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Where Medicine Went Wrong explores how the idea of an average value has been misapplied to medical phenomena, distorted understanding and lead to flawed medical decisions. Through new insights into the science of complexity, traditional physiology is replaced with fractal physiology, in which variability is more indicative of health than is an average. The capricious nature of physiological systems is made conceptually manageable by smoothing over fluctuations and thinking in terms of averages. But these variations in such aspects as heart rate, breathing and walking are much more susceptible to the early influence of disease than are averages.It may be useful to quote from the late Stephen Jay Gould's book Full House on the errant nature of averages: ?? our culture encodes a strong bias either to neglect or ignore variation. We tend to focus instead on measures of central tendency, and as a result we make some terrible mistakes, often with considerable practical import.? Dr West has quantified this observation and make it useful for the diagnosis of disease.
The field of solid state ionics deals with ionically conducting materials in the solid state and numerous devices based on such materials. Solid state ionic materials cover a wide spectrum, ranging from inorganic crystalline and polycrystalline solids, ceramics, glasses, polymers, composites and nano-scale materials. A large number of Scientists in Asia are engaged in research in solid state ionic materials and devices and since 1988. The Asian Society for solid state ionics has played a key role in organizing a series of bi-ennial conferences on solid state ionics in different Asian countries. The contributions in this volume were presented at the 10th conference in the series organized by the Postgraduate Institute of Science (PGIS) and the Faculty of Science, University of Peradeniya, Sri Lanka, which coincided with the 10th Anniversary of the Postgraduate Institute of Science (PGIS). The topics cover solid state ionic materials as well as such devices as solid state batteries, fuel cells, sensors, and electrochromic devices. The aspects covered include theoretical studies and modeling, experimental techniques, materials synthesis and characterization, device fabrication and characterization.
Author : Institute of Medicine Publisher : National Academies Press Page : 312 pages File Size : 31,56 MB Release : 2000-03-01 Category : Medical ISBN : 0309068371
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine
In 1998, Nicholas Gonzalez, M.D. received National Cancer Institute approval for a clinical trial to evaluate his nutritional-enzyme approach in the treatment of patients with pancreatic cancer. Though Dr. Gonzalez hoped the venture would initiate an era of cooperation between conventional scientists and serious alternative researchers, problems plagued the study from its beginning. The design discouraged patient participation; conventional oncologists discouraged patients from joining and at times pressured those already admitted for nutritional therapy to change to more conventional treatment. Then in 2000 the NCI insisted that all patient selection decisions be turned over to the Principal Investigator, who as it turned out helped develop the chemotherapy protocol used as the control treatment.Repeatedly, the Principal Investigator approved patients for the nutritional treatment who did not meet the entry requirements, or who were too ill or uncommitted to follow the self-administered regimen. An evaluation by government scientists in early 2005 confirmed that so many patients had failed to follow the prescribed nutritional therapy that the data had little meaning. Despite such problems, without Dr. Gonzalez¿ knowledge the Principal Investigator published an article implying the study was properly run, patients complied fully and that the nutritional therapy had no effect.In response, Dr. Gonzalez, a former journalist, has written What Went Wrong, to bring the truth of this project to light, and show how bias, indifference, and at times incompetence undermined a promising research effort that, if properly run, might have ushered in a new direction in cancer treatment.
Originally published in 2012, revised edition published in 2013, by Fourth Estate, Great Britain; Published in the United States in 2012, revised edition also, by Faber and Faber, Inc.
Medical mistakes are more pervasive than we think. How can we improve outcomes? An acclaimed MD’s rich stories and research explore patient safety. Patients enter the medical system with faith that they will receive the best care possible, so when things go wrong, it’s a profound and painful breach. Medical science has made enormous strides in decreasing mortality and suffering, but there’s no doubt that treatment can also cause harm, a significant portion of which is preventable. In When We Do Harm, practicing physician and acclaimed author Danielle Ofri places the issues of medical error and patient safety front and center in our national healthcare conversation. Drawing on current research, professional experience, and extensive interviews with nurses, physicians, administrators, researchers, patients, and families, Dr. Ofri explores the diagnostic, systemic, and cognitive causes of medical error. She advocates for strategic use of concrete safety interventions such as checklists and improvements to the electronic medical record, but focuses on the full-scale cultural and cognitive shifts required to make a meaningful dent in medical error. Woven throughout the book are the powerfully human stories that Dr. Ofri is renowned for. The errors she dissects range from the hardly noticeable missteps to the harrowing medical cataclysms. While our healthcare system is—and always will be—imperfect, Dr. Ofri argues that it is possible to minimize preventable harms, and that this should be the galvanizing issue of current medical discourse.
National Academies of Sciences, Engineering, and Medicine
Author : National Academies of Sciences, Engineering, and Medicine Publisher : National Academies Press Page : 473 pages File Size : 19,37 MB Release : 2015-12-29 Category : Medical ISBN : 0309377722
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
Medications such as Vioxx and procedures such as vertebroplasty for back pain are among the medical "advances" that turned out to be dangerous or useless. What Dr. Vinayak K. Prasad and Dr. Adam S. Cifu call medical reversal happens when doctors start using a medication, procedure, or diagnostic tool without a robust evidence base—and then stop using it when it is found not to help, or even to harm, patients. In Ending Medical Reversal, Drs. Prasad and Cifu narrate fascinating stories from every corner of medicine to explore why medical reversals occur, how they are harmful, and what can be done to avoid them. They explore the difference between medical innovations that improve care and those that only appear to be promising. They also outline a comprehensive plan to reform medical education, research funding and protocols, and the process for approving new drugs that will ensure that more of what gets done in doctors' offices and hospitals is truly effective. "Every doctor should read this book."—JAMA Internal Medicine "[A]n excellent and realistic discussion of some of the horror stories that occur in medical practice . . . Highly recommended."—Choice "Ending Medical Reversal goes far in teaching medical students and practicing physicians alike how to learn on our own."—The Lancet "This has to be on the reading list for medical and nursing students."—Nursing Times "Ending Medical Reversal presents persuasive evidence that many current standard-of-care treatments are probably ineffective or harmful, thoroughly explains how such treatments came to be accepted, and proposes a number of ways to address the general problem (only some of which involve avaricious companies and mercenary physicians) and minimize its impact on a specific patient."—Journal of Clinical Research Best Practices "Dr. Prasad and Dr. Cifu offer a five-step plan, including pointers for determining if a given treatment is really able to do what you want it to do, and advice on finding a like-minded doctor who won't object to a certain amount of back-seat driving."—The New York Times "When I describe Ending Medical Reversal as revolutionary, I don't use the term lightly. Go out and read it—right now."—Common Sense Family Doctor "Should be considered for undergraduate reading lists. Keep a copy in the pharmacy or your briefcase as a great icebreaker or discussion point with other local healthcare professionals."—The Pharmaceutical Journal
An acclaimed medical expert and patient advocate offers an eye-opening look at many common and widely used medical interventions that have been shown to be far more harmful than helpful. Yet, surprisingly, despite clear evidence to the contrary, most doctors continue to recommend them. Modern medicine has significantly advanced in the last few decades as more informed practices, thorough research, and incredible breakthroughs have made it possible to successfully treat and even eradicate many serious ailments. Illnesses that once were a death sentence, such as HIV and certain forms of cancer, can now be managed, allowing those affected to live longer, healthier lives. Because of these advances, we now live 30 years longer than we did 100 years ago. But while we have learned much in the preceding decades that has changed our outlook and practices, we still rely on medical interventions that are vastly out of date and can adversely affect our health. We all know that finishing the course of antibiotics prevents the recurrence of illness, that sunscreens block harmful UV rays that cause skin cancer, and that all cancer-screening programs save lives. But do scientific studies really back this up? In this game-changing book, Dr. Paul A. Offit debunks fifteen common medical interventions that have long been considered gospel despite mounting evidence of their adverse effects, from vitamins, sunscreen, fever-reducing medicines, and eyedrops for pink eye to more serious procedures like heart stents and knee surgery. Analyzing how these practices came to be, the biology of what makes them so ineffective and harmful, and the medical culture that continues to promote them, Overkill informs patients to help them advocate for their health. By educating ourselves, we can ask better questions about some of the drugs and surgeries that are all too readily available—and all too heavily promoted.