Wednesday, September 30, 2009

Langara's Energy Healing Program

Here is an article discussing the Integrative Energy Healing program at Langara College, a well known college in the Greater Vancouver area.

I very much agree with Chris Macdonald, the author of the post, Langara is ripping off their students with a course based in pseudoscience. Supporters of energy healing may claim that doctors (read medical student in my case) are so wrapped in modern medicine that they are not willing to consider the possibility of alternative therapies, but, in this case, nothing could be further from the truth. I welcome the potential benefits of alternative therapy. However, I believe there should be substantial research supporting "energy healing" before it is packaged as a certificate program and sold to students. Until then, can we really trust a graduate of this program with our health?

Saturday, September 19, 2009

There is No Doctor Shortage, Only a Sleep Surplus

I recently came across an article describing how Australian doctors are made to work longer hours. Apparently the health authority has decided that doctors can work 80 hour work weeks if they just drink 6 cups of coffee a day.

Of course, this health authority wants to assure everyone that they are not in their ivory tower creating esoteric advice that doesn't apply to real world situations. They add that they realize drinking that much coffee is "not always feasible or realistic"; their solution: physicians should take caffeine pills instead.

Seriously? There is a health authority in a respected, developed country that thinks the answer to a doctor shortage is to force doctors awake with a stimulant so that they can work longer hours? What's next? I mean, cocaine is a better stimulant than caffeine...if they still have a doctor shortage maybe the health authority can strike a deal with a Colombian cartel?

Oh, and side effects of caffeine can be anxiety, insomnia, and agitation...the exact qualities I'm looking for in my physician...

Wednesday, September 16, 2009

Vaccine Misinformation

There have been a number of stories in the media for the past few years about the vaccine conflict. The pro-vaccine group is all for vaccinations and wants to ensure the entire population is immune to diseases like diphtheria and pertussis. The anti-vaccine group believes that vaccines are bad and cause problems, like autism. If you are considering vaccinations for yourself, or your children, I strongly suggest discussing your concerns with your doctor. There is a lot of misinformation and fear mongering out there that distract people from the facts.

The truth is that vaccines are not 100% safe, but wait!!!!...Nothing really can be 100% safe. Even drinking water can be dangerous...if you suddenly lose coordination of your swallowing reflex...water could get into your lungs, and you could drown, but does that mean you're going to run off to the Sahara and never drink anything...ever? No, of course not. Obviously the vaccination issue is a much more complex issue than drinking water, but we all need to realize that many good ideas/important activities come with associated risks. Just remember, we need to weigh those risks against the potential benefits gained.

I recently spoke with a friend who has hand, foot, and mouth disease (HFMD). A very infection disease caused by a virus. She got HFMD from her little cousin who was recently vaccinated for MMR (Measles, Mumps, Rubella). Her cousin picked up the HFMD a few days after receiving the vaccination. Now her entire family believes that the MMR vaccination directly gave this little boy HFMD. That didn't happen! Measles, mumps, rubella, and HFMD are all different diseases. The MMR vaccine does NOT contain HFMD virus. The MMR vaccine could not have directly infected this boy with HFMD! It didn't happen! To get HFMD the boy needed to come into contact with the HFMD virus. Please consider the possibility that getting HFMD shortly after the vaccination was a coincidence, not causation! If a child is vaccinated and then gets straight A's on his report card, you shouldn't assume that the vaccine made him smarter! (Well, you could...because if the vaccine prevented him from being sick...he probably went to class more...leading to him learning more...resulting in the good report card...)

It is the media frenzy attacking vaccinations that is causing people to fear irrationally. I'm not discouraging caution, but I am encouraging critical thinking. As I mentioned earlier, if you are considering vaccinations for you or your child, discuss your concerns with your doctor. You don't just have to take your doc's word either, you can ask your doctor to provide you with evidence. There have been many studies looking at the effects of vaccinations.

Just in case you come across peer reviewed articles written by Dr. Andrew Wakefield claiming that MMR vaccines are linked to autism...please check out this article, which states that the link between MMR vaccination and autism is extremely unlikely and that Dr. Wakefield's work is being discredited.

Sunday, September 13, 2009

Why INR is Important for Coumadin Users

Your INR (International Normalized Ratio) is a measurement of how quickly you clot (stop bleeding). It is an important measurement if you are using coumadin (warfarin) a drug that "thins your blood", reducing how quickly you clot. Patients are given coumadin because they have a clotting problem; for example, they may have suffered from pulmonary embolisms or strokes. A pulmonary embolism occurs when a clot blocks off blood to your lungs and a stroke is a similar problem, but it affects your brain.

If you are on coumadin, you will undergo a bleeding test to determine your INR. Ideally, your INR should be higher than normal (normal is around 1), but not TOO high. If your INR is too high, your blood is too thin and you are at risk of bleeding out.

For example, if a healthy person gets hit hard enough in the arm, they will get a bruise. A bruise is a sign that the person was bleeding underneath his skin, but the blood clotted and he has began healing. Now, if your INR is too high, you may take significantly longer to clot because your blood is very thin (clotting factors are missing).

The reason I mention this is because a gentleman was telling me about a time when his INR was high and although he was told he needed to come in to see his family doctor, he didn't. I don't know if the doctor didn't clearly convey the danger of the situation, or if he just ignored his physician's warning, but he didn't bother to make an appointment. Later that week, he went to his chiropractor who did some work on his back. He ended up having a sore back the next day; he thought he broke his back because the pain felt the same as when he broke his back years ago. Turns out that the pressure the chiropractor put on his back caused him to bleed internally because his blood was so ridiculously thin. The blood didn't have anywhere to go because his skin was intact, so it pooled in his lower back. Blood pooling into a restricted space increased the pressure in his back and caused the pain.

This man was very fortunate that the blood pulled in a relatively safe way. If he bled into his chest cavity, for example, this could stop your heart from beating and be fatal.

Saturday, September 12, 2009

What Are The Chances?

I was told a story about a person who was watching House and saw a case where a patient had heart palpitations when anyone put pressure on his abdomen. The patient on House had a pheochromocytoma.

This person went into her doctor's office and claimed that she too had a pheochromocytoma and described her symptoms and how they were similar to the case she saw on House.

I'm guessing 99% of the time when a patient presents at their doctor's office with a diagnosis they came too while watching a fictional tv show...they are wrong. This is even more likely when the diagnosis is as incredibly rare as a pheochromocytoma. There are endocrinologists who go their entire career without seeing a SINGLE case of pheochromocytoma.

Turns out this woman was right and she did have this incredibly rare disease. Seriously, what are the chances?

Saturday, September 5, 2009

Hackers Guide to H1N1

I came across a guide to hacking influenza. It creates an impressive analogy comparing DNA to hard disk memory, RNA to RAM, and amino acids to pixels.

The guide discusses how to theoretically hack influenza, making the current strain of H1N1 substantially more dangerous. The post goes on to describe how influenza may well figure out how to perform the aforementioned hack on itself. However, I suspect that if that particular genetic modification made influenza more infectious, it would have already happened by now. If influenza was more infectious, it would infect more people (obviously!), and this would make it more evolutionarily fit because it would be passing on its genes at a higher rate. Thus, since we don't see the hack in the real world, it may be because that particular genetic change makes the influenza less infectious. This same phenomena is seen in HIV. HIV can become resistant to medication, which seems like a genetic advantage, but sometimes when medication is stopped, the HIV infection loses its resistance to the drugs. This is because the non-resistant HIV strain is more evolutionarily fit than the resistant strain and out-competes the resistant strain if it is not hampered by medication. (If this makes you want to stop your HIV meds...DON'T...Go talk to your doctor first!!!)

The guide describes how influenza is made up of genetic compartments and co-infection of a host by two strains of influenza can lead to the creation of novel influenza strains.
Consider what happens when a host is infected by two types of Influenza at the same time. If the genes were stored as a single piece of DNA, there would be little opportunity for the genes between the two types to shuffle. However, because Influenza stores its genes as 8 separate snippets, the snippets mix freely inside the infected cell, and are randomly shuffled into virus packets as they emerge. Thus, if you are unlucky enough to get two strains of flu at once, the result is a potentially novel strain of flu, as RNA strands are copied, mixed and picked out of the metaphorical hat and then packed into virus particles. This process is elegant in that the same mechanism allows for mixing of an arbitrary number of strains in a single host: if you can infect a cell with three or four types of influenza at once, the result is an even wilder variation of flu particles.
This mechanism for genetic variation leads to the most dangerous influenza outbreaks. Imagine two strains of influenza, strain A infects humans and pigs and strain B infects pigs only. Strain A is relatively harmless to humans because we have been exposed to it for a long time and our immune systems have learned how to fight it. Strain B is harmless to humans because it does not contain the required proteins to infect us. However, if a pig was infected by strain A and strain B and the strains shared genetic information, then a new strain, strain C, may be created sharing genetic components from both strain A and strain B. Strain C can be especially dangerous because it may have proteins from strain A that make it infectious to humans, but the proteins from strain B are completely unrecognized by the human immune system, meaning we have little immune defence against strain C. This is what happened with swine flu, avian flu, and the Spanish flu.

Another interesting point brought up in the guide is using influenza as a biological weapon. Theoretically a very scary and dangerous possibility. However, it would be ridiculously difficult to control a weapon like that. Influenza can rapidly spread across the globe, even when the entire world is prepared and trying to stop it. A "surprise attack" with influenza would probably be very difficult to contain and the attacker would be putting himself in grave danger too!