NEJM roundup

I’m pressed for time but wanted to draw your attention to a very interesting number of the New England Journal of Medicine, the top medical journal in the country. There are three fascinating features.

First, it turns out you can get, I kid you not, anthrax, from using animal-hide drums made in the developing world. Overpowered by funk, indeed. (old spores are liberated by the banging on the drum and then inhaled or swallowed.)

Second, a flawed but intriguing study suggests that Tai Chi may be beneficial when compared to listening to lectures and doing a few minutes of stretching in patients with fibromyalgia. While the study does not answer the question of whether it is the sense of empowerment, belief, and independence that comes from doing Tai Chi (or any similar practice) or something about channeling the qi itself (I rather suspect the former), it does suggest that lecturing to someone about fibromyalgia will not fix them. This also is an important step forward in demedicalizing certain conditions in which medicalization has often led to narcotic dependence and complications from injection therapy (I once met a lady who literally almost died from “trigger-point” injections). I am eager to see further studies that help to define what other disciplines or modes of empowerment will be useful in this disease and frankly will be delighted if enrollments in Tai Chi studios increase.

Third, a provocative study from Massachusetts General Hospital suggests that incorporating “palliative care” early in the course of metastatic lung cancer actually improves survival by 2 months, a result that will get a new chemotherapy approved by the FDA as beneficial. This is stunning, and we should be careful not to make too many conclusions from a single (albeit well-designed) study. Before we assume this is true, we should wait for more studies of larger groups of people. The authors suggest that the survival advantage relates to less depression among patients with cancer and point to well-known but probably misleading association between depression and early death in cancer. The other striking possibility, and one the authors do not address adequately with their data, is that aggressive care at the end of life may actually shorten it (there are other possible explanations as well). Often patients are presented with a dire choice–try more experimental chemotherapy (and the aggressive care that surrounds it), or you will be giving up and you will die. This study may suggest (and we need to remember to be tentative here) that choosing “aggressive” care may actually be shortening lifespan in some circumstances. A sobering thought indeed.


  1. it does suggest that lecturing to someone about fibromyalgia will not fix them.

    *Filed under “Also applies to parenting”

  2. file under Random Question-

    My wife will not let my kids do martial arts because she is a singer and yelling in martial arts causes vocal nodes. (This is an undebatable fact, btw). Does Tai Chi involve yelling?

  3. Well, that puts an end to my promising drumming career. Thanks a bunch.

  4. there are huge debates about vocal fold polyps in terms of what causes them (ie it is quite debatable), though she’s right that if they appear they are a big problem for a singer. maybe loud whispers?

    (all I know about Tai Chi is that it is meant to channel qi and that it involves complex poses; no clue whether they yell)

    And Ardis–just get the animal skin drum from a reliable ranch in the US.

  5. I’m about 95% sure that Tai Chi involves no yelling. But I don’t know that its really considered a martial art either (I think its similar to Capoeira in that it is more or less a dance that is derived from fighting styles)

  6. Kevin Barney says:

    I’m pretty sure there’s no yelling in Tai Chi.

    I remember one of those “Li’l Penny” commercials (with the puppet voiced by Chris Rock who was supposed to be a little version of Penny Hardaway) when he said he was so worked up he had to go do some Tai Chi just to calm down. Funny stuff.

  7. When I saw the title, I of course thought of what it was, because I am one of the biomedical research geeks who thinks that MPH stands for a public health degree, not mileage.

    But I assumed that in this context, the initials must stand for something else related to Mormonism, with the last M standing for Mormons. Non-endowed Junior Mormons? New Exciting Journal of Mormonism?

  8. Rigel Hawthorne says:

    Reminds me of the case of grandma getting plague from the chair of honor. An upholstered chair was pulled out of a shed for grandma to sit in during a country outdoor family gathering. Apparently rats had been living in the upholstery and the arthropod vector left crawling in the upholstery transmitted it to her.

  9. Rigel Hawthorne says:

    no, this was not my grandma…

  10. That reminds me of my freshman roommate, who contracted plague from hanging around the palm trees. We non SoCal natives were unaware rats live in palm trees (to this day I have no idea where–do they burrow?) and she picked up a flea and was infected.

    She moved back east shortly after, as I recall.

  11. Re: 2

    Matt, you can rest easy, as tai chi does not involve yelling. It is meditative and flowing in its practice, and is performed in silence, or with relaxing music in the background.

    I would be curious to know why you think it is undebatable that martial arts cause vocal nodes. Do you have any references to support your claim?

  12. Tai chi in fact does involve yelling: Me yelling at the little Chinese ladies striking poses in the park, for my amusement.

  13. :D

  14. It’s not a question of whether it is scientifically debatable, but it is not debatable with my wife.

  15. I just typoed my name. It must be early.

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