Wednesday, July 25, 2007

Medical Trends

So according to yesterday's queries, everyone has bipolar disorder. Or, everyone has written a memoir about having it. We've been getting a lot of them since that Newsweek article a few months ago on it.

Diagnostic trends are very interesting. They're not so much trends but further understandings of disease and our limited abilities to categorize them. The patient wants to hear something. A classic case is Crohn's Disease/Ulcerative Colitis. In the ten years since my diagnosis with the former, I've heard dozens of stories of people who've said they were misdiagnosed with one and really had the other and only just found out. There's a doctor on my team who has a theory that UC is actually one of the five subtypes of Crohn's, and you can determine which type you have based on a blood test. I had the blood test, and the numbers came back, and I asked what they meant, to which my doctor replied, "We don't know yet. We'll know in about ten years." It was basically research. This doctor probably isn't wrong, either; he's the guy who invented immuno-suppressant drugs, which were the major way of fighting the disease until Remicade came along in 1998.

Psychiatry has even greater challenges because of so many symptoms that overlap, are inconsistent, and are sometimes incredibly subjective. Two hundred years ago, everything was monomania. Then they added schizophrenia. Then manic depression. Then bipolar disorder. Then they divided bipolar disorder into two types, Type I or II, then debated whether one of the types wasn't just manic depression, because the two major symptoms (mania and depression) were overlapping. Then they started labeling people with various personality disorders, which gave them a much wider range to work with, but didn't really define anything except in certain cases. I have a friend who was diagnosed with "schizoid affective disorder. " I cannot find a single doctor who can effectively tell me what that is. Also, he has symptoms that don't fit into that subtype, and I know he's not under good care, so he may well be misdiagnosed. For a while it didn't matter, because treatment was limited, but now that we not only have SSRIs but know how to use them in combination with newer drugs, it's more and more important to put the right label on the right person.

Anyway, I don't think the little boom of bipolar-based memoirs is due to the Newsweek article entirely, but it helped. There were probably people with memoirs floating around about their illness, and they decided to mention the diagnosis in the query, figuring bipolar disorder is a hotter topic than it was a year ago (which is true). Also, because it's being more commonly diagnosed (to the point where many say it's over-diagnosed), we're just going to see more people who say they have it.

All of this doesn't work for or against the query. When it comes to memoir, it's whether the person has an intriguing story and the ability to communicate in a way that makes people want to read about it is or not is the determining factor. I just thought that was an interesting little note.

Monday, July 23, 2007

Evil Rejector!

Blogger has decided I am not a spammer and should be allowed to post again. Finally, I can promote bulk generic versions of prescription drugs and stock tips on my blog!

Tonight/tomorrow is a fast day, Tisha B'av when the Jews mourn the destruction of our two temples, 2000 years ago about 2500 years ago, respectively. They happened on the same day of the calender (the 9th of Av). It's the same day that the Jews were expelled from Spain in 1492, and the day that Auschwitz opened. In general, it's a bad day.

I've been exempt from all of the fasts in the Jewish calender for many years. On various occasions doctors have said I was well enough to fast, which generally ended in disaster. Oh, and one time, I got crazy paranoid and started calling my friends and asking if they hated me for some reason. Yeah.

I'm going to work tomorrow, which is not forbidden on Tisha B'Av, but I wouldn't if I was fasting. As I just explained above, I'm not in the right state of mind while fasting, and despite what I usually imply, I actually take people's life's work in the form of a bad manuscript very seriously. I don't do it when I'm not up to it for crazy reasons.