A Glimpse at North Korea: Pyongyang Zoo

I’m not a real friend of zoos, but after having seen the Revolutionary Martyr’s cemetery with a St. Mary like worshipping of Kim Il Song’s wife Kim Jong Suk our next stop has been the Central Zoo, also at the foot of Mt. Taesong. It keeps quite a lot of species and some are marked as present by either Kim Il Song or Kim Jong Il. As I’ve already said, I’m not particularly interested in caged animals, but looking at the crowds was quite interesting. Smiling faces; smiles even on the faces of sober clad cader. And a good number of prep school children, all dressed up like going to see the President himself.


No wonder, our itinerary has let us to the zoo, happy people in a happy country. It’s always a bad idea, thinking that people are stupid. Does seeing a few chosen people to enjoy themselves destroy a picture that glimpses at the reality already had painted?

Fibromyalgia and Quack Therapies

Fibromyalgia patients as well as other patients with chronic pain suffer so much, that they are so desperate and would to do anything to relieve these pains. I feel very sad, when I see “colleagues”, pharmaceutical or neutriceutical firms, institutions, or self acclaimed gurus to exploit these people with quack medicines or therapies.


How can they get past scientific scrutiny? Very easily. These quack methods stay well outside the scientific world. The masterminds behind do pseudoscience, which they publish in esoteric corners. They might use some scientific reference or reference from other fields that are irrelevant to medicine. These masterminds become gurus, with followers, who try to cry or sue silent any critic with proclaiming unquestionable truths. For example: “It has been proven without any doubt: fibromyalgia can be cured!” or (my favourite): “Are you afraid you wil lose your desperate patients who believes in your ignorance and stupidity”. Questioning and discussing new methods or hypothesis is essential for scientific research.


Now, we shall build a quack therapy against fibromyalgia. You will see, how easy it is and how easily you might believe someone, who relieves you of your money, but hardly of your pain.


Let’s call our therapy: Shamanistic tattooing of fibromyalgia. That’s still too long, abbreviations look more convincing, so it’s the STF Therapy.


We have a name, now we look into the method. Ötzi, the Tyrolean iceman, had several carbon tattoos. Have a look at the Wikipedia article of Ötzi under tattoo: http://en.wikipedia.org/wiki/%C3%96tzi_the_Iceman . Do you see it? We’ve already hit the mark! Someone asked questions about these tattoos like “5200-year-old acupuncture in central Europe?” or: "A medical report from the stone age?". These questions were articles. published in scientific papers. We can refer to these papers ( http://www.ncbi.nlm.nih.gov/pubmed/9841386 and http://www.ncbi.nlm.nih.gov/pubmed/10501382 ). And now we look for a crude method concerning healing with symbols: esowatch has something (esowatch does in German what quackwatch does in English, both are highly recommended) worth looking up: http://www.esowatch.com/ge/index.php?title=Neue_Hom%C3%B6opathie#ixzz1hRjftsSJ . "New homeopathy is a form of pseudo medical, magic spirit healing, in which certain characters are painted on the skin of sufferers." "This goes back to the Viennese electrician of the Austrian Mail, esoteric, and medical laymen Erich Körbler (1938-1994)..." Esowatch


“According to Körbler’s conviction, symbols ("bar code antennae") are used to "influence cell communication and exchange of energy in living systems". The geometry of the painted symbols at acupuncture points should have "balancing" effects on a supposed meridian system." Esowatch


You can further refer to people practicing painting symbols to heal like http://www.leonie-zander.ch/021_aim_alltag.html in Switzerland (Angewandte Informations Methode - Applied information method).

Now we look for a tattoo artist, who wants to make money. You come across this guy from Siberia, whose grandfather has indeed been a shaman. You copyright and trademark your method. You set up a practice with enough shamanistic paraphernalia and are ready for floods of clients (better call your patients clients). You have a talk with your lawyer not to break a law you have overseen. You send articles that praise your method to self help groups. You start business. You get rich. You escape to the Bahamas.


If someone offers you STF Therapy or any equal quack therapy because you are desperate to get rid of your pain, please keep a critical mind!

Spam

Sorry, folks. I'm stalked by a spammer, who belongs to a sectarian group. I will remove the nonsense as soon as I see it. hm richel [h.richel@gmail.com] is also spamming my email account.

FreitagsGedichte

Im Laub

Der harte Regen hat
Blätter von den Bäumen geschlagen

Nun liegen sie
Auf dem Laub vom letzten Herbst
Das immer noch verendet

VerEinzelte SonnenStrahlen
DurchWühlen das Laub

Einer trifft auch mich


Spalten

Spalten
Scheit um Scheit um Scheit

Spalten
Haar um Haar um Haar

Spalten
Wort um Wort um Wort

Bei allem Spalten
Wo bleibt das Bindende?


Abspringen

Das Rad der Welt
Dieses RiesenRad der Gefühle
Dreht sich unAusWeichlich
Manchmal eiert es
Manchmal läuft es perfekt
Immer läuft es
Zieht uns mit sich
UnAusWeichlichlich
Bis wir abSpringen

.

Increased Prescription of Narcotic Analgesics for Osteoarthritis in the Elderly Is Associated with Increased Falls and Fractures in the Post-Vioxx Era

Is it really coincidence that this study has the number 9-11? Merck’s withdrawal of Vioxx in 2004 had ampact on the COX-2-inhibitor world, which can be compared to the world after 9-11.


Lydia Rolita and colleagues looked into the unintended consequences of narcotic analgesics for osteoarthritis in the elderly. Narcotic analgesics contribute to falls in the elderly. Prescriptions were rising post-rofecoxib from 8% to 40%. The rate of falls has been higher in the group of narcotic analgesics users. The authors concluded that “these findings strongly indicate that recommendations for the treatment of chronic pain be reevaluated.”


[MON] 911
Unintended Consequences; Increased Prescription of Narcotic Analgesics for Osteoarthritis in the Elderly Is Associated with Increased Falls and Fractures in the Post-Vioxx Era.
Lydia Rolita1, Adele Spegman2 and Bruce N. Cronstein3.
1NYU School of Medicine, New York, NY, 2Geisinger Health System, Danville, PA, 3New York Univ Medical Center, New York, NY
Conclusion: After Vioxx was taken off the market there was a marked increase in the prescription of narcotic analgesics. Falls and fractures in this elderly population with OA increased markedly and all of the increase in falls were in patients prescribed narcotic analgesics. These findings strongly indicate that recommendations for the treatment of chronic pain be reevaluated.

Pain Assessment at our Center (1st Visit)

When patients come to our center for the first time, they might not know,  how to talk about their pain. Nearly all patients coming to see a rheumatologist for the first time come beause of pain. Every patient receives a 5 pages questionnaire to assess symptoms, a pain inventory, drugs, allergies, and so on, a HAQ, and a pain manniquin.

Short questionnaire to assess your pain

How much pain did you have?

0  1   2   3   4   5   6   7   8   9   10
no pain                                      great pain

How much fatigue did you have?
0   1   2   3   4   5   6   7   8   9   10
No fatigue                                  great fatigue

Where did the pain start? (open question)
Since when do you have pain? (open question)
I there a certain time of  the day, when pain is especially intense? (open question)
What would you character your pain? pulling, stabbing, burning, boring, cutting, unpleasant, disturbing, annoying (and more, open for addional characteristics)
What relieves the symptoms? (open question)

What enhances the complaints? (open question)



When taking the patient's history we can take this as a starting point for questions to get a deeper knowledge. For instance strongest and weakest pain during the past 24 hour or week to look for fluctuations.

All in all this small inventory has helped to get started with assessing pain.

What is lacking in fibromyalgia studies on drugs?

I think it’s a discussion on reasons for the observed (small) effects. It may be a bias that comes into effect before people come to enter a study. I see different patients: drug seeker, drug takers, drug avoiders, drug deniers, compensation seekers, non compensation seekers, depressed avoiders, happy sustainers, and patients who fit more categories if you like. I think that motivation for or against a therapy effects outcome. Currents studies do not address this issue. If you have a larger number of drug seekers coming to your drug testing center and a small number of drug avoiders of drug deniers, you might get a wishful thinking effect, a self fulfilling prophecy.


But wait a minute; we’ve got our placebo group! Look at the study of LJ Crofford et al. on Pregabalin in Fibromyalgia (Arthritis Rheum 2005, 52: 1264-1273), an eight week, randomized, double-blind, placebo-controlled, monotherapy dose-finding study. A reduction of pain greater than 50% compared to baseline has been primary endpoint of the study. This has been achieved in 13,2% of the placebo group, 13% in the 150 mg group, 18,9% in the 300 mg group, and 28,9% of the 450 mg group. Now let’s have a closer look at one of all the possible side effects: dizziness. Dizziness was complained in 15% of the placebo group, 30% in the 150 mg group, 42% in the 300 mg group, and 65% of the 450 mg group. So side effects aren’t matched! If patients desperately seek to get rid of their pains, this has an effect on quality of life, they cling to every straw. If you take a drug and notice that it’s doing something to you like dizziness, would you not also expect that it relieves your pain?


Drug studies in fibromyalgia patients should tell more about the motivation of patients to different therapies. A statistical analysis taking different levels of side effects into account should be established in these studies.