Exanthems

I did not know this:

In antiquity, [exanthem - "eruptive" or rash-involving] illnesses were all lumped together. Eventually, a distinction was made between measles and pox (with growing clarity over about a millennium). However, what people called the “pox” and what was then called the “measles” are now known to each include a variety of distinct diseases.

Six separate childhood exanthems were defined from what was once called the “measles.” In the early part of the 20th century, these were often referred to by number. Measles and scarlet fever were the first two to be separated. Rubella (German measles) was called “third disease”; atypical scarlet fever was “fourth disease”; erythema infectiosum was (and is) “fifth disease,” and roseola was “sixth disease.”

Chickenpox and smallpox, the other two classic childhood exanthems, were recognized as separate from each other in the 18th century. These both had blisters, or pox, that set them apart from the red rashes of the other group.Today, dozens of exanthems are recognized, including adenovirus, anthrax, mononucleosis, Colorado tick fever, mumps, cat-scratch fever, rat-bite fever, Rocky Mountain spotted fever, relapsing fever, meningococcemia, typhus, hand-foot-mouth disease, and many others.

Exanthems (DrGreene.com)

There's good news and bad news...

PhD Comics explains succinctly why we're not likely ever to see "a cure" for cancer.

This is your brain on jazz

It would come as no surprise to the late saxophonist and improvisational master John Coltrane, but when accomplished jazz musicians play free-form, their brain activity suggests a release of self-expression from conscious monitoring and self-censorship.

Such neural activity may lie at the heart of musical improvisation and perhaps other improvisational feats, propose auditory scientist Charles J. Limb of Johns Hopkins Hospital in Baltimore and neurologist Allen R. Braun of the National Institute on Deafness and Other Communication Disorders in Bethesda, Md.

"What we think is happening is that when you're telling your own musical story, you're shutting down neural impulses that might impede the flow of novel ideas," says Limb, himself a trained jazz saxophonist.

Riff Riders: Brain scans tune in to jazz improvisers (Science News, 8 March 2008)

Fascinating article. They had to design a foldable, nonmetallic keyboard that would fit into an MRI machine, and then they did live brainscans of musicians as they played improvisationally:

The part of the frontal brain that has been linked to planning and self-censorship saw a marked decline in activity. At the same time, activity spiked in a small frontal structure that has been linked to being able to tell a story about oneself.

New and improved prevarication

Lying is a time-honored strategy for misleading someone; it's wonderfully effective in the short term, and if you construct the lie well enough, it will hold up brilliantly over time... at least to the extent that you can fool some of the people all of the time, as Honest Abe had it.

But most of us aren't that smart.

A much better plan is to stick to the truth, but be extremely selective about the information you share. In other words, "don't tell everything you know."

Cherrypicking the facts that support your argument gives you the appearance of intellectual honesty, with most of the advantages you'd have obtained by lying in the first place.

Just ask the drug companies:

The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found.

In published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but by a modest margin, concludes the new report, which appears Thursday in The New England Journal of Medicine.

Previous research had found a similar bias toward reporting positive results for a variety of medications; and many researchers have questioned the reported effectiveness of antidepressants. But the new analysis, reviewing data from 74 trials involving 12 drugs, is the most thorough to date. And it documents a large difference: while 94 percent of the positive studies found their way into print, just 14 percent of those with disappointing or uncertain results did.

Antidepressant studies unpublished (New York Times, 19 January 2008)

Malignant symphony

Berger has been working with cancer researchers and mathematicians on non-invasive ways to detect cancer. Instead of doing a biopsy, you can do things like medical [sic] resonance imaging, also known as MRIs. But the problem is that MRIs give you so much information, it's hard to know what to do with it. In a visual form, it's virtually impossible to separate the important data from the meaningless stuff.

So, Berger assigned different sounds to different data points. "Imagine there's an orchestra of one hundred players, and each of those points is mapped to one of those orchestra players," he says. Essentially, he's creating a symphony based on the information contained in the cells. And our ears can tell the difference between a benign symphony, which is a low, pulsing beat...

And then there's a tinnier, more bell-like, malignant symphony...

The Sound of Cancer, and Golf - Weekend America (American Public Media)

Happy new year!

For the first post of 2008, a reminder that here at enrevanche, we're Not Afraid To Be Service-y:

For such a common malady, the hangover still has a bit of mystery about it. As an M.D. wrote in an NIH publication wrote a few years back, “Despite the prevalence of hangovers … this condition is not well understood scientifically.”

Still, it is possible to piece a few things out. Alcohol interferes with a hormone that regulates urination, leaving drinkers dehydrated, according to a hangover review in the Annals of Internal Medicine.

Booze irritates the stomach and intestines, which can contribute to the gut pain and nausea associated with hangover. It also interacts with several neurotransmitters and hormones that have been associated with headaches, though the hangover-headache connection isn’t entirely clear.

Anatomy of a Hangover: Wall Street Journal Health Blog

Check the box, save a life

[R]esearchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half.

The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you’re worrying about what treatment to give a woman who won’t stop seizing, it’s hard to remember to make sure that the head of her bed is in the right position.) A second effect was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. In a survey of I.C.U. staff taken before introducing the ventilator checklists, he found that half hadn’t realized that there was evidence strongly supporting giving ventilated patients antacid medication. Checklists established a higher standard of baseline performance.

[...]

If someone found a new drug that could wipe out infections with anything remotely like the effectiveness of Pronovost’s lists, there would be television ads with Robert Jarvik extolling its virtues, detail men offering free lunches to get doctors to make it part of their practice, government programs to research it, and competitors jumping in to make a newer, better version. That’s what happened when manufacturers marketed central-line catheters coated with silver or other antimicrobials; they cost a third more, and reduced infections only slightly—and hospitals have spent tens of millions of dollars on them. But, with the checklist, what we have is Peter Pronovost trying to see if maybe, in the next year or two, hospitals in Rhode Island and New Jersey will give his idea a try.

Annals of Medicine: The Checklist (Atul Gawande, The New Yorker, December 10, 2007)

Meet "Dr. Gourmet"

Timothy Harlan is a trained chef and practicing physician. (Naturally, he practices in New Orleans!)

At his site, Dr. Gourmet, he offers recipes and advice:

Working as a caterer throughout [Emory Medical] school, he continued to be involved with food and cooking but noticed a lack of knowledge in the medical field about eating healthy and eating well. Neither patients nor health care providers understood much about a healthful diet. Patients, it seemed, were usually told not what they could eat but, rather, what they could not eat.

Indeed. Aside from registered dietitians--and they are, pardon the expression, thin on the ground--very few medical folks seem to have solid medical-nutritional chops. I've bookmarked the site and plan to try some of the recipes.

"I have no confidence in the system"

The first doctor gave her six months to live. The second and third said chemotherapy would buy more time, but surgery would not. A fourth offered to operate.

Karen Pasqualetto had just given birth to her first child last July when doctors discovered she had colon cancer. She was only 35, and the disease had already spread to her liver. The months she had hoped to spend getting to know her new daughter were hijacked by illness, fear and a desperate quest to survive. For the past year, she and her relatives have felt lost, fending for themselves in a daunting medical landscape in which they struggle to make sense of conflicting advice as they race against time in hopes of saving her life.

“It’s patchwork, and frustrating that there’s not one person taking care of me who I can look to as my champion,” Ms. Pasqualetto said recently in a telephone interview from her home near Seattle. “I don’t feel I have a doctor who is looking out for my care. My oncologist is terrific, but he’s an oncologist. The surgeon seems terrific, but I found him through my own diligence. I have no confidence in the system.”

Cancer Patients, Lost in a Maze of Uneven Care (New York Times, July 28, 2007)

Sadly, "I have no confidence in the system" is a very well-informed, thoroughly educated position to take, especially when it comes to any condition where the treatment options are complex.

And the "one person taking care of you who you can look to as your champion" pretty much has to be you (with support from your loved ones, hopefully)... and that at a time when, to put it mildly, you aren't feeling very well.

Battling hospital-acquired infections

At a veterans’ hospital [in Pittsburgh], nurses swab the nasal passages of every arriving patient to test them for drug-resistant bacteria. Those found positive are housed in isolation rooms behind red painted lines that warn workers not to approach without wearing gowns and gloves.

Every room and corridor is equipped with dispensers of foamy hand sanitizer. Blood pressure cuffs are discarded after use, and each room is assigned its own stethoscope to prevent the transfer of microorganisms. Using these and other relatively inexpensive measures, the hospital has significantly reduced the number of patients who develop deadly drug-resistant infections, long an unaddressed problem in American hospitals.

The federal Centers for Disease Control and Prevention projected this year that one of every 22 patients would get an infection while hospitalized — 1.7 million cases a year — and that 99,000 would die, often from what began as a routine procedure. The cost of treating the infections amounts to tens of billions of dollars, experts say.

[...]

“People don’t believe it’s in their institution, and, if it is, that it’s too big to do anything about, that you just have to accept it,” said Terri Gerigk Wolf, director of VA Pittsburgh Healthcare Systems. “But we have shown you can do something about it.”

Swabs in Hand, Hospital Cuts Deadly Infections (New York Times, 27 July 2007)

I have more than a passing interest in this topic. Both of my parents have contracted HAI's (hospital/healthcare-acquired infections) while patients in hospitals or nursing homes, and an multiple-antibiotic-resistant strain of Klebsiella pneumoniae, acquired during a hospital stay, killed my father.

Related:

• Centers for Disease Control: The Impact of Hospital-Acquired Bloodstream Infection
  
  "Nosocomial bloodstream infections are a leading cause of death in the United States. If we assume a nosocomial infection rate of 5%, of which 10% are bloodstream infections, and an attributable mortality rate of 15%, bloodstream infections would represent the eighth leading cause of death in the United States."

Family health update

Mom had cataract surgery on her right eye this morning, and it went very well; she is now resting comfortably at home.

This procedure is so quick that I think they will soon be offering it at drive-thru windows: I went to buy a newspaper and a cup of coffee after they wheeled her back into the O.R., and had literally just settled into my seat in the waiting room when they called my name... the whole thing took less than 20 minutes, and she was on her way home about an hour after that.

Even with the most optimal outcome imaginable, Mom will not be able to see normally after the surgery, or see well enough to read or watch TV--she will still be legally blind--*but* her doctor is firmly convinced that the more light that hits what's left of her optic nerve, the better, and that the likelihood that this procedure *will* improve her vision somewhat is quite good.

In short, the potential payoff was good and the potential risk was very low, and I'm happy to report that the "risky" part seems to have gone without a hitch.

We also like flavor and texture

"We hit on the idea of a chewing gum because obese people like chewing."