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Comment Jurassic Park redux (Score 5, Interesting) 536

All we need to do now is to take that DNA, splice it back together with human 'junk' DNA and breed Neanderthals for the next great Disney theme park! Instead of being entertained by people walking around in giant suits pretending to be cartoon characters, it could be the greatest edutainment center in the world!!

But seriously. People have sex across interspecies barriers all the time; animal, vegetable, mineral, it doesn't matter. I doubt that Homo sapiens and Neanderthals looked at each other and said, Hey, I can't have sex with you, you're obviously a different species! Probably they thought to themselves, Two arms, two legs, looks about right, the bits are in the right places, why not?

Comment Non-story (Score 1) 101

The linked article could only have been written by a surgeon with incoherent longings for stardom and filthy lucre.

This technology offers no increased assistance for surgeons. It really doesn't matter when you're that close in a laparoscopy. It's not like the structures you need to see are that small for most laparoscopic procedures. I would have been more impressed if they'd hooked this up for use in neurosurgery, eye surgery, vascular surgery, something where real resolution and delicacy is required.

Big MEH.

Comment Re:Interesting .. but.... (Score 1) 112

Cancer below the elbow or below the knee is medically unheard of ...

Actually there are soft tissue malignancies (epithelioid sarcoma; clear cell sarcoma; probably rare cases of Ewing's sarcoma) which have a predilection for the distal extremities. You perhaps have not heard of them because they're uncommon and haven't generated the same kind of political/public attention that other cancers have. They're also more difficult to treat, with fewer chemotherapeutic options than breast, colon or prostate cancer, so yes, sometimes amputations are necessary.

I thought the Luke arm was awesome when the videos for it were posted, but getting that sensory feedback is even cooler. Unfortunately with an artificial implant there's always a risk of infection, so it would be even cooler if somehow the next iteration should somehow provide a scaffolding for natural tissue to regrow...maybe we'll see that in a couple of years. Or at least we can hope.

Comment Problem with clinical trials (Score 1) 430

The problem with a clinical trial for H1N1 vaccines is that they take too long to set up and analyze. By the time the data collection closed, we'd be into the summer of 2010, and then what good would have come of it? To accumulate enough data, it would have to be a multicenter trial (i.e. conducted in many different cities). Given the public policy enforcing vaccination, it would be extremely difficult (impossible) to get approval from a hospital research ethics board to even run the trial.

Unfortunately medicine is not a 'hard' science, in spite of our best efforts the systems are too complex and difficult to completely control (unlike physics or chemistry). Not to mention the fact that most doctors trained in the life sciences and do not understand the mathematics well enough to analyze a clinical trial, so unless they have sought out additional training in epidemiology/statistics, their grasp of numbers is always suspect.

That being said, if most doctors are numerically challenged, journalists tend to be both numerically and scientifically illiterate, which I suppose is even worse.

Comment Not as revolutionary as it seems to be (Score 1) 43

Cool, although it has to be said that tumours (from the Latin, for 'swelling') can often be felt by the surgeon and often it is not difficult to delineate the margins required for a tumour. This would be most useful in cases of nonpalpable lesions (like a very tiny breast cancer or pre-cancer). The linked article does not reference any original publications, so it is difficult to know what they used as a control, what compounds they tested for (as the above posters have mentioned), if they were just comparing signatures against each other, etc.. Many methods have been touted themselves as the magic one for cancer detection/analysis: analysis of proteins in the serum (prostate specific antigen, I'm talking about you), compounds in urine, etc. etc. And the initial studies always look great. But time and again, when put into practice, the picture is never quite so clear as in the pilot studies. In the case of PSA, yeah, an elevated PSA says that there's something wrong with your prostate, but maybe it's just that your prostate's gotten larger, or it has a subclinical infection, or maybe there's cancer. There is a similar information about CA-125 for ovarian cancer. There is a bit more hope in this case, because this method actually samples tissue.

Comment Mainframes and the refrigerator thing (Score 1) 422

In using fridges to measure mainframe size, are we talking about a beer fridge, Maytag fridge, JennAir double-door fridges with the funky LCD and ice dispenser with the glistening stainless steel doors that smudge the moment you touch them, or the kind of uber-fridge that slaughterhouses use to store cow carcasses on hooks?

I demand a car analogy.

Comment Why doctors hate... (Score 1) 1064

I wish non-scientific journalists would not attempt to comment on scientific matters. "No cervix, no cancer," writes this journalist.

Perhaps she should consider the scenario where a woman had a radical hysterectomy for cervical cancer. In this scenario, this patient would remain at risk for vaginal and vulvar carcinoma. Perhaps the cancer is incompletely excised and a few cancer cells remain in the vaginal vault. A Papanicolau smear would pick that up. That is a completely justifiable Pap smear.

Consider further the scenario where a patient reports to you, her doctor, that she had her uterus removed. Only she didn't tell you that her that it was just her uterus that was removed, not her cervix -- a subtotal, not a total hysterectomy. I have found that clinicians are sometimes careless with their terminology. Such a woman might be lumped in under the category of 'woman with hysterectomy' without further thought. But she would still have a cervix and still require screening

The devil is in the details. Outsiders to the profession often have false expectations, or do not realize that the reality more granular and confusing than it first appears to be.

Coming from a country with socialized medicine, I find the US health care system mind-boggling. I used to think that the amount of paperwork in my country was bad, but I can hardly understand why anyone would choose to put up with endless reams of paperwork and contracts and co-pays and deductibles, plus the anxiety all of this must entail, for the luxury of 'choice' in health care. Yes, there are issues with socialized health care, but if you need investigations done on an urgent basis, they generally get done here on an urgent basis.

Comment Immortality versus cancer. (Score 1) 146

Some cells have genetic switches and gizmos that allow them to replicate almost indefinitely under appropriate hormonal and biochemical stimuli. Germ cells (sperm, eggs) and stem cells (like the hematopoietic stem cells) have this function. The important point, which the poster above alluded to, is that the process of cell division is tightly controlled. It starts and stops when demanded. Any deviation from protocol should cause immediate destruction via apoptosis.

In contrast, neoplastic cells (one subset of which includes cancer cells) do not respond to the normal start/stop signals of cell division and they escape quality control mechanisms (apoptotic signals).

Regarding graft-versus-host disease, that is more of an issue with hematopoietic (bone marrow) transplantation. The host's immune system could be an issue for a foreign graft, but this sounds more like a dialysis machine to replace the liver's function. (I have not yet read the source material.) With the prevalence of hepatitis B in the Asian population, and the desire of some countries there to show some muscle in the scientific arms race, I am not entirely surprised that some trials were conducted there.

Comment They're missing the point (Score 2, Informative) 567

I'm an organic chemistry major who took the route into medical school.

The actual subject material of organic chemistry has no direct relationship with medicine. Nobody has ever asked me to elucidate the molecular structure of protein X and synthesize it from scratch. When I started medical school with all those bloody didactic lectures, I felt as though I was at a severe disadvantage for scoffing at the biological sciences.

However, organic chemistry is as close to the 'hard' sciences (physics, math, computing, etc.) as some (most?) biology majors get. Organic chemistry mimics the learning process of medical school. During class, you're taught maybe 10 basic principles which allow you to predict and understand how molecules interact. In the lab (I mean a real synthetic organic lab where they build molecules, not the three-hour follow-the-recipe thing), one is given the opposite situation: given this molecule, how does one arrive at a set of starting materials? It is analogous to medicine. Patients don't (usually) come to the office and say, 'Doctor, I've got a pleural effusion.' They say, 'I'm short of breath' and then you have to figure out the disease. You have to be able to work backwards.

We have a saying, "Diseases don't read textbooks." Disease can present in odd ways. The old-school doctors -- the guys who actually have read their pathology and understand their disease processes -- can figure it out. Others can't. Most of the premed kids don't give a rat's ass about mechanisms. They don't care about understanding. They're focused on getting good grades and pretending to be altruistic. They don't like organic chemistry because it is 'hard' and 'difficult to get good grades'. They don't like organic chemistry because it's simply different, and consequently mentally challenging, frustrating and sometimes incomprehensible. (And smelly.)

Guess what? Organic chemistry is a pretty good preview of what medicine is like on the wards.

And as for suggestions of 'more biochemistry', I'd have to say that I haven't noticed a lot of biochemistry involved in medicine either. Most of us have forgotten, or could only give you the most basic outlines of the active site for any drug -- and that's only if the mechanism of action for a drug is known. The last time I needed to know about the Krebs cycle was...for the MCAT, I think. I'm not even sure it showed up then. I did learn about cholesterol synthesis in an organic chemistry class...now that IS relevant to today's doctor.

With respect to research -- most people are not born researchers. Most people who work at a university-affiliated 'academic' center do research because it's a condition of their employment. Truly gifted researchers are few and far between. Organic chemistry isn't human alchemy -- it can't turn a dimwit into a genius. I suppose it could help some people learn to formulate proper hypotheses and experiments.

A proper premed curriculum, IMHO, contains a good mixture of: physical sciences (calculus, algebra, STATISTICS, physics (some basic electronics and quantum mechanics)), programming (information storage, manipulation, retrieval and general problem solving skills), chemistry (organic, analytical, and physical), anatomy and physiology, English and preferably a second language (because you need to communicate with your patients and/or lawyers), basic psychology (see point above), and perhaps some biomedical ethics/philosophy/history

After learning how to think and solve problems, learning enough molecular biology, biochemistry, microbiology, etc. to be a good doctor is a relatively minor matter.

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