Prairie Doc Perspective Week of December 22nd, 2024
“FDA Approval”
By Debra Johnston, MD


Most of my family dreads the thought of going to a museum with me. It really doesn’t matter what the museum is, or how interested they might be in the subject, they’d prefer to do something, perhaps anything, else. 


I recognize that I am the problem. I love museums. One of my early memories is of exploring the King Tut exhibition at the Chicago Field Museum, and being drug out by my exasperated parents long before I was ready to leave. I wasn’t done reading all that fascinating information. 


Perhaps this explains why my Apple News Feed often presents me with historical trivia. Recently, I encountered a description of a patent medication marketed well into the 20th century that almost stopped my doctor heart. This particular product was targeted to parents, promising a myriad of benefits from soothing their fussy infant to freshening his breath. I have no doubt those fussy babies stopped crying. The combination of alcohol and opioids is generally pretty sedating. It is also pretty dangerous, and some of those babies never woke up. 


It wasn’t until the Pure Food and Drug Act of 1906 that companies were required to specifically identify the presence and amount of certain ingredients, at least in products sold across state lines. Importantly, this law did not prohibit the sale of ingredients like cocaine, chloroform, or formaldehyde in over the counter medications. It simply said that if those ingredients were present, and the product wasn’t being sold in the same state where it was manufactured, the label had to say so. At least now those parents knew they were giving morphine to their children! 


This same act prohibited “filthy, decomposed, or putrid animal or vegetable” material in food products. Admittedly, this applied only to items transported from out of state. If your groceries came from your own state, you were on your own. 


Over time, amendments to that original law, court decisions, and new laws brought us to the expectations we as consumers have today: 
-That manufacturer claims about food and medication are true 
-That medications and medical devices are safe and effective
 -That we can find information about the potential risks and side effects of a treatment
 -That product labels are accurate 
-That common allergens are identified 
-That imported foods and medicines are held to the same standards as domestically produced products 
-That ongoing monitoring of products occurs 


Still, the system is imperfect. There aren’t enough inspectors, and there isn’t enough post-market testing. Changes in drug manufacturing processes have introduced risky chemicals that go undetected for years. Contaminated foods sicken and kill before they are identified and pulled out of the food chain. 


Concerningly, people are often unaware that many products aren’t regulated even to these imperfect standards. Herbal and nutritional supplements aren’t reviewed even for safety prior to sale. Most skin and hair care products are classified as cosmetics and can also be marketed without any FDA approval (sunscreen is an exception). 


History has important lessons to teach us. Maybe I should be dragging my family along to those museums after all.


Debra Johnston, MD. is part of The Prairie Doc® team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.  

Prairie Doc Perspective Week of December 15th, 2024
“Plastic Surgery: Transforming Lives Inside and Out”
By Jill Kruse, DO


When many people hear the term plastic surgery images of Hollywood stars trying to fight back the effects of aging come to mind.  It is easy to assume that plastic surgeons just deal in vanity.  However, that would minimize everything that these talented surgeons accomplish with their scalpels.  The term “Plastic Surgery” comes from the Greek term “Plastikos” meaning “to shape or form.”  
Plastic surgeons work to form or change the outward appearance of people for a variety of reasons.  They work on reconstructing how a person looks after having a disfiguring injury such as a severe burn or major trauma.  They can also help with patients who have had an amputation.  The goal is to try to give the person the appearance closer to what they had prior to the injury or minimize the outward appearance of damage.  
For patients who were born with cleft lip and/or palate, plastic surgeons perform surgeries to close the defects in the lip and roof of the mouth that did not close properly prior to the patient being born.  These abnormalities can make eating and speech development difficult.  Plastic surgeons will often need to perform a series of surgeries to slowly repair and restore the appearance and function of the lips, nose, and mouth.  
Women who have suffered from breast cancer may elect to have surgeries to repair or replace the breast tissue that was removed in order to remove the cancer to save their life.  After major weight loss, many patients have excess skin folds that do not go away when the weight is lost.  The extra abdominal skin can hang down like an apron and chafe surrounding skin as well as get skin infections.  Plastic surgery can be performed to remove this excess skin.  
Whether for cosmetic or reconstructive reasons, the surgeon’s job is the same.  Their job is to help improve how someone feels about their appearance and improve function.  What may seem like a minor issue to a stranger could be the only thing that patient sees when the look in the mirror.  While we say beauty is only skin deep, many people have been teased or criticized for the way they look.  Plastic surgery can change this if the patient desires.  
The plastic surgeon can help change the outward appearance of a person to help them feel more confident and comfortable with their body.  The various applications of their skills are so numerous, that it is hard to list them all.  In the hands of a skilled plastic surgeon, the transformation goes far beyond appearances, helping patients reclaim their confidence, functionality, and quality of life.  Thus, plastic surgeons truly can transform lives both inside and out.  
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook, Instagram, and Threads featuring On Call with the Prairie Doc®, a medical Q&A show on SDPB, 2 podcasts, and a Radio program, providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central and wherever podcast can be found.

Prairie Doc Perspective for the Week of December 8th, 2024
“Anatomical Variations: Connecting Research & Patient Care”
By Ethan Snow, PhD


The human body is composed of a typical pattern of anatomy, yet every structure varies in form from person to person. For example, humans develop with a standard set of defined muscles, yet the shape and mass of each muscle varies significantly among individuals. Sometimes, “anatomical variations” develop – that is, anatomical structures that do not conform to the typical range of regular morphology (for example, an entirely separate “extra” muscle that develops in one person).


Human anatomy is so intricate that the prevalence of an anatomical variation is thought to be certain in every individual; in this regard, what makes each of us unique is the very thing we have in common. Certain variations can elicit complex symptoms, muddle diagnoses, and complicate treatments. Fortunately, though, most anatomical variations are asymptomatic and pose little to no clinical concern. Sometimes variations can even be beneficial; for example, an accessory muscle-tendon unit can be useful autograft material in musculoskeletal reconstruction surgeries.


Anatomical variations are challenging to study because they are often found incidentally. In surgery, clinicians operate in a limited window of visibility in order to complete procedures with minimal incisions. When surgeons find an unexpected variation in their operating window, they often only see part of it and are not able to expose the entire structure. Anatomists, however, dissect the entire body (as an embalmed cadaver) and expose variations in full detail. Cadaveric case analyses of anatomical variations provide clinicians with insights for adjusting protocols to suit variations during surgery and in noninvasive treatment plans, and they help anatomists teach clinically significant variations to students learning human anatomy. 


Strategic anatomist-clinician collaborations foster the mutual exchange of expert-level skills to promote the highest-quality medical education and patient care, particularly involving anatomical variations. These collaborative relationships form the fundamental underpinning of evidenced-based medicine and embrace the “bench-to-bedside” model for making translational research influential to patient care.


Modern technology has improved the study of anatomical variations. Many anatomical case analyses now involve radiologic imaging, histopathology, digital modeling, and other contemporary techniques, making them more relevant to clinicians and patient care. In the fast-paced disciplines of education and medicine, innovations such as virtual reality (VR) are being used to advance anatomy education and improve patient care. While defined variations and clinical conditions can be simulated by technology and offer many impactful benefits, tech-based programs are currently unable to generate accurate models of potential anatomical variations.


For the nearly 2500 years, human cadavers from whole body donors have served instrumental roles in establishing anatomical knowledge, including what is known about anatomical variations. Human cadavers are unparalleled for tactile feedback, unscripted anatomical variations, and clinical associations. They also convey more than anatomy; they are considered by most students as their first patients and teach students about clinical anatomy, variation, disease, ethics, humanity, respect, and many other important values. Educators, clinicians, and students remain extremely grateful to whole body donors for their selfless contributions to advancing medical education, knowledge, practice, and patient care – particularly as related to anatomical variations.


Ethan Snow, PhD is an Anatomist and currently serves as an Assistant Professor of Innovation in Anatomy at South Dakota State University in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 

Prairie Doc Perspective Week of December 1st, 2024
“Doctor Chekhov, Physician & Writer”
By: Eric Holm


Literature classes worldwide study Anton Chekhov (1860-1904), a great innovator of the short story. He wrote closely observed and deeply empathic slices-of-life with a great sense of humor — but the Russian-Lit-class-version of Dr. Chekhov often overlooks the vitality of his work in the theater. Theater-people like me know him as a playwright, the creative counterpart to the acting teacher Konstantin Stanislavsky, who directed and starred in Chekhov's breakthrough play, The Seagull. Together with the other artists of Moscow Art Theater, Chekhov and Stanislavsky pioneered a new style of ensemble performance, focusing on the whole society, rather than one "main character."


So if the literature-people under-appreciate his brilliance as a playwright, and theater-people undervalue his excellence in prose, both groups could stand to note his life-long dedication to medicine. Even after he became a famous writer, Dr. Chekhov never stopped seeing patients, and at the height of his literary career, he traveled nearly 6000 miles from Moscow to a notorious prison on Sakhalin Island to study the failures of the island-prison’s health care system. After his trip, Chekhov wrote a carefully reported book-length argument for prison health care reform, a work of investigative medical journalism. He once wrote in a letter: “Medicine is my lawful wife, and literature is my mistress.”


My Dad was the great Dr. Rick Holm, whose mind was also rich with a multiplicity of passions and talents. I sometimes think that the way Chekhov’s devotion to medicine was overshadowed by his success as an artist is an inversion of the way my Dad’s devotion to art was overshadowed by his success as a doctor. He was well-known as a singer and a choral conductor, founding the (still ongoing) Hopeful Spirit Chorale, but his other artistic pursuits were less well-known: he was a fine amateur painter, a long-time member of the board of Prairie Repertory Theater, a talented draftsman (his book Life’s Final Season includes his own anatomical drawings), and when he died, he was writing historical fiction — a novella set in in the twelfth century in Salerno, Italy, about the first Western medical school.


I think Dr. Chekhov's perspective as a physician sharpened his observational powers as an artist. His plays and stories are full of people who suffer from habits of mind that they can’t understand; the good doctor seems, with his careful, diagnostic observation, to identify problems with his characters’ mental health (obsessions, depressions, manias, addictions) years before the vocabulary for such mental health disorders had been developed. Like Shakespeare, Dr. Chekhov writes honestly about both the very poor and the very rich, treating servant characters with as much detail and dignity as the owners of the estate. Though the good doctor’s ‘slice-of-life’ literary style is deeply rooted in reality, his work is paradoxical, both traditional and unconventional at once, using a physician’s skill-set and a prescient fascination with the health-of-the-mind to create literary, theatrical, and journalistic work that was, thrillingly, ahead of its time. 


Eric Holm is an artist and teacher working mostly in performance, film, and music. He trained in Minneapolis and New York and is a founding member (with fellow Brookings-person Katie Melby) of the BREAD Arts Collective. Now based in Houston, Texas, Eric is an adjunct theater and film professor at the University of Houston, Galveston College, and Lone Star College, and is working on self-producing his second album. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.