Medical Diagnostics Quotes

Translation software is not making translators obsolete. Has medical diagnostic software made doctors obsolete?

Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD.15 Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as “oppositional defiant disorder,” meaning “This kid hates my guts and won’t do anything I tell him to do,” or “disruptive mood dysregulation disorder,” meaning he has temper tantrums. Having as many problems as they do, these kids accumulate numerous diagnoses over time. Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.

Acts of psychological abuse include berating or humiliating the victim; interrogating the victim; restricting the victim's ability to come and go freely; obstructing the victim's access to assistance (e.g., law enforcement; legal, protective, or medical resources); threatening the victim with physical harm or sexual assault; harming, or threatening to harm, people or things that the victim cares about; unwarranted restriction of the victim's access to or use of economic resources; isolating the victim from family, friends, or social support resources; stalking the victim; and trying to make the victim think that he or she is crazy.

We have been focusing on the role that psychiatry and its medications may be playing in this epidemic, and the evidence is quite clear. First, by greatly expanding diagnostic boundaries, psychiatry is inviting and ever-greater number of children and adults into the mental illness camp. Second, those so diagnosed are then treated with psychiatric medications that increase the likelihood they will become chronically ill. Many treated with psychotropics end up with new and more severe psychiatric symptoms, physically unwell, and cognitively impaired. This is the tragic story writ large in five decades of scientific literature.

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains—that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant. —RICHARD BENTALL, Journal of Medical Ethics, 1992

I don’t think the people today who start hearing voices, stop eating and sleeping, and run amuck are likely to get good treatment. Having more knowledge, better diagnostic capabilities, better medications with fewer side effects, can’t make up for the fact that most patients are being treated by doctors, therapists, and hospitals, who are operating under constraints and incentives that reward non-treatment, non-hospitalization, non-therapy, non-follow-up, non-care. Lost to follow-up is the best outcome a health insurer can hope for.

Women are more likely to be offered minor tranquillisers and antidepressants than analgesic pain medication. Women are less likely to be referred for further diagnostic investigations than men. And women’s pain is much more likely to be seen as having an emotional or psychological cause, rather than a bodily or biological one.

Consider the top man–machine medical diagnosticians, circa 2035. They will make life-and-death decisions for patients, hospitals, and other doctors. But what in a malpractice case should count as persuasive evidence of a medical mistake? The judgment of either “man alone” or “machine alone” won’t do the trick, because neither is up to judging the team. Sometimes it will be possible to ascertain that a top human team member was in fact a fraud, but more typically the joint human–cyber diagnostic decisions themselves will be our highest standards for what is best. Having one team dispute the choice of another may indicate a mistake, but it will hardly show malfeasance. When

Gene patents are the point of greatest concern in the debate over ownership of human biological materials, and how that ownership might interfere with science. As of 2005—the most recent year figures were available—the U.S. government had issued patents relating to the use of about 20 percent of known human genes, including genes for Alzheimer’s, asthma, colon cancer, and, most famously, breast cancer. This means pharmaceutical companies, scientists, and universities control what research can be done on those genes, and how much resulting therapies and diagnostic tests will cost. And some enforce their patents aggressively: Myriad Genetics, which holds the patents on the BRCA1 and BRCA2 genes responsible for most cases of hereditary breast and ovarian cancer, charges $3,000 to test for the genes. Myriad has been accused of creating a monopoly, since no one else can offer the test, and researchers can’t develop cheaper tests or new therapies without getting permission from Myriad and paying steep licensing fees. Scientists who’ve gone ahead with research involving the breast-cancer genes without Myriad’s permission have found themselves on the receiving end of cease-and-desist letters and threats of litigation.

I was diagnosed with ADHD in my mid fifties and I was given Ritalin and Dexedrine. These are stimulant medications. They elevate the level of a chemical called dopamine in the brain. And dopamine is the motivation chemical, so when you are more motivated you pay attention. Your mind won't be all over the place. So we elevate dopamine levels with stimulant drugs like Ritalin, Aderall, Dexedrine and so on. But what else elevates Dopamine levels? Well, all other stimulants do. What other stimulants? Cocaine, crystal meth, caffeine, nicotine, which is to say that a significant minority of people that use stimulants, illicit stimulants, you know what they are actually doing? They're self-medicating their ADHD or their depression or their anxiety. So on one level (and we have to go deeper that that), but on one level addictions are about self-medications. If you look at alcoholics in one study, 40% of male adult alcoholics met the diagnostic criteria for ADHD? Why? Because alcohol soothes the hyperactive brain. Cannabis does the same thing. And in studies of stimulant addicts, about 30% had ADHD prior to their drug use. What else do people self-medicate? Someone mentioned depression. So, if you have been treated for depression, as I have been, and you were given a SSRI medication, these medications elevate the level of another brain chemical called serotonin, which is implicated in mood regulation. What else elevates serotonin levels temporarily in the brain? Cocaine does. People use cocaine to self-medicate depression. People use alcohol, cannabis and opiates to self-medicate anxiety. Incidentally people also use gambling or shopping to self-medicate because these activities also elevate dopamine levels in the brain. There is no difference between one addiction and the other. They're just different targets, but the brain systems that are involved and the target chemicals are the same, no matter what the addiction. So people self-medicate anxiety, depression. People self-medicate bipolar disorder with alcohol. People self-medicate Post-Traumatic-Stress-Disorder. So, one way to understand addictions is that they're self-medicating. And that's important to understand because if you are working with people who are addicted it is really important to know what's going on in their lives and why are they doing this. So apart from the level of comfort and pain relief, there's usually something diagnosible that's there at the same time. And you have to pay attention to that. At least you have to talk about it.

And there is one thing that I really, really like to have company for. Watching TV. I'm not particularly needy in relationships, I actually demand a fair amount of space. But I really like to be in bed with another human being and watch TV. That's as intimate and reassuring and tender as it gets for me. I find dating exhausting and uninteresting, and I really would like to skip over the hours of conversation that you need just to get up to speed on each other's lives, and the stories I've told a million times. I just want to get to the watching TV in bed. If you're on a date with me, you can be certain that this is what I'm evaluating you for—how good is it going to be, cuddling with you in bed and watching Damages I'm also looking to see if you have clean teeth. For me, anything less than very clean teeth is fucking disgusting. Here's what I would like to do: I would like to get into bed with a DVD of Damages and have a line of men cue up at my door. I would station a dental hygienist at the front of the line who would examine the men's teeth. Upon passing inspection, she(I've never met a male hygienist, and neither have you) would send them back to my bedroom, one at time, in intervals of ten minutes, during which I would cuddle with the man and watch Damages. Leaving nothing to chance, using some sort of medical telemetry, I would have a clinician take basic readings of my heart rate and brain waves, and create a comparison chart to illustrate which candidate was the most soothing presence for me. After reviewing all the data from what will now be known in diagnostic manuals throughout the world as the Silverman-Damages-Nuzzle-Test, I will make my selection.

The DSMs have a mixed record. They have served an extremely valuable function in improving the reliability of psychiatric diagnosis and in encouraging a revolution in psychiatric research. But they have also had the very harmful unintended consequence of triggering and helping to maintain a runaway diagnostic inflation that threatens normal and results in massive overtreatment with psychiatric medication.

The sequencing of questions must be custom designed for your solutions and it must be navigated in different ways according to the physical reality of each individual customer. All sequenced diagnostic maps™ are based on a generic format that I call the Bridge to Change (see Figure 3.2). FIGURE 3.2 Building the Bridge to Change The Bridge to Change is patterned after the tools and methods that physicians use to diagnose complex medical conditions and prescribe appropriate solutions.

The doctor looked shifty. “He’s still breathing,” he said. “Look, his pulse is nearly humming and he’s got a temperature you could fry eggs on.” He hesitated, aware that this was probably too straightforward and easily understood; medicine was a new art on the Disc, and wasn’t going to get anywhere if people could understand it. “Pyrocerebrum ouerf culinaire,” he said, after working it out in his head. “Well, what can you do about it?” said Arthur. “Nothing. He’s dead. All the medical tests prove it. So, er…bury him, keep him nice and cool, and tell him to come and see me next week. In daylight, for preference." "But he’s still breathing!” “These are just reflex actions that might easily confuse the layman,” said the doctor airily. Chidder sighed. He suspected that the Guild, who after all had an unrivalled experience of sharp knives and complex organic compounds, was much better at elementary diagnostics than were the doctors. The Guild might kill people, but at least it didn’t expect them to be grateful for it.

Every diagnostic challenge in medicine can be imagined as a probability game. This is how you play the game: you assign a probability that a patient’s symptoms can be explained by some pathological dysfunction—heart failure, say, or rheumatoid arthritis—and then you summon evidence to increase or decrease the probability. Every scrap of evidence—a patient’s medical history, a doctor’s instincts, findings from a physical examination, past experiences, rumors, hunches, behaviors, gossip—raises or lowers the probability.

If the cultural standing of excrement doesn't convince them, I say that the material itself is as rich as oil and probably more useful. It contains nitrogen and phosphates that can make plants grow and also suck the life from water because its nutrients absorb available oxygen. It can be both food and poison. It can contaminate and cultivate. Millions of people cook with gas made by fermenting it. I tell them that I don't like to call it "waste," when it can be turned into bricks, when it can make roads or jewelry, and when in a dried powdered form known as poudrette it was sniffed like snuff by the grandest ladies of the eighteenth-century French court. Medical men of not too long ago thought stool examination a vital diagnostic tool (London's Wellcome Library holds a 150-year0old engraving of a doctor examining a bedpan and a sarcastic maid asking him if he'd like a fork). They were also fond of prescribing it: excrement could be eaten, drunk, or liberally applied to the skin. Martin Luther was convinced: he reportedly ate a spoonful of his own excrement daily and wrote that he couldn't understand the generosity of a God who freely gave such important and useful remedies.

different subject. The story of the serotonin hypothesis for depression, and its enthusiastic promotion by drug companies, is part of a wider process that has been called ‘disease-mongering’ or ‘medicalisation’, where diagnostic categories are widened, whole new diagnoses are invented, and normal variants of human experience are pathologised, so they can be treated with pills. One simple illustration of this is the recent spread of ‘checklists’ enabling the public to diagnose, or help diagnose, various medical conditions. In 2010, for example, the popular website WebMD launched a new test: ‘Rate your risk for depression: could you be depressed?’ It was funded by Eli Lilly, manufacturers of the antidepressant duloxetine, and this was duly declared on the page, though that doesn’t reduce the absurdity of what followed. The test consisted of ten questions, such as: ‘I feel sad or down most of the time’; ‘I feel tired almost every day’; ‘I have trouble concentrating’; ‘I feel worthless or hopeless’; ‘I find myself thinking a lot about dying’; and so on. If you answered ‘no’ to every single one of these questions – every single one – and then pressed ‘Submit’, the response was clear: ‘You may be at risk for major depression’.

There was a time when the public had an unquestionable faith in biomedicine and the practitioners who translated it into everyday patient care—and physicians believed that the public's trust was justified based on their educational qualifications and training. But today, many patients believe that individual clinicians must earn their trust, just as a close relative has earned it through shared experience. ...Gallop polling over the last several decades that demonstrates how much the public's confidence in most US institutions has deteriorated. Confidence in the medical system in particular fell from 80% in 1975 to 37% in 2015. Statistics from the General Social Survey confirm this troubling trend. Baron and Berinsky explain the historical reasons for this shift in attitudes, but the more pressing question is: How can individual clinicians, and the profession as a whole, regain the patients' trust? 

Yet skill in the most sophisticated applications of laboratory technology and in the use of the latest therapeutic modality alone does not make a good physician. When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex history and physical examination; order the appropriate laboratory, imaging, and diagnostic tests; and extract the key results from densely populated computer screens to determine whether to treat or to “watch.” As the number of tests increases, so does the likelihood that some incidental finding, completely unrelated to the clinical problem at hand, will be uncovered. Deciding whether a clinical clue is worth pursuing or should be dismissed as a “red herring” and weighing whether a proposed test, preventive measure, or treatment entails a greater risk than the disease itself are essential judgments that a skilled clinician must make many times each day. This combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is as necessary to the practice of medicine as is a sound scientific base.

Western medicine’s love of drawing people into diagnostic categories and applying disease names to small differences and minor bodily changes is not specific to functional disorders – it is a general trend. Pre-diabetes, polycystic ovaries, some cancers and many more conditions have all been subject to the problem of over-inclusive diagnosis. My biggest concern in this regard is the degree to which many people are wholly unaware of the subjective nature of the medical classification of disease. If a person is told they have this or that disorder, they assume it must be right. The Latin names we give to things and the shiny scanning machines make it look as if there is more authority than actually exists. To a certain extent, Sienna pursued each diagnosis she was given, but other people have diagnoses thrust upon them, having no idea that there might be anything controversial about it – and having no idea that they have a choice. Western medicine’s hold on people, and its sense of being systematic and accurate, makes it a powerful force in the transmission of cultural concepts of what constitutes wellness or ill health. But Western medicine is just as enslaved to fads and trends as any other tradition of medicine.

As many speakers noted, this tool wasn’t particularly well suited for assessing outcomes of a psychiatric drug. How could a study of a neuroleptic possibly be “double-blind”? The psychiatrist would quickly see who was on the drug and who was not, and any patient given Thorazine would know he was on a medication as well. Then there was the problem of diagnosis: How would a researcher know if the patients randomized into a trial really had “schizophrenia”? The diagnostic boundaries of mental disorders were forever changing. Equally problematic, what defined a “good outcome”? Psychiatrists and hospital staff might want to see drug-induced behavioral changes that made the patient “more socially acceptable” but weren’t to the “ultimate benefit of the patient,” said one conference speaker.11 And how could outcomes be measured? In a study of a drug for a known disease, mortality rates or laboratory results could serve as objective measures of whether a treatment worked. For instance, to test whether a drug for tuberculosis was effective, an X-ray of the lung could show whether the bacillus that caused the disease was gone. What would be the measurable endpoint in a trial of a drug for schizophrenia? The problem, said NIMH physician Edward Evarts at the conference, was that “the goals of therapy in schizophrenia, short of getting the patient ‘well,’ have not been clearly defined.

Although these digital tools can improve the diagnostic process and offer clinicians a variety of state-of-the-art treatment options, most are based on a reductionist approach to health and disease. This paradigm takes a divide-and-conquer approach to medicine, "rooted in the assumption that complex problems are solvable by dividing them into smaller, simpler, and thus more tractable units." Although this methodology has led to important insights and practical implications in healthcare, it does have its limitations. Reductionist thinking has led researchers and clinicians to search for one or two primary causes of each disease and design therapies that address those causes.... The limitation of this type of reasoning becomes obvious when one examines the impact of each of these diseases. There are many individuals who are exposed to HIV who do not develop the infection, many patients have blood glucose levels outside the normal range who never develop signs and symptoms of diabetes, and many patients with low thyroxine levels do not develop clinical hypothyroidism. These "anomalies" imply that there are cofactors involved in all these conditions, which when combined with the primary cause or causes bring about the clinical onset. Detecting these contributing factors requires the reductionist approach to be complemented by a systems biology approach, which assumes there are many interacting causes to each disease.

In March 2002, the National Academy of Sciences, a private, nonprofit society of scholars, released a high-profile report documenting the unequivocal existence of racial bias in medical care, which many thought would mark a real turning point. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care was so brutal and damning that it would seem impossible to turn away. The report, authored by a committee of mostly white medical educators, nurses, behavioral scientists, economists, health lawyers, sociologists, and policy experts, took an exhaustive plunge into more than 480 previous studies. Because of the knee-jerk tendency to assume that health disparities were the end result of differences in class, not race, they were careful to compare subjects with similar income and insurance coverage. The report found rampant, widespread racial bias, including that people of color were less likely to be given appropriate heart medications or to undergo bypass surgery or receive kidney dialysis or transplants. Several studies revealed significant racial differences in who receives appropriate cancer diagnostic tests and treatments, and people of color were also less likely to receive the most sophisticated treatments for HIV/AIDS. These inequities, the report concluded, contribute to higher death rates overall for Black people and other people of color and lower survival rates compared with whites suffering from comparable illnesses of similar severity.

If they’re not practicing deliberately, even experts can see their skills backslide. Ericsson shared with me an incredible example of this. Even though you might be inclined to trust the advice of a silver-haired doctor over one fresh out of medical school, it’s been found that in a few fields of medicine, doctors’ skills don’t improve the longer they’ve been practicing. The diagnostic accuracy of professional mammographers, for example, doesn’t get more accurate over the years. Why would that be? For most mammographers, practicing medicine is not deliberate practice, according to Ericsson. It’s more like putting into a tin cup than working with a coach. That’s because mammographers usually only find out if they missed a tumor months or years later, if at all, at which point they’ve probably forgotten the details of the case and can no longer learn from their successes and mistakes. One field of medicine in which this is definitively not the case is surgery. Unlike mammographers, surgeons tend to get better with time. What makes surgeons different from mammographers, according to Ericsson, is that the outcome of most surgeries is usually immediately apparent—the patient either gets better or doesn’t—which means that surgeons are constantly receiving feedback on their performance. They’re always learning what works and what doesn’t, always getting better. This finding leads to a practical application of expertise theory: Ericsson suggests that mammographers regularly be asked to evaluate old cases for which the outcome is already known. That way they can get immediate feedback on their performance.

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Until recently, three unspoken principles have guided the arena of genetic diagnosis and intervention. First, diagnostic tests have largely been restricted to gene variants that are singularly powerful determinants of illness—i.e., highly penetrant mutations, where the likelihood of developing the disease is close to 100 percent (Down syndrome, cystic fibrosis, Tay-Sachs disease). Second, the diseases caused by these mutations have generally involved extraordinary suffering or fundamental incompatibilities with “normal” life. Third, justifiable interventions—the decision to abort a child with Down syndrome, say, or intervene surgically on a woman with a BRCA1 mutation—have been defined through social and medical consensus, and all interventions have been governed by complete freedom of choice. The three sides of the triangle can be envisioned as moral lines that most cultures have been unwilling to transgress. The abortion of an embryo carrying a gene with, say, only a ten percent chance of developing cancer in the future violates the injunction against intervening on low-penetrance mutations. Similarly, a state-mandated medical procedure on a genetically ill person without the subject’s consent (or parental consent in the case of a fetus) crosses the boundaries of freedom and noncoercion. Yet it can hardly escape our attention that these parameters are inherently susceptible to the logic of self-reinforcement. We determine the definition of “extraordinary suffering.” We demarcate the boundaries of “normalcy” versus “abnormalcy.” We make the medical choices to intervene. We determine the nature of “justifiable interventions.” Humans endowed with certain genomes are responsible for defining the criteria to define, intervene on, or even eliminate other humans endowed with other genomes. “Choice,” in short, seems like an illusion devised by genes to propagate the selection of similar genes.

What’s behind these terribly low diagnostic rates? “One of the reasons celiac disease is so grossly underdiagnosed in this country,” says Dr. Green, “is that the pharmaceutical industry has such a major role in the direction of health care here. In many countries around the world, where there are national health plans, doctors are actively encouraged to diagnose celiac disease. In this country, the pharmaceutical industry provides eighty percent of the money for medical research. It also provides a lot of money for postgraduate education, and there just aren’t any drug companies that are interested in researching celiac disease. There’s basically no money in it—no drug company will provide funds for the research.” Simply put: Since there are no drugs to treat celiac disease, pharmaceutical companies stand to gain no profits from encouraging its diagnosis.

Don’t depend on an unapproved diagnostic tool, like the opinion of a naturopathic doctor or the popular Cyrex Array tests recommended by Dr. Perlmutter. Why not? Just ask Dr. Alessio Fasano: When you develop a new drug or test, there are these rules created by the American Medical Association that [we are asked] to obey. We don’t take this lightly since we are dealing with health and therefore the well-being of human beings, so we want to make sure that we do this right. If somebody will develop a new tool, a new biomarker, a new test—first and foremost, it needs to be validated. The tests that are offered for gluten sensitivity didn’t go through this vigorous validation process.

In addition, traditional medical education has always taught doctors to find one cause for all of the patient’s symptoms. This is deeply ingrained in every physician’s education. We generally are not taught to look for multifactorial causes of an illness. Therefore, if a Lyme disease patient presents with thirty-five different symptoms, the established paradigm would be to try and explain these complaints according to the accepted medical model: one primary diagnosis. If the doctor could not find a single etiology, or cause, for your symptoms, it must be because it is psychological in nature, and you are crazy. Or the answer might be elusive because the symptoms can’t be understood in the HMO-dictated fifteen-minute time frame. Or perhaps the physician hasn’t looked hard enough, or just sees the world through one narrow diagnostic lens.

It’s ironic that our nearly three trillion dollar medical system actually has some of the most sophisticated diagnostic equipment available in the world, which detects and measures energies and frequencies in the body. This diagnostic equipment includes devices you probably heard of like MRIs (Magnetic Resonance Imaging), PET scans (Positron Emission Tomography), CAT scans (Computed Axial Tomography), EEGs (Electro encephalograms), EKGs (Electrocardiography), ultrasound devices and more. Our medical system diagnoses the body energetically with modern physics (Quantum Field Theory), and then treats with drugs and surgery (Newtonian Science). What is wrong with this picture? The Book Of Science is Constantly Being Rewritten Nothing is so fatal to the progress of the human mind as to suppose our views of science are ultimate; that there are no new mysteries in nature; that our triumphs are complete; and that there are no new worlds to conquer. —Humphry Davy (from a public lecture given in 1810)

As a result of these legal actions, “defensive medicine” is being practiced. Defensive medicine involves the ordering of a multitude of tests, regardless of their medical necessity or expense. Therefore, if a malpractice suit is filed, the physician cannot be accused of failure to obtain all “relevant” diagnostic information. Defensive medicine is a poor practice of medicine, as it is excessively expensive and invites iatrogenic disease. Thus the legal profession, due to its own lucrative role in malpractice suits, helps to perpetuate this vicious cycle.

Diagnostic inflation has led to an explosive growth in the use of psychotropic drugs; this then produced huge profits that have given the pharmaceutical industry the means and the motive to blow up the diagnostic bubble into an ever-expanding balloon.

Instead, we often use guanfacine, a nonstimulant that was originally developed to treat high blood pressure but has also been used to treat ADHD. Guanfacine targets specific circuits in the prefrontal cortex where adrenaline and noradrenaline exert their action, improving impulsiveness and concentration, even in situations of high stress. While I felt good about taking a more systemic approach, like the doctors who first began to suspect that a compromised immune system was behind HIV/AIDS, I was working on a medical frontier. There wasn’t (and still isn’t) a clear set of diagnostic criteria or a blood test for toxic stress, and there is no drug cocktail to prescribe. My biggest guide for what symptoms might be toxic stress–related was the ACE Study itself, but I knew that the number of diseases and conditions it accounted for might just be the tip of the iceberg. After all,

Those transitions provide a lot of opportunities for things to fall through the cracks, so it shouldn’t come as a surprise that following hospital discharge nearly half of hospitalized patients experience at least one medical error in medication continuity, diagnostic workup, or test follow-up.51

To my amazement, staff discussions on the unit rarely mentioned the horrific real-life experiences of the children and the impact of those traumas on their feelings, thinking, and self-regulation. Instead, their medical records were filled with diagnostic labels: “conduct disorder” or “oppositional defiant disorder” for the angry and rebellious kids; or “bipolar disorder.” ADHD was a “comorbid” diagnosis for almost all. Was the underlying trauma being obscured by this blizzard of diagnoses?

We will continue to concentrate our energies entirely on prescription medicines and in vitro diagnostics, rather than diversify into other sectors like generics and biosimilars, over-the-counter medicines and medical devices.” ■ “With our in-house combination of pharmaceuticals and diagnostics, we are uniquely positioned to deliver personalized healthcare.” ■ “Our distinctiveness rests on four key elements: an exceptionally broad and deep understanding of molecular biology, the seamless integration of our pharmaceuticals and diagnostics capabilities, a diversity of approaches to maximise innovation, and a long-term orientation.” ■ “Our structure is built for innovation. Our autonomous research and development centres and alliances with over 200 external partners foster diversity and agility. Our global geographical scale and reach enables us to bring our diagnostics and medicines quickly to people who need them.

I apply this to the trade-offs among health, wealth, and time. You can trade time and health to accumulate more wealth. Why health? You may be stressed, lose sleep, have a poor diet, or skip exercise. If you are like me and want better health, you can invest time and money on medical care, diagnostic and preventive measures, and exercise and fitness. For decades I have spent six to eight hours a week running, hiking, walking, playing tennis, and working out in a gym. I think of each hour spent on fitness as one day less that I’ll spend in a hospital. Or you can trade money for time by working less and buying goods and services that save time. Hire household help, a personal assistant, and pay other people to do things you don’t want to do. Thousand-dollar-an-hour New York professionals who pay $50 an hour for a car and driver so they can work while they commute understand clearly the monetary value of their time.

Additionally, after a thirty-hour shift without sleep, residents make 460 percent more diagnostic mistakes in the intensive care unit than when well rested after enough sleep. Throughout the course of their residency, one in five medical residents will make a sleepless-related medical error that causes significant, liable harm to a patient.

There's nothing wrong with me. This has been medically proven, once. My former insurance company stopped honoring my requests for more diagnostics and labs. A therapist gave me medicine but I didn't take it because she didn't even run tests. She based her diagnosis on my answers, on the things I told her, and I bullshitted so much I couldn't even remember which parts were genuine. How could I take a pill based on that? And what if it worked? What if my bullshit was the right-sized hole for a pill-shaped fix? I felt helpless in the face of someone helping me.

Using this technique, Baum et al constructed a forest that contained 1,000 decision trees and looked at 84 co-variates that may have been influencing patients' response or lack of response to the intensive lifestyle modifications program. These variables included a family history of diabetes, muscle cramps in legs and feet, a history of emphysema, kidney disease, amputation, dry skin, loud snoring, marital status, social functioning, hemoglobin A1c, self-reported health, and numerous other characteristics that researchers rarely if ever consider when doing a subgroup analysis. The random forest analysis also allowed the investigators to look at how numerous variables *interact* in multiple combinations to impact clinical outcomes. The Look AHEAD subgroup analyses looked at only 3 possible variables and only one at a time. In the final analysis, Baum et al. discovered that intensive lifestyle modification averted cardiovascular events for two subgroups, patients with HbA1c 6.8% or higher (poorly managed diabetes) and patients with well-controlled diabetes (Hba1c < 6.8%) and good self-reported health. That finding applied to 85% of the entire patient population studied. On the other hand, the remaining 15% who had controlled diabetes but poor self-reported general health responded negatively to the lifestyle modification regimen. The negative and positive responders cancelled each other out in the initial statistical analysis, falsely concluding that lifestyle modification was useless. The Baum et al. re-analysis lends further support to the belief that a one-size-fits-all approach to medicine is inadequate to address all the individualistic responses that patients have to treatment. 

Sonnet of Self-Diagnosis Superstition is the opium of the ill-informed public, Conspiracy is the opium of the over-informed public. With ten minutes of googling every flipping flat-earther feels and behaves like a reputable rocket scientist. Human mind has a prehistoric predisposition of paranoia, To counteract ignorance mind cooks up brilliant fantasies. Thus scientific expertise succumbs to facebook expertise, Facebook groups become authority on medical diagnosis. Self-diagnosis is a modern day healthcare crisis, Where the patient desperately tries to redeem control. In trying to oust the experts from science and medicine, Google certified society only heralds its own funeral. Take people out of healthcare, and healthcare is dead. Take doctors out of healthcare, and healthcare is damage.

One of the epithets the Buddha acquired over the years was “the Doctor of the World.” A reason for this is that the central insight and framework that he taught, known as the Four Noble Truths, is cast in the formulation of a classical Indian medical diagnosis. The format begins with the nature of the symptom. In this particular kind of psychological or spiritual disease, the symptom is dukkha, the experience of dissatisfaction; this is the First Noble Truth. The second element in this diagnostic format is the cause of that symptom, which the Buddha outlined as being self-centered craving, greed, hatred, and delusion. These are the toxins that Matthieu referred to, the negative afflictive emotions, habits, and qualities that the mind gets caught up in and that poison the heart; this is the Second Noble Truth. The third element is the prognosis, and the good news is that it is curable. This is the Third Noble Truth, that the experience of dissatisfaction can end; we can be free from it. The fourth element—and the Fourth Noble Truth—is the methodology of treatment: what the Buddha laid out as the way to heal this wound. It’s known in some expressions as the Eightfold Path, but it can be outlined in three fundamental elements: first, responsible behavior or virtue, living a moral and ethical life; second, mental collectedness, meditation, and mind training; and third, the development of insightful understanding in accordance with reality, or wisdom. These three elements are the fundamental treatment for this psychological, spiritual ailment of dissatisfaction. I should underline that the Buddha didn’t make any claim to have a monopoly on truth. When somebody once asked him, “Is it the case that you’re the only one who really understands the way things are, and that all other spiritual teachings are incorrect, all other paths are erroneous?” He said, “No, by no means.” It’s not a matter of the way the teachings are framed, the language or symbolism that one uses. It is simply the presence or absence of these three central qualities: ethical behavior, mental collectedness, and wisdom. If any spiritual path contains those three elements, then it will certainly lead to the possibility and the actuality of freedom, peace, a harmony within oneself, and an easefulness in life. If it doesn’t contain those elements, then it cannot lead to easefulness, peace, and liberation.

The US National Institutes of Health states: "There is a lot of overlap between the terms 'precision medicine' and 'personalized medicine.' According to the National Research Council, 'personalized medicine' is an older term with a meaning similar to 'precision medicine.' However, there was concern that the word 'personalized' could be misinterpreted to imply that treatments and preventions are being developed uniquely for each individual; in precision medicine, the focus is on identifying which approaches will be effective for which patients based on genetic, environmental, and lifestyle factors.

Your microbiome looks perfect,” Google tells you. “Also, blood glucose levels are good, vitamin levels fine, but an increased core temperature and IgE levels…” “Google—in plain English?” “You’ve got a virus.” “A what?” “I ran through your last forty-eight hours of meetings. It seems like you picked it up Monday, at Jonah’s birthday party. I’d like to run additional diagnostics, would you mind using the…” Well, take your pick. Alphabet’s healthcare division, called Verily Life Sciences, is developing a full range of internal and external sensors that monitor everything from blood sugar to blood chemistry. And that’s just Alphabet. The list of once multimillion-dollar medical machines now being dematerialized, demonetized, democratized, and delocalized—that is, made into portable and even wearable sensors—could fill a textbook.

Since the 19th century, medicine has focused on specific disease states by linking collections of signs and symptoms to single organs.... Systems biology and its offspring, sometimes called Network Medicine, takes a more wholistic approach, looking at all the diverse genetic, metabolic, and environmental factors that contribute to clinical disease. Equally important, it looks at the preclinical manifestations of pathology. The current focus of medicine is much like the focus that an auto mechanic takes to repair a car. The diagnostic process isolates a broken part and repairs or replaces it.... Although this strategy has saved countless lives and reduced pain and suffering, it nevertheless treats the disease and not the patient, with all their unique habits, lifestyle mistakes, environmental exposures, psychosocial interactions, and genetic predispositions.

I don't make baseless claims like - I'll remove all your fears, I'll remove all your anxieties, I'll remove all your insecurities. I am a scientist, not an influencer - which means, I am dutybound to adhere to the truth, no matter how inconvenient they are, instead of peddling comforting lies for exposure. And the truth is, if bombarding people with some fancy facts about the mind removed their worries, every household with a DSM (Diagnostic and Statistical Manual of Mental Disorders) would be the happiest place on earth.

Self-diagnosis is a modern day healthcare crisis.

The holy grail of Modern Medicine is you can’t fix healthcare until you fix health; and you can’t fix health until you fix the food. Everyone is talking about healthcare, few people are talking about health, and nobody is talking about the food. Medical Incompetence To be clear, better screening, diagnostics, and treatment is what Modern Medicine does; but preventing or reversing NCDs is what Modern Medicine doesn’t do.

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains—that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant. —RICHARD BENTALL, Journal of Medical Ethics,

I anticipate diagnostic AI will exceed all but the best doctors in the next twenty years. This trend will be felt first in fields like radiology, where computer-vision algorithms are already more accurate than good radiologists for certain types of MRI and CT scans. In the story “Contactless Love,” we see that by 2041 radiologists’ jobs will be mostly taken over by AI. Alongside radiology, we will also see AI excel in pathology and diagnostic ophthalmology. Diagnostic AI for general practitioners will emerge later, one disease at a time, gradually covering all diagnoses. Because human lives are at stake, AI will first serve as a tool within doctors’ disposal or will be deployed only in situations where a human doctor is unavailable. But over time, when trained on more data, AI will become so good that most doctors will be routinely rubber-stamping AI diagnoses, while the human doctors themselves are transformed into something akin to compassionate caregivers and medical communicators.

When it comes to medical diagnostics, Magnetic Resonance Imaging (MRI) plays a vital role in helping doctors detect and treat various health conditions. However, the cost of an MRI scan can often be a concern for many individuals. In this article, we will explore the MRI cost in Gurgaon and how Sanar Care offers affordable imaging solutions without compromising on quality.

We also know that ADHD can crop up for the first time in adulthood. This often happens when the demands of life exceed the person’s ability to deal with them. Classic examples are when a woman has her first baby or when a student starts medical school. In both instances the organizational demands of daily life skyrocket and the person shows the symptoms of ADHD that he or she had been able to compensate for in the past. It is then that ADHD can and should be diagnosed. Indeed, adult-onset ADHD is a recognized condition in the big book of psychiatric disorders, the Diagnostic and Statistical Manual (DSM-5).

etc. In the APA program abstract Dr. Jaeger wrote, “Regardless of the initial diagnosis, patients who underwent brain SPECT prior to, or during, psychiatric hospitalization had markedly shorter stays than controls. As demonstrated by this clinical database (two thousand patients), brain SPECT may lead to more effective, shorter, safer, and less expensive diagnostic and treatment modes in children and adolescents with suspected neuropsychiatric illness.” His experience completely dovetailed with mine. I wondered, “How can we not look at the brain?” Cardiologists look at the heart, orthopedic doctors have X-rays to examine bones, gastroenterologists look at the gut, pulmonologists look at the lungs, every other medical specialist looks at the particular organ they treat. And, we deal with the most complicated organ in the body. How can we treat it without having any information on how it functions? Psychiatrists are the only medical specialists who never look at the organ we treat!

Intuitive information—unuttered, mind-locked data—does pass from person to person. Energy medicine is largely dependent upon a practitioner getting an image, gut sense, or inner messages that provide diagnostic and treatment insight. Edgar Cayce, a well-known American psychic, was shown to be 43 percent accurate in his intuitive diagnoses in a posthumous analysis made from 150 randomly selected cases.43 Medical doctor C. Norman Shealy tested now well-known intuitive Caroline Myss, who achieved 93 percent diagnostic accuracy when given only a patient’s name and birth date.44 Compare these statistics to those of modern Western medicine. A recent study published by Health Services Research found significant errors in diagnostics in reviewed cases in the 1970s to 1990s, ranging from 80 percent error rates to below 50 percent. Acknowledging that “diagnosis is an expression of probability,” the paper’s authors emphasized the importance of doctor-patient interaction in gathering data as a way to improve these rates.45 A field transfers information through a medium—even to the point that thought can produce a physical effect, thus suggesting that T-fields might even predate, or can at least be causative to, L-fields. One study, for example, showed that accomplished meditators were able to imprint their intentions on electrical devices. After they concentrated on the devices, which were then placed in a room for three months, these devices could create changes in the room, including affecting pH and temperature.46 Thought fields are most often compared to magnetic fields, for there must be an interconnection to generate a thought, such as two people who wish to connect. Following classical physics, the transfer of energy occurs between atoms or molecules in a higher (more excited) energy state and those in a lower energy state; and if both are equal, there can be an even exchange of information. If there really is thought transmission, however, it must be able to occur without any physical touch for it to be “thought” or magnetic in nature versus an aspect of electricity. Besides anecdotal evidence, there is scientific evidence of this possibility. In studying semiconductors, solid materials that have electrical conduction between a conductor and an insulator, noteworthy scientist Albert Szent-Györgyi, who won the Nobel Prize in 1937, discovered that all molecules forming the living matrix are semiconductors. Even more important, he observed that energies can flow through the electromagnetic field without touching each other.47 These ideas would support the theory that while L-fields provide the blueprints for the body, T-fields carry aspects of thought and potentially modify the L-fields, influencing or even overriding the L-field of the body.48

This is how things appear, and it’s going to be necessary to face them: if I don’t accept defining myself as a transsexual, as someone with “gender dysphoria,” I must admit that I’m addicted to testosterone. As soon as a body abandons the practices that society deems masculine or feminine, it drifts gradually toward pathology. My biopolitical options are as follows: either I declare myself to be a transsexual, or I declare myself to be drugged and psychotic. Given the current state of things, it seems more prudent to me to label myself a transsexual and let the medical establishment believe that it can offer a satisfying cure for my “gender identity disorder.” In that case, I’ll have to accept having been born in a biobody with which I don’t identify (as if the body could be a material given that is there before linguistic or political action) and claim that I detest my body, my reproductive organs, and my way of getting an orgasm. I’ll have to rewrite my history, modify all the elements in it that belong under the narrative of being female. I’ll have to employ a series of extremely calculated falsehoods: I’ve always hated Barbie dolls, I’m repulsed by my breasts and my vagina, vaginal penetration makes me sick, and the only way I can have an orgasm is with a dildo. All this could be partly true and partly nonsense. In other words, I’ll have to declare myself mentally ill and conform to the criteria established by the DMS-IV, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, of the American Psychiatric Association, in which, beginning in 1980, transsexuality was designated as a mental illness, just like exhibitionism, fetishism, frotteurism, masochism, sadism, transvestism, voyeurism . . . just like almost everything that isn’t straight reproductive sexuality and its binary gender system.

When no interpreter was present, the doctor and the patient stumbled around together in a dense fog of misunderstanding whose hazards only increased if the patient spoke a little English, enough to lull the doctor into mistakenly believing some useful information had been transferred. When an interpreter was present, the duration of every diagnostic interview automatically doubled. (Or tripled. Or centupled. Because most medical terms had no Hmong equivalents, laborious paraphrases were often necessary. In a recently published Hmong-English medical glossary, the recommended Hmong translation for “parasite” is twenty-four words long; for “hormone,” thirty-one words; and for “X chromosome,” forty-six words.) The prospect of those tortoise-paced interviews struck fear into the heart of every chronically harried resident.

A perplexing aspect of Long COVID is that numerous sufferers undergo a plethora of medical tests, which typically return results that are either 'within normal limits' or unusually abnormal, eluding easy explanation. On the surface, everything might look ostensibly normal, or biomarkers may display only slight variations. This diagnostic uncertainty leaves us grappling with a fragmented understanding of the condition, akin to a scene from "The Simpsons" where Mr. Burns is diagnosed with the fictional Three-Stooges Syndrome, humorously illustrating the dilemma of too many symptoms trying to manifest simultaneously, much like the Stooges attempting to pass through a door at the same time.

Within the class of neuroendocrine cancers, carcinoid is the most common specific cancer, but there also is a wide variety of other, much less common neuroendocrine cancers such as gastrinomas, somatostatinomas, VIPomas, etc.  All of the neuroendocrine cancers have symptoms which can partially mimic mast cell disease.  However, in the vast majority of cases of these rare tumors, the total range and duration of symptoms, and the pattern of progression/worsening, don’t come anywhere close to what’s typically seen in mast cell disease.  Nevertheless, in part because of the partial symptom mimicry, patients who are ultimately found to have mast cell disease often have been previously suspected of having – and thus have been intensively tested for, and sometimes even treated for – a neuroendocrine malignancy for which definitive diagnostic evidence cannot be found.

It was fundamental doctrine within the medical establishment that KS was the diagnostic signal of the AIDS pandemic. The very existence of AIDS was inextricably linked to KS. If HIV was not responsible for the outbreak of Kaposi’s Sarcoma, then there had to be another culprit.

First I have to discover what exactly is wrong with each patient. Medical students today don't spend enough time on simple diagnostic skills. They rely too heavily on technology. But when you have a whole bunch of symptoms and a complicated medical history, you have to listen and look and use your hands.

Traditional diagnostic results are the foundation for AI diagnostic systems. AI diagnostics is a fast-growing sector because there is a lot of enthusiasm about potentially using AI in the future. Sometimes this takes the form of claiming to make diagnosis more accurate. Sometimes people are open about their goal of replacing doctors and medical personnel, usually as a cost-cutting measure. The way you figure out what is going on in state-of-the-art computational science is by looking at open-source science. All of the people developing proprietary AI methods look at what’s happening in open science, and most use it for inspiration. Microsoft’s GitHub, the most popular code-sharing website, hosts most of the available code.

You need more than a wound pack and a pain patch, compadre. I’m flying. Closest minor care, or a real medical center?” He looked down at his leg and sighed. “Medical center. I can feel one of them grating against my bone.” He tilted his chin toward her. “You need diagnostics, too.” “What, this?” She wiped at the blood that was trickling down her neck from her torn ear and wiped her hand on her already bloody top, careful to avoid her inexplicably bruised ribs and keep the weight off her badly bruised right shin. “I’ve had worse than this in faculty curriculum committee meetings. Academia is a cutthroat business.

Bell had developed the Method from his youth and considered it a core medical skill. “All careful teachers have first to show the student how to recognize accurately the case,” he would declare. This was best done with the doctor’s own eyes, informed by experience. Patients, after all, could lie or misperceive their own symptoms. A man with a long-term injury might fail to recognize how his work did him damage; a drunkard might conceal his consumption. For Bell, observation sliced straight to the bone of diagnostic truth. It was all about trifles: “the accurate and rapid appreciation of small points in which the disease differs from the healthy state.

Goodlife Physical Medicine now offering Diagnostic tests which help our physicians diagnose, detect disease, other related or non related medical conditions.

In nature, ecosystems consist of fauna and flora, climatic characteristics, soil conditions, geologic features, and a host of other interacting influences. Similarly, the precision medicine ecosystem is made of many interacting components, including patients, clinicians, researchers, laboratory services, CDS software, genomic databases, smartphones, servers, claims data, mobile apps, biobanks to store clinical specimens, and EHRs. EHRs need to serve as gateways to this ecosystem. And for the EHR to become an effective conduit, it needs a way to organize these diverse sources in a way that lets clinicians and patients make more effective diagnostic and treatment decisions.

What these older physicians exhibited is termed clinical curiosity. They stroke to understand their patients in order to elucidate the underlying medical conditions. This thoroughness, patience, and dogged curiosity may have been ingrained in them because they trained at a time when they were no rapid CTs or MRIs. But even now, when these diagnostic tools are at their fingertips, these physicians maintain this approach to patients, one that serves to appreciate the dignity and uniqueness of each patient and his or her illness.

the most sophisticated diagnostic equipment available in the world, which detects and measures energies and frequencies in the body. This diagnostic equipment includes devices you probably heard of like MRIs (Magnetic Resonance Imaging), PET scans (Positron Emission Tomography), CAT scans (Computed Axial Tomography), EEGs (Electro encephalograms), EKGs (Electrocardiography), ultrasound devices and more. Our medical system diagnoses the body energetically with modern physics (Quantum Field Theory), and then treats with drugs and surgery (Newtonian Science). What is wrong with this picture?

Do you think ADHD should be recognized as a separate disability category according to IDEA? Support your position. What are the three subtypes of ADHD? List three symptoms typical of each subtype. Identify three possible causes of ADHD. Give an example of each. Give five examples of characteristics typical of children and adolescents with ADHD. Why do you think pupils with ADHD frequently exhibit other academic and behavioral difficulties? How is ADHD diagnosed? What role do parents and teachers play in the diagnostic process? What role does medication play in the treatment of ADHD? Why is this approach controversial? Describe three other intervention options for students with ADHD. How can assistive technology help students with ADHD? ADHD is usually a lifelong condition. In what ways might this disorder affect the lives of adults with ADHD? Why are some professionals concerned about the identification of ADHD in students from culturally and linguistically diverse backgrounds?

Trained Obstetrician and Gynaecologist in Dubai Dr Elsa de Menezes Fernandes is a UK trained Obstetrician and Gynaecologist. She completed her basic training in Goa, India, graduating from Goa University in 1993. After Residency, she moved to the UK, where she worked as a Senior House Officer in London at the Homerton, Southend General, Royal London and St. Bartholomew’s Hospitals in Obstetrics and Gynaecology. She completed five years of Registrar and Senior Registrar training in Obstetrics and Gynaecology in London at The Whittington, University College, Hammersmith, Ealing and Lister Hospitals and Gynaecological Oncology at the Hammersmith and The Royal Marsden Hospitals. During her post-graduate training in London she completed Membership from the Royal College of Obstetricians and Gynaecologists. In 2008 Dr Elsa moved to Dubai where she worked as a Consultant Obstetrician and Gynaecologist at Mediclinic City Hospital until establishing her own clinic in Dubai Healthcare City in March 2015. She has over 20 years specialist experience. Dr Elsa has focused her clinical work on maternal medicine and successfully achieved the RCOG Maternal Medicine Special Skills Module. She has acquired a vast amount of experience working with high risk obstetric patients and has worked jointly with other specialists to treat patients who have complex medical problems during pregnancy. During her training she gained experience in Gynaecological Oncology from her time working at St Bartholomew’s, Hammersmith and The Royal Marsden Hospitals in London. Dr Elsa is experienced in both open and laparoscopic surgery and has considerable clinical and operative experience in performing abdominal and vaginal hysterectomies and myomectomies. She is also proficient in the technique of hysteroscopy, both diagnostic and operative for resection of fibroids and the endometrium. The birth of your baby, whether it is your first or a happy addition to your family, is always a very personal experience and Dr Elsa has built a reputation on providing an experience that is positive and warmly remembered. She supports women’s choices surrounding birth and defines her role in the management of labour and delivery as the clinician who endeavours to achieve safe motherhood. She is a great supporter of vaginal delivery. Dr Elsa’s work has been published in medical journals and she is a member of the British Maternal and Fetal Medicine Society. She was awarded CCT (on the Specialist Register) in the UK. Dr Elsa strives to continue her professional development and has participated in a wide variety of courses in specialist areas, including renal diseases in pregnancy and medical complications in pregnancy.

for hospitals, physicians, medications, and diagnostic testing yet skimp in broad areas that are central to health, such as housing, clean water, safe food, education, and other social services. It may even be that Americans are spending large sums for health care to compensate for what they are not paying in social services—and the trade-off

Medical historians have cited many observations which they regarded as indicating the ancient existence of syphilis; but most of these, on close scrutiny, turn out to be unconvincing […] Ozanam quotes two sonnets from a Florentine poet—one entitled ‘De Matrona,’ the other 'Ad Priapum'—which he accepts as definite proof that syphilis existed in 1480, when the poems were written. Careful translation of these sonnets, with particular scrutiny of the expressions in them which are diagnostically significant, leads to the conclusion that they are merely very nasty poems, with no precise reference to the disease.

Ivan Pulyui, a college professor at the University of Vienna from the Ukraine, is sometimes credited with having sold the first x-ray tubes, before the x-ray was discovered. The claim is semi-true. His Pulyui Lamp was available perhaps as early as 1882, but it was sold as a light bulb, and Pulyui did not realize that it was streaming x-rays along with a blue glow until he read Röntgen’s paper in 1895. Pulyui immediately saw the medical diagnostic use of x-rays, and his lamps became quite useful.

The consequence of the demand for fast answers to complicated health matters is the endless demand for tests, diagnostics, and pharmaceuticals.

THE DSM-V: A VERITABLE SMORGASBORD OF “DIAGNOSES” When DSM-V was published in May 2013 it included some three hundred disorders in its 945 pages. It offers a veritable smorgasbord of possible labels for the problems associated with severe early-life trauma, including some new ones such as Disruptive Mood Regulation Disorder,26 Non-suicidal Self Injury, Intermittent Explosive Disorder, Dysregulated Social Engagement Disorder, and Disruptive Impulse Control Disorder.27 Before the late nineteenth century doctors classified illnesses according to their surface manifestations, like fevers and pustules, which was not unreasonable, given that they had little else to go on.28 This changed when scientists like Louis Pasteur and Robert Koch discovered that many diseases were caused by bacteria that were invisible to the naked eye. Medicine then was transformed by its attempts to discover ways to get rid of those organisms rather than just treating the boils and the fevers that they caused. With DSM-V psychiatry firmly regressed to early-nineteenth-century medical practice. Despite the fact that we know the origin of many of the problems it identifies, its “diagnoses” describe surface phenomena that completely ignore the underlying causes. Even before DSM-V was released, the American Journal of Psychiatry published the results of validity tests of various new diagnoses, which indicated that the DSM largely lacks what in the world of science is known as “reliability”—the ability to produce consistent, replicable results. In other words, it lacks scientific validity. Oddly, the lack of reliability and validity did not keep the DSM-V from meeting its deadline for publication, despite the near-universal consensus that it represented no improvement over the previous diagnostic system.29 Could the fact that the APA had earned $100 million on the DSM-IV and is slated to take in a similar amount with the DSM-V (because all mental health practitioners, many lawyers, and other professionals will be obliged to purchase the latest edition) be the reason we have this new diagnostic system?

AT 3:00 P.M. SHARP on August 23, 2012, Colonel Edgar escorted the two men into Mattis’s office on MacDill Air Force Base in Tampa. The sixty-one-year-old general was an intimidating figure in person: muscular and broad shouldered, with dark circles under his eyes that suggested a man who didn’t bother much with sleep. His office was decorated with the mementos of a long military career. Amid the flags, plaques, and coins, Shoemaker’s eyes rested briefly on a set of magnificent swords displayed in a glass cabinet. As they sat down in a wood-paneled conference room off to one side of the office, Mattis cut to the chase: “Guys, I’ve been trying to get this thing deployed for a year now. What’s going on?” Shoemaker had gone over everything again with Gutierrez and felt confident he was on solid ground. He spoke first, giving a brief overview of the issues raised by an in-theater test of the Theranos technology. Gutierrez took over from there and told the general his army colleague was correct in his interpretation of the law: the Theranos device was very much subject to regulation by the FDA. And since the agency hadn’t yet reviewed and approved it for commercial use, it could only be tested on human subjects under strict conditions set by an institutional review board. One of those conditions was that the test subjects give their informed consent—something that was notoriously hard to obtain in a war zone. Mattis was reluctant to give up. He wanted to know if they could suggest a way forward. As he’d put it to Elizabeth in an email a few months earlier, he was convinced her invention would be “a game-changer” for his men. Gutierrez and Shoemaker proposed a solution: a “limited objective experiment” using leftover de-identified blood samples from soldiers. It would obviate the need to obtain informed consent and it was the only type of study that could be put together as quickly as Mattis seemed to want to proceed. They agreed to pursue that course of action. Fifteen minutes after they’d walked in, Shoemaker and Gutierrez shook Mattis’s hand and walked out. Shoemaker was immensely relieved. All in all, Mattis had been gruff but reasonable and a workable compromise had been reached. The limited experiment agreed upon fell short of the more ambitious live field trial Mattis had had in mind. Theranos’s blood tests would not be used to inform the treatment of wounded soldiers. They would only be performed on leftover samples after the fact to see if their results matched the army’s regular testing methods. But it was something. Earlier in his career, Shoemaker had spent five years overseeing the development of diagnostic tests for biological threat agents and he would have given his left arm to get access to anonymized samples from service members in theater. The data generated from such testing could be very useful in supporting applications to the FDA. Yet, over the ensuing months, Theranos inexplicably failed to take advantage of the opportunity it was given. When General Mattis retired from the military in March 2013, the study using leftover de-identified samples hadn’t begun. When Colonel Edgar took on a new assignment as commander of the Army Medical Research Institute of Infectious Diseases a few months later, it still hadn’t started. Theranos just couldn’t seem to get its act together. In July 2013, Lieutenant Colonel Shoemaker retired from the army. At his farewell ceremony, his Fort Detrick colleagues presented him with a “certificate of survival” for having the courage to stand up to Mattis in person and emerging from the encounter alive. They also gave him a T-shirt with the question, “What do you do after surviving a briefing with a 4 star?” written on the front. The answer could be found on the back: “Retire and sail off into the sunset.

Psychiatric disorder consists of symptoms and behaviors that are not self-correcting - a breakdown in the normal homeostatic healing process. Diagnostic inflation occurs when we confuse the typical perturbations that are part of everyone's life with true psychiatric disorder[.]

The medical research community came to recognize that insulin resistance and a condition now known as “metabolic syndrome” is a major, if not the major, risk factor for heart disease and diabetes. Before we get either heart disease or diabetes, we first manifest metabolic syndrome. The CDC now estimates that some seventy-five million adult Americans have metabolic syndrome. The very first symptom or diagnostic criterion that doctors are told to look for in diagnosing metabolic syndrome is an expanding waistline. This means that if you’re overweight or obese—as two-thirds of American adults are—there’s a good chance that you have metabolic syndrome; it also means that your blood pressure is likely to be elevated, and you’re glucose-intolerant and thus on the way to becoming diabetic. This is why you’re more likely to have a heart attack than a lean individual—although lean individuals can also have metabolic syndrome, and those who do are more likely to have heart disease and diabetes than lean individuals without it. Metabolic syndrome ties together a host of disorders that the medical community typically thought of as unrelated, or at least having separate and distinct causes—getting fatter (obesity), high blood pressure (hypertension), high triglycerides, low HDL cholesterol (dyslipidemia), heart disease (atherosclerosis), high blood sugar (diabetes), and inflammation (pick your disease)—as products of insulin resistance and high circulating insulin levels (hyperinsulinemia). It’s a kind of homeostatic disruption in which regulatory systems throughout the body are misbehaving with slow, chronic, pathological consequences everywhere.

The definitions of mental disorder generally require the presence of distress, disability, dysfunction, dyscontrol, and/or disadvantage. This sounds better as alliteration than it works as operational guide. How much distress, disability, dysfunction, dyscontrol, and disadvantage must there be, and of what kind? [...] Not having a useful definition of mental disorder creates a gaping hole at the center of psychiatric classification, resulting in two unanswered conundrums: how to decide which disorders to include in the diagnostic manual and how to decide whether a given individual has a mental disorder.

On the other hand, I can tell you, both from extensive research and from firsthand experience, that as convincing as the case made by Lane and his fellow Antipharma critics can be, the distress felt by some social phonics is real and intense. Are there some 'normally' shy people, not mentally ill or in need of psychiatric attention, who get swept up in the broad diagnostic category of social anxiety disorder, which has been swollen by the profit-seeking imperatives of the drug companies? Surely. But are there also socially anxious people who can legitimately benefit from medication and other forms of psychiatric treatment- who in some cases are saved by medication from alcoholism, despair, and suicide? I think there are.

Viața intimă a oamenilor, ca și cea profesională, e plină de greșeli, mai mari, mai mici. Un scriitor scrie azi o carte foarte bună, iar mâine scrie o carte mediocră. Un actor interpretează azi magistral un rol, creând un personaj de neuitat, adevărat punct de referință pentru interpretările generațiilor viitoare, mâine - un personaj care nu i se mai potrivește chiar ca pielea pe trup. Spectatorul și cititorul sunt neiertători, nu trec niciodată cu vederea ce-a fost prost, și-n această neîndurare uită și ce-ai făcut bun. Sita care cerne fără părtinire este posteritatea. Ce posteritate are însă actorul de teatru, care moare definitiv în fiecare seară, cu fiecare spectacol, el , artistul irepetabilului? Ce posteritate are un medic? El moare definitiv cu fiecare diagnostic, cu fiecare succes, cu fiecare eșec.

Fiscal Numbers (the latter uniquely identifies a particular hospitalization for patients who might have been admitted multiple times), which allowed us to merge information from many different hospital sources. The data were finally organized into a comprehensive relational database. More information on database merger, in particular, how database integrity was ensured, is available at the MIMIC-II web site [1]. The database user guide is also online [2]. An additional task was to convert the patient waveform data from Philips’ proprietary format into an open-source format. With assistance from the medical equipment vendor, the waveforms, trends, and alarms were translated into WFDB, an open data format that is used for publicly available databases on the National Institutes of Health-sponsored PhysioNet web site [3]. All data that were integrated into the MIMIC-II database were de-identified in compliance with Health Insurance Portability and Accountability Act standards to facilitate public access to MIMIC-II. Deletion of protected health information from structured data sources was straightforward (e.g., database fields that provide the patient name, date of birth, etc.). We also removed protected health information from the discharge summaries, diagnostic reports, and the approximately 700,000 free-text nursing and respiratory notes in MIMIC-II using an automated algorithm that has been shown to have superior performance in comparison to clinicians in detecting protected health information [4]. This algorithm accommodates the broad spectrum of writing styles in our data set, including personal variations in syntax, abbreviations, and spelling. We have posted the algorithm in open-source form as a general tool to be used by others for de-identification of free-text notes [5].

Helping a client with all those things is part of your job. But before you can begin-in fact, before that person walks through the door-you must prepare yourself. In many agencies part of your preparation will be reading some documentation on the client. That may be nothing more than a two-line summary of the problem the client has reported and a telephone number you can call to set up an appointment. On the other hand, if the case is being transferred to you, it may mean a huge file that includes a medical history, a psychiatric evaluation, a mental status exam, a biopsychosocial assessment by a previous clinician (or clinicians), that clinician’s progress notes, a report of psychological testing, a diagnostic code, and many other types of information. Whether it is one page or fifty, though, your response ought to be the same: What don’t I know that I need to know? Start making some written notes for yourself, beginning with those questions that you need to have answered before you call the client back to arrange an appointment. For instance, you may want further clarification of her current problem, if possible, so you can be sure she is coming to the right place. You may want to find out if anyone told her there is a fee charged. Or, if the case appears to involve more than one person, you may want to inquire about who should be included in the first interview. You should raise those questions with your supervisor or with the person who had the initial phone contact.

three associates of the William Pepper Clinical Laboratory at the University of Pennsylvania used well over a hundred children under the age of eight at the St. Vincent’s Home for Orphans, a Catholic orphanage in Philadelphia, for a series of diagnostic tests in which a tuberculin formula was placed in the test subjects’ eyes. 23

With the lens of Jobs to Be Done, the Medtronic team and Innosight (including my coauthor David Duncan) started research afresh in India. The team visited hospitals and care facilities, interviewing more than a hundred physicians, nurses, hospital administrators, and patients across the country. The research turned up four key barriers preventing patients from receiving much-needed cardiac care: Lack of patient awareness of health and medical needs Lack of proper diagnostics Inability of patients to navigate the care pathway Affordability While there were competitors making some progress in India, the biggest competition was nonconsumption because of the challenges the Medtronic team identified. From a traditional perspective, Medtronic might have doubled down on doctors, asking them about priorities and tradeoffs in the product. What features would they value more, or less? Asking patients what they wanted would not have been top of the list of considerations from a marketing perspective. But when Medtronic revisited the problem through the lens of Jobs to Be Done, Monson says, the team realized that the picture was far more complex—and not one that Medtronic executives could have figured out from pouring over statistics of Indian heart disease or asking cardiologists how to make the pacemaker better. Medtronic has missed a critical component of the Job to Be Done.

Would ancient Tibetan medicine recognize the value of X-rays? “Absolutely!” the doctor said. “When patients bring me their X-rays from the clinic up at Khunde, this is extremely helpful in my treatment.” On the other hand, Dr. Tenzin was mystified by other diagnostic practices in Western medicine. “When they do urinalysis up at Khunde, all they do is stick a slip of paper into the sample,” he said. “But that can’t be enough. I just don’t think it is possible to diagnose a medical problem and propose a course of treatment without tasting the urine. Certainly I wouldn’t begin a diagnosis of your shoulder until I had tasted your urine. It tells so much about a patient’s health status.

Before prescribing medication, the NOF recommends that doctors implement the following procedures:  Obtain a detailed patient history pertaining to clinical risk factors for osteoporosis-related fractures and falls.  Perform physical examination and obtain diagnostic studies to evaluate for signs of osteoporosis and its secondary causes.  Modify diet/ supplements and other clinical risk factors for fracture.  Estimate patient’s ten-year probability of hip and any major osteoporosis-related fracture using the United States–adapted FRAX.  Make decisions on whom to treat and

Medical assistants aid doctors by performing basic clinical procedures and handling a variety of administrative duties. Medical Assistant Programs Sacramento focuses on front office administrative responsibilities such as clerical and bookkeeping functions, processing medical insurance claims as well as back office clinical responsibilities, during which students get hands-on experience conducting a variety of diagnostic tests.

When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain. They may visit multiple specialists, undergo extensive diagnostic tests, and be prescribed multiple medications, some of which may provide temporary relief but all of which fail to address the underlying issues. Their diagnosis will come to define their reality without ever being identified as a symptom of their attempt to cope with trauma.

the introduction, we talked about Deep Patient, a machine learning system that researchers at Mount Sinai Hospital in New York fed hundreds of pieces of medical data about seven hundred thousand patients. As a result, it was able to predict the onset of diseases that have defied human diagnostic abilities. Likewise, a Google research project analyzed the hospital health records of 216,221 adults. From the forty-six billion data points, it was able to predict the length of a patient’s stay in the hospital, the probability that the patient would exit alive, and more.41

Some medical conditions create symptoms that look very much like ADD. A few examples are thyroid conditions, fibromyalgia and allergies. To make matters even more complicated, ADDers can have both ADD and one or more other problems that muddy the diagnostic picture. Fibromyalgia, for example, seems to travel along with ADD in many cases. It produces a syndrome that includes muscle pain as well as mental fogginess. Allergies can also interfere with mental functioning.

The expert medical doctors took days of diagnostic testing to determine that I had a severe mitral valve prolapse.

Desperate to join the medical mainstream, psychiatry recognized that its diagnostic system was grossly inadequate. For instance, in the 1968 second edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-II), depressive neurosis was defined as “An excessive reaction of depression due to an internal conflict or to an identifiable event such as the loss of a love object or cherished possession.”4 Is moderate depression a week after the loss of a favorite cat “excessive”? One diagnostician would say, “No, not at all, people love their cats”; another, “After a week, it is obviously excessive!” Such disagreements made psychiatry’s scientific aspirations laughable. The solution was a radical revision, DSM-III, published in 1980.5 Written by a task force of the American Psychiatric Association under the leadership of psychiatry researcher Robert Spitzer, it purged psychoanalytic theory from DSM-II and replaced its 134 pages of clinical impressions describing 182 disorders with 494 pages of symptom checklists that defined 265 disorders. “Depressive neurosis” was eliminated. The definition of a new diagnosis, “major depressive disorder,” said nothing about internal conflict; it only required the presence of at least five of nine possible symptoms for at least two weeks. Every diagnosis was now defined by a checklist of necessary and sufficient symptoms. DSM-III transformed psychiatry.6 It made possible standardized interviews that epidemiologists could use to measure the prevalence of specific disorders.

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