My PJ colleague Walter Hudson published a compelling argument regarding physician-assisted suicide in response to the ongoing dialogue surrounding terminal cancer patient Brittany Maynard. His is a well-reasoned argument regarding the intersection of theology and politics, written in response to Matt Walsh’s Blaze piece titled “There is Nothing Brave About Suicide.” Both pieces are a reminder that, in the ongoing debate over whether or not Maynard has the right to schedule her own death, little has been said regarding the role the medical profession plays in the battle to “Die with Dignity.” Walsh argues:
None of us get to die on our own terms, because if we did then I’m sure our terms would be a perfect, happy, and healthy life, where pain and death never enter into the picture at all.
It’s a simplistic comment that ignores a very real medical fact: Death can come on your own terms. And that doesn’t have to mean suicide.
My mother was a nurse for 20 years. During that time she worked in a variety of settings, from hospitals, to private practice, to nursing homes. Much like Jennifer Worth, the nurse and author of the Call the Midwife series, my mother practiced at the end of Victorian bedside nursing and the dawn of Medicare. As a result, the abuses she witnessed in the name of insurance claims were grotesque. For instance, if a patient required one teaspoon of medication, an entire bottle would be poured into the sink and charged to that patient’s insurance company. This was just the tip of the iceberg of unethical practices that would become priority in the name of the almighty “billing schedule.”
How informed is informed consent and does it matter much, or as much as medical ethicists say it does? Do doctors have a duty only to make sure that their message is sent, or also a duty to make sure that it is received, and if received that it is retained? The prayer of General Absolution in the Book of Common Prayer refers to those things which we have done and ought not to have done, and those things which we ought to have done and have not done. When it comes to informed consent, there are also those things which patients have heard and ought not to have heard, and those things which they ought to have heard and have not.
This is proven in a recent paper in the British Medical Journal. Patients with stable angina in ten hospitals in the United States were asked what they thought the benefits were of the percutaneous coronary procedures they were about to undergo. The scientific evidence on this matter is more or less universally accepted: such procedures improve angina symptoms but do not increase life expectancy or reduce the rate of heart attacks.
Testicular cancer survivor Thomas Cantley is pushing a giant ball across America to raise awareness for men’s health.
He quit his job and sold his house to push a six-foot ‘testicle’ from Los Angeles to New York City after he was diagnosed with testicular cancer, according to his website.
He’s travelled more than 1,500 miles so far, but the story doesn’t say how much money he’s raised. “Awareness” is a more difficult measure, but there is a giant rolling testicle involved.
Traveling slightly north, we have this potentially related story from Wake Forest:
Researchers at the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina, are assessing engineered penises for safety, function and durability. They hope to receive approval from the US Food and Drug Administration and to move to human testing within five years.
Professor Anthony Atala, director of the institute, oversaw the team’s successful engineering of penises for rabbits in 2008. “The rabbit studies were very encouraging,” he said, “but to get approval for humans we need all the safety and quality assurance data, we need to show that the materials aren’t toxic, and we have to spell out the manufacturing process, step by step.”
The penises would be grown using a patient’s own cells to avoid the high risk of immunological rejection after organ transplantation from another individual. Cells taken from the remainder of the patient’s penis would be grown in culture for four to six weeks.
This is great news for men with congenital defects or disfiguring injuries, but I fear what will happen when the porn industry inevitably gets hold of this technology.
Screenwriters are not known for being sticklers for facts. And when it comes to disasters, writes University of Texas Professor David A. McEntire, “many of Hollywood’s portrayals are based on myths and exaggerations….” That’s certainly the case when it comes to disease disaster films. Here are 10 “fun” movies that are of no use whatsoever in terms of helping viewers respond wisely to a pandemic.
10. Panic in the Streets (1950)
“Patient Zero” is carrying the pulmonary version of bubonic plague. A public official (played by Richard Widmark) has 48 hours to find him before the disease spreads throughout the city. Director Elia Kazan delivers a moody, atmospheric, underappreciated film. But if this is how the police, public health officials and reporters will really act during a crisis, well, we’re all doomed.
I didn’t fully appreciate how spiritually free I am as an American woman until I set foot on an El Al plane.
“Do you speak Hebrew?” the fretting woman in front of me asked.
“No, not really.”
“It’s okay, I speak English,” she hurriedly replied, obviously looking for a friendly face. “These Orthodox,” she motioned to the people sitting next to her, “they don’t like sitting next to women.”
“Well, that’s their problem.” My response was pointed, matter-of-fact, American.
She smiled as if a light bulb went off in her head. “You’re right!” Her expression grew cloudy. “But what if I take off my sweater? They won’t like that I expose my shoulders with my tank top.”
Again, I simply replied, “That’s their problem.”
She smiled, empowered. Removing her sweater, she took her seat and stood her ground.
And at that moment I thanked God I was raised in pluralistic America, and realized, oddly enough, that the Holy Land was giving me my first chance to practice the biblical feminism I’ve preached.
Israel is a Western nation in that women have equal rights by law. Israel is also a confluence of religious and ethnic cultural attitudes, not all of which are friendly to women. Two days into our trip to Jerusalem, a family member who also happens to be a retired journalist explained the latest story to hit the nightly news. A man accused of spousal abuse was released to return home. Later that evening, police found his wife had been shot dead. The husband confessed to the murder. Apparently, domestic violence and death is a relatively small but significant problem in Israel. When I asked my former journalist why, he pointed to the influence of Middle Eastern (both Arabic and radical Islamic) patriarchal culture as the primary source.
Yet, even religious Jews in Israel (and around the world), despite their insular nature, are far from immune to sexual abuse. Sex scandals among the Haredim (ultra-Orthodox) show up frequently on the evening news. In this case it’s not the Arab/Muslim influence, but perverted behaviors that arise from rabbinic abuse of biblical teachings. How do you expect a man to relate to a woman sexually when he’s not even allowed to look her in the eye?
We live in the age of acronym. To read a medical journal is sometimes like trying to decipher a code; once, when I was a judge in a competition of medical poetry, I read a poem composed entirely of figures and acronyms:
RTA [road traffic accident]
ETA [expected time of arrival] 13.20 hrs
CGS [Glasgow Coma Scale] 3…
The last line of the poem, inevitably, was:
Sometimes one has the impression that the acronym has been devised before the thing that it is attached to has been decided. In a recent paper in the New England Journal of Medicine, for example, I came across the acronym SWEDEHEART. It stood for the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies. If the web system come before the acronym, however, you could see why the latter was necessary, the former being longer than the average tin-pot dictator’s list of honorific titles.
The paper in which the acronym occurred was yet another in which a common medical practice was shown to be valueless, or very nearly so. It turns out yet again that doctors do things not because they do the patients any good, but because they can do them.
When Hamlet tells Claudius that Polonius, whom he has just killed, is at dinner being eaten rather than eating, Claudius is puzzled. Hamlet explains that the worms are eating Polonius, and Claudius, still puzzled, asks Hamlet what he means by this
Nothing [replied Hamlet] but to show how a king may go a progress through the guts of a beggar.
In other words, we all come to the same end.
I thought of this passage when I read a paper about the death of Richard III in a recent edition of the Lancet. His remains were found recently buried under a car park in Leicester, a dismal provincial town in England, one of many ruined by planned modernization. The car park had once been a priory.
A long historical battle has raged over Richard’s real nature, whether he was hero or villain as per Shakespeare (few people think he might have been something in between the two). Certainly his remains, now more than 500 years old, have not been treated with undue respect: a team of forensic pathologists and archaeologists have examined them minutely for clues as to how he died at the battle of Bosworth Field in 1485.
Apple’s HealthKit — coming this week to iOS 8 for iPhone, iPad, iPod Touch, and next year to Apple Watch — is becoming much more than a simple fitness tracker:
Stanford University Hospital doctors said they are working with Apple to let physicians track blood sugar levels for children with diabetes. Duke University is developing a pilot to track blood pressure, weight and other measurements for patients with cancer or heart disease.
The goal is to improve the accuracy and speed of reporting data, which often is done by phone and fax now. Potentially doctors would be able to warn patients of an impending problem. The pilot programs will be rolled out in the coming weeks.
Apple last week mentioned the trials in a news release announcing the latest version of its operating system for phones and tablets, iOS 8, but this is the first time any details have been made public. Apple declined to comment for this article.
Apple almost never comments. The company’s former PR chief, Katie Cotton, elevated not saying anything to an art form. But that’s another story.
Mu question after reading this story is, just how many sensors are they packing into Apple Watch, and what do they plan to pack into future iterations?
The question is important because public health emergencies allow governments to ignore the usual restrictions or restraints upon their actions. In public health emergencies, governments can override property rights and abrogate all kinds of civil liberties such as freedom of movement. They can .r our goods and tells us where to go and where to stay. They do so only for our own good: health being the highest good, of course.
A recent edition of the New England Journal of Medicine discusses the issue in the context of the declaration of a public health emergency in Massachusetts by the governor of that state, Deval Patrick.
In most people’s minds, no doubt, a public health emergency would be something like the Black Death, the epidemic of plague that wiped out a third of Europe’s population in the fourteenth century. A natural disaster of large proportions might also count, not only because of the death and injury caused directly by the disaster, but by the epidemics which often follow such disasters.
What, then, was the public health emergency that “obliged” Patrick to declare that it existed and that he could and should take uncontrolled administrative measures to halt it?
I read the comments on these articles, you know. “Rip’s a fat guy. Don’t believe anything he says about fitness.” “Fit people don’t look like Rip’s fat ass. Run awaaaaay!!” As I sit here finishing the last of an unclaimed birthday cake from Kroger, listening to Chicago’s “Free Form Guitar” on repeat, this harshness brings a tear to my chubby, piggish little eyes. People are so hateful sometimes. Usually they’re just stupid and ignorant, and that can be interpreted as hateful.
But not by me, Nosiree. I know how people are, and they just haven’t thought clearly about several important aspects of human existence. First, I’m not a model, although my rugged good looks qualify me for such work (I was kidding about the birthday cake and the eyes). I’m a coach, a lecturer, and an author. I’m paid for what I know, not how I look. Tom Landry didn’t look like Randy White, but that didn’t keep him from being effective. My job is not to have abs, and it’s not even to show you how to get them. My job is to teach you how to get strong with barbell training, and why you should, and I’m quite good at it.
I have been doing this since 1978, and I’ve forgotten more about strength and conditioning than many coaches will ever have an opportunity to learn. But I’m 58, I’ve accumulated a lot of injuries, I can’t train as hard as I used to, I like to eat and drink, and I have a little belly. That doesn’t keep me from being an effective coach, lecturer, and author. And it’s amazing to me that I actually have to explain this to people who haven’t thought about what a coach does. They’re not hateful, just slow.
This is important too: I’m no longer primarily concerned with my appearance, and many of you in this particular audience aren’t either. Vanity is a luxury we don’t have time for — a costly, unnecessary luxury for truly mature individuals who are content to be merely strong, healthy, and physically competent. I’m not interested in being a fat slob, and as long as I’m training and thinking clearly about what I eat and drink, I won’t be. My primary interest now is that my continued physical existence be such that I’m still having fun.
Ladies and gentlemen, that doesn’t require “abs.”
For several years now the inimitable Theodore Dalrymple has provided PJ Media and PJ Lifestyle with erudite, witty commentaries on controversies in the worlds of health, drugs, and disease, as well as their impact on culture. Here’s a collection featuring links to many of the questions he’s addressed, often in response to some shaky thinking in a new study or an ideologically slanted medical journal article.
What health and medical questions would you like to see him and other writers explore in the future? Please leave your suggestions in the comments.
2011 and 2012
- Is Salt Really Bad for Your Heart?
- Are There Health Effects Due to the Financial Crisis?
- Should the ‘Morning After’ Pill Be Available to All Ages?
- Can Children Be Manipulated into Eating Their Veggies?
- Should We Be Worried about Bird Flu?
- Is Surgery Not Always Necessary for Appendicitis?
- Genomic Medicine: A Great Leap Forward?
- Aspirin: The Elixir of Life?
- Do Nicotine Patches Actually Work?
- Does ‘Good Cholesterol’ Really Help Prevent Heart Attacks?
- Should Women’s High School Soccer Be Banned To Reduce Knee Injuries?
- Is Grief Always Depression?
- Does Fish Oil Prevent Alzheimer’s Disease?
- Do Proactive Measures by Doctors Aid in Smoking Cessation?
- Can Dark Chocolate Reduce High Blood Pressure?
- How Come People Rarely Die of Dementia in Poor Countries?
- Should You Take Antibiotics?
- Is Obesity a Disease or a Moral Failing?
- Are Obese Kids Victims of Child Abuse?
- Need A Few Arguments Against Tattoos?
- Are the Treatment and Prevention of Obesity Different Problems?
- Why Are Psychiatric Disorders Not the Same as Physical Diseases?
- Do Today’s Medical Ethics Prevent New Breakthroughs?
- Should We Be Worried About Parasites from Cats?
- Do Doctors Turn Their Patients into Drug Addicts?
- Should Doctors Lie to Their Patients About Their Survival Chances?
- As Life Expectancy Increases Will the Elderly Become a Greater ‘Burden on Society’?
- What Is the Best Way to Treat Diabetes?
- What Can Be Done to Reduce Post-Hospital Syndrome?
- How Can a Mammogram Kill You?
- Human Feces as Medicine?
- What Will Happen if I Consume Too Much Calcium?
- Is Marijuana a Medicine?
- Why Is Immunization so Controversial?
- Is America at the Point Where HIV Testing Should Be Routine?
- Is Physical Therapy Overrated?
- How Many Smokers Could Quit If Someone Paid Them $10 Million?
- Is Nutrition Really the Key to Good Health?
- Is It Even Possible to Accurately Measure Physical Pain?
- Can Doctors Determine Who Should Be Allowed to Carry a Concealed Gun?
- Does Practice Really Make Perfect for Doctors?
- Should Doctors Be Allowed to Choose Not to Treat Fat People?
- Should Pre-Term Infants Receive Risky Oxygen Treatments?
- We Mock Prudish Victorian Euphemisms, But Are We Really Any Better?
- How Often Do Medical Emergencies Occur on Flights?
- What Is the Safest Day of the Week for Surgery?
- Are Antibiotic-Resistant Diseases Mother Nature’s Revenge?
- How Dangerous Is Obstructive Sleep Apnea During Surgery?
- Can Advances in Medical Technology Make Us Less Healthy?
- Does Badgering Patients to Exercise and Eat Better Actually Work?
- Should an Alcoholic Be Allowed to Get a Second Liver Transplant?
- Can Living With Chickens Protect Against Face-Eating Bacteria?
- Does the Sleep Aid Zolpidem Impair Driving the Next Day?
- Does Too Much Sugar Increase the Risk of Dementia?
- Men: Need Another Excuse to Put Off That Prostate Exam?
- Is Drug Addiction Really Like ‘Any Other Chronic Illness’?
- How Many Doctors Support Suicide for the Terminally Ill?
- What Are the Dangers in Screening for Diseases?
- Was Sir Winston Churchill Right About Exercise?
- Should Doctors Relax the ‘Dead-Donor Rule’ to Increase Organ Transplants?
- Is Living Near an Airport Dangerous for Your Health?
- Can Money Become Medicine?
- Gastric Bypass or Laparoscopic Gastric Band?
- How Do You Measure a Good Doctor Vs a Bad One?
- Should You Eat Lots of Nuts?
- As More People Live Longer Why Are Rates of Dementia Falling?
- Should Treatment of Obesity Begin Before Birth?
- Why Is It So Difficult to Translate Genetic Breakthroughs into Clinical Benefits?
- Can Scientists Create a Cure for Pain From Scorpions, Spiders, and Centipedes?
- Should the Age to Buy Cigarettes Be 21?
- Should You Vaccinate Your Children?
- Is Your Heart Attack More Likely to Kill You at Night or During the Day?
- A Cure For Peanut Allergies?
- Should Taxpayers Pay for the Junky’s Substitute Smack?
- Who Pays for Illegal Immigrant Tetraplegics’ Treatment?
- How Much Would You Pay to Survive Four Months Longer with a Terminal Disease?
- Euthanasia for the Insane?
- Does Valium Increase Your Chances of An Early Death?
- Are Diet Supplements Dangerous?
- Did Flu Drug Companies Perpetuate a Billion Dolllar Scam Around the World?
- What is One of the Most Dangerous Ideas in All of Medicine?
- Why Do Some Mothers Induce Illness in Their Own Children?
- Why Might a Doctor Be Relieved When a New Study Fails To Reduce Deaths?
- Should Prisoners Receive Better Health Care Than the General Population?
- Is Ebola the World’s Most Terrifying Disease?
- What Can Happen to Your Lungs if You Smoke 20 Cigarettes Every Day for A Decade?
- Is This the End of Mammograms to Screen for Breast Cancer?
- Do Medical Experiments on Animals Really Yield Meaningful Results?
- Will Legal Marijuana Be a Bonanza for Trial Lawyers?
- Should You Get Your DNA Tested to See if You’re More Likely to Get Cancer?
- What to do when the Risk of Treatment Outweighs the Benefits?
- Why Must We Take One Step Forward, Two Steps Back in the Battle Against Tuberculosis?
- Is Ignorance Really Bliss? What Is the ‘Nocebo’ Effect?
- What Does Moral Narcissism Looks Like in the Medical World?
- Why is Treating Statistical Markers of Disease Is Not the Same as Treating Disease Itself?
- Heterochronic Parabiosis: Reversing Aging With Young Blood?
- Should Everyone Consume Less Sodium?
- Does a Popular Antibiotic Raise the Risk of Heart Attack?
- Do You Really Need That Colonoscopy?
- Is It ‘Unjust’ for Doctors to Die from Ebola?
image illustration via shutterstock / Sherry Yates Young
When I visited the John F. Kennedy hospital in Monrovia during the long Liberian Civil War, it had been destroyed by a kind of conscientious vandalism. Every last piece of hospital furniture and equipment had been disabled, the wheels sawn off trolleys and gurneys, the electronics smashed. This was not just the result of bombardment during the war but of willful and thorough dismantlement.
There were no patients and no staff in the hospital; it was a ghost establishment, completely deserted. I was severely criticized for suggesting in a book that the painstaking destruction of the hospital, which shortly before had performed open heart surgery, was of symbolic significance.
I was pleased to see from an article in a recent edition of the New England Journal of Medicine that it had re-opened, but saddened to see that its problems were now of an even more terrifying nature than those it encountered during the civil war: for the hospital is at the center of the epidemic of Ebola virus disease, and two of its senior physicians, Sam Brisbane and Abraham Borbor, have recently died of it. The article in the journal lamented their passing and praised them for their bravery in not deserting their posts; they both knew of the dangers of refusing to do so.
Readers may recall my description of aortic valve replacement last year and a warning of the importance of treating heart disease seriously. Here’s another lesson from medical misadventure: if you are going to have a stroke, it is best to have it on an operating room table. And best of all, avoid strokes if at all possible. As miserable and expensive as last year’s surgery and recovery was, I think I would make that trade.
This started as the classic symptoms of a heart attack on the evening of August 2: chest pain, pressure, left-arm pain, a sense of confusion. So I had my wife drive me to an urgent care facility, where they decided that I was beyond the level that they could treat other than giving me aspirin and nitroglycerin, and calling the Ada County Paramedics to transport me to St. Alphonsus hospital. In retrospect, my wife could have driven me there directly in less time, and saved the insurance company $1300.
Every few months I receive a computerized invitation from my doctor asking me to have a colonoscopy to screen for polyps in my bowel. I always tell myself that I am too busy just now, I will have it another time. But really I don’t want to have it at all, and I know that when the next invitation comes I will be too busy then as well.
I am also eager to find a rational reason, or at least a rationalization, for my refusal. I thought I found it in a paper from Norway in a recent edition of the New England Journal of Medicine.
The authors examined the death rate from colorectal cancer in Norway among the 40,826 patients between 1993 and 2007 who had had polyps removed at colonoscopy in that country (the records are more or less complete). They compared the number of deaths in that population with the expected death rate from the disease in the population the same age as a whole. The paper reports that 398 deaths were expected and 383 deaths were observed.
This small difference does not mean that colonoscopy does not work in preventing death from colorectal cancer, of course. This is because the relevant comparison is with people who had polyps not removed by colonoscopy rather than with the population as a whole.
The 40,826 patients who had polyps removed at colonoscopy, however, were not a random sample of the adult population because Norway does not have a screening program for colonic polyps. The patients had colonoscopy in the first place because they were symptomatic, for example bleeding per rectum. They were therefore much more likely to suffer from polyps or cancer in the first place than the rest of the population.
I happened to notice recently a report in a French newspaper of a study just published in the British Medical Journal, a study that had purportedly shown an increased incidence of cardiac death in people who took an antibiotic called clarithromycin. As I had myself taken this drug a couple of times in my life (though not, of course, quite as prescribed, because no one ever takes drugs quite as prescribed), I felt a certain personal interest in the question.
I needn’t have worried because the paper, from Denmark, claimed that the increased risk of cardiac death occurred only while the patient was taking the drug, not afterwards. But the closer I looked at the paper, the more darkness it seemed to shed on what doctors ought to do.
Denmark is a small country with a population of about 5.5 million, but it has the best health records in the world. This means that statisticians are able to churn out comparisons as Danish dairy farmers churn out butter.
By now you’ve probably seen 1,000 ice bucket challenge videos auto-play on your Facebook newsfeed by now. Everyone is doing it — kids, pets, celebrities, politicians, you name it. Yesterday I heard my neighbor do it on our front porch, but as I heard him explain, they didn’t have a bucket, so he used a “very cold” can of Coke instead. I’ve seen a few outtake lists, where instead of people having a bucket of water poured over them, the person pouring instead had the entire bucket full of water dropped onto their heads — it was painful to watch, I can’t imagine how painful it was to experience. The challenge has some haters, namely people annoyed at how many of those taking the challenge aren’t donating, and are instead wasting water. This meme popped up in my newsfeed this morning:
To which I say: Lighten up. The ice bucket challenge has gone viral like no other charitable cause I’ve ever seen, and has netted millions of dollars for ALS charities, over $15 million at last count (compared with less than $50,000 during the same period last year). I have no dog in this argument: I haven’t done the ice bucket challenge personally (please don’t nominate me, I’m poor and really dislike cold water), but I really applaud those participating and donating.
Many people have been misinformed regarding human-to-human transmission of Ebola. The Canadian Health Dept. States that airborne transmission of Ebola is strongly suspected and the CDC admits that Ebola can be transmitted in situations where there is no physical contact between people, i.e.: via airborne inhalation into the lungs or into the eyes where individuals are separated by 3 feet. That helps explain why 81 doctors, nurses and other healthcare workers have died in West Africa to date. These courageous health care providers use careful CDC level barrier precautions such as gowns, gloves and head cover, but it appears they have inadequate respiratory and eye protection. Dr. Michael V. Callahan, an infectious disease specialist at Massachusetts General Hospital who has worked in Africa during Ebola outbreaks said that minimum CDC level precautions “led to the infection of my nurses and physician co-workers who came in contact with body fluids.”
Currently the CDC advises health care workers to use goggles and simple face masks for respiratory and eye protection, and a fitted N-95 mask during aerosol-generating medical procedures. Since so many doctors and nurses are dying in West Africa, it is clear that this level of protection is inadequate. Full face respirators with P-100 replacement filters would provide greater airway and eye protection, and I believe this would save the lives of many doctors, nurses and others who come into close contact with, or in proximity to, Ebola victims.
It is apparent that the primary mode of person-to-person Ebola transmission is through direct contact with the body or bodily fluids of Ebola victims, but it is unwise to ignore the airborne mode. I believe the current evidence supports healthcare workers using a higher level of airway and eye protection than is currently recommended. Since CDC level respiratory/eye precautions for Ebola are inadequate for healthcare workers in West Africa, I assume they will also be inadequate in the United States.
The dream of rejuvenating the aged by the infusion of young blood is much older than anyone living. It is said that the Scythians thought to make themselves strong by drinking the blood of their enemies killed in battle. And Dracula kept himself youthful by drinking the blood first of young maidens visiting Transylvania and later of maidens in England once he had moved there.
Blood is not the only tissue that has been thought to protect and rejuvenate the elderly. In the 1920s a Franco-Russian surgeon named Serge Voronoff transplanted monkey testes into men (some of them eminent, for example Kemal Ataturk) whose virility had declined, and claimed that it worked. He made a fortune but soon became the object of mockery and scorn, dying in prosperous obscurity in Switzerland in 1951.
There is always an air of charlatanry about those who claim to be able to turn the biological clock back (it is easy to find smooth-talking promoters of recaptured youth on the internet, for example), but a recent article in the New England Journal of Medicine suggests that some of the old ideas about the rejuvenating qualities of young blood may not have been quite so far-fetched after all. It is early days to proclaim that eternal youth is around the corner, and personally I am not sure I would want it even if it were, but according to the author a technique known as heterochronic parabiosis has retarded or reversed the aging process in mice. It is, of course, some distance from Mouse to Man.
What stands to reason is not always borne out by facts, for reality is often refractory to human wishes. There was a good illustration of this unfortunate principle in a recent edition of the New England Journal of Medicine.
It has long been known that low concentrations of high-density lipoproteins (HDL) and high concentrations of low-density lipoproteins (LDL) are associated, in a more or less linear fashion, with cardiovascular disease such as strokes and heart attacks. It would seem to stand to reason, therefore, that raising the HDL and lowering the LDL would lead to fewer cardiovascular “events,” as strokes and heart attacks are called.
One way to achieve this wished-for biochemical change is to treat patients at risk of such events with niacin, a B vitamin, in addition to the statins that they are already taking. The largest placebo-controlled trial of niacin ever undertaken, with 25,673 patients who had already had a stroke or heart attack, has shown that the addition of niacin, though it does indeed increase HDL and decrease LDL, has no effect on the rate of heart attack or stroke. Worse still, it gave rise to serious side effects, such as worsening of diabetes and unpleasant gastrointestinal, musculoskeletal and dermatological effects. One of the most unexpected findings of the trial was the excess of infections in people treated by niacin. If anything, the overall death rate in the niacin-treated group was higher than that in the placebo control group, though the difference was not statistically significant (which is not quite the same thing as saying that it was not real). The patients were followed up, on average, for nearly four years and at no time was treatment with niacin superior to that with placebo.
I have been following Mark Rippetoe’s Starting Strength program twice a week now for a few months. I have to say it has worked really well for me.
Since having a heart attack many years ago, I was afraid to do squats and deadlifts with much weight, if at all. However, Mark gave me the confidence to feel that I could indeed, do them again, albeit with some modifications. I have been using lighter weight, mainly just the 45 pound bar for deadlifts and the same for squats. Yeah, it’s light but sometimes I add five pounds on each side if I feel like it. I do three sets of five reps of each of the exercises with rest in-between as Rippetoe suggests. At first, I thought it didn’t seem like this plan would do much but I have noticed subtle changes over the past few weeks.
My lower back rarely hurts and my legs are much stronger. I have been doing overhead presses also that help me keep my posture in line and my upper body no longer hurts from the computer as much as it did. I feel better and can easily squat down now to lift things more readily. The idea of these exercises is to give one more functional ability in his or her daily life and they definitely have done that for me. I am still doing some yoga and other exercise for variety but I think the squats and deadlifts have really been key to helping me achieve the goals that I wanted–less pain and more ability to do tasks in my daily life. Thanks Mark!
Check out some of Mark Rippetoe’s biggest hits at PJ Lifestyle:
All medical journals these days feel the compulsion to be high-minded, but none is as high-minded as the Lancet. It is as if the editors had taken lessons both in moral philosophy and rhetoric from Mr. Pecksniff himself.
Mr. Pecksniff, you may remember, was the preposterous hypocrite in Dickens’ Martin Chuzzlewit, who introduces his daughters, Charity and Mercy, by adding “Not unholy names, I hope?” As Know thyself was inscribed over the entrance to the temple to Apollo at Delphi, and Abandon hope, all ye who enter here over the entrance to Dante’s hell, so Mr Pecksniff’s words, Let us be moral, must be inscribed over the entrance to the offices of the Lancet, figuratively if not literally
In the week before a Malaysian Airlines plane, taking many AIDS doctors and activists from Amsterdam to Melbourne for an international conference on AIDS, was shot down over eastern Ukraine, the Lancet published a statement called the Declaration of Melbourne, a typically sickly and nauseatingly unctuous statement of ethical principles. It began by saying something that, if not a lie exactly, was certainly not a truth:
We gather in Melbourne, the traditional meeting place of the Wurundjeri, Boonerwrung, Taungurong, Djajawurrung and the Wathaurung people, the original and enduring custodians of the lands that make up the Kulin Nation, to assess progress on the global HIV response and its future direction, at the 20th International AIDS Conference, AIDS 2014.
This, of course, is the purest 21st century Pecksniffery; and unless the signers of the declaration (who look extremely self-congratulatory in photos accompanying the article) can each and severally explain in what sense the Djajawarrung are the custodians of the lands on which the city of Melbourne is built, I suggest that they be banished to the outback for five years to live as pre-contact Australian Aborigines lived.
One of my first medical publications was on the nocebo effect, the unpleasant symptoms patients may suffer as a result of being made aware of potential side effects of a treatment they are about to receive or a procedure they are to undergo. Thus patients who were having a lumbar puncture were either told or not told they might suffer a headache afterwards; and lo and behold, those who were told that they might get headaches duly got headaches while those who were not told didn’t.
On the whole, as an article in a recent edition of the Journal of the American Medical Association points out, doctors are well aware of the placebo effect, that is to say the good that their treatment may do patients by means of mere suggestion, but have little awareness of the opposite nocebo effect, the harm that their treatment may do their patients by mere suggestion.
The nocebo effect poses an ethical dilemma for doctors, say authors of the article. On the one hand, doctors are supposed to do their patients no harm; on the other, they are supposed to be open and honest with their patients about the potential harms of drugs and other treatments. The dilemma is this: foreknowledge of those harms can harm some patients. Should the need for honesty trump the ethical injunction to do no harm?
When my PJ Media editor suggested that I write about having lupus, I almost said no.
I was diagnosed with SLE in 1991 and have been in remission since around 1995. My book about living with this chronic illness came out two years later. Like most writers, by the time a book comes out, I’m so sick – pun intended – of its topic that I dread having to revisit it.
Having been in remission for almost 20 years, I can honestly make the rather unusual claim that not even the perspective of hindsight has changed my ideas or feelings about what being a pain-wracked invalid was like. Not even a little bit.
I feel like I’m supposed to say the opposite: that looking back, I could have “handled” my disease differently, or learned other, “better” lessons from it, and so forth.
But then, from the very beginning, I didn’t fit the mold of the “disease of the week” TV movie heroine, or some “poster child” for lupus.
Here are some things I learned (or, perhaps more accurately, some pre-conceived ideas I had reinforced) when I was at my very sickest.
Warning: What follows is NOT inspirational. At all.
After spending a few hours with Mark Rippetoe and two members of his coaching team — John Petrizzo and Nicholas D’Agostino — I’ve learned that online strength training information, though often of high quality, takes a distant second to an in-person session from a top-notch coach. And you simply cannot find one at a corporate gym. Maybe you have found one, or thought you had, but my experience from this project has been that years, dollars, and perhaps time spent recovering from injuries could have been saved had I originally sought out the advice considered to be the best by those who train for a living.
For more detail on that, I asked Petrizzo why he was drawn to Rippetoe’s methods and chose to become an affiliated coach:
All through high school and college I read everything I could get my hands on in regards to training for enhanced strength and athletic performance. Starting Strength stood out. I had never seen a comparable level of analysis applied to the barbell lifts in terms of their application and execution. Prior to SS, everything I had read in regards to lifting technique was merely the author’s opinion. I had never read anything that applied a sound biomechanical rationale for every aspect of the movements included in the program, and why they should be coached and taught in the manner they were presented in the book.This was sorely lacking in my formal undergraduate education as an Exercise Science major.
Coach Rippetoe has been writing introductory strength training articles for PJ Media this year. I called him to suggest we do a “video coaching” project, wherein I would follow the advice from his Starting Strength, record each training session, and then send him the video to critique. He didn’t like that idea, explaining that top-level coaching needs to occur in-person.
A few weeks later, Rippetoe, two coaches, and a cameraman were in my lifting partner’s basement gym, showing us everything we’ve been doing wrong all these years.
There’s a reason potential Olympians move to Colorado Springs, and why talented youth tennis players move to Florida. Serious improvement comes from a trained eye watching your every move, giving immediate and correct feedback. This doesn’t happen online, and the trained eyes who can do this at the highest level are few. The difference between Rippetoe, his colleagues, and every other trainer I have worked with? They are meticulous: they always noticed flaws immediately, they gave me the proper fix, and I felt an immediate improvement in performance. If you want improve your strength for any reason — the best being long-term well-being — then you should consider a visit with the best.
We’re breaking the video from that training session into five parts, which we will publish over the next few weeks at PJ Lifestyle. On the following page is the first video: “The Squat, Part One.” Topics covered:
Weight gain: As Rippetoe has previously covered here, the big, strong guy is both self-sufficient and healthier than the waif. You need to eat if you want to get consistently stronger on a strength program — sometimes those plateaus occur from an insufficient diet. What kind of weight gain might someone pursuing greater strength expect?
Foot placement: How far apart, and at what angle?
Back angle: Rippetoe displays, with a simple hands-on test, that a less vertical back angle instantly helps you move more weight.
Eyes on the floor: With another simple test, Rippetoe shows that the typical eyes-forward squat taught by corporate gyms represents weaker positioning.
Bar placement: You are probably placing the bar too high on your back, which can lead to that more vertical back angle. Dropping it down — where it doesn’t feel so comfortable at first — shortens the lever and gives you a mechanical advantage over the high bar position.