The journals: My monthly potpourri

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How often do doctors make an error in diagnosis? Take a guess. That’s the first issue in today’s look into the medical and scientific literature.

  1. A medical error rate of 10 to 15 percent is considered average, but there are variances among specialties and diagnoses, The New England Journal of Medicine reported in June. Diagnosing pulmonary emboli has an estimated 55 percent error rate.

There are biases built into the human brain. We process information in two general ways, commonly called intuitive and analytic. The first type uses “blink” diagnoses. Those are especially error prone.

In life and on television, these add to showmanship that needs to be controlled when the goal is a matter of health or calculating the trajectory of a spacecraft.

  1. The Intergovernmental Panel on Climate Change, established by the United Nations and World Meteorological Organization, is generally regarded as the leading assembly of experts on the subject. Thousands of scientists from 175 countries evaluate data and review each other’s work.

The latest report confirms the seriousness of climate change and the probability it is largely man-made.

Optimistic estimates of ocean rise in this century, assume a rapid response and mitigation. It would limit the rise to 8 inches, enough to cause severe beach erosion.

Assuming a continued rapid rise in emissions, the estimates of 2 to 3 feet will cause flooding of coastal cities.

I claim no expertise and I allow that researchers can be wrong and even dishonest. I seldom hear much from the public, other than emotional opinions. To suggest that we are responsible to be better informed is one of those arguments best handled on another page.

I’m offering what I consider to be the most reliable and current information.

  1. The Journal of the American Medical Association recommended against injection therapy for chronic low back pain. Injecting steroids and painkillers in patients with nerve root symptoms and pinched nerves proved less effective than controls over a four-year follow up.

A team from the University of Washington reviewed eight studies of injecting steroids into the area around the spinal cord and nerves arising from it, the epidural space. Some patients get relief, but it tends to last only for weeks.

  1. Popular Science ran an interesting article in August. Three-dimensional printing has grown to a $2.7 billion industry. Instead of spraying ink on a page, various materials can be layered to make 3-D structures.

Small human cells are about the size of inkjet droplets.

The first work was actually done with an old inkjet printer. It was shown that human tissue can be built up in layers. There is hope that blood vessels and other simple structures might be made in the near future.

Making an organ, with many kinds of cells, seems a long way off.

  1. Popular Science also adds some humor to a report on a serious problem with an important, weird-sounding therapy.

A type of diarrhea called clostridium difficile is linked to 14,000 U.S. deaths per year and the disease has become more resistant to antibiotics. A 2012 study achieved 92 percent effectiveness in treating 26 patients with antibiotic-resistant c. difficile.

The therapy involved instilling uncontaminated feces from healthy individuals into patients through a colonoscope.

The piece in Popular Science covered the work of a Canadian researcher who grows colonies from small amounts of feces. Maybe her fake-poop project will produce a more specific and more acceptable alternative — maybe not.

In 1960, my professors pleaded that we restrict our use of antibiotics. It never happened. Patients come with an expectation they’ll get pills or shots. Advertisements tout the value of medicines and high-tech machines. Doctors generally give in.

At least, there’s plenty of poop to go around.

  1. In the July edition of Science I read about the kind of dishonest research report that makes people wonder what to believe. It lends support to those who challenge all of the sciences.

A Kyoto university team published false reports on the antihypertension drug Valsartan. A Swiss company promoted it under the name Diovan, and it became Japan’s best-selling drug as well as a product with a worldwide market.

It took a few years, but the data was challenged in two British journals. An investigation revealed researchers changed data from patient records before putting them into the database, and that the lead researcher received $1.4 million from drugmaker Novartis.

Novartis responded that the problem resulted from “a lack of guidelines and a misunderstanding ...”

My take? Drug companies and equipment manufacturers offered to bring lunch for my staff meetings and invited me to take vacations, posed as educational programs.

I accepted no free meals and only one trip, because I was a speaker at that one.

Most major institutions in the U.S. have made rules to restrict such behavior. Our federal government has tighter rules than Japan has had in the past.

Future changes are expected as part of the new health program. Outcome-based reporting should help a great deal.

The role of government regulation will always be a good news-bad news situation, but the pressure of big money needs to be addressed.

A researcher may benefit in many ways from money that goes to his/her university. Bonuses or promotions are powerful incentives and being fired for being underfunded is even more so.

In my field, radiation equipment can cost anywhere from millions to hundreds of millions of dollars. I’ve had the pleasure of working with a company that has high standards, but there is always a free lunch available for the asking.

We don’t have to indict all of medical research to conclude that only a small number of departments need to bend to pressure to see the launch of ineffective and dangerous treatments on the market.

There are sure to be more Kyoto debacles. Remember that the system worked to flesh them out.

Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at amazon.com and other online book retailers. He can be reached at mulkerin@charter.net.

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