Unexplained Medical Syndromes

The Feb. issue of FASEB Journal (Vol. 21, pp. 299-301) had an
interesting editorial by Gerald Weissman entitled "'Chronic Lyme' and
other medically unexplained syndromes." Here is one excerpt:

[TW]
Groups of patients and advocates march against medical science under the
banners of "chronic fatigue syndrome," "myalgic encephalitis,"
"irritable bowel syndrome," "total chemical allergy," etc. There is no
question that patients suffer—and often terribly—from conditions to
which these labels have been given. There is also no question that their
disability is real. Skeptics worry, however, that the hallmark of these
"diseases" is that diagnosis requires the complete absence of objective
physical or biochemical derangement. They wonder whether such patients
are not really victims of a complex set of socially and medically
constructed diseases—much as the "railway spine," "chronic
appendicitis," or "female hysteria" favored by 19th century clinicians.

Full text available at:
http://www.fasebj.org/cgi/content/full/21/2/299

___________________________
[D-]

Pfizer announced (June 22, 2007) that the FDA approved Lyrica [Pregabalin] for the management of fibromyalgia. According to the company, in the 2 clinical trials with more than 1800 subjects, Lyrica demonstrated rapid and sustained improvements in pain compared with placebo. Lyrica’s approval for fibromyalgia represents the eighth Pfizer treatment to receive “priority review” status from the FDA over the past two and a half years, the company said. http://www.fdanews.com/newsletter/article?articleId=94987&issueId=10352

A Priority designation is intended for those products that address unmet medical needs. http://www.accessdata.fda.gov/scripts/cder/onctools/Accel.cfm

Pregabalin is a schedule IV controlled substance (low potential for abuse) and was initially approved in December 2004 for the management of neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia. Pregabalin is also indicated as an adjunctive therapy for adult patients with partial onset seizures. More than 5 million patients worldwide have been prescribed the drug, according to Pfizer.

So, not only do we have a medical condition that is defined in the absence of objective physical or biochemical derangement, we have a drug to treat it that has "priority" FDA approval in the absence of an understood mechanism of action. I really think a third study arm should have used gummy bears.


dras

published homeopathy and life-energy studies

eCAM 2007 4(2):149-163

Immunology and Homeopathy. 5. The Rationale of the ‘Simile’
Paolo Bellavite1, Riccardo Ortolani2, Francesco Pontarollo1, Giuseppina
Pitari3 and Anita Conforti4
1Department of Scienze Morfologico-Biomediche, University of Verona,
Piazza L. A. Scuro, 37134 Verona, 2Association for Integrative Medicine
‘Giovanni Scolaro’, 3Department of Basic and Applied Biology,
University of L’Aquila and 4Department of Medicina e Sanità Pubblica,
University of Verona, Italy

>>>>snip<<<<<<<<<

I think this journal is setting itself up for acceptance and publication of something Alan Sokal -esk.

Actually, I'm working on my own Altmed-naturopathic theory that uses the mysterious global forces that account for the powers of the Island in the series "Lost." I'm sure I can explain feng shui and any form of energy medicine. Still working on incorporating homeopathy, though. The above is an excellent article, as it has many vogue-sounding, scientifical terms and phrases I can incorporate into my theory. I especially like, "chaotic dynamics and physical-electromagnetic levels of regulation."

It is a cool idea for homeopathy to barrow ideas of using mathematics to describe abstractness with the assertion that such formulations will reveal counter-intuitive scientific truth. There is an old WB cartoon with FogHorn LegHorn, the rooster, who plays hide-n-seek with a braniac child/chick. While he hides behind the barn, the braniac child uses a slide rule and math equations to formulate a spot in the barnyard, where a shovel reveals FogHorn is hiding. While FogHorn tries to come to grips at how the braniac child dug him up in the yard when he knows he was hiding behind the barn, the child simply shows him the mathematical equation. I think this analogy is very close to what homeopathy does with their mathematics - if you hide a rooster behind the barn, you can mathematically prove it's buried in the yard.

dras
------------------------------------------------------------------------------------

eCAM 2007 4(2):225-232

Ki-energy (Life-energy) Stimulates Osteoblastic Cells and Inhibits the
Formation of Osteoclast-like Cells in Bone Cell Culture Models
S. Tsuyoshi Ohnishi1, Kozo Nishino2, Satoshi Uchiyama3, Tomoko Ohnishi4
and Masayoshi Yamaguchi3
1Philadelphia Biomedical Research Institute, King of Prussia, PA, USA,
2School of Nishino Breathing Method, Shibuya-ku, Tokyo, 3Laboratory of
Endocrinology and Molecular Metabolism, Graduate School of Nutritional
Sciences, University of Shizuoka, Shizuoka, Japan and 4University of
Pennsylvania School of Medicine, Philadelphia, PA, USA

Full text at:
http://ecam.oxfordjournals.org/cgi/content/full/4/2/225



My first observation is that there is a leap taken from incidental findings of post menopausal BMD exams for some people who practice specific breathing techniques, to showing "ki-energy" projection onto a petri dish alters cellular growth. It's supposed to make sense as a "possible mechanism" when you know about the authors prior investigations, but realistically it is quite a stretch. The observation does not lead to a practical theory, nor does the study correlate or consider any number of more plausible explanations for incidental high BMD results in a few post menopausal Ki-Energy practitioners.

Second, I am disappointed in the descriptions of the published study concerning the comparison between the active and control petri dishes. I'm not convinced that study groups are treated environmental equal aside from the active administration of "ki-energy." Also, the average number of samples is less than 10 in any one group. I am not a cellular biologist, or geneticist, but my suspicion is that there is some over analysis of overly broad ranges of data in finding the statistically significant differences in groups. Also, a clear reason and implications for changing the study protocols after initial results are not explained.

Overall, I don't think this study makes a good argument for further study of Ki-energy. I don't question the results of their laboratory data, or methods of data collection, but the illogical premise, lack of detail to controls, small sample size, and apparent overdependance on singular data outcomes combine to make this a rather poor source for the development of conclusions about "ki-energy" impacts on bone density.

dras

Is Spirituality a Part of Health Care?

Would you be willing to pay a doctor specifically for telling you to walk a mile each day? (I said "would" not "should") Would you be willing to pay a little more into your employer-sponsored health plan so all your co-workers and families can go to yoga classes twice a week? There is much that goes into all that is involved in the patient-provider-payor struggle for defining what is "medicine." For good or bad, it's all about costs, coverage, and reimbursement. I'll argue this is what defines "medicine." Despite all the apparent impropriety, injustice, or unfairness, I think this system provides enough checks and balances that it is the way it should be defined until some paradigm shift occurs in our attitudes about money and health.

dras

Comments to Reply:

[D-]> Would you be willing to pay a doctor specifically
> for telling you to walk a mile each day? (I said
> "would" not "should")

[RS]
If this is medical prescription to help a condition I
have, then I would pay the doctor to give that
prescription. Maybe the cardiologist says do not walk
much because it is dangerous for your condition. I
would also pay for this prescription because
cardiologist knows better than I know about heart
disease and specifics. You would not pay for this
expert guidance from highly educated doctor?

[D-]
In our reimbursement world, when a qualified doctor evaluates the medical condition of a patient and advises a patient to walk, or not walk a mile each day, it's called an evaluation and management episode of care. More specifically, I'm asking if that episode of care should be further broken down to the level that the physician should expect unique reimbursement, aside from whatever other intervention is performed or recommended, for advising the patient about a 1-mile walk. I'm not trying to be as cynical or trite as the question sounds. Similar instances happen all too often in real-life, and the topic has a long history: http://www.cms.hhs.gov/Transmittals/downloads/R954CP.pdf


[D-]> Would you be willing to pay a
> little more into your employer-sponsored health plan
> so all your co-workers and families can go to yoga
> classes twice a week?

[RS]: No I would not because this is not prescription for
specific condition advised by doctor to specific
patient with specific medical condition where it is
useful.I would not pay more in my plan so everyone
could go swim in pool at the YMCA because they enjoy
to have a dip. I would pay more to go swim myself if
expert doctor gives me the prescription telling me it
is very useful for my specific medical condition of
physical or mental illness.


[D-]
How about a willingness to pay for a home spa for your co-worker prescribed by his expert doctor for his chronic back pain? A health club membership prescribed for his fibromyalgia? A custom-built GMC van prescribed for his peripheral neuropathy? A personal massage therapist prescribed for his chronic malaise and fatigue?

[D-]> There is much that goes into
> all that is involved in the patient-provider-payor
> struggle for defining what is "medicine." For good
> or bad, it's all about costs, coverage, and
> reimbursement. I'll argue this is what defines
> "medicine."

[RS]:This is wrong. Maybe this is how it becomes necessary
because of economics but that does not make it the
right definition. Medicine is to cure and prevent
disease and also to ease the bad symptoms. It is not
to decide cost and reimbursement. Maybe the cost and
reimbursement makes this difficult for many to get
medicine but this does not make the definition of
medicine change for that reason.

[D-]
I agree, economics should not define what is considered medicine. But our degree of willingness to put a value on a service does.

[D-]> Despite all the apparent impropriety,
> injustice, or unfairness, I think this system
> provides enough checks and balances that it is the
> way it should be defined until some paradigm shift
> occurs in our attitudes about money and health.

[RS]: I think this is what would be sophistry. The question
is what is definition of medicine, what treatments and
offers and not what is restricted because of economics
that makes medical practice unavailable for some.
Richard Singh

[D-]:
Not sophistry, as I see it. It's my understanding of how our society that uses a third-party payment system for medicine defines what is considered "medicine." The definition is influenced within a semblance of checks and balances created by the provider, patient, and the payor. Unfortunately, priorities for all three groups are often economic-based. I only defend it in comparison with the alternative of government socialized medicine, that removes the patient or consumer from the equation and leaves the definition to only providers and the government payor. And the alternative of unregulated consumer-driven health care, which comes with the risk of sacrificing science and legitimacy from the definition.

The enigma of medicine lies within the philosophy of the definitions. Those with a more relativistic view of medicine are much more comfortable calling yoga, various CAM modalities, and even "spirituality", medicine. The dangerous consequences of promoting a relativistic philosophy toward the idea that whatever impacts health is therefore medicine are three-fold, as I see it. One, we foster a mistaken association that all medicine is relatively beneficial. For example, I might come to falsely believe that if I pray, do yoga, and have surgery for cancer, I can do without chemotherapy, and expect the same outcome as if I'd done the chemotherapy and left out the yoga. Two, we risk creating the same attitude of entitlement for all "medicine" that we currently have for doctor and hospital-based medicine. That is, we expect Medicare, private insurance, or someone else besides ourselves to provide us with whatever "medicine" we feel we need at the time. Three, we then
travel precariously closer to accepting state-sponsored religion. If I use a relativistic basis of medicine to infer that a specific vitalistic (faith-based) belief or modality improves health outcomes, and can convince congress/CMS to pay for it, I can compel you to at least fund it, if not accept it.

I do not know what should be called "medicine." But I would like to be empowered with the tools to create a definition for myself, and the freedom to act on my decision, whether financially or personally. I'm very comfortable calling religious ideals and personal values a type of medicine, and I hesitate to argue against whatever talisman, ritual, or belief system any individual believes is keeping or making them well. I also think we should hold on to our traditional value of charity in health care. As a (U.S) nation, we want everyone to have access to medical care, and have always subsidized those who are less fortunate in health and wealth than ourselves. I hope we continue in that attitude, and the current trend of consumer-driven health does not leave more people out-in-the-cold due the collective selfishness of those of us who are more well or wealthy.

Best Regards,
dras

Is Spirituality a Part of Health Care?

Would you be willing to pay a doctor specifically for telling you to walk a mile each day? (I said "would" not "should") Would you be willing to pay a little more into your employer-sponsored health plan so all your co-workers and families can go to yoga classes twice a week? There is much that goes into all that is involved in the patient-provider-payor struggle for defining what is "medicine." For good or bad, it's all about costs, coverage, and reimbursement. I'll argue this is what defines "medicine." Despite all the apparent impropriety, injustice, or unfairness, I think this system provides enough checks and balances that it is the way it should be defined until some paradigm shift occurs in our attitudes about money and health.

dras

Comments to Reply:

[D-]> Would you be willing to pay a doctor specifically
> for telling you to walk a mile each day? (I said
> "would" not "should")

[RS]
If this is medical prescription to help a condition I
have, then I would pay the doctor to give that
prescription. Maybe the cardiologist says do not walk
much because it is dangerous for your condition. I
would also pay for this prescription because
cardiologist knows better than I know about heart
disease and specifics. You would not pay for this
expert guidance from highly educated doctor?

[D-]
In our reimbursement world, when a qualified doctor evaluates the medical condition of a patient and advises a patient to walk, or not walk a mile each day, it's called an evaluation and management episode of care. More specifically, I'm asking if that episode of care should be further broken down to the level that the physician should expect unique reimbursement, aside from whatever other intervention is performed or recommended, for advising the patient about a 1-mile walk. I'm not trying to be as cynical or trite as the question sounds. Similar instances happen all too often in real-life, and the topic has a long history: http://www.cms.hhs.gov/Transmittals/downloads/R954CP.pdf


[D-]> Would you be willing to pay a
> little more into your employer-sponsored health plan
> so all your co-workers and families can go to yoga
> classes twice a week?

[RS]: No I would not because this is not prescription for
specific condition advised by doctor to specific
patient with specific medical condition where it is
useful.I would not pay more in my plan so everyone
could go swim in pool at the YMCA because they enjoy
to have a dip. I would pay more to go swim myself if
expert doctor gives me the prescription telling me it
is very useful for my specific medical condition of
physical or mental illness.


[D-]
How about a willingness to pay for a home spa for your co-worker prescribed by his expert doctor for his chronic back pain? A health club membership prescribed for his fibromyalgia? A custom-built GMC van prescribed for his peripheral neuropathy? A personal massage therapist prescribed for his chronic malaise and fatigue?

[D-]> There is much that goes into
> all that is involved in the patient-provider-payor
> struggle for defining what is "medicine." For good
> or bad, it's all about costs, coverage, and
> reimbursement. I'll argue this is what defines
> "medicine."

[RS]:This is wrong. Maybe this is how it becomes necessary
because of economics but that does not make it the
right definition. Medicine is to cure and prevent
disease and also to ease the bad symptoms. It is not
to decide cost and reimbursement. Maybe the cost and
reimbursement makes this difficult for many to get
medicine but this does not make the definition of
medicine change for that reason.

[D-]
I agree, economics should not define what is considered medicine. But our degree of willingness to put a value on a service does.

[D-]> Despite all the apparent impropriety,
> injustice, or unfairness, I think this system
> provides enough checks and balances that it is the
> way it should be defined until some paradigm shift
> occurs in our attitudes about money and health.

[RS]: I think this is what would be sophistry. The question
is what is definition of medicine, what treatments and
offers and not what is restricted because of economics
that makes medical practice unavailable for some.
Richard Singh

[D-]:
Not sophistry, as I see it. It's my understanding of how our society that uses a third-party payment system for medicine defines what is considered "medicine." The definition is influenced within a semblance of checks and balances created by the provider, patient, and the payor. Unfortunately, priorities for all three groups are often economic-based. I only defend it in comparison with the alternative of government socialized medicine, that removes the patient or consumer from the equation and leaves the definition to only providers and the government payor. And the alternative of unregulated consumer-driven health care, which comes with the risk of sacrificing science and legitimacy from the definition.

The enigma of medicine lies within the philosophy of the definitions. Those with a more relativistic view of medicine are much more comfortable calling yoga, various CAM modalities, and even "spirituality", medicine. The dangerous consequences of promoting a relativistic philosophy toward the idea that whatever impacts health is therefore medicine are three-fold, as I see it. One, we foster a mistaken association that all medicine is relatively beneficial. For example, I might come to falsely believe that if I pray, do yoga, and have surgery for cancer, I can do without chemotherapy, and expect the same outcome as if I'd done the chemotherapy and left out the yoga. Two, we risk creating the same attitude of entitlement for all "medicine" that we currently have for doctor and hospital-based medicine. That is, we expect Medicare, private insurance, or someone else besides ourselves to provide us with whatever "medicine" we feel we need at the time. Three, we then
travel precariously closer to accepting state-sponsored religion. If I use a relativistic basis of medicine to infer that a specific vitalistic (faith-based) belief or modality improves health outcomes, and can convince congress/CMS to pay for it, I can compel you to at least fund it, if not accept it.

I do not know what should be called "medicine." But I would like to be empowered with the tools to create a definition for myself, and the freedom to act on my decision, whether financially or personally. I'm very comfortable calling religious ideals and personal values a type of medicine, and I hesitate to argue against whatever talisman, ritual, or belief system any individual believes is keeping or making them well. I also think we should hold on to our traditional value of charity in health care. As a (U.S) nation, we want everyone to have access to medical care, and have always subsidized those who are less fortunate in health and wealth than ourselves. I hope we continue in that attitude, and the current trend of consumer-driven health does not leave more people out-in-the-cold due the collective selfishness of those of us who are more well or wealthy.

Best Regards,
dras

TB Hysteria ala QXCI Marketing

Hey, TB's a TOXIN, ain't it? And any QXCI marketer/practitioner will tell you the machine unfailingly identifies ANY toxins in the body. However, after being tested, they will also unfailingly tell you that you don't have TB, but that you DO have mercury or a number of other myriad of "toxins" in your body for which you need immediate, and long-term "treatment" and supplements.

On a more serious note:

It's embarrassing when even the CDC can't seem to get it right.

http://acsh.org/healthissues/newsID.1552/healthissue_detail.asp

From the article:

"Using its legal powers to prevent the spread of disease, CDC put Speaker on the U.S. "no fly" list -- and told him to enter an Italian hospital, where he would be put in isolation indefinitely. Speaker and his bride asked if the CDC could provide transportation -- even if it had to be a cargo ship -- so that he could get home for treatment. The agency denied the request."

And:

"Please note that CDC doctors -- and those from the Denver hospital where Speaker is now being treated -- have repeatedly stated that the chance that he infected others is extremely low -- near zero. Indeed, his bride is free of TB, even now -- after their honeymoon, which presumably saw considerable contact."



The contagiousness of TB is nothing to scoff about. Those of us in Hospital health care can recall our mandatory TB inservices and annual skin testing. I even have my old custom-fitted HEPA mask lying around somewhere. But, I think you really only need to worry if you're someone who is hanging around the likes of Doc Holladay (someone with TB who is coughing up sputum or blood.) Even then, if you're healthy, the odds are in your favor of not becoming infected:

http://www.umdnj.edu/~ntbcweb/coretp.htm
"Infection rates [for persons who often spend time with someone who has infectious TB] have been relatively stable since 1987, ranging from 21% to 23% for the contacts of infectious TB patients...For contacts of persons with drug-resistant TB, infection rates seem to be similar. However, because they may have a poor response to treatment, patients with drug-resistant disease are often infectious for longer periods and therefore have the potential to infect more contacts."

Remember, you have to be infected a second time before getting sick. (The first time around only qualifies you for a periodic chest x-ray versus skin testing.) Still, it only takes one droplet of 1 to 5 microns - that can hang around suspended in the air for hours - to do the deed.

dras