Top Medical News: Vaccines, Scorpion Sperm, Botox, Bird Flu, Diabetes & Cancer Treatment, Bullies, CVS Troubles & More...

Rather than navigating to a variety of websites to stay on top of the top daily medical news, try bookmarking the MedFriendly Blog and using this feature, where the day's top medical stories are compiled all in one place.


1. California, Vermont consider tougher vaccine-exemption rules: Physician organizations are concerned about the rising number of parents who skip immunizing their children for personal or philosophical reasons.

2. Botox may treat nighttime teeth grinding: Botox may help prevent teeth grinding at night, a small study suggests.

3. Sperm Viability Greatly Reduced in Offspring of Animals Treated With Common Antibiotic Tetracycline: Male pseudoscorpions treated with the antibiotic tetracycline suffer significantly reduced sperm viability and pass this toxic effect on to their untreated sons.

4. Dutch okays mutant bird flu study's publication: The Dutch government on Friday gave a top scientist the green light to publish a research paper in the United States on a mutant killer flu virus, following approval by a US panel of experts.

5. Newborns battle drug withdrawal: As more babies are born addicted to prescription painkillers, a hospital focuses on helping these tiny victims.

6. Chicken Scratches vs. Electronic Prescriptions: Studies show that errors are much less likely when doctors send prescriptions to the pharmacy via computer. But the move to such e-prescriptions has been relatively slow.

7. Kids With Type 2 Diabetes, Combo Treatment Best?: Study Shows Early Aggressive Treatment May Result in Better Blood Sugar Control.

8. Bullied Children at Greater Risk for Self-Harm, Study Finds: Children who are bullied are three times more likely than others to self-harm by the time they are 12 years old, according to a new study.

9. Cancer Survivors Told To Exercise, Eat Healthily, And Maintain Ideal Bodyweight: If you are a cancer survivor and you want to minimize your risk of that cancer recurring, or another cancer developing, you should eat a healthy diet, do plenty of exercise, and maintain a healthy body weight, says the American Cancer Society in its new guidelines.

10. Feds weigh pulling drug licenses for two CVS stores: A federal hearing began on Wednesday on whether to bar two CVS Caremark Corp drugstores in Florida from selling potentially addictive painkillers as part of a government crackdown on prescription pain pills, especially oxycodone.

11. Heavy teens have trouble managing diabetes: New research sends a stark warning to overweight teens: If you develop diabetes, you'll have a very tough time keeping it under control.

12. Chef fights rheumatoid arthritis with ‘Hero Foods’: Seamus Mullen, a chef and owner of the New York City-based restaurant Tertulia, was diagnosed with rheumatoid arthritis (RA) in 2007. He wrote Hero Foods: How Cooking With Delicious Things Can Make Us Feel Better, which discusses the foods you should eat if you are dealing with an autoimmune disease.

13. Best and worst paid doctors survey: More and more U.S. doctors are regretting their career choices.

Top Medical News: KFC, Viagra, Fruit Flies, Salty Food, Meat Glue, Insomnia, Glaucoma, Pain, & More

Rather than navigating to a variety of websites to stay on top of the top daily medical news, try bookmarking the MedFriendly Blog and using this new proposed daily feature, where the day's top medical stories are compiled all in one place.

1. KFC ordered to pay $8.3 million to Australian girl: Fast food giant Kentucky Fried Chicken has been ordered to pay Aus$8 million (US $8.3 million) to an Australian girl who suffered severe brain damage and was paralysed after eating a Twister wrap.

2. Soft drinks: Public enemy No.1 in obesity fight?: Would cutting sweetened drinks help America's fight against weight or diabetes? About 25% of Americans gets at least 200 calories a day from sugary drinks. Beverage makers say their products are part of a sensible diet.

3. Loyal Companion Helps a Veteran Regain Her Life After War Trauma: Tori Stitt is among a growing group of war veterans finding that service dogs can offer relief from some of the effects of post-traumatic stress disorder.

4. High Reps With Low Weights Builds Muscle, Too: Study shows that lifting a ton is not the only way to bulk up.

5. Research Gets Closer to Genetic Roots of Glaucoma: Two genetic variations are linked to a common form of glaucoma, known as primary open-angle glaucoma, according to new research.

6. Denosumab (Xgeva) Not Approved For Metastasis Prevention: Amgen's application for expanded indications for denosumab (Xgeva) were turned down by the FDA (Food and Drug Administration) - the expanded indications were to include bone metastases prevention in patients with castration-resistant prostate cancer.

7. High salt intake linked to higher stroke risk: Older adults with salty diets may have an increased risk of suffering a stroke, a new study suggests. 

8. Should you be grossed out by 'meat glue?': Still reeling from the specter of "pink slime," beef industry officials on Friday fought off another culinary creep-out: “meat glue.” Reports say some restaurants are sticking together scrap meat and calling it prime steak, but experts contend that's not quite the case.

9. Thirty percent of US workers don't get enough sleep: Nearly a third of workers in the U.S. aren't getting enough sleep, according to a new government report.

10. Study reveals direct correlation between negative thinking about pain and poor sleep: Chronic pain sufferers who learn to dwell less on their ailments may sleep better and experience less day-to-day pain, according to results of research conducted on 214 people with chronic face and jaw pain.

11. More physicians calling the shots in latest round of ACOs. Most of the new accountable care organizations approved by Medicare are led by doctors, who can share bonuses for keeping patients healthy and cutting costs.

12. D.C. Week: Hospital Payment Update Proposed. The Centers for Medicare and Medicaid Services proposed a slight pay hike for hospitals for 2013, and the Government Accountability Office said the Obama administration should cancel a Medicare bonus program.

13. Fruit Flies Provide New Knowledge About Uninhibited Cell Growth: In a new study, scientists at the University of Copenhagen show that a specific type of carbohydrate plays an important role in the intercellular signalling that controls the growth and development of the nervous system.

14. FDA Backs New Rival For Viagra: The Food and Drug Administration on Friday approved a new drug from Vivus Inc. to treat erectile dysfunction.

The Fat Naked Guy on Ft. Lauderdale Beach: Society's Abandonment of the Mentally Ill

A few weeks ago, I took a trip back to Fort Lauderdale, Florida, a place where I used to live from 1998 to 2002. I loved living there at the time and was excited to return. While I found some things the same, I noted that the area was generally run down. People had told me that and I did not want to believe it, but it was true. For example, in my formerly beautiful apartment complex, a dog was swimming in the pool and many residents had their personal belongings packed onto their balconies making it look like a scene from A&E’s hit TV show, Hoarders. The formerly spacious and pristine Fashion Mall was abandoned. The spacious Sawgrass Mills Mall was strewn with litter between the rows of palm trees. Many of the downtown shops on the famous Las Olas Riverfront were gone, partly due to hard economic times. The beautiful downtown Riverfront area was also non-functional, with no working escalators and sections cordoned off by police tape.

Thankfully, my graduate school alma mater, Nova Southeastern University was in great shape and the campus was gorgeous. The Davie Ale House was still terrific and the famous Zingers were a delicious accompaniment to lunch. Dinner at The Oasis Café was nice on the famous swing tables along the beach.

But it was what I saw after dinner that completely ruined my entire day and return to the Ft. Lauderdale area. After dinner, I decided to take a walk with my family along the beach walkway. Across the street from the Route 66 Rock Bar on A1A, my wife and I noticed a large dark object on the beach wobbling from side to side and making strange noises. At first, we did not know what it was, but upon closer inspection, it became clear that this was a morbidly obese naked man rolling around in the sand who was barking at times and aggressively talking gibberish to people walking by.

I could not believe what I was seeing. Never, when I used to live there, would something like this be permitted.  Fortunately, we were quick enough to be able to shield our young children’s eyes from this scene but other families were likely not so lucky. Having moved past him, we took one picture for documentation purposes which is shown above. Then, we saw three young adults standing over him, laughing, apparently taunting him, and snapping pictures of him. This was equally disturbing. No one seemed to be trying to rectify the situation and there were no police officers were in sight.

So, I walked over to the Beach Place open mall area which was about a block away (and also run down). I walked up to a security guard and described what I saw. He instantly knew who I was talking about, smiled, and laughed, as did the person who was standing next to him. They told me that the man had been coming there for years and he is sometimes taken away when enough people complain but that he always finds his way back there somehow. They showed absolutely no interest in trying to have the man removed again. In speaking with a clothing store worker across the street from where he was laying, she stated that he has been coming there for about four years and that there have been times when he actually has stopped traffic due to rolling out onto the road. She seemed frustrated but did not seem to believe she could fix the situation. Before I left for the night, someone had thrown a towel on him.

When I got home, I began to do some research on this situation and discovered that his name is Kelvin (Kelvin Lamar Willaims to be exact). In some of the Youtube videos, he is shown singing incoherently. It is clear that he is mentally ill. He apparently has some ability to walk and had been seen getting to the beach by bus. One person noted that he was a frequent patient in a local mental health facility, a problem known to many health professionals as the revolving door syndrome. In all of the videos I found, Kelvin had his clothes on so his nakedness appears to be something new. One such video is here:







The situation I saw led me to reflect about:


1. How society has failed to properly care for many people with chronic severe mentally illness. Kelvin is just one example but his case is portrayed here to highlight the problem. While the police can take Kelvin to a mental health facility, they do not have funds to keep him there forever. He claims to be a former military member and if true, the Veteran’ Administration should bear some responsibility for his care. Kelvin needs to be taken to a mental health facility when needed and eventually brought to some type of supervised living situation designed to care for such individuals. One of the core functions of government is to provide a safety net for the most vulnerable members of society. If Kelvin does not qualify, I do no not know who does.

2. Law enforcement is apparently not dealing with the problem effectively. I am not saying that Kelvin should be put in jail, but he cannot be allowed to stay there. Public nudity is not allowed on the beach, is not appropriate for children to see, and it is scary for people to see someone aggressively yelling at people who pass by on what should be a relaxing beach. Regardless of the fact that he keeps coming back after being taken away, since when is that an excuse not to enforce the law? Again, this does not mean he should be imprisoned, but there needs to be better coordination between law enforcement, mental health facilities, and social services to keep him in the proper setting.

3. The apparent lack of concern of many in society towards the severely mentally ill. It was clear that many in the area viewed the situation as comical or have just become so used to it that they have given up.    

4. How this typified the degradation of the Ft. Lauderdale area. What is the Chamber of Commerce thinking? Do they think this is a scene that endears tourists to the area? I would never go back there, particularly with children, until some massive changes take place. It pains me to say this because I have great memories and love for the Ft. Lauderdale area.

Plan of Action:

1. Since no one on the beach seemed to want to address this situation or felt helpless to address it, I decided I would try to bring some attention to the matter by writing a blog entry about it, especially since I could not find any local news articles written about this situation via an internet search. This is remarkable considering that he has been there for years.

2. I am going to send a copy of this blog entry to the two local newspapers (Miami Herald and the Sun Sentinel) to see if either is willing to bring more public attention to this matter.

3. Posting this to the Ft. Lauderdale Chamber of Commerce Facebook page. They will probably delete it but you can go there and demand they use their influence to try to do something about the situation. I will email them the blog post as well.

4. Contact the Mental Health Association of Broward County at info@mhabroward.org

5. Contact the state Senator’s and local legislator’s for that area. 
    A. Senator Bill Nelson can be contacted here.
    B. Senator Marco Rubio can be contacted here.
    C. Congressman Allen West can be contacted here.  

6. Contact the Broward Sheriff’s Office.

7. Contact the National Alliance on Mental Illness.

8. Contact the local Channel 7 news channel. 

9. Spread the word on social medial sites.

Update on 6/1/12: Not a single one of the above sources responded to my email inquiries and as predicted, the Ft. Lauderdale Chamber of Commerce deleted the Facebook post about this matter. Also, as further evidence of the decline of the Ft. Lauderdale area, Ft. Lauderdale resident Rudy Eugene recently had the distinction of becoming the person who chewed a man's face off in broad daylight on the Miami Causeway.

Update on 6/25/12: I found out that Kelvin Williams was arrested for cocaine possession shortly after I saw him on the beach. Here is his mug shot.

Providing Independence and Safety

As family members grow older, the risk of being alone increases. If you have a loved one who is living by himself at home, a medical alert system might be his only way to communicate in an emergency. These lifelines are a must for any senior who desires to remain independent without sacrificing his safety.


Moving into an assisted living center signals the end of independence for a senior, which can be emotionally devastating. If a senior can still take care of herself and conduct daily activities without help, there is no need for her to move. Remaining in her own home can prevent the trauma of losing her independence. Medical alert devices are used to let the senior stay in her home, which may make improve her happiness level by staying independent.

A medical alert device gives even the most independent senior citizens a safety net. Should the senior fall and cannot reach a phone, she only has to touch the button on the medical alert device she wears to send a signal to the the system's dispatcher who may contact the family, an ambulance, or a doctor. This method is the preferred option as the dispatch center acts as a control to determine the level of assistance the senior needs. Sometimes the signal goes straight to the local 911 dispatcher, but such 911-direct systems pose the risk of triggering too many false alarms with 911.

Most alert systems are designed for simple use, even for a senior who may have difficulty with moving their hands or seeing. Such simplicity makes these devices a better alternative to a home telephone or cell phone in an emergency because phones require remembering and dialing several numbers. A senior in an emergency situation may not recall the phone number of those she needs to reach. With a pendent alert, a single button gets the senior in touch with a person who will get help.

While there are a variety of medical alert systems available to choose from, the important thing is to find one for your senior loved one. Giving them an alert device can give you peace of mind knowing that your relative will be able to get help in an emergency. Such a device also gives the senior the ability to remain independent while maintaining her personal safety. There can be no better gift for every member of the family.

The above is a guest blog entry.

Ladies...Check Those Tampons

A few days ago, a blogger named Danielle Parr posted the image below, stating that she discovered it in a box of Kotex tampons. She stated that it was a moldy tampon, and yes, that’s exactly what it looks like. Usually, we associate mold with old food, bathroom walls, attics, toilet or toilet bowls but it can infest cotton or rayon, the materials used to make tampons. Many women who use tampons have gotten into such a routine with them, that it is common to just take them out of the wrapping and insert them without looking at them. Based on this story, it makes sense to check these things out before using them. If anyone inserted a moldy tampon inside of them, you could potentially become quite ill, despite Kotex officially responding that the mold poses no health risk. As of now, the mold is being testing by ABC affiliate, WFAA. Lastly, it is worth noting that people have claimed finding all sorts of things in manufactured products, only for it to later be found to be a false claim. However, Kotex’s response that this sort of mold has been found on their tampons before makes that unlikely to be the case here. The difference is that now people have blogs and can get information out to the masses.

Why Obamacare is in Deep Trouble

In the 2007 Democratic primary, Barack Obama and Hillary Clinton fought tooth and nail on many issues. One of them was on universal healthcare, in which every American would have health insurance. Both agreed that they wanted to implement a universal healthcare system but they differed on the approach. Hillary’s plan was to implement an individual mandate. That is, each American would be forced to purchase healthcare or face a stuff penalty. Obama opposed the mandate at the time because he stated Americans who could not afford to purchase it would be worse off – they would have no health insurance, plus they would have to pay a fine or have the money taken out of their pay checks. He compared this to forcing the homeless to buy houses, obviously something that would be ridiculous.

Once Obama was elected, however, his healthcare plan changed in that he implemented the exact individual mandate that he railed against during the campaign. That is, if you did not purchase health insurance you could not only face a fine but be imprisoned. Obama defended this by arguing that if his plan lowered the cost of healthcare premiums by having more people pay premiums, that it would not be fair to allow some people not to pay for it. He also argued that this is similar to people being mandated to purchase car insurance. However, there are two major differences. The first is that auto insurance laws are set by the states and states do have a right to set mandates. The difference with a federal health insurance program, however, is that while the U.S. Constitution grants the federal government (via Congress) the right to regulate commerce, it does not grant it the right to force people to purchase anything such as insurance premiums. Secondly, even in states where there are mandates to purchase auto insurance, this only applies if you own an automobile. But there is no mandate to purchase the automobile to begin with and not everyone owns an automobile for various reasons. 

The other problem with a federal healthcare mandate is that it opens the door to almost any activity that can be conceivable linked with healthcare to be federally regulated such as the types of food you eat (e.g, a mandate to eat vegetables every day) and the activities you engage in (e.g., mandated exercise). For a country that was established on the principles of a centralized government with limited federal powers, the individual mandate would open new doors to increase those powers dramatically. In addition, the mandate would essentially amount to a tax on young people to pay thousands of dollars in healthcare premiums (when the true cost they should be paying is under $1000) to help pay for the costs of the elderly and the sick. Thus, the mandate is essentially a tax that is not explicitly identified as one. It’s a hidden tax and no one likes hidden taxes. However, most Americans have figured this one out and most people want the law repealed.

What is really incredible about this whole issue is that the Obama administration and many other Democrats apparently never considered that an individual mandate could be considered unconstitutional. Either that, or they did think about it but did not believe it would be successfully challenged. For example, when House Speaker Nancy Pelosi was asked about this very issue two years ago by a reporter, her only response was repeating the phrase “Are you serious?”

Now, the individual mandate and the healthcare law is before the U.S Supreme Court since 26 states have challenged it along with a group of plaintiffs consisting of the National Federation of Independent Business. If the questioning by the Supreme Court Justices is any hint as to the final ruling (which is usually the case) then it looks like the individual mandate will be ruled unconstitutional. If that occurs, Obamacare (Patient Protection and Affordable Care Act) may be eliminated entirely because the mandate is critical for the law’s success.

10 Conditions Parents Often Misdiagnose

The article below was sent to me by the staff at the National Nannies website and per their request, I have decided to feature part of it here because I thought that some of the points are well-made.

One of the roles we play as parents on occasion is that of family physician. Recognizing and treating minor ailments and then deciding whether a doctor visit might be in order is all in a day’s work for most moms and dads. That’s not to say our diagnoses are always right; we do get it wrong on occasion too, and here are some common illnesses and ailments that trip us up. The following is a list of the 10 most misdiagnosed kids’ ailments by parents:

1. ADHD – Parents will often interpret the signs of this disease as being indicative of a disruptive or unruly child. It is necessary to conduct testing to ascertain that the child is indeed suffering from Attention Deficit Hyperactivity Disorder.
2. Asperger’s Syndrome – Parents of children with Asperger’s Syndrome will frequently confuse the symptoms with autism. Naturally, either case requires a professional diagnosis, but initial tendency is for parents to lean towards their child having autism unless proven otherwise.
3. Bacterial Meningitis – Sharing many of the same symptoms of the flu such as fever and headaches, bacterial meningitis is often mistaken for the more common flu. Light sensitivity, seizures and skin rashes may also accompany those symptoms.
4. Vocal Cord Dysfunction (VCD) –This illness is characterized by sudden, abnormal narrowing of the vocal cords, which results in obstructed airflow and a wheezing sound during breathing. This is frequently misdiagnosed by parents and doctors alike as asthma.

For more, see the original version is at this link.

The Mickey Mouse Sign in Medicine: part 4

Today is the fourth and last example of the Mickey Mouse sign in the field of medicine. The image below comes from a 63-year-old man with diabetes mellitus who underwent ultrasound scanning of the femoral arteries (types of arteries in the legs). The picture below (presented in this article) shows a Mickey Mouse appearance formed by the presence of a blood clot in the legs.  Such blood clots are not always associated with symptoms and can be deadly. The presence of the Mickey Mouse sign on such scans helps identify such blood clots much easier. Be sure to check out the first, second, and third examples of the Mickey Mouse sign. The image below is copyrighted by BMJ Publishing Group Ltd & the British Association for Accident and Emergency Medicine.

The Mickey Mouse Sign in Medicine: part 3

The third way in which the Mickey Mouse sign can show up in medicine is via ultrasound scanning in the detection of anencephaly. Anencephaly is the absence of a large part of the brain and the skull. It is the most common abnormality affecting the central nervous system (brain and spine). Most babies born with this condition do not survive birth. The picture below (copyrighted by Wiley from this article) shows the appearance of a Mickey Mouse face on the ultrasound. In reality, it is showing a large amount of protruding, abnormally developed brain tissue. The sign was first identified in 1994 and its presence helps diagnose anencephaly early in pregnancy. Be sure to check out the first Mickey Mouse sign, the second Mickey Mouse sign, and the fourth Mickey Mouse sign.

The Mickey Mouse Sign in Medicine: Part 2

Today is the 2nd example of The Mickey Mouse sign in the field of medicine. What you will see in the picture below is an image from a coronary angiography of a 58-year-old man presented in this article. An angiography is a technique that produces a picture of the inside structure of blood vessels. You will see two large black circles shaped like Mickey Mouse ears, which is an aneurysm. An aneurysm is a balloon-like expansion of a blood vessel due to weakening of the blood vessel walls. Be sure to also see part one, part three, and part four of the Mickey Mouse sign.The image below is copyrighted by the American Heart Association.

The Mickey Mouse Sign in Medicine: Part 1

Mickey Mouse was created by Walt Disney in 1928. His impact has been felt all over the world, including the field of medicine. If you have children, your pediatrician’s office likely has pictures of Mickey to make it more comforting. For the same reason, pediatric nurses often wear Mickey on their clothes, children are sometimes given Mickey Mouse stickers, and Mickey Mouse cartoons may be playing in the waiting room. But beyond the obvious use of Mickey Mouse in pediatric medicine, Mickey Mouse has managed to show up in various images of the body, all of which are referred to as Mickey Mouse signs. In the next four blog entries (excepting the MedFriendly Blog contest over the weekend), I will provide four examples of the Mickey Mouse sign in medicine.

Case 1 involves a 55-year-old woman with breast cancer who underwent a bone scan to determine if the cancer had spread to the bones. In the picture of the spinal area below, the Mickey Mouse sign is the black area seen in the 2nd lumbar vertebrae (lower back). The black pattern of three dots shows areas in which the injected radiotracer was absorbed by the bone. The finding was consistent with Paget’s disease, which is a form of chronic bone inflammation and rapid bone destruction that distorts the bone structure. As a result, unusual patterns can present on bone scan images, including the Mickey Mouse sign. Come back tomorrow to see another Mickey Mouse sign. The image below was featured in this free article and is copyrighted by the Society of Nuclear Medicine. Be sure to see part two, part three, and part four of the Mickey Mouse sign.

Why Kermit the Frog Rules

Kermit the Frog is the undisputed leader of the Muppets and his presence dates back to 1955. He’s the only Muppet to be featured prominently of The Muppet Show and Sesame Street. Kermit the Frog is used here as a symbol for all sorts of frogs (and toads), which play an important role in medical science. If you think back to middle school or high school, you likely had to dissect a frog in science class to learn about different parts of the body. For many children, this spurred further interest in the inner workings of the body and turned many on to the biological sciences.  

Observations of frog deaths and body malformations in frogs have been taken by some to be warnings of possible environmental effects on humans. Scientists have also genetically engineered headless tadpoles, which led to speculation that headless people may be genetically created in the future for organ donation harvest. Frogs have been used to study the effects of space flight, which include changes in the lungs, tails, growth, and behavior. Although frogs may sound like perpetual victims (it’s not easy being green), they are actually a resilient species, being one of the unexpected survivors from the Mt. St. Helens volcanic eruption. In fact, the western toad experienced a population boom there because they fed of the algae that resulted from the lack of lakeshore trees and because their predators (snakes and birds) had not yet recovered. The findings helped ecologists better understand the resilience of some species and ways that some species can survive natural disasters. Yes, folks, Kermit the Frog truly rules and science owes him a lot.

If you liked this entry, you may also like Cookie Monster is Not Autsitic

Reference: Am J Med Genet. 2001 Nov 22;104(2):99-100. Is Kermit the frog in trouble? Cohen MM Jr

10 Ways to Mismanage Your Patient's Heallthcare

Below is a satirical and easy to follow recipe to quickly and easily mismanage your patient’s healthcare. By following these steps, you too will be able to conceptualize cases improperly, misdiagnose people, and order improper treatments.



STEP 1: Overbook your patients: Schedule so many patients each day that you cannot possibly spend ample time with them or see them back for timely follow-ups. This step is not essential, but doing so allows the next steps to occur more easily.

STEP 2: Do not take a thorough history: Although a patient’s history usually provides essential clues to properly conceptualize cases, ignoring important aspects of the history such as family medical/psychiatric history, personal psychiatric history, history of substance abuse, and history of trauma helps get the interviews done faster so you can move on to the next patient. These topics are the easiest to discard because they are the most uncomfortable to discuss, despite the potential value they provide in understanding the current patient presentation. Do not obtain the patient’s medical records because this takes too much time as opposed to only relying on self-report.

STEP 3: Do not use any objective criteria for diagnosis: The diagnostic process is much faster and easier when relying purely on clinical intuition as opposed to a combination of intuition with objective diagnostic criteria. Doing so requires no standard and allows you to diagnose all sorts of conditions purely because you say so. This step also allows you to make up your own name for some medical conditions.

STEP 4: Prescribe unproven treatments: With no solid foundation for a proper diagnosis, you are now ready to move on to the step which involves prescribing medications, therapies, and use of various medical devices and techniques that have little to no scientifically validated evidence to support their use. If a proven treatment is available, ignore that and use the unproven one.

STEP 5: Do not coordinate care with other medical providers: If your patient is followed by multiple physicians, make no attempt to account for the patient’s numerous medications and the ways in which taking one can interfere with another or cause various adverse reactions.

STEP 6: Make no attempt to objectively measure treatment progress: Once the treatment is selected, keep it ongoing indefinitely and do not use objective measures it to check if it is successful. Simply rely on patient self-report and maintain the same general treatment approach if symptoms are still endorsed. Having no criteria for discharge is a bonus here.

STEP 7: Never alter case conceptualization: Once an initial diagnosis is settled upon (see step 3) do not alter it even if symptoms are reported indefinitely. Do not try to gather new information to figure out why this is happening but if new information arises, simply ignore it if it does not comport with the original diagnosis. Continue with the prior steps.

STEP 8: Do not refer to specialists: Since you already know the diagnosis and proper treatment, do not send the patient for evaluation by a specialist for a second opinion. This is the worst thing you can do because it may lead to an altered case conceptualization or different treatment approach. This is especially true if the specialist uses objective scientific approaches to patient care. The only exception to this rule is if you know of a specialist(s) who always agrees with you.

STEP 9: Make no attempt to measure symptom validity: Trust all subjective symptoms as accurate and make no attempt to measure (or refer to someone who can measure) symptom under-reporting or over-reporting in cases where the context would indicate it is appropriate to do so. Thus, if a patient has a severe medical problem but denies significant symptoms and wants to be released for certain activities, do this without considering reasons for why this may be the case (e.g., poor insight in a possible dementia case; desire to be normal again). Similarly, if a patient suffered a mild medical problem but reports severe symptoms grossly disproportionate to the event, make no attempt to assess for (or refer to someone who can assess for) why this may be the case (e.g., exaggeration to obtain medication and/or compensation benefits).

STEP 10: Do not keep up with the scientific literature or just ignore it: This step allows you to remain unaware of new scientific developments and maintain one’s accustomed way of doing things. If you become aware of research that suggests you should consider a different diagnostic and treatment approach, ignore it and continue with the old approach.

More Medical School Secrets Revealed

March Madness, Syracuse vs UNC Asheville, & the Science of Referee Bias

Tonight, during March Madness, the main story was about the game between the #1 seed in the East (Syracuse) and the #16 team, UNC Asheville. As a disclaimer, I am a HUGE Syracuse fan (LET’S GO ORANGE). Besides the possibility of the near upset that took place, the biggest aspect of the story was several calls by the referee that went against UNC Asheville that helped Syracuse.


This included a no goal tending call when goal tending seemed to take place, a lane violation call towards the end of the game that actually was correct, and the referees giving the ball back to UNC Asheville after the ball bounced off of Syracuse player, Brandon Triche, followed by a UNC Asheville player hitting into him. There was some question as to whether Triche was fouled before the ball went off of him, causing him to go out of bounds.

Ok, so what does all of this have to do with anything medical you ask? Good question. Nothing. But MedFriendly is a site that not only explores medical topics but psychological topics as well. Part of psychology is the study of bias. Some UNC Asheville fans believe that the officials were biased against them, which is what resulted in the calls above.

So, I tried to see if anyone had explored the notion of officiating bias scientifically in college basketball. I found one study, performed in 2009. The study examined officiating bias (in terms of foul calls) in 365 NCAA basketball games during the 2004-2005 season. Results indicated that officials are more likely to call fouls on the team with the fewest fouls, making it likely that the number of fouls will tend to even out during the game. The greater the difference of fouls between the two teams, the higher the probability that a foul would be called against the team with fewer fouls. The researchers found a significant bias towards officials calling more fouls on the visiting team (probability as high as 70%), and a bias towards foul calls on the team that is leading.

All in all, the evidence indicates that there was not bias against UNC Asheville by the referees because they met all conditions in the study by which one would expect bias to be in their favor as opposed to Syracuse. That is, they were losing at the time, had less fouls (Syracuse was in the bonus), and technically were considered the visiting team on a neutral court due to their lower seed and greater distance from their home geographical location. Ok Syracuse. Now go beat K-State!

American Idol, Coca-Cola, and Obesity

So, I am sitting at home and the popular show American Idol is on. Randy Jackson has a red shirt on, which is color coordinated with a large red Coca-cola cup. J-Lo is sitting by his side, also with a red Coca-Cola cup. Same with Steven Tyler.  When one of the artists takes the stage, there is a large red moving video banner promoting Coca-Cola. It’s called product placement and it has been going on for decades on television and the movies. There is nothing wrong with it of course, but in the case of Coca-Cola, the situation gets a little more interesting because some worry that such advertising may be contributing to the obesity problem in children.

In 2011, researchers from the Rudd Center for Food Policy and Obesity in New Haven, CT, published a study examining the number of food, beverage, and restaurant brand appearances within shows during prime-time programming examined by Nielsen in 2008. Items were analyzed by product category and company as well as exposure to children adolescents, and adults. They found that food, beverage, and restaurant brands appeared 35,000 times prime-time TV programming (60% of which were energy/sports drinks). It was noted that young people were rarely exposed to this type of advertising with on exception…

“Coca-Cola products were seen 198 times by the average child and 269 times by the average adolescent during prime-time shows over the year, accounting for 70% of child exposure and 61% of adolescent exposure to brand appearances. One show, American Idol, accounted for more than 95% of these exposures… Coca-Cola has pledged to refrain from advertising to children, yet the average child views almost four Coke appearances on prime-time TV every week. This analysis reveals a substantial, potential loophole in current food industry self-regulatory pledges to advertise only better-for-you foods to children.”

While this may make it sound like Coca-Cola has violated their pledge, they really have not when you read their pledge carefully. Here is the relevant section:

 “…we are committed not to directly market messages for any of our beverages to children under 12. We have historically not placed – and continue the practice today of not placing – advertising for any of our beverages on any media that is primarily directed to, and has an audience of 50% or more, children under the age of 12.”

First, as you can see, it is not correct to say that Coca-Cola has pledged to not advertise to “children.” Rather they pledged not to directly market their products to children under 12 with a specific audience make-up.  Secondly, I do not see how one can make the argument that a few Coca-Cola cups and a Coca-Cola banner on American Idol would be directly marketing to children. Direct marketing to children would be showing Bert and Ernie chugging down a Coca-Cola after singing the alphabet or Sponge Bob and Patrick singing about how good Coca-Cola tastes when paired with a Krabby Patty.

Third, American Idol, which was singled out in the study, gets about 25 million viewers. Of these, about 2 million are estimated to be in the 2-11 age range. That’s 12.5% in that age range which is far from the 50% number in the Coca-Cola pledge. Lastly, for other prime time TV shows, young children will not make up more than 50% of the demographic group because the shows are on too late at night. This is why children’s programming is predominant in the morning and the day. All in all, it seems to me that Coca-Cola has maintained their pledge and has not exploited any type of loophole.

March Madness Associated Deep Vein Thrombosis

March Madness officially started last night. In fact, as I am typing this I am watching Iona take on BYU (great comeback BYU!). This is a great time of year for any college basketball fan because you have several days in which most of the time is taken up with continuous games. This means lots of opportunity to sit or lay down for prolonged time periods. Remaining immobile for long time periods, however, can cause deep vein thrombosis (DVT), which is clot formation in a deep vein. If this clot dislodges, it can be fatal in about 3% of cases in which the clot came from the lower extremity.

While DVT formation can be caused by any form of prolonged inactivity, one group of clinicians at Walter Reed Army Medical Center reported a case of March Madness associated DVT formation in an 83-year-old man. One of the signs of a DVT is edema (swelling), which was first noticed in this man after a full day of sitting and watching March Madness. He had recurrent prostate cancer which was felt to be contributory to the DVT, but that prolonged sitting from watching March Madness was a significant contributory factor to clot formation. Patients with a hypercoaguable state (blood disorder leading to clot formation) increases the risk further. The authors recommended the following steps to prevent DVT formation: decreased alcohol and caffeine intake, drinking a liberal amount of water and fluids, and standing at regular intervals to stretch and promote circulation.

Reference: South Med J. 2005;98(3):396. March madness-associated deep vein thrombosis. Wilson RL, Ritter JB, Roy MJ

MedFriendly Website Recommendation #1: The Khan Academy

Tonight I stumbled across a very cool non-profit educational website that I wanted to share with you. It’s called The Khan Academy. Although it may sound like a place you send someone to learn karate, it is actually a website filled with thousands of micro lectures via video tutorials. The topics are very broad and include healthcare, medicine, biology, chemistry, and organic chemistry.

Examples of lectures in healthcare and medicine include one on diabetes, normal colon tissue, colon cancer, vitamin C, and drug pricing. There are many other topics covered outside of healthcare as well including math, the humanities (e.g., history, finances), and much more. The site is funded by donations, such as from Google and the Bill and Melinda Gates Foundation. So check out the site and I think you will find it a worthy bookmark.

Daylights Savings Time & Fatal Car Accidents

This weekend was daylights savings time, the one everyone dreads because you lose an hour of sleep. Sometimes, daylights savings time comes as a surprise to people who forgot about it or who did not realize it was coming.

Some people may know it is coming and adjust their clocks appropriately, but still wake up late because their bodies have yet to adjust. One potential risks of sleep disruption from spring daylights savings time is fatal car accidents. In the fall, you gain the much beloved one extra hour of sleep. There is some evidence for increased and decreased numbers of car accidents after fall daylights savings time. Increased car accidents after fall daylights savings time may be due to staying up longer than usual. Decreased car accidents after fall daylights savings time may be due to some people sleeping an extra hour that night.

An interesting study was performed in 2001 to examine the association between daylights savings time and fatal car accidents in more detail. The researchers examined data from 21 years of United States' fatal automobile accidents. The average number of accidents on the days at the time of daylights saving time shifts (Saturday, Sunday and Monday) was compared to the average of accidents on the matching day of the weeks before and after the shift. This was repeated for each daylights saving time shift.

The results of the study showed that there was a significant increase in accidents for the Monday immediately following the spring shift to daylights savings time. There was also a significant increase in number of accidents on the Sunday of the fall shift from daylights savings time. No significant changes were observed for the other days.

The authors concluded that sleep deprivation on the Monday following a shift to spring daylights savings time results in a small increase in fatal accidents. For fall daylights savings time, the authors concluded that the behavioral changes associated with anticipating the longer day on Sunday led to an increased number of accidents. This suggested an increase in late night (early Sunday morning) driving when traffic related fatalities are high possibly related to alcohol consumption and driving while sleepy.

The authors recommended that public health educators should probably consider issuing warnings both about the effects of sleep loss in the spring shift and possible behaviors such as staying out later, particularly when consuming alcohol in the fall shift. The authors concluded that physical and behavioral responses of the body to forced circadian rhythm changes (the body’s biological clock) due to daylights savings changes are important factors for sleep clinicians to be aware of.

Suggested reading: Daylight Savings Time Change May Increase Heart Attack Risk.

Reference: Varughese,J., Allen, R. (2001). Fatal accidents following changes in daylight savings time: the American experience. Sleep Med., 2(1):31-36.

Pink Slime in Your Children's Hamburgers

One of my favorite shows on TV is “Good Eats” with Alton Brown. If you have not seen the show, he focuses a half hour episode on a particular food product and he teaches you how to prepare certain meals from it along with interesting historical and scientific tidbits. Last weekend, I tuned into a show he did on hamburgers. He showed a very easy way to make your own burgers by purchasing fresh cuts of beef and grinding it yourself. If that sounds too time consuming, it isn't because you can easily do it with 10 pulses in the food processor. If you grind the beef yourself, you can feel much more comfortable about what is in your burger as opposed to purchasing the beef in an already ground up form.

The reason the above is important is because I have recently become revolted by the revelation that most ground beef products humans are eating (primarily from fast food restaurants) contain something known as “pink slime.” Pink slime (see above) is a nick name for a filler substance made from previously inedible cuts of beef that are made edible through a spinning separation process that involves treatment with water and ammonia. I used to add ammonia to a mop bucket and hot water when I mopped floors as a kid. It is not something that should ever be added to food. I used to think that I could trust the ingredients label on the package to know what was in my food, but as it turns out when pink slime is used, it is not listed and neither is the ammonia present. This is because the FDA does not view ammonia as an ingredient but part of a “process.” This makes no sense whatsoever because all cooking is a process and if a substance is being added to my food, especially if it is a chemical, I want to know about it. This is why I have dramatically changed my eating habits and that of my children after writing the blog entry called: Does Your Kids Cereal Contain BHT or BHA? – Mine Did.

Fortunately, many fast food chains now say that they are pulling “pink slime” from their food products. Unfortunately, many school cafeterias are still serving it to children and they use it as a filler as opposed to using originally edible meat. The FDA says pink slime is safe, but even if you believe that, why would anyone want to feed this to your children. Don’t get me wrong, enjoy a hamburger, but do it right and make sure the meat is actually real and do it yourself for the best results. The video below is really a must see for those who want to be educated more about this issue.