While this study is of general interest to the field of medicine, I was particularly intrigued because our medicine department and program has uniquely embarked on an “educational innovation,” under the aegis of the residency review committee of the Accreditation Council for Graduate Medical Education, which introduces humanities at the bedside. We have found this has a salutary effect on resident performance and perhaps on patient care outcomes. It has significantly changed my faculty, our program, and our identity—and me. It’s been great fun and extraordinarily educational. Among other things, we measure empathy (yes, there are several instruments for this) and find that our residents really do care, deeply, and that our curriculum enhances this, consistent with the message of this article. I heartily and seriously recommend some thoughtful, enlightened reflection (humanities driven or other) to help sustain the passion and excitement for medicine.
FOR CHOCOHOLICS
(AND WHY NOT RHEUMATIC DISEASE PATIENTS?)
Bloomberg News reported on March 31 that “a daily nibble of dark chocolate may slash the risk of heart attacks and strokes by more than one-third.” Intake of 6 gm of chocolate daily was associated with statistically significantly slightly lowered blood pressure (about 1 mmHg) and 39% less risk of stroke or myocardial infarction (Eur Heart J. 2010;31:1616-623). How might this be? Flavonols in cocoa are biologically active. Rheumatologists, with a rich tradition of using therapeutic agents like colchicine, fish oils, plant oils, cyclosporine, and others, shouldn’t be surprised at these potential properties of plants and foodstuffs. Flavonols lower blood pressure, decrease LDL oxidation, diminish C-reactive protein, increase endothelial-dependent dilation, reduce platelet reactivity, and modulate elaboration of cytokines and eicosanoids. Some years ago, I wondered why we hadn’t put statins in the drinking water already, because of their array of salutary effects on general health, and perhaps rheumatic diseases, too. Maybe we should be washing down our statins with some red wine (probably white also) and a healthy bite of chocolate and advising our patients to do the same. Just as we’ve seen studies of statins for various rheumatic diseases, I expect to read about the experimental effects of chocolate or our disorders. But a note of warning—the Archives of Internal Medicine (2010; 170:699-703) reported an association of chocolate consumption with depression.
ARE WE WHAT WE EAT?
A recent JAMA article (2010;303:1848-1856) critically reviewing perceptions of the prevalence of food allergies was highlighted in The New York Times. The review emphasized the paucity of high-quality studies pertaining to food allergies. The authors noted that the prevalence of food allergies was somewhere between 1–2% and 10% of the population; no single diagnostic test merited recommendation; evidence supporting efficacy of therapeutic elimination diets was lacking; value of immunotherapy was unclear; and approaches for managing high-risk infants were still unclear. Otherwise we know everything there is to know about food allergies.
