INTERESTING TIMES

Here's the article and poll in the BMJ: http://www.bmj.com/content/351/bmj.h3735
( Thoughts )

The Oregon Association of Naturopathic Physicians is one of the best state associations for my profession. Ever since the ACA was passed they've been working to force insurance companies to cover ND primary care in the same way that they cover MD primary care. I'm happy to hear that they're going after this particular company. If a licensed ND provides basic medical care in a competent fashion, that care should be covered just the same.

I do have mixed feelings about the ACA and negative feelings about insurance in general. I wish that we had a different system.

Link to press release: http://c.ymcdn.com/sites/www.oanp.org/resource/resmgr/Docs/Lawsuit_Press_Release_FINAL_.pdf

You can’t escape that much of what we do in medicine doesn’t make patients better. We work in a system that is driven by perverse incentives: we get paid more for doing more to patients. It’s got to stop.
--Dr Steve Nissen

A historical overview of bacteriophage therapy
as an alternative to antibiotics
for the treatment of bacterial pathogens.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916379/

What is Phage (bacteriophage) therapy:
http://www.phagetherapycenter.com/pii/PatientServlet?command=static_phagetherapy&secnavpos=1&language=0

Bacteriophage Therapy at the Phage Therapy Center
in Tbilisi, Republic of Georgia
http://www.phagetherapycenter.com/pii/PatientServlet?command=static_home

We went to the Mission last night to hear about Viruses from Hell, and it turns out the speaker was a PhD professor who is into viruses that come from acidic hotsprings. He looks a lot like my friend Gordon who is also a brilliant academic--something about that jutting forehead must allow for extra brains. Ken Stedman is a professor at Portland State University who has made a career of viruses. His research has mostly involved examining the genomes of extremophile viruses and comparing them. It was faintly interesting to me--genetics is interesting, and yet I am so homocentric. I really want to know about bacteriophage therapy for healing horrible infections. I want to hear about the evolution of the flu. But his research wasn't about this and his talk was about the questions that will ensure that he gets grants and funding in the future. I couldn't help but to think of the right wing perspective that academics are parasites on society and perform no useful function other than keeping themselves in priuses. There is truth it that, though it is also true that there is nothing more important for our future than to keep investigating our world and what is in it. Scientists have specialized training that makes it possible for them to think of things that I don't have words or concepts for. There is so much more of the world to know about. I am learning this narrow fraction that is medicine, and it is more than I can ever take in. Within that sea I must pick a drop.

Circling back to VIRUSES, I did bring home a few interesting factoids. I call things factoids until they've been demonstrated beyond the shade of MY doubt. He defines viruses in several ways but my favorite was "a capsid encoding organism", also known as a phage. He told us that the major reservoir of viruses on the planet is in seawater, though they infect everything else that lives. Some 5% of the oxygen in our atmosphere is produced by bacteria that are infected with viruses. The viruses increase the oxygen-production of these microbes. I learned that 10% of the human genome is viral---and this is just the ones that have been demonstrated beyond a shade of HIS doubt. Professor Stedman said that up to 43% of the human genome could be viral, and that many of the genes we got from viruses are important ones, without which we would not be here. Apparently all placental mammals share one particular viral gene so it got in there a long time ago.

One of the main points that Professor Stedman made was how much of the world is made up of viruses, and how small they are. He said that if you put all the Earth's viruses end to end the lineup would reach to the Andromeda Galaxy. And they'd weigh more than some huge number of whales, and so on.

One nice thing about going to science pubs is being around people for whom evolution just is, instead of having to debate about it. It makes me realize how much energy I put into defending a basic scientific mindset. Too many groovy spiritual people and homeopaths in my life. They stress me out.

For today my mantra is "it is OK to do nothing" and I have been enjoying it. I need to take breaks more often. And journal. Just for me.

One of the biggest tragedies of human civilization is the precedence of chemical therapy over nutrition. It's a substitution of artificial therapy over natural, of poisons over food, in which we are feeding people poison trying to correct the reactions of starvation. You all know how ridiculous that is, but you all know how widely it's being done.
--Dr. Royal Lee, January 12, 1951

I'm not big on woo woo. When practitioners choose modalities simply because they "resonate" with them, I am skeptical. But when science backs up the use of something that has long been thought of as energy medicine, I am happy to recommend it. Of course people will tell you something is backed by science when it isn't, so you have to go look at the science for yourself, or find sources like me that you know are science-minded and skeptical to help filter the claims for you.

Here's a case of energy medicine turning out to be something real. Scientists have found that acupuncture points are detectable by CT (computed tomography, fancy medical imaging). All those points have a certain size of larger blood vessels, and also thick mats of fine blood vessels that have lots of forks (birfucations) in them. Piercing the tissues at these points is probably affecting the nervous system associated with those blood vessels. This supports my belief that energy medicine (that actually works) has a anatomical and physiological basis. Acupuncture is well proven to be effective for pain, short term at least. To treat pain longterm one must take the naturopathic approach and find the reason for the pain, and change that.

These notes from the Oct 15, 2013 Grand Rounds at OHSU in the Psychiatry department. Watching it online, it's about "what you need to know about the new DSM".
( notes )

It's only work
if you'd rather be
doing something else.
--Abigail Van Buren (Dear Abby)

For me, the study of medicine could take over my whole life.... I want to do it, and the information comes to me in great floods which I try to understand and sort through so as to be able to apply it.

The other day while challenging us with a case in which the patient needed extensive advanced medical care the prof asked "OK, what next?". I responded with "Does the patient have medical insurance?" And the professor joked that first on the TO DO list is a "wallet biopsy". We laughed. It is necessary to assess people's ability to pay for treatments, but too painful to use such terms with a patient. But at that point I decided that I need to begin collecting medical slang, not jargon but the most offensive and borderline slang that I hear. I have always been interested in language.

So tonight I was working on my homework assignment for clinic synthesis, and trying to find the abbreviations for a few things, when I ran across the wikipedia page listing medical slang. I have pilfered the entire contents of the wiki page, and started adding to it. I think this may be the beginning of something especially perverse. I LOL'd when I saw the definition of the acronym TEETH.

( medical slang list here, not all offensive, moved forward from 2/20/09 )