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What many people do not realize, however, is that bean sprouts can be just as dangerous as raw meat. Yes, bean sprouts. Why? Because the sprout seeds can easily become contaminated in the fields where they are grown. Bean sprouts need to be grown in a warm and moist environment. Such environments are the ideal setting for bacteria to grow, including salmonella and E. coli. Some of the sprout seeds can also become contaminated by animal manure where they are grown.
To be safe, it is best to avoid bean sprouts at restaurants because you have no way of knowing how well they were cooked, unlike meat, which you can inspect. If you want to eat bean sprouts at home, health officials suggest immersing the sprouts in boiling water and cooking them thoroughly to kill harmful bacteria.
The context of this blog entry is that today, a man in Orlando Florida, was arrested for humiliating a child (that he was not even the parent or legal guardian of) on a video he posted online by shaving off the child’s hair, threatening him with a belt, beating him with a belt, and then making him do push-ups and sprints as a form of boot camp. This was all done because the child got in trouble in school and the man was concerned that the child would go to prison one day. Valid concerns. Invalid approach…which is why he was later arrested. While this man’s behavior may have been considered acceptable 20 years ago, today it is considered a form of child abuse.
After the diagnosis, Gould wrote a brief essay that came to be a source of inspiration for many people in similar situations. He lived a productive life for twenty years after the diagnosis. Not bad for someone given eight months to lived. Below, I have reproduced Gould’s essay, entitled “The Median is Not the Message.” Please read it over, share it with friends, and most importantly, pass it on to anyone you know of who was diagnosed with a serious medical illness (particularly cancer).
Hence the dilemma for humane doctors: since attitude matters so critically,
should such a sombre conclusion be advertised, especially since few people have
sufficient understanding of statistics to evaluate what the statements really
mean? From years of experience with the small-scale evolution of Bahamian land
snails treated quantitatively, I have developed this technical knowledge - and
I am convinced that it played a major role in saving my life. Knowledge is
indeed power, in Bacon's proverb.
The problem may be briefly stated: What does "median mortality of eight
months" signify in our vernacular? I suspect that most people, without
training in statistics, would read such a statement as "I will probably be
dead in eight months" - the very conclusion that must be avoided, since it
isn't so, and since attitude matters so much.
I was not, of course, overjoyed, but I didn't read the statement in this
vernacular way either. My technical training enjoined a different perspective
on "eight months median mortality." The point is a subtle one, but profound
- for it embodies the distinctive way of thinking in my own field of
evolutionary biology and natural history.
We still carry the historical baggage of a Platonic heritage that seeks
sharp essences and definite boundaries. (Thus we hope to find an unambiguous
"beginning of life" or "definition of death," although
nature often comes to us as irreducible continua.) This Platonic heritage, with
its emphasis in clear distinctions and separated immutable entities, leads us
to view statistical measures of central tendency wrongly, indeed opposite to
the appropriate interpretation in our actual world of variation, shadings, and
continua.
In short, we view means and medians as the hard
"realities," and the variation that permits their calculation as a
set of transient and imperfect measurements of this hidden essence. If the
median is the reality and variation around the median just a device for its
calculation, the "I will probably be dead in eight months" may pass
as a reasonable interpretation.
But all evolutionary biologists know that variation itself is nature's only
irreducible essence. Variation is the hard reality, not a set of imperfect
measures for a central tendency. Means and medians are the abstractions.
Therefore, I looked at the mesothelioma statistics quite differently - and not
only because I am an optimist who tends to see the doughnut instead of the
hole, but primarily because I know that variation itself is the reality. I had
to place myself amidst the variation.
When I learned about the eight-month median, my first intellectual reaction
was: fine, half the people will live longer; now what are my chances of being
in that half. I read for a furious and nervous hour and concluded, with relief:
damned good. I possessed every one of the characteristics conferring a
probability of longer life: I was young; my disease had been recognized in a
relatively early stage; I would receive the nation's best medical treatment; I
had the world to live for; I knew how to read the data properly and not despair.
Another technical point then added even more solace. I immediately
recognized that the distribution of variation about the eight-month median
would almost surely be what statisticians call "right skewed." (In a
symmetrical distribution, the profile of variation to the left of the central
tendency is a mirror image of variation to the right. In skewed distributions,
variation to one side of the central tendency is more stretched out - left
skewed if extended to the left, right skewed if stretched out to the right.)
The distribution of variation had to be right skewed, I reasoned. After all,
the left of the distribution contains an irrevocable lower boundary of zero
(since mesothelioma can only be identified at death or before). Thus, there
isn't much room for the distribution's lower (or left) half - it must be
scrunched up between zero and eight months. But the upper (or right) half can
extend out for years and years, even if nobody ultimately survives. The
distribution must be right skewed, and I needed to know how long the extended
tail ran - for I had already concluded that my favorable profile made me a good
candidate for that part of the curve.
The distribution was indeed, strongly right skewed, with a long tail
(however small) that extended for several years above the eight month median. I
saw no reason why I shouldn't be in that small tail, and I breathed a very long
sigh of relief. My technical knowledge had helped. I had read the graph
correctly. I had asked the right question and found the answers. I had
obtained, in all probability, the most precious of all possible gifts in the
circumstances - substantial time. I didn't have to stop and immediately follow
Isaiah's injunction to Hezekiah - set thine house in order for thou shalt die,
and not live. I would have time to think, to plan, and to fight.
One final point about statistical distributions. They apply only to a
prescribed set of circumstances - in this case to survival with mesothelioma
under conventional modes of treatment. If circumstances change, the
distribution may alter. I was placed on an experimental protocol of treatment
and, if fortune holds, will be in the first cohort of a new distribution with
high median and a right tail extending to death by natural causes at advanced
old age.
It has become, in my view, a bit too trendy to regard the acceptance of
death as something tantamount to intrinsic dignity. Of course I agree with the
preacher of Ecclesiastes that there is a time to love and a time to die - and
when my skein runs out I hope to face the end calmly and in my own way. For
most situations, however, I prefer the more martial view that death is the
ultimate enemy - and I find nothing reproachable in those who rage mightily
against the dying of the light.
The swords of battle are numerous, and none more effective than humor. My
death was announced at a meeting of my colleagues in Scotland, and I almost experienced
the delicious pleasure of reading my obituary penned by one of my best friends
(the so-and-so got suspicious and checked; he too is a statistician, and didn't
expect to find me so far out on the right tail). Still, the incident provided
my first good laugh after the diagnosis. Just think, I almost got to repeat
Mark Twain's most famous line of all: the reports of my death are greatly
exaggerated.
Where patient advocacy starts to become problematic and can lead into patient enabling, is when there is: a) a lack of objective biomarkers to indicate the presence of a pathological physical condition and/or b) the patient is pursuing some form of compensation (e.g., disability application, workers compensation claim, no-fault insurance claim, and/or litigation). By objective biomarkers, this means that there are no significant abnormalities on blood tests, x-rays, MRI scans, physical exam, or other objective measures. When a and b are both present, the risk of patient enabling increases significantly.
In sum, health care providers best help patients by using objective data to guide case conceptualization, treatment, and advocacy efforts. Sometimes, you need to be skeptical, sometimes you need to say no, sometimes you need to say something the patient may not want to hear, and sometimes you need to decide and communicate that there is nothing else you can do. This can all be done in a polite, caring, and respectful way. It does not mean that you have failed if all of your patients do not get better. Some will never get better and some do not want to. It’s just the reality of working in the modern day medical system.
Are helicopter parents becoming a thing of the past? I sure hope so. Last spring I received an email from a parent asking about their child’s grade on a test. The parent wanted to know what their child could do to improve their grade. Right now you may be thinking, “That is not so bad.” Well what if I told you that I teach at a major university? Yeah, now you are with me.
I have never heard of a child dying from disappointment and rarely hear my adult friends complain that they had to problem-solve for themselves as children. Being a resilient adult includes facing challenges, dealing with disappointment and “bucking up”.
1. Amazing Images of Extreme Bodies and Body Parts: This is the clear winner with 76 page views. People love the visuals. I’ll try to put up more images next month.
2. Guest Blog Entry: Chakras 101: This was the first guest blog entry since the MedFriendly Blog relaunched. It came in a close second with 57 views. Will a follow-up to this entry be in the works? Stay tuned.
3. White blood cells promote cancer: Cancer will always be an interesting topic for readers. But hearing that white blood cells many play a role in the disease? Definitely of interest. Comes in at 43 views.
4. Abandoning Alzheimer’s Disease: My Response to Pat Robertson. This was my response to Pat Robertson’s advice that a husband of an Alzheimer’s patient should divorce her after putting her in custodial care. It was featured on the popular medical blogging site, KevinMD. Comes in at 42 page views.
5. What to do if You Can’t Afford Medications: A helpful primer for patients on this topic. Comes in at 41 page views.
I remember the beginnings of the website idea like it was yesterday. I was driving with a friend in Ft.Lauderdale, Florida, where I was attending graduate school. The person I was driving with told me that his girlfriend had a website that she made about psychology.
Tomorrow, to commemorate the 10 year anniversary of MedFriendly, I will unveil a major new detailed entry that has been months in the making on a topic that is medically, legally, and historically fascinating. Come back tomorrow to see what it is. Thanks to the readers and fans of MedFriendly for helping make it a popular healthcare website! Here’s to another 10 years!
The next thing you know, you wake up in an ambulance. There is something in the right side of your face. You figure it’s a rock. The doctor examines you. It’s a live grenade fragment that was supposed to explode when it hit you but it did not. You need it removed. But there’s a problem. If people try to remove it and it explodes, everyone within a 32 mile radius will be blown to smithereens.
Well, now it has happened again…this time to a woman in her 60s in Brazil, who was pronounced dead from pneumonia after suffering two strokes. In this case, the woman’s daughter came to see her mother in the morgue and gave her one final hug. When doing so, she realized her mother was still breathing. The hospital was notified but this was after the poor woman had spent two hours in a plastic bag. The patient was immediately put back on life support. The nurse who first checked her vital signs was fired.
It is reassuring that this has not happened in the United States yet but it may just be a matter of time. My concern is that there may be too casual of an attitude towards death and that the evaluations of these patients were not done as carefully as they should be. In many cases, where people have advanced directives to keep them alive at any circumstances, there would usually be an objective way to test to see if the person was truly dead – an absence of electrical activity of the heart as measured by an electrocardiogram.
However, some people have advanced directives that they should not be resuscitated and so they may not be hooked up to such electrical tests. This often happens in nursing homes, for example. In such cases, a nurse usually checks the pulse and respiration (breathing). This should be double checked by another nurse. In hospitals, a doctor usually does this. It is very hard to imagine, if the nurse or doctor took their time doing this assessment, how a person can be declared dead when they are alive because they would be breathing and have a pulse, even if both were decreased. These issues need to be taken more seriously because what happened in these two cases should never happen anywhere.
But recently, things have changed. For example, I am aware of specific recent policy implemented by some health care organizations that any employee who has a social media account (e.g., Facebook, Twitter) or a blog cannot post information related to a specific patient case even if the patient is the only person who may be able to identify him/herself based on the information posted. One way around this is getting consent from the patient, but sometimes you may not think to write about a specific situation months of years later after reflecting on it.
In those cases, retrospectively obtaining consent is unrealistic and can seem unprofessional to the atient. For example, imagine making this kind of phone call:
“Hi, Mr. Jones, this is Dr. Smith. I saw you at General Hospital a few years ago. Yes, yes, I’m doing good. How about you? Good. So anyway, I was wondering if you could give me permission to write about your case on a blog I run.”
One of the medical blogs I like to follow is KevinMD. One of the main features is that it shows a collection of the top medical and healthcare blog postings from the internet each day. I was perusing some of these entries last night and I was interested to see that there are still many doctors posting about specific patient cases. These are good posts. Excellent posts. Posts to learn from.
But I fear we are increasingly going to reach a point where these types of posts decline in frequency, either for fear of litigation for arguably violating patient privacy (even if the patient is the only person who can identify him/herself) or for fear of termination by an employer. Personally, I’ve decided to take the safe route and not report on any specific patient cases from my current place of employment. But I am curious what other medical and healthcare bloggers think about this and how they are handling (or plan to handle) this potential limitation in blog posting at present or in the near future.
When considering these recent restrictions, I think back with a smile to the days where you could open an old medical text and see pictures documenting specific medical conditions in patients, full face and all.
I remember watching a TV show about this a few years ago and the best explanation was the wick effect. That is, a source of flame (such as a burning cigarette), burns the clothing of the victim in one area, splitting the skin and releasing fat from under the skin. The fat is then absorbed into the burned clothing, and acts like a candle wick. The burning can continue for as long as the fuel is available. This hypothesis was successfully demonstrated on the show with a pig. With that being said, some debate whether this process can occur in humans and cases continue to pop up now and then.
If you have not heard of a specific case, below is a report of a case of spontaneous human combustion reported several days ago by Nick Collins at The Telgraph.
Man 'spontaneously combusts'
Spontaneous human combustion has long been the stuff of fiction, endorsed by eccentric scientists and employed by novelists including Charles Dickens as a convenient plot twist.
But yesterday the most unlikely cause of death, in which people burst into flames without any external source of ignition, was given official sanction when Irish coroner found a pensioner had burned to death for no apparent reason.
Michael Flaherty, 76, was found dead at his home in Galway last December after a neighbour heard the smoke alarm in his house go off in the middle of the night.
But while his body had been burned to cinders, fire officers who attended the scene were astonished to find nothing else had been damaged apart from the floor below him and a patch of ceiling above.
There were no signs of any devices which could have ignited the body, and no indication of foul play, officials said – Mr Flaherty's body appeared to have simply cremated itself.
Officers who attended the scene claimed they had never seen anything like the extraordinary case, and the inquest heard fire officers were unable to give any explanation for what sparked the blaze.
Recording his verdict, west Galway coroner Dr Kieran McLoughlin was left with little option but to become the first coroner in the country's history to record the unusual verdict.
He said: "This fire was thoroughly investigated and I'm left with the conclusion that this fits into the category of spontaneous human combustion, for which there is no adequate explanation."
Spontaneous human combustion was a phenomenon first described by Victorian doctors, who suggested the body could suddenly go up in flames as a divine punishment for alcoholism.
Other explanations for the unexplained combustion of the body include the influence of ghosts or other paranormal entities, the production of unusual concentrations of gas, or external factors like cigarette sparks.
In the 1850s Charles Dickens, the novelist, attracted controversy after Krook, a rag and bottle merchant, spontaneously combusted in Bleak House.
The mystique of the theory is heightened by the striking similarities between documented cases. In many instances the body is found reduced to ash while the arms, hands and legs remain, and in several others the victim is completely consumed while nearby objects such as furniture remain untouched.
In one example, a Welsh policeman who found the victim's body noted that the fire appeared to have come from within her abdomen.
The latest case bore many of the hallmarks of the classic case – the victim was found on his back by the fireplace, with his head intact but the rest of his body entirely consumed.
Fire experts said the evidence suggested the fire had not been the source of ignition.
Bob Rickard, of the paranormal magazine the Fortean Times, told the Telegraph: "It has become rare now, I have not heard of a case for a couple of decades. But what is even more interesting to me in this case is it is the first time I can remember that a coroner has come out and announced a verdict of spontaneous human combustion.
"Normally they try to leave an open verdict or try to express it in some other way."
Mr Flaherty's family said they were satisfied with the investigation, the Irish Independent reported.