Topic: Medicine/Society and Medicine

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Grapefruit–drug interactions

Medicine Food and drink Medicine/Toxicology Pharmacology Medicine/Society and Medicine

Some fruit juices and fruits can interact with numerous drugs, in many cases causing adverse effects. The effect was first discovered accidentally, when a test of drug interactions with alcohol used grapefruit juice to hide the taste of the ethanol.

The effect is most studied with grapefruit and grapefruit juice, but similar effects have been observed with certain other citrus fruits. One medical review advises patients to avoid all citrus juices until further research clarifies the risks. Effects have been observed with apple juice, but their clinical significance is not yet known.

One whole grapefruit, or a small glass (200 mL (6.8 US fl oz)) of grapefruit juice, can cause drug overdose toxicity. Fruit consumed three days before the medicine can still have an effect. The relative risks of different types of citrus fruit have not been systematically studied. Affected drugs typically have an auxiliary label saying “Do not take with grapefruit” on the container, and the interaction is elaborated upon in the package insert. People are also advised to ask their physician or pharmacist about drug interactions.

The effects are caused by furanocoumarins (and, to a lesser extent, flavonoids). These chemicals inhibit key drug metabolizing enzymes, such as cytochrome P450 3A4 (CYP3A4). CYP3A4 is a metabolizing enzyme for almost 50% of drugs, and is found in the liver and small intestinal epithelial cells. As a result, many drugs are affected. Inhibition of enzymes can have two different effects, depending on whether the drug is either

  1. metabolized by the enzyme to an inactive metabolite, or
  2. activated by the enzyme to an active metabolite.

In the first instance, inhibition of drug-metabolizing enzymes results in elevated concentrations of an active drug in the body, which may cause adverse effects. Conversely, if the medication is a prodrug, it needs to be metabolised to be converted to the active drug. Compromising its metabolism lowers concentrations of the active drug, reducing its therapeutic effect, and risking therapeutic failure.

Low drug concentrations can also be caused when the fruit suppresses drug absorption from the intestine.

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Karōshi, death by overwork

Medicine Death Health and fitness Japan Medicine/Society and Medicine Japan/Culture Japan/Science and technology

Karoshi (過労死, Karōshi), which can be translated literally as "overwork death" in Japanese, is occupational sudden mortality. The major medical causes of karoshi deaths are heart attack and stroke due to stress and a starvation diet. This phenomenon is also widespread in other parts of Asia.

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Lucky iron fish

Medicine Medicine/Society and Medicine Cambodia Medicine/Reproductive medicine

Lucky Iron Fish are fish-shaped cast iron ingots used to provide dietary supplementation of iron to individuals affected by iron-deficiency anaemia. The ingots are placed in a pot of boiling water to leach elemental iron into the water and food. They were developed in 2008 by Canadian health workers in Cambodia, and in 2012 a company, The Lucky Iron Fish Project, was formed to develop the iron fish on a larger scale, promote them among rural areas, and distribute them to non-governmental organization partners. Notably, recent research found that the iron ingot had no effect on anemia. It therefore recommended against its use in Cambodia and other countries with low levels of iron deficiency.

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Min Chiu Li

Biography Medicine Biography/science and academia Medicine/Society and Medicine

Min Chiu Li (Chinese: 李敏求; pinyin: Lǐ Mǐnqiú; 1919–1980) was a Chinese-American oncologist and cancer researcher. Li was the first scientist to use chemotherapy to cure widely metastatic, malignant cancer.

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Roseto effect: close-knit communities experience a reduced rate of heart disease

Medicine Sociology Physiology Medicine/Cardiology Medicine/Society and Medicine

The Roseto effect is the phenomenon by which a close-knit community experiences a reduced rate of heart disease. The effect is named for Roseto, Pennsylvania. The Roseto effect was first noticed in 1961 when the local Roseto doctor encountered Dr. Stewart Wolf, then head of Medicine of the University of Oklahoma, and they discussed, over a couple of beers, the unusually low rate of myocardial infarction in the Italian American community of Roseto compared with other locations. Many studies followed, including a 50-year study comparing Roseto to nearby Bangor. As the original authors had predicted, as the Roseto cohort shed their Italian social structure and became more Americanized in the years following the initial study, heart disease rates increased, becoming similar to those of neighboring towns.

From 1954 to 1961, Roseto had nearly no heart attacks for the otherwise high-risk group of men 55 to 64, and men over 65 had a death rate of 1% while the national average was 2%. Widowers outnumbered widows, as well.

These statistics were at odds with a number of other factors observed in the community. They smoked unfiltered stogies, drank wine "with seeming abandon" in lieu of milk and soft drinks, skipped the Mediterranean diet in favor of meatballs and sausages fried in lard with hard and soft cheeses. The men worked in the slate quarries where they contracted illnesses from gases and dust. Roseto also had no crime, and very few applications for public assistance.

Wolf attributed Rosetans' lower heart disease rate to lower stress. "'The community,' Wolf says, 'was very cohesive. There was no keeping up with the Joneses. Houses were very close together, and everyone lived more or less alike.'" Elders were revered and incorporated into community life. Housewives were respected, and fathers ran the families.

Unethical human experimentation in the United States

Human rights Military history Military history/North American military history Military history/United States military history Military history/Military science, technology, and theory Military history/Weaponry Medicine Biology Military history/World War II Military history/Cold War United States History Medicine/Society and Medicine

Unethical human experimentation in the United States describes numerous experiments performed on human test subjects in the United States that have been considered unethical, and were often performed illegally, without the knowledge, consent, or informed consent of the test subjects. Such tests have occurred throughout American history, but particularly in the 20th century. The experiments include: the exposure of humans to many chemical and biological weapons (including infection with deadly or debilitating diseases), human radiation experiments, injection of toxic and radioactive chemicals, surgical experiments, interrogation and torture experiments, tests involving mind-altering substances, and a wide variety of others. Many of these tests were performed on children, the sick, and mentally disabled individuals, often under the guise of "medical treatment". In many of the studies, a large portion of the subjects were poor, racial minorities, or prisoners.

Funding for many of the experiments was provided by the United States government, especially the United States military, the Central Intelligence Agency, or private corporations involved with military activities. The human research programs were usually highly secretive, and in many cases information about them was not released until many years after the studies had been performed.

The ethical, professional, and legal implications of this in the United States medical and scientific community were quite significant, and led to many institutions and policies that attempted to ensure that future human subject research in the United States would be ethical and legal. Public outrage in the late 20th century over the discovery of government experiments on human subjects led to numerous congressional investigations and hearings, including the Church Committee and Rockefeller Commission, both of 1975, and the 1994 Advisory Committee on Human Radiation Experiments, among others.

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Crimson Contagion

United States/U.S. Government United States Medicine Medicine/Society and Medicine

Crimson Contagion was a simulation administered by the U.S. Department of Health and Human Services from January to August 2019 that tested the capacity of the U.S. federal government and twelve U.S. states to respond to a severe influenza pandemic originating in China. The exercise involves a scenario in which tourists returning from China spread a respiratory virus in the United States, beginning in Chicago. In less than two months the virus had infected 110 million Americans, killing more than half a million. The report issued at the conclusion of the exercise outlines the government's limited capacity to respond to a pandemic, with federal agencies lacking the funds, coordination, and resources to facilitate an effective response to the virus.

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Henrietta Lacks

Biography Medicine Women's History Medicine/Society and Medicine

Henrietta Lacks (born Loretta Pleasant; August 1, 1920 – October 4, 1951) was an African-American woman whose cancer cells are the source of the HeLa cell line, the first immortalized human cell line and one of the most important cell lines in medical research. An immortalized cell line reproduces indefinitely under specific conditions, and the HeLa cell line continues to be a source of invaluable medical data to the present day.

Lacks was the unwitting source of these cells from a tumor biopsied during treatment for cervical cancer at Johns Hopkins Hospital in Baltimore, Maryland, U.S., in 1951. These cells were then cultured by George Otto Gey who created the cell line known as HeLa, which is still used for medical research. As was then the practice, no consent was obtained to culture her cells, nor were she or her family compensated for their extraction or use.

Lacks grew up in rural Virginia. After giving birth to two of their children, she married her cousin David "Day" Lacks. In 1941 the young family moved to Turner Station, near Dundalk, Maryland, in Baltimore County, so Day could work in Bethlehem Steel at Sparrows Point. After Lacks had given birth to their fifth child, Joseph, she was diagnosed with cancer. Tissue samples from her tumors were taken without consent during treatment and these samples were then subsequently cultured into the HeLa cell line.

Even though some information about the origins of HeLa's immortalized cell lines was known to researchers after 1970, the Lacks family was not made aware of the line's existence until 1975. With knowledge of the cell line's genetic provenance becoming public, its use for medical research and for commercial purposes continues to raise concerns about privacy and patients' rights.

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Daughter from California Syndrome

Medicine Death Medicine/Society and Medicine

"Daughter from California" syndrome is a phrase used in the medical profession to describe a situation in which a long-lost relative arrives at the hospital at which a dying elderly relative is being treated, and insists that the medical team pursue aggressive measures to prolong the patient's life, or otherwise challenges the care the patient is being given. In his 2015 book The Conversation: A Revolutionary Plan for End-of-Life Care, American doctor Angelo Volandes ascribes this to "guilt and denial," "not necessarily what is best for the patient."

The "daughter from California" is often described as angry, articulate and informed.

Medical professionals say that because the "daughter from California" has been absent from the life and care of the elderly patient, they are frequently surprised by the scale of the patient's deterioration, and may have unrealistic expectations about what is medically feasible. They may feel guilty about having been absent, and may therefore feel motivated to reassert their role as an involved caregiver.

The phrase was first documented by a collective of gerontologists in a 1991 case report published in the Journal of the American Geriatrics Society, titled "Decision Making in the Incompetent Elderly: 'The Daughter from California Syndrome'". In the paper, Molloy and colleagues presented strategies intended to help medical staff deal with the difficult family members of mentally incompetent patients.

In California, the "daughter from California" is known as the "daughter from New York".

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Mary Mallon

Biography Medicine Women's History New York (state) Medicine/Society and Medicine New York (state)/Long Island Northern Ireland

Mary Mallon (September 23, 1869 – November 11, 1938), also known as Typhoid Mary, was an Irish-born cook believed to have infected 53 people with typhoid fever, three of whom died, and the first person in the United States identified as an asymptomatic carrier of the disease, Salmonella typhi. Because she persisted in working as a cook, by which she exposed others to the disease, she was twice forcibly quarantined by authorities, eventually for the final two decades of her life. Mallon died after a total of nearly 30 years in isolation.

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