Invalidating Bloodletting with Science

Blood on the Tracks – Podcast Episode 38

Learn about a piece of epidemiological history: one of the earliest examples of population-level clinical studies influencing medical practice. This podcast tells the story of how French physician Pierre Charles Alexandre Louis studied a group of patients and ended up discovering quantitative evidence on the detriment of bloodletting. Learning the history helps place these tools in a broader context, which isn’t crucial, but interesting nonetheless.

Listen to the Podcast here

The first population study in history was born out of a dramatic debate involving leeches, “medical vampires,” professional rivalries, murder accusations, and, of course, bloodletting, all in the backdrop of the French Revolution. The second of a multipart series on the development of population medicine, this episode contextualizes Pierre Louis’ “numerical method,” his famous trial on bloodletting, and the birth of a new way for doctors to “know”.


Source

Bedside Rounds: Episode 38: Blood on the Tracks (PopMed #2)

Public Health in the Precision-Medicine Era

Ronald Bayer, Ph.D., and Sandro Galea, M.D., Dr.P.H.

“The NIH’s most recent Estimates of Funding for Various Research, Condition, and Disease Categories report (www.report.nih.gov/categorical_spending.aspx) shows, for example, that total support in fiscal year 2014 for research areas including the words ‘gene,’ ‘genome,’ or ‘genetic’ was about 50% greater than funding for areas including the word ‘prevention.’…The proportion of NIH-funded projects with the words ‘public’ or ‘population’ in their title, for example, has dropped by 90% over the past 10 years, according to the NIH Reporter.”

“Without minimizing the possible gains to clinical care from greater realization of precision medicine’s promise, we worry that an unstinting focus on precision medicine by trusted spokespeople for health is a mistake — and a distraction from the goal of producing a healthier population.”

Read More


Source

NEJM: Public Health in the Precision-Medicine Era by Ronald Bayer, Ph.D., and Sandro Galea, M.D., Dr.P.H.

Earthlings (2005)

Earthlings is a 2005 American documentary film about humankind’s total dependence on animals for economic purposes.  Presented in five chapters (pets, food, clothing, entertainment and scientific research) the film is narrated by Joaquin Phoenix, featuring music by Moby, and was written, produced and directed by Shaun Monson.”


How Not to Die describes the numerous health benefits of eating a plant-based diet. After reading through half the book, I watched Earthlings to see arguments from the animal rights activists for eliminating animal products from the dinner table. Personal health has always been my primary interest for minimizing meat consumption. But the message in this documentary is just as difficult to ignore as it is to watch.

There are some valid counter arguments to abandoning meat, which are listed in this reddit thread. The most compelling was that from an Indian man who argues he will not stop eating meat nor stop providing it for his family because he has genuine concern that his children my not survive due to malnutrition. Perhaps citizens of the more developed nations are the primary audience for this documentary.

I have watched a handful of anti-meat documentaries, and often they appeal to emotions such as shame, guilt, or anger. Earthlings takes a more objective role, showing film of industrial animal manufacturing in the United States. It was refreshing to be treated as a neutral observer, instead of being reprimanded. There are definite appeals to emotion, but the dialogue in the documentary is more calm than any I’ve seen before.

Earthlings has made me reconsider my current relationship with meat and animal products.  I imagine I have grown up with more livestock experience than many of my neighbors. I learned from my family to slaughter fish, chickens, turkeys, and rabbits for food. I attempted a pescatarian diet for several years in my twenties, but only for personal health reasons. This is the most cognizant I have been of my indirect participation in the massive consumption of animals, and what that actually means.


Three Stages of Truth

  1. Ridicule
  2. Violent Opposition
  3. Acceptance

Attributed to German Philosopher Arthur Schopenhauer (1788–1860)


Sources

Using It or Losing It? The Case for Data Scientists Inside Health Care

“As much as 30% of the entire world’s stored data is generated in the health care industry. A single patient typically generates close to 80 megabytes each year in imaging and electronic medical record (EMR) data. This trove of data has obvious clinical, financial, and operational value for the health care industry, and the new value pathways that such data could enable have been estimated by McKinsey to be worth more than $300 billion annually in reduced costs alone…Read More


Source

NEJM Catalyst: Using It or Losing It? The Case for Data Scientists Inside Health Care by Marco D. Huesch, MBBS, PhD & Timothy J. Mosher, MD

Does Pure Nicotine Cause Cancer?

Cigarettes contain many chemicals that increase the risk of cancer. Polycyclic hydrocarbons and tobacco-specific N-nitrosamines are some of the more well-known carcinogens in this class.

But now, e-cigarettes appear to be isolating nicotine, and leaving behind many of the old toxins from cigarettes. This sounds like e-cigarettes may be “better” for the modern smoker. Are smokers of e-cigarettes increasing their chances of cancer later in their lives? If so, what is the risk of cancer from smoking pure nicotine?

For the sake of discussion, let’s ignore the possibility for novel cancer-inducing chemicals introduced from the various oils and heating mechanisms in e-cigarettes. Let’s assume it is possible to have a method of smoking that only exposes the smoker to nicotine and nothing else. Would this method of smoking still cause cancer?

This review of the literature on Nicotine from 2015 suggests the answer is “yes”. Nicotine alone still increases the risk of cancer for the smoker of pure nicotine.

“Several lines of evidence indicate that nicotine may contribute to the development of cancer.

“Evidence from experimental in vitro studies on cell cultures, in vivo studies on rodents as well as studies on humans inclusive of epidemiological studies indicate that nicotine itself, independent of other tobacco constituents, may stimulate a number of effects of importance in cancer development (5, 6).”


Source

NCBI: Nicotine: Carcinogenicity and Effects on Response to Cancer Treatment – A Review

The Power of Mindsight

Prolific child neurologist and author, Dr. Siegel uses a variety of images to explain what he thinks should be taught to children in America.


He uses his hand to provide a concrete visual model of the brain.

Related image


He also summarizes his “mindsight” model as a combination of brain, mind, and relationships. He expounds on the over emphasis of brain, or somatic, focus in mainstream culture and medical school. He argues we neglect the education of mind and relationships after children graduate kindergarten.

Image result for siegel brain mind relationships triangle


Source

TEDx: The Power of Mindsight by Daniel J. Siegel, M.D. – 10/18/09

A Practical Introduction to Factor Analysis

A Practical Introduction to Factor Analysis: Exploratory Factor Analysis

Survey questions or “items” (e.g., on a scale from 1 to 5, how strongly do you agree with the following statement…) may be repeated measures of certain underlying “factors”. Where factors are a true underlying construct that a survey attempts to measure. For example, a factor a survey may attempt to measure might be the anxiety caused by learning statistical analysis (using SPSS software). Factor analysis looks at understanding what is really being measured by multiple questions in a survey.

There are a ton of new concepts in this class, but online resources are often a more simple and clear way to learn.

fig03b


UCLA Institute for Digital Research and EducationA Practical Introduction to Factor Analysis: Exploratory Factor Analysis

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