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RNZ News
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- Health
- RNZ News
Against the Odds: The Kiwi women who fought to become doctors
This year Otago Medical School turns 150. Half of the graduates will be women. But it was not always the case, and a new book details the struggle of women to become part of New Zealand's medical fraternity. Against the Odds: New Zealand's First Women Doctors covers a 70 year period from the 1890s to 1967 - the year before a medical school would open in Auckland, with biographies of 150 of the 400 female Otago graduates over that time. Many faced discrimination from their family, peers and lecturers - told they were "taking a man's place" or that they'd simply "leave to have babies". In some cases, bits of flesh would be put into lab coat pockets - some teachers made female students leave the room during lectures on the reproductive system. Yet they persisted - with the majority of those graduating over those 70 years going on to have successful careers. Kathryn speaks to the book's author Cynthia Farquhar and researcher Michaela Selway.
Telegraph
27-05-2025
- Health
- Telegraph
Mystified by the human brain? This doctor has spent years observing it
Doctors' accounts of their lives and work have historically tended towards the megalomaniacal. This is true not only of those dealing with matters of life and death both daily and viscerally (emergency doctors; surgeons), but also of those who are used to holding dominion over the brain. I've read more than a few medical memoirs that betray no uncertainty, reveal no insecurity, offer no hesitation or deviation from the wearying doxa that nothing bar rocket science could compare to the complexity and prestige of studying the brain. The Mind Electric, Pria Anand's first book, is nothing like these. It brings together into one compelling volume autobiography, clinical anecdotes, family lore, medical history, medical mystery and an appropriate dose of politics – for Anand works at what is known in the American system as a 'safety-net hospital', and continually confronts the consequences of her country's paltry yet blisteringly expensive approach to public healthcare. Because neurology continually moves between the brain and the mind, between the manifest and the unseen, and between what patients feel and doctors think, it's impossible, in general, to fully disentangle it from the practice and history of psychiatry, nor the violence which punctuates that murky past. Anand doesn't flinch in confronting this legacy or its continued grip on medical discourse. She describes, for instance, how the specific terminology that doctors use – the patient 'complains'; the patient 'denies' – imbues the clinical encounter with needless adversity. Anand writes with circumspection and sensitivity, and with creativity and verve as well. Despite her abiding interest in narrative coherence, the book itself is delightfully labyrinthine; Anand refuses linearity, much less chronological order, and instead offers a strange and compelling tapestry of stories somehow both discrete and happening all at once, its threads overlapping and interweaving with layers hidden underneath. She takes readers from ancient Egypt, through the Salpêtrière (France's brutal 17th-century women's hospice), and right into the consulting rooms of today. With no need for exaggeration or polemic, she brings into especially sharp relief how neurology has enacted the mistreatment of women's health for as long as men have been messing about with our nerves. In a particularly jarring example, she explains that not only do women suffer from multiple sclerosis three times as frequently as men, but they're still also frequently disbelieved, being dismissed as 'hysterical' by doctors repeatedly before finally being diagnosed. Amid all this, Anand unabashedly braids in intimate and exposing personal details. She discloses private tragedies, moral injuries, mistakes; these are the pieces that make this memoir genuinely compelling. Several times, Anand calls her medical training 'alchemical', making clear that what might be mythologised as an impossible power really offers a Midas touch, its initiants being possessed of intimate knowledge of human life while being required to detach from, or even deny, their own humanity. At one point, she describes being plagued for months by overwhelming aural symptoms – the persistent, resonant, throbbing sound of her own pulse, accompanied by debilitating disorientation – while being equally stubbornly attached to an imaginary bright line between sick people and doctors. She writes of her 'refusal to acknowledge my physical frailty welling from some primal desire to separate myself from my patients, to imagine that I was in some elemental way apart from the suffering that surrounded me [and] somehow inoculated against it'. Such insights not only show the thoughtfulness with which Anand reflects upon her profession: they also underscore the project of The Mind Electric, which is – at least in part – to move us beyond the limits of our prior knowledge. She wants us to imagine new, less precise and less totalising narratives about the mind, medicine and power; she invites us to think again about what happens at all of life's edges and in-betweens. For Anand, those projects are inescapably literary, born of her abiding love of fables and tales of magic, her enduring enchantment with folklore and the fantastic. It's plain to see that her imagination, in turn, underpins her skill as a physician. As this superb book shows, the human impulse to gather information, to put things into order – then speak, be understood and be believed – controls quite possibly every aspect of our lives.
Times
23-05-2025
- Health
- Times
What links our Hertford house and Catherine the Great
Port Hill House in Hertford looks like a standard 17th-century farmhouse, with its symmetrical façade, red-brick chimneys, gabled roof and casement windows. Its backstory, however, is rather more intriguing. In 1762, Thomas Dimsdale, who was born in Essex in 1712, moved into the seven-bedroom property in the parish of Bengeo, a mile from the centre of Hertford. Dimsdale was a doctor and pioneer of the smallpox vaccine. He used Port Hill House as a base to administer vaccinations against the contagious disease — indeed, it became known locally as Inoculation House. A year after he moved in, Dimsdale built a small house at the bottom of his garden, known as Pest House, which was purpose-built to inoculate against smallpox. It is now called the Old
New York Times
15-05-2025
- Health
- New York Times
Baby Is Healed With World's First Personalized Gene-Editing Treatment
Something was very wrong with Kyle and Nicole Muldoon's baby. The doctors speculated. Maybe it was meningitis? Maybe sepsis? They got an answer when KJ was only a week old. He had a rare genetic disorder, CPS1 deficiency, that affects just one in 1.3 million babies. If he survived, he would have severe mental and developmental delays and would eventually need a liver transplant. But half of all babies with the disorder die in the first week of life. Doctors at Children's Hospital of Philadelphia offered the Muldoons comfort care for their baby, a chance to forgo aggressive treatments in the face of a grim prognosis. 'We loved him, and we didn't want him to be suffering,' Ms. Muldoon said. But she and her husband decided to give KJ a chance. Instead, KJ has made medical history. The baby, now 9 ½ months old, became the first patient of any age to have a custom gene-editing treatment, according to his doctors. He received an infusion made just for him and designed to fix his precise mutation. The investigators who led the effort to save KJ are presenting their work on Thursday at the annual meeting of the American Society of Cell & Gene Therapy, and are also publishing it in the New England Journal of Medicine. The implications of the treatment go far beyond treating KJ, said Dr. Peter Marks, who was the Food and Drug Administration official overseeing gene-therapy regulation until he recently resigned over disagreements with Robert F. Kennedy Jr., the secretary of health and human services. More than 30 million people in the United States have one of more than 7,000 rare genetic diseases. Most are so rare that no company is willing to spend years developing a gene therapy that so few people would need. But KJ's treatment — which built on decades of federally funded research — offers a new path for companies to develop personalized treatments without going through years of expensive development and testing. Illnesses like KJ's are the result of a single mutation — an incorrect DNA letter among the three billion in the human genome. Correcting it requires pinpoint targeting in an approach called base editing. To accomplish that feat, the treatment is wrapped in fatty lipid molecules to protect it from degradation in the blood on its way to the liver, where the edit will be made. Inside the lipids are instructions that command the cells to produce an enzyme that edits the gene. They also carry a molecular GPS — CRISPR — which was altered to crawl along a person's DNA until it finds the exact DNA letter that needs to be changed. While KJ's treatment was customized so CRISPR found just his mutation, the same sort of method could be adapted and used over and over again to fix mutations in other places on a person's DNA. Only the CRISPR instructions leading the editor to the spot on the DNA with the mutation would need to be changed. Treatments would be cheaper, 'by an order of magnitude at least,' Dr. Marks said. The method, said Dr. Marks, who wrote an editorial accompanying the research paper, 'is, to me, one of the most potentially transformational technologies out there.' It eventually could also be used for more common genetic disorders like sickle cell disease, cystic fibrosis, Huntington's disease and muscular dystrophy. And, he said, it 'could really transform health care.' The story of KJ's bespoke gene-editing treatment began on the evening of Aug. 8, when Dr. Kiran Musunuru, a gene-editing researcher at the University of Pennsylvania got an email from Dr. Rebecca Ahrens-Nicklas at the Children's Hospital of Philadelphia. A baby had been born, and genetic testing showed he had CPS1 deficiency. Could he save the baby? Dr. Musunuru had begun investigating the use of gene editing for fairly common gene mutations. Developing a gene editor to treat patients is a deliberate process that can take years. But KJ did not have years to wait — perhaps as few as six months before a mounting risk of severe brain damage or death. 'At this point, the clock starts in my mind,' Dr. Musunuru said. 'This is real life. This is not hypothetical.' KJ's disease is caused by an inability to rid the body of ammonia, a byproduct of protein metabolism. Ammonia builds up in the blood and crosses into the brain. His doctors put him on a diet that severely restricted protein — just enough for him to grow. He also had a medicine, glycerol phenylbutyrate, that helped remove the ammonia in his blood. But he still was at high risk for brain injury or death. Any illness or infection could make his ammonia levels soar and cause irreversible damage to his brain. KJ lived at the hospital under 24-hour care. Building a gene-editing system for the Muldoons' baby and testing it was not easy. 'There was a lot of shooting from the hip,' Dr. Musunuru said. He began working with Fyodor Urnov at the University of California, Berkeley, who made sure there were no unexpected and deleterious gene edits elsewhere in the DNA. Dr. Urnov is a part of an academic collaboration with Danaher Corporation, a company capable of producing the gene editor for KJ at a standard that would allow it to be used in a patient. Danaher in turn collaborated with two other companies it owned, two additional biotechnology firms and another research institute, said Sadik Kassim, its chief technology officer for genomic medicines. 'At every step of the process, we were always expecting someone to say, 'No, sorry,'' Dr. Kassim said. 'And that would be the end of the story.' But his fears were unfounded. Danaher and the other companies charged only for the raw materials to make the drug, he added. The F.D.A. also smoothed regulatory approval of the treatment, Dr. Ahrens-Nicklas said. Dozens of researchers put all else aside for months. In Berkeley, Dr. Urnov said, 'scientists burned a vat of midnight oil on this the size of San Francisco Bay.' He added that 'such speed to producing a clinic-grade CRISPR for a genetic disease has no precedent in our field. Not even close.' David Liu of Harvard, whose lab invented the gene-editing method used to fix KJ's mutation, said the speed was 'astounding.' 'These steps traditionally take the better part of a decade, if not longer,' he said. Only when the gene-editing solution was in hand and the F.D.A. approved the researchers' work did Dr. Ahrens-Nicklas approach KJ's parents. 'One of the most terrifying moments was when I walked into the room and said, 'I don't know if it will work but I promise I will do everything I can to make sure it is safe,'' she said. On the morning of Feb. 25, KJ received the first infusion, a very low dose because no one knew how the baby would respond. He was in his room, in the crib where he had lived his entire life. He was 6 months old and in the seventh percentile for his weight. Dr. Musunuru monitored the two-hour infusion, feeling, he said, 'both excited and terrified.' KJ slept through it. Within two weeks, KJ was able to eat as much protein as a healthy baby. But he still needed the medication to remove the ammonia from his blood — a sign that the gene editor had not yet corrected the DNA in every affected cell. The doctors gave him a second dose 22 days later. They were able to halve the medication dose. He got a few viral illnesses in that time, which normally would have triggered terrifying surges in his ammonia levels. But, Dr. Ahrens-Nicklas said, 'he sailed through them.' A week and a half ago, the team gave KJ a third dose. It is too soon to know if he can stop taking the medication completely, but the dosage is greatly reduced. And he is well enough for the team to start planning to discharge him home from the hospital. He is meeting developmental milestones and his weight is now in the 40th percentile for his age, but it is not yet known if he'll be spared a liver transplant. The result 'is a triumph for the American peoples' investment in biomedical research,' Dr. Urnov said. The researchers emphasized the role government funding played in the development. The work, they said, began decades ago with federal funding for basic research on bacterial immune systems. That led eventually, with more federal support, to the discovery of CRISPR. Federal investment in sequencing the human genome made it possible to identify KJ's mutation. U.S. funding supported Dr. Liu's lab and its editing discovery. A federal program to study gene editing supported Dr. Musunuru's research. Going along in parallel was federally funded work that led to an understanding of KJ's disease. 'I don't think this could have happened in any country other than the U.S.,' Dr. Urnov said. Those who worked on saving KJ were proud, Dr. Urnov said. 'We all said to each other, 'This is the most significant thing we have ever done.''
Medscape
12-05-2025
- Health
- Medscape
Are Tonsils Low-Hanging Fruit?
William G. Wilkoff, MD I was 6 when I had my tonsils and adenoids taken out. I have two distinct memories of the event. The first was the odor of ether. I had been instructed to count down to 1 from 10 but never made it past 5. The second memory was waking in the middle of my first night home from the hospital and vomiting a volume of blood so great that I was in my fourth year of medical school before I saw its equal. My near-exsanguination was managed at home with a phone call. What I don't remember is why I had my tonsils removed. I am told I was a fairly healthy kid. Most of my colds ended with a prolonged nocturnal cough, not surprising since both of my parents smoked, and we lived in a small house. I remember fondly the taste of cherry-flavored, codeine-laced cough medicine. I asked my parents many times what had prompted my tonsillectomy. They always said they couldn't remember, although I often wondered if there was some dark family secret I was never to learn. I always suspected that my maternal grandmother may have had a hand in the decision. She frequently boasted about having her tonsils removed on the kitchen table by her uncle — who is the only medical doctor in my lineage. Apparently, it was a family affair, as he operated on her two siblings on the same afternoon. It may have been that in the late 1800s, tonsillectomy was a sort of rite of passage, like today's precollege trip to the oral surgeon for wisdom teeth extraction among families in affluent suburbs. Tonsils of good size are easily viewed and can be accessed without an abdominal incision. They are the proverbial low-hanging fruit. In the early 1970s, investigations by Jack Wennberg, MD, MPH, and Alan Gittleson, MD, revealed that there were factors beyond boasting grandmothers that were influencing the frequency of tonsillectomies. By comparing the number of tonsillectomies across a broad geographic area, researchers found wide variations between communities. For example, in one Vermont town, 20% of the population had had their tonsils removed before age 15. In the next town over, that number was 60%. These studies of geographic variations eventually included other surgeries and medical diagnoses and in 1996 culminated in the publication of the first Dartmouth Atlas by Wennberg. Although the results of the initial study may have been one of the factors in the gradual decline of tonsillectomies nationwide, more than a half million procedures are still performed annually and wide variations persist. An updated version of the Dartmouth Atlas covering 2007-2010 in three New England states found a frequency of 2.7 tonsillectomies per 1000 persons in Bangor, Maine, and a fourfold difference in Littleton, Vermont, at 10.9 per 1000. One would expect, or at least hope, that several decades after the initiation of these epidemiologic revelations, some standard would have evolved and the variations in tonsillectomy rates would have narrowed. The explanation may in part reside in the fact that studies regarding the efficacy of tonsil and adenoid removal have at times yielded conflicting results. For example, in March of this year, a multicenter study of 459 children with mild sleep-disordered breathing found that compared with a control group managed with watchful waiting, children who had undergone adenotonsillectomy experienced a 32% reduction in total healthcare encounters and a nearly 50% reduction in prescriptions. On the other hand, 7 years ago, a study in Denmark looking at the records of 1.2 million children found that children who had their tonsils and adenoids removed had an increased risk of later experiencing respiratory, allergic, and infectious diseases. The authors of that study concluded that these 'risks were considerably larger than changes in risk for the disorder these surgeries aimed to treat.' One could argue we shouldn't be comparing apples (sleep disturbances) and oranges (respiratory disease, allergy, and infection). However, a study from Epic Research published in 2024 that compared 7590 patients who had their tonsils removed with the same number of patients with tonsillitis but without the surgery found that those who had undergone tonsillectomy had 'lower rates of influenza, otitis media, strep throat, and sinusitis.' It is interesting that during this study, which ran between 2018 and 2021, the investigators could 'not find a significant difference in the frequency of COVID-19 between patients who had undergone tonsillectomy and those who had not.' So where does this leave us primary care pediatricians? We are often the folks initiating or at least signing off on a parent-requested referral to the ear, nose, and throat (ENT) specialist. Although adenotonsillectomies have a low mortality risk, it is not zero and is certainly higher in patients with multiple and complex problems. We in primary care must keep abreast of the literature as best we can and make our referrals based on our own judgement while leaning heavily on the experience of the ENT, who will make the final decision. I suspect, like me, many of you may target your referrals to the surgeons who share your biases. If parental anxiety and not my professional concern is the primary driver of the referral, I may intentionally select an ENT who leans toward watchful waiting. Despite the lack of standardization, we must congratulate ourselves that we have moved on beyond an era when tonsils were removed because they were easy to get at.
