30 March 2004

Medical Error: Wrong Diagnoses Can Kill You

I've been arguing for years at major healthcare conferences that the probability of a correct diagnosis during a typical patient visit of a few minutes is at best 50%, on average. I rarely get any kickback. A former head of the Massachusetts Medical Society thought he did better than that. I told him he was better than average.

The real numbers are worse than that. After many patient visits and hospitalization, and after the patient is dead, postmortems indicate that major problems are missed in 39% of cases and experts agree that over 30% of diagnoses are wrong, even with all that medical science and all the attending physicians have to offer during the entire period you are still breathing before you are sent to the morgue.

We need something a lot better than the current lab tests and CAT scans. I predict that electromagnetic medicine will have a huge impact on diagnosis in the future.

Wrong diagnoses are killing patients
Michael Day, New Scientist, 18 February 04

Many patients in intensive care units are being wrongly diagnosed, according to a study in a UK hospital. Some are dying because doctors fail to spot major conditions such as heart attacks, cancer and pulmonary embolism. The reason, experts say, is not incompetence but that so few post-mortems are now performed that doctors cannot learn from their mistakes.

Fang Gao Smith, a consultant in intensive care medicine at Birmingham Heartlands Hospital, and her team checked the accuracy of diagnoses by comparing post-mortem results with patients' medical records. In 39 per cent of cases, they found major problems had been missed.

The problem is not limited to one hospital, or to the UK. Gao Smith says her findings are consistent with other studies done in Europe and the US. She thinks doctors place too much faith in sophisticated scanners when making diagnoses, and are failing to learn from their mistakes because fewer and fewer autopsies are being done, both in the UK and the US.

26 March 2004

Chronic Headache: When to Avoid Your Doctor

We should all practice evidence based medicine and use treatments that are proven in randomized clinical trials, right? Well, there are certain cases where you should avoid your general practicioner because clinical trials show you will get worse treatment. Lower backpain is one. Chronic headaches are another.

While electronic frequencies can often help with headaches, this has not been proven in clinical trials. Meanwhile, see your acupuncturist. Kudos to the British Medical Journal for being an open source publisher!

Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial
Andrew J Vickers, assistant attending research methodologist, Rebecca W Rees, research officer, Catherine E Zollman, general practitioner, Rob McCarney, research officer, Claire M Smith, senior trials coordinator, Nadia Ellis, lecturer, Peter Fisher, director of research, Robbert Van Haselen, deputy director of research
BMJ 2004;328:744 (27 March), doi:10.1136/bmj.38029.421863.EB (published 15 March 2004)

Objective: To determine the effects of a policy of "use acupuncture" on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of "avoid acupuncture."
Design: Randomised, controlled trial.
Setting: General practices in England and Wales.
Participants: 401 patients with chronic headache, predominantly migraine.
Interventions: Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care.
Main outcome measures: Headache score, SF-36 health status, and use of medication were assessed at baseline, three, and 12 months. Use of resources was assessed every three months.
Results: Headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34% reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16% reduction from baseline). The adjusted difference between means is 4.6 (95% confidence interval 2.2 to 7.0; P = 0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication (P = 0.02), made 25% fewer visits to general practitioners (P = 0.10), and took 15% fewer days off sick (P = 0.2).
Conclusions: Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS acupuncture services should be considered.

20 March 2004

Nature News Alert: EM pulses cause cancer cell death, fat cell destruction, etc.

Nanopulses can make cells commit suicide.
Photo by SPL. Nature, 16 Mar 2004

Rifers have been reporting on this since the 1920's. Now even MIT is starting to get with the program studying how electromagnetic pulses can cause cancer cell apoptosis (cell death). Nature is saying this was discovered in the late 1990s! Duh!

This is the normal scientific process. First you are a kook. Then when others try it and it works, they say it couldn't possibly work because there is no theoretical explanation of how it could work (i.e. they are ignorant and don't want to admit it). Then a couple of leading labs start publishing on it and people claim they discovered it first, even though they are 80 years late! Well, the next step is mainstream science where they will say we knew it all along, it's not even news, it is NIH policy. From that point, it will take at least 17 years to find its way into the practice of the average physician. So we are still at least 20 years away from widespread application of electromagnetic replacements for antibiotics, chemotherapy, radiation, and even many surgical procedures like fat deposit removal, the latest rage at Mass. General Hospital here in Boston.

Ultra-fast shocks scramble cells: Powerful electrical pulses might zap tumours.
Helen Pearson, Nature Science Update, 16 Mar 2004

Using very short, very powerful electric shocks, researchers are developing a way to jolt cancer cells into committing suicide, or healthy cells into healing wounds...

Longer shocks blow a cell apart, but researchers have found that the fleeting nanopulses leave the cell membrane unaffected while mixing up its insides. Now they are working out how to vary the timing and intensity of the shocks to make cells behave in specific ways...

Schoenbach and his colleagues were the first to recognise that you could use high-power, brief shocks to manipulate cells in other ways. Working with electrical engineers in the late 1990s, they discovered that such pulses fry bacteria and sterilize contaminated water.

One of the most significant discoveries was that nanopulses make mammalian cells commit suicide, rather than blowing them up. This is a relatively gentle way of killing, because scavenger cells come and swallow the debris. By contrast, long electric shocks explode cells and liberate toxic molecules that cause inflammation and pain.

For this reason, researchers hope to use nanopulses to kill cancer cells while leaving healthy tissue intact. Schoenbach's team has already shown that the pulses can shrink mouse tumours by over 50%, and is working on catheters or non-invasive ways to deliver the shocks to the body.

Quite how nanopulses trigger cell suicide still leaves scientists scratching their heads. One idea is that the shock flips molecules in the cell membrane from the inside to the outside, which tells surrounding cells of their imminent death. "It says 'get rid of me,'" says Thomas Vernier, who is studying the technique at the University of Southern California, Los Angeles.

However they work, the nanopulses are prompting a flurry of ideas for their use. They might replace liposuction as a way to demolish unwanted flab, or blast away the fatty plaques that cause heart disease. "It is like asking what to do with a newborn baby," says Weaver. "Our speculations probably will not pick up the most important things."

18 March 2004

Health Effects of Tai Chi

As reported previously, chi is a powerful force that can be used to lift Japanese executives of major companies 6 feet in the air and throw them 20 feet across a room without touching them, as in the photo above. It can also be used as a healing force and I recommend everyone try Chi Lel, a form of medical Tai Chi, that anyone can perform, even when ill and unable to move.

The Archives of Internal Medicine published an article this month which reviews health effects of Tai Chi. It is too bad someone won't study the effects of a real Chi master. It probably would not be publishable because it would not be explainable by conventional medicine. Lifting the editor up in the air and bouncing him off the wall without touching him would be interpreted as fraud. They would have to send in Randi the magician as European medical journals did a few years ago to prove some unusual data was fake. The fact that Randi would be bounced off the wall like everyone else would be suppressed as aberrant data unpublishable in a reputable journal. Actually, I think Randi is smart enough to avoid messing with a real Chi master.

But I digress. A force that can throw a person across a room can have a dramatic effect on internal organs when focused properly, either to heal or to maim, depending on intent. Trying to heal yourself with it is a worthy effort, particularly when it improves balance, flexibility, and cardiovascular fitness as a side effect. Why not direct that time at the gym towards a more profound effort?

The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review.
Wang C, Collet JP, Lau J.
Arch Intern Med. 2004 Mar 8;164(5):493-501

OBJECTIVE: To conduct a systematic review of reports on the physical and psychological effects of Tai Chi on various chronic medical conditions.
DATA SOURCES: Search of 11 computerized English and Chinese databases. STUDY SELECTION: Randomized controlled trials, nonrandomized controlled studies, and observational studies published in English or Chinese.
DATA EXTRACTION: Data were extracted for the study objective, population characteristics, study setting, type of Tai Chi intervention, study design, outcome assessment, duration of follow-up, and key results.
DATA SYNTHESIS: There were 9 randomized controlled trials, 23 nonrandomized controlled studies, and 15 observational studies in this review. Benefits were reported in balance and strength, cardiovascular and respiratory function, flexibility, immune system, symptoms of arthritis, muscular strength, and psychological effects.
CONCLUSIONS: Tai Chi appears to have physiological and psychosocial benefits and also appears to be safe and effective in promoting balance control, flexibility, and cardiovascular fitness in older patients with chronic conditions. However, limitations or biases exist in most studies, and it is difficult to draw firm conclusions about the benefits reported. Most indications in which Tai Chi was applied lack a theoretical foundation concerning the mechanism of benefit. Well-designed studies are needed.

Prion Frequencies

I've received several email messages asking about prion frequencies. The current epidemic flu produces proteins which appear to be susceptible to frequencies, so it ought to be possible to knock out a prion. I've responded that without a test case, or better yet, a set of test cases, it is difficult to identify  frequencies, assess whether there are various strains that require different frequencies, or whether the DNA structure varies across individuals.

In any event, microscopic photos are a good source of candidate frequencies. The frequency of the prion in the image below is 5654.24hz. A number of proteins seem to respond well to frequencies in the 5000-7000hz range. This is an area which obviously needs a lot more study.

Microscopic image of a tissue sample from a human brain that shows a clump of infectious prions (dark pink area).
Image: Dr.Neil Cashman, University of Toronto

Possible diagnosis, treatment, vaccine for mad cow, prion diseases found
Raising antibodies against tyrosine-tyrosine-arginine amino acid sequence the key
by Janet Wong, University of Toronto, 4 Jan 2004

June 2, 2003 -- Research led by scientists at the U of T and Caprion Pharmaceuticals has uncovered the basis for a diagnostic, immunotherapy and vaccine, providing a way to detect and treat the brain-wasting damage of infectious prions like those found in mad cow disease and its human version, Creutzfeldt-Jakob Disease.

Dr. Neil Cashman, a principal investigator at U of T's Centre for Research in Neurodegenerative Diseases and professor in the Department of Medicine (neurology) and a Caprion founder, says a vaccine approach - which would likely be of most use in animals and livestock - could prevent animals from becoming infected. For humans with diseases like classical or variant Creutzfeldt-Jakob, an immunotherapeutic would provide patients with antibodies that bind infectious prions, enabling the immune system to recognize and attack them. For both humans and animals, the diagnostic screening potential of this discovery could significantly improve the safety of the human blood and food systems.

Cashman, who also holds the Jeno Diener Chair in Neurodegenerative Diseases at U of T, says his team tried a new approach in studying infectious prions, which are particles thought to be composed of normal prion proteins that have been compromised and folded into rogue shapes. "The usual way of raising antibodies in the immune system is to grind the infectious agent up and inject it into a mouse to see if it prompts antibody production," he says. "Scientists have tried this method with prions over the past 15 years, all without success. My group decided to examine it from the sub-molecular level to determine if antibodies would recognize and react to the amino acids exposed at the surface of a prion. It was a novel idea, and when we found that our hypothesis actually worked, we were surprised and pleased." The researchers' findings are reported online in the June 1 version of Nature Medicine.

All mammals have prion proteins, the highest levels of which are present in the brain, explains Cashman, a senior scientist at Sunnybrook and Women's Research Institute and a neurologist in the Department of Medicine at Sunnybrook and Women's College Health Sciences Centre. Mammals can contract prion diseases by ingesting abnormal or infectious prions. From the digestive system, these prions make their way to the brain. When an abnormal prion comes in contact with a normal prion protein, it causes the protein to misfold, thus creating a copy of the infectious prion. Cashman says the process is more akin to co-opting than replication. However, since the abnormal prion has similar characteristics to the original host protein, the immune system does not recognize it as a foreign invader and does not attack it.

13 March 2004

Evidence Based Medicine: Government Distorts and Manipulates Results

Blackburn, Elizabeth. Bioethics and the Political Distortion of Biomedical Science. NEJM, 1 Apr 2004.

When prominent scientists must fear that descriptions of their research will be misrepresented and misused by their government to advance political ends, something is deeply wrong. Leading scientists are routinely called on to volunteer their expertise to the government, through study sections of the National Institutes of Health and advisory panels of the National Academy of Sciences and as advisers to departments ranging from health and human services to defense. It has been the unspoken attitude of the scientific community that it is our duty to serve our government in this manner, independent of our personal political affiliations and those of the current administration. But something has changed. The healthy skepticism of scientists has turned to cynicism. There is a growing sense that scientific research — which, after all, is defined by the quest for truth — is being manipulated for political ends. There is evidence that such manipulation is being achieved through the stacking of the membership of advisory bodies and through the delay and misrepresentation of their reports.

Electromagnetic Frequencies Help Children With Bronchial Asthma

The effect of the pulsatile electromagnetic field in children suffering from bronchial asthma.
Sadlonova J, Korpas J, Salat D, Miko L, Kudlicka J.
Acta Physiol Hung. 2003;90(4):327-34.

From the bibliography it is well known that pulsatile electromagnetic field has an anti-inflammatory and analgesic effect. It causes vasodilatation, myorelaxation, hyper-production of connective tissue and activation of the cell membrane. Therefore our aim was to study the possible therapeutic effect of pulsatile electromagnetic field in asthmatic children.

Forty-two children participating in this study were divided in two groups. The 1st group consisting of 21 children (11 females, 10 males, aged 11.8 +/- 0.4 yr) was treated by pulsatile electromagnetic field and pharmacologically. The 2nd group served as control, consisting also of 21 children (11 females, 10 males, aged 11.7 +/- 0.3 yr) and was treated only pharmacologically. Therapeutic effect of the pulsatile electromagnetic field was assessed on the basis of pulmonary tests performed by means of a Spirometer 100 Handi (Germany). The indexes FVC, IVC, ERV, IRV, FEV1, FEV1/FVC%, MEF75,50,25, PEF, PIF and the changes of the flow-volume loop were also registered.

The pulsatile electromagnetic field was applied by means of the device MTU 500H, Therapy System (Brno, Czech Republic) for 5 days, two times daily for 30 minutes (magnetic induction: 3 mT, frequency: 4 Hz as recommended by the manufacturer). The results in children of the 1st group showed an improvement of FVC of about 70 ml, IVC of about 110 ml, FEV1 of about 80 ml, MEF75 of about 30 ml, PEF of about 480 ml, PIF of about 550 ml. The increases of ERV, IRV and FEV1/FVC and decreases of MEF25,50 were statistically insignificant. The results in the 2nd group were less clear. The flow-volume loop showed a mild improvement in 14 children. This improvement in the 2nd group was less significant.

The clinical status of children and their mood became better. We believe that the pulsatile electro-magnetotherapy in children suffering from asthma is effective. On the basis of our results we can recommend it as a complementary therapy.

12 March 2004

USDA Threatens to Prosecute Anyone Who Tests a Cow for Mad Cow Disease

NPR reported today on a USDA threat to prosecute anyone who tests a cow for mad cow disease. A beef producer asked the USDA to test all his cows. He offered to pay for the testing. The USDA not only refused to test his cows but told him they would prosecute anyone else who tested them.

This is the one of many example of vested business interests using government agencies as pawns to undermine the health and safety of the American people. The same type of behavior is rampant in healthcare. Our system is a regulated beaurocracy that systematically suppresses innovation that could help the consumer.

One can turn to the Harvard Business Review for an analysis of "the most entrenched, change-averse industry in the United States."

Christensen, CM; Bohmer, R; Kenagy, J. Will Disruptive Innovations Cure Health Care? Harvard Business Review, Sep-Oct 2000, pp. 103-111.

"Imagine a portable, low-intensity X-ray machine that can be wheeled between offices on a cart. It creates images of such clarity that pediatricians, internists, and nurses can detect cracks in bones or lumps in tissue in their offices, not in a hospital. It works through a patented "nanocrystal" process, which uses night-vision technology borrowed from the military. At 10% of the cost of a conventional X-ray machine, it could save patients, their employers, and insurance companies hundreds of thousands of dollars every year. Great innovation, right? Guess again. When the entrepreneur who developed the machine tried to license the technology to established health care companies, he couldn't even get his foot in the door. Large-scale X-ray equipment suppliers wanted no part of it. Why? Because it threatened their business models.

"What happened to the X-ray entrepreneur is all too common in the health care industry. Powerful institutional forces fight simpler alternatives to expensive care because those alternatives threaten their livelihoods. And those opponents to low-cost change are usually lined up three or four deep. Imagine for a moment that our entrepreneur was able to license the technology. Even then, he would probably face insuperable barriers. Regulators, afraid of putting patients at risk, would withhold approvals. Radiologists, who establish the licensing standards that regulators enforce, don't want to lose their jobs, so they'd fight it, too. Insurance companies, which approve only established licensed procedures, would refuse to reimburse for it. And hospitals, with their large investments in radiology and emergency departments, want injuries to flow to them--so they, too would join the forces holding back change."

At the MIT Future of Health Technology Summit we discuss these issues every year among some of the top leaders in healthcare. The consensus last October was that aligning business incentives with the safety and well being of patients was the core of the problem and that radical change was necessary. Frankly, the only way I see this happening is massive consumer revolt causing major political repercussions. It is essential that every healthcare consumer concerned about themselves, their children, and the elderly in their family to become educated, to take charge of their own healthcare and the healthcare of their loved ones, and to demand accountability and political action.

Let's hope aging baby-boomers will still have the mojo to act on this. It will make stopping the Vietnam war look like a cakewalk. Check out Robert McNamara in "The Fog of War." If that doesn't get your juices flowing, try seeing "Apocalypse Now" for the third time. When I finished my 100th mission over North Vietnam in 1968, there were only about 25000 dead U.S. soldiers and it was clear that we were in the wrong place at the wrong time. It took more than another 25,000 to get people to wake up. In healthcare we have more than four Vietnams of medical error every year. That doesn't count lives that would be saved without systematic suppression of innovation.

07 March 2004

EM FAQ: Can electromagnetic frequencies affect biochemical processes in the cell?

The answer is yes, either positively or negatively, depending on state of the cell, electromagnetic frequency, and timing.

Zeeman-Stark modeling of the RF EMF interaction with ligand binding
A. Chiabrera, B. Bianco, E. Moggia, J.J. Kaufman
Bioelectromagnetics, Volume 21, Issue 4 , Pages 312 - 324, © 2000 Wiley-Liss, Inc.

The influence of radiofrequency electromagnetic exposure on ligand binding to hydrophobic receptor proteins is a plausible early event of the interaction mechanism. A comprehensive quantum Zeeman-Stark model has been developed which takes into account the energy losses of the ligand ion due to its collisions inside the receptor crevice, the attracting nonlinear endogenous force due to the potential energy of the ion in the binding site, the out of equilibrium state of the ligand-receptor system due to the basal cell metabolism, and the thermal noise. The biophysical output is the change of the ligand binding probability that, in some instances, may be affected by a suitable low intensity exogenous electromagnetic input exposure, e.g., if the depth of the potential energy well of a putative receptor protein matches the energy of the radiofrequency photon. These results point toward both the possibility of the electromagnetic control of biochemical processes and the need for a new database of safety standards.