Surgeons treating patients with noncardiac vascular surgery, such as the repair of blood vessels in a leg, will typically order a cardiovascular angiogram beforehand to check the condition of the heart vessels.If a problem is found, cardiac bypass surgery or angioplasty is done before the limb operation. The heart surgeon is justified in his work because the benefit to risk ratio of the cardiac surgery is favorable. The vascular surgeon is happy because complications from his surgery are now half as likely.
However, a new study finds that the risk factors of all the surgeries combine to increase the chances something will go wrong to an unacceptable level.1 The researchers conclude that the patient is better off to ignore the cardiovascular condition and just proceed with the one originally planned surgery. They suggest that government agencies would do better to consider success rates of overall treatment plans instead of individual modality statistics when evaluating hospital competency. Perhaps this is another example of focusing on individual areas and losing sight of the overall picture.
Mammograms: A Waste of Time?
According to a Canadian study, routine mammography is a waste of time and money.2 Analyzing their findings, the authors state that "the benefit is marginal, the harm caused is substantial, and the costs incurred are enormous,"3 and go on to say that public funding for mammography is not justified for any age group. While earlier studies have found benefits in screenings of women over the age of 50, more recent research since 1982 has shown little benefit even in that age group, according to the researchers.
Grain Dust and Kidney Failure
Doctors in Belgium have noticed that a large number of patients with chronic renal failure have a history of working with grain dust; many of the patients were bakers by occupation. They theorize that silicon in the grain is responsible, since other risk factors include frequent exposure to sand particles and other silicon-containing heavy metal compounds.4
Eight Cases of Polio Each Year in U.S.
Each year in the United States about eight children and adults contract polio. In each case over the last 15 years, the cause has been traced not to some chance encounter in nature with the polio virus, but to the live polio vaccine itself.5 Some medical doctors are questioning the value of the current vaccine. Many are calling for a return to the killed virus version, first developed by Dr. Salk. The controversy is mostly over the premise that the live vaccine is supposed to prevent asymptomatic carriers from infecting susceptible, unvaccinated persons. One might point out, however, that many recent infections were initiated by a victim changing the diaper of an inoculated baby.
It's somewhat disheartening to know that even though there is so much uncertainty about the benefits and dangers of current vaccination programs, government policies are even now being formulated that would further overrule the informed person's personal decisions in this matter. A federal advisory committee on immunization practices is expected to decide in October what action the government should mandate.
Nicotine and SIDS
A Duke University study has found a possible mechanism for the high incidence of Sudden Infant Death Syndrome among smoking households. They have discovered that rats exposed to nicotine react poorly to low oxygen levels. Normally, diminished oxygen in the blood triggers an adrenaline release that increases cardiac output and helps arouse the subject from sleep. However, nicotine seems to block this release and the rats die from cardiac arrest.6 The study was funded by the Smokeless Tobacco Council, a tobacco trade association.
SIDS Victims Cry Differently
Researchers using sophisticated audiometric equipment to analyze the cries of over 21,000 babies have spotted patterns relating to victims of Sudden Infant Death Syndrome. The respiratory passages of these babies apparently create a somewhat higher resonant pitch in their vocalizations. The sound is very subtle, however, and hard to detect without specialized equipment.7
Toxic Algae in Santa Cruz
An alga native to Monterey Bay has been found to produce a toxin called domoic acid that can spread through the food chain via clams and fish. Commercial seafood is monitored for the toxin, but contaminated mussels and other seafood caught by sports fishermen could find their way to someone's dinner table. Symptoms include stomach distress, and if the levels are high enough, brain damage and even death could occur.
In animals, domoic acid produces erratic behavior before death. Alfred Hitchcock's movie "The Birds" is said to have been inspired by one particularly severe proliferation of the toxin. It is thought that the organism that produces the poison only does so under certain conditions which are not yet understood.8
Bad Acetaminophen Kills 51 Children
The British Medical Journal9 reports that an epidemic of kidney failure has been traced to an over-the-counter preparation of acetaminophen. Over 300 children were affected, 51 of them dying from the drug. It was found that a manufacturer, "trying to save money,"10 substituted diethylene glycol for the more accepted propylene glycol. Diethylene glycol has been banned for use in drugs in the United States, but it can still be found in different preparations in a number of countries. Recently in Nigeria, manufacturers unknowingly used the chemical, which had been substituted by a wholesaler, to prepare a batch of acetaminophen that resulted in 73 deaths.11
Surgeon out to Lunch
Ever forget you left a patient on the adjusting table? One brain surgeon in North Carolina is being sued for something, well, maybe not quite exactly like that. The lawsuit charges that the doctor suddenly left the patient in the operating room with her skull open and brain exposed. No other doctors were in attendance. Operation room personnel searched for 25 minutes before they found the doctor in another part of the hospital having a snack. When the doctor finally returned, the suit contends he did not bother to disinfect or put on sterile clothing. The patient is said to have suffered a permanent injury from infection.
The doctor no longer practices at that hospital.12
Post-Partum Blues Impact Baby Boys
In a study reported in New Scientist magazine, a British psychiatrist reports that boys, but not girls, are susceptible to their mother's moods shortly after birth. Dr. Deborah Sharp found that about one third of the women she surveyed exhibited depression shortly after giving birth. Testing the offspring at four years old, she found that the boys from the depressed mothers scored significantly lower on I.Q. tests than any of the other groups. The study involved 250 mothers and their children.13
Hospital Medication Errors Prevalent
According to the leader of a Harvard research group investigating prescription drug errors at hospitals, "Supermarkets track mayonnaise more carefully than some hospitals track morphine."14 The group found a large number of drug prescription and dosing errors at two prominent Boston hospitals in a study published in the Journal of the American Medical Association.15 The largest group of errors were by physicians who prescribed improper doses or a drug to which the patient was allergic. One example is a doctor who prescribed one gram of medication when he meant one milligram. The episodes ranged from being caught before damage was done to creating life-threatening complications. Another study published in the same journal finds that one out of every 15 patients at the same hospitals suffered complications from correctly prescribed medications.
Naps Improve Productivity
The Association of Professional Sleep Societies says that our normal circadian rhythm includes sleepiness at 2 or 3 in the afternoon. Reports have shown that naps benefit night-shift workers, and a study by the National Institute for Occupational Safety and Health finds that a siesta makes the average worker more alert and improves performance.16
Vitamin A in Greens No Good?
A study published in the July 8th issue of The Lancet seems to contradict a widely held belief that increased consumption of dark-green, leafy vegetables will improve a vitamin A deficiency. Researchers supplemented vitamin A deficient women's diets daily with one of three items: a vegetable stir-fry dish, a vitamin A enriched wafer, and a placebo. The women, who were breastfeeding, donated samples of blood and breast milk for analysis. The stir-fry and placebo groups showed no improvement, while the enriched-wafer group had higher vitamin A levels in both fluids. Other studies to check these results are sure to follow.
- According to Dr. Mark Hlatky, one of the co-authors in the study published in the June 28, 1995 issue of JAMA.
- The Lancet, July 1, 1995.
- Charles Wright of Vancouver Hospital and Barbara Meuller of McMaster University.
- The Lancet, July 1, 1995.
- Associated Press, July 10, 1995 "MDs Debate Polio Vaccine."
- Brain Research Bulletin, July 1985.
- Pediatrics, July 1995.
- Research was done by the University of California, Santa Cruz, and funded by the California Sea Grant in response to a massive kill in 1991.
- BMJ, July 8, 1995.
- Dr. Michael Bennish, investigator and Professor at Tufts University in Boston.
- Investigated by Dr. Richard Spiegal of the U.S. Centers for Disease Control.
- United Press Story, July 6, 1995: "Doctor Left Brain Surgery Patient."
- Reuter, July 6, 1995.
- Associated Press, July 5, 1995.
- JAMA, July 5, 1995.
- United Press, July 4, 1995 "Naps at Work can be Beneficial."
Brian Sutton, DC
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