• A Note from the Editor-in-chief
• Departmental News: Nutritional Sciences
• Pre-Med Society News
• Paramedical Profession: Up Close and Personal
• Is Privacy the Best Policy?
• Science news: How an Embryo May Weaken Mom's Immune System for Its Survival
• The U of T "Pain Group"
• Personal Experience: Breast Cancer: Not Just a Women's Issue Anymore
• Test Your Knowledge

A Note from the Editor-in-chief
By Clement Zai

Sorry to keep you all waiting.  The second issue is finally out, with an in-depth look at the life of a physiotherapist, not one filled with days of treating patients with broken bones and torn muscles but one full of research, problem-solving, and interactions with patients and other health-care professionals.  Besides a few words about the Nutritional Sciences program, as well as some announcements and statistics from the Pre-Med Society, there is an introduction to the U of T Pain Group, and the Club for Undergraduate Biomedical Engineering.  Moreover, there is an overview of an ethical issue regarded highly by many health-care institutions, patient confidentiality, and a personal experience with breast cancer, male breast cancer.  Furthermore, Kaplan has given us an article on how to choose "the right medical school".  Last but not least, two interesting scientific articles examine the theory behind the breathalyzer, and the method by which an embryo survives gestation.  This issue is packed with enriching information which you may find useful.  Take some time to read it, and if you have any comments, please feel free to e-mail us any time.

Departmental News -- Nutritional Sciences
By Albert Chang

Nutritional Sciences is the study of nutrition and its impact on health.  Nutritional Sciences is an interdisciplinary study that involves many aspects of biological sciences, such as Physiology and Biochemistry.  Studies involving Nutritional Sciences include the chemistry of foods, the study of metabolic processes related to food, and the social and behavioural factors involved in nutrition.  A specialist in Nutritional Sciences, in addition to graduate work in the field, is often in demand in the food and drug industry.  Research on food additives and alternative food products are examples of what is being carried out.  Such research will help in the development of future weight management products, and healthier foods that would reduce the risk of many diseases including cancer.  The specialist program also provides excellent preparation for entry into a professional program, for graduate studies in nutrition research (M.Sc./PhD), or for studies in community nutrition in the master of health sciences program (M.H.Sc.).  As well, the Nutritional Sciences program offers a solid background for a dietetic internship, leading to a dietician degree; however, the Department of Nutritional Sciences at University of Toronto does not offer this program.

The courses offered by the department include a diverse array of subjects related to the study of Nutrition.  In third year, the department offers two courses which serve as the foundation for fourth year studies.  Since the study of Nutritional Sciences is not based on nutrition alone, students are required to take courses related to the field, as they prove valuable as the groundwork for fourth year studies in nutritional sciences.  These include Biochemistry and its laboratory techniques component, as well as Analytical Chemistry and Physiology.  These complement the diverse courses offered in fourth year, such as Nutrition and Human Disease, Food Safety and Toxicology, and the Socio-Cultural Aspects of Nutrition.  In addition, some of these courses are shared with the graduate department of Nutritional Sciences and thus form a solid background for future graduate studies.  Areas of research include studies of molecular, physiological and behavioural responses to food and its components, as well as study of food systems and their relationship to cardiovascular disease, diabetes, and cancer.  Research supervisors are often cross-appointed from many fields, and many of their laboratories operate outside the department (located at the Fitzgerald Building), such as university-affiliated hospitals like Toronto General and Hospital for Sick Children.  Students wishing to pursue graduate careers or summer student research opportunities are encouraged to apply early. 

Information about the Nutritional Science program can be obtained by visiting the Fitzgerald Building, 150 College Street, Room 316, or by calling (416) 978-2747.

FIRST GENERAL MEETING  - A HUGE SUCCESS! 
By Sowmya Kanikkannan, President, Pre-Med Society

The Pre-Med Society had its first general meeting on October 7, 1998.  The meeting featured talks by medical students at the University of Toronto. The Pre-Med Society would like to thank Alexandra Nevin, Chris Tam, Ashish Chawla, and Paul Galiwonga from the University of Toronto Medical School for engaging the audience with their informative and entertaining presentations. The eager ears of the pre-meds in attendance at the meeting were filled with invaluable information.

Our year is off to a great start with the first meeting boasting an attendance of over 200 students.  Our membership is growing at a fast pace this year. We ask that our members submit their e-mail addresses  (if you have not done so already) to our Communications Director, Navindra Persaud ([email protected]) as soon as possible so that you may be notified of upcoming events.

The MCAT Simulation for this term, which the Princeton Review has generously offered to host, has been planned for Saturday, November 14, 1998. You will be notified of the location and exact time through e-mail.  Admittance to the Simulation is free of charge for members. Non-members can sign up on the day of the Simulation.  After the simulation, the Pre-Med Society will be selling Princeton's "The Best Medical Schools" Guide at a discounted  price for members.  Whether you are in first, second, third or fourth year, it is never too early to start practising for the MCAT. We encourage students in all years to attend the Simulation. 

The following are some statistics on admission to the U of T Medical School (presented by Alexandra Nevin and Chris Tam at our first meeting): 
 

Average Undergrad GPA for class of 2002: 3.84/4.00

47% Female / 53% Male

Average Age: 26

Approx.  40% have graduate degrees

Approx. 7% have a Ph.D.

Current Class Size:  177 students

Number of Applications Received: 1700

 

 

Check out the U of T Medical School on the web:
http://utl1.library.utoronto.ca/www.medicine

Further information about the MED-TALKS in our first meeting will be posted on our web site (http://www.utoronto.ca/premed/index.html).  Our web-site is currently undergoing modifications which should be updated by the end of October.  We thank you for your patience.  See you at the MCAT Simulation!

Paramedical Profession: UP CLOSE AND PERSONAL
By Catherine Lam

The last time we got together we gave you the scoop on occupational therapy and promised you an exciting encounter with another health profession...  Physiotherapy is a word that we may hear a lot (in fact, we mentioned it in our last issue!), but we may still have many questions about what it involves exactly and whether it could be the dream profession for us...

Definition:  (Canadian Physiotherapy Association - Scope of Practice)
“Physiotherapy is a professional health care discipline directed primarily toward the prevention or alleviation of movement dysfunction, which may be related to neuromuscular, musculoskeletal, cardiovascular or respiratory systems.  Treatment may include specific manual techniques, therapeutic exercises and physical agents.”

Hmmm.  Want a more personal look?  Get comfortable and let’s get some answers from Sonia Bibershtein, an osteoporosis specialist at the Women’ s College Hospital...

What is it like to be a physiotherapist?

Great!  It encompasses many aspects of health:  wellness promotion, consultation, hands-on treatment, sports care, obstetrics...  You may do research and plan programs, or work on women’s health newsletters, and teach at the university.  There are so many options within this profession that give you room to apply your “other” skills [that you may not automatically associate with this field] like business and computers.

Do we have what it takes?

You have to be dynamic.  [I wonder if the fact that I change my mind every 5 days about what I’d like to become counts as being dynamic?] 
Remember, it’s not just passive rehabilitation; you look at the body and try to integrate it with other things.  A strong science base is helpful.  You also have to like dealing with people, and have good communication skills that let you work as part of a team. 

How did you get here?

I volunteered in a physiotherapy department.  You don’t get a flavor for a profession until you are in it.  Even then, there are so many areas to specialize in.  Sometimes where you end up can be a bit of a fluke!  It’s a good idea to volunteer.

Satisfaction guaranteed?

For me there is.  This depends on your setting; for myself, this is a great environment, giving me the room to be flexible.  I can grow here...
I really think it’s a great profession!  At a time when few people seem to be happy with their work, it is nice to find something satisfying to oneself and at the same time enabling me to serve others.

I have been in this job for 8 years. [!!]  When I graduated from high school you could go directly into a four-year B.A. in physiotherapy, whereas now you need at least two or three years of undergraduate training beforehand. 

So your enjoyment of your job hasn’t changed, but it seems that plenty of other things have...  What’s new and buzzing in this field?

Now there is a lot more emphasis on prevention, not just waiting to see the problem and then treating it.  For example, we can suggest to the patients more exercise and lifestyle modifications.  There is a lot more research involved now – many more physiotherapists are getting their Master’s degrees and Ph.D.'s; it’s great to see research done specifically by trained physiotherapists.  Here, there is a large aging population, so there is a growing focus on post-menopausal and geriatric areas.  There are also nontraditional roles being developed for physiotherapists specializing in ergonomics and industries, or in incontinence  (a growing discipline), or in working with musicians, for example.

More and more, we get the patients involved in the decision-making, changing from an “us to them” approach to an “us with them” approach.  The field is also getting more attention.  I would sometimes get comments like “I didn’t know you were an expert in this...”  Now, the public as well as other health care areas know more about this profession.  We can work with nurses, dietitians, and others as integral parts of a team sharing a holistic view.

You can basically take any skill and apply it well in this field.  Physiotherapists tend to be great people – but I’m biased!  [mischievous smile!]  There is no “deadline” -- if there is something you would love to do, go for it!  If you are interested in this field, visit and call up the hospitals and associations, and spend time observing...

By the way:

4,900 physiotherapists are currently registered in Ontario

13,000+ physiotherapists are licensed in Canada

13 University-based physiotherapy academic programs exist in Canada

Average starting salary in Canada is $45,000

 

 

Thanks to:  Women’s College Hospital, Dorothy Madgett Physiotherapy Clinic, Ontario Physiotherapy Association, Canadian Physiotherapy Association

Feature:  Biomedical Ethics:
IS PRIVACY THE BEST POLICY?
By Iris Sun

Physicians are ethically and legally obligated to keep patients' personal information confidential and private.  Patients need to feel secure when confiding to their physicians about their health problems and concerns.  Proper medical diagnoses and treatment necessitate full cooperation and trust of the patients.

Physicians in Ontario are prohibited from providing patients' information to third parties without their consent, unless the law requires the disclosure.  Examples where notification is legally required occur when patients are deemed not suitable for driving a vehicle or operating machinery, or when there is suspicion of child abuse.  A breach of confidentiality without authorization may prompt disciplinary action by the College of Physicians and Surgeons of Ontario and/or result in a civil suit.  Similar legislation and practices exist in the rest of Canada.

In 1969 at California, the patient, Mr. Poddar, confided to his psychologist that he would murder his former girlfriend, Ms. Tarasoff.  The psychologist requested the police to detain the patient.  Mr. Poddar assured the police that he was rational and would be in no contact with Ms. Tarasoff.  The patient was released and no subsequent action was carried out.  No one warned Ms. Tarasoff or her family about the threat.  Two months later, Mr. Poddar murdered Ms. Tarasoff.

A principle set through the Tarasoff case is that physicians are expected to warn foreseen victims of their patients' potential threat to them.  The College of Physicians and Surgeons of Ontario also states that physicians have a duty to override confidentiality in order to avert potentially serious harm to the patients or others.  Physicians must prudently evaluate and compare the seriousness of the harm to the patient and the intended victim(s), and the possibility of their occurrence.  They should also seek professional advice when necessary.

Any decisions involving a breach of confidentiality should be discussed with the patients beforehand and the patients should give their consent if possible.  The disclosure should only contain the information, and be directed only to those individuals, as is necessary to prevent the anticipated harm.  A genuine interest and effort should be taken to minimize the negative effects inflicted upon the patients due to the disclosure.

There are benefits and consequences of disclosure of private information about a patient, both to the individual and to society.  Critical damage to the well-being of the patient could be possible loss of dignity and increased vulnerability.  The patient and others in the future may also withhold personal information or be discouraged from seeking needed treatment.  The lack of confidence in health care professionals would threaten the health of all.  However, revealing the information may be the only reasonable approach to prevent the otherwise substantial and imminent harm to the individual(s); it can be in the interest of the public.

DISCLOSURE OF EXPOSURE?
Medical confidentiality is essential to encourage those most at risk to receive HIV testing and clinical attention.  Infection with HIV continues to be associated with personal behaviours involving drug use and sexual activity.  Efforts to protect those infected with or affected by HIV/AIDS from discrimination and rejection by family, friends, and the community are necessary to minimize the fear of disclosure.

Many groups claim that they need to know the HIV status of others to safeguard their health.  They include health-care providers, patients, correctional officers, and victims of sexual assault.  Given the limited opportunities for transmission through intercourse or needle-sharing, only special circumstances justify a "need to know" basis.  Measures should always be undertaken towards personal risk reduction, regardless of others' HIV status.

Consequences of public disclosure of AIDS-related personal information can result in stigmatization, loss of employment, loss of benefits, and/or loss of accommodations.  However, this information could produce considerable public good with regards to monitoring the spread of infection, partner notification, counseling infected individuals, and medical research.  Despite the controversies about guarding individual privacy and protecting public health, we generally all have a common interest in preventing the spread of AIDS.

TEST YOUR CQ  (Confidentiality Quotient)
Honesty is the best policy, but what about patient confidentiality?  Please answer the following questions  (you may select more than 1 choice in the multiple-choice questions.)

1.  Mr. A was convicted of having sexually assaulted Ms. B.  The psychiatrist, who had treated Ms. B over a ten-year period, read the media account of the trial and believed that this may have been an unjust conviction.  What should the psychiatrist do first?
a)  The psychiatrist has a duty to respect confidentiality, thus does nothing.
b)  The psychiatrist should consult legal counsel and the Medical Board.
c)  The psychiatrist should enlist the patient's consent to disclosure of her medical information to authorities.
d)  The psychiatrist should make a more thorough assessment of the facts of the case.
e)  None of the above.

2.  Confidentiality is a "decrepit concept" because:
a)  Medical care involves a team of individuals in the provision of care and its administration.
b)  There is increasing computerization and technological innovations.
c)  It is an ancient medical principle.
d)  All of the above.
e)  Confidentiality is not a decrepit concept.

3.  There has been unconfirmed information from the neighbour of an epileptic patient, Ms. C, that Ms. C still suffers from seizures.  The patient sometimes drives short distances to bring her children to school or to run short errands.  Should the physician inform the Ministry of Transportation?

4.  What information about the patient should be considered when deciding to breach confidentiality?
a)  Reports of past violence
b)  Intention to commit a specific act of violence
c)  Criminal record
d)  Occupation and social status
e)  All of the above.

5.  Mr. D has tested positive for the HIV blood test.  The physician offers to meet with Mr. D and his wife to assist with the disclosure of this information.  Mr. D declines the offer and states that he does not want his wife to know of his condition.  Mrs. D is a close friend and also a patient of the physician.  Should the physician breach confidentiality?

6.  Please list the following in order such that the justification for overriding confidentiality becomes progressively stronger.
a)  Disclosure would prevent some possible risk of harm to someone, but that individual cannot be identified with certainty.
b)  Disclosure would produce some considerable public good.
c)  Disclosure would prevent some highly probable harm to specific and identifiable individuals.

References:
Beauchamp, Tom L., James F. Childress.  Principles of Biomedical Ethics,  2nd ed.  New York:  Oxford University Press, Inc., 1983.
"Canadian Bioethics Report, October 1996:  Court/Tribunal Decisions"
URL:  http://www.cma.ca/cbr/oct96/decision.htm
Daglish, Tracey.  "How Private is a Visit to Your Doctor?"
URL:  http://www.acs.ucalgary.ca/~dubrent/380/webproj/tracey.html
"HIV/AIDS:  A Need for Privacy"
URL:  http://www.ipc.on.ca/web_site.eng/matters/sum_pap/papers/aids-e.htm
Jurgens, Ralf, Michael Palles.  "HIV Testing & Confidentiality:  A Discussion Paper"
URL:  http://www.aidslaw.ca/elements/TESTING-H-CONFIDENTIALITY.html
Kleinman, Irwin, et al.  "CMAJ-Feb. 15, 1997/Bioethics for clinicians:  8.  Confidentiality"
URL:  http://www.cma.ca/cmaj/vol-156/issue-4/0521.htm
Sim, Myre.  "Legal limits to physician-patient confidentiality"
URL:  http://www.cma.ca/cmaj/vol-155/issue-7/0859e.htm
Veatch, Robert M.  Medical Ethics.  Boston:  Jones and Barlett Publishers, 1989.

ANSWERS to CQ Test:  The "correct" responses, if they do exist, are confidential!

Science News: How an Embryo may weaken Mom’s immune system for its survival
By Gabriel Chan

When will a mother be likely to attack her own child in an innate, natural way before the child is even born?  In fact, a fetus contains paternal foreign genetic materials, and as they develop as essentially foreign tissues within the womb, they may trigger a potentially fatal attack from mom’s immune system.

How an embryo avoids the bombardments by the maternal natural defense system has long been a mystery.  It has been suggested that the mother may somehow suppress her immune response to the child, or that the placenta may act as an anatomical barrier to her immune cells.  However, new experiments conducted recently may provide an answer to this problem. 

A study reported in Vol. 281 of Science (Pg. 1191. Aug 21st, 1998) suggested that the embryo actively shuts down the mother's natural immune system.  The experiments, performed by Andrew Mellor, David Munn, and their colleagues at the Medical College of Georgia in Augusta, showed that the embryonic cells in the placenta make an enzyme known as indoleamine 2,3-dioxygenase, or IDO.  IDO destroys an amino acid, tryptophan, which is vital to the functioning of the mother’s immune sentries, known as T cells.  In the absence of tryptophan, T cells can no longer reproduce, as they usually do when activated, and therefore cannot attack the embryo. 

In this way, the embryo might have, as Mellor put it, “survived gestation” by producing IDO that slows down T-cell activity, minimizing the risk of spontaneous miscarriages.  For example, if drugs that mimic the effect of IDO’s T-cells dampening activity can be developed, they may prevent miscarriages resulting from the failure of the fetal cells to produce enough of the enzyme.  Such drugs may even be useful for preventing transplant rejection and treating autoimmune diseases.  Conversely, compounds inhibiting IDO may lead to abortifacients that work by boosting the mother’s innate rejection response. 

Initially, the researchers discovered that macrophages, a group of immune cells, are able to sedate the T-cells by destroying tryptophan residues.  Further investigation pointed to the production of IDO by the macrophages as the reason for the tryptophan depletion.  Then, by looking for its physiological role in human, they found that IDO is also produced in the placenta by fetus-derived cells called synctiotrophoblasts.  To explore the role of IDO in the fetus, they did experiments with two groups of pregnant female mice.  One group was bred to genetically identical fathers of an inbred strain, while the other was bred to a genetically different strain.   The mice were then treated with either an IDO inhibitor or a control substance.  In only one group was fetal rejection found – mice that had been given the inhibitor and were carrying genetically foreign fetuses.  Thus, when IDO was inhibited, the mother was rejecting the placenta and eventually the embryo choked off and died.  Other experiments also provided evidence that the mothers’ T cells serve as instigators of the attack. 

While some found such observations as striking, interesting, and provocative, others have reservations about this scenario.  They find it hard to explain why the embryo, which cannot produce tryptophan, would destroy this essential amino acid.  Munn and Mellor concede that more work will be required to show that loss of tryptophan, and not some currently unsuspected consequences of IDO action, is behind the embryo’s ability to ward off an immune attack.  Moreover, they want to see whether defects in IDO production or actions in placenta might be linked to repeated miscarriages.

In addition, immunologists will want to explore if IDO has a broader role in immune regulation.  The Georgia team has evidence in lab animals that the enzyme also suppresses the activity of T cells that might otherwise attack the body’s own tissues.  If so, the researchers may have tapped into a new arena of the immune system’s checks and balances, especially in patients with autoimmune diseases. 

The University of Toronto "Pain Group"
By Patrick Leung

What is pain?  On TV, pain is sometimes portrayed as a throbbing reddish glow or a small lightning bolt attacking the muscles in commercials.  According to the Oxford Dictionary, pain is "the range of unpleasant bodily sensations produced by illness or be harmful physical contact," and it also constitutes a major clinical problem.  Large amounts of money is being put into the treatment of pain by the health care system in Canada.  What is being done with the money? 

From the U of T Pain Group web site, it states that "There have already been great advances in our knowledge of the mechanisms sub-serving pain and these are leading to improved diagnosis and management.  The U of T has an active core of internationally recognized experts in pain research and management.  The purpose of the U of T Pain Group is to capitalize on these recent advances in pain research and the expertise of the various pain researchers in Toronto in order to enhance the research programs and treatment of pain at the U of T and its affiliated hospitals and institutions."  The U of T Pain Group administrative structure and functions, though yet to be implemented, consist of a director, and a committee whose function is to coordinate and promote interactions between the various interdisciplinary areas involved in pain research and management and other centrally organized activities such as:
 

organizing regular rounds/meetings of interest to the scientific  (basic and clinical) community,

creating a newsletter to allow awareness of current scholarly and other pain activities within U of T and its affiliated hospitals,

organizing and hosting national and international meetings related to pain, including refresher/update courses for health care professionals involved in pain diagnosis and management,

creating a committee or liaison for dispersion of information to the public and/or media,

providing management and peer review of funds for students, postdoctoral fellows and pilot projects, and

identifying areas of weakness in pain research and management at U of T and help organize recruitment into these areas.

The following is a brief list of departments and institutions with active pain research, diagnosis and management programs:
Dept. of Physiology,
Dept. of Anatomy and Cell Physiology,
Dept. of Surgery, Division of Neurosurgery,
Dept. of Anesthesia,
Faculty of Dentistry,
Pain Investigation Unit, Toronto Hospital,
Craniofacial Pain Research Unit, MSH,
Playfair Neuroscience Unit,
The Toronto Hospital Research Institute,
Hospital for Sick Children, Division of Neuroscience, and
Sunnybrook Hospital.

For more details, please point your browser to its website, http://www.utoronto.ca/pain.

A Personal Experience: Breast Cancer:  Not Just a Woman's Issue Anymore
By Jason Yee

A few weeks ago, my sister participated in the annual CIBC Run For The Cure, a fund-raising event for breast cancer which takes place in Toronto.  The event works like this:  participants must find sponsors to pledge money for breast cancer research, and then run 5 km in order to "earn" the money.  This year, the event was held on October 4.  After the run, my sister returned home, exhausted, and began telling me about what had happened.  One particular part of her story caught my attention:  at the end of the run, all of the participants were told to sign their names on a large sheet called the "Wall Of Hope".   My sister was about to sign it when she noticed that another participant, a young woman, had written the words "I miss you, Dad".  When I heard this, I thought, 'Wow, guys can get breast cancer?!'

Apparently, we can.  Although most males  (at least the ones I know) are probably more worried about prostate cancer, breast cancer among men is also a legitimate concern.  In the United States, about 1 in every 100 cases of breast cancer pertains to men  (constituting about 0.2% of all malignancies in males).

There exist many symptoms of male breast cancer.  The first and the most common symptom is a painless lump which usually appears beneath the areola, an area where breast tissue is more concentrated.  However, other symptoms include nipple discharge  (at times bloody), and signs of spreading such as nipple retraction and skin ulcers.  Most male breast cancers are small with tumours usually measuring less than 3 cm in diameter.

Given that the male breast is generally smaller than the female, one might assume that symptoms of breast cancer in men would be easier to detect.  Unfortunately, this is not the case.  Usually, by the time the cancer is diagnosed, it has already started to spread.  This may be due to the fact that the male breast is small, and even a small tumour will fit in close to, and between, the skin and the chest wall.  In addition, many people have no idea that male breast cancer exists, and individual men and their physicians fail to examine men's breasts, even during routine physical examinations.  Finally, even though some men notice a lump in their chest, they attribute it to a "flaw in their masculinity", and try to ignore it.

So who's at risk?  Well, the following is a list of some risk factors and their implications:
 

Age:  the incidence of male breast cancer grows with age, the average age of diagnosis is 65.

Ethnicity:  studies have shown that breast cancer affects 14 out of every million black men and 8 out of every million white men.

Geography:  some countries have higher rates of male breast cancer, such as Egypt and Zambia.  Some people believe this may be linked to certain liver diseases.

Socioeconomic Status:  men afflicted with breast cancer were more likely to be college graduates who worked as professionals or managers.

Heredity:  several cases of male breast cancer involve multiple patients from a single family.

Hormones:  Abnormal hormone activities, such as abnormal patterns of hormone metabolism and excretion, may also play a role in the development of male breast cancer.

In many ways, symptoms of breast cancer appear similar in both men and women.  The treatments are also quite similar.  When the disease is still in its early stages and no growth of the tumour can be observed, the basic treatment is surgery.  A mastectomy is performed, where the breast is surgically removed; this is the treatment used in about 80% of male breast cancer patients.  If a man is deemed not strong enough to withstand surgery, radiation therapy is sometimes applied.  A third option is adjuvant chemotherapy, in which toxic drugs are implemented as treatment.

For cases in which the cancer has progressed to a more dangerous stage, different types of treatments exist.  One is ablative hormone therapy, in which the testes, adrenal glands, or pituitary gland are removed; this treatment has been known to cause tumours to shrink and even disappear.  Other treatments include chemotherapy and various hormone therapy treatments.

Male breast cancer does exist.  Because its occurrence is so rare, sufficient data does not exist, and there have been many disagreements among researchers.  Although the average age of diagnosis is 65, it has been reported in a 5-year old boy, so, as with any other disease, early detection and diagnosis is the key to living healthy!

Reference:
http://www.interact.withus.com/interact/mbc/about.htm

Test Your Knowledge
By Clement Zai

Unscramble the letters given to yield the names of several medical conditions.  Their symptoms are provided as a guide.  See how much you know.

1.  DINOSSDA'  SEEDISA 
The symptoms of this disease often include general weakness, fatigability, weight loss, low blood pressure, gastrointestinal distress, low blood sugar, depression, irritability, and increased skin pigmentation.

2.  SHIREMZELA' EDASEIS
This disease causes the progressive loss of brain functions as one ages, and in most cases, it leads to senile dementia.

3.  TRGSBIH' ASSEDEI
This disease is characterized by fatigue, appetite loss, facial puffiness, abdominal or flank pain, and most importantly, scanty, smoky, dark urine.

4.  RCALAP NETLUN MONDRYES
Patients with this illness suffer from inflammation and swelling in their wrist tendons, as well as numbness and pain in the base of their thumbs.

5.  TAACTRAC
Opaque lens of the eye or of its capsule is the key to the diagnosis of this disease which causes a loss of vision of the patients; however, the patients still have the ability to distinguish between light and darkness.

6.  LACEROH
This disease causes violent diarrhea with characteristic "rice-water stools", vomiting, thirst, muscle cramps, and sometimes circulatory collapse.

 7.  RAMGNE SELEMSA
Patients with this disease have the characteristic rose-coloured rash on the skin of their faces, chests, and abdominal areas; they usually also have a slight fever, sore throat, and swelling of lymph glands behind the ears.

8.  ESOYNTIRENPH
This common medical condition is characterized by elevated systolic and often heightened diastolic pressure.

9.  SIRPRONSKAN' ISESDEA
This is a slowly progressive disabling ailment which is marked by tremor and increasing stiffness of the muscles, excessive salivation, and bending of the head and spine forward.

10.  SOOTERSPOSIO
This is a bone condition characterized by a decrease in bone mass, resulting in bones that are more porous and more easily fractured than normal bones.

Answers:  1.  Addison's Disease; 2.  Alzheimer's Disease; 3.  Bright's Disease; 4.  Carpal Tunnel Syndrome; 5.  Cataract; 6.  Cholera; 7.  German Measles; 8.  Hypertension; 9.  Parkinson's Disease; 10.  Osteoporosis.

Reference:  Encarta 95.

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