February 22nd, 2007 by Dr. Val Jones in News
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Recent research suggested that circumcision may reduce the rate of HIV transmission by 50% (foreskin cells are particularly vulnerable to infection with the virus). In response to this news, adult men in Uganda and Kenya have been undergoing the procedure in the hope of reducing their risk of HIV infection.
Some young boys in Kenya were actually expelled from school for not being circumcised. Their parents were asked to bring them back to school once the deed was done.
HIV rates have decreased in Uganda from 15% to 5% after aggressive public health initiatives raised awareness of the importance of safe sexual practices. This is an incredibly positive achievement.
One would hope, however, that circumcision in infancy would become the preferred target age for future procedures.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 21st, 2007 by Dr. Val Jones in News
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Malaria is caused by a crafty little parasite that has become resistant to many medicines. But now researchers at Northwestern University have discovered a chink in its armor – a blood pressure medicine called propranolol. Who knew that a common beta-blocker used to treat hypertension might provide the death blow to such a scourge?
Usually, malarial parasites infect their host’s blood stream through a mosquito bite, and then congregate in the liver and pounce on red blood cells as they pass by. They have a way of adhering to the red blood cells via certain surface receptors (beta 2 adrenergic receptors linked to Gs proteins). They latch on to the red cells and then burrow into the cell and hijack it in order to reproduce inside it. Then, like the horror movie Alien, once they’re fully grown (into “schizonts”) they burst out of the cells and roam free to repeat the process all over again.
Now propranolol happens to block the Gs proteins, which effectively makes it impossible for the parasites to attach themselves to the red blood cells (which they need to use to reproduce themselves).
So what’s the caveat to of all this? Well, folks don’t know they have been infected with malaria until they have symptoms, and the symptoms include high fevers and low blood pressure… so giving someone a medicine that lowers their blood pressure even further might not be a good idea.
The other caveat is that propranolol works like a charm in the test tube, and in mice, but we haven’t yet tried it out in humans who have malaria.
Still, it seems to me that a little bit of propranolol might go a long way to preventing malarial infections in at risk populations. I’ll be interested to see what further studies show!
And if you’re interested, I’ll create a few more blog posts about parasites and other creepy crawly human invaders… Just let me know if you can handle more of this!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 21st, 2007 by Dr. Val Jones in News
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I really couldn’t help but feel saddened by three recent news stories about the continued attitudes that are so harmful to women. If these media reports are right, Japan’s leadership appears to be way off target, referring to women as baby machines and refusing to apologize for enslaving and raping ~200K women in World War II.
America has a more insidious version of sexism that can harm young minds – exposing children repeatedly to age-inappropriate sexually explicit images and ideas. As we expand our understanding of neuronal plasticity, it is becoming more and more clear that what we see and experience can imprint itself on our brains and literally change the way we think and feel. We spend a lot of time worrying about what we put in our bodies (e.g. avoiding trans fats, food chemicals, etc.) I wonder if we should think a little bit more critically about what we let into our minds?
Here’s what I’m talking about:
Japanese health minister says women are “birth-giving machines”
In a report in which the health minister explained how dangerous the low birth rate is for Japan’s economic future, he suggested that women are a rate limiting factor. There are only so many “birth-giving machines… and all we can ask is for them to do their best.”
There has been an outcry in Japan against the health minister though it’s unclear if he’ll resign.
Japan refuses to apologize for crimes against women
Japan admits its army forced women to be sex slaves during World War II but has rejected compensation claims.
Historians believe at least 200,000 young women captured during World War II were forced to serve in Japanese army brothels.
A large number of the victims – who were known as comfort women – were Korean, but they also included Chinese, Philippine and Indonesian women.
The media’s portrayal of young women as sex objects harms girls’ mental and physical health, US experts warn.
Magazines, television, video games and music videos all have a detrimental effect, a task force from the American Psychological Association reported.
Sexualisation can lead to a lack of confidence with their bodies as well as depression and eating disorders.
For more information on kids and sexualization, see Dr. Stryer’s recent blog post.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 20th, 2007 by Dr. Val Jones in News
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In a recent article in the New York Times the process of sperm banking was described in a fairly whimsical way, but the real bizarreness of the business could be found between the lines. Apparently sperm banks compete with one another as they go to all kinds of lengths to tout the quality of their donors:
“It’s kind of an arms race,” explains William Jaeger, director of Fairfax Cryobank, in Fairfax, Va., which, along with California Cryobank, based in Los Angeles, is among the largest sperm banks in the country.
“One year someone adds a personality profile, the next year someone adds something else,” Mr. Jaeger says. “If one of your competitors adds a service, you add a service.”
Certain donor profiles are particularly popular, making it difficult for the supplier to keep up with the demand.
The most-requested donor is of Colombian-Italian and Spanish ancestry, is “very attractive, with hazel eyes and dark hair,” and, Ms. Bader adds, is “pursuing a Ph.D.”
The bank’s files have one man, Donor 1913, who fits that description.
Donor 1913, the staff notes in his file, is “extremely attractive,” adding in a kind of clinical swoon, “He has a strong modelesque jaw line and sparkling hazel eyes. When he smiles, it makes you want to smile as well.”
Donor 1913 is an all-around nice guy, they say. “He has a shy, boyish charm,” the staff reports, “genuine, outgoing and adventurous.”
He also answers questions, including, “What is the funniest thing that ever happened to you?”
Donor 1913 relates an incident that occurred when he asked his girlfriend’s mother to step on his stomach to demonstrate his strong abdominal muscles.
“As she stepped on top of my stomach, I passed gas,” he writes.
Is Don Juan the gas-passer also the most popular donor at Fairfax Cryobank?
The sperm banks say that they only accept 1-3% of donors, but the criteria that I could glean from the article seemed to be:
- You’re not overweight
- You’re tall (unless you’re a doctor or a lawyer, then you can be as short as 5’7” to 5’8”)
- You’ve got a college degree
- You have high SAT scores
- You are good looking
- You have healthy sperm
Apparently, the most requested sperm donor in one of the California banks is a tall man who was in college at the time of his donations, but who later dropped out and took up residence in a mobile home park and made a living walking other people’s dogs.
So, who were the other 97% who didn’t make the cut?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 18th, 2007 by Dr. Val Jones in Opinion
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In a happy coincidence, my favorite blog fodder feeder sent me a link to an article about Kaiser Permanente’s electronic medical record woes a day prior to Dr. Feld’s latest post on the subject of EMRs. Dr. Feld’s thoughts on the matter will certainly help to round out this discussion.
I’ve always been fascinated by technologies that are ahead of the curve. I blame this on my parents (take note – parents can be blamed for good things). Growing up in rural Canada our family was ahead of the tech curve – we had a satellite dish before there was scrambling, we had the very first Apple computers at home, and we built our own yogurt factory complete with an advanced digitally automated temperature gauge system, before the rest of the industry had moved beyond millimeters of mercury.
In college I was the first kid with a laptop in class, and in med school I was one of the first with a PDA. I took a portable printer with me to Europe in the late 80’s to go along with my Wordstar word processing program. I thought I was pretty cool, I guess! Stirrup pants, granny boots, permed hair and pink lip gloss. Those were the days.
Cliff Bassett recently asked me why I was working at a new company (Revolution Health) that was so cutting edge rather than remaining in clinical practice. I had never thought about why I did it before – but now I see that it was part of my pioneering pattern. There’s nothing more fun than being ahead of the curve… but it can be aggravating as well.
Technologies are awkward for their first adopters – they aren’t streamlined, they can actually take more time rather than saving it, and they can make communications with others (who don’t use it yet) more difficult. But a few of us do it anyway – we jump in head first, believing by faith that the enterprise itself is worthwhile and that once we get to version 3.0 we’ll be sitting pretty.
But what do we do when we’re at version 1.0? Normally, we just tear our hair out and send lots of “bug alert” messages to developers. But when the technology affects someone’s health, the bugs are a lot more sinister. The recent article about Kaiser Permanente’s digital growing pains is disturbing indeed:
Kaiser Permanente’s $4-billion effort to computerize the medical records of its 8.6 million members has encountered repeated technical problems, leading to potentially dangerous incidents such as patients listed in the wrong beds, according to Kaiser documents and current and former employees… Other problems have included malfunctioning bedside scanners meant to ensure that patients receive the correct medication, according to Kaiser staff.
Still, 90% of physicians use paper records, making it difficult to share information – and this is no doubt contributing to the IOM’s estimated 98,000 error related deaths/year. Dr. Feld explains the complexity of a fully functional electronic medical record:
However, a paperless chart is in reality worth little unless the information entered is usable in a relational data base format rather than word processing format. Only then, can patient care be enhanced…An effective Electronic Health Record must consist of five components
Electronic Medical Records
Personal health records (PHR)
Continuity of Care Record (CCR)
Electronic health record (EHR)
Financial Management Record (read more…)
So, the bottom line is that the EMR is in version 1.0 at Kaiser Permanente, and only a twinkle in our government’s eye. It is complicated to create, nearly impossible to coordinate, dangerous if implemented half-way, and yet utterly necessary for ultimate cost savings and patient safety.
What can we do between version 1.0 and 3.0? Prayer and vigilance come to mind… it will be up to the foot soldiers (the docs, nurses, and hospital staff) to keep patients safe while juggling paper and digital until digital can fly on its own.
How do you think we can minimize our digital growing pains?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
