Curious Medicine

Brain damage to football players

2009-10-22T08:35:00.000-05:00

It is beginning to appear that a series of even relatively minor bumps to the head--those not strong enough to cause concussions--can lead to serious brain damage. Autopsy results on football players as young as 18 are finding remarkable accumulations of tau, an abnormal protein found in Alzheimer's patients. Quoted in the New Yorker, researcher Ann McKee said "You don't see tau like this in an eighteen-year-old. You don't see tau like this in a fifty-year-old." The New York Times reported today on the topic as well.

Trading jungle for medical care

2009-09-25T08:31:00.000-05:00

New Mexico native Kinari Webb decided as an undergraduate that she was going to study orangutans in Borneo. Through an eye-popping series of events, she now runs a medical clinic there. Villagers receive medical care in exchange for a small affordable payment and a pledge not to destroy what's left of the rain forest. The village goes green, and the villagers get healthier. PBS is planning a piece on this little clinic, which is two hours from the nearest airport. Read about her, if only to convince yourself that amazing things can and do happen in this world. (Not least amazing: Webb has reportedly never paid a bribe to Indonesian officials.)

How reliable are lie detectors?

2009-09-15T20:00:00.000-05:00

Not very.

We ought to know this by now, but the press still breathlessly reports it when people fail polygraph tests as if that meant something. (In the Annie Le murder investigation, I only wish it did, but the suspect's alleged defensive wounds mean more.)

The National Academy of Sciences has found that most studies purporting to investigate the polygraph are bad science ("the substantial majority of the studies most relevant for this purpose were below the quality level typically needed for funding by the National Science Foundation or the National Institutes of Health...Almost a century of research in scientific psychology and physiology provides little basis for the expectation that a polygraph test could have extremely high accuracy"). (Unfortunately, the federal government doesn't appear to have read the NAS report.)

Let the polygraph go the way of the wedding ring on the string, folks.

The next stethoscope is here.

2009-09-14T12:31:00.000-05:00

When I was in fourth grade, my father, a cardiologist, helped me design a science fair project that used his ultrasound probe to look at goldfish in Dixie cups. As a medical student, I borrowed the machine to look at my own bladder, kidneys, and heart. And in my practice as an emergency physician the ultrasound machine has allowed me to make important decisions at the bedside. Does this elderly person have low blood pressure because of insufficient blood volume, or a failing heart? Does this swollen area on the skin conceal a pus pocket? Is this fetus still alive? "It's the stethoscope of the future," as my father has been telling me since I was eight. (And as with the stethoscope, it has taken quite a while to catch on. Some of my colleagues consider themselves well enough off without it.)

I love ultrasound for the freedom it gives me to peer safely into the body at a moment's notice. But like any piece of shared equipment in a workplace, half the time you can't find the damn thing, or the last person forgot to clean it off, or there's barely any space at the bedside to wheel it into. Now there's a pocket version, called the Signos, at a price--4 grand--a doctor can actually afford. I haven't played with it (and have no relationship with the company). But I'm excited about the prospect of a pocket ultrasound becoming part of the standard toolkit, not just in developed-country EDs that can easily afford them, but also as an alternative to more expensive equipment for clinicians in poor countries. A recent unbiased review in an emergency medicine magazine waxed ecstatic about the Signos. I can't wait to try it.

Douse your night-light

2009-09-11T16:02:00.003-05:00

"Cover up your alarm clock," I instructed my partner as we were preparing to go to sleep. The clock's face glowed so brightly one could almost read by it.

He laughed, reminding me that I never switch the light on in the bathroom at night, instead leaving the door open to catch dimmer outdoor light and foresaking auditory privacy. As with most of my eccentricities (yeah, yeah, the Manhattan bicycling habit aside), this one can be traced to a neurotic desire to shave some percentage points off my risk of a miserable death. There is evidence to suggest that light at night raises the risk of certain types of cancer.

Joining the long list of seemingly benign things that raise your risk of cancer (peanut butter, fried carbs, night shifts, among others) is light pollution at night. Even through closed eyelids, the brain and pineal gland appear to sense the light, and the nightly release of the hormone melatonin is powerfully suppressed. Melatonin is "oncostatic," meaning it can help suppress tumor growth, so switching it off just so you don't have to grope for the toilet paper roll seems like a bad idea. Interestingly, cancer rates are higher in night-shift workers.

"What about moonlight?" my friend sensibly asked. "Did we evolve to sleep completely out of sight of the full moon?"

I wasn't sure how to respond to that. Maybe early humans draped kittens over their eyes. Until we figure it out, I'll keep using a sleep mask. What the hell--I already look like a cavewoman when I sleep.

Twins, their plumbing, and an old painting

2009-09-07T13:55:00.000-05:00

Twin-twin transfusion syndrome (TTTS), in which one developing fetus funnels extra blood to the other to the detriment of both, was first described in 1875 after some clever observations by a German physician named Friedrich Schatz. It happens in identical twins (and triplets) that share a placenta, and the trouble lies in abnormal blood vessels that flow one way from the "donor" twin to the "recipient." The recipient gets extra blood, and his kidneys filter it and expel it in the form of amniotic fluid--too much amniotic fluid, in fact, to the point where the recipient's bladder and body swell up. The donor, on the other hand, loses blood volume, shrinks, and within his own sac he floats in so little fluid that he can appear stuck to the wall of the uterus on ultrasound. The survival rate is low without treatment, and good treatments are few and uncertain, though lasering the abnormal connections seems to help.

Here's an interesting side note. Fetuses that survive to be born may look a little unusual, with the donor appearing small and pale and the recipient looking reddish and rather too robust. Wikipedia's article on the syndrome displays a 1617 painting of two wizened, swaddled babies looking rather strikingly TTTS-ish. Could this be an early illustration of the disease ?

The scholarly pursuit of seeking out medical diagnoses by studying paintings and other works of art is called "diagnosing the canvas." An astonishing amount of information can be gleaned from old paintings. The New York Times has more.

Psychology in the news: Why the SEC never busted Madoff

2009-09-02T15:04:00.002-05:00

It seems that Bernie Madoff was investigated five times by the SEC. They even found him contradicting himself and yet didn't follow up.

I'm guessing that this is because the esteem Madoff enjoyed on Wall Street. He was a personage there, a big philanthropist and wildly successful guy who knew everyone and had chaired NASDAQ. People were all but begging to be allowed to invest with him. He was the granddaddy, the godfather. If someone is that trusted and respected, suspecting them of something as base as Ponzi scheming is nearly unthinkable. You figure you must have misunderstood.

This reminds me of the Milgram experiments, in which unwitting subjects administered what they thought were lethal shocks to other people because a white-coated authority figure had told them to do so. When faced with authority, people tend not to rebel. Perhaps we should screen government investigators to find the few who continue to think independently in the face of authority.