Posts Tagged ‘medicine’
It happens when you least expect it: when you’re sitting at home or having a simple conversation with a friend, you get the feeling that you’ve been there and done that before. Deja vu, meaning “already seen” in French, is the phenomenon described previously, where you believe that what you’re experiencing right now has already taken place sometime in the past. Varying reports claim its frequency: some say 60%, others at least two-thirds, and some others even up to 97% of people have experienced this perception. But there’s no doubt that it’s common.
In addition to varying reports of its frequency, there are varying theories on how it works. Alternative or parapsychological explanations aside, there are as many as 30 current theoretical explanations into its origin. Current research into paramnesia (another word for deja vu) includes familiarity-based recognition, which is supported by academic psychologist Anne Cleary. In this theory, she asserts that deja vu is as a result of the current experience seeming familiar to us because of a past event that was similar but not exactly like the current event.
Similar to Cleary’s theory, Alan Brown, and Elizabeth Marsh, tends to concentrate on a recognition memory-based theory involving double perception. This theory takes much less time than Cleary’s: while Cleary’s involves past memories, double perception involves quick glances. Their theory explains that deja vu is simply when our first glance takes a superficial note of the experience, and we then immediately take in the experience with full awareness.
My theory on deja vu takes a similar feel to Cleary’s and Brown and Marsh’s theory, but also includes dual processing theory, which is what happens when “two cognitive processes are momentarily out of sync.” My theory is quite simple: when we experience a moment, the dual cognitive processes get registered in our brain in separate areas: first, the experience is registered in our short- or long-term memory before its ever processed in real-time. When our second cognitive process finally processes the event, the experience tends to feel familiar because it has already been “misplaced” in the memory before it could be processed.
My theory is different from Cleary’s theory because it only invokes familiarity with the event which is happening now only through the process of dual processing as opposed to an experience from the true past (say, an hour/day/week/month/year ago). It’s also different from Brown and Marsh’s theory in that I only include one perception of the experience instead of their two (the superficial and then full-awareness). My theory ties these two together by invoking dual processing, simply registering the experience as a memory before it can be processed in real-time by the cerebral cortex.
One way to validate my theory would be to copy the experiments of Cleary and Brown and Marsh’s, and take images of the participants’ memory creation processes during the experiments. If the memory is created before evidence of the processing of the experience and the participant recognizes a perception of deja vu, then it would be easy to see how dual processing is the culprit. This research could have a great effect on neuroscience, including rehabilitation of those in traumatic brain injuries, pedagogical processes, and understanding experience processing and memory retention.
While the American healthcare system has many flaws due to finances, it’s also undergoing an epidemic that’s hitting the entire world: a shortage of primary care physicians. With more medical students going into specialties, the primary care field has a shortage on par if not worse than the nursing shortage, and it threatens to derail President Obama’s national healthcare plan, among other healthcare initiatives and reforms. The American College of Physicians isn’t any more optimistic given its article, “The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care.”
Although foreign doctors have picked up some of the absences, studies still expect a decrease in the number of medical students becoming generalists, and thus a 35,000-44,000 doctor shortage for adult care. It already impacts every state, and articles have been written about the dwindling primary care physician availability in Massachusetts, California, Maine, Alabama, Washington, and Wisconsin, among many others. Cities with large, reputable healthcare organizations aren’t excluded: even Boston has a problem finding primary care physicians. And you know it’s bad when it hits well-supported issues, such as the availability of mammograms.
There are several theories for solutions to the shortage, with the vast majority of them focusing on increasing the number of primary care physicians. These theories include:
- An article about Texas claims it cured its doctor shortage through tort reform. It argues that by decreasing the malpractice liability and the amount a patient can win from a suit, the doctor saves money on their insurance, and the patient then sees decreased costs. This isn’t an argument I support whatsoever. While I’m well aware of the insurance costs and liability to physicians and other healthcare practitioners, I truly believe the savings to the individual person or family would be very little. This also doesn’t particularly encourage medical students to consider primary care, considering primary care is still the least profitable field for physicians.
- We could also increase enrollment in medical schools, but I agree with the consensus that it would just further encourage medical students to pursue specialties. That obviously doesn’t solve the problem.
- I disagree with this doctor who says the easy solution is to increase medicare reimbursement by 20%. Throwing money at the problem won’t help, and creates a slippery slope whereby increases in the reimbursement may be necessary as the number of primary care physicians continue to dwindle.
- Another less talked about option would be to increase the National Health Service Corps, which, according to their Web site, “helps Health Professional Shortage Areas (HPSAs) in the U.S. get the medical, dental and mental health providers they need to meet their desperate need for health care.” But there are still liability and organizational issues with the corps.
I suggest, along with some others, that our healthcare system should be reevaluated and roles appropriated. Instead of attempting to encourage more medical students, with their $140,000+ in medical school debt, to pursue the least profitable field, it would make much more sense to increase the number of nurse practitioners (PDF) with the eventual goal of replacing all primary care medicine with nurse practitioners.
Nurse practitioners, a relatively young profession at just about 50 years old, has shown to be less expensive (for both the individual and economy), have less liability, and about the same efficacy as a primary care physician. According to the Mayo Clinic (via the American Nurses Association), “approximately 60 to 80 percent of primary and preventive care can be performed by nurse practitioners.” So why can’t it become 100%, allowing for cheaper healthcare, and allowing physicians, with all their schooling and debts, to pursue specialty fields upon being referred by the NP? It simply doesn’t make sense to invest, as a society and individual, so much in primary care physicians and all their schooling and debts to take a role which can be filled by equally effective nurse practitioners.
The main problem with this plan is the availability of nurse practitioners, but with less debts incurred by these students and less time of program competition, it’s easily more practical and affordable to increase the number of nurse practitioners with government and organizational incentives such as debt relief and bonuses. This also strengthens and makes our specialty care fields more competitive by allowing more physicians to pursue those fields.
While I have little doubt that this would be, in essence, a paradigm shift to the medical community, I think it’s one we’re going to find more practical as a long-term solution as the world’s population grows. There are only so many positions available in a medical school, and only so many people who can complete the entire program. We should allow nurse practitioners to assume the primary care role to increase availability and decrease cost of the medical services we encounter most often so long as the standard of medical care isn’t decreased. And current NPs have shown they’re up to the task in both education and training.
Many times the secrets to medicine and science are right in front of us. Or, perhaps more appropriately, beneath us. In the case of the development of antibiotics, we needn’t look any further than the simple ant for inspiration. Ants have a small-but-distinguishing feature that makes them unique and very valuable to antibiotic research: the metapleural gland. This gland, which has been around for at least 98 million years and is found on many if not most ant species, creates antibiotics on the ant’s exoskeleton that fight bacteria and fungi.
Noted in 1860, the gland wasn’t thought to be of any particular significance. It wasn’t until 1898 that a more anatomical approach was taken to the gland, which was about 20 or so years after the discovery or at least the notation of the aspects of antibiotics. While there was some research in the early-to-mid 1900′s, it wasn’t until 1984 that great research on the metapleural gland (PDF) was available. And, finally, in 1989 Australian researchers discovered that the antibiotics could be used to treat fungal infections in humans, and was followed in 1992 with further research.
Much of the research on ants since then and especially recently has focused much more on the symbiotic relationship between attine ants and a particular bacterium. In this relationship, the ants house and secrete a baterium that produces antibiotics (PDF), which in turn kills invading fungi. Those same ants, which actually cultivate and feed off of another kind of fungus, houses baterium (PDF) that produces antibiotics that selectively fight the bad, invading fungus, and protect their gardens, thereby allowing the ants to thrive.
The initial reaction to such research is generally, “Let’s harvest these ants and take the antibiotics and use them for humans!” There’s one main problem with this, however: ants with metapleural glands are notoriously difficult to “domesticate” (insofar as you can domesticate an insect!). Interestingly, ant species which don’t have the gland are more apt to be domesticated. But that doesn’t mean there aren’t things to be learned or applied using this research.
The foremost reason to study this gland is to learn the mechanisms by which it can produce antibiotics and harbor baterium which produces the antibiotics. Doing so may allow us to create better environments for bacteria we find beneficial for our own health and the health of our crops and animals.
Further, it’s important to understand the mechanism for the production of the antibiotics and how the antibiotics can change given evolutionary processes found in the invading fungi. This helps us understand microbiological evolution, epidemiology, and gives us a better lead off of which to base immunological research.
We can use this research in other, non-pharmaceutical concepts, as well, including the development of anti-biological and chemical warfare armor. Perhaps the gland will reveal a way to best defend against such weapons, and offer a way to change the defense of the armor given the particular weapon. I can also imagine this research being applied to the advancement of printers, particularly those that may be used in the future to create human tissues.
While we often look for answers using many advanced concepts, sometimes the facet that leads to the best solution is one that has already been through the trials of nature. That’s what makes entomology so fascinating when coupled with medicine: oftentimes the answers to our problems have already been solved by creatures of which for so long we thought very little.
What if the free will we experience every moment of our lives was mere illusion? Being a causal determinist, I argue that all of life and its choices are actually simply culminations of progressions of physical and chemical reactions. While it at first seems absurd to question a part of life we encounter so frequently and so consciously, but, as René Descartes wisely began his First Meditation,
Some years ago I was struck by the large number of falsehoods that I had accepted as true in my childhood, and by the highly doubtful nature of the whole edifice that I had subsequently based on them. I realized that it was necessary, once in the course of my life, to demolish everything completely and start again right from the foundations if I wanted to establish anything at all in the sciences that was stable and likely to last.
Therefore, it would be prudent of us to, when attempting to understand human thought and reason, also question at a very basic level what makes us act the way we do. It is through this exploration at a very basic level that led me to this conclusion: since our bodies are composed entirely of chemicals, and we know that chemicals go through processes and reactions, we can then associate our actions with those chemical processes. This is where my argument for causal determinism is based.
According to Robert C. Solomon, determinism is “the position that every event has a cause (including thoughts and decisions) and is fully governed by the laws of nature.” According to the view, since everything in the universe, including humans, is material of some sort, and materials have physical reactions, we too are wholly based in and guided by those reactions. Freedom and free will are simply illusions.
Before giving evidence of this position’s validity, I’ll first go through three other similar perspectives to rule out any confusion:
- Fatalism: in fatalism, actions happen because they are meant to happen, for some reason such as karma. Fatalism is different than determinism in that deterministic actions must happen due to their static physical qualities, while fatalistic actions happen because they are meant to happen by some other force.
- Predestination: predestination is the view that the world is predetermined by some being, and our lives are simply playing out the stories which will necessarily lead into the predetermined conclusion. While it would be fair to say that a deterministic view will lead to a conclusion that could have been determined, predestination invokes a deity or being that oversees the storyline.
- Soft determinism: another view is soft determinism, also called compatibilism, which holds that freedom still exists due to the fact that we can never know all of the causes which have brought about the current action. This view concludes that we are free due to certain “free actions,” such as by rationality, without “external compulsion,” or by some other non-induced action.
Even though soft determinism fits well with our consciousness and the seemingly ever-present ability we have to make decisions through our own rationales, it’s my position that causal determinism is the reality of our nature and everything else in the universe.
For evidence of causal determinism’s validity we needn’t look any further than psychoactive drugs. While many would argue that the human mind isn’t material, psychoactive drugs have great effects on the mind, our perceptions, and our thoughts. For example:
- Major depressive disorder is thought to be based on a lack or imbalance of one or more of the monoamines (serotonin, norepinephrine and dopamine). Antidepressant drugs work by increasing the levels of such monoamines. Therefore, depression in this instance and its psychological implications are chemically-based.
- Lysergic acid diethylamide, otherwise known as LSD, has visual effects, as well as distortions of the perception of time. LSD works by affecting G protein coupled receptors, including dopamine and adrenoreceptor subtypes.
In each of these cases, and many more that are similar to these cases, it is a chemical which is having an effect on the chemicals in our brain. The reactions between those chemicals in our brain change the way our mind works, perceives, and, in turn, affects the way we interact with the outside world. My evidence for the validity of causal determinism is, simply, because chemicals interact and influence our mind, our mind is therefore made of chemicals. It follows, then, that because our mind is simply a culmination of physical and chemical processes, we are no different than anything else in the universe: humans, animals, rocks, lightning, plasma, ice, and photons, all just physical and chemical processes acting in the strict governance of the laws of nature.
It’s not the nicest view, but it is one for which I find clear and unequivocal evidence. In future posts I’ll explore a casual deterministic perspective of law and punishment, learning, and other implications.
I find it incredibly surprising that many who read about the human swine flu outbreak chalk it up to a media sensation instead of a viable health concern. Whether the outbreak concludes in a pandemic or by fizzling out much like the previous human swine flu of 1976 probably depends on how well this outbreak is contained.
Main concerning points of this flu are three-fold:
- While the mortality rate of this disease cannot yet be determined, taking initial reports into account, you’re looking at approximately a 10% mortality rate. That’s the number of deaths (approximately 150 at this moment) divided by the number of cases (approximately 1,600). These figured are sure to be reevaluated as more cases are found and more deaths occur. (As a point of interest, the avian flu/SARS has a mortality rate of over 50% of confirmed cases.)
- The infection seems to spread rather easily. One could say that a mere 1,600+ cases in a city of 22 million doesn’t constitute a big infection, but it’s growing every day. In the United States alone the number of confirmed cases has almost doubled every day.
- This infection isn’t just swine-derived, but is actually a hybrid of two separate swine flus, a human flu, and an avian flu.
Another interesting point about swine flu has been the World Health Organization‘s response. Already under fire for not moving into Phase 4 on April 24th, there’s some cause for concern on why they’ve yet to declare a Phase 5 Pandemic Alert. Simply put, their definition of Phase 5 is:
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.
Swine flu meets the very first criteria defined in their statement: human-to-human spread of the virus into at least two countries in one WHO region. You could also argue that it meets the definition for Phase 6, which is defined as:
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.
With infections now reaching Mexico, United States, Canada, Spain, Scotland, Israel, New Zealand and perhaps more (possible cases were reported in Australia, France, Germany, Sweden, Norway, and South Korea), you could reasonably say that at least Phase 5 has been reached. Higher community-level outbreaks in Europe are probably needed for Phase 6.
But the question is whether the WHO has thus far acted more in the interest of politics and economics rather than health. When acting as the world’s main health organization, it’s prudent of them to act in the best interest of doctors, scientists, and the general public. If the issue’s severity warrants the closing of borders and mass transit to contain the disease, which is one of the first and best ways to stop an infectious disease, then the determination needs to come swiftly. If they’re worried about causing panic or adversely affecting politics or economies, then they need to reevaluate their Pandemic Alert phases and perhaps institute separate ones for health officials and the public.
It will be interesting to see how this disease continues to spread and what short- and long-term effects it has on pandemic preparedness and the WHO’s determination and communication of such issues.