Thursday, December 28, 2006

Blessed be Google

Forget just googling your name, doctors are using this powerful search engine to help diagnose diseases. A new study in the British Medical Journal demonstrated that googling worked to identify the disease 58% of the time from the Case Records of the New England Journal of Medicine.

We're just that much closer now to the Star Trek Tricorder that Bones used to diagnose patients.

Tuesday, December 26, 2006

Egocentric Parenting

There is an interesting topic at Medpundit linking to an article describing situations where parents will, using Pre-implantation Genetic Diagnosis (PGD), intentionally select embryos "for the presence of a disability." Since I don't want to start an war Medpundit's comments section, I will elaborate here.

Medpundit correctly (I think) characterizes this is "still an egocentric mindset. Parenting as self-gratification." However, I disagree with this statement: "It's really no different than parents who use the procedure to avoid having a child with a disability."

With PGD, embryos are created in vitro and their DNA analyzed. If there are unwanted characteristics or genetic predispositions found (such as Huntington's Chorea, Tay Sach's disease, etc), that embryo is not implanted. I have two objections. First, who decided that a woman is pregnant only after implantation? The only difference between a newly-fertilized egg floating through the fallopian tube and one that is newly-implanted is merely a matter of real estate - location, location, location. The embyro's inherent properties remain exactly the same.

Therefore, using PGD to avoid having a child with a disability means that the offending embryo in question is not implanted. Since this will result in the death of that embryo, there is a gigantic difference between this and parents who use PGD to select a child with disabilities. While the latter calls into question those parents' suitability for raising children, the former is nothing less than infanticide.

As a former embryo myself, I think that just as children don't pick their parents, parents should not be allowed to pick their children.

Friday, December 15, 2006

Noni No-No

Proprietors of the Polynesian and South Pacific noni plant (Morinda citrifolia) believe it to be the next great panacea. Of particular interest is the substance named "xeronine" by Ralph Heinicke, former pineapple enzyme researcher for Dole. Noni's various phytochemicals are thought to have beneficial effects based on isolated findings in animal and laboratory tests. For example, a Hawaiian study suggested that high-dose intraperitoneal injections of noni extended the life of mice with lung carcinoma (Proc West Pharmacol Soc. 1994;37:145-6). A separate unpublished study reported in vitro activity against mycobacteria. Another study suggested sedative and analgesic effects on animals.

Although no human studies have been completed, there have been case reports of potential harm such as hyperkalemia (Am J Kidney Dis. 2000 Feb; 35 (2):330-2), hepatoxicity (Europ J Gastroenterol., 2005; 17:445-7) and possible Coumadin resistance (Am J Hematol. 2004 Sep;77(1)103). Furthermore, one study of noni leaf extract screening for antibacterial activity using disc diffusion demonstrated no effect on K. pneumoniae, P. aeruginosa, E. coli, S. aureus, and MRSA (Trop Biomed. 2005 Dec;22(2):165-70). Interestingly, even Heinicke admits that xeronine is almost impossible to detect, and that noni's activity is dependent upon fresh fermentation and gastric motility. After a comprehensive review, Dixon concluded that "the celebrity of noni is out of proportion to the facts" (Economic Botany. 1999. 53(1) pp 5 1-68).

Despite the paucity of evidence, noni has attracted many ardent followers including spokesman actor Danny Glover (star of "Lethal Weapon" and admirer of Hugo Chavez). The National Center for Complementary and Alternative Medicine is currently enrolling patients in a Phase I clinical trial, but at this point it appears that one can get the same antioxidant properties from a can of V-8 juice, and that the "energy boost" achieved is merely from all the sugar sweeteners used to conceal its putrid taste and smell. Perhaps it is no coincidence that the only existing patent for noni is actually for "eliminating grease, sewage odor and hydrogen sulfide from restaurant grease traps and municipal sewage systems" (patent #4666604).

Wednesday, December 13, 2006

The Civilized Bowel

Does "death begin in the colon"? Patients may be asking about the virtues of colon cleansing products on TV such as Almighty Cleanse or Dual Action Cleanse. The latter is marketed by a man possessing the dubious name of Klee Irwin and an even more dubious-appearing pencil mustache. All of these informercials essentially resurrect the concept of colon autointoxication made popular by John Harvey Kellog (inventor of corn flake cereal) around the turn of the 20th century. In fact, Kellogg's practices at his Battle Creek Sanitarium in Michigan were what prompted T. Coraghessan Boyle to write "The Road to Wellville".

The theory of autointoxication is that fecal matter adheres to the walls of the colon, allowing toxins or bacteria to enter while preventing nutrients from gaining access by "clogging up your colon". Remember that this idea was refuted back then (JAMA 72:8-13, 1919; JAMA 78:884-888, 1922) and today (J Clin Gastroenterol 1997 Jun; 24(4):196-8). Besides, we've all seen the intestines intraoperatively or during colonoscopy enough times to know that this is simply untrue.

In addition to citing the urban legend that John Wayne had 40 pounds of stool in his colon at the time of autopsy, Mr. Irwin guarantees a "buoyant sense of energy and cleanness". According to him, the benefits of Dual Action Cleanse include several nebulous claims such as "supports the liver", "blood purifier", and "digestive support". The numerous ingredients range from the relatively benign (Milk Thistle) to the potentially dangerous (garlic and ginger inhibit platelet aggregation; Hawthorn can augment effects of vasodilators and digoxin).

Incidently (or not), Mr. Irwin has received warning letters and "cease and desist" letters from the FDA and FTC for some of his prior marketing effots.

If you're like me, you must first resist the urge to tell your patients that the reason people like Irwin are fascinated with cleansing the colon is because that is where their heads are permanently located. Instead, inform them that while constipation can be a real problem in clinical practice, there is no evidence that these aggressive bowel cleansing products are able to cure fatigue, sinus problems, skin blemishes, mood swings or other maladies. They can lead to electrolyte disturbances and would be dangerous with ongoing colitis conditions. Educate them that it is not necessary to have 2-3 bowel movements daily, nor is it even possible to achieve the kind of surgical sterility of the colon that they insist is important. Remind them that the colon is designed specifically for the purpose of eliminating fecal matter, which is by definition "dirty".

In the 1994 movie adaption of "The Road to Wellville", the character Goodloe Bender exclaimed, "Health! The 'open sesame' to the sucker's purse!" Before your patients "waste" their money, you might consider referring them to the following website:

Tuesday, December 12, 2006

Welcome to Stethoscope Song

In 1848 Oliver Wendell Holmes wrote, "Stethoscope Song: a professional ballad", warning of the dangers of allowing clinical decisions to be influenced by little more than assumptions and conjecture. I'm a board-certified internist who authors a column in our health system's newsletter investigating the so-called Alternative/Complementary Medicine products. The feedback has been positive enough that I've become crazed with grandiose ideas of my own self-importance to the extent that I feel compelled to share my thoughts with the world. These profound reflections will encompass the areas of medicine, science, politics, and religion.

Of course, the priceless nuggets of golden wisdom found here are not meant to be a substitute for reasoned discussion with your primary care physician, pastor, or drinking buddy. The views expressed here are strictly my own and do no reflect the views of my employer (or perhaps even the majority of the planet).