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Monday, August 29, 2005

College Football & Coeds

Oh what a surprise, the five schools with the most attractive coeds according to ESPN are four schools from the south and the University of Southern California.

Kickoff is this Saturday (Sept. 3rd) versus Hawaii...which just means I have to study that much harder this week (and not spend time posting...like now) so I can spend a good chunk of Saturday watching the game.

Fight On

Friday, August 26, 2005

Cell Division

So there is this cell just chugging along when the number of small peptide growth factors binding to some of it's receptor integral proteins reaches some threshold and the second messenger system inside eventually causes the expression of a proto-onco gene whose product causes, among other things, the expression of a gene that produces cyclin.

Cyclin is involved in activation the cdc 2+/cdc 28 kinase on the Maturation Promoting Factor (MPF). MPF has three major functions in cell division: it signals the phosphorylation of the nuclear lamina intermediate filaments which breaks down the nuclear membrane, it condenses the DNA, and it helps in the creation of the spindle apparatus.

Free Speech

Uh....I'm a rising political star currently holding the position of Attorney General in a southern state and I'd like to adhere myself to the hearts of soccer moms. The state of Tennessee is trying to stop Gretchen Wilson from pulling out a can of Skoal during her concerts.

Tuesday, August 23, 2005

Austin, TX & Walgreens

This is a less shadowy area.

Because Walgreens has a contract to provide pharmacy services to patients in Austin's "medical assistance" program, the terms of such a deal could easily require Walgreens to stock and dose out emergency contraceptives.

As long as the consequences of not doing so are in the marketplace and not criminal or civil then...

Med School Curriculum

From Kevin M.D.:

I'm pretty pleased with my curriculum so far. Apparently a lot of students aren't. Granted I've only been in class four weeks and I haven't done a single rotation...

How can over 35% of students not study medical ethics? I've spent so much time these first four weeks covering the ethics and professionalism of my chosen career...

Go Pharmacist Go

I've commented on this completely misplaced Illinois law earlier but, here it is again; this time hopefully facing nullification.

Apparently, there's a "right" for a woman not to "feel" embarrassed and harassed by trying to buy Plan B contraceptive in a store that might not have it but there's no right for me to stock what I want to stock at my pharmacy or store.

Sunday, August 21, 2005

Internet

It is hurting my productivity that I have wireless internet all over campus. Coming to the library to avoid distractions is less effective than it might be. Oh well...

Saturday, August 20, 2005

Duck Hunting

A medical student, an Internist, a Psychiatrist, a Surgeon and a Pathologist go duck hunting. They barely find their duck blind before the first duck flies over.

The medical student is the first to raise her shotgun, but unable to tell if the duck is really a duck, she does not shoot.

The internist aims his shotgun, but can not tell if the duck is male or female and he does not shoot.

The psychiatrist has the duck framed in his sight, but then lowers his shotgun, claiming "I know this is a duck, but does the duck know he's a duck?"

The surgeon quickly raises his shotgun, aims, and without pause shoots. The duck falls to the ground. The surgeon turns to the pathologist and says, "Go figure out if that'’s a duck or not."

(H/T MUSC Tiger)

Autonomy

Doctor, you say there are no haloes
around the streetlights in Paris
and what I see is an aberration
caused by old age, an affliction.
I tell you it has taken me all my life
to arrive at the vision of gas lamps as angels,
to soften and blur and finally banish
the edges you regret I don't see,
to learn that the line I called the horizon
does not exist and sky and water,
so long apart, are the same state of being.
Fifty-four years before I could see
Rouen cathedral is built
of parallel shafts of sun,
and now you want to restore
my youthful errors: fixed
notions of top and bottom,
the illusion of three-dimensional space,
wisteria separate
from the bridge it covers.
What can I say to convince you
the Houses of Parliament dissolve
night and night to become
the fluid dream of the Thames?
I will not return to a universe
of objects that don't know each other,
as if islands were not the lost children
of one great continent. The world
is flux, and light becomes what it touches,
becomes water, lilies on water,
above and below water,
becomes lilac and mauve and yellow
and white and cerulean lamps,
small fists passing sunlight
so quickly to one another
that it would take long, streaming hair
inside my brush to catch it.
To pain the speed of light!
Our weighted shapes, these verticals,
burn to mix with air
and change our bones, skin, clothes
to gases. Doctor,
if only you could see
how heaven pulls earth into its arms
and how infinitely the heart expands
to claim this world, blue vapor without end.

-- Lisel Mueller, "Monet Refuses the Operation"

Vioxx Verdict

This award will be reduced for Texas' punitive awards cap, although the story doesn't make it clear how much of the award was based on future earnings and how much was punitive. There are more than 4,000 Vioxx cases pending and this one was apparently, by some opinions, not a particularly strong one. Apparently there were significant causation issues, and yet Merck was still found liable.

I don't think I know enough to make a legitimate comment on this case. There's a reason causation is so difficult in many drug cases, because that's the way biochemistry actually works. As the FDA has made it clear Vioxx has a place in the marketplace, and although your chance of a heart attack versus a placebo is significant (like 15x greater or something) your chances of suffering such are still 'low', at least by my standards. I'm sure that for those who feel they've lost a family member to a Vioxx related heart problem that this is little consolation.

Wednesday, August 17, 2005

Leaving Home

This is a tragic event. I have incredible admiration for Ariel Sharon. Here was a man who trumpeted Jewish settlement of Gaza early and life, and yet having seen the only way to peace he has risked his career and his reputation and suffered to watch settlers torn from their homes in order to give such a chance.

Israel has made a giant consolation. If the Palestinian Authority cannot control the militants now, then may Israel bomb them into oblivion and be done with them.

How A Person Becomes A Patient

I hope I never look at a person as a disease but it is far too easy. This is a pretty brutal and impolite situation.

Here's how it happens, from the New York Times.

Five Minutes of Medical School
























This is five minutes of medical school.

I'm sure the vast majority of undergraduate biochem majors have or will see this pathway during their college work, but to cover it in five minutes? It is merely the speed of medical school and the amount of information presented that makes it so difficult.

Tuesday, August 16, 2005

Designer Babies

Will parents be able to choose the sex and genes of their embryos before implantation in Britain?

The medical director of one of Texas' most successful and largest infertility clinics came and talked to my class today in an ongoing clinical correlation set of lectures tied to gross anatomy. His clinic wouldn't reveal or allow parents to choose the embryos to implant based on sex (except in the case of X linked diseases).

As well, if the parents didn't take back their unused embryos, no embryo, no matter if PDG revealed chromosomal abnormalities, was destroyed. All of them were sent to long term cryogenic storage.

Monday, August 15, 2005

In The Past

The kid doubles over like he’s about to hurl and then comes rhythmically back up, extending his arms and leaning back; stretching his abs which he hasn’t willed to contract. He remembers back to the time he was ill. This is his only reminder of it, these cramps and contractions. The scar from his surgery is even hidden from his view as so he can simply pretend it isn’t there.

“You okay?”

The kid nods as his opponent puts the basketball down. Predictably, a few seconds into the mess and the muscles start to relax. The muscles give up in a wave, from top to bottom until his side doesn’t ache anymore and the breaths become easier. He picks the basketball up. Back to normal he can once again forget about those days in the hospital, years ago.

He was sick though. It began with a backache; low down a single side of his body and deep. The way he remembers it, the few times he thinks of it, is of days, perhaps a week, where at times the pain left him curling up in bed and others where it seemed a mild inconvenience. A fever comes several days later.

“You have the flu,” or something of the sort, his mother thinks.

There’s reason to think it. The night before he’s admitted to the hospital he goes out to the movies with friends. He can remember that. It’s a joke now. He gets home after dark and crawls into bed. At some point he begins to feel sick and then to vomit. It doesn’t stop though. At no point does the heaving relieve the wrenching of his stomach, as he might expect from past experiences. His parent’s are concerned as he wakes them up.

There’s reason to be now. When the sun finally rises and the private labs open, it’s off to get blood drawn.

“He’s dehydrated,” they say; an easy enough diagnosis. It is to the hospital with him. He’s resentful, a little. There was an unspoken expectation that his first hospital admittance would be at 60 for a hip replacement. Maybe the thoughts weren’t so specific in nature, but they were there. There’s little time for that. The fluids they put in him bring an incomparable, unbearable pain.

So bad he embarrassingly can’t stop himself from writhing or letting the tears come to his eyes. He doesn’t want to remember feeling cowardly and wimpy that night or how it helped a little when later in his hospital stay a fireman, turned nurse, told him his pleurisy was the worst pain he had ever experienced. He wishes he would tell that to all the people who saw him that first night.

The pneumonia found on the scans explains the effusion and later the culture reveals the bacteria is no super bug, bowing to antibiotics quickly. The doctor takes his time explaining this to him even fielding ridiculous questions (or at least the kid will imagine them as such later), like, despite the culture could the effusion be caused by something else, say, cancer? He can’t remember the doctor’s name despite this consideration.

The morphine helps, both before and after the diagnosis. More and more and more with the little push button until the next thing he knows the doctor is leaning over him asking him how many fingers he’s holding up, who the president is, what day it is.

“I’m waiting for the trick question,” the kid says. They know he’s alright with that. He doesn’t ponder what it must have been like for his mother, sitting there in the room, as he starts imaging and rambling about three legged animals, or so he’s told that’s what he spoke of. Instead he’s absorbed in the thought, that he was so cowardly in dealing with the pain that he drove himself into a morphine induced hallucination. It does make for a good story however, later in life. His experience with drugs.

They send him home eventually, waiting for the effusion to go away by itself. Trips to the hospital show it merely dries up into a fibrous solid. Yes, there’s some trouble breathing, but let it be, he thinks, it’s better than the solution.

When he wakes up in the ICU after the surgery he’s vindicated. Like with that first night in the hospital, when he remembers, he remembers the pain. It hurts when they can’t get the material out with a scope and have to cut and spread your ribs at your side. He remembers being able to feel himself pee out the catheter, despite the epidural.

Nowadays he can say, “It wasn’t that bad, it could’ve been worse.” He even talks about how, if he was going to have to get a scar, he wishes they had made it longer, cooler. Those around him know it was tough though. They watched him from his bedside. They remember better than he does.

Slow steps around the hospital as he starts to walk a day or two after the surgery. He tries not to be a wimp for this part of it. And then, it’s home, and changing your own bandages, and having to sit on a stool while taking a shower as standing for long periods is still difficult.

It’s as if as soon as he’s home he starts to forget. It was another life when those doctors took care of him, when those friends came and visited him in the hospital. As the incision heals and scars so does that part of his brain holding those memories.

He thinks about Christmases and family trips and that time on his high school basketball team when he hit those free throws to beat St. Anthony’s but he can’t even remember the year he went into the hospital. Was it 1999 or 2001? All major events but not all equal

Maybe they did their job to perfection then. Everyone who cared for him, that is. He’s normal, he’s healthy, and except for that scar he can’t even see in the mirror, the entire trip may have been made up. A vivid dream, that’s how hazy some of the memories are.

If he stopped he might feel ungrateful for trying to forget his experience. After all, those healthcare providers did an awful good job on him, he might suppose, and yet he can’t remember a thank you or even their names.

He might excuse himself with, “They wouldn’t even remember me.”

Maybe that’s not important. It might have been a big enough thank you the day he walked out the door.

Money...

...can buy happiness, as presented at the American Sociological Association annual meeting.

Saturday, August 13, 2005

Accutane

Sometimes it is hard to separate your own personal experience with studies and facts. Accutane was a wonder drug for me, I loved it, it was simply put amazing. However, the FDA is imposing new restrictions on the drug for fear of neurological changes in users (and birth defects in pregnant women who take it).

Friday, August 12, 2005

HIV Treatments

A UT - Southwestern (hooray) ID researcher, of some renown, has led a study that offers a very very promising new treatment for HIV/AIDS patients. It's making its way through the news sources very quickly.

PTSD

The Veteran Affairs health system is going to review every case of diagnosed PTSD between 1999 and 2004 to see if the veterans should truly be receiving disability benefits.

I'm skeptical of many psychiatric diagnosis that can appear with wide ranging symptoms and require a subjective diagnosis above and beyond say what an ID doctor must make. However, this is clearly a witch hunt for the VA to save a few million dollars at the expensive of this country's veterans -- otherwise they'd be looking at veteran's applications whose PTSD disability claims were denied as well, in hopes of finding those that should be receiving benefits but aren't.

Tuesday, August 09, 2005

The Drug War

Make no mistake. I hate John Tierney. However, despite my less than libertarian views on stifling immigration and opposition to abortion, most of my social views fall along the party line. Among them is my belief in the legalization of illicit drugs, which Tierney has written a column about in the NY Times.

It's not only the right thing to do in terms of restoring rights but also the pragmatic solution to a problem, the use of illicit drugs, which has grown only worse since the declaration of the 'war' on drugs.

H/T to DB's Med Rants, who comments on the article here.

Monday, August 08, 2005

Preventing Tumor Metastasis

UNC School of Medicine faculty have found a protein, CIB1, which appears to inhibit cell migration. If a successful promoter can be found for protein production or an acceptable delivery method can be built it may help slow or prevent tumor metastasis.

I think oncology would be an incredibly interesting and noble specialty. We're going over basic, basic, basic (let me emphasis that again, basic) cell cycle stuff in Histo right now. To make it interesting the lecture and syllabus spends a good chunk of time providing clinical correlations to the material; most notably what 'goes wrong' in the cycle when cancer occurs. It's pretty fascinating.

The Smell

Although I had heard it from first year medical students during the application process it's difficult, without experiencing it, to understand the personal aroma that you leave the anatomy lab with...

Sunday, August 07, 2005

Human Cloning

From a story on Snuppy, a newly cloned dog:

"Bring me human eggs, the necessary social consensus and legal permission and I can get you your replica within a year," said Park Se-pill, a senior researcher of Maria Biotech and a top cloning expert.

"In contrast to widespread public belief, cloning a human is much easier than cloning a cow or a pig," Park said.

It's probably inevitale. The question becomes, when and where.

Cranial Nerves

  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Trochlear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Vestibulocochlear
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal

Friday, August 05, 2005

Vocabulary

I'm posting a lot today. Trying to make up for lost time.

I've come to understand a big reason why doctor's are revered as intelligent. It's true medical school is tough to get into and difficult to complete, although that's a comparative statement. But, it's hard for the general public to appreciate that.

I think one thing, of many, that forms people's impressions of medicine as a group of smart people is the vocabulary of the physician.

I've been in class a week, and I can already say something like, "the erector spinae muscle masses, of which the iliocostalis is the most lateral, are deep to the serratus posterior inferior."

That tells me almost nothing important but it sure sounds cool...

Specialty Hospitals

I responded to a Healthcare Renewal post a while back about Hermann Memorial in Houston wanting to boost it's paying customers. I applauded Hermann's effort; as academic community hospitals face a staggering financial burden.

In my response, which I retold in my own post here, I argued that specialty hospitals hurt public hospital income by taking all simple high profit procedures and leaving nothing but the most difficult and indigent cases. Now, from Kevin, MD, here's an article citing the same thing.

Worst Op-Ed Ever

I'll be honest, although I believe in intelligent design (even more so after seeing the workings of the human body yesterday during my first gross lab dissection), I do not believe it should be taught in school. It is a matter of faith.

Even so, this op-ed in this po-dunk newspaper may be one of the most brutal of the year. It makes it sound like the teaching of intelligent design would be the end of America's golden age of enlightenment. It's people like this journalist who have pushed the PC movement and the liberalization of this country to the point it is now...where a completely private school has the government decide who it will admit and who it won't.

At least the way I've attempted to reconcile intelligent design and scientific fact is just a personal belief that God put the world and it's natural workings in motion. There is really nothing more to teach than that. I fully believe in the evolutionary process and I believe most proponents of intelligent design do as well.

Thursday, August 04, 2005

First Gross Anatomy Dissection

How amazing it was.

It was of the muscles of the back. I was lucky enough to make the first incision in our body (I feel disrespectful calling it a body. However, all other options, such as giving it a name, seem even worse). I cut from just below the occipital protuberance down to the end of the coccyx. I was surprised how quickly I got the feel for how much pressure needed to be applied to the scalpel in each section of the body.

I am ever grateful to whoever this person was who donated themselves, especially since they were skinny when their time came, making the learning process and the dissection that less tedious (cleaning fat is a long process on some bodies).

I did fail to find the occipital nerve on my half of the head or the accessory cranial nerve invenerating the trapezius on my half as well, so I felt a slight failure. But, I searched hard, and I'm sure I could identify both in the practical, so I'm a little less worried.

We've taken good care of our body so far; taking extra time to clean away excess fat and make our dissection look good, beyond just completing it. It sounds morbid but in some ways I feel that actually taking stuff out of our body, and making it look nice is a sign of respect. I was proud of my tankmates, they all did a better job than I and made it that much easier on me.

Tuesday, August 02, 2005

National Electronic Health Records

Take this study with a grain of salt. Make that two gains of salt.

What The %#@!

The Kamehameha Schools receive not a dime of federal or state funding and yet they cannot use race as an admission factor.

You can deny the private school leader's right to run their PRIVATE business the way they want and serve who they want but my God if those same school leaders are going to deny someone else the right to go to any school they want to! If I own a private business I should be able to discriminate on any basis I want and if I walk into a private business I should understand the same could be my fate. It may be unethical, a terrible thing, and a generally terrible business practice, I will agree, but it's certainly not government's place to regulate it.

Public institutions should not be allowed the same privileges (that's why affirmative action is inappropriate at public universities). As well, government funding and contracts should be conditional on unbiased policies amongst the companies and organizations that receive such monies. But this is a case of neither.