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At the Membranes of Care: Stories in Narrative Medicine, Rita Charon, 2012
At the Membranes of Care: Stories in Narrative Medicine
Rita Charon, Acad Med. 2012 Mar; 87(3): 342–347.
doi: 10.1097/ACM.0b013e3182446fbb


Recognizing clinical medicine as a narrative undertaking fortified by learnable skills in understanding stories has helped doctors and teachers to face otherwise vexing problems in medical practice and education in the areas of professionalism, medical interviewing, reflective practice, patient-centered care, and self-awareness. The emerging practices of narrative medicine give clinicians fresh methods with which to make contact with patients and to come to understand their points of view. This essay provides a brief review of narrative theory regarding the structure of stories, suggesting that clinical texts contain and can reveal information in excess of their plots. Through close reading of the form and content of two clinical texts—an excerpt from a medical chart and a portion of an audio-taped interview with a medical student—and a reflection on a short section of a modernist novel, the author suggests ways to expand conventional medical routines of recognizing the meanings of patients' situations. The contributions of close reading and reflective writing to clinical practice may occur by increasing the capacities to perceive and then to represent the perceived, thereby making available to a writer that which otherwise might remain out of awareness. A clinical case is given to exemplify the consequences in practices of adopting the methods of narrative medicine. A metaphor of the activated cellular membrane is proposed as a figure for the effective clinician/patient contact.
medicine  healthcare  stories  narrative 
may 2019 by pierredv
Is the FDA Too Conservative or Too Aggressive?: A Bayesian Decision Analysis of Clinical Trial Design, Aug 2015, Vahid Montazerhodjat & Andrew W. Lo
Via Tom Hazlett, Nov 2017

NBER Working Paper No. 21499
Issued in August 2015
NBER Program(s):Health Care, Health Economics

Implicit in the drug-approval process is a trade-off between Type I and Type II error. We explore the application of Bayesian decision analysis (BDA) to minimize the expected cost of drug approval, where relative costs are calibrated using U.S. Burden of Disease Study 2010 data. The results for conventional fixed-sample randomized clinical-trial designs suggest that for terminal illnesses with no existing therapies such as pancreatic cancer, the standard threshold of 2.5% is substantially more conservative than the BDA-optimal threshold of 27.9%. However, for relatively less deadly conditions such as prostate cancer, 2.5% is more risk-tolerant or aggressive than the BDA-optimal threshold of 1.2%. We compute BDA-optimal sizes for 25 of the most lethal diseases and show how a BDA-informed approval process can incorporate all stakeholders’ views in a systematic, transparent, internally consistent, and repeatable manner.
NBER  medicine  risk-assessment  probability  statistics  decision-making  Bayesian  research  healthcare  cancer  BDA  FDA 
december 2018 by pierredv
Picking Cherries in Science: The Bio-Initiative Report – Science-Based Medicine
The Bio-Initiative Report is the basis for AlignandShineDesign's claims about energems
health  science  medicine 
august 2018 by pierredv
Estimating the Likelihood of Wireless Coexistence Using Logistic Regression: Emphasis on Medical Devices - IEEE Journals & Magazine
Mohamad Omar Al Kalaa ; Seth J. Seidman ; Hazem H. Refai
Medical device manufacturers incorporate wireless technology in their designs to offer convenience and agility to both patients and caregivers. However, the use of unlicensed radio spectrum bands by both medical devices and other equipment raises concerns about wireless coexistence. Work by the accredited standards committee C63 of the American National Standards Institute (ANSI) to provide the community with a consensus standard for coexistence evaluation resulted in the publication of the ANSI C63.27 standard, which was later recognized by the U.S. Food and Drug Administration. Estimating the likelihood of wireless coexistence of a system under test (SUT) in a given environment is central to the evaluation and reporting of wireless coexistence, as made clear in the C63.27 standard. However, no method to perform this estimation is provided. In this paper, we propose the use of logistic regression (LR) to estimate the likelihood of wireless coexistence of a medical device in its intended environment. Radiated open environment coexistence testing was used to realize a test scenario in which the interfering network was IEEE 802.11n Wi-Fi and the SUT was ZigBee; exemplary wireless technologies for interfering network and medical device, respectively. LR model fitting was then performed to derive a model that describes the performance of SUT under a range of wireless coexistence phenomena. Finally, results were incorporated with the outcome of a spectrum survey using Monte Carlo simulation to estimate the SUT likelihood of wireless coexistence in a hospital environment.
Wireless  coexistence  Interference  probability  risk-assessment  medicine  devices 
june 2018 by pierredv
I help repurpose everyday drugs like aspirin to fight cancer | New Scientist July 2016
Issue 3082

Interview with Pan Pantziarka about repurposed drugs used for cancer

"Clinicians and scientists often characterise older drugs like aspirin as “dirty” drugs because they hit multiple targets. We see this as an advantage. For example, the painkiller diclofenac helps to stop tumours growing their own blood vessels. Research suggests it also primes the body to respond better to chemotherapy and radiotherapy. It does multiple jobs in one tablet."

"There’s evidence to show that aspirin is beneficial for colorectal cancer after diagnosis, and that it can reduce the recurrence of adenomas – benign tumours that are often a first step towards colorectal cancer – after they are surgically removed. Another example is the beta blocker propranolol, which has shown a positive effect when used before surgery in a number of cancers, including ovarian cancer. Cancer is aided by bodily systems that increase the proliferation of cells while also lowering immunity, but propranolol reverses these pro-tumour effects."
NewScientist  cancer  pharma  healthcare  medicine 
march 2017 by pierredv
When Evidence Says No, but Doctors Say Yes - The Atlantic
". . . RightCare Alliance, a collaboration between health-care professionals and community groups that seeks to counter a trend: increasing medical costs without increasing patient benefits."

"The greater concern is: How can a procedure so contraindicated by research be so common?"

"Striking the right balance between innovation and regulation is incredibly difficult, but once remedies are in use—even in the face of contrary evidence—they tend to persist. "
medicine  health  theAtlantic  innovation  regulation 
february 2017 by pierredv
The scary reality of medical U-turns, and how to stop them | New Scientist - aug 2016
Lists 10 major reversals
= hormone replacement therapy
= peanut allergy
= surgery for osteoarthritis of the knee
= cancer screening
= heart stents
= vertebroplasty
= intensive blood sugar lowering for type 2 diabetics
= pre-implantation genetic testing
= lowering body temperature for aneurysm surgery
= ear tube surgery
NewScientist  medicine  health  healthcare  evidence  evidence-based 
november 2016 by pierredv
For my next trick... | The Economist 26 Mar 2016 - clinical trials
"Too many medical trials move their goalposts halfway through. A new initiative aims to change that"
" A meta-analysis—a study of studies—published in BMC Medicine in 2015 found that 31% of clinical trials did not stick to the measurements they had planned to use. Another paper, published in PLOS ONE, also in 2015, examined 137 medical trials over a six-month period and found that 18% had altered their primary outcomes halfway through the trial, while 64% had done the same with secondary, less-important measures of success."
medicine  clinical-trials  scientific-method  reproducibility  experiment  Ben-Goldacre 
august 2016 by pierredv
Journal Editors To Researchers: Show Everyone Your Clinical Data : Shots - Health News : NPR
"last Wednesday, the editors of the leading medical journals around the world made a proposal that could change medical science forever. They said that researchers would have to publicly share the data gathered in their clinical studies as a condition of publishing the results in the journals. This idea is now out for public comment."
research  medicine  transparency  reproducibility  NPR  opinion 
january 2016 by pierredv
Professionals, your time is up, prepare to be sidelined by tech - New Scientist 21 Nov 2015
"A new book, The Future of the Professions [by Richard and Daniel Susskind], argues that machines will soon do the work of lawyers, doctor and others. Should babies be delivered by robots? "
books  reviews  NewScientist  AI  judgment  professions  law  medicine 
december 2015 by pierredv
7 mind slips that cause catastrophe – and how we can avoid them = New Scientist
confirmation bias; fixation error; primal freeze; outcome bias; group think; default mode; tech clash
NewScientist  bias  decisionmaking  fear  medicine  aviation 
october 2015 by pierredv
Death: The blurred line between dead and alive - health - 24 October 2012 - New Scientist
"IT IS now easier to be declared dead than at any time in human history. The standards have fallen so low that your heart can be beating, your brain can be sending out brainwaves, and the doctor can still declare you an ex-person. The good news: only about 1 per cent of the population is subject to minimal death criteria. The bad news: if you fall into this 1 per cent, you may be vivisected."
death  NewScientist  medicine  dying  healthcare 
february 2013 by pierredv
Beyond Coping: I. The Buddha as Doctor, the Dhamma as Medicine
The Buddha as Doctor, the Dhamma as Medicine - inventory of passages in the Pali canon where the medical metaphor is used. For comparison with Nussbaum's book "Therapy of Desire" about Hellenistic philosophy. Interesting quote at the end, by analogy with Four Noble Truths: For a comparison with ancient Indian medical theory: From the >Caraka Sa.mhitaa, 9.19: "The best physician, one fit to treat a king, is he whose knowledge is fourfold: the cause [hetu], symptom [], cure [pras/amana], and non-recurrence [apunarbhava] of diseases."< Per wikipedia, Caraka Saṃhitā or "Compendium of Caraka" is an early Ayurvedic encyclopedia on medicine, datable to the period 100 BCE -- 100 CE
metaphor  accesstoinsight  texts  buddhism  medicine  philosophy 
october 2012 by pierredv
Placebos can work even when you know they're fakes - health - 23 December 2010 - New Scientist
In the latest study, Kaptchuk tested the effect of placebo versus no treatment in 80 people with irritable bowel syndrome. Twice a day, 37 people swallowed an inert pill could not be absorbed by the body. The researchers told participants that it could improve symptoms through the placebo effect. While 35 per cent of the patients who had not received any treatment reported an improvement, 59 per cent of the placebo group felt better. "The placebo was almost twice as effective as the control," says Kaptchuk. "That would be a great result if it was seen in a normal clinical trial of a drug."
placebo  research  medicine  NewScientist 
february 2012 by pierredv
Playing Video Games May Contribute To Keyhole Surgery Skills
A small US study suggests that surgeons who played video games have better keyhole surgery skills than those that did not.
healthcare  skill  medicine  games 
may 2010 by pierredv
new strategy in the fight against cancer - Robert Gatenby - Nature podcast 28 May 2009
see interview with Robert Gatenby on new approach to cancer: metaphor of suppressing pests rather than completely curing a bacterial infection. The idea is that if you try to cure a cancer by completely removing it, you kill all but the drug-resistant cells, which then come back and kill the patient. If, on the other hand, you merely try to contain the size of the cancer, the majority of cells will keep the really bad drug-resistant ones in check. It’s counter-intuitive for cancer treatment – I wonder if the same conceptual struggle occurs in the security community as well
security  cancer  health  medicine  NatureJournal 
august 2009 by pierredv
The science of voodoo: When mind attacks body - health - 13 May 2009 - New Scientist
Survey of the nocebo effect, with a variety of excellent stories in side-bars: = guy took overdose of antidepressants, but they were controls in the clinical trial = end-stage liver cancer patient who died in the predicted short period, but was found on autopsy not to have had cancer = mass psychogenic illness, e.g. high shool in Tennessee where a "gasonline-like" smell lead to 100 people admitted to emergency room
health  psych  psychology  medicine  mind  NewScientist 
july 2009 by pierredv
New Computer Modeling Program Can Help Hospitals Prepare For The Worst
"A new and novel computer modeling platform developed through intensive, multidisciplinary collaboration at New York University can help hospitals and cities to be more prepared for catastrophic public health scenarios"
agentbasedmodeling  modeling  healthcare  medicine 
june 2009 by pierredv
Ultrasound Imaging Now Possible With Smartphone
"coupling USB-based ultrasound probe technology with a smartphone, enabling a compact, mobile computational platform and a medical imaging device that fits in the palm of a hand."
via Paul margie
medicine  telephony  healthcare 
april 2009 by pierredv
Pacific NW | Dr. Sigvard Hansen challenged assumptions and helped turn around trauma care | Seattle Times Newspaper
the problem with today's evidence-based medicine is that it requires prior evidence - so people who would be innovative are shut down
stories  people  medicine  surgery  foot 
march 2009 by pierredv
Is the common cold becoming a killer? - health - 03 September 2008 - New Scientist
new strains, and background on viral infectivity. DNA sequencing is turning up large numbers of previously unknown viruses, but no-one really knows what they do. (Not unlike all the bacterial DNA that's being turned up - you can't culture them, but sequences don't tell you what they do)
health  medicine  NewScientist 
january 2009 by pierredv
FairDeal Homeopathy: Home
via feedback column in new scientist, 2 feb 08
humor  medicine  NewScientist 
march 2008 by pierredv
Nextbook: The Good Doctor
Examining Maimonides with Sherwin Nuland
Interview by Sara Ivry
medicine  books 
december 2007 by pierredv
Oh, no! I'm the first patient these 23 med students have ever examined. - By Emily Yoffe - Slate Magazine
wonderfully written, funny and touching description of the experience of being a "standardized patient"
health  humor  medicine 
july 2007 by pierredv
The right and wrong way to think about heart attacks. - By Darshak Sanghavi - Slate Magazine
perils of plumbing analogies for heart attacks
also a great story of Forsmann tying a nurse to an operating table when she tried to stop him put a catheter up his own arm
medicine  metaphor  stories 
may 2007 by pierredv

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