Archive for the ‘medicine’ Category

Dick Boggs

Thursday, March 15th, 2012

When I was a medical school junior, we had a rotation on the Neurology service at LA County Hospital. One of my classmates was planning a career in neurology but the reason it was so popular with the students like me who were interested in surgery was that we got to do tracheostomies. A number of patients with severe neurological lesions would require respirators or had trouble with airway secretions requiring a tracheostomy. This was our one chance to do surgery, even a minor procedure as things go. It was good practice and I later did a lot of tracheostomies, some quite difficult and rushed.

Our resident was a very interesting guy named Dick Boggs. He was tall and looked a lot like Orson Welles did when he was young and making “The Third Man.”Boggs was quiet and aloof but let us do trachs and work up any patient we wanted to. I had some very interesting cases. One was a woman who showed all the signs of alcoholic neuropathy, which is very similar to diabetic neuropathey. It was a popular rotation for juniors. Boggs was popular among the residents and was elected the president of the Interns and Residents Association, which under his leadership took on some of the characteristics of a union.

At the time, intern and resident pay was very low and, aside from a new dormitory that was built for single house staff, we were on our own. I was married with one child, born in March 1965, so I was really on my own. My wife quit her job as a teacher in January 1965 and I was working after hours doing histories and physicals at private hospitals for $7 per hour. Fortunately, my tuition was covered by scholarship but living expenses were tight. We lived on $200/month contributed by our parents, $100 from my father and the same from Irene’s parents. Half of that went for the rent of our two bedroom house in Eagle Rock, near Pasadena. I’m spending some time on details to emphasize what Boggs accomplished for us all.

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Another Powerline deleted comment.

Monday, November 14th, 2011

Apparently, the webmaster at Powerline does not approve of some of my comments and deletes them. The latest example;

“strategery123@hotmail.com (signed in using Hotmail)
I think this series would have a lot more impact if you just called it annals of british medicine…I don’t recall a single instance where you referenced any other government medicine (horror) story. surely there are stories out of spain, france, canada, italy, belgium, etc etc.
it is also disappointing (but not surprising just thought you were above that sort of stuff) that you equate the NHS with Obamacare…they are not the same…government medicine (nhs) versus government insurance (obamacare).the NHS is the equivalent of a federal dept where all employees, doctors, nurses, etc are actual employees of the government and the government owns the hospitals, clinics, etc. That is not the same as obamacare where it amounts to government insurance unless you actually believe that all the doctors and healthcare workers will be employees of the government.”

My comment in reply to this was two words; Natasha Richardson.

Natasha Richardson the actress and wife of actor Liam Neeson was skiing at a Canadian ski resort in Quebec when she had a seemingly trivial head injury. Over the next few hours she developed signs of an intracranial bleed. No CAT scan or MRI was available and, in spite of frantic efforts to transport her, she died of an intracranial hemorrhage( an acute epidural hemorrhage). Grace Kelly had a similar history but, of course, that was in 1982 when CAT cans were very new. In both cases, the high tech device was not available.

Does anyone think that a US ski resort would lack immediate access to a CAT scan ? If Natasha Richardson had been skiing at a US resort, she would be alive today. Epidural hematomas are eminently treatable, even without a CAT scan. The lucid interval is almost diagnostic of the lesion. Decompression of the hematoma is curative.

Australian health care

Saturday, November 12th, 2011

I posted a comment in response to a question on the blog but WordPress ate it so I will try to Post some thoughts about the Australian system. In the 1970s, Australia may have had the best system in the world but politics, as usual, screwed it up. When I was first starting out in the 1970s, we were out for dinner with a couple of Australian surgeons. They explained the system as it existed at the time. The hospitals were almost all owned by the states which funded them. There was a private health care system, called “Medicare” in which individuals who wanted private care paid a monthly premium though the Post Office. All hospital care was in the state owned public hospitals. The hospital based specialists cared for everyone regardless of insurance status in the same setting.

In the early days of the National Health Service in England, a similar situation existed with private patients in NHS hospitals. Then, in the early 1970s, under the Labour government, the unions of NHS employees refused to care for private patients. The result was that Harley Street specialists and their patients left for Belgium. A few years later, there was a small scandal in which the Labour Health Minister had her hysterectomy performed in Belgium by a private specialist. Such hypocrisy is an old story.

In Australia, the Labor Party campaigned in the 1984 election telling voters that, if they were elected, health care would be free. They would abolish the Medicare premium. As it happened, they had made no provision to pay doctors. It’s not clear if this was the result of ignorance on their part or if it was a calculated risk in an election they did not expect to win.

I visited Australia a few years later and saw the remains of the mess. Big states, like New South Wales, had no private hospitals and hospital based specialists, like surgeons, had no source of income. Patients dropped their Medicare premium and the doctors were screwed. With time, there has been a reorganization and official descriptions gloss over the story. If you read this description, for example, there is no description of the chaos that I found in 1988. There were daily newspaper stories, at the time, of patients going without treatment.

I was visiting friends, two GPs in Toowoomba, in Queensland. From them, I learned considerable background. Queensland, the most conservative Australian state, had both private and public hospitals. The public hospitals were not on the same level of sophistication and equipment as the private ones. The doctors in Queensland told their patients that, if they wanted private care, they had better pay their Medicare premiums. My friends owned their own office building and surgery center (called day-surgery). The public hospital also had a day surgery across the street from the private one. A year after my visit, the public hospital approached the two GPs and asked them if they would take over management of the publicly own day surgery as well as their own.

I think most of the major mistakes of the Labor government have been corrected with time. I don’t think the system is as good as it was 30 years ago.

Is socialized medicine bad ?

Thursday, November 10th, 2011

There was a post on Powerlineyesterday, which attracted a lot of comments, including one of mine that never appeared. Maybe it was too long but I was trying to respond to a question.

This is a better place to respond so I will try here. The questioners seemed to be single payer advocates.

“Brody Halverson · Top Commenter · College for Financial Planning
Where is Michael’s response? I’m eager to learn of your findings after years of studying this.”

I had earlier posted a comment that I had studied medical errors and medical quality for years. The issue was whether the NHS has better outcomes than the US record.

I have had some experience with the NHS going back 15 years. In 1995, I went to northern England as part of a group from Dartmouth to advise primary care doctors on how to cope with the new “Fund Holding” system introduced by the Conservative government. Fund Holding was a way of dealing with a chronic NHS problem. In the NHS, hospitals and hospital-based physicians have almost no contact with the general practitioners. The GPs find it nearly impossible to find out what happens to their patients while hospitalized. Fund holding allowed the GPs to send their patients to hospitals that are not the local district hospital. The payment for treatment followed the patients. The result was a considerable improvement in the relationship between hospital based-specialists and GPs. A lot more information was shared, similar to what happens in the US system.

A personal friend of mine, a surgeon and teacher of anatomy at a London medical school, has told me that he cannot get Muslim female students and nurses and junior doctors, to scrub their forearms before going into surgery. Hospital infections in NHS hospital are high and rising. NHS hospitals are described as “dirty” and there are problems with obvious issues as changing bed linen. This is pretty bad.

Then there is the notorious order from the health ministry to reduce ER waiting times or face fines. The response of NHS hospitals was quite a bit different from those of US hospitals, even public hospitals. In the NHS, the “target waiting time is four hours. Even at that some hospitals have refused to allow ambulances to bring patients to ERs if the wait will exceed the rules. Instead, the ambulance have been forced to wait in the parking lot until the wait time is reduced.

For one thing, patients in the UK have spent 30 million pounds when ambulances were not available or wouldn’t come. THere are stories of patients dying in ambulances during the wait.

Some commenters have described Medicare as “socialized medicine.” This gets into definitions. Fee-for-service medicine is what is at issue here. There are some patients who prefer HMOs, like Kaiser. That is not a problem because they have a choice. The French have the best medical care system in Europe because they have kept most of it fee-for-service. The patient has a choice. Some of them go to community clinics, similar to our HMOs because choice of physician is not important to them.

However, the fact that the French system is largely fee-for-service makes the single payer segment responsive. Those doctors know that their patient volume may drop precipitously if the patients lose confidence in the system.

Canada has had a modified fee-for-service system for years but it has been starved of funding to the point that patients have begun to seek non-government care. The same thing is happening to Medicare here. The changes are still small and not that many people are affected yet. Most of the problem has to do with the elderly. There are severe restrictions on care of the frail elderly, how frequently the doctor can see them, for example. A government official complained recently that surgery on the elderly is useless because ‘most of these people die anyway.’ In fact, that is a distortion of the data. Only those patients who died were included in the study. I have done major surgery on 90 year old people. The key was that they knew the facts and wanted the surgery.

In Canada people are seeking private care. Technically, it is illegal however a recent decision of the Canadian Supreme Court ruled that a government health care system does not mean that care is available. We are seeing an increasing level of private care used by Medicare patients in this country. Expect this trend to increase if Medicare is subjected to increasing cuts, as in the Obamacare plans.

My recommendations for reform follow the pattern of the French system and I have tried to provide some detail on my reasons.

Why socialized medicine is a bad idea.

Tuesday, November 1st, 2011

For many years the term “Socialized Medicine” has been a watchword for reactionary and out of date doctors who think we still live in an era of self-reliance. Everybody knows that health care should be a communitarian responsibility because no one can afford their own healthcare. I can’t afford a car crash, either, but I have car insurance for that.

Now, we have evidence that we can’t afford, as individuals, community health care either. The federal government now has a powerful agency named “United States Preventive Services Task Force (USPSTF), which by its name one would think is in charge of making sure we get our preventive medicine testing as advocated by Nancy Pelosi. Except Nancy has changed her mind.

The Obamacare legislation has transformed the USPSTF from its former status as a mere (one might say milquetoasty) advisory board, which made recommendations on preventive health that doctors and patients could take or leave alone, into an extraordinarily powerful GOD panel (Government Operatives Deliberating) that determines, definitively, which preventive services are to be covered and not covered by private insurers, Medicare, and Medicaid.

If USPFTF determines that something will not be paid for, God help you in getting it done. I first noticed this when I was at Dartmouth. It was found that many men with positive PSA tests, which suggested the presence of prostate cancer, did not die of prostate cancer, at least for many years. These tended to be older men and men with lower levels of PSA. The result was a drive to educate men to NOT have PSA tests. Too many men were having the test and undergoing radical prostatectomy.

I was in some sympathy with this view. I had seen examples of overtreatment. Still, it seemed more fair to allow the patient to choose. I see no similar movement to deny mammography to women although the recent dustup about youngest age at which Medicare will pay from mammography does seem similar

just yesterday, the New York Times published a “news analysis” which aggressively begins selling the public on that very notion – that medical screening tests are, by and large, a bad thing to do.

Even DrRich thought the Progressives would be somewhat circumspect about breaking such remarkable and counter-intuitive news to us in the great unwashed – especially considering that they have just spent the last three decades teaching us just the opposite. But then he recalled their smooth, unapologetic and entirely unremarked transition, around twenty years ago, from sounding the alarm about global cooling to catarwauling about global warming.

And he reminded himself that when you are a Progressive, history always began 10 minutes ago. And this turns out to be a great convenience.

In this case it is particularly convenient, when you consider the passionate declarations by Ms. Pelosi and others in 2009 that the watchword of Obamacare – indeed, the very key to the dramatically lower costs we would realize with this new legislation – would be “prevention, prevention, prevention.”

Expect to hear about this. Here’s another way of

The British medical journal Lancet reported last month that 32% of elderly American patients undergo surgery in the year before they die, a statistic culled from Medicare data. In an accompanying editorial, Dr. Amy Kelley of Mount Sinai School of Medicine labeled the 32% figure a “call to action”—to reduce costly surgeries, intensive-care stays and other high-intensity care for the elderly. Her call was parroted in hundreds of media outlets nationwide. But advocates for limiting health-care spending on the elderly are distorting science to make their argument.

Don’t be bamboozled: The Lancet investigators looked only at patients who died, making surgery appear unsuccessful. That’s like saying Babe Ruth struck out 1,333 times so he must have been a poor ball player—even though he had a .342 lifetime batting average and 714 home runs. Investigators should have considered how all surgery patients fared, including those who recovered, returned home from the hospital and resumed active lives.

The day is coming when divided loyalties will be the most serious problem in medicine. Who has YOUR best interest at heart ?

The answer to a question I had

Friday, October 21st, 2011

Here is the answer to the question of why Steve Jobs procrastinated about his pancreatic cancer.

http://www.youtube.com/watch?v=zYZDqNAB8LI&feature

I have seen this so many times. One instancewas a young GP who I remembered from the time he was an intern at LA County. He was convinced of the merits of Alternative Medicine. It was sort of a hippie thing. Remember, I finished my surgery training in 1971.

A few years later, he was practicing his version of medicine in Mission Viejo, an unlikely place. He turned up in my office one day close to Christmas. He was having symptoms and wanted me to examine him. The findings showed a large mass in his abdomen. It turned out to be an advanced cancer of the small intestine. These are rare and early diagnosis would probably not have helped. What shocked and distressed me was learning that he did not have any insurance, of any kind. I didn’t charge doctors for care in those days so it didn’t affect me but he didn’t even have life insurance ! He was married and, I believe, he had children.

Steve Jobs’ family will be well cared for but he passed up the best chance he had to be there for them another 20 years by his belief in magical thinking. I suspect his politics may have been affected, as well.

Sorry about the gap in blogging

Wednesday, October 19th, 2011

In September, the 12th, I believe, we decided to drive to Tucson where we have a house. Our daughter, Annie, lives there while she attends the U of Arizona. I have complained about the curriculum before but Annie seems to be immune to the attempted indoctrination. Her US History Since 1877 course, for example, was full of misinformation. She was taught that the settlers in the western plains learned agriculture from the Plains Indians. This is ridiculous as the Plains Indians were hunter-gatherers and were the last of the aboriginal peoples to cross the the Bering Strait. The Pilgrims, as every child in school in the 1950s learned, were taught to plant corn with a fish in each clump for fertilizer. The eastern Indians, like the Iroquois, were far advanced compared to the Plains Indians, and some had glass windows in their houses. Dartmouth College was founded in 1759 to educate the children of the Indians and settlers. Unfortunately, the Indians chose the French in the coming war (A European War they should have stayed out of) in hopes that the English settlers would be driven out. This was a gross miscalculation and was a catastrophe for the Indians. After Quebec fell, they were the enemy.

My daughter is studying French, not due to sympathy for the Indians but in hopes of getting an internship in France next year and then a job for the French company that employes her uncle. She loves France and has been there multiple times. When we visited Nice a few years ago, she spent the next several weeks checking housing prices. At least she has a plan that is grounded in reality.

Anyway, we were in Tucson a couple of days when my daughter found me sitting in the family room looking unwell. I was confused and had slurred speech. I don’t remember this episode and awakened in a hospital in Tucson having a coronary angiogram. At first they thought this was all neurological but my cardiac enzymes bounced above the normal level so it became a heart attack (Myocardial infarction). The angiogram finally showed a high grade (90% stenosis) lesion in my anterior descending coronary. My coronary anatomy is abnormal in that both coronary arteries come off my aorta together. I learned this a couple of years ago when the cardiologist could not find my right coronary artery. A subsequent spiral CT scan showed it and there was no disease seen in either of them. After the coronary lesion was found, it became a matter of surgery. I used to do this surgery, so I knew what was involved. As it happened, I had this solitary lesion so needed only one bypass. The surgeon, a nice young man who looked a little older than my medical students, explained his plan. The internal mammary artery, which runs down the back on the sternum, is about the same diameter of the anterior descending coronary. In years gone by, this artery was used in the Vineberg Operation and implanted into the cardiac muscle. I will give my surgeon a copy of my Book on medical history so he knows this story. Anyway, the plan was to connect the internal mammary to my LAD, or left anterior descending. Osler called this “The artery of sudden death,” so it matters that it is fixed.

I was in St Joseph’s Hospital in Tucson, a pleasant place considering. I was then transferred to Tucson Heart Hospital for the surgery. That was performed on 9/26/11, less than three weeks ago. On the third day post-op, Cindy and I drove back to California and my recovery has been uncomplicated. My chest is still a bit sore (I was warned that this approach would hurt more) but I am getting along pretty well. I posted a few comments on other blogs but didn’t feel up to blogging myself.

Global Warming and acupuncture

Thursday, June 16th, 2011

It looks as though the sun is entering a new dormant period, similar to the Maunder Minimum which led to the Little Ice Age.

This will almost certainly end the global warming hysteria in a few years. The people who continue to cling to this sort of hoax, will be looking for the Next Big Thing. I don’t mean to imply that the earth did not warm over the past century. The Little Ice Age ended about 1850 so a warming trend is expected following such an event. The hoax is the contrived evidence that humans are responsible. I was skeptical about that from the first. The forces involved are too large. If humans affected climate, it probably began with the development of agriculture. Perhaps we have had no ice age in the past 10,000 years because of the effects of agriculture and forest changes. I have previously discussed this and nothing has changed my mind.

The next question is what will replace global warming as the religion of the bored classes ? There are signs that it may be “New Age” medicine. This sort of thing is common in certain circles and has considerable similarity to the global warming arguments.

The Center for Integrative Medicine, Berman’s clinic, is focused on alternative medicine, sometimes known as “complementary” or “holistic” medicine. There’s no official list of what alternative medicine actually comprises, but treatments falling under the umbrella typically include acupuncture, homeopathy (the administration of a glass of water supposedly containing the undetectable remnants of various semi-toxic substances), chiropractic, herbal medicine, Reiki (“laying on of hands,” or “energy therapy”), meditation (now often called “mindfulness”), massage, aromatherapy, hypnosis, Ayurveda (a traditional medical practice originating in India), and several other treatments not normally prescribed by mainstream doctors. The term integrative medicine refers to the conjunction of these practices with mainstream medical care.

Here we have what may become the replacement for AGW in the minds of the exquisite privileged class. It has all the requirements.
1. America is corrupt and inferior ? Yes.
2. Capitalism is corrupt and inferior ? Yes
3. Only the truly intelligent and sensitive can appreciate it ? Well.

You might think the weight of the clinical evidence would close the case on alternative medicine, at least in the eyes of mainstream physicians and scientists who aren’t in a position to make a buck on it. Yet many extremely well-credentialed scientists and physicians with no skin in the game take issue with the black-and-white view espoused by Salzberg and other critics. And on balance, the medical community seems to be growing more open to alternative medicine’s possibilities, not less.

That’s in large part because mainstream medicine itself is failing. “Modern medicine was formed around successes in fighting infectious disease,” says Elizabeth Blackburn, a biologist at the University of California at San Francisco and a Nobel laureate. “Infectious agents were the big sources of disease and mortality, up until the last century. We could find out what the agent was in a sick patient and attack the agent medically.” To a large degree, the medical infrastructure we have today was designed with infectious agents in mind. Physician training and practices, hospitals, the pharmaceutical industry, and health insurance all were built around the model of running tests on sick patients to determine which drug or surgical procedure would best deal with some discrete offending agent. The system works very well for that original purpose, against even the most challenging of these agents—as the taming of the AIDS virus attests.

But medicine’s triumph over infectious disease brought to the fore the so-called chronic, complex diseases—heart disease, cancer, diabetes, Alzheimer’s, and other illnesses without a clear causal agent. Now that we live longer, these typically late-developing diseases have become by far our biggest killers. Heart disease, prostate cancer, breast cancer, diabetes, obesity, and other chronic diseases now account for three-quarters of our health-care spending. “We face an entirely different set of big medical challenges today,” says Blackburn. “But we haven’t rethought the way we fight illness.” That is, the medical establishment still waits for us to develop some sign of one of these illnesses, then seeks to treat us with drugs and surgery.

A science blog states the case for scientific medicine.

Speaking of bad ideas, in contrast to his previous article, in which he managed at least to get the gist of what Ioannidis teaches but merely spun it in what I considered to be an annoying fashion, the entire idea behind Freedman’s new article channels the worst fallacies of apologists for alternative medicine. The whole idea behind the article appears to be that, even if most of alternative medicine is quackery (which it is, by the way), it’s making patients better because its practitioners take the time to talk to patients and doctors do not. In other words, it’s a massive “What’s the harm?” argument. Yes, that’s basically the entire idea of the article boiled down into a couple of sentences. Deepak Chopra couldn’t have said it better. Tacked on to that bad idea is a massive argumentum ad populum that portrays alternative medicine (or, as purveyors of quackademic medicine like to call it, “complementary and alternative medicine” or “integrative medicine”) as the wave of the future, a wave that’s washing over medicine and teaching us cold, reductionistic doctors to care again about patients and thus make them better. Freedman even contrasts this to what he calls the “failure” of scientific medicine. I kid you not. Worse, Freedman makes this argument after having actually interviewed some prominent skeptics, including Steve Salzberg and Steve Novella, in essence, missing the point.

I expect to see more and more of “alternative medicine” because it appeals to the science illiterate and it damns another traditional source of authority, scientific medicine. Global warming hysteria attacks capitalism and prosperity. Alternative medicine is also going to be useful to Obamacare as a way of cutting reimbursement for traditional care. That will be a powerful wind behind it.

Bacteria, Bowels and Health

Friday, December 24th, 2010

Most people do not understand that we live in a sea of bacteria. There are bacteria, and related organisms called Archea, at the bottom of the sea and probably deep into the earth. The vast majority of these bacteria do us no harm and, in fact, some are necessary for health and even life. For example, if a patient has been taking antibiotics for several weeks, their blood clotting may be seriously impaired. This is because vitamin K is manufactured in the gut by bacteria, which are killed off by antibiotics.

Antibiotics have another undesirable effect on bacteria in the gut. The bacteria which are sensitive to that antibiotic are killed off and this leaves room for more dangerous bacteria, which are resistant to the antibiotic, to take up residence. My professor of surgery had a theory, which I have not seen proven, that harmless bacteria are the best adapted for life in the gut. If they are killed off by antibiotics and replaced by pathogenic organisms, removal of the antibiotics will allow the harmless organisms to reestablish themselves, displacing the pathogenic strains. I saw evidence of this in his and my own patients.

He kept a pure culture of Escherichia coli, a common colon bacterium, in the hospital lab. This strain was sensitive to all antibiotics so would be quickly killed off in their presence. Many of his elective surgery patients would come in for surgery with highly antibiotic resistant organisms in their colon. This was because they had been taking antibiotics, usually for diverticulitis. If these patients developed an infection postop, most common antibiotics would be useless. What he did was to stop all antibiotics and give the patient a dose of the lab E. coli in a malted milkshake. On admission, we would take a culture of the patient’s stool and have the lab check sensitivity to the common antibiotics. Usually, we found that the stool organisms were resistant. A couple of days after the dose of sensitive E coli had been given (I never asked the patients if they knew what was in the milkshake), the stool culture was checked again. In almost all cases, we found that the resistant organisms had been replaced by sensitive ones.

The residents at the County Hospital used a variant of this method on elective colon surgery patients. Since the lab was not about to keep a culture of sensitive organisms for us, we used an alternate source for them. Patients coming in for simple surgeries, like hernia repairs, who had not been on antibiotics and who had not been around hospitals, had a stool sample taken. That stool specimen was mixed with a malted milkshake and given to the colon surgery patients. Needless to say, they were not told the contents of the milkshake. We were less able to test the effect because the labs were very uncooperative with any of these exotic concepts. Still, I think it worked although we now know that the bowel flora is actually not what we thought it was in the 1960s. The anerobic organisms, like Clostridia, were not well understood and Bacteroides had not been discovered. It is now known that 90% of colon organisms are anerobic, meaning they cannot survive in an oxygen containing atmosphere. Many species have not been discovered because they cannot be cultured. They also produce nutrients, like fatty acids, that are essential for the health of the colon mucosa. There is even a disease called “diversion colitis” that is due to diversion of the fecal stream, by a colostomy usually, from the lower colon.

Why am I bringing up these old war stories ? There is a lot of interest right now in how colon bacteria affect normal health. Irritable Bowel Syndrome is much in the health news. There is a theory that it is caused by bacteria in the bowel that produce too much gas and cause other irritating conditions.

Researchers have built a strong case that bacteria may be the actual culprit. Mark Pimentel, M.D., a colleague of mine at Cedars-Sinai Medical Center who heads the GI Motility Program, has spent the last decade studying IBS, specifically the role bacteria may play in causing the condition. He and his colleagues unveiled the results of a large clinical study during Digestive Disease Week earlier this year in New Orleans. This study showed an antibiotic is effective in providing long term relief of IBS symptoms – excellent news for a large number of IBS sufferers.

If an antibiotic is helpful, what about other bacteria that may not cause the irritation ? WE hear a lot the past few years about “probiotics” on the radio. What are they ?

Our bodies are a complicated ecosystem full of flora. In fact, the bacteria outnumber our own cells by 10 times. There are around 10 trillion cells that make up the human body, and we have around 100 trillion bacteria cells in our digestive tracts.

As more people become increasingly aware of the importance of this “good bacteria,” hundreds of products in recent years have attempted to catch our eye by promising to help our troubled stomachs. Probiotics, defined as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host,” have become a big business. During a casual flip through the television channels, I frequently encounter commercials filled with attractive women gushing that their digestion has never been more regular thanks to certain yogurts or other products.

There may be something to some of those claims.

Probiotics include both yeastlike members of the saccharomyces group and teria, which usually come from two groups: Lactobacillus or Bifidobacterium. Probiotics are sold as capsules, tablets and powders, as well as in a growing number of foods. Among them, yogurt, yogurt drinks, kefir, miso, tempeh, as well as some juices and soy beverages. Sometimes the bacteria were present originally, and sometimes they are added during the preparation of the foods.

I have for many years prescribed yogurt and lactobacillus containing milk, available in the supermarket, for my patients recovering from conditions in which they took antibiotics.

Despite its narrow range of participants, the study confirmed that probiotic yogurt aided many of those involved. “We have shown that simply giving a probiotic drink to elderly patients who are prescribed antibiotics reduces their risk of getting diarrhea,” says Mary Hickson, a research dietician at Imperial College in London and the lead author of the study.

Gastrointestinal illness is a common side effect in an antibiotic’s battle against bacterial infection. Antibiotics don’t just go after the bad guys — they also kill some of the beneficial or neutral place-holding flora in our digestive tracts. This collateral damage allows deleterious organisms to establish themselves, often inflicting abdominal distress and discomfort as a result. Yogurt, like other “probiotic” foods, helps to promotes the growth of favorable bacteria in our digestive tracts. These microorganisms assist us in absorbing nutrients from our food and also occupy valuable real estate so that pathogens cannot proliferate and make us sick.

It’s nice to see the theory catch up with practices that I and others have been using for 40 years. Those patients who got the fecal milkshakes never knew how advanced the therapy they were getting really was.

The crisis of the intellectual

Saturday, December 11th, 2010

I was directed to an excellent post by Walter Russell Mead today. It is on the subject of the American social model and the coming era of tumultuous social unrest as the old welfare state model collapses. Europe is already seeing this collapse as nations like Greece face bankruptcy and England deals with the consequences of severe cutbacks in social spending to avoid it.

The US is facing similar economic consequences if the level of spending is not addressed soon. The 2010 elections show that the people recognize the crisis but the “political class” seems less concerned.

“It’s telling to note that while 65% of mainstream voters believe cutting spending is more important, 72% of the Political Class say the primary emphasis should be on deficit reduction,” Rasmussen said.

“Deficit reduction” is code for raising taxes. Spending is heavily embedded in the culture of the political class.

Mead is concerned that the intellectual demographic, those with advanced degrees and careers denominated by thinking rather than doing, is unable to cope with the new situation.

There’s a lot of work ahead to enable the United States to meet the coming challenges. I’m reasonably confident that we remain the best placed large society on earth to make the right moves. Our culture of enterprise and risk-taking is still strong; a critical mass of Americans still have the values and the characteristics that helped us overcome the challenges of the last two hundred years.

But when I look at the problems we face, I worry. It’s not just that some of our cultural strengths are eroding as both the financial and intellectual elites rush to shed many of the values that made the country great. And it’s not the deficit: we can and will deal with that if we get our policies and politics right. And it’s certainly not the international competition: our geopolitical advantages remain overwhelming and China, India and the EU all face challenges even more daunting than ours and they lack our long tradition of successful, radical but peaceful reform and renewal.

No, what worries me most today is the state of the people who should be the natural leaders of the next American transformation: our intellectuals and professionals. Not all of them, I hasten to say: the United States is still rich in great scholars and daring thinkers. A few of them even blog.

His concern is that the intellectuals seem caught in a mind set that goes back to the 19th century and the Progressive Era.

Since the late nineteenth century most intellectuals have identified progress with the advance of the bureaucratic, redistributionist and administrative state. The government, guided by credentialed intellectuals with scientific training and values, would lead society through the economic and political perils of the day. An ever more powerful state would play an ever larger role in achieving ever greater degrees of affluence and stability for the population at large, redistributing wealth to provide basic sustenance and justice to the poor. The social mission of intellectuals was to build political support for the development of the new order, to provide enlightened guidance based on rational and scientific thought to policymakers, to administer the state through a merit based civil service, and to train new generations of managers and administrators.

It’s interesting that one of the comments, a lengthy one, exactly restates this issue but supports this model and argues with Mead that it is still superior.

Second, there are the related questions of interest and class. Most intellectuals today still live in a guild economy. The learned professions – lawyers, doctors, university professors, the clergy of most mainline denominations, and (aspirationally anyway) school teachers and journalists – are organized in modern day versions of the medieval guilds. Membership in the guilds is restricted, and the self-regulated guilds do their best to uphold an ideal of service and fairness and also to defend the economic interests of the members. The culture and structure of the learned professions shape the world view of most American intellectuals today, but high on the list of necessary changes our society must make is the restructuring and in many cases the destruction of the guilds. Just as the industrial revolution broke up the manufacturing guilds, the information revolution today is breaking up the knowledge guilds.

He goes on to criticize medicine as a guild but I think he is unaware of the rapid changes going on in medicine today. The image of the family GP is quickly shifting to the multispecialty group with primary care provided by nurse practitioners and physician assistants. Those who want a personal relationship with a primary care physician, or even a favored specialist, will increasingly be required to pay cash for the privilege as many doctors who want to continue this model of practice are dropping out of insurance and Medicare contracts because of the micromanagement and poor reimbursement.

In most of our learned professions and knowledge guilds today, promotion is linked to the needs and aspirations of the guild rather than to society at large. Promotion in the academy is almost universally linked to the production of ever more specialized, theory-rich (and, outside the natural sciences, too often application-poor) texts, pulling the discourse in one discipline after another into increasingly self-referential black holes. We suffer from ‘runaway guilds’: costs skyrocket in medicine, the civil service, education and the law in part because the imperatives of the guilds and the interests of their members too often triumph over the needs and interests of the wider society.

Almost everywhere one looks in American intellectual institutions there is a hypertrophy of the theoretical, galloping credentialism and a withering of the real. In literature, critics and theoreticians erect increasingly complex structures of interpretation and reflection – while the general audience for good literature diminishes from year to year. We are moving towards a society in which a tiny but very well credentialed minority obsessively produces arcane and self referential (but carefully peer reviewed) theory about texts that nobody reads.

Once again, costs in medicine are a subject by themselves but the solution does not lie in controlling doctors incomes. With respect to the academic institutions, I have personal experience here and will describe some of it. The Humanities have been hollowed out by a trend to both politicize and to leave the subject behind as “critical thinking” goes on to analysis that has little to do with it. The Sokol Hoax is but one example.

The Sokal affair (also known as Sokal’s hoax) was a publishing hoax perpetrated by Alan Sokal, a physics professor at New York University. In 1996, Sokal submitted an article to Social Text, an academic journal of postmodern cultural studies. The submission was an experiment to test the magazine’s intellectual rigor and, specifically, to learn if such a journal would “publish an article liberally salted with nonsense if it (a) sounded good and (b) flattered the editors’ ideological preconceptions.”[1]

The hoax precipitated a furor but did not result in much improvement in such publications. My daughter had personal experience when her freshman courses in English Composition and American History Since 1877 both contained numerous examples of political and “social justice” alteration of the subject matter. For example, she was taught that the pioneers in the west survived by “learning to live like the Native Americans.” The fact is that the pioneers were mostly farmers and ranchers and the Native American tribes of the southwest were hunter gatherer societies who did not use agriculture or animal husbandry. She was also taught that the “Silent Majority” of the 1960s were white people who rejected the Civil Rights Act of 1964. Thus they were racists. Even Wikipedia, no conservative source, disagrees:

The term was popularized (though not first used) by U.S. President Richard Nixon in a November 3, 1969, speech in which he said, “And so tonight—to you, the great silent majority of my fellow Americans—I ask for your support.”[1] In this usage it referred to those Americans who did not join in the large demonstrations against the Vietnam War at the time, who did not join in the counterculture, and who did not participate in public discourse. Nixon along with many others saw this group as being overshadowed in the media by the more vocal minority.

She has since transferred to another college.

The foundational assumptions of American intellectuals as a group are firmly based on the assumptions of the progressive state and the Blue Social Model. Those who run our government agencies, our universities, our foundations, our mainstream media outlets and other key institutions cannot at this point look the future in the face. The world is moving in ways so opposed to their most hallowed assumptions that they simply cannot make sense of it. They resist blindly and uncreatively and, unable to appreciate the extraordinary prospects for human liberation that this change can bring, they are incapable of creative and innovative response.

I think this is the source of the “media bias” so prominently referred to by the Right and by many who are not politically focused. This is why talk radio and Fox News have been such huge successes to the consternation of the political class and their supporters. Charles Krauthammer famously said, “Rupert Murdoch (owner of Fox News) found a niche market that contained 50% of the population.”

The Tea Parties are another manifestation of the frustration of the general population with the political class but also with the intellectual class that seems to be wedded to the first. The university community is, at least in the non-science segment of it, to be increasingly isolated from the concerns of the society that supports them. CalTech has for many years had a Humanities program to expose science and engineering students to culture. Unfortunately, a student in a large university will find much less culture and much more politics in Humanities departments these days.

A couple of other blog posts are worth reading on this subject. One is here and the other is here. They are both worth reading in full.