General Medicine
- Heart Medications Vs. Angioplasty
- Cell Phones and Brain Tumors
- Strained Doctor-Patient Relations
- Loud Noise and Hearing Loss
- The Necessity of Sleep
- Convincing Medical Research
- Test Sensitivity and Specificity
- The Lives of Demented Patients
- The Definition of Antibiotics
- Doorknob Syndrome
Heart Medications Vs. Angioplasty
Posted by
Anthony Lee
Anthony Lee
Between medications and angioplasty, which is the better option for coronary artery disease? A recent study provides an interesting answer.
Coronary artery disease (CAD), which can result in a heart attack (either unstable angina or myocardial infarction), is treated with medications, with or without the revascularization methods of angioplasty (an invasive nonsurgical procedure, also called percutaneous coronary intervention or PCI) or coronary artery bypass grafting (an open surgery). How far the cardiologist goes with treatment depends much on the severity of the individual patient's condition.
The August 14, 2008, issue of The New England Journal of Medicine published the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. The study randomized 2,287 patients with coronary artery disease to receive either PCI with drug therapy or drug therapy alone. Clearly, PCI with drug therapy has significantly greater benefit than drug therapy alone, at least for the first 36 months. Otherwise, the benefit appears to be similar after that point. Furthermore, patients with the most severe angina (chest pain) resulting from their CAD do better after PCI with drug therapy than after drug therapy alone.
The study has two implications:
Source: Weintraub, William S., et al. "Effect of PCI on Quality of Life in Patients With Stable Coronary Disease." The New England Journal of Medicine. 2008 Aug 14;359(7):677-687.
The August 14, 2008, issue of The New England Journal of Medicine published the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. The study randomized 2,287 patients with coronary artery disease to receive either PCI with drug therapy or drug therapy alone. Clearly, PCI with drug therapy has significantly greater benefit than drug therapy alone, at least for the first 36 months. Otherwise, the benefit appears to be similar after that point. Furthermore, patients with the most severe angina (chest pain) resulting from their CAD do better after PCI with drug therapy than after drug therapy alone.
The study has two implications:
- Patients with the most severe CAD should have PCI with drug therapy.
- Patients with otherwise less severe CAD can do just fine on medications alone without PCI, given that the benefit is similar between the two in the long run.
Source: Weintraub, William S., et al. "Effect of PCI on Quality of Life in Patients With Stable Coronary Disease." The New England Journal of Medicine. 2008 Aug 14;359(7):677-687.
Posted by
Anthony Lee
Anthony Lee
In recent years, studies of cell phones causing brain tumors have been inconclusive, but the fear still remains.
The cellular phone is such a useful and ubiquitous tool that we forget about the electromagnetic waves transmitting the signals for communication. Obviously, they don't cause immediate harm or discomfort, but considering how certain types of radiation can cause cancer, it's natural to wonder if cell phone radiation can do the same with tissues in the head, including brain tissue.
Studies have attempted to link cell phones to brain tumors and other conditions, including cancer of the salivary gland. Collectively, results appear to be mixed, either denying any association or stating that they can cause cancer. Regardless of what you believe, there are two important things to consider. First, because the effects of cell phones, if any at all, are not immediate, such studies would have to follow cell phone users over several decades, much like studies linking cigarette smoking to lung cancer. Second, studies of cell phones have to minimize confounding variables by look at cell phone users with similar phones, manner of using the phone, frequency of phone use, and location of phone use. It's difficult given how people use their phones freely in so many different ways.
Nevertheless, if you are afraid of the risks of cell phone radiation, there are steps you can take. You can minimize use of the phone overall. If you do use your phone, use a headphone/microphone apparatus to distance the phone away from your head. Using the phone in more wide open spaces may be helpful, too. It'll be years before we truly know whether cell phones are the next cigarettes, but it doesn't hurt to take precautions.
Studies have attempted to link cell phones to brain tumors and other conditions, including cancer of the salivary gland. Collectively, results appear to be mixed, either denying any association or stating that they can cause cancer. Regardless of what you believe, there are two important things to consider. First, because the effects of cell phones, if any at all, are not immediate, such studies would have to follow cell phone users over several decades, much like studies linking cigarette smoking to lung cancer. Second, studies of cell phones have to minimize confounding variables by look at cell phone users with similar phones, manner of using the phone, frequency of phone use, and location of phone use. It's difficult given how people use their phones freely in so many different ways.
Nevertheless, if you are afraid of the risks of cell phone radiation, there are steps you can take. You can minimize use of the phone overall. If you do use your phone, use a headphone/microphone apparatus to distance the phone away from your head. Using the phone in more wide open spaces may be helpful, too. It'll be years before we truly know whether cell phones are the next cigarettes, but it doesn't hurt to take precautions.
Strained Doctor-Patient Relations
Posted by
Anthony Lee
Anthony Lee
A major but overlooked public health problem has emerged in recent years: a rift between doctors and patients.
Decades ago, the public expressed high regard for the medical profession. Now, there is a shift in the public's attitude towards doctors, one learning on suspicion, frustration, and sometimes anger.
Patients are now researching medical information on the Internet, which can be a problem if the information is incomplete and not taken with a grain of salt. They are also bringing journal articles to their doctors. It's almost as if clinic visits are for questioning the doctor, not trusting the doctor's advice. Such patients often have expectations that their disease is perfectly curable with no side effects from treatment. On the other side, physicians are forced to see more patients in less time. Some also admit that their rigorous medical training focuses too much on technical details and little on interpersonal contact.
There is no doubt a rift in the doctor-patient relationship. There are many possible causes, but I like to point out one specifically: the media. I know from experience that medicine is an imperfect science. One should not assume disease to be 100% curable or treatments to be 100% safe and effective, but standard treatments still have a good chance of success. However, with news stories that tend to highlight the worse medical scenarios and the neatest medical breakthroughs, it's easy to forget that medicine is an imperfect science.
The solution to this is for all of us to work together. If doctors and patients take the time to understand the other side, then there won't be any needless tension. I myself am playing a role by constantly sharing with you what I know about medicine.
Patients are now researching medical information on the Internet, which can be a problem if the information is incomplete and not taken with a grain of salt. They are also bringing journal articles to their doctors. It's almost as if clinic visits are for questioning the doctor, not trusting the doctor's advice. Such patients often have expectations that their disease is perfectly curable with no side effects from treatment. On the other side, physicians are forced to see more patients in less time. Some also admit that their rigorous medical training focuses too much on technical details and little on interpersonal contact.
There is no doubt a rift in the doctor-patient relationship. There are many possible causes, but I like to point out one specifically: the media. I know from experience that medicine is an imperfect science. One should not assume disease to be 100% curable or treatments to be 100% safe and effective, but standard treatments still have a good chance of success. However, with news stories that tend to highlight the worse medical scenarios and the neatest medical breakthroughs, it's easy to forget that medicine is an imperfect science.
The solution to this is for all of us to work together. If doctors and patients take the time to understand the other side, then there won't be any needless tension. I myself am playing a role by constantly sharing with you what I know about medicine.
Posted by
Anthony Lee
Anthony Lee
Excessive noise is a problem that some people often overlook.
If there is one thing I see frequently in our current age of digital technology, it's MP3 music players. I cannot ride the train to and from work without seeing at least one person listening to music on headphones. There are times, however, when I could hear the song through the headphones.
I would like to take this opportunity to remind everyone about excess noise. Our ears and sense of hearing are things to be grateful for. Therefore, we should make sure we don't damage them with unnecessarily loud noise.
This is not anything new, of course, especially with certain workers who wear protection with regular exposure to loud noise. The message may be important for young people who listen to music that is too loud, whether through headphones or at a concert. Just because one's sense of hearing is good early in life does not mean it will definitely stay that way decades later.
When I listen to music through headphones, what I like to is to set the volume level to the minimum necessary to hear the music. It's loud enough to hear it but I could still converse with people if I want to. If you want to protect your ears, this is one thing you can do. And, of course, if you can avoid being near speakers at a musical event or anything that is a source of potentially deafening noise, then why not?
I would like to take this opportunity to remind everyone about excess noise. Our ears and sense of hearing are things to be grateful for. Therefore, we should make sure we don't damage them with unnecessarily loud noise.
This is not anything new, of course, especially with certain workers who wear protection with regular exposure to loud noise. The message may be important for young people who listen to music that is too loud, whether through headphones or at a concert. Just because one's sense of hearing is good early in life does not mean it will definitely stay that way decades later.
When I listen to music through headphones, what I like to is to set the volume level to the minimum necessary to hear the music. It's loud enough to hear it but I could still converse with people if I want to. If you want to protect your ears, this is one thing you can do. And, of course, if you can avoid being near speakers at a musical event or anything that is a source of potentially deafening noise, then why not?
Posted by
Anthony Lee
Anthony Lee
Sleep deprivation can be a bigger problem than people may realize.
Sleep is necessary for optimal function of the human body. You have probably heard the recommendations about how much sleep is necessary. They say that seven to eight hours of sleep each night is best for adults.
Yet, the time for sleep can be a challenge in an industrialized society. With duties that include employment from early morning to late afternoon and raising families during the remaining hours, some people don't get enough sleep. Furthermore, they attribute this problem to their busy lives and may not consider sleep as important as making money. Of course, I'm not suggesting that one should quit his or her job to sleep more, but the need for sleep should not be ignored.
First off, sleep deprivation leads to interruptions in concentration, which is dangerous for driving or other tasks that require alertness for safety. However, there may more to sleep deprivation than just daytime drowsiness. Sometime back, I saw an episode of the news program 60 Minutes where healthy volunteers were forcefully deprived of sleep. One of them had elevated blood sugar, a finding that suggests the possibility of sleep deprivation leading to diabetes. Then there are things people do to fight sleep, such as drinking coffee. While caffeine acts as a stimulant, it is no substitute for rest. Plus, coffee may have their own long-term health effects, like contributing to obesity.
This may be a good time to stop and ask ourselves this question: is sleep such a bad thing that we must have as little of it as possible? Rather than go against nature, it may be best to accept how we function. If we need eight hours of sleep each night to be healthy, then we need to schedule that into our lives.
Sleep does not hinder life. Rather, it's the reverse.
Yet, the time for sleep can be a challenge in an industrialized society. With duties that include employment from early morning to late afternoon and raising families during the remaining hours, some people don't get enough sleep. Furthermore, they attribute this problem to their busy lives and may not consider sleep as important as making money. Of course, I'm not suggesting that one should quit his or her job to sleep more, but the need for sleep should not be ignored.
First off, sleep deprivation leads to interruptions in concentration, which is dangerous for driving or other tasks that require alertness for safety. However, there may more to sleep deprivation than just daytime drowsiness. Sometime back, I saw an episode of the news program 60 Minutes where healthy volunteers were forcefully deprived of sleep. One of them had elevated blood sugar, a finding that suggests the possibility of sleep deprivation leading to diabetes. Then there are things people do to fight sleep, such as drinking coffee. While caffeine acts as a stimulant, it is no substitute for rest. Plus, coffee may have their own long-term health effects, like contributing to obesity.
This may be a good time to stop and ask ourselves this question: is sleep such a bad thing that we must have as little of it as possible? Rather than go against nature, it may be best to accept how we function. If we need eight hours of sleep each night to be healthy, then we need to schedule that into our lives.
Sleep does not hinder life. Rather, it's the reverse.
Posted by
Anthony Lee
Anthony Lee
In order for studies to be widely accepted by doctors, several things should be considered.
Medicine is an evidence-based profession. Everything we know about diagnosis and treatment is based on research. These days, a patient may print out a study related to a specific disease or treatment and bring it to their doctor. There's nothing wrong with doing so, unless one fails to understand how much it takes to convince a healthcare professional.
For one thing, a study involving many patients has more power than smaller studies. Case reports and small case series usually won't do. If something about a disease or treatment can be proven, it should be seen on a large scale.
For treatments, studies have to show statistically significant difference between the new treatment and the standard one. Therefore, patients receiving the new treatment should be compared with patients receiving the standard one. After all, if the two treatments are equivalent in safety, efficacy, and price, what would be the point of the new treatment? This is why doctors like comparative studies, especially randomized controlled trials.
The last thing to consider is the number of studies. Even if a great randomized controlled trial demonstrates success with a new treatment, the study should be repeated in a similar fashion. If the same results can be replicated, then the medical community would have further promising evidence for this treatment.
These are the main things doctors look for when reviewing clinical research. It takes a lot to convince the medical community of any new fact about a disease or treatment.
For one thing, a study involving many patients has more power than smaller studies. Case reports and small case series usually won't do. If something about a disease or treatment can be proven, it should be seen on a large scale.
For treatments, studies have to show statistically significant difference between the new treatment and the standard one. Therefore, patients receiving the new treatment should be compared with patients receiving the standard one. After all, if the two treatments are equivalent in safety, efficacy, and price, what would be the point of the new treatment? This is why doctors like comparative studies, especially randomized controlled trials.
The last thing to consider is the number of studies. Even if a great randomized controlled trial demonstrates success with a new treatment, the study should be repeated in a similar fashion. If the same results can be replicated, then the medical community would have further promising evidence for this treatment.
These are the main things doctors look for when reviewing clinical research. It takes a lot to convince the medical community of any new fact about a disease or treatment.
Test Sensitivity and Specificity
Posted by
Anthony Lee
Anthony Lee
How sensitive and specific a diagnostic test is determines how reliable it can be.
We like to think that any test ordered by a doctor is perfect. If it can reliably detect the presence of a certain disease and it's always right, it's something to be thankful for. In reality, no test is 100% perfect. Good tests are sensitive and specific, though not absolutely.
The following are quick statements about the sensitivity and specificity of tests.
The following are quick statements about the sensitivity and specificity of tests.
- Sensitivity means how well the test finds that someone with a disease indeed has it. Ideally, all patients with a disease are tested positive for it. Otherwise, there would be false negatives from failed detection.
- Specificity means how much the test result depends on the presence or absence of that disease. Ideally, all patients without the disease are tested negative for it. Otherwise, there would be false positives from the presence of other diseases.
- A test that is sensitive but not specific is problematic, because a positive test result could come from many different things.
- A test that is specific but not sensitive is problematic, because the condition the test is for may not be detected.
- Although nothing is 100% sensitive and specific, tests that are standard of care still have enough sensitivity and specificity to be worth using, and it sometimes helps to use tests in combination.
The Lives of Demented Patients
Posted by
Anthony Lee
Anthony Lee
An organization called Project StoryKeeper is doing something to remember people with Alzheimer's disease: recording their life stories.
Alzheimer's disease is a heartbreaking burden for patients and their families. It is more than a gradual decline of memory and cognitive functions. It is a loss of one's sense of self and the world. For any caregiver or loved one, the thought of being alive with no meaningful awareness and only a sense of confusion is saddening.
Given that no cure exists for Alzheimer's disease, the focus is to maximize their quality of life and recognize them as individuals. To help achieve the latter, a non-profit organization called Project StoryKeeper is aiming to preserve the life stories of people with Alzheimer's disease. The organization does not necessarily limit itself to this population, because it does the same for veterans, Native Americans, and other groups of people who deserve to have their stories told to the world. Project StoryKeeper is also partnered with LifeLenz, an online social network that provides the means for families to share text, images, and video to record life's memories.
Whether or not you are with Project StoryKeeper, anyone can play a role in helping those with Alzheimer's disease be recognized as people. For that matter, this goes for all people regardless of what medical conditions they face. Everyone deserves the best care in the remaining years of life.
Given that no cure exists for Alzheimer's disease, the focus is to maximize their quality of life and recognize them as individuals. To help achieve the latter, a non-profit organization called Project StoryKeeper is aiming to preserve the life stories of people with Alzheimer's disease. The organization does not necessarily limit itself to this population, because it does the same for veterans, Native Americans, and other groups of people who deserve to have their stories told to the world. Project StoryKeeper is also partnered with LifeLenz, an online social network that provides the means for families to share text, images, and video to record life's memories.
Whether or not you are with Project StoryKeeper, anyone can play a role in helping those with Alzheimer's disease be recognized as people. For that matter, this goes for all people regardless of what medical conditions they face. Everyone deserves the best care in the remaining years of life.
Posted by
Anthony Lee
Anthony Lee
An explanation of what antibiotics are may clear up any confusion about it.
Antibiotics are a type of medication used to treat infectious diseases. If you break the word "antibiotic" down into its individual parts, you have the prefix "anti" that specifies antagonism and the suffix "bio" that refers to life. Literally, an antibiotic would suggest that it's a medication that kills any living thing. Of course, that is not entirely true. People do understand that antibiotics acts against microorganisms.
But do they target all microorganisms? Not quite. Microscopic pathogens include bacteria, viruses, fungi, and parasites, but antibiotics work against bacteria. Viruses are treated with antiviral medications, fungi are treated with antifungal medications, and parasites are treated with other medications. The term "antibiotic" might be used a little incorrectly because it actually refers to an antibacterial medication.
It's especially confusing for people with minor infections. For example, a patient may have a sore throat that a doctor concludes is from a virus, not a bacterium, based on certain physical findings. In such a case, the patient may expect to be given antibiotics and even assume the doctor does not care when he or she tells the patient that no medications are needed. However, antibiotics are for bacterial infections, not viral infections. Viral upper respiratory infections are usually self-limited in their natural course.
In any event, asking a doctor or consulting a medical dictionary may resolve such situations, even if one may think he or she knows the definition already.
But do they target all microorganisms? Not quite. Microscopic pathogens include bacteria, viruses, fungi, and parasites, but antibiotics work against bacteria. Viruses are treated with antiviral medications, fungi are treated with antifungal medications, and parasites are treated with other medications. The term "antibiotic" might be used a little incorrectly because it actually refers to an antibacterial medication.
It's especially confusing for people with minor infections. For example, a patient may have a sore throat that a doctor concludes is from a virus, not a bacterium, based on certain physical findings. In such a case, the patient may expect to be given antibiotics and even assume the doctor does not care when he or she tells the patient that no medications are needed. However, antibiotics are for bacterial infections, not viral infections. Viral upper respiratory infections are usually self-limited in their natural course.
In any event, asking a doctor or consulting a medical dictionary may resolve such situations, even if one may think he or she knows the definition already.
Posted by
Anthony Lee
Anthony Lee
Waiting until the last minute to ask the doctor something is a problematic thing to do.
Some people may be intimidated by the doctor and too embarrassed to talk about certain things. The doctor, of course, does his or her best to elicit from the patient what needs to be done. After all, a doctor uses interpersonal skills to show that he or she is just as human.
Sometimes, the fear to speak up is too strong. The worst thing that could happen is that the patient finally has the courage to bring up what he or she wanted to tell the doctor all along and does so just as the doctor is leaving the room. This is sometimes called "doorknob syndrome" because the doctor is ready to open the door when the patient speaks up.
It's a problem for both sides. The patient still doesn't get his or her real problem addressed while the doctor realizes that it's now too late to even do so. There's always a future clinic visit, but it's something important, it becomes frustrating to wait even longer.
A useful tip for patients would be to have a list of questions and issues ready before the doctor comes in. It's easier on everyone when the agenda is laid out from the start. When time is used efficiently, the doctor can surely deliver the best care possible.
Sometimes, the fear to speak up is too strong. The worst thing that could happen is that the patient finally has the courage to bring up what he or she wanted to tell the doctor all along and does so just as the doctor is leaving the room. This is sometimes called "doorknob syndrome" because the doctor is ready to open the door when the patient speaks up.
It's a problem for both sides. The patient still doesn't get his or her real problem addressed while the doctor realizes that it's now too late to even do so. There's always a future clinic visit, but it's something important, it becomes frustrating to wait even longer.
A useful tip for patients would be to have a list of questions and issues ready before the doctor comes in. It's easier on everyone when the agenda is laid out from the start. When time is used efficiently, the doctor can surely deliver the best care possible.
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