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The Relationships Between Poverty and Healthcare

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Readers interested in the relationships between poverty and healthcare will want to read several new postings on the Web.

One is an article about my Rhoades Lecture at the Wayne County Medical Society in Detroit, “Poverty and Healthcare in America.” It is posted on the World Socialist Web Site.

Second is by James Marks, MD, MPH, Vice President of the Robert Wood Johnson Foundation, entitled “The Poor Feel Poorly.” It is posted on the Huffington Post site.

Third is “Health and Healthcare in America’s Poorest City,” a tragic and dramatic portrayal of America’s failures to its own in Detroit, also on the World Socialist Web Site.

Finally, here is a link to a collection of papers on social inequalities in health by the McArthur Network on SES and Health, published by the New York Academy of Medicine under the title, “Biology of Disadvantage.”

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

Sir James Black (1924-2010): The Father Of Analytical Pharmacology

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Sir James Black - David Levenson Rex Features.jpgHave you ever taken an over-the-counter heartburn relief remedy such as Tagamet, Zantac, or Pepcid? How about the beta-blocker atenolol (Tenormin) or metoprolol (Lopressor) for antihypertensive therapy, or the original less-selective beta-blocker propranolol (Inderal) for migraines, presentation anxiety, or stage fright?

If you answered “yes” to either question, you owe a debt of gratitude to Sir James Black, the Scottish physician who left us earlier this week at age 85. The best obituary I have seen memorializing Sir James comes from the UK Telegraph.

Black was called the father of analytical pharmacology and was said to have relieved more human suffering than thousands of doctors could have done in careers spent at the bedside. Certainly, no man on earth earned more for the international pharmaceutical industry. Read more »

*This blog post was originally published at Terra Sigillata*

Wireless Incontience Detection Device

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An Australian company called Simavita is releasing an incontinence detection device to be used in nursing homes across New South Wales. The SIMsystem uses a strip that detects liquid and a cellular device to send a note to a nursing station or a care provider.

From the product page:

The SIM™box, when fitted into the individual resident’s stretchpants (SIM™pants), transmits sensor readings from the SIM™strip in the SIMpad® over a wireless network to the SIM™server. The SIMsystem™ Manager software running on the SIM™server then detects key information about continence events and determines when to alert care staff about an event requiring attention.

Alerts are sent via text message to the carer’s mobile phone or via the facility’s paging system if preferred. As carers are often unable to immediately respond to events, the software will display a summary log of alerts and manual observations can also be entered. The final bladder chart includes all observations in one easy-to-read report. Read more »

*This blog post was originally published at Medgadget*

Topical Medications And Bathing: A Source Of Water Pollution

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I have written two posts in the past on proper disposal of unused medications, and I have always been mindful of the medicines as a source of environmental water pollution. This past week the American Chemical Society reminded (head-slapped me) that topical medications are a source of environmental water pollution from their active pharmaceutical ingredients (APIs). Yes, the simple act of bathing washes hormones, antibiotics, and other pharmaceuticals down the drain into the water supply.

Ilene Ruhoy, M.D., Ph.D. and colleague Christian Daughton, Ph.D. looked at potential alternative routes for the entry into the environment by way of bathing, showering, and laundering. These routes may be important for certain APIs found in medications that are applied topically to the skin — creams, lotions, ointments, gels, and skin patches. These APIs include steroids (such as cortisone and testosterone), acne medicine, antimicrobials, narcotics, and other substances. Read more »

*This blog post was originally published at Suture for a Living*

The “File Drawer” Effect: Failure To Publish Negative Studies

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A new study published in PLOS Biology looks at the potential magnitude and effect of publication bias in animal trials. Essentially, the authors conclude that there is a significant file drawer effect –- failure to publish negative studies -– with animal studies and this impacts the translation of animal research to human clinical trials.

SBM is greatly concerned with the technology of medical science. On one level, the methods of individual studies need to be closely analyzed for rigor and bias. But we also go to great pains to dispel the myth that individual studies can tell us much about the practice of medicine.

Reliable conclusions come from interpreting the literature as a whole, and not just individual studies. Further, the whole of the literature is greater than the sum of individual studies –- there are patterns and effects in the literature itself that need to be considered.

One big effect is the file drawer effect, or publication bias –- the tendency to publish positive studies more than negative studies. A study showing that a treatment works or has potential is often seen as doing more for the reputation of a journal and the careers of the scientists than negative studies. So studies with no measurable effect tend to languish unpublished. Read more »

*This blog post was originally published at Science-Based Medicine*

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