Medical headlines that make you go WTF

Harber found the risk of the Female Athlete Triad -- three separate but interrelated conditions of disordered eating, amenorrhea and osteoporosis -- is another area that urgently needs attention for young female athletes.

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Do flame retardants reduce fertility?

A number of animal studies have found that PBDEs can impair neurodevelopment, reduce thyroid hormones, and alter levels of sex hormones.

Personally, I suspect a lot of fertility/sexual/metabolic syndrome problems are due to chemicals in the environment, so I wouldn't be surprised.

on the other hand, how bad is this "risk" versus the number of people (especially children) who didn't die when their clothing caught fire?

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And a disturbing report on the death murder of Ruben Navarro. I didn't see the NBC Dateline newsprogram, but NotDeadYet has questions:

important questions left hanging that will now never be answered:

• Rosa Navarro claimed that she was told that Ruben could only be on a ventilator for five days and then would be taken off; Who told her this?  Was it hospital policy?  No hospital representative in coverage has confirmed or denied this claim.
• What happened to the medical chart?
• Was Ruben Navarro really dying? 

The Neolithic Revolution, Bread, and gluten free twinkies

But eating wheat did have a downside: Some people had a genetic tendency to develop an “auto immune” problem when exposed to wheat gluten.

The CDC has a lot of ongoing studies trying to figure out the biological aspects of the disease, because like many “auto immune” problems, such diseases are seeming to be more common nowadays, and celiac disease overlaps other autoimmune diseases and symptoms.(In “autoimmune” diseases, your body’s immune system attacks your own tissues  and causes disease.)

In Celiac disease, Gluten seems to be the trigger, but why is the big question.

Once Gluten intolerance or Celiac disease, was considered as rare, and mainly diagnosed in children with “inability to thrive”; nowadays, doctors are recognizing that it has been under-diagnosed, and is seen in almost one percent of the American population.

Celiac disease involves an gene present in one third of the population that, given the right environment, can cause diarrhea.So maybe the question is not “why is Celiac disease so common?” but should be “Why is Celiac disease so rare?” And that is a big question.

Why, despite the fact that 30% to 40% of the population worldwide has the necessary HLA DQ2/DQ8 genes (ie, class II human leukocyte antigen HLA genes DQ2 or DQ8) and despite that virtually everyone is exposed to gluten, do only 1% of individuals develop celiac disease? Several studies presented at this year’s DDW meeting attempted to answer this question. Three of these studies advocated a third element, the loss of the intestinal barrier function, as an integral part of the problem.

Actually, that might overestimate the problem, since those genes are rare in Oriental Asians, where rice, which does not contain gluten, is consumed.

Yet recent reports suggest that with the increase of wheat consumption in the Asia Pacific region, and an increased awareness of the problem, more cases may be diagnosed in the future.

So if you investigate people with chronic diarrhea, even in Asia, doctors are now finding that many have intestinal changes of Celiac disease, and find relief by eliminating gluten from their diet.

Does this mean I stop eating wheat, or blame all my neurotic symptoms on bread?

No, but as a woman cursed with both a neurotic personality and a tendency toward food allergies, I suggest that if you have irritable bowel symptoms and other vague medical problems, you might want to try the diet. Don’t go overboard on this, but on the other hand recognize that a trial of diet might help.

Ironically, in a study of severe cases of celiac disease, the diet improved the diarrhea but not other “quality of life” symptoms.Is this related to the “autoimmune” problems not relalted to the gluten? Or is it related to other problems? One study puts it this way:

 Moreover, these data show that health-related quality of life in coeliac disease is impaired by poor compliance and by co-morbidity with irritable bowel syndrome-type symptoms.

In other words, if you don’t stick with your diet and like to blame something for all your problems, the diet won’t be a cure all..Luckily, for us docs, the majority of our patients stay on the diet and do well.

There are all sorts of sites on the internet that show you tricks on where to buy gluten free foods, or how to make foods without the gluten (and remember, it’s the gluten, not the wheat, that is the problem here). There are sites telling you where to buy gluten free beer, and find recipes to bake gluten free substitutes for your favorite foods.

Yes, you can even bake your very own gluten free twinkies. YUM.

Article links: Cellphones and Anthrax

Despite initial worries that it was terrorism, later reports assured the American people that it probably was not from a foreign source, but an inside job, since the strain of Anthrax was not a multi-resistant strain but an ordinary but virulent barnyard strain of Anthrax that was traced to an American bioweapons lab.

So first, they hounded Dr. Hatfill, until he sued to get them off his back. Then they hounded one Dr. Ivins, until he went paranoid from the pressure and killed himself with Tylenol with codeine.

Once Dr. Ivins killed himself, case closed.

Or is it?

Last week, esteemed political columnist Michael Barone noted:

Here’s some news I missed. Edward Jay Epstein reported on December 21 that the FBI’s anthrax case has fallen apart. … Epstein reports, it turns out that Dr. Ivins did not have access to the sophisticated form of anthrax used in September 2001.

Actually, this is not news: even in 2008, NYTimes reporters noted that even if Dr. Ivins had access to this strain of anthrax but not in the “aerosolized” form used in the letters, and that he lacked expertise in weaponizing the anthrax…

My point was that the "hard part" of making barnyard anthrax into a fatal powder required grinding skills and equipment to protect you from dying, both of which Dr. Ivins didn't have.

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As for cellphones and Alzheimer's disease:

Alzheimer’s disease is not caused by a loss of brain cells as much as it is caused by the build-up of amyloid (protein) and plaques, which then destroy the brain cells.

So, a scientist took some mice who were genetically prone to get Alzheimer’s like brain changes with cognitive changes, and exposed them to cellphone radiation.

The University of South Florida study showed that the electromagnetic waves erase brain deposits of the harmful protein beta-amyloid, which represents a hallmark of mentally crippling Alzheimer’s disease. The exposure also prevented build-up from the protein in younger Alzheimer’s mice — a possible lead on future non-invasive Alzheimer’s treatments for humans.

And then there is this:

Even the non-demented mice saw benefits from the exposure through increased blood flow and energy metabolism in the brain. That improved brain activity actually boosted the memory of the mice to above-normal levels.

So it is unclear why the experiment helped the mice (the scientists were not looking for that result).

Headline review

The chronic, intermittent condition also has been linked to genetic abnormalities, and Darwin's mother and uncle had symptoms of the illness, Dr. Hayman wrote.

Among 39 patients interviewed as of December 9, including some of the 19 case-patients enrolled in the case-control study, 14 knew the type of frog involved in their exposure, and all 14 identified the frog as an African dwarf frog (Figure 2). When asked about potential for Salmonella infection, 19 of 36 (53%) patients reported awareness of association between contact with reptiles and Salmonella infection, but only 11 of 36 (31%) reported awareness of association with amphibians.* Among 20 patients from whom the information was available, the frog's aquarium was cleaned in the kitchen sink in the homes of six persons (30%) and in the bathroom sink in the homes of seven others (35%).

I remember when a similar outbreak was found from pet turtles...I had one little girl patient quite sick from it...

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You can't treat people if you are dead

The actual headline at CNN says: Security concerns cause doctors to leave hospital, quake victims, but the URL says “haiti.abandoned.patients”.

From the story

Earthquake victims, writhing in pain and grasping at life, watched doctors and nurses walk away from a field hospital Friday night after a Belgian medical team evacuated the area, saying it was concerned about security.

The decision left CNN Chief Medical Correspondent Sanjay Gupta as the only doctor at the hospital to get the patients through the night.

Actually, if you read the rest 0f the story, you will discover that the doctors and nurses didn’t “walk away”: they were ordered out by their superiors, who were worried about roving gangs of thugs attacking the clinic/hospital, and that they would be killed for lack of enough security personnel.

The telling part of the story is this:

Sandra Pierre, a Haitian who has been helping at the makeshift hospital, said the medical staff took most of the supplies with them.

This is even more shocking: Because it means locals who are there won’t have medical supplies to use for their fellow Haitians.

CNN stressed that Dr. Gupta was there helping, and God bless him.

But could I put in a word for reality?

Been there, done that. Actually, done that, twice.

The dirty little secret about Haiti is that it has satanic gangs. Pat Robertson was “over the top” for blaming God for the earthquake, because the problem is not God but Satan. The dirty little secret is that politicians in Haiti used the “negative” side of African religion to control gangs so they could stay in power.

Like most religions, African traditional religion is about ceremonies to God and about living a moral life: but if you err, you get sick, so a nganga will hold a ceremony to placate the spirits to cure you; Most of African religion is positive, but like the “black mass” or the occult ceremonies of Himmler’s SS, ruthless people who seek power believe they can use negative “magic” to get power.

I’m old enough to remember the Duvaliers, Papa Doc and Baby Doc.

e. 1958 - After an unsuccessful attempt to overthrow him in June, Duvalier takes steps to consolidate his position…

With chief aide Clément Barbot, he organises the Volontaires de la Sécurité Nationale (Volunteers for National Security), or Tonton Macoutes (Bogeymen), a private militia estimated to number 9,000-15,000 that will be used to terrorise and murder opponents.

Recruits are drawn initially from the slums of Port-au-Prince. They receive no salary, relying instead on protection rackets and crime to support themselves. The Tonton Macoutes act as Duvalier’s front-line security force and as a balance to the political power of the armed forces.

Read the whole thing. From there things go downhill. But you get the idea. Duvalier not only recruited local thugs and gangs to intimidate and kill those who opposed him, but he used the beliefs in witchcraft to keep ordinary people in fear of him and his gangs.

Fast forward to a Haiti that is seeking to reestablish decent governance, with the help of UN Peacekeepers, a multinational group that includes almost a hundred from the Philippines. From a NYTimes article from 2007.

PORT-AU-PRINCE, Haiti, Feb. 5 — For years, street gangs have run Haiti right alongside the politicians. With a disbanded army and a corrupted wreck of a police force, successive presidents have either used the gangs against political rivals or just bought them off… “We’re taking back Port-au-Prince centimeter by centimeter,” said Lt. Col. Abdesslam Elamarti, a peacekeeper from Morocco. “We’re pressing these gangs so the population can live in peace.”

Since the gangs are locals, and often connected with the powerful who run the neighborhoods, and who are able to fight back not only with weapons but with human shields whose deaths can be used to manipulate NGO’s and the press when “innocent civilians” are hurt, you can see the problem that they face. Peacekeeping has not been an easy job, but the result has been to maintain some semblence of peace in that poor country…until the earthquake hit, and destroyed the housing of the peacekeepers and UN staff, and killing some of them.

So the Philippine Inquirer reports that our soldiers with American troops are trying to rescue some trapped in the rubble of the hotel that housed the UN and a nearby supermarket, while other peacekeepers are patroling to keep them safe from “looters”.

But there are “looters” (i.e. desperate people who may hit you with a stick if you stop them from getting food for their starving family) and there are “LOOTERS” (well armed gangs with automatic weapons who are used to stealing and killing without being punished, and who see the chaos as an opportunity to take high priced items to make them rich).

A few armed guards will stop the first; against the second, it takes soldiers who know how to shoot, and a place of safety for civilians so they don’t get caught in the crossfire.

So why would such looters hurt those in a clinic? Well, lots of stuff there to steal…first of all, there are drugs, including narcotics, at such field hospitals. There are electric fans, scissors, and medical equipment that can be stolen and “sold back” at high prices to hospitals and clinics that desperately need them. And then there are lower priced items that can easily be sold on the black market, from hospital gowns to blankets to cots and furniture. Such gangs will steal everything not tied down, and not care if it can be used. And if you are in the way, you can be killed or worse (and if the gangs are high on drugs, heaven help you if they decide to kill you just for fun).

When I say “been there, don that”, the reason is that I worked in two different African countries, and in both of them, I was sent home when anarchy erupted, but before the hospitals were attacked. But I know others who stayed, and were killed by such looters or robbers.

A dead physician can’t treat patients, and leaving medical supplies to be looted by thugs only endangers the patients who are unable to evacuate the hospital, because it means more looters will be attracted to steal, and if nothing is there, they will take their anger out on the people.

So God bless Dr. Gupta,who has a history of taking off his reporter’s cap and putting on his surgery cap to save lives when he was reporting in Iraq.

But one wonders what CNN is thinking. These thugs don’t respect a CNN badge, and unless they came with their own well trained bodyguards, putting him in danger isn’t helping people, it’s endangering one of their employees to get a headline.

So maybe General Honore comment to CNN was taken out of context:

“I find this astonishing these doctors left,” he said. “People are scared of the poor.”

Uh, no. They aren’t afraid of the poor.

They are afraid of the well armed and dangerous gangs that run the slums and terrorize the neighborhoods, and who are ruthless enough to kill physicians and nurses without pity.

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