Antibiotics

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I idolized the American medical establishment. When I was a mere Blue Cross number-collecting lackey working at the front desk of the Emergency Room of Massachusetts General Hospital, I sometimes saw, slipping into the doctors’ lounge, notable people — doctors whose surname in footnotes graced the basic core medical textbooks I was using as parallel reading in France, to prepare myself for my American examinations in medicine. I never wanted to penetrate more than the lowest echelons of the American medical establishment when I returned from France.  I mean I doubted the Harvard-types would open their world to me easily, no matter how clever I was. I proved to be right.  At a Harvard-associated residency program, I was actually asked at the interview if anyone in my family was a Harvard University trained physician. I still remember the program chairman’s barely muffled laughter when I told him my father held a graduate degree from the Harvard University School of music. Read more on Drug Misuse in American Medicine Leads to Possible Catastrophe…

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One of the themes that keeps coming up in those little “newslets” for 15 minutes of Continuing Medical Education each is that systematic screening for several serious diseases, like cancers, is simply not as efficient as one wishes it were. At the very least, in terms of cost, it rarely pays. Sometimes people try to identify a subset of people who should be screened; but all too often, even that is a daunting task.

Some stalwart and doubtless realistic physicians sometimes suggest–screen patients who ask for it. This seems strikingly similar to the young doctor in Amiens who told me, that if he wanted to build a practice and feed his family, he had to give everyone antibiotics. It is that ancient trend of anti-intellectualism, patients who second-guess the doctor, people who are worried about their health– And yet, these people could argue that (they have paid their health insurance and earned what they think is good care), and they are individuals and not statistics. Read more on When To Screen For Things Medical That Could Kill…

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When I’m not on the internet, I generally catch the latest news on the car radio, like lots of other folks tied up in California freeway traffic.  Yesterday the question had been raised whether Foster Farms chicken was in some way associated with a salmonella outbreak. The company suggested that improper preparation of the raw chicken was responsible.

Not so.  Now the news reported by USA Today, whom I applaud for picking up this story, says that Foster Farms was also the origin of a salmonella outbreak in 2012 in Oregon and Washington that sickened 134 people in 13 states.

It is reasonable to ask, “What the hell is going on?” Read more on Playing Chicken With The Gvt. Shutdown…

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I kind of like ABC news, since they at least reported the news about azithromycin and a lot of other folks didn’t.

For more information, here is the original article, and here is the FDA safety announcement (this link leads to a PDF which will load in a separate window, but you must have the Adobe Acrobat reader – free – installed). Read more on Azithromycin Scare…

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Strange, that the meningitis-tainted steroids in Tennessee  make me think of the chocolate bar case from Oklahoma. Two young, and it seemed to me, perfectly honest if somewhat histrionic  young women who found worms in their Hershey bars — the hard way.  Both were unemployed and mothers of several children each, and one was pregnant.  They were enjoying their chocolate bars in a dark room by the light of the TV set when one noticed something funny. Comparing experiences, the other one agreed that the bars tasted “off.” Turning on the lights (and — pardon me — spitting out the foul tasting candy) they saw a horrible sight.  The almonds were infested with worms. Oh, it was  scary, and one in particular told me she started throwing up, and had lost weight.  She had developed some sort of a phobia for chocolate bars in general, and had poor sleep, and was 3 months pregnant.  They both had the classic signs of Post Traumatic Stress Disorder — they could not stop thinking about and reliving the ordeal, they developed an avoidance of any chocolate or other type of candy bar, and they had a violent “startle” reaction if they encountered a TV commercial or if somebody they saw in public was eating a candy bar. Now the expectant mother did not particularly want to medicate for fear of damaging her unborn child, and that was fine with me.  I recall we tried to use a little relaxation, or NLP  (neurolinguistic programming), or anything, really, non-medical to calm  down this young lady.  We succeeded, at least somewhat, but not entirely. She did tell me that the Hershey bar had  “been around” for a  little, but I was unaware of any expiry date existing for Hershey bars;  checked some at the supermarket, and never saw a date. Read more on Meningitis and Hershey Bars…

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In the National World War II museum, it is easy and even triumphant and pride-generating to look back and see some of the scientific advances made during World War II.  There’s no doubt that science is advancing.  But I wonder if our ethics can keep pace.

I am fairly proud of Teflon.  And synthetic cortisone is widely used and may have saved plenty of lives. It’s a steroid that knocks down the action of the immune system.  When a medical substance becomes cheaper and easier to use and known to the public, then it runs a real danger of getting overused.  Most concern about overuse is focused on illegal steroids taken by athletes.  Nevertheless, everything that can be helpful and fast may make things worse. One example would be the over-prescribing of steroids to kids with allergies.

Penicillin had been invented before WWII, but its use did not become widespread until WWII.  Of course, it took people awhile to find out about the ability of bacteria to develop resistances to antibiotics.  This has led to newer and stronger antibiotics, which would not be the worst thing in the world. Unfortunately, the excessive use of antibiotics has led to untreatable infections, such as methicilline-resistant strep and an untreatable strain of tuberculosis. Read more on Science and War (and Ethics)…

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As it turns out, this whole bit about the use of antibiotics in livestock and poultry is a complex issue.  It’s well beyond anything that anyone would guess at first blush.  The best online summary is the position paper put out by Food Marketing Institute.  Curiously enough, it doesn’t have a year on it.  Based on the references, I’d guess it was probably around 2005.

The Food and Drug Administration has approved the use of therapeutically low doses of antibiotics in feed.  However, very few studies were conducted.  They decided that giving little bits of antibiotics to animals would help avoid illness.  What this means in practical life is that they will grow faster and produce more meat prior to being slaughtered and eaten.

Everybody agrees that using too many antibiotics in humans can cause humans to become resistant to those antibiotics.  This has been blamed on everything from patients who want a prescription for an illness that isn’t caused by bacteria to doctors feeling they need to give a prescription to justify their fee.  This kind of talk has been around for a long time. Read more on Antibiotics in Livestock Feed Endanger The Entire World…

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I read a joke once about a husband’s preemptive strike in the bedroom.  He walks in holding two aspirin and a glass of water.  When his wife asks what it’s for he says it’s for her headache.  She replies “But I don’t have a headache.”  “Gotcha!”

Headaches are no fun, so we might as well get a little chuckle at their expense.  And if you suffer from sinus headaches, there might be quick and inexpensive relief your doctor hasn’t shared with you.

Listen, I have had allergies since I was small but sinus headaches have been rare.  That is, until I got my complete dental implants.  They have wildly improved my quality of life, but I have had more intense and regular sinus headaches as a result.  My surgeon had removed teeth prior to the implants and freely admitted he had been up in my sinus area.  He said I could see an ear nose and throat specialist if the sinus headaches became too much of a problem.  He tried to ignore my laughter as I told him I could fix this myself. Read more on What Your Doctor May Not Tell You About Sinus Headaches…

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On A Cat Aging
by Sir Alexander Gray

He blinks upon the hearth-rug
And yawns in deep content,
Accepting all the comforts
That Providence has sent.

Louder he purrs and louder,
In one glad hymn of praise
For all the night’s adventures,
For quiet, restful days.

Life will go on forever,
With all that cat can wish;
Warmth, and the glad procession
Of fish and milk and fish.

Only – the thought disturbs him –
He’s noticed once or twice,
That times are somehow breeding
A nimbler race of mice.

Merlin the wizard from King Arthur

MERLIN

I loved Merlin – King Arthur’s court wizard — when I was a kid and that was just about the time that Disney came out with “The Sword in the Stone.”

WOW – nearly 50 years ago!

Later I was to love the Arthurian legend in many deep and symbolic ways — love it so much that for a long time I kept a light-up, plug-in sword which was (actually, fairly easily) removed from a plastic pseudo-crystalline rainbow light-shooting stone.  Doing so didn’t make me a queen of anything, though.

It is almost impossible, I think, to be human and anything more than partially literate without knowing the splendor of the Arthurian legend.

Fast forward to the present, and I am a wizard in my own way – a doctor. I wanted every patient to have the smiling sense of the Arthurian splendor that I had when I pulled that ersatz sword from the ersatz stone.  Most of them did, until that piece, like many dear to me, was lost in a series of moves.

Read more on Of Mice And Men And The Fountain Of Youth…

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I remember when I was very tiny, getting a TB (tuberculosis) skin test as part of some public school campaign.  It was negative.  My parents were pleased with me, but they never had any doubts that I would be “clean.”  They said something about poor people with poor hygiene being at risk, but not nice middle class folks like us.  No problem.

Fast forward to a far more vivid memory.  I had to get another TB test in France when I attended medical school there.  It was a hassle, as I had to get someone to take class notes for me while I went to a cavernous and overwhelming public health office.

InnoculationI was in line with all the rest of the “aliens” as the laws required me to be.  There were people who looked more terrified than I — young mothers from North Africa with four or five young children orbiting around them like out-of-control satellites.  Unlike this frightened young lady, at least I knew what they were going to do to me — even though I was only a first year med student.  They called it a “scarification.”

There was a very petite nurse who had to reach up to give me some scratched parallel lines on my left shoulder.  It was the BCG, the “Bacille de Calmette et Guerin.”  They told me that it was a strain of tuberculosis that had been developed in Lille, a few miles to the north of Amiens where I was, and that it was a gift to the world.  It was a benign form of tuberculosis that would give me immunity. Read more on Antibiotic Abuse — We Are Creating Monster Epidemics…

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