A Short History of Thorazine.

Wow. This ad is almost as controversial as the drug it promotes, and that’s a feat. Unlike the other banned ads, this isn’t just showcasing out-dated values— it’s advertising the beginning of a mental health revolution. 

Considered a breakthrough medication, Thorazine secured FDA approval on March 26, 1954 as the first psychiatric medication. Prior to Thorazine’s inception, mental illnesses were treated with psycho- and electroshock therapies and institutionalization. The lobotomy was also popular (its inventor, Egaz Moniz, received the 1941 Nobel Prize in Medicine).

Change came when psychiatry finally crossed paths with the rest of medicine. Following in the footsteps of Paul Ehrlich, a German scientist who discovered a cure for syphilis, researchers all over the world were looking for compounds— “magic bullets”— to cure other diseases that plagued humanity.

Thorazine, generic name Chlorpromazine, was the result of researchers in France trying to find a “magic bullet” for malaria. Instead, they found a sedative thought to be potentially useful in surgery. They also discovered that it produced “a medicinal lobotomy.”

And why do with surgery what you could do with drugs?

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The Great Canadian Foreskin Debate.

While Americans are debating the legality of offering all of their citizens access to health insurance, Canadians are trying to make their (universal) medical care a little more humane.

Specifically, whether or not it is okay to circumcise male infants.

Though female circumcision is usually the trending topic in genital welfare debates, a growing number of parents are choosing not to circumcise their sons, and some are even suggesting the practice be outlawed.

Referred to as “intactivists,” the people calling for a ban are asking if infants should be subjected to a medical procedure when they are too young to consent.  Which begs the question: does it provide any medical benefits?

Male circumcision is currently being promoted in Africa as a means of fighting HIV transmission, and a recent study in the Lancet found that circumcision reduces transmission of HPV, a virus links to genital warts and cervical cancer. At the same time, a 2010 study found that circumcision outside of Sub-Saharan Africa offered little benefit. In addition the both the Canadian Pediatric Society and the American Academy of Pediatrics no longer recommend the procedure because it is not medically necessary.

Whether slightly reduced HPV transmission rates are a benefit to male circumcision may not matter anyway. There are many other less invasive, irreversible ways to control HPV than lopping off part of an infant’s penis.

For those of you brave enough to see how the procedure is done, click here.

To see the discussion, click here.

 

Will They Or Won’t They?

A second federal court judge ruled today that the healthcare law violates the constitution. The problematic provision? It requires all Americans to obtain commercial insurance, the New York Times reports.

It’s the latest development in the melodrama of universal healthcare in United States, a country that can grow organs but can’t decide if basic health insurance is really something everyone should have.

Stay tuned.

HIV Preferable to Diabetes.

Did you know that doctors are learning how to re-grow body parts? It’s true. Not even just bladders and tracheas (as seen on Grey’s Anatomy), but finger tips and nails too. But are these kind of medical advances really what we should be spending our time on? I mean, we barely know how to feed ourselves.

This was the topic of debate this past Saturday at the Harvard Business School’s 8th Annual Healthcare Conference.

The conference kicked off with a keynote address from Robert Epstein, the Chief Medical Officer at Medco, who trumpeted regenerative medicine as one of the four “amazing innovations in science that hold the promise of true healthcare reform,” along with genetics, epigenetics, and stem cell therapies

But Epstein’s assertion that these breakthroughs will help bend the cost curve down was disputed in the very next panel. Larry Fitzgerald, the chief financial officer of the University of Virginia Medical Center, thinks those types of innovations will bring the cost curve up, because they extend life rather than eliminate disease.

“Instead of having neurological problems at age 80, we’re going to have them at age 95 or 100,” he said during the Health IT panel discussion. “We’re still going to have them.”

And so emerged the topic of the day: instead of sinking our resources into ground-breaking innovation, we should be concentrating on preventative medicine and behavioural changes?

According to the U.S. State Department, chronic diseases such as obesity and diabetes account for seven out of every ten deaths in the U.S. and are projected to cause the majority of deaths worldwide by 2020, outstripping infectious diseases such as malaria and HIV/AIDS.

This topic dominated the global health panel, since treating chronic diseases will be a new challenge to the healthcare non-profits, the majority of which currently address infectious diseases.

“We have patients in Sub-Saharan Africa who say they would rather HIV than diabetes, because they can get treatment for HIV,” said Epidemiologist and panelist Todd Reid.

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How Stories Save Lives.

I recently started reading a new medical memoir, White Coat, by Ellen Lerner Rothman. I know, it’s surprising that I would continue to read what doctors have to say after the last memoir, but 45 pages in, Rothman has already caught my eye.

Rothman is another Harvard Medical School student, and in the chapter about her first year, she writes about her class’ obsession with ER. Why the attraction to ER over the many other medical dramas?

It was written in part by Neal Baer, who was a third-year medical student at Harvard at the time.

I have seen Baer speak at Harvard twice in the past year, and he is excellent, partly because he is so passionate about public health education, and partly because he uses accurate story lines on his TV show to educate people. It is for these reasons that Baer became the subject of my first ever blog post:

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The Scientific Temper.

Does better science education create more rational human beings? Bruce Alberts thinks so.

For those of you not in the know, Bruce Alberts is the editor-in-chief of Science and a former president of the National Academy of Sciences. On Thursday Alberts spoke at Harvard University, his alma mater (where he both went to college and earned his Ph.D.), explaining why and how science education in America needs to change.

People stood in the back of the room and sat in the stairwells of the lecture hall, while Alberts explained how in 1996, while he was president, the Academy released a set of science education standards that sought to put the emphasis on abstract thinking and active inquiry.

The plan outlined experiments for even children as young as five. For example, the children could put on clean white socks and walk around in the school yard, collecting dirt and seed on their socks like animals do on their fur. Back in the classroom, they could then try and separate what they thought were seeds from what they thought was dirt, using inexpensive plastic microscopes. To test their hypotheses, the kids could plant both the seeds and the dirt to see which grew.

Unfortunately, what happened next Alberts refers to as a “disaster.” The states all chose different parts of the 1996 standards to adopt, and most of what was left out was the focus on abstract thinking and active learning. Instead, students’ science education focuses on memorization and word recognition.

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Drugs Don’t Help.

Tracy Kidder

“It hurt his feelings prematurely,”said journalist Tracy Kidder, trying to recover from his admission that he read sections of his unpublished work to one of his subjects, including the part that described the subject as the kind of guy who threw like a girl.

The subject, was understandably hurt by this description. Kidder was hurt that the subject had to find out directly from him, instead after the book was published.

Kidder came to speak at Harvard last week, and just when you are thinking that this post is going to have nothing to do with healthcare, let me remind you that Kidder is a journalist and one of his most famous books chronicles the life of Dr. Paul Farmer.

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