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August 3, 2009

Blast from the past — BehindTheMedspeak: Why the internet is better than your doctor

Doctor_8

Even truer now than when originally posted on September 25, 2006; it follows.

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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.

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    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.

Youu

Trust me....

August 3, 2009 at 04:01 PM | Permalink | Comments (3) | TrackBack

In the Forest — Ring by Ornella Iannuzzi

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Dry mushrooms, petrified wood and bark with moss set in sandblasted silver.

35 x 35 x 40 mm.

£800 to order.

August 3, 2009 at 03:01 PM | Permalink | Comments (0) | TrackBack

Spandex e-x-p-a-n-d-s

Impress everyone next time you're at a party by asking, "What's the origin of the word 'Spandex?'"

According to Patricia Marx, writing in the August 3, 2009 issue of the The New Yorker, "Spandex, an anagram of 'expands,' was invented in 1959 by scientists at DuPont as a rubber substitute. (The company trademarked it as Lycra)."

Now, don't you feel smarter than before you read this?

I know I do.

But then, there's an awful lot of upside around here....

August 3, 2009 at 02:01 PM | Permalink | Comments (0) | TrackBack

What is it?

Qqqqqq

Answer here this time tomorrow.

Alien - Welcome to Tennessee

If we're still in the hood....

August 3, 2009 at 01:01 PM | Permalink | Comments (3) | TrackBack

Blast from the past: The Pointer Sisters at their best, in an early 70s studio rehearsal

Concur.

August 3, 2009 at 12:01 PM | Permalink | Comments (3) | TrackBack

Retro Radio-Controlled VW Camper Van

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Wrote Jonathan Margolis in his "technopolis" column in the August 1, 2009 Financial Times "How To Spend It" magazine, "For this month's mandatory dose of daftness, I finally diverge from the photographic to a piece of glorious tat which is still as summer-holiday-flavoured as it gets. The remote-controlled VW Camper Van is as useless a piece of entertaining rubbish as it's possible to imagine, but managed to amuse me from the moment I saw it. I know, I know, it will not be winning the Nobel Prize for Gadgetry any time soon. It's enduringly kitsch, with sticker depicting view of 1960s smelly-socks alternativeness on the windows.

"Yet such sloppy gadgetry somehow adds to the gimmick's hippie-esque charm. A perfect gift, both in this holiday season and in the run up to — eek! — Christmas for anyone (and almost any ex-Earls Court Aussie of a certain vintage) who enjoys regaling you with tales of the Summer of Love and their adventures touring Europe on 3p a day in a beat-up Volkwagen van."

£19.95.

August 3, 2009 at 11:01 AM | Permalink | Comments (0) | TrackBack

The Neglected Books Page — 'Where forgotten books are remembered'

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Res ipsa loquitur.

August 3, 2009 at 10:01 AM | Permalink | Comments (0) | TrackBack

Nasal Cones

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From the website:

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Nasal Cones

Breathe easier and snore less.

Everyone in the house will sleep better.

These Nasal Cones are a simple but effective idea.

They are comfortable (no sticky tape) — and reusable.

Finally — a good night’s sleep for the person who snores and for everyone else in the house.

You’ll be amazed by how much more air you’re getting when you put these soft cones in place.

They open nasal airways instantly and, unlike sticky nose tape, they’re comfortable and reusable.

To ensure a custom fit, you get two pairs — one large and one small: trim to fit.

Virtually invisible, they stay put all night.

Wash and reuse hundreds of times.

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455656

$9.95.

August 3, 2009 at 09:01 AM | Permalink | Comments (2) | TrackBack

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