Reliability health advice on the internet, a study July 23, 2010
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A study looking into the reliability of Googled health information in answering common health questions has shown that governmental sites gave uniformly accurate advice. News sites gave correct advice in 55% of cases. No sponsored sites were encountered that gave the correct advice.
In my experience people tend to find the information or advice they were looking for, for example, parents who are strongly against vaccination will find info on why vaccines are bad, and largly ignore more authoritative information on vaccine safety.
Used wisely there is a lot of very good health information on the internet.
Update on Evaluation and Treatment of Bronchiolitis – Emergency Medicine March 10, 2010
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Update on Evaluation and Treatment of Bronchiolitis – Emergency Medicine
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Swine ‘flu again, another letter to the Bangkok Post July 17, 2009
Posted by drolarn in Medical musings, Rants, Uncategorized.Tags: flu, health, influenza, medicine, thailand
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I was disappointed to see that in your editiorial column today (17th July), you have chosen sensationalism over sensibility. While the 2009 flu does seem to spread rapidly, it is clear from data from around the world that it is no more serious than the usual seasonal flu of which there are outbreaks every year. The number of deaths from 2009 flu is proportionally no greater than seasonal flu, indeed many have reported that cases of 2009 flu are often milder than seasonal flu. To say that in Thailand the 2009 flu is the greatest health threat in history, to describe it as deadly, is just scaremongering on your part. Either your editor is sadly misinformed or you are deliberately adding fuel to the fire of public anxiety. Yes some people have died, but the fact remains that 2009 is far from being the leading cause of preventable death at this time. HIV-AIDS remains a far more serious disease than flu of any type, and if you want deadly, tuberculosis causes far more death and suffering in this country than flu. As for the government not telling the truth, if you had taken the trouble to look at the facts, the government simply does not have reliable data that can be presented to the public. Cases of 2009 flu are beyond identifying and counting at this time, and not just in this country. Any data generated from sampling a small select population can only further mislead the public. Other countries have already shifted the emphasis from counting to treating cases of flu. My belief that the Bangkok Post is above using irresponsible sensational tactics to boost circulation seems to have been misplaced. I hope you will prove me wrong in the future.
Swine ‘flu, my letter to the Bangkok Post. July 14, 2009
Posted by drolarn in Medical musings, Rants, Uncategorized.Tags: flu, influenza, swine, thailand
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Your editorial column rightly stated that the public anxiety over swine flu is partly exacerbated by a lack of authoritative information and advice from from the nation’s health authority. Comments like “there are over 3000 confirmed cases but probably 200000 actual cases” are hardly reassuring and gives the impression that the government does not know what is going on. Government spokesmen appearing on TV seemed more concerned about appearing to be doing everything possible than about giving accurate and useful information. The media is also partly to blame for the panic and confusion. The Thai language press particularly are focused on the number of deaths and the rapidly rising number of sufferers, giving little if any emphasis on the now well established fact that the vast majority of swine flu sufferers recover uneventfully. In countries where the number of cases run from hundreds of thousands to well over a million, as is the case the USA, statistics have shown that swine flu is no more virulent than seasonal flu. Another truth that has emerged is that despite the very best efforts of health authorities in countries with more experience and more resources in dealing with disease epidemic than Thailand, the spread of swine flu can at best only be slowed down a little. No country has been successful in preventing or containing the outbreak. The government is accused by the media, the public, and the opposition of not doing enough and this may be true but it is hard to see what effective measures can the government really take. Short of shutting the country down, the virus is going to continue its march, until enough people are infected and consequently become immune, then the outbreak will peter out, and this is an inevitable fact. It will happen just as surely as the sun will rise tomorrow. Shutting schools and workplaces down for prolonged periods, urging the entire nation to wear masks, it has all been tried without discernible benefit. One thing our government has not mentioned to the public as far as I know, is that the capacity for testing for swine flu has been hopelessly overwhelmed weeks ago. The number of people who have had obvious symptoms of flu but have not been tested for swine flu literally cannot be counted. The estimate of 100000 to 200000 is an absolute shot in the dark and verges on the meaningless. Without the ability to test for swine flu, the government simply has no meaningful data on how many cases there has been. Without knowing the number of cases, the number of fatalities become useless other than to cause more panic. We know it is not 1%, but is it 1 in 1000? 1 in 10000? very much less than this? In all likelihood the number of preventable deaths in this country caused by road traffic accidents probably outnumber the number of swine flu deaths by several orders of magnitude. If there has been 17 deaths from swine flu in the past month, how many more have died from RTA’s? Surely not less than 100, but nobody is panicking over RTA deaths because it is not even old news, it’s not news at all. The sad fact is that if the government wants to save lives, it is more likely to achieve a degree of success trying to prevent RTA’s that to prevent swine flu spread, and for much less cost. But the government has to address the public’s concern over a disease outbreak, and as little as it can effectively do, it must be seen to be doing something. So we can expect more government spokesmen repeating the same vague useless information and advice. No person of authority is ever going to come out and say that the outbreak cannot be contained because frankly the government has no idea how to contain it. The public might try seeking reassurance by looking at what has happened in other countries where the epidemic started before ours. The number of cases will rise, it will reach a peak, and then it will fall. A few people will die. And then the next year as has happened every other years, there will be a different flu epidemic, with a different predominant flu virus, only it will no longer be hot news, and people will find something else to panic over. Dr. S (Olarn Seriniyom)
Český Krumlov 5 June 2009 July 11, 2009
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Cesky krumlov castle
Český Krumlov world heritage town, Czech republic.
Soy peptide drinks July 1, 2009
Posted by drolarn in Medical musings, Rants.Tags: fads, food, health, pseudoscience
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soy peptide drinks vs tofu
Of all the pseudo-scientific health food concepts this is one of the stupidest.
Peptides are break down or digestive products of proteins. Proteins are made up of amino acid molecules in a long chain. Peptides are short chains of two or more amino acids.
When you eat food containing proteins, the digestive process in your gut breaks down the large protein molecules into smaller peptides which are then absorbed into your blood stream through the gut wall.
Which means if you want soy peptide, all you have to do is eat any soy product such as soya milk, tofu, or cooked soybeans which are delicious and cheap. And it is not like it takes much of an effort for your gut to digest soy protein, you gut does the job efficiently, automatically, and cheaply.
So is there anything special about soy proteins and the derived soy peptides? Really, no. In fact biologically plant proteins are lower in quality than animal proteins as plant proteins lack some of the amino acid components that your body needs, which are only found in animal proteins. Soy, as a source of protein, is simply inadequate on its own.
What about the claims that soy peptide drinks enhance your brain function? It is pseudoscience, same kind of stuff used to push all kinds of useless pills, potions, weird health food products, many of which become hugely popular for a while only to gradually fade away as their extravagant claims cannot be maintained. For more about pseudoscience read this Quackwatch.com article http://www.quackwatch.com/01QuackeryRelatedTopics/pseudo.html
or in Wikipedia
http://en.wikipedia.org/wiki/Pseudoscience
Everybody should read about pseudoscience really, so as not to be easily fooled by the hordes of quacks, charlatans and so-called nutritionists out there.
What about the many, many people who have tried Peptein (the commonly available soy peptide drinks on sale in Thailand)? Many have said the drinks make them feel good, more energetic, more alert, etc etc. Are they all liars? or in the pay of the company that makes the drink? or are they just gullible fools? Well not really. If a bunch of people say eating/drinking something makes them feel good, it is probable that they honestly felt it, but you can get the same positive response to most anything if the subject already has a positive attitude and expectation of the result, that’s just us being humans.
Don’t listen to the hype, use your brains, the science behind these things is not even difficult. As stated at the beginning, if you can get the same stuff out of a 10-baht box of soya milk as you can from a 33 baht fancy bottle of, what is effectively diluted pre-digested soya milk, how is drinking the 33 baht stuff a smart thing to do?
Overtreated July 1, 2009
Posted by drolarn in Medical musings, Rants.Tags: health, medicine
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One question that is being asked frequently about Michael Jackson’s death is: did he die because he took too many prescription drugs?
I believe that many people have died, or suffered ill health, from being over-medicated. Some because the drugs are addictive, or induce psychological or physical dependency. Sleeping pills and painkillers are common and well know examples of these. But many suffer simply because they are taking too many medicines which are not addictive, and are prescribed to treat symptoms and conditions that the patient is suffering from or complaining of.
There are many reasons why patients may be prescribed too many medicines, to the point where the medicines make them sicker. Firstly the patient himself may be fond of taking pills, and doctors who are willing to indulge are not uncommon. Secondly many doctors feel that if they more drugs, especially the newest strongest drugs, that makes them more proactive in their treatment than others who judiciously use tried and tested therapies. Thirdly, and I have seen this happen many times and in conjunction with the other two scenarios, the doctor and patient get in to a vicious cycle of drugs and symptoms. This is how it happens:
Imagine a patient comes in with a rash that itches and irritates but otherwise not serious. A doctor gives him steroids which he finds is effective in controlling the rash. Long term steroid use cause him to be hypertensive, so the patient goes to see a cardiologist who gives him blood pressure medicine. This controls his blood pressure but causes him to have insomnia so he goes to see a neurologist who gives him sleeping pills. This helps him sleeps but causes him to be anxious, so he goes to see a psychiatrist who gives him anxiolytic drugs, which gives him nausea and heartburn, the treatment of which gives him diarrhoea, and meanwhile the steroid is giving him diabetes and so on and so forth.
All drugs have undesirable side-effects. Treating the side effects with more drugs lead to more side effects. If one doctor was in overall control of one patient’s treatment, things may not get out of hand but in situations where the patient has a free choice of doctors and doctors fail to communicate with each other, patients could be receiving drugs that work against each other, or duplicate each others effects and side effects, or otherwise interact adversely. In countries where the government provides universal health coverage and drug consumptions are kept under control, this situation is less likely to arise. But in a situation where the patient can freely shop for health care and doctors compete for business, it is common place. In (good) medical schools prospective doctors are taught to limit drug treatment to a minimum. The elderly particularly, are rarely able to cope with more than 4 different drugs in a day. In private hospital it is common place for patients to be on 12-15 different drugs at the same time, prescribed by up to half a dozen different doctors, and costing the monthly wage of the average man in the street.
If you are taking more than four different drugs everyday, chances are you are overtreated. Ask yourself are you really feeling better ,overall, on these drugs than before you were started on them.
If you are consulting with more than one doctor, and your doctors are not seen to be communicating and cooperating, no matter how disparate their specialties, you are running a high risk of overtreatment. Find a doctor who is happier giving you explanations rather than pills, with luck he will help you stop the vicious cycle.
A life saved June 29, 2009
Posted by drolarn in Medical musings, Uncategorized.Tags: medicine
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Baby J.
This little boy was born with a haemoglobin level of 3, which roughly speaking means he had lost 75% of his blood, prior to delivery. He was literally white as a sheet, this picture was taken after he was treated. He looked like a ghost and was well on his way to becoming one.
Because his blood was too thin to carry adequate oxygen to his vital organs, his heart was working over time and was on the verge of failing. He could not breath fast enough and with all the effort, his blood was turning acid.
I could not just pour blood into him, transfusing him too quickly would have overloaded his already stressed circulation. Giving him blood too slowly and he might have gone into shock. A risky procedure that is sometimes indicated in this situation is to perform an “exchange transfution”, whereby baby’s blood is removed and replaced simultaneously with donor’s blood. The procedure requires twice or three times as much donor’s blood as baby’s total blood volume, and even though most of the time this procedure is safe if performed with great care, it is never without considerable risk. Instead I gave him blood as fast as I dared, in the meanwhile he had to be put on a breathing machine as he was too exhausted to breath by himself. I had to give him a big slug of bicarbonate to counteract his acidic blood.
The hours I spent watching him turn from white and gasping to pale pink and relaxed were anxious hours indeed. Luckily he had just enough resilience left to turn the corner and now, a day later, is out of intensive care and breast-feeding.
A bit of shameless bragging on my part, but heck, I’ve earned the right!
Oto-laryngo-urology joke June 28, 2009
Posted by drolarn in Humour, Uncategorized.Tags: humor, Humour, joke
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An old gentleman walks into a clinic. The receptionist asked him what he wanted to see the doctor about.
“‘It’s my penis!” said the old gentleman in a rather loud voice like the hard-of-hearing often do.
“Shh!” said the receptionist, “Don’t say penis, you might upset some people. Say it’s your ear instead. Let’s start again, what seems to be the problem?”
“”It’s my ear!” said the old gent.
“What’s the matter with it?” asked the receptionist?
“”I can’t pee out of it!” replied the old gentleman.
