Monthly Archives: July, 2008

Beijing Olympics Face Major Health Issues,including Doping(part 2)

Following on to my earlier post of 23rd July, the prediction that air pollution was going to be a major health hazard looks a reality as Beijing has been enveloped in a thick haze the last few days.

Common pollutants measured in Beijing include particulates, sulfur dioxide and nitrogen dioxide. Particulates,  which can come from dust and fire, are the most common.

The Forbidden City Looks Forbidding with the Thick Haze

The degree of pollution is measured by the Air Pollution Index(API), which ranges from zero to 500, with the level of 100 being accepted as the maximum permissible level. Take a look here to see the API levels for the last three years as well as today’s levels.

The city has put in place a series of drastic pollution controls since July 20 that included pulling half the city’s 3.3 million vehicles off the roads, halting most construction and closing some factories in the capital and surrounding provinces.

Now, with the air quality still poor, Beijing authorities are considering two further measures:

  1. restricting further the number of cars which totals 3.3 million in the capital
  2. cloud-seeding to induce rain.

Really, the only hope at this late stage is to invoke Mother Nature and hope that she will bring wind and rain over the next few days.

To quote an Olympic official, what Beijing desperately needs now is a constant gust of wind and rains at night.

New Drug Discovery-How to Search for the Truth Behind the News

Ever so often, the media will highlight yet another ‘wonder drug’ that will revolutionise the way a disease is treated..raising much hope amongst consumers. Yet, if one cares to scan the news a bit deeper, there’s more to it than meets the eye.

Take for example this item widely reported in many newspapers worldwide:

“Scientists have unveiled a new drug for prostate cancer which  could help up to 80 per cent of patients with the aggressive and previously untreatable form of the disease.”   –the Telegraph,22nd July 2008.

On reading the fine print, 2 facts emerge in this article:

  1. This drug was tried on only 21 patients.

2.  This study is a Phase One Trial, meaning the drug was at the stage  of being tested to assess its safety but not yet its efficacy.

In other words, it would be many years before the drug would be available, assuming it passes the the other phases of the trial and no untoward side-effects appear during this process. In the best scenario, the drug will appear after a few years and it will be costly(you bet!); and in the worse-case scenario, it will be consigned to the waste-basket due to the presence of terrible side-effects which hitherto had not yet been detected.

Take the case of another popular drug, Vytorin. When it was first introduced 5 years ago, it was touted to not only lower blood cholesterol, but it also claimed that that the narrowed arteries could appear less narrow. The ENHANCE study disproved the latter -it was published in March this year although the study was completed 2 years ago! I do not understand why the results were delayed by 2 years..(It has been reported that the sales of Vytorin has fallen 40% since the release of the study in March).

  Video:Comment from TIME magazine concerning Misleading Ads

So why does the media appear to overplay new drug discoveries?

Put it simply, such items are big news..and news sells! Not forgetting, of course, the commercial benefits the company producing the drugs receive, or the publicity it attracts to the researchers concerned.

What can we learn from all this? Some tips on how to evaluate news items that you may come across..

  • It is a fact that competition is intense among medical journals, research bodies and medical journals to attract media attention. Media themselves compete with each other to come out with the latest. Try to read the same news from several sources. Obviously, if the item is reported in just one obscure source, it should carry less weight.
  • Look for key-words like suggestive or may (as opposed to will) as this does not always indicate a cause and effect meaning. Many people make hard-core assumptions based on such words.
  • It is the nature of scientific studies that for a given topic, several would say one thing and a few would say the complete opposite. It is for the trained professional and their peer-groups to make an informed decision to advise consumers. Bear in mind that space is a premium with the mass media and such reports usually omit vital details which will affect accuracy.
  • Personally, I feel reports originating from researchers and pharma companies should not appear in the mass media without vetting by an appropriate professional body so as to convey the proper perspective to the audience at large. So if a news report originates from a professional body, that would be worth listening to.

Beijing Olympics Face Major Health Issues,including Doping

Come August, one of the more popular activities worldwide will be  watching,directly or indirectly, the greatest sports event in the world. Already, concerns have been raised about the air pollution in Beijing, with the Australian contingent reportedly delaying their arrival till just before their respective events, thereby giving the opening ceremony a miss.

To their credit, the Chinese authorites have spared no effort in ensuring that the skies will be clear. Some of the measures include allowing cars ending with even numbers on their registration plate to be permitted on the roads on even dates. This enables 1 million vehicles to be off the road at any given day!

The Shenyang Olympic Stadium is the main venue for the Olympics Aug 8-24, 2008

The Shenyang Olympic Stadium is the main venue for the Olympics Aug 8-24, 2008

One of the potentially explosive health issues which will involve the athletes is the question of doping. Already, during the Sydney 2000 Olympics, some high-profile athletes were caught using prohibited performance-enhancing drugs.

Marion Jones used prohibited substances and was finally caught a few years later

Marion Jones used prohibited substances and was finally caught a few years later.

The most highly-publicised case was that of sprinter Marion Jones who was finally banned,  jailed for 6 months (she is currently serving her term) and asked to return the 5 Olympic medals which she won in 2000.

Usage of performance-enhancing drugs is by no means confined to the Olympics as professional athletes have been caught in other sports as well.

However, I predict the Olympics will be a real testing-ground for two drugs whose usage is steeped in controversy on many counts.

The first is HGH (human growth hormone) which builds strength, bone density and endurance,  minus the side-effects of steroids  like what was used by Marion Jones. It is difficult to detect by conventional doping tests because it is a naturally-occuring substance in the body and, more important, can be withdrawn well before the event without any apparent untoward effects and therefore avoid detection.

The other performance-enhancer is EPO (erythropoietin) which is also a naturally occuring hormone that causes increased production of red blood cells in the body, thereby increasing the oxygen-carrying capacity of the blood to the muscle tissues. Its like using high-octane petrol to boost your engine. The detection of EPO is complicated by the lack of accuracy of the current test methods. Marion Jones was tested positive at the Sydney Olympics but subsequently declared negative on the second test.

Whatever it is, the World Anti-Doping Agency (WADA) which is responsible for testing the specimens are confident detection techniques have improved.For more, click here.

Fast Food Furor

Quite a number of New Yorkers were shocked at the calorie content of common fast-foods when legislation was introduced in the city compelling large food-chains to disclose this. Starting Saturday, 19 July 2008,restaurant chains that fall under the rule will face fines of up to $2,000 per store for not disclosing calorie information in a prominent spot on their menus.

Many news agencies have reported that most consumers were unaware about the extra calories in food items which were touted to be healthy. Take a look at this item found in Starbucks:

Although labelled"fat free," a slice of banana chocolate chip cake at Starbucks has 390 calories((MSNBC pic)

Although labelled"fat free," a slice of banana chocolate chip cake at Starbucks has 390 calories((MSNBC pic)

Many experienced ‘sticker shock’ when they came to terms with the calorie values of their favourites. A Big Mac with a small bag of french fries and a large coke totalled 1,080 calories.

Two pieces of KFC fried chicken (breast & thigh) with a small bag of fries and a large coke added up to 1,170 calories.

Don’t believe me? Check the calorie counts for Macdonalds and KFC.

If you are into Malaysian foods, check here.

Either of the two food plates mentioned above provide a substantial amount to one’s total daily requirements, which is approx 2,000 calories. So, by the time you add in the rest of the meals for the day, the calorie excess will be simply converted to fat in the body!

Personally, I doubt that the City of New York’s regulations are going to significantly affect people’s lifestyles although the authorities claim that the measures could reduce the number of obese New Yorkers by 150,000 over the next five years, and prevent 30,000 cases of diabetes.

What is certain is that the revelation of these facts can empower the individual to make informed decisions for themselves and make them more health-conscious.

Device revives man after swimming pool heart attack

BBC News reported of a 69 year old man who suffered cardiac arrest while on one of his regular swimming exercises at his club pool. He had done about 20 lengths when he was noted to suddenly veer off,stopped moving and started to sink. The lifeguards sprang into action, commenced CPR while the pool manager ran off to get a defibrillator which was used to shock him. He was later transferred by ambulance to the ICU where he remained unconscious for a few days but subsequently recovered enough to have a heart bypass operation. Today, he has resumed his swimming exercises.

A Defibrillator about to be used during CPR

A Defibrillator about to be used during CPR

I have noticed that tales such as this are becoming more frequent nowadays. In this case, with the implementation of UK government-funded schemes  where there are some 700 of these devices in high-risk places like airports, train stations and sports centres, about a third of those on whom the defibrillators were applied survived (without using this device the chances of survival during a cardiac arrest is virtually zero). In fact, some airlines do have them on board, just in case any passenger gets a cardiac arrest. American Airlines have now carried these devices for 10 years and claim that 76 lives have been saved as a result.

Basically, the usage of this device requires a previously-trained person( all flight attendants are taught to use these devices) applying a pair of paddle-like electrodes on the chest and pressing a couple of buttons to discharge a burst of high electrical energy anywhere between 200-400 joules. This is enough to cause the affected person to go into an involuntary jerk or spasm, quite similar to that seen in TV movies. This electric ‘jump-start’ then restarts the heart to beat properly.

The device has to be applied within a few minutes of the cardiac arrest, otherwise irreparable brain damage might set in due to the loss of the pumping action of the heart.

Why are there not more defibrillators placed in public places? Basically, its a question of cost-effectiveness as each one may cost about USD 1,500.  Despite this, many health advocates have called for more of these devices as several studies, including this one, have shown that placing these devices in high-risk public areas meet the usual standards of health cost-effectiveness.

If bought and used by local airlines, it would give credence to the motto “now everyone can fly!”.

Health Alert(1): FDA issues warning on CT scans for patients with pacemakers

The Food and Drug Administration(FDA) is warning doctors and patients that electronic devices such as pacemakers, cardiac defibrillators and insulin pumps can malfunction when people get computerized tomography (CT) scans.

The popular scans can cause medical devices to shock patients or start sending inaccurate signals, the FDA said in a public health alert issued 14 July 2008.
It has received six confirmed reports of devices that malfunctioned after a CT scan and another nine reports of suspected problems, FDA spokeswoman Karen Riley said. No deaths occurred.

This untoward effect has not been generally well-known amongst doctors, unlike the widely-recognised rule of not allowing  patients with pacemakers to undergo MRI scans.

CT scans have been known for their high radiation effects, with reports ranging about 500-600 times a normal chest-ray for each CT scan procedure (see my earlier post here)

Identifying Kids Who Will Smoke

Researchers at the University of Massachusetts Medical School can identify which kids will end up smoking by asking them 2 questions:

  1. How easy is it for you to get cigarettes?
  2. Do you have friends who smoke?

If the answers are ‘yes’, then it is likely that they will end up smoking later in high school.

I guess it boils down to identifying this target group so that antismoking measures can be implemented.

Speaking of which, I came across this uniquely-designed smoking lounge with a ceiling mural sent to me by e-mail (source unknown) :

An Effective Anti-Smoking Measure?

An Effective Anti-Smoking Measure?

Just in case you didn’t know that nicotine is the main culprit for heart disease and tar is the one that causes cancer; or that tobacco contains over 19 known cancer-causing chemicals  and more than 4,000 other chemicals, there’s a single-pager on the effects of smoking here.

On Eating..

This being the weekend with a tendency to overdo it (eating, I meant), the following quotation is worth remembering.

“I saw few die of hunger; of eating, a hundred thousand.”

Benjamin Franklin

Benjamin Franklin

Autopsy Results Reveal Cause of Death

Esmin Green, the 49year old lady that died in the Emergency Room of a New York Hospital after waiting for more than 24 hours to see a doctor (and then collapsed on the floor for more than 1 hour before being attended to) has been confirmed on autopsy to have suffered from Deep Vein Thrombosis.

This video, courtesy of Associated Press explains further:

Deep vein thrombosis (DVT), aka economy class syndrome , is a condition associated with clotting of the deep veins in the legs usually aggravated by prolonged sitting down. Although reported amongst travellers in the back of the plane, this condition is not exclusive to the ‘cattle-class’ as many doctors, this blogger included, have come across DVT among business-class travellers.

This poor lady could have got this condition having waited more than 24 hours in the waiting-room!

By itself,DVT is not potentially fatal, but it is the travelling of this clot (now known as embolus) to the lungs, causing a blockage of the blood vessels of the lungs(pulmonary embolus) that is the one that can lead to potentially fatal results, as in this case.

The bigger question, of course, is why a patient has been allowed to wait for over a day in the emergency room of a large hospital? And why were there so many apathetic people around?

A Deadly Decision

What do you do if an AIDS patient is dying but does not want the family members to know the diagnosis?

This was an ethical dilemma that I faced some time ago. This young man was admitted with pneumonia and expressly told the doctors not to disclose his illness to family and friends. As doctors, we were bound to uphold confidentiality.  Should this be absolute at all costs, no matter what?

As was expected, his condition quickly deteriorated and he lapsed into coma. Close friends and relatives soon arrived at the hospital, each one enquiring on what was wrong.

Needless to say, a decision had to be made quickly enough on what to reveal or, more important, what not to reveal. We decided that, as the patient had nominated a next-of-kin, that this person would be the proxy for determining the future management and course of action. The patient had voluntarily nominated a person to make decisions on his behalf, so, by inference, this person should be told of his actual disease.

However, after much discussion, the medical team agreed that, as it was unlikely that the patient would survive another 24 hours, telling the next-of-kin was not going to affect decisions on management anyway. It would have been different if there were possibilities that treatment could realistically prolong his life; then the next-of-kin would have needed to be told of the diagnosis in order to obtain permission for the next course of action.

The patient eventually passed on a few hours later and relatives were told that he died of pneumonia due to an underlying cause for which the doctors were not under the liberty to disclose.

In this case, the duty to maintain doctor-patient confidentiality was maintained. This duty is not absolute always as pointed out above. Also, as AIDS is a notifiable disease, health authorities needed to be informed and further action necessary if there is a suggestion that the patient had infected others.

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