In 1991 previously healthy young women in Brussels started showing up at clinics with advanced kidney damage. An inquiry revealed that they had all attended the same weight-loss program and, due to a mix-up, had received the Chinese herb Aristolochia as part of the regimen. More than 100 women developed irreversible kidney damage requiring dialysis or transplantation, and a high percentage went on to develop cancer of the upper urinary tract.
Had it not been for the unusual nature of the outbreak and alert clinicians, the incident might well have gone unnoticed. As it turned out, the Brussels cluster dramatized in an unprecedented way the previously unacknowledged threat that can be posed by herbal remedies.
In the 25 years since the Brussels outbreak, we have learned a great deal about the use and harmful effects of toxic herbs. This knowledge, however, has not translated into policies to reduce the harm caused by botanicals. Instead, the World Health Organization has launched an ambitious program that flies in the face of the scientific evidence the organization demands elsewhere and shamelessly promotes the use of traditional medicine, including herbal treatments, that could be dangerous.
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http://www.slate.com/articles/health_and_science/medical_examiner/2016/09/the_world_health_organization_promotes_traditional_medicine_without_knowing.html?
Wednesday, September 7, 2016
Tuesday, September 6, 2016
Think Like a Doctor: The Sick Traveler Solved! - The New York Times
On Thursday, we challenged Well readers to take on the complicated case of a 50-year-old woman who felt feverish and couldn't stop vomiting and who ended up losing a lot of weight. Like the doctors who saw her as she searched for a diagnosis, many of you focused on her recent journey to Kenya as the source of her symptoms. It was a completely reasonable approach, and one that was extensively explored by the doctors who cared for her. But ultimately it was incorrect.
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Online medical, sickness, and illness symptoms: Googling our medical symptoms is making us sicker — Quartz
Every year, Americans spend at least $20 billion on unnecessary medical visits in the US. This is one of the drivers behind the spiraling cost of health care, which is predicted to soar to $5.5 trillion by 2024. The last thing you'd imagine is that the internet would have anything to do with this. But guess again.
Medical doctors are already aware of the connection, because they see it every day. Patients arrive at offices and clinics with a "Google stack," as it's sometimes called: a pile of print-outs from the online research they've done that has led them to form their own amateur medical opinion.
Seventy-two percent of Americans search for health information online, according to a 2013 Pew study. About 35% search for diagnostic information, and of those who attempt to self-diagnose, just over half proceed to make an appointment with a medical professional to talk about what they found online. In June 2016, Google reported that roughly 1% the site's searches are related to medical symptoms.
For a number of reasons, most medical professionals aren't too happy about the self-diagnosis trend. It isn't simply a matter of loss of control or an undermining of their authority though online medical searches—it can mess with the diagnostic process, because the results can suggest rare or morbid conditions to patients, which in turn can prompt the appearance of new "symptoms." You search online for "sore throat," for instance, and find yourself engrossed and horrified by descriptions of esophageal cancer. Your anxiety escalates.
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http://qz.com/773031/googling-our-medical-symptoms-is-making-us-sicker/?utm_source=nextdraft&utm_medium=email
Medical doctors are already aware of the connection, because they see it every day. Patients arrive at offices and clinics with a "Google stack," as it's sometimes called: a pile of print-outs from the online research they've done that has led them to form their own amateur medical opinion.
Seventy-two percent of Americans search for health information online, according to a 2013 Pew study. About 35% search for diagnostic information, and of those who attempt to self-diagnose, just over half proceed to make an appointment with a medical professional to talk about what they found online. In June 2016, Google reported that roughly 1% the site's searches are related to medical symptoms.
For a number of reasons, most medical professionals aren't too happy about the self-diagnosis trend. It isn't simply a matter of loss of control or an undermining of their authority though online medical searches—it can mess with the diagnostic process, because the results can suggest rare or morbid conditions to patients, which in turn can prompt the appearance of new "symptoms." You search online for "sore throat," for instance, and find yourself engrossed and horrified by descriptions of esophageal cancer. Your anxiety escalates.
More ...
http://qz.com/773031/googling-our-medical-symptoms-is-making-us-sicker/?utm_source=nextdraft&utm_medium=email
Pondering Miracles, Medical and Religious - The New York Times
There was no mistaking the diagnostic significance of that little red stick inside a deep blue cell: The Auer rod meant the mystery patient had acute myelogenous leukemia. As slide after slide went by, her bone marrow told a story: treatment, remission, relapse, treatment, remission, remission, remission.
I was reading these marrows in 1987, but the samples had been drawn in 1978 and 1979. Median survival of that lethal disease with treatment was about 18 months; however, given that she had already relapsed once, I knew that she had to be dead. Probably someone was being sued, and that was why my hematology colleagues had asked for a blind reading.
Imagining an aggressive cross-examination in court, I emphasized in my report that I knew neither the history nor why I was reading the marrows. After the work was submitted, I asked the treating physician what was going on. She smiled and said that my report had been sent to the Vatican. This leukemia case was being considered as the final miracle in the dossier of Marie-Marguerite d'Youville, the founder of the Order of Sisters of Charity of Montreal and a candidate to become the first Canadian-born saint.
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Sunday, September 4, 2016
NYTimes: How to Tell a Mother Her Child Is Dead
First you get your coat. I don't care if you don't remember where you left it, you find it. If there was a lot of blood you ask someone to go quickly to the basement to get you a new set of scrubs. You put on your coat and you go into the bathroom. You look in the mirror and you say it. You use the mother's name and you use her child's name. You may not adjust this part in any way.
I will show you: If it were my mother you would say, "Mrs. Rosenberg. I have terrible, terrible news. Naomi died today." You say it out loud until you can say it clearly and loudly. How loudly? Loudly enough. If it takes you fewer than five tries you are rushing it and you will not do it right. You take your time.
After the bathroom you do nothing before you go to her. You don't make a phone call, you do not talk to the medical student, you do not put in an order. You never make her wait. She is his mother.
When you get inside the room you will know who the mother is. Yes, I'm very sure. Shake her hand and tell her who you are. If there is time you shake everyone's hand. Yes, you will know if there is time. You never stand. If there are no seats left, the couches have arms on them.
You will have to make a decision about whether you will ask what she already knows. If you were the one to call her and tell her that her son had been shot then you have already done part of it, but you have not done it yet. You are about to do it now. You never make her wait. She is his mother. Now you explode the world. Yes, you have to. You say something like: "Mrs. Booker. I have terrible, terrible news. Ernest died today."
Then you wait.
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http://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tell-a-mother-her-child-is-dead.html?
I will show you: If it were my mother you would say, "Mrs. Rosenberg. I have terrible, terrible news. Naomi died today." You say it out loud until you can say it clearly and loudly. How loudly? Loudly enough. If it takes you fewer than five tries you are rushing it and you will not do it right. You take your time.
After the bathroom you do nothing before you go to her. You don't make a phone call, you do not talk to the medical student, you do not put in an order. You never make her wait. She is his mother.
When you get inside the room you will know who the mother is. Yes, I'm very sure. Shake her hand and tell her who you are. If there is time you shake everyone's hand. Yes, you will know if there is time. You never stand. If there are no seats left, the couches have arms on them.
You will have to make a decision about whether you will ask what she already knows. If you were the one to call her and tell her that her son had been shot then you have already done part of it, but you have not done it yet. You are about to do it now. You never make her wait. She is his mother. Now you explode the world. Yes, you have to. You say something like: "Mrs. Booker. I have terrible, terrible news. Ernest died today."
Then you wait.
More ...
http://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tell-a-mother-her-child-is-dead.html?
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