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Your worth as a physician can be judged by how people invoke God

WhiteCoat, MD

Physician

January 26, 2011

As I walked into the ED for my shift, the nursing supervisor was fumbling with a syringe attempting to get medication out of a small vial.

“Ummmm. Looks like you need to adjust your bifocals,” I quipped. We have a running joke about who is older and bust on each other about our ages every chance we get.

When she turned around, the look she gave me signaled that it was no …

FDA regulation and non-approved use of drugs

Douglas Perednia, MD

Medications

January 26, 2011

The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies. He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate. He …

Useful things to buy during medical school

Josh Herigon, MPH

Medical Education

January 26, 2011

The following is a brief list of some of the things I think have been useful and worth their money in my first two years of med school:

1. Large, widescreen computer monitor. The volume of information required to internalize during the preclinical years of medical school can’t be compiled and organized on paper. You would end up with bookshelves filled with those gigantic 4″ binders. Therefore, almost everything happens on …

Malpractice attorneys shouldn’t rely on clinical guidelines

Charles A. Pilcher, MD

Physician

January 26, 2011

The Institute of Medicine has been an advocate for clinical guidelines for many years.

Although the value of guidelines has never really been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past few months and I review it briefly here.

A few years ago Dr. Robert Ewart discussed the ethics of using guidelines to screen patients …

Government is already involved with the majority of health care

ER Stories, MD

Health Policy

January 26, 2011

US District Judge George Steeh of Michigan ruled last year that the constitution permits the federal government to require individuals to obtain health insurance coverage.

This lawsuit was filed by a Christian legal organization called the Thomas More Law Center, as well as others. Other lawsuits are in the works in numerous other states. These suits are filed primarily by Libertarian-types who don’t want to be forced to buy health insurance …

Palliative care can lead to higher quality of live and longer survival

John Schumann, MD

Patient

January 25, 2011

Every once in awhile amidst the weekly deluge of medical articles comes a show-stopper that has the potential to change the way we practice.

Rarer yet is the article that not only changes how we practice, but calls into question why we do what we do.

This recent article from the New England Journal of Medicine is just such an article. Before you bolt, let me simplify it for you.

Here’s …

Formula and the placebo effect on your baby

Michael Gonzalez, MD

Patient

January 25, 2011

You are a new parent. Your infant is gassy, fussy, spitty, and does not sleep much. In other words your infant is a normal baby. You are stressed, and like any good parent, you want to fix what “ails” your infant. As you stroll down the baby aisle at the grocery store, you see labels that tout words like gentle, comfort, and restful. Formula manufacturers are brilliant. They know their …

Depersonalization of the patient and the loss of compassion

Wendy S. Harpham, MD

Physician

January 25, 2011

A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.

So let’s take a look at compassion.

Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …

How repeal and replace will affect patients

Rishi Manchanda, MD, MPH

Health Policy

January 25, 2011

by Rishi Manchanda, MD

As a primary care doctor for working families, I am interested in anything that can tangibly address my patients’ health problems. But how do I prescribe repeal?

The House effort to repeal and replace last year’s health care law is not just an untested placebo with major potential side effects, like increasing the number of Americans without health coverage. For those of us on …

Nicotine vaccine to treat tobacco abuse and nicotine addiction

Chris Rangel, MD

Medications

January 25, 2011

Antibodies are complex proteins created by immune cells that are targeted to very specific parts of other large and complex molecules called antigens.

Much smaller molecules like nicotine, called haptens, do not normally induce any significant immunologic response so researchers chemically bound several nicotine molecules to a large protein to form an adduct. This combined molecule does induce an immune response, i.e, causes immune cells to produce antibodies targeted to the …

What your medical office can learn from Norman Rockwell

Brandon Betancourt

Physician

January 24, 2011

This past summer I got a chance to visit Washington DC. While I was there, I saw a Norman Rockwell exhibition at the Smithsonian American Art Museum. As it turned out, the exhibition was the private collection of George Lucas and Steven Spielberg. The exhibition highlighted Rockwell’s masterful storytelling.

I didn’t know much about Norman Rockwell before that day. I knew he was a famous American painter and I had seen …

Adherence to HIV treatment in Africa

Paul Sax, MD

Patient

January 24, 2011

There has been an irresistible urge for people — doctors, public health officers, politicians, journalists, the usual pundits — to compare adherence to HIV treatment in resource-rich vs. resource-limited setting.

I suspect this is because the whole issue got off to a famously bad start in 2001, when then-head of the U.S. Agency for International Development (USAID) Andrew Natsios said in an interview with the Boston Globe that Africans,

don’t know what Western time …

Read more…

Adherence to HIV treatment in Africa

Guns and why doctors should partner with the National Rifle Association

George Lundberg, MD

Health Policy

January 24, 2011

Is there anything that we physicians can and should be doing to help with the huge problem of gun violence in America?

We all know it is nuts to sell guns and ammo to nuts, yet as a country we do it every day.

We all know that, in contrast to rifles and shotguns, the only moving targets for hand guns are people; that the Congress and president in this century legislated …

Create a disease to market a new drug

Kevin

Medications

January 24, 2011

An excerpt from White Coat, Black Hat.

by Carl Elliott

Many of us have a relatively simple, commonsense view of the way that drug development and marketing work.

People get diseases; scientists develop drugs to treat those diseases; and marketers sell the drugs by showing that the drugs work better than their competitors. Sometimes, however, this pattern works in reverse. Drug company scientists develop a drug …

Read more…

Create a disease to market a new drug

Can a doctor and a nurse be friends in the OR?

Anesthesioboist T., MD

Physician

January 23, 2011

One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven’t seen her since I was in school, we’re still in touch and expect to be seeing each other at last in a couple of months.

By some coincidence one of my best friends now is also an O.B. nurse. I’ll call her Ziva (yes, I …

Should obesity be classified as a brain disease?

Michele R. Berman, MD

Conditions and Diseases

January 23, 2011

Many of our most popular stories are about diets and weight management.

Did you know that some psychologists and psychiatrists would like to classify obesity as a brain disease? The reason for this is that there is mounting evidence that food, or certain types of food, can trigger the same addictive effects in the brain as drugs like heroin and cocaine. There is also substantial evidence that some people lose control over …

How MD anesthesiologists have become victims of their own excellence

Jeffrey Parks, MD

Physician

January 22, 2011

The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.

Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …

Problems with the connection between thimerosal and autism

Kevin

Medications

January 22, 2011

An excerpt from Tabloid Medicine: How the Internet is Being Used to Hijack Medical Science for Fear and Profit.

by Robert Goldberg, PhD

From the beginning, there were two problems with the connection between thimerosal and autism. The first problem with was that thimerosal, while about half mercury, contains ethyl mercury, for which there were no exposure guidelines. So the scientists used the ones for methyl mercury. However, the ethyl mercury …

Payment systems must take into account the art of medicine

Marya Zilberberg, MD, MPH

Health Policy

January 22, 2011

You know that joke about the farmer whose cows are not producing enough milk? A university panel gathers under the leadership of a theoretical physicist. They analyze each aspect of the problem thoroughly and carefully, and after much deliberation produce a report, the first line of which is “First, assume a spherical cow in a vacuum.”

This joke has become short-hand for some of the reductionist thinking in theoretical physics, but …