"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
Curbing Appetites: In Uganda, the prevalence of HIV infection has fallen from 15% to 5% in the past ten years. The reason appears to be (surprise!) a decrease in promiscuity:
In the face of the then pervasive national campaign to encourage sticking to regular partners ('zero grazing' ...), reported multiple partner behaviour dropped noticeably. The Global Programme on AIDS surveys found that the proportion of men with one or more casual partners in the previous year fell from 35% in 1989 to 15% in 1995, and the proportion of women from 16% to 6%. Notably, the proportion of men reporting three or more non-regular partners fell from 15% to 3% (see bmj.com). "
Another Sad Week in MedMal Crisis Land: Our city lost another physician to the medical malpractice insurance crisis last week. This one was a surgeon. His malpractice premiums increased by $100,000 a year, from $150,000 to $250,000. That left nothing for him to live on, so he closed his practice. He's going to be doing locum tenens work. I'm going to miss him. He was arrogant, but he was a good surgeon.
And yet again, the Senate failed to pass tort reform for medical malpractice cases. Said one senator who opposes caps on non-economic damages:
'I've never seen such special-interest legislation,' said Senator Patrick J. Leahy, Democrat of Vermont. 'Instead of going about doing the people's business, we seem to be going about the political action committees' business, and that's why, of course, nothing is getting done.'
Medpundit Art History Lesson: There's a story about the death of Lincoln that is often told in religious sermons:
From his earliest days in politics, Lincoln had a critic, an enemy, who continually treated him with contempt, a man by the name of Edwin Stanton. Stanton would say to newspaper reporters that Lincoln was a 'low cunning clown' and 'the original gorilla'. He said it was ridiculous for explorers to go to Africa to capture a gorilla 'when they could find one easily in Springfield, Illinois.' Lincoln never responded to such slander; he never retaliated in the least. And when, as President, he needed a Secretary of War, he selected Edwin Stanton. When his friends asked why, Lincoln replied, 'Because he is the best man for the job.'
The story may not be true. Stanton was something of a Republican mole in James Buchanan's Administration. Lincoln, or at least the Republican party, probably owed him a few favors. Nevertheless, its message of forgiveness and charity toward ones enemies makes it a fitting story for a president who was an emancipator of men and who died on Good Friday at the hands of his political enemies. It's all a part of the hagiography of Lincoln.
That transformation from reviled politician to American saint began early. Walt Whitman wrote poems immortalizing him. Henry Ward Beecher, who once condemned him from the pulpit, endowed him with a Christ-like legacy in his eulogy,""Dead-dead-dead, he yet speaketh." And American historical artist Alonzo Chappel gave him the classical heroic death portrait:
The son of a tinsmith, Chappel was born in 1828 in New York City. He had a life-long fascination with early American history, which he turned into a career by painting famous 18th century American events and people. Little wonder that someone so enamored of the 18th century would choose the "Death of.." form of historic painting for this watershed moment in American history.
The most famous "Death of..." protrait was The Death of Wolfe by Benjamin West. Painted in 1770, eleven years after Wolfe's actual death on the Plains of Abraham, the painting is more romance than history, (most of the men gathered around the slain hero were at the battle, but not at Wolfe's side), but as hagiography it's splendid, evoking the posture of the dead Christ as seen in so many Descent from the Cross paintings, as well as Greek depictions of fallen heroes. (Wolfe's death was also immortalized in song.)
Thirty-five years later, Horatio Nelson got the same treatment by Arthur William Devis, but to a more realistic effect. Devis strove for accuracy, visiting Nelson's ship, The Victory when it arrived in port, sketching the men who attended him during his last hours and relying on the numerous detailed published accounts of his death. In Nelson's case, the portrait, serves as both hagiography and historical record. (Nelson got a theatetrical West painting, too, though it manages to be both less accurate and less moving.)
Sixty years later, and Chappel's The Death of Lincoln is even more realistic and less romantic. It doesn't so much tell a story as record an event, much like a camera would. Lincoln lies on a bed, already dead, not dying, and not in the arms of his men, although his wife does lie across him, weeping, in an appropriately dramatic style. Each of the men and women surrounding the death bed were actually with him before he died, although not at the same time. (It was a small room.) Even their postures are reminiscent of the photographs of that period - stiff, formal, and posed. It's the heroic death painting gone common. But, while it may lack the theatrics of Wolfe's death portrait or the poignancy of Nelson's, it nonetheless must have spoken to the hearts of a grieving nation. posted by Sydney on
4/09/2004 07:47:00 AM
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Thursday, April 08, 2004
Having Good Babies: So this is why I had such sweet babies:
Babies born to women who ate chocolate daily smiled and laughed more, their mothers reported.
And all this time I just thought they had inherited their father's good nature. posted by Sydney on
4/08/2004 09:47:00 AM
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Measles Outbreak: Another measles outbreak, this time in Washington:
Seven children from King and Snohomish counties have confirmed or probable cases of red measles and may have exposed hundreds of people in 21 public places in King and Snohomish counties.
All of the children were recently adopted from China and came to the United States with their new families on March 26.
I thought you had to show proof of immunization before entering the country, but I could be wrong. posted by Sydney on
4/08/2004 09:43:00 AM
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The biggest implication of the new study is that Lipitor and other statins, now taken by 11 million Americans at a cost of almost $14 billion a year, might also benefit tens of millions more patients than doctors had ever expected. This could prevent hundreds of thousands of heart attacks annually--yet it would add tens of billions of dollars to the nation's already-bloated bill for prescription drugs.
What's more, it won't really decrease the chances of a heart attack all that much for each individual. Using high dose Lipitor decreases the chances of having a heart attack by about four percentage points. How many of us would pay $120 a month for a four percent improvement? Very few. But far more of us would ask someone else to pay $120 a month to give us that small advantage. posted by Sydney on
4/08/2004 09:31:00 AM
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Uber-Athletes: Some say that performance-enhancing drugs should be legalized and supervised for professional athletes since they're all using them anyway. Then we could have separate leagues for the enhanced vs. the unenhanced:
To be sure, monitoring all this would be tricky. Balancing benefits and costs is hard. So for pharmco Luddites who want a simpler world, where performance enhancers don't transform competitions and the cult of the natural still thrives, I have an answer: Create one league for the genetically engineered home-run hitter and another for the human-scale slugger. One event for the sprinter pumped up on growth hormones and another for the free-range slowpoke. One tour for the supercharged cyclist and another for the antidoping racer.
Personally, I'm more impressed by athletic accomplishments when they happen naturally rather than from pharmacological enhancements, but to be sure, the natural league would probably be less spectacular than the enhanced league. It's hard to get behind this, though. Specters of the East German athletes still haunt. Although it isn't likely that children will be secretly given performance enhancing drugs, there would be even greater pressure for them to take them than there is now if they aspire to the "big leagues." posted by Sydney on
4/08/2004 09:19:00 AM
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Practice Makes Perfect: Don't worry about the time your kids spend playing video games. Today's video game junkies are tomorrow's surgeons.
Warped Market:Trent McBride points out that our healthcare system isn't really part of the free market:
If I had to make a wild guess, our health care system will be paid for by explicit or implicit public funds at a rate of 65-70%. My question is this: if we have a nationalized health care system now, and that system is by your estimation broken, is more nationalization the way to go? Especially when every other sector or industry in this country is privately funded and avoids this problem. Except, that is, for education and the military. Oh, yeah, they're publically funded, too. (The problem of getting health care to the poor is independent of this - there is a big difference between publically funding for those who can't pay for themselves and publically funding those that can.)
I've heard others call our system a corporate/socialist system, and I think that phrase best explains what we have going. A large chunk of the bill is picked up by the government, which decides what they'll pay. The rest of the bill is picked up by private insurance companies who decide what they'll pay in their corporate boardrooms. The two people at the heart of the transaction - the patient and the doctor - are entirely out of the loop in deciding the value of the services. And the same goes for the relationship between the pharamcist and the patient.
I had two recent cases that highlight how warped this system really is. One of my patients had a pap smear last October. Her pap form was marked incorrectly, resulting in the lab performing an extra test that wasn't medically necessary. Her insurance wouldn't cover it, so she got a bill for $148. Since it was my fault, I offered to credit her account. But, she only pays a $10 co-pay for each visit, and she usually only comes in once a year for her pap. It would take me over 14 years to give her back anything of comparable value to that one laboratory test. I'm getting paid more than $10 for the paps, once you count the insurance payments, but to the consumer of my services, they're only worth $10.
The other is a patient who is what most reasonable people would consider "well-off." The other day he was lamenting that he couldn't find a prescription allergy medication that worked. He ended by saying, "Too bad Claritin isn't available anymore. That worked wonders for me." I pointed out that it is available. It's just over the counter now. His response was, "But buying it over the counter would be a waste of my insurance!" He'd rather have have his insurance company pay for an ineffective medication and suffer his allergy symptoms than fork over the money for an effective medication himself. Folks, this is not a free market system.
Pots and Kettles: Hard to believe, but people are getting up in arms over condom labels:
“This is completely pointless,” the 24-year-old Chicagoan said of the warning telling him that, while condoms can help prevent the spread of some sexually transmitted diseases, there are no guarantees.
Even so, that tiny bit of print is at the center of a raging debate now that President Bush has asked the Food and Drug Administration to modify the current warning to include information about human papillomavirus, commonly called HPV or genital warts.
...“The lack of information getting to the American public regarding this disease is beyond comprehension,” said Linda Klepacki, manager of the abstinence policy department at Focus on the Family, a Colorado-based organization.
She and others point to research showing that condoms don’t necessarily prevent the spread of HPV, in part because it may be found on parts of the body the latex devices don’t cover. Abstinence is the best way to prevent the disease, she argues.
Adding that information to a condom label would be “truth in advertising,” said Libby Gray. She’s the director of Project Reality, an Illinois-based group that teaches public school students about abstinence — and notes that most students she speaks with have no idea what HPV is.
But scientists who study HPV worry that abstinence groups are dismissing important information to promote their own values.
“I want to be polite. But it appalls me when I see scientific and medical studies being manipulated for a different agenda,” said Tom Broker. He’s a professor of biochemistry and molecular genetics at the University of Alabama at Birmingham and president of the International Papillomavirus Society, a coalition of experts who study HPV.
A label warning that condoms aren't 100% effective is probably a "different agenda" than Mr. Broker's, but is it really manipulating science or is it just common sense? Let's see what the trusted family physician has to say on the subject:
Can STDs be prevented?
Yes. The only sure way to prevent STDs is by not having sex. If you have sex, you can lower your risk by only having sex with someone who isn't having sex with anyone else and who doesn't have an STD.
You should always use condoms when having sex, including oral and anal sex.
Do condoms prevent STDs?
Male latex condoms can reduce your risk of getting an STD if used correctly (see the box below). Be sure to use them every time you have sex, during all types of sex, including vaginal, anal and oral sex. Female condoms aren't as effective as male condoms, but should be used when a man won't use a male condom.
Remember, though, that condoms aren't 100% safe and can't protect you from coming in contact with some sores, such as those that can occur with herpes, or warts, which can occur with HPV infection.
Who knew that the AAFP was a front for those right wing political organizations? posted by Sydney on
4/06/2004 08:05:00 AM
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Marlboro Men: Helena, Montana, banned smoking in public places for six months and saw a decrease in heart attack admissions. There were 16 fewer heart attacks in the region that serves 68,000 people during the six months of the ban. (The study is here in pdf form.) That's a very small difference, and could be accounted for by just about anything - from fluctuations in population size to other illnesses such as respiratory infections that might have been circulating in the community. But expect it to be used to support more public smoking bans. posted by Sydney on
4/06/2004 08:03:00 AM
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For Want of a Doctor, the Base was Lost: Even the military isn't immune to the effects of the medical malpractice insurance crisis:
.....the crisis could hurt Scott Air Force Base next year as the Defense Department embarks on another round of base closures.
That's because the Department of Defense will weigh quality-of-life issues, including access to healthcare providers and facilities, when it evaluates domestic military installations for closure starting next year.
...Republicans and Democrats agree that medical malpractice insurance premiums have risen sharply, making it costly for doctors to do business in Illinois. The Metro East has been hit particularly hard, officials said. Numbers are hard to come by, but John Baricevic, the Democratic St. Clair County Board Chairman, said that some 40 physicians have left Belleville's Memorial Hospital in the last year.
...The issue is "probably more important for the general fabric of the community than it is for Scott Air Force Base," Baricevic said. "But nevertheless it is a quality-of-life issue and it will be a piece of the puzzle, even if it is not the biggest piece." posted by Sydney on
4/06/2004 08:02:00 AM
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Not So Sweet Breath of Life: Emergency workers are overinflating the dead and the near-dead:
The researchers, led by Dr. Tom P. Aufderheide of the Medical College of Wisconsin, observed paramedics in Milwaukee giving CPR to heart attack patients.
The American Heart Association recommends administering 12 to 15 breaths a minute.
In the first seven patients observed, the paramedics gave about 37 breaths a minute, the study found. When the researchers retrained the emergency workers, the rate for the next six patients improved, going down to 22 breaths. Still, all the patients died.
Don't feel bad, EMS people. Your breath is still superior to flagellation, fumigation, and the bellows method. And actually, CPR has an abysmally low success rate. It isn't at all clear that adminstering fewer breaths per minute would result in better outcomes. Often, it's just that the person is already dead and nothing's going to bring them back.
posted by Sydney on
4/06/2004 07:58:00 AM
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Prohibition: The Teletubbies will no longer be allowed to corrupt the world's children:
The Teletubbies and Tweenies are to be banned from promoting unhealthy children's food, the BBC announced yesterday
...Tweenies and Teletubby chocolate bars, marshmallows and jellies will disappear completely, although the characters will still be allowed to appear on Easter eggs and birthday cakes.
...The Fimbles, Bill and Ben and Andy Pandy will also be covered by the new rules. However other favourites, such as Bob the Builder, Thomas the Tank Engine and Postman Pat are not owned by the BBC. Rupert Gavin, the chief executive of BBC Worldwide, said: 'We are conscious of the small but high-profile part we play through our licensing of children's TV characters to food manufacturers.
Do Thomas the Tank Engine and Bob the Builder have food products?
UPDATE: Bard-Parker says that, yes, Bob the Builder is a corrupter of youth:
My kids eat some sort of Bob the Builder themed gummy-bear type candy. The Tweenies are so annoying that any foodstuffs they promote are forbidden in the Parker household. posted by Sydney on
4/06/2004 07:56:00 AM
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Across the Netherlands hotel owners are lengthening beds and raising door mantles to stop the nation's tall youth suffering from irreparable anatomical damage.
According to a New Yorker essay on the subject last week, Dutch ambulances are even having to keep their back doors open on many occasions to allow for the prodigious dimensions of their patients' legs.
Better check those children for steroids.
It's difficult to take this article seriously, though. Especially in light of this explanation for why "during the Little Ice Age, in which temperatures plummeted across the world between 1300 and the mid-19th century, there was a noticeable decrease in human stature":
Firstly, all mammals get shorter and rounder when climates cool. It is a physiological response to cold. Short, round bodies preserve heat better than tall cool ones.
I can only think of one part of the body that shrinks as a physiological response to cold, and only about half of us are endowed with it.
UPDATE: A reader notes:
This article is so obviously biased in its anti-Americanism, it's laughable. On its face it doesn't make sense because we are the fattest group of people on earth, and slinging around the term, "poor nutrition" without citing any evidence for that, such as a dietary analysis, is pure conjecture. Something tells me there are a fair amount of vitamins and proteins sneaking in with all those calories.
Furthermore, they also tossed out the racial mix as a possible explanation without adequately analyzing it, either. They did not look at the current racial mix of Denmark, the UK and the US- they only pointed out that in the past, the US had lots of immigrants, too, and came out ahead of Europe. However, I would be willing to bet that the height measurements done in the nineteenth century may have completely ignored entire groups of immigrants, race relations and health care being what they were in those days.
Simply put, until they know the racial makeup of the people who were
actually measured, this study is worthless. On the other hand, if you
compared the height of North Dakotans against the Danes, you'd have much more closely matched groups.
P.S. As an interesting aside, in another article the Guardian noted
that it's taking up to 18 months to get an MRI in the UK. There's that good ol' socialized medicine at work again!
Some critics apparently think that raising any ethical concerns regarding uses of biotechnology is tantamount to reviving the war of religion against science. They would rather have an ethics council that, after fussing a little, simply pronounced its blessings on the technologically inevitable. We, by contrast, mean to give the ethical issues preeminence, while trying always to be accurate about the relevant science and hearing always from all sides of the debates.
Scornful Academics: I have some thoughts on Elizabeth Blackburn, the cell biologist whose term on the President's Council for Bioethics was not renewed and who has made quite a fuss about it in the media, over at Tech Central Station.
An additional bit of information that I wasn't able to fit into the column, but that shows just who on the Council is driven by agendas, is this appendix by Janet Rowley, (Dr. Blackburn's co-author in the PlosBiology article, which charges the Council of being politicized) in the Council's most recent report, Reproduction and Responsibility: The Regulation of New Biotechnologies (emphasis mine, although she emphasized those points, too, along with others.):
In my view, the report should have done much more to applaud the medical advances that have occurred leading to the effective treatment of an important medical problem, namely infertility, rather than focus primarily on the potential hazards and misuses of the new technologies. In addition, I think it is important to note plainly that some of the major concerns highlighted in the Report could be resolved relatively painlessly by changes in current governmental regulation, at the State and at the Federal level. I am also disappointed that the Report does not call for federal funding of basic and clinical research seeking improved methods of assisted reproduction or for mandated health insurance for ART services. Both of these measures would help to reduce the risks of ART to women and children.
Second Hand Killers: A new study says that living with smokers can kill you:
Evidence that living with a smoker can shorten your life has emerged from a study in New Zealand.
The study, one of the largest ever done, looked at deaths among people aged 45 to 74 who completed census returns in 1981 and in 1996.
Those who had never smoked but lived with people who did were 15 per cent more likely to die in the three years after each census than were those who had never smoked and lived with non-smokers.
The original article is available here, but only in pdf form. The actual numbers aren't as impressive as the relative risk reported in the London Times and other media stories would have you believe. Here's what they found:
From 1981 to 1984, men who were never exposed to tobacco smoke had a mortality rate of 1,530/100,000, or a mortalty rate of 1.5%. Men who had been exposed to someone else's tobacco smoke had a mortality rate of 1,684/100,000, or of 1.7% - only a 0.2% difference. For women during those years, the numbers were 1009/100,000 for those who were never exposed to tobacco smoke and 1050/100,000 for those who were exposed to second hand smoke. Both translate into a mortality rate of 1%.
From 1996 to 1999, men who were never exposed to tobacco smoke had a mortality rate of 1025/100,000 or 1% and men who were exposed to second hand smoke had a mortality rate of 1198/100,000 or 1.2%. Again, a 0.2% difference. For some reason, women during this time period had more of a difference than the previous decade. Women with no history of tobacco smoke exposure had a mortality rate of 672/100,000 or 0.7%, but those who had exposure had a mortality rate of 855/100,000 or 0.9%.
The authors call the increased mortality rate among those exposed to second-hand smoke "modest but consistent," although in the case of women, it isn't even consistent. And it's far too modest to justify Draconian anti-smoking laws.
