1-1banner
 
medpundit
 

 
Commentary on medical news by a practicing physician.
 

 
Google
  • Epocrates MedSearch Drug Lookup




  • MASTER BLOGS





    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov




    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.




    "Opinions are like sphincters, everyone has one." - Chris Rangel



    email: medpundit-at-ameritech.net

    or if that doesn't work try:

    medpundit-at-en.com



    Medpundit RSS


    Quirky Museums and Fun Stuff


    Who is medpundit?


    Tech Central Station Columns



    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews

    Review


    Medical Blogs

    rangelMD

    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc

    richard[WINTERS]

    code:theWebSocket

    Psychscape

    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It

    medmusings

    SOAP Notes

    Obels

    Cut-to -Cure

    Black Triangle

    CodeBlueBlog

    Medlogs

    Kevin, M.D

    The Lingual Nerve

    Galen's Log

    EchoJournal

    Shrinkette

    Doctor Mental

    Blogborygmi

    JournalClub

    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House

    .PARALLEL UNIVERSES.

    SoundPractice

    Medgadget
    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day

    BioEdge

    The Business Word Inc.

    Point of Law

    In the Pipeline

    Cronaca

    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station

    Blogcritics

    Overlawyered.com

    Quackwatch

    Junkscience

    The Skeptic's Dictionary



    Recommended Reading

    The Doctor Stories by William Carlos Williams


    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn


    Intoxicated by My Illness by Anatole Broyard


    Raising the Dead by Richard Selzer


    Autobiography of a Face by Lucy Grealy


    The Man Who Mistook His Wife for a Hat by Oliver Sacks


    The Sea and Poison by Shusaku Endo


    A Midwife's Tale by Laurel Thatcher Ulrich




    MEDICAL LINKS

    familydoctor.org

    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info

     



    button

    Saturday, August 14, 2004

    Medicine Garden Blogging: Devil's Club. aka Wonder Weed
     

    posted by sydney on 8/14/2004 02:03:00 PM 0 comments

    Looking to the Future: The FDA recently approved two drugs that protect against dirty bomb radiation:

    The U.S. Food and Drug Administration has approved two new drugs designed to counter the radioactive effects of a so-called 'dirty bomb.'

    The agency said the drugs, penetrate calcium trisodium (Ca-DTPA) and penetrate zinc trisodium (Zn-DTPA), are safe and effective for treating contamination from plutonium, americium, or curium -- three elements that could be used to produce a dirty bomb.


    I'm not sure, but I think those might be "penetate" forms of the elements. They're very experimental, but if you've been exposed to a dirty bomb, there are few choices for treatment. Drugs such as those listed above have apparently shown some promise. Makes you wonder what sort of intelligence is buzzing about terrorist attacks, doesn't it?
     
    posted by sydney on 8/14/2004 01:58:00 PM 0 comments

    Attacking Root Causes: Of Alzheimer's:

    Amyloid beta, the waxy protein that litters the brains of Alzheimer's patients, is like a criminal with many arrests but no convictions. Studies have implicated amyloid plaques in the disease, but nobody has proved that they cause it.

    Now, scientists working with mice report that antibodies tailor-made to attack amyloid can wipe it out and reverse an experimental version of Alzheimer's disease if the intervention begins early enough. What's more, removing amyloid rubbed out its partner in crime, a protein called tau that collects in tangles inside brain cells.

    In their tests, LaFerla and his colleagues used mice genetically engineered to make excess amyloid and tau. The researchers then injected antibodies against amyloid into the animals' brains.

    Three days later, the researchers could not find any amyloid plaques in the brain region targeted by the injection, but neurons there still contained tau tangles. After 2 more days, these tangles were cleared too.


    Interesting. And more promising in potential than stem cells.
     
    posted by sydney on 8/14/2004 01:49:00 PM 0 comments

    Friday, August 13, 2004

    ??? The acting head of the FDA says that terrorists might attack through reimported drugs:

    Tampering with prescription drugs could be a way for terrorists to launch an attack on Americans, acting Food and Drug Administration Commissioner Lester M. Crawford said Wednesday.

    Crawford said in an interview with The Associated Press that possible action by terrorists was the most serious of his concerns about the increasing efforts of states and cities to import drugs from Canada to save money.


    The Department of Homeland Security doesn't know what he's talking about. Mr. Crawford is talking out of his hat. If they could adulterate Canadian drugs, they could adulterate U.S. drugs, too. It's not as if the FDA inspects every batch of pills that rolls off the assembly line (or whatever pills roll off.) Sounds like nothing more than scare tactics. And that's too bad, because it discredits further arguments against reimportation.
     

    posted by sydney on 8/13/2004 12:38:00 PM 0 comments

    Spendthrift: A cost analysis of Kerry's proposals finds them very expensive, indeed, with the lion's share going to healthcare:

    Our best estimate is that Kerry's proposals will add up to between $2 trillion and $2.1 trillion over the next ten years. Since the revenue from his tax proposals relative to the current baseline is actually negative, this implies that the Kerry proposal would increase the deficit by perhaps as much as $2.5 trillion over the next ten years.

    On August 3, 2004, the Kerry campaign responded to criticisms such as this with a revised budget plan. The main difference between the first and second plans is that the campaign now claims to be able to save about $300 billion from eliminating corporate welfare. Even if we include this rather implausible savings in our estimate, the net increase in the deficit associated with Kerry's proposals is on the order of $2.2 trillion.

    What would he spend the money on? According to our analysis, roughly half of this additional spending is attributable to Senator Kerry's health care proposals that would add more than $900 billion in federal outlays. Education expenditure accounts for nearly one quarter of Kerry's new spending, with almost $500 billion added over ten years. A $400 billion expansion of military personnel and benefits for veterans comprises most of the remainder of Kerry's spending plans, with the balance distributed among numerous social programs and increases in international aid.


    And if Kerry's voting record is any indication, he'll be cutting money from defense and intelligence to help pay for it. We really need to ask ourselves if that's something we can afford, or even need.



     
    posted by sydney on 8/13/2004 12:32:00 PM 0 comments

    Thursday, August 12, 2004

    More on Stem Cells: The Wall Street Journal's Opinion Journal has an editorial this morning noting that NIH funding for embryonic stem cell research has increased under the Bush Administration.

    And elsewhere, the New England Journal of Medicine says that it isn't the President who's thwarting embryonic stem cell research, it's the Dickey Amendment:

    The Presidential challenger Senator John Kerry (D-Mass.) has stated that he would overturn the Bush restrictions and allow federal funding for research involving any human embryonic stem-cell line. Although a boon to stem-cell research, a change of administration would not immediately clear the way for important areas of embryo research. An even more restrictive element of government policy prohibits the use of funds for 'the creation of a human embryo or embryos for research purposes; or . . . research in which a human embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death.' Proposed in 1996 by Representative Jay Dickey (R-Ark.) as a rider on the appropriations bill for the Department of Health and Human Services and renewed every year since, the Dickey Amendment prohibits federal engagement in a field of research pertaining to the nature of the human embryo, its disorders of development, and the derivation of new human embryonic stem-cell lines. Although most embryos created in vitro during fertility procedures are deemed unsuitable for pregnancy and are discarded, federal funds may not be used to ascertain what went wrong. Such studies, beyond improving the efficacy of fertility treatments, offer promise for understanding many chromosomal and developmental disorders that originate in the early embryo.

    The Dickey Amendment prohibits federally funded scientists from deriving lines that model human disease. The use of somatic-cell nuclear transfer to generate pluripotent lines from patients with disorders such as schizophrenia, Alzheimer's disease, amyotrophic lateral sclerosis, and diabetes offers new strategies for unraveling the pathophysiology of these conditions, and the derivation of lines from patients with genetic diseases such as sickle cell anemia and immune deficiency hold promise for combining gene therapy with autologous cell-replacement therapy. Such studies have an immediate, compelling medical rationale, yet they cannot be pursued with federal grants.


    Knowing how Kerry voted in 1996 when the Health and Human Services Appropriations Bill came up would certainly be useful. (I couldn't find anything in my limited Google search.)

    ADDENDUM: And here's a 37 year old with Parkinson's disease on the same subject. (A disease, by the way, in which embryonic stem cells have shown some promise - unlike Alzheimer's.)

    UPDATE: Evidently, Kerry voted against the appropriations bill. (And welcome Instapundit, readers!)

    UPDATE II: Or did he? Here's the omnibus bill that Ipse Dixit found. There's no mention in its long list of amendments of the Dickey Amendment or anything about restricting embryonic stem cell research. But HR 2264 does mention it, and Kerry voted for the Senate version. (I'm not sure which bill contained the original Dickey Amendment, though. It's all very confusing. Perhaps someone who's used to mining through Congressional records can figure it out.)

    UPDATE III: There's a complete record of Kerry's votes here, but for some reason there's no appropriations bill listed for 1996.

    UPDATE IV: But wait. The original amendment was part of this bill which Kerry voted against considering in the Senate. But it disappears from the record after that. Surely, it must have shown up again, somewhere. Geesh. My sympathies to those who make a living sorting through this stuff.
     

    posted by sydney on 8/12/2004 10:06:00 AM 0 comments

    Rationing Resources: The letter from a cancer patient's husband that prompted DB's post about the doctors and dying patients (see last post from Aug 11), has gotten under my skin. The letter was published by the New York Times in Jane Brody's weekly health column, in the hope that doctors everywhere would take note and be kinder to their dying patients. Here's the letter in its entirety:

    Dear Doctor: I'm writing to you in reference to my wife, who died on May 29, 2004. I wish to make clear from the outset that I am not impugning your medical competence but am seeking to bring to your attention what, in my opinion, constitutes a grave breach of the moral contract you entered into with her.

    "As you know, my wife was diagnosed with lung cancer in 1997 and was treated successfully by you for almost seven years. During that time, she developed a relationship of confidence with you which, given her many unhappy past experiences with doctors, was both encouraging and surprising.

    "And yet, at the end, to her (and my) profound disappointment, you failed her. When you realized that you could do no more to reverse her progressive disease and that death had become inevitable, you abandoned her. You evaded her telephone calls; you waited 10 days before informing her of the April 2004 CAT scan results; you pulled away. The empathy you had displayed was replaced by what she experienced as indifference. And, sadly, your behavior dovetailed perfectly with the New York Times article "Facing Up to the Inevitable, in Search of a Good Death" of Dec. 30, 2003, which speaks of physicians who withdraw from patients rather than address feeling 'guilty, insecure, frustrated and inadequate.'

    "It is true that you informed my wife, offhandedly, that the hospice staff would care for her during the final phase. As they did - with dedication and great dignity. However, your coldness during her final weeks made it more difficult for us because she felt that she had lost the medical anchor you had provided and no longer had a doctor she could trust to explain what was happening to her as her body withered and her vulnerability grew.

    "Much precious time was wasted trying to turn her mind from your dismissal of her that she experienced as a professional and personal betrayal. Which I believe it was.

    "Would it have cost you so much, doctor, to have picked up the telephone to speak with her after almost seven years of treatment? Would it have been so intolerable to you to have looked into her eyes - at the hospice perhaps - and told her that you wished her well and wanted a chance to say goodbye? Were you truly unable to offer even a shred of comfort, a word of condolence to her family? Had she really become no more than another statistic, a failure you preferred to brush aside?

    I am asking you to help ensure that oncologists like yourself, who work with many patients they are bound to lose, not abandon them emotionally, as you did. I am asking that you suggest that your hospital consider setting up a training program for doctors like yourself so that other patients can be spared the pain of the rejection my wife experienced. Because it is my conviction that doctors treating terminally ill patients have a moral obligation to stand with them from start to finish even when, at the end, those patients must be transferred to hospice care. It is not easy for me to tell you that from this perspective, I believe that your failure was monumental.

    "Perhaps this letter will help you display greater feeling with future patients and not ask them, as you did my wife from a distant height, 'What would you like us to do for you?' What she wanted you to do was simple: she wanted you to speak to her with courage; she wanted you to show a bit of concern, which would have meant as much to her then as all the chemotherapy you prescribed when there was still hope; she wanted you to help her die more peacefully - as you had promised that you would but did not. It would have made the work of the hospice staff easier. It would have been a consolation to her and to the family and friends who loved her.


    It's a very eloquent and moving letter. Any doctor with a conscience would be devastated to receive it. The thing is, there's probably not a doctor anywhere on this earth who hasn't caused a patient, usually inadvertently, the same emotional pain.

    In most cases, it's not that we don't care, but that our attentions are required elsewhere by patients with more urgent needs. It's not so uncommon. I had a patient accuse me of being uncaring because I left the exam room during one of her visits. I don't make a habit of this. My staff only interrupts me for emergencies. In this case, it was another patient having a heart attack. It didn't matter to the first patient, though, she couldn't see beyond her own needs - and she left me because of it.

    I remember another case, during residency, that happened to one of my fellow residents. It was during his intensive care rotation. One of his patients was scheduled to have an invasive procedure the next day and was very anxious about it. My fellow resident was a very conscientious and sensitive person, and he spent a great deal of time trying to console and reassure the patient. But he wasn't very successful. The patient kept asking the nurses to page him throughout the night so he could ask questions and get more reassurance. But my colleague had a lot more pressing matters to attend to that night - patients who would die if he ignored them. He finally said (in exasperation) to the anxious patient, "Look, I don't have time to spend all night holding your hand." A cold and uncaring comment, yes, but one uttered by a doctor at the end of his rope. It bothered him a lot - that's how I know about it. He felt so bad that he included it in his report at morning rounds. It was also a turning point in his career. He left family medicine and became a psychiatrist.

    And that's what bothers me about this letter. The patient obviously expected more from her doctor than he could give, and assumed that his failure to meet her expectations was due to a deficiency of his character. But it was more likely a deficiency of his time. Only comic page doctors have the unlimited time to devote every waking hour to one patient.

    UPDATE: 100% of readers disagree with me on this. A couple of samples:

    I think you gave yourself an easy out by stating that doctor's are just too busy to continue being involved in their terminally ill patients lives. Yes, time is a cruel mistress and none of us have enough to go around, but a simple call or even saying goodby would not have left this patient with a sence of guilt that they had done something wrong by dying.

    And..

    I understand your concern for doctors who have so little time and have to do so much, but here's the sentence from the husband's letter that bothered me:

    "you waited 10 days before informing her of the April 2004 CAT scan results;"

    Due to serious illnesses in 3 family members, I have had experience with nearly a hundred doctors - good and bad, caring and unkind - from Maryland to California. That sentence makes me believe this man's concerns are well-founded.


     
    posted by sydney on 8/12/2004 09:07:00 AM 0 comments

    Asbestos, Attorneys, and Doctors: A reader shares his first-hand experience with the asbestos litigation industry, an experience not unlike my patient's:

    My father, now deceased, contracted asbestosis in the Kaiser Shipyards during WWII. It, fortunately, didn't affect his life until his mid-70's, when the symptoms began and continually worsened until his death at age 87. He was on oxygen 24/7 the last five years of his life.

    He was recruited by one of the law firms involved in the asbestos class action suits to file a claim with them. His asbestosis diagnosis was originally from Letterman Army Hospital in SF, CA, subsequently confirmed by two Central CA hospitals, (Sutter Memorial in Sacramento and St. Josephs in Stockton). Nothing to do with lawyers and their confirm for a fee Dr.'s. Short of the long of it, he received $125.00 has his share of the settlement, the law firm received something over $1.8 billion. I wish your patients much success. They'd be hugely better off using your information to sue the attorneys and there lackey & corrupt Dr.'s.
     
    posted by sydney on 8/12/2004 08:23:00 AM 0 comments

    Wednesday, August 11, 2004

    Final Days: Med Rants has a long thoughtful poast on the emotional impact of dying patients on physicians.
     

    posted by sydney on 8/11/2004 03:17:00 PM 0 comments

    Heh: From the "nerve of some people" department.
     
    posted by sydney on 8/11/2004 02:54:00 PM 0 comments

    Blog World News: I've meant to mention it for some time, but The Bloviator has a lovely new look. And he's back from his long hiatus, blogging up a storm on public health issues.
     
    posted by sydney on 8/11/2004 02:34:00 PM 0 comments

    Okie MedMal: Walter Olson reports that Oklahoma is losing another malpractice insurance carrier.
     
    posted by sydney on 8/11/2004 01:16:00 PM 0 comments

    Narcissism vs. Optimism: An examination of the stem cell positions by Eric Cohen in The Weekly Standard:

    Ronald Reagan--"an eternal optimist," as Kerry described him when invoking his memory to advance the stem cell cause--had a very different faith in the future. When diagnosed with Alzheimer's disease after a long and heroic life, Reagan had the dignity to say goodbye to the nation he loved. He accepted that his own best days were behind him, but he believed in the future because he believed in those who would follow. "I now begin the journey that will lead me into the sunset of my life," he wrote. "I know that for America there will always be a bright dawn ahead." In other words, Reagan was an optimist, not a narcissist. And while he sympathized with the patients and families suffering with degenerative diseases, he would have found it indecent (or evil) to use the seeds of the next generation as tools for saving his own life. Progress, he knew, means not living forever, but passing down a more decent society to one's children.

    The nation is obviously divided about whether destroying human embryos in search of cures is progress, regress, or both at once. And perhaps it is not easy to see the humanity of human embryos when faced with the agonizing suffering of those we know so well and love so dearly. But only a zealot would ignore the moral hazards of pursuing a national project of embryo destruction, and only a zealot would demand that all citizens pay for research that many citizens find unconscionable. In the embryonic stem cell debate, Bush is the moderate; Kerry is the zealot.



    UPDATE: More on the debate here and here.
     
    posted by sydney on 8/11/2004 12:39:00 PM 0 comments

    More Double-Edged Swords: Canadian health authorities have advised against the use of the newer anti-depressants in pregnancy:

    International and Canadian reports reveal newborns whose mothers took medications containing Selective Serotonin Re-uptake Inhibitors or other newer anti-depressants during late pregnancy developed complications at birth requiring prolonged hospitalization, breathing support and tube feeding.

    Reported symptoms include feeding and/or breathing difficulties, seizures, muscle rigidity, jitters and constant crying. In most cases, the anti-depressant was taken during the last three months of pregnancy.

    The symptoms could indicate a direct adverse effect on the baby, or possibly a discontinuation syndrome caused by sudden withdrawal from the drug.


    Severe depression during pregnancy certainly warrants treatment. In those cases the benefits of the drugs far outweigh their risks. But the newer anti-depressants are generally so well-tolerated that they get over-used in practice. Using them in pregnancy just to mood swings and grouchiness is not recommended.
     
    posted by sydney on 8/11/2004 08:39:00 AM 0 comments

    Double-Edged Swords: Lots of news today about the potential for vaccines against common infections. A vaccine is in the works for strep throat, and there's some evidence that the pneumonia vaccine also
    confers protection against viral infections. However, both the strep pneumonia bacteria and the pneumococcal pneumonia bacteria are, to some extent, natural residents in the human body. It's when the balance of power gets upset and they take over that they become a problem. Other bacteria are also natural residents of the respiratory tract - including Staph aureus, a bacteria that has become more and more resistant to antibiotics.

    So, what's the problem? Another study in today's JAMA suggests that when Strep pneumonia levels go down, Staph aureus levels go up. We should proceed with caution. We might be preventing one relatively minor bacterial infection but opening the door for a far more dangerous one.
     
    posted by sydney on 8/11/2004 08:08:00 AM 0 comments

    Freedom of Choice: Irwin Savodnik looks at old style Soviet psychiatry and modern American psychiatry and finds some disturbing similarities.
     
    posted by sydney on 8/11/2004 07:58:00 AM 0 comments

    Out-Maneuvered: Some insurance companies have given up the battle and decided to pay for over-the-counter medications, instead of their prescription counter-parts:

    When Claritin became available without a prescription, many consumers were savvy enough to ask their doctor to switch them to one of the remaining prescription non-sedating antihistamines -- Clarinex, Allegra or Zyrtec.

    Consequently, some insurers determined they're better off paying for the over-the-counter version of Claritin than one of the related prescription drugs, which carry a wholesale cost of $75 to $80.

    Since Claritin became available without a prescription in late 2002, its price has been cut by more than half -- to less than $1 a pill.

    Comparison shoppers can find a 30-day supply of Claritin or its generic equivalents for $20 or less, depending on weekly sales and coupons.

    Likewise, the over-the-counter version of Prilosec costs about $20 for a 28-day supply, compared with about $138 for the prescription version, Dankoff said.
     
    posted by sydney on 8/11/2004 07:57:00 AM 0 comments

    Tuesday, August 10, 2004

    New Ways, Old Ways: Some pages from a 14th century physician's belt book, a medieval Palm.
     

    posted by sydney on 8/10/2004 09:48:00 PM 0 comments

    Careless Doctors: Doctors are also apparently giving the wrong drugs to the elderly:

    Medications that are considered unsafe for older people are frequently being prescribed to patients over 65, researchers reported yesterday.

    The study, which examined prescription rates, found that 1 in 5 older patients received at least one unsafe drug.


    Here's the study:

    A total of 162,370 subjects (21%) filled a pre-scription for 1 or more drugs of concern.... More than 15% of subjects filled prescriptions for 2 drugs of concern, and 4% filled prescriptions for 3 or more of the drugs within the same year.

    The drugs of concern fall for the most part into three categories - muscle relaxants, tranquilizers, and old generation anti-depressants. The list also includes an old anti-inflammatory drug, Indocin, which is used for gout.

    All of the drugs have the potential for serious side effects in the elderly. They can cloud the senses, throw a person off balance, and in the case of indocin, cause renal failure or gastrointestinal bleeding. So why do doctors prescribe them? Sometimes, they have no choice. The old generation anti-depressants are sometimes used for sleep disorders and for peripheral neuropathy. They're safer for sleep disturbances than tranquilizers. They're also used at times for urinary incontinence. There are, to be sure, other drugs that can be used for these disorders, but when others fail, sometimes the only choice is to turn to these sorts of drugs.

    Indocin is better at kicking the pain of gout than most other anti-inflammatory drugs - and it's only used for a few days at at time. The dangers of using it increase with duration of use. When used appropriately, its dangers should be minimal.

    And finally, there are the tranquilizers. In many cases, the elderly who are taking these have been on them since their young adult years. They're the refugees of the "mother's little helper" era. But years of using them leaves the body physically dependent on them. It's notoriously difficult to wean someone off of them after such long use - and dangerous. (Withdrawl can cause seizures, among other things.)

    To be sure, there are some doctors who are reckless in prescribing these sorts of drugs, but for most doctors, it's more a matter of weighing the costs and benefits of the drugs for each patient, and coming down on the side of prescribing them - despite their potential side effects.
     
    posted by sydney on 8/10/2004 08:35:00 PM 0 comments

    Silent Killers: Sometimes, diseases can be dodgey. And not surprisingly, when the present in an atypical fashion, they sometimes get overlooked. So this story that some heart attacks occur without chest pain holds few surprises:

    In the study, published in the journal Chest, researchers looked at data collected in 14 countries on 20,881 patients hospitalized for acute coronary syndromes. Of those, 1,763, or 8 percent, did not report chest pain. Older patients, women and diabetics were more likely to fall into this group.

    The researchers found that the conditions of about a quarter of such patients were initially misdiagnosed, compared with only 2 percent of patients with chest pain.
    .

    Nothing new or surprising there. In the elderly and diabetics, doctors have to remain ever on guard for the unusual in those groups. However, the next statement gives one pause:

    But in the study, the patients without chest pain were less likely to be given drugs to thin their blood to reduce the risk of further damage, or to undergo surgical intervention. The difference in treatment continued up until the patients left the hospital, when they were less likely to be discharged with prescriptions for drugs to reduce blood pressure or cholesterol.

    The study also found a significant difference in death rates during hospitalization: 13 percent for patients without chest pain versus 4 percent for those with chest pain.

    The authors said that at least some of the difference in survival rates could be explained by differences in health before the heart attacks, and that some might be caused by the delay in diagnosis. But the study also noted that omissions in therapy were not adequately corrected during hospital admission and presumably contributed to the poorer outcome.


    One reason for the differences in mortality could be that the atypical presentations occurred in groups that are less resilient to disease to begin with - the elderly and diabetics. And the differences in medication choices? Could be due to the higher likelihood of intolerance and contraindications to those medications in the elderly and diabetics.
     
    posted by sydney on 8/10/2004 08:33:00 PM 1 comments

    Freedom of Choice: When I see stories like this:

    Later this week, the American Bar Association will consider a resolution introduced by its Section of Individual Rights and Responsibilities, which sets forth its opposition to government policies that interfere with the "ability of patients to access, in a timely manner, either directly or referral, medically appropriate care."

    ....It is this core exercise of religious conscience — and the government's accommodation of it — that the ABA finds so objectionable.

    .....No one at the ABA seems to see the irony in the fact that a resolution seeking to override the exercise of religious conscience by thousands of Catholic health care providers is being proposed by a committee devoted to the protection of "individual rights and responsibilities." Apparently, the free exercise of religion is not an individual right protected by that particular committee.

    And comments like this:

    National Journal quotes a trial lawyer at the Democratic convention: 'Oh, it's over the top. The stars lined up, absolutely. This is the absolute A-team.'

    The gentleman was talking about the Democratic ticket from the point of view of his profession.


    It makes me fear that four years of Kerry/Edwards will do more to destroy personal freedom than any other Administration in recent history.

    UPDATE: The American Bar Association withdrew their resolution.
     
    posted by sydney on 8/10/2004 08:00:00 PM 0 comments

    A Matter of Interpretation: Trial lawyers, radiologsits, and asbestos, my TechCentralStation column.
     
    posted by sydney on 8/10/2004 07:44:00 PM 0 comments

    Medical Blog Alert: Another medical blog, also by a family physician: Dr. B's Finest Kind Medical clinic and Fish Market. Don't miss his insect post, including a recipe for spider cake!
     
    posted by sydney on 8/10/2004 08:36:00 AM 0 comments

    Pluripotency: Stem cell research seems to have become a hot campaign topic, or at least embryonic stem cell research has. Yesterday, the Kerry/Edwards campaign issued a statesman-like statement on the subject:

    John Kerry and John Edwards are committed to scientific research based on fact, not ideology, and in the White House, will encourage the use of science and innovation to meet the challenges of the future, from job creation to medical breakthroughs to strengthening the American economy.

    “Today we mark a sad anniversary,” Edwards said. “But our focus isn’t on what happened three years ago - our focus is on what can happen for millions of Americans who have diseases and conditions that one day could be cured or abated by stem-cell therapy. Today is about what we can do to lift those roadblocks and allow science and compassion to do their work.”


    It sounds so reasoned. Who could object to the use of science to advance humanity? Well, Laura Bush for one:

    While Mr. Bush was appearing in Virginia, his wife, Laura, was addressing the Pennsylvania Medical Society in Langhorne, Pa., where she urged a cautious, go-slow policy on stem-cell research and declared that such research has ethical and moral implications "that must not be treated lightly."

    ...In her Pennsylvania appearance, Mrs. Bush said, "I hope that stem-cell research will yield cures," according to The Associated Press. "But I know that embryonic stem-cell research is very preliminary right now, and the implication that cures for Alzheimer's are around the corner is just not right. And it's really not fair to people who are watching a loved one suffer with this disease."


    Mrs. Bush is correct. There is no current research that suggests that stem cells of either variety - adult or embryonic - might provide hope for Alzheimer's patients. (They have been used for Parkinson's disease, on the other hand.)

    She's also correct about the larger issue - the importance of considering the possible consequences of our actions. Science doesn't operate in a vacuum. Just because science makes someting possible, doesn't mean that it should be done. Moral implications need to be taken into account. Even Einstein, an atheist, understood this:

    Concern for man himself must always constitute the chief objective of all technological effort -- concern for the big, unsolved problems of how to organize human work and the distribution of commodities in such a manner as to assure that the results of our scientific thinking may be a blessing to mankind, and not a curse.

    The area of disagreement in the embryonic stem cell debate is not whether or not stem cell research should advance. Research is still taking place with embryonic cell lines that already exist. The debate is about whether or not new embryos should be produced to make new cell lines. That means creating life with the sole intent of sacrificing it for science. We do that with lab animals, but is it not understandable that some of us reject the idea of doing that with human life?

    The other aspect of this debate that never gets mentioned in the papers or the campaign rhetoric, is that there are stem cells that can be obtained without sacrificing life to do it. They're called adult stem cells, and they've been more successful in treating disease than embryonic stem cells. The reason for their neglect in the stem cell campaign has a lot to do with the self-interest of researchers:

    British researchers editorialized in the February 2003 Journal of Cell Science that 'despite such irrefutable evidence of what is possible, a veritable chorus of detractors of adult-stem cell plasticity has emerged, some doubting its very existence, motivated perhaps by more than a little self-interest.

    (Michael Fumento has more on the issue here.)

    It may be that science is being misused here, but not by the Republicans.



     
    posted by sydney on 8/10/2004 08:25:00 AM 0 comments

    Monday, August 09, 2004

    Motivation: An English couple gave up smoking for the health of their parrot. The power of love.
     

    posted by sydney on 8/09/2004 09:07:00 PM 0 comments

    Safety First: ABC News wants you to have a safe vacation, but try not to be too neurotic about it.
     
    posted by sydney on 8/09/2004 09:04:00 PM 0 comments

    I Am Woman Hear Me Roar: From a reader:

    I wonder if I'm the only one, but after reading your blog for a couple of months, I never thought you were a woman! Only after reading your post about your experience with St. Jude did I get a hint that you were married to a man, which led me to believe that you were a woman. I guess I'm guilty of that awful stereotype that doctors are male until otherwise proven female. I'm confident I don't think male doctors are better than female doctors in any way. This reminds me of failing the brain teaser: A man and his son were in an automobile accident. The man died on the way to the hospital, but the boy was rushed into surgery. The emergency room surgeon said "I can't operate, that's my son!" How is this possible?

    Sorry about that.


    No need to apologize. Common misperception. It's the androgynous pseudonym.
     
    posted by sydney on 8/09/2004 08:48:00 PM 0 comments

    Sunday, August 08, 2004

    Mad Cows: Researchers say that they've found a second person who got mad cow disease from a blood transfusion. Well, he didn't really have mad cow disease. That is, he had no symptoms of it. What he did have was a history of having received blood from a person with known "mad cow" disease, or variant Crueztfeld-Jakob disease. He died of unrelated causes, but in the interest of science had a special autopsy to check for the prions that are associated with mad cow. They found the prions, but that doesn't necessarily mean he would have gotten the disease. The natural history of variant Crueztfeld-Jakob disease has yet to be fully understood. Science is still on the learning curve for this one.

    Still, you can't blame them for being cautious with the blood supply. Better safe than sorry. But I wouldn't lie awake worrying if you have had a blood transfusion in the past.
     

    posted by sydney on 8/08/2004 08:23:00 AM 0 comments

    Public Health Extremes: This story about giving British children vaccines against drug addiction reads like a Steven Glass story. But evidently, there really is research being done on this sort of thing, and there really is a Professor David Nutt. Yikes. What's next, a vaccine to make us all think like a public health professional?
     
    posted by sydney on 8/08/2004 08:00:00 AM 0 comments

    Medicine Garden Blogging: There's an interesting case study in this week's New England Journal of Medicine about a woman who mistook foxglove for dandelion greens (requires subscription), and ate them in her salad. Foxglove is one source of the modern heart medication, digoxin. It's very potent in its natural form, so she ended up in the hospital with cardiac toxicity. Other garden plants and animals produce a similar substances:

    In addition to foxglove, several other plant and herbal sources of cardiac glycosides may be detected by serum immunoassays for digoxin or digitoxin (as in this case), including woolly foxglove (Digitalis lanata), ornamental oleander (Nerium oleander), yellow oleander (Thevetia peruviana), squill or sea onion (Urginea maritima), lily of the valley (Convallaria majalis), and ouabain (Strophanthus gratus). Another source of cardiac glycosides is venom extracted from skin glands in certain species of toads (Bufo marinus and Bufo alvarius). This compound has turned up in some aphrodisiacs and Chinese medications (e.g., chan su). Ingestion may cause symptoms and clinical findings similar to those of digitalis overdose, and deaths have been reported.

    They may be natural, but they're still poisonous.

    ADDENDUM: More garden medicine here.
     
    posted by sydney on 8/08/2004 07:45:00 AM 0 comments

    Saintly Favors: One of my patients told me recently that she's been praying to Saint Odelia to preserve her eyesight. She said it in a sheepish way, as if she were afraid I'd think less of her for it. She doesn't know about me and St. Jude.

    I've never been one to pray to saints. It's too close to polytheism for the Baptist in me. But, I once had a brush with saintly intervention that has left me less skeptical. One winter day in Syracuse, my husband brushed the snow from his pants while clearing his car. His ring flew off his finger. We searched and searched for it to no avail. We were newly married, and I attached a great deal of importance to that ring, so its loss made me very sad. Every day before I got in my car, I'd scour the ground for it. Sometimes, one of my friends would also stop and help me look. No luck. Spring came, the snow melted, and still no ring. Summer went by, and my morning ritual continued, but still no ring. Then, one day in the fall, as my husband and I were getting in the car, he stopped, bent over, and came back up with his wedding ring. How we overlooked it all those months is beyond me. When I told my friend about our good luck, she smugly told me it wasn't luck. She'd been praying to St. Jude for us. Coincidence? Maybe. But after that, I found new comfort in the picture of St. Jude hanging from the resident call-room wall at the hospital. (St. Jude also has his own heart valve, but it's named after the company that makes it.)

    Praying to saints still doesn't come easy to me, but the few times I have, it's worked. To Mary on her feast day, for the safe delivery of one of my children. And to Saint Nicholas for an ill child. After that, it would be ungracious of me not to believe at least a little bit. Even if the research suggests that prayer is more like the fairies in Peter Pan, it works if you believe.

    UPDATE: Another experience with saints and wedding rings:

    I got a kick out of your St. Jude story - but I thought it was St. Anthony for lost things. I too lost my wedding ring. Scour the front yard where I knew I lost it. No luck.

    Later a co-worker said she would pray to St. Anthony - St. Anthony please come around something's lost and can't be found.

    It sounds too much like magic to me, but . . . that night when I got home right near the front steps was the ring in plain view.

    My wife and I often joke about the "fourth dimension" to explain those items that go missing and then mysteriously show up just where you were sure you looked.

    The world can be wondrous in its complexity.


    Yes, indeed, it can.
     
    posted by sydney on 8/08/2004 07:20:00 AM 0 comments

    This page is powered by Blogger, the easy way to update your web site.

    Main Page

    Ads

    Home   |   Archives

    Copyright 2006