Thursday, June 28, 2007

"A medical student grows and learns"

This is an interesting blog post about the learning experience of a Harvard medical student with the bariatric surgery group in a medical centre : posted by a hospital blog on Tuesday 26 June 2007 :

The student wrote in his journal:

"Like most people, I think that obesity is a lifestyle issue -- it is a reflection of our society with gluttony of unhealthy food and paucity of exercise. And like most people, I feel uneasy about "fixing" obesity by reducing the size of the stomach to give the "artificial" feeling of safety and/or to curb the caloric intake by shortening the length of the digested food transit. Is this an appropriate and responsible medical approach? Is obesity a condition indicating for surgical procedure? What kind of people would allow, or even demand, to have one's body altered in such unnatural ways to escape from obesity?"

"Having spent almost one year with my patient, I am beginning to realize some answers.... ......................" Read more at Running a Hospital.

The student concluded that candid conversations with the patient have taught him to "relinquish assumptions, to empathize and above all, to never forget to listen to my patients so that I can offer them what they really need."

What is your view on this?

Middle aged women have more stroke than men

US researchers found that women aged 45 to 54 were more than twice as likely to have a stroke as men of the same age.

The National Stroke Association (US) poll found that many women could not recognise even one stroke symptom. The F.A.S.T. test helps women detect the stroke symptoms. Read more...

RCOG statement on unassisted childbirth

Royal College of Obstetricians and Gynaecologists (RCOG) issued a statement to warn that the practice of freebirth is new to the UK and little research exists regarding its safety and success

Drug derived from sea squirt shows anti-tumour activity

An article published early online on 21 June 2007 in the The Lancet Oncology "Efficacy of trabectedin (ecteinascidin-743) in advanced pretreated myxoid liposarcomas: a retrospective study" concluded that the drug, trabectedin, derived from sea-squirt shows anti-tumour activity in more than half of patients with advanced pre-treated myxoid liposarcomas, a specific type of cancer associated with chromosomal translocations. Read more.

Tuesday, June 26, 2007

Should doctors go to patients' funerals

Professor Bruce Arroll and colleague, Dept of General Practice and Primary Health Care, University of Auckland, explained why dcotors should consider going to their patients’ funerals in the BMJ article "Should doctors go to patients' funerals", 23 June 2007, 334:1322.

He said he had a positive experience of attending patients' funeral where the family was very appreciative of his presence. The funerals provided him the opportunity to meet the family of the deceased and talk about funeral matters with other patients.

A consultant physician said that HIV physicians " should exercise caution before attending patients’ funerals".

Read more at Medical News Today

Echinacea can prevent common cold

A popular herbal remedy, echinacea, in Europe and the US can lower the chance of catching a common cold by half. The findings are published in The Lancet Infectious Diseases after reviewing the evidence of the anti-cold properties of the plant from 14 different studies.

Experts believe echinacea, a collection of nine related plant species indigenous to North America, may work by boosting the body's immune system but stress that further invetsigation on its possible risks is needed.

Estrogen therapy and healthier arteries

The level of calcium in the coronary arteries is an important predictor of future cardiovascular risks. A new study "Estrogen therapy and coronary-artery calcification" published on 21 June 2007 in NEJM, 356:2591-2602, found women between 50 and 59 who took estrogen had significant lower coronary-artery calcification than those who received placebo. However the authors note that "estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways" and conclude that hormone therapy should be given with the lowest effective dose for the shortest duration.

In 2002, a WHI study indicated that women who took hormone therapy had substantially higher risk of heart attacks resulting in many women stop taking the drugs overnight.

In April 2007, WHI published a new analysis from 2 hormone trials to bring the effects into sharper focus by years since menopause. Read the summaries of the findings : "Postmenopause hormone therapy and risk of cardiovascular disease by age and years since menopause".

Wednesday, June 20, 2007

Occupational stress hits oncology registrars

An article "Occupational stress in palliative medicine, medical oncology and clinical oncology specialist registrars " in Clinical Medicine, June 2007, the RCP journal ( only available to members) may be of interest to oncology registrars.


401 oncology registrars in the UK were surveyed with a questionnaire and a test for short-term changes in mental health, 63% replied :
  • 102 with levels of psychological distress
  • 44 had scores indicating depression
  • 15 expressed suicidal ideas.

The main reasons cited include being over-stretched, keeping up-to-date with knowledge, fear of making mistakes, lack of senior support/supervision and conflict between work and family commitment.

The survey suggested a change in culture is needed to help doctors discuss difficulties without fear of affecting career prospect, mentorship from a different specialty, regular meetings for discussingg team-related issues and support from senior doctors might be helpful in addressing these problems. Read the press release.

Avandia and pharmacovigilance

An interim analysis published by NEJM added new data to the previous meta-analysis and found that Avandia (Rosigilitazone) is associated with an increased risk of myocardial infarction.

BMJ published an editorial, "Rosiglitazone and implications for pharmacovigilance: postsurveillance data should be systematically collected and publicly available." Kazi D. BMJ 2007; 334: 1233-4 (16 June) and concluded that "the ongoing use of rosiglitazone merits careful deliberation." ( You can access the full text with an Athens password).

The author said that pharmacovigilance is the weakest in the regulatory processes of drug safety on both sides of the Atlantic and called for a radical change in the culture of existing regulatory agencies.

Monday, June 18, 2007

America low in primary care physicians

In a study "Diagnostic scope of and exposure to primary care physicians in Australia, new Zealand and the United States : cross sectional analysis of results from three national surveys" published in the BMJ 2007; 334:1261 ( 16 June), Bindman and colleagues compared the mix of patients, scope of practice and duration of visit in primary care physicians in Australia, New Zealand and the US using data from national surveys of primary care physicians in each of these countries. ( You can read the full text if you have an Athens password).

Findigns showed that length of consultation in the US is about half the average of New Zealand and one-third of Australia. The author concluded that such severe shortfall of duration of visits might be one of the reasons why the US does not achieve health outcomes that correspond to its high costs in healthcare.

Read the press release and other findings :

  • Australia has the highest number of primary care physicians per 100,000 population and 56% trained in primary care while the US has 36%

  • range of problems dealt with in primary care is narrower in the US than the other 2 countries due to greater proportion of specialists in the US healthcare system

  • average duration of a visit was about 16.5 mins in the US, 15 mins in New Zealand and 14.9 mins in Australia, but the Americans had fewer visits.



Emergency medicine and journal club blog

Few studies explore the efficacy of traditional journal club to imapct physician practice in emergency medicine (EM).

The Monut Sinai Hospital (New York) residency program has developed a journal club blog that residents can post summaries of their analysis of articles from EM literature and other relevant information such as links to presented article, guidelines, EBM tools etc and and invite other colleagues to comment on their posts and how they incorporate the findings into practice.

The blog, easily accessed via the Internet, has encouraged discussions and acts as a reference to current topics in EM research. The authors said that blogging may help influence physician behaviour.

The journal club blog is featured in the journal Academic Emergency Medicine, Vol 14, 5, Supplement 1, 218 ( subscription required).

Friday, June 15, 2007

CME and drug marketing

Daniel Carlat, Professor of Psychiatrist at Tufts Medical School, Massachusetts, Boston, wrote in the article "Diagnosis : conflict of interest" in The New York Times that drug industry financing medical education has increased fourfold since 1998 and has "set the agenda for what doctors learn about drugs, crucial information about potential drug dangers is played down to the detriment of patient care."


The current debate of the diabetes drug Avandia and the withdrawal of Vioxx in 2004 are just two examples of such corruption. He said that "drug companies should never have been allowed to become the primary educators for America's doctors"



It was suggested that CME sponsored by drug companies shlould/would be discredited, doctors would be encouraged to seek CME from other sources. "A commitment to unbiased education would allow doctors to learn about drug risks sooner for the good of doctors and patients."


An earlier posting "There is no free lunch" discussed the relationship between physicians and drug industry and how it changes physicians prescribing behaviour.

Racial differences in care after heart attack

A large study published in the June 13 issue of JAMA has found that black Medicare patients are less likely than white patients to receive blood vessel opening procedures following a heart attack, whether they are admitted to hospitals that provide or do not provide these procedures, but also have higher mortality rates after 1 year.

The authors suggest that "efforts to standardize post-AMI treatment with evidence-based protocols and aggressive risk-factor management are essential to eliminating racial differences in care for AMI and other coronary syndromes."

Read the press release "Black patients less likely to receive certain coronary procedures following heart attack and have higher mortality rates one year later"

Thursday, June 14, 2007

Patients denied sight-saving drugs

NICE, UK's health watchdog, says sight-saving drugs, Lucentis and Macugen, are too expensive for general use on the NHS in England and Wales.

NICE says Lucentis should only be used once patients had already lost the sight in one eye and Macugen should not be used.

Health campaigners said the ruling would condemn 20,000 people a year to blindness. A final ruling on the drugs is expected by the end of September. Read more...

Has NICE put a price tag on people's health like the US economists have done? Read an earlier posting "How much is your life worth?" on June 11, 2007.

Wednesday, June 13, 2007

A radiologist and his blog

A radiologist develops a blog and shares his experience with others posting interesting cases from his practice along with interesting abstracts. His blog has been visited by more than 30,000 visitors from all over the world with thousands of queries from patients, colleagues and students. He says that blogging may become a new way of exchanging information and building opinions in radiology.

Read the article "Blog/web log- a new easy and interactive website building tool for a non-net savvy radiologist" in Journal of Thoracic Imaging. 22(2):115-119, May 2007. Sethi, Sumer K. MD (subscription required)

Selected Radiology resources:
  • Musculoskeletal Radiology - a blog containing links and images free for use for teaching and learning developed by a SpR

  • RadiologyEducation.com - a digital library of radiology education resources with links to textbooks, teaching files, atlases, journals, education, dictionaries etc. curated by Professor Michael P D'Alessandro, University of Iowa. The site has won awards and numerous reviews

  • Medical Matrix - Radiology - evaluated by reviewers, require free registration for accessing range of resources such as news, full text / multimedia, abstracts, textbooks, practice guidelines, cases and CME, education and forums.

  • Hardin.MD - Radiology - medical imaging & MRI, created and sourced from the Hardin Library for the Health Sciences at University of Iowa

  • The Scottish Radiological Society Case Index
    A collection of radiological cases with answers, also tutorials and MCQs etc

Monday, June 11, 2007

How much is your life worth?

This is not a philosophical question.

In an article "Pinning down the money value of a person's life" in the New York Times, health economists try to answer the question of the price of health in determing whether a new treatment or medicine is worth the cost.

Studies of real world situations suggest that average Americans value a year of life at $100,000 - $300,000, according to Tufts - New England medical Centre that measures the cost-effectiveness of new treatments.

Healthcare economists have created the idea of "quality-adjusted life year" (QALY) - that a year in perfect health is worth more than a year spent in pain, depression or a wheelchair, with rough estimates and use them as guides to the diseases and conditions that people will spend the most to avoid, then rank the "costs" of various diseases to determine the worthiness of a particular treatment.

However, economists argue that the inefficiencies that contribute to the high cost of American healthcare will mean that the US will have to follow other countries such as Britain when considering the coverage of new treatments.

How much is a person's life worth in Britain?

Patient with dark green blood

The Lancet reported a team of Canadian surgeons performed urgent procedures on a patient who had developed compartment syndrome, they were shocked when the patient began shedding dark green blood.

In this case, the patient has taken large doses of the migraine medication, sumatriptan, that caused a rare condition called sulfhaemoglobinaemia. The patient recovered and stopped taking sumatriptan after discharge. After 5 weeks, he was found to have no sulfhaemoglobin in his blood.

Thursday, June 07, 2007

If you hear voices.....

Intervoice was formed in 1997 and is now is made up of 18 member countries representing support groups around the world for people who hear voices . Representatives include professionals in the field of auditory hallucinations who meet every year to discuss new research.

Intervoice launched a new website on 5 June at its annual congress held in Copenhagen, Demark with the aims to challenge the view that hearing voices is a form of mental illness and present a very different way of thinking about the meaning of hearing voices, that offers hope and recovery.

Wednesday, June 06, 2007

Avandia - an interim analysis

Following the concerns raised about the drug Avandia's heart risk, NEJM has published a report online on 5 June 2007 "Rosiglitazone evaluated for cardiovascular outcomes - an interim analysis " with new data that come from the RECORD trial, sponsored by the drugmaker Glaxo, designed to assess the drug's effect on the heart.

The authors concluded that the interim findings from this study were inclusive, "Rosiglitazone was associated with an increased risk of heart failure", but "the data were insufficient to determine whether the drug was associated with an increase in the risk of myocardial infarction."

General public lacks basic medical knowledge

A questionnaire survey, published in the open access journal BMC Medicine 2007 "Do citizens have minimum medical knowledge (MMK) ? - a survey" showed Swiss citizens did not know more than a third of the MMK and people with medical experience ( personal or professional) are only slightly better informed suggesting that there is a consistent lack of knowledge in the general public about the typical signs and risk factors of serious clinical conditions.

Monday, June 04, 2007

Breaking news - Reed Elsevier to exit arm business

I posted an news item on March 28, 2007 "If you are authors or readers of The Lancet...." about Reed Elsevier's connection with the arm trade.

Reed Elsevier announced on 1 June 2007 to exit the defence exhibitions sector after growing pressure from a number of important customers and authors who have expressed real concerns about the publisher's involvement in the defence exhibitions business.

NICE backed cancer-drug refund scheme

NICE backed the scheme that the NHS should pay for the bone marrow-cancer drug, Velcade, which costs about £18,000 per patient, only when it worked. Initially, NICE recommended that the drug should not be made available on the NHS, but changed its mind following an appeal by the drugmaker, Janssen-Cilag and its proposal of a refund scheme.

Last February, the OFT said in a report that drug companies are paid hundreds of millions of pounds too much by the NHS for branded medicines but it does not reflect the value of those drugs to patients.

OFT recommended value-based pricing would give companies stronger incentives to invest in drugs for those medical conditions where there is greatest need.

NHS independence

The Nuffield Trust commissioned a project to review the governance structures and the position of the NHS. The author said in the report that politicians should stop meddling in the NHS and allow it to be run as an independent body.

Folic acid supplements reduce stroke risk

A review in the June 2 issue of The Lancet shows that taking folic acid supplements reduces the risk of stroke by 18%. The findings also suggest that mandatory fortification of flour could reduce death rates from strokes.