Monday, December 22, 2014

"All Lives Matter"

The ongoing controversies regarding the Ferguson and Staten Island issues of white-on-black police brutality have reached new heights (or maybe the proper word would be "depths).  A current article describes a recent incident at Smith College concerning a campus-wide e-mail circulated by Smith's president, Kathleen McCartney.

Dr. McCartney's e-mail announced her concern, and the concern of the Smith community about not "losing faith in the quest for racial equality, and how you fear for people of color."  It went on to speak about how violence of this nature serves as a reminder of the existence of racial injustice.  The president ended her note with the following:

"We are united in our insistence that all lives matter."

Apparently some Smithies interpreted this phrase as racist.  They argued that it "minimizes the anti-blackness of this current situation."  It was felt that McCartney, in using this phrase, was not sensitive to the problems that specifically befall African-Americans.

McCartney apologized for "drawing attention away from the focus on institutional violence against Black people......" and went on to commit herself to "learning from the lived experiences of people of color....."

We really have a problem when a statement proclaiming the equal value of all human life is considered insensitive and biased - and results in an apology.

Thursday, December 11, 2014

The Usefulness of Medical Data in Managing Disease

Dr. Sandeep Jauhar (Op-Ed NY Times, Dec 11) questions the use of standard accepted medical guidelines in the management of patients.  He is correct in pointing out that there have been such treatment guidelines published by a myriad of medical specialty organizations, outlining what current evidence indicates is the best method of evaluating and treating various conditions.  These organizations have committees of recognized experts in their respective fields who review all available published data that may pertain to a particular disorder/procedure.  Their conclusions are then published in the medical literature - not only as guidelines, but with "guidelines" as to how to evaluate the recommended guidelines.

The "guidelines" to evaluate the guidelines look at the statistical validity of the populations studied:  (A)were multiple populations studied,  (B)were there limited populations studied, or (C)were there only very limited populations studied.  Based on the data analyzed, the experts then classify procedures/treatments according to apparent benefits v. possible risks.  Class I indicates that the data clearly indicates that the procedure/treatment is very beneficial and is highly recommended.  Class II concludes that benefits are not conclusive, may indeed be worthwhile, but suggest additional studies.  Class III is comprised of treatments/procedures that have not been shown to be helpful or may actually be harmful.

Evaluating these criteria, and then following the suggested treatment/procedure outline is what is called evidence-based medicine.  This is the way to manage patients - this is the way to manage disease.  When a treatment/procedure is found to work in a significant majority of people (evidence-based), physicians should use it!  Denying the validity of such recommendations, is to deny the validity of using properly collected statistical data.  On what else can conclusions and recommendations be based?

Dr. Jauhar argues that such "homogenized health care" is not always the best treatment.  Of course not.  There are always times when any one individual will react negatively to a recommended course of therapy, or where it might be contraindicated for one reason or another.  He concludes that personalizing care is better.  Of course it is.  But until individual genomic analysis allows medicine to personalize care (and it is moving in that direction), so called "homogenization" is not to be denigrated.

Remember - what works well for the significant majority of a population will, in the vast majority of instances, work well for you too!  Though you are an individual and have your own personal genetic makeup, your genetic similarities to others is vastly greater than any differences - and you are  far more apt to have the same benefit/risk result to a recommended guideline as your neighbor.

Monday, December 1, 2014

Government and Ebola

Physicians may not always be unbiased when it comes to issues such as the Affordable Care Act and similar subjects that govern how they work and how their incomes may be affected. The non-medical community may certainly and rightly differ with their points of view.   But when it comes to evaluating the facts regarding science-based health issues, physicians whose medical and scientific expertise is well recognized should be listened to, and their recommendations generally followed.

A recent editorial in the highly regarded New England Journal of Medicine (Nov 20) discusses the matter of Ebola virus and quarantine.  It points out how the 21-day quarantine on health care workers returning to the United States from West Africa is "unfair and unwise, and will impede essential efforts to stop these awful outbreaks....."  Government should listen to the presentation of the facts and not "drive a carpet tack with a sledgehammer."

1.  Ebola is transmitted via contact with bodily fluids.
2.  Viral transmission occurs only when the viral load is very high, which is why asymptomatic individuals are not considered contagious.
3.  Fever precedes the contagious stage.
4.  The blood test for Ebola only becomes positive 2-3 days after the onset of fever or symptoms, supporting absence of contagion prior to that time.

It is important to remember that only those individuals caring for Thomas Duncan (the American who died in a Texas hospital from Ebola) at the time of hospitalization, when he had a very high viral load, became infected, while his family members, exposed during the very early start of his illness, were unaffected.

Government officials who ignore the facts and follow their "instincts" in order to achieve what they believe to be "the greater good" for their constituents, must provide the public with some evidence to support these unscientific and unsubstantiated programs which, in fact, are more harmful than helpful.