Resistance to antibiotics is often described by neo-pagans as Mother Nature’s vengeance on Man for having had the temerity to interfere in her natural biological processes. According to the neo-pagans, this vengeance has left Man (deservedly) worse off than if he had never discovered antibiotics at all. I do not see the logic of this.

There is no doubt, however, that bacterial resistance to antibiotics is a serious problem worldwide. It is particularly serious in hospitals, where patients may pick up infections that they never had before admission. Many patients die from these infections, which may be of epidemic proportions.

The most important such infection is MRSA, methicillin-resistant Staphylococcus aureus. (Methicillin is a semi-artificial penicillin that was developed when the Staphylococcus first became resistant to ordinary penicillin, and soon met with resistance itself.) MRSA accounts for most post-surgical infections; the proportion of patients infected by it is often taken in research as a measure of a hospital’s hygiene.

An important paper in a recent edition of the New England Journal of Medicine compares various strategies for reducing the spread of MRSA in intensive care units, a common place for patients to become infected.

The method of control usually employed is to screen patients for MRSA on admission to the ICU and to institute special precautions such as isolation and barrier nursing if they test positive. The authors compared this method with attempts by means of antibacterial products at “decolonization” of those who tested positive, and similar “decolonization” practiced on every patient admitted to an ICU irrespective of whether or not he tested positive for MRSA.

Everyone who needs an operation (which eventually will include most of us) wants to be assured that it will be carried out in the best and safest conditions possible. All operations are serious for those having them; a minor operation, as the British physician, George Pickering, once put it, is an operation carried out on someone else.

Most people with the time or ability to search for the best hospitals, surgeons, etc., will not think of considering the day of the week on which the operation will be performed as a factor of safety. It has long been known that emergency operations done at night or at the weekends have worse results than those done during the day on weekdays; but what about routine or planned operations, those (the great majority) that can be done at the surgeon’s and hospital’s leisure, as it were?

A huge statistical study done in Britain and recently published in the British Medical Journal examined the 30 day death rates after all non-emergency operations performed between 2008 and 2011 (except day cases) according to the day on which the procedure was performed.

There were in total 27,582 deaths after 4,133,345 operations, a raw rate of 6.7 per 1000: a figure that by itself would have astonished our forebears, who were used to, and took as inevitable, death rates at least a hundred times higher.

What the researchers found was that people who underwent operation on Fridays had a death rate 44 per cent higher than those who underwent operation on Mondays, while those who underwent operation at the weekend had a death rate 82 per cent higher.

Sometimes what is not said is more eloquent than what is. The implicit often has a more powerful effect on the imagination than the explicit; as Emily Dickinson put it, “Success in Circuit lies.” A recent article in the New England Journal of Medicine about Hepatitis C was eloquent in its omissions.

Hepatitis C is a virus infection which for many years causes no symptoms but which often goes on to produce chronic liver disease, cirrhosis, and cancer. About 85 percent of people infected with the virus develop chronic liver disease.

The article in the NEJM is titled “Hepatitis C in the United States.” The authors provide an estimate of the number of people infected with the virus: between 3.2 and 3.5 million.

The infection can now be treated so as to prevent its long-term consequences. Unfortunately, the treatment is expensive: about $70,000 per head for a full course, according to the authors. If every person who tested positive for the virus were treated, the cost would therefore be between $224,000,000,000 and $245,000,000,000. That is some stimulus to the economy!

The cost of treatment might come down (or, of course, go up, as new and costlier treatments are discovered). Not everyone who is infected needs treatment. Perhaps a vaccine will be developed and the problem in effect will go away. For the moment, though, we must deal with the silent epidemic – as the assistant secretary for health, Howard Koh, called it – with the tools now available to us.

Simple scientific questions require simple scientific answers; doctors want unequivocal guidance to their practice so that they do not fumble in the dark. But it is easier to ask questions than to answer them, as two papers published in the same week in the New England Journal of Medicine and the Journal of the American Medical Association attest.

The question asked by the two papers was the optimum level of oxygenation in the blood of pre-term infants. In the past it was rather naively supposed that if oxygen were necessary, then more of it must be better; but premature infants who were exposed to high levels of oxygen developed a condition known as retinopathy of prematurity, often leaving them blind or severely impaired visually.

The two trials, one from Britain, Australia and New Zealand, and the other from the United States, Canada, Argentina, Finland, Germany and Israel, sought to establish whether a higher or lower level of oxygen saturation of the blood was better for infants born very prematurely. The results were different, if not quite diametrically opposed.

The first trial found that babies treated so that their blood oxygen saturation was higher had a lower death rate at 36 weeks than those treated so that their levels were lower. 15.9 percent in the high-saturation group died compared with 23.1 per cent in the lower. You would have to treat 14 babies with the high oxygen saturation to save life more than treating them at the lower level.

Not long ago I bought a book, published in 1922, titled Syphilis of the Innocent. Needless to say, the title implied a corollary: for if syphilis could be contracted by the innocent (as, for example, in the congenital form of the disease), it could also be contracted by the guilty.

In general, however, physicians do not inquire after the morals of their patients, except in so far as those morals have immediate pathological consequences. They do not refuse to treat patients because they find them disgusting, because they find them unappealing, because they are appalled by the way they choose to live. They try to treat them as they find them; they may inform, but they do not reprehend.

However, in practice things are sometimes more complex than this ecumenical generosity of spirit might suggest. According to an article in a recent edition of the New England Journal of Medicine, some doctors have been turning away patients on the grounds that they were too fat (one physician suggested that she did so because, ridiculously, she feared for the safety of her staff once the patients weighed more than 200 pounds), or that their children have gone unimmunized. Is such discrimination by physicians legitimate or illegitimate, legally or morally speaking? Is there not a danger that physicians may hide behind pseudo-medical justifications to express their personal prejudices or to coerce patients into doing what the physicians think is good for them?

Does practice really make perfect? Does it even lead to improvement? One feels instinctively that it should, that the more experience a physician has, the better for the patient. Much of the skill of diagnosis is pattern-recognition rather than complex intellectual detection, and it follows that the longer a physician has been at it, the quicker he will recognize what is wrong with his patients. He has experience of more cases than younger doctors to guide him.

But the practice of medicine is more than mere diagnosis. It often requires manual dexterity as well, and the ability to assimilate new information as advances are made. These may decline rather than improve with age. Too young a doctor is inexperienced; too old a doctor is past it.

A recent paper, whose first author comes from the Orwellianly named Department of Veterans’ Affairs Center for Health Equity Research and Promotion, examined the relationship between the years of an obstetrician’s experience and the rate of complications the women under his care experienced during childbirth. The authors examined the records of 6,705,311 deliveries by 5,175 obstetricians in Florida and New York. No one, I think, would criticize the authors for the smallness of their sample.

They examined the rate of serious complications such as infection, haemorrhage, thrombosis, and tear during or after delivery, divided by obstetrician according to his number of years of post-training experience. Reassuringly, and perhaps not surprisingly, experience reduced the number of such complications decade after decade. The rate of complications was 15 percent in the first ten years after residency; it declined by about 2 percent to 13 percent in the first decade thereafter, by about 1 percent in the subsequent decade to 12 percent, and by  half a percent in the next. In other words, improvement continued, but less quickly as the obstetricians became more experienced; the authors appear not to have continued their study to the age at which the rate of complications started to rise again (if indeed there is such an age).

Pain is obviously one of the most important symptoms with which doctors deal, but measuring its severity objectively is difficult. Some people turn a twinge into agony, while others raise not a murmur in the last extremities of torture. And it is universally accepted that a person’s psychological state or disposition has a profound effect on his perception of pain.

Philosophers, indeed, have used the phenomenon of pain to debate what seemed to them an important question, namely whether there were such things as private languages or inner states inaccessible to others.

Clever experiments reported in a recent issue of the New England Journal of Medicine offer the hope, perhaps illusory, that brain imaging techniques might one day distinguish between real and severe pain on the one hand from exaggerated or false pain on the other (people may exaggerate or lie about pain for a variety of reasons).

Week 10 of my second 13 week season: low carb diet and more exercise, tracking my weight, blood glucose, and body fat. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy (free!) and follow my daily exercise, and maybe even start tracking your own.

On Tuesday the 9th of April, about 2PM, I was at work and feeling very strange. I was sleepy, felt sick and shaky, and couldn’t think clearly. I decided to take off early. But driving home, not more than a mile from my house, well, something happened.  I zoned out, I fell asleep, I fainted — whatever it was, I was looking at a green light at the interesection and then I was looking at a red light with traffic starting to cross the intersection.  I hit the brakes, I swerved to drive around the front of the CenturyLink truck in front of me, and I almost made it.  But not quite. I caught the front bumper of the truck with my left rear fender.  I bumped my head against the door frame, and came to a stop crossways in the intersection. After a minute, I pulled off the road.

At first I felt — considering the circumstances — okay. I made sure the other guy was okay (he was) and went to stand by the car and wait for the police.

Then I realized I was feeling really really cold, and even shakier than I had felt when I left the office. I went to sit down in the car and when the police arrived told them I thought I needed the EMTs. Or else it was someone who was calling 911, I don’t remember it very clearly.

Anyway, both an ambulance and a fire truck arrived, and a rather cute female firefighter interviewed me for about 30 seconds before trotting to the EMTs, who came and walked me to the ambulance.  I’m somewhat proud of myself for resisting my initial urge, which was to tell the firefighter “Hey, I’m just sick, I’m not on fire.”

The Duke of Wellington, surveying his soldiers before the Battle of Waterloo, famously said that he did not know what they did to the enemy, but by God they frightened him.

No one thought in those days of the psychological effect upon the soldiers of witnessing so much violence (more than 30,000 were killed during the battle, about one in six of those who took part in it); nor could anyone have done so if he had thought of it. But it is now accepted wisdom that active military service leads men subsequently to commit crimes of violence, though the reasons for this are unknown.

A recent paper in The Lancet examined the association of military service and subsequent crimes of violence, which turned out to be much weaker than suspected. The authors examined the criminal records of 8,280 British soldiers who had served in Iraq and Afghanistan with that of 4,080 of those who had not. When controlled for such factors as age, level of education, pre-service record of violent offenses, rank, and length of service, there was no significant difference in the criminal records of those who had served in Iraq and Afghanistan and those who had not.

When, however, those who were deployed in a combat role were compared with those who had not been so deployed, it was found that the former had higher levels of violent offending as measured by their criminal records. Interestingly, however, those who were involved in actual fighting had considerably higher prior levels of violent offending than those not so involved, suggesting that more aggressive types either volunteered or were selected for combat service. Somewhat alarmingly, nearly half of soldiers involved in the fighting had criminal records for violence.

For a long time doctors were subject to contradictory imperatives with regard to AIDS. On the one hand they were enjoined to treat it as they would treat any other disease, without animadversion on the way in which the patient had caught it; on the other hand they had, before testing for the presence of HIV, to seek special permission of the patient and to ensure that he or she had had counselling before the test was taken – quite unlike the testing for any other disease, syphilis for example. So AIDS was at the same time a disease like any other and also in a completely different category from all other diseases.

It cannot be said that pre-test counseling is universally popular among patients. There was an Australian clinic that famously offered the test with “guaranteed no counseling” and it did not lack for clients. For quite a number of years, however, HIV-test counselling has provided a living for the kind of people who like to hover around the edges of human catastrophe.

However, the recommendation by the United States Preventive Services Task Force (USPSTF), reported in an article in a recent edition of the New England Journal of Medicine, that henceforth the screening of adults for HIV infection should be routine will, if adopted, put paid to all such pre-test counseling. One cannot counsel scores or hundreds of millions of people.

Seven years ago the USPSTF came to a different conclusion on the question of screening for HIV, believing that the benefits were insufficient to recommend it. Since then, however, evidence has accumulated that treating people early in the course of their infection not only prolongs their life but reduces spread of the infection.

For some reason that I have never quite fathomed, immunization against infectious diseases has from its very inception in Jenner’s time been one of the most viscerally feared and bitterly opposed of all medical techniques. Perhaps people felt that to immunize was to interfere sacrilegiously with the course of nature, and that people, especially children, had the duty to die of infectious diseases just as Nature “intended.” Perhaps they felt that, if it worked, it would allow the survival of the unfittest. At any rate, few medical procedures have been as persistently, minutely, and fervently examined for harmful effects as immunization has.

In general, the results have been disappointing for those who wished to show that immunization was invariably followed by Nature’s retribution, particularly in the neurological sphere. Scare has succeeded scare without ever being confirmed, though those who hold to the anti-immunization faith refuse to abandon it. Now, at last, there seems to be evidence of a genuine association between a certain type of immunization and a neurological condition.

That association is that between the immunization of children with an anti-influenza virus and narcolepsy, a condition characterized by chronic, excessive daytime sleepiness and a tendency to cataplexy, that is to say a loss of muscular tone triggered by strong emotion. It was first observed in Finland and Sweden; subsequent studies in other European countries and in Canada failed to find an association, but a further study, this time in England, and reported in the British Medical Journal, confirmed that the Finnish and Swedish findings.

In October 2009, children at risk of pulmonary complications during a pandemic of influenza were immunized against it with a vaccine against the causative virus. Most of the children immunized suffered from asthma (interestingly, one of the theories to account for the recent rise in the proportion of children suffering from asthma and other allergic conditions is that, having been immunized against all the common childhood infectious diseases, their immune systems have not developed as Nature “intended”).

No doubt I have forgotten much pharmacology since I was a student, but one diagram in my textbook has stuck in my mind ever since. It illustrated the natural history, as it were, of the way in which new drugs are received by doctors and the general public. First they are regarded as a panacea; then they are regarded as deadly poison; finally they are regarded as useful in some cases.

It is not easy to say which of these stages the medical use of cannabis and cannabis-derivatives has now reached. The uncertainty was illustrated by the on-line response from readers to an article in the latest New England Journal of Medicine about this usage. Some said that cannabis, or any drug derived from it, was a panacea, others (fewer) that it was deadly poison, and yet others that it was of value in some cases.

The author started his article with what doctors call a clinical vignette, a fictionalized but nonetheless realistic case. A 68-year-old woman with secondaries from her cancer of the breast suffers from nausea due to her chemotherapy and bone pain from the secondaries that is unrelieved by any conventional medication. She asks the doctor whether it is worth trying marijuana since she lives in a state that permits consumption for medical purposes and her family could grow it for her. What should the doctor reply?

So, as far as my own progress goes, the last couple weeks were kind of boring: I wasn’t losing any weight, my glucose was coming down, but nothing very dramatic was happening.

Since the last time, though, I’ve done several things: I got “after” pictures taken for the first 13 weeks, I have started tracking bodyfat as well as weight, and best of all, I got my post-13-weeks bloods done.

Those are the most fun, so let’s hit them first.

Glucose. My A1c is now down to 5.9 percent, from a starting A1c of 7.5. That means I’ve lowered my average glucose from roughly 170 mg/dL, or just over 100.

My doc was more or less slack-jawed. I had to talk her into doing the A1c, as she didn’t think it could have changed much since the one I had in January.

I’ve cut my metformin to 1000 mg/day from 2500 when I started this.

Cholesterol. Or more generally, blood lipids. Now, remember that I’m following what is, by traditional medical measures, the perfectly wrong diet for cholesterol — heavy on meats, no grains at all, and with roughly 60 percent of my calories coming from fats.

My total cholesterol is down to 123. That’s the bottom of the normal range; that’s a score that the ultra-low-fat Ornish diet would be happy to reach.

Low-density lipoproteins — LDL, the “bad cholesterol” — is down to 70.

High density lipoproteins — HDL, the “good cholesterol” — is up to 26 (up in this case being the good direction.) Although it’s still low as an absolute number, what’s perhaps more important is the ration of HDL tot total cholesterol. HDL of 26 makes my total cholesterol over HDL ratio about 4.7. This is now well under the boundary the American Heart Association recommends.

In other words, while my HDL could be better, I am now in the “good” to “very good” range.

Body fat. I’ve just started tracking this, so the numbers don’t mean a lot yet, but as you can see from the chart, it is showing a real down trend. I’m somewhere around 30 percent right now, and obviously I hope it’ll drop significantly in this 13 weeks.

My daily bodyfat percentage.

Exercise

So far, I’ve mainly been tracking Fitocracy points, which are a kind of arbitrary measure of various kinds of exercise, but handy because it converts various exercises into one easily-tracked number. (I hope to have an interview with some of the Fitocracy people in the near future; in the meantime, if you want to follow me, you can sign up for Fitocracy here.)

Since this 13 weeks season has started, i’ve accumulated 2800 Fitocracy points.

Of course, David Steinberg is doing his own series on this. I sent him some videos which didn’t work out, but I’ve just taken another set. Have a look at his piece this week, in which he makes some entirely unsubstantiated suppositions about how I’ve managed to practically break every bone in my body over 57 years. It’s pretty funny, and good advice.

­­­During my childhood, medicine always tasted disgusting and I suspected that adults made it so deliberately to spite children. They could have made it delicious had they wanted to.

Disgusting ingredients have been used in supposedly therapeutic concoctions down the ages. They had three qualities: vileness, rarity, and expense. These strongly promoted the placebo effect, for who would not claim to feel better if continuing to swallow camel’s goat’s bile were the alternative? A little bit of what revolts you does you good, that is the theory.

Now at least when we resort to disgusting means, they are scientifically reasonable. I worked for a time for a surgeon in a country where antibiotics were not easily available, who wanted to test honey as an antiseptic dressing for open wounds (bacteria do not grow in honey). I cannot remember the results from the bacteriological point of view, but I recall that the aesthetic results were not pleasing.

I have also seen the use of maggots for wound cleaning. The therapy is effective, but it is difficult not to be repelled by it, especially if (as I have) you have actually suffered a parasitic skin infection by maggots.

However, my disgust at honey and maggots paled by comparison with what I felt upon reading the title of a paper in a recent edition of the New England Journal of Medicine, “Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile.” The excrement of various creatures was long an ingredient of supposed remedies in the days when nothing really worked, but I had fondly supposed that medicine had passes what Freud, in another context, would have called the anal stage.

Life being complex, many simple principles turn out on examination to be not as simple as at first thought. For example, everyone knows, or thinks that he knows, that prevention is better than cure. But is it always? It is often very difficult to say with certainty.

Three articles in a recent British Medical Journal tackle the vexed question of mammography, whose purpose is to detect cancer of the breast early in its development on the assumption that early detection leads to more effective treatment. The advice to women, therefore, is to get themselves scanned regularly.

This seems straightforward and commonsensical, but in fact the question of whether the light of mammography is worth its candle is devilishly complex. For example, if the treatment of breast cancer has improved (and death rates in Britain have almost halved between 1990 and 2010, thanks mainly to improved treatment rather than to early finding), then the number of cases found by mammography in order to save a single life has to increase. This in turn means that old trials – and all trials to determine the long-term effect of mammography have to be old – may no longer be relevant to the present situation. Trials of mammography are, in effect, always trying to hit a moving target.

The main problem that has bedevilled mammography is that of the false positive: the diagnosis of cancer when in fact there is none. For example, it is estimated that approximately 70,000 women in America are falsely diagnosed with cancer annually by means of mammography, that is to say a half of all those who are diagnosed.

Hospital is a dangerous place, especially for the old and very sick — which is one reason why a measure of a hospital’s efficiency is the speed with which it discharges patients home after treatment. Another reason for this measure is, of course, economy. Long stays in hospital are hugely expensive.

However, aiming to discharge patients as quickly as possible may be neither humane nor efficient. People are not units of accounting or components in an assembly line or mere mechanical contrivances. Hospitals are not car repair shops.

An article in the New England Journal of Medicine reflects upon the fact that nearly a fifth of patients treated under Medicare, 2.6 million individuals, return to hospital for further treatment within 30 days of their discharge as cured or sufficiently improved to manage at home.

Rather surprisingly, perhaps, the chances of a patient having to return to hospital do not reflect the seriousness of his original condition, nor are re-admissions invariably for the same condition as that for which the patient was admitted in the first place. On the contrary, in the majority of cases the patient is readmitted for something quite different. For example, 63, 71 and 64 percent of patients readmitted after treatment for heart failure, pneumonia, or chronic obstructive pulmonary disease are readmitted for reasons other than their original diseases.

In 1967 the Beatles song “When I’m Sixty-Four” appeared on the now iconic Sgt. Pepper album, and many, including this writer, considered age 64 “old.” (Of course, I was only 12, but 64 was old at that time.)

But when General Norman Schwarzkopf recently died at age 78, I did not consider him old.

So what happened to change my view of when old age begins?

Well for starters, I got old along with the 76 million Americans born between 1946 and 1964 who are affectionately known as “baby boomers.” Boomers transformed America at every stage of life.  Unfortunately, our nation was totally unprepared for all the change we brought every step of the way and now is no different.

Last year at an Aging in America conference, Ken Dychtwald, CEO of the consulting firm AgeWave, summed it up like this:

“We weren’t prepared for the boomers,” he said. “There weren’t enough hospitals or pediatricians. There weren’t enough bedrooms in our homes. There weren’t enough schoolteachers or textbooks or playgrounds. The huge size of this generation has strained institutions every step of the way.”

Then Dychtwald compared his New Jersey high school, with such overcrowding that students had to go to classes in shifts, to what’s in store for aging baby boomers in the coming decades.

“The boards of education had 13 years to see this coming. What was the surprise there?” said Dychtwald. “But it’s the same today with senior care and geriatric medicine and continuum of care. It’s staggering how unprepared we are.”

Yes, it is staggering indeed — and, as the saying goes, “we ain’t seen nothin’ yet.”

Medical controversies last a long time and are often bitter not only because science gives provisional rather then definitive answers to most questions, any of which answers may soon be overturned by further evidence, but because science by itself provides no means of deciding between incommensurable results according to a single criterion of value. Besides, everyone likes a good intellectual argument and wants to keep it going as long as possible.

An editorial in a recent edition of the New England Journal of Medicine claims that the long-running controversy over whether surgery or angioplasty is better for diabetic patients with ischaemic heart disease has now been decisively resolved in favor of the former, thanks to a paper published in the same edition. The matter is not a small one: in the United States alone 175,000 diabetic patients were treated last year either with surgery or angioplasty, and the figure is likely to rise as the number of diabetics grows.

The paper described a trial in which 947 diabetic patients with ischaemic heart disease underwent surgery and 953 underwent angioplasty (there were no untreated controls). At five years, mortality in the angiolasty group was 16.3 percent as against 10.9 percent in the surgical group; in total 26.6 percent of those treated with angioplasty had either died or had had a stroke or heart attack, as against 18.7 percent of the surgical group.

My father’s life expectancy at birth was 48 years. He survived to be 83, and he was by several years younger at his death than his brothers and sister at their deaths. He and they lived through what has been called “the demographic transition,” from low life expectancies to high.

A recent paper in the Lancet charts the worldwide evolution of life expectancy between 1970 and 2010. Life expectancy has fallen in only 4 of the 187 countries with populations of 50,000 or more, the four being Zimbabwe, Lesotho, Ukraine, and Belarus. In the first two, AIDS was the cause; in the second two, alcohol.

Worldwide life expectancy between 1970 and 2010 rose at a rate of 3-4 years per decade, except for the 1990s, when the rate of improvement was considerably lower. In Asia and Latin America, the average age at death rose by 1 year every 2 years, a startling rate of improvement. But the greatest improvement in recent years has been in sub-Saharan Africa: life expectancy in Angola, Ethiopia, Niger, and Rwanda has increased by 10–15 years since 1990.

According to the authors, two medical interventions account for this: first the availability of anti-retroviral drugs to treat AIDS, and second the availability of both insecticide-treated mosquito nets and artemisin-combination treatment regimes for malaria.

Doctors of the old school tend to be rather proud of how hard they worked when they were young, and to attribute their current enormous technical competence as well as the magnificence of their character to the long hours that they then endured. They were not much fun at the time, perhaps, but it made them what they are.

I remember those long hours well, and how at the end of a forty-eight hour shift my head felt as if it contained nothing but lead shot, as if it might just fall off my body. Leaving the hospital was like leaving prison after a long sentence; the starving man dreams of food, but the sleepless man dreams of bed.

It has long been suspected that such exhaustion cannot be good for patients; no one in his right mind would wish to be flown by a pilot who had gone two days without sleep, for example. Why should doctors be immune from the normal effects of fatigue on performance?

A study in a recent edition of the Journal of the American Medical Association attempted to demonstrate the effects of a protected sleep period on interns and residents when they were obliged to work shifts longer than 30 hours. On some such shifts they were given five hours, between 12:30 am and 5.30 am, when they could not be interrupted except by the direst emergency, and when they were given the opportunity to sleep. This might not be what most mothers would call a good night’s sleep, but it was better than what was normally available to such interns and residents.

The subjects of the experiments acted as their own controls: half the time they had protected sleep periods, and half the time they hadn’t. Unsurprisingly, they got more sleep (about an hour more per night) when they were given such a protected period rather than when they were not. They were more alert, both subjectively and objectively, when they had slept 3 hours a night instead of only 2. Three hours is hardly enough to make one feel fully rested, but slugabeds know that even a quarter of an hour of extra sleep can seem the most luxurious thing in the world.

via Cold Remedy Cocktails: Do They Work? – ABC News.

When it comes to adding a shot of alcohol to your cold or flu remedy, it’s hard not to wish those boozy concoctions are doing some good for your health. As it turns out, they are.

Well, kinda.

Drinks like hot toddies, which traditionally contain whiskey, lemon and honey, can actually give cold and flu patients relief from their symptoms, said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn.

It just can’t prevent or cure a cold or flu virus.

“It would not have an effect on the virus itself, but its effect on the body can possibly give you some modest symptom relief,” Schaffner said. “The alcohol dilates blood vessels a little bit, and that makes it easier for your mucus membranes to deal with the infection.”

Since Sept. 30, more than 5,100 influenza cases have been reported to the Centers for Disease Control and Prevention, including 40 cases of H1N1.

Schaffner said warm moisture from a steaming mug of any beverage can offer symptom relief.

“That’s part of why chicken soup is thought to work,” he said.

*****

Related at PJ Lifestyle:

At dinner the other night, a cardiologist spoke of the economic burden on modern society of the elderly. This, he said, could only increase as life expectancy improved.

I was not sure that he was right, and not merely because I am now fast approaching old age and do not like to consider myself (yet) a burden on or to society. A very large percentage of a person’s lifetime medical costs arise in the last six years of his life; and, after all, a person only dies once. Besides, and more importantly, it is clear that active old age is much more common than it once was. Eighty really is the new seventy, seventy the new sixty, and so forth. It is far from clear that the number of years of disabled or dependent life are increasing just because life expectancy is increasing.

There used to be a similar pessimism about cardiopulmonary resuscitation. What was the point of trying to restart the heart of someone whose heart had stopped if a) the chances of success were not very great, b) they were likely soon to have another cardiac arrest and so their long-term survival rate was low and c) even when restarted, the person whose heart it was would live burdened with neurological deficits caused by a period of hypoxia (low oxygen)?

A paper in the New England Journal of Medicine examines the question of whether rates of survival of cardiopulmonary resuscitation have improved over the last years and, if so, whether the patients who are resuscitated have a better neurological outcome.

Human kind cannot bear very much reality, wrote T. S. Eliot, and a recent paper in the New England Journal of Medicine bears him out. The authors of the paper asked 1193 patients who had opted for chemotherapy for their metastatic cancer of the colon or lung how likely it was that the chemotherapy would cure them. The correct answer, of course, was that it was very unlikely (in the current state of the art); but 69 percent of patients with lung cancer and 81 percent with cancer of the colon had a much higher hope of cure than was reasonable in their circumstances.

The authors found that those patients with the least accurate estimate of the chances of cure (that is to say who were the most falsely optimistic) rated their doctors the highest for their communication skills. In other words it is possible that doctors who give an optimistic message are those that patients think have told them the most, in the best and clearest way; but it is also possible that optimistic patients view their doctors in a benevolent light. What doctors tell patients, and what patients hear their doctors tell them, may be very different as every doctor is, or ought to be, aware.

The paper raises the question of what constitutes truly informed consent. How many patients know or truly appreciate that, as the authors put it, “chemotherapy is not curative, and the survival benefit seen in clinical trials is usually measured in weeks or months”? For there to be informed consent, is it necessary for the doctor merely to have given the relevant information, or is it necessary for the patient to have inwardly digested it, to believe it? Is the onus entirely on the doctor, or does the patient have some responsibility? Is a doctor automatically to blame if a patient has not understood and absorbed his message? At any rate, the authors say that “this misunderstanding could represent an obstacle to optimal end-of-life planning and care.”