New Medical Training

This article examined a new plan in medical school training that would get medical school graduates working as physician sooner. Grads would skip residency and go straight to treating patients. This new model would help the physician shortage and get physicians into areas with not enough physicians. Residency programs have limited space so many med school graduates are left with the qualifications, but without residency experience, creating a bottleneck effect. However, people argue that medical school is not intended to prepare you to go into practice, that is what residency is for. Some states are trying to implement a position called a “physician in training” or an “assistant physician” (different from a physician’s assistant) who are people who have graduated from med school, but not completed residency. The job allows them to provide primary care services as long as they are supervised by a physician. These new rules and positions are not planned to take effect until fall 2016. Continue reading “New Medical Training”

Comfort Settings for the Terminally Ill (Extra Analytical Posting)

In the article “Abraham House: ‘Next best thing to home’“, author Amy Neff Roth investigates an Upstate NY model comfort home for the terminal ill, and interviews some patients in the home along with family members with experiences. I was initially struck by the caption under the article photo: ““When I heard about Abraham House, I wished I had learned about it before my mom passed away,” said Bowen, who would have rather had her mother stay at the facility in her final days.” In my mind, this mirrors the statistic we learned about in class regarding how many people die in hospital settings against their wishes. Thus, Roth provides us with a view of an alternative: a home-like pallative care hospice setting.

Continue reading “Comfort Settings for the Terminally Ill (Extra Analytical Posting)”

Light May Work on Nonseasonal Depression, Study Finds

http://well.blogs.nytimes.com/2015/11/24/light-treatment-may-work-on-nonseasonal-depression-study-finds/?ref=health&_r=0

 

The nytimes article by Nicholas Bakalar discusses the possibility that light may work for individuals suffering from nonseasonal depression.  In past studies, light has been found an affective treatment to individuals suffering from seasonal depression.  Seasonal depression is described in the article as a depression that… “comes on at a specific time every year, often the dark days of late fall and winter, and then lifts” (Bakalar).  Fluorescent lights has been affirmed to be useful for those suffering with seasonal depression. Continue reading “Light May Work on Nonseasonal Depression, Study Finds”

How does a Hispanic CAM share a dance with the medical dominance

According to a recent NewYorkTimes article Wary of Mainstream Medicine, Immigrants Seek Remedies From Home, the popularity of herbal therapies is increasing in the Latino and Carribean community. Researchers such as an “ethnobotanist”, local Botanica, and Hispanic consumers are actively exploiting the treasure of traditional herbal remedies. Not only does this type of alternative therapy widely preferred among the Hispanic population, mainstream science is also put more efforts in exploring the mechanisms behind it.

The so-called “alternative therapies” (Complimentary and Alternative Medicine, “CAM”) are neither taught in medical schools nor widely used by doctors even if they sometimes are covered by health insurance. For example, there are herbal remedies, acupuncture, meditation, faith healing, sex therapy, etc.

The clientele e pool mostly consists of Latino and Caribbean immigrants. Instead of abandoning traditional herbs after moving to urban areas, in New York’s immigrant communities, the latest wave of people from Mexico and Central America and Dominicans, Puerto Ricans and Jamaicans have been comparing notes on using herbs and foods as medicines. This subculture is not only popular but also solid. The Hispanic community has a strong belief in the efficacy of herbal remedies. Dr. Vandebroek said, “many Dominicans believed that drugs merely hid the pain of disease but did not cure it. Herbs were thought to expel the root causes of illness.”

Why does Hispanic community prefer herbs? There are a number of reasons. Although the constrained choice theory was originally proposed to explain women’s disadvantage in receiving healthcare, The Hispanic community is facing the similar situations here.

Their preferences on traditional herbal remedies could be attributed to several factors. First of all, it could derive from their difficulty in affording mainstream medical treatment and successfully engaging in the physician-patient interaction due to the language barrier. The situations where minority patients are underserved are not uncommon. According to the author of the article, 43 percent of Hispanics in the United States do not have a primary personal care physician or health provider. More than one-third lack health insurance, nearly double the rate for blacks and triple that for white Americans. Known as the Hispanic paradox, the better health condition of the Hispanic immigrants in the US is not completely cracked yet. Now the herbal therapies, as well as the spiritual healing and community care, offer another hypothesis.

 

However, apart from the gradual recognition of the (modern) scientific mechanism of alternative therapies, postmodernism itself is the driving force for this popularity. This Botanica provides more than just herbal pills. According to the former patient, treatments from this Latino herb shop include “cleansing the spirit of negative aura”. Patients are looking for holistic, spiritual treatment, as well as affectionate care and unhurried service. In this case, the legitimacy of natural science itself is questioned. Its limitations are being sought and magnified. Additionally, consumers nowadays are seeking products that are whole and natural. The authentic image of the alternative therapies fits this imagery. Therefore, this trend could be the results of a new tide of marketing schemes.

 

Researchers such as Dr. Vandebroek who received modern higher education from universities are now trying to include herbal remedies in the mainstream medicine. First of all, they may use the methodology and methods from modern science to explain the biochemical mechanisms of herbal medications. Secondly, they emphasize that alternative therapies and mainstream treatment share traits and origins. For example, they claim that until the 19th century, physicians were generally botanists as well. We can found out that the anti-mainstream feature of CAM is greatly downplayed. The ideal future should be that the two systems work in parallel, a.k.a., “hand in hand”. The power of consumers is prevalent in deciding the survival of certain CAM.

One benefit of “inclusion policy” is the safer practice of CAM. Similar to any other unregulated activities, the safety of herbal remedies are little scrutinized and monitored. The lack of dosage guidelines and scientific evidence of their efficacy are prominent. Worse still, the possible adverse interactions with pharmaceutical drugs will still exist if these remedies keep living in the shadow.

 

 

 

Communicating prognosis

This article called “Communication of Prognosis in Palliative Care” discusses the ways in which the news about their situation should be delivered to patients and the importance of healthcare that is not only based on cure. As we have discussed in the lectures, the profession of medicine is centered about curing disease, which leaves terminal patients and patients with chronic diseases without the same level of care. While acknowledging the significance of end-of-life care in medicine, the article highlights the importance of communication between the physician and the patient as well as their families.

One of the key points in the article is that good communication is very likely to increase the quality life for patients and help alleviate the pain of their loved ones. One would think that delivering a prognosis or a diagnosis should be straightforward, but the example in the article states an opposing finding: “In a study of 1193 patients with metastatic lung and colorectal cancer, 69 percent of those with lung cancer and 81 percent of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer”. From this, it can be inferred that communicating with patients in palliative care is more sensitive than one would imagine.

The article suggests several reasons for the presence of ambiguity and confusion in communication when it is with patients who are in end-of-life care. One explanation is that the patients are in shock, possibly in denial, or hopeless to hear or process information about their terminal illness. The same thing goes for the families. Another point made in the article is this: “Clinicians may be reluctant to discuss prognostic information because they are concerned it will negatively affect the patient-doctor relationship, or the patient’s psychological state. Clinicians frequently articulate the concern that discussing prognosis will “take away hope.””

One other thing discussed is the precision and the uncertainty of the prognosis. The article talks about the online tools that can approximate how much a person has to live based on their symptoms, disease, or other biological factors–possibly better than doctors would. While such a tool might be useful, it is accessible to everyone and it feels inhumane to find out how much more one is likely to live from a website. These findings altogether emphasize the significance and indispensibility of the human element in medicine, just like how the human touch is a miracle for some patients.

http://www.uptodate.com/contents/communication-of-prognosis-in-palliative-care

Antioxidants and Cancer

Earlier this month, an article was published about the role of supplemental antioxidants in promoting or inhibiting cancer. Research has shown that some antioxidants get rid of “free radicals” that harm cancer cells along with other cells. By attacking these molecules, the article claims that antioxidants may actually help cancer spread rather than promote health. The most recent study, in 2014, found that “antioxidants accelerated the spread of human lung cancer cells implanted in mice, partly by blocking a cancer-fighting gene called p53”. The author also looked into clinical trials dating back to the 90s and these trials corroborated the results from the mice. “In 1994, a large trial reported that supplement-size doses of beta carotene increased the risk of lung cancer in male smokers by 18 percent” and then “a 2011 study of 35,500 men found that large doses of vitamin E increased the risk of prostate cancer by 17 percent”. All of these studies aside, it was also pointed out that “a handful of studies have found that antioxidants inhibit melanoma and other malignant cells growing in lab dishes”. So how do you know which antioxidants to take and when?

This article was particularly interesting to me because my mom is a firm believer in the power of antioxidants, but she’s also a breast cancer survivor. So I can’t help but wonder if antioxidants played a role (no matter how minor) in the progression of her cancer. I think the biggest problem here is figuring out which antioxidants do more harm than good in an ethical manner, since you can’t ethically give people anything that would be detrimental to their health and well-being. Until then researchers will have to rely on animal testing and individual cases that may not apply to the general population.

http://www.statnews.com/2015/11/05/antioxidants-promote-cancer/

http://www.today.com/health/charlie-sheen-reveals-hes-hiv-positive-today-show-exclusive-t56391

The recent events surrounding Charlie Sheen are extremely relevant to the conversation we have been having in class. Specifically, we have discussed the stigma that surrounds certain conditions such as HIV/AIDS. In the US, there is an overwhelming racial inequality when it comes to HIV in that African Americans, primarily those below the poverty line, make up the majority of the statistic. It is often believed that people with HIV have it because of their own poor choices or risky behaviors, and many people look down on them for this. The experience of the disease is much different from the biology. Now, a famous white actor has come out with being HIV positive, though he has said he tried to hide it and released the information unwillingly. In his interview, he claims his confession will be helpful to others living with HIV.

Do you think he is correct? Will this change the stigma around HIV for the better or for the worse? Watch his interview if you are interested in his outlook.

Climate change and public health- Tabbaa November posting

http://www.cnn.com/2015/04/08/health/obama-climate-change-public-health/index.html

“President Obama, others link climate change to public health” is an article posted today on CNN’s health news. The article is about how climate change can have a detrimental effect on health. All of us have heard about climate change; we know that there are people who continue to dispute it and that fighting pollution isn’t in everyone’s fiscal best interest. But now we have a reason to fight climate change that should get everyone’s attention- people are going to die. Continue reading “Climate change and public health- Tabbaa November posting”

Regulating Medical Testing

FDA Targets Inaccurate Medical Tests, Citing Dangers and Costs

http://www.nytimes.com/2015/11/24/us/politics/fda-targets-inaccurate-medical-tests-citing-dangers-and-costs.html?ref=policy

Inaccurate, unreliable tests promote unnecessary medical interventions, causing medical costs to increase. This is a threat to Obama’s plan of “personalized medicines,” a new way of treating patients based on their genetic characteristics. This approach relies on diagnostic tests. Thus if the tests are unreliable, the treatments could be ineffective. Currently, diagnostic tests are regulated differently depending on where they were developed and manufactured. “Commercial test kits,” those sold to multiple labs are typically reviewed by the FDA before going on market, and there are protocols in place if a product proves to be defective or unreliable. The problem lies for tests that are manufactured and used within a single lab, as there are no actively enforced regulatory requirements. This has become a problem now because their products are being used just as much as the commercial tests; they are no longer just a small portion of goods produced. Thus, it’s important to make sure that the tests do what they are supposed to do.

It’s scary to think that these independent manufacturers weren’t being tested and regulated before. If a patient’s sample is being sent to a lab, doctors should know for sure that the instruments that they use are accurate. It’s sad that it has taken a large volume of independently designed and manufactured products to be sold in the market for the federal government to decide to finally step in and get involved. As with any argument about federal regulation, there are two sides to it: those who oppose and those who are supporting the decision. It is not at all surprising to me that the medical profession is against it. The article sites one of the representatives, who also happens to be a physician, concerned that “regulation will stifle medical innovation and open the door to federal regulation of the practice of medicine.” The medical profession seems to favor autonomy more than the health of the people they supposedly serve. Medical innovation is important, and the government not being involved in regulating it is important. The fact that inaccurate test results that lead to treatments that could lead to more harm than good for a patient is not so important.

Home Medic

Although it is certain that we refer to our doctors for most of our medical concerns and knowledge, there are those who find it necessary to self-diagnose before even reaching the doctor’s office. Yet when we come across something so simple as blood pressure, it’s appalling how variant it can be, depending on time of the day, food intake, or even your posture. In the article “Blood Pressure, a Reading with a Habit of Straying”, Kolata takes a look at how taking your own blood pressure may land you in the doctor’s office for the wrong reasons.

Have you ever wondered what exactly the doctor is listening for when they put the cuff around your arms and slowly deflate? All it produces is two simple numbers, and yet this may not be providing the whole story. Kolata explains how “blood pressure measured in the doctor’s office can be wrong about half the time.” While this is not necessarily the doctor’s fault (in fact it’s more likely to based a myriad of other factors), it certainly does change the perspective on such diagnoses  as high blood pressure. Yet an abundant number of Americans must come to terms with their diagnosis or even take medication for it.

Considering there are more accurate ways to measure your blood pressure, why do we still resort to the same old methods that doctors have been using for years? And is it necessarily beneficial to have patients take their own blood pressure at home, when it’s even less likely that these will be accurate? Kolata also claims “it turns out that blood pressure can jump around a lot – as much as 40 points in one day in my case – which raises the question of which reading to trust.”

I find this article relates nicely to a few of the discussions that we’ve had in class and in discussion about how much authority we put in the hands of the patients for their own healthcare. Although we would all like to feel empowered and control the way our bodies function, it may not necessarily be pertinent to mull over every little function of our body. The more that we informed about our natural systems, the better we can make our health care decisions and solve our physical troubles.