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Mice take one for the human team… again

Gone are the days of Beaver Cleaver – and apparently the days of Mickey & Minnie mouse are numbered as well.

In this new study, humans give LSD to the little rodents:

“Of course, we don’t know what the mice experience when they are treated with these drugs,” Sealfon said. “But we do know that there is a head twitch response in the mice that provides a good correlation with drugs that are known to be hallucinogenic in humans.”

So um… why are we doing this?

The Onion spoofed animal research very nicely, picturing an obesity study lab rat nestled among snickers bars and M&Ms.

And in another recent study, we gave mad cow disease to our furry friends:

“As expected… at 9 weeks of age they developed sponginess in the brain tissue, all the mice developed behavior and memory problems, for example they stopped burrowing.”

Hey, I have an idea for a new study – let’s see what mice infected with mad cow disease do if we also give them LSD?

I feel a bit sad for the tiny critters, don’t you?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Wrong diagnosis: physician instinct may harm or help?

A member of our editorial team kindly brought me some blog fodder last week – a recent article from the New Yorker. It was an inflammatory piece, describing four types of errors that doctors make in diagnosing patients:

  1. Representativeness error – when a physician fails to consider diagnoses that contradict their mental templates of a disease. E.g. thin, fit, young male with chest pain – unlikely to have heart attack, but did have one.
  2. Availability error – the tendency to judge the likelihood of an event by the ease with which relevant examples come to mind. E.g. a patient coming to the ER in the middle of a flu epidemic, with flu-like symptoms was diagnosed with flu but actually had aspirin poisoning.
  3. Confirmation bias – confirming what one expects to find by selectively accepting or ignoring information. E.g. “sub-clinical pneumonia” diagnosis given even though lungs are clear.
  4. Affective error – the tendency to make decisions based on what physicians wish were true. E.g. nice young patient has mild fever – physician presumes it’s a typical post-op fever rather than early sepsis.

Although these biases (I wouldn’t really call them “errors”) are indeed real, I thought the author went a little too far, finishing his article with a scathing quote from a Canadian physician:

“The implicit assumption in medicine is that we know how to think. But we don’t.”

Ouch.

I have mixed feelings about this – for as many examples they can think of that demonstrate how physicians got the wrong diagnosis, I can also think of examples of physicians getting the right diagnosis against all odds.

Consider the middle aged woman who came to the ER with a headache – one sharp physician had a “gut feeling” that this headache was not typical, and resisted the protocol to do a head CT to rule out a sub-arachnoid hemorrhage and send her home. Instead he got blood tests that revealed the underlying diagnosis: advanced leukemia. Her blood was so thick with dividing leukemia cells that it was causing her to have a headache. She underwent immediate dialysis and survived what could have killed her.

Or what about the man who complained of chronic sinusitis? Instead of giving him an antibiotic with outpatient follow up, one physician took a detailed history and realized that this man had been having sinus pain since a recent fall from a ladder (while using a nail gun) at a construction site. The doc got a head X-ray and found a nail lodged in his sinus! During the fall the nail gun had shot a nail into the corner of his eye, leaving no entrance wound. Because of the jarring nature of the fall, the man didn’t even realize he had been shot. The man had an ENT surgeon remove the nail, and she also cleaned out what could have become a life threatening abscess.

The truth is that doctors (like anyone else) are vulnerable to making false assumptions about people – and that we would all benefit from using a software program that would automatically generate a large differential diagnosis to consider each time we see a patient (just to keep other possibilities in the forefront of our minds). However, if you ask patients if they’d rather be treated by a machine or a human being – I’m sure the majority would choose the latter. I think we can all agree that instinct and judgment still have value in this information age. The trick is to marry accurate information with good instincts without ordering every single test in the book to rule out rare diagnoses on everyone! That’s a tough balance to achieve.

Do you know of any examples of a physician making an unexpected diagnosis based on gut instincts?  I’d love to hear about it.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Does good research get buried?

We had a problem in our pregnancy forum today – there were so many forum posts submitted so quickly that people didn’t get the chance to answer a post before it was buried underneath an avalanche of other questions. This left the people asking the questions quite frustrated.

A few hours later I was peer reviewing an article for the AJNR. I did a Medline search as part of a background check for my review. I found 30 pages of research articles. I was reading through their titles when, glazing over on page 28, I realized that a very similar study had already been conducted… in 1979.

It suddenly occurred to me that good questions (and good answers) can be buried by time. They say that history is doomed to repeat itself… the Internet is beginning to help me understand why that’s so.

What do you think?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The secret to long life and good health

My dad is 76 years old. He takes one baby aspirin a day and has no medical conditions. He looks about 10 years younger than his age, and his mind is sharp and clear. How does he do it?

I think the secret is the time he spent working on a farm. At age 40 he retired from his consulting firm in Manhattan and bought some land in rural Canada. Without realizing what he was getting himself into, my dad bought some cattle to work the farm. When winter came he had to keep the animals in the barn, and he soon discovered that each steer and cow produced its own weight in manure every 2 weeks (that’s about a half ton for those of you city slickers out there). So all winter long my dad shoveled manure. He did this for 35 years.

My dad now keeps fit with regular sit ups and push ups in the morning and long walks every day. But to me, the secret to his success was the shoveling. Life is full of little ironies – sometimes “crappy work” can result in amazing health benefits.

Although the New York Times wrote a fairly scathing review of my mom’s book about their adventures in shoveling (which ultimately led to a yogurt business) – I think my dad got the last laugh.  Healthy and well, he can look forward to a long and enjoyable retirement.  I wonder if the folks in Manhattan (who choose to spend their lives shoveling a less physically challenging BS) can say the same?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Sleep your way thin?

Yes my friends, I’m afraid it’s true… lack of sleep can pack on the pounds! In 2004 a couple of researchers were analyzing the NHANES database, and noticed that sleep deprivation was an independent risk factor for obesity. Since that observation, more studies have confirmed that sleep debt is associated with weight gain. It’s not completely clear how this works – but one writer summarizes:

“Sleep causes changes in the brain, leading to abnormal secretion of hormones which can result in several body disturbances that include excessive daytime sleepiness, mood changes such as depression or anxiety, altered hunger and eating patterns, and ultimately further sleep disturbances. It’s a vicious cycle!… Throw out the diet bars, and fluff up the pillows.”

I bet my sleep expert colleague, Dr. Steve Poceta, has some further thoughts on this. Let’s ask him!

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Unaccountable: A Book About The Underbelly Of Hospital Care

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