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Ambika Kilaparthi

Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why. - 0 views

  • response to placebo was considered a psychological trait related to neurosis and gullibility rather than a physiological phenomenon that could be scrutinized in the lab and manipulated for therapeutic benefit. But then Benedetti came across a study, done years earlier, that suggested the placebo effect had a neurological foundation. US scientists had found that a drug called naloxone blocks the pain-relieving power of placebo treatments. The brain produces its own analgesic compounds called opioids, released under conditions of stress, and naloxone blocks the action of these natural painkillers and their synthetic analogs.
  • Placebo-activated opioids, for example, not only relieve pain; they also modulate heart rate and respiration. The neurotransmitter dopamine, when released by placebo treatment, helps improve motor function in Parkinson's patients. Mechanisms like these can elevate mood, sharpen cognitive ability, alleviate digestive disorders, relieve insomnia, and limit the secretion of stress-related hormones like insulin and cortisol.
  • Alzheimer's patients with impaired cognitive function get less pain relief from analgesic drugs than normal volunteers do. Using advanced methods of EEG analysis, he discovered that the connections between the patients' prefrontal lobes and their opioid systems had been damaged. Healthy volunteers feel the benefit of medication plus a placebo boost. Patients who are unable to formulate ideas about the future because of cortical deficits, however, feel only the effect of the drug itself. The experiment suggests that because Alzheimer's patients don't get the benefits of anticipating the treatment, they require higher doses of painkillers to experience normal levels of relief.
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  • placebo response has limits. It can ease the discomfort of chemotherapy, but it won't stop the growth of tumors. It also works in reverse to produce the placebo's evil twin, the nocebo effect. For example, men taking a commonly prescribed prostate drug who were informed that the medication may cause sexual dysfunction were twice as likely to become impotent.
  • placebo aids recovery is by hacking the mind's ability to predict the future. We are constantly parsing the reactions of those around us—such as the tone a doctor uses to deliver a diagnosis—to generate more-accurate estimations of our fate. One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug. Researchers call these social aspects of medicine the therapeutic ritual.
  • What turns a dummy pill into a catalyst for relieving pain, anxiety, depression, sexual dysfunction, or the tremors of Parkinson's disease? The brain's own healing mechanisms, unleashed by the belief that a phony medication is the real thing. The most important ingredient in any placebo is the doctor's bedside manner, but according to research, the color of a tablet can boost the effectiveness even of genuine meds—or help convince a patient that a placebo is a potent remedy.
  • Red pills can give you a more stimulating kick
  • green reduces anxiety
  • White tablets—particularly those labeled "antacid"—are superior for soothing ulcers
  • More is better,scientists say. Placebos taken four times a day deliver greater
  • Branding matters. Placebos stamped or packaged with widely recognized trademarks are more effective than "generic"
  • Clever names
  • volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.
  • hybrid treatment strategies that exploit the placebo effect to make real drugs safer and more effective. Cancer patients undergoing rounds of chemotherapy often suffer from debilitating nocebo effects—such as anticipatory nausea—conditioned by their past experiences with the drugs. A team of German researchers has shown that these associations can be unlearned through the administration of placebo, making chemo easier to bear.
  • body's response to certain types of medication is in constant flux, affected by expectations of treatment, conditioning, beliefs, and social cues.
  • Big Pharma have moved aggressively into Africa, India, China, and the former Soviet Union. In these places, however, cultural dynamics can boost the placebo response in other ways. Doctors in these countries are paid to fill up trial rosters quickly, which may motivate them to recruit patients with milder forms of illness that yield more readily to placebo treatment. Furthermore, a patient's hope of getting better and expectation of expert care—the primary placebo triggers in the brain—are particularly acute in societies where volunteers are clamoring to gain access to the most basic forms of medicine. "The quality of care that placebo patients get in trials is far superior to the best insurance you get in America
  • The HAM-D was created nearly 50 years ago based on a study of major depressive disorder in patients confined to asylums. Few trial volunteers now suffer from that level of illness. In fact, many experts are starting to wonder if what drug companies now call depression is even the same disease that the HAM-D was designed to diagnose.
  • What all of these disorders have in common, however, is that they engage the higher cortical centers that generate beliefs and expectations, interpret social cues, and anticipate rewards. So do chronic pain, sexual dysfunction, Parkinson's
  • In standard trials, the act of taking a pill or receiving an injection activates the placebo response. In open/hidden trials, drugs and placebos are given to some test subjects in the usual way and to others at random intervals through an IV line controlled by a concealed computer. Drugs that work only when the patient knows they're being administered are placebos themselves.
  • Ironically, Big Pharma's attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn't care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That's potent medicine.
Peter Kimmich

Historic Deadly Plagues and How They Would Be Treated Today - 0 views

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    In past centuries humans have been at the mercy of all kinds of bacteria, viruses and other icky stuff. Here is a list of famous human pandemics, and how the diseases responsible would be handled today.
Peter Kimmich

Inspirational Websites for the Sick and Injured - 0 views

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    Websites telling the inspirational personal stories of people battling disease, injury and illness.
anonymous

A web-based simulation of a longitudinal clinic used in a 4-week ambulatory rotation: a... - 0 views

shared by anonymous on 01 Apr 09 - Cached
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    A web-based tool, Continuity of Care Online Simulations (COCOS), was designed for use in a one-month, postgraduate clinical rotation in endocrinology. It is an interactive tool that simulates the continuing care of any patient with a chronic endocrine disease. Twenty-three residents in internal medicine participated in a study to investigate the effects of using COCOS during a clinical rotation in endocrinology on pre-post knowledge test scores and self-assessment of confidence.
avivajazz  jazzaviva

National Library of Medicine (NLM) ///:/// National Institutes of Health (NIH) - 0 views

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    Access research studies, publications, conference proceedings, reference materials, databases, tools, and other resources of interest to medical researchers, health care providers, patients, consumers, citizens, and policymakers.
anonymous

The Biomedicine Research Labs Island - 0 views

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    The Biomedicine Research Labs Island, which opened in January, 2008, is in fact the digital headquarters of RL organization S.H.R.O. of Philadelphia, PA. According to their press release "S.H.R.O. is committed to excellence in basic genetic research to cure and diagnose cancer, cardiovascular diseases, diabetes and other chronic illnesses and to foster the training of young international doctors in a spirit of professionalism and humanism".
anonymous

100 DIAGNOSTIC CHALLENGES IN CLINICAL MEDICINE - 0 views

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    100 Diagnostic Challenges in Clinical Medicine is composed of one hundred well-illustrated clinical scenarios and their appropriate investigations. A wide variety of specialties are covered including cardiology, neurology, dermatology, endocrinology, tropical medicine, haematology, metabolic medicine, radiology, ophthalmology, venereology, and infectious diseases. Presenting the relevant investigations corresponding to each case in an interesting and easy-to-read Q&A format concerning diagnosis and management
anonymous

Top 100 EM articles - 0 views

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    "They review some classics including: "The rational clinical examination. Is this patient having a myocardial infarction?" in JAMA 1998. "The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease" in JAMA 2000. "Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis" in NEJM 2003. "The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma" in NEJM 2003. "Computed tomography of the head before lumbar puncture in adults with suspected meningitis" in NEJM 2001."
anonymous

A pediatric digital storytelling system for third year medical students: The Virtual Pe... - 0 views

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    "A new type of CBPS, the digital storytelling system, has been developed and evaluated which and appears to be successful in overcoming some of the limitations of earlier CBPS by featuring patient's stories in their own words, by focusing on problems rather than diseases, and by having stories that are quick for students to work through."
anonymous

JAMA Network | JAMA | Banning the Handshake From the Health Care Setting - 0 views

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    "Banning the handshake from the health care environment may require further study to confirm and better describe the link between handshake-related transmission of pathogens and disease. "
mmgillis

Assessment of decision-making capacity in adults - 3 views

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    "WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration
Fco Javier Casas Ciria

Ahead of Print -Delivering on Antimicrobial Resistance Agenda Not Possible without Impr... - 0 views

    • Fco Javier Casas Ciria
       
      Candidiasis invasiva asociada a previa infección bacteriana y previa tratamiento antibacteriano, con inapropiada combinacióna antibiótica
  • 81% were exposed to multiple antibacterial drugs, either concomitantly or sequentially
  • Early therapy of Candida spp. bloodstream infection greatly improves patient outcomes and the outcome is even better if correct therapy is given immediately
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  • Once Candida-associated sepsis is confirmed, antibacterial agents can usually be stopped and, if Candida sepsis is ruled out, empiric antifungal therapy can be stopped.
  • for ruling out a diagnosis of invasive candidiasis,
  • the 1,3 β-D-glucan assay
  • Candida albicans germ tube antibody test, which is used with serum samples
  • and a nonculture-based molecular assay
  • Overuse of antifungal agents is costly, can promote antifungal resistance, and has the potential for causing toxicity and various detrimental drug interactions in patients
Dianne Rees

Stanford Mini Med School - Stanford University School of Medicine - 0 views

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    3 semesters worth of lectures on human biology, health and disease, medical research, and health care. The lectures are available through iTunes, YouTube, and on the Stanford Mini Med School website. Click winter term, spring term, and fall term to access the different lectures.
Dianne Rees

HealthEducation - jokaydia: Exploring Virtual Worlds and Games in Education - 0 views

  • the Consumer Health Library which houses an extensive collection of resources and exhibitions on a range of health issues including social anxiety and agoraphobia, and Alzheimer's disease
avivajazz  jazzaviva

HealthBase | New Semantic Search | MedSearch - 0 views

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    Content sources tapped for "atherosclerosis" search results: Pubmed, NewsRX, MedicineNet, NaturalNews, oilofpisces.com, NIDDK, NIH, eMedicine, Children with Diabetes, Yahoo! Health
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