Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts

Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman) Review

Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman)
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Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman) ReviewIf you want to save yourself from being labeled with a disease you don't have and take medications you don't need, then you must read this book.
Worried Sick is a follow up to Dr. Hadler's The Last Well Person. It has updated research information and written for the public at large. In this book, Dr. Hadler examines many of the common diagnoses and treatments and questions their validity and scientific basis. He shows clearly that many of them are not founded based on science, and that treatments are of questionable value, and possibly harmful.
Here is a brief overview but you really need to read the book for the whole story.
1- Heart bypass surgery and angioplasty: Dr. Hadler explains how bypass surgery has not been shown to be of any use. In fact, some patients whose chests were simply opened and closed had similar improvements in their level of pain after the surgery. However, those who had the surgery experiencing dementia (40%) and difficulty returning back to their regular jobs. Although, the efficacy of this treatment has never been proven, it and angioplasty continues to account for 500,000 procedures a year in the US.
2- Type 2 diabetes: He mentions that increase blood glucose level is an expected part of aging, and the effort to regulate blood sugar with medication has shown no effect in terms of preventing damage to the eyes or kidneys or preventing heart disease or stroke. In fact, ten years of intensive therapy offered no real advantage to 1000 middle aged hyperglycemic (high blood glucose level) people. So, why would anyone want
to be on therapy and suffer the side effects of medications that have no real benefits? He says changes in diet, weight loss, and exercise have are a much better approach. Also what is considered a high blood glucose level? Those levels are set by committees, not necessarily based on scientific medicine, but many times based on influence by pharmaceutical companies.
3. Hypertension: Dr. Hadler also points out that high blood pressure is another area where science has not proven that by lowering the mild high blood pressure one can really make a difference in preventing heart disease or damage to organs. He recommends for people who have diabetes and hypertension and are elderly to be treated, if regular exercise, weight loss, and diet modifications do not help. But, to be focused on keeping the blood pressure at 120/80 and getting medication to those who are 140/90 and higher, and who have no symptoms and are feeling well, is not supported by research. One thing research has shown is that a cheap first generation diuretic works just as well as the latest and very expensive anti-hypertension drugs.
4. Ruptured disc: He points out that the concept of ruptured disc as cause of back and leg pain was proposed some 70 years ago and should have remained there. There is no evidence that a ruptured disc causes any harm. All the spinal changes due to age detected in an MRI or CT scan are normal. Some 200 randomized studies clearly show that all the treatments ranging from spinal manipulation, shots, and surgeries are of no benefit. All studies have shown that patients who refused treatment recovered as well or better than those who were treated. He recommends taking Tylenol for the pain and discomfort and getting back into one's regular routine and job.
4. Knee and shoulder pain: he also points out that knee pain is of the same case. The current diagnoses, such as a torn meniscus or torn rotator cuff, and treatments are of no value, and perhaps the solution is to take some Tylenol fro the pain and keep going until the individual recovers, whether it's back or knee pain.
5. HRT therapy for post menopausal women: here is another area which is touted as a way of preventing heart disease and osteoporosis in women. He points out that not only this has failed, but the equipment they use for testing is not accurate most of the time, and that the medications used for it don't really work. Exercise is a better alternative. Also hip replacement surgery could easily be replaced with pinning the hip,
which is less costly with a faster recovery rate.
6- Cancer screening: Like Dr. Welch, author of Do I Need to Be Tested for Cancer, he too finds no scientific basis that screening well people for cancer has any benefit. He calls it, "looking for a very small needle in a big hay stack."
There is much more in the book that you need to read for yourself, and I highly recommend that you do. I used to trust my doctor and the medical system until I began to have back pain. Due to improper diagnoses and treatments I developed pain in my neck, legs, arms, hands, and became completely disabled. That's when I realized I needed to take charge of my own health. This is where physician and health educators like Dr. Hadler provide a great service. By the way, he is also a consultant to ABC News. You can watch his commentaries and read his writing at ABC News website.Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman) Overview

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Why We Get Sick: The New Science of Darwinian Medicine Review

Why We Get Sick: The New Science of Darwinian Medicine
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Why We Get Sick: The New Science of Darwinian Medicine ReviewThis is a very readable book and an excellent introduction to a subject that has hitherto been sorely neglected. The main argument presented by Nesse and Williams is that disease must be understood from the perspective of evolutionary biology.
The authors begin by asking, "Why, in a body of such exquisite design, are there a thousand flaws and frailties that make us vulnerable to disease?" Through evidence and insights from evolutionary biology, the authors carefully give a detailed answer to this question, which might be summed up thus: The mechanism of evolution fits our bodies for reproduction, not for optimum health. Furthermore the mechanism is imperfect and subject to mutation. Additionally we are in competition with other organisms, e.g, viruses, bacteria, etc., that work toward their fitness, sometimes at our expense (the parasite-prey "arms race"). Noteworthy is the idea that natural selection cares little for the maintenance of the organism after the age of reproduction, and that sexual reproduction actually fosters mechanisms that increase the fitness of youth while neglecting the aged, leading to the phenomena of senescence and death.
Seeing disease from the viewpoint of evolution, the authors argue, helps us to understand disease and the mechanisms involved, which in turn can help us to fight disease. Allergy, for example, is a disease characterized by an over active immune system. Copious amounts of histamine are produced to fight off a few molecules of pollen. Why? The authors make the point that our immune systems operate on the principle that better an overreaction to something harmless than an under reaction to a real threat. It's like jumping at the sight of a piece of rope lying on the ground. It's not a snake, but better this little harmless error than being too slow to get back from the real thing.
Some other interesting ideas: Fever has a purpose. It raises body temperature enough to interfere with the chemistry of some pathogens, thereby killing them. If we take medicines that reduce fever, are we prolonging our illness? In some cases, the authors answer, yes. If we take medicines that suppress coughs and sneezing can that also prolong our illness? Again the answer is in some cases, yes. The point is that in treating the symptoms of disease we need to make a distinction between which are defensive mechanism of our bodies and which are not. Some pathogens, for example, make us sneeze or cause diarrhea in order to better spread themselves to the next victim. The rabies virus makes a dog bite other animals in order to spread itself. But our bodies cause us to cough and sneeze primarily to expel pathogens.
The authors see some of our health problems as the result of genetic "quirks," or evolutionary hangovers. Dyslexia is an example. In the Environment of Evolutionary Adaptation back in the Stone Age, dyslexia was no problem because there were no books to read. Indeed, it might be that the dyslexic approach to some perception problems, is better than the "normal" one, allowing a quicker, better understanding of the objects being viewed. Other genetic quirks include our predisposition to eat too much fat when available because in the EEA there was precious little fat to be had so it made sense to eat as much as possible when it was available. Something similar can be said of alcohol. Before agriculture, and especially before the process of distillation, a predisposition to alcoholism was no danger because there was very little alcohol to be had. These "quirks" are examples of disease caused by "novel environments," much of the modern world being a novel environment to our Stone Age bodies.
Nesse and Williams show that the modern environment, which requires a lot of close work from all of us, especially the reading of books, is the cause of the epidemic of myopia that modern humans experience. I would like to add that it is possible that myopia under some conditions could be adaptive. In the rainforest it would probably be better to see well close at hand than far away (the opposite of what would be valuable on the savannah). Also those people who concentrated on things small and up close might well identify and process food sources overlooked by others.
While this is an excellent book, gracefully written and full of valuable information and insight, it is now a little dated (copyright 1994), and some of the ideas need reworking in light of recent discoveries. For example, while the authors discuss the ill effects of too much fat and sugar in our diets, they say nothing about the carbohydrate intolerance that leads to obesity. This too can be seen as an evolutionary quirk since there were no cultivated fields of amber grain in the prehistory, and the grains that were available were small and required a lot of hand processing so that it was very difficult to overindulge. Consequently there was no need for natural selection to evolve a protection against eating too much. Also their discussion of heart disease and how it is the result of genetic factors and faulty diet fails to mention the idea that heart disease might be caused by a bacteria. (See for example, Plague Time: How Stealth Infections Cause Cancers, Heart Disease, and other Deadly Ailments (2000) by Paul W. Ewald.)
All things considered, though, this is a classic of evolutionary literature, nicely presented to a nonspecialist, but educated public. Now if we can only get the doctors to read it!Why We Get Sick: The New Science of Darwinian Medicine Overview

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Infections and Inequalities: The Modern Plagues, Updated with a new preface Review

Infections and Inequalities: The Modern Plagues, Updated with a new preface
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Infections and Inequalities: The Modern Plagues, Updated with a new preface ReviewFinally Dr. Farmer couples his lucid historical, political and economic analyses of the conditions that put the poor at risk for bad health outcomes, with a plainly indignant calling out of healthcare professionals and healthcare organizations to make honest efforts to understand and remedy conditions which would never be tolerated among the well off in Western nations. In his goundbreaking, earlier books, "AIDS and Accusations," and "The Uses of Haiti," Dr. Farmer matter of factly discusses the global and local structural conditions and misrepresentations which led to the spread of disease and persistent, dismal health conditions in Haiti. In "Infections and Inequality," Dr. Farmer adds moral overtones to incisive, sociopolitical analysis and his characteristic accounts of individuals suffering from disease. The book consequently provides a powerful reflection from a man who has worked in some of the world's poorest regions on what the benefits of medical technology mean for people who have not traditionally had access to them. A powerful, informative read that clearly reflects the years of experience of a physician who has wrestled with the global responsibility of caring for the those who are worst off. An obligatory read for anyone even thinking of working for the impoverished of the world.Infections and Inequalities: The Modern Plagues, Updated with a new preface Overview

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The Nazi Doctors: Medical Killing And The Psychology Of Genocide Review

The Nazi Doctors: Medical Killing And The Psychology Of Genocide
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The Nazi Doctors: Medical Killing And The Psychology Of Genocide ReviewThis book explores the question of how doctors, who are sworn to do no harm, became the integral organizers and managers of the Nazi death camps. Through exhaustive interviews with these doctors, people who knew them, and camp survivors, Lifton arrives at more than just individual psychological profiles of these professional killers. He presents us rather with a dense, psychosocial exploration of the dynamics of state-organized terror, along with enough history to describe the milieu in which these dynamics evolved. (Many people will be surprised to discover that the eugenics movement, which fueled the Nazi terror, had a large following in the United States during the 1930's.)
The book reads like a novel in parts (especially the chapter on Josef Mengele). However, I found the introduction one of the most interesting sections; in it Lifton describes the process he went through to gather and analyze his data. This included interviewing ex-Nazi doctors, who suspected or knew outright that Lifton himself is Jewish. Lifton's descriptions of the verbal dances he and these doctors did around the German/Jewish conflict are fascinating.....For obvious reasons this book is not an "easy read," despite the quality of the writing. It will literally give you bad dreams. But it serves to instruct us about demons which still inhabit the collective human psyche, demons which we fail to acknowledge only at our peril. For this reason, if no other, it demands our attention.The Nazi Doctors: Medical Killing And The Psychology Of Genocide Overview

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House and Philosophy: Everybody Lies (The Blackwell Philosophy and Pop Culture Series) Review

House and Philosophy: Everybody Lies (The Blackwell Philosophy and Pop Culture Series)
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House and Philosophy: Everybody Lies (The Blackwell Philosophy and Pop Culture Series) ReviewI'm a big fan of the various series of books on philosophy and popular culture. (There are three such series that I'm aware of: "Popular Culture and Philosophy" from Open Court Publishing, the "Blackwell Philosophy and Pop Culture Series" from Wiley, and "The Philosophy of Popular Culture" from The University of Kentucky.) All of these series use popular culture -- TV shows, movies, music, popular books, sports, fads, etc. -- to illustrate important issues in philosophy and ethics. I have read several of the books in these series, and have been very impressed with all of them. I especially enjoyed reading "House and Philosophy: Everybody Lies" (which is part of the Blackwell Philosophy and Pop Culture Series). As a lifelong student of philosophy, and a huge fan of the TV series "House, M.D.", I had to get this book.
"House, M.D." is a show about Dr. Gregory House, a brilliant but misanthropic diagnostician with a razor sharp wit and a contemptuous disregard for the feelings of others. House has little use for hospital rules or medical ethics. He openly rebels against any form of authority that would attempt to interfere with his ability to do what he thinks is best. He abuses his staff, insults his patients, manipulates his friends, alienates everyone who cares about him, ridicules anyone who disagrees with him, and takes pleasure in making others as miserable as he is. He is an unrepentant drug addict, a heavy drinker, and a frequent client of prostitutes. He is a militant atheist with nothing but contempt for religion and conventional morality. He will not hesitate to break the law or violate other people's rights in order to get what he wants. He can be brutally honest or a boldfaced liar, depending on his mood and his motives. House is basically a sociopath. He also saves lives. He does it by solving medical mysteries that completely baffle other doctors. Although he doesn't really care about his patients as human beings, he is an obsessive puzzle solver; and he will not rest until he has figured out what is wrong and how to treat it. You wouldn't want House as your family doctor. But, if you were dying of a mysterious illness, you would definitely want House on the case.
As you might imagine, this show raises a number of fascinating ethical and philosophical issues. Many of these issues are explored in this wonderful book: "House and Philosophy: Everybody Lies". One thing I really like about the essays in this book is that they are very well written and accessible, even to someone with no background in philosophy or medical ethics. Some of the other philosophy and popular culture books I have read have included essays that dealt with fairly esoteric philosophical issues, and would be more suitable for readers who have a fairly strong background in philosophy. But this book avoids that. I think that anyone who is a fan of "House, M.D." will find this book engaging, entertaining, enlightening, and easy to follow, even if they've never taken a single class in philosophy or ethics.
One caveat though: While you don't have to have a background in philosophy in order to understand and enjoy this book, you do need to have at least a basic familiarity with the TV show "House, M.D." -- its premise, its characters, the overall story arc, etc. If you're new to the show, then you may want to wait until you've watched at least the first three seasons before you try to tackle this book. (Note that the book deals mainly with themes from the first three seasons of the show; though there are a few references to events from the early episodes of the fourth season.) I would highly recommend this book for all "House, M.D." fans -- especially those with an interest in philosophy and ethics.House and Philosophy: Everybody Lies (The Blackwell Philosophy and Pop Culture Series) Overview

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The Innovator's Prescription: A Disruptive Solution for Health Care Review

The Innovator's Prescription: A Disruptive Solution for Health Care
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The Innovator's Prescription: A Disruptive Solution for Health Care ReviewIt is a commonplace that the U.S. healthcare system is broken, but the discussion often degenerates into a debate about who is responsible. This book takes a different approach, focusing on what is wrong with the healthcare system and needs to change so it can work better.
The proposed solution is to discard the current fee for healthcare service model, in which healthcare providers are systematically paid to treat illness without recompense for fostering welfare, and create a three-track system:
(1)Fee for service would continue to apply to diagnostic services, where - due to the nature of the patient's condition and the state of medical knowledge - there is a high need for intuitive investigation versus results-based treatment for conditions that are well understood. (The process described brings to mind episodes of House, a TV show in which a brilliant but irascible doctor challenges a team of colleagues to find the problem before the patient dies.)
(2) Fee for result would apply for treating conditions that are well understood and have a clearly defined solution -- colonoscopies, laser eye surgery, implantation of stents, etc.
(3)User networks for patients with chronic conditions/ unhealthy practices to learn how they can help themselves and be motivated to do so.
As is pointed out again and again, disruptive changes will be needed to get from A to B. Thus, hospitals must be redirected to focus on diagnostic services and cede provision of standardized care and wellness coordination to specialized clinics and other agencies. Primary care physicians (the traditional "family doctor") should concentrate on diagnostic services at a lower level rather than acting as "gatekeepers" for referrals to specialists. Enabling changes in reimbursement rules, health insurance arrangements, and medical record keeping are spelled out in detail.
When the dust settles, there will be fewer hospitals (with the survivors focused on enhanced diagnosis, like the Mayo Clinic), fewer medical specialists (who currently operate in narrow niches, often without a full grasp of a patient's situation), more primary care physicians and nurses with augmented responsibilities, a new model for pharmaceutical companies that focuses on targeted medications for precisely defined conditions versus the development and marketing of "blockbuster" drugs that only help a fraction of the users and require enormously expensive mass clinical trials, and a lot of medical work performed by less highly trained personnel with better diagnostic tools.
Andy Kessler presented an analogous vision in "The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor," Harper Collins (2006). His book is very entertaining, but this one covers the ground in a more disciplined and comprehensive manner. I would recommend "The Innovator's Prescription" for anyone who is seriously concerned about the current healthcare system.
Doctors, hospitals, and other healthcare providers cannot make the needed changes on their own, because they do not control all the levers. Having the government take the lead is said to be problematic, for reasons that are dispassionately stated and I happen to agree with. The authors suggest that the best candidate entities for leading the transition to healthcare in the new mode might be employers that profit from the good health of their employees. Then there is the intriguing possibility of expanding the role of integrated healthcare providers,e.g., Kaiser Permanente.
Let's hope our country chooses the right path.The Innovator's Prescription: A Disruptive Solution for Health Care Overview

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Kaplan Medical USMLE Master the Boards Step 3 (Kaplan USMLE Master the Boards: Step 3) Review

Kaplan Medical USMLE Master the Boards Step 3 (Kaplan USMLE Master the Boards: Step 3)
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Kaplan Medical USMLE Master the Boards Step 3 (Kaplan USMLE Master the Boards: Step 3) ReviewI have gone through pretty much all of the step 3 review books in the market including FA, Crush step 3, the nail the board, Board and ward, and Strong Medicine. I also have read the Kaplan Q book step 3
This volume surpass all of the above in terms of the quality of content, amount of fine detail, board relevancy, and the author's unique insights into the material as a good teacher himself.
He tend to shed a lot of good insight into the board questions. I had met him once in person when I was a medical student at the FHMC in Queens, NY.
But this book is not perfect (There is no such thing as a perfect board review book, we all know it). I wish there are more complete index, which is pretty bad and too brief. It takes some time to find a topic with "rushed out" kind of index.
Also, there are a few errors. It says that Mitral valve prolapse with even regurgitaion does not need endocarditis Prophylaxis but I have been able to verify with a few medical references including Harrison-the recent update- and Washington manual that MR with regurgitation needs prophylaxis.
the author boldly claims that there is no prophylatic therapy for cluster headache with some rather unconvincing logic, but I have read from several respectful sources that beta blockade or Calcium channel blockade must be given for prophylatic RX for cluster HA.
I also found this misleading information about ASCUS in Pap smear results. It says that if pap results in ASUC, the patient need HPV testing, But it does not mention the important fact that if the patient is a high risk group, ASUCS must mandate immediate Colposcopy biopsy.
Other shortcoming is the Leukemia section, which he almost neglect to cover the important facts about ALL and AML but throw in very vague mixed information under title "Acute leukemia".
Other than the index, it is a decent volume and very reasonable priced. I would not recommend it as a sole review source though. Step 3 seem to ask the understanding of the concepts and application of the further managements contrast to the step 2 which is more of recognition of the key words and classic signs. Thus I reject this book's so called Guarantee passing score Claim....I highly recommend a second review book beside this for a better performance on step 3.It is really unreasonable to claim that this book has "everthing" to do pass step 3. I never recommend Strong Medicine, which is consistent of skeletal bullet list of the information without no actual bread and butter for each disease presentation. This book fails to demonstrate the competency and confidence of the material presented with a fair amount of wrong information as well.
FA is also not recommended since its missing out too many topics and is also very boring to read with little insights. I only use the 100 CCS cases on the back of this book. Board and Ward is not recommended as well since its too basic to tackle the step 3 questions, which tend to ask much more in dept understanding and managements than mere factual key words, which is what is all about Board and Ward. It was useful for step 2 though and NBME Shelf exams.
PS: I passed the step 3 with 217/91%,(October 2010) which I have to give a lot of credit toward this great book. Peace after the agony of waiting for the score, which sent to me via a lengthy email @ 12 PM, midnight third wednesday. Yet the matching process is yet to be known. Career in medicine consumes my soul and the person itself. Prayers for all.Kaplan Medical USMLE Master the Boards Step 3 (Kaplan USMLE Master the Boards: Step 3) Overview

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In the Land of Invisible Women: A Female Doctor's Journey in the Saudi Kingdom Review

In the Land of Invisible Women: A Female Doctor's Journey in the Saudi Kingdom
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In the Land of Invisible Women: A Female Doctor's Journey in the Saudi Kingdom ReviewI almost gave up on this book after just a few pages, frustrated by the sub-par writing and editing. Editing is one of those jobs that's invisible when done well. Not here.
But: I'm glad I kept reading. The substance of the book is compelling and important, and the author's perspective is sane and intelligent.
If you adjust your expectations of writing as art, you can enjoy and appreciate this book. I only wish it were dystopian fiction and not 21st century reality.In the Land of Invisible Women: A Female Doctor's Journey in the Saudi Kingdom Overview

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