July 13, 2008
Dr. Michael DeBakey, R.I.P.
Dr. Michael DeBakey (previous posts here) died late Friday at the age of 99. One of the most influential men in Houston's history, Dr. DeBakey was the world-famous cardiovascular surgeon who researched, developed and initially implemented not only a variety of devices that help heart patients, but also such now-common surgical procedures as heart-bypass surgery. Two of the Chronicle's finest reporters -- Science reporter Eric Berger and Texas Medical Center reporter Todd Ackerman -- provide this outstanding article on Dr. DeBakey's remarkable life, and Eric provides an audio file of his 2005 interview of Dr. DeBakey here. The New York Times' article on Dr. DeBakey's death is here.
As with my late father, Dr. DeBakey was one of the leaders of a talented generation of post-World War II doctors who embraced the optimistic view of therapeutic intervention in the practice of medicine, which was a fundamental change from the sense of therapeutic powerlessness that was widely taught to doctors by their pre-WWII professors. As noted earlier here and here, that seismic shift in medicine has changed the course of human history.
But the tremendous impact that Dr. DeBakey had on medicine is exceeded by the massive effect that he had on Houston. When Dr. DeBakey accepted the president's position at Baylor College of Medicine a few years after the end of World War II, the Texas Medical Center was a sleepy regional medical center. Over the next two decades, Dr. DeBakey was one of the key leaders who transformed the Medical Center into one of the largest and best medical centers in the world. Dr. DeBakey was the catalyst who established the culture within the Texas Medical Center of cutting-edge research, productive competition but also widespread collaboration, quality care for patients and good, old-fashioned hard work that attracted the best and brightest physicians, teachers and students from around the world to the Medical Center.
This massive importation of intellectual capital over the last 60 years of Dr. DeBakey's life generated enormous wealth and benefits for Houston. Today, the medical facilities of the Texas Medical Center are the largest aggregate provider of jobs in the Houston area, even greater than the local jobs provided by the energy industry.
That's quite a legacy in my book.
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May 1, 2008
Neuroscience and the Law
I am always on the lookout for creative and interesting Continuing Legal Education seminars. This one clearly fits the bill:
Baylor College of Medicine’s Initiative on Neuroscience and Law is proud to announce its 2008 Conference. This conference showcases talks from experts in several aspects of neurolaw. Topics include responsibility, punishment, prediction, rehabilitation, brain death, genetics, competence, intention, and ethics – all with an eye toward understanding how cutting edge neuroscience will touch the current practice of law.
The conference, which is worth 3.5 hours of CLE credit, will take place on Friday, May 23, 2008, from 1-5 p.m. at Baylor College of Medicine (Room M321) in the Texas Medical Center. One of the speakers for the conference is Daniel Goldberg, a local attorney and former Texas Supreme Court clerk who is currently working on his PhD at the University of Texas Medical Branch while serving as a Research Professor at Baylor's Initiative on Neuroscience and Law and as a Health Policy Fellow at Baylor's Chronic Disease Prevention & Control Research Center (Daniel is also a frequent commenter on health care and health care finance issues on this blog). The preliminary agenda for the conference is here. Check it out.
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April 23, 2008
Getting to 120/80
Jane Brody, the NY Times' excellent reporter on health and fitness issues, provides this good overview of the current treatment options for high blood pressure, including this summary of the current drugs that are most commonly prescribed. My late father was one of the pioneers in the development of the first drugs and treatment protocols for hypertension.
As this earlier post noted, if FDR's physicians had known in 1945 what doctors know today about the damaging effects of high blood pressure, those physicians would not have recommended that the seriously ailing FDR be allowed to go toe-to-toe with an avaricious Stalin at Yalta. Even a relatively short delay in the insight gained from scientific research can have a major impact on the course of mankind.
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April 17, 2008
What is Tiger thinking and has The Masters become a bore?
So, Tiger Woods is being forced to take a month off from the PGA Tour as he rehabs from knee surgery. I know that Woods' workout routine is considered cutting edge, particularly for a professional golfer, but what on earth is he running seven miles per workout with a bad knee? Don't his trainers know that long-distance running is not a particularly healthy form of exercise?
Long-distance running is a fine form of recreation for folks who enjoy it. But as a method of exercise, I am hard-pressed to think of one that is more physically damaging. Woods would be smart to re-think his workout to delete long-distance running and concentrate on short sprints for the aerobic part of his workout.
The knee operation will prevent Woods from defending his title at the Wachovia Championship in two weeks or competing in The Players Championship at TPC Sawgrass a week after that.
By the way, Geoff Shackelford (see this Daniel Wexler post, too) is leading a discussion over at his blog on whether the design changes at Augusta National -- which have clearly prompted players to play more defensively and less aggressively during the Masters Tournament -- have undermined the excitement of the tournament for spectators. Geoff passes along the following interesting stat from Brett Avery's Golf World stat package:
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April 7, 2008
Acupuncture or fake acupuncture?
This Respectful Insolence blog post reports on yet another in an increasingly long line of medical studies that demonstrate that acupuncture is nothing more than an elaborate and fancy placebo. In this particular study involving patients in "true" acupuncture and "fake" acupuncture protocols, patients in the sham acupuncture group improved more than patients in the "true" acupuncture group.
My conclusion? On one hand, if you stick pins in people who are complaining about something, then some of them will eventually quit complaining. On the other hand, if you take pins out of some people who were previously complaining, then some of them will also stop complaining.
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February 25, 2008
Thinking about schizophrenia
Two recent NY Times article regarding the vexing nature of schizophrenia, one sad, one hopeful. Let's all hope for more of the latter.
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February 19, 2008
An emerging risk of youth sports
As youth sports become increasingly specialized, a family from The Woodlands is the subject of this Gina Kolata/NY Times article on one of the big risks to children of that trend -- increased torn anterior cruciate ligaments ("ACL"), the main ligament that stabilizes the knee joint:
The standard and effective treatment for such an injury in adults is surgery. But the operation poses a greater risk for children and adolescents who have not finished growing because it involves drilling into a growth plate, an area of still-developing tissue at the end of the leg bone.Although there are no complete or official numbers, orthopedists at leading medical centers estimate that several thousand children and young adolescents are getting A.C.L. tears each year, with the number being diagnosed soaring recently. Some centers that used to see only a few such cases a year are now seeing several each week.
A friend of mine and I were discussing last week how unfortunate it is that most children these days depend on their parents to organize athletic activities for them rather than simply playing sports informally with neighborhood friends. Increased specialization is the natural evolution of organized sports, which means more games, more practice and more pressure on growing muscles, joints and bones. Not a particularly healthy risk in my book.
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February 3, 2008
WinkingSkull.com
Check out WinkingSkull.com, a worthy counterpart to the Visual Medical Dictionary (noted earlier here) in better understanding anatomy and medical conditions.
Along those lines, did you know that "the bacteria count in the plaque on human teeth approaches the bacteria count in human feces?" (H/T Kevin, MD)
Still biting those fingernails? ;^)
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January 30, 2008
Arnold Kling's Medicare experience
As I've noted many times, EconLog's Arnold Kling is doing some of the best writing and thinking about health care and health care finance issues in the U.S. right now. In his latest TCS op-ed, Kling describes the care received recently by his elderly father (who sounds as if he should have been a patient of my late father) and observes:
Medicare is wonderful for relieving the elderly from the burden of worrying about health care expenses. By the same token, it is wonderful for relieving doctors of the burden of worrying about the elderly as customers. You get paid for understanding the billing system, not for understanding your patients.
Read the entire op-ed. An update post is here.
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January 25, 2008
The vanishing primary care physicians
This earlier post on my internist's decision to adopt a concierge health care model for his practice noted that the economic crisis faced by most primary care physicians was one of the primary reasons for the change in his practice. In this recent post, Kevin Pho passes along the story of yet another internist hanging up the stethoscope as a result of not being able to make ends meet within the frazzled U.S. health care finance system:
"I am an Internist for over 20 years, and I recently closed my primary care practice as I cannot make a living at it. I made $23K in the last 11 months. And, my departure from practice is only the beginning of a tsunami of closures of primary care practices . . .Primary care is unraveling around us. Indeed, all of the articles about the inordinate strain & crowding of emergency departments across the U.S., overlook the obvious - the impending failure of primary care is going to completely overwhelm emergency rooms. There is no way to prepare for this other than to save primary care.
The whole house of cards has begun to collapse, and all the articles and discussions fail to put it in terms with sufficient emphasis. All of the 'universal' systems that actually work are built on very strong and well-funded foundations of primary care. Everything else in health care is built upon that foundation, and that is precisely what is failing across the country. Why are emergency rooms overcrowded? Why are the wait times increasing even for the seriously ill? Because primary care is failing!
Just remember, I told you so."
And here is another primary care physician's analysis of why he turned to the concierge model.
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January 21, 2008
Visual Medical Dictionary
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January 17, 2008
The fascinating "Flea"
Eric Turkewitz interviews Dr. Robert Lindeman, the Boston-based pediatrician who caused quite a stir last year when the Boston Globe broke the story that he was the anonymous blogger nicknamed "Flea" who was blogging a medical malpractice trial while participating as a defendant. One of Dr. Lindeman's answers even has a Houston twist:
A hypothetical question: You've been called for jury duty and the case involves a question of medical malpractice. What will you tell the attorneys during the jury selection process about your ability to sit impartially?Answer: "I will tell them that Roger Clemens will admit to using performance-enhancing drugs before I will able to sit impartially on a malpractice jury."
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January 11, 2008
America's worst 20 fast food items
Most folks can get by quite well with eating less than 2,000 calories per day. Each of these food items pretty well gets you there.
Caramel Banana Pecan Cream Stacked and Stuffed hotcakes?
By the way, just to show that you can find almost anything on the Web, The Healthy Dining Finder can help you pick healthier choices from standard restaurant menus by eliminating high-calorie add-ons.
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January 9, 2008
No sympathy
This NY Times article from the other day reports on the increasing numbers of lawyers and doctors who are plagued by self-doubt (who'd have ever thought that?). Mr. Juggles over at Long & Short Capital has no sympathy:
To the lawyers:In case the Neiman Marcus purchases succeeded in lifting your morale and left you with the impression that what you did counted for something, please let me add some critical information: It doesn’t. This is why you are paid, on an hourly-adjusted basis, like a recent (2nd tier) college graduate.
To the doctors:
The fact that I was able to diagnose my own illness after 15 min on WebMD speaks to the value of your knowledge. Perhaps our relationship would be more productive if you would stop making me wait 3 days for an appointment (and 90 minutes once I get to the office) to diagnose a sinus infection that I already know I have. Give me the antibiotics without the self-importance. I will come see you again when I have something you can actually be helpful with. For instance, after I break my arm trying to carry my bonus home, I will come see you and you can set the cast. Until then, please stop whining.
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January 8, 2008
Dr. Pou's fog of Katrina
This Dr. Susan Okie/New England Journal of Medicine article (H/T Kolahun) provides the most extensive analysis to date of the circumstances surrounding the tragic deaths of the nine New Orleans area hospital patients during the aftermath of Hurricane Katrina that led to the egregious prosecutorial decision to bring criminal charges against one of the treating physicians, former University of Texas Medical School physician, Dr. Anna Pou (previous posts here). Dr. Okie addresses the key question of why these nine patients died ". . . in light of the eventual evacuation of about 200 patients from [the hospital], including patients from the intensive care unit, premature infants, critically ill patients who required dialysis, patients with DNR orders, and two 400-lb men who could not walk." It's an important question to address, but not in the context of a criminal case.
The fog of war analogy is certainly appropriate. Even with as good information as we have about the horrific conditions at the hospital in the aftermath of Katrina, it's still hard to imagine how difficult it was making even basic decisions in the face of the breakdown of civil society and infrastructure. What we do know is that Dr. Pou, who was not experienced in providing emergency medical services in what amounted to a heavy combat war zone, was no ethicist on mission to make a political statement. Rather, she was simply a physician doing the best she could to make the right decisions under the worst circumstances imaginable. It should not surprise us if, with the benefit of hindsight bias, some of those decisions would not have been the ones that a reasonable physician would have made under better conditions.
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December 21, 2007
Self-deception about calories
This Gina Kolata/NY Times article (previous posts here) explains how many people continue to misconstrue exercise as a primary means of weight-control by overestimating the number of calories they expend during exercise. A well-structured exercise program can assist in controlling a person's weight over the long term, but it really doesn't have much effect on weight over the short term.
On the other hand, my anecdotal experience is that many of the same folks who overestimate the amount of calories that they expend during exercise dramatically underestimate the amount of calories that they are consuming, particularly in regard to restaurant food.
I'm convinced that the combination of these misunderstandings -- along with not having a clear understanding of the difference between exercise and recreation -- has much to do with the obesity syndrome that many Americans battle throughout their lives.
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December 19, 2007
The remarkable story of Kevin Everett
Three months ago, Kevin Everett, a tight end for the Buffalo Bills who was born and raised in Port Arthur just east of Houston, suffered a serious spinal cord injury during an NFL game. At the time of the injury, there was grave doubt whether Everett would ever walk again.
As this Sports Illustrated article recounts, Everett's recovery from his serious injury has been nothing short of amazing. One of the interesting aspects of Everett's recovery is that it may have been fueled by the gutsy call of a 45 year-old orthopedic surgeon on the scene in Buffalo, but it was certainly facilitated by the remarkable rehabilitation services of the Texas Medical Center's Institute for Rehabilitation and Research (known as "TIRR") and the inspiring resolve of the 25 year old patient. TIRR is regularly ranked as one of the finest rehabilitation institutions in the U.S. and is one of the many reasons that Houston is among the world's finest medical centers.
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December 17, 2007
Satel on desperately seeking kidneys
Sally Satel, the receipient of Virginia Postrel's kidney (see also here), authored this amazing NY Times Magazine article in which she describes the overwhelming emotions that donors and would-be recipients go through under the current system of donating organs:
A week after my 49th birthday in January 2005, half a year after being given a diagnosis of renal failure, a friend and I were drinking coffee at a Starbucks when I wondered aloud if I would find a donor before I reached 50. I wasn’t hinting. I knew she would never offer because she was so squeamish about blood and pain. My friend, whom I met a decade before when we were both new to Washington and worked together on an advocacy project, was a little older than I; she was charming, stylish, smart — and a hypochondriac.Nor, to be honest, did I want her kidney. Anyone as anxious about health as she was would surely view donation as a white-knuckle ordeal. And the bigger the sacrifice for her, the heavier the burden of reciprocity on me. The bigger the burden on me, the more I would resent her. Then I would feel guilty over resenting her and, in turn, resent the guilt. Who could survive inside this echo chamber of reverberating emotions? Thank goodness my friend would be holding on to her kidney.
But then to my amazement, within a minute or so of my speculating when or if a donor would ever appear, she offered to do it. Later that night we talked on the phone and she rhapsodized about what a “mitzvah” it would be. Yes, her sentiments were lovely, but I felt secretly annoyed because I knew it was her habit to embark upon grandiose plans; when they fizzled, she would just shrug. I told her that giving me a kidney was out of the question — “It would be too weird,” was what I kept saying — but she persisted. I couldn’t quite believe it when she told her family of her decision (they were graciously in favor) and then had blood tests and consulted with my transplant team.Gradually, I began to believe that she meant it, and I decided to embrace her just as you might accept an in-law, as someone who could drive you a little mad but whom you loved because they were the source of something very precious to you — in my case, not a spouse but a kidney. But then after a few months she stopped talking about it. When I finally broke the silence, she said her doctor had advised against it. More likely, I thought, she was scared. I felt sorry to have put her in this position, but I was also bitter: just when would she have gotten around to telling me?
Such near-transplant experiences are not uncommon. All of the transplant candidates I spoke to, as part of my own small nonscientific sample, mentioned at least one person who promised to donate, had some tests done and then developed cold feet. Transplant teams explicitly, and properly, offer face-saving “medical alibis” to potential donors who don’t really want to go through with it, which suggests that bailing out isn’t all that rare. They might tell the person needing the transplant and the rest of the family, for example, that additional tests on the prospective donor revealed a compatibility problem or some evidence that the donor might be putting her own health at risk.
Inasmuch as the supply-demand imbalance for kidneys and other organs is well known, it seems obvious that the simple solution is to allow markets to fix the problem. However, absent political leadership to change the existing obsolescent system, many patients who need a transplant will remain relegated to long waiting lists. Many of those patients will die before their name is called. As Satel notes at the end of her article:
"But unless we stop thinking of transplantable kidneys as gifts, we will never have enough of them."
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December 14, 2007
More on the myth of beneficial long-distance running
The increasing evidence that long-distance running is not healthy has been a frequent topic on this blog, and this Lou Schuler/Men's Health article surveying the most recent research and expert opinions comes to the same conclusion:
[No expert] today believes that endurance training confers immunity to anything, whether it's sudden death from heart disease or the heartbreak of psoriasis. Every time you lace up your running shoes, there's a chance your final kick will involve a bucket, and every expert knows this. [. . .]The highest death rate is among the men who exercise long and hard, and is much higher than that of the men who exercise short and hard.
Schuler concludes that frequent, short exercise sessions that balance strength-training with moderate aerobic exercise is probably the healthiest approach. Read the entire article.
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November 6, 2007
30 year anniversary of the first angioplasty
Angioplasty has been a common topic on this blog, so it seems fitting to pass along this article and related video about Dolf Bachmann, the first patient to undergo balloon angioplasty. Bachmann was 38 years old when he underwent the procedure on September 16, 1977 and now is a healthy and happy 68 year-old who enjoys an "excellent life" that includes hobbies such as "hiking, Nordic walking, skiing, working in my garden and playing cards."
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November 5, 2007
Risky business
The tragic death Saturday morning of 28-year-old veteran marathoner, Ryan Shay, during the United States Olympic trials marathon in Central Park in New York City reminds us of a very important health tip -- long-distance running is not particularly healthy.
Update: Another participant in the marathon died afterward.
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October 26, 2007
My concierge health care experience
Bill Lent is one of Houston's finest internists. How do I know this? Well, because I know who trained him (my late father) and he has been my personal physician for the past 15 years or so. Having been blessed with good health, the only medical service that I buy from Dr. Lent in most years is my annual physical, which I generally schedule for about this time each year. I always enjoy catching up with Dr. Lent, who provides me with "on the front line" information regarding the horrific cost of health care regulations, which are literally strangling the market for primary care physicians in the U.S.
It's been particularly interesting watching the evolution over the years of Dr. Lent's internal medicine practice, from one in which Dr. Lent provided an unusually high level of personal care to his patients (something my father emphasized in his teaching) to a high volume, impersonal practice that virtually all primary care practices have been required to adopt to remain even marginally profitable under the present U.S. health care finance system. Over the past ten years or so, Dr. Lent has continually confided to me during our annual visits that he was uncomfortable with the direction of his practice.
So, I was pleased to learn when I scheduled my physical a couple of weeks ago that Dr. Lent is doing something about it. Starting next month, Dr. Lent is commencing a concierge health care practice, administered by MDVIP out of Boca Raton, in which he is limiting his practice to about 600 patients who will pay Dr. Lent $1,500 annually for the benefit of receiving his personalized style of service. Coincidentally, this Wall Street Journal ($) article earlier this week described the proliferation of pre-paid health care plans, which is sort of a lower-priced form of what Dr. Lent is doing. The WSJ article essentially describes how many primary care physicians are simply dropping out of insurance plans -- both public and private -- in favor of prepaid plans that offer unlimited access to basic health care for set monthly fees.
Inasmuch as the employer-based health insurance system typically offers low-copays and deductibles for the vast majority of health care services, a substantial amount of the American health care finance system is basically prepaid health care already. In order to maintain profitability in a highly-regulated market, insurance companies compensate for these low usage fees by charging higher monthly premiums, lowballing doctors' fees, and challenging claims continually. The result has been the evolution of a primary care system that is incredibly bureaucratic (have you ever tried to figure out how your insurance pays claims?) and literally breaking down.
The MDVIP model treats primary care service similar to a health club membership. The model focuses on the delivery of relatively inexpensive, protocol-driven care than can be offered at a relatively low cost while still providing patients more overall access. MDVIP's model is relatively expensive, so low-income patients will have a difficult time affording the fee. However, providing a tax deduction for individual health insurance would make such pre-paid plans more affordable for low-income patients, while providing Medicaid patients with vouchers for prepaid health care would have a similar impact.
Who will be threatened from the proliferation of these plans under the current health care finance system? Well, it's a bit early to speculate, but my sense is that insurance companies with big stakes in employer-based health insurance will not enjoy the competition from MDVIP-type practices. Similarly, speciality providers who depend on state regulatory mandates in comprehensive insurance plans to subsidize their practices will also feel the competitive pressure if these types of plans catch on in a big way.
So, I'm going to enjoy learning about how Dr. Lent's practice changes over the next year under the MDVIP structure. If it is successful, as I suspect it will be, it makes you wonder -- if such entreprenurial spirit can be generated even in the current highly-regulated health care finance system, then imagine what could happen if we unleashed the power of the marketplace to reform the delivery of health care and the health care finance system?
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October 19, 2007
The risk of witch doctors
It never fails to amaze me that seemingly rational people continue to seek out witch doctor treatments for anything more complicated than a massage:
On the same shift I saw two very sick patients, both of whom were under the care of chiropractors before they decided to pay us a visit in the Emergency Department. The first was an old woman with a one week history of dyspnea, chest pain, and a cough. Her chiropractor had diagnosed her with a “displaced rib,” and had been dilligently popping it back into place every day for the previous week. After a simple set of vital signs revealing low blood pressure, a slow heart rate, and a slightly low temperature, not to mention a chest x-ray which showed a huge unilateral pleural effusion, it was not hard to come up with the diagnosis of pneumonia with sepsis.“He [the chiropractor] said she didn’t have a fever and she wasn’t coughing anything up,” said the sister. [. . .]
The second patient was a 70-year-old man who finally came in after a week of ineffectual adjustments for “muscle aches” and general malaise which had evolved, by the time we saw him, into a vague intermittant chest pain related to exertion but which the chiropractor insisted, apparently, was some kind of subluxation. The EKG told the true story, an evolving myocardial infarction. My patient would have probably died if his son hadn’t raised the alarm and insisted his father see some real doctors.
Meanwhile, this article reports that researchers have determined that acupuncture works. But the same research study concluded that fake acupuncture, where the needles are inserted shallowly and in the wrong places, also works:
The results suggest that both acupuncture and sham acupuncture act as powerful versions of the placebo effect, providing relief from symptoms as a result of the convictions that they engender in patients.
My conclusion: On one hand, if you stick pins in people who are complaining about something, then some of them will eventually quit complaining. On the other hand, if you take pins out of some people who were previously complaining, then some of them will also stop complaining.
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October 18, 2007
The end of socialized medicine
Peter Huber is a Manhattan Institute senior fellow, an MIT-trained engineer and a lawyer who has authored several books, including Hard Green: Saving the Environment from the Environmentalists and Galileo’s Revenge: Junk Science in the Courtroom. In this provocative City Journal article, Huber observes that the complexity of modern diseases virtually assures that a "one-size-fits-all" socialized medical system will fail:
That is the real crisis in health care—not medicine that’s too expensive for the poor but medicine that’s too expensive for the rich, too expensive ever to get to market at all. Human-ity is still waiting for countless more Lipitors to treat incurable cancers, Alzheimer’s, arthritis, cystic fibrosis, multiple sclerosis, Parkinson’s, and a heartbreakingly long list of other dreadful but less common afflictions. Each new billion-dollar Lipitor will be delivered—if at all—by the lure of a multibillion-dollar patent. The only way to get three-cent pills to the poor is first to sell three-dollar pills to the rich.With almost $30 trillion under management, Wall Street could easily double the couple of trillion it currently has invested in molecular medicine. The fastest way for Washington to deliver more health, more cheaply, to more people would be to unleash that capital by reaffirming patents and stepping out of the way.
On the other side of the pill, molecular medicine can only be propelled by the informed, disciplined consumer. Any scheme to weaken his role will end up doing more harm than good. Foggy promises of one-size, universal care maintain the illusion that the authorities will take good care of everyone. They reaffirm the obsolete and false view that health care begins somewhere out there, not somewhere in here.
Neither Pfizer nor Washington can ever stuff health itself into a one-price uniform, One America box—not when health is as personal as ice cream, genes, and pregnancy, not when every mother controls her personal consumption of carbs, cholesterol, Flintstones, and Lipitor. But the thought that government authority can get more bodies in better chemical balance than free markets and free people is more preposterous than anything found in Das Kapital. Freedom is now pursuing a pharmacopoeia as varied, ingenious, complex, flexible, fecund, and personal as life itself, and the pursuit will continue for as long as lifestyles change and marriages mix and match. Given time, efficient markets will deliver a glut of cheap Lipitor for every glut of cheap cholesterol. And given time, free people will find their way to a better mix.
Read the entire article here.
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October 17, 2007
Immune to reason
Paul Howard is a senior fellow at the Manhattan Institute Center for Medical Progress and the editor of the blog Medical Progress Today. In this Washington Post op-ed, Howard addresses the potential danger to public health of indulging in the current wave of trendy skepticism toward vaccinations:
Sadly, too many parents have lost faith in vaccines. Partly, this is because of a "generation gap." In 1940, U.S. infant mortality rates stood at 40 deaths per 1,000 live births. Tens of thousands more children would go on to be killed or maimed by measles, polio and chicken pox. Today, infant mortality averages about 7 deaths per 1,000 live births, and those other diseases have been largely vanquished by vaccines. A childhood free of serious illness is now taken for granted.When mysterious disorders like autism strike seemingly healthy children -- at about the same age when childhood vaccines are typically administered -- frustrated parents lash out at doctors and pharmaceutical companies. And today's vaccine inventors must contend with a powerful force that had yet to arise when Jonas Salk created his revolutionary polio vaccine -- mass litigation.
The birth of "liability without fault" in pharmaceutical litigation in 1958 -- captured in Dr. Paul Offit's riveting book The Cutter Incident -- set the dangerous precedent that vaccine companies would be held liable for side effects even when their products were made using the best available science and according to government regulations. [. . .]
The debate over vaccine litigation has thus shifted from a presumption of innocence to a presumption of guilt. While the number of major studies that have failed to find any substantive link between vaccines and developmental disorders or autism is now in the double-digits (including a September 27th CDC study in the New England Journal), critics are effectively demanding that scientists prove that thimerosal does not cause illness -- an impossible standard.
The very success of vaccines has become their downfall. As Dr. Offit writes in Vaccinated, "When [vaccines] work, absolutely nothing happens. Parents go on with their lives, not once thinking that their child was saved."
The entire op-ed is here. This earlier post addresses the devastating impact that the Cutter Incident had on the production of vaccines and public health.
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October 9, 2007
Kolata on Good Calories, Bad Calories
NY Times nutrition columnist Gina Kolata (previous posts here) reviews Gary Taubes' new book, Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control and Disease (Knopf September, 2007), which was previewed earlier here. Kolata observes:
His thesis, first introduced in a much-debated article in The New York Times Magazine in 2002 challenging the low-fat diet orthodoxy, is that nutrition and public health research and policy have been driven by poor science and a sort of pigheaded insistence on failed hypotheses. As a result, people are confused and misinformed about the relationship between what they eat and their risk of growing fat. He expands that thesis in the new book, arguing that the same confused reasoning and poor science has led to misconceptions about the relation between diet and heart disease, high blood pressure, cancer, dementia, diabetes and, again, obesity. When it comes to determining the ideal diet, he says, we have to “confront the strong possibility that much of what we’ve come to believe is wrong.” [. . .]Taubes convincingly shows that much of what is believed about nutrition and health is based on the flimsiest science. To cite one minor example, there’s the notion that a tiny bit of extra food, 50 or 100 calories a day — a few bites of a hamburger, say — can gradually make you fat, and that eating a tiny bit less each day, or doing something as simple as walking a mile, can make the weight slowly disappear. This idea is based on a hypothesis put forth in a single scientific paper, published in 2003. And even then it was qualified, Taubes reports, by the statement that it was “theoretical and involves several assumptions” and that it “remains to be empirically tested.” Nonetheless, it has now become the basis for an official federal recommendation for obesity prevention.
But the problem with a book like this one, which goes on and on in great detail about experiments new and old in areas ranging from heart disease to cancer to diabetes, is that it can be hard to know what has been left out. [. . .[
. . . I kept wondering how he would deal with an obvious question. If low-carbohydrate diets are so wonderful, why is anyone fat? Most people who struggle with their weight have tried these diets and nearly all have regained everything they lost, as they do with other diets. What is the problem?
On Page 446, he finally tells us. Carbohydrates, he says, are addictive, and we’ve all gotten hooked. Those who try to break the habit start to crave them, just as an alcoholic craves a drink or a smoker craves a cigarette. But, he adds, if they are addictive, that “implies that the addiction can be overcome with sufficient time, effort and motivation.”
I’m sorry, but I’m not convinced.
John Tierney comments, too.
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September 21, 2007
Coopertown?
Dr. Kenneth Cooper of Dallas may have oversold the benefits of aerobic exercise, but will the same be true for his new real estate venture?:
Dr. Cooper is developing a $2 billion residential wellness community here called Cooper Life at Craig Ranch that is going up on the first 51 of an eventual 151 acres on the Texas plains, north of Dallas.Taking the concept of spa real estate into the medical realm, Dr. Cooper’s community promises home buyers a life that sounds equal parts Norman Rockwell and Olympic village: a small town where doctors will make house calls and where every resident has a bevy of experts close at hand for keeping in tiptop shape.
It appears to be the first of its kind. . . .
Included in the monthly residential fee ($1,041 for an individual to $2,181 for a family of six) will be an annual physical and a six-month follow-up, which Dr. Cooper calls key to his utopian vision of a place where everyone can live in peak health. The fee also includes home doctor visits, a fitness center membership, concierge services and exterior home maintenance, lectures and social activities.
While a diverse mix of ages and fitness levels are welcome, Dr. Cooper admits that many prospective residents may well be baby boomers with cushy bank accounts. “They’ve got the money,” Dr. Cooper said, “now they want to live long enough to enjoy it.”
I get exhausted just thinking about the thought of living there. ;^)
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Something ailing you?
If so, and even if not, check out these 100 Web Resources for Medical Professionals.
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September 18, 2007
What makes us healthy?
Gary Taubes, a writer for Science magazine, is the author of the soon-to-be-released book Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control and Disease (Knopf September 25, 2007). He provides a don't miss preview of his book in this past Sunday's New York Times:
Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem. [. . .]The dangerous game being played here, as David Sackett, a retired Oxford University epidemiologist, has observed, is in the presumption of preventive medicine. The goal of the endeavor is to tell those of us who are otherwise in fine health how to remain healthy longer. But this advice comes with the expectation that any prescription given — whether diet or drug or a change in lifestyle — will indeed prevent disease rather than be the agent of our disability or untimely death. With that presumption, how unambiguous does the evidence have to be before any advice is offered? [. . .]
Richard Peto, professor of medical statistics and epidemiology at Oxford University, phrases the nature of the conflict this way: “Epidemiology is so beautiful and provides such an important perspective on human life and death, but an incredible amount of rubbish is published,” by which he means the results of observational studies that appear daily in the news media and often become the basis of public-health recommendations about what we should or should not do to promote our continued good health. [. . .]
All of this suggests that the best advice is to keep in mind the law of unintended consequences. The reason clinicians test drugs with randomized trials is to establish whether the hoped-for benefits are real and, if so, whether there are unforeseen side effects that may outweigh the benefits. If the implication of an epidemiologist’s study is that some drug or diet will bring us improved prosperity and health, then wonder about the unforeseen consequences. In these cases, it’s never a bad idea to remain skeptical until somebody spends the time and the money to do a randomized trial and, contrary to much of the history of the endeavor to date, fails to refute it.
Read the entire article.
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August 31, 2007
Property rights, economics and AIDS
Peter F. Schaefer explains how economics and property rights in African nations combine to facilitate the proliferation of the AIDs virus:
However no one in the US government and few in the anti-AIDS community are dealing with a major issue in the transmission of AIDS called "property stripping." Since the cure for property stripping is cheap, technically quite easy and would have an enormous secondary impact on economic growth (poverty is a hidden vector of AIDS) it would seem like a sure thing for attention. But it is virtually ignored.On World AIDS Day two years earlier Dr. Jim Yong Kim - [head of World Health Organization's HIV Division, Kevin] De Cock's predecessor - said,
"In sub-Saharan Africa almost 60 percent of AIDS sufferers are women [and] in some settings ... we are finding ... that the number one risk factor for women in becoming infected with HIV is marriage. [And] married women have the highest rates of HIV infection. We have to take on some of the most fundamental and difficult cultural and social issues that are definitely affecting the way this epidemic is spreading. And ... if we can take on things like for example, property rights [so] women can inherit the property of their husband if [he] dies, that really reduces the likelihood of them getting into sex work for example. If we can ... change laws, change fundamental beliefs and culture by [getting] people the right kinds of prevention messages we will have done a lot not just for HIV AIDS but for issues like gender equity that have been with us forever."In the scholarly literature, the traditional practice of the husband's family inheriting all his property after he dies is called "property stripping." In normal times, this had some logic; the husband's family had responsibility for the widow and her children, a brother often taking her as a second wife and so assuming responsibility for his nieces and nephews.
But things have changed. In the time of AIDS, the widow is likely also infected with the HIV virus, though not yet sick since her husband often gets it first and the disease is less advanced in her when her husband dies. So even if her brother-in-law hasn't died from AIDS himself, he is not willing to marry someone infected with HIV. And often the brother-in-law himself is sick or dead. Nevertheless, the family often still follows custom and seizes her house and farm and so she has no recourse but to turn to menial jobs, begging or prostitution. And since she was infected later, she may have years to spread her illness to her sex partners which are commonly many a day.
[A] Washington Post editorial by Richard Holbrooke . . . noted that increased testing and detection efforts was the "only effective prevention strategies can stop the spread of AIDS." He goes on to point out that "...monogamous women [are] thrown out of their homes for a disease they got from their husbands."
Read the entire article, which is another reminder that there are few simple solutions to this terrible disease.
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August 28, 2007
What's ailing you?
Have you had a symptom of an illness or an injury that has bothering you for awhile? Medgle allows you to click on the body part that's bothering you and select the specific symptom from a list of possible options. Then, Medgle asks how long the symptom has been apparent, as well as th inquirer's sex and age. Medgle then returns a listing of possible matches for the symptoms.
Moreover, you can then take the result that Medgle generates and, on the following page, provides you with a brief summary of the condition and a Google search relating to treatment, prevention, drugs, tests, research, diet, alternative medicine, and fitness. You can even refine the search by changing the age or gender.
This is never going to replace a visit to your doctor, but it sure provides a handy way to increase the patient's knowledge and understanding regarding diagnosis and treatment. Check it out.
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August 27, 2007
In Dr. Pou's words
Dr. Anna Pou (previous posts here), the former faculty member of the University of Texas Medical Branch in Galveston, performed heroically in the horrific aftermath of Hurricane Katrina. For her heroism, she became the main subject of one of the most egregious examples of prosecutorial misconduct in recent memory. In this extensive Newsweek article, Dr. Pou finally tells her side of the story and it magnifies the enormity of the injustice that a few irresponsible Louisiana state officials have put her through. The following are a few tidbits:
What was it like after the levees broke?Monday after the storm passed, we figured, ‘OK, minimal damage; we began organizing how we were going to evacuate the hospital.’ We didn’t have full power so we needed to move patients. Tuesday morning we were planning our day and one of the nurses called me to the window and said you’ve got to come see this. Water was gushing from the street. So we all kind of looked in disbelief. What is this? We could tell the city was flooding, you could see water down Claiborne Street. It was rising about a foot an hour. Then the whole mood at the hospital changed and what we were doing changed. We were in hurricane mode and we had to go into survival mode because we knew we had to be there for some time.
How did things change on Wednesday?
Tuesday night, we lost generator power, and that changed things a lot. ‘Til then we were on generator power so we did have some lights, and we did have some water. Water wasn’t clean, but it was running. But then we didn’t have water, we didn’t have any electricity, commodes were backing up everywhere. Conditions in the hospital started to deteriorate Tuesday night and early Wednesday. When that happens it makes care a lot more difficult. I was called to help suction a patient who had a tracheotomy but we had no suction running. We were going down to very, very basic care. You try every old-time method you can … [P]eople in charge were trying to get helicopters to come, [but] at that time we were told we were low priority. There were people on rooftops [who were going to get rescued first]. They said … there’s not going to be a lot of help coming, [so] what we decided [was] if helicopters were going to show up sporadically, we have to have patients ready and waiting to go. [. . .]
The conditions were unbearable. Inside the hospital it was pitch black, with odors, smell, human waste everywhere. It was very rancid. You would take a breath in and it would burn the back of your throat. The patients were very sick. That’s when we had to go from triage to reverse triage because we came to realize if patients aren’t being evacuated, [we had to deal with what we had]. Basically it was a general consensus that we’re not going to be able to save everybody. We hope that we can, but we realize everybody may not make it out. [. . .]
By the time Wednesday evening came around, if you can imagine in our mind, there is a central area that is a sea of people. A lot of very sick patients in that central triage area. It’s grossly backed up. Few patients had been evacuated. So there was just enough space to walk between the stretchers. It is extremely dark. We’re having to care for patients by flashlight. There were patients that were moaning, patients that are crying. We’re trying to cool them off. We had some dirty water we could use, some ice. We were sponging them down, giving them sips of bottled water, those who could drink. The heat was—there is no way to describe that heat. I was in it and I can’t believe how hot it was. There are people fanning patients with cardboard, nurses everywhere, a few doctors and wall-to-wall patients. Patients are so frightened and we’re saying prayers with them. We kind of looked around at each other and said, “You know there’s not a whole lot we can really do for those people.” We’re waiting [for help]. The people in that area could have [been evacuated] by boat but no boats were coming. I would do what I could with the nurses: changing diapers, cooling patients down with fanning. It wasn’t like, “I’m a doctor, you’re a nurse.” We were all human beings trying to help another human being, whatever it took.
What happened Thursday?
On Thursday morning we were told nobody was coming and we had to fend for ourselves. Everybody was kind of like at a loss here. What is plan B? Or plan C?
How did you come to be the one administering the injections? Louisiana Attorney General Charles Foti made a point of saying you had administered medication to people who were not your patients.This was an emergency situation. There were no LifeCare doctors. In an emergency situation, the patients become everybody’s patients. What are you supposed to do if a patient needs to be cleaned and have IV fluids, say, “You’re not my patient, good luck”? That’s absurd. If that’s the case I dare say three-fourths of the population of Memorial Hospital would have been left without a doctor. We’re in medicine because we care about people. This is what we do. We don’t run around murdering people. That’s why what he said is so ludicrous.
When did you leave the hospital and who was still there when you left?
I left Thursday around 6 p.m. in a helicopter. When I left no one was in the hospital. There were a handful of patients on the helipad. I went to [another hospital and then] on a bus to Baton Rouge because my family was there.
How did you feel?
I was tired but I was more in total disbelief that the sick and the poor could be abandoned the way that they were in the United States of America. I never thought I would ever live to see that day. I was sad, heartbroken, kind of amazed and shocked at the lack of organization—the fact that there was no type of coordination. I have friends who practice in the third world and this was less than third world.
What was it like to be arrested in 2006?
I had [performed] surgery that Monday. It was bedlam in the medical community after Katrina. I had surgery Monday, Tuesday, Wednesday, Thursday and clinic on Friday. And the attorney general’s office knew that. I was taking care of indigent patients. He put my patients at risk. I am still angry about that. And then I was basically sitting by myself eating a salad, still in scrubs. I was starving and really dehydrated because I had been on call the weekend and been up 48 hours before. There was a knock on the door. It was four agents from the attorney general’s office.
The whole way [to jail] I was asking God to help my family get through this. I have nieces and nephews, and my hospitalized patients, who found out about this on the 10 o’clock news, which was heinous. Had I known [about the arrest], I could have spoken to my patients. Instead I just don’t show up and they see me on the news. There were cancer surgeries that had to be rescheduled. These patients’ treatments were delayed because of what happened. I am still furious about it. It just really makes me mad.
There is much more, so read the entire article. Again, I ask -- where is the investigation of the public officials who are responsible for attempting to organize this lynch mob against this hero?
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August 18, 2007
A job well done
University of Houston student-athlete and football player Jerrod Butler was stricken by sudden cardiac arrest on Monday during a weightlifting session at the University of Houston. Butler passed out and stopped breathing.
Members of the UH athletic training staff, led by Mike O'Shea and John Houston, immediately revived Butler, performing CPR and using an automatic external defibrillator. Butler was then rushed the short drive to the Methodist Hospital emergency room at the Texas Medical Center, where he was put on a ventilator and placed in the intensive care unit.
On Thursday, Butler was moved out of the ICU and into a regular room.
It's easy in our busy lives to take professionals such as O'Shea and Houston for granted, but they are the type of dedicated people who make Houston such a special place to live. A tip of the hat to these two fine professionals on a job well done.
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July 31, 2007
Endurance training to death
As noted in previous posts here and here, the myth that endurance training and long-distance running are good for one's health remains firmly entrenched among most Americans, despite sad reminders such as this. In this timely article, Mark Sisson lucidly explains why endurance training is hazardous to one's health. Here is a snippet:
The problem with many, if not most, age group endurance athletes is that the low-level training gets out of hand. They overtrain in their exuberance to excel at racing, and they over consume carbohydrates in an effort to stay fueled. The result is that over the years, their muscle mass, immune function, and testosterone decrease, while their cortisol, insulin and oxidative output increase (unless you work so hard that you actually exhaust the adrenals, introducing an even more disconcerting scenario). Any anti-aging doc will tell you that if you do this long enough, you will hasten, rather than retard, the aging process. Studies have shown an increase in mortality when weekly caloric expenditure exceeds 4,000. [. . .]Now, what does all this mean for the generation of us who bought into Ken Cooper’s "more aerobics is better" philosophy? Is it too late to get on the anti-aging train? Hey, we're still probably a lot better off than our college classmates who gained 60 pounds and can't walk up a flight of stairs. Sure, we may look a little older and move a little slower than we'd like, but there's still time to readjust the training to fit our DNA blueprint. Maybe just move a little slower, lift some weights, do some yoga and eat right and there's a good chance you'll maximize the quality of your remaining years… and look good doing whatever you do.
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July 27, 2007
Fit Nation Map
The map on the left purports to track the increase in the percentage of obese persons in the U.S. over the past 20 years. I don't know about the methodology of the statistical analysis, but the map is pretty darn cool.
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July 25, 2007
Good news for Dr. Pou
An old saying in criminal defense circles is that a prosecutor could persuade a grand jury to indict a ham sandwich if the prosecutor is inclined to do so.
Fortunately, that was not the case in regard to former Houston area resident, Dr. Anna Pou (previous posts here). Dr. Pou served on the faculty of the University of Texas Medical Branch in Galveston from 1997-2004, where she was the Director of the Division of Head and Neck Surgery from 1999 to 2004. Kevin, M.D. has been doing a good job of tracking developments and comments regarding the case against Dr. Pou, and here is the link to the website that has been established to help raise funds for Dr. Pou's defense.
Following on this recent post on developments in Dr. Pou's case, a New Orleans Parish grand jury today declined to indict Dr. Pou for second-degree murder in connection with the deaths of several elderly patients in the horrifying aftermath of Hurricane Katrina. The decision en