I apologize for not updating recently at all. Totally goes against what I've been hoping to do, but with the end of classes (on April 3rd) and my current sinus infection, I've been under the weather with regard to blog posting.
That said, the latter does bring up one of my current rants.
I went looking for a decongestant today, because my sinuses are terrible (and when they block up, I get horrible shooting pains in my skull, specifically near my eyes). Now, I know as a rule that when one looks for a decongestant, one looks from a drug called pseudoephedrine. Essentially, pseudoephedrine is a vasoconstrictor (that is it constricts blood vessels) and this allows less fluid to leave the blood stream and slows mucus production significantly, as well as reducing inflamation.
However, pseudoephedrine (you have no idea how annoying it is to type that out every time) is also an important precursor in the creation of methamphetamine. As a result of this, and of the corrispondingly more stringent rules against the sale of pseudoephedrine, drug companies have begun to reformulate decongestants with other, less illicitly useful drugs, primarily phenylephrine.
The problem is, clinically speaking, that phenylephrine hasn't been shown to have any useful effect at all. A variety of studies have shown it to be no more or less effective than a placebo.
Which makes it somewhat troublesome for those of us who just want to get our nasal passages declogged to do so.
Is it reasonable that we restrict the distribution of a known-useful substance in order to prevent it from being used illicitly? This isn't a merely hypothetical question; this question springs up at every level of governance and law, from firearms to narcotics to motor vehicles.
It's probably unlikely someone will die due to their nasal passages being clogged up and unable to be relieved. It's equally well known that people have died from methamphetamines.
The problem is that judging risks and rewards when the numbers are measured in human lives is a very grisly business, and rarely do we accept that perhaps it's better to let a few people die for convenience...
Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts
Monday, April 7, 2008
Wednesday, March 5, 2008
Medical Basics...
One of the things I find most difficult about studying medicine is the very basics, and it's a topic that I find ill-covered in any of the material that I've studied so far.
Often the text with refer to, for example, O2 stats of a test-case patient. However, the text does not define the normal range of oxygen saturation for a patient, what instrument one would use to measure it, what the results of a decreased O2 saturation would be, and what the clinical indications of decreased O2 saturation are. This leaves me scrambling to either Wikipedia if I'm at my desk or to write it down if I'm not so that I can later look up the specific test and the results, and I feel it's inefficient.
Practically speaking, I am sure one can find a book outlining basic diagnostic tests, how to perform them, what results one should expect, and what it means if one receives a different result. However, I haven't yet found such a book.
Similarly, it seems as though medicine often results in such complications, and it is possible that I simply don't have a sufficient classroom grounding to deal with the basic terms and concepts- there is a great deal of interrelation between psychiatry, examination of a patient, anatomy, basic texts, radiology, and so on.
That said, so far, I have found Clinical Psychiatry (the medical text and field I am studying at the moment) exceptionally helpful. Despite being dense in format, the text is clear and readable, and presents a variety of helpful tables- such as what drugs are indicators for specific psychiatric conditions, and in contrast, what drugs one might use to treat psychiatric conditions.
It has covered the Mini-Mental State Exam in detail (a very basic cognition test) as well as outlining the clinical bases and utilities of a variety of other tests, and beginning to outline treatment regimes, as well as covering the bases of psychiatric illness.
Perhaps oddly, it has done more to make psychiatry 'available' to me than perhaps anything else has.
Often the text with refer to, for example, O2 stats of a test-case patient. However, the text does not define the normal range of oxygen saturation for a patient, what instrument one would use to measure it, what the results of a decreased O2 saturation would be, and what the clinical indications of decreased O2 saturation are. This leaves me scrambling to either Wikipedia if I'm at my desk or to write it down if I'm not so that I can later look up the specific test and the results, and I feel it's inefficient.
Practically speaking, I am sure one can find a book outlining basic diagnostic tests, how to perform them, what results one should expect, and what it means if one receives a different result. However, I haven't yet found such a book.
Similarly, it seems as though medicine often results in such complications, and it is possible that I simply don't have a sufficient classroom grounding to deal with the basic terms and concepts- there is a great deal of interrelation between psychiatry, examination of a patient, anatomy, basic texts, radiology, and so on.
That said, so far, I have found Clinical Psychiatry (the medical text and field I am studying at the moment) exceptionally helpful. Despite being dense in format, the text is clear and readable, and presents a variety of helpful tables- such as what drugs are indicators for specific psychiatric conditions, and in contrast, what drugs one might use to treat psychiatric conditions.
It has covered the Mini-Mental State Exam in detail (a very basic cognition test) as well as outlining the clinical bases and utilities of a variety of other tests, and beginning to outline treatment regimes, as well as covering the bases of psychiatric illness.
Perhaps oddly, it has done more to make psychiatry 'available' to me than perhaps anything else has.
Saturday, March 1, 2008
The art of mentality
One of the most difficult things about psychiatry, as opposed to surgery, or immunology or, in fact, most medical disciplines, at least to me, is the fact that it's extremely unclear whether someone is actually sick or not, and there's no real way to tell. Drugs can be effective on people who are not necessarily mentally 'ill'; and drugs can not be effective on people who are mentally 'ill'.
Stoudemire's Clinical Psychiatry defines a mental disorder by saying "It is, in fact, impairment of function that distinguishes 'eccentric behavior' from psychiatric illness."
Perhaps this seems self-evident; well and so. The difficulty is that establishing when someone is impaired is also a questionable task. One of the best examples of this is Attention Deficit Hyperactivity Disorder, which may strike as many as 7% of children. However, all sufferers are struck with different severities of symptoms, from the crippling to the almost unnoticeable; and it tends to be more a matter of art than of science in determining how to deal with the issue.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) attempts to clarify the issue, but in my opinion, rarely does. Rather than setting out specific itemizations, the details presented are merely rough guidelines.
Rather, you are left with a wide variety of people, especially Americans, in my experience, who believe they have mental disorders- without necessarily a severe impairment of function, for which they receive pharmaceutical support. Because these pharmaceuticals can alter the biology of 'healthy' people just as well as they can the 'ill', in fact, these people do undergo changes. Of course, it is then up for debate as to whether they are 'healthy' now as opposed to before.
Arguably, the only definition that matters is whether they are more functional after whatever treatment than before. In this respect, it may be that psychiatric treatment is nothing more than a lifestyle choice- albeit an expensive one with possibly drastic side effects.
Stoudemire's Clinical Psychiatry defines a mental disorder by saying "It is, in fact, impairment of function that distinguishes 'eccentric behavior' from psychiatric illness."
Perhaps this seems self-evident; well and so. The difficulty is that establishing when someone is impaired is also a questionable task. One of the best examples of this is Attention Deficit Hyperactivity Disorder, which may strike as many as 7% of children. However, all sufferers are struck with different severities of symptoms, from the crippling to the almost unnoticeable; and it tends to be more a matter of art than of science in determining how to deal with the issue.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) attempts to clarify the issue, but in my opinion, rarely does. Rather than setting out specific itemizations, the details presented are merely rough guidelines.
Rather, you are left with a wide variety of people, especially Americans, in my experience, who believe they have mental disorders- without necessarily a severe impairment of function, for which they receive pharmaceutical support. Because these pharmaceuticals can alter the biology of 'healthy' people just as well as they can the 'ill', in fact, these people do undergo changes. Of course, it is then up for debate as to whether they are 'healthy' now as opposed to before.
Arguably, the only definition that matters is whether they are more functional after whatever treatment than before. In this respect, it may be that psychiatric treatment is nothing more than a lifestyle choice- albeit an expensive one with possibly drastic side effects.
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