August 21st, 2009 by Medgadget in Better Health Network, News
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The individual in the photo is not displaying his newly acquired gold tooth bling, but rather something more precious: the first fully functioning 3D organ derived from stem cells, described in PNAS as “a successful fully functioning tooth replacement in an adult mouse achieved through the transplantation of bioengineered tooth germ into the alveolar bone in the lost tooth region.”
More from The Wall Street Journal:
Researchers used stem cells to grow a replacement tooth for an adult mouse, the first time scientists have developed a fully functioning three-dimensional organ replacement, according to a report in the Proceedings of the National Academy of Sciences. The researchers at the Tokyo University of Science created a set of cells that contained genetic instructions to build a tooth, and then implanted this “tooth germ” into the mouse’s empty tooth socket. The tooth grew out of the socket and through the gums, as a natural tooth would. Once the engineered tooth matured, after 11 weeks, it had a similar shape, hardness and response to pain or stress as a natural tooth, and worked equally well for chewing. The researchers suggested that using similar techniques in humans could restore function to patients with organ failure.
Press release from the Tokyo University of Science (in Japanese)…
Full story in WSJ: From Stem Cells to Tooth In the Mouth of a Mouse…
Takashi Tsuji Lab…
*This blog post was originally published at Medgadget*
August 21st, 2009 by Bongi in Better Health Network, True Stories
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Surgeons are not stand back kind of people. They fall more comfortably into the category of charge in where angels fear to tread. I think the work tends to preferentially attract those type of people. But sometimes standing back can be the lesser of two very evil evils.
The call was a standard weekend consultation. The patient had hematemesis and his doctor was worried. Nothing I hadn’t seen many times before. But when he came in the patient’s wife had a few more details to spice the story up a bit.
Just about a year ago he had had a resection of his stomach for cancer. The surgeon had told his wife they couldn’t get all the cancer out because it was growing into some big blood vessels behind the stomach. For some reason they both decided not to tell him this. So when he was referred for his chemotherapy (something that could not be described as awe-inspiringly effective in stomach cancer) he truly thought he was well on his way to full recovery. and now he lay before me, pale and restless.
He was a shadow of what he once must have been. His skin hung loosely as if in remembrance of the large man it once covered. I was not happy with the mass I clearly felt just under his left rib margin. The cancer was back and it seemed angry. I got the necessary drips running and ordered blood. I considered dropping to my knees but due to a back injury when I was still a student I wasn’t sure I’d be able to get up onto my feet again.
The wife called me aside and told me the patient was not aware of the fact that the operation was not a roaring success and therefore that he was essentially living on borrowed time (which I grimly thought he is about to pay back with interest).
“You need to tell him.” I said.
“No!! Doctor!! I can’t do that.” She needed the truth.
“This man, your husband may die here in this hospital within a day or two. you need to speak to him.” But she would hear none of it. She also didn’t want me to tell him things were not so rose coloured (I suppose depending on what colour roses you’re talking about of course).
The next day the patient was feeling much better. Amazing what a bit of blood will do. We chatted a bit. You know, shared a moment. He even laughed at how bad he had felt the previous day in comparison to today. Then it was back to business. In this case business meant I was going to take a long, not so thin pipe and stick it down his throat to take a quick look at the source of the bleeding in his stomach. I sort of lied to myself, telling myself that maybe I’d see something that could be fixed with a knife. In truth I knew what I would see. The palpable mass and the history dispelled almost all my doubt (or hope). But I knew I needed to look. I needed to know for sure how much or how little I would be able to do for him. Maybe I needed evidence for one day after it all when I am called to account.
The cancer was a large fungating mass with a deep necrotic core. It was gently oozing blood but I could see it was capable of so much more. It seemed to me it had stopped its torrent of blood long enough to give me a glimpse as if to taunt me. As if to say you know me and you know you have no power here. It was right.
After the procedure the patient once again started spewing forth blood. I sat with him for quite some time. between his retching we spoke.
“This is not good, doctor.”
“I know.” What more was there to say?
“What are we going to do?”
“We are going to hope the bleeding stops.” What more was there to do?
Then I went against the wishes of his wife. I told him this cancer was going to be the end of him. He looked at me with a calmness and a gentle smile.
“I know.”
He probably had known for some time but I think he felt he had to go along with the charade and maintain the lie with his wife. He seemed relieved that the truth was out. He seemed to relax.
That night the sister called me to tell me he was bleeding massively. I explained the situation and asked her to push blood IV. If that didn’t help, nothing that I could do would. The next morning he was dead.
Somehow when we sit behind our computers and in our nice expensive offices deciding about the futility of certain treatments and who should get what based on cost or whatever, the actual point is lost. The nice old man finally vanquished by the hideous monster called cancer or the old lady with heart disease or whatever who is forced to succumb to the dark inevitable is the point. It is the person, the individual. the one like me. and maybe like you.
I was just left with a sense of how difficult it is to stand back and let someone die when you know what that means. It, I assume, is much easier for the powers that be, snug in their artificial real worlds.
*This blog post was originally published at other things amanzi*
August 20th, 2009 by BarbaraFicarraRN in Better Health Network, Health Tips
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A Guest Blog by Kevin Soden, MD
I ran into an old friend this past week and, as all of us over 60 do, we began talking about our health and the various ailments afflicting us as we age.
He shared with me that he was currently dealing with a bad case of the “shingles” (known as Herpes Zoster in medical circles) at age 65 and how terribly painful they were. He said that he wouldn’t wish them on his worst enemy.
As many of you may know because you’ve suffered a similar problem, shingles is caused by the Varicella Zoster virus, the same virus that causes chickenpox.
Only someone who has had a case of chickenpox – or gotten chickenpox vaccine – can get shingles. The virus stays in your body and it can reappear many years later to cause a case of shingles.
Always being the doctor, I asked my friend whether or not he’d gotten the vaccine to help reduce his risk of getting shingles.
He acted shocked and was quite angry as he explained that he’d never been told by his doctor about that there was a vaccine available that might prevent shingles.
The vaccine available for adults 60 and over to prevent shingles is called Zostavax. In clinical trials, the vaccine prevented shingles in about half of people 60 years of age and older. Even if you do get shingles after being vaccinated, it may help reduce the pain associated with shingles but it cannot be used to treat shingles once you have it.
I’m really not pushing the Zostavax vaccine because it’s not recommended for everyone but rather am reminding everyone that prevention is much better than treating after someone has a disease.
Talk to your doctor at your yearly visit to see what preventive steps you should be taking.
Check the CDC website for more information about vaccines that might be right for you especially if you are traveling to other countries.
Frankly, if your doctor is not talking to you about preventing disease, then it just might be time to find another doctor.
About Kevin Soden, MD
Dr. Kevin Soden has been a medical journalist for over 20 years appearing on CBS, NBC and most recently on NBC’s Today Show. He now serves as the host for Healthline, the national award-winning daily medical television show seen on the Retirement Living Network. He also serves as the worldwide Medical Director for Texas Instruments and Cardinal Health and teaches as a courtesy Professor at the Univ. of Florida College of Medicine.
His awards include 3 Telly’s, the 2008 CableFax award for best cable health show, the 2008 and 2001 National Award for Excellence in Medical Reporting from the National Association of Medical Communicators, a finalist for the International Freddie Awards in 2001, and as the Executive Producer for Rush of the Palms received the 2003 International Film Critics award for short films.
Kevin published The Art of Medicine: What Every Doctor and Patient Should Know…a critically acclaimed book focusing on improving doctor-patient communications. He is also the primary author of a consumer medical book Special Treatment: How to Get the High-Quality Care Your Doctor Gets. He is also a contributing author to the recently published A Practical Approach to Occupational and Environmental Medicine and to Physician Leaders: Who, How and Why Now? He has just finished his third book Think Like a Man: Male Behaviors that Can Help Woman Lighten the Load, Loosen Up and Find Happiness in a Stress-Filled World. He also is a regular contributor to numerous popular magazines.
Soden graduated with honors from the University of Florida College of Medicine and is one of the original inductees into the UF Medical Wall of Fame. He also has a Masters in Public Health from the Medical College of Wisconsin and a Masters in Personnel Administration from Florida State University.
*This blog post was originally published at Health in 30*
August 20th, 2009 by EvanFalchukJD in Better Health Network, Health Policy, Opinion
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As I’ve blogged about before (here, here, here and here), a big reason reform is going so badly is this: Reformers don’t understand how people react when you try to make changes to their health benefits.
Companies across America have been making changes to health benefits for years.
Reformers seem to have ignored the lessons of their experience.
Take one of the hottest trends in benefits – evidence-based plan design.
These are plans that offer better coverage if care is done based on evidence-based guidelines. It’s similar to the “comparative effectiveness” ideas that are so important to some of the reform proposals.
The National Business Group on Health published a study of challenges companies face implementing these plans. The study tried to understand how employees feel about these kinds of changes to their benefits.
Here are three of the major findings.
1. Most employees believe that more care is better care. Employees tend to view the idea that sometimes less care is the right care as “both unfamiliar and counter-intuitive.” Quality care is viewed as “trying as many things as possible, including new or alternative treatments.” In other words, you get what you pay for, and efforts to pay less are interpreted as efforts to give less.
2. Employees are suspicious of their employer’s motives. Employees tend to assume that their employer just wants to save money, and doesn’t really care about the quality of care they get. They suspect that moving to an evidence-based plan design is really just the first step toward more severe restrictions on choice and access.
3. Employees worry that employers are overstepping their bounds. Employees report worries that their employer wants to influence treatment decisions. They feel strongly that those decisions should be made by them and their doctor.
Reformers made a big mistake by focusing so intently on health care cost savings as the “single most important fiscal issue we face as a country.” It’s almost as if they decided to pick a way to promote reform that would create the most resistance.
Spend less on health care? That was almost certain to be understood as meaning you want to deny me or my loved ones the care we deserve. A panel of government experts deciding what treatments are effective? Who are they to tell me and my doctor what’s right? And don’t you dare tell me the reason you want to do all this is to make sure I get the best care.
Reformers have stumbled into a trap of their own making. Based on the continuing effort to demonize those who raise objections, they still don’t see it.
This is why reform is going so badly.
*This blog post was originally published at See First Blog*
August 20th, 2009 by Steve Novella, M.D. in Better Health Network, Quackery Exposed
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It is my contention that terms such as “complementary and alternative medicine” and “integrative medicine” exist for two primary purposes. The first is marketing – they are an attempt at rebranding methods that do not meet the usual standards of unqualified “medicine”. The second is a very deliberate and often calculating attempt at creating a double standard.
We already have a standard of care within medicine, and although its application is imperfect its principles are clear – the best available scientific evidence should be used to determine that medical interventions meet a minimum standard of safety and effectiveness. Regulations have largely (although also imperfectly) reflected that principle, as have academia, publishing standards, professional organizations, licensing boards, and product regulation.
With the creation of the new brand of medicine (CAM and integrative) came the opportunity to change the rules of science and medicine to create an alternative standard, one tailor made for those modalities that do not meet existing scientific and even ethical standards for medicine. This manifests in many ways – the NCCAM was created so that these modalities would have an alternate standard for garnering federal dollars for research. Many states now have “health care freedom laws” which create a separate standard of care (actually an elimination of the standard of care) for self-proclaimed “alternative” practices.
But perhaps the most insidious and damaging double-standard that is being advocated under the banner of CAM is a separate standard of scientific research itself. The normal rules of research that have evolved over the last few centuries are being subtly altered or discarded, with clever newspeak. It is a way for proponents to choose their evidence, rather than having the evidence decide what works and what does not work. We saw this strategy at play with the recent acupuncture study for back pain that clearly showed acupuncture was no more effective than placebo acupuncture. Proponents (propagated by an uncritical media) turned scientific logic on its head by interpreting this result as indicating that placebo acupuncture must work also (if only we could figure out how, they unconvincingly mused).
We see this strategy at work also with the use of so-called “pragmatic” studies – a rebranding of “unblinded” studies. This is a way to choose their evidence – in this case, poorly controlled unblinded studies that are more likely to reflect the bias of the researchers and therefore give them a result that they like. This is their reaction to well-designed placebo controlled trials that show their preferred modality does not work.
Another strategy is to change the meaning of the concept of placebo effects. This one was ready-made, and most people grossly misunderstand the nature of “the” placebo effect. One of my first articles for SBM was about the placebo effect because this concept is so criticial to science-based medicine. To summarize – the placebo effect is really many effects. It is everything other than a physiological response to the treatment. It is not all a real effect of mind-over-matter – it includes every bias and artifact of observation as well. It includes things like subjects reporting they feel better to the researcher because they want the treatment to work and they want to please the authority figure, who also wants the treatment to work and may be encouraging the perception of benefit.
It is most important to understand how the term “placebo effect” is used in the context of a controlled clinical trial. Scientific methodology is about controlling variables – because we want to know which variables work and which ones do not. In any clinical scenario there are a multitude of variables that may affect the outcome or the perception of the outcome. Therefore a well-designed study maximally controls all the variables – ideally so that the one variable of interest (the treatment) is completely isolated. This is accomplished in a number of ways. One method is randomization – randomly assigning subjects to the various treatment and placebo arms of a clinical trial. Randomization combined with sufficiently large trial size (number of subjects) results in all variables not specifically controlled for averaging out among the various arms. Another way to look at is that randomization prevents systematic biases in who gets treated and who gets a placebo from affecting the results.
Another method of controlling variables is the double-blind placebo control. Ideally one group of subjects will receive the treatment being studied while another group will receive a treatment that is identical in every way except that it is inert (i.e. it controls for all possible variables and isolated the one variable of interest – the treatment). Both the subject and the examiner are blinded to which is which to control for psychological effects. In order to conclude that the treatment “works” those subject receiving the active treatment must do statistically significantly better than those receiving the placebo. If the activity of the treatment was the only variable, then we can confidently conclude it was responsible for the improvement.
I know this is all very basic, but it is these very basic concepts that are being challenged by proponents of so-called CAM. They are trying to say the the effect measured in the placebo arm of such studies is a real effect, something valuable and alone is sufficient to justify the treatment. This philosophy has been termed by critics “placebo medicine” and is just the latest attempt at creating a double standard. But the claim is utterly ignorant of the scientific nature of the placebo effect. It is a method of controlling for biases, artifacts, and variables (known and unknown) – it is not a real effect.
There may be some non-specific therapeutic effects mixed into placebo effects. For example, people who are being studied tend to take better care of themselves and are more compliant with treatments (because they are being watched). They may also feel better as a result of the positive attention from a health care provider – old-fashioned good bedside manner. These are some of the variables being controlled for. But it is scientifically absurd to argue that they justify an ineffective treatment. But that is exactly what CAM proponents are doing.
The latest manifestation of this strategy is a report put out in the UK by The Kings Fund – a health policy charity. They put together a committee to examine how the UK can find evidence to support CAM therapies. They are not interested in figuring out “if” such treatments work, but rather how they can show “that” they work. They report:
Explaining the need for different types of research when assessing complementary practice, Professor Dame Carol Black said: ‘It has become widely accepted that a stronger evidence base is needed if we are to reach a better understanding of complementary practices and ensure greater confidence in their clinical and cost effectiveness. The challenge is to develop methods of research that allow us to assess the value of an approach that seeks to integrate the physical intervention, the personal context in which it is given, and non-specific effects that together comprise a particular therapy.’
Got that? We need new kinds of research (read “double standard”) in order to demonstrate the value of these special CAM practices. The reason that we need to find new ways to demonstrate their value is because they fail under the accepted scientific methods. The last sentence is just a fancy way of saying that placebo effects should count as real effects.
It further says:
‘As long as findings from research can provide confidence in the positive effect of the physical intervention at the heart of the treatment, then any added benefit brought by the therapeutic relationship and the context for treatment should count as part of the treatment effect,’ the report says.
‘For complementary therapies such a holistic approach to effectiveness should be adopted by bodies such as NICE, when comparing cost-effectiveness across a range of treatments.’
The “physical intervention at the heart of the treatment” is functionally the same thing as – non-specific placebo effects. They want to take a “holistic” approach to evidence (another useful marketing brand), meaning they get to decide what the evidence means. George Orwell would be proud.
As usual, Edzard Ernst (the go to expert for the media) gets it exactly right. He is quoted as saying:
‘This is the introduction of double standards through the back door.’
‘In this case we might as well allow an ineffective medication on the market, because it too will have a placebo effect.’
That latter point is a favorite of mine as well. Whenever CAM proponents try to change the rules of science to suit their needs, I invite my r
*This blog post was originally published at Science-Based Medicine*
