Sexual Education in US Secondary Schools- Eye Opening

Source: LiveScience.com

Here is a report from the CDC on HIV, STD and pregnancy prevention in US secondary schools. As you you will note, sexual education varies considerably across states and is appallingly insufficient in some. 


Take a particular look at Table 3,  a state by state summary of condom related topics taught in grades 9-12. The numbers speak for themselves. 


As an infectious diseases physician who sees and treats many young people with sexually transmitted infections and newly acquired HIV infections, the reports above are deeply concerning.

Periodontal Disease and Heart Disese

Source: Perio.org

Here is a statement from the American Heart Association on the association between periodontal disease and coronary artery disease.. 


The mouth is teeming with bacteria and serious infections, such as endocarditis, are commonly from an odontogenic source.  The purported pathophysiology behind periodontal disease and coronary artery disease includes indirect mechanisms such as inflammation and mimicry and direct mechanisms such as bacterial invasion of atherosclerotic plaques.  


The data to date support an association between periodontal disease and heart disease independent of known confounders, they do not, however, support a causative relationship.Last, there is no convincing data to suggest that treatment of periodontal disease will impact, in the long term, cardiovascular disease.


Heart disease has also been associated with Chlaymydia pneumoniae and Helicobacter infections. Association does not mean causation and to date coronary artery disease is not treated with antibacterials.

Scientific Misconduct in Medicine: A Pox On Us!

Source: Nature.com

Here are two disturbing reports published in the British Medical Journal about  the falsification of scientific data in medical research. One report is a survey of research misconduct among Dutch physicians while the other is on scientific misconduct in the UK.

I fortuitously came across the above reports after reading this thought provoking post by Eli Parencevich on the retraction rate of scientific articles, particularly in high impact journals.

The motives behinds scientific misconduct are multiple and include career advancement, recognition and the opportunity for larger, more prestigious grants. This is compounded by a peer-review process that is not sufficiently rigorous to uncover errors in methodology as described here in the Economist.

When the scientific method is corrupted by falsification, bias and conflict of interest, there is a betrayal of trust in science and medicine and a resultant compromise of the common good. 

Fecal Microbiota Transplantation- The Universal Donor

The blender- not just for smoothies! 

I spent much of the weekend updating a C.difficile lecture. I added new fecal microbiota transplantation references with particular emphasis on a paper reporting the use of a 'universal donor' for stool .

 A few points. Fecal transplantation is a reasonable and effective treatment for recurrent C.difficile colitis. The goal is to restore the normal microbiologic flora of the colon to prevent recurrences of C.difficile colitis. Here is a scholarly review on fecal bacteriotherapy for the treatment of recurrent C.difficile colitis.

Once stool donors are screened for HIV, Hepatitis B and C, donor stool can then be screened for pathogens such as salmonella, shigella, giardia, C.difficile, and cryptosporidium. A slurry is made with normal saline in a blender. The particles are removed via sieves and then concentrated via a centrifuge. The concentrated fecal solution can be administered  immediately  via nasogastric tube or by colonoscopy with enema, or, it can be frozen for future (transplantation) use.

We need to get past the yuck factor and make this therapy available for those who suffer from recurrent C.difficile colitis

SHEA Meeting and Evidence Based Infection Prevention Practice

Hand Hygiene. Source: World Health Organization

Here is a summary in Infection Control Today on evidence based infection prevention interventions advocated at the recent SHEA conference.

A couple of considerations. All infections are not preventable. Not all infection prevention interventions are easily implemented and not all are backed by high quality evidence.  Implementation takes administrative support, finances, trained infection preventionists and significant effort.

So where does a hospital infection prevention program start? The following list is worthy of universal application.

• Improve hand hygiene among healthcare professionals
• Use of appropriate isolation precautions for patients known to be colonized with dangerous or drug-resistant organisms like Clostridium difficile or MRSA
• Ensure adequate cleaning of the environment and equipment
• Remove catheters and other devices promptly
• Educate healthcare professionals and patients

Care for the Patient, Not the Disease

Sir William Osler

The other day on the infectious diseases consult service I was reminded of the importance of understanding a patient's subjective experience of disease. 


After a patient with AIDS was admitted to the medical service with an acute gastrointestinal bleed, he repeatedly expressed his disapproval for the delay in receiving a medicated cream to treat his mild case of seborrheic dermatitis. When I suggested that he should worry more about taking the HIV medications and addressing the current GI bleed, he put things in perspective for me. 


"Doc, I may be a bit vain about my face, but when I am broken out" he said in a low voice, "people be asking me if I have that disease (HIV)."


The biopsychosocial impact of illness is undeniable. In this instance, I had failed to recognize his fear of stigma from even a mild case of seborrhea. I was properly humbled.


To quote Sir William Osler: Care more particularly for the individual patient than for the special features of the disease (address to the students of Albany Medical College, 1899).

The New MCAT- Behavioral and Social Sciences

The new MCAT: more than just science

The Medical College Admission Test (MCAT) traditionally focuses on the biological and physical sciences but scientific knowledge and technical savvy do not always make a good doctor.

Effective 2015, the new MCAT will also test the social sciences by requiring students to analyze passages in areas such as ethics, humanism and cross-cultural studies. At hand is a multiple choice test that will theoretically screen for the right mix of a scientist, humanist and future doctor. 

Will it work? Maybe.

Here is an informative read on the matter, in the NY Times' Education Life magazine, and an argument in favor of the new MCAT published in the New England Journal of Medicine.