Suffering Worse Than Death

 Posted by on 17 January 2014 at 10:00 am  History, Holocaust, Medicine
Jan 172014
 

A while back, I had to look up the spelling of Dr. Mengele’s name, and as a result, I came across this horrifying article: Why One Auschwitz Survivor Avoided Doctors for 65 Years.

The transport to Auschwitz took two weeks. His sick father died on the journey. Upon arrival, they had to strip and submit to an inspection. Ganon’s mother and five siblings were then sent to the gas chambers.

Yitzhak Ganon was taken to the Auschwitz-Birkenau hospital, where Josef Mengele, the so-called “Angel of Death,” conducted grisly experiments on Jewish prisoners.

Ganon had to lie down on a table and was tied down. Without any anesthetics, Mengele cut him open and removed his kidney. “I saw the kidney pulsing in his hand and cried like a crazy man,” Ganon says. “I screamed the ‘Shema Yisrael.’ I begged for death, to stop the suffering.”

After the “operation,” he had to work in the Auschwitz sewing room without painkillers. Among other things, he had to clean bloody medical instruments. Once, he had to spend the whole night in a bath of ice-cold water because Mengele wanted to “test” his lung function. Altogether, Ganon spent six and a half months in the concentration camp’s hospital.

Although I read a slew of books on the Holocaust last year, I avoided reading about the gruesome experiments of Nazi doctors. For someone to deliberately inflict suffering worse than death on innocent people, including children. As much as I want to recognize the historical facts and honor the victims, it’s far, far too horrifying imagine.

MRSA on the March

 Posted by on 18 December 2013 at 10:00 am  Health, Medicine
Dec 182013
 

This USA Today article — Dangerous MRSA bacteria expand into communities — is a good bit of journalism. It begins:

Eric Allen went to bed March 1, thinking he had a light flu. By the time he staggered into the hospital in London, Ky., the next day, he was coughing up bits of lung tissue. Within hours, organs failing, he was in a coma.

Tests showed that Allen, 39, had a ravaging pneumonia caused by methicillin-resistant Staphylococcus aureus, or MRSA, an antibiotic-resistant bacteria once confined to hospitals and other health care facilities. Allen hadn’t been near a doctor or a hospital.

Same with the next victim, a 54-year-old man, who came in days later and died within hours. And the victim after that, a 28-year-old woman, dead on arrival.

The doctors were alarmed.

“What really bothered me was the rapidity of their deterioration, a matter of hours,” says Muhammad Iqbal, a pulmonologist who chairs the infection control committee at Saint Joseph-London hospital. “We were worried that something was spreading across the community.”

Indeed, a deadly form of MRSA had sprung from nowhere, picking off otherwise healthy people. The cases thrust Iqbal and his colleagues to the front lines of modern medicine’s struggle against antibiotic resistant bacteria – perhaps the nation’s most daunting public health threat. No drug-defying bug has proved more persistent than MRSA, none has caused more frustration and none has spread more widely. In recent years, new MRSA strains have emerged to strike in community settings, reaching far beyond hospitals to infect schoolchildren, soldiers, prison inmates, even NFL players.

A USA TODAY examination finds that MRSA infections, particularly outside of health care facilities, are much more common than government statistics suggest. They sicken hundreds of thousands of Americans each year in various ways, from minor skin boils to deadly pneumonia, claiming upward of 20,000 lives. The inability to detect or track cases is confounding efforts by public health officials to develop prevention strategies and keep the bacteria from threatening vast new swaths of the population.

Now… go read the whole thing: Dangerous MRSA bacteria expand into communities. It’s well-worth a few minutes of your time!

I was intrigued by the hypothesis that MRSA is carried by a certain low percentage of the population, then strikes when its host is weakened by flu or other illness. However MRSA is spread, the prospect of life in a post-antibiotic world is damn scary.

As it happens, I answered a question about antibiotic resistance in a free society on the 17 February 2013 episode of Philosophy in Action Radio that might be of interest. If you’ve not yet heard it, you can listen to or download the relevant segment of the podcast here:

For more details, check out the question’s archive page.

The Affordable Relationship Protection Act

 Posted by on 20 November 2013 at 10:00 am  Funny, Love/Sex, Medicine, Politics
Nov 202013
 

Chris Land posted this to Facebook yesterday, and it’s too awesome not to share:

Announcing the AFFORDABLE RELATIONSHIP PROTECTION ACT

Looking for a romantic partner takes time, energy and money. Sadly, many American adults are currently unrelationshipped. Who can they turn to in need? To whichever institution is in the best position to help, that’s who!

A few years after the passage of the Affordable Relationship Protection Act, the website YourLoveMatch.gov will go live. Unrelationshipped adults can then create an online profile with the help of specially funded Coaches. Based on your individual selection criteria, an exciting new partner will be assigned in 4-6 weeks. Love at last!

To provide the necessary funding, all adults will be required to set up an account or face a small penalty (this is not a tax unless it needs to be for legal reasons). Those already in a relationship will be required to register that relationship. Government is what we do together.

IF YOU LIKE YOUR PARTNER, YOU CAN KEEP YOUR PARTNER. Any significant changes (like change of job or residence or a new tattoo) will require re-registration. Approval will be routine unless you’ve selected a substandard partner. In those rare cases, your new partner will be a big improvement!

Sure there will be a few bugs to work out. A few kinks, some bumps in the road. But let’s all keep the end goal – happy relationships for everyone! – firmly in mind. Anyone against this WANTS people to be unhappy. Stride forward, comrades! Forward to the future!

I’m looking forward to upgrading my substandard partner soon! Sure, I’ll have to pay a bit more, but I’ll get something much better, right? Right?!?

 

PJ Media has just published my latest column, “Will Tomorrow’s Medical Innovations Be There When You Need Them?

My basic theme is that we must protect the freedoms necessary for the advancement of medical technology.

I start with a pair of vignettes:

How much has American medicine changed in the past 30 years?

Let’s turn the clock back to 1983. A middle-aged man, Dan, is crossing the street on a busy midday Monday. An inattentive driver runs a red light and plows into Dan at 45 mph, sending him flying across the pavement. Bystanders immediately call for help. An ambulance rushes Dan to the nearest hospital. In the ER, the doctors can’t stabilize his falling blood pressure. They prep him for emergency surgery. The trauma surgeon tries desperately to stop the internal bleeding from his badly fractured pelvis but is unsuccessful. Dan dies on the operating table.

The surgeon gives Dan’s wife the sad news: “I’m sorry, but your husband’s injuries were too severe. We did everything we could. But we weren’t able to save him.”

Fast forward to 2013. Dan’s now-grown son Don suffers the same accident. But within minutes of his arrival in the ER, he’s sent for a rapid trauma body CT scan that shows the extent of the pelvic fractures — and more importantly, shows two badly torn blood vessels that can’t be easily reached with surgery.

An interventional radiologist inserts a catheter into the femoral artery in Don’s right leg. Watching live on the fluoroscopy screen, the radiologist skillfully guides the catheter through the various twists and turns of the arterial system and positions it at the first of the two “bleeders.” From within the blood vessel, he injects specially designed “microcoils” into the torn artery and stops the bleeding. He then guides the catheter to the second bleeder and repeats the procedure. Don’s blood pressure recovers. The surgeons now have time to repair Don’s pelvic fractures and other internal injuries.

The surgeons give Don’s wife the good news: “Your husband’s injuries were pretty bad. But we were able to fix everything. He’ll still have to go through recovery and physical therapy. But he should be back to normal in six months”…

For more, read the full text of “Will Tomorrow’s Medical Innovations Be There When You Need Them?

(The material for the opening vignettes was drawn from two excellent presented last month at the 2013 annual meeting of the American Society of Emergency Radiology. )

Update #1: A great example of medical innovation coming from unexpected places was this 11/14/2013 New York Times article describing how an Argentinian car mechanic saw a Youtube video on how to extract a stuck cork from a wine bottle and realized it could also be used to help extract babies stuck in the birth canal.

His idea will be manufactured by Becton, Dickinson and Company and has already undergone initial successful safety testing in humans. It could save the lives of many babies in Third World countries and also reduce the need for Caesarean section in industralized countries.  (Via Gus Van Horn.)

Update #2: For those interested in the real-life technology used in the fictional scenario I discussed, here’s a nice medical slideshow from UCLA interventional radiologist Dr. Justin McWilliams, “Life-saving Embolizations: Trauma and GI bleeding“.

 

October 2013 is Breast Cancer Awareness Month.

Hence, it’s apropos that Forbes has just published my latest OpEd on this topic, “Why The Federal Government Wants To Redefine The Word ‘Cancer’“.  Here is the opening:

The federal government wants to reduce the number of Americans diagnosed each year with cancer. But not by better preventive care or healthier living. Instead, the government wants to redefine the term “cancer” so that fewer conditions qualify as a true cancer. What does this mean for ordinary Americans — and should we be concerned?…

I discuss the reasons behind the proposed redefinition, why it could matter from a political (as well as medical) standpoint, and implications for patients and doctors.

I’d like to thank Dr. Milton Wolf for providing the quote at the end!

(Read the full text of”Why The Federal Government Wants To Redefine The Word ‘Cancer’“.)

Coping with Life-Threatening Food Allergies

 Posted by on 23 September 2013 at 10:00 am  Food, Health, Medicine
Sep 232013
 

On Wednesday — the 25th — I’ll interview food allergy mom Jenn Casey about living well despite life-threatening food allergies. Unfortunately, the topic has been in the news of late, due to the death of Natalie Giorgi.

Here’s what happen to Natalie, as told by her parents:

Natalie Giorgi died July 26 after eating a Rice Krispie treat that had been prepared with peanut products at Camp Sacramento on the final day of a multi-family camping trip, her parents said. Giorgi had a documented allergy to peanuts.

“We had been there before. We had eaten their Rice Krispie treats before. We had never had a problem before,” Louis Giorgi said.

Giorgi said immediately after taking one bite of the treat, his daughter told her parents. She had been dancing with friends when she took the bite. “We gave her Benadryl like we’d been told,” Natalie’s father said.

Over the next several minutes, the Giorgis said their daughter showed no signs of a reaction whatsoever. “I kept asking, ‘are you OK?’ She kept telling me she was fine, and she wanted to go back to dancing with her friends,” Natalie’s mom said. Natalie kept asking her parents to go back to her friends, but they kept telling her she had to stay with them, to make sure she was OK.

“Then suddenly, she started vomiting,” Louis said. “It spiraled downhill out of control so quickly.” Natalie’s father, a physician, administered both of the EPI-Pens — used to slow or stop an allergic reaction — that the family carried with them. A third was obtained from the camp and administered. None of them stopped her reaction. Her dad called 911.

“I did everything right, in my opinion. I couldn’t save her,” Louis Giorgi said. Emergency responders who arrived later couldn’t save her, either.

“She had been fine, and had been talking to us. This was a worst-case scenario. One of the last things she said was, ‘I’m sorry, mom,’” Natalie’s mother said as she wiped a tear away from her cheek.

It’s a heartbreaking story, particularly because neither Natalie nor her parents were in any way irresponsible about their daughter’s food allergy.

Natalie’s death has raised a new round of questions about when epi-pens should be administered — after the ingestion of the known allergen or when symptoms appear. Natalie’s parents followed the latter protocol (which many doctors endorse) but that was too late.

On that question, this “Ask the Expert” Column from the American Academy of Allergy, Asthma, and Immunology was very informative. Here’s a bit:

These cases [of death due to ingestion of an allergen] illustrate a very important point. That is, the mean time to respiratory or cardiovascular arrest after the ingestion of a food to which a patient is allergic is 30 minutes (Pumphrey RS, Clinical and Experimental Allergy 2000; 30(8):1144-1150). Thus there is very little time for one to act after patients express even the mildest symptom of an anaphylactic event.

Nonetheless, we have all seen children (and adults) who experience initial symptoms such as itching of the back of the throat or nausea after eating a food, and who recover spontaneously. In the practice of Allergy, we do food allergen challenges on a regular basis and observe these spontaneous recoveries. Thus we are all prejudiced by these observations. These personal anecdotal observations have resulted in the debate as framed in this quote from the Journal of allergy and Clinical Immunology:

“Although there is little debate about using epinephrine to treat a SCIT SR” (meaning anaphylactic reactions to injection of an allergen), “there is a lack of consensus about when it should be first used.”

This debate has certainly extended to anaphylactic reactions to foods. The issue is not whether epinephrine is the drug of choice. Clearly it is. Other agents such as antihistamines do not act in time to prevent fatalities. Thus if we are going to prevent a fatality, the only tool we have to do so is epinephrine.

So what should be done? (Mind you, even if you don’t have food allergies, you might need to give someone advice on this matter at some point — and you could save their life!)

As the article says: “In July 2008, the World Allergy Organization published the following statements:”

Anaphylaxis is an acute and potentially lethal multisystem allergic reaction. Most consensus guidelines for the past 30 years have held that epinephrine is the drug of choice and the first drug that should be administered in acute anaphylaxis. Some state that properly administered epinephrine has no absolute contraindication in this clinical setting. A committee of anaphylaxis experts assembled by the World Allergy Organization has examined the evidence from the medical literature concerning the appropriate use of epinephrine for anaphylaxis. The committee strongly believes that epinephrine is currently underused and often dosed suboptimally to treat anaphylaxis, is underprescribed for potential future self-administration, that most of the reasons proposed to withhold its clinical use are flawed, and that the therapeutic benefits of epinephrine exceed the risk when given in appropriate intramuscular doses.

Again, I hope that you join Jenn and me on Wednesday for our discussion of living well with food allergies. We won’t just be focused on the person who has the food allergy: we’ll talk quite a bit about what friends and family can (and should) do to keep that person safe, without driving anyone crazy.

 

PJ Media has published Part 3 of my 4-part series on the changing face of American medicine under ObamaCare, “The Eyes of Big Medicine: Electronic Medical Records“.

I discuss the ObamaCare mandate for physicians to implement electronic medical records (EMRs), how this can harm patient care, and the government’s agenda in using EMRs to control doctors.

Earlier articles in the series:

Part 1: “Your Future Under Obamacare: Big Medicine Getting Bigger“.

Part 2: “How Big Medicine Will Affect Patient Care“.

Tips for Going to the ER

 Posted by on 1 July 2013 at 1:00 pm  Emergencies, Health, Health Care, Medicine
Jul 012013
 

As y’all know, I recently interviewed emergency medicine physician Dr. Doug McGuff about “Avoiding the Emergency Room” on Philosophy in Action Radio. If you’ve not yet heard it, you can listen to or download the podcast here:

Toward the end of that interview, Dr. McGuff offered some tips for if you do end up in the ER, including being very honest and factual about your symptoms. Along those lines, I recently stumbled across an article with useful tips for getting better care at the ER. Here’s the list of basic recommendations, but check out the article for more details.

  • Avoid nights, weekends and holidays
  • Call your regular doctor before you go
  • Bring a list of your medications
  • Have your medical records and tests handy
  • Make sure your hospital treats what’s ailing you
  • Try to be understanding
  • Bring somebody with you
  • Avoid the ER altogether

Obviously, if you’ve just been run over by a bus, you’re just going to have to muddle along as best you can. However, often you can plan in advance, and in that case, the advice is good!

 

Forbes published my latest OpEd, “Is Concierge Medicine The Correct Choice For You?

I discuss the benefits of this practice model for both patients and doctors as well as dispelling some myths.

(Some of this material is drawn from my recent SnowCon 2013 talk, “Concierge Medicine: The Last Bastion of Health Care Freedom”).

Denver-area readers might also be interested in this related recent short piece in 5280 Magazine: “The Doctor Is (Always) In“.

The Rise of Drug-Resistent Tuberculosis

 Posted by on 15 February 2013 at 10:00 am  Medicine
Feb 152013
 

On Sunday’s Philosophy in Action Radio, I’ll answer a question on antibiotic misuse — particularly “How would antibiotic misuse be handled in a free society?” By happenstance, some very alarming reports on drug-resistent tuberculosis have been emerging from South Africa. Here’s the opening of a US News article, Doctors Struggling to Fight ‘Totally Drug-Resistant’ Tuberculosis in South Africa:

In a patient’s fight against tuberculosis–the bacterial lung disease that kills more people annually than any infectious disease besides HIV– doctors have more than 10 drugs from which to choose. Most of those didn’t work for Uvistra Naidoo, a South African doctor who contracted the disease in his clinic. For those who contract the disease now, maybe none of them will.

A new paper published earlier this week in the Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal warns that the first cases of “totally drug-resistant” tuberculosis have been found in South Africa and that the disease is “virtually untreatable.”

Like many bacterial diseases, tuberculosis has been evolving to fend off many effective antibiotics, making it more difficult to treat. But even treatable forms of the disease are particularly tricky to cure; drug sensitive strains must be treated with a six-month course of antibiotics. Tougher cases require long-term hospitalization and a regimen of harsh drugs that can last years.

Naidoo, then an avid runner, says he continued training for months with the disease, which affects more than 389,000 South Africans annually (about one fourth of Africa’s cases), according to the World Health Organization. It wasn’t until he went to visit his family in Durban (he had been working with TB patients in a pediatric clinic in Cape Town) that his family noticed he had lost more than 30 pounds.

“I had flu symptoms and chest pains, but I was still running so I didn’t think anything was wrong,” he says. But when he went in for an X-ray, doctors found that his entire right lung had filled with fluid. Within weeks, he was on his deathbed as his body wasn’t responding to the most commonly prescribed antibiotics.

“One night I nearly passed away–it didn’t look good,” he says.

His father, also a physician, suggested that he may have had an emerging MDR, or a multi drug-resistant strain of TB. The emergence of MDR and its even more dangerous cousin, XDR (extremely drug-resistant TB), have pushed tuberculosis cure rates in the country from a high of 73 percent in 2008 down to 53 percent in 2010.

Naidoo survived the night and doctors eventually found a treatment regimen that worked, but he was in and out of the hospital for three years, and the drugs’ side effects were almost unbearable, he says. He developed Stevens-Johnson Syndrome, a complication that causes layers of skin to separate from each other and can be deadly. He regularly bled from his eyes. He fell into a deep depression.

“The TB doesn’t feel like it’s killing you, but the drugs do. I am a doctor and was informed that the drugs you take make you feel worse,” he says. “My case was three years long. I don’t think the average patient has that kind of patience.”

The whole article is worth reading, so go check it out. I was particularly fascinated to hear about the New York hospital where 32 patients caught drug-resistent tuberculosis in the early 90s.

While drug resistance has certainly emerged for other infectious diseases, tuberculosis seems to be the canary in the coal mine, given that the treatment is long-lasting, expensive, and painful.

So what can and should be done about such drug resistance? Well, for that, you’ll have to listen to that episode!

Suffusion theme by Sayontan Sinha