Tag Archive: Medicine

  1. A Tough Pill to Swallow

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    Lina Pradeep is always on the move — she shovels the driveway and bustles around the house.  She even plays with her toddler.  However, less than a year ago, Pradeep was diagnosed with symptoms of multiple sclerosis, an immune disease that severely affects a person’s nervous system and impairs mobility.

    Pradeep had constant pain in her legs and was unable to walk for more than 10 minutes when her doctor first identified the symptoms in June.  Rather than follow through with additional testing, though, Pradeep decided to come to the Amadeus Center for Health & Healing in New Haven for acupuncture treatments.  The biweekly visits are a family affair — her husband and son accompany her for the two hour round trip from her home in Woodbury, Conn..

    Now, eight months into her treatment, the pain is nearly gone.

    While the walls of herbal supplements inside the Amadeus Center hint at its healing philosophy, similar treatments are also in progress in the Yale Stress Center, about a mile away.  In the past year, the Stress Center has started offering acupuncture to many conditions ranging from chronic pain to mood disorders.

    For Eunjie Klegar, clinician in psychiatry at the Yale School of Medicine, “It’s a way of being able to treat the whole person.”

    ***

    This field of medicine has many names: alternative, integrative, complementary, naturopathic, oriental.  They all refer to the wide range of non-conventional treatments that includes homeopathy, naturopathy, acupuncture and even lifestyle management.

    However, despite common tendency to use these names interchangeably, Marcia Prenguber, dean of the University of Bridgeport College of Naturopathic Medicine, does not think that all are equally appropriate.

    “Calling it ‘alternative’ can put up a barrier,” Prenguber said. “‘Complementary’ is better, but can still sound insignificant.”

    Though “alternative” may indeed sound alienating, it appeals to some patients who are frustrated with conventional medicine.  In Pradeep’s case, for instance, distrust of American doctors drove her to see a naturopathic practitioner.  In her native Russia, eastern medicine plays a more prominent role than it does in the United States.

    “The effectiveness of acupuncture is a fact there,” Pradeep said. “I want to be cured, not diagnosed. And I don’t see that happening with [conventional] medications.”

    Pradeep’s journey is a familiar one to David Katz SPH ’93, director of the Yale-Griffin Prevention Treatment Center.  Formerly involved in the Integrative Medicine Center at Griffin Hospital, Katz often saw patients who had tried all other mainstream options available to them.  Integrative medicine provided him with the creativity he needed to effectively treat those who had exhausted conventional treatments.

    Integrative medicine can also afford patients a sense of control. Robert Krause YSN ’98, a lecturer at the Yale School of Nursing, incorporates alternative medicine into his psychiatry practice, using yoga and meditation in conjunction with psychopharmacology to treat patients.  He said his patients who pick non-conventional treatments often report feeling in command of their daily lives.

    Erin Hofstatter, professor of medicine, noticed similar results when her patients began requesting herbal supplements.  At the Yale Cancer Center, Hofstatter tries to accommodate her patients’ desires — she typically allows the use of herbal supplements as long as they don’t interfere with the patient’s other medications.

    “The patients want to feel in control,” Hofstatter said.  “There’s nothing like a cancer diagnosis to make you feel out of control.”

    Hofstatter began her research into plant-based therapies in response to her patients’ demand for treatments with fewer side-effects. She is currently working on a clinical study of black cohosh, a compound with cancer-preventative properties — she hopes that this study will fit into a larger trend of non-conventional clinical trials.

    ***

    But elsewhere in the Yale School of Medicine, some clinicians see alternative medicine in a less favorable light. Steven Novella is a professor of neurology and a prominent member of the opposition, termed the “scientific skepticism movement.”  Novella is the founder and executive editor of Science-Based Medicine, a blog that evaluates alternative medical treatments from a scientific perspective.

    “Alternative medicine is a term that’s used a lot,” said Jann Bellamy, a contributor to the blog.  “But there should just be medicine.”

    Medicine is rooted in safety and effectiveness, and according to Bellamy, if a treatment can’t ensure both, then it cannot be classified as medicine.  This critique — that non-conventional treatments do not have a scientific basis — is a popular critique among skeptics.

    However, many practitioners of alternative medicine maintain that science provides a firm grounding for their work.  Michelle Hessberger is a naturopathic physician who practices at Revive Wellness Center in New Haven.  In addition to her doctoral degree in naturopathy, she also has a master’s degree in cellular and molecular biology, a qualification that surprises many people.

    “I’m looking at cells and molecules to see how I can make them function better,” she said.  “For example, by looking at biochemical processes, you can help the mitochondria produce more energy.”

    Although she carries out conventional lab testing for her patients, she does not take results at face value, the way a primary care physician would.  Rather than check if a patient’s vitamin levels fall within the accepted range, she determines the patient’s optimal level, given their lifestyle and history; this approach has helped many patients who felt ill despite normal lab results.

    For Prenguber, too, science is central to naturopathy.  Modern science can explain the mechanisms of ancient treatments, she said.

    “We’re blending centuries-old traditions with the backing of more advanced research,” she said.

    The long-standing history of plant-based medicines — including everyday aspirin, which can be derived from willow tree bark — is a common argument for the scientific soundness of naturopathy.  Skeptics do not dispute this; they just ask that alternative medicine and conventional treatments meet the same rigorous standards.

    Hofstatter has encountered this very dilemma in carrying out her black cohosh study.  While she acknowledged that alternative treatments should be as effective and safe as conventional therapies, she said that a lack of funding and grant money complicates the process.  The large pharmaceutical companies that typically fund studies are less interested in integrative medicine, a less profitable endeavor.

    Many School of Medicine researchers attempting to carry out studies on natural treatments echoed this concern.  Ather Ali SPH ‘06, a director of the Integrative Medicine at Yale program, pointed out that many alternative treatments cannot be patented, making them less profitable.

    Since there is little funding, researchers have less incentive to pursue studies that could otherwise prove the effectiveness of alternative treatments, Hofstatter said, generating a vicious cycle preventing progress in the field.

    She posed a question to skeptics and fellow researchers alike: “Is it fair to hold [alternative medicine] to the same standards when there’s no feasible way to test the treatments in the same rigorous manner?”

    ***

    Although most agree that a gap exists between practitioners and researchers of alternative medicine, successful research could ultimately unite the two groups.

    “Theoretically everyone benefits,” Ali said.  “If [a study] demonstrates promise, it becomes directly applicable to the small practice down the street.”

    At the moment, though, the field is finding it difficult to gain traction in the academic community.  In November 2014, the Integrative Medicine Center at Griffin Hospital, a Yale affiliate in Shelton, closed.  According to a note on the website, this closure was due to “the changing landscape in healthcare.”

    Katz, the founder and director of the Integrative Medicine Center, explained that the facility had difficulties maintaining a cost-effective model of integrative care.  Each session with a patient required a team of clinicians and took as long as two hours.  The center was losing money for the hospital, Katz said, resulting in its closing after fifteen years of operation.

    At the Yale School of Medicine, integrative medicine does not have its own department — instead, the Integrative Medicine at Yale program provides a limited opportunity for students and faculty to collaborate and receive guidance.  However, it is not a formal program.

    Yung-Chi Cheng, professor of pharmacology at the Yale School of Medicine, thinks that Yale can do better when it comes to alternative medicine.  There is a lack of research activity and faculty interest, Cheng said.  He did note, though, that Yale is taking action — the School of Medicine has helped found the Consortium for Globalization of Chinese Medicine, of which Cheng is chairman.

    “In spite of the limited activity at Yale, our work is being watched carefully around the world,” Cheng said.  “If it works, it can be modeled for people to show how they should approach exploring the potential of Chinese medicine.”

    ***

    The next generation of practitioners and researchers may have a chance to break the vicious cycle currently impeding the progress of alternative medicine.

    There are currently five accredited programs in naturopathic medicine in the United States — one just down the road in Connecticut at the University of Bridgeport, under Prenguber’s leadership.  Prenguber admits that her students have trouble getting hands-on experience in the field without the clinical access that medical students enjoy.

    At Yale as well, resources are somewhat limited for students interested in alternative medicine.  Vanessa Noelte ’16 has been excited about integrative medicine ever since high school.  After hosting a screening of the film “Escape Fire” in order to spark discussion about the healthcare system, Noelte realized that a substantial group of undergraduates shared her interest.

    In her sophomore year, she founded the Integrated Medicine at Yale Undergraduate group to invite speakers and host discussions, but she still feels a lack of mentorship for undergraduates interested in integrative medicine.  As the only undergraduate director of the Integrative Medicine at Yale program, Noelte acts as a liaison, directing Yale College students to opportunities in non-conventional medicine.

    “I think integrative medicine is the future,” Noelte said.  “Hopefully the school and the students realize that soon.”

    Correction: Feb. 28

    A previous version of this article misstated the class year of Robert Krause YSN ’98.

  2. Just Like Magic?

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    Just off the central rotunda of the Yale Medical School, past the teratology (the study of monsters) display and above the collection of human brains, you’ll find the main room of the Medical Historical Library. It’s an imposing, wood-paneled room, and on most days, the first thing you’ll see walking into it is the giant portrait of Andreas Vesalius hanging over the fireplace. Vesalius, whose depictions of public dissections in “De humani corporis fabrica” are considered the foundation of modern anatomy, is a grim-looking man in somber clothes: He matches the décor.

    If you walk into the library from now until Feb. 28, however, you’ll find Vesalius slightly obscured. Brightly colored signs with the names of the four Hogwarts houses hang from the second-level balcony; a display of magical kitsch and multi-lingual editions of “Harry Potter” rests to the left of the entrance; and a set of panels containing a combination of text and images stands directly in front of the fireplace. The space is temporarily home to the National Library of Medicine’s traveling show, “Harry Potter’s World: Renaissance Science, Magic and Medicine,” and although the Potter aesthetic might seem incongruous under Vesalius’s stern gaze, the exhibit is concerned with making a strong case for their relation.

    From the immersive theme park in Orlando to the interactive reading experience of pottermore.com, the Harry Potter universe is continuously being animated and re-animated — virtually, physically, culturally — for a variety of purposes. “Harry Potter’s World” capitalizes on the power of the magic metaphor; each of the six large panels that comprise the exhibit links a thematic aspect of the wizarding world to a specific person and text in the history of science. The subject of “Herbology” is paired with Jacob Meydenback’s plant catalogue, “Hortus Sanitatis,” and “Immortality” goes with Agrippa’s “De Oculta Philosophia,” and so on. In this context, Harry Potter acts as both cultural access point and mnemonic device. The task the exhibit asks of you is simple: You can use one story to understand another.

    The exhibit argues that the fantasy of Harry Potter is based in real historical truths: Magic, we learn, has “an important role in the development of Western science.” In sometimes comically jarring or forced ways, the information on the panels illustrates this interpretation. “Like Harry’s professors, 16th-century Swiss naturalist and physician Konrad Gesner appreciated the knowledge gained by studying nature,” begins one such clumsy simile on the “monsters” panel. Later, words from Sirius Black on the persecution of merpeople are juxtaposed with information about the medical reformer Paracelsus, who apparently “appreciated what other cultures could teach about healing.”

    The beliefs that Gesner, Paracelsus and others held about animals, plants and people are often fascinating, but the exhibit locates them in contemporary scientific discourse in a way that feels didactic. A clear ideology is at stake, one of respect for the diversity of life, objective observation and the sanctity of the experimental process. The environs of the Medical Historical Library reinforce this argument; Harry Potter is implicated in a history of “the steep ascent from the unknown to the known.”

    I’m more invested in an inverse proposition: that the processes we consider to be objective and scientific have their roots in the mystical and the occult. The panel on “potions” insists that the practice of alchemy led linearly to modern chemistry. But the text referenced, “Aurifontina Chymica,” relates a story in which alchemy and chemistry are inextricably entwined. The spelling of the word itself, “chymica,” reveals its double origin. Tracing a narrative of influence becomes harder when the objects in question are not easily described or differentiated.

    Just as I don’t really want to yoke Paracelsus and Sirius Black together in a quality called “tolerance,” I’m also skeptical that the knowledge found in herbals or alchemical treatises was incorporated smoothly into the bodies of thought called “biology” and “chemistry.” Perhaps this reaction is partially the point, or at least the point that I drew from my observation: What’s really interesting about this exhibit is not the content itself, but the potential for interactions, congruent or not, among the objects, bodies and literatures that it evokes.

    If you go, make sure to attend one of series of related talks (I’m going to “Herbals: food as medicinal and medicinals as food”), look at pictures of human dissections in Vesalius, or investigate a set of surgical instruments for amputating and trepanning. Be curious, be critical, and don’t let the exhibit alone determine the terms of your engagement.

  3. “Haven Games” bring Hollywood to Med School

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    In case you haven’t had a chance to see The Hunger Games in theaters yet, an abridged version geared specifically for Yalies surfaced on YouTube on Thursday.

    Titled “The Haven Games,” the video — written and produced by Yale School of Medicine students — aims to welcome recent admits to the Medical School’s class of 2016. It follows the basic steps of The Hunger Games trailer but offers a cool, unique, Yale-inspired spin. Rather than fight to the death, as the characters in The Hunger Games are expected to do, the players in The Haven Games must measure heart rates and operate lab equipment to gain one of 100 coveted spots in a medical school class.

    In one scene, a student at “other med school” discusses his worries with Katniss Everdeen, a Medical School student.

    “I just keep wishing that at medical school, we didn’t have to kill each other,” he says in frustration. “If I’m going to die, I want to still be me.”

    But Katniss has an answer ready.

    “Oh, at Yale, we really don’t have to think about that,” she says with a wink.

  4. School of Medicine grad wins big settlement

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    A Sacramento jury awarded a Yale School of Medicine graduate $168 million in damages last week in a lawsuit over 18 complaints of harassment and professional misconduct at Sacramento’s Mercy General Hospital, the Los Angeles Times reported.

    Ani Chopourian MED ’99 began working as a physician assistant for the cardiovascular surgical team at Mercy General in August 2006. Once on the job, Chopourian saw inappropriate behavior by numerous surgeons. One surgeon, she said, stabbed her with a needle and, in a fit of rage, broke the ribs of an anesthetized patient, she said. Another surgeon called her “stupid chick” and asked if she was a member of the terrorist group al-Qaida because of her Armenian heritage, she said. Two years after she joined Mercy General, as she was filing complaints about the harassment she had experienced, Chopourian was fired for unprofessional conduct.

    The $168 million in damages Chopourian won represents the largest judgment for a single victim of workplace harassment in U.S. history.

    “Cardiac surgery brings in the most money for any hospital facility, which is why they are willing to turn a blind eye to illegal and inappropriate behavior,” Chopourian told the Associated Press. “We had four very strong witnesses who were frightened to speak out but did so because they felt it was important that someone put a stop to this.”

    The court’s Wednesday verdict includes $125 million in punitive damages and $42.7 million for lost wages and emotional trauma. Mercy General President Denny Powell said the hospital stands by its decision to fire Chopourian and will appeal the verdict.

  5. Medical School starts blog to answer health questions

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    Got a medical question? A new blog from the Yale School of Medicine may have the answer.

    “Ask Yale Medicine” enlists experts from across the school’s faculty to field emailed questions and post replies on the site. A number of blogs have already been posted — questions answered include “How can I prevent winter sports injuries?” and “Do I need to worry about sun exposure in the winter?”

    In an inaugural post explaining the website’s mission, the founders emphasized that the tool was intended as an information source that would supplement, but not replace, patient-doctor relations.

    “This blog is your opportunity to ask questions of the physicians of Yale School of Medicine,” the post read. “The information provided here may help you make more informed choices.”

  6. Dean ’71 talks health care, Yale

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    Howard Dean on Meet the Press

    Long considered one of the most knowledgeable figures on the topic of health care, Howard Dean ’71 has recently been the subject of a number of profiles, as debate on a “public option” continues.

    Dean will be teaching a residential college seminar this semester, “Understanding Politics and Politicians,” with his friend and fellow Piersonite, organizational psychologist David Berg ’71 GRD ’72. He spoke with the News on Friday about health care, his course and why he wants to teach at Yale.

    Q: How has your role in the health care reform debate changed since you decided to teach at Yale early this year?

    A: I don’t know that it has changed all that much. Health care reform is something I have been interested and involved in for a long time — over 30 years.

    Q: Are you surprised by how long it is taking for a bill to move through Congress?

    A: I am not surprised. My original prediction, one I still think is true now, is that I am confident the President will sign health care reform into law in November.

    (more…)

  7. Two Kohs are better than one

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    thekohsaresoadorable.jpg

    Bored during your internship? Here’s something to add to your reading list: A profile of former Yale Law School Dean Harold Hongju Koh and his brother, Howard Koh ’73 MED ’77, that appeared in The Boston Globe today. The brothers are now, respectively, legal adviser in the Department of State and assistant secretary for health in the Department of Health and Human Services.

    The whole article is worth reading, if only to find out that Harold Hongju Koh, who was once seen hoisting two Boston Red Sox World Series trophies in the Law School dining hall, will throw out the first pitch at Fenway Park on August 29. It is also worth reading because of the adorable photograph, above, that accompanies it.

  8. Senate approves Koh. No, not that one.

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    harold.jpg howard1.jpg

    One of the above Kohs has been confirmed by the Senate. Guess which one! (Hint: The less controversial one.)

    The Senate voted Friday to approve the nomination of Howard Koh ’73 MED ’77 — pictured at right — for the position of assistant secretary for health in the Department of Health and Human Services, said Regan Lachapelle, a spokesman for Senate Majority Leader Harry Reid. Koh will be the primary adviser to Secretary of Health and Human Services Kathleen Sebelius on matters relating to public health.

    (more…)

  9. Seven hospitalized after acid spill at School of Nursing building

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    Updated Wednesday 1:28 p.m. Seven people were hospitalized Tuesday after an acid spill at a dialysis center that shares a building with the Yale School of Nursing.

    Around 5:30 a.m., workers at the privately-run dialysis center spilled several gallons of an acid mixture used to clean dialysis equipment, the New Haven Register reported. The workers tried to ventilate the area after the spill, but in doing so, they allowed fumes to spread throughout the building. When other workers and patients arrived later in the morning, several complained of nausea, abdominal pains and throat irritation.

    The seven people hospitalized have since been released from local hospitals.

  10. Third swine flu death in Connecticut

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    A woman in her early 40s has become the third person in Connecticut to die from swine flu.

    The woman died yesterday at Waterbury Hospital, according to The Associated Press. She had been admitted after complaining of respiratory problems and later tested positive for the virus. The hospital said that the woman had other health conditions that diminished her body’s ability to fight the flu virus.

    As of last week, the Connecticut Department of Public Health had confirmed 637 cases of the flu in the state.

  11. First swine flu death in Connecticut

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    Following a brief hospitalization, a woman from Waterbury died of swine flu on Tuesday, the Connecticut Department of Public Health announced today.

    The woman was over 60 years old and at a higher risk for influenza-induced complications due to underlying risk factors, health officials said.

    So far, 397 cases of the H1N1 flu have been officially confirmed in Connecticut, with the woman’s death being the first case that has proven fatal. Worldwide, 66 countries have reported over 19,000 cases of swine flu, with 117 of them fatal.