Errata Sheet for the Book
Why I Wrote the Book
While working on a biomedicine-biomedical engineering text book, I learned an amazing thing. I am not perfect. I make mistakes. And my advice to anyone who, like me, is not perfect; "If you can't stand making mistakes, don't ever try to write a book." However, there are tools that help us to point out and overcome our errors and one of those tools is an errata sheet. Before going into more biomedical detail on this page, the following information discusses and corrects a number of errors that appear in my book.
If you don't have the book, just scroll down to the material below the errata sheet where I discuss a number of issues associated with medicine and biomedicine. Oh! I should explain the difference between medicine and biomedicine. For me, the word "medicine" refers to the art and practice of standard allopathic medicine - - - the medical tradition, practice and procedures you experience in your doctor's office, clinic or hospital. Biomedicine is more associated with the scientific element of medicine. Even though certain aspects of biomedicine have been well known in the scientific community for 20 to 30 years; a significant amount of it is still not known, understood or incorporated into practice by medical doctors. More information on this topic appears below the errata sheet.
Errata Sheet for: George D. O'Clock, Electrotherapeutic Devices: Principles, Design and Applications, Artech House, Boston, MA (2007).
page 6 At the bottom of paragraph 3, the expression for current density (J) is given as current divided by area (A). The divide sign is not very clear, and this occurs in a number of similar mathematical expressions in the book where the variables and the divide sign are all "squashed" together.
page 17 Problem 5. (the answer is on page 206) This problem is soooo interesting. Some sources will state that the average power for each cell in the human body is approximately 1 pW. If one includes all of the cells in the body (tissue, blood cells, bacteria, etc.), the total number of cells in the human body ranges from 75 Trillion to 100 Trillion cells. So the basal (or rest) body power would be somewhere between 75 W and 100 W for the human body. That is close. Estimates often given are 100 W for basal metabolic requirements and up to 1,600 W for short periods of exercise time. Apparently, we are at the 90 W level even when we are sleeping. But a 1 pW power requirement per cell does not fit in very well with with our daily glucose/fat consumption, adenosine triphosphate (ATP) production-consumption requirements in tissue, and the hydrogen ion flow required to maintain our rest metabolism. Freitas, in his book "Nanomedicine" states that the power requirement per cell is approximately 30 pW. If one multiplies that number by approximately 5 Trilliion tissue cells in the human body, a body power of 150 W results. However, I do not believe that all of our cells are engaged in the same amount of production-consumption of ATP and energy expenditure at the same time. I assume that, at any one time, approximately 4.5% of our cells require the major part of our energy stores. And over a period of minutes or hours, the group of cells requiring the major part of the energy stores will change. So my calculations estimate that each one of those cells within the 4.5% that require most of the energy available, have a power of 560 pW.
page 27 On the third line, the Faraday constant should be 96,487 C / mole. "C" represents Coulombs.
page 28 In the middle of the page near the end of the paragraph, the "voltages of 23 to 47 µV" should be corrected to read "voltages of 23 to 47 mV."
page 77 Reference 1 is: Journal of Cerebral Blood Flow & Metabolism. Reference 2 is: In Vitro Cellular & Developmental Biology - Animal.
page 108 In Figure 5.1 (a) and (b), the numbers 284 and 426 on the horizontal axis should be 213 and 284.
page 164-165 Prior to publication, I went through a lot of agony over these two pages. At the top of page 165, beginning on the fifth line, the sentence should be changed to "- - - the endogenous current densities are in the range of 0.05 mA cm2 to 1 mA / cm2." The next sentence starting with "In this case - - -" should be eliminated. The calculations on these two pages used a little more rigor along with the model provided by Thomasset (Figure 3.3). Using typical cell impedances and impedances of the interstitial space around the cells, some significant discrepancies occur for calculated current densities and current levels compared with those associated with the more simple examples given in problems 2, 5 (b) and 6 in Chapter 1. When the results from all these models (simple and complex) are compared, differences in current densities and currents of a factor of 20 can occur between the simple and more complex expressions. This often happens in physics and biology as more analytical rigor is employed, more realistic assumptions and values are used and more detail is applied to the models. Let's just say that the calculations given are useful for estimates, but pages 164 and 165 are still a "work in progress."
page 203 For iatrogenic disease comparisons, the approximately 20 million hospital admissions per year figure does not account for an additional 16 to 17 million admissions associated with OB/GYN and ER. Total hospital admissions were closer to 37 million per year in the 2004-2005 time frame.
page 206 In line 11, "t he" should be written "the."
page 207 Looking at what happened on this page, I must remind myself; "Never use a mathematical expression that comes back from the publisher. Use the mathematical expressions as they appear in the original manuscript." In problem 8, the exponent (fourth power) for the Stefan-Boltzmann relationship is incorrect. The temperature term in the Stefan-Boltzmann relationship (TTUMOR - TSINK)4 should be corrected to read ((TTUMOR)4 - (TSINK)4).
The resulting tumor temperature is still very hot (436 degrees Kelvin or 320 degrees Farenheit), but not as hot as stated in the book. Fortunately, in spite of the error, the conclusions of the problem are not changed.
page 208 The 0.17 degree Celsius temperature is high by a factor of pi (3.14). This makes the calculated temperature difference even smaller and the conclusions of the problem are not changed.
page 209 The number 2.368 appears twice, and the decimal point is somewhat obscurred.
As additional errors and typos are discovered, they will be included in the above errata sheet.
Now, lets look at some of the reasons why I wrote the book.
In 1973, when doctors went on strike in Israel, a crisis occurred. The Jerusalem Burial Society reported that the number of funerals dropped by almost 50%. The mortuary business was bad, and getting worse. Funeral directors were facing a serious catastrophe with the decline in their revenues. They wondered, "Where did all the dead people go?" (R.S. Mendelsohn, MD, Confessions of a Medical Heretic, Warner Books, 1980). In 1976, when medical doctors went on strike in Los Angeles, the death rate dropped 20%. In the same year, when medical doctors went on strike for 72 days in Bogota, Columbia, the death rate dropped by 50%. After the strikes ended, the death rates rapidly increased back to previous levels.
These figures represent part of the Iatrogenic disease problem. Iatronic disease is defined as a health problem or complication that is the result of an examination, diagnostic procedure or treatment administered by a physician, surgeon or medical facility. Iatronic disease can be the result of a medical mistake. And it can be the result of a medical procedure that is considered proper according to medical dogma, but still injures or kills the patient.
Not much has changed since Molière's time (1622-1672). His famous quote, "Nearly all men die of their medicines, not of their diseases" is as relevant today as it was in the 17th century.
The following is based on data from the New England Journal of Medicine (Vol. 315, pp 1259-1266, 1986, Vol. 324 pp. 370-376, 1991 and Vol. 348, pp. 2570-2572, 2003), American Journal of Public Health (Vol. 10, pp. 1253-1256, 1990), the Journal of Internal Medicine (Vol. 246, pp. 379-387, 1999), the Journal of the American Medical Association (Vol. 279, pp. 1200-1205, 1998 and Vol. 284, pp. 483-485, 2000) and several U.S. Congressional House Oversight Subcommittee reports on unnecessary surgery. The number of iatrogenic deaths, or deaths, by medicine (includes adverse drug reactions, medical errors in hospitals, malnutrition, outpatient errors, surgery ralated, unnecessary procedures, nosocomial infection, pressure ulcers) is in excess of 780,000 patients per year with a direct annual cost of at least $282 B. This loss in American lives represents approximately sixteen "full duration" Vietnam wars per year, a little more than five September 11th incidents occurring every week or approximately 50 jumbo 747 jets going down every week with all passengers lost.
These figures represent approximately 38 iatrogenic deaths per year per hospital and over 9 iatrogenic deaths per year per clinic.
In her July 26, 2000 paper in the Journal of the American Medical Association, Barbara Starfield, MD reported that iatrogenic disease contributed to 250,000 patient deaths per year in the U.S. But it gets worse. She also reported that only 20% of the incidents are reported. Therefore, as disturbing as Dr. Starfield's iatrogenic death figures are, they are significantly understated.
Excluding OB/GYN and ER admissions, iatrogenic deaths represent 3.9% of the remaining 20 M annual hospital admissions. If OB/GYN and ER admissions are included, iatrogenic deaths represent 2.1% of the total 37 M hospital admissions per year. In the U.S., we spend approximately $1.6 T annually for these kinds of results. And, we can add another $262 B to the $1.6 T for costs related to iatrogenic events, or death by medicine. Medical mistakes alone appear to result in patient deaths and costs that consume approximately 2.5% of the Gross National Product (~$11 T annually). The entire $1.882 T of health care and patient iatrogenic death costs represents over 17% of the entire U.S. Gross National Product.
As terrible as the iatrogenic death and disease problems are, we have to be careful with our finger pointing. The primary cause of iatrogenic disease and death is not due to incompetent medical doctors. Iatrogenic disease and death problems are due to poor health care system design, outdated medical dogma, and dangerous diagnostic and therapeutic methodology.
With respect to poor health care system design, one example of this problem was discussed in the January, 2009 on-line segment of the New England Journal of Medicine. The Harvard School of Public Health announced that eight hospitals reported a reduction in deaths from surgery by over 40% after using a checklist prior to surgery. If applied nation-wide, tens of thousands of lives could be saved each year and an annual $20 B reduction in medical costs could be achieved if surgeons would use a relatively simple 19 point checklist before operating. Some of the 19 points include 1) appropriate antibiotics administered and available, 2) availability of extra blood, 3) having the surgical staff introduce themselves to each other (incredible!!), 4) reviewing safety measures, etc. I find it amazing that surgeons and the surgical staff do not go over a checklist as a routine measure before engaging in any surgical activity. In fact, whether flying a 747 or practicing surgery, not reviewing a checklist before initiating the activity is not simply "poor system design;" it would have to be classified as gross negligence.
The iatrogenic death and disease problem is further exacerbated by the complexity and dangers of the inappropriate diagnostic tools and faulty therapeutic techniques that medical doctors are required to consider and use. And one of the reasons why modern medicine has lost its way with respect to dangerous diagnostic tools and therapies is rooted in the way medicine abandoned physics and became more infatuated with chemistry in the late 1800's and early 1900's.
Another contributor to the iatrogenic death and disease problem involves the fact that many medical doctors continue to practice medicine based on what they learned twenty years ago. Many of them are almost totally uninformed about developments in the science of medicine that have occurred during that twenty year period. This fact was revealed in a New England Journal of Medicine article by Claude Lenfant, MD, Director of the National Heart, Lung and Blood Institute (C. Lenfant,"Clinical Research to Clinical Practice - Lost in Translation, New England Journal of Medicine, Vol. 349, pp. 868-874, 2003). For example, many ophthalmologists are not aware of the past ten years of ophthalmology research activity involving electrotherapeutic techniques (Transcorneal Electrical Stimulation, or TES) to treat various eye diseases. In fact, most of them are not even aware that ophthalmologists and surgeons pioneered the use of electrotherapy for visual disease applications in the 1800's. Many oncologists are not aware of the past 35 years of activity and results in the use of electrotherapy to treat cancer.
If you would like to read about highly effective, safe, patient friendly and relatively low cost electrotherapeutic and magnetotherapeutic techniques that are applicable in the treatment of cancer and neurological disorders; you might find the following website of interest: http://www.iabc.readywebsites.com .
When you read the material in the IABC web site, you will understand why I dedicated my book (shown above) to a medical doctor who was the former Head of Diagnostic Radiology at Karolinska Institute and former President of the Nobel Assembly for Medicine; Björn E.W. Nordenström, MD, PhD.
My book goes a little beyond the IABC web site and provides more details concerning electrotherapeutic and magnetotherapeutic techniques for the treatment of cancer, neurolgical disorders, wound healing and visual disease. I would also recommend two additional books that are very helpful in this area; The Body Electric by Robert O. Becker, MD and Gary Selden (Quill, 1985) and Energy Medicine: The Scientific Basis by James Oschman (Churchill Livingstone, 2000). Oschman does an excellent job of explaining certain facets of Dr. Robert Becker's work.
With respect to the visual disease research activity previously mentioned, you might be interested in the use of electrotherapy to treat various visual disease problems (currently focused on dry age related macular degeneration; but also relevant to retinitis pigmentosa, diabetic retinopathy, glaucoma, Stargardt's disease, neuropathy, etc.). The results of recent FDA guided and supervised clinical trials that have been successfully completed by Acuity Medical Systems have been incorporated into the following website: http://acuitymedicalsystems.net . This particular website was updated during the Summer of 2009 and should have more technical information by August-September of 2010. In addition, a MEDLINE indexed paper covering the design issues, protocol and clinical study results for electrotherapy in visual disease applications is available from the IEEE (G.D. O'Clock and J.B. Jarding, "Electrotherapeutic Device/Protocol Design Considerations for Visual Disease Applications," Proceedings of the 31st International Engineering in Medicine and Biology Society Conference, EMBS '09, Minneapolis, MN, September 2-6, 2009 [MEDLINE]).
And to finally put everything in perspective, I would recommend Dan Haley's book Politics in Medicine (Potomac Valley Press, 2000). This book is way beyond just interesting. After reading Politics in Medicine, many people have a reaction that is somewhere between "disturbed" and "enraged."
© George D. O'Clock, 2008, 2009, 2010