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Geography is destiny in medicine

6 Apr

Heraclitus of Ephesus (Ἡράκλειτος, Herakleitos; c. 535 BC – 475 BC), a Greek philosopher, is known for having said: character is destiny (otherwise said A man’s character is his fate.)
The two main reasons why the derived adage “geography is destiny” applies to medicine are first that exposure to diseases risk factors varies from one region to another in a same country with the same health services and health insurance coverage :

and second that the pattern of care chosen by practitioners to treat the population for a given condition also greatly varies depending of the place of abode (still at a same health services and health insurance coverage level):

“A study of the geographic distribution in elementary school children discloses no correlation between Tonsillectomy and any other factor, such as overcrowding, poverty, bad housing, or climate. In fact it defies any explanation, save that of variation of medical opinion on the indications for operation.”

Quoted from:

There is tremendous unexplained variation in rates of surgical procedures from hospital catchment area to hospital catchment area, and region to region that cannot be explained by epidemiologic factors. For example, colleagues and I discovered in 1992 (see Spine, 1992) that the 15 fold difference in surgical procedures on the spine in Washington State was inexplicable by almost all population and diagnostic factors.

Quoted from:

From the citations quoted above we could even go further in completing the adage by saying: in medicine geography is not only destiny it is also the caregiver.

Breast cancer mortality and screening: results of a randomized trial approved by the School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada;

15 Feb

In 1980 the School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada approved a randomized controlled trial: 89 835 women, aged 40 to 59, were affected at random to either an annual mammogram during five years or an annual physical examination without any mammogram during the same period of time. Now 25 years after the results are publicly available here:

And they are astonishing, so astonishing that we feel compelled to quote them:

“Conclusion Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.”

Meaning: not only searchers did not find any evidence of difference in the instantaneous risk of death from breast cancer between the two groups (hazard ratio not significantly different from one) but moreover what they found was over-diagnosis of breast cancers (ie 106 more cancers in the mammogram group even 15 years after the screening that is even when all the cancers of the non screening group should have been detected due to their natural evolution).

Those chilling facts have to be discussed, that is the least that we should do in the health services community given the budget allocated to breast cancer screening by mammograms.

Perhaps the mammographies in the eighties were not as sophisticated as those which are offered now? And in the contrary physicians in the eighties were perhaps more efficient than the 21century doctors at the physical examination of the breast?

Thanks to the incidental economist who gave me the news:

Who is the caregiver?

26 Dec
English: Healthy Life Years and Life Expectanc...

English: Healthy Life Years and Life Expectancy with Disability in the 25 EU Member States, 2006, both sexes (Photo credit: Wikipedia)


The end of life is not the same for women and men. It is common to think that women are more healthy, live longer and thereof can support their partner. But in fact, at birth, the difference for one individual between his Life Expectancy (acronym LE) and his Healthy Adjusted Life Expectancy (acronym HALE) is larger in average for women than it is for Men. So there is some chances that the care giver could not be the one we thought of at the first sight.
The link below is the address for a very sensitive article posted by France Woolley.




Thich Nhat Hanh: teach me, heal me, feel me, touch me

8 Aug


The famous refrain of the Who’s song seems to apply to the course of meditation given by Thich Nhat Hanh at the Plum village (village des pruniers) near Bordeaux, France. The Vietnamese Buddhism way of appraising the world be it matter or living being as a whole and the exercises on our body, our feelings, our mind and the world around us that Thich Nhat Hanh advises us to practice regularly  should be mandatory putted in the curriculum of every schoolchildren in my view.

Enjoy the amazing video, given to us for free by the famous Vietnamese Buddhism Master, it includes good advises for preventing numerous diseases brought by the western stressing life we live in the developed countries. All the more there is a paragraph entirely dedicated to the scientists and the state of mind they should adopt to soundly apprehend the object of their research; nature.


Instead of exporting manufactured products to Africa you should form its engineers

8 May

I recently saw two videos reproduced here and they provoked the thought stated above in the title of this post.
The first video advertised a carbon for water program consisting in sending to Africa a lot of water filters. The second was about solar-powered internet schools manufactured by Samsung and placed on the African soil.

And then I remembered this young engineer, whose name is Tsengue Tsengue, student of the Ecole Centrale de Paris, who came back in his native country, namely the Congo, to patent several of his invention and install a factory which hired numerous young unemployed.

What should be the best: bringing materials and devices already packaged to Africa or bringing well-educated African engineers to Africa? Neither of the two propositions aren’t good in my view. Instead, the best would be to form directly engineers in Africa with exchange of students between Africa and other countries. Indeed I think that it serves better the African’s interests to develop enterprises leaded by African entrepreneurs than to carry toward Africa devices and goods already manufactured abroad. That’s why the OAPI (African Intellectual Property Organization) must be strongly supported. Patented African innovations would be the only pathway to reduce the unemployment of the youth and to enhance the proud of African nations.

Here below is another video in French about Tsenge Tsenge and his enterprise called Challenge Futura, click below:
Rencontre avec l’inventeur Tsengue-Tsengue par Congo-SiteOfficiel

Inspiring stories and beautiful pictures about humankind

4 May

This slideshow requires JavaScript.

Photographers, poets and writers often focus on topics related to health or at least well-being which is a concept very near from health.
I have just discovered this wonderful Blog which tales us short stories along with heart minded photographs, all of them talking about humankind and inner feelings. An other Blog reminds me this kind of inspiration, and precisely its name his “inspiration and Chai”. Inspiration nurtures the mind and Chai warmth the body can we read under the title of this Blog as a mission statement. Surfing those kinds of Blogs makes you feel much better afterward. We could say that they play a mindfulness inducing role. Better than antidepressant isn’t it?

Above are examples of  photographs I dug up in one of those  Blogs referenced below.

More content:

1) Pictoryblog. View true daily photo stories from contributors around the world, or submit your own.

2) Inspiration and Chai
3) WrittenImpact. Let us tell your Compelling Human and Business Story.

4) Humankind, voices of hope and humanity

The runaway jury by John Grisham

22 Apr

How the tobacco companies handle the lawsuits they are charged with.

If you want to discover how the tobacco companies (and not the weapon manufacturers like in the movie) handle the lawsuits they are charged with in the USA read the tremendous awesome paperback book entitled The runaway jury written by John Grisham.
Millions of dollars are spent in the unique goal not to be convinced with the charge of manufacturing an unhealthy addictive product. And the companies managed to reach their goal. The jury selection ending with twelve jurors selected from a group of more than a hundred persons with the key advices of psychological experts working for both parties (defendant and victim) is in itself astonishing. But it’s only the beginning, after that comes the methods to influence the jurors such as buying the whole nation wide store company that posses the local store in which one of the juror is a seller. This book made me think a lot of the David against Goliath struggle undertaken by Dr Braillon in France. I have not yet see the movie but I really enjoyed reading the book.
Beside why the film producer has replace the tobacco companies by the riffle manufacturer companies? Has he received any pressure, hasn’t he?

More content:

Politique de lutte contre le tabagisme en France: De la guerre au compromis et à la collaboration.
Alain Braillon (a), Anne-Sophie Mereau (b) et Gérard Dubois (b)

Braillon A, Dubois G. TOBACCO CONTROL: UP IN SMOKE IN EUROPE? Addiction. 2012;107(5):1016-1017. Available from:

Letters to the Editor:
Searching for an Indicator of the Influence of the Tobacco Lobby on Politicians
Alain Braillon, MD, PhD
Amiens, France

The effect of bicycling on both men and women sexuality

13 Apr

If you don’t forget to wear your helmet bicycling is better for your health than doing no sport at all!

one comment made me laugh on Youtube: “Those ladies should really be wearing helmets. Safety first!”

Not too late, the parity is restored in the issued of bicycling and potential sexual impairment: women too could be concerned.

Two studies published in the same peer reviewed journal: The journal of sexual medicine [1-2] address this issue and go further by providing advices such as the use of nose less saddles or a less bended position.

More over an intervention study with cases being their own controls six month later was implemented to test the efficacy of the no nose saddle in a bicycle police officers population [3].

I object to the authors of these two studies that they have compared cyclists only to other sportsmen (runners swimmers other cyclists) thus non being able to highlight the advantages of cycling as compare as no sport at all in term of sexual well being. They should have in my opinion included a third comparison group composed by sedentary people not practicing any sport. Because exercise protect against erectile dysfunction by enhancing the quality of the cardiovascular system.
Caution: Take care of your health; do not follow the imprudent behaviour that is followed by those imprudent naked ladies in the video: wear a helmet!


1 Guess MK, Connell K, Schrader S, Reutman S, Wang A, LaCombe J, et al. ORIGINAL RESEARCH—WOMEN’S SEXUAL HEALTH: Genital Sensation and Sexual Function in Women Bicyclists and Runners: Are Your Feet Safer than Your Seat? The Journal of Sexual Medicine. 2006;3(6):1018-1027. Available from:

2 Huang V, Munarriz R, GoldsteinI.ORIGINAL RESEARCH—PATHOPHYSIOLOGY: Bicycle Riding and Erectile Dysfunction: An Increase in Interest (and Concern). The Journal of Sexual Medicine. 2005 Sep;2(5):596-604. Available from:

3 Schrader SM, Breitenstein MJ, Lowe BD. ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Cutting Off the Nose to Save the Penis. The Journal of Sexual Medicine. 2008 Aug;5(8):1932-1940. Available from:

More contents in press releases:

2012 Seoul Nuclear Security Summit

27 Mar

President Obama Speech at Hankuk University in Seoul, South Korea – 3/26/12

One of the major condition to maintain the health integrity of a population is the absence of either war or terrorism action, especially nuclear war or nuclear terrorism.

That’s why the 2012 Seoul Nuclear Security Summit is a milestone for every person who is concerned by public health. President Obama in his allocution said on that occasion (paraphrased):
“We have to begin to construct the world as it ought to be.
Securing the world’s nuclear material, to improve nuclear security is our collective goal. Our vision of a world without nuclear weapon will not be reached quickly perhaps not during my life time. We have to turn this vision into a reality. Already, Ukraine has removed all uranium from its territory and twenty nation have signed the treaty. Terrorist organisations are on the path to defeat.
We are building an international architecture which is safe keeping in mind that the smallest amount of plutonium can kill thousand of persons.
We have to fulfil the promise to secure nuclear material.
That’s how our national community should work.
A new agreement to recover material is on the way.
Taking concrete steps toward a world without nuclear weapon becomes our obligation.
The USA has a unique responsibility to act.
Indeed we have a moral obligation.
I say this as the president of the only nation that has ever used the nuclear weapon.
I say this as the commander in chief who knows that nuclear codes are never far from my side
Most of all I say this as a father who wants my two young daughters to grow up in a world where everything they know and love can’t be instantly wiped out.
We have more nuclear weapons than we need.
We can insure the security of USA and our allies and maintain a strong deterrent against any threat and still pursues further reduction in our nuclear arsenal.
There are those who say it’s impossible.
I say to them come in south Korea, a country committed to progress and to people.”
End of paraphrasing.

More content to be found here:

Physical activity: a healthy habit (among five)

11 Mar

Aerobic exercise reduces low back pain perception.


Exercising (Photo credit: NOAA's National Ocean Service)

English: Whether you are at the beach, in a pa...

Image via Wikipedia

English: Exercise work zones (Fox and Haskell ...

Image via Wikipedia

From a medical point of view there are only four healthy habits: first eating 5 or more fruits and vegetables daily, second exercising regularly, third consuming alcohol in moderation, and fourth not smoking. From my point of view we could eventually add: fifth capacity for happiness and sixth meditation but both of them have not been yet scientifically evaluated as far as I know.

Exercising physically once a day takes daily a part from your precious time but could appear to be a profitable asset.

Not only for hearth’s but also for articulation’s, including the spine, health.

Provided that the exercise do not provoke any pain it brings oxygen to your muscles, articulations and their ligaments and hamstrings and thus alleviates or at least reduces chronic pain stemming from articulation disease. More than that, aerobic exercise could even reduce the perception of pain in low back pain suffering patients.

With regard to the heart which is also a muscle the AHA advises to exercise 150 minutes a week with a moderate activity like brisk walking.

But the main barrier to healthy habit implementation seems to be the lack of time according to a study here below cited. If you say often to yourself I have not enough time to do all that stuff that eventually could make me healthier, you ought to know that approximately 80 percent of people is confronted with the same issue of lack of time.

And as stated in the first study referenced below, the more the individuals are obese, the more they would benefit from acquiring healthy habits.

Works consulted:

1) Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals

Matheson EM, KingDE, Everett CJ. Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals. The Journal of the American Board of Family Medicine. 2012 Jan;25(1):9-15. Available from:

2) Pain Relief and Aerobic Benefits of an Exercise Bike

By: J. Talbot Sellers, DO

3) Experimentally induced pain perception is acutely reduced by aerobic exercise in people with chronic low back pain.

Martin D. Hoffman, MD; Melissa A. Shepanski, MS; Sean P. MacKenzie, MD; Philip S. Clifford, PhD

J o u r n a l   o f   R e  h a b i l i t a t i o  n   R e s e a r c h   &   D  e v e l o p m e n t

Volume 42, Number 2, Pages 183–190 March/April 2005

4) Survey shows people have little time for healthy habits

March 9,2012 inHealth

Heart association finds Americans struggle to eat right, exercise and brush their teeth regularly.


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