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Q. Did medical doctors and nurses watch the ER series when it was popular?A. I liked the show and the characters, but the medicine was bad, contrived, inaccurate, and fantasized. I imagine what other professions Hollywood gets wrong. Policemen, attorneys, reporters must cringe all the time.The contemporaneous medical show Chicago Hope was more realistic and less dramatized, in the beginning.Scrubs surprisingly was more accurate. ER actually had a script consultant (Greg Moran, MD) who trained in Emergency Medicine and Infectious Disease at USC and is Vice Chair of Emergency Medicine at UCLA.TV Medical Drama Accuracy FAIL! (In 3 Categories) - Soliant Healthby TERA TUTEN onAPRIL 13, 2011“It must be true…I saw it on TV,” many non-medical professionals exclaim, after catching some insights on a procedure or disease during a modern medical drama episode.It’s a refrain heard over and over again, and while many entertaining depictions of life from the ER to the OR employ consultants in the medical industry, there’s no rule that says their advice has to be obeyed.From entire series’ to reoccurring myths to specific (sometimes brutal) technical blunders, here are a few of the glaring accuracy fails we’ve spotted in three cringe-inducing categories…TVs most prominent medical shows ranked according to accurate portrayal of real-life hospital situations:Scrubs – Surprisingly, this bumbling live-action cartoon was heralded by doctors and med students as the most true-to-life medical TV series in terms of both technical accuracy and capturing the culture of doctors and interns (more…)St. Elsewhere – Sure, it was easier to remain true to the real-life profession when TV reigned as the supreme medium and ratings were a cakewalk, but the folks at St. Eligius did it with an homage to real medical doctors, nurses and hospitals that’s tough to equal in any decadeER– Despite having the master of researched fiction – Michael Crichton – as its creator and consultant, the team at County General lands just in the middle of the spectrum. (To put it in perspective, though, Crichton is the same person who created Jurassic Park.)House, MD – Some well-researched plots but also some pretty far-fetched situations you wouldn’t encounter outside the world of fiction. (full medical reviews of each episode…)Grey's Anatomy – Squarely at the bottom, TV’s most popular medical drama is also heralded by doctors as the least accurate, when it comes to portraying life working at a hospital. As addictive as it is, Grey’s is also by-far the greatest committer of the following sins:Most common inaccurate portrayals of hospitals and their staff on TV medical dramas:The TV myth: Doctors operating outside their specialtyThe reality: Though shows like ER or Grey’s depict surgeons performing every procedure in the hospital, this just ain’t so. The sheer variety of surgeries in different specialties that doctors perform on these shows is also something you’ll only see on TV.The TV myth: Doctors doing everything at every step in patient careThe reality: Many patients who are fans of these shows are amazed to see that the nurses in real hospitals seem to do everything. (Usually this appearance is because patients see nurses many times more often than doctors, though it’s also because – unlike on TV– doctors don’t do most of the stuff to patients that looks cool on TV.)The TV myth: Patients revived just in time for the commercial breakThe reality: Though lots of medical dramas let the credits roll right after a dramatic death scored with a melancholy Top 40 ballad, the same shows also rely on just-in-time resuscitations before or after commercial breaks. In reality, flat-lines can’t be solved with paddles, CPR is rarely successful, and hospital resuscitations are successful 5-10% of the time in ideal circumstances.The TV myth: Every resident leaving the hospital at the same time (often to go have drinks)The reality: Though this was a favorite of ER and Grey’s, it’s just mathematically impossible. In addition, as one poster on http://forums.studentdoctor.net/ puts it “you aren’t going to meet too many surgeons who tie one on every weeknight to the point of inebriation and are able to show up in the morning ready to work. (Many of the surgeons I know won’t even drink coffee within a day of a surgery because it makes them jittery).”The TV myth: Doctors hooking up with colleagues on-the-jobThe reality: *Ahem* You know which show we’re talking about here…Beyond doctors on almost every post on the web that discusses this laughingly wondering which hospital in America they could work at that would actually allow them enough time to form a romantic relationship with a colleague, such broom closet rendezvous’ would be serious cause for dismissal at pretty much any real-life facility.Specific medical accuracy FAILs on TVIn one Grey’s Anatomy episode, two characters perform an illegal autopsy against a family’s wishes. On the show, the characters are forgiven (instead of arrested) because they discover the patient had a rare genetic disease. Since the Tuskegee tragedy, noted a recent Slate article, doctors have instilled institutional checks to ensure that clinical research is ethical. Unfortunately, many patients may still avoid doctors because now they are afraid of being experimented on after – in their minds – TV fiction confirmed their worst fears.Medical Investigation (NBC, 2004-2005), did the out-in-the-field epidemic detective work of the CDC but were identified as employees of the National Institutes of Health (a federal agency more focused on lab-based science.) Also, the heroes wore leather jackets while checking for a deadly pathogen (*pff!* who needs that mandatory protective gear.)A Canadian study out of Halifax Nova Scotia’s Dartmouth University showed that TV doctors and nurses responded inappropriately to seizures almost half the time: “Television dramas are a potentially powerful method of educating the public about first aid and seizures,” said study author Andrew Moeller. “Our results, showing that television shows inaccurately showed seizure management half the time, are a call to action. People with epilepsy should lobby the television industry to adhere to guidelines for first aid management of seizures.”In another Grey’s episode, Dr. Yang asks a woman to donate her husband’s organs after he dies. Yang tanks in the sensitivity department, dispassionately asking for the husband’s eyes and skin, then runs out of the room as the wife begins to cry. “The scene is rife with errors that could damage public perception of organ donation,” noted the same Slate piece. As it turns out, Yang is jockeying for the husband’s organs because another patient – a close friend of the chief of surgery – is dying from liver failure and will be saved if the wife agrees. In real life, hospitals go to great lengths to prevent these types of conflicts of interest, barring doctors from approaching patients and designating statewide organizations (rather than individual hospitals) to distribute organs.That’s not all…More TV medical myths:http://realdoctorstu.com/2011/01/19/the-top-10-medical-tv-myths/New program pairs U.S. health officials with Hollywood writers: http://www.deseretnews.com/article/660213843/US-health-officials-prescribing-doses-of-medical-accuracy-for-TV-shows.htmlKeeping medicine on TV real: http://www.msnbc.msn.com/id/18233164/ns/health-health_care/The most accurate television show about the medical profession? Scrubs.By Joanna WeissZach Braff in ScrubsAny fictional television show about a real profession runs the risk of getting things wrong. I work for a newspaper and cringe whenever I see reporters portrayed on TV. (They're always so self-serving and venal. What's up with that?) I once interviewed a criminology professor who complained about the stunningly obvious things CSI characters say at crime scenes. Real forensic investigators, he explained, don't shout, "Look at this! It looks like blood! We'd better send it to the lab!" But if you talk to doctors, they'll often sing the praises of one medical show in particular, which they say captures the training process, the profession, and the dynamics of a hospital with remarkable accuracy. No, it's not House, the tale of a misanthrope who happens to be a doctor. It's not Grey's Anatomy, a torrid romance novel disguised as a medical show. It's not even the recently departed ER, which broke television ground with its realistic gore. It's Scrubs.After seven seasons on NBC and an eighth on ABC, the series airs tonight what might be its final episode. If it returns next fall—"a coin flip," at this point, creator Bill Lawrence told me—it will feel like a different show, tracking familiar characters but at a different stage in their lives and careers. Scrubs follows the travails of doctors John "J.D." Dorian (Zach Braff), Christopher Turk (Donald Faison), and Elliot Reed (Sarah Chalke), who launched their careers in 2001 as interns at the fictional Sacred Heart Hospital.To the layman, the half-hour sitcom may hardly seem like a paragon of factual accuracy. Its approach isn't realist or vérité—on the contrary, it's essentially a live-action cartoon, filled with fantasy cut-aways, bathroom humor, sex jokes, and jiggy dances. At any moment, a Sacred Heart physician might imagine sick patients ballroom dancing through the ward or a scowling malpractice lawyer strutting through the waiting room and tossing out business cards like a blackjack dealer. J.D., meanwhile, has been known to contemplate a tough medical decision while stroking Justin, his stuffed "soul-searching unicorn."This probably doesn't sound like any hospital you've visited. But if you look past the cartoonishness, you find a series that's quite in tune with the real lives of doctors—and unlike your typical medical drama, one that's not required to end each episode with a climactic surgical procedure or whiz-bang diagnosis. ER, for instance, was about the heroic things doctors do to save lives, and every episode was rife with calamity. Scrubs, on the other hand, is mostly about what happens at hospitals between crises—the way doctors and nurses handle ordinary cases. And doctors say that as a depiction of the residency process, the show hits strikingly familiar emotional notes. J.D. narrates nearly every episode in a voice-over, setting up jokes and transitions between bits, but also describing his thoughts and insecurities. Doctors say they recognize in J.D.'s internal monologue the real thought processes of a young doctor at work."He says exactly what a resident feels, day in or day out. 'Am I hurting the patient? Am I learning what I should? Am I kissing up too much to the attending?' " says Jonathan Samuels, an attending rheumatologist at the NYU Hospital for Joint Diseases. "I always thought Scrubs was right on."If the show feels like somebody's real-life experience, that's probably because it is. Creator Bill Lawrence, the man behind Spin City, Clone High, and the upcoming Cougar Town, built Scrubs around stories from his college friend Jonathan Doris, now a cardiologist in Los Angeles and a medical adviser to the show. He found humor in Doris' experiences, he says, and also a truth about human nature that's not often seen in medical shows. "In television, we like our doctors to be very heroic and very dramatic, and they kick doors open, and they say the word stat a lot," Lawrence says. But: "If your buddy was a funny kind of goofball that made jokes out of everything in college, then as a doctor, he's the same guy."Some moments from Doris' residency found their way directly onto Scrubs, says Dr. Paul Pirraglia, an internist in Providence, R.I., who was part of Doris' Brown University resident class. In the pilot, J.D. performs a procedure called a paracentesis to drain fluid from a patient's distended belly; he turns away for a moment, then looks back to discover a geyser of fluid gushing into the air. It happened—just like that—to a fellow resident at Brown. Lawrence says Doris, like the fictional J.D., also hid in a closet early in his residency to avoid being the first doctor on the scene when a patient was coding.In fact, Lawrence says, nearly every medical scenario on the show has originated with a real-life situation, tweaked a little bit for drama and the constraints of half-hour comedy. Each year, he assigns his writers to interview five doctors and report back with story ideas. Doctors often volunteer funny stories as well, he says, though many of them involve objects that patients manage to insert in their rear ends—a plotline Lawrence and his crew could use only once. (For Scrubs purposes, it was a light bulb.)But Pirraglia and other doctors say what makes Scrubs resonate isn't the specific scenarios so much as the broader themes. The show tracks the tensions between surgical and internal medicine residents—the jocks vs. the chess club, as J.D. puts it in the pilot. It captures the allure of private practice—in Season 6, Elliot takes that route and enjoys the fruits of an inflated salary. It explores the risks and rewards of intra-hospital romance, through the on-again, off-again relationship between Elliot and J.D.—which is currently quite on. It dramatizes the ways hospitals struggle to allocate resources—Dr. Kelso, Sacred Heart's chief of medicine, has more than once ordered a patient without insurance to go untreated. And it pokes fun at the way residents jockey to get plum assignments—in one episode, residents race down a hallway like Pamplona bulls for the right to treat a member of the hospital board, trampling one another and several patients in the process.Even these fantasy sequences can be seen as an element of the show's verisimilitude, suggesting a sort of survival tactic, a way to endure the grueling rhythms of life on 36-hour shifts. Scrubs captures the agony of hunger and fatigue those shifts force doctors to endure, says Dr. Svetlana Krasnokutsky, another attending rheumatologist at NYU and Samuels' fiancee. (Hospital romance does happen in real life; there's hope for J.D. and Elliot yet.) She recalls watching a Scrubs doctor eat food off a comatose patient's tray. Krasnokutsky says she's never gone that far, but she's thought about it.Krasnokutsky says she, too, identifies with J.D.'s constant self-reflection and self-doubt. In the pilot, J.D. declares, "I don't know jack," and the show in many ways has been an ongoing exposition of that point. Residents often feel like they know nothing, Pirraglia says, yet they're suddenly invested with huge amounts of responsibility, expected to give orders to much-more-experienced nurses, required to make quick decisions with life-or-death consequences."Being a resident is a strange place between officially being a doctor, which you are, but also really not knowing it all," he says. "You get this level of authority that you don't think you deserve. All of a sudden you're the doctor and people are going to listen to you."What helps—and also comes through on Scrubs, he says—is the support of fellow doctors. A seminal moment in his own residency came when he was called to a patient with a serious gastrointestinal bleed. Blood poured over the table. Time was running out. And suddenly, the room was filled with fellow residents, offering unsolicited help. Over and over again, even when they're mired in hospital politics or a relationship squabble, Elliot and J.D. do the same for each other. In the Season 4 episode "My Office," they snipe at each other relentlessly after being named co-chief residents. But when a patient codes, they work together without a second thought. "The best thing about this place," J.D. says in his voice-over, "is that when somebody's really in trouble, all the pettiness melts away."Despite the dogged efforts of the medical staff, however, the patients on the show sometimes die anyway—sometimes because the Scrubsdoctors have made fatal mistakes. Scrubs isn't a procedural built around dramatic recoveries, and many of the episodes, as goofy as they are, end on notes that are wistful or just plain sad. "You never promise a patient they're gonna be fine," the abrasive Dr. Cox growls to J.D. in the Season 4 episode "My Best Moment." "God hates doctors. He truly does. …"That case had a happy outcome—it was a Christmas episode, after all. Unflinching as it often is, Scrubs also maintains an unabashedly sentimental perspective on medicine. That could well be something else that doctors love about the show and a reason Lawrence is asked to speak at medical school graduations. J.D and his colleagues may be by turns blustery and mired in secret self-doubt, but they're also uniformly human and well-meaning; even the supposedly hard-hearted, penny-pinching Dr. Kelso has turned out to be a softie in the end. God might hate doctors, but Scrubs loves them, and the feeling is mutual.Script DoctorsJun 07, 2012 | MD Magazine Staff.Since at least the 1950s, medical dramas have been a staple of television programming—and for good reason. Where else are the stark realities of life and death more vividly experienced than in the work of doctors and other medical professionals? Few television writers and producers have a background in medicine, though, so MDs have been enlisted as consultants to help lend these programs a sense of reality. To find out what it takes to help produce medical dramas that are both accurate and entertaining, we spoke with consultants from two of the most popular examples of the genre in recent decades: House and ER.If you’re interested in working as a consultant on a medical show, it generally comes down to who you know. Harley Liker, MD, MBA, helped his friend and neighbor, television producer David Shore, sketch out the cast of characters for a new show Shore was developing that would center on solving medical mysteries—and ended up as a consultant on House from its first season on. Greg Moran, MD, who did a residency in emergency medicine and a fellowship in infectious diseases, started out feeding ideas for odd maladies to a friend from his residency program at USC who was a consultant on ER and went on to become a consultant himself for the show’s final five seasons. Compared with Liker and Moran, Lisa Sanders, MD, took a slightly unorthodox route to her position as a consultant on House: Her monthly Diagnosis column in the New York Times Magazine, which explains how physicians sleuth out difficult cases, was an inspiration for the show and has served as the basis for a number of its episodes.Once on board, medical show consultants generally keep their day jobs. Although Moran’s friend, who got a film degree in addition to an MD, moved up the ranks and ultimately became an executive producer of ER, most consultants are strictly part-time. “It was a side thing,” says Moran, who is vice chair of emergency medicine at Olive View-UCLA Medical Center and a professor of medicine at UCLA. “It was a few hours a week.” When the work comes through, however, it has to be attended to quickly. “No matter what’s happening in my life, when a script comes, I have to drop everything and look at it, because I only have 48 hours to make suggestions on how to fix it,” says Sanders, an assistant professor of medicine in the internal medicine and primary care program at the Yale School of Medicine.Medical consultants are just one part of a complicated apparatus, and their feedback can have significant consequences for others involved in making the show. “The scripts get moving pretty quickly, and there is a whole production cycle of when a script gets released to the time it needs to be revised to the time it gets to the actors to the time it gets to the special effects and props people so they can get what they need,” says Liker, who is an associate clinical professor of medicine at UCLA and provides concierge medical services through his company, Liker Consulting. “Say I had to give a writer a note or comment where I thought that the patient absolutely needed to have an MRI and imagine there wasn’t a reproduction of an MRI machine on the set and they are going to have to go out and get one—you can’t do that in a day.”The basic role of the consultant is to help ensure that the medical details of each episode are accurate—pointing out when a drug that is only available orally is scripted to be delivered intravenously, for instance—and help the writers imagine how medical scenarios might play out. On ER, Moran would generally receive an outline of an episode script with broad sketches of what was to happen in each scene and then write a first draft of the medical sections. This might involve coming up with a plausible dispute between two characters over how to approach a particular case. On House, consultants vet scripts for medical accuracy and play a role in coming up with the ultimate diagnosis for each episode as well as the false leads that the physicians might pursue in trying to treat it.“It’s a 60-minute show, and in the first 45 or 50 minutes, you basically want to distract the viewer,” says Liker. “Maybe it’s a pneumonia, OK, let’s treat it with antibiotics. Oh, we treated for pneumonia, but he’s not getting better, so maybe it’s something else. And I think they needed a lot of help with the something elses and how to step through to get to the end.”When working on a television show, however, consultants learn to balance absolute verisimilitude against the need to tell a good story. One challenge is working with a limited cast, which means that characters might be shown performing a procedure that is far outside their normal area of practice. “For instance, you’ve got someone like Chase [on House] who is trained as a pulmonary critical care expert occasionally doing neurosurgery,” says Liker. “That would never happen. Only a neurosurgeon would do neurosurgery.” And, of course, there is House’s central character, the famously cantankerous yet brilliant Gregory House, MD, who cuts ethical corners, disregards patients’ treatment preferences, and berates colleagues and patients alike, all in the pursuit of the greater good. “In internal medicine, we spend a lot of time teaching our residents how to behave properly on the theory that if you’re good to your patients, you have a much, much better chance of getting the whole story,” says Sanders. “So there are a whole bunch of people who do primary care who just hate House because he has such a terrible bedside manner.”Moran acknowledges that the drama was frequently amped up much higher on ER than it was in a real-life emergency room, but takes pride in how the show managed to have physicians and other medical staff use the sort of medical language they would in reality. “We would have to find a way to make it self-explanatory so the audience could tell what was going on, but we would use all the technical jargon,” he says. “That was just part of the feel of the show—that the docs and the nurses were speaking in the way that they would in the real world.” Another mark of ER’s realism: Some patients actually died. “That really is more reflective of the real-world situation,” Moran says. “A lot of patients do die. Clearly the outcomes on ER overall were better than in the real world, but they didn’t always have to have a happy ending.”Sanders says that House’s writers and producers are generally eager to incorporate her suggestions for correcting errors to help make the show as accurate as possible, although there was one notable exception—the time she challenged a writer’s description of an infection in a man’s mouth as “bacterial vaginosis,” meant to imply that he had been engaged in oral-genital contact. “I sent this long email saying that, first of all, that organism doesn’t grow in the mouth, but even if it did, it wouldn’t be called ‘bacterial vaginosis’ because it’s not in the vagina, so it would be called oral stomatitis or something, and then I gave a few other suggestions that would convey that kind of contact in a funny way,” she says. “Twenty minutes later, the answer came back, and it was just one line: ‘Thanks, Lisa, but my way is funnier.’ And, you know, it was. I thought, ‘Oh, right, I get that.’ It’s nice to be accurate, but sometimes it’s also good to get off a really good joke.”In the end, as Liker points out, the shows belong to the writers and the producers, not the consultants. “The writers come up with the ideas, and the medical consultants help them shape those ideas to create stories that will be compelling and as technically accurate as possible given the understanding that the show is a drama and not meant to represent pure reality,” he says. “It’s like somebody builds a beautiful car, and we shine the chrome to make it a little brighter, but we’re not building the car.”- See more at: Script Doctors

The question 'Does aluminum really cause the disease of Alzheimer's?' could be more accurately re-stated as 'Could exposure to aluminum cause Alzheimer's disease and could a causal link even be proven?' simply because aluminum is such a pervasive element in modern life, it's practically impossible to pinpoint frequency, duration and dosage of exposure at the individual level, let alone establish a cause-and-effect linkage between this one element, aluminum, on the one hand, and a complex, obviously multi-factorial disease such as Alzheimer's (AD) on the other hand. Simply, conclusive data's lacking. Rather epidemiological support of link between cumulative aluminum exposure and correlative risk of developing AD is confusing and inconclusive.This answerOutlines some basic facts about aluminum as it pertains to degree and variety of biological exposure.Summarizes conclusions from some recent meta-analyses, and systematic and umbrella reviews on the link between Aluminum and AD.Aluminum’s Pervasive in Human Foods, Daily Use Products and EnvironmentThird only to oxygen and silicon in its prevalence, aluminum is estimated the most abundant metal in the Earth's crust (1). Although there's as yet no evidence it is metabolized or even metabolizable by living things, its exponential industrial use from mid-20th century onwards has likewise exponentially increased human exposure to it. Though since the early 1970s, the pervasive soda can is a poster child of such use, it's far from the only one since aluminum has now become ubiquitous in not just human food and drinks but also in construction and the aircraft industry. After all, industrial aluminum use is pervasive, being used in everything from water treatment to generate drinking water to cosmetics, food, medical use and vaccines (see sequentially below from 1, 2),'The largest markets for aluminium metal and its alloys are in transportation, building and construction, packaging and in electrical equipment. Transportation uses are one of the fastest growing areas for aluminium use. Aluminium powders are used in pigments and paints, fuel additives, explosives and propellants. Aluminium oxides are used as food additives and in the manufacture of, for example, abrasives, refractories, ceramics, electrical insulators, catalysts, paper, spark plugs, light bulbs, artificial gems, alloys, glass and heat resistant fibres. Aluminium hydroxide is used widely in pharmaceutical and personal care products. Food related uses of aluminium compounds include preservatives, fillers, colouring agents, anti-caking agents, emulsifiers and baking powders; soybased infant formula can contain aluminium. Natural aluminium minerals especially bentonite and zeolite are used in water purification, sugar refining, brewing and paper industries.'Source of ingested aluminum is thus either natural, or through food and drug additives and daily use products, which constitute both consumer as well as occupational exposure (in the form of work in aluminum production and user industries).Natural: from its presence in foods grown in aluminum-containing soils. This can vary widely since aluminum compounds are more soluble in low pH soil, which is often the consequence of acid rain. This in turn increases aluminum content in plants animals and surface water (1, 3). Drinking water is another source since Flocculation - Wikipedia, a commonly used water treatment process, uses aluminum salts (1, 2), though the concentration is estimated low, <0.2mg/liter (4).Food and drug additives: With regard to aluminum in foods, starting sometime in the late 19th century and progressively more so since the mid-20th century, large-scale industrial food production the world over has enabled the abrupt and dramatic switch from a largely unprocessed to processed diet, the so-called 'Western' diet. Doing so has only increased aluminum bioavailability, especially human oral exposure. Such additives are found in dairy (milk, processed cheese, yogurt), staples (cereals, flours, grains), sweets (sugar, jams, jellies, baking sodas, powdered or crystalline dessert products (1, 2, 4). Use in food thus ranges from anticaking agents to buffers, emulsifying agents, firming agents, leavening agents, neutralizing agents and texturizers (2, see below from 4).While diet-based aluminum consumption is estimated to be ~10mg/day, over-the-counter drugs such as analgesics and antacids can increase this by several grams per day (5). Aluminum hydroxide for example is a common antacid ingredient that helps neutralize stomach acid while aluminum in antacids helps increase bioavailability of the active ingredient which is typically poorly soluble in the stomach's acidic environment (4).Daily use products: Cosmetics (perspirants, sunscreens, lotions, pigments), cookware, packaging are aluminum-containing daily use products. Aluminum's heat conductivity explains its pervasive presence in cookware. Leaching from cookware and packaging is estimated to add 2 to 4mg of aluminum per day in food, representing ~20% of daily aluminum intake (6, 7, 8).Estimated daily exposure between countries varies as much as 4-to 8-fold (see below from 4). This makes the task of estimating cumulative exposure in epidemiological studies attempting to discern a link between aluminum and AD or any other disease all the more challenging.Aluminum and Alzheimer's Disease (AD): Conclusions from Meta-analyses, & Systematic and Umbrella ReviewsAlzheimer's disease is classified as either the less frequent familial (1 to 5%) or the far more prevalent late-onset AD (LOAD), which is presumed the outcome of complex genetic, epigenetic and environmental interactions. Since hereditary factors fail to explain most AD cases, environmental factors have become prime research focus.Aluminum emerged as a candidate in the 1960s when a 1965 study observed neurofibrillary tangle (NFT)-like degeneration after directly injecting aluminum into rabbit brains (9), i.e., lesions similar but not identical to those considered a hallmark of AD. A 1973 study followed-up with the report of higher levels of Aluminum in post-mortem AD brain samples (10).Numerous mechanistic studies in the succeeding decades have proven inconclusive. After all, brain tissue degeneration in AD may simply make it better suited to accumulate metals such as aluminum. How to prove cause and effect? In addition, AD brain increase in aluminum levels isn't always accompanied by aluminum level increase in CSF (cerebrospinal fluid) with some studies suggesting it does and others not (11).Thus, establishing a conclusive link between increased human bioavailability of Aluminum and Alzheimer's disease remains elusive. For example, aluminum use in cosmetics such as antiperspirants became a focus of attention starting in the 1980s and yet, after decades of cumulative study, the FDA concluded (12),'The agency does not find the current evidence sufficient to conclude that aluminum from antiperspirant use results in Alzheimer’s disease.'Epidemiological studies trying to establish link between aluminum exposure through food and risk for AD are extremely complicated since it's present in such a wide variety of foods. Since AD's assumed to require years if not decades to develop, such studies would have to monitor aluminum exposure not just long-term but also at great depth, examining large study populations so that subset numbers remain large even after stratification, all amounting to a prohibitively expensive proposition.OTOH, epidemiological studies that tried to establish link, if any, between aluminum exposure through drinking water or occupational exposure and risk for AD have more promise since there's less ambiguity about the degree of daily and cumulative exposure. One 2016 meta-analysis of 8 such studies (4 drinking water, 4 occupational) on a total population of 10567 individuals found a significant association between aluminum exposure and risk for AD (13). Specifically, this study established chronic exposure to aluminum increased AD risk by 71%, where chronic exposure was defined as >100µg/liter aluminum in drinking water or its equivalent occupational exposure.A 2016 umbrella review of systematic reviews and meta-analyses (14), also concluded suggestive link between aluminum and AD. Other factors that also showed up as suggestive included factors as disparate as education, herepesviridae infection, low frequency electromagnetic fields and NSAIDs. OTOH, factors they concluded were highly suggestive included cancer, depression at any age, physical activity (high level being protective). However, the authors concluded cautiously (see below from 14, emphasis mine),'Several risk factors present substantial evidence for association with dementia and should be assessed as potential targets for interventions, but these associations may not necessarily be causal.'Thus, as of 2017, there is no consensus on whether and how aluminum exposure, specifically its bioavailability, influences AD risk. This is because numerous meta-analyses and systematic reviews that examined the totality of aluminum exposure, not just through drinking water or occupational exposure but also through cosmetics, over-the-counter drugs, processed food, vaccines, found the evidence to be inconclusive. For example, following a massive 2007 systematic review (1) that concluded there was little unambiguous evidence that aluminum exposure increased AD risk, a 2014 systematic review examined in great detail a total of 469 peer-reviewed studies, delving into not just exposure sources but also routes, amounts and potential toxicity to different organ systems. Evaluating the data by comparing to existing standards and guidelines for aluminum, it too concluded that (see below from 15, emphasis mine),'The results of the present review demonstrate that health risks posed by exposure to inorganic Al depend on its physical and chemical forms and that the response varies with route of administration, magnitude, duration and frequency of exposure. These results support previous conclusions that there is little evidence that exposure to metallic Al, the Al oxides or its salts increases risk for AD, genetic damage or cancer'Bibliography1. Krewski, Daniel, et al. "Human health risk assessment for aluminium, aluminium oxide, and aluminium hydroxide." Journal of Toxicology and Environmental Health, Part B 10.S1 (2007): 1-269. https://www.researchgate.net/profile/Robert_Yokel/publication/5764224_Human_Health_Risk_Assessment_for_Aluminium_Aluminium_Oxide_and_Aluminium_Hydroxide/links/0fcfd50187fc6a9eb4000000.pdf2. Yokel, Robert A. "Aluminum in food–the nature and contribution of food additives." (2012): 203. http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1030&context=ps_facpub3. http://www.who.int/ipcs/publications/jecfa/reports/trs940.pdf4. Vignal, C., P. Desreumaux, and M. Body-Malapel. "Gut: An underestimated target organ for Aluminum." Morphologie 100.329 (2016): 75-84. http://www.spritzer.com.my/wp-content/uploads/2016/09/Vignal-Morphologie-Gut-Al-2016.pdf5. Reinke, Claudia M., Jörg Breitkreutz, and Hans Leuenberger. "Aluminium in over-the-counter drugs." Drug Safety 26.14 (2003): 1011-1025.6. Jorhem, Lars, and Georg Haegglund. "Aluminium in foodstuffs and diets in Sweden." Zeitschrift für Lebensmitteluntersuchung und-Forschung A 194.1 (1992): 38-42.7. Wang, L., D. Z. Su, and Y. F. Wang. "Studies on the aluminium content in Chinese foods and the maximum permitted levels of aluminum in wheat flour products." Biomedical and environmental sciences: BES 7.1 (1994): 91-99.8. Al Juhaiman, Layla A. "Estimating Aluminum leaching from Aluminum cook wares in different meat extracts and milk." Journal of Saudi Chemical Society 14.1 (2010): 131-137. http://ac.els-cdn.com/S1319610309000751/1-s2.0-S1319610309000751-main.pdf?_tid=45465cbe-999a-11e7-968e-00000aab0f02&acdnat=1505427532_7874942c940894faf91bf7c71b0a5f059. Klatzo, Igor, Henryk Wiśniewski, and Eugene Streicher. "Experimental production of neurofibrillary degeneration: I. Light microscopic observations." Journal of Neuropathology & Experimental Neurology 24.2 (1965): 187-199.10. Crapper, D. R., S. S. Krishnan, and A. J. Dalton. "Brain aluminum distribution in Alzheimer's disease and experimental neurofibrillary degeneration." Science 180.4085 (1973): 511-513.11. Kapaki, Elisabeth N., et al. "Cerebrospinal fluid aluminum levels in Alzheimer's disease." Biological psychiatry 33.8 (1993): 679-681.12. FR Doc 03-1414013. Wang, Zengjin, et al. "Chronic exposure to aluminum and risk of Alzheimer’s disease: A meta-analysis." Neuroscience letters 610 (2016): 200-206. http://ac.els-cdn.com/S0304394015302512/1-s2.0-S0304394015302512-main.pdf?_tid=a04de4d8-99a9-11e7-90f5-00000aab0f02&acdnat=1505434127_91565c1d9cca3832c1bc29264a97ff4214. Bellou, Vanesa, et al. "Systematic evaluation of the associations between environmental risk factors and dementia: An umbrella review of systematic reviews and meta-analyses." Alzheimer's & Dementia 13.4 (2017): 406-418.15. Willhite, Calvin C., et al. 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I wrote a full article about this here: 20 use cases for automatic text summarization.These are some use cases where automatic summarization can be used across the enterprise:1. Media monitoringThe problem of information overload and “content shock” has been widely discussed. Automatic summarizationpresents an opportunity to condense the continuous torrent of information into smaller pieces of information.2. NewslettersMany weekly newsletters take the form of an introduction followed by a curated selection of relevant articles. Summarization would allow organizations to further enrich newsletters with a stream of summaries (versus a list of links), which can be a particularly convenient format in mobile.3. Search marketing and SEOWhen evaluating search queries for SEO, it is critical to have a well-rounded understanding of what your competitors are talking about in their content. This has become particularly important since Google updated its algorithm and shifted focus towards topical authority (versus keywords). Multi-document summarization can be a powerful tool to quickly analyze dozens of search results, understand shared themes and skim the most important points.4. Internal document workflowLarge companies are constantly producing internal knowledge, which frequently gets stored and under-used in databases as unstructured data. These companies should embrace tools that let them re-use already existing knowledge. Summarization can enable analysts to quickly understand everything the company has already done in a given subject, and quickly assemble reports that incorporate different points of view.5. Financial researchInvestment banking firms spend large amounts of money acquiring information to drive their decision-making, including automated stock trading. When you are a financial analyst looking at market reports and news everyday, you will inevitably hit a wall and won’t be able to read everything. Summarization systems tailored to financial documents like earning reports and financial news can help analysts quickly derive market signals from content.6. Legal contract analysisRelated to point 4 (internal document workflow), more specific summarization systems could be developed to analyze legal documents. In this case, a summarizer might add value by condensing a contract to the riskier clauses, or help you compare agreements.7. Social media marketingCompanies producing long-form content, like whitepapers, e-books and blogs, might be able to leverage summarization to break down this content and make it sharable on social media sites like Twitter or Facebook. This would allow companies to further re-use existing content.8. Question answering and botsPersonal assistants are taking over the workplace and the smart home. However, most assistants are fairly limited to very specific tasks. Large-scale summarization could become a powerful question answering technique. By collecting the most relevant documents for a particular question, a summarizer could assemble a cohesive answer in the form of a multi-document summary.9. Video scriptingVideo is becoming one of the most important marketing mediums. Besides video-focused platforms like YouTube or Vimeo, people are now sharing videos on professional networks like LinkedIn. Depending on the type of video, more or less scripting might be required. Summarization can get to be an ally when looking to produce a script that incorporates research from many sources.10. Medical casesWith the growth of tele-health, there is a growing need to better manage medical cases, which are now fully digital. As telemedicine networks promise a more accessible and open healthcare system, technology has to make the process scalable. Summarization can be a crucial component in the tele-health supply chain when it comes to analyzing medical cases and routing these to the appropriate health professional.11. Books and literatureGoogle has reportedly worked on projects that attempt to understand novels. Summarization can help consumers quickly understand what a book is about as part of their buying process.12. Email overloadCompanies like Slack were born to keep us away from constant emailing. Summarization could surface the most important content within email and let us skim emails faster.13. E-learning and class assignmentsMany teachers utilize case studies and news to frame their lectures. Summarization can help teachers more quickly update their content by producing summarized reports on their subject of interest.14. Science and R&DAcademic papers typically include a human-made abstract that acts as a summary. However, when you are tasked with monitoring trends and innovation in a given sector, it can become overwhelming to read every abstract. Systems that can group papers and further compress abstracts can become useful for this task.15. Patent researchResearching patents can be a tedious process. Whether you are doing market intelligence research or looking to file a new patent, a summarizer to extract the most salient claims across patents could be a time saver.16. Meetings and video-conferencingWith the growth of tele-working, the ability to capture key ideas and content from conversations is increasingly needed. A system that could turn voice to text and generate summaries from your team meetings would be fantastic.17. Help desk and customer supportKnowledge bases have been around for a while, and they are critical for SAAS platforms to provide customer support at scale. Still, users can sometimes feel overwhelmed when browsing help docs. Could multi-document summarization provide key points from across help articles and give the user a well rounded understanding of the issue?18. Helping disabled peopleAs voice-to-text technology continues to improve, people with hearing disabilities could benefit from summarization to keep up with content in a more efficient way.19. Programming languagesThere have been multiple attempts to build AI technology that could write code and build websites by itself. It is a possibility that custom “code summarizers” will emerge to help developers get the big picture out of a new project.20. Automated content creation“Will robo-writers replace my job?” That’s what writers are increasingly asking themselves. If artificial intelligence is able to replace any stage of the content creation process, automatic summarization is likely going to play an important role. Related to point 3 (applications in search marketing and SEO), writing a good blog usually goes by summarizing existing sources for a given query. Summarization technology might reach a point where it can compose an entirely original article out of summarizing related search results.