"To get the best care, you have to go out and get it"

he desire to be seen as a person is a common complaint among cancer patients caught in a system that seems overwhelmed by waiting lists and swamped by test results, where phone calls tunnel through to voice mail and a busy doctor may have mere minutes to explain the most complicated, heart-stopping medical information.

Lynda Coghill recalls how her doctor barely spared a few seconds to deliver a curt death sentence. The Newmarket, Ont., school teacher was diagnosed with ovarian cancer at 39. At an appointment after surgery and radiation, she told her oncologist she was still bleeding. He did a quick exam, announced she had a new tumour, and said bluntly: “Your chances are slim to none.” He told her to wait a few weeks for the results of a biopsy, then left to treat a patient down the hall.

“I looked at the nurse in sheer disbelief,” Ms. Coghill says. “The doctor had proceeded to tell me, in less than 30 seconds, that I was going to die. He didn't seem to care that I had three small children.”

She cried for days, unable to eat or sleep. She and her husband planned her funeral. At last, she contacted the sympathetic nurse from the doctor's office and persuaded her to call for an “unofficial” biopsy report. The tumour was benign. Eight years later, Ms. Coghill remains angry about having been treated “like a numbered object on an assembly line.”

To get the best care, patient advocates say, it's not enough to wait passively in an appointment room. You have to go out and get it.'

From The Globe and Mail - Link

This article does not, we think, apply just to cancer patients...and it is telling that physicians dread falling ill, because then they would be cast in the role of... patients.

From the drama/film WIT with Emma Thompson. This patient was too good, and paid the ultimate price.
It's good to be patient - but not too patient...

Illuminations from THE RUNAWAY BUNNY by Margaret Wise Brown.

ACRE--A High Powered Harvard Stealth Pharma Front Group

Image inspired by Charles Pachter

ACRE--A High Powered Harvard Stealth Pharma Front Group
Saturday, 25 July 2009
ACRE's mission is to persuade physicians that MORE rather than less industry involvement in Continuing Medical Education programs is good for patients--much as industry's "Harry and Louise" ads were aimed at convincing the public that universal healthcare was BAD for them.
Daniel Carlat, MD , is Associate Clinical Professor of Psychiatry Tufts University School of Medicine Publisher and Editor The Carlat Psychiatry Report Co-chair, CME Committee Massachusetts Psychiatric Society. Above all, he is an independent psychiatrist whose informative blog contains fascinating information about powerful, financially compromised groups such as the APA Task Force that is currently engaged in further expanding psychiatry's diagnostic / practice guide, the DSM-V . Their perspective--given their financial stake--is in sync with Pharma's market expansion agenda.

ACRE is Pharma's latest, powerful, mostly Harvard-based front group: it is spearheaded by Harvard professor, Thomas Stossel, MD. ACRE's mission is to persuade physicians that MORE rather than less industry involvement in Continuing Medical Education programs is good for patients--much as industry's "Harry and Louise" ads were aimed at convincing the public that universal healthcare was BAD for them. Both attempt to confuse. ACRE poses as the Association of Clinical Researchers and Educators.

ACRE held its charter conference earlier this month at Harvard Medical School.l Its steering committee consists of physicians from Harvard Medical School, the State University of New York Downstate and the Mayo Clinic. Dr. Jeffrey Flier, Dean of the Harvard Medical School, introduced this high powered Pharma-physician conference, which was managed by Rockpointe, a science-based medical communications company that produces "educational programs" for doctors most often sponsored by pharmaceutical companies.

Below we post the financial ties uncovered by Dr. Carlat: the ties that bind ACRE steering committee to Big Pharma--ties that were undisclosed on the ACRE website. Of course, it would be most instructive to learn the secret dollar amount that Harvard Medical School--and its affiliated hospitals--rake in from these unabashed marketing promos masquerading as CME courses! Dr. Carlat dubbed the organization, “Academics Craving Reimbursement for Everything.” PharmaGossip renamed ACRE: Forum for University Corporate Kickbacks in Education as Determined by University Professors:

Why is ACRE very ripe for satire? As Dr. Carlat explains, because "it consists of rich doctors complaining that they want more money from drug companies, and such an organization lacks any inherent credibility, and seems, frankly, absurd."

Dr. Carlat noted that "In all the hoopla and excitement of forming a new organization such as ACRE, certain minor details are easy to overlook. One of these details is a listing of financial disclosures, which is conspicuously missing from the ACRE website."

Below are two of Dr. Carlat's ACRE posts--one about the undisclosed financial ties of the speakers and the post describing the flavor of the ACRE conference:

"...the eeriest presentation came from one J. Michael Gonzalez-Campoy, an endocrinologist who was flown out on the ACRE-jet from Minnesota. His job was to convince everybody that Minnesota’s 1993 physician payment disclosure law (the first in the nation) was an awful mistake. His tactic, theoretically, was a good one. “The law has been terrible for patients,” he declared, speaking in the ominous tones of a doctor notifying you of grim laboratory results.

“Oh boy,” I thought, pen poised, “finally, some data on the effects of transparency laws on patient outcomes.” But alas, Dr. Gonzalez-Campoy’s evidence base amounted to a single patient, a 73 year old man with severe diabetes. “Do you know what drug he was on?” He asked incredulously. “The cheapest drug money will buy—Glyburide….When I asked my patient why he was on that drug, I was appalled by his answer. He told me that his PCP said it is the most cost-effective drug.” It got worse: the patient had apparently been reading newspaper articles saying bad things about the newer diabetes drugs, like Avandia. The kicker was when he told Dr. Gonzalez-Campoy that “I’ve read that doctors are getting brain-washed by drug companies to prescribe these drugs.” Don’t you see what the Minnesota disclosure law has wrought? Patients getting prescribed generic medications. Patients reading the newspaper. Patients questioning the morals of their physicians.
The ACRE conference, it would appear was "full of sound and fury signifying nothing."
Posted by Vera Hassner Sharav
Link

Harvard Medical Students Rebel Against Pharma-Ties
Tuesday, 03 March 2009
200 Harvard Medical School STUDENTS are confronting the administration demanding an end to pharmaceutical industry influence in the classroom.
A front page report in the Business section of the New York Times should bestir some of Harvard Medical School alumni. 200 Harvard Medical School STUDENTS are confronting the administration demanding an end to pharmaceutical industry influence in the classroom.
"The students say they worry that pharmaceutical industry scandals in recent years - including some criminal convictions, billions of dollars in fines, proof of bias in research and publishing and false marketing claims - have cast a bad light on the medical profession. And they criticize Harvard as being less vigilant than other leading medical schools in monitoring potential financial conflicts by faculty members."
Harvard received the lowest grade--an F--from the American Medical Student Association, a national group that rates how well medical schools monitor and control drug industry money. Harvard Medical School's peers received much higher grades, ranging from the A for the University of Pennsylvania, to B's received by Stanford, Columbia and New York University, to the C for Yale.

The revolt began when a first year medical student "grew wary" when a professor promoted cholesterol drugs and "seemed to belittle a student who asked about side effects." He later discovered that the professor, a full-time Harvard Medical faculty member, was a paid consultant to 10 drug companies, including manufacturers of cholesterol drugs.
Link

What happens when drugs, science and money mix at Canadian institutions of learning today? Blandishments and mis-education may well lead to a dangerous lowering of the standard of care.
Read Blind Faith here.

Whatever would Dr. Osler say?

Suggestions for an Approach to the Management of Thyroid Deficiency

http://thyroid-disease.org.uk/index.php?option=com_content&task=view&id=18&Itemid=31

SUGGESTIONS FOR AN APPROACH TO THE MANAGEMENT OF THYROID DEFICIENCY

by Dr Barry J Durrant-Peatfield M.B., B.S., LR.C.P., M.RCS. Approved Civil Aviation Medical Examiner

From the article:
"The clinical syndrome of thyroid deficiency is very much more common than is generally realized; (Dr. Broda) Barnes, in several publications, drew attention to this in the last two decades, as has the present writer more recently. One reason for this, is a tendency to think of hypothyroidism and myxoedema as one of the same thing, when this is quite wrong. Myxoedema, as doctors were taught in medical school, is the end result of a progressive disease process resulting in more or less total absence of thyroid hormone; whose symptoms and signs are no doubt perfectly familiar. But this state of deficiency has to start somewhere, winding down over a variable period to the terminal state of myxoedema. Symptoms and signs will naturally vary according to the extent of the level of deficiency reached. Clearly, a 10% loss may have little to show for it; whereas a 25% loss may have several very definite symptoms and signs; and a 40% loss even more so. Furthermore, patients show very individual response to any given level of dysfunction; while one may complain of excessive fatigue and weight gain, another may be more troubled by depression and menstrual problems.

That the diagnosis is all too frequently missed, is an inevitable result of this fundamental misunderstanding, and is commonly the result of an incomplete clinical appraisal in favor of the standard thyroid function tests. These tests are the real problem in diagnostic failure since there are inherent problems in interpreting blood levels of thyroxine and/or thyroid stimulating hormone (TSH) when blood levels may differ widely from tissue blood levels. Since the diagnosis may very properly, and easily, be made clinically, unreliable blood levels should NOT take precedence over clinical judgment.

Equally unsatisfactory is the acceptance by doctors and patients alike of poor response to thyroid replacement.

The present writer has been constantly alarmed and dismayed by hypothyroid patients who for years, all too often, have been obliged to accept a much less than satisfactory amelioration of their illness, being taught to expect no more than some improvement. It is perfectly possible that complete and long lasting remission should be obtained, and neither doctor nor patient should accept anything less. Further, the response should be monitored, not just by the doctor, but by the patients themselves. Since there often is a dynamic situation, the patients should be educated and taught to monitor themselves, making their own adjustments to dosage. In this connection, frequent monitoring by blood tests may be quite misleading and unhelpful. Surely it must be more satisfactory for the physician to ask the patients how they feel; and guide the informed patient in establishing the right dosage levels of replacement therapy."

We are sure Dr. Osler would agree. But if our physician does not listen but instead turns us out of his office after a woefully inadequate fifteen-minute appointment, and our lives are ruined as a result, what then?

Signs of the Times

Osler computer wallpaper, with neither the great doctor nor a patient anywhere in sight...
These days it seems doctors want to be like "Doogie Howser MD" - a sort of precocious Peter Pan physician.
HOUSE MD, another popular medical television show, features a disabled hero who is friendless and addicted to drugs. Neither character is a proper role model for healers.



When you hear physicians talking together in your hospital, are they discussing health or holidays, medicine or mortgages? If perks and a big salary represent your physician's most precious goals, maybe it's time to hand him a golf ball and tell him to Tee Off.

Thyroid Dysgenesis

No type of human transformation is more distressing to look at than an aggravated case of cretinism. The stunted stature, the semi-bestial aspect, the blubber lips, retrousse nose sunken at the root, the wide open mouth, the lolling tongue, the small eyes half-closed with swollen lids, the stolid, expressionless face, the squat figure, the muddy dry skin, combine to make the picture of what has been termed the "pariah of nature." Not the magic wand of Prospero or the brave kiss of the daughter of Hippocrates ever effected such a change as that which we are now enabled to make in these unfortunate victims, doomed heretofore to live in hopeless imbecility, an unspeakable affliction to their parents and their relatives.
[Sir William Osler, 1897]

Remarkable progress in our therapy and knowledge of congenital hypothyroidism (CH) has been made since the demonstration by Murray in 1891 that thyroid extract could ameliorate many of the features of untreated cretinism, an advance described in dramatic detail in the above quotation from Sir William Osler. At this time, despite the striking improvement in the clinical features observed in affected patients, the associated developmental delay proved to be less amenable to therapy, and indeed some cognitive delay was thought to be inevitable. It was not until the 1970s that the importance of the timing of postnatal treatment in obviating the mental retardation was demonstrated convincingly. In a study by Klein et al. (1), 78% of infants with CH treated before 3 months of age but 0% treated after 6 months of age had an intelligence quotient (IQ) above 85, the mean IQ of the early treated group being 89, compared with an IQ of 54 in those treated late. Unfortunately, only one third of patients were recognized clinically within the first 3 months, and even fewer (10%) in the first month of life. The subsequent development by Dussault and Laberge (1A ) of a sensitive and specific RIA for the measurement of T4 in dried whole blood eluted from filter paper paved the way for the modern era of newborn screening for CH prior to the development of clinical manifestations.

Continues at Link

Embryology
Thyroid gland development and disease in children - PDF

Images of thyroid dysgenesis

Physical Diagnosis: A Lost Art?

Image: Sir Willam Osler at a patient's bedside

"The history and physical examination remain the backbone of medical evaluation and assessment. However, the many advances in both laboratory and imaging technology and the pace of modern medicine have resulted in the physical examination being abbreviated and undervalued, and viewed (subconsciously, perhaps) as redundant.

Although few studies examine physical diagnosis skills over successive generations of physicians, skill and familiarity with certain bedside maneuvers and confidence in eliciting physical signs appear to have declined, with increased dependence on the aid of a radiologist or first-tier laboratory data. The new student on the wards soon finds that skills at the computer in getting data back and arranging for tests to be done are valued as much or more than learning to percuss well or hear a pericardial friction rub. At times, it almost seems as if the patient in the bed is an icon for the real patient who exists in the computer, and 'rounds' (a word that in this context connotes motion) are conducted with the participants immobile and seated in a room and with the patient represented either on an index card or a PDA (personal digital assistant) screen."

Link


If your doctor is paying more attention to his gadgets and to test results than to you and what you tell him, maybe it's time to worry...

Myxedema

Thyroid patients restored to health - Before and After.




http://en.wikipedia.org/wiki/Myxedema

http://www.thefreedictionary.com/Myxedema+madness

Merck on Thyroid disorders



Hands and feet may swell in hypothyroid conditions. Doctors should not confuse this with acromegaly.
http://tinyurl.com/hypothyroid-hands-and-feet

Hypothyroid presenting as psychosis - PDF

Veterinary: Hypothyroid in Canine Care

Veterinarians know that Hypothyroidism is a common disorder in dogs, particularly Japan's Akita.

Cats more often suffer from Hyperthyroidism.

Pets get proper physical workups and examinations, and are not automatically given Prozac.

People may not be so lucky.

http://www.provet.co.uk/health/diseases/hypothyroidism.htm

http://www.provet.co.uk/health/diseases/hypothyroidismclass.htm Classifications of Hypothyroidism

http://www.peteducation.com/article.cfm?c=2+1597&aid=449

Townsend Letter: Adrenal Exhaustion and Chronic Fatigue

The outer part of the adrenal gland, the cortex, also makes many important hormones. These include:

* Cortisol. The adrenal glands increase their production of cortisol in response to stress. Cortisol raises the blood sugar and blood pressure levels and moderates immune function, in addition to playing numerous other roles. If the cortisol level is low, the person has fatigue, low blood pressure, hypoglycemia, poor immune function, an increased tendency to allergies and environmental sensitivity, and an inability to deal with stress.

* Dehydroepiandrosterone sulfate (DHEA-S). Although its mechanism of action is not clear, DHEA is the most abundant hormone produced by the adrenal cortex. If it is low, patients will feel poorly. Patients often feel dramatically better when their DHEA-S levels are brought to the mid-normal range for a twenty-nine-year-old. DHEA-S levels normally decline with age, and appear to drop prematurely in chronic fatigue patients.

* Aldosterone. This hormone helps to keep salt and water balanced in the body.

* Estrogen and testosterone. These hormones are produced in small but significant amounts by the adrenals as well as by the ovaries and testicles. Half of a woman's testosterone is produced in the adrenals.

Causes of Adrenal Insufficiency

About two-thirds of chronic fatigue patients appear to have underactive adrenal glands. One reason may be that the hypothalamus does not make enough corticotropin-releasing hormone (CRH), which is the brain's way of telling the adrenals that more cortisol is needed. Others may have autoimmune damage to their adrenals. I suspect that many people also have adrenal burnout. Dr. Hans Selye, one of the first doctors to research stress reactions, found that if an animal becomes severely overstressed, its adrenal glands bleed and develop signs of adrenal destruction before the animal finally dies from the stress.

http://findarticles.com/p/articles/mi_m0ISW/is_243/ai_109946562/

We can only wonder why the Canadian government has classified DHEA, a hormone necessary for life, in the same category as illegal bodybuilding steroids. Why physicians are not outraged about this, we don't know. But some doctors we have spoken with think that DHEA is a health food supplement. This is worrisome...

Health care's missing care

"Part of the mistrust of doctors is the growing sense that they seem uninterested in caregiving."

http://www.theglobeandmail.com/news/opinions/health-cares-missing-care/article1214800/

This was once a problem that seemed confined to the USA, but now hard attitudes have come to Canada too. Tommy Douglas would be rolling in his grave.

Steven Crowder takes on the Canadian health care system here:
http://www.youtube.com/user/StevenCrowder