|
medpundit |
||
 |
 |
|
Saturday, May 11, 2002posted by Sydney on 5/11/2002 07:58:00 PM 0 comments
“While working as The New York Times' corporate physician, Dr. Horn said, company executives asked her to let them see patients' medical records even though she didn't have patient permission to share the confidential information. She also claims, in court documents, that the vice president for human resources told her to "misinform employees regarding whether injuries or illnesses they were suffering were work-related so as to curtail the number of workers' compensation claims filed against The Times." When she didn't comply, Dr. Horn said, she was fired.” They don’t even attempt to deny the accusation in their defense. Instead, they concentrate on whether or not the doctor has any right to sue them at all: “The newspaper argued -- and a minority of the court agreed -- that Dr. Horn shouldn't be allowed to bring a lawsuit because there is no right to do so under New York's at-will employment doctrine.” What’s more, judging from the court’s majortiy opinion, the Times argued that patient confidentiality isn’t an integral part of the medical professional code: "We must reject the Times' contention that confidentiality is not part of the professional code that is essential to the survival of the medical profession," the court said. "Indeed, the confidentiality rule that Dr. Horn refused to violate is a primary tenet of the medical profession and one of profound importance to patients and to the public." That's no way for a liberal newspaper to behave, especially one that has a history of championing patient confidentiality, as they do in this editorial on HIV testing. posted by Sydney on 5/11/2002 01:02:00 PM 0 comments
Both are AIDS drugs made by Glaxo, but Combivir costs about $200 more a bottle than Ziagen. The company has investigated and ruled out a bottling error at the factory. It looks like someone intentionally put Ziagen in a Combivir bottle to make some extra money. I suppose that was easier than manufacturing placebo to put in the bottles, and less likely to be detected than putting a really cheap drug in them like aspirin, or maybe they were just crooks with consciences who thought that putting another AIDS drug in the bottles would do no harm. If it was the latter, they were sadly mistaken. Both Combivir and Ziagen are in the same class of AIDS drugs called nucleoside reverse transcriptase inhibitors. They work by inhibiting or decreasing the replication of the AIDS virus in cells. ( For an illustration of the HIV life cycle and how the drugs interrupt it, click here.) Combivir is a combination of two different drugs in this class, zidovudine and lamivudine. Ziagen is the brand name for abacavir. One of the current treatment recommendations for HIV infection is to use Combivir and Ziagen together. If a patient received his real Ziagen as well as the Ziagen masquerading as Combivir, he would in reality be getting twice the dose of Ziagen, and thus be more likely to suffer its adverse effects, which can include death. Combivir is also recommended for treatment of pregnant HIV women and of their infants; Ziagen is not. It’s sad to see criminals branching out into the pharmaceutical industry this way. Why can’t they just content themselves with diet scams and insurance fraud? posted by Sydney on 5/11/2002 10:04:00 AM 0 comments
posted by Sydney on 5/11/2002 08:33:00 AM 0 comments
I know, I know. It’s supposed to help those who can’t talk for themselves, like the demented and the comatose, but still there’s something creepy about putting scannable information into a person’s body like this. The company also has plans to develop a chip that will use a GPS tracking system to locate lost people. The potential for abuse and misuse is phenomenal. It’s not hard to imagine chips like this being used to keep track of parolees, for example, or "deadbeat dads," or chips that include a person's criminal record or financial history as well as their medical history. It's just too Orwellian. posted by Sydney on 5/11/2002 08:26:00 AM 0 comments
posted by Sydney on 5/11/2002 08:17:00 AM 0 comments
posted by Sydney on 5/11/2002 08:14:00 AM 0 comments
“..that supplementing the Zone diet with omega-3 fatty acids commonly found in fish is the key to wellness. He adds that his book can reveal the status of your immune system and that fish oil can be used to correct any imbalances, fight disease and shed excess pounds. One of Sears' key claims, for example, is that fish oils can be used to control hormones, an important factor in attaining wellness. "Wellness has really been defined as hormonal balance," says Sears. "The better you can balance your hormones, the better well we are."” Omega-3 fatty acids are helpful in lowering cholesterol and may also be of benefit in arthritis, but there is no reason to believe that they are the miracle substance Dr. Sears seems to think they are. Quite frankly, we have very little knowledge about the role of hormones in “wellness,” if that wellness is defined as an overall sense of well-being. Our belief that the dysphoria of menopause or premenstrual syndrome is caused by “hormone imbalance” is largely just supposition and doesn’t rest on any hard scientific proof of the effect of hormones on the brain. We also have absolutely no idea how ingesting omega-3 fatty acids influences those hormone levels. That, too, rests on supposition. Sears is just hypothesizing. There’s nothing wrong with that, but he makes absurd conclusions on the basis of that hypothesis: “Sears maintains that through individual interpretation of blood tests — finding the ratio of fats called triglycerides to levels of "good" or HDL cholesterol, for example — one can determine how much fish oil they should be taking to obtain hormonal balance.” That’s just so much hooey, but then fiction always sells better than nonfiction, doesn’t it? posted by Sydney on 5/11/2002 07:59:00 AM 0 comments
Friday, May 10, 2002posted by Sydney on 5/10/2002 05:49:00 AM 0 comments
posted by Sydney on 5/10/2002 05:22:00 AM 0 comments
Meanwhile, Dr. Antinori, that mad Italian reproductive researcher, says his cloned babies continue to do well in various stages of pregnancy. One of his former colleagues, however, says the doctor is lying. Antinori does seem to change his story alot. First they were all in an Islamic country, now only one is in an Islamic country. He suggests the pregnant women are actually from the West, where reproductive cloning is frowned upon, but why would they stay in Russia and the Middle East once the clone was implanted? His story has too many holes in it to be believable. posted by Sydney on 5/10/2002 05:16:00 AM 0 comments
posted by Sydney on 5/10/2002 05:11:00 AM 0 comments
posted by Sydney on 5/10/2002 05:09:00 AM 0 comments
Thursday, May 09, 2002posted by Sydney on 5/09/2002 07:18:00 PM 0 comments
"Legislators in Vermont and California are considering taxing soda and junk food; anti-tax Texas has instead made physical education mandatory in elementary school; and this year schools in Pennsylvania and Florida sent warning letters home to the parents of overweight kids." The gist of the article is that the anti-fat zealots are modelling their campaign on the anti-tobacco movement and are urging the government to police our eating habits. Ms. Cottle makes an excellent argument against this: "What it comes down to, ultimately, is that our relationships to food are simply too complex for the government to oversee. People eat differently in New Orleans than they do in Berkeley. And they do so, for the most part, because they want to. Sure, we would be a healtheir society if everyone ate what they eat in Berkeley. But do we really want to live in a country where the government pressures us to do so? Health is only one measure of a good life, and government is far too crude a mechanism to effectively - or humanely - calibrate its importance for millions of different people." I'm not sure we'd be a healthier nation if we all ate like they do in Berkeley. All that fiber and lack of meat makes one gassy and anemic, and, judging by the reputation of Berkeleyites, a cantankerous liberal. The rest of her point, though, is on the mark. posted by Sydney on 5/09/2002 07:57:00 AM 0 comments
“I’d rather do this than have my teeth cleaned any day.” - Julie Tapley, 44, of Swainsboro, Ga., who goes for her Botox shots together with her mother, Shelba Youmans, 64. “It is very common for actresses to tell me, ‘Doctor, I have to do such and such a scene. If you do the injections the proper way, you can give them a natural expression without the little lines. They love that. They want to look expressive, but not that intense.” -Ezra Kest, a Beverly Hills dermatologist "Two or three faint pinches on each side of my eyes, and I’m done. That’s it—no stinging, no soreness."-Newsweek reporter Ana Figueroa I have to say, I’m 36, and now I have 22-year-old men hitting on me. The rest of it is there, you know. I exercise. I’m thin. But my face made me feel very bad...The pain is really no big deal. You’re not going to sit there and cry. I’m tough, I admit, but it’s no biggie....My friends all notice. Everyone notices. I have women come up to me everyday now and tell me I’m beautiful. People at the gym, at church, everywhere.”-Dallas mother and Botox enthusiast, Whitney Enoksen. Testimonials like that will do far more for the promotion of Botox than any ad campaign could do. Surely Newsweek's editors are aware of that. posted by Sydney on 5/09/2002 06:03:00 AM 0 comments
In the early days of our current system, residents weren't paid at all. They were given room and board in exchange for their training. That's why they were called "residents." They were the doctors who lived at the hospital. When you finish medical school you can't yet practice medicine on your own. It's in residency where you really learn to practice medicine, medical school only gives you the basic ground work, and the incoming residents are dependent on the hospitals for that training. Medical licenses aren't even granted until the successful completion of the first year of residency. In truth, the hospitals would be justified in charging them tuition. The lawsuit also comes at a time when graduate training programs are vulnerable to financial pressures, and, if successful, it could be devastating to our current system. Training programs are heavily dependent on Medicaid and Medicare for their financial reimbursement, and with these being cut many of them are on financial tenterhooks. These guys should be careful what they ask for, they just might get it; and in the process eliminate their positions completely. posted by Sydney on 5/09/2002 04:45:00 AM 0 comments
Wednesday, May 08, 2002posted by Sydney on 5/08/2002 06:46:00 AM 0 comments
The difference in intelligence between breast and bottle fed infants once they reached adulthood, however, wasn’t all that great. According to the JAMA article, the differences in intelligence test scores were as follows: “Full Scale WAIS (Wechsler Adult Intelligence Scale) IQs were 99.4, 101.7, 102.3, 106.0, and 104.0 for breastfeeding durations of less than 1 month, 2 to 3 months, 4 to 6 months, 7 to 9 months, and more than 9 months, respectively (P = .003 for overall F test).” So, if your mom breast feeds you for nine months, but not more, you might have on average about seven more points on an intelligence scale. We’re not exactly talking the difference between morons and geniuses here. I don’t object to breast feeding. Breast milk, after all, is designed to feed a human infant and infant formula makes a valiant attempt to reproduce breast milk as closely as possible. What I do object to, however, is the tendency for breast feeding advocates to overglorify and oversell it to the point that a new mother feels like a failure if she fails to live up to their expectations. I can’t tell you how often I’ve sat with a woman in my office in tears because she’s convinced she’s let her baby down by being unable to breast feed successfully. The truth is, babies on formula do just as well. They thrive, and grow, and do well in school and go on to live productive lives. The advantage to breast feeding over formula both socially and medically is only statistically significant, not truly significant. posted by Sydney on 5/08/2002 06:42:00 AM 0 comments
posted by Sydney on 5/08/2002 06:40:00 AM 0 comments
Tuesday, May 07, 2002"A delegation from the British Medical Association was at the EFMA meeting. The representation of events in your article is inaccurate. A statement on the Israeli- Palestinian conflict was tabled at the meeting, having not been circulated to delegates beforehand. The British delegation suggested amendments to be made to the statement, which were discussed and agreed with our colleagues from the Israel Medical Association. It was agreed that these made it more consistent with international law and ethics, and our understanding was that we had reached an amicable compromise." Some sort of resolution was clearly being considered that had to be debated and amended. Furthermore, the Post had this update on the WMA on May 5: "In a resolution at its council meeting in France today, the WMA, which represents 80 million doctors around the world, stressed the need to achieve a balance between the assurance of the delivery of services and security need, and called on those in positions of authority to place the interests of patients at the center of decision- making. Israel Medical Association chair, Dr. Yoram Blachar, and its ethics committee chair, Prof. Avinoam Reches, said they consider the resolution a great accomplishment for Israel and the IMA. They said they had been concerned the IMA would be suspended from the organization." Me thinks the WMA was protesting too much on its web site. I guess 20,000 angry emails a day got them thinking about their position. The power of the internet is just plain amazing. As for the WMA, it will be a very long time before I trust them again. posted by Sydney on 5/07/2002 08:18:00 AM 0 comments
"During April 2002 an article appeared in the Jerusalem Post citing that the WMA was to consider expelling the Israel Medical Association because of their inability to help solve the Middle East conflict. This statement was a complete hoax, with no basis of truth. Since then the WMA has received up to 20 000 e-mail messages per day to protest against this plan. THe WMA Secretary-General, Dr. Delon Human, stated: "The WMA has received no request whatsoever for the Israel Medical Association to be expelled. As responsible leaders of the global medical community, we do however want to analyze, in detail, the violations of human rights to our physician colleagues and patients, on both sides, and then do something about it." The WMA council will meet from 2 to 5 May 2002 to discuss the medical aspects of the crisis in the Middle East, amongst other issues." They also go on to condemn the use of ambulances as bomb conveyances. I'm glad to hear that it was a hoax. The story shook my confidence in the integrity of my profession. I'm sorry, though, that I was taken in by the Jerusalem Post article. I thought it was a reliable newspaper. posted by Sydney on 5/07/2002 07:12:00 AM 0 comments
posted by Sydney on 5/07/2002 06:55:00 AM 0 comments
For more detailed information about the human genome, try the Online Mendelian Inheritance in Man site. It lists the gene locus for a variety of conditions, gives a synopsis of the condition and what's known about its genes and inheritance patterns, and shows you where on the human chromosome the gene appears. Search for “eye color”, for example, and it will tell you the gene responsible for eye color as well as give you a rundown on the basic genetics of eye color inheritance. Click on the gene locus and it takes you to a map of the chromosome with that gene highlighted. You can also, of course, look up diseases. I did a search for “hypophosphatasia” and found a nice, concise synopsis of it that's far better than anything I can find in a traditional textbook, complete with links to references. The last time I looked up this condition was about seven years ago. I had to do a Medline search then hunt down the individual articles and come up with my own synopsis. It was very time consuming. Now, all of that can be had at the click of a mouse. I just love what the internet is doing for information dispersal. posted by Sydney on 5/07/2002 06:43:00 AM 0 comments
posted by Sydney on 5/07/2002 06:41:00 AM 0 comments
“Research by doctors in Israel found heavy drinkers - those who drank more than 14 cups of tea a week - had a 44% lower death rate than non-tea drinkers in the three and a half years following their heart attacks. Moderate tea drinkers - those who consumed less than 15 cups a week - had a 28% lower rate of dying over the same period, according to the study, published in the journal Circulation. Dr Kenneth Mukamal and colleague's at the Beth Israel Deaconess Medical Centre in Boston, US, examined 1,900 people, mainly in their 60s, who had suffered a heart attack. The patients were interviewed on average four days after their attack and asked how much tea they consumed. Some 1,019 were categorised as non-tea drinkers, 615 were moderate drinkers 266 were considered heavy drinkers. The patients were followed up almost four years later, by which time 313 had died mainly from heart disease. The researchers found that the less tea the patients drank the more likely they were to have died during the period. There was little difference between patients in terms of education, income, and their exercise, smoking and drinking habits, which could generally be responsible for variations in mortality rates.” Unfortunately, I couldn’t access the article from Circulation without paying for it. I’ll have to wait for it to come out in my local hospital library, but the abstract didn’t give much more information than the BBC piece. I have to wonder if the difference in mortality is truly significant, however, given the large disparity in numbers between non-tea drinkers and tea drinkers. The relatively small numbers of heavy tea drinkers can make their survival rates seem more significant than they truly are. The actual numbers may not turn out to be as impressive as the authors make them sound. Of course, even if tea is good for your heart, you can get too much of a good thing, as shown by this case study of a man who was excessively fond of his tea: "A 44-year-old man presented in May, 2001, with muscle cramps. He had no medical history of note, but volunteered the fact that he had been drinking up to 4 L of black tea per day over the past 25 years. His preferred brand was GoldTeefix (Tekanne, Salzburg, Austria). Since this type of tea had given him occasional gastric pain, he changed to Earl Grey (Twinings & Company, London, UK), which he thought would be less harmful to his stomach. 1 week after the change, he noticed repeated muscle cramps for some seconds in his right foot. The longer he drank Earl Grey tea, the more intense the muscle cramps became. After 3 weeks, they also occurred in the left foot. After 5 weeks, muscle cramps had spread towards the hands and the right calf. Occasionally, he observed fasciculations of the right adductor pollicis and gastrocnemius. Additionally, he noted distal paraesthesias in all limbs, and a feeling of pressure in his eyes, associated with blurred vision, particularly in darkness." He cut his tea back to one liter a day and did much better. No report on how healthy his heart is. posted by Sydney on 5/07/2002 06:31:00 AM 0 comments
Monday, May 06, 2002posted by Sydney on 5/06/2002 07:46:00 AM 0 comments
Doctor Ogden’s story is a good one, and it’s told well and fairly by Michael Winerip, the reporter. He started his practice in the 1970’s in a small town in western New York state, and was very successful. Unfortunately, he never learned to limit his obligations and save time for himself and his family. His response to the pressure was to drink himself into oblivion every night. Even more unfortunately, when you’re the doctor in a small town, emergency calls can’t be avoided at night. He got into big trouble after the death of a baby he delivered, and a concerned nurse reported his drinking to the state medical board. The story is told in a fair and balanced way, unusual for these kinds of reports. Ulitimately, it’s a story of redemption. The doctor’s license was suspended for a year; a year which he used to get his priorities straight and to stop drinking. He gave up medical practice altogether and is now the town’s health commissioner. The people of the town all seem to have forgiven him, and he seems quite happy to be out of the rat race. Doctor Levine’s story is the story of a young doctor headed down the same path of limitless obligations, but the solution he’s considering is to join a boutique medical practice where he can see only two or three patients a day for an exorbitant fee. When you read about Dr. Levine, it’s clear that he has overextended himself and needs to pull back. He has a panel of 4,000 patients (most physicians agree that a manageable number for one doctor is around 3,000), and he begins his day at 6:45 in the office doing paperwork. That’s a full two hours and fifteen minutes before the first patient even walks through the door. After he sees the last patient of the day, he spends another two to three hours answering phone calls and doing more paperwork. When I read about his day, it becomes clear that he needs to learn to delegate. Many of those phone calls could be done by a medical assistant or a nurse. His office, however, has invested in a computerized phone message and office record system that actually takes up more of his time (and overhead) than he probably realizes. His phone messages are all converted to e-mail which only he can answer, rather than put on a piece of paper that he could write an answer on to be relayed by his nurse. His medical records are on his computer, so he has to go back to his desk and enter the information rather than jotting it down on a paper chart while he’s in the room. As for all of those forms he has to fill out, that, too, could be done by an office assistant. It’s no wonder Dr. Levine is burned out at such a young age. He defintely needs to cut back, but he doesn’t have to forsake his principles to do that. He just needs to set some boundaries for himself. This is true for all of us, of course, regardless of profession, but doctors are at greater risk because we convince ourselves that we need to serve selflessly and without limits. It just isn't humanly possible, however, to be all things to all people, and we do no one any favors when we push ourselves past our limits, least of all our patients. posted by Sydney on 5/06/2002 07:20:00 AM 0 comments
Tommy Thompson evidently feels this way. He's scheming to get us all to practice good health habits. He doesn't know yet how he's going to do it, but by God, he'll find some way to get us all to eat right, exercise regularly, and otherwise remove every pleasurable vice from our lives. He wants the insurance companies to help him do it, too. Evidently, he’s a man with a mission: "For the 60-year-old Thompson, whose father had diabetes and died of a heart attack at age 61, the message that "a little prevention won't kill you" has had a sense of personal urgency. So he has led by example, dropping eight pounds since January and planning to lose at least two more. He has challenged his staff of 65,000 to do the same. His cholesterol, once as high as 300, is now 183. He has stopped eating late at night, cut back on starches and increased his servings of fruits and vegetables. This week, he ran nine-minute miles in the 3-mile Capital Challenge race. " They say there's nothing worse than a reformed smoker. Looks like there is at least one thing worse - a reformed overeater who happens to be the Secretary of Health and Human Services. posted by Sydney on 5/06/2002 06:46:00 AM 0 comments
Sunday, May 05, 2002posted by Sydney on 5/05/2002 05:32:00 PM 0 comments
“Children on the autistic spectrum, however, are "mind blind"; they appear to think that what is in their mind is identical to what is in everyone else's mind and that how they feel is how everyone else feels. The notion that other people — parents, playmates, teachers — may take a different view of things, that they may harbor concealed motives or duplicitous thoughts, does not readily occur. "It took the longest time for Tommy to tell a lie," recalls Pam Barrett, and when he finally did, she inwardly cheered.” She cheered because he lied? What's wrong with her? The “notion that other people..may take a different view of things, that they may harbor concealed motives or duplicitious thoughts” does not occur “readily” to any child. This is something we all learn as we grow older and get knocked about by the world. It isn’t merely a part of the “autistic spectrum,” it’s part of the spectrum of all human behavior. This is fundamentally what’s wrong with calling Asperger syndrome (also known as "mild autism" or the "geek syndrome") a disease. All human behavior falls along a spectrum of normal to abnormal. The question is, what’s truly abnormal and thus worthy of the “disease” label? Asperger syndrome surely isn’t. Those who can be categorized as having it live healthy, successful, productive lives. We should think twice before shutting down their beautiful minds, whether with medication, genetic engineering, or behavioral therapy, just because they don’t fit some arbitrary definition of normal. As for the explosion of cases of autism, that, too, is a myth. The incidence of autism isn't expanding, only our definition of it is. This may seem like trivial semantics, but by exaggerating the prevalence of a condition, lobbying groups like the Autism Society of America can get public money diverted from more worthy causes into their own coffers. This is just plain irresponsible. It's also irresponsible to try to pin blame for this pseudoepidemic on a childhood vaccine that has done much to decrease morbidity and mortality in childhood, the measles, mumps and rubella vaccine. There is absolutely no evidence that the vaccine is related in anyway to autism. It just happens to be a vaccine that is given at the time when children begin to interact with the world in any meaningful way, and so when any deviations from normal behavior would be noticed. Time hasn't done anyone any favors with this article. posted by Sydney on 5/05/2002 02:04:00 PM 0 comments
"I support regenerative medicine research because I believe that human life requires and begins in a mother's nurturing womb, not in a petri dish. As I considered the ethical appropriateness of nuclear transplantation in regenerative medicine research, two facts stood out. The egg (with its nucleus removed) is never fertilized with sperm. And, the resulting unfertilized, electrically "activated" embryo will not be implanted into a woman's womb (or any type of artificial womb that may be developed some day) so there is no chance of a birth." This makes no sense, and it undermines the Senator's own pro-life, anti-abortion stance. An aborted embryo never has a chance for birth, either, but he considers that life worthy of protection. He seems to believe life only counts as life if it is conceived in the usual way and allowed to develop in a uterus. This is clearly wrong. It doesn't matter where the chromosomes come from or how they get placed in the egg, or where they develop. If you believe that life begins at conception, as Senator Hatch does, then any egg with a full set of human chromosomes is life. It’s a little baffling to hear Senator Hatch change his tune in such a convoluted argument. That is, it’s baffling until you realize that his second biggest source of campaign money is the pharmaceutical industry, which stands to profit from therapuetic cloning. posted by Sydney on 5/05/2002 11:54:00 AM 0 comments
"I will do a detailed examination of my genetic code and use that as a basis of writing my book on genomics," he said." Oh joy. posted by Sydney on 5/05/2002 11:08:00 AM 0 comments
|
|
