Medical


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Medicine is first and foremost a hard science. Laboratory research, measurable data, and the search for objective truths are what makes treatments actually work. Scientists experiment to develop drugs and other treatments that keep folks alive and well. Patients would not be able to trust their doctors and nurses if medicine were based on hunches and gut feelings. Doctors and nurses are scientists and technicians, and they need to get things right.  

 

There’s a problem, though. Medicine treats people. And people are complicated. When medicine ignores the human element, things go haywire. Patients get confused. They get hurt. They get angry. Doctors and nurses need to be able to communicate their messages effectively if patients are going to be able to take care of themselves.

Bridging Disciplines

Over the past two decades, a growing movement has been calling for the medical fields to take some hints from their dreamy distant relatives over in the humanities. This movement (which includes doctors like Atul Gawande and Rita Charon, as well as writers like Eula Biss and the late Susan Sontag) aims to improve patient care by focusing on the things medical professionals don’t always learn in school: empathy, clear writing, ethical literacy, and more. As hospitals become more and more automated, this need becomes even greater. Our increasingly digital health care already leaves patients feeling alienated, and medical professionals need to work hard to bridge that gap.

What’s in it for the Patient?

Does it seem far-fetched to suggest that surgeons brush up on their Shakespeare? You might be surprised. Physicians who study the arts in addition to science have better understanding of patient-centered care. These doctors can relate to their patients better and thus tailor their messages to suit the situation. Patients often need to complete complex self- care plans after they get out of the hospital; doctors who understand their patients’ points of view will be better equipped to communicate those plans in plain language. Patients who understand a doctor’s orders will obviously have an easier time following doctor’s orders.

 

One common approach to closing communication gaps is called “narrative medicine.” Narrative medicine attempts to teach medics how to “treat the whole person.” A patient suffering from a terminal, chronic disease is more than a bunch of data points on a chart; a patient is a human being going through an intense and confusing experience. According to narrative approaches to medicine, physicians who look beyond the test results in order to get a more complete picture of the patient will do a better job of educating and treating the patient.

What’s in it for the Medical Professionals?

So what exactly can fiction and pretty pictures do for a hard working doctor? In addition to improved patient care, medics can get a lot out of creative endeavors. Doctors report that writing and reading provide stress relief, greater closeness to their patients and coworkers, and profound philosophical understanding of their lives. Doctors and nurses have ethically complex and emotionally taxing careers; art and literature give them a powerful tool for exploring their personal issues in a safe environment. In short, the humanities can provide medics with that ever-elusive but essential thing: meaning.

   

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The Pitfalls of the Traditional Model

For years, Western medicine has taken an imprecise approach to new drugs: Test new drugs on as large a group as possible in a clinical trial, and if enough of those participants benefit, make the drug available to the general public. Sure, this wide-cast net may not help everyone, goes the theory, but with such large numbers, it’s bound to catch a fair number. Plus, it appears efficient, as it deals with thousands of patients with a single trial and a single drug. However, medical professionals are beginning to remark on the flaws in this system.

Even drugs that pass rigorous clinical trials may help surprisingly few patients: the top ten highest-grossing drugs in the US only help between 1/4 and 1/25 of the people who take them. These disappointing figures are exacerbated by the fact that clinical trials disproportionately enlist white participants, whose responses to given drugs are not necessarily identical to other ethnicities’ responses. Trials also tend to focus heavily on chemical analyses to the point of ignoring genetic and environmental factors that play an important role in medication.

Moving Towards Personalized Medicine

Perhaps, it’s time to explore a “precision” approach. Generally, this model means taking into account more factors that affect individuals’ responsiveness to drugs. It may even involve ultra-personalized, one-person studies. In these, the participant would test out a drug, and be tracked in a detailed way over a long period of time, with attention given to genetic and environmental factors. The story wouldn’t end with studying a single person; the results of all these trials together would be aggregated to yield information that is predictive for members of the wider population. By using patterns found in the aggregate data, doctors may be able to more accurately predict how well a treatment will work for a given subset of the population.

Of course, there are significant barriers to the use of one-person studies, chief among them cost. Tailoring trials to individuals tends to cost more than running a broad, one-size-fits all study. Nonetheless, this new model seems slowly to be gaining traction. In January 2015, President Obama announced that he would seek $215 million for the Precision Medicine Initiative, which proposes to use patients’ specific genetic and physiological characteristics to better treat them. Of this, the FDA would receive $10 million to build personalized-medicine databases and to examine its regulatory processes for personalized treatments. Following suit, this year the state of California also unveiled a $3 million precision-medicine project to investigate personalized treatments and diagnoses. As time goes on, we may see a real paradigm shift in how doctors study and treat patients, to understand them as unique individuals whose data points reveal truths about the wider population, rather than the other way around.

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The Warning Signs of Cancer

The Warning Signs of Cancer


Posted By on Mar 30, 2015

How to Recognize Early Symptoms

While it’s true that it isn’t always easy to detect cancer in its early stages, early diagnosis is a huge advantage in treatment. Therefore, it’s a good idea to inform yourself of cancer’s possible warning signs to help you look out for the health of yourself and your loved ones. The American Cancer Society provides a checklist of some general red flags to watch out for:

  • Change in bowel/bladder habits
  • Unexplained weight loss
  • Persistent fever or fatigue
  • Obvious changes in the shape/color/size of birthmarks, moles or sores, or general changes in one’s skin: itching, redness, etc.

This list is designed to reflect a variety of cancers. However, there’s no need to panic if you think you exhibit one of the signs, as none of these are anything like surefire. It’s also not a comprehensive list–you should also get checked if you display more specific indicators such as: lumps in the breast or testicle tissue, sores in your mouth that do not quickly heal, frequent nausea or headaches, or fluid in the lungs (this last could be a sign of mesothelioma). Since cancer can develop nearly anywhere in the body, its signs and symptoms are highly variable. If you have experienced one of these symptoms for two weeks or more, it’s better to be safe than sorry and see a doctor, as early detection can greatly improve one’s prognosis.

What You Need to Know About Screenings

Because of the advantages of early detection for many types of cancer, even if you have no symptoms, your doctor will likely want to perform several screenings. The most common screenings are:

  • Colonoscopies (colorectal cancer screenings). For people at average risk, these are recommended yearly between the ages of 50 and 75.
  • Mammograms (breast cancer screenings). These are recommended for women between the ages of 40 and 74.
  • Low-dose helical computed tomography (lung cancer screenings). Thesre are generally recommended only for smokers between the ages of 55 and 74.
  • Pap smears (cervical cancer and HPV screenings). These are recommended for all women aged 21-65.

Depending on your risk factors, your doctor may recommend others, such as blood tests, skin exams, and breast MRI’s. Depending on family history, some people may even benefit from genetic testing. However, more screenings are not necessarily better, and some actually have associated risks. Colonoscopies, for example, can cause tears in the lining of the colon. In addition, both false-positive and false-negative results are possible.

In some cases, the cancer never actually displays serious symptoms—the patient could have lived quite happily without the detection and subsequent treatment of the disease. Since there are many factors involved, your decisions about screenings should be tailored to your situation and made in consultation with your doctor. Remember that when your doctor suggests a screening, it is purely preventative; it does not mean you have cancer. If you take the proper, informed preventative steps, you increase your chances of living a long and healthy life.

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Telemedicine is the remote diagnosis and treatment of patients through telecommunications technology. According to a January 2015 article in Forbes, telemedicine’s time has finally come in 2015 for the following reasons:

  • Technology has matured enough that doctors can offer patients a good experience.
  • Telemedicine technology now includes asynchronous messaging, so doctors can better utilize their time.
  • There is a greater demand among patients for the convenience of telemedicine.
  • The 60+ age group, which is not adverse to technology and has more difficulty getting to the doctor than younger patients, is expected to fully embrace the convenience of telemedicine.
  • Telemedicine will save a great deal of money and increase the value of doctors’ time by reducing the amount of time spent with patients who do not need to be seen in the doctor’s office.
  • It can keep patients engaged with their primary health care providers and their care integrated with existing health care records.

However, not everyone agrees that telemedicine is a good thing. The Texas medical board, for example, issued an emergency ruling on January 16, 2015 requiring doctors to meet personally with their patients before prescribing medications, as reported in a February 12, 2015 article in the Texas Tribune. The Tribune reports that the medical board felt these emergency measures were necessary to protect public health.

Teladoc, one of largest telemedicine companies in Texas, obtained a temporary restraining order from a Travis County judge to prevent the ruling from going into effect four days after it was issued on the basis that there was no existing imminent danger to public safety, health, or welfare. The Tribune article quotes Tara Kepler, a telemedicine attorney, as saying that all medical boards across the nation are taking similar actions, and that Texas is just a little bolder.

According to the Tribune article, Dr. Russell Thomas, an osteopath, expressed the opinion that telemedicine services pose risks for patients, particularly when drugs are prescribed. He questioned the quality of service a physician would be able to provide sight unseen, with no relationship with the patient.

The Great Plains Telehealth Resource & Assistance Center (g pTRAC) argues that telemedicine is not meant to replace existing healthcare methods, but rather intended as a tool to complement them. According to g p TRAC, e-visits are not intended for new patients or for established patients with urgent medical conditions or conditions requiring a physical examination or with significant visible components, such as a rash.

Medicaid.gov describes telemedicine as “a cost effective alternative to the more traditional face-to-face way of providing medical care . . . that states can choose to cover under Medicaid. Within certain provider and facility guidelines, Medicaid allows states the option to determine whether or not to cover telemedicine, what types of telemedicine to cover, and where and how it is provided.

The consensus of opinion appears to be that telemedicine has a number of advantages, not the least of which is the convenience and the time and money it can save. However, the question remains whether or not virtual doctors can provide the standard of care that American patients are entitled to expect from their healthcare providers.

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Computed tomography (CT) scans can help doctors to avoid missing or delaying a diagnosis of cancer or other serious medical conditions. However, the exposure to ionizing radiation that these tests involve may, at the same time, increase a patient’s risk of developing cancer.

This why many doctors and organizations are calling for patients to learn more and discuss the risks and benefits of a CT scan with their doctor before they undergo one, as ABC News/Health.com recently reported.

According to the article, CT scans have become increasingly used by doctors to check a patient for cancer due to the fact that they are cheaper and faster than MRIs or exploratory surgery and provide more detail than traditional X-rays. Between 1980 and 2013, the number of CT scans performed each year in the U.S. soared from around 3 million to 76 million, the article states.

However, a patient undergoing a CT scan generally receives a high dose of ionizing radiation. While the body can repair damage caused by small doses of radiation, the high dosage in a CT scan is one that simply overwhelms the body’s “repair mechanisms,” potentially leading to cancer, the article states.

The cancer risk is higher if a patient undergoes multiple CT scans, and women may face a higher possibility of developing cancer from the radiation than men, according to ABC News/Health.com.

The report cites a 2009 National Cancer Institute study which found that 29,000 future cases of cancer could result from 72 million CT scans that were performed in the U.S. in 2007.

Cardiologists Call for Patient-Doctor Discussion About CT Scans

As Reuters reports, several medical organizations issued a statement in September2014 in the medical journal, Circulation, which urged doctors to carefully discuss the risks and benefits of chest CT scans with their patients and to explain to patients why a CT scan was being used in their case.

Ultimately, a patient and doctor must “share” the decision to go forward with the test, according to the statement, which was signed by organizations that included the American Heart Association and American College of Cardiology.

Dr. Andrew J Einstein of Columbia University in New York told Reuters that patients should not necessarily be “scared off” by the discussion or refuse undergoing what could be a potentially life-saving test.

Still, Einstein said, “As doctors, it is our obligation to make sure that we, our colleagues and our patients understand the potential benefits of a medical imaging study as well as potential risks,” according to Reuters.

Questions You Should Ask Your Doctor

If you are suffering symptoms of cancer or any other serious medical condition, your doctor may tell you that he or she would like to order a CT scan. Before you agree to undergo the test, ask your doctor:

  • What specific symptoms make the CT scan necessary?
  • Could alternatives such as X-rays, MRIs or ultrasounds be used instead, and how do those alternatives compare to a CT scan in terms of risks and benefits? You may also ask about how the alternatives compare in terms of cost and the amount of time involved to perform each one.
  • If a CT scan is needed, what is the typical dosage of radiation for such a scan and/or the actual dosage that will be used in this specific test?
  • Will there be additional CT scans? If so, how many more tests? What are the risks and benefits of multiple CT scans?

The bottom line is that you have the right, as a patient, to have as much information as possible about the tests your doctor orders you to undergo. Ultimately, if you find that the risks outweigh the benefits, you have a right to withhold consent and seek a second medical opinion.

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The idea that diet can maintain good health and fight disease is an old one. For centuries, physicians and parents alike have pushed certain foods to cure the body’s ills. Jewish mothers serve chicken soup to anyone with a cold, following the famous recommendation from the 12th century Hebrew physician Maimonides (who actually said it would cure asthma and leprosy). Chinese parents add ginger to their kids’ meals, and Mexican abuelas slip a little chili into the sopa.

When it comes to cancer and other serious illnesses, though, patients are cautioned about dietary claims that a certain food will cure or slow a disease. A visit with a nutritionist is a much better idea to ensure the diet is well-rounded and includes nutrients to strengthen weakened immune systems.

Derivative of a Popular Indian Spice May Slow Mesothelioma

But now, researchers in U.S. and German universities say curcumin, which comes from the spice turmeric, contains a peptide that slows the progression of mesothelioma. Asbestos exposure is the only known cause of mesothelioma. Mesothelioma attorney Joseph Belluck says that any medical breakthrough is important when it comes to cancer. Although we don’t have a cure for mesothelioma, we have new information studied by doctors, such as the study of turmeric.

Turmeric is used throughout Asia and is prominent in Indian food. At this point, though, evidence that consuming it will slow the disease is thin at best. But can it be restructured for this, perhaps in a future medication?

Mesothelioma and other cancers are often triggered by the protein and transcription factor STAT3, which sends messages to start and continue the cancer’s growth. PIAS3, a protein inhibitor, or peptide, is a very effective agent against STAT3. And, according to researchers, it is found in curcumin. “We must develop a curcumin analog that is absorbable by the human body,” Afshin Dowlati, MD, Professor of Medicine at Case Western Reserve University School of Medicine, Science Daily reports. “Currently, curcumin ingested as the spice turmeric has practically no absorption within the gut.”

High PIAS3 Tramples STAT3, Kills Mesothelioma Cells

Dowlati, who is the senior author of a report that will be published October 10 in Clinical Cancer Research, and colleagues at Georg-Speyer Haus in Frankfurt, Germany, looked at tissue samples from mesothelioma solid tumors removed from patients in different parts of the US. Each sample contained information about how long the patient lived with the disease and the type of mesothelioma.

Patients with low PIAS3 peptides had active STAT3 and were more likely to die sooner. But those with high PIAS3 levels were 44 percent more likely to live another year, “which is substantial,” Dowlati says in a Case Western press release.

The researchers conclude that curcumin and PIAS3 peptides raised PIAS3 levels, which lowered STAT3 activity and caused mesothelioma cells to die, a finding that can lead to clinical trials.

PIAS3 May Hold Clues to Mesothelioma Progression

The study also shows that PIAS3 may be a reliable indicator of mesothelioma progression. Mesothelioma tumors rarely progress the same way as other ones, making it hard to predict what twists and turns patients and physicians can anticipate.

 

“PIAS3 activation could become a therapeutic strategy,” Dowlati theorizes. “Our findings beg the question of what role [it] could play in limiting STAT3 activation in other cancers as well.”

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