Medical Fact of the Day – How Can Smoking and Coffee Be Good for You?
Smoking is probably the single largest preventable cause of deaths worldwide, increasing the chance of lung cancer, emphysema, atherosclerosis, and hypertension. But how can it be good for you?
In several studies, patients who smoked or consumed caffeine daily were significantly less likely to have Parkinson's Disease. Furthermore, increasing the smoking or caffeine dose further decreased the risk.
Of course, this is not to say that one should smoke purely to avoid Parkinson's. But it does raise the question of the mechanism of this effect. Parkinson's is a deficiency in dopamine-producing neurons in the brain. Dopamine is a neurotransmitter that is essential in maintaining reward (which is mainly why smokers become addicted) and muscle movements. Take away dopamine, and you no longer have smooth muscle movements, showing Parkinson's symptoms.
So might it be that overusing the reward circuit has a protective effect on dopamine-producing cells? Or are there other chemicals in smoking that prevent dopamine-producing cells from dying? To find this out, a scientist might investigate whether any other addiction showed decreased risk of Parkinson's. Clarifying interesting mechanisms like this one can lead to new treatments.
This man might not get Parkinson's.
Bonus: I came across this site claiming many more benefits of smoking, some with more dubious data. The organization behind that site wishes to rid government intervention in "personal lifestyle choices" of diet and habits. In the case of smoking, intervention was clearly needed to dampen the effects of secondhand smoke. But it's often useful to try to understand opposite viewpoints and critically evaluate evidence.
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Reflections on Being Sick
About two and a half weeks after I first reported an illness, I've just about recovered. There is the last remnant of a sore throat and a dry cough, but it will probably disappear in a few days.
It's been a painful and long illness, and I have two salient thoughts on it:
- People actually want to avoid you. This is somewhat obvious and logical, but it actually made me feel alienated. I would quarantine myself in a corner of the classroom, but other times students would purposefully avoid being around me. This is nothing compared to the stigma HIV/AIDS patients faced in the 1980s/90s, and I am so happy that education has changed much of that, at least in some areas. Experiencing what a patient endures can really make you a more understanding doctor.
- An itchy throat is annoying, the tiny little scratch in the back of the throat that forces you to cough but won't disappear even when you do. I was often in situations when I really did not want to cough repeatedly - in lecture or in public - and could go red in the face just trying to suppress the cough. Fun fact: this itchy sensation is caused by irritation of the mucosal membrane, often when there is insufficient mucus.
I'm glad to be somewhat healthy again, and I hope it doesn't repeat later in the winter.
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Medical Fact of the Day – Why White Coats?
I wore my white coat today to shadow a geneticist in clinic. This made me wonder - why do doctors even wear white coats? It is a recognizable symbol of the medical profession, but how did it start?
WIthout any context, this man looks like a doctor. What a powerful symbol the white coat is.
One answer seems to be that the knee-length coat is indicative of a scientific approach to medicine. It had traditionally been used to ward off chemicals in the laboratory. In the 1900s, scientific medicine competed with homeopathy and traditional remedies, but the development of more powerful drugs established the power of science to treat humans. As a result, doctors adopted the white coat as symbolic of the role of science within medicine and to claim legitimacy in their roles.
Alternatively, my TA in anatomy had a bloodier story. In the early days of surgery, there were very few ways to see inside the patient's body to know exactly what to operate on and where other things were. As a result, the surgeons practiced their procedures on dead bodies right before trying their hand at the real patients. The white coats were thus worn to shield the doctor from the dead body's fluids before transitioning to the live patient. I couldn't verify this story, though it certainly is meaty.
Nowadays, there is debate on the appropriateness of the white coat. Some say it can increase infection and is an unnecessary symbol of medical hubris. However, the white coat has become such a clear marker of the doctor that patients are much more likely to trust physicians wearing the white coat.
Personally, I also find its pockets useful to hold pens, electronic devices, and a stethoscope.
Fun fact: Medical students wear shorter white coats that extend to the waist, while doctors with their MD degrees have longer coats extending almost to the knee. Often patients address me as doctor despite my shorter coat, which is giving me far more credit than I deserve.
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I Am Fully Sick
I last reported on a sudden illness and its disappearance. Now later in the week, different symptoms have erupted and I now have an actual disease. I have a productive cough (coughing up phlegm), swollen lymph nodes, and a very sore throat without white exudates (pus, which would be a sign of strep throat). I'm thinking it's a viral infection, which means I can't do all that much about it.
There's a slight possibility that it's the dreaded H1N1. In April, a few students at Harvard Dental School were verified to have H1N1. The (unverified) story goes that a student's boyfriend had visited Mexico, returned, and the two of them visited parties without showing symptoms. In response the school was shut down for several days.
The H1N1 flu is common enough now that cases do not need to be sent to the Centers for Disease Control (CDC) for verification, but it is still a looming threat in the coming flu season.
In any case, I'm going to take it easy for a while until I recover more.
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I Am Sick
On Friday, I played basketball with several friends. Being out of aerobic shape, I was short of breath by the end of the game.
On Saturday, I woke up with a sore throat. I thought nothing of it and went to a review session (class on Saturday!) but became increasingly feverish over the day. By night, I had a full-blown fever with chills and a raging sore throat. I slept throughout the night and had some delirious dreams as typical of a fever, and I woke repeatedly in the night.
Today I rose perfectly fine, a mild sore throat but no fever. I was surprised by this as I had never developed and resolved fever so rapidly. Like a proper medical student, I began reaching from my (limited) knowledge. We had learned in immunology that when the immune system fights off an infection, the next time it sees that disease the response is much swifter and fiercer. Maybe that was what happened? Did the basketball play have anything to do with it, perhaps increasing respiratory distress?
Usually I tell people (my parents especially) that I haven't been sick in years and that I'll be fine in flu season. Can't be quite so smug now.
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