Whose going to look at and interpret all of that mostly worthless data? Bottom line is that there is no objective measurement of anything that would allow us to predict disaster any quicker than you yourself starting to feel sick would. Measuring things continuously (as opposed to periodic measurements for screening purposes) in someone who is healthy and doesn't have symptoms is a complete waste of time, unless all you're doing is collecting data on your control group.
We have the tech. You can monitor ICP continuously if you wanted to, and you could at least get a qualitative sense of the composition of someone's CSF from watching it come out of a lumbar drain. The thing is, are you really going to do a ventric or LP on everybody who falls down skiing and has a headache?
As far as MIs, though, quite possibly the greatest factor affecting your survival is how quickly you can get carted away to the cath lab, and I can't see how continuously monitoring anything is going to get you there any sooner than just paying attention to that crushing substernal pressure radiating to your left arm and calling 911.
(1) Troponin measurements are only helpful when repeated over a duration of time
(2) Even EKG changes aren't instantaneous. You'll have been having chest pain for quite some time before you start showing hyperacute T waves.
(3) But, finally, you have to target your measurements. Standard continuous cardiorespiratory monitoring is probably going to show you an increased heart rate and increased respiratory rate. Not very helpful. Continuous cardiac monitoring doesn't have the same resolution as an EKG; you're only probably going to get useful data if the patient is actually wearing a the full-12 lead set of electrodes, and again, see (2). And continuous troponin measurements would be extraordinarily low yield. I can't imagine what it would gain you over the usual q6h measurement, nor is there a point of measuring it when you're not symptomatic.
I can't think of anything we could've measured on Natasha Richardson that would involve a monitoring machine that she could've worn. Maybe if there were such a thing as a wearable CAT scanner, but would the radiation exposure be worth it? Probably the only thing helpful would've been continuous neuro checks, and you need a human being to do those.
If going to the phone would actually result in payment, more people would do it. But this is what we get when we have an industry that earns its profits by not paying health care providers.
1. Private insurance will not pay for a woman's well visit if they don't have a Pap smear. They don't care that the woman doesn't have a cervix. If you don't do it, you don't get paid, and it's just easier to do it no matter how nonsensical it is than it is to get on the phone with someone who is not medically trained and argue that, yes, you did do a well woman exam even though you didn't do a Pap smear.
2. There is a case to be made for anal Pap smears, because HSV also causes anorectal cancer in people who participate in anal sex. Unfortunately, because it's not standard of care, private insurance won't pay for that either.
(We don't even need to talk about Medicare or Medicaid because they don't pay for preventative visits.)
Not that I would buy one, but that whole PC-to-TV thing the author is talking about: isn't that what the Apple iTV is for?
Of course, you could always buy that kit that connects your iPod or iPhone to your TV to watch movies you downloaded from the Internet. (And, no, you don't have to buy them from iTMS)
You get Ancef (cefazolin) intravenously. The idea is that you might end up with bacteria in your bloodstream from your skin after they cut on you. Unfortunately, Ancef will kill all the Streptococcus and methicillin-sensitive Staphylococcus aureus on your skin and will let MRSA take over.
In terms of topical agents, surgeons routinely use Betadine (povidone iodine) and Hibiclens (chlorhexidine). These can completely eradicate bacteria on your skin and physicians sometimes recommend patients colonized with MRSA to take baths with chlorhexidine for a month (in addition to sticking Bactroban (mupirocin) in your nose)
70% ethanol is bacteriocidal (that's what those hand gels are made of), but those alcohol wipes we use (that have isopropranol) don't really do much other than get rid of gross contamination.
Well, yes and no. Certainly bad hygiene will put you at a disadvantage, but you could shower three times a day and still be colonized with community-acquired MRSA.
Antibiotic overuse also plays into this, but is it really overuse when the patient is septic and dying? What this is is an example of artificial selection. Antibiotics are a huge selective pressure, and the development of resistance is inevitable.
Granted, universal precautions, sterile technique, and simple handwashing cut the risk of infection significantly, but we're never going to get to a point where no iatrogenic infections ever occur.
One thing we probably should be doing, though, is routine sterilization of computer keyboards in the hospital.
Luckily, there have only been a couple of cases of VRSA, although we're seeing a lot more VISA (vancomycin intermediate Staph aureus) Unfortunately, we tend to use vancomycin like candy (hence the nickname, vitamin V, not to be confused with Valium or Viagra.) The standard broad-spectrum cocktail that we use at the hospitals I work at is nicknamed Vosyn, for vancomycin and Zosyn (piperacillin/tazobactam)
We seem to be doing OK in terms of Gram positive cocci. MRSA is killable with vancomycin and VRE (vancomycin resistant Enterococcus) is killable with linezolid and Synercid (dalfopristin/quinupristin). DRSP (drug-resistant Streptococcus pneumoniae) is also killable by vancomycin. We've come out with a lot of new drugs recently that can kill GPCs, like daptomycin, telithromycin, tigecycline. What scares the crap out of me are the Gram negative rods. These buggers will kill you in less than 24 hours if they're floating around in your blood. I've seen people who are completely well turn completely septic in minutes from probable inoculation. (Specifically, cancer patients who have in-dwelling ports. The nurse went to flush it, and the patient almost immediately got hypotensive and febrile. He probably had some bugs hanging around on the inside of the port, and flushing it sent a nice big bolus of GNRs into his blood stream.) And we haven't come up with a new drug targetting GNRs in 30 years.
Once, one of our units had an outbreak of pan-resistant E. coli. It was essentially unkillable. I wasn't around when it happened, so I have no idea what they did, other than seal the patients up in their room and wait for them to die from sepsis. Pseudomonas aeruginosa can adopt a mucoid form that is also essentially unkillable. And then there are the naturally pan-resistant GNRs that live in the environment, and which wreak havoc on immunocompromised and chronically ill patients.
Yeah, who knows what havoc the cattle industry is causing by feeding their animals antibiotics.
The active ingredient of antibacterial soap (as others have mentioned) is triclosan, and it works more like something "complex," as you put it, as it inhibits a particular enzymatic process necessary for bacterial replication. However, many common pathogens (E. coli, Staph aureus, Pseudomonas aeruginosa) can develop resistance to this.
Luckily, there are no antibiotics that cross-react with triclosan, and it's probably harmless, although it doesn't really add any benefit, either.
The U.S. has been dealing with MRSA since the 1970's (back when methicillin was actually in use.) Health care workers have been aware of it for quite some time now, although, truthfully, we are in an epidemic.
I wonder if your numbers are illustrative of the difference between nationalized health care and the chaos that masquerades as a functional health care system here in the States.
I also wonder if physicians who work in a nationalized health care system are more likely to abide by infectious disease guidelines with regards to antibiotic prescribing practices than their non-nationalized counterparts.
In any case, I have a friend who works for the CDC, and when that JAMA article came out, all hell broke loose in their offices because of all the irate and panicked phone calls, so if Americans didn't care before, they certainly care now.
Staphylococcus aureus lives on normal skin. You're probably crawling with billions of these little buggers. Such is life. Most of the time, methicillin-sensitive Staph outgrows the methicillin-resistant Staph (in theory, there is a difference in rate of replication, since MRSA has that extra cassette that it needs to copy)
But in certain places in the U.S., community-acquired MRSA infections make up as many as 35% of all infections (from simple skin infections to bacterial sepsis), at which point isolation practices are pretty pointless, particularly since they've never been proven to actually decrease rate of transmission. (Although granted, if you die from MRSA, it's going to be hospital-acquired MRSA that gets you.)
Other multi-drug resistant bacteria are prevalent in the environment--in the soil, on flat surfaces, in computer keyboards--and don't cause illness in immunocompetent people. Examples are Pseudomonas aeruginosa, Acinetobacter baumanii, Enterobacter cloacae, Stenotrophomonas maltophila, and Alcaligenes xylosoxidans. But Gram-negative rods, more so than Gram-positive cocci, are likely to kill you in less than 24 hours. (Necrotizing fasciitis--caused by so-called "flesh-eating bacteria"--is more likely caused by Group A Streptococcus, which is very sensitive to straight-up penicillin, and MSSA)
MRSA and other multi-drug resistant bacteria are simply not transmitted by air. Respiratory isolation rooms (negative pressure rooms with separate air filters) are good for preventing the spread of pulmonary tuberculosis, and various non-fatal viral illnesses, but that's about it. And when you've got 30-40 kids with RSV, there's no way you're going to isolate all of them.
Most vectors of these bacteria are not sick from them, and they're so prevalent that it's not practical to exclude people who are colonized with this stuff. Most health-care workers are definitely colonized, for example, and it's no good preventing these people from working. Making people who have upper respiratory symptoms wear masks may be helpful, but making everyone do so? Studies don't show any difference in transmission.
Any linens that might have been contaminated are destroyed anyway.
The measures that have been proven to decrease transmission of bacteria and viruses are (1) thorough hand washing, meaning lathering up and running your hands under water for at least 15 seconds or (2) using the alcohol-based anti-bacterial gels (although this won't destroy Clostridium difficile spores) Everything else (masks, gowns, gloves), in terms of preventing transmission of these bacteria, is, according to the studies, infection control theater. (I'm not talking about universal precautions here, which definitely keep health care workers from getting HIV and hepatitis.)
And when you come in on a backboard with C-collar because you were in a car-crash, infection control sort of takes a back seat until they take care of your airway, breathing, and circulation. There's no way you're going to keep someone dying from trauma in a quarantined area until you make sure they're not colonized with any of this stuff.
Bottom line: wash you hands, and stop asking your physician for antibiotics whenever you or your kid have the sniffles. That'll cut the incidence of MRSA and other multi-drug resistant bacteria.
Just a nitpick: there really shouldn't be any significant hardware differences, considering that Apple makes all of the machines that run Leopard. Unless, of course, the guy is running on a Hackintosh.
OK, fine. I think it would be a bad idea to eat nothing but olive oil and/or nuts for every meal. Are you happy now?
Sure, we can argue all day long about whether or not certain subclasses of fats are better than others, but when you get right down to it, the body is perfectly capable of intraconverting between all the different forms, and no matter what kind of fat you're eating, if you eat too much of it, it will be bad for you.
Well, I'm not going to play armchair diagnostician. I'm in no position to second guess someone who has actually seen you.
You right, I have no idea what you've done in pursuit of the relief of your symptoms. What I do notice is that the first thing that you mention is pain. What I'm trying to tell you is that most clinicians are trained to essentially ignore pain. Whereas the typical patient comes in to see the physician for relief of symptoms, the typical physician is more interested in trying to figure out what is actually causing the symptoms rather than the symptoms themselves. I'm not saying this is right or wrong, I'm just saying that this is the disconnect between the patient's thought process, and the physician's thought process.
So when someone comes in complaining of pain, or shortness of breath, or dizziness, the average clinician is not primarily interested in these things. What they find interesting is the possible syndrome that underlies these complaints. This is where the Bayesian reasoning comes in. In a young otherwise healthy male with total body pain, what is the most likely cause?
The clinician is apt to pursue things that will help him/her discover this cause. The patient is probably a lot more interested in figuring out a way to make the symptoms stop.
But when there's a mention of pain, and there is no obvious reason for it, unfortunately, a vast majority of people trained in Western medicine is going to jump to the conclusion that (1) it's psychiatric or (2) it's because there's some kind of secondary gain.
Again, I'm not trying to say this is right, but I suspect this may be why you have encountered such a wide variance of opinion, and why the quality of the medical care you've received may have been sub-optimal.
Whatever. I'm just telling you how it is from the clinician's side of the fence. Most of them are simply wary of prescribing pain meds whether it's the E.R. or the office. If you've gotten crappy treatment for pain, this is probably why, and unfortunately you're going to have to work around the system to get what you need.
Fact of the matter is, most clinicians, if faced with an otherwise stable patient, will tend to ignore pain.
Low back pain is unfortunately one of those conditions that allopathic medicine is very bad at treating, and most patients who have it do in fact suffer for decades without relief.
What's interesting about your case is the early age of onset. Have you had workup done for spondyloarthropathies?
Well, sad to say, but you go into an emergency room demanding morphine, and everyone in there thinks they've got themselves a drug abuser, never mind that you might be actually sick. One of the easiest ways to get a physician to stop listening to you is to start talking about pain meds.
I'm just trying to give you some insight into what the average health care worker thinks when someone complains first of pain, and then maybe secondarily about whatever disease process they're actually experiencing.
Is this being an asshole? Sure. But is it reality? Yep, it sure is. Face it, the world sometimes sucks.
OK, the burden of proof is on you on this one. Which scientists are you talking about that are good at Bayesian inference, without a computer? My point is not that physicians are better than laymen, but that they're probably better than most people, including other scientists, mostly because they tend to do it frequently.
Sure, from a non-scientific point-of-view, it matters if the patient is suffering, but when the latest treatments have been shown to be equivalent by a randomized, controlled trial, the average physician doesn't really care if you prefer one or the other. If it made a difference, no sane physician would randomly change your medication.
Latest does not mean greatest. The most proven treatments typically are the ones that have been rigorously studied and tested and are generally not the latest treatments, so it makes no sense that you'd criticize this.
I would note that most medications that are being advertised on TV are not really new medications. Some of the ones that come to mind are Zyrtec (cetirizine), which is a metabolite of the old antihistamine Atarax (hydroxyzine), Clarinex (desloratidine)—the metabolite of Claritin (loratidine), and Nexium (esomeprazole), the stereospecific form of Prilosec (omeprazole). None of these medications have ever been shown to be superior to other members of their respective class. Not offering these medications is hardly a problem of not knowing about the latest treatments. If you're going to argue about the fact that physicians are easily swayed by advertisement, well, what can I say, they're human beings. But I have yet to hear of a physician who knowingly prescribed a drug that was advertised but ineffective instead of a drug that was obscure but would actually treat their condition. In most jurisdictions, this would be called malpractice.
I admit that pain is probably one of the areas that medicine is very poor at managing. If you look at the studies, you'll see just how abysmal physicians are at taking people's pain seriously. But, as crass as it sounds, no one ever died of pain. Oh, you may die because of the underlying condition/disease/mechanical trauma/torture that's causing your pain, but pain itself is not fatal. In fact, it's a sign that you're still alive. But fact of the matter is that there is no objective measure of pain. There is no blood level that can be drawn, and while there are physical findings, they are extremely variable from person to person. So the treatment of pain is by necessity unscientific.
Granted, most clinicians don't perform research. But there are a lot of clinicians who do, and there are a lot of M.D./Ph.D.s who perform the basic science you are touting. Medicine is an interlocking system, and obviously no single physician would ever be able to "do it all."
That said, while medicine itself may not be strictly a science, it clearly has scientific underpinnings. The engineers who build ballistic missiles may not be scientists, but clearly rocketry and nuclear physics are scientific endeavors. The guys who built your video card and your CPU probably aren't scientists either, but obviously electromagnetism and the materials science involved in semiconductors are also products of science.
Maybe the question is semantics. You say tomato, I say tomato.
No one is good at intuiting probabilities. If even a few people were, there would be no way to make casinos profitable. Still, since prognosis requires the application of Bayes Theorem, physicians probably do this more than the average person, and are probably better at it than most people.
The ability to change a treatment regimen at the patient's whim is a sign that it probably doesn't really matter. No one ever died of allergic rhinitis.
Physicians (at least in the U.S.) are required to re-certify their board certification at least every seven years. (Demanding subspecialities require recertification as often as every two years..) The board re-certification exam is generally based on clinical evidence and practice guidelines from within the last three or four years. Every year physicians are required to earn a fixed number of continuing medical education credits. Sure, you can sometimes fulfill these with a few seminars to Hawaii, but the cheaper and easier way is probably to simply read the current literature.
Disagreements in treatment are a sign that either the disease in question is not well studied or there is no right answer. You'll notice that the treatment of very common diseases and pathological states have become very standardized. For example, the management of ventricular fibrillation or asystole, and the management of acute coronary syndrome, to name a few. Pneumonia and asthma exacerbations are also generally protocolized, as are respiratory infections in children. Most disagreements in treatment are really stylistic differences that generally don't change the outcome. And a lot of times, the choice is between dying from performing an invasive/dangerous procedure or its complications, or dying because no intervention was done.
Except that it's the main reason why most people end up having to see a doctor in the United States. It is estimated that one out of three children born in the U.S. today will develop type 2 diabetes. Diabetes, hypertension, coronary artery disease, chronic kidney disease, cerebrovascular disease, and even infertility and impotence are all conditions that are often associated with obesity.
It's getting to be such that the practice of internal medicine in the United States is mostly the treatment of the complications of obesity.
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If you're not going to be willing to take care of yourself, continuous monitoring ain't going to save you.
Whose going to look at and interpret all of that mostly worthless data? Bottom line is that there is no objective measurement of anything that would allow us to predict disaster any quicker than you yourself starting to feel sick would. Measuring things continuously (as opposed to periodic measurements for screening purposes) in someone who is healthy and doesn't have symptoms is a complete waste of time, unless all you're doing is collecting data on your control group.
As far as MIs, though, quite possibly the greatest factor affecting your survival is how quickly you can get carted away to the cath lab, and I can't see how continuously monitoring anything is going to get you there any sooner than just paying attention to that crushing substernal pressure radiating to your left arm and calling 911.
Even then, I fail to see what you could possibly monitor continuously that would convince you that you didn't have to go to the emergency room.
(2) Even EKG changes aren't instantaneous. You'll have been having chest pain for quite some time before you start showing hyperacute T waves.
(3) But, finally, you have to target your measurements. Standard continuous cardiorespiratory monitoring is probably going to show you an increased heart rate and increased respiratory rate. Not very helpful. Continuous cardiac monitoring doesn't have the same resolution as an EKG; you're only probably going to get useful data if the patient is actually wearing a the full-12 lead set of electrodes, and again, see (2). And continuous troponin measurements would be extraordinarily low yield. I can't imagine what it would gain you over the usual q6h measurement, nor is there a point of measuring it when you're not symptomatic.
I can't think of anything we could've measured on Natasha Richardson that would involve a monitoring machine that she could've worn. Maybe if there were such a thing as a wearable CAT scanner, but would the radiation exposure be worth it? Probably the only thing helpful would've been continuous neuro checks, and you need a human being to do those.
Exactly. You really don't need to see your vital signs fluctuating to know that you're having a heart attack.
If going to the phone would actually result in payment, more people would do it. But this is what we get when we have an industry that earns its profits by not paying health care providers.
1. Private insurance will not pay for a woman's well visit if they don't have a Pap smear. They don't care that the woman doesn't have a cervix. If you don't do it, you don't get paid, and it's just easier to do it no matter how nonsensical it is than it is to get on the phone with someone who is not medically trained and argue that, yes, you did do a well woman exam even though you didn't do a Pap smear.
2. There is a case to be made for anal Pap smears, because HSV also causes anorectal cancer in people who participate in anal sex. Unfortunately, because it's not standard of care, private insurance won't pay for that either. (We don't even need to talk about Medicare or Medicaid because they don't pay for preventative visits.)
BASIC 2.0 seems pretty worthless without support for all the PEEKs, POKEs, and SYSs, though. Is there a port of BASIC 7.0? Or at least BASIC 3.5?
Not that I would buy one, but that whole PC-to-TV thing the author is talking about: isn't that what the Apple iTV is for?
Of course, you could always buy that kit that connects your iPod or iPhone to your TV to watch movies you downloaded from the Internet. (And, no, you don't have to buy them from iTMS)
You get Ancef (cefazolin) intravenously. The idea is that you might end up with bacteria in your bloodstream from your skin after they cut on you. Unfortunately, Ancef will kill all the Streptococcus and methicillin-sensitive Staphylococcus aureus on your skin and will let MRSA take over.
In terms of topical agents, surgeons routinely use Betadine (povidone iodine) and Hibiclens (chlorhexidine). These can completely eradicate bacteria on your skin and physicians sometimes recommend patients colonized with MRSA to take baths with chlorhexidine for a month (in addition to sticking Bactroban (mupirocin) in your nose)
70% ethanol is bacteriocidal (that's what those hand gels are made of), but those alcohol wipes we use (that have isopropranol) don't really do much other than get rid of gross contamination.
Well, yes and no. Certainly bad hygiene will put you at a disadvantage, but you could shower three times a day and still be colonized with community-acquired MRSA.
Antibiotic overuse also plays into this, but is it really overuse when the patient is septic and dying? What this is is an example of artificial selection. Antibiotics are a huge selective pressure, and the development of resistance is inevitable.
Granted, universal precautions, sterile technique, and simple handwashing cut the risk of infection significantly, but we're never going to get to a point where no iatrogenic infections ever occur.
One thing we probably should be doing, though, is routine sterilization of computer keyboards in the hospital.
Luckily, there have only been a couple of cases of VRSA, although we're seeing a lot more VISA (vancomycin intermediate Staph aureus) Unfortunately, we tend to use vancomycin like candy (hence the nickname, vitamin V, not to be confused with Valium or Viagra.) The standard broad-spectrum cocktail that we use at the hospitals I work at is nicknamed Vosyn, for vancomycin and Zosyn (piperacillin/tazobactam)
We seem to be doing OK in terms of Gram positive cocci. MRSA is killable with vancomycin and VRE (vancomycin resistant Enterococcus) is killable with linezolid and Synercid (dalfopristin/quinupristin). DRSP (drug-resistant Streptococcus pneumoniae) is also killable by vancomycin. We've come out with a lot of new drugs recently that can kill GPCs, like daptomycin, telithromycin, tigecycline. What scares the crap out of me are the Gram negative rods. These buggers will kill you in less than 24 hours if they're floating around in your blood. I've seen people who are completely well turn completely septic in minutes from probable inoculation. (Specifically, cancer patients who have in-dwelling ports. The nurse went to flush it, and the patient almost immediately got hypotensive and febrile. He probably had some bugs hanging around on the inside of the port, and flushing it sent a nice big bolus of GNRs into his blood stream.) And we haven't come up with a new drug targetting GNRs in 30 years.
Once, one of our units had an outbreak of pan-resistant E. coli. It was essentially unkillable. I wasn't around when it happened, so I have no idea what they did, other than seal the patients up in their room and wait for them to die from sepsis. Pseudomonas aeruginosa can adopt a mucoid form that is also essentially unkillable. And then there are the naturally pan-resistant GNRs that live in the environment, and which wreak havoc on immunocompromised and chronically ill patients.
Yeah, who knows what havoc the cattle industry is causing by feeding their animals antibiotics.
The active ingredient of antibacterial soap (as others have mentioned) is triclosan, and it works more like something "complex," as you put it, as it inhibits a particular enzymatic process necessary for bacterial replication. However, many common pathogens (E. coli, Staph aureus, Pseudomonas aeruginosa) can develop resistance to this.
Luckily, there are no antibiotics that cross-react with triclosan, and it's probably harmless, although it doesn't really add any benefit, either.
The U.S. has been dealing with MRSA since the 1970's (back when methicillin was actually in use.) Health care workers have been aware of it for quite some time now, although, truthfully, we are in an epidemic.
I wonder if your numbers are illustrative of the difference between nationalized health care and the chaos that masquerades as a functional health care system here in the States.
I also wonder if physicians who work in a nationalized health care system are more likely to abide by infectious disease guidelines with regards to antibiotic prescribing practices than their non-nationalized counterparts.
In any case, I have a friend who works for the CDC, and when that JAMA article came out, all hell broke loose in their offices because of all the irate and panicked phone calls, so if Americans didn't care before, they certainly care now.
If only it were as simple as you say!
Staphylococcus aureus lives on normal skin. You're probably crawling with billions of these little buggers. Such is life. Most of the time, methicillin-sensitive Staph outgrows the methicillin-resistant Staph (in theory, there is a difference in rate of replication, since MRSA has that extra cassette that it needs to copy)
But in certain places in the U.S., community-acquired MRSA infections make up as many as 35% of all infections (from simple skin infections to bacterial sepsis), at which point isolation practices are pretty pointless, particularly since they've never been proven to actually decrease rate of transmission. (Although granted, if you die from MRSA, it's going to be hospital-acquired MRSA that gets you.)
Other multi-drug resistant bacteria are prevalent in the environment--in the soil, on flat surfaces, in computer keyboards--and don't cause illness in immunocompetent people. Examples are Pseudomonas aeruginosa, Acinetobacter baumanii, Enterobacter cloacae, Stenotrophomonas maltophila, and Alcaligenes xylosoxidans. But Gram-negative rods, more so than Gram-positive cocci, are likely to kill you in less than 24 hours. (Necrotizing fasciitis--caused by so-called "flesh-eating bacteria"--is more likely caused by Group A Streptococcus, which is very sensitive to straight-up penicillin, and MSSA)
MRSA and other multi-drug resistant bacteria are simply not transmitted by air. Respiratory isolation rooms (negative pressure rooms with separate air filters) are good for preventing the spread of pulmonary tuberculosis, and various non-fatal viral illnesses, but that's about it. And when you've got 30-40 kids with RSV, there's no way you're going to isolate all of them.
Most vectors of these bacteria are not sick from them, and they're so prevalent that it's not practical to exclude people who are colonized with this stuff. Most health-care workers are definitely colonized, for example, and it's no good preventing these people from working. Making people who have upper respiratory symptoms wear masks may be helpful, but making everyone do so? Studies don't show any difference in transmission.
Any linens that might have been contaminated are destroyed anyway.
The measures that have been proven to decrease transmission of bacteria and viruses are (1) thorough hand washing, meaning lathering up and running your hands under water for at least 15 seconds or (2) using the alcohol-based anti-bacterial gels (although this won't destroy Clostridium difficile spores) Everything else (masks, gowns, gloves), in terms of preventing transmission of these bacteria, is, according to the studies, infection control theater. (I'm not talking about universal precautions here, which definitely keep health care workers from getting HIV and hepatitis.)
And when you come in on a backboard with C-collar because you were in a car-crash, infection control sort of takes a back seat until they take care of your airway, breathing, and circulation. There's no way you're going to keep someone dying from trauma in a quarantined area until you make sure they're not colonized with any of this stuff.
Bottom line: wash you hands, and stop asking your physician for antibiotics whenever you or your kid have the sniffles. That'll cut the incidence of MRSA and other multi-drug resistant bacteria.
Just a nitpick: there really shouldn't be any significant hardware differences, considering that Apple makes all of the machines that run Leopard. Unless, of course, the guy is running on a Hackintosh.
OK, fine. I think it would be a bad idea to eat nothing but olive oil and/or nuts for every meal. Are you happy now?
Sure, we can argue all day long about whether or not certain subclasses of fats are better than others, but when you get right down to it, the body is perfectly capable of intraconverting between all the different forms, and no matter what kind of fat you're eating, if you eat too much of it, it will be bad for you.
Well, I'm not going to play armchair diagnostician. I'm in no position to second guess someone who has actually seen you.
You right, I have no idea what you've done in pursuit of the relief of your symptoms. What I do notice is that the first thing that you mention is pain. What I'm trying to tell you is that most clinicians are trained to essentially ignore pain. Whereas the typical patient comes in to see the physician for relief of symptoms, the typical physician is more interested in trying to figure out what is actually causing the symptoms rather than the symptoms themselves. I'm not saying this is right or wrong, I'm just saying that this is the disconnect between the patient's thought process, and the physician's thought process.
So when someone comes in complaining of pain, or shortness of breath, or dizziness, the average clinician is not primarily interested in these things. What they find interesting is the possible syndrome that underlies these complaints. This is where the Bayesian reasoning comes in. In a young otherwise healthy male with total body pain, what is the most likely cause?
The clinician is apt to pursue things that will help him/her discover this cause. The patient is probably a lot more interested in figuring out a way to make the symptoms stop.
But when there's a mention of pain, and there is no obvious reason for it, unfortunately, a vast majority of people trained in Western medicine is going to jump to the conclusion that (1) it's psychiatric or (2) it's because there's some kind of secondary gain.
Again, I'm not trying to say this is right, but I suspect this may be why you have encountered such a wide variance of opinion, and why the quality of the medical care you've received may have been sub-optimal.
Whatever. I'm just telling you how it is from the clinician's side of the fence. Most of them are simply wary of prescribing pain meds whether it's the E.R. or the office. If you've gotten crappy treatment for pain, this is probably why, and unfortunately you're going to have to work around the system to get what you need.
Fact of the matter is, most clinicians, if faced with an otherwise stable patient, will tend to ignore pain.
Low back pain is unfortunately one of those conditions that allopathic medicine is very bad at treating, and most patients who have it do in fact suffer for decades without relief.
What's interesting about your case is the early age of onset. Have you had workup done for spondyloarthropathies?
Well, sad to say, but you go into an emergency room demanding morphine, and everyone in there thinks they've got themselves a drug abuser, never mind that you might be actually sick. One of the easiest ways to get a physician to stop listening to you is to start talking about pain meds.
I'm just trying to give you some insight into what the average health care worker thinks when someone complains first of pain, and then maybe secondarily about whatever disease process they're actually experiencing.
Is this being an asshole? Sure. But is it reality? Yep, it sure is. Face it, the world sometimes sucks.
Granted, most clinicians don't perform research. But there are a lot of clinicians who do, and there are a lot of M.D./Ph.D.s who perform the basic science you are touting. Medicine is an interlocking system, and obviously no single physician would ever be able to "do it all."
That said, while medicine itself may not be strictly a science, it clearly has scientific underpinnings. The engineers who build ballistic missiles may not be scientists, but clearly rocketry and nuclear physics are scientific endeavors. The guys who built your video card and your CPU probably aren't scientists either, but obviously electromagnetism and the materials science involved in semiconductors are also products of science.
Maybe the question is semantics. You say tomato, I say tomato.
Except that it's the main reason why most people end up having to see a doctor in the United States. It is estimated that one out of three children born in the U.S. today will develop type 2 diabetes. Diabetes, hypertension, coronary artery disease, chronic kidney disease, cerebrovascular disease, and even infertility and impotence are all conditions that are often associated with obesity.
It's getting to be such that the practice of internal medicine in the United States is mostly the treatment of the complications of obesity.