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Thursday, June 12, 2014

Women Favoring Permanent Hair Removal Over Home Kits

Scorching summer weather and the call of the beach or the pool has many women considering their options for hair removal. Generally speaking, that means one of two things: waxing, which is a somewhat temporary fix, or laser removal, which has much longer-lasting results.

Since waxing can be done at home, women are sometimes inclined to go this route for the sake of convenience. Others prefer the longer-term solution. Most women who opt for permanent hair removal methods have made that decision based on several key factors.

Hair Removal Isn't Seasonal

While the bikini area sparks hair removal plans in the summer, many women have cosmetic needs that last year-round. A few rounds of temporary removal are no big deal for swimsuit season, but when women are working to shape eyebrows or keep clear skin around the lips or on the forearms, the weather is irrelevant.

They want those areas hair-free year-round. As a result, they decide that a single trip to their local center can take care of summer along with the other three seasons, greatly reducing the inconvenience of maintaining their appearance year-round.

There Are Different Kinds of Convenience

Social media is full of funny stories about home waxing mishaps, and there’s a good reason. It happens a lot. Attempting to do something like this to yourself with no experience and mediocre equipment, all performed with the rudimentary instructions that came folded up in the box, is a recipe for laughs at best and pain at worst.

The temptation to go this route is driven by either money or convenience. Women feel like a spontaneous weekend trip to the coast is more easily managed with a home kit, but they later find that the subsequent day at the pool, afternoon at the spa, or big date with the husband are sending them to the store time and again to buy another kit, resulting in another comedy of errors in the bathroom. Tired of all this hassle, many women just make an appointment and get something done once and for all.

There Are Different Kinds of Safe, Too

Other women harbor concerns about the safety of laser systems, thinking there could be permanent damage to their skin or their eyes if they seek out a laser treatment. While the image of a goggled technician zapping you with something that looks like a prop from “Star Wars” can be a little scary, the fact is that the devices are FDA-regulated and approved. So why is the worker taking such pains to protect herself? A good technician is closely watching each point of treatment with the laser. A day’s work doing that can be very bad for their eyes because they are looking directly at the affected area. The client, meanwhile, is comfortably facing away, and even if she’s watching, it’s only for a few minutes. Any work done on the face will involve eye protection for the client.

The point of reference from home is the awkward maneuvering of your body in the tub, on a stool, or wherever you choose to do it yourself. The twisting and contorting you do while trying to steadily handle the wax is a serious danger for burns and falls, two good ways to ruin your vacation.

What’s Your Threshold For Pain?

Again, laser removal generates some degree of fear among would-be recipients, because we can’t seem to shake that word “laser”. But the process doesn’t involve futuristic weaponry trained on your body, and it won’t blow a smoldering hole through you. Keep in mind that you probably know a dozen people who have undergone laser eye surgery. Eye surgery! Lasers, for all the sci-fi fantasy we’ve seen or read in our lifetimes, are not painful, they aren’t destructive, and they are in the hands of skilled people. Most women who give laser treatment a chance now measure that as a polar opposite to the results they saw from their escapades with a popsicle stick, a pot of hot wax, and a foot up on the vanity.

Results, Results, Results

Ultimately, that’s what women are searching for. They are willing to pay good money for good results. Shaving, home wax, and all the other alternatives ultimately don’t produce the great look, lasting results, and ease of permanent removal with a laser system. That conclusion is what’s driving the proliferation of such salons, making the procedure ever more affordable and convenient for consumers in almost any location.

This is a post by Nancy Evans.

Tuesday, May 27, 2014

The Health Benefits Associated With Massage Therapy

Massage therapy has long since been considered a luxury therapy: one designed to soothe, but not provide any substantial health benefits. However, in recent years, it is becoming more and more common to see massage therapy being practiced in hospitals, clinics and other medical establishments.

The reason for this influx is due to the many advantages for the body associated with this specific treatment. In fact, massage therapy has been shown to improve symptoms in a number of conditions, as well as promote overall healing while simultaneously preventing healing complications.

The word "massage" is a general term for rubbing, kneading, pressing or otherwise manipulating the skin, muscles and underlying tissues. Depending on the type of massage, as well as on the practitioner, pressure and targeted areas can vary. Typically, a massage involves the use of a specialized massage table and on occasion creams and oils specifically for the targeted massage. Sites like Massage Table Outlet have these available for you if you feel that you could benefit from massage therapy.  Here is a list of physical ailments that have shown improvement when treated by massage.

1. Anxiety

Massage and tissue manipulation have been shown to reduce certain symptoms of anxiety, including insomnia, restlessness, headache, pain in the joints and muscles, nausea, loss of appetite and more.

2. Stress

Like anxiety, stress is often approached with massage therapy. Since massage can relieve stress, it may also play a role in treating and preventing complications like high blood pressure, insomnia, headache, weight gain and more.

3. Digestive Disorders

In patients with IBS, chronic constipation and other digestive disorders, massage can provide relief and stimulate healthy digestive function.

4. Fibromyalgia

The widespread pain associated with fibromyalgia is often treated through tissue manipulation. Deep-tissue massage has been shown to increase the brain's production of "feel good" chemicals called endorphins, which can reduce pain, fatigue and other symptoms of fibromyalgia.

5. TMJ

TMJ disorders can be extremely painful, and can also interfere with eating, speaking, sleeping and other aspects of everyday life. However, facial massage can help ease pain and tension, thus improving quality of life for sufferers of TMJ.

6. Injuries

Sprained ankles, broken bones, injuries to the muscles or joints are commonly treated with massage. In addition to relieving pain and discomfort, tissue manipulation has been shown to promote healing, which can result in quicker, healthier recoveries.

7. Migraine

Migraine headaches can be extremely painful and, in some cases, debilitating. And since tension often plays a role in the development of migraine headaches, massage is a great way to reduce pain and prevent flare-ups.

8. Spinal Misalignment

Spinal misalignment is associated with dysfunction or misalignment of the vertebra, or bones of the spinal column. This condition can lead to pressure on the nerves, discs or soft tissues of the spine, which often results in pain, numbness, tingling and other uncomfortable effects. Massage can be used to correct spinal misalignment, as certain techniques are designed to safely and effectively guide the vertebra back into place.

In conclusion, massage therapy can provide significant benefits for individuals suffering from various illnesses and complications with their health. Speak to a doctor to see if massage is right for you!

This is a post by Nancy Evans.

Friday, May 23, 2014

Is There Any Treatment For Optic Nerve Atrophy?

Optic Nerve Atrophy results from damage or degeneration to the optic nerve. The nerve is responsible for transporting visual information from the eye to the visual center of the brain for processing. The visual cortex of the brain then interprets the signals produced by the retina light stimulation through the optic nerve as visual images.

Signs & symptoms

Some of the leading symptoms of optic nerve atrophy include:

•  Reduced brightness of one eye

•  Decrease in side vision (peripheral vision), contrast sensitivity, sharpness, and/or clarity of vision (visual activity)

•  Optic disc changes

•  Degree of color vision impairment

•  Decreased pupil reaction to the light

•  Loss of retina ability to see fine detail

Individuals facing one or more of these symptoms may not necessarily mean they have optic nerve atrophy, but seeing an ophthalmologist is strongly recommended for a complete assessment.

What causes optic nerve atrophy?

This condition can occur without a proven cause, but the following are the known causes that may lead to optic atrophy:

Hereditary eye disease: this disease mostly occurs in the early 20s or late teens. It is diagnosed by the development of painless, but serious visual loss in one eye, followed by the same impairment in the other eye.

Sight swelling is normally experienced in the beginning, but eventually the optic nerve atrophied leads to permanent vision loss in most instances.

Inflammation of the optic nerve: eye pain which becomes severe upon the movement of the eye. Inflammation may cause optic neuritis in women young to middle-age. Some individuals suffering this condition may develop multiple sclerosis with age.

Nutritional deficiencies: this may be caused by vitamin deficiencies, vitamin B group deficiencies in particular. These deficiencies could result from a poor diet, frequent starvation, problems with absorption or alcoholism. Usually vitamin B12 deficiency is the leading cause of nerve damage. According to glaucoma.org, this condition is accountable for 90% of glaucoma cases. It develops slowly and has symptoms and damage that may not be noticed in the early stages.

Toxins and poisons: may cause optic neuropathy. The condition results from tobacco or alcohol amblyopia, which is known to be caused by cyanide exposure from smoking tobacco, and by vitamin B12 deficiency. Exposure to lead, carbon monoxide, moonshine (methyl alcohol) and antifreeze (ethylene glycol) may also lead to optic neuropathy.

Treatment options

Optic nerve atrophy info from Natural Eye Care explains that, at the moment, there isn’t any effective treatment for this condition. This is because the nerve fibers in the optic nerve never heal or grow again once they are lost. The best defense is an early diagnosis because detection of the root cause can prevent further damage. 

For example, if increased fluid pressure around the spinal cord and the brain is detected early and reduced, it may prevent further damage. A specialist may prescribe spectacles to correct refractive error, and tinted lenses may keep visual function healthy.

Studies

There is no specific research on this condition, but there are studies on nutrients like zeaxanthin, lutein and bilberry that have been found to have a positive effect on the health of the optic nerve. There are some studies going on about the transplantation of limbal stem cells from a healthy eye, which can repair the patient’s cornea and give back sight, according to a research report. But most of these studies are still in the early stages.

This is a post by Nancy Evans.

Thursday, May 22, 2014

How to Help a Drug Addict

Drug addiction is unfortunately a very real and serious problem in our society today. Whether it be alcohol, prescription medication or illegal substances, the reality is that we will encounter at least one person in our lives who is battling with a drug addiction of sorts.

One thing we all wish we could do is help our friends and loved ones in these times of need, offering help, support and treatment in order to get them back on track. This can be intimidating and overwhelming if you don’t know where to start.

Initially, everyone thinks of rehab and the sort of shows like Celebrity Rehab which people often turn to, when seeking help and recovery. However there are many other things which can be done to help a drug addict which can both complement and in some cases be employed instead of rehab.

Signs/Symptoms

The first step in helping a drug addict is spotting the signs. These can be different from person to person and vary depending on which substance they use, but ultimately they are the initial step in recognizing that somebody may have a problem.

Common physical signs of addiction to drugs include a decline in physical appearance and grooming, sudden weight loss or gain, dilated pupils and bad dental hygiene. Of course not all symptoms will be purely physical, and sometimes may not even present in this way at all.

There are other behavioral signs to consider here too. An addict’s problem is all-consuming, almost completely taking over their lives. Often, finding the next high becomes the most important thing in that person’s life, and they will do anything to get it. This is where you may notice a change in behaviors such as skipping work or school commitments, neglecting family life and friends, and becoming withdrawn or distant.

In addition to this forgetful, blasé and uncaring attitude, other behavioral signs may come into play helping you to recognize addiction. For instance if the addict is suffering financially, he or she might result to stealing to fund their habit, or carry out violent threats, actions or blackmail in order to lead them to their next high.

Of course these behaviors and appearances are not exclusive, but are the most common displays of symptoms that someone is a drug addict.

Show Compassion

Sometimes this can be the most difficult thing to do if you have just learned that somebody close to you has a drug habit, but it is one of the best things you can do in this situation. Try not to become angry, sad or show signs of hurt, and where possible avoid any conflict with the addict.

Addicts can become easily angry and are often irrational, especially whilst under the influence of their chosen drug. The key is not to upset  them or creating a situation which makes the addict feel uncomfortable, threatened or undermined. Don’t be confrontational – if you can, be comforting, understanding and offer support.

Seek Treatment

After you have spoken to the addict about their problem, and both recognized together that help is needed, the next step in the process is to seek treatment.

Sometimes, if an addict is reluctant to recognize that they have a problem, or does not want to seek help, an intervention may be more appropriate at this stage. There are plenty of intervention specialists who can help you plan this and work out how to approach the situation, who should be involved, what needs to be said and so forth.

If, however, that stage was not necessary and your friend or loved one has reached out to seek help, you will need to go through the range of treatment options available. This can of course vary depending on the addictive substance, and how bad the addiction itself is.

Sometimes, an addict may benefit from attending therapy sessions, and attending anonymous group meetings periodically. It can also help if they have a sponsor to lean on and relate to, in order to help them recover. This can quite often be the help process employed for alcohol addicts, but again the level of addiction, substance consumed and impact on the person’s life has to be taken into account here.

Usually, the logical treatment process is to enter a rehabilitation center which will keep patients in the facility for a minimum period of time, allowing the patient to detox, learn, talk and recover. Again in these situations, programs can vary dependent on the addiction in question, though it is possible in some cases and in some facilities, to enroll in a program which combats multiple addictions.

It can be a bit of a tough choice searching through programs and facilities at different centers to decide on the best appropriate treatment, especially if you have never had any dealings with such facilities before.

Hopefully this list of how to help a drug addict proves useful to you, in the instance that you ever need to approach a friend or loved one about an addiction, and look to seek them some help.

This post is by Timothy Lon.

Thursday, April 24, 2014

10 Recent Inspirational Cancer (and Other) Survival Stories

Recently, a 15-year-old boy survived as a stowaway in a wheel well during a 5-hour flight from California to Hawaii, despite being exposed to subzero temperatures and oxygen depletion. Here are 10 other recent inspirational cases of improbable survival based on a review of published scientific data.

These cases show that one should never give up no matter what the diagnosis is. Be sure to send this to any friends or family with serious medical problems for inspiration. The numbers of the references below correspond to the numbers of the cases cited. Links to the free articles are provided when available.

FEATURED BOOK: The Cancer Survivor's Companion

1. BREAST CANCER: A 55-year-old woman with recurrent breast cancer survived long-term (about 5 years) after developing abnormal fluid and pressure buildup around the heart due to inflammation of the sac-like covering around the heart, which was caused by the spread of cancer cells there. Such long-term survival is usually rare. A surgical procedure that created an opening to drain the fluid around the heart likely helped extend her life.

2. MENINGITIS: A 6-year-old boy survived a battle with a rare and more than 95% fatal form of meningitis caused by an amoeba (Naegleria fowleri ). He received immediate treatment, which is believed to central to saving his life. He was discharged home in 3 weeks.

3. MALE REPRODUCTIVE CANCER: A 45-year-old man survived a rare form of blood vessel cancer in the reproductive system after receiving chemotherapy, radiation, and surgery. He has been cancer-free for 6 years since therapy ended, the longest ever reported. The multi-modal therapy was considered to be a factor in his survival.

4. STOMACH CANCER: An 84-year-old man with advanced stomach cancer that spread to the liver and lymph nodes achieved long-term progression-free survival with a new individualized treatment approach: use of Avastin (which slows the growth of new blood vessels that feed tumors) combined with low-dose S-1 (chemotherapy).

5. NO LIVER FUNCTION: A 66-year-old man survived after 66 hours (odd coincidence) of no liver functioning due to severe bleeding complications during a liver transplant while awaiting a second suitable donor organ.  There were no known neurological complications, which is also unusual.

6. INTESTINAL CANCER: A 45-year-old man with a rare form of recurrent cancer of the small intestine has been disease free after 8 years following surgery and multiple forms of chemotherapy.

7. MULTIPLE ORGAN SYSTEM DYSFUNCTION (MODS): A 55-year-old man is the oldest man known to survive MODS, which is the leading cause of death in intensive care units. Prognostic indicators indicated certain death in his case yet he survived, recovering almost all organ function after 6 weeks. He had developed MODS after suffering a stroke.

8. THYMUS CANCER: A 73-year-old man with a rare form of cancer of the thymus obtained long-term (greater than 4 years) of progression free survival and good quality of life. The thymus is an organ located in the upper part of the chest and is very important in producing substances that protect the body against disease. The patient achieved his long-term survival after treatment with S-1 when first-line chemotherapy and radiation failed.

9. MULTIPLE BRAIN TUMORS: A 51-year-old woman survived for three years after developing two different types of brain tumors at once: glioblastoma and meningioma. This is the first known case of its kind to have survived this long.

10. HEART ATTACK AND HYPOTHERMIA: A 65-year-old woman survived without any problems after suffering a heart attack from deep accidental hypothermia.

References:

1. Ikeda H, Kikawa Y, Nakamoto Y, Takeo M, Yamamoto M. (2013). A patient with recurrent breast cancer showing long-term survival after developing pericardial effusion and cardiac tamponade caused by carcinomatous pericarditis. Breast Care (Basel). 8(1):71-3. Free article here.

2. Sood A, Chauhan S, Chandel L, Jaryal SC. (2014). Prompt diagnosis and extraordinary survival from Naegleria fowleri meningitis: A rare case report. Indian J Med Microbiol. 32(2):193-6. Free article here.

3. Chang K, Sio TT, Chandan VS, Iott MJ, Hallemeier CL. (2014). Angiosarcoma of the seminal vesicle: a case report of long-term survival following multimodality therapy.Rare Tumors.6(1):5202. Free article here.

4. Fang J, Wang H, Xu Q. (2013). Bevacizumab combined with low-dose S-1 as maintenance therapy with a long progression-free survival in an elderly patient with heavily pre-treated advanced gastric cancer: A case report. Biomed Rep. (2):239-242. Free article here.

5. Photi E, Crawford M, Pulitano C. (2014). Long-term survival after 66 hours of anhepatic time with no neurological deficit. Ann Transplant. 19:93-5.

6. Nagaraj G, Zarbalian Y, Flora K, Tan BR Jr. (2014). Complete response and prolonged disease-free survival in a patient with recurrent duodenal adenocarcinoma treated with bevacizumab plus FOLFOX6. J Gastrointest Oncol. 5(1):E1-6. Free article here.

7. Kleiman DA, Barie PS. (2014). Survival in Fully Manifest Multiple Organ Dysfunction Syndrome. Surg Infect (Larchmt). (epub).

8. Tanaka H, Morimoto T, Taima K, Tanaka Y, Nakamura K, Hayashi A, Kurose A, Okumura K, Takanashi S. (2013). The long-term survival of a thymic carcinoma patient treated with S-1: a case report and literature review. Onco Targets Ther. (2013). 7:87-90. Free article here.

9. Linhares P, Martinho O, Carvalho B, Castro L, Lopes JM, Vaz R, Reis RM. (2013). Analysis of a synchronous gliosarcoma and meningioma with long survival: A case report and review of the literature. Surg Neurol Int. 4:151.

10. Meyer M, Pelurson N, Khabiri E, Siegenthaler N, Walpoth BH. (2014). Sequela-free long-term survival of a 65-year-old woman after 8 hours and 40 minutes of cardiac arrest from deep accidental hypothermia.(2014). J Thorac Cardiovasc Surg. 147(1):e1-2.

Saturday, April 19, 2014

Weight Loss: 10 Recent Scientific Findings

Below is a summary of 10 of the most recent scientific findings on weight loss. The numbered references at the end correspond to the numbered sections below. Links to free versions of the full articles are provided when available if you are interested in reading more.

FEATURED BOOK: The DASH Diet Weight Loss Solution

1. Barriers and Help for Women: The two main barriers of weight loss include a) struggling with self such as poor self-control, insecurity, health problems, and difficulties changing food habits and b) problems implementing a diet. Self-determination (which was associated with having clear goals) and social support from friends and family helped achieve weight loss.

2. Telephone support: People who received 4 telephone wellness coaching calls and completed a weight loss program reported losing three pounds. This was more weight loss than people who were not targeted for wellness coaching and people who did not complete a weight loss program. Telephone support appeared to provide a small weight loss benefit but reliance on self-reported weight is a limitation of the study.

3. Predictors of Weight Loss Maintenance: Based on a survey of 450 people, the best weight loss maintenance predictors were weekly weighing, decreased evening snacking, decreased portion size, and being physically active each day.

4. Psychological Problems: In 138 obese women, 77% had symptoms of anxiety, 61% had moderate to major depression symptoms, and half had low assertiveness. The prevalence of these problems increased with the degree of eating disorders. Feelings of ineffectiveness were common among the women’s psychological profiles.

5. Zonisamide: A case study of an obese adolescent showed that when treated with Zonisamide, weight loss decreased from 279.5 pounds to 234 pounds, a 16.25% reduction. The authors discuss the possibility of using this medication, which is normally used to treat seizures, for weight loss in adolescents. Clinical trials are ongoing to study this medication for weight loss.

6. Effects on Offspring: Dietary interventions are important during pregnancy because maternal obesity has long-term consequences for the offspring’s ability to metabolize of lipids (fats) in the liver.

7. Benefits of Lap Bands: The first 10% weight loss from the lap band procedure, which involves partial clamping of part of the stomach to slow down food consumption, is associated with improved kidney function, metabolism, blood flow, and sympathetic nervous system functioning. The sympathetic nervous system is the part of the nervous system that generally excites the body by doing things such as increasing both the heart rate and blood pressure.

8. Urinary problems: Weight loss in obese women helps reduce episodes or urinary incontinence, urine leakage, and quality of life.

9. Benefits of a Revised Gastric Bypass Surgery: A revised gastric bypass surgery that is performed after the first failed or when converting stomach stapling to a gastric bypass surgery provides less weight loss and more health complications compared to if gastric bypass surgery was performed initially and was successful. However, the revised gastric bypass surgery provides an excellent opportunity to reduce other diseases related to obesity.

10. Low Intensity Weight Loss Programs: Even low intensity weight loss programs in the workplace can lead to clinically significant weight loss (5 or more % of body weight) in a significant number of participants. Weight tracking tools through a website were most predictive of weight loss. Other helpful weight loss predictors were eating more fruits and vegetables, increased physical activity, and reducing stress.

References

1. Hammarström A, Wiklund AF, Lindahl B, Larsson C, Ahlgren C. (2014). Experiences of barriers and facilitators to weight-loss in a diet intervention - a qualitative study of women in Northern Sweden. BMC Womens Health.14(1):59.

2. Tao M, Rangarajan K, Paustian ML, Wasilevich EA, El Reda DK. (2014). Dialing in: effect of telephonic wellness coaching on weight loss. Am J Manag Care. 20(2):e35-42.

3. Abildso CG, Schmid O, Byrd M, Zizzi S, Quartiroli A, Fitzpatrick SJ. (2014). Predictors of Weight Loss Maintenance following an Insurance-Sponsored Weight Management Program. J Obes. FREE article here.

4. Panchaud Cornut M, Szymanski J, Marques-Vidal P, Giusti V. (2014). Identification of psychological dysfunctions and eating disorders in obese women seeking weight loss: cross-sectional study. Int J Endocrinol. FREE article here.

5. Nguyen ML, Pirzada MH, Shapiro MA. (2013). Zonisamide for weight loss in adolescents. J Pediatr Pharmacol Ther. 2013 Oct;18(4):311-4. FREE article here.

6. Nicholas LM, Rattanatray L, Morrison JL, Kleemann DO, Walker SK, Zhang S, Maclaughlin S, McMillen IC. (2014). Maternal obesity or weight loss around conception impacts hepatic fatty acid metabolism in the offspring. Obesity (Silver Spring).

7. Lambert EA, Rice T, Eikelis N, Straznicky NE, Lambert GW, Head GA, Hensman C, Schlaich MP, Dixon JB. (2014). Sympathetic Activity and Markers of Cardiovascular Risk in Nondiabetic Severely Obese Patients: The Effect of the Initial 10% Weight Loss. Am J Hypertens. (epub ahead of print).

8. Gozukara YM, Akalan G, Tok EC, Aytan H, Ertunc D. (2014). The improvement in pelvic floor symptoms with weight loss in obese women does not correlate with the changes in pelvic anatomy. Int Urogynecol J. (epub ahead of print).

9. McKenna D, Selzer D, Burchett M, Choi J, Mattar SG. (2014). Revisional bariatric surgery is more effective for improving obesity-related co-morbidities than it is for reinducing major weight loss. Surg Obes Relat Dis. (epub ahead of print).

10. Carpenter KM, Lovejoy JC, Lange JM, Hapgood JE, Zbikowski SM. (2014). Outcomes and utilization of a low intensity workplace weight loss program. J Obes. FREE article here.

Friday, April 18, 2014

Mothers Who Kill: 10 Scientific Facts about Infanticide

On April 13, 2014, Megan Huntsman from Utah was arrested after admitting to killing 6 newborns, placing them in plastic bags, and storing them in boxes inside her garage.  This occurred over a 10-year period from 1996 to 2006. Her estranged husband made the discovery the day prior to her arrest after cleaning out the garage and noticing a strange package with a strong and foul odor. Police then discovered other dead infants that were allegedly strangled or suffocated. One infant, a seventh, was reportedly a stillborn.

FEATURED BOOK: Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill

The murder of infants (known as infanticide), neonatocide (killing an infant within 24 hours after birth), and/or filicide (a parent killing their own child) are some of the most reviled crimes in society. It naturally leads most people to ask how and why someone can do such a thing. In Hunstsman’s case, the answer could not be that she did not have a safe way to get rid of children she did not want because Utah has a Safe Haven law that allows infants that parents do not want to be dropped off anonymously at a hospital without any legal consequences.

The following is 10 facts about infanticide based on a recent scientific review of the literature (reference below).

1. STATISTICS: The killing of infants and newborns is one of the most common forms of murder by women. In industrialized countries, for every 100,000 infants, 2.4 to 7 are murdered. The true incidence is likely under-reported because the existence of some deceased babies is unknown until the bodies are discovered. Up to 10% of sudden infant death syndrome (SIDS) cases are actually undetected homicides. Most murdered infants and newborns are killed by the biological mother.

2. DIFFERENT CHARACTERISTICS: Women who murder newborns tend to be younger than age 25, single, live with their parents, unemployed or attending school, do not seek prenatal care, and are no longer involved with the child’s father. Women who murder infants older than one day of age tend to be older than 25, are often married, well-educated, and commit the crime as a form of retaliation (e.g., against an abusive spouse).

3. MENTAL ILLNESS: Many to most women who kill infants are not formally designated as mentally ill. Other factors associated with infanticide besides illness include less education (e.g., dropping out of school), anger, youth of the mother, and not wanting to invest personal time in child rearing. Personality styles and hormone levels have not been found to differ between women committing infanticide and those who did not vomit infanticide. Psychosis (detachment from reality) and clinical depression is rare in mothers who commit infanticide, although some mild emotional disruption may be present.

4. LANGUAGE: The perpetrators of infanticide often use language to deflect personal responsibility  (e.g., “when my baby died” instead of “when I killed my baby”.)

5. SYMBOLISM: The infant victim is typically viewed by the mother as an object rather than as an independent living person.

6. CAUSE OF DEATH: Most women use their hands in the murder (e.g., suffocation, drowning, strangulation) instead of using external weapons.

7. GENDER OF VICTIM: Most murdered infants are male in Western nations whereas in some Eastern countries (e.g., India, China) most murdered infants are female. The male preference in Western cultures may be because the male is more symbolic of the female’s reproductive partner. (In Eastern countries it may be because females are viewed as less desirable).

8. CONCEALMENT: As in the Huntsman case, most cases of infanticide involve the mother trying to conceal it in some way (e.g., placing in garbage cans, refuse sites). This is similar to the Hunstsman case, with the infants stored in boxes in a garage. In neonaticide cases, the mother typically tries to make the pregnancy and birth a secret.

9. RECIDIVISM: The rate of recidivism of infanticide is unknown but there have been other cases of repeated infanticide, as high as eight. In some of these cases, the deaths had previously been attributed to Sudden Infant Death Syndrome.

10. PRIOR ARRESTS: Most women who murder infants do not have a prior arrest record.

Reference: Porter and Gavin (2010). Infanticide and neonaticide: a review of 40 years of research literature on incidence and causes. Trauma Violence Abuse. 11(3):99-112.

Tuesday, April 15, 2014

Advances in Medical Testing that Just Might Save Your Life

Here's a shocking fact. One of the most important elements of a doctor's lifesaving decision making process has absolutely nothing to do with medicine. It has to do with logistics. Medical testing takes on many forms.

Blood tests are what immediately spring to mind for most of us. You go to your doctor because you are having symptoms of a high fever and chills. The doctor suspects some type of infection. She orders a blood culture that will detect bacterial and fungal germs in the blood. What happens next is not medicine, but logistics. The samples she ordered has to be sent off to a lab for testing. The proper handling and transport of those samples could make all the difference in the quality of your treatment.

Lab relocation and transport of samples between patients, doctors, labs, and scientists is one of the most critical aspects of a good diagnosis. It is not just a matter of putting in in a box and shipping it FedEx. Among other things, it involves expertise in:

The science of cryo-preservation
The countless state and federal regulations governing shipping and transportation, and...
The products and equipment needed to preserve materials at ultra-low temperatures

Get the cryo-preservation a little bit wrong, and the lab does not have a usable sample for an accurate reading on which your doctor can base a proper diagnosis.

Of course medical testing consists of a lot more than simple blood cultures. Recent advances in medical testing are yielding results that may appreciably extend the human lifespan in your lifetime. Just consider the advances we have made with regard to some of the most common life shorteners:

New technology advances cancer detection through blood testing.

One of the big challenges of cancer research is the ability to isolate CTCs. Circulating tumor cells are rare and difficult to categorize. New technologies have made it possible to address cancers of epithelial origin: prostate, breast and colorectal. There is reason to believe that more effective treatments are within our grasp thanks to advances in medical testing.

Future devices may eliminate the need for invasive glucose monitoring.

In the span of a single lifetime, we have already seen diabetes go from a death sentence with inevitable complications, to a manageable condition that does not have to hinder or shorten a normal life. For many, the most inconvenient part of having diabetes is the finger pricking necessary for frequent glucose monitoring.

Today, we can test glucose with a tiny implant under the skin that sends information to an external device. Currently, it does not replace the finger prick entirely. But it will in time, just as the finger prick replaced urine samples. Though current technology has not yet caught up to the vision, researchers are looking to wrist-worn devices to perform the task of persistent glucose monitoring. It is rumored in some quarters that Apple is working on such a feature in its upcoming iWatch wearable.

There are new methods of detecting heart disease.

Right now, heart disease is the number one killer. We are devoting a great deal of research to push it down in the rankings. One of the best ways to do that is detecting it early enough to do something about it. One of the newer tests is engineered to detect the presence of cardiac troponins which are only found in the heart. Another more recent test helps to diagnose patients who present with chest pain. It can more accurately determine if a heart attack has occurred. By using these and other advanced methods, we are able to greatly reduce the damage cause by heart disease.

This is a post by Nancy Evans

Saturday, April 12, 2014

Pictures of 10 Deadly Viruses, Bacteria, & Parasites

Many people have heard of the deadly viruses, bacteria, and parasites shown below, but have you ever seen what they look like? Below is a collection of images depicting the microbial monsters. Which one do you think looks the most frightening?

FEATURED: Viruses, Plagues, and History: Past, Present and Future

10. Severe acute respiratory syndrome (SARS): SARS is a potentially deadly and highly contagious viral syndrome. It led to an outbreak in China that killed nearly 1000 people. The virus causing SARS (known as the SARS coronavirus) is pictured.


9. Typhoid fever: Typhoid fever is a bacterial disease that typically affects the intestines. However, it can affect the lungs in some case with no signs of intestinal damage. It is transmitted by ingesting food or water containing the feces of the infected person which contains the bacteria, Salmonella enterica enterica (pictured).


8.Yellow fever: This is a viral disease that can cause liver damage resulting in yellow skin.  It is caused by a virus (a type of Flavivirus; pictured) transmitted by mosquitoes. There is no cure.


7. Cholera: This is an infection of the small intestine caused by the bacteria Vibrio cholerae (pictured). It is known to cause diarrhea, vomiting, dehydration, and gray-blue skin. It is spread by coming in contact with water or food contaminated by the bacteria. If untreaded, 50 to 60% of people infected with it, will die.


6. Malaria: Malaria is a serious disease caused by parasites that is spread by mosquitoes. This picture shows healthy red blood cells surrounding red blood cells (pale color) that are being attacked by malaria parasites.


5. Bird Flu (Avian Flu): This is a type of flu that has adapted to birds but which can adapt to infect different species, including humans. A picture of the bird flu virus is shown.


4. Marburg virus: This is a virus (pictured) that causes fever and bleeding disorders. In many cases, it leads to shock and death, which is why it is considered a severe disease in humans. It is named after the city of Marburg, Germany, where the virus was first identified during an outbreak in the 1960s.


3. Ebola virus: This is a very dangerous virus (pictured) that causes severe disease in humans and other primates.  It is named after the Ebola River in the Republic of Congo where the first recorded ebola virus took place.


2. Human Immunodeficiency virus (HIV): HIV is a virus that attacks the body’s immune system, leading to infections and harmful tumors. AIDS is a decrease in the effectiveness of the body's immune system that is due to HIV infection. An HIV virus particle is shown in the picture.


1. Bacillus anthracis: This is the bacteria known to cause anthrax, a type of biological infection. Signs and symptoms of anthrax infection typically begin one to five days after being exposed to anthrax spores, but can take as long as sixty days to appear. A spore is a form of bacteria that is resistant to heat, drying, and chemicals. The picture above shows anthrax spores. It is important to note the big difference between being exposed to anthrax and being infected with it. Exposure to anthrax only means that one has come in contact with the bacteria. Not everybody who is exposed to anthrax becomes infected, although some do. Anthrax infection means that the anthrax spores have invaded the body and are multiplying, causing various signs and symptoms.


Thursday, April 10, 2014

Adolescent Mass Murderers: 10 Warning Signs

On 4/8/14, 16-year-old Alex Hribal is alleged to have stabbed 21 people in school with kitchen knives in Murrysville Pennsylvania. As of now, not much is known about Hribal’s past except that he has been described as a loner by some peers (although his attorney denies this).

As it turns out, however, this is the main characteristic of adolescent mass murderers. Peers who have been interviewed to date have said they are unaware of Hribal being bullied. Law enforcement officials have said that his social media presence was minimal and that he does not appear to have owned a cell phone.

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When events like this occur, especially when they lead to murder, people naturally try to understand why. What follows are 10 characteristics of 34 male adolescent (ages 11 to 19) mass murderers (intentionally killing 3 or more victims) between 1958 and 1988 based on the work of Meloy and colleagues (2001). Although Hribal cannot be classified as a mass murderer at this time, this easily could have happened given the critical condition status of 4 of the victims. Some of the characteristics below are accompanied by my own editorial comments and may not necessarily reflect the thinking of Meloy and colleagues.

1. Most (70%) are described as loners. Peers may consider the person an outcast, which can cause and/or reinforce the loner status. When one is a loner, by definition, they are less attached to others around them. When one is less attached to those around them, emotional barriers are removed that would normally prevent seriously harming others. School officials must do a better job at identifying loners and trying to better socially engage them.

2. In 62% of cases, the adolescent was known to abuse substances, including alcohol, marijuana, cocaine, amphetamine, LSD, PCP, inhalants, and heroin. In my experience, this is often due to the adolescent using drugs as way to escape personal emotional pain.

3. In 59% of cases, there was some type of precipitating event (hours or days before the murder) that was significantly emotionally disturbing to the perpetrator or was obvious when reviewing the social history. Examples include but are not limited to a real or fantasized loss of a relationship with a girl, family dispute (see point X below), school suspension, bullying (see point X), or being fired from a job.

4. In 58% of cases, the adolescent made some type of threat regarding mass murder to a third party, usually days or months before the killings. 44% discussed murder with at least one person before the event. This is why it is important for parents to monitor their children’s social media accounts and to alert school officials about any alarming statements.

5. In 48% of cases, the adolescent was known to be preoccupied with war or weapons. Examples include but are not limited to owning a large amount of weapons, owning many materials related to violent themes, frequent trips to shooting ranges, grandiose fantasies about war and weapons, infatuation with Nazi regalia or street gangs, and idealization of fictionalized or non-fictionalized violent characters or people.

6. In 46% of cases, the adolescent had been arrested in the past and 42% had a history of violence against another personal, animal, or property. As of this time, Hribal is not known to have a violent past.

7. Many (43%) were bullied. Peers thus far interviewed have stated that they were not aware of Hribal being bulled. This does not mean he was not bullied, of course. Regardless, it is a reason why anti-bullying programs must continue in school.

8. Many (44%) were “fantasziers” in that they had a daily pre-occupation with fantasy games, books, or hobbies. Violent fantasies were common, which is why when I evaluate adolescents I look for these themes when discussing their interests. What kind of video games do they like (e.g., all first person shooters?)? What kind of books, TV shows, movies and music do they like? If they all center around violence, this could indicate a problem. Of course, the vast majority of adolescents who play fantasy games or violent video games do not become mass murderers but when this is combined with the other factors discussed, it increases cause for concern.

9. Many (37%) come from broken families where the parents are separated or divorced. This can result in anger, exposure to more family disputes (before or after the separation/divorce), decreased emotional attachment, and fewer adults present to detect when something is going awry with their child. Hribal is reported to come from a close family, however.

10. Weapon of choice: Most (85%) use a gun, with the most common caliber being .22. The most common shotgun gage was 12. Sharp weapons, such as knives and swords were used in some cases. Blunt objects, such as baseball bats and hammers have also been used. Adolescent mass murders usually bring about 2 to 3 weapons to commit the crime, most of which are taken from home or are purchased. This makes it all the more important for health care providers to assess for ease of access to firearms and for parents to make sure that their children do not have access to firearms.

Some of the percentages listed above may be larger or smaller than presented because for some of the variables there was insufficient data to determine their presence for all adolescents. It is important not to focus only one of these factors in isolation. However, the more of these risk factors that are combined together, the greater the risk becomes and should be a cause for concern and mental health intervention. Predicting mass murder in adolescents will always remain a challenge, because it is a very low frequency event.

Reference: Meloy JR1, Hempel AG, Mohandie K, Shiva AA, Gray BT. (2001). J Am Acad Child Adolesc Psychiatry. 40(6):719-28. Offender and offense characteristics of a nonrandom sample of adolescent mass murderers.

Tuesday, April 08, 2014

10 Ways to Get Free Access to Scientific Journal Articles

One question I am often asked is “How can I obtain free copies of peer reviewed scientific journal articles if I do not have access to a medical school library or college/university library?” It is a very good question because the cost to download a single research paper in a scientific journal is often somewhere between $20 and $40.

These costs are often set as a per article price, regardless of length. That is a lot to pay just to read a few pages, especially for health care providers in private practice or a layperson trying to learn more about a health condition affecting a loved one.

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Here are 10 ways to get free copies of research articles, some of which require more work than others. Feel free to post other methods in the comment section.

1. SEARCH PUBMED: PubMed is a free government-run website that contains an archive of over 23 million research citations. Simply type in a search term and click on one of the results. Sometimes, in the search results you will see the words “Free PMC article” or “Free Article” listed. Click on that and it will bring you to the abstract page where on the top right of the page you will see a button that indicates the free article status. Click on the button and the article downloads.

2. USE FREEMEDICAL JOURNALS.COM: Freemedicaljournals.com is a great resource provides an amazing compilation of access to free medical articles, including from some of the most well-respected journals.

3. USE HIGHWIRE: Highwire is another extensive collection of free online full text research articles.

4. SEARCH THE JOURNAL WEBSITE: Sometimes simply searching the journal’s website will show you that the article is available for free. Many journals, including the New England Journal of Medicine and the Journal of the American Medical Association highlight a few free articles a month for casual readers.

5. SEARCH PROFESSIONAL ORGANIZATIONAL WEBSITES: Many journals are published on behalf of a professional association. The name of the organization will be listed on the journal’s home page. For example, The Clinical Neuropsychologist is the journal for the American Academy of Clinical Neuropsychology (AACN). By going to the AACN homepage and searching for position papers, you will find an entire list of free articles available to you, such as here.

6. CONTACT THE AUTHOR: You can usually find the email address of a study author on the journal article page below the abstract, such as here. Simply send the author a request for a copy of the email and you will usually get a response with a copy very shortly as most researchers are happy to share their work. Can’t find the author’s email in the journal? Then just type the author’s name into a search engine and you can often find the author’s email address listed in the institutional directory of their employer. If no email is listed, try making a phone call to the author for such a request.

7. SEARCH ENGINE CHECK: Sometimes, just typing in the name of the article into a search engine will bring you to a free link that contains the pdf. You will be amazed at what you can find with a quick internet search.

8. JOIN A LISTSERV: Joining a listserv of health-care professionals in your field (such as here) is a great way to learn new things from colleagues. Simply post an email about a topic and an email is sent to all members of the listserv. Request that someone send you a copy of the article and someone is likely to have a copy and will send it to your privately. Listserv managers generally frown upon sending a copy of the article to the entire listserv unless it is already free in the public domain to prevent copyright violations.

9. USE SOCIAL MEDIA: Not a healthcare provider and don’t have access to a listserv? No problem. Join a social media site such as Facebook, Twitter, Google+, Google Groups, or Reddit and ask people interested in the same topic as you to send you a copy of the article if they have it. Again, the article should be sent privately if it is not in the public domain.

10. JOIN YOUR STATE LIBRARY: State libraries contain extensive access to journal articles that are typically not free elsewhere. All you need is a valid state library card, a login code, and you are all set. A good example is the extensive journal collection available at the New York State Library.

Saturday, April 05, 2014

No Need for Viagra Ads During the Final Four

It’s Saturday night, the Final Four is here, and it is the best night of the year for college basketball fans. All of those preseason games, non-conference games, grueling conference games, conference tournament games, and NCAA tournament games eliminated all but 4 out of 351 Division 1 basketball teams vying for the national championship.

Two of the teams in this year’s Final Four come from states where there is no professional basketball team: Connecticut and Kentucky. In these states in particular, basketball fans young and old rally around their team because it brings a sense of community. The players on these teams are treated almost like professional basketball players in their community by the fans. Florida and Wisconsin have their share of ardent young fans as well who follow their teams for state pride, because a relative went to one of the schools, or both. And then there are the children who are basketball fans of other college hoops teams who are staying up for the first game (6:09 pm EST start time) and all of part of the second game (8:49 pm EST start time).

With all of these young children watching these games, Pfizer (the maker of Viagra) and TBS (the station that airs the Final Four) should show more restraint and avoid placing advertisements for erectile dysfunction (ED) during these games. That goes for other ED medication manufacturers as well. There is no need for any parent or other adult to have to answer questions from their children about what the adult terms and themes mean in these commercials.

Sadly, this is nothing new. Democrat Congressman, Jim Moran, had complained in 2009 about these types of ads running in the daytime. He introduced a bill (H.R. 2175) to prevent the broadcasting of such ads between 6:00 am and 10:00 pm. I agree with him. The bill (known as the Families for ED Advertising Decency Act) advised the Federal Communications Commission (FCC) to treat such ads as indecent.

The counter-argument is that Pfizer is targeting their ads during times when most men who suffer from ED would be watching. True, but they are also running the ads during a time when most men are probably watching the game with their children or grandchildren. There are many other times and venues (e.g., late night TV, adult-themed media) when men are watching and children should not be watching, where Pfizer can place such ads.

So what ever happened to H.R. 2175? It died in the 111th Congress, likely due to powerful lobbying interests by the pharmaceutical industry. If you care about this issue, you can share this article with the social media buttons below and send this article to your Congressman or Senator and ask that one of them consider reintroducing the bill. I will be doing so as soon as this blog entry is published.

Wednesday, March 26, 2014

The Latest Scoop On Mesothelioma & Its Treatment In The US

Although mesothelioma, the rare and fatal cancel in peritoneum (abdomen) or pleura (chest lining), has leveled off in the United States since the 90s, the prevalence of the disease is still very real.

The prime cause is asbestos exposure; the body is not able to free itself from inhaled asbestos, which triggers physiological reactions resulting in mesothelioma, even decades after first exposure. In fact, a victim may breathe asbestos fibers for many decades before mesothelioma is finally diagnosed.

It is estimated that 2,500 to 3,000 American citizens to be diagnosed as malignant mesothelioma victims in 2014. They also classify mesothelioma in lung cancers that continue be the common cause of cancer deaths in the U.S., accounting for around 50% of overall cancer deaths among males and females.

And due to asbestos exposure decades ago, several are projected to develop the disease in the next several years. The Mesothelioma Center’s advocacy group and website on asbestos informs that incidence of mesothelioma in the U.S. may have peaked near 2010, and the source cites a study which projects approximately 85,000 people in the country to be diagnosed with mesothelioma from 2008 to 2054.

The rise in asbestos litigation

According to the U.S. Government Accountability Office, more than $30 billion have been set aside by companies from mesothelioma victims since the 80s. And between 1982 and 2002, the companies sued increased from 300 to 8,400, while the number of asbestos plaintiffs went from 1,000 to 730,000.

Asbestos litigation has also been classified as the mass tort litigation longest running in U.S. history. Thousands of lawsuits have been filed over the last decade, with many resulting in settlements or verdicts awarding $1,000,000 and in some cases, even more to the litigants.

Plaintiffs also continue to face challenges because of the long-latency period associated with asbestos-based diseases and mesothelioma law varying state by state. Many states allow three years to file a claim after diagnosis while others only allow a year.

Each case is different, so it is important for current and future plaintiffs to know how to file a mesothelioma lawsuit as soon as possible after the diagnosis. Some judges dealing with the case will also speed up the process knowing that mesothelioma is life-threatening, and requires significant financial resources for health treatment.

New research and treatments

Research is always ongoing when it comes to mesothelioma treatment.

PDT (photodynamic therapy) is a new technique being used for treatment in several clinics: a drug (light-activated) is injected into the patient’s vein, and it spreads across the body to collect cancer cells. Days later, after surgery, a red light is inserted into the chest cavity causing a chemical change that triggers the drug and kills the cancer cells. The approach may lead to few side effects because the drug is only activated in parts exposed to the light, instead of the entire body.

Gene therapy is another new treatment being tested in mesothelioma cases. It involves adding new genes (special viruses) into cancer cells so they are easier to kill. A version of this approach includes a virus hosting a gene that triggers the immune system to kill the cancer cells.

Given the circumstances, mesothelioma health effects are expected to increase in coming years. Victims who take legal action immediately after diagnosis and stay updated with treatment options will increase their chances of adequate compensation and recovery.

This is a post by Nancy Evans.

Saturday, January 18, 2014

MedFriendly Publishes the Most Comprehensive Entry on Stevens-Johnson Syndrome

On 1/18/14, MedFriendly, LLC, published the most comprehensive online review on Stevens-Johsnon syndrome. Stevens-Johnson syndrome is a rare but serious condition in which the skin and at least two surfaces of the mucous membranes (or the mucous membranes only) are damaged by a severe reaction to infection or medication.

A mucous membrane is one of four major types of thin sheets of tissue that line or covers various parts of the body. Detailed information is provided on the causes of Stevens-Johnson syndrome, diagnostic methods, treatment methods, and much more

The Stevens-Johnson syndrome entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defined within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages.

Friday, January 10, 2014

Pharmacogenetics To Redefine Medical Diagnosis

The age of genetic testing made its impact when the human genome sequencing project was completed in 2003. From that point onwards, the understanding of drug behavior and how different therapies can be modulated has continued to evolve.

More specifically, genetic testing today refers to the detection of mutations that define a therapeutic response in humans. Pharmogenomics has also provided a key insight into the understanding of disease initiation.

A recent study conducted at the University of Washington School of Medicine points out a gene PON1, which plays an important role in cardiac activity. Previously, physicians thought that the high density lipoprotein being cardio-protective would play a role in cardiovascular risk stratification.

However, the findings reveal that there is a liver based enzyme, encoded by the gene PON1, which protect against a number of human diseases. Using genetic testing, the physician can know the activity level of the enzyme and which therapy would best suit it.

Popularizing resources

A major trend that has allowed pharmacogenetics to establish itself is that of bioinformatics. Bioinformatics uses the data of DNA and proteins in living organisms and modulates them in the form of simulated drugs that physicians can administer.

An example for professionals in this regard is the ExPASy bioinformatics resource portal, where the doctor or a pharmaceutical researcher can check the secondary structure of any protein, and effectively decide which drug would work best.

There are also conduit resources that are helping healthcare professionals to use medication monitoring and manage the medication therapy of patients. According to www.millenniumlabs.com, the use of advanced technology by these resources, combined with research and education, helps doctors and relevant professionals personalize treatment plans, improving patient outcome and safety.

Among the many benefits of such an approach, two are most important. First is the fact that the data can be used to decide whether the drug being given is effective or not. Enzymatic detoxification has been proven in a number of studies as the best method to know the efficacy of a drug.

Secondly, the drugs that are given in cancer therapy are harmful to normal body cells. However, using molecular medicine, which is based on the understanding of genetic behavior, targeted therapy can be selected.

The pharmaceutical sector and healthcare professionals are looking forward to the cure of complex diseases such as cancer and autoimmune disorders. The existent mode of treatment focuses on reducing the damage or managing the symptoms.

However, genetic intervention and therapies such as siRNA provide a new avenue of hope, which means that pharmacogenomics can become a dominant field.

The underlying principle in this approach is that the alteration of gene expression is responsible for disease. Genes encode proteins through RNA as per the central dogma of molecular biology. By inhibiting RNA formation, the formation of toxic proteins in the body can be inhibited. This is an excellent approach, which provides a promising discovery strategy.

It is now up to the doctors to utilize the effectiveness of pharmacogenomics to help reform healthcare.

The above entry is a guest blog post.

Wednesday, January 08, 2014

Malingering: Why Healthcare Providers Continue to Keep their Heads inthe Sand

Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives such as avoiding work, obtaining financial compensation, evading criminal prosecution, avoiding military duty, or obtaining drugs (APA,1994). In layman’s terms, it is lying or significantly exaggerating in order to get something. 

Malingering is a major problem for the healthcare system and society because:

a) It decreases access to needed healthcare services (e.g., doctor appointments, diagnostic tests, therapy sessions) for patients with genuine health problems. This can delay diagnosis and reduce treatment onset and treatment effectiveness. 

b) It leads to billions of dollars in wasted health care resources for unnecessary doctor visits, diagnostic tests, and treatments (e.g., medications, therapy sessions). This leads to increased insurance premiums.

c) It leads to billions of dollars in wasted tax dollars towards fraudulent disability awards (e.g., Social Security Disability, military disability benefits). Disability and compensation benefits awarded through private workers compensation companies, no-fault insurance companies, and other private companies are a further cause of wasted funds and increased insurance premiums.

d) It leads to billions of dollars wasted in legal costs and settlements for companies defending themselves against fraudulent claims. Many companies opt to pay to settle a case rather than pay the larger cost of mounting a legal defense.

Malingering is a topic that I have spent a great deal of time writing about. For example, in August 2012, a book I co-edited on the topic was published. The title is Mild Traumatic Brain Injury: Symptom Validity Assessment and Malingering. One of the chapters provides suggestions to help physicians and non-neuropsychologist healthcare providers detect poor effort and symptom exaggeration that can be a result of malingering. In September 2012, I was interviewed for a story by amednews.com entitled, Detecting Deception: How to Handle a Malingering Patient, which aimed to raise physician awareness about the issue. I have continued to publish on this topic in peer reviewed academic journals and international lectures but have not written about it on my blog since 2011 and figured it was time for an update due to some recent developments.

As I showed in the opening chapter of my book with numerous tables, there has been a significant increase in publications (e.g., research articles, books) about malingering, in addition to legal cases mentioning the word. Thus, it is not as if healthcare providers, insurance companies, and government officials are unaware that the problem exists.

Despite this increased knowledge of the topic, in the most recent update of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), the word “malingering” has been removed from the index. The DSM-5 is a guide that many healthcare providers use to diagnose mental disorders. In DSM-5, malingering is no longer listed as an issue that needs to be ruled out when a patient is suspected of having a somatoform disorder (now called a “somatic symptom disorder”).

As it has traditionally been conceptualized, a somatoform disorder is a condition in which one develops physical symptoms in response to psychological distress. While these patients may exaggerate, the exaggeration is not done for external gain (e.g., to win a lawsuit). In reality, some patients malinger and have somatoform disorders but in some cases the distinction between the two is an important one to make. While malingering does remain in the text of DSM-V, it is buried within it on pages 726 and 727 and difficult to find even if you are specifically searching for it.

I do not believe that the omission of malingering from the index and other sections of the DSM-V was an accident. As I described in my December 2011 blog entry on this topic, there are many reasons why physicians and other healthcare providers are motivated to ignore the topic of malingering. These reasons include not wanting to deal with retaliatory false complaints lodged against them for exposing it, the uncomfortable nature of discussing the topic with the patient, extreme patient advocacy by healthcare providers, being overly trusting of patient self-report, and not wanting to cause the patient a loss of financial benefits.

While I still believe that these are reasons that healthcare providers often ignore malingering, there are additional reasons that all involve financial incentives…but this time for the healthcare provider. Specifically:

a) If a healthcare provider labels a patient as malingering, the insurance company will likely not pay for additional costly treatments and medical tests. That potentially can lead to losses of thousands to millions of dollars of treatment revenue. For example, hospitals make a great deal of money from diagnostic tests (e.g., magnetic resonance imaging), weekly therapy sessions, and pain medication injections.

b) Due to healthcare reform, hospitals will now receive more money from the government if they have higher patient satisfaction ratings. Identifying malingering results in lower patient satisfaction scores and would then lead to less money for the hospital.

c) Some healthcare providers may be knowingly contributing to malingering by signing off on fraudulent disability applications. This presumably involves some type of kickback fee for enabling the fraudulent claims.

As an example of healthcare providers enabling malingering, a large scheme was recently discovered in which about 1,000 people (mostly police and firefighters) defrauded the Social Security Administration (SSA) for disability benefits, claiming mental illness from the September 11th attacks. In this way, malingerers often prey on other’s sympathies and trust to try and avoid detection.  They know that it will be politically incorrect for anyone to challenge a disability claim based on terrorism exposure, particularly if they were in a trusted societal occupational role (e.g., cop, firefighter, corrections officer). 

It was a well-organized scheme in which people were coached on how to fail memory tests, how to  fake panic attacks, how to dress for appointments, and how to build a false medical record for about a year before applying for disability. The cost to society? 400 million dollars. And that is just for these 1,000 cases. That is a drop in the bucket compared to how much of this is taking place throughout the country.
How were they eventually caught? Instinctively, you may think that the doctors figured it out.

However, that was not the case. It finally took two Social Security Administration investigators to become suspicious of how it was that people documented as mentally  incapacitated were able to maintain a pistol license. It was a significant discrepancy between self-reported problems and real –world behaviors that did not make sense, which is common in malingering.  This led to monitoring of these people’s social media accounts and more in depth file reviews.  The review found that patients claiming total disability were pictured doing all sorts of activities that they should not have been able to do if their disability claims were accurate such as flying helicopters, riding motorcycles, and holding separate jobs. Reports from undercover agents and intercepted phone calls were the proverbial icing on the cake.

The Manhattan district attorney, Cyrus Vance, was quoted as saying about those indicted that “Their brazenness was shocking.” In a way, it does seem shocking at first. But when one stops to think about it, was their behavior really so shocking when they know that no health care provider will say they are malingering? It is unknown at this point if any of the health care providers actually knew of this scheme,  but one of the ringleaders indicted (Joseph Minerva) was allegedly specifically tasked with finding psychiatrists and psychologists to diagnose conditions that would lead to a determination of disability.

For Minerva to pull this off would require him to have done one of two things (or both): a) find healthcare providers who knew about the scheme and would write false notes in exchange for kickbacks, b) find healthcare providers who were naïve enough to believe everything presented to them. The latter would have also been laden with financial incentives due to an increased referral base.  It is significantly problematic that the healthcare providers in these cases were completely fooled by over 1,000 patients and that they presumably did not identify a single case themselves as malingering.

While some may say that it is easy to Monday morning quarterback these cases, the reality is that many of these malingering cases could have been detected by healthcare providers...if all they did was look. In fact, no field in healthcare has developed more sophisticated techniques to identify malingering than clinical neuropsychology, although techniques do exist in other fields. Utilizing healthcare professionals who use scientifically reliable and valid techniques to detect feigned mental disabilities is important because in these cases, the claimants decided to try to fake mental disabilities, not physical ones. It should also be noted that although some of these patients reportedly had genuine physical problems, that does not automatically translate to valid mental problems. However, malingerers will often use a valid condition in one area to try to gain credibility of a feigned disability in another area. As an example, the thought process of the malingerer goes something like this, “If my leg and arm were broken then surely I cannot be suspected of lying about having posttraumatic stress disorder.”

It is important to note that it was the field of clinical neuropsychology that raised the awareness of the SSA to the problem of malingering. Initially, due to numerous misconceptions, the SSA decided to no longer fund the use of techniques that can help identify malingering in a ruling on September 13, 2012. However, after consultation with national neuropsychological organizations, U.S. Senator Tom Coburn wrote a letter to the SSA urging reconsideration of this policy based on the weight of the current scientific evidence. The Social Security Administration responded that they would seek external expertise to evaluate their policy on tests that can help identify malingering when determining disability (Congressional Report No. A-08-13-23094, 2013). This recent scheme that was uncovered should provide further evidence that Senator Coburn is correct and that the use of such techniques should be funded by the SSA. Click here so see Senator Coburn’s interview on 60-minutes, where he goes into detail regarding the costs of malingering to society.

An additional recommendation that I and others in this area have is for healthcare providers to be afforded administrative and/or legal protections against complaints by identified malingerers, so long as the determination of malingering can be defended using currently accepted scientific standards. Until that happens (which may be never), patients who report mental disabilities in the context of a disability claim, litigation, compensation-seeking, seeking academic accommodations, seeking prescription drugs of potential abuse (e.g., pain killers, stimulants), who have a potential desire to avoid work, military service, school, or prosecution, should be required to undergo a comprehensive neuropsychological evaluation by an evaluator who uses scientifically reliable and valid malingering detection methods. The results of such evaluations need to be incorporated by other health care providers to reduce the financial burdens on the healthcare system and on society.

Board certified neuropsychologists can be located at the American Board of Clinical Neuropsychology and the American Board of Professional Neuropsychology websites. Healthcare providers need to be reminded that they are supposed to be scientific-practitioners first (basing diagnoses and treatment planning on reliable and valid objective information) and to be patient advocates second. Unfortunately, for too many healthcare providers, patient advocacy has superseded the scientific method and now we are all paying the price...literally and figuratively.

Friday, December 20, 2013

Making the Switch to a Healthier Lifestyle

The following is a guest blog entry. 

I think it came to me about a year ago. I was sitting on the couch going over my finances. It didn't take me very long to realize that a great deal of my monthly earnings were going towards bad habits - cigarettes, alcohol, junk food, etc. The hit this was having on my wallet was nothing in comparison to what it was doing to my body, however. Still young, I had age on my side, but the lack of energy and slow accumulation of flab that came along with my lifestyle were beginning to rear their ugly heads.

Deciding to Make a Change

There's no getting around the fact that guilt can have a dramatic impact on life experience. As time went on, I began to feel increasingly bad each time I would go to the store for a pack of cigarettes or a case of beer. This was becoming no more than a raw habit, and I knew I needed to make a change. It started off slowly as I'd say to myself "maybe I'll only have one or two drinks tonight instead of going crazy like I normally do on a Friday."

I'd tell people that I was looking to make some changes in my life, but no one in my circle of friends really believed me. They all said that "moderation" is a tease and that the only way to really achieve my goals would be to quit everything altogether. I try to think that life is quite a bit less black and white than this, however, and it actually angered me that they felt this way. It was at that moment that I decided I was going to take control of my life and make the changes I wanted to see happen.

Setting Things Into Motion

One thing that I needed to make clear for myself was that I was going to have a way to track my progress, so I set up a spreadsheet and decided that each day I would journal about my goals and keep track of the changes I'd made. I had one column listing how much alcohol I'd allot myself in a given week and was determined to stick to it. I had a "notes" section that would allow me to list small changes that would inevitably make a huge difference in my overall health. I wanted to go to my spreadsheet as soon as I made the move to switch to an electronic cigarette or substitute fatty foods for organic fruits and vegetables. Being a detail-oriented person, it was essential that I had a way of tracking the changes I was making in my life, and it worked.

As time went on, I started taking on more and more tasks to help push my life in the right direction. Once I had changed my diet and quit smoking traditional cigarettes, I successfully lowered my alcohol intake and started going to the gym. I knew that if I didn't start slow with the latter that I would fall off quickly, so I stuck to 3x per week with the intention of ramping things up as time went on. Much to my delight, it took a mere few weeks until I was able to push this up to 4x per week and then 5x per week after that. It seemed as if the more I took my time with all of this, the faster I was seeing change.

The Takeaway

In the end, I realized that the one thing that was keeping me from living a healthier lifestyle was pretty easy to pinpoint; I needed a reason. It was my friends' doubts that really caused me to rise to the occasion, and I can't thank them enough today for the differences that one conversation made in my life.

Wednesday, December 04, 2013

MedFriendly Publishes the Most Comprehensive Entry on Stress Incontinence

On 12/4/13, MedFriendly, LLC, published the most comprehensive online review on stress incontinence. Stress incontinence is the most common form of urinary incontinence (involuntary or uncontrollable urine loss). It occurs when a physical movement or activity increases pressure inside the abdomen, which places involuntary pressure on the urinary bladder. Detailed information is provided on the causes of stress incontinence, diagnostic methods, treatment methods, and much more

The stress incontinence entry is the latest in hundreds of easy to understand entries available for free at MedFriendly.com. All entries on MedFriendly are written in an easy to understand format, with all complex terms defined within the same entry. This prevents the reader from needing to do extra research to understand what the writer is trying to convey. All entries are written on a single page, exposing the reader to fewer ads. Please share this link with others, bookmark MedFriendly and the MedFriendly Blog, and follow us on the MedFriendly Facebook and Twitter pages.