Originally created 04/23/98

Health capsules: Defibrillators now thought safer



Saving hearts

Defibrillators, machines that apply an electrical charge to the chests of people whose hearts have stopped, were at one time dangerous devices fit only for use by trained professionals. But things have changed.

Modern defibrillators equipped with embedded computer chips can diagnose a person's medical condition and be programmed only to unleash electrical charges when they are needed to restart an ailing heart. Yet only a handful of states have adopted laws that would allow lay people to use "smart" defibrillators.

In a special report issued by the American Heart Association, cardiac experts argue that it is time to begin promoting the wider use of defibrillators, which could save thousands of lives each year.

An economic argument to do so was framed by Myron Weisfeldt, past president of the association. It takes about $2 billion to equip 10 million automobiles with seatbelts, Dr. Weisfeldt said, and these belts can be expected to save about 2,000 lives annually, which works out to a cost of about $1 million per life saved.

If society spent $2 billion on defibrillators, it would buy enough to have one for every 300 people, Dr. Weisfeldt calculated, and if all the defibrillators were deployed optimally, the cost of each life saved would be in the neighborhood of $30,000.

"We usually consider health programs that cost less than $50,000 per quality-adjusted life-year to be economically attractive," said Dr. Graham Nichol, lead author of the study.

Mean doctors

Physicians like to think of themselves as caring, kind people, but a fair percentage of them must be pretty mean, according to a new study published in the Journal of the American Medical Association.

A survey taken by researchers at Chicago's Rush Medical College found that more than 90 percent of second-year medical residents reported at least one incident of mistreatment by superiors. The survey of more than 1,200 medical residents said that public humiliation or belittlement was the main indignity they endured.

But more than 10 percent of the young doctors said that on three or more occasions they were subjected to things like being "slapped, pushed, kicked or hit" and having the older docs threaten their reputations or careers.

Also, about 70 percent of the young doctors said they saw what they considered mistreatment of patients by other doctors.

Got milk?

Lethal septic shock, a severe complication of bloodstream infections, may be fought with a protein found in milk, researchers report.

Writing in the March issue of the journal Infection and Immunity, scientists from the Chicago Medical School and Abbott Laboratories report benefits provided by the protein lactoferrin. They fed the protein to some piglets, but not to others, and then induced septic shock in all the animals.

While fewer than 20 percent of the piglets getting lactoferrin died, about 75 percent of the others died.

"Despite the development of potent broad-spectrum antibiotics, septic shock remains both the most frequent cause of death of intensive-care patients and the 13th leading cause of death overall in the United States," the researchers wrote. "These results represent the first report that oral administration of lactoferrin can significantly modify septic shock."

Mental decline

A long-term study suggests that when people begin to suffer from dementia-causing afflictions such as Alzheimer's disease, there is a fairly fast and noticeable decline in mental ability rather than a gradual one.

In 1979 researchers at Washington University in St. Louis began examining healthy volunteers every year to gauge their mental abilities. More than 80 volunteers between the ages of 64 and 83 were studied, some for up to 15 years.

"People without disease can look forward to good mental function in old age," said Dr. Eugene Rubin, a psychiatrist directing the study. "Unfortunately, those with Alzheimer's disease usually face a sharp decline."

Stability was the key to distinguishing normal aging from dementia, said Dr. Rubin, whose study was published in the March issue of Archives of Neurology.

"On average, someone who takes the tests for the first time at age 80 won't do as well as a person who is 70 or 60," Dr. Rubin said. "But our most important finding was that when someone takes the tests each year, they maintain their performance over time. Those who develop Alzheimer's disease experience an abrupt decline between one test and the next."