Medical Journeys

Posts Tagged ‘national institutes of health’

This may sound like a silly question, everyone knows what disease is. But have we ever bothered to define disease, or health for that matter. Right now, in the United States, there is an enormous political debate about “health care delivery” which is, at least ostensibly, about improving the health of the citizens. Is “health” though a commodity which can be delivered by government? Throughout the world, governments have enormous bureaucracies and departments tasked with addressing health and disease such as the National Institutes of Health and the Centers for Disease Control. The US Food and Drug Administration by some estimates regulates some one sixth of the US economy, when it approves a drug it does so based from clinical trials which are intended to show a drug is both safe and effective against a particular disease. So again, why don’t we start at the very beginning and ask just what is disease? When you think about it for a while you begin to realize that, like defining “life”, it is not at all easy to define health or disease.

For example, what a healthy 20 year old and a healthy 80 year old can do are generally much different. If a twenty year old could not run a mile one would worry about disease, if an eighty year old could run a mile we would be impressed. If one has a broken leg, while one is not healthy, I don’t know of any culture that would call them diseased. So, it is not simply diminishment, or even loss of function or ability which defines disease. If the same individual however, had a broken leg not from falling off a ladder but as a consequence of cancer or a genetic condition, then we likely would speak of them as having disease. How about a patient who has recovered from cancer, at what point is the disease no longer “in remission” but instead the person is free of disease? What about carriers of infectious disease such as “typhoid Mary” or someone who doesn’t realize they have tuberculosis, do they themselves have disease? Suppose Typhoid Mary was a hermit who never interacted with others, do they have disease at that point? What about someone with latent or inactive tuberculosis (this is some one third of the world population), they have no effects from tuberculosis, they are not contagious to others, yet, they may have a walled off cyst of live tuberculosis bacteria somewhere in their lungs.

Medical practitioners speak of the “signs” and “symptoms” of disease. The signs of disease are those changes appreciable to the senses which indicate disease. So, for instance, a fever is a sign of disease, the crackles and wheezes heard through a stethoscope are signs of disease. These signs of disease are investigated in the physical exam and other diagnostic tests which may be ordered. The symptoms of disease on the other hand are what the patient is experiencing. So a patient may say, I feel chills, when the physical exam finds a fever, or I am coughing a lot when the exam hears wheezes in the lungs and the x-ray shows a picture of a fluid filled lung, or a child may say that their ear hurts and looking at the ear with an otoscope the nurse or doctor sees an inflamed middle ear. Sometimes, the patient will have symptoms of disease, when no signs of disease can be found, so for instance the patient says, I have a headache and after an exam turns up nothing unusual the doctor says take two aspirin and call me in the morning. Other times there can be signs of disease but no symptoms, so a patient may go for an annual physical and though they feel healthy are told your blood sugar level is very high, you may have diabetes.

I wanted to start with this philosophical look at disease so as to present two arguments. First, Western Medicine generally does a good job treating disease and second most of what Western Medicine does is not treatment of disease. The first point could be argued at length, I would just ask if you had a serious acute disease, say an appendicitis, where would you want it treated? The second point requires some more discussion to be taken seriously. To do this we need to introduce some more medical terminology. A “risk factor” for a disease is something which is believed to place someone at increased risk for a disease. These risk factors may either be something which can’t be changed, such as family history, gender, or presence of a particular gene, or ones which can be changed such as the habit of smoking or having high blood pressure.

These second type of risk factors are called “modifiable risk factors” and over the past half a century a tremendous amount of effort has been placed on attempting to change “modifiable risk factors” so that disease doesn’t occur in the first place. While this is a noble goal, it is also one that is more “risky” than simply treating a disease for a number of reasons. You see, by any definition, someone who only has a risk factor for a particular disease, does not have the disease, therefore whatever “medicine” you are giving is not being given to treat disease it is being given to a healthy person. All medicines carry with them a certain degree of risk and it is a whole different proposition to be giving medicine to a healthy person than to a sick person. If one was diagnosed with an incurable cancer and was told a drug would give them a 50% chance of a cure but would triple their risk of a heart attack or increase their chance of having leukemia in later life they likely wouldn’t give a second thought to taking the drug. If one the other hand, someone was in good health and was told that a drug would give them a 50% less chance of ever developing the cancer but it would triple their risk of heart attack it is an entirely different situation. If instead of preventing the cancer, the drug instead only prevents heartburn or joint pain and has no effect on risk of or progression of disease the risk/benefit scenario is even further skewed away from wanting to take the medicine.

When you give medicine to a sick person it is generally for a very limited period of time, i.e. until they get better. If you rely on a medicine to change a risk factor for disease they may be on it their whole lives. This again greatly increases the possibility of a serious side effect to occur from the medicine. The number of people with a risk factor for a disease will also be much larger than the number of people with the actual disease. This means the number of people on the medicine will be very large and even rare serious side effects may end up affecting a large number of people. Moreover, for any one disease, there may be multiple modifiable risk factors which might be treated pharmacologically. So as is often the case, someone in perfect health may be on multiple medicines to treat various risk factors for disease.

This again increases the possibility of interactions between the various medicines leading to an adverse event. Finally, it is much more difficult to study and determine with any confidence whether treating someone with a risk factor for disease is actually improving their long term health. For one, only a small percentage of the people with a risk factor for disease would be expected to develop the disease so the numbers involved to find any sort of possible difference between treated and untreated groups must be very large. Secondly, the studies must be very long term, over years or decades even to begin to get an idea of who might develop disease. Because of these logistical problems there won’t be a large number of confirmatory studies, and as with any other scientific study one must be concerned about the possibility of bias, especially if one is only relying on a small number of studies. Even if one does improve the risk for developing a disease has one improved overall health. As has often been the case only after a drug has been approved and been given to millions of people does it become apparent that the damage outweighs any benefit.

Tomorrow we will look more into the issue of giving medicine to healthy people as well as the related issue of treating the symptoms of a disease without treating the disease itself and conclude with a modest proposal for how to change the drug review process.

Author: Paul D Maher
Article Source: EzineArticles.com
Provided by: Cellphone news

According to studies and surveys performed by the National Institutes of Health, many patients are unhappy with conventional Crohns disease treatment and more than half seek alternatives. Crohns disease symptoms are difficult to live with and affect the quality of a persons life, so it is understandable that those who suffer from the condition would seek alternatives, when traditional therapies are ineffective or cause unwanted side effects.

Crohns disease treatment depends primarily on the severity of symptoms. Crohns disease symptoms may include abdominal pain, diarrhea, loss of appetite and weight loss. The primary Crohns disease symptoms may lead to complications including abscesses, ulceration of the deepest layers of the lining of the digestive tract or abnormal openings, called fistulas, in the intestine. There may be intestinal bleeding and that combined with recurrent diarrhea are Crohns disease symptoms that may lead to vitamin deficiencies, malnourishment and anemia.

Initially Crohns disease treatment may include an anti-diarrhea medication such as Imodium A-D, an over the counter product that is designed to stop diarrhea and reduce abdominal pain. When Crohns disease symptoms are moderate to mild, aminosalicylates or corticosteroids may be prescribed. If neither of these is effective or if stopping corticosteroids causes symptoms to return then Crohns disease treatment may include prescription medications that suppress the immune system.

The theory behind Crohns disease treatment plans to suppress the immune system stems from the fact that inflammation is present. Crohns and ulcerative colitis are known as inflammatory bowel diseases and the belief is that the immune system overreacts to bacteria that normally lives in the bowel and attacks it in the way that it would normally attack invading bacteria or infection. It is believed that Crohns disease symptoms may be caused by this dysfunction of the immune system, since inflammation is present, but not infection.

Non-steroidal anti-inflammatory drugs, such as ibuprofen, are not normally included in Crohns disease treatment, because they have been linked in clinical studies to flare-ups and worsening of Crohns disease symptoms. Thus corticosteroids are the most common choice of Crohns disease treatment to control inflammation. Corticosteroids are not safe for long term Crohns disease treatment or for the treatment of any disease, because they have serious side effects including high blood pressure, osteoporosis and increased risk of infection. When used for extended periods of time, some people become steroid dependent, even though they become ineffective after long term use and Crohns disease symptoms return.

When a Crohns disease treatment plan includes medications to suppress the immune system and control inflammation in that way, there is a greater risk of infection. Obviously if the immune system is suppressed, it cannot fight infection effectively. In addition, there is a greater risk of cancer, because the immune system normally attacks and destroys abnormal cells that if left unchecked may eventually become cancer cells.

Aminosalicylates relieve Crohns disease symptoms in some cases, but cannot be used by certain people and may reduce white blood cell counts; once again, lowering a persons resistance to other infections and diseases by impairing the immune system. Prescription medications for Crohns disease treatment are obviously lacking, both in effectiveness and safety. Scientists continue to research new drugs for Crohns disease treatment.

When Crohns disease symptoms are severe, surgery may be recommended to remove the affected portions of the bowel. This choice for Crohns disease treatment is extreme and is understandably avoided by most patients. However, those who have had surgery no longer suffer from Crohns disease symptoms. There are numerous support groups both for people who are considering surgery for Crohns disease treatment and for those who have had surgery, since certain adjustments and lifestyle changes may be necessary at least initially. Most people who have had surgery for Crohns disease treatment report that they are able to lead normal lives and that the relief of Crohns disease symptoms has improved their quality of life.

A recent study (August, 2006) found that 52% of the time, Crohns disease treatment was inappropriate. This was a group of gastroenterologists, surgeons and general practitioners evaluating the prescribed Crohns disease treatment plans of their colleagues. For those who suffer from Crohns disease symptoms, this may be discouraging news. Many people choose self-treatment with aloe, slippery elm or other botanicals. While the effectiveness of these natural products has not been proven, there is evidence of traditional use as digestive aids, which suggests that they may be effective for Crohns disease treatment and the relief of Crohns disease symptoms.

Aloe, in particular, has been scientifically proven to be a natural anti-inflammatory. Many researchers, doctors and scientists believe that natural anti-inflammatories may be gentler to the body, safer overall and more effective, because they target several inflammatory responses; synthetic anti-inflammatories may target only one molecule. Natural anti-inflammatories do not hamper the immune system, as do prescription anti-inflammatories for Crohns disease treatment.

Relieving inflammation can relieve Crohns disease symptoms. While decisions about Crohns disease treatment are a personal choice, those who suffer from the disease should advise their doctor about natural products they are using, particularly when using prescription medications at the same time. Botanicals and herbals have been known to interact with prescription medications typically used in Crohns disease treatment. For more information about natural products that may be useful for the relief of Crohns disease symptoms, visit www.digestive-disorders-guide.com.

Author: Patsy Hamilton
Article Source: EzineArticles.com
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