Quantum Biology

Richard P. Feynman in his published lectures, The Strange Theory of Light and Matter QED, wrote,

"The theory of quantum mechanics ... explained all kinds of details, such as why an oxygen atom combines with two hydreegen atoms to make water and so on. Quantum mechanics thus supplied the theory behind chemistry. So, fundementally theoretical chemistry is really physics."

The parallel in molecular biology is quite obvious. We deal with DNA at the molecular level. The next great step will be a theoretical explaination of molecular biology at the electron, photon and particle level, the level of quantum intanglement. Thus the theoretical understanding of molecular biology will also really be physics.

2,450 years ago Greek medicine was called physics. Aristotle had contemplated the existence of particles. The enquiry into how things worked, especially physiology was called physics and the stem of our word physician is indeed physics. With quantum biology we have come full circle.

23 and Me

23andMe posted a letter to its customers announcing that after two years of work they are now able to  share the wellness implications of their customers DNA directly to its customers. They promis a report by year end. 

The 23andMe database appears to be the biggest in the World and academic institutions are buying into the data for research. Furthermore, the vault of stored samples remains available for further research while the data remains anomonous with the individuals information remaining the property of the individual rather than some other institution or the government.

This becomes a breakthrough for clinical medicine, which heretofore faced a roadblock over confidentiality, the position of nearly all specialty groups and the assumption that the information would be too sensitive for the patient to have access to. Now, the clinician will have access to a patient history containing multiple SPN traits that are of preventive as well as diagnostic value, a great day for translational medicine.

Molecular Biology

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As we attempt to accept the data afforded by genomics, the greatest challenge to health remains nutrition and poverty. While the science accelerates the issues of fresh produce, healthy eating and poverty languish. Why is that?

Wrong Diagnosis

Share |Suprise, surprise, as medical schools scramble to introduce curriculum reform to keep pace with mediocrity, they eliminate the microscope, the doctor's personal lab, the autopsy, and in the name of confidentiality and privacy, bedside teaching is all but forgotten. Sub standard medical schools are a growth industry. Best evidence concentrates so on treatments that we have treatments in search of a diagnosis, particularly expensive highly profitable procedures or drugs. We teach with "standardized patients" a synanym for actors who can never teach the student the reality of a disease or its diagnosis. In our haste to produce alternative providers, we treat health care at the lowest denominator of competence. Any one with a stethescope around their neck is a provider. There are still true physicians, but they are fenw and far between. We still have great medical schools but they are under pressure to make the big bucks, to be self sustaining. Physicians today struggle with commercializations as renasance physicians struggled with the church.  

5 Disasters of the Afordable Care Act, Obama Care

1. It is indeed a tax, progressive fortunately, but inequitably so.

2. There is no provision for autopsy or a physician's own small laboratory, prohibited.

3. There are lots of provisions for providers without adequate medical school training.

4.  The Act allows drug companies to charge what ever they want and prohibits negotiation.

5  it encourages the recording of false or erroneously superfluous diagnosis.

What it has done is acknowledge the need for universal health care,but it needs to morph into a dual system private coverage competing with a universally available single payer system.

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Autopsy

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http://www.pbs.org/wgbh/pages/frontline/criminal-justice/post-mortem/without-autopsies-hospitals-bury-their-mistakes/

Four years later and autopsies remain the forgotten basis of scientific medicine. Headlines read, autopsy rates are falling, but they cannot fall from the near zero percent presently undertaken. Some new hospitals do not even provide examining space for autopsies. The NEJM publishes CPCs on living patients. A pity today's epidemic of curriculum reform does not include autopsies, a further sad accommodation to today's reality. Check the PBS link, it's well done.

The renaissance of modern medicine was lead by the microscope and the study of anatomy; it became clinical with the routine practice of autopsy by Marie Francois Bichat in Paris 1793, the stethescope, Rene' Laennec 1822 and the classical bedside teaching of the great Scottish and Irish physicians in the early 1800s. From Bichat, over the door to his autopsy room, "Death comes to the aid of the living." 

Cynically speaking -- we have all but legislated these practices out of existence, the autopsy for money, bedside teaching for privacy, basic science for curriculum reform with greater emphasis on preceptors and, ah the stethescope, it hangs around the neck in color coordinated pastel colors only to pretend to hear something through the patient's clothing. An anatomy professor recently commented, "They have a microscope down in Seattle under glass so students can see what one looks like."

Community Acquired Pneumunia

Share |NEJM reports a study of community acquired pneumonia comparing treatment with bata lactams, macrolide-beta lactams combination therapy or fluoroquinolone mono-therapy with mortality.

Why "community acquired pneumonia"? Hippocrates was more specific. By the very name we are excusing ourselves from the very art of clinical diagnosis that has taken centuries to develope. We have not replaced that art with PCR or fluorescent microscopy. The term community acquired pneumonia can only be an excuse for expedient treatment and disposition. I would wager that the stethoscope was applied over the shirt and the acknowlegment of community acquired pneumonia not made until the X-ray was positive. By then we might better call it late diagnosis of pneumonia of unknown etiology obscured by inappropriate antibiotic therapy.

Rene Lanec brought us the stethoscope, but we wear it around our neck, color coordinated as a fashion statement and we listen through clothing if at all. One should easily diagnose pneumonia before the X-ray is positive and with a bit of a history and a Gram stain narrow down the etiology and a culture before starting any antibiotic.

d-pneumo. Is the easiest to identify with a Gram stain and any strings of strep. clearly justify beta-lactams. Macrolides cover the hard to identify atypical pneumonia and the clumps of staph on the slide suggest a more resistant organism. Beta lactam macrolide in combination may still cover the possibility of atypical, but with the combination of a bacterialstatic with a bacterialsisal, the one may inhibit the effectiveness of the other. Then there is TB and pneumonocysticis - in more vulnerable patients. But what is community acquired pneumonia other than an excuse.

NEJM 2015,372: 1312-1323;  2 April. DOI 10.1056/NEJMoa1406330