May 30th, 2011 by Mark Crislip, M.D. in Health Tips
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It is hard to get infected. The immune system is robust and has a multitude of interlinking defenses that are extremely efficient in beating off most pathogens. Most of the time.
Fortunately, it is a minority of microbes that have evolved to be virulent in humans. Bacteremia is common with our own microbiome. When you brush or floss, bacteria leak into the blood stream:
We identified oral bacterial species in blood cultures following single-tooth extraction and tooth brushing. Sequence analysis of 16S rRNA genes identified 98 different bacterial species recovered from 151 bacteremic subjects. Of interest, 48 of the isolates represented 19 novel species of Prevotella, Fusobacterium, Streptococcus, Actinomyces, Capnocytophaga, Selenomonas, and Veillonella.
but with a good immune system, low virulence bacteria and no place to go, unfortunately the bacteria rarely cause infections.
Even heroin users rarely get infection. Heroin is a rich melange of bacteria and, on occasion, yeasts (I hate to say contaminated, since avoiding microbes is hardly a worry of heroin manufacturers), and the water used for injection is rarely sterile, yet infections are relatively rare despite the filth in which many heroin users exist.
I used to be somewhat fatalistic about hospital acquired infections. However, as the institutions in which I have worked have proven, almost all infections in the hospital are preventable if the institutions aggressively pursue high standards of care.
There are many systems in place in society to prevent infections: flush toilets, good nutrition, public health, vaccines, antibiotics, good hygiene, and an understanding of disease epidemiology, and I suspect people forget there are bugs out there that are pathogenic, just waiting to sicken and kill us. At least a couple of times a year I see patients come into the hospital, previously healthy, who rapidly die of acute infections. But for most people, most of the time, it takes a lot of effort to get an infection.
From my perspective we are Charlie Chaplain on skates , mostly unaware of the infections that awaits us if we do something silly, Read more »
*This blog post was originally published at Science-Based Medicine*
May 16th, 2011 by Mark Crislip, M.D. in Health Tips, Quackery Exposed
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I saw a patient recently for parasites.
I get a sinking feeling when I see that diagnosis on the schedule, as it rarely means a real parasite. The great Pacific NW is mostly parasite free, so either it is a traveler or someone with delusions of parasitism.
The latter comes in two forms: the classic form and Morgellons. Neither are likely to lead to a meaningful patient-doctor interaction, since it usually means conflict between my assessment of the problem and the patients assessment of the problem. There is rarely a middle ground upon which to meet. The most memorable case of delusions of parasitism I have seen was a patient who I saw in clinic who, while we talked, ate a raw garlic clove about every minute.
“Why the garlic?” I asked.
“To keep the parasites at bay,” he told me.
I asked him to describe the parasite. He told me they floated in the air, fell on his skin, and then burrowed in. Then he later plucked them out of his nose.
At this point he took out a large bottle that rattled as he shook it.
“I keep them in here,” he said as he screwed off the lid and dumped about 3 cups with of dried boogers on the exam table.
To my credit I neither screamed nor vomited, although for a year I could not eat garlic. It was during this time I was attacked by a vampire, and joined the ranks of the undead. Read more »
*This blog post was originally published at Science-Based Medicine*
May 10th, 2011 by admin in Health Tips, Research
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Calcium is good for us, right? Milk products are great sources of calcium, and we’re told to emphasize milk products in our diets. Don’t (or can’t) eat enough dairy? Calcium supplements are very popular, especially among women seeking to minimize their risk of osteoporosis. Osteoporosis prevention and treatment guidelines recommend calcium and vitamin D as an important measure in preserving bone density and reducing the risk of fractures. For those who don’t like dairy products, even products like orange juice and Vitamin Water are fortified with calcium. The general perception seemed to be that calcium consumption was a good thing – the more, the better. Until recently.
In a pattern similar to that I described with folic acid, there’s new safety signals from trials with calcium supplements that are raising concerns. Two studies published in the past two years suggest that calcium supplements are associated with a significantly increased risk of heart attacks. Could the risks of calcium supplements outweigh any benefits they offer? Read more »
*This blog post was originally published at Science-Based Medicine*
April 25th, 2011 by David Kroll, Ph.D. in News
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After spending the first 21 years of life in New Jersey and Philadelphia, I ventured to the University of Florida for graduate school. For those who don’t know, UF is in the north-central Florida city of Gainesville – culturally much more like idyllic south Georgia than flashy south Florida.
It was in Gainesville – “Hogtown” to some – that I first encountered the analgesic powder. I believe it was BC Powder, first manufactured just over 100 years ago within a stone’s throw of the Durham, NC, baseball park made famous by the movie, Bull Durham. I remember sitting with my grad school buddy from Kansas City watching this TV commercial with hardy men possessing strong Southern accents enthusiastically espousing the benefits of BC. I looked at Roger – a registered pharmacist – and asked, “what in the hell is an analgesic powder?”
What I learned is that powders of analgesic compounds were one of the individual trademark products of Southern pharmacies during the early 1900s. Many of these powders became quite popular with mill and textile workers needing to calm headaches induced by long hot days with loud machinery. The original powders contained a precursor to acetaminophen called phenacetin. However, phenacetin was found to cause renal papillary necrosis, such as in this 1964 case report in Annals of Internal Medicine.
Today, most of these powders are comprised of aspirin, acetaminophen, and caffeine. Read more »
*This blog post was originally published at Science-Based Medicine*
April 22nd, 2011 by admin in Health Policy, Opinion
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Despite the variety of health systems across hundreds of different countries, one feature is near-universal: We all depend on private industry to commercialize and market drug products. And because drugs are such an integral part of our health care system, that industry is generally heavily regulated. Yet despite this regulation, little is publicly known about drug development costs. But aggregate research and development (R&D) data are available, and the pharmaceutical industry spends billions per year.
A huge challenge facing consumers, insurers, and governments worldwide are the acquisition costs of drugs. On this point, the pharmaceutical industry makes a consistent argument: This is a risky business, and it costs a lot to bring a new drug to market. According to PhRMA, the U.S. pharmaceutical industry’s advocacy group, it cost $1.3 billion (in 2005 dollars) to bring a new drug to market. The industry argues that high acquisition costs are necessary to support the multi-year R&D investment, and considerable risks, in to meet the regulatory requirements demanded for new drugs.
But what goes into this $1.3 billion figure? Read more »
*This blog post was originally published at Science-Based Medicine*
