deal of the decrease in deaths from heart attacks over the past two decades can be attributed to specific medical technologies like stents and drugs that break open arterial blood clots. But a study by health economists at Harvard, M.I.T., Columbia and the University of Chicago showed that heart attack survival gains from patients selecting better hospitals were significant, about half as large as those from breakthrough technologies.
That's a big improvement for nothing more than driving a bit farther to a higher-quality hospital.
More ...
http://www.nytimes.com/2016/08/23/upshot/the-life-changing-magic-of-choosing-the-right-hospital.html?
Tuesday, August 23, 2016
Doctors thought it was a simple foot infection. They were so wrong. - The Washington Post
Melissa Curley Bogner was baffled: Why did her feet feel suddenly hot — in January?
The 41-year-old management analyst for the Navy had grown accustomed to periodic bouts of neuropathy — numbness in her hands and feet — the apparent legacy of a severe allergic reaction to a drug she took in 2000 to treat a gynecological infection.
But this 2015 episode was different. Along with the sensation that her feet felt unusually warm, the skin on the second toe of her right foot looked inflamed. Weeks later, she noticed a small blister.
Bogner, who lives in Southern Maryland, initially shrugged it off. She figured that whatever was wrong would go away on its own.
More ...
https://www.washingtonpost.com/national/health-science/doctors-thought-it-was-a-simple-foot-infection-they-were-so-wrong/2016/08/22/7d6347e4-36ed-11e6-9ccd-d6005beac8b3_story.html?
The 41-year-old management analyst for the Navy had grown accustomed to periodic bouts of neuropathy — numbness in her hands and feet — the apparent legacy of a severe allergic reaction to a drug she took in 2000 to treat a gynecological infection.
But this 2015 episode was different. Along with the sensation that her feet felt unusually warm, the skin on the second toe of her right foot looked inflamed. Weeks later, she noticed a small blister.
Bogner, who lives in Southern Maryland, initially shrugged it off. She figured that whatever was wrong would go away on its own.
More ...
https://www.washingtonpost.com/national/health-science/doctors-thought-it-was-a-simple-foot-infection-they-were-so-wrong/2016/08/22/7d6347e4-36ed-11e6-9ccd-d6005beac8b3_story.html?
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