There is a new compilation of the latest research on the long-term impact of childhood adversity. I have written about this key subject in earlier blogs (here and again here). Now there is a new DVD where the latest research and its implications for policy are presented by those who conducted the studies.
I first met Howard Spiro, MD in 1980 when I applied for a position in the Department of Gastroenterology he established at Yale in 1954. He brilliantly blended encyclopedic knowledge (he wrote one of the major textbooks in the field singlehanded), superb clinical skills and droll wit. I really wanted to learn from him and thought I might have a chance when I was the only person on rounds that day (apart from him) to know the cause of an abnormality on a patient’s x-ray. Alas, it was not to be and I completed my training at UCLA instead.
Keele University in Staffordshire, England is fifty years old and educates 10,000 undergraduates on a square mile of land once owned by the same family for four centuries and prior to that by the medieval Knights Templar. Their arthritis research unit has published an interesting paper comparing usual care of low back pain with a new approach based on stratifying patients into three groups (1).
A therapist recently posed a key question about adverse childhood experiences (ACEs): what is the benefit to a patient of their family doctor knowing this information?
Thirty five years ago, Robert Ader, PhD serendipitously discovered a key part of our physiology that was not thought to exist. The story begins with rats drinking water sweetened with saccharine. Half the rats were simultaneously given low doses of Cytoxan to cause stomach pain. (Cytoxan is a chemotherapy drug for cancer.) It was no surprise that soon the rats associated the sweetened water with the pain and refused to drink it.
The latest evidence of the woeful state of care for Psychophysiologic Disorders (Stress Illness) comes from my local newspaper. In a Health column, we find the following question from a reader:
A match for the Women’s World Chess Championship recently finished in Tirana, the capital of Albania. The winner was incumbent champion Hou Yifan, a 17 year old from China who won the title last December, the youngest ever. The pressure on her was enormous for several reasons. The weight of national pride was heightened by the fact that Ms Koneru, her 24 year old challenger, is a native of India, China’s geopolitical rival. Ms Koneru had also surpassed Hou (slightly) in the world rankings. In addition, prize money for the match winner was more than $50,000 greater than for the loser.
I attended the 13th Collaborative Family Healthcare Association (CFHA) meeting in Philadelphia last week. A prominent theme was difficulty gaining acceptance from medical clinicians about the role of mental/behavioral health practitioners in the primary care setting. These practitioners provide skills helping people with complex medication regimens (insulin for example), weight management, smoking cessation, exercise regimens, substance abuse and stress management as well as help with mental health disorders. But these resources are not used nearly as well as they could be.
Stress Illness (also known as Psychophysiologic Disorder or PPD) is one of the most common causes of Medically Unexplained Symptoms (MUS). These are symptoms for which no link to a diseased organ or structure can be found after diagnostic testing. Javier Escobar, MD and colleagues (1) at the Robert Wood Johnson medical school in New Jersey, USA, decided to try a treatment called Cognitive Behavioral Therapy for these patients.