bookofjoe

BehindTheMedspeak: Why the internet is better than your doctor

Dr. Jerry Avorn, a professor of medicine at Harvard Medical School, wrote a very refreshing Op-Ed page piece that appeared in the September 16, 2006 New York Times.

Long story short: It's not very hard to know more about what's wrong with you than your doctor.

I knew Avorn was the real deal when he wrote, "I drove home and reached for three of the most useful medicines I know: aspirin, acetaminophen (Tylenol) and the Internet."

Here's his essay.

The Sting of Ignorance

Late on a summer afternoon not long ago, the water at Lucy Vincent Beach on Martha’s Vineyard was warm, and the toxic jellyfish that had plagued bathers weeks earlier had floated out to sea. Body-surfing in on my last wave, I suddenly felt as if someone had whacked my leg with a lead pipe studded with nails. On the 1-to-10 pain scale we use with patients, I would have called it a 14. When I rubbed the area with my hand, my whole palm stung. Apparently those toxic jellyfish hadn’t all left.

A crowd of passers-by gathered to offer tips from the tainted well of conventional wisdom. “Use ammonia.” “Rub in some meat tenderizer.” “Apply vinegar.”

Soon a small army of bronzed youths in official-looking tank tops arrived carrying enormous medical kits. One poured sterile water on the sting area; another rubbed it with an ice pack. A third worked an alcohol-based anesthetic into the wound. Each treatment made the pain worse.

Eventually our group attracted the attention of a nurse strolling down the beach. A year-round Vineyard resident, she had seen her share of vacation-related medical emergencies. “You’ve removed the tentacle, haven’t you?” she asked matter-of-factly. No one, including the medical-professor patient, had thought of this. She took a piece of gauze and pulled off a slimy, transparent string laced with neurotoxins. It had continued to send those toxins into my leg for the first 20 minutes of my care. They are particularly activated, I would later learn, by distilled water, by mechanical pressure (as from an ice pack), and by alcohol-based topical medicines — all the treatments I had so earnestly been given.

Now the pain began to abate. I drove home and reached for three of the most useful medicines I know: aspirin, acetaminophen (Tylenol) and the Internet. As the first two began to take effect, the third revealed a study published in February in The Medical Journal of Australia.

The clever Aussies (whose beaches are also infested by toxic jellyfish) had conducted a clinical trial that randomly assigned sting victims to application of hot water (to deactivate the poison) or icepacks. The trial was stopped halfway through because the hot-water group did so much better that it would have been unethical to continue. I didn’t discover this through any proprietary medical search engines. I used Google and Wikipedia, and it took about two minutes.

Coincidentally, much of my work is about defining which medications work best for which conditions, and how to close the gap between that knowledge and the care patients typically receive. My research group constantly comes across effective treatments that are underused, and poor-choice drugs that are widely prescribed. Even when good clinical trial data on a regimen or medicine exist, no coherent system ensures that the message gets out to doctors and patients. As a result, many treatment choices are driven by habit, old information or glitzy promotional campaigns.

My aquatic encounter was a small example of what millions of patients confront daily, in much more serious circumstances. The nation faces two yawning medical information gaps. First, we need more studies comparing treatments to each other, as that simple Australian trial did. Drug companies don’t usually do such tests, preferring to evaluate their new products by comparing them to placebos. (The drugs usually win.)

The National Institutes of Health, facing its first real-dollar budget cut in generations, isn’t likely to expand its mandate in this direction. But what about the insurers, private and governmental, who pay such a large share of the nation’s $220 billion annual drug bill? They could support such studies with the rounding error of their annual budgets — and then save billions if the findings were put into practice.

The second problem is that much of the knowledge we do have is not communicated to the people who need it. Drug companies are adept at barraging doctors and patients with slick messages touting their most expensive products — even if they are no better than older, more affordable standbys. Maybe if Merck held the patent on hot water, my well-intentioned beach squad would have known all about the Australian study. But that’s a poor way to ensure that patients receive the right care.

We need an unbiased, efficient system to get the word out to practitioners on what works best. My colleagues and I have done pro bono research aimed at developing such an approach. Because the drug industry is so adept at changing beliefs and practices, we’ve taken a few leaves from its book.

In a program financed by the Commonwealth of Pennsylvania, called the Independent Drug Information Service, we scan the medical literature for the best evidence on how to treat a given medical problem (like high cholesterol or arthritis), boil it down into user-friendly packets of information, and then send nurses and pharmacists out to doctors’ offices to recommend optimal treatments. The information we provide is unbiased and noncommercial, and we don’t offer free trips to golf resorts. The resulting savings from more cost-effective prescribing could more than cover the costs of programs like this.

The approach has been adopted in several Canadian provinces, and Australia runs a continent-sized program to update its primary care doctors (though I don’t know if it addresses jellyfish injuries). The government covers expenses, but scientific content is determined by nonprofit professional organizations. Their recommendations are transmitted in person by “outreach educators,” in concise newsletters, and electronically to doctors, health workers and patients.

If the Vineyard beach first responders had known of the latest research results, they wouldn’t have done everything they could to transfer toxin from the jellyfish tentacle to my leg. All of us need access to current, noncommercial medical information. Besides helping to contain our runaway medication expenditures, programs of this kind could prevent a lot of needless suffering — by patients and doctors alike.

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One thing that has confounded me ever since I was in medical school is how easily doctors — people whom you'd think would know better — are bamboozled into prescribing and using, not only for their patients but for themselves and their families, new drugs.

Motrin, Advil, Vioxx, Celebrex, the parade never ends.

They cost many times what the old stand-bys do and don't work as well, yet because of powerful advertising they somehow insinuate themselves into the medicine chest.

I've never taken anything but aspirin and/or Tylenol for the aches and pains of everyday life, nor do I believe anyone else should.

Here's my foolproof remedy for almost anything that hurts, be it a headache, sore muscles, joints, you name it:

Three (3) regular aspirin tablets and two (2) extra-strength (500 mg apiece) Tylenol.

Repeat every 3-4 hours as needed.

It's that cheap and easy.

Don't be fooled into believing newer is better — in this case, it's not even as good.

Trust me....

New York Times Front Page Birthday Puzzle

Were you born between January 1, 1888 and December 31, 2001?

You weren't?

Well, skip this post, then.

Everyone else, you might find it of interest.

From the website:

New York Times Personalized Puzzle

This custom jigsaw puzzle is created for you when you select any inclusive date from 1888 to 2001 from the front page of the New York Times.

Once you send your selected date to the manufacturer, a 400-piece jigsaw puzzle kit is created from quality 1.5mm millboard and delivered in a gift box that includes an area on the front for a personalized message.

Includes a full-sized paper facsimile copy of the selected front page.

The center piece of each puzzle is shaped to resemble an open newspaper and when completed, the puzzle reproduces the page to the approximate size of the original at 18-1/2" H x 12-1/4" W.

$49.95.

The Whitsun Weddings — by Philip Larkin

That Whitsun, I was late getting away:
Not till about
One-twenty on the sunlit Saturday
Did my three-quarters-empty train pull out,
All windows down, all cushions hot, all sense
Of being in a hurry gone. We ran
Behind the backs of houses, crossed a street
Of blinding windscreens, smelt the fish-dock; thence
The river's level drifting breadth began,
Where sky and Lincolnshire and water meet.

All afternoon, through the tall heat that slept
For miles inland,
A slow and stopping curve southwards we kept.
Wide farms went by, short-shadowed cattle, and
Canals with floatings of industrial froth;
A hothouse flashed uniquely: hedges dipped
And rose: and now and then a smell of grass
Displaced the reek of buttoned carriage-cloth
Until the next town, new and nondescript,
Approached with acres of dismantled cars.

At first, I didn't notice what a noise
The weddings made
Each station that we stopped at: sun destroys
The interest of what's happening in the shade,
And down the long cool platforms whoops and skirls
I took for porters larking with the mails,
And went on reading. Once we started, though,
We passed them, grinning and pomaded, girls
In parodies of fashion, heels and veils,
All posed irresolutely, watching us go,

As if out on the end of an event
Waving goodbye
To something that survived it. Struck, I leant
More promptly out next time, more curiously,
And saw it all again in different terms:
The fathers with broad belts under their suits
And seamy foreheads; mothers loud and fat;
An uncle shouting smut; and then the perms,
The nylon gloves and jewellery-substitutes,
The lemons, mauves, and olive-ochres that

Marked off the girls unreally from the rest.
Yes, from cafés
And banquet-halls up yards, and bunting-dressed
Coach-party annexes, the wedding-days
Were coming to an end. All down the line
Fresh couples climbed aboard: the rest stood round;
The last confetti and advice were thrown,
And, as we moved, each face seemed to define
Just what it saw departing: children frowned
At something dull; fathers had never known

Success so huge and wholly farcical;
The women shared
The secret like a happy funeral;
While girls, gripping their handbags tighter, stared
At a religious wounding. Free at last,
And loaded with the sum of all they saw,
We hurried towards London, shuffling gouts of steam.
Now fields were building-plots, and poplars cast
Long shadows over major roads, and for
Some fifty minutes, that in time would seem

Just long enough to settle hats and say
I nearly died,
A dozen marriages got under way.
They watched the landscape, sitting side by side
—An Odeon went past, a cooling tower, And
someone running up to bowl — and none
Thought of the others they would never meet
Or how their lives would all contain this hour.
I thought of London spread out in the sun,
Its postal districts packed like squares of wheat:

There we were aimed. And as we raced across
Bright knots of rail
Past standing Pullmans, walls of blackened moss
Came close, and it was nearly done, this frail
Travelling coincidence; and what it held
stood ready to be loosed with all the power
That being changed can give. We slowed again,
And as the tightened brakes took hold, there swelled
A sense of falling, like an arrow-shower
Sent out of sight, somewhere becoming rain.

LEDLight.com — The Forrest Gump 'Shrimp is the fruit of the sea' of light-emitting diodes

Shrimp this, shrimp that, all those shrimp dishes lovingly recounted.

Now comes this website to pull it all together.

Watch Ferran Adriá cook

The master (above), proprietor of El Bulli Restaurant in Roses, Spain and considered by many the greatest chef in the world, will lead "ten of the most prominent chefs from Spain, including Juan Mari Arzak and Martin Berasategui," in demonstrations of their wizardry next month in New York City.

The occasion: The French Culinary Institute is celebrating the opening of its new home, The International Culinary Center, with a festival entitled "Spain's 10: Cocina de Vanguardia," from Thursday, October 12 through Saturday, October 14.

Saturday's your big day if you so choose.

From the website:

The Summit — All-Day Event at Guastavino’s

This is the kind of event that is the stuff of culinary lore! The Summit—modeled after the prestigious Madrid Fusión conference—will showcase the awe-inspiring talents of Spain’s most lauded chefs. Your hosts will be leading American speaker, consultant, and writer on Spanish wine, Gerry Dawes, along with esteemed culinary journalist Anya von Bremzen, and influential Spanish chef, José Andrés. For one amazing day of gastronomic excellence, the ten most prominent Spanish chefs, Ferran Adrià, Juan Mari Arzak, Martin Berasategui, Alberto Chicote, Quique Dacosta, Daniel García, Enrique Martinez, Joan Roca, Paco Roncero, and Paco Torreblanca will demonstrate what makes these chefs the true vanguards of the culinary world.

Be one of the lucky food enthusiasts, travel devotees, and industry professionals who attend this unforgettable event, where you will be immersed in all things Spanish. Witness cutting-edge cooking as you’ve never before seen it, partake in delectable (and unique) food samplings, enjoy an amazing tapas lunch, learn about and taste Spanish wines and indulge in a marketplace made up of selected food and wine products from approximately 40 Spanish producers.

Don’t let this opportunity get away! Seats are limited. Tickets are $300 for a full day, including continental breakfast, demonstrations by 10 Spanish chefs, a tapas lunch, and marketplace sampling.

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Guastavino's is at 409 East 59th Street (between 1st Avenue and York).

Tickets here.

Oh, yeah, one last thing: don't forget to bring your copy of Adriá's cookbook (below)

so he can sign it.

Smitten Kittens Sweatshirt

My inner child tells me that I would have loved to have one of these when I was little.

From the website:

Smitten Kittens Sweatshirt

Just the cutest sweatshirt I've seen in many a day.

Those good-looking red mittens at the waist are actually cozy pockets.

And the rest of the design takes you back to your childhood rhymes ("These little kittens, won't lose their mittens ...").

In youth sizes (sizes run small): XS (2-4); Small (6-8); Medium (10-12); Large (14-16).

$22.99.

Librarians' Internet Index — 'Websites you can trust'

Res ipsa loquitur.

Zaha Hadid Red Aqua Table

Launched this past weekend as part of the London Design Festival.

It's a special limited edition of 39 to help the Red campaign, which raises funds to combat AIDS and HIV in Africa.

Each is signed by Hadid and U2 frontman Bono, Red's founder.

£20,000 (€29,700; $38,000) from Established & Sons.

Cheap, relatively: consider that a prototype of Hadid's table sold at auction for $296,000 and the original edition of 12 (one of which is pictured below)

was priced at $78,000 apiece when it came out last year.