Better Lucky Than Good

thedisgruntledgradstudent:

PhDork, if you don’t want me to link to this, let me know, and I will take it down. I figured that was more polite than reblogging.

I think that it’s important to understand that there are a number of different methods of talk therapy, that they are not all equally effective, and that some of them work better for some people than others. I can only give a quick overview of the 3 main types here (6am rounds tomorrow), but I can describe them in detail if anyone is interested.

Psychoanalytic therapy: What most people think of when they think of therapy. Couches and Freud and questions about you childhood. I actually know the least about this kind of therapy because it’s not really practiced by medical doctors (aka psychiatrists) anymore. Also, of note, it has never been demonstrated to be of benefit in controlled clinical trials.

Psychodynamic therapy: This is probably what the above poster is describing and is in some ways the modern descendant of psychoanalytic therapy. It is predicated on the theory that if the patient can understand the internal source of their negative thoughts and feelings then they will be better able to cope with them during daily life. It is frequently described as “insight-based.” It is about as effective as SSRI antidepressants in controlled clinical trials but the effects aren’t durable (do not persist after therapy has been discontinued). Therefore, it is usually conducted at low frequency (1-2x per month) for long periods of time (years).

Cognitive Behavioral Therapy: Developed by Aaron Beck in the 1960’s and the first form of talk therapy to demonstrate benefit in controlled clinical trials. It is predicated on the theory that thoughts and feelings are behaviors just like any other and that they can be influenced consciously. It does not chase after sources these thoughts and feelings and instead focuses on developing mental techniques to recognize them and deal with them effectively. As a result, the sessions are highly interactive with the therapist doing much of the talking. It is also about as effective as SSRI antidepressants (and probably synergistic if used concurrently, though that study has not been published yet) and the effects have been found to be durable. For this reason, therapy sessions tend to be frequent (several times per week) and treatment is limited in duration (typically a month or two).

Again, sorry that this was so brief and simplistic. I can provide citations for anyone who is interested (or appropriately skeptical about scientific studies of qualitative patient experiences).

thedisgruntledgradstudent:

betterluckythangood replied to your post: lickystickypickywe replied to your post: This is…

Uh, I’m still a couple of years away from being a doctor, but I’m pretty sure that you can’t get an air embolism from blowing into the vagina.

BetterLucky is ruining Wikipedia’s scare tactics.

Maybe they mean with an air compressor or something equally violent like that?

So I’m going to have to retract/heavily qualify that last statement. A quick literature search turned up some case reports like this gem from 1993 (the most recent case report): “Venous air embolism following orogenital sex during pregnancy.” (http://www.ncbi.nlm.nih.gov/pubmed/8476458). Apparently, late in pregnancy and following certain types of life-threatening trauma, the inferior uterine venous plexus becomes dilated enough to absorb non-trivial amounts of air, should it be injected in large quantities and at high pressures. Of note, this is incredibly rare, but I’m still forced to upgrade it from “Nearly Impossible” to “Extremely Difficult.”

The Blind Assassin

I need some reading advice and I think that this might be the best place to ask. I’m finally ascending from the abyssal plain of my Core Clerkship year and I’m finding myself with some reading time. Before med school completely consumed my life, I was about half-way through “The Blind Assassin” by Margaret Atwood. It came highly recommended and garnered a ton of positive literary reviews. I ended up putting it down about half-way through (a rare thing for me) because of the ~250 pages that I had read, about 200 of them were devoted to extensive descriptions of food, flowers, and clothing, ~25 to a painfully allegorical (though entertaining) story-within-a-story, and about 25 pages of Things Happening, after which seemed it pretty clear to me what the Twist and the Counter Twist are going to be. So, my question is, for those of you who’ve read it, does everything wrap up into a crazy Reverse Double Counter Twist that totally justifies another 200 pages of skirt pleats and azalea arrangements and strawberry tarts, or should I just read the plot summary on Wikipedia and be done with it?

Cancer Vaccines

thedisgruntledgradstudent:

I know I’m not a doctor or medical researcher of any kind, but the idea of finding a vaccine for cancer just sounds like a long chase for a wild goose. It just doesn’t make sense. How could a vaccine stop cells from random, uncontrolled mutations?

The word “vaccine” might be a little confusing in this context because most of us are familiar with the use of vaccines for primary prevention (i.e. we give it to you before you get sick to prevent you from getting sick) of infectious diseases. This makes it reasonable to assume that a “cancer vaccine” is something that we would give to people for the primary prevention of cancer. In fact, the word “vaccine” actually refers to a collection of biochemical techniques that allow us to convince a person’s immune system that certain small organic organic molecules are Bad News and that the associated cells should be terminated with extreme prejudice. As I’m sure that you can imagine, recruiting the patient’s immune system to give us a hand with the patient’s cancer is a very attractive idea. Thus, “cancer vaccines” are, in fact, being designed to assist in the treatment of people who already have cancer (i.e. secondary prevention).

Convincing the human immune system to really bring the pain is (conceptually, at least) relatively straight-forward with viruses and most bacterial, as they produce somewhere between dozens to thousands of proteins that are never expressed by any human cell.  These foreign proteins are readily identifiable as Bad News and the associated cells can be killed with minimal collateral damage. Cancer cells are derived from the body’s own tissue, though, so a vast majority of the proteins that they produce are just normal human proteins. The good news is that some (many? Possibly all? It’s a very active field of research) tumor cells express aberrant proteins that are only found in significant concentrations in cancer cells. Also, and this is the amazing part, these aberrant proteins are remarkably consistent from patient to patient. Virtually all “random” mutations either have no effect or leave the cell dead, either by self-induced euthanasia or via a Natural Killer pile-on. It turns out that there are only a finite number of ways to become a successful tumor, and some ways are much better than others. For example, nearly 30% of all breast cancers highly express an orphan growth factor receptor called HER2/neu, which is the target of the monoclonal antibody trastuzumab (aka Herceptin) and is an active target for a breast cancer vaccine. Other tumor types, such as melanoma, prostate cancer, and lung cancer, are notoriously antigenic and are also considered to be excellent targets.

Unfortunately, as formerly normal body cells, tumor cells and their unique proteins enjoy special protection from an immune response through a process called tolerance. At present, this process is poorly understood, but, as anyone with an autoimmune disease will tell you, this process can be overcome. There are currently a number of approaches to this, as you can see herehere, and here. Nothing is ready for prime time as of yet and, like other targeted therapies, there probably will not be a single silver bullet that works for everyone. Still, nearly 560,000 people will die of cancer this year and it’s the leading cause of death in Americans under the age of 85, so even small percentages are important.

Yes, the problem is serious. But protests and partisan politics only go so far. Ultimately the solution comes from intellectual understanding of the broader issues, which go well beyond the details of this particular legislation. We must understand the dynamic of intervention and the role of fiat money and the central bank in funding the whole process.

Health Care Intervention

Slowly Reading through this

(via moxielicious)

I don’t know what book or article this is from, but anyone who starts out by hating on fiat currency and the central bank is inevitably going to come to some jackass Libertarian conclusion like “The healthcare market is naturally self-regulating and every single one of our problems stem from onerous and inefficient governmental intervention. Additionally, private citizens should either have enough medical knowledge to treat themselves or enough money to afford private, market-priced healthcare, and those who don’t aren’t my problem.”

And yeah, I did just say “jackass Libertarian” in the Internet :-)

moxielicious:

(Chlamydia muridarum, Chlamydia trachomatis, Chlamydia pneumoniae) 
Chlamydia is a bacterial infection of the genital tract and is the most common STI. It often goes undetected because the symptoms are mild or “silent”.
Symptoms can include:
discharge in men and women
painful urination
lower abdominal pain
painful intercourse in women
testicular pain in men
If left untreated can lead to complications:
higher risk to HIV or other STDs
Pelvic Inflammatory Disease
chronic pelvic pain
rectal inflammation
epididymitis
infertility in men and women
prostatis
eye infection
Treatment is simple! Azithromycin, a macrolide antibiotic, is often used as a course of treatment in a single dose or as long as ten days. It usually clears up in one to two weeks. Those testing positive for chlamydia should discuss with their partners and stop having sex during treatment.
Prevention includes using condoms, limiting number of sex partners, and getting tested often.

Chlamydia is a fun organism because it is nearly impossible to culture and is not a free-living extracellular organism. Rather, it spreads from cell to cell by means of infectious but non-redproducing elementary bodies which transform into the reproductive reticular bodies shown above once entering a host cell. There was historically some debates as to whether it was a really, really complex virus or a really, really simple bacteria. Genetic analysis identified them as bacteria, but places them alone in their own phylum.
In a related notes, the co-carriage rates of C. trachomatis and N. gonorrhea are so high that they are tested for using the the same swab / urine sample and getting a positive result on either buys you the treatment for both.

moxielicious:

(Chlamydia muridarum, Chlamydia trachomatis, Chlamydia pneumoniae)

Chlamydia is a bacterial infection of the genital tract and is the most common STI. It often goes undetected because the symptoms are mild or “silent”.

Symptoms can include:

  • discharge in men and women
  • painful urination
  • lower abdominal pain
  • painful intercourse in women
  • testicular pain in men

If left untreated can lead to complications:

  • higher risk to HIV or other STDs
  • Pelvic Inflammatory Disease
  • chronic pelvic pain
  • rectal inflammation
  • epididymitis
  • infertility in men and women
  • prostatis
  • eye infection

Treatment is simple! Azithromycin, a macrolide antibiotic, is often used as a course of treatment in a single dose or as long as ten days. It usually clears up in one to two weeks. Those testing positive for chlamydia should discuss with their partners and stop having sex during treatment.

Prevention includes using condoms, limiting number of sex partners, and getting tested often.

Chlamydia is a fun organism because it is nearly impossible to culture and is not a free-living extracellular organism. Rather, it spreads from cell to cell by means of infectious but non-redproducing elementary bodies which transform into the reproductive reticular bodies shown above once entering a host cell. There was historically some debates as to whether it was a really, really complex virus or a really, really simple bacteria. Genetic analysis identified them as bacteria, but places them alone in their own phylum.

In a related notes, the co-carriage rates of C. trachomatis and N. gonorrhea are so high that they are tested for using the the same swab / urine sample and getting a positive result on either buys you the treatment for both.

Yes, Obama duped the young people of this country by not doing every single thing they want, so now they’ll all vote Republican. It’s like when I want some bread I will not settle for half a loaf, I will instead have a muffin made of broken glass.

Stephen Colbert responding to Republican Tim Pawlenty when he said that Obama has duped young people. (via therecipe)

The fact that Obama has been disappointing does not make him worse than the alternatives.

(via stfupenguins)

Ahh, the Democratic Party campaign slogan of the 21st century “No what you want, but better than the alternative!” Time to get fired up!

I thought that religious scholarship had pretty much positively established the Roman Catholic Jesus as a syncretic deity based on Mithra and Sol Invictus ages ago? Can someone give me the 5 min version?

I thought that religious scholarship had pretty much positively established the Roman Catholic Jesus as a syncretic deity based on Mithra and Sol Invictus ages ago? Can someone give me the 5 min version?

53 percent of Americans now support gay marriage. Which means that 47% of the country are still assholes.

Bill Maher (via cosmosweednlife)

America: Still largely populated by assholes

Science fiction magazine rejection email.

love-and-radiation:

Poop.

I’m going to organize three submissions this afternoon to make up for it.

I feel like I’m not science-fictional enough for the sci-fi mags and too science-fictional for all the “contemporary literary fiction” mags.

I thought “Crossovers” were hot right now?