"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
Apologies: Still no internet access from our home. SBC says that the most they can guarantee is that service will be up by Monday at 5PM, unless the weather goes bad again. It's snowing now, and I have little faith that they'll be able to locate the phone cable under the snow. I can't complain too much. Just a few blocks from our house, families are still without electricity. And I know the SBC people are trying hard. I passed an SBC truck from Michigan this morning working on a downed line.
I'm blogging this from the office where I came to catch up on some paperwork, but I don't plan to blog from here. It's one thing to blog from home on my laptop where the kids can interrupt me any time they need me. It's quite another to isolate myself in the office blogging and surfinf the internet. It feels too much like neglect. Before I left this morning my son asked me if I was going to the office, then sighed heavily when I said "yes." He really knows how to lay on the guilt.
Blogging will resume whenever the good graces of SBC and mother nature allow.
When Nature Strikes: Blogging will be limited. An ice storm took out our home phone lines and the power and phones at the office. The office is back on line, but there's precious little time for blogging here. Regular blogging to resume when phones (and DSL connections) are fully operational. posted by Sydney on
1/06/2005 02:12:00 PM
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Tuesday, January 04, 2005
Residents Strike Back: Residents and interns in Haiti's largest hospital are on strike:
All 75 resident doctors walked off the job last week because the government has not paid their salaries for three months, said Albert Camille Archange, director of the General Hospital in the capital, Port-au-Prince.
The doctors, who make about $145 a month, extended the strike Tuesday after the government ignored their demands. The hospital's 65 interns were also on strike out of solidarity with the residents. posted by Sydney on
1/04/2005 09:44:00 PM
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True Lies: The Georgia great-grandmother who claimed to be pregnant with twins wasn't:
'To the surprise of even her family, it was recently discovered that Harris is not pregnant with twins,' Harris said in a statement distributed Tuesday by her 39-year-old son, Fred Jackson.
'Due to some personal issues that are still being evaluated, Mrs. Harris believed that she was pregnant with twins and was able to convince her family and friends that she was expecting as well.'
PDA Recycling: Have a Palm or other hand-held device you no longer need? Donate it to doctors in Africa. posted by Sydney on
1/04/2005 04:28:00 PM
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Weighty Studies: In a comparison of studies that studied weight loss program (not actually a study of the programs themselves), Weight Watchers was the winner. Although, the authors also noted that very low calorie diets resulted in more weight loss. The studies they studied were of "poor quality." The nice thing about Weight Watchers is that it has a built-in support group as well as sensible life-long eating plan. It retrains people to eat healthy. The hard part, as always, is staying on the wagon. posted by Sydney on
1/04/2005 08:50:00 AM
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Totalitarian Physicians: Color me uninformed, but I never knew Che Guevara was a doctor. Here are some of his other achievements:
Che presided over the Cuban Revolution's first firing squads. He founded Cuba's "labor camp" system—the system that was eventually employed to incarcerate gays, dissidents, and AIDS victims. To get himself killed, and to get a lot of other people killed, was central to Che's imagination. In the famous essay in which he issued his ringing call for "two, three, many Vietnams," he also spoke about martyrdom and managed to compose a number of chilling phrases: "Hatred as an element of struggle; unbending hatred for the enemy, which pushes a human being beyond his natural limitations, making him into an effective, violent, selective, and cold-blooded killing machine. This is what our soldiers must become …"— and so on.
What he was good at was killing people, and he became one of history's cruelest serial killers. He was Castro's primary henchman, murdering hundreds of innocent people without due process, usually finishing off the work of the mass-production firing squads with shots to the back of the neck. He was and will always be the most despicable, disgusting figure of the Castro killing machine, the foreigner who was made a serial killer of Cubans by Castro, and got great pleasure from his role."
Indeed, he did. Guevara, famous as he is — famous as his mug is — is little known. He was, as Diaz-Balart says, Castro's number-one revolutionary thug. He presided over those summary executions at La Cabaña — the old fortress that Guevara commandeered — and he very much enjoyed administering the coup de grâce. He also enjoyed parading people past El Paredón, the reddened wall against which the victims were killed.
We doctors like to pride ourselves on being humanitarians. But there's also a strong totalitarian streak in our training. Usually, it manifests itself only in mundane things, like bullying our patients about diet, weight, smoking, drinking and exercising. But, there are a disturbing number of doctors who take the totalitarian bent to new heights - Syrian dictators, al Qaeda leaders, Nazi henchmen to name a few. You don't see other professions - except maybe lawyers - going bad so often. Can you think of any totalitarian accountants? posted by Sydney on
1/04/2005 08:42:00 AM
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Overweight women who have not yet completed childbearing should consider using a backup form of birth control while on the pill, such as condoms or other barrier methods.Overweight and obese women who take oral contraceptives are 60-70 percent more likely to get pregnant while on the birth-control pill than women of lower weight, according to research published in the January issue of Obstetrics & Gynecology.
The results in the story are only given in terms of relative risk, but it appears that the absolute risk is a relatively small one:
Among 100 women taking oral contraceptives for a year, Holt's study suggests that an additional two to four women will get pregnant due to being overweight or obese.
It's a good idea to try to maintain a healthy weight, but don't assume that because you're overweight your birth control pill is useless. Far from it.
Requiem for the Drugstore: This year, more insurance plans are insisting that their enrollees get their drugs by mail, which may well mean the end of the local drug store:
Across the country, many state and city governments, as well as private employers, already require employees to obtain their medications for chronic conditions through the mail. Early last year, General Motors, Ford, DaimlerChrysler and the United Automobile Workers introduced a mandatory mail-order requirement, which now applies to more than two million auto industry workers and retirees.
As drug costs continue to rise, the changeover is accelerating. The switch has already been met with resistance from some consumers who complain that they are losing the help of a knowledgeable, trusted friend - their local pharmacist. For independent pharmacists who depend on walk-in business, the shift to mail-order prescriptions can be devastating.
"It's going to kill the little guys," said Howard Baskind, owner of Prospect Gardens Pharmacy in the Park Slope section of Brooklyn.
The biggest drawback to those mail-order plans is the loss of a pharmacist. There's the potential confusion when the mail-order pharmacy changes the brand they use and a pill of a different color shows up in the mail. The patient has no one to go to in that situation to ask if the medicine is the correct one, they just have to take it on faith. Yes, they could call the mail-order pharmacy, but many people have difficulty describing the changes over the phone, and it's also very difficult to get through to someone who understands your questions at the mail order firms. (I've had trouble with that even when I'm returning a call from them - no one ever seems to know who called or why they wanted me and I get put on hold for fifteen minutes or more.)
The local pharmacy is a far better mechanism for error avoidance. If there's a question about the medication, the patient can take pills in and show them to a knowledgable pharmacist. There's also something to be said for dispensing pills in small quantities (thirty at a time) to a smaller number of people whose drug histories are known by the pharmacist vs. mass automated dispensing.
UPDATE: Readers are less fond of local pharmacies. From the Precision Blogger:
I have long argued that the heavyweights in the music industry no longer have any right to exist, and are using their government contacts, and any handy laws, to try to keep a monopoly on a business that no longer needs them to choose artists, mass produce, advertise or distribute.
I think it is only fair to subject pharmacy stores to the same level of examination. In today's world do they provide services that need to be preserved?
It seems obvious that the answer is "Yes." You discussed how the pharmacist is the last line of defense against getting a wrong medication. It's obvious there are a set of related issues,
all of which point to the value of providing human beings who can give objective advice on many aspects of medication.
Something is seriously wrong however. Pharmacies these days seem to have diversified immensely. They cannot compete with Walmart but they seem to feel that they can only make enough money by being a super convenience store as well. If I remmember correctry, pharmacies were almost as diversified in the 1950's, although their non-pharmacological stock was smaller:
icecream/soda fountains
beauty products
books and mags
stationery
candy
toys
and so on and so on.
Lack of access to pharmacists will result in tragedies, and more lawsuits against drug companies and employers. So it seems that government and big business should have a serious interest in keeping pharmacists in business. But perhaps their business of the future needs to be something drastically different from what it is now.
For discussion purposes, here's a strawman: A future pharmacy might receive the drugs that we now propose to send to people via email, and disburse them to customers. Pharmacists would not make a profit on the pills (and would not operate a convenience store). They would be on salary and stipend, and would get bonuses by averting prescription mistakes. These pharmacists would be in a position to give objective advice about remedies in general since they did not sell them at a profit. And they would have the direct contact with patients to at least try to check about conflicting medications, or note when patients had become too hazy to control prescribed self-medication. They would of course stock the medicines that need to be prescribed rapdily and cannot wait for mail. (I'd much rather the pharmacists had these stocks than the prescribing doctors.)
If you feel it makes sense for pharmacies to sell all the other things they sell, try to imagine a doctors' office that operates a store on the same scale as CVS, on the theory that they expect people to wait 30 minutes to see a doctor, and meanwhile they ought to BUY something.
And another:
I agree with a lot of the comment in the NYT article, but the writer seemed (to me) to gloss over the fact that when mail order is "mandatory" it's almost always for chronic conditions and only for chronic conditions - meaning prescriptions where it makes sense to fill a 60 to 90 days supply. Yeah, the article uses the word "chronic" a couple of times, but without specifying what that might mean. So I think it leaves the impression that everyone must get all their prescriptions thru the mail - and I don't think that's true.
About local pharmacies? First, I live in Manhattan, and I don't have a local pharmacy I really trust. When I was in other cities, I did. Second, if a local pharmacy can compete, good. If not, is there really a problem? I don't see the logic of paying more for my prescription, so an uncompetitive business can keep charging me more, especialy where I receive no other service in return (e,g, trusted advice). Maybe it's just me, but I don't see the logic.
It's true that the chain pharmacies have declined in customer service over the years as they focused more on the store and less on the pharmacy. They also stretch their pharmacists rather thin, relying on pharmacy technicians to pick up the slack. I'm not sure what kind of training a pharmacy technician receives, but I know they can never take my verbal orders when I call in a perscription, so their knowledge of drugs must be minimal. The big chains have, in some ways, undermined the expectation of service that used to be associated with a pharmacy.
It must be sad to be a pharmacist and see your profession decline to nothing more than pill-counters in the eyes of the public.
Amid the Strife: There's been much written about the evil of nature and crises of faith in the wake of the tsunami. To many, it's natural disasters like this that make it impossible to accept that there is a God. It's the same with illness and disease. Many's the time I've sat with patients who have lost a spouse or a child, and who have lost their faith as a result. How could God be so unjust and uncaring? I've never felt it appropriate to answer their rhetorical questions of faith. I'm not very good at sharing my own religious beliefs, at least in person. Or maybe I've just never been able to forumulate an answer that doesn't seem trite. So, I never have an answer, just a shoulder to lean on.
Speaking for myself, though, it's because this world is unjust that I believe in God and in the Redemption that is central to Christianity. The reality is that life as we know it is brutal. It's so brutal, that if it's the only reality then, well, life just isn't worth living. If it weren't for my faith, I'd quickly fall into overwhelming despondency in the face of my impotence against so many of the ills that aflict my patients. But, as imperfect as this world is, I believe we're on the road to a better world to come. An Eastern Orthodox theologian explained it best in last week's Opinion Journal:
Perhaps no doctrine is more insufferably fabulous to non-Christians than the claim that we exist in the long melancholy aftermath of a primordial catastrophe, that this is a broken and wounded world, that cosmic time is the shadow of true time, and that the universe languishes in bondage to 'powers' and 'principalities'--spiritual and terrestrial--alien to God. In the Gospel of John, especially, the incarnate God enters a world at once his own and yet hostile to him--'He was in the world, and the world was made by him, and the world knew him not'--and his appearance within 'this cosmos' is both an act of judgment and a rescue of the beauties of creation from the torments of fallen nature.
Whatever one makes of this story, it is no bland cosmic optimism. Yes, at the heart of the gospel is an ineradicable triumphalism, a conviction that the victory over evil and death has been won; but it is also a victory yet to come. As Paul says, all creation groans in anguished anticipation of the day when God's glory will transfigure all things. For now, we live amid a strife of darkness and light.
His eyes dry quickly, forcing him to add drops every 10 to 15 minutes, and still sometimes his eyelids rasp across his eyes, scratching his corneas and dimming his sight.
“Can you imagine sandpaper scratching your eye every day, all day long?” said Rhonda Huffman, Beck’s mother.
...“I feel like Job every day. God told the devil, ’You can do anything to him except kill him.’ I’ve been there,” Beck said.
He underwent an experimental surgery that transplants a salivary gland to the forehead to provide moisture for the eyes:
But on Thursday, Dr. Randal C. Paniello transplanted a saliva gland from Beck’s neck to a spot near his temple, where it can provide moisture that can preserve the eye.
The 12-hour surgery was the first of its kind in the United States, the St. Louis Post-Dispatch reported Friday. The procedure has been successful about 80 percent of the time in treating dry-eye conditions in other countries, the newspaper said.
...The procedure bathes the eye in saliva, which is mostly water but also contains a mild thickening protein called muscin, which could help the eye retain moisture better. The saliva’s weak digestive enzyme, amylase, hasn’t appeared to damage eyes of past patients, Paniello said.
Politician Medical Watch: California Congressman Robert Matsui has died at age 63 of myelodysplastic syndrome. A disease which, contrary to CNN, isn't all that rare:
The actual incidence is unknown. MDS was first considered a separate disease in 1976, and occurrence was estimated at 1500 new cases every year......The perception that the incidence is increasing may be due to improvements in recognition and criteria for diagnosis. Statistics from 1999 show that 13,000 new cases occur per year (approximately 1000 cases each year in children), surpassing chronic lymphocytic leukemia as the most common form of leukemia in the Western Hemisphere.
It's the Law: In the mail last week came a notice from the health insurance plan that covers my employees. There's a federal law that requires health plans to cover breast reconstruction after mastectomy. The health plans, and by extension I, am required to remind enrollees yearly that such a benefit exists. (Funny, I'm not required by law to remind them about other benefits in the insurance plan.) Strangely, the Women's Health and Cancer Rights Act of 1998 does not require mastectomies be covered in the first place. Apparently, maintaining appearances is more important than providing therapy - at least in the eyes of the law.
posted by Sydney on
1/02/2005 08:33:00 AM
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Rape and Justice: A reader forwarded this article that worries about the new Department of Justice guidelines for treating rape victims. Evidently, the guidelines don't mention emergency contraception. But, since they're from the Department of Justice, why would they? The goal of the Justice Department is to prosecute crimes, not to treat patients. We would expect the primary focus of any guidelines from the Justice Department to be is on collecting forensic evidence in a reliable manner. Perhaps it would have been wiser not to call their guidelines "medical," but in rape that evidence collection is done by doctors and nurses, so the confusion is understandable. I really wouldn't expect - or want- the lawyers at the Justice Department to make therapeutic recommendations.
posted by Sydney on
1/02/2005 08:26:00 AM
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