THE NOTORIOUS BULLS EYE

TICKS

Dear Mister SASB, I live out in the woods with three dogs. I get a lot of ticks on me. No Lyme disease yet but it’s just a matter of time!!! Is there anything I should do? – WoodyLane5

Image credits” Yersinia Pestis. 
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.

Dear MISTER SASB: My grandmother’s got stomach cancer. She’s had surgery, drugs, and chemo. Now the doctor says she should get hospice care which totally (if it’s okay to say) sucks big time. Grannie taught me to read and to ride a bike and even how to cut cocaine. There MUST be something they can do! –  Nancy Trill

Dear Nancy:

It sounds like yer granny could open up her own pharmacy.

Anyway, to answer your question, her Docs COULD get your granny hooked up with a clinical trial that offers some new hope. But they probably won’t. Denise Mann (Web MD) says most patients who could qualify for clinical trials, won’t even hear about them. At least, not from their own doctors.

This doesn’t mean doctors are a bunch of bums. The ones I’ve worked with (and consulted) are almost uniformly terrific. They work hard and they’re, mostly,  very smart. BUT they are human (surprise!). Just so many hours in a day. Just so many dollars in a paycheck. They can’t be everywhere. Can’t do everything. Gotta go home sometime. And this has a lot to do with why they’re shy about introducing their patients to clinical trials. Keeping up with 8,000 trials is SLIGHTLY impossible. When would that “keeping up”  happen? Before 5 AM? Or after 2 PM? Medicine is intense. The hours are long and the stakes are high. And there’s a lot of required reading just to stay current in day-to-day practice.

Also, there’s the relationship thing.  Maybe a particular clinical study does offer “a shot” (usually a long one). Still. It probably means the patient’s off to some distant place at a time that’s infinitely crappy and emotional horrendous.  And the patient and his.her doc often have a thing going, a doctor patient relationship. Believe it or not, separating from the Doc who took the patient this far down  Dismal Road  can be tough for both the patient and the physician.

INVESTIGATE EARLY

People, naturally, do the regular stuff, first. If things don’t work out, maybe they start looking around for unregular stuff.  It’s tempting to see clinical trials like the extra innings. After the first nine. (A little baseball metaphor here.) Well, sorry, Bub, but that may be too late. Some of these trials won’t let patients who are practically gonners into their programs. They need to get at them earlier in the progression of the disease.

THE RIGHT ANSWER

You’re kidding, right? If I knew the right answers to this stuff, do you think I’d be sitting here cranking out blog articles? I don’t know how to get doctors back into this loop either.  But something’s gotta change. That’s for sure. It’s not right to expect patients, on their own and at the worst possible time in their lives, to become medical detectives, capably sorting through the relevant research. And it’s not like NO doctors are referring to clinicals. Maybe we need to understand what the doctors who get this right are doing.

Mister ScienceAintSoBad‘s an optimist. He thinks things will improve.

Sooner’s better than later.

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Credit for above cartoon (which I don’t exactly understand either) to, xkcd.

CHEAPER THAN MEDICAL SCHOOL

I guess you’ve been watching all the smuggies with their smartphones.

You can live without one, right?

Till now.

Here’s an app so good you gotta buy a phone to carry the app around.

I think I’m serious.

Healthagen developed this thing called iTriage

Stunning!

iTriage’s brilliance is the way it puts a simple interface over medicine. Your phone becomes your Startrek Tricorder. The pain’s in the biceps? All the time? Just at night?

Click “look up symptoms” to search an ordered list of likely symptoms.

Once you think you know what’s causing the problem, you can “Find Medical Treatment” or “Learn About Procedures”.

You can even “Find A Doctor”.

If you don’t understand a medical term you can look that up.

I was chicken to try the “Emergency” button . Was it gonna make an entire team of paramedics materialize right out of the phone? What would I tell ‘em? Just looking?

Jabber, Jabber, Jabber

Test: How is political debate different from science?

I will pick up your papers at the end of the class. I don’t want you looking at anyone else’s answers.

THAT'S one. (A pancreas.)

image from Creative Commons

Medicine: Type 1 Diabetes.

An artificial pancreas really is just over SOME horizon now. An announcement from Cambridge (article in the Lancet) describes the fine work of Dr Roman Hovorka at the University of Cambridge, working with a group of seventeen diabetic kids.

A cure for diabetes would be nice, of course. And there are some intriguing hints but, for now, an artificial pancreas would be stunning enough.

If it works out (and if it is widely accepted), this development has the potential to greatly reduce the complications of the disease, ease peoples’ lives, and reduce health care costs significantly (Wouldn’t THAT be nice?).

Back to which horizon this is over.

It’s hard for MISTER ScienceAintSoBad to say this but, once again, this is only a tantalizing possibility of something that is badly needed. We ARE a lot closer, thanks to the great work being done. Maybe as little are three, four or five years.

Karen Addington (Juvenile Diabetes Research Foundation) says this is a “proof of principle” and that we “need to redouble our efforts.”

I’m not sure that’s what we want to hear. But reality IS so darn real, isn’t it?

ScienceAintSoBadRating = 9

- – - – - – - – - Postscript – - – - – - – - –

Karen Addington was nice enough (and ubiquitous enough) to leave a comment which I am duplicating below since it addresses the question of when this device might really hit the road. Notice that her motivation is personal.

Her comment:

Thanks for picking up on this new research.

We know that developments like the artificial pancrease can’t come quickly enough for people living with type 1 diabetes, and their families. That’s why we’re working really hard to make sure that the artificial pancreas becomes a reality as soon as possible. In January my colleagues at JDRF International (based in the USA) announced a partnership with Animas (a Johnson & Johnson company that manufactures pumps) to develop a first generation artificial pancreas.

The goal is to develop a system that can prevent the extremes of both hypoglycaemia and hyperglycaemia automatically – but will still need some input from the wearer, such as informing the system of meal times and periods of exercise.

This partnership is planned for four years and by the end we hope to reach the point where it will ready to go forward for approval by regulatory bodies like the US Food and Drug Administration (FDA) and the European Medicines Agency (EMEA), and from there to people with type 1.

I have had type 1 diabetes for 30 years, and I’m really excited about what this research could soon mean for me, and everyone else with type 1.