Tuesday, December 20, 2016

Do Women Make Better Physicians Than Men?

A new study published in JAMA Internal Medicine raises the very real possibility that in some undefined way, women may be better physicians than men. The authors of the study examined the records of more than a million and a half Medicare patients 65 and older admitted to a hospital, using 30-day mortality and readmission rates as their measured endpoints. They found that the 30-day death rate for patients treated by women physicians was lower than for patients treated by men physicians (11.07% vs. 11.49%). Patient readmission rates, too, were lower for women physicians. The differences were statistically significant and independent of medical condition or severity of illness.

To control for how patients were assigned to doctors, the authors focused on patients whose admissions were non-elective at hospitals and where the assignment of physician depended only on the physician's work schedule, and not on choice. Finally, to eliminate differences in physician specialty as a factor, the study focused only on physicians who were general internists.

The difference between 11.07% vs. 11.49% deaths would translate to four fewer deaths for every thousand patients treated by women physicians. Given that more than 10 million Medicare patients are admitted to hospitals every year, tens of thousands of lives might be saved if we could learn exactly how women physicians are different. One theory is that women physicians are more likely to stick to evidence-based protocols and medical practice guidelines, but that would need to be tested.

Thursday, December 15, 2016

A Full Recovery From Metastasized Colon Cancer

A woman with a type of colon cancer that had already metastasized to her lungs has now recovered, thanks to a new type of cancer therapy that relies on her own immune cells.  It may be too early to say that she is cured forever, but apparently she is now tumor-free.

The therapy relied on a type of immune cell called a tumor-infiltrating lymphocyte (TIL).  TILs are naturally occurring immune cells that recognize the specific genetic mutations in a tumor.  They attach to the tumor cells, attacking and killing them but leaving normal cells alone.  In most patients there aren't enough of these cells, though, to stop the cancer from growing.  In the specific patient case presented in the article, the researchers isolated some of these TIL cells from the woman's tumors, grew them in the laboratory, and then returned them (100 billion of them, in fact) to the patient, where they attacked and destroyed her tumors.

Researchers caution that this is the first and only time that this type of therapy has worked completely; a previous attempt in another patient had failed, probably because too few TILs were harvested.   However, a similar approach has been used to produce long periods of remission in 20-25% of patients with advanced melanoma, a particularly deadly form of skin cancer.  And similar experiments are underway with TILs found on other soft-tissue cancers such as pancreatic cancer.

With findings like this, we may yet see some cancers curable in our lifetimes.

Friday, December 9, 2016

Life expectancy declines in the U.S.

Life expectancy is defined as the number of years a person born in any given year can expect to live, on average.  It's commonly used to as a comparative measure of the health of a population over time, or to compare different populations.

In the past, life expectancy in the U.S. generally rose year-over-year as health care improved and the U.S. became more safety-conscious (the requirement that we use seat belts while driving, for example).  But now the Centers for Disease Control & Prevention (CDC) reports that life expectancy actually declined in 2015. A person born in 2015 can expect to live 78.8 years, on average - down from 78.9 years in 2014.

A decline of only 0.1 years doesn't sound like much, and indeed it isn't.  But life expectancy in the U.S. has risen steadily and consistently for over 45 years, so 2015 represents a noticeable change.  The only other year in those 45 years that life expectancy declined was 1993, at the height of the HIV/AIDS epidemic.

This time around, there doesn't seem to be just one obvious cause.  In 2015, eight of the ten top causes of death (including suicides and accidents, as well as chronic diseases such as heart disease and diabetes) showed an increase in death rates.  If life expectancy continues to decline in future years, health officials will have to dig deeper to try to discern the cause.  For now, a wait-and-see approach seems most appropriate.

Friday, December 2, 2016

AIDS "Patient Zero" Was Wrongly Accused

For many years, it was believed that the first outbreak of AIDS in the U.S. was triggered by just one person, dubbed "patient zero". That belief was popularized by Randy Shilts's best-selling book And The Band Played On, published in 1987. Patient zero was allegedly Gaetan Dugas, a French-Canadian flight attendant who was thought to have picked up H.I.V. in Haiti sometime in the late 1970s. Mr. Dugas died of AIDS in 1984. After his death Mr. Dugas was vilified by the media; a 1987 New York Post headline called him "The Man Who Gave Us AIDS".

The myth of "patient zero" persisted for almost 20 years. It wasn't until 2014 that careful detective work provided convincing evidence that HIV actually arrived in New York City around 1971 and was well established in the U.S. before Mr. Dugas became infected. And just recently, DNA analysis of a sample of Mr. Dugas's stored blood confirmed that he was not the infamous "patient zero", if indeed there ever was one.

Mr. Dugas was not the villain he was made out to be, despite the fact that he continued to be sexually active after he became infected. He deserves our belated apology.