Thursday, September 1, 2016

New Alzheimer's Drug; Game Changer?

Medic-ALL -9/1/2016-RESEARCH

In what has been described as a possible game changer for patients suffering Alzheimer's disease, an experimental drug aducanumab given once a month for a year to patients in a clinical trial was found to clear the brain of protein (amyloid) plaques which are believed to play a key role in disrupting cellular processes and nerve cell communication processes in the brain. These plaques are commonly seen in aging brains but Alzheimer’s patients tend to have much more of these plaques.

One of the hallmarks of Alzheimer's disease is the accumulation 
of amyloid plaquesbetween nerve cells (neurons) in the brain

The study included 165 participants divided into 4 groups and treated with an intravenous infusion of either aducanumab or a placebo for over 54 weeks. The 4 groups of patients received 4 different doses of the experimental drug and PET brain scans showed reduction in plaques at all doses and duration with the greatest reduction observed in the highest dose group.

Of course, the fact that the study involved just a handful of patients is something to be mindful of before making any firm conclusions, as well as how much this plaque reduction translates to cognitive benefit for the patient. The researchers are mindful of the fact that many other Alzheimer’s drugs have appeared promising but never lived up.

It is known that these plaques begin to build up in Alzheimer’s patients’ years before the onset of symptoms. It is therefore encouraging that the plaques in the patients observed to have taken 20 years to accumulate were removed in a 12 month period.

Larger trials of drugs involving Alzheimer’s patients are in progress and are scheduled to run until 2020.

Medic-All 2016

Wednesday, June 22, 2016

The Physician, The Leader!

Medic-ALL, June 22, 2016

Lately I have been exposed like never before to the diversity of roles available in a medical team  in a developed country like the United States and this has made me wonder even more about the role of the Physicians as the "Head of the medical team" and leaders in the medical sector and the responsibilities that come with such leadership positions that most physicians have to imbibe rather than learn.
As Physicians, do we have to master all, to lead all?
I came across this interesting article on the "proper way for physicians to be leaders" by a Pathology resident one, one of my favorite medical blogs and I thought i should share 
via, by Benjamin Mazer MD, MBA
In medical school, you learn very quickly that you can’t know everything. By the end of your first-year anatomy course, you’ll probably give up on learning the names of every part of the body, let alone the intricacies of how they function. As physicians, we must grow comfortable with our limitations. We seek help from our colleagues and try not to let our egos get in the way of patient care. We accept that no physician will ever master the entirety of his or her discipline.
But are physicians now expected to master other disciplines, such as software engineering and social work? If you read the popular press and even academic journals you may think so. I like to call this phenomenon, this growing body of subjects doctors “should” master, “Hippocratic capture.”
I was reminded of this new pressure most recently while reading this article in a New York Times blog. The author makes some excellent points. Medical curricula are relatively stagnant while our world rapidly changes. The best medicine will incorporate modern technology and respect for the socioeconomic factors that influence patients’ health. The author also complains that he sometimes feels as if he has only one tool in his toolbox: the biomedical framework. For many health problems, this feels like simply not enough.
It’s hard to imagine any physician not empathizing with this struggle. But is the solution for medical students to take design courses from a fine arts school, as the new Dell Medical School is planning (according to the NY Times blog)? Should doctors also become designers?
Doctors face the paradox of being among the most visible and respected members of the health care field. While this authority provides many rewards, it also places an enormous expectation on us as leaders of health care. Doctors are expected to heal the sick (and we want to). If socioeconomic struggles are leading to sickness, doctors are expected to fix that. If technology provides the opportunity to democratize health care, then doctors are expected to lead the charge. We’re even supposed to design better hospital gowns according to Dell Medical School’s example of its innovative new curriculum.
But to point out the obvious: We can’t do it all! Doctors have already come to terms with our inability to master the entirety of biomedical knowledge, and we need to come to terms with our inability to personally fix every social determinant of health or poorly-designed health system. In fact, we can better provide these influencers of health the respect they deserve by allowing the true experts to take charge.
There are millions of social workers, public health professionals, software engineers, designers, and others who have the ability and desire to improve people’s health through their respective disciplines. The solution isn’t for physicians to master yet another subject; it’s to build powerful interdisciplinary teams that can address these aspects of health care in an egalitarian manner by including many kinds of experts. Doctors and other providers can no longer be the only ones responsible to the public for creating the best possible health care system. This physician-dominant model is regressive and inefficient.
I am not suggesting that doctors should ignore problems outside of the biomedical framework. I personally attended business school in addition to medical school because I was excited by the opportunity to improve patients’ health through innovative health care delivery. But I went to business school precisely because I didn’t expect the intricacies of management and economics to be taught in medical school. I don’t expect all physicians to master this part of medicine.
I am suggesting that if doctors are expected to master the multitudinous disciplines that are relevant to health then eventually the biomedical aspect of medicine will suffer. After all, despite the need to address the social determinants of health, you still need someone who knows how to take out an appendix. In forward-thinking health circles, the “biomedical framework” has become an epithet. It represents the myopia of past physicians, who thought scientists in a lab would cure every disease, ignoring issues of poverty, education, and behavior. But biomedicine is still a vital part of good care delivery and should remain at the center of medical education.
While many types of professionals can address health care policy, good design, and innovative technology, only physicians have the duty to provide medical care under the biomedical framework. When someone requires a surgery or drug for their illness, it is doctors who are responsible for ensuring the proper selection and delivery of that type of care. We can dilute our education, but we cannot dilute that responsibility.
Doctors should have some familiarity with the many disciplines that affect health. This isn’t a new idea, despite what the popular press would lead you to believe. I attended the University of Rochester’s medical school, which since the 1970’s has been home to the “biopsychosocial model” of medicine. I greatly value the broad experiences I received from learning under this medical model. Even in this environment, however, I spent plenty of time learning the pathophysiology and technical skills that are traditional parts of medical education.
I personally look forward to addressing the business side of health care in addition to providing good medical care under the biomedical framework. When I do work on issues outside of this framework, however, I expect to succeed not by knowing everything there is to know about health care delivery, but by engaging administrators, engineers, and others through interdisciplinary teamwork. If physicians are expected to be leaders of the health care system, then this is the proper way to lead. Hippocrates, after all, didn’t need an MBA or MSW to be a good doctor.
Benjamin Mazer is a pathology resident and can be reached on Twitter at @BenMazeror at his self-titled site, Benjamin Mazer, MD, MBA.
Medic-ALL 2016

Wednesday, March 9, 2016

First U.S Uterus Transplant Fails

Medic-ALL (03:09:2016)

The first attempt at a womb transplant in the United States has failed after a sudden complication forced its removal about 2 weeks after the initial surgical operation.

The recipient, the 26 year old Lindsey, is however recovering well according to reports.

The technique is a new frontier that would hopefully one day offer woman born without a uterus or who lost their uterus to disease a chance of getting pregnant.

The failed transplant was the first of 10 planned by the Cleveland Clinic in a clinic trial, and the hospital said the study is continuing.

Medic-ALL Inc 2016