Specialists; Boosting the immune system; FLU 1918; and spitting coffee

From Edwin Leap via Dr. Kevin this week an rather sad plea from a doctor who still actually touches patients. I feel his pain. I've treated thousands of patients now. I know pretty much from a glance who is sick and who isn't. If I call you, Dr. Smartie Specialist, it's because I need help; the patient really needs help. I really don't send patients to the ER who really don't need to be in the ER, Dr. Emergency Room. I'm really sorry if the "paper patient": the white count, CT, vitals, etc. don't seem impressive. The patient is. From Dr. Leap's post:

"We have made medicine into a series of check-boxes. Enough positive boxes and some other physician might get interested. But humans aren’t like that. Humans fool us; they ignore the boxes. And suddenly, they die without warning."

Thanks to hospital administrators and insurance executives for pushing the compartmentalization of the patient, too. Hope that I can look up from my streamlined, built-in ICD-9 coding, disease-diagnosing checklist when you, your mother, your wife, or your child is ill.

Is medical technology making doctors less relevant?

I would argue more, actually. It's a treat, an everyday miracle to be able to look inside somebody with labs, ultrasounds, MRI, PET scans, etc. No scalpel necessary. But even surgery doesn't always demonstrate function. Putting it all together is quite a challenge. Laying the paper at the foot of the patient takes some skill. And time. I'm biased, however.

Mark Crislip, the infectious disease specialist who blogs and podcasts at Quackcast, utterly cracks me up. I have a serious talent crush. He has an ID podcast, a journal-watch kind of thing, which I listen to while on the treadmill. Not only is it informative, it's hilarious. But Quackcast is something special. This week, on Science in Medicine, he reworked a Quackcast about boosting the immune system. Not only is it ridiculously informative, it's funny:

"The other popular phrase (made by vitamin and supplement manufacturers) is “support”. A product supports prostate health, or breast health or supports the immune system. It sounds like the immune system is sagging against gravity due to age and needs a lift . . .

. . . The immune system, if you are otherwise healthy, cannot be boosted, and doing those things you learned in Kindergarten health (reasonable diet, exercise and sleep), will provide the immune system all the boosting or support it needs . . .

. . . And there all the non specific parts of immunity that help prevent infection: platelets and cilia that sweep potential pathogens out and iron metabolism that keeps iron away from bacteria and the list goes on and on and on. The above is the briefest of overviews of the constituents of the immune system. It is almost like saying you have
described the works of Shakespeare by noting it contains the words ‘the’, ‘and’, ‘of’, ‘verily’, and ‘forsooth.’ But the purpose of this post is not to describe the immune system in detail as I would soon embarrass myself.

So when something allegedly boosts the immune system, I have to ask what part. How? What is it strengthening/boosting/supporting? Antibodies? Complement? White cells? Are the results from test tubes (often meaningless), animal studies or human studies? And if in human studies, what was the study population. Are the results even meaningful? Or small, barely statistically significant, outcomes in poorly done studies?"

Amen. Read his whole post. He throws just enough jargon around to keep you on your toes, but not to make you feel stupid.

Boost your immune system?

While you're wondering about boosting your immune system, think hard about aging rapidly and letting your immune system go to seed. From Clinical Correlations an interesting historical perspective on the flu, particularly the Spanish Flu epidemic of 1918. Consider this:

"It is estimated that for every American soldier who died in battle in World War I, 1.02 died of disease."

Chew on that--more soldiers died of the flu than the war--while you wait in line for your flu shot. With your kids. Later, while you're just sitting there appreciating breathing, picture this:

The appearance of victims’ lungs at autopsy gave the first clues to this question. Pathologists saw devastation of the lungs caused by the usual lobar and bronchopneumonias, but they saw something different in the lungs of 20-40 year old victims who died quickly during the pandemic. A pathologist was quoted as saying “[there was] essentially toxic damage to alveolar walls and exudation of blood and fluid. Very little evidence of bacterial action could be found in some of the cases.”[1] Whereas in bacterial pneumonia the infection rages inside the alveoli, in these lungs, the spaces between the alveoli were also filled, brimming with debris of destroyed cells, white blood cells, immune modulators, and blood.[1]

Ouch. Destroyed by your own immune system reacting to a new pathogen. Hey, I have an idea. Go get your damn flu shot!

The forgotten influenza of 1918: when a strong immune system becomes a weakness

Ben Goldacre at Bad Science tipped me off to a pretty neat PDF with nifty information in Q&A format about reading articles in the paper about health and healthcare. Anything which suggests spitting coffee might be an appropriate response to some health journalism warrants a read to me.

How to read articles about health and healthcare

My own rules: Is this article causing me to want to be prone and asleep? Are the statistics making my eyes glaze over? Are the numbers involved so big that I start to convert them to dollars and daydream about the cool appliances I could buy? If I want to be napping, if I'm thoroughly confused by the statistical analysis, and the "N's" involved are making me think, "Subzero" then I might be on to a good article.

That's all for now.....Dr. Latte