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Friday, December 30, 2005

Caffeine & Memory

This probably helped me, at least a little this semester. God bless you Red Bull.

But, while helping memory in short supply, 137 cans in a row of the caffeine in that stuff would kill me.

Thursday, December 29, 2005

Funny but Off-Topic Once Again

"Actually, I don't have a problem with all five of [the Detroit Piston's starters] being All-Stars...because it is clear to me that the fans don't have a clue. 403,000 people voted for Raef Lafrentz...100,000 people voted for Chris Mihm..."
-- Charles Barkley

Sir Charles is actually intelligent and damn funny.

Hwang Woo Suk's Betrayal

Disappointing. Nothing else needs to be said about this.

The journal Science said it will retract a stem cell study it ran in May from South Korean scientist Hwang Woo Suk if the study's co-authors don't retract the paper by tomorrow on their own.

Breast Cancer Hope

A UK drug, Femara, already being used to reduce tumor size before surgeries is shown in a new English study to reduce the chances of breast cancer recurrence by a third over five years. That actually does sound pretty impressive.

More on Femara in the US.

An HIV Vaccine Killed By Costs...

An NIH exec is claiming the private sector will never develop an HIV vaccine since such would be of little commercial value.

As Asymmetrical Information says:

An AIDS vaccine would eliminate the value of retroviral therapies. Since those are expensive now, an AIDS vaccine would only be worthwhile to develop if it could be priced high -- say $100,000 a pop...[b]ut Merck, or whichever poor schlub actually invested the damn thing could not charge Africa, or anyone, $100,000 for a dose of AIDS vaccine. Public opinion would force them to give it away for free, or for a very low price.

Personally I lean very much towards AI's reasoning on this situation. You can read a little bit more, and where I found Asymmetrical Information's post, at In The Pipeline.

Maybe the answer is for the world's wealthy nations to guarantee to pay a "reasonable" (or unreasonable but profitable) price for an HIV vaccine to be used in the third world. Unless of course the national health organizations of the west truly believe they can develop an HIV vaccine on their own without major help from private industry.

Then again, as can be expected, I don't think the government should be funding this anyway. Or funding sending a future vaccine to hard hit countries. Step up charity; and it can work that way.

The World is More Secure?

Slate links to an article which misinterprets the world situation once again. Chatterbox seems to have an issue in assuming cause and effect relationships. Then again, I do sometimes as well. But here they've screwed up again.
"Just about every geopolitical argument put forth since 9/11 has taken as its starting point that the world has become a more violent place."
While the world as a whole may be safer if we take Mack's arguments as is, the west may be much more in harm's way today than it was in 1992. Mack's op/ed doesn't address, as I can see, the distribution of weapons or several other notable issues. For instance, it is not only arguable, but likely, that the world's nuclear weapons are less secure today than 13 years ago.
When the west refers to the world as a more violent or less secure place, they obviously are solely concerned with the west's security and that may well be less than it was in 1992. In the case of nuclear weapons, this is an issue that affects the west's security far more than the third world's.
Finally, I'm unsure about the causality Slate and Mack assume between policy and this belief in increased violence.
In many cases, a growing risk aversion and a growing intolerance for the world's violence, not necessarily a belief that the world is actually MORE violent, is fueling policy. The end result for policy decisions is the same.
Why do I, as an American, care how violent the world is before 9/11? But after that fateful day, any perceived instability throughout the world is a larger threat to me, even if the level of that instability and violence is actually decreasing. That change in viewpoint may actually be accurate, certainly Mack's op/ed has nothing to say about it.

Saturday, December 24, 2005

What Can You Say...

Unprofessional medical students are more likely to make unprofessional medical doctors. Well, duh, kind've.

But as examples used in a post at MedPundit illustrate, a lot of this goes deeper. There's evidence in the NEJM published study that the problem students lack empathy for patients or respect for authority figures. This is nothing that can be cured while in medical school.

I believe training in professionalism is a good thing for medical students but in many cases an attitude that was twenty years in the making, I don't think, can be undone in four. The answer, if this is a major problem, which I'm not even sure the study shows it is, is to focus on medical student recruitment - making attitude and empathy, at the expense of grades and MCAT scores, a bigger part of the medical school admissions process.

You can check out Over My Med Body's irked response (which I agree with) to MedPundit's original post.

Thursday, December 22, 2005

Euthanasia

Did doctors in New Orleans take to euthanizing patients?

This story really doesn't make it out to be an ethical dilemma the hospital was dealing with it. It sounds like the staff was just getting lazy but under such a situation that may not be giving these people enough credit.

Despite what may appear, from the article, as a cut and dry ethical situation I'm not sure my ethics class in medical school did one iota to make me better situated to handle a situation like the one they faced in the aftermath of Katrina. Either, by the time you get here, you have a compass of what to do...or you don't.

Maybe the focus needs to be on doing a better job of trying to fish out who has such a compass during the admissions process for medical school rather than trying to instill it in students once they get here.

Sunday, December 18, 2005

Bug Evolution

I'm not a Doonesbury fan but...


Saturday, December 17, 2005

Ball Steal

I'm making a dedication to try to keep this blog on subject and off sports (Spurs, Trojans, Cowboys, Saints, Astros) but this is pretty funny:

Brett Farve gets the ball taken from him by Cincinnati Bengals fan.

Friday, December 16, 2005

Operation: Semester

I'm kind of 1/8th of the way done with medical school.

What's troubling however is that Biochem is worth more to my GPA than say...my Pediatrics clerkship third year. Maybe that only seems wrong in the immediate aftermath of that wreck that was my final Biochem test of the semester.

Now I got three weeks off.

Tuesday, December 13, 2005

My First

It dawned on, as things tend to do while looking at histo pics, that I hadn't commented on what I'm going to call my first procedure, and I use that word with a smothering of sarcasm. This despite the fact it is at least two weeks in the past. That is actually kind of sad. I'll talk all day about the politics of medicine but the humanistic moment when I first stuck a catheter up a guy's penis goes without a word.

I was following around a trauma surgeon and down in the ER was encouraged by one of the third years to ask a tech if I could put in a foley, and what do you know they let me. I think they thought I was further along my education than three months, because they seemed surprised I couldn't put on the gloves and keep them sterile at the same time. It is harder than you might imagine. They were good sports considering I went through three pairs before figuring it out, not that I could duplicate it right now if I had to.

It was my second time spending the night down with the trauma service. This one was interesting in its own way, but certainly much slower than the first time around. Beyond the foley I went up and watched a resident clean out an anal fissure and fistula (like I said, slow), which looked like a pretty miserable thing for this patient to be living with for a decade.

A foley ain't much of anything, but at least for me as a first year, it was something to marvel at. I hope that never goes away as I learn more, as things I see become common, this sort of excitement over all medicine is.

Penises and assholes...interesting.

Monday, December 12, 2005

Free Will To The Wind

Should extreme bigotry be considered a mental illness?

Just throw it in the pot with the rest of the "diseases," and maybe their biological basis will turn up at some time in the future.

H/T to Slate

Tort Incompetence

In the Pipeline has a nice dissection of just what exactly Merck withheld from the VIGOR study published.

If the data were beyond the cutoff date for the study, then strictly speaking Merck did the correct thing by not including them in the analysis. Questions of propriety would arise only if Merck chose to include other data beyond the cutoff, such as some GI events. If the cutoff had altered the statistical conclusions, Merck would have been ethically obligated to disclose this, but that appears not to have been the case.

-- In the Pipeline Comment

Cries from attorneys for a mistrial and the probability that this will hurt Merck's outcomes at future trials shows nicely that lawyers and lay juries are incapable of digesting and understanding complicated medical data.

I really think what Merck did was within the realm of reason and shows no attempt to hide adverse data. From Point of Law, linked by In the Pipeline: the knowledge was out there (the FDA had it and it appeared on Vioxx's packaging), and the data deleted was inconsequential to VIGOR. What NEJM did without regard for the available context is sort of disheartening.
Why make a press release the afternoon of the closing argument? This looks like an attempt to affect the federal trial.

Sunday, December 11, 2005

Perspective

I was trying to put studying for my last round of tests this semester (or not) into perspective. Maybe I was just trying to kill time from the biochem study guide by starring off into space.

The first two months here I had a medical ethics and humanities class. It was kind of a disorganized hodge-podge, addressing both the history of medical ethics and basic ethical reasoning as well as how you could approach patients empathetically as stories. Pretty new age, at least down here in Texas.

A physician came in and told us one of the most incredible stories I had ever heard, and I'm not really sure what brought it back to me today, although I had certainly forgotten about it for a while.

I changed it some, hopefully enough. I wonder if the ethical implications of posting identifiable info are changed by the fact I have a readership of right around zero. Probably not...

The doctor was a family physician who had finished his residency at the beginning of the AIDS epidemic, and so when he went out into practice he took up a position, really apparently actually built it from nothing, at an AIDS clinic.

A few years into his practice a patient who he's close with is in the hospital and in bad shape, and the patient decides his time has come and he wants to go home with a hospice nurse. Probably the right thing, but the physician feels close to the patient and kind of wishes he would keep fighting.

A couple days after the patient goes home the physician decides to go see him. He hassles with the patient and finally gets him to agree to let him draw some blood to take back to the lab and see what the T cell count is. The physician is hoping for good news.

He draws the blood, something he's done a thousand times, but there's no sharp container to dump the needle in, so the physician wraps it in a paper towel and sticks it in a bag with the blood. He forgets about it on the way back to the clinic.

Back in his office he reaches into the bag and something sticks him and he immediately realizes what has happened.

The first test comes back negative. The second test comes back negative. All the while he's on anti-retroviral meds. It's nearly eight weeks, two months, after the stick, that the third test comes back positive. From a needle stick.

There's something humbling about being the patient, as this doc became. You realize there's great power and there should be great responsibility in what physician's are allowed to do.

Sometimes there seems to be a lot of professionalism rhetoric and a pedestal that physicians seem to place themselves on. There are doctors with egos. All the while however the public respect for the medical professional seems to be dropping. In that environment the talk about humanism and how noble this profession is can seem kind of like fluff; like old windbags talking up their choice of profession.

Stories like the one above actually kind of restore my pride in the path I'm on. Not to say that that pride was ever completely gone, just that it takes a dip every now and then.

Cheesey Wallpaper


Until I find a better one, here's a Rose Bowl wallpaper (1024 x 768).

Heisman

Monday, December 05, 2005

Bioprinting

Five or ten years until we're "printing" implantable organs??

Seems optimistic but maybe I'm not giving biotech advancement enough credit.

Saturday, December 03, 2005

Good News, (Bad News)

The number of emergency coronary artery bypasses done following angioplasty has dropped over the past 25 years. No surprise as the interventionalists get better at the procedure.
"Our review of almost 25 years of data on angioplasty suggests that there has been a dramatic reduction of almost 90 percent in the incidence of coronary artery bypass graft surgery following angioplasty; and this is despite the fact that more recently we are performing angioplasty on very high risk patients," said Mandeep Singh, M.D., F.A.C.C., from the Mayo College of Medicine in Rochester, Minnesota.