"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
Political Research: Michael Fumento has more on the politics behind the Juvenile Diabetes Research Foundation. posted by Sydney on
3/12/2005 07:49:00 PM
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Medpundit Art History Lesson: Every age has its Paris Hiltons and Pamela Andersons, women who parlay their sexuality into a life of celebrity and fortune. These days, we hardly notice them. They're just another arm of the entertainement industry, their sex for sale to all of us. But in the days of Kitty Fisher, women with such talents had to peddle their wares to a much more limited - and privileged - clientele. And yet, they were no less famous or deprived of fortune than their modern counterparts. At least not Kitty Fisher.
Born in London to an emigre German cabinetmaker, Catherine Maria Fischer , or Kitty, began her professional life as an actress on the 18th century English stage and a favored model of the painter Sir Joshua Reynolds. But it was as a courtesan that she reached her highest, and most profitable, popularity. Cassanova claimed to have passed on her favors because her inability to speak French would make their intercourse less than pleasurable. He was a man, he said, who like to "have all my senses, including that of hearing, gratified." ( One suspects, however, that it was more likely he balked at her 100 pound fee, for which she was a stickler. She is said to have eaten a 50 pound note with bread and butter when given to her by the Duke of York, just to make a point. )
When the Irish portraitist, Nathaniel Hone painted her in 1765, she was at the height of her popularity. So much so that the she remained unnamed in the portrait's Society of Artists showing. Instead the catalog described her as a "lady whose charms are well known to the town." Lest there be any doubt of her identity, she sits coyly next to a kitty fishing in a goldfish bowl, itself a statement on the nature of her celebrity. Although difficult to see in this image, there's an ogling public reflected on its surface.
A few years earlier, and an ocean a way, a surgeon in the British Army sat in an encampment along the Hudson River, humming a popular ditty about Kitty Fisher to himself as he watched the colonial recruits who had joined the regular British Army to help fight the French and Indians:
Lucy Locket lost her pocket Kitty Fisher found it Not a bit of money in it, Only binding round it.
The surgeon, Richard Shuckburgh, was a man known on the New York frontier for his wit. As he sat watching the local yokels, the Kitty Fisher tune became:
Yankee Doodle came to town Upon a little pony He stuck a feather in his hat And called it Macaroni
. The rest rest is history. And all thanks to Kitty Fisher. Beat that Paris Hilton.
Alas, poor Kitty. She died two years after the portrait by Hone. Poisoned by the lead in her make-up. posted by Sydney on
3/12/2005 04:38:00 PM
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Wednesday, March 09, 2005
Women and Aspirin: Is it futile for women to take aspirin to prevent heart disease?
Until now, doctors have widely recommended low-dose Aspirin therapy for both genders, even though that advice was based on studies that mostly included men.
But when researchers tested Aspirin on nearly 40,000 women, they found the women who received a placebo were no more likely to have a first heart attack than those who regularly took Aspirin for 10 years.
The study (full pdf version here for free), however, was heavily skewed towards younger women, who are already at a low risk of heart attacks. Although the mean age of the participants was 54, 60% of them were younger than 54, 30% were between 55-65, and only 10% of them were over 65. And the study did find that aspirin reduced the risk of both heart attacks and strokes in this last group, which also happens to be the subset at highest risk for those ailments.
It could be that women who have heart attacks at young ages have some other factor responsible for their heart disease (like their genetic makeup) that isn't amenable to aspirin therapy, wherease elderly women have the same sort of coronary artery disease that men have, caused more by the effects of aging than anything else. And that it's this latter sort of heart disease that responds to aspirin therapy.
Moral of the Story: If you're an elderly post-menopausal woman with no history of prior heart disease, it's probably worth it to take one baby aspirin a day.
NOTE: Another criticism of the study is the dosage of aspirin therapy they used. Instead of studying the widely used 81mg of aspirin a day, the study used 100mg. The higher dose would mean a higher incidence of side effects from the drug, which in fact, the authors did report. A better study would have looked at the more commonly used dosage. posted by Sydney on
3/09/2005 08:41:00 AM
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Yet More Adventures in Computerized Medicine: Elsewhere, two articles in this week's JAMA cast a skeptical eye on the ability of computer systems to improve error rates. In the first, researchers took a look at one hospital's system and found many deficiencies. This description of the inadequacies of a computer system to deal with the realities of patient care is particularly revealing:
Nurses are required to record (chart) administration of medications contemporaneously. However, contemporaneous charting requires time when there is little time available. Computerized physician order entry systems compound this challenge considerably. To chart drug administrations, nurses must stop administering medications, find a terminal, log on, locate that patient’s record, and individually enter each medication’s administration time. If medications are not administered (eg, patient was out of the room), nurses must scroll through several additional screens to record the reason(s) for nonadministration.
Nurses reported that up to 60% of their medications are not recorded contemporaneously but are charted at shift end or post hoc by the nurse manager via global computer commands.
Many house staff, aware of recording inaccuracies, seek nurses to determine real administration times of time-sensitive drugs (eg, aminoglycosides). House staff reported that these additional steps are distracting and time-consuming. Interrupted ordering or medication reviews can increase error risks.
Moreover, because of cumbersome charting, some medications, especially insulin, are recorded on parallel systems (ie, paper chart, separate paper sheets, or directly in CPOE). Multiple systems cause confusion, and off-system information is sometimes lost.
Not all computer systems are created equally, and until you work with it, it's hard to tell how it will fit into any one style of practice or needs.
UPDATE: D'Oh. Forgot to mention the second study which found a paucity of proof that computerized systems improve patient outcomes:
Fifty-two trials assessed 1 or more patient outcomes, of which 7 trials (13%) reported improvements. posted by Sydney on
3/08/2005 10:10:00 PM
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More Adventures in Computerized Medicine: Hospital rounds have been taking more time than usual lately, not only because I've had more patients (the place is bursting at the seams with pneumonia and the like), but because I've been trying out the hospital's new wireless tablet PC's. In an effort to help us make our rounds faster, they hospital is supplying us with wireless tablets that let us tap into the hospital computer system to get patient information. At least, the hope is it will make our jobs easier and more effecient and thereby improve patient care. But, if I, and the sole other partaker of the tablets this weekend were any indication, that may be too much to hope.
It's not an unreasonable hope. The system brings up patient census lists, lab results, and even x-rays (the actual films, mind you, not just the reports.) Theoretically, doctors should be able to carry carry these little tablets from room to room, with the main page showing a list of the doctor's patients. Then, when he needs the lab or x-ray results, he just clicks the patient's name with the mouse-pen to pull up the latest reports. But someone in the IT department decided to set the tablets to hibernate after just the amount of time it takes to talk to and examine a patient (or to write a progress note), so that when you're ready to turn to the computer for information, it's booted you off the wireless network and you have to sign in all over again. To top it off, they hid the control panel so it's impossible to change the settings. Clever people.
I also found it physically awkward to juggle the tablet and the patient's chart, which I often had to do this weekend when paged in the middle of writing a progress note. But then, I find the design of the tablet PC in general awkward, and working with these made me glad I chose notebooks over tablets for my office. There's no easy way to enter information (such as user id's and passwords) into these tablets without rotating the screen around to face the keyboard. And then you have to rotate it again to transform it back to an easy-to-carry form. The mouse-pen, which is necessary when the screen is in tablet position, adds to the awkwardness. I found myself continuously switching back and forth between my conventional writing pen for the chart and the mouse-pen for the tablet. Of course, a lot of the awkwardness would be eliminated if the tablet replaced the hospital chart. That day may come, but it doesn't appear to be in the near future.
Unfortunately, the the tablets don't appear to have caught on with the staff. According to the sign-out sheet, only a handful of doctors have used them since they've been introduced. And in recent days, I've been the only one. This past weekend it was only myself and one of the gastroenterologists. He, too, found it slowed the progress of his rounds, even though he was already familiar with the system.
Part of the lack of enthusiasm is due to lack of communication. There hasn't been much of an effort to launch or promote the tablets, or to educate us on how to use them. My only tip off was an email a few weeks ago telling me the tablets were available. I never would have known about all the features of the system, or that I could get it installed on my office computer, if it weren't for the friendly gastroenterologist. (Of course, if I attended staff and department meetings with anything approaching regularity, I might know these things.) I suspect, however, that the biggest reason so few have elected to use the tablets is an unwillingness to experience the steep learning curve of learning to use new equipment and of adopting a new routine. It definitely slows you down, and who can afford that in the midst of flu season? posted by Sydney on
3/08/2005 10:07:00 PM
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