Got Flu?

13 12 2010

Dr. Mary Beth, PKIDs’ advice nurse, helps you get through nasty influenza.

Listen now!

Right-click here to download podcast (6mins/2.5mb)





Got a Cold?

29 11 2010

Dr. Mary Beth, PKIDs’ advice nurse, offers tips on relieving some of those cold symptoms!

Listen now!

Right-click here to download podcast (5.5 min/4mb)





Medicine: Modern v. Ancient

18 11 2010

As the number of Americans with no health insurance soars and more people use the emergency room as a primary care clinic, it is no wonder many Americans have the jitters about healthcare.

With all the news coverage and grim forecasts, it’s easy to forget that many aspects of modern medicine are dramatically superior to days of yore.

Take Arcagathus for example: the first doctor in Rome, he was widely admired until word got around that his use of knives and cautery was more likely to bury the patient than heal him.  Thereafter, he was known as the “Executioner.”

Nowadays, we can be grateful that physicians have to go to school and learn all sorts of ways not to harm a patient before they’re allowed near one.

Modern medicine may be expensive and over-prescribed, but as a rule it doesn’t contain heroin.

In the late 1800s, Bayer added heroin to their cough suppressant for kids, and boy did it work.  But after a few years, people noticed the hospitals were filling up with addicts.  They still weren’t coughing, but what a trade-off!  By the early 1900s, Bayer pulled the drug.

On the upside, and at about the same time, Bayer brought aspirin to us, and where would we be without it?

Reports from two centuries ago of experimental treatments by the surgeons of the Royal Navy provide additional perspective on today’s healthcare woes: One pneumonia patient had pints of blood removed in an effort to cure him—it was called bloodletting. He still managed to expire, confounding his surgeon.  Another Royal Navy favorite was “tepid salt water baths.” Surprisingly, there were never any survivors of this therapy.  One poor sod who fell overboard and nearly drowned had tobacco smoke blown on him as a cure.  He did survive, but ended up hospitalized for pneumonia.

In ancient Mesopotamiaa sorcerer would be called in to determine which god caused what illness in a patient. Having identified the god, the sorcerer would attempt to send it away with charms and spells.  We do not have accurate records as to the success rate of this treatment.

The Egyptians believed mightily in the practice of medicine and left copious notes on papyrus for following generations.  Dr. Bob Brier shared some of their cures in his book, Ancient Egyptian Magic. After reading a bit, our mood elevated, our perspective shifted, and we decided to just shut up and soldier on, happy with the modern medicine we have.

In case you’re curious about what was written on some of that papyrus, read on, but do not try this at home:

Cure for Indigestion

  • Crush a hog’s tooth and put it inside of four sugar cakes. Eat for four days.

Cure for Burns

  • Create a mixture of milk of a woman who has borne a male child, gum, and ram’s hair. While administering this mixture say:

Thy son Horus is burnt in the desert. Is there any water there? There is no water. I have water in my mouth and a Nile between my thighs. I have come to extinguish the fire.

Cure for Lesions of the Skin

  • After the scab has fallen off put on it: Scribe’s excrement. Mix in fresh milk and apply as a poultice.

Cure for Cataracts

  • Mix brain-of-tortoise with honey. Place on the eye and say:

There is a shouting in the southern sky in darkness, There is an uproar in the northern sky, The Hall of Pillars falls into the waters. The crew of the sun god bent their oars so that the heads at his side fall into the water, Who leads hither what he finds? I lead forth what I find. I lead forth your heads. I lift up your necks. I fasten what has been cut from you in its place. I lead you forth to drive away the god of Fevers and all possible deadly arts.

Modern healthcare certainly has its problems, but at least today’s patients are free of spells, tobacco smoke and bloodletting. Is that better than a 4-hour ER visit? You be the judge.





Lessons Learned from Botswana’s AIDS Fight

16 07 2010

In the early to mid-’90s, life expectancy in Botswana was 65 years. Ten years later, it was below 40 years of age due to the impact of AIDS. The children of Botswana were also affected by the pandemic. To date, nearly 100,000 children have lost at least one parent to AIDS

Faced with such losses in a country with a population under 2 million, and determined to save its people, the government took action and the Botswana-Harvard AIDS Institute Partnership (BHP), was founded.

The Institute provides training and research, and acts as point of contact for the efforts to reduce HIV/AIDS in Botswana. In 2001, simultaneous to the opening of a state-of-the-art lab funded by the Institute, the government launched the Masa (or “new dawn”) treatment program, buying antiretrovirals and making them widely available at no cost to infected citizens. The research capabilities of the BHP, along with Botswana’s HIV/ AIDS education, prevention, and treatment efforts, are unparalleled and show impressive results.

Key factors in Botswana’s fight against HIV/AIDS include:

  • International and national funding and research partnerships (represented by the Botswana-Harvard AIDS Institute)
  • Coordination of education efforts at the national level, and targeted to specific populations including school-age children, pregnant and new mothers, and high risk adult populations
  • Education outreach including targeted mobile outreach (involving peer-to-peer education and counseling)
  • Focus on enrolling mothers in the program to prevent mother-child transmission of the disease.

Stemming the tide of mother-to-child transmission of HIV is crucial in halting the spread of disease. In Botswana, peer-to-peer enrollment in the government-sponsored prevention and treatment program slowly increased maternal participation from under 10% to just over 33%.

Both the Masa and the Botswana-Harvard Institute aren’t easily replicated in countries without a similarly high level of financial and governmental support, but the lessons learned can still be applied.

Although it’s unlikely that most developing countries have the resources to accomplish what wealthy Botswana has done, it is a bit of bright news in the otherwise depressing struggle that is HIV/AIDS in Africa.





Placebo Effect

14 07 2010

The placebo effect. For some of a certain age, that phrase brings to mind the M*A*S*H TV show, where Col. Potter and his docs ran out of pain medication and ended up using sugar pills until their supply was replenished. It worked!

OK, it was pretend, but it also works in real life.  Sometimes.

Whether it’s called the “meaning response” or the good old “placebo effect,” we end up in the same place—a fake treatment potentially causing a real, positive result.

Dr. Harriet Hall wrote a piece featured in skeptic.com that compares various studies done over the years. In it, she indicates that the placebo effect is real for some.  Sometimes, the problem and the effect are self-reported, but not measurable using objective data. Other times, the results are measurable, suggesting there may be a  neurobiological response causing the positive result.

Some scientists, like Dr. Mark Crislip, do not believe there is a placebo effect.

The whole thing can be rather confusing.

As parents, we know that placebos or something like them work.  How many of us have given a small child a sip of sugar water or a piece of candy and promised it would make the pain go away?  And then it did.  Subjective?  You bet!

Some of us have children living with chronic diseases, and we employ subterfuge on occasion to get over the small bumps in that road—nothing claiming to cure, just a little something to ease the pain or discomfort.

Is it real?  Is it ethical?  We each have our opinions.  What do you think?

 





Access to ART? Good Luck.

4 06 2010

We know how to control HIV—we do it with antiretroviral therapy (ART). We’re so successful, an HIV infection is now a chronic condition rather than a death sentence . . . for some. For those with access to ART.

Before and after ART

But what about those without access? What about everybody else? As of the end of 2008, just 42 percent of those in lower- and middle-income countries were able to get these drugs.

Why is it so hard to provide this lifeline to those in need? A report put out in May 2010 by Médecins Sans Frontières (a.k.a. Doctors Without Borders), says it’s about the lack of infrastructure, particularly human resources, for the administration of treatment and care, including:

  • Inadequate salaries and poor working conditions, which lead to ‘brain drain,’ attrition, and an inability to attract new health workers
  • National policy barriers that block the possibility to shift tasks to lower level health staff
  • Lack of adequate national and international resources committed to address the health care worker crisis
  • Lack of donor funding for recurrent human resource costs, particularly salaries, due to concerns about “sustainability” and other constraints
  • Limits on spending from ministries of finance and international finance institutions, which can hinder governments’ ability to invest adequately in the health workforce

In addition to infrastructure, the AIDS charity AVERT suggests that barriers to universal access to treatment include:

  • A safe and sufficient supply chain of drugs
  • A life-long commitment on the part of patients to antiretroviral drugs (ARVs) and the ability of healthcare workers to help patients stick to the regimen
  • An awareness of the need for testing and treatment

This group goes on to explain that, “Focusing too heavily on treatment can also be problematic if it detracts too much from efforts to prevent new HIV infections, a scenario which would only add to the eventual treatment burden. Furthermore, unless treatment programmes focus on the vital tasks of monitoring and patient retention, many patients will eventually die from treatment failure.”

The real risk of reducing the work being done in prevention by focusing so much on treatment adds a troubling layer to the discussion.

So, there we are—the usual mountain of reasons why we can’t do what needs to be done. But, what’s a mountain? There are steps we as individuals can take to support universal access to ART:

  1. Press our politicians to stop backing off their commitment to help fund HIV/AIDS services in poorer countries.
  2. Find a reputable charity already in place and doing the work, then do a little fundraising of our own and give it to the charities doing the most good.
  3. Keep talking about these challenges, and if we haven’t been doing so, then start talking.  Silence isn’t an option, given the potential outcomes

Share





New HCV Drug: Will it work in humans?

18 12 2009

Recently, a new drug, SPC3649, was administered by IV to four HCV-infected chimpanzees over a period of twelve weeks.

Rather than targeting the actual virus, this drug targets a molecule that is found naturally in the liver. The hepatitis C virus uses this molecule to replicate and multiply. The SPC3649 drug attempts to inhibit the molecule to prevent replication of the virus.

In the chimpanzees, the hepatitis C viral load was dramatically reduced in those that received the highest dose. Additionally, the virus did not appear to develop any resistance to the SPC3649 drug.

Trials for SPC3649 in humans with healthy livers are currently in process. Trials for people with hepatitis C will likely start in 2010.

Share