"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
Other West Nile News: The link between West Nile and blood transfusions begins to look plausible, and the Califronia case is confirmed. As more cases of the virus are documented, the news frenzy is reaching new heights. But the wildlife pathologist who first identified the virus in New York in 1999 reminds us that this sort of outbreak is really no surprise:
"I predicted it would be about four years," he said, noting that the disease never really went away after the 1999 outbreak but has been slowly spreading and incubating every summer.
By next year we’ll be so blase about this it won’t even be an issue, aside from screening the blood supply and testing for it in puzzling cases of critical illness. posted by Sydney on
9/14/2002 08:40:00 AM
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A Senator of Very Little Brain: Patrick Leahy thinks West Nile virus is a bioterror threat and wants authorities to investigate it:
"I think we have to ask ourselves: Is it a coincidence that we are seeing such an increase in West Nile virus, or is that something that is being tested as a biological weapon against us?"
Sounds like he’s been watching too many Bugs Bunny cartoons:
Of Thee I Sting, 1946
A battalion of mosquitoes is shown training for its mission, taking off from a sardine-can aircraft carrier, attacking and defeating a well-defended farmer, and then crash landing in the water.
Considering that the virus is less fatal than influenza, and that it can only be transmitted by mosquitoes, it’s a very poor choice for a bioterrorist agent. What did those terrorists do, unleash a bunch of infected mosquitoes in the swamps of Louisiana? Let’s hope Senator Dr. Frist sets his colleagues straight on the matter so tax dollars and manpower hours aren’t misspent tracking down terrorism links to West Nile. posted by Sydney on
9/14/2002 08:04:00 AM
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Doctors of Very Little Brain: Three medical students of Middle Eastern descent make a joke (so they claim) about blowing up something in Miami, and so ruin their careers before they start; and an American physician, for whom the personal is political, writes a letter defending Saudi Arabia (via Moira Breen):
I lived in Saudi Arabia for nearly two years, working as a physician. I was treated with nothing but respect and kindness by every Saudi with whom I came in contact. If there is hatred in Saudi Arabia for Americans, it is well concealed.
All of which just goes to show, you don’t have to be a rocket scientist, or even a cogent thinker, to go to medical school.
UPDATE: The medical students now claim they never said a word about blowing up anything, not even in jest. posted by Sydney on
9/14/2002 07:48:00 AM
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Celebrity Medical Watch: Warren Zevon, whose symbol on all of his records since 1986 has been a smoking skull, has terminal lung cancer. I’m not a great fan of his, but I am fond of his Life'll Kill Ya disc. I like to listen to it while I’m doing paper work. “My Sh***’s F****ed Up” is one of my favorites. It’s a line I’ve often been tempted, but never dared, to use on a patient. The last song on the CD, “Don’t Let Us Get Sick”, is a poignant prayer for a gentle old age, and also highly recommended.
Celebrity Medical Watch II: Christopher Reeve's miracle via electrical nerve stimulation. You have to hand it to him for sticking so doggedly to a research trial that has had so little overt success. He’s the only one who has shown any progress, if I read the story correctly. posted by Sydney on
9/14/2002 07:43:00 AM
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Friday, September 13, 2002
One Drug's Story: The British Medical Journal is reporting that some members of an FDA advisory panel on Lotronex, the drug for irritable bowel that was approved, pulled, and reapproved, are accusing the FDA of drug company favoritism. One member, Dr. Paul Stolley, who is also a member of the Naderite group Public Citizen, gives the details of the re-approval process:
Three days later Stolley and three colleagues sent a 20-page memo to the director of the gastrointestinal division, warning that a "risk management" plan, the option favoured by the company, would not stop the rising toll of "deaths, colectomies, ischemic colitis, and complications of treatment that were never seen previously in the management of irritable bowel syndrome." The memo refuted the company's argument that controlling constipation among patients taking the drug would "manage the risk" of serious adverse events, including ischaemic colitis.
On 28th November the company and the regulator met again. Stolley's notes on the meeting record company officials aggressively attacking the 16th November memo as being "crappy" and full of errors, while senior FDA officials sat by and failed to defend their staff. "What message is this sending to young epidemiologists?" he asks. "In my opinion it is sending the message that we don't argue with drug companies; we listen to their distortions and omissions of evidence and we do nothing about it."
...According to Stolley, other staff concerned about the drug's harms were also urged to "help get this drug back on the market," and one of the most senior experts on drug safety was explicitly told not to work on alosetron. Internal emails from the time, published elsewhere, seem to support Stolley's suspicions of an unhealthy closeness between senior officials at the FDA, including Woodcock, and senior officials at the company. Both the company and Woodcock reject that dealings were unhealthy, and both argue they were motivated by a desire to help patients. "The FDA had to work with the company in order to facilitate the drug's availability," said Woodcock.
The FDA had to facilitate the drug’s availability? That isn’t the FDA’s job. The FDA’s job is to make sure the drug is safe and effective, and worthy of being brought to market. This doesn’t look good for the FDA. Irritable bowel syndrome is a benign condition. Left to run it's normal course, it can be very inconvenient, but never life threatening. The drug in question, however, is life threatening. It makes no sense to use a drug that does more harm than the condition it's used to treat. The argument that the drug company and irritable bowel activists have used to bring the drug back is that it should be used compassionately for those who are severely inconvenienced by their symptoms. That seemed like a reasonable argument, but after reading the BMJ's account, it seems like a con.
The FDA relies on the drug companies to give them extra money so we the taxpayers don’t have to fund all of their activities. This, along with pressure of activist groups (some of whom are also funded by drug companies), is corrupting the system. It would be far better for us if our Congress gave the FDA the money they needed to do their job instead of doling out cash for autism and obesity. posted by Sydney on
9/13/2002 08:25:00 AM
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Antibiotic Resistance Update: The FDA is turning their attention to antibiotics in animal feed, a potential cause of antibiotic resistance in bacteria resident in our bodies:
The proposal outlined by the FDA on Wednesday suggests procedures drug manufacturers could use to determine whether new animal antibiotics would contribute to the escalating problem of drug-resistant bacteria.
The agency said humans are most likely exposed to resistant bacteria through animals produced for food. Environmental groups said the statement shows the agency is acknowledging that animal antibiotics are overused and are a health risk.
FDA spokesman Larry Bachorik said the agency isn't making conclusions, but wants to assess whether using drugs on farm animals is a health risk to humans.
There have been recent studies to suggest that resistant organisms from animals are transmitted to people when we ingest them. Resistant strains of salmonella have been found in grocery store ground meat, and resistant strains of enterococci have shown up in the stool of people who ate chicken, and pork that contained the resistant organisms. Once in the gut, the resistant bacteria have the potential to share their resistant genes with other gut bacteria, making the threat of growing antibiotic resistance a real one that goes well beyond the visiting chicken, pork, and beef bacteria. (Yes, even bacteria have sex.) posted by Sydney on
9/13/2002 08:24:00 AM
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Life and Death in America:We're living longer than ever, up to an average of 76.9 years. Some reasons for the increased longevity:
Infant mortality: The portion of babies dying before their first birthday hit a record low in 2000, reaching 6.9 per 1,000 live births. That rate has fallen 75 percent since 1950.
Young deaths: Mortality among children and young adults, between 1 and 24 years old, declined by more than half since 1950. Researchers credited drops in death rates in accidents, cancer, heart disease and infectious diseases. Homicide and suicide rates generally increased over the half century, though they have been falling since the mid-1990s.
Adults: Death among adults ages 25 to 44 declined by more than 40 percent between 1950 and 1999. During the mid-1990s, HIV was the leading cause of death for this age group, but these rates have fallen significantly.
Older adults: Mortality among adults ages 45 to 64 fell by nearly 50 percent, including drops in heart disease, stroke and injury. Cancer is the leading cause of death in this group, and those death rates rose slowly through the 1980s and then began to decline.
Heart disease: Much of the improvement in life expectancy is traced to falling heart disease rates. In 1950, just over 585 people in the United States developed heart disease for every 100,000. By 1999, that had been more than cut in half, falling to just under 268 people per 100,000.
Stroke: In 1950, nearly 181 of every 100,000 people died of stroke and other cerebrovascular disease. By 1999, it was just 62 per 100,000.
The report says that deaths from diabetes and the incidence of diabetes are going up, and blames it on obesity. But, if the incidence of strokes and heart attacks is going down, it could be that the diabetics are no longer dying from these diseases at the high rates of the past, leaving them free to die of diabetes instead. The rising incidence of diabetes could be because we’re fatter, but it could also be because we’re getting older. Never fear, though, the health activists will be sure to use the numbers to get more funding for obesity programs and obesity research. posted by Sydney on
9/13/2002 07:17:00 AM
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Thursday, September 12, 2002
Eye of the Beholder II: Same studies, different results:
The two studies are in The New England Journal of Medicine this morning. They’re both from Sweden. They both compare “watchful waiting” of prostate cancer to radical prostatectomy. One looks at mortality, the other at
quality of life. Overall mortality was the same, regardless of the approach, although more men died of prostate cancer in the watchful waiting group. Quality of life was the same in both groups, too, although there was a higher incidence of impotence in the radical prostatectomy group. Looks like it’s a toss-up. posted by Sydney on
9/12/2002 08:52:00 AM
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Hubristic Psyche: The arrogance of the mental health profession was on full display in yesterday’s New York Times. In the days after September 11, 2001, many of them rushed to the scene to offer their services for “emergency counseling,” but found few takers:
In the 48 hours after the attacks on the World Trade Center, the phones at Lifenet, the 24-hour referral hot line run by the Mental Health Association of New York, were unusually quiet.
...Yet as many trauma experts had also predicted, in the early days of the crisis, psychiatric emergency rooms and clinics remained largely unused, and volunteers found themselves with little to do.
And most telling:
... But in some cases, counseling was pushed rather than offered. And there was no good way for the public to tell what would be helpful and what would not.
You don’t have to be trained in traumatic psychology to know what to do with someone in the immediate aftermath of a trauma. You only have to be human. You listen, you hold a hand, give a hug, a cup of coffee, share a tear, offer a tissue, whatever the moment calls for. And the "public" doesn't need mental health professionals to tell them what they need. Distress is not pathology. It can't be talked away in the immediate aftermath of a devastating event. It’s about time for the mental health profession to get down from their high horse and join the rest of humanity. They act as if they’re an association of demi-gods who hold the keys to happiness, when in fact they are the the largest collection of asses to be found. They may have convinced themselves that they were all rushing down there to help others, but the truth is they were rushing down there to help themselves. It was their way of dealing with their psychic trauma.
Meanwhile, surveys have shown that the incidence of major psychiatric illnesses, even among those most affected by the attacks, are smaller than expected. Experience apparently bears this research out:
Therapists in private practice report little increase in their patient loads. The New York Academy of Medicine researchers found only a very slight bump in the number of New Yorkers who reported having seen a mental health professional — from 16.9 percent before the attacks to 19.4 percent five to eight weeks afterward. People with post-traumatic stress disorder or depression were more likely to have increased their use of mental health services, the survey found.
"But the increase was not clinically significant," said Dr. Joseph A. Boscarino, a senior scientist at the academy. "We expected higher use rates.".
Yet the mental health professionals still insist on their own importance in times of national crisis:
Because of this, disaster experts argue, mental health — both in the broadest sense of comforting anxious citizens and in its narrower definition of treating psychiatric casualties — must play a central role in the government's planning.
First things first. The central role in the government’s planning for disasters should be insuring physical well-being: treating the wounded, and providing clean water, food, and shelter. The counseling can come later for those who need it and want it. You can't heal the soul while the body's still sick and miserable, or worse, dead. posted by Sydney on
9/12/2002 07:33:00 AM
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Bodily Humors: Illness as comedy. The comedian claims he gets no therapuetic benefit out of making light of his illness, but I bet he does, and there’s nothing wrong with that. Humor won’t always cure you, but it can help you cope. "Each patient carries his own doctor within him," as Albert Schweitzer once said. posted by Sydney on
9/12/2002 07:30:00 AM
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Eye of the Beholder: Even seemingly objective direct observation can be influenced by bias. As evidence, consider the case of the Venus and the astronomer. At the turn of the last century, astronomer Percival Lowell turned his telescope on Venus. To see it better, he reduced the aperture of his scope to less than three inches. He was the only astronomer to describe a series of channels on the planet similar to those seen on Mars. Strangely, the channels never moved. This didn’t jibe with current planetary knowledge. Different spots on Venus should be visible from the earth at different times since both planets are orbiting around the sun at different rates. No problem. He theorized that Venus and Earth were in synchronous orbit around the sun. His colleagues ridiculed him, but he persisted. It turns out, though, that by narrowing the aperture of his telescope, he turned it into an ophthalmoscope. He wasn’t looking at Venus, but at the retina of his own eye. posted by Sydney on
9/12/2002 07:10:00 AM
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In Remembrance: This isn’t even remotely about medicine. It’s just some thoughts on September 11. Last Sunday, our church had the American flag at the altar. The last time the flag stood there was the Sunday immediately after 9/11. That first Sunday, the church was filled to such a capacity as is usually only seen on Christmas Eve. We all sat there, waiting for words of comfort. What we heard was a homily that emphasized the importance of peace and of turning the other cheek. Then, at the end of the service, after the recession had ended and the last chord of the last hymn sounded, the pianist broke out into a spontaneous rendition of “God Bless America.” Everyone started singing. Even people who were on their way out the door turned around and returned to the pews to sing the entire song. Our priest might not have had the appropriate response, but the rest of us did.
This year, we have a different priest, and this year we got the homily we should have had last year. It was based on the verse from Matthew, “For where two or three are gathered together in my name, there am I in the midst of them.” The priest reminded us that God never promised us a world without pain and suffering. We don’t live in paradise, after all. He only promised to be with us always, our comfort and our hope - our comfort and our hope that there’s a better world in the life to come. That “life to come” doesn’t necessarily have to be the afterlife. It can mean the life to come in this world, too. Maybe, in the grander scheme of things, the events of 9/11 and whatever wars they spawn, are a movement towards that better life - toward the elimination of despotism and tyranny, and toward a universal recognition of the rights of man. You don’t have to believe in God to find hope and comfort in that idea. I’ll leave you, as a final homage to 9/11, with the words of a an old Shaker hymn that expresses it far better than I ever could:
My life flows on in endless song
Above earth's lamentations,
I hear the real, though far-off hymn
That hails a new creation.
Through all the tumult and the strife
I hear it's music ringing,
It sounds an echo in my soul.
How can I keep from singing?
While though the tempest loudly roars,
I hear the truth, it liveth.
And though the darkness 'round me close,
Songs in the night it giveth.
No storm can shake my inmost calm,
While to that rock I'm clinging.
Since love is lord of heaven and earth
How can I keep from singing?
When tyrants tremble sick with fear
And hear their death knell ringing,
When friends rejoice both far and near
How can I keep from singing? posted by Sydney on
9/11/2002 06:04:00 AM
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Resilience: Researchers in New York are surprised at how quickly people in the city overcame their shock and distress:
In the month after the devastation of Sept. 11, researchers with the Academy of Medicine found that an estimated 449,000 people reported symptoms of post-traumatic stress disorder.
Yesterday, Dr. David Vlahov, an epidemiologist with the academy, said a more recent survey found that some 90,000 cases of post-traumatic stress disorder still exist among city residents.
"We were somewhat surprised with the rate that these cases decreased," Vlahov said. "We're not sure why that happened and it's something we're still trying to figure out.
Public Health and 9/11: The CDC announced this week that the Morbidity and Mortality Weekly Report, their newsletter on disease trends, will be published published more frequently if necessary, to provide needed information in event of a bioterrorist attack. They also have coined new diagnosis codes to track mortality and morbidity from terrorism. Before September 11, 2001, victims of terrorism were lumped together as homicides. Now, they have their own designations, one “for terrorism involving an assault (homicide)” and “another for terrorism involving intentional self-harm (suicide).” The entire issue of MMWR this week is devoted to Sept. 11, including the final death toll.
posted by Sydney on
9/11/2002 05:55:00 AM
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Changing the CDC: The CDC says it's trying to adapt to the new public health priorities:
Over the past year, the C.D.C. has funneled $914 million from its parent agency, the Department of Health and Human Services, to state and local health departments, nearly 10 times as much as the agency said it disbursed the year before. The money is being used to upgrade disease surveillance systems, improve communication with local doctors and hospitals and bolster the ability of a network of laboratories throughout the country to detect the microbes considered most likely to be used in a bioterrorist attack.
The fruits of this spending aren’t yet visible in our community. I still have the same memo I got about two weeks after the anthrax attacks with phone numbers to call if I have a suspicious case. The last newsletter from our public health department was about the same old stuff - teen pregnancy, sexually transmitted diseases, and WIC, influenza vaccines, with no mention at all of bioterror. Each of those topics are important services our health department provides to people with very little money, but it seems odd that they haven’t even mentioned bioterror preparedness. It deserves at least a little blurb in this day and age. posted by Sydney on
9/10/2002 06:07:00 AM
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Vaccinia Today: Those who argue that smallpox vaccine is too dangerous to use for voluntary mass immunization, fear that it would be too risky for the unsuspecting immunocompromised. They could get complications merely from being exposed to the vaccinated. Yet health departments are dropping oatcakes full of it on people's land to prevent rabies in racoons:
It's best to avoid contact with the vaccine, Horman said, because it is composed of a live, genetically modified vaccinia virus, the same virus used to create the smallpox vaccines routinely administered to schoolchildren before 1972.
Health authorities said there is a small risk of a skin infection similar to smallpox vaccination sores.
"Millions have been used without serious health effects," he said, "but we still don't want people [with weakened immune systems] or real young children coming into contact with it unnecessarily." posted by Sydney on
9/10/2002 06:04:00 AM
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Every Surgery Has Its Risks: A Detroit councilwoman died after having obesity surgery. This is sure to get a lot of prominent play given all the press on fitness we’ve had lately. She had a relatively new laparascopic procedure called Lap-Band Adjustable Gastric Banding . It’s basically a tourniquet applied to the stomach to limit the amount of food that can pass through. Compared to older procedures, it’s less invasive and thus theoretically safer. However, it’s also new, and there’s a learning curve in learning new procedures. Complications are higher in the first few months of a procedure’s introduction. Cutting edge isn’t always the best.
Meanwhile, her family has retained a familiar figure to sue the doctor:
Her family has retained attorney Geoffrey Fieger, whose clients have included assisted-suicide advocate Jack Kevorkian.
Fieger said two autopsies revealed perforations in Scott's stomach. He said there was no other way the holes could have occurred except in surgery.
Blame Mom: Today's over-scheduled children are the fault of educated women. The usual tripe is trotted out as an explanation for the connection: maternal guilt and overly ambitious career women. It’s so easy to criticize other people’s parenting styles. So easy, in fact, I’ll join in:
Claire Holland, a 44-year-old lawyer, said she tries to strike the right balance between giving her four children a healthy exposure to activities, while keeping family life sane. She has an enormous kitchen calendar, plus a palm pilot, to keep track of the soccer, gymnastics, basketball, and drama lessons that her children take part in. She also scaled back her work hours to a part-time schedule, roughly 20 hours a week, so she can serve as the family's chauffeur.
''I deliberately set it up this way,'' she said while picking up her son at a Watertown soccer field last week. ''It's the only way it could work.''
Come on. She’s using the kids’ activities as an excuse to cut back on her work schedule. She may have struck balance in her life, but not in the kids’ lives. posted by Sydney on
9/10/2002 06:02:00 AM
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Vexing People: A reader says that the legal equivalent of Munchausen’s is the “vexatious litigant,” a term which turns up throughout the English-speaking world in a google search. I’m not so sure it’s quite the same as Munchausen’s, though. The vexatious litigant examples I could find seemed more like vindictivecranks than people addicted to the drama of the court system. But, then, maybe it’s impossible to tell the difference. posted by Sydney on
9/10/2002 06:01:00 AM
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Monday, September 09, 2002
Dubious Worth: Pfizer has been conducting a study of their hormone replacement drug, FemHRT, to see if it makes a woman's skin prettier. The merits of such research are now being called into question in light of the recent revelation of small, very small, increases in breast cancer and heart disease among users of hormone replacement therapy. It’s annoying to see the phrase “small but significant increase” repeated so often about the hormone replacement study. The increases were indeed small, (only 8 per 10,000 cases of breast cancer and 42 per 10,000 cases of heart disease in users of hormones) and only “significant” in a statisitical sense. That is, the increases weren’t likely to be have been due to chance. They aren’t, however, significant in the sense that they involved large numbers of women, which is what that phrase “small but significant” conveys. Still, it’s also hard to feel sympathy for the drug company regarding this trial. They obviously designed their study so they could apply for permission to claim that their product enhanced skin beauty, a claim that would give them a marketing edge. How do you objectively measure skin quality, anyway? Beauty’s only skin deep,after all. posted by Sydney on
9/09/2002 07:32:00 AM
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Errata: Hospital errors are in the news again. This time it’s a study that looked at medication adminstration in thirty six hospitals nationwide:
In the 36 institutions, 19% of the doses (605/3216) were in error. The most frequent errors by category were wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). Seven percent of the errors were judged potential adverse drug events. There was no significant difference between error rates in the 3 settings (P = .82) or by size (P = .39). Error rates were higher in Colorado than in Georgia (P = .04)
The newspaper story says that translates into 40 medication errors a day per hospital. But wait a minute, are all of those really errors? It’s not really an error to give a medication one hour later than scheduled because the nurse was attending to another patient who was in a medical crisis. It would be a grave error to ignore a patient in crisis while making sure everyone else's medication is exactly on time. Missing a dose could be an error, but as errors go it isn’t likely to be harmful. The wrong dose and the wrong drug, however, are defintely errors, but those only made up 21% of the cases. That means that only 8 serious errors occured per day per hospital. That’s still eight errors too many, but addressing those sorts of errors would be a better use of resources than lumping them all together. As an article last week in the Annals of Internal Medicine pointed out, not all “errors” are mistakes. posted by Sydney on
9/09/2002 06:40:00 AM
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Dramatis Personae:The New York Times Magazine had a case presentation of a case of Munchausen's syndrome, a disorder in which a person loves playing the role of patient so much they make themselves sick on purpose. I had a case like this when I was in residency training. My patient injected the feces under skin, though, to create an abscess. Yuk. Munchhausen’s in medicine is well-documented, but what I want to know is, does the legal profession have anything analogous to it? Are there people so addicted to the drama of the courtroom that they sue at the slightest provocation? I wondered about this when I was sued after a fender bender in which no fenders were bent. My opponent appeared absolutely delighted to be in the courtroom. She even came with a yellow legal pad and took more notes than her lawyer. He was young (his older partners probably knew her well and stuck him with the case) and she kept offering him words of encouragement during the breaks, as if she were the lawyer and he were the client. She also had a long history of suing people, according to my attorney. I’m convinced her primary motive in suing me wasn’t so much to profit from it financially, but to bask in the limelight of a trial. (She lost by the way, thereby restoring my confidence in our legal system.) posted by Sydney on
9/09/2002 06:19:00 AM
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Sensible Advice: Laura Bush says to just turn off those television sets on 9/11. Small children don't need to see those horrible images again and again and again. Once was enough. She’s absolutely right. And the idea of lighting a candle in rememberance is an excellent one, too. posted by Sydney on
9/09/2002 06:17:00 AM
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Sunday, September 08, 2002
Quote of the Day: "To seek to tell the virtues and greatness of this holy herb, the ailments which can be cured by it, and have been, the evils from which it has saved thousands would be to go on to infinity . . . this precious herb [tobacco] is so general a human need not only for the sick but for the healthy." - Juan de Cardenas, 16th century Spanish physician and tobacco promoter.
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9/08/2002 12:48:00 PM
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Stoner Sanctuary: According to The New York Times Americans are fleeing to Canada to smoke pot medicinally. They portray themselves as morally equivalent to runaway slaves and Vietnam War protesters:
"It's an exodus," said Renee Boje, 32, a California fugitive from drug charges who has applied for refugee status. "Canada has a history of protecting the American people from its own government like during the Vietnam War, and the Underground Railroad that protected American runaway slaves."
But you have to wonder about some of the examples the article musters up:
Steven W. Tuck, a 35-year-old disabled veteran of the Army, fled to Canada pretending he was going fishing after his club was repeatedly raided and he faced drug charges. He was arrested for overstaying his visa and, fearing deportation, applied for refugee status.
Sitting recently in Vancouver's Amsterdam Cafe, where smoking marijuana is allowed, he was sweating and shaking awaiting a friend who had gone out to buy some. "I have to have marijuana to stay alive," said Mr. Tuck, who said his torment began in 1987 with an Army parachuting accident that caused spinal and brain injuries.
If he is sent home and denied marijuana, Mr. Tuck says, he fears he will die "choking on my vomit in jail."
His symptoms sound more like drug withdrawal than pain symptoms, and his fear of “choking on my vomit” also sounds like fear of drug withdrawal than any symptoms he would likely have from spinal or brain injuries. The truth is that marijuana isn’t any better for pain than codeine. Mr. Tuck could easily be given better pain treatment, legally, in the United States. What he can’t get, though, is a drug to keep him in a constant state of euphoria.
Then there is the drug war refugee:
The most prominent American fugitive here is Steve Kubby, 55, the Libertarian Party candidate for governor of California in 1998. He and his wife, Michele, have an Internet news program on marijuana issues.
..They fled California last year for the rural British Columbia town of Sechelt after the police found 265 marijuana plants, a mushroom stem and some peyote buttons in their house. Mr. Kubby had been sentenced to four months of house arrest and three months of probation, which he feared might eventually lead to a prison term in which he would be denied the marijuana that he says he needs to treat his adrenal cancer.
"If I don't smoke pot," he said, "my blood pressure goes through the roof and would either burst a blood vessel or cause a heart attack."
Marijuana, or at least the active ingredient in marijuana, delta-9-tetrahydrocannabinol, can help with nausea and vomiting from chemotherapy. It’s a little better than the weakest of the anti-nausea drugs, but less effective than the drugs we have of moderate potency. Their chief value lies, again, in their euphoric effect, an effect that few would begrudge a patient in the throes of cancer. Mr. Kubby, however, doesn’t take it for nausea and vomiting, but for blood pressure. There is no evidence that marijuana decreases blood pressure. In fact, it increases the heart rate and increases the blood pressure when lying down, although it can make blood pressure drop when you change positions. With the wealth of effective blood pressure medicine available today, there’s no reason Mr. Kubby needs to rely on marijuana to treat his adrenal cancer. His physician must have been high himself when he wrote the note to allow him to use it medicinally. (You also have to wonder what Mr. Kubby does with those peyote buttons and mushrooms.)
Even if marijuana were legal, I wouldn’t recommend it medically. Smoking pot is just as harmful to the lungs as smoking tobacco. And, although tobacco smoking was once used for medicinal purposes, we now know better. We know better when it comes to marijuana, too.
Bioterrorism Preparedness: A survey of family physicians just after 9/11, found them wanting in bioterror preparedness:
Twenty-six percent of respondents said they would know what to do in case of a bioterrorist attack, compared with 65 percent who said they would know what to do in the event of a natural disaster and 66 percent who reported knowing what to do during an infectious disease outbreak.
Only 24 percent of FPs surveyed thought they could recognize signs and symptoms of bioterrorism-related illness in their patients. And while 93 percent of survey respondents said they report notifiable infectious disease cases to the health department, only 57 percent said they would know whom to call to report a suspected bioterrorist attack.
Although the survey was done just after 9/11, I doubt if the responses would be much different if it were to be repeated today. There really haven’t been any attempts to educate physicians on bioterrorism, aside from a few articles in JAMA and The New England Journal Medicine, and information on websites of the various professional organizations. Sadly, few physicians are plugged into the internet, so that information isn't widely disseminated. Bioterror education is something our public health departments could be doing. They could hold local seminars on bioterror preparedness, educating us in how to recognize a potential bioterror-related illness and what to do about it. They've been conspicuosly silent on the matter, though, much to their shame. posted by Sydney on
9/08/2002 12:15:00 PM
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