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Remembrance of things past

There was more to Jackson's vision than a vivid imagination, however. If he saw movement where no one else did, if objects seemed to rotate and transmute in space it was partly because in his eyes they did. For as long as he could remember Jackson had been afflicted with hallucinatory spells. They came without warning and could be as short as an instant or as long as several minutes. In the late 1940s after years of silence even with Lee he described the affliction to Roger Wilcox. “With his eyes open wide, in a normal situation, he would suddenly begin to see all these swirling images,” Wilcox remembers Jackson telling him, “a swirling of lines and images, swirling tangles of lines. It was like real . . . He wanted to know if there was something wrong with his eyes or with his sanity.” Having done some research on visual phenomena in connection with an invention, Wilcox reassured him, “It's just a temporary malfunction in the optic nerve. It's inside your head, not in your eyes.” Jackson was relieved. “At least there's nothing wrong with my eyes,” he said. (Later, Wilcox researched the problem in medical and optical journals and concluded on the basis of Jackson's description that “It was just a temporary malfunction in the optic chiasm, triggered by a malfunction of the perceptual circuits in the occipital lobe of the cerebral cortex and projected onto the retina.”) The generally accepted medical term for this painless ocular disturbance is an ocular migraine. (Steven Nafeh and Gregory White Smith. Jackson Pollock: An American Saga. Aicken, South Carolina: Woodward and White Inc, 1989:538–9.)

Bacteria in biofilms is a problem in medicine

Recent evidence suggests that bacteria do not in fact spend much time as isolated cells. Rather they adhere to various wetted surfaces in organised colonies that form diverse communities. In these complex and tenacious films, known as biofilms, bacteria can be nearly impossible to eradicate with conventional antibiotics. At times antibiotics and germ fighting cleansers may fail to be able to penetrate these biofilms. Moreover, in biofilms many bacteria may be in areas in which they are not replicating but are able to survive. This makes them immune to antibiotics that work by interfering with bacterial replication. At least one novel drug is already being investigated to combat the bacteria in biofilms. Investigators in Australia are studying how substituted furones seem to interfere with the formation of biofilms. These studies may be particularly important to ophthalmologists since contact lenses are one of the most familiar surfaces that are colonised by biofilms. (Scientific American2001;285:75–81.)

Glucosamine sulphate is superior to ibuprofen in treating osteoarthritis

Glucosamine sulphate has been used for the treatment of osteoarthritis in veterinary medicine for more than a decade. It has only been used extensively for human patients during the last few years. Only a few well controlled studies have been completed in human patients. Now in a controlled randomised double blind study in Canada glucosamine sulphate has been compared to ibuprofen in the treatment of the pain and disability associated with temporomandibular joint osteoarthritis. In this study of 45 patients glucosamine sulphate had a significantly greater influence in reducing pain during function and the effect of the pain reduction lasted longer than in those patients treated with ibuprofen. No significant side effects of glucosamine sulphate were noted in this study. (Journal of Rheumatology 2001;28:1347–55.)

Marijuana can trigger myocardial infarction

Smoking marijuana is known to have significant haemodynamic consequences including a dose dependent increase in heart rate, supine hypertension, and postural hypertension. In the determinance of myocardial infarction onset study from Boston it was demonstrated that the risk of myocardial infarction was 4½ times greater than normal in the 60 minutes immediately after marijuana use. The elevated risk rapidly decreased thereafter. The mechanism whereby myocardial infarction may be associated with marijuana has yet to be determined. (Circulation2001;103:2805–9.)

Obesity's heavy toll

Obesity which can cause heart disease and diabetes leads to 300 000 deaths annually in the United States, second only to the 400 000 that are associated with tobacco use. Obesity accounts for 5.5–7% of the total US healthcare cost. At the 11th European Congress held in Vienna this year researchers demonstrated that about 30–40% of all cancer cases stem from excessive weight. A successful strategy to reduce obesity would appear to have the potential to significantly reduce the risk of cancer. (Scientific American 2001;265:22.)

How common is symptomless deep vein thrombosis during air travel?

The problem of deep vein thrombosis during air travel is being reported with increased frequency. In a study from Lister Hospital in London 89 men and 142 women over 50 years of age with no history of thromboembolic problems were studied. One group wore elastic compression stocking below the knee and the other group did not. All of the studied subjects made air journeys lasting more than 8 hours per flight and returned to the United Kingdom within 6 weeks. Ultrasonography demonstrated that 10% of the study group had developed symptomless deep vein thrombosis in the calf. None of these passengers had worn elastic compression stockings. Four patients who did wear these stockings developed superficial vein thrombophlebitis. Deep vein thrombosis appears to be a relatively common complication of long haul airline travel. Wearing elastic compression stockings may reduce the problem significantly. (Lancet2001;357:1485–9.)

Cataract extraction is related to coronary heart disease in women

Oxidative damage to proteins in the human lenses is believed to be important in the aetiology of age related cataract. Because free radical mediated oxidative damage to life of proteins may accelerate atherosclerosis, a study from Harvard Medical School investigated the hypothesis that the development of a cataract might be a marker for atherosclerosis and the subsequent risk of coronary heart disease. This study was performed in women and, over a 10 year follow up period in over 60 000 patients, a positive association between cataract extraction and coronary heart disease was demonstrated. This association was even stronger in women with a history of diabetes. (American Journal of Epidemiology2000;153: 875–81.)

Thunderstorms may precede epidemics of asthma

A case-controlled study performed in six towns in south eastern Australia has demonstrated that thunderstorms were detected on 33% of days when epidemics of asthma occurred as opposed to only 3% on controlled days. These findings are consistent with the hypothesis that some epidemics of exacerbations of asthma occur because of a high concentration of allergic particles associated with a downdraft from a thunderstorm. This appears to be a common cause of exacerbations during the pollen season. (Thorax2001;56:468–71.)

Recommended reading

Hal Hellman. Great feuds in medicine: Ten of the wildest disputes ever. New York: John Wiley and Sons, 2001.

Hal Hellman, a respected science writer, has written a fascinating and provocative book describing 10 feuds that have occurred in medicine since the 17th century. Some of the feuds described include Harvey v Primrose, Pasteurv Liebig Pruchet and Koch, as well as Freudv Bruer and Jung. However, it is the most recent feuds that are most interesting in this book. These include the Sabin v Salk controversy about polio vaccine, Franklin v Wilkins on the structure of DNA, and most recently Gallo v Montiginer on the aetiology of AIDS. Hellman describes the AIDS drama in detail and highlights the unfortunate impact that both American politics and media had in the evolution of this feud. Perhaps as a result Hellman overemphasises the role of the press in medical feuds. Clearly, many of the controversies that he describes from the 18th and 19th centuries were not fuelled by the forces of modern day print and media hyperbole. Nevertheless, this is an extremely well written and fascinating book about some of the most interesting advances in medicine.

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