palmd | February 23, 2009If you read the news, you know that Justice Ruth Bader Ginsburg has pancreatic cancer. I am not privy to the details of her illness, but it was apparently amenable to surgery, which gives her a fighting chance, and today, she returned to the Bench. I was going to use her illness to explore the specifics of pancreatic cancer and of cancer screening in general as part of my series on cancer, but some idiot is already using her story for political gain, so my hands are tied.
Senator Jim Bunning (R, KY) issued a god-like pronouncement over the weekend, declaring that:
he supports conservative…
palmd | February 20, 2009This is an essay from several years ago, but with so many WWII vets dying, I thought I'd keep this little bit of oral history around.
About an hour before my patients begin to show up, I sit at my desk and enjoy a cup of coffee while looking over the charts for the day. On my list was a new patient for the 9:00 slot. I opened his computer chart and saw that he was not new to the VA, only to me. He had been to a series of doctors over the years, and was noted to be hostile and dissatisfied with each. This is often how people seeking help become labeled as "bad patients", and are even "fired"…
palmd | February 19, 2009I don't link to Pharyngula very often---our content just doesn't intersect that much, but I followed a link from today's post and had a good laugh.
You see, some comedian creationist cult leader put out a new book, and the reviews on Amazon are a real hoot. From one review:
My only disappointment with the proofs provided in this book is that my favorite, Eve, isn't listed among them. Evolution could have made her look like anything at all--like Rush Limbaugh, a big hairy wookie, or a naked mole rat for example. There's no way Adam would have tapped that. Instead, God chose to fashion one…
palmd | February 19, 2009It's been a slow flu season this year---until now. In the last week I've seen people dragging themselves into the office looking like absolute hell---fevers, cough, severe muscle aches---in other words, they've got the flu.
The latest CDC data shows a marked increase in flu activity.
A large percentage of isolates are influenza A, type H1N1, which is currently resistant to one of our antiviral medications oseltamivir (Tamiflu). Of 110 influenza isolates collected so far in Michigan this season, 74 are A(H1N1). The strain is still susceptible to zanamivir (Relenza), rimantadine, and…
palmd | February 19, 2009It seems the same questions keep coming up when looking at the cult leaders of the infectious disease promotion movement. When you listen to them preach or read their liturgy you can't help thinking, "dumb, evil, or both?" I think I'm going to vote for "both" when it comes to Deirdre Imus. Her sermon last week in the Huffington Post was so far over the top that my nose is still bleeding from climbing her tower of intellectual excrement.
Her title advises health consumers, "On Vaccinations: Consider the Source and Follow the Money."
I don't know what that means, but Deirdre explains, "…
palmd | February 18, 2009Before I started medical school I worked at a clinic that served the deaf and hard-of-hearing community. I was the "front office", greeting patients, answering the phone by TDD/TTY or by relay service (this was before the existence of text messaging, instant messaging, or anything else that relied on cell phones or on the internet---none was in common use). I learned some rudimentary ASL (simple, polite phrases), and was introduced to the deaf community. It was simply fascinating. I learned about the controversies surrounding deaf culture (such as cochlear implants, assimilation, and…
palmd | February 18, 2009There was a piece of good news on vaccine front this week. The first judgments from the Autism Omnibus Trial were announced, and the special masters (who served as judges) agreed with the rest of the reality-based community in ruling that vaccines do not cause autism. The rulings weren't subtle, using phrases such as "misled by physicians who are guilty, in my view, of gross medical misjudgment". This is the Dover of the "other" ID promotion movement.*
Like any cult, however, the infectious disease promotion movement is unlikely to be persuaded by any level of evidence. This, despite…
palmd | February 17, 2009I'm getting really tired of this nature vs. nurture debate when discussing homosexual rights. It's always interesting to investigate the origins of human behavior, and occasionally something is found to be purely genetic, but I suspect that sexuality, like many human attributes, has a complex mix of biological and non-biological causes. That doesn't piss me off. What pisses me off is the insistence by right wing religious cults on "proving" that homosexuality is a choice.
Sexuality phenotype is a tough concept if you really think about it. The harder you try to nail down the difference…
palmd | February 16, 2009Morning report is a daily conference for medical residents. It is done differently at different institutions, but normally a case is presented, often by the post-call team, and discussed by the senior residents and an attending physician. Today's case will be the first in an occasional series. It is best read above the fold first, and then going below the fold after digesting the first part adequately. --PalMD
A fifty year-old woman presented to her primary care physician with hemoptysis (bloody cough). She has a history of emphysema and tuberculosis, which was treated about 25 years ago.…
palmd | February 16, 2009The New York Times is reporting that the economic stimulus bill will include over a billion dollars to fund research into medical evidence. This is a good thing, but it's bound to be controversial. I've mentioned before that we need to spend money to improve our medical infrastructure, and this could be a step in the right direction.
Much of what we do in medicine is science-based, and much of it has evidence to support it, but some does not. There are plenty of open questions about how we practice medicine, and in order to deliver safe, quality care, we need answers. For example, a…
palmd | February 15, 2009Science is hard. But science, and the methodological naturalism that underlies it, has proved to be the best way to observe, describe, and explain our reality. Sure, people can come up with ridiculous straw man arguments like, "but how do you measure love?" but these arguments ring hollow. (We measure "love", a behavior, by the observable behaviors that human beings report when they are "in love".) To a scientist, the appeal to magic to describe the world is difficult to understand, since the real puzzle is so much more fun. If, for example, you discover the cause of a particular disease…
palmd | February 12, 2009In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is my diary from the trip. Part IV is here.
Leaving
Our final evening in Juticalpa saw the reunion of the medical teams that had been sent to the outlying countryside. Our friend Jeremy returned essentially unscathed but with a few stories from the hinterlands. His group was lodged in a small house in a distant village. They bathed with buckets of river water from a…
palmd | February 12, 2009The Pope has decided that forgiven doesn't mean forgotten. When he recently un-excommunicated some dissenters, and they continued to spew hateful, anti-semitic Holocaust-denial, the Pope's silence implied consent. He is silent no more. That isn't to say he has re-excommunicated the offender, but he has called him out. It's a start.
palmd | February 11, 2009There's been some pretty cryptic talk on ScienceBlogs over the last day or so, which brings up some topics that may seem obscure to some readers.* Worse, it gives an appearance that bloggers are engaged in some sort of self-indulgent flame war over minutiae. Let me help draw a guide for those of you who care (and I will try to make clear why all of you should care).
First, I hate debates about "discourse". When we argue about how we argue, we often lose track of the meat of the issue. But discourse is not irrelevant. More on this in a bit.
Medicine was traditionally a male-dominated…
palmd | February 11, 2009In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is my diary from the trip. Part III is here.
After Hours
We returned each night over the route we came, waving to our patients along the way, occasionally stopping to say hello or take a picture of the cloud-shrouded mountains. Our first stop was always the bodega, to drop off our gear and resupply for the next day's work. Afterward, we retreated behind the gate of…
palmd | February 10, 2009In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is my diary from the trip. Part II is here.
Zopilotepe; the Clinic
We loaded our supplies and our tired but excited selves into a jeep and headed out to the highway. Shortly after leaving town we turned down an unremarkable dirt road that threaded through bean and corn fields. The rough-hewn wooden fences were covered with purple and pink morning glories. As we wound…
palmd | February 10, 2009There's a lot of talk about there about "economic stimulus" and "infrastructure", but what is "infrastructure"? Traditionally, it's the basic physical and social structure needed for a society to operate. Roads, sewers, utilities, schools---these are the "guts" of our nation. Without these things, and the pooling of resources they require, we are nothing more than an anarchic collective coexisting on a shared continent. Much of what is defined as infrastructure is about the basics of life---food and its distribution, public health, safety. How is health care not a part of that?
When we…
palmd | February 9, 2009In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is part II of my diary from the trip. Part I is here.
To Juticalpa
As we left Teguz, we crossed one more bridge and began to climb into the hills that surround the high valley in which rests the city. Thin dogs wandered along the roadside sniffing at the animal skulls lining the road. Women and children crowded into ravines to wash clothes in the river which was both…
palmd | February 9, 2009I keep pandagon.net on my google reader. I don't agree with everything I read there, which is a good thing, but I do respect Amanda Marcotte's opinions (and they are always well-written).
I must take some exception with her recent analysis of the octuplet fiasco. It's not just that I have a problem with blaming everything bad on Teh Patriarchy (which I do), but I think that sometimes dealing with patriarchy distracts from other real issues. Yes, sexism and patriarchy are important in society, but not everything is that simple. Let's take a look (emphasis mine):
At this point in time, I…
palmd | February 9, 2009Via Tara Parker-Pope at NYT I learned of a little economics piece in the same paper. It looks into the economics and cost of waitng for health care services.
No one like waiting at the doctor. I've heard many people say, "Well, if he is going to use up my valuable time, then I'm sending him a bill."
While I appreciate the sentiment, it's not that the doctor thinks her time is more valuable than yours; it's not a matter of your time vs. the doctor's. It's yours vs. the other patients. All of a doctor's patients compete for the reletively limited resource of her time. There may be a few…