Pre-operative fasting: let them eat … anything?

It is routine for patients to be fasted before an anaesthetic, usually for six hours, but for morning lists patients are usually fasted from midnight. The fasting is meant to reduce the risk of aspirating (vomit and have gastric contents enter the lungs) during the induction of anaesthesia, which can damage the lungs and be very harmful. But does fasting decrease the risk of this complication occurring? Once again, the benefits of fasting have been overestimated and the harms have been underestimated. And once again, when faced with a difficult decision, doctors have chosen the (seemingly) cautious path, and in doing so have not provided any proven benefit, and have possibly harmed patients. It may not seem like a big deal, but with over 200 million surgical procedures performed in the world each year, it can add up.

Book review: The Medicalization of Society

Title: The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (2007)

Author: Peter Conrad

Publisher: The Johns Hopkins University Press

Continuing the work of pioneers in medicalization such as Irving Zola and Ivan Illich, this veteran but intermittent author on medicalization gives us a sociologist’s perspective on medicalization. Conrad provides us with examples, but also gives us some causes (such as direct-to-consumer advertising, managed care, changing definitions and ‘domain expansion’) and consequences of medicalization.

Book review: How Much is Enough: Money and the Good Life

Title: How Much is Enough: Money and the Good Life (2012)

Authors: Robert and Edward Skidelsky

Publisher: Other Press, New York

This book is not about health, although it does touch on health in that our measurements of general health are intertwined with well-being and happiness. That is one justification for squeezing it into this series of book reviews. The real reason I included this book is because the authors challenge our current (economic) thinking; questioning our goals and the prevailing wisdom that guides current practice. In other words, they are skeptical.

Patient care overlooked in the concern over patient privacy

A recent journal article (paywall) had the lead-in line of:

“Patient privacy and confidentiality are being overlooked in the burgeoning use of smartphones to take medical photos”.

I argue the opposite: that ease of access to medical images has been overlooked in the concerns over privacy and confidentiality.

Cruciate ligament reconstruction: wait and see

The anterior cruciate ligament (ACL) is a major ligament deep inside the knee. It is commonly torn during sport and once torn, it usually does not heal. An ACL deficient knee is often unstable, leading to “giving way” on certain movements. Previous attempts (1960’s and 70’s) to repair the ligament did not lead to good results. Later, attempts to repair the ligament were abandoned in favour of a reconstruction in which the torn ligament is replaced with some normal tissue (part of the patella ligament or some hamstring tendons). It is a very common injury and reconstruction is a common procedure for orthopaedic surgeons. If you only want information about the procedure, there are thousands of websites that will help you. If you want to know whether the surgery is necessary, read on.

Does CPR save lives?

In TV land, most people not only survive CPR (cardiopulmonary resuscitation), but they go home from hospital and function normally afterwards (yes, they actually studied this). In reality, less than 10% survive, and for many that do, it’s not a good life. The low number of people that survive and function well after CPR (as low as 2% in some studies) leads to a question: if the results with CPR are so dismal, what would the results be if we did not do CPR? In other words: does CPR itself do anything; were those that survived going to survive anyway?

Book review: Effectiveness and Efficiency, by A Cochrane

Effectiveness and Efficiency: Random Reflections on Health Services (1972)

Author: Archibald Cochrane

Publisher: The Royal Society of Medicine Press.

Cochrane was a physician and epidemiologist whose request for an organised summary of all randomised clinical trails in medicine was answered in the form of the Cochrane Collaboration (www.cochrane.org). This classic book, written as an invited lecture, is essential reading for anyone interested in of the evolution evidence based medicine, and anyone sceptical about modern medicine. Archie Cochrane pushed for evidence based medicine before the phrase was coined.  He questioned the effectiveness of much of the (then) current medical practice (such as prolonged bed rest for heart attack patients, oral therapy for diabetes, iron for anaemia, ergotamine for migraine, and my favourite, antidepressants) and was proved right.