Mid term in any school setting is an excellent time for reflection. It offers the students a chance to measure the value of their chosen course of study; to weigh the benefits of their time spent in a darkened lecture hall against the demands of a busy life. If continued attendance alone is any barometer of appreciation, then the benefits are far outweighing the costs for the more than three hundred students enrolled in Mini-Med School.
Mini-Med School is a community outreach program, offered free of charge by The University of Maryland Medical School. The workshop is designed to give attendees a layman’s education in a broad range of important medical topics. In session I, we learned about sleep disorders and Lyme disease. Sessions II and III offered four more compelling topics.
Dr. Laura H. Finkelstein, assistant professor in the department of pediatrics, delivered a timely and important talk on lead poisoning. The overall cost of lead related healthcare in the U.S. alone is a staggering $43.5 billion dollars a year. Lead is a soft, flexible metal, found in a variety of products, from car batteries and fishing tackle to stained glass, ammunition and imported pottery. Historically, lead was also used in women’s make-up; in plumbing pipes; as an additive to gasoline and as a base for ordinary house paint. It is in old pipes and in paint that lead presents the greatest dangers to people today.
Lead is sweet tasting and children who grow up in older homes are especially at risk for ingesting the dangerous metal. Studies have shown that lead can cause severe neurological problems including hearing loss, poor nerve conduction and cognitive and behavioral troubles. For every level of lead in the body greater than 10mcg/dl, a child may lose 2-3 points of I.Q. level.
To make matters worse, molecularly, lead resembles calcium and iron. The body will confuse the three and store lead as it would the other two crucial minerals. Studies show that lead stored in the bones can stay there for more than 25 years, increasing iron deficiency which can lead to lead poisoning. Malnourished children are especially susceptible to this phenomena, though interestingly, health enthusiasts who fast may be at risk as well. A body depleted of minerals through fasting will latch onto lead as a quick substitute for missing iron and calcium.
Among the many ways adults can contract the disease are by ingesting lead dust from old painted windows, from food which was grown in contaminated soil, or from exposure in jobs like construction, plumbing, auto repair, glass and rubber manufacturing and police work. Hobbyists like hunters, fishers, glazed pottery makers, painters and handymen are also at risk.
Finkelstein noted that since 1971, the Centers for Disease Control has seven times redefined what it considers the toxic level for lead. Prior to 1971, the toxic level was counted as anything over sixty micrograms/deciliter (mcg/dl). Today that number has been reduced to anything greater than only five mcg/dl.
The fight against lead poisoning has been aided by legislation like the Clean Air Act. The 1970 statute set standards to remove lead from gasoline. The act was hailed at the time, though the initial goal of phasing out lead for consumers by 1979 was not actually achieved until 1995. Thankfully, statistics show a rapid decline in the prevalence of the product after a final peak in1980. Even so, some modern race cars and commercial vehicles still run on leaded gasoline.
Lead in paint, which was once touted for enhancing the products brightness and durability, has also been reduced to an almost inconsequential level, thanks to standards set in 1978 by the U.S. Consumer Product Safety Council.
Finkelstein says the best cure for lead poisoning is prevention. “Screening is the best way to determine if you or your children are at risk.” In acute cases (over 45 mcg/dl) it is advised to remove the entire family to a lead-free environment. In cases where levels are over 70 mcg/dl, children should be admitted to a hospital for treatment.
Finkelstein said that Chelation therapy is an acceptable method of treatment in cases where the levels are over 45mcg/dl. She stressed, however, that one thing people with lead poisoning should avoid is folk remedies.
Delia Chiaramonte, assistant professor of family and community medicine at the University of Maryland School of Medicine, talked about the hot button topic of complementary medicine. Chiaramonte was quick to differentiate between the terms, “complementary medicine” and the more popular, “alternative medicine.” She noted that alternative medicine carries the connotation of “instead of medicine” where as complementary medicine incorporates a more integrated approach.
Are Americans serious about complementary approaches to medicine (CAM’s)? It appears they are. In 2007 Americans spent an estimated $33.9 billion dollars on natural products, mind-body therapies, manipulative body-based treatments and other types of CAM practices; most of which are not covered by insurance plans.
Natural products like ginger have been used for centuries in folk medicine. Today, it is used for the nausea associated with motion sickness, Chemotherapy and pregnancy. Fish Oil supplements, which contain Omega-3 fatty acids are also widely suggested as a possible aid to those with heart disease, rheumatoid arthritis or depression.
Another product which has gained widespread acceptance in the world of complementary medicine is probiotics. Dr. Chiaramonte explained the benefits of having “good bacteria” in the intestines. These benefits include a reduction in the severity of colds and flu and as an aid to those who suffer from irritable bowel syndrome and Crohn’s disease.
Chiaramonte pointed out that some forms of CAM, particularly body manipulation, do not have a lot of scientific validation, but are seen as “no risk” options in that they do seem to work for some people. Chiaramonte did, however stress that there are dangers to CAM, especially in the are of drug interactions. St. Johns Wort was given special attention, in that it interacts with so many drugs. Chiaramonte urged the students to keep a list of all the medications they are taking, including supplements, and ask your doctor or pharmacist about possible adverse interactions.
Adding to Dr. Chiaramonte’s talk about complementary medicine was a succinct presentation on taking medications properly and drug interactions by Cherokee Layson-Wolf, associate professor in the department of pharmacy practice and science at the University of Maryland, School of Pharmacy. Layson-Wolf began by asking how many students could name the drugs they were on. Many could not. She then asked if we always remembered to take our meds at the properly prescribed intervals. Again, most did not. Layson-Wolf then revealed that in professional circles, people who adhere 100% to their appointed medicine routines are actually considered deviant; that is, almost nobody takes their medicine as prescribed. The reasons for this include:
- Ignorance of the medication’s purpose
- Fear of medicine
- Questions about interactions
- Concern about side effects
- Inability to cover the cost
Layson-Wolf urged students to carry a list of their medications with them at all times and to talk with their doctors and pharmacists about any concerns, noting that failure to adhere to prescription guidelines are both costly and deadly. She also suggested practical tools, such as the daily pill box and easy open bottles as means to keep patients on track. For those with special needs or memory problems, such as Alzheimer’s patients, prescription bottle glow caps, such as the ones sold by Vitality may be beneficial.
The one down note about the first three sessions of Mini-Med School was the talk about Lupus presented by Dr. Violeta Rus. Dr. Rus is an associate professor in the department of medicine at the University of Maryland. Lupus is one of the most common autoimmune diseases. It affects women almost nine times more than men, with African-American and Hispanic women having a 3-5 fold greater incidence compared to whites. Lupus also appears in the children of mothers with the disease. There are genetic and environmental factors to the disease and those who contract it are at greater risk for heart attack and stroke.
Unfortunately, Dr. Rus’ talk seemed to meander. Her power points were disorganized, overly technical and difficult to follow. Worse, she inserted charts and slides which were not included in the workbook, leaving many of the students frustrated and lost.
In explaining the confusing character of Dr Rus’ presentation, Heather Graham Phelps, Director, Communications and Marketing for Office of Communications and Public Affairs, told the Baltimore Post-Examiner the professors are requested to submit their material several months in advance of printing of the workbooks. “Occasionally,” Phelps explains, “the doctor will make changes in their power point notes to reflect the latest research or findings in a given field. Unfortunately, if they’ve made last minute changes, we cannot update the workbooks. We just hope the students, especially the older ones, are able to follow along.”
Phelps’ explanation made perfect sense, still upon exiting the Lupus lecture, I remarked to a friend that if I wanted to get a grasp on the subject now, I felt I would have to research it on my own. My friend replied, “That kills the whole idea behind this class.”
The workbook does include an evaluation sheet for every session. Students are encouraged to rate the lectures and offer suggestions in areas of concern.
Mini-Med School is presented in cooperation with the National Institutes of Health and the Association of American Medical Colleges. It is free and open to the public. Though registration is now closed for this year’s classes, information about the program may be found here.
Other useful sources:
Anthony C. Hayes is an actor, author, raconteur, rapscallion and bon vivant. A one-time newsboy for the Evening Sun and professional presence at the Washington Herald, Tony’s poetry, photography, humor, and prose have also been featured in Smile, Hon, You’re in Baltimore!, Destination Maryland, Magic Octopus Magazine, Los Angeles Post-Examiner, Voice of Baltimore, SmartCEO, Alvarez Fiction, and Tales of Blood and Roses. If you notice that his work has been purloined, please let him know. As the Good Book says, “Thou shalt not steal.”