Want to take the fun out of alochol? A paper in the Journal of Neuroscience reports the effects of dihydromyricetin on ethanol’s ability to get you drunk. The New Scientist write up describes the study,

[Dr. Jiang Ling, primary investigator,] injected rats’ abdomens with a dose of alcohol proportionate to the amount a human would get from downing 15 to 20 beers in 2 hours by a human, they took about 70 minutes, on average, to right themselves. However, when an injection of the same amount of booze included a milligram of DHM per kilogram of rat body weight, the animals recovered their composure within just 5 minutes.

DHM also stopped rats in a maze from behaving in ways resembling anxiety and hangovers. Rats given heavy doses of alcohol cowered away in corners of the maze, whereas those given the extract with their alcohol behaved normally and were as inquisitive as rats given no alcohol at all, exploring the more open corridors of the maze.

Finally, DHM appeared to discourage rats from boozing when they had a free choice between drinking a sweetened solution of alcohol or sweetened water. Over a period of three months, rats will normally get addicted to increasing volumes of the hard stuff. Rats given DHM, though, drank no more than about a quarter of the amount that the “boozers” eventually built up to. Moreover, boozy rats that had worked up to the higher levels suddenly dropped down to a moderate intake when given DHM after seven weeks.

I don’t like the idea of an anti-intoxication pill. Drinking is what it is because of the way it makes you feel. And the ill effects of drinking are what they are to prevent your overconsumption. Taking a pill prophylactically to allow yourself to drink as much as you want without feeling the effects of the alcohol defeats the purpose. As does taking a pill, after the fact, to, with certainty, relieve your hangover and the consequences of drinking too much.

There’s some evidence in the study that dihydromyricetin may help prevent true, physiologic withdrawal symptoms such as tremors, anxiety, delirium and may even work to raise the seizure threshold. Such would be a legitimate use. Otherwise I think I may have a philosophical problem with the development of an anti-booze drug.

The Snooki tax, a 10% tax on indoor tanning services, that appeared as part of the ACA and its sister bills may or may not be “working,” to reduce the use of indoor tanning services as some of the authors intended.

The impact of the tax on consumer behavior remains unclear. Only 26% of salons surveyed reported experiencing fewer clients after implementation of the tax, and distinguishing the impact of the tax from the current economic climate as the source of decline was difficult. Furthermore, a large number of respondents (78%) reported that clients did not seem to care about the tax.

Study participants frequently reported that the salon’s younger and first-time clients were less likely than its older clients to notice or care about the increased prices resulting from the tax. Taken as a whole, these results may indicate that the demand for indoor tanning services is somewhat inelastic and perhaps insensitive to a 10% tax level.

I’m not a proponent of targeted taxes in general; certainly not those targeted to influence behavior. I don’t support the cigarette tax and I don’t support any hypothetical soda taxes and I don’t support the indoor tanning levy. And I wouldn’t be surprised at all if, at 10%, the influence of the tax was nothing or so small as to be impossible to detect.

Senator Mark Kirk is the junior Senator from Illinois. He currently holds President Obama’s old seat which he won in a special election in 2010 to replace Roland Burris.

He has apparently suffered a large right sided, non-dominant hemisphere middle cerebral artery stroke, potentially after a carotid artery dissection on that side. And he’s now undergone a decompressive craniectomy on the right from the late edema suffered with such a large stroke.

Dr. Fessler said the stroke “will affect his ability to move his left arm, possibly his left leg and possibly will involve some facial paralysis. Fortunately, the stroke was not on the left side of his brain, in which case it would affect his ability to speak, understand and think.”

Chances for a full mental recovery were “good” but chances for a full physical recovery were “not great,” Fessler said.

The doctor said he was hopeful that, after rehabilitation at an acute care facility, Kirk would regain the use of his left leg, but said prospects for regaining the full use of his left arm were “very difficult.”

He said recovery is a matter of weeks or months — “it’s not going to be days.” Kirk’s relative youth and good physical shape are positives, Fessler said, and he expects Kirk could return to “a very vibrant life.”

I’m sure they’ve been aggressive considering his age and functional status, not to mention his stature. But to feel the need to go ahead with a craniectomy following a stroke implies a large area of ischemia. Decompressive craniectomy for large middle cerebral artery strokes is not terribly uncommon and the popularity for it has probably grown over the decades. As one, admittedly international paper, describes it.

Decompressive craniotomy in the setting of acute brain swelling from massive MCA infarct is a life saving procedure. It should be considered in patients with initial good GCS, who are deteriorating in neurological status. With the team effort of neurologist and neurosurgeons these cases have good outcome contrary to the natural history of disease…Thus an ideal candidate for decompressive craniotomy is the victim who is young, with no risk factors, who presents early and has nondominant, middle cerebral artery territory infarct, with a reasonable Glasgow Coma Scale with no (or) early signs of herniation. The key for success of these cases of large MCA infarcts is early detection. Clinicians should concentrate on formulating newer clinical, radiological and technical protocols to detect the suitable patients at an early stage.

Certainly from what we know Senator Kirk appears to be an ideal candidate. From the description of his possible long term deficits he appears to have had a large non-dominant hemisphere middle cerebral artery stroke. He is relatively young and fit. And, as The Chicago Tribune describes it, he presented with a relatively good exam and deteriorated quickly.

My thoughts and prayers are with him and his family. He has a long road ahead of him.

A group of public health researchers out of UCSF and Columbia have a piece in the pending edition of Health Affairs. In it they argue that 1c per ounce tax on sugar sweetened drinks would,

prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths, while avoiding more than $17 billion in medical costs

over the next ten years. If you can’t access the full study on Health Affairs behind the firewall then here’s a write up on a Los Angeles Times blog.

First and foremost I have a major problem with taxation to influence behavior. I don’t even like the federal tax on cigarettes. I understand the public health issues involved in second hand smoke. Even factoring those I think something like the tobacco tax, which is beyond discredit in terms of its success, is beyond the purview of the government.

And the junk food tax is likely to be something less effective than the tax on cigarettes and targets a behavior with far few social costs; even admitting that the bill for diseases associated with obesity is footed in part by society in general it is a far cry from say the public health effects of second hand smoke.

Plenty of previous data finds the conclusions of the Health Affairs paper optimistic.

[A] trio of economists analyzed 16 years of U.S. household health data to study the feasibility of using a soft-drink tax to help Americans lose weight. In a 2008 paper, the researchers calculated that a 1-percentage-point increase in the tax would reduce the average body mass index by just 0.003 units.

In other words, an overweight person with a BMI of 27 would end up with a BMI of 26.997 — still well short of the 20-25 range considered healthy.

Even a soft-drink tax increase of 20 percentage points wouldn’t help much, because soda accounts for only 7% of calories in the American diet.

I am highly dubious rising the cost of a can of soda 12c or a six pack by less than a dollar is liable to significantly discourage use.

Tobacco taxes are also much higher than anything likely to be adopted for food and beverages. Slapping a 10% tax on a $1.50-bottle of Coke would raise the price a mere 15 cents — not enough to persuade most shoppers to drink Diet Coke instead. Many calorie-laden foods are simply too cheap to be priced out of the market by any but the most draconian of taxes.

As well, such a tax would be highly regressive since sweetened drink use is inversely proportional to socioeconomic status (myself excluded of course; I go through 4-5 sodas a day).

In the end though, like I said, I just don’t like the idea of government dictating what we should and shouldn’t be eating and drinking. Their role in such, with agricultural subsidies and regulations of commercial foodstuff is already too big. The idea of a tax to specifically influence or diet is too much to take.

Background
God bless the British Medical Journal. Every Christmas they publish original research of humorous endeavor. Last year a couple of orthope(a)dic registrars and a consultant took a look at the stereotype that orthope(a)dic surgeons are meat heads; stronger than their physician counterparts and dumber as well. Here is the study, available in full.

Subramania, P., S. Kantharuban, V. Subramanian, SAG Willis-Owen, and CA Willis-Owen. “Orthopaedic Surgeons: As Strong as an Ox and Almost Twice as Clever? Multicentre Prospective Comparative Study.” British Medical Journal 343 (2011).

Via Dr. Au

Design
The study was a prospective non-randomized sampling which looked at 36 male orthopedic surgeons and 40 male anesthesiologists at three hospitals in the United Kingdom. It compared intelligence and dominant hand grip strength between the two groups.

Intelligence was measured using the iPhone app Mensa Brain Test, which poses questions taken from some actual Mensa, self administered, qualifying exam grading participants with a standard intelligence quotient.

Strength was measured using a dynamometer in the dominant hand.

Results

• No surprise, the orthopedic surgeons were on the mean stronger than their matched anesthesiologists. The orthopedists generated 47.25 kg of force on mean in their dominant hand versus 43.83 kg for the anesthesiologists
• The orthopedic surgeons also had a higher mean intelligence score as graded by the iPhone app, 105.19 versus 98.38 for the anesthesiologists.

Conclusion
While not a rigorous study, it is certainly cute. I think the authors sum up their conclusions better than I could:

The stereotypical image of male orthopaedic surgeons as strong but stupid is unjustified in comparison with their male anaesthetist counterparts. The comedic repertoire of the average anaesthetist needs to be revised in the light of these data. However, we would recommend caution in making fun of orthopaedic surgeons, as unwary anaesthetists may find themselves on the receiving end of a sharp and quick witted retort from their intellectually sharper friends or may be greeted with a crushing handshake at their next encounter.

As more nurses, pharmacists and physical therapists claim this honorific [title doctor], physicians are fighting back. For nurses, getting doctorates can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients. But so far, the new degrees have not brought higher fees from insurers for seeing patients or greater authority from states to prescribe medicines.

So the debate over scope of practice and titles begins again in The New York Times.

As ancillary staff within the healthcare system get more and more advanced and as more and more independent care falls to them the lines between physician and other health care practitioners has blurred. Nowhere more vain than in the use of the title “doctor.”

We know the lengthy history of the title in Europe; rising with emergence of the post-Medieval university. In the United States however almost exclusively in social and professional spheres it has been used to refer to physicians. Not chiropractors or pharmacists or nurses or physicists or poets or mathematicians or lawyers. When you introduce yourself to a patient, or indeed anyone, as a “doctor” their first question isn’t, “Doctor of what?” or “What type?” There is a norm and understanding that you’re introducing yourself as a physician. And there’s nothing wrong with that norm; it merely is the way it is.

As Doctor Steven Knope put it in an NPR article from several years past,

“If you’re on an airline and a poet with a Ph.D. is there and somebody has a heart attack, and they say ‘Is there a doctor in the house?’ — should the poet stand up? Of course not.”

It’s ego partly, admittedly. But especially amongst primary care physician, it may also be about future competition and scope of practice,

[M]any physicians are suspicious and say that once tens of thousands of nurses have doctorates, they will invariably seek more prescribing authority and more money. Otherwise, they ask, what is the point?

Dr. Roland Goertz, the board chairman of the American Academy of Family Physicians, says that physicians are worried that losing control over “doctor,” a word that has defined their profession for centuries, will be followed by the loss of control over the profession itself. He said that patients could be confused about the roles of various health professionals who all call themselves doctors.

I see slippery slope and the worry from physicians. “Doctor” has always been an unregulated honorary title. It has become socially acceptable only for use, outside academics, by physicians. To use it otherwise was to draw snickers or scorn. But the rise of a largely independently practicing class of advanced, doctoral degree holding nurse practitioners provides a challenge to the title. Here are practitioners holding advanced degrees, performing many but not all of the same health care delivery that physicians give. There may still be quizzical looks at cocktail parties when the title “doctor” is used but there are bound to be fewer and fewer of such in the clinic as “physician extenders” with professional doctoral degrees take on more and more responsibility.

In the end while I support the expanded scope of practice for ancillary providers, I’m with Razib Khan. Blogging on the Discovery Magazine website,

[I]n this case we’re seeing greater and greater credentialism in fields which were traditionally perceived to be auxiliary to medical doctors. This is not a good sign. Instead of challenging the unquestioned prominence of medical doctors in domains where nurses are sufficient and more cost effective, the nursing profession is “fighting fire with fire.” This is not going to end well

Whatever my opinion I think the tide likely favors the advanced non-physician practitioners. It will be a slow generational shift but no doubt someday in the future it will be almost universally socially accepted that there are non-physician “doctors.”

The DaVinci surgical robot, used primarily at present in urological surgery, has gotten a lot of media. Here it is showing its stuff by skinning a grape. So I guess it’d be useful in the kitchen as well as the OR.

I think there’s a future, as the cost comes down because the benefit appears relatively marginal at present, for robotics in just about all surgical fields in the future. I can certainly see a robot help splitting the fissure or dissecting away an acoustic or the like in neurosurgery.

Medical professionals in Bahrain are being sentenced for treating wounded protesters during this years unrest.

Thirteen doctors and nurses who treated anti-government protesters during demonstrations in Bahrain earlier this year have been jailed for 15 years for crimes against the state.

The Physicians and Nurses Faced A Military Tribunal.

Their seems to be a systemic nature and focus on denying those who opposed the government healthcare services in Bahrain. Intimidation forced many medical NGOs, including Doctors Without Borders, out of the country during the unrest.

[W]hat human rights activists call a particularly odious aspect of the Bahraini protests: the government’s systematic effort to deny medical services to wounded protesters — partly by jailing or intimidating the doctors, nurses and paramedics who have tried to treat them.

Many medical workers in Bahrain are often too frightened to help protesters, activists say, and the wounded themselves are often too frightened to seek help, fearing they will be arrested.

At the height of the protests, led by the kingdom’s Shiite majority, seeking more rights from the Sunni monarchy, security forces commandeered the Salmaniya Medical Complex, Bahrain’s largest public hospital. Dozens of doctors and nurses who treated protesters were arrested.

In a report last month, Human Rights Watch said the crackdown included “attacks on health care providers; denial of medical access to protesters injured by security forces; the siege of hospitals and health centers; and the detention, ill-treatment, torture and prosecution of medics and patients with protest-related injuries.” It called the attacks “part of an official policy of retribution against Bahrainis who supported pro-democracy protests.”

I like Al Jazeera, I think it does some really good reporting. They have a documentary series called People & Power which a couple of months ago ran a piece on pain control in the developing world.

The conclusion of the piece is really incredible. They find that the main obstacle to pain control for patients in most of the world is not costs or drug availability, it is the stigma of opiates and the war on drugs.

Overall, Freedom from Pain reveals that bureaucratic hurdles, and the chilling effect of the global war on drugs, are the main impediments to a pain free world. Patients will continue to suffer until global bodies actively work with countries to exclude medical morphine from the war on drugs, and change the blunt drug laws that curtail access to legitimate medical opiates worldwide. Uri Fedotov, the executive director of the United Nations Office of Drugs and Crime, admits in the film that the war on drugs is cutting people off from pain medication, but offers little in the way of concrete proposals for changing the status quo.

If you have the time it is well worth the 30 minutes to watch the piece.

God bless functional MRI as it proceeds to do everything from predict our future behavior to tell us whether we’re lying or not.

Now making the rounds in the international media are reports of a study published this week in Current Biology by a group out of the University of California.

While volunteers watched movie clips, a scanner watched their brains. And from their brain activity, a computer made rough reconstructions of what they viewed.

[...]

For now, the reconstructed movie clips are only crude representations, loosely mimicking shapes and movement, but not nearly detailed enough to show that a blurry human-like figure represents the actor Steve Martin, for example.

As the video at the top of the post shows very cool. However the work is hardly arising de novo. It builds off of work out of Japan that could accurately reconstruct still images patient’s stared at based off of fMRI data. Here’s one of their major papers out of Nature.

I’m not sure of the incredible limits of what we’re going to be able to do with functional MRI by the time my career as a physician is over.