July 12th, 2007 by Dr. Val Jones in News
5 Comments »
The New England Journal of Medicine published a letter to the editor about a man who was struck by lightning while wearing his iPod. He was jogging home in a thunderstorm, listening to some energy-boosting music when -whammo- the poor Canadian man got more than he bargained for on the energy front. A nearby tree was struck by a lightning bolt, and the side flash reached him, and followed the wiring to his ear buds. The electrical shock passed from one ear bud to the other, blowing out his ear drums and causing such a violent contraction of all his facial muscles that his jaw snapped under the tension.
So this begs the question: could this happen to you? Does carrying a cell phone or iPod put people at higher risk for being struck by lightning?
Well, because lightning strikes are exceedingly rare there are very few case reports in the literature about folks who have been struck while talking on their cell phone or carrying an electronic device. And best I can tell, this is the bottom line: carrying a cell phone or iPod does not increase your chance of being struck by lightning (there is not enough metal in those items to act as a lightning rod). The lightning is more likely to strike a nearby tree or tall object than it will a human. However – if you are struck (such as the man described above) any metal objects (even ions found in your sweat) that you are in contact with can influence the direction of the current. Normally, lightning passes over the skin externally, but if you are wet or have metal in your ears, it can direct the electricity internally, where it can do more damage.
So if you’re caught in a lightning storm, I’d consider keeping metal out of direct contact with your skin. But the chance of you being struck by lightning in your lifetime is almost one in a million, so I think there is little cause for general alarm. Or to use a bad pun: we can all lighten up about lightning risks.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 11th, 2007 by Dr. Val Jones in Medical Art
1 Comment »
Nikon’s 33rd Annual Small World Photomicrography
Competition is a must-see. The top 100 photos of microscopic life forms, cells, and chemicals are on display – and you can vote for your favorites. There will be a special “people’s choice” award based on your votes. These photos are truly awe inspiring and make you think about the amazing complexity of the invisible world all around us. Enjoy!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 9th, 2007 by Dr. Val Jones in Opinion
5 Comments »
One of my colleagues just forwarded me a NY Times article by Jerome Groopman. The article begins with the issue of inexperienced interns – how newly minted MDs begin clinical care for patients in July of each year, and how these rookies can make harmful mistakes.
He goes on to explain that doctors aren’t trained to think well about the diagnostic process (the thesis of his recent book) and that we’d all benefit from studying cognitive psychology.
Dr. Groopman makes some interesting points in this article, but I was most struck by his flippancy regarding the dangers of getting treatment in July. He simply says, “Today, most hospitals closely watch over interns.”
I personally think the issue is more sinister than that – there are many ways that an intern can make mistakes, without ordering a single test or procedure, and under the full scrutiny of red tape regulations and documentation practices.
When an intern fails to recognize a life threatening condition and chooses to do nothing, or to let the patient wait for an extended period of time before alerting his or her team to the issue, serious harm can befall that patient. And that harm is not caused by inexperienced procedural technique, or ordering the wrong medicine – it’s caused by doing nothing. This “doing nothing” is the most insidious of intern errors – and it is not remedied by any form of hospital quality improvement initiatives. It is the risk that a hospital takes by having inexperienced physicians in the position of first responders. Interns gather large amounts of information about patients and then create a summary report for their supervisors. The supervisors (more senior residents) don’t have time to fact check every single case, and must rely on the intern’s priority hierarchy for delivering care.
But many hours pass between the time an intern examines a patient and when a supervising physician checks back in with that patient. And within that period of time, many conditions can deteriorate substantially, resulting in the loss of precious intervention time.
Dr. Groopman describes an experience from his own life in which a surgical intern (in July) correctly diagnosed his son with an intussusception (twisted bowel) but then incorrectly determined that the baby could wait to go to the O.R. Of course, untreated intussusceptions are nearly always fatal, and each minute that passes without intervention can increase the risk of death.
And so, in my opinion, it is in fact more dangerous to be admitted to a teaching hospital in July, but not necessarily for the reasons that people assume (procedures performed by inexperienced physicians or drug errors – though those mistakes can be made as well). Rather, it is because interns don’t have the clinical experience to know how to prioritize their to-do lists or when to notify a superior about a patient’s health issue. Timing is critically important in quality care delivery – and that variable is not controlled by our current intern oversight system.
Now that I’ve completely terrified you – I will offer you a word of advice: designate a patient advocate for your loved one (or yourself) if you have to be in the hospital as an inpatient (especially in July). If you can, find someone who is knowledgeable about medicine – and who knows how to navigate the hospital system. A nurse, social worker, or physician are great choices. That person will help you ensure that concerns are prioritized appropriately when your intern doesn’t yet fully appreciate the dangers behind certain signs symptoms. If you have no advocate, then befriend staff members who are particularly caring and experienced. Be very nice to them – but don’t be afraid to insist on being examined by the intern’s supervisor if you really are concerned. Unfair as it may seem, sometimes the most vocal patients get the best care.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 9th, 2007 by Dr. Val Jones in News
1 Comment »
In a charming news article, the BBC reports that the British Sandwich Association is concerned about high salt levels in national fare. If you have high blood pressure, there is now new evidence that avoiding soup and potato chips will not be sufficient in curbing your salt intake. Yes, even the humble sandwich can be a good hiding place for sodium. But this article is even more whimsical than informative.
First of all, I think it’s terribly funny that the “British Sandwich Association” actually exists – and that its public health warnings are taken very seriously. Second, I think that the contents of common British sandwiches are somewhat disturbing: a “prawn mayonnaise” sandwich lacks a certain appeal in my mind. And the fact that this variety of sandwich was selected as a representative example of a typical sandwich is also amusing.
And finally, the website for the British Sandwich Association is hilarious. Check out part of their mission statement:
“To safeguard the integrity of the sandwich market by setting standards
for sandwich making, by encouraging excellence in sandwich making and
by encouraging the development of the industry in terms of skills,
innovation and overall market development.”
And the BBC includes this very astute quote from the organization’s director:
“Sandwiches involve the assembly of ingredients,” said Jim Winship, director of the organisation. “The fact is that the salt is already in the ingredients…”
Well, I think the take home message here is that if you have high blood pressure or are on a low salt diet, remember that sandwiches often contain very high sodium levels. The message between the lines is that the British are inherently funny and have bizarre taste in food.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 9th, 2007 by Dr. Val Jones in Quackery Exposed
1 Comment »
Norman Vincent Peale wrote a bestselling book in the 1950’s,
“The Power of Positive Thinking.” I read
it a few years ago and found it to be a tad simplistic but it had an undeniable point: a positive attitude is important in
life.
In my last post I described the dangers of magical thinking
– since it opens the door to pseudoscience-touting snake oil salesmen. But now we will turn our attention to
positive thinking – a favorable psychological condition.
There is no doubt that there is a mind-body connection that
affects health. “Type A personalities”
are known to engage in behaviors that increase the risk for heart attack;
anxiety and perceived stress can cause higher output of adrenaline and
cortisol, and in turn contribute to inflammation, atherosclerosis, heart
disease, sleep disturbances, and weight gain.
Depressed individuals (for example) are more likely to suffer from pain
syndromes, and may have impaired immune function.
Because our mind influences the health of our body, it is
physically therapeutic to focus attention on peace of mind as a preventive
health measure. And in so far as
techniques are developed to reduce stress, decrease mental anguish, and improve
psychological wellbeing – they are helpful in keeping the body in a healthier
state.
Now, the temptation is to
exaggerate the benefits of peace of mind – that one might be able to avoid
cancer (for example) with the right attitude, which is blatantly false. So this is where positive thinking and
magical thinking can be confused.
Magical thinking ascribes excessive value to a treatment, while positive
thinking understands the limitations of treatments and yet respects the reality
of the mind-body connection.
Let’s consider back pain, for example. A magical thinker would look for the “secret
cure” for their back pain, and turn over every stone – fully anticipating that he would discover a miracle solution that others don’t know
about. He would read books promising the
ultimate back treatment “that your doctor doesn’t want you to know about” and
would spend a great deal of money on treatments that have been
rumored to have some benefit in treating back pain (without any supporting evidence). The magical thinker is vulnerable to snake
oil, and would rather risk thousands of dollars on experimental treatments than
consider traditional modalities first.
A positive thinker, on the other hand, will realize that
back pain is difficult to treat, has variable causes, and responds to different
therapies based on an individual’s unique circumstances. A positive thinker would have a realistic
view of recovery, would accept the limitations of therapeutic options, but
would focus on his abilities rather than his disabilities and look for ways to
make the best of his current circumstances.
He would actively participate in physical activity, perhaps join a support
group, get good rest and engage in a healthy lifestyle while working towards a
brighter tomorrow one step at a time.
Definitions for clarity:
Snake oil is a treatment whose efficacy is knowingly exaggerated by those who wish to turn a profit on its sale. E.g. diet pills that will “miraculously correct morbid obesity in a matter of weeks.”
A placebo is a treatment that has no known plausible mechanism for a physical effect – but may affect the individual through the mind-body connection. E.g. a sugar pill that is substituted for a pain killer may cause a patient to experience his pain differently, though there is no active ingredient in the pill.
An untested treatment is neither snake oil nor a placebo but could be used as either under certain circumstances. It is simply a proposed intervention of unclear clinical significance. There are many of these currently undergoing scientific review, and it takes patience to analyze their potential efficacy and safety.
A magical thinker is a person who is willing to accept snake oil as a valid treatment option for his condition despite a vast preponderance of evidence to the contrary. Magical thinking is belief-based, rather than evidence-based. Many very good and reasonable people are tempted to adopt magical thinking under duress.
A positive thinker is a person who choses to look for the positives in all circumstances, and approaches health with a can-do attitude. Realistic and yet optimistic, the positive thinker will focus on abilities rather than disabilities – and reach out for support as needed to optimize his psychological well being.
All of this is simply to say that a positive attitude, peace of mind, stress reduction techniques and a healthy lifestyle are an important foundation for good health. Placebos are most relevant for influencing psychological well being or pain perception (obviously they’re not appropriate for treating infections, type 1 diabetes, and the like), and magical thinking and snake oil are dangerous hindrances to wellbeing. Stay positive and protect yourself from snake oil salesmen. Knowledge is power. There are voices of reason to guide you here at Revolution Health.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
