March 26, 2011

A Little Weekend Reading

(this is a little bit how I felt this morning -
but a nine mile run and a very very large smoothie perked me up
a bit - enough to catch up on some reading)

To entertain you this weekend, here are two awesome articles to check out addressing two MAJOR questions in health care (and in my life right now).

(1) Is it legitimate when people refuse to have doctors-in-training or even just young doctors involved in their care? Would we do the same thing?

The answer from recent research is a definitive NO! In fact, it shows that having doctors-in-training participate in operations and care actually DECREASES MORTALITY. Add to that that the learning a doctor-in-training gleans from working with an actual patient is critical to creating doctors you want operating on you and taking care of your health in the future. Plus, I think medical schools are really training students to be more holistic, better listeners, and better advocates for patients health. Definitely qualities I'd want in anyone helping me with my health.

That data revealed that while patients who had residents participating in surgery did develop more complications, those complications were not necessarily serious. And once one complication occurred, those patients with residents involved in their care were more likely to recover and less likely to fall prey to the so-called domino effect of complications, where one leads to another and ultimately to death. “It may be the fact of having a whole team of surgeons rather than just one that ‘rescues’ patients from these complications and even death,” Dr. Ko observed.

(2) Can we come up with a treatment algorithm in medicine/psychology for patients who have suffered childhood events that lead them to worse health?

A pediatrician in San Francisco says YES. Dr. Nadine Burke's clinic treats some of the poorest children and adolescents in San Francisco, many of whom are living in foster care, have dropped out of school, and/or are using street drugs. Recently she has been researching whether many of her patients health problems can be explained by what she calls "adverse childhood experiences" creating "ACE score", where they give each person a point for each event, such as growing up with a parent who is an alcoholic, being assaulted or neglected, having a parent die, or whose parents went through a divorce. The research shows that YES they can be - that not only are children who have a higher "ACE score" more likely to participate in risky health behaviors like having sex at an early age, drinking alcohol at an early age, using illegal drugs or cigarettes, but also have more health problems even in the absence of these behaviors, including heart disease, COPD, and cancer.

The article discusses how Dr. Burke is collaborating with other researchers to A) find the biological basis for this and B) create a treatment algorithm for people based on their ACE scores.

One of the biological explanations for how adverse childhood experiences affect health is by adding methyl groups to specific genes, called "methylation" which is one of the ways the body turns off genes . Researchers have found that the genes turned off when people experience adverse life events are involved in the stress hormone response (fight or flight type stuff), making people less adaptive to stress. This is shown by increased inflammatory markers of people with high ACE scores much much later in life, regardless of their health behaviors.

The treatment algorithm is a little more tricky, but in addition to more typical medicine, Dr. Burke is testing out biofeedback treatments, insight-oriented therapy, mind-body awareness, child-parent psychotherapy, and yoga.

"listen to me, he said, when your dreams are of some world that never was or some world that never will be, and you're happy again, then you'll have given up. Do you understand? And you can't give up, I won't let you" -Cormac McCarthy, The Road

"there's an anger to everything in our culture right now. and I'm sort of ready for a kind of sweetness and softeness to things" - Tom Ford

1 comment:

  1. This makes me think a lot about the health equity work I'm doing with my youth, and all the discussions we have been having about how racism can affect people's health.

    do you think this could be linked to the same stress hormone response?

    I'm getting a lot of this info from a documentary called "Unnatural Causes" there are some clips online.