Medical Science News Thread

[Edge]

Very interesting, and very frustrating!

I'd love to read the whole thing - any NS subscribers amongst us who'd be willing to share?

[Avatar]

The other thing of course, is that it deals with only the most common strain of the virus. HIV though is so successful at mutating, at shifting it's antigens, that already more virulent strains are becoming prevalent.

And a potential problem of finding something that prevents one incarnation of it is that it may encourage it to mutate further, bypassing the potential remedy before it can make enough of a difference.

--Avatar

[Dragonlily]

We have to keep trying, though.

[Avatar]

Couldn't agree more.

--A

[duchess of malfi]

Slow walking may be prescription for obese
Researchers: Strolling burns more calories, reduces injury risk

Wednesday, July 6, 2005; Posted: 8:24 a.m. EDT (12:24 GMT)


John Imbergano, who weighs 280 pounds, walks the stairs to reach his office in downtown Denver, Colorado.
DENVER, Colorado (AP) -- Restaurant consultant John Imbergamo drives to work but he takes time for a daily walk, either through Washington Park near his home or from his office to clients downtown.

"I end up walking a lot. It's easier than getting in my car and driving, especially downtown," said the 6-foot-1 Imbergamo, who at 280 pounds says walking is his main form of exercise. "Hopefully walking helps me keep my weight where it is."

Now researchers at the University of Colorado at Boulder have better news for walkers: Strolling can help obese adults burn more calories per mile than brisk walking and might even lower the risk of arthritis and injuries to the joints than picking up the pace.

Doctoral student Ray Browning and his colleagues studied 20 men and women of normal weight and 20 considered obese as they walked set distances at different speeds. They found the obese people burned more calories walking at a slower pace for a longer time than walking at a faster speed.

It might be just the incentive needed for people turned off by the traditional advice to take at least five brisk walks, 30 minutes at a time, per week.

About 60 million Americans age 20 or older are considered obese, according to the National Center for Health Statistics. Their health care costs amount to about $100 billion a year, according to the American Obesity Association.

Browning says vigorous exercise can decrease the risk of heart disease and other chronic illnesses, but a slow walk can help people stay active while easing the stress on their joints. Obese adults are more at risk for knee osteoarthritis, which can cause painful stiffness.

"We're not at all advocating less physical activity, or less vigorous activity. We're just saying slow walking might be a way to burn a few extra calories a week," said Browning, a former professional triathlete.

Browning's team is trying to expand on the idea that walking at a more leisurely pace puts less stress on a person's lower body.

Another study is aimed at unlocking a surprise the Colorado researchers came across:

Previous research showed that a person of normal weight who tried to emulate an obese person by wearing leg weights and walking with a wider leg swing spent 50 percent to 100 percent more energy to walk. But in the latest study, the team found obese individuals spent only about 10 percent more energy than their lighter counterparts.

"Does someone with obesity walk differently than the way normal people walk? Do they do something to make it cheaper to walk? It appears they do something in the walking pattern to make it cheaper," Browning said, meaning they burn fewer calories.

His team guessed that obese people may walk with a straighter leg so the skeleton -- rather than muscles -- support their weight, or that they walk with shorter, faster steps. It could be a year or two to find an answer.

"People have speculated on whether differences in the cost of energy expenditure are a factor in weight gain. He's got a way to measure that now," said James Hill, head of the Center for Human Nutrition at the University of Colorado at Denver.

If researchers can unlock the answer, they can find ways for people to spend more energy simply by walking -- and sometimes by walking slowly.

"The message we need to give people is, get out and walk," said Hill, whose group America on the Move encourages walking and small cutbacks in calories to lose weight. "Any speed is fine. Some speeds are better than others, but get out and do it."

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

[Avatar]

People certainly walk too little these days. It used to amaze me when, in my old place, my landlord/neighbour used to drive the 800 odd metres to the nearest shop.

--A

[duchess of malfi]

TOLEDO, Ohio, July 7-For Jeffery Gold, M.D., the disaster in London today brought back memories of Sept, 11, 2001. On that day, when he got the call, he was at Montefiore Medical Center in the Bronx, miles away from the tip of Manhattan and the smoldering remains of the World Trade Center towers.


"I called my wife and kids to make sure they were okay, I took my ID so in case anything happened to me I could be identified, and I went," he recalls. "I was on a call list, and interestingly, most of the people called that day didn't want to go."


Dr. Gold, who is now dean of the College of Medicine of the Medical University of Ohio here, believes it "would be radically different today." He believes doctors today would want to go. The question is whether they would be ready.


Today in London, within a few hours of the blasts that rocked the city's transport system during the morning rush hour, the BBC was reporting that area hospitals were treating at least 400 casualties, including about 150 people who were seriously injured in the explosions. Other sources were putting casualties at more than 1,000.


Emergency department physicians know that when disaster strikes, they'll be on the front lines -- it comes with the territory. But in a crisis, every doctor, nurse and allied health professional may be called on to respond, and everyone needs to know where to go, what to do, whose orders to follow, and how to think on the fly, according to disaster preparedness experts.


"There's probably no specialty of medicine that is immune to the need to be knowledgeable and to be prepared," says Dr. Gold, a thoracic surgeon.


Dermatologists, for example, need to be vigilant for signs of biologic, chemical, or nuclear forms of terrorism, because many of the victims may first present to them with skin lesions or external other diagnostic signs.


Similarly, general practice physicians, pediatricians, allergists, or pulmonary specialists may see the first signs of airborne chemical or biologic attacks, and neurologists may be the first professionals to see victims of attacks with nerve agents.


The keys to preparedness, says James J. James, M.D., director of the AMA Center for Disaster Preparedness and Emergency Response, are education and training in specific techniques of emergency response.


"We need to get away from teaching physicians, nurses, etc., what they already know, and teach them how to be a part of public health response system, and that's important because not everyone in a public health response is going to be doing the same things that they do day-to-day," Dr. James says. "They may be taking on newer roles."


Those roles may include performing triage, stabilizing patients for transportation, cooperation with incident command, disease surveillance, understanding of public health systems, and working with public safety and legal authorities.


"It's very possible that physicians will have to be dealing with a non-conventional terrorist incident, such as a chemical or a biological situation, so physicians don't necessarily have to have all of that information all of the time in their pocket," says Leonard J. Marcus, Ph.D., co-director of the National Preparedness Leadership Initiative at the Harvard School of Public Health in Boston. "However, they need to know how they can access that information immediately."


In addition to having human resources in place and critical information at hand, disaster preparedness requires availability of essential supplies and services, such as trauma beds, respiratory support equipment, medications and supplies for treating burn patients, and adequate stocks of antibiotics and anti-infective agents.


During the heat of a crisis, communication and coordination of services are also essential, and haphazard planning or mixed signals on the part of emergency response personnel can cost lives.


In its final report, the National Commission on Terrorist Attacks Upon the United States, or 9/11 Commission, noted that responders in different public safety departments -- police, fire, Port Authority -- used different radio frequencies or incompatible equipment, and that some firefighters at the World Trade Center had low-powered radios that didn't work in the depths of the buildings, and may have missed urgent evacuation orders.


Similarly, Japanese researchers who analyzed emergency responses to the 1995 nerve gas attacks in the Tokyo subway system found that rescue efforts were crippled by a lack of decontamination facilities and by the failure of police, fire, hospitals and government to coordinate services


The human element of a disaster -- the emotional and intellectual responses of individuals in an emergency -- are also important elements to preparedness, says Dr. Marcus. He relates the experience of a colleague at Hadassah Hospital in Jerusalem, who says that in the 90 seconds it takes for him to reach the emergency room from his office, if he can reach his wife and kids on their cell phones and confirm that they are safe, he'll be able to concentrate on his work.


And even after the smoke has cleared and the dust has settled, doctors still need to be vigilant for aftershocks of stress related-illnesses, such as systemic infections, cardiovascular problems, gastrointestinal distressed, memory impairment, and clinical depression."


"It's safe to say that a lot of these symptoms will be showing up in London, and should be part of the preparedness for a terrorism event anyway," says David Ropeik, director of risk communication for the Harvard Center for Risk Analysis at the Harvard School of Public Health.


Ultimately, Dr. James says, "we have got to drive this into the undergraduate curriculim, into the medical schools, into the nursing schools, and that's one of those great next steps that need to be accomplished."


Dr. Marcus agrees, noting that Al Qaida's pattern is to hit multiple targets simultaneously, whether those targets are African embassies, American jets, Spanish trains or British buses.


"If they hit multiple cities with mass casualty events, it could very well be that people will start streaming out of cities, and rural physicians who didn't think that they would be affected because they're not in the big cities could be on the front line of dealing with casualties of a terrorist attack," he says.


"We're preparing as a country, we're not preparing as a hospital, or a city or a state, it's really national preparedness," says Dr. Marcus.


Primary source: AMA Center for Public Health Preparedness and Disaster Response

[[Syl]]

Frog Glue.
"A chubby yellow frog, which resembles a famous Faberge egg, may hold the key to a surgical glue potentially worth billions of dollars."

[duchess of malfi]

Alzheimer's damage may be reversible, study suggests

Thursday, July 14, 2005; Posted: 3:38 p.m. EDT (19:38 GMT)


WASHINGTON (AP) -- Some recovery of memory may be possible in the early stages of Alzheimer's disease, suggests a provocative new study in mice that could help researchers open a two-pronged attack against the mind-robbing illness.

The research shows a mutant protein named tau is poisoning brain cells, and that blocking its production may allow some of those sick neurons to recover. It worked in demented mice who, to the scientists' surprise, fairly rapidly regained memory.

The work is years away from being useful in people. There are no drugs yet to block tau, and most of the recent search for Alzheimer's treatments has focused instead on another protein, called beta-amyloid.

But Thursday's study, published in the journal Science, is sure to refocus attention on finding ways to attack this second culprit, too.

"There basically are two prongs and we need to deal with both," said lead researcher Karen Ashe, a University of Minnesota neurologist. "What we're showing is that there are neurons which are affected (by Alzheimer's) but not dead."

It's important research because it bolsters the notion of targeting those sick neurons in hopes of one day reversing at least some of dementia's damage, said William Thies, scientific director of the Alzheimer's Association. Today's Alzheimer's drugs only treat symptoms.

"If you can actually rescue some of these sick cells, that really brings the possibility of return of some function, which would be of tremendous value," he said.

No one knows exactly what causes Alzheimer's, a creeping brain degeneration that afflicts about 4.5 million Americans and is on the rise as the population ages.

The leading theory is that something spurs abnormal production of beta-amyloid, which forms sticky clumps that coat brain cells and kill them -- plaque that is the disease's hallmark. But tau clearly plays some role: A mutant form of this protein forms fibrous tangles in brain cells of Alzheimer's patients, and tau seems to be primarily responsible for another form of dementia.

To see if the tangles themselves are a cause or symptom of dementia, Ashe and colleagues specially engineered a mouse to mimic the kind of tau-and-tangle formation seen in Alzheimer's patients' brains.

Sure enough, as the rodents aged, more tangles built up and more brain cells died -- and the mice showed dramatic memory loss.

How could they tell? Mice don't like water and thus quickly learned how to swim out of a water maze. But as they became demented, it took longer to get out of the water until eventually the mice just swam aimlessly.

The mice were bred so that eating a certain antibiotic would switch off a gene responsible for producing the bad tau.

Here's the first surprise: As tau production plummeted, the rodents' memory loss didn't just stop, they regained some memory. It wasn't a full recovery -- dead brain cells can't be brought back -- but after repeated retesting to confirm the results, Ashe concluded that memory function improved to about half the pre-demented state. Also, neuron death stopped.

The second surprise: Those fibrous tangles continued to form even as the mice got better.

That suggests the tangles aren't killing brain cells, but the mutant tau itself is. Perhaps the tangles form as the brain tries to fight off poisonous tau by sequestering it, Ashe said.

Studies using mice who overproduce that other Alzheimer's culprit, beta-amyloid, also have suggested that blocking that protein might reverse memory loss, with or without getting rid of the accompanying amyloid plaques, Thies noted. That's why numerous drug companies are hunting medicines to target amyloid production.

Similar efforts to block tau have lagged because until now there hasn't been a good animal model of tau-caused dementia to test, he said.

That now is likely to change, and Ashe foresees one day attacking both proteins simultaneously.

She adds a caution: Don't think antibiotics are the key -- Ashe just happened to use one to switch off a gene specially bred into these mice.

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

[Dragonlily]

That would be a HUGE boon.

[duchess of malfi]

'Double diabetes' puzzles doctors

Tuesday, July 19, 2005; Posted: 9:47 a.m. EDT (13:47 GMT)


Martha Larkin, 11, walking with her mother Cindy Stevans, has Type 1 diabetes and is high risk for Type 2.
WASHINGTON (AP) -- Having one type of diabetes is bad enough, but two? Doctors are seeing a new phenomenon dubbed double diabetes that makes it harder to diagnose and treat patients -- especially children.

The mix can strike at any age, and comes in various forms: Children who depend on insulin injections because of Type 1 diabetes gain weight and then get the Type 2 form in which their bodies become insulin resistant, for example.

Or someone with classic Type 2 symptoms isn't responding to therapy, and tests reveal they also are developing the insulin-dependent form of the disease. Or they may not fall clearly into either category.

The labels are important -- different forms require different treatments.

Yet "there are many people in which it's very blurred as to what kind of diabetes they have," says Dr. Francine Kaufman, a University of Southern California pediatric endocrinologist and past president of the American Diabetes Association.

There are no good statistics on this complex disease-mixing.

But the Children's Hospital of Pittsburgh counts about 25 percent of child patients with Type 1 diabetes who also are overweight and have other Type 2 features, says Dr. Dorothy Becker, a pediatric endocrinologist and leading double-diabetes researcher.

And an ongoing study to determine the best treatment for child Type 2 diabetics is uncovering many participants who harbor antibodies that signal they have or are developing the Type 1 form, too, says Kaufman.

Those findings echo a handful of recent research reports raising concern about the phenomenon, which some call atypical diabetes or "diabetes 11/2" or even Type 3 diabetes.

Diabetes occurs when the body can't turn blood sugar, or glucose, into energy, either because it doesn't produce enough insulin or doesn't use it correctly.

With the Type 1 form, the patient's own immune system attacks the insulin-producing islet cells in the pancreas. Once thought to strike only in childhood, it also can develop in adults. Symptoms usually appear suddenly and can quickly become life-threatening. Insulin, given by shots or a pump, is required to survive.

With the Type 2 form, the body loses its ability to use insulin properly, even though the pancreas pumps out extra and drugs often are given to rev up that production even more. Type 2 usually develops slowly, and once was thought to hit only the middle-aged but now is striking even overweight children.

Both forms can lead to heart and kidney disease, blindness and amputations, and kill if not properly treated. But Type 2, which afflicts over 90 percent of the more than 18 million U.S. diabetics, has gotten more attention recently because it's an epidemic fueled by increasing obesity.

Yet specialists knew Type 1 was quietly increasing, too -- and then they began spotting double diabetics.

The theory: Overweight people need more insulin to process glucose regardless of whether they're insulin-resistant yet. So, perhaps obesity overworks the pancreas until it wears out, Pittsburgh's Becker suggests. Or perhaps obesity accelerates the autoimmune destruction -- meaning someone genetically predisposed to Type 1 diabetes might not have gotten it had they stayed thin.

"You've not just exceeded what you can make but perhaps accelerated the destruction," and then insulin-resistance sets in, agrees Kaufman, who just authored a book called "Diabesity" exploring the overall obesity-diabetes threat.

Whatever you call that mix, it complicates treatment.

Consider Martha Larkin of Pittsburgh, diagnosed with Type 1 diabetes at age 3. For years, her mother would wake up in the middle of the night to test Martha's blood sugar and administer insulin. Set mealtimes and off-limit foods became the family's norm.

Then early puberty hit at 10, and Martha began gaining weight, says her mother, Cindy Stevans. Now almost 12, Martha's daily insulin requirement grew to that of grown man, signaling developing insulin resistance. And, in a vicious cycle, the more insulin she gets, the hungrier she feels.

A recently implanted insulin pump is helping, and the family joined a pool in hopes that physical activity will help Martha stave off double diabetes -- and that her twin brother will stay diabetes-free. But weight is a problem for this whole family of bookworms who hate exercise so much that Stevans calls it "torture."

"It's painfully hard," she says of her daughter's co-battles with diabetes and weight.

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

[Avatar]

Man, it seems as though rampant obesity is just causing more and more problems. I think I'm going to start a thread about it in the 'Tank. I think it's one issue we've never talked about.

--Avatar

[duchess of malfi]

www.newscientist.com/article.ns?id=dn7358

Pheromone attracts straight women and gay men

Smelling a male pheromone prompts the same brain activity in homosexual men as it does in heterosexual women, a new study has found. It did not excite the sex-related region in the brains of heterosexual males, although an oestrogen-derived compound found in female urine did.

The testosterone-derived chemical AND is found in male sweat and is believed to be a pheromone. It activated the anterior hypothalamus and medial preoptic area of gay men and straight women alike. Researchers led by Ivanka Savic at the Karolinska University Hospital in Sweden believe this brain region integrates the hormonal and sensory cues used in guiding sexual behaviour.

The research demonstrates a likely link between brain function and sexual orientation, Savic suggests. But she told New Scientist that the study “does not answer the cause-and-effect question”.

So the brain-activation of gay men by AND may contribute to sexual orientation of those men, or simply be the result of their orientation and sexual behaviour. She added that the brain scans revealed no anatomical differences between any of the participant’s brains.

Lavender and cedar
The team observed 36 healthy men and women, who were exposed in turn to AND, the oestrogen-derived compound EST and other odours, including lavender oil, cedar oil, eugenol and butanol.

While the subjects were consciously aware of each unidentified smell as it was presented, Savic does not believe the reactions in the subjects brains were intentional in any way: “The pattern of activation does not suggest cognitive processing,” she says.

PET and MRI scans revealed that the ordinary odours activated parts of the brain associated with smelling in all test subjects. But in addition to that activation, AND excited the brain areas associated with sexual behaviour for female and gay male participants, as did the EST for straight men.

Open minded
Ada Frumerman, a psychotherapist based in New York, US, who has presented papers on related topics, says sexual orientation is probably determined by a mixture of biological and psychological influences.

“I think we should be open minded,” she says. “It would not be advisable to focus solely on biological causes. Similarly, it would do a disservice to only look for psychodynamic causes.”

Savic's team has also conducted similar experiments with gay women and the researchers are currently analysing the results.

Journal reference: Proceedings of the National Academy of Sciences (DOI: 10.1073/pnas.0407998102)

[duchess of malfi]

www.newscientist.com/article.ns?id=dn7069

Gay men read maps like women
18:32 25 February 2005
Gay men employ the same strategies for navigating as women - using landmarks to find their way around - a new study suggests.

But they also use the strategies typically used by straight men, such as using compass directions and distances. In contrast, gay women read maps just like straight women, reveals the study of 80 heterosexual and homosexual men and women.

"Gay men adopt male and female strategies. Therefore their brains are a sexual mosaic," explains Qazi Rahman, a psychobiologist who led the study at the University of East London, UK. "It's not simply that lesbians have men's brains and gay men have women's brains."

The stereotype that women are relatively poor map readers is borne out by a reasonable bulk of scientific literature, notes Rahman. "Men, particularly, excel at spatial navigation." The new study might help researchers understand how cognitive differences and sexual orientation develop in the womb, he says.

The results are "very intriguing" and provide "further insight into the origins of route-learning strategies, and the organisation of cognitive abilities in general" says Jean Choi at the University of Lethbridge, Canada, who researches spatial behaviour in humans.

Left at the church
Previous tests challenging men and women to make their way through virtual-reality mazes, or real-life scenarios, have shown that men tend to be speedier and use different strategies to women.

But Rahman points out this does not mean that all women are bad map readers, or that it is the mental strategy employed that makes the difference.

Women tend to navigate using landmarks. For example: "Turn left at the church and carry on past the corner shop." Rahman told New Scientist that "men rely more on the points of the compass; they have a better sense of north, south, east and west". They are also more likely to describe distances.

"Cross-sex shifts"
Rahman and his colleagues designed the study to test a theory that gay men and lesbian women might show "cross-sex shifts" in some cognitive abilities as well as in their sexual preferences.

The hypothesis is that homosexual people shift in the direction of the opposite sex in other aspects of their psychology other than sexual preference. That is, gay men may take on aspects of female psychology, and lesbians acquire aspects of male psychology.

Gay men did indeed show a "robust cross-sex shift" in the study, says Rahman. Volunteers were asked to look at a pictorial map and memorise four different routes for about a minute. They then had to recall the information as though they were giving a friend directions from one place to another.

"As we expected, straight men used more compass directions than gay men or women, and used distances as well. Women recalled significantly more landmarks," says Rahman. But gay men recalled more landmarks than straight men, as well as using typically male orientation strategies.

Verbal fluency
"The results support the notion that males' and females' cognitive abilities may be organised in different ways, and highlight the importance of accounting for sex-specific patterns of behaviour," Choi told New Scientist.

The difference between gay men and lesbian women might hint at differences in development, says Rahman. Previous work has shown that lesbians show little difference in their cognitive skills compared with straight women.

The only measure on which they appear to shift is on language production or verbal fluency, he adds. Like straight men, lesbians tend to be more sparing with words than straight women. Gay men, however, are inclined to speak as much as straight women.

"It might be that whatever causes sexual orientation and cognitive differences are uncoupled in lesbian development, while in gay men the two things could be tightly coupled," Rahman suggests.

Journal reference: Behavioral Neuroscience (vol 119, p 311)

[Avatar]

Very interesting Duchess.

--A

[duchess of malfi]

www.time.com/time/nation/article/0,8599 ... ml?cnn=yes

Katrina's Lingering Medical Nightmare
Chronically ill storm victims struggle to piece together medical records lost in the storm
By AMANDA BOWER

Posted Thursday, Sep. 22, 2005
Melinda Amedee was scheduled to have a tumor removed from her kidney at a New Orleans hospital on August 30. She lives far enough away from the city to have missed serious damage from Hurricane Katrina. But when the 17th Street Canal levee broke the day before, she knew she wouldn't be having an operation at the Ochsner Cancer Institute anytime soon. With a 25-year history of kidney problems, Amedee, 39, was worried about the delay, and quickly arranged to have the surgery at the MD Anderson Cancer Center in Houston. But like thousands of other patients evacuated after the storm, Amedee presented her new doctors with a challenge: no medical records, and no way of contacting her Louisiana kidney specialist.

"Not having a portable medical record has been a massive challenge," says Mark Clanton, a deputy director of the National Cancer Institute, of the tens of thousands of patients dispersed around the country and needing access to doctors and drugs. "We need to create plans to evacuate and provide better care for the immediate medical needs of all people with chronic illness, not just cancer."

The NCI has set up a special Katrina-related page on its website, with information on how to find new doctors and continue receiving drugs and therapy. So far, it's received about 5,000 page views, with another 500 on a Spanish-language site. But there is no doubt that many cancer patients displaced by Katrina—the region has 7,600 participants in experimental trials, with many thousands more receiving conventional care—have had delays or disruptions to treatment, in some cases with devastating consequences.

Scott Cheek, a radiation oncologist in Dallas, Texas, said that about a week after the storm he saw a retiree from New Orleans who said he had lung cancer. The patient, in his late 60s, had no idea what kind of cancer he had or what stage it had developed to. He had no x-rays, no pathology reports, no access to his doctor, and had spent more than a week getting his family situated in Dallas before contacting Baylor Sammons Cancer Center, missing an estimated 10 radiation treatments.

"It looks like he has a new lesion in his lung," says Cheek. "We can't be sure, but I think it's probably a pretty reasonable possibility that it wouldn't have [spread] if he could have stayed in New Orleans and continued treatment." Although it's likely that the lung cancer was going to kill his patient, Cheek says the man was "probably going to have a little bit longer and better quality of life" if he had received continuous radiotherapy.

Delays in treatment are also dangerous for people with infectious diseases. An estimated 8,000 people with HIV and AIDS have been displaced by Katrina, and missing medication may lead to them developing resistance to the drugs treating the disease. Tuberculosis patients, many of whom are notoriously non-compliant in taking their six-month-long treatment regimen, may be relapsing and infecting others in crowded shelters. Before the hurricane, public health workers would visit the homes of many of New Orleans' 50-odd TB patients, and stand over them as they took their medication. Raoult Ratard, with the Louisiana office of public health, says "one of the goals we would like to achieve within the next 30 days is to try to find out where they went."

In contrast, doctors at MD Anderson say Melinda Amedee was a model patient. They were able to repeat tests and gather enough information to perform surgery on Tuesday. "It would have been a nightmare if she hadn't known what medications she was on," says Christopher Wood, associate professor of urology and cancer biology at MD Anderson. "Unfortunately it's not uncommon to have patients say they take a little blue one, a green one, a big brown one, and you have absolutely no idea what they're talking about."

Many families were separated by Katrina, so even if parents know all about their children's conditions, they sometimes weren't around to pass that information on. Paul Sirbaugh, director of emergency services at Texas Children's Hospital, says his staff was confronted by children with liver transplants, cystic fibrosis, chronic asthma and seizures —and no idea of what medication they were on. "If we don't know what medicines they're on, we don't know what levels to measure to monitor their condition," Sirbaugh says. "A lot of times we have to start over."

Healthcare workers treating hurricane evacuees are finding themselves in the unusual position of wishing that patients had a little less faith in their doctors. "It does amaze me that in this day and age, people don't know what drugs they're on, what their treatment plan is," says Roy Herbst, a professor of medicine at MD Anderson. "That's probably because they trust their physician."

The lesson to be learned from New Orleans, where many physicians' records have been washed away forever, is that patients are well-advised to take on basic record-keeping themselves, health officials say. A waterproof, wallet-sized list of medications and important health information should be carried at all times.

But perhaps a bigger lesson learned is the need for a national databse of electronic medical records. "We're all aware of the issues of protection of privacy, and that's an absolute requirement," says John Gallin, director of the National Institutes of Health Clinical Center. "But I consider this one of the top priorities for the health care delivery system in this country." Throughout the chaos of Katrina, doctors treating displaced patients in the Veterans Affairs system have had access to information that those outside the VA are dreaming of: up to 20 years of lab results and six years worth of x-rays, scans, doctors' notes and medication records, available for all 5.2 million active patients.

"The electronic health record is available 100 percent of the time for 100 per cent of the VA patients," says Jonathan Perlin, the VA's undersecretary for health. "Once you see it, you would wonder why people use horse and buggy tools in the information age."

Every day, 931,000 doctors' orders, 567,000 doctors' notes and almost 500,000 diagnostic images are uploaded to the system, which Perlin says costs $78 per patient, per year, to run. "We asked the question early on, not could we afford to do this, but could we afford not to do this," he says.Hurricane Katrina has given him the answer.

That national database is a dream come true. We have had some patients come into our hospital as refugees from Mississippi, and we could immediately access their records and refill their prescriptions for them.

[Dragonlily]

How do they justify this against the strict new Federal laws protecting medical privacy?

[The Laughing Man]

Man, it seems as though rampant obesity is just causing more and more problems. I think I'm going to start a thread about it in the 'Tank. I think it's one issue we've never talked about.

--Avatar

A "thread" about "fat"?

[duchess of malfi]

Well the patients had come from us from other VA hospitals, which is how and why we could access their records.

Other pharmacies, such as large chains, also have nationwide data bases. When I took a long trip out west a few years ago, I knew I would run out of one of my asthma meds towards the end of my trip. But my local pharmacy would not fill it before I left because it was "too soon" for a refill according to my HMO. So I ended up refilling it in Glenwood Springs, Colorado, at another store of the same chain. They could pull my prescription records right up and refill it for me. And enough days had gone by that it was an approved refill by my cheapass insurance company.

At the VA we differ in that all of the patient records, up to and including x-rays, labs results, pharmacy and dental records, nursing notes, etc. can be accessed.

I am not sure how that all accords (or does not) with current federal law. I do know that we have to go through several hours of training each year about confidentiality of patient information and the like. And if anyone is found riffling through patient records without a reason could be subject to investigation by the FBI and face fines and/or jail time. And there are a million firewalls, etc. on the computer systems. I think it would have to be a pretty talented hacker to break in, and the FBI would be after him or her pretty quickly.

[Dragonlily]

Yes, that makes sense, all within one hospital or pharmacy chain. If someone in a little outback clinic could pull up the records of Johns Hopkins, that would be a different matter.

Penalties are enforced, that's for sure. I know of at least one person who was fired for looking in the wrong places.