The Weirdest Things on Pubmed

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The Weirdest Things on Pubmed’ sounds like the title of a drab ITV2 entertainment show. The kind of thing that would find a home on a Wednesday morning, sandwiched between ‘The Real Housewives of Beverly Hills’ and ‘Take Me Out’. Which is exactly why it is the perfect article for a student magazine – we are the only people lucky enough to have the time to enjoy such trash on a weekday morning (well, us, the unemployed, and pensioners). Besides, at medical school we are taught about the prevalent problems, the ones we are most likely to face in our day-to-day lives. But what about the weird problems? What are you going to do when you see something so earth- shatteringly extraordinary that not you nor anyone else has seen anything of its like before? That is the underlying aim of this article – to prepare you for the weird.

The first paper that comes up when you type the word ‘weird’ into Pubmed is: “Polyembolokoilamania: Self-insertion of a transistor radio antenna in male urethra”(1). Apparently, polyembolokoilamania is a broad term referring to putting foreign objects into a body orifice, usually children putting things in their ears. People who do this often are polyembolokoilamaniacs. Okay, I made that up, but it could be true. The paper details the abnormal case of a man with an itchy urethral infection, who inserted a transistor radio antenna as an “improvised itch stick (which) subsequently migrated proximally out of reach.” What surprises me is that it took the man a week since application to attend the hospital, finally tellingDoctors what he had done. A line from the paper reads, “A diagnosis of foreign body in the male urethra was made.” I wonder when they worked it out: when the patient told them that he had inserted a radio antenna up his urethra, or when they looked at this cryptic x-ray.

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This x-ray captured my imagination: is there an extensive account of foreign bodies trapped in human orifices? The answer is yes: a 1986 paper entitled, “Rectal foreign bodies: case reports and a comprehensive review of the world’s literature.”(2) An early line reads: “An Anorectal foreign body is no longer a medical oddity, rather it is encountered frequently.” A comforting thought for us future Doctors, I’m sure. What proceeds is a list of foreign objects, aligned with the number of reported cases. It reads like a strange edition of ‘Family Fortunes’, with big scorers being bottle or jar (31), sexual devices (23), glass or cup (12) and stick or broom handle (10). Less commonly, we have: balloon (1), balloon attached to cylinder (1), tennis ball (1), toothbrush holder (1) and toothbrush package (1). I’m not sure where the toothbrush was in all of this, but thankfully it doesn’t make the list. The paper notes the expected embarrassment of the patients involved, with their most common explanation being they fell on the foreign object, which subsequently disappeared. It explains that manual extraction is possible for superficial foreign bodies, although “when they migrate to the sigmoid colon, an ideal instrument would be able to grasp a large object without damaging the bowel wall…no such instrument exists.” There’s something for Dragon’s Den, then. The paper sly adds later, “The surgeon’s hand is the best surgical instrument.” Still want to be a GI surgeon, then?

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As I scour through Pubmed results, I start to pick up on a strange theme: a lot of psychology papers are using the word WEIRD. These papers are confusing me: “It’s not just the subjects – there are too many WEIRD researchers”(3), “Most people are not WEIRD”(4), “WEIRD people, yes, but also WEIRD experiments”(5) and “WEIRD societies may be more compatible with human nature.”(6) It seems a bit much to continually refer to people as WEIRD; especially people who have been good enough to participate in your experiments.

What did they ever do to you? However, WEIRD turns out to be a popular acronym (ah, so that’s why it was in capitals!) in psychology papers for ‘Western, Educated, Industrialised, Rich and Democratic’. Apparently, too many of their studies focus on participants from this demographic, which may skew results, becoming a severe limitation to certain studies. Clinicians using this term should take note of my confusion; a patient may be offended if you say, ‘Unfortunately you’re not eligible for this study, because you’re weird.’ This is an interesting aside, but it’s not the kind of weird that I’m looking for, so thus I shall move on.

The title of the next article merely states on Pubmed, ‘A weirder than weird story, and yet…’(7). Intrigued, I click on it and read the opening line: “At first, the idea of collecting faeces, putting it in a blender, and then transferring it into the gastrointestinal (GI) tract of another person might seem to be the creation of a third-grade boy writing a composition on the grossest thing he could think of.”

Wow. It seems I have hit the weird jackpot! But the more I read on, the more I recognise what the authors are talking about. In fact, I’m convinced that Dr Dhaliwal even touched upon this topic in a lecture during our GI block. This paper talks about the possibility of a faecal microbiota transplant for recurrent C. Difficile infections. The idea is that through replenishing intestinal microbiota from a healthy donor, more balanced bacterial growth can occur, helping to control the infection. One feels like this might be a hard sell to a patient; what do you call such a procedure? They would probably want a more simple explanation than ‘Faecal microbiota transplantation’, but then again ‘poo transplant’ sounds a tad juvenile. And how would you attract donors? I suppose it could be easy or difficult, depending on how you look at it. It’s not like they’re asking for your pancreas – I mean you have this stuff ‘on tap’ as it were, but then if someone were to ask for it outright, well, it just sounds a bit weird.

Continuing the theme of human excrement (there’s a sentence I never want to write again), a 2012 Dutch paper details how dogs might be able to sniff out diagnoses from stool samples8. Again, the bacterium in question is C. Difficile, with 2-year-old beagle Cliff trained to sit or lie down if the bacterial scent is detected. This sounds like the plot of a bad Disney film: a highly intelligent dog becomes a Doctor, getting into all sorts of hilarity and hijinks with his sceptical and patronising human colleagues. The truth is much more clinically relevant.

When presented with 100 stool samples, 50 of which being positive for C. Difficile and 50 being negative, Cliff gave a positive response to all 50 positive samples and a negative response to 47 of 50 negative samples, the remaining three being recorded as inconclusive responses. Not onlyisCliff’sdiagnosticaccuracy first-rate, he can also carry out his test in just 10 minutes, and doesn’t even need physical contact with the sample, or the patients; he seemingly sniffs out the C. Diff. in the surrounding air. But there are questions to be asked of this research: what was Cliff actually smelling in his test (was it a quantity of bacteria, bacterial products or something else?). Would the unpredictable nature of dogs make them a possible safety hazard to patients and clinicians? And what if Cliff gets too cocky, starts teaching himself and canine friends to diagnose other conditions, slowly asserting control over the world’s healthcare system, before making a grab for world domination? It’s less ‘Planet of the Apes’ and more ‘Planet of the Dog

Doctors’, and it’s a spine-chilling prospect. But on a serious note, the earlier limitations are relevantly highlighted by the paper, as well as other issues, and it indicates that a lot more research is necessary before we get anywhere near a truly viable option. Unfortunately for Cliff, thismeanshewon’tbegettinghis Professorship for some years yet, something he is said to be very bitter about.

So there you have it – four and a half extremely weird articles on Pubmed. There were many that didn’t make the cut, notably “Clinical Findings in Ten Persons Reporting Demon Possessions”9 and “Ice cream evoked headaches (ICE-H) study: randomised trial of accelerated versus cautious ice cream eating regimen.”10 I can’t help but wonder: if this is what I can find in an hour and a half on a computer, what strange destinies await us in our respective careers? It is a scary but exciting thought. There truly is a whole wide world of weird medicine out there.

References

1 Bello JO, Badmus KO, Babata AL, Bello HS. Polyembolokoilamania: Self- insertion of transistor radio antenna in male urethra. Niger Med J. 2013 May; 54(3):206-8. doi: 10.4103/0300-1652.114578.

2 Busch DB, Starling JR. Rectal foreign bodies: case reports and a comprehensive review of the world’s literature. Surgery. 1986 Sep;100(3): 512-9.

3 Meadon M, Spurrett D. It’s not just the subjects – there are too many WEIRD researchers. Behav Brain Sci. 2010 Jun; 33(2-3):104-5. doi: 10.1017/ S0140525X10000208. Epub 2010 Jun 15.

4 Henrich J, Heine SJ, Norenzayan A. Most people are not WEIRD. Nature. 2010 Jul 1;466(7302):29. doi: 10.1038/466029a.

5 Baumard N, Sperber D. Weird people, yes, but also weird experiments. Behav Brain Sci. 2010 Jun;33(2-3):84-5. doi: 10.1017/S0140525X10000038. Epub 2010 Jun 15.

6 Maryanski A. WEIRD societies may be more compatible with human nature. Behav Brain Sci. 2010 Jun;33(2-3): 103-4. doi: 10.1017/ S0140525X10000191. Epub 2010 Jun 15.

7 Mandell BF. A weirder than weird story, and yet… Cleve Clin J Med. 2013 Feb; 80(2):73. doi: 10.3949/ccjm.80b.02013.

8 Bomers MK, van Agtmael MA, Luik H, van Veen MC, Vandenbroucke-Grauls CM, Smulders YM. Using a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study. BMJ. 2012 Dec 13;345:e7396. doi: 10.1136/ bmj.e7396.

9 Ferracuti S, Sacco R, Lazzari R. Dissociative trance disorder: clinical and Rorschach findings in ten persons reporting demon possession and treated by exorcism. J Pers Assess. 1996 Jun; 66(3):525-39.

10 Kaczorowski M, Kaczorowski J; Ice cream evoked headaches. Ice cream evoked headaches (ICE-H) study: randomised trial of accelerated versus cautious ice cream eating regimen.

 

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