Sound Medicine -- March 1, 2003

Hosts Barbara Lewis and Dr. Mike Bogdewic talk to physicians & researchers about:

Ancient DNA

Movement disorders

Ancient DNA

Using techniques similar to forensic scientists, researchers studying ancient DNA discover fascinating facts about human and animal populations that lived thousands of years ago. Indiana University's Department of Anthropology conducts such research in one of the few ancient DNA labs in the country. Researcher Frederika Kaestle, PhD, assistant professor of anthropology, explains the work and what we can learn from it.

Dr. Kaestle describes looking for genetic variations in ancient humans to determine familial relationships and relationships among populations. Genetic markers can also reveal how populations moved -- for example out of the old world into the new. For humans, the genetic material (typically bones and teeth) ranges from 10,000 to 45,000 years old. For animals it can be even older. She says work on the human genome helps anthropologists understand disease outbreaks, how they traveled, and which populations were affected.

Dr. Kaestle also talks about her own work studying links between western native Americans, paleoindians, and ancient Siberians, perhaps the oldest Americans. We still need DNA data from many modern populations, Kaestle says, to find definitive answers, but she offers interesting speculations about these first, highly mobile, north Americans.

Resources:

Read more about Dr. Kaestle's research on ancient native American population movement on her IU Bloomington home page.

A 1996 Archaeology Institute of America article, "The Great DNA Hunt" provides good background on the topic of ancient DNA.

Lay genealogist Kevin Duerinck offers good synopses of a handful of human migration studies based on genetic research, including the "daughters of Eve."

Read excerpts from the 2002 book, The Molecule Hunt: Archaeology and the Search for Ancient DNA, by Martin Jones, at Amazon.com.

Movement disorders

For millions of people with neurological movement disorders, a simple wave of the hand is nearly impossible. Movement disorders are classified by excessive movement or by lack of movement. But speech, learning and behavior may be affected in these patients as well. The most common conditions are Parkinsons and Huntingtons disease and Tourette's Syndrome. This week we meet Dr. Bhuwan Garg, professor of neurology and a pediatric specialist, and Dr. Joanne Wojcieszek, clinical associate professor of neurology, both experts on the topic and faculty members at the Indiana University School of Medicine.

We learn all about tics, tremors and physical mannerisms -- who suffers from them, which ones are serious, and how they're classified. Causes are probably genetic but largely unknown; alcohol, drugs, and brain surgery can relieve or stop many symptoms. Athletes and musicians who compulsively sniff and grunt during performances are examples of innocuous mannerisms. Strong medicines can reduce more troublesome tics but come with long-term complications. For serious disorders such as Parkinsons disease, treatments include "deep brain stimulation" in which a part of the brain is destroyed or an electrode is placed in the brain to block excessive activity.

Dr. Garg and Wojcieszek also talk about complexities that arise when movement disorders manifest alongside emotional and mental disturbances. For example, many Tourette's children also suffer from attention deficit/hyperactivity disorder (ADHD). Dr. Wojcieszek discusses the basal ganglia areas of the brain, revealing why certain movement disorders are linked with behavioral and cognitive problems, and why neurologists and psychiatrists often work together to help patients. For parents worried about tics in their children, Dr. Garg advises watching for new behaviors, learning problems, or personality changes. Finally, Dr. Wojcieszek discusses potential advances in genetic research that are helping patients with Huntingtons and Parkinsons disease and Tourette's Syndrome.

Resources:

Drs. Garg and Wojcieszek discuss this topic further during their Mini Medical School lecture, Tuesday evening, March 4.

The nonprofit organization We Move provides excellent and copious material on this topic, including teaching slides and continuing medical education opportunities for medical professionals.

The MEDLINEplus directory supplies authoritative information, including definitions and links to clinical trials and support groups.

The Neurology Channel Web site classifies movement disorders by symptoms.

Also find information from the NIH site, The National Institute of Neurological Disorders and Stroke.

Is there a medical topic you'd like us to cover? Reach us by email: soundmed@iu.edu
or by phone:
(317) 274-4848.

A recent study undertaken in England found that, generally speaking, electric toothbrushes are really no better than manual brushes for dental care. This study did discover, however, that a specific type of electric toothbrush marginally outperformed the manual brush. Which of the following was it?

A. One having side-to-side movement features
B. One with rotation-oscillation movements
C. One with ultrasonic vibrations

Find out!

From sword fighting prowess to a mother's age when she gives birth, numerous theories exist to explain the cause of left handedness. Is it genetics, or is an environmental cause at work?

Find out!

The death of transplant patient Jesica Santillan at Duke University Medical Center last week provokes yet another discussion on medical errors. In this week's issue of the Journal of the American Medical Association, researchers report on a study of patient and physician attitudes regarding the disclosure of medical errors.

The study concentrates on 13 focus groups in which patients and physicians discussed hypothetical medical errors. The focus groups, conducted between April and June 2002, consisted of patients, physicians, and mixed patient-and-physician groups.

The findings? Patients consistently asked for more information, an apology, and emotional support from physicians. In contrast, the physicians felt the need to "choose their words carefully" to avoid legal repercussions. But they too desired support to manage emotional stress.

In conclusion, the authors wrote, "Our study ... suggests that the current response to medical errors may meet neither patients' desire for information about errors nor the needs of patients and physicians for emotional support following an error." In addition, the study advises that "physicians should strive to meet patients' desire for an apology and for information on the nature, cause, and prevention of errors. Institutions should also address the emotional needs of practitioners who are involved in medical errors."

Read an abstract of this Feb. 2003 JAMA article.