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“For instance, my injury cost me my savings I had accumulated up through the middle of my senior year in high school. I had visited an eye surgeon who was as cold as a pump handle and he assured me rather slickly that there was a good chance he could restore an appreciable amount of vision to my blind eye. Twenty years later I was told by a top surgeon in New York that this prognosis was absolute venal nonsense and that nothing was possible for this eye, which remained true until recently. The operation was the most miserable failure conceivable and I spent two weeks in the hospital, the first of them totally blinded to keep my eyes still. The idea was to design an early version of a contact lens but this proved thickish and painful to install and wear and more importantly I couldn’t see a thing except a vague perception of the colour green. I threw this plastic gismo into the swamp outback of our house and quite naturally entered another depression, this one more dangerous as it has the tinge of the suicidal.” (

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Ginkgo is one of the most common herb supplements consumed in many parts of the world. The ginkgo tree is remarkable as it may grow as high as 40 m and live for more than a thousand years. Ginkgo fossils have been dated as far back as 250 million years ago. But does ginkgo enhance cognitive function? Gold and colleagues have critically reviewed the literature and conclude that most studies done today are too small or with such poor controls that it is impossible to be certain whether any positive effect on cognitive function occurs as a result of consuming ginkgo. Nevertheless, they suggest that there is just enough information that appears to suggest a positive result that further studies should be completed. The National Institute on Aging in the US is currently supporting a clinical trial to evaluate the efficacy of ginkgo in treating the symptom of Alzheimer’s disease. The results of this trial will not be available for several years. (

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There is increasing concern that preventable medical errors occur far too frequently. In a study from the University of Washington, 13 focus groups were organised to discuss this problem. Six groups of adult patients, four groups of academic and community physicians, and three groups of physicians and patients were formed. From these focus groups it would appear that both patients and physicians have unmet needs following medical errors. Patients wanted disclosure of all harmful errors and sought information about what happened, why the error happened, how the error was consequentially mitigated, and how recurrences will be prevented. Physicians agree that harmful errors should be disclosed but “chose the words carefully” when telling patients about errors. Although physicians disclose the adverse event, they often avoid stating that the error occurred, why the error happened, or how occurrences will be prevented in the future. Patients also expressed a desire for emotional support from physicians following medical errors including an apology. However physicians worry that an apology might create legal liability. (

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Linus Pauling, PhD was the only person to win unshared Nobel prizes: the chemistry prize in 1954 for work on proteins and the peace prize in 1962 for his opposition to nuclear proliferation. For the last two decades of his life he focused on so-called orthomolecular medicine and the promotion of large amounts of vitamin C for health purposes. The National Library of Medicine has now made available a collection of letters, notes, speeches, photographs, and other materials documenting his life. (Go to http://profiles.nlm.nih.gov/)

Treatment options for patients with secondary progressive multiple sclerosis are still relatively few. Encouraging results have been reported with the use of mitoxantrone. In a placebo controlled double blind randomised multicentred trial coordinated in Düsseldorf, Germany, 194 patients with worsening relapsing-remitting or secondary progressive multiple sclerosis were assigned placebo or mitoxantrone. Mitoxantrone was generally well tolerated and reduced progression of disability and clinical exacerbations. Further studies are needed to identify patients with those forms of multiple sclerosis which are most likely to respond to this therapy. (

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It is well known that there is considerable variation in an individual patient’s tolerance of comparable levels of pain. Now a study from the University of Michigan and the National Institute on Alcoholism and Alcohol Abuse suggest that a common variation in a gene coded for a key brain enzyme increases susceptibility to pain. The enzyme, catechol O-methyltransferase (COMT) is vital to normal brain function as it is involved in the metabolism of noradrenaline and dopamine. The genetic variation changes the amino acid valine to methionine and results in a three to four fold reduction in COMT’s efficacy. Approximately 16% of the population carries the genetic variation corresponding to a low COMT activity and thus heightened pain response. (

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Because moderate alcohol consumption is associated with a low risk of cardiovascular disease in the elderly one might expect a moderate alcohol consumption to be associated with a lower risk of dementia associated with atherosclerotic vascular disease. In a nested case controlled study of 373 cases with incident dementia and 373 controls who participated in the Cardiovascular Health Study, a prospective population based cohort study in four communities was performed. Compared with abstention, consumption of one to six alcoholic drinks weekly is associated with a lower risk of incident dementia among older adults. A trend toward greater odds of dementia associated with heavier alcohol consumption was most apparent among men and participants with an apolipoprotein E ε4 allele. (

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Maternal diabetes is known to be associated with specific infant malformations, for example segmental optic nerve hyperplasia. In a study from the University of Texas Southwestern gestational diabetes was diagnosed in 2277 women of whom 230 had fasting hyperglycemia diagnosed. The remaining women consistently demonstrated normal fasting serum levels. Pregestational diabetes was diagnosed in 410 women. Infant malformations occurred in 1.5 % of non-diabetic women but in 4.8% of women with gestational diabetes plus fasting hyperglycemia and in 6.1 % in those with pregestational diabetes. Thus women with pregestational diabetes or gestational diabetes plus fasting hyperglycemia have a three to four fold increased risk of infant malformations. (

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In the United States, more people kill themselves with firearms than with all other methods combined. In a study from the Harvard School of Public Health data for nine regions in 50 states in the United States over a 10 year period were examined to establish the association between levels of household firearm ownership and the rates of suicide. In both regional and state level analyses the US population as a whole, for males and females, and for virtually every age group, a significant association existed between the levels of household ownership and suicide rates. The firearm ownership levels are highest as disproportionately large number of people died from firearm related suicide. (

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