palmd | January 28, 2009I love my podcast. A lot. I have great guests lined up. Really.
But I also have a dead computer (I'm using a hospital PC right now). My laptop has all the "stuff" I need for the podcast, so please don't give up! When it's back out again (hopefully this weekend), I'll let you know.
That is all.
palmd | January 28, 2009It's hard to hide severe back pain. When I stand up, I look like a question mark. The visibility of the problem, combined with the general goodness of my fellow human beings, leads to lots of unsolicited advice. Folks have given me great advice (take some NSAIDs, stretch, and don't lay in bed) and some questionable advice (go to the chiropractor, get some acupuncture). My colleagues and I have written a lot about acupuncture. It's sort of a "gateway CAM", in that it has a patina of plausibility. But the evidence of its efficacy has pointed toward it being an elaborate placebo.
To help…
palmd | January 28, 2009Look, the Pope gets to make the rules---it's his club and he gets to decide who plays and who doesn't. The Vatican does not claim to be democratic. That being said, all decisions rest on him, and him alone, and cannot be blamed on "the will of the people". The buck really does stop with Papa. So when he invites rabid anti-semites back into the fold, it's a reflection of his personal beliefs. Catholicism, and Christianity in general, places a premium on forgiveness---it's some good shit for the soul, and the story of Pope John-Paul II reconciling with his would-be assassin is truly heart-…
palmd | January 27, 2009Now, both of my readers may note that: 1) the number "37" appears to be randomly assigned, and 2) "incoherent" would appear to be redundant. But let me explain.
Many, many years ago I injured my back. It got better. Until 3 a.m. this morning. Since then, I have been a walking question mark, except when I'm laying on the X-ray table or floor trying to find a flat surface from which I might just have a chance to get up again. It's both humiliating and humorous to hobble through an enormous American hospital holding onto the walls. Normally, I stride rapidly from room to room, down tunnels…
palmd | January 26, 2009Blog buddy and all-around great guy lucite box of diodes, Orac of Respectful Insolence, has won "Best Health Policies/Ethics Weblog of 2008", sponsored by MedGadget.com. According to the website:
Orac of Respectful Insolence has been chosen as the Best Health Policies/Ethics Weblog of 2008. As one of the members of Science Blogs, Orac attempts to bring sanity to the world full of medical quackery. His efforts at exposing the dangers of alternative medicine, pseudoscience, and evolution deniers have made Orac one of the most recognized online activists against medical fraud and pseudoscience…
palmd | January 26, 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. --PalMD
Case:
Mrs. M is an 89 year old woman who resides in a nursing home who was admitted with confusion and lethargy. She has a past medical history significant for stroke, coronary artery disease, depression in the distant past, and no history of dementia. She has lost significant weight over…
palmd | January 26, 2009It's true that words matter, and that we who practice real medicine have often let cult medicine practitioners get the linguistic high ground. We've let them get away with calling non-science-based practices "alternative" and "complementary", without really asking, "alternative to what?" or "does it really "complement, or just distract?" We've often ignored language, and when we don't, we are accused of being pedantic, of focusing on "rhetoric" rather than "real" issues. Language is powerful. There is no such thing as "it's just a word".
Language is even more important in the fight…
palmd | January 26, 2009A short time ago, I told you about H. flu, a nasty, but preventable disease. Now, Orac tells us about some unfortunate idiots who chose not to prevent it. Go and read.
palmd | January 25, 2009Sometimes I feel like I'm pounding my head against a wall. I've been wondering why the issue of so-called conscience clauses just won't die, why otherwise intelligent people can't just agree with me just don't get it.
Quick review: some health care professionals wish to be able to deny patients certain types of care, and want to be protected by law for imposing their own morals on others, in violation of basic medical ethics and human dignity (as you can see, I don't have a strong opinion about this one).
Ethical behavior is difficult. It requires empathy---but in a very particular sense…
palmd | January 24, 2009...or so goes the refrain of the addict. I was going to put up a more substantive, well-researched post, but I wanted to give you a few weekend thoughts to chew on.
I deal with addictions a lot, but the most common and deadly one is tobacco. Tobacco is responsible for millions of serious illness and deaths every year in the U.S., all of which are preventable. But, like other substance use disorders, we don't really know how to talk about tobacco addiction (which is more properly "nicotine addiction"). There is no doubt that nicotine is powerfully addictive, and the health and social…
palmd | January 24, 2009I don't have a lot of experience with small hospitals. My medical school's hospital was about two square blocks of buildings, all of them attached, ranging in age from 100 years to 10 years. The were connected by irregular bridges and linked (ex)-fire escapes, and by miles of dim tunnels.
During my residency, the campus covered several square blocks, with buildings linked by more airy bridges (a la Minneapolis) and "secret" tunnels that you could find if you just knew where to look---although getting lost underground was the rule.
My current hospital is---by number of admissions---one of…
palmd | January 23, 2009Similar to this classic geek comic, xkcd shows the stupidity of the above-average geek.
palmd | January 22, 2009I've written quite a bit of the need for good health reporting, and I've had the good fortune to talk to some terrific reporters. But bad reporters are easy to come by, which is kind of sad, especially since jobs are getting scarce.
When this article came across my browser, something looked familiar. The Stamford (CT) Advocate has shown up on my blog before. The last time, it was an article about a naturopath preying on immigrants. When I saw a new story pop up, I was sure it would be the same reporter. The article is locked in the archives, so it took some searching, but I eventually…
palmd | January 22, 2009This is just for kicks, and requires a little work. I recently became aware of a dreadful article that I'd love to share with you, but then I thought, "my readers are pretty damned smart; let's see what they have to say first."
The article in question, "External Qi of Yan Xin Qigong differentially regulates the Akt and extracellular signal-regulated kinase pathways and is cytotoxic to cancer cells but not to normal cells" just seems ripe for feeding into the dewooificator. Now, the full text is behind a paywall, and it wouldn't do for me to share my full text copy with you. I certainly can…
palmd | January 21, 2009I'm one of those wacky idealists for whom January 20th was a great day. But with those high hopes, I have some fairly high expectations of our new president, one of the first of which is to repeal the Church Amendment, an HHS directive allowing health care providers to abandon proper ethics without consequence.
I've done quite a bit of blogviating about so-called conscience clauses, the rules that would allow health care providers to deny patients care not because it is outside the standard of care but because it bothers the personal beliefs of the provider. In case my previous writings…
palmd | January 21, 2009Nearly a year ago, a young girl was killed by her parents. She was dying of diabetic ketoacidosis, and her parents provided only prayer. They weren't living on some compound under the thrall of some cult leader. They weren't living in a third-world country far from modern medical care. They were living in the middle of Wisconsin, and had access to any care they might need, but while their child suffered, the parents did the equivalent of nothing. This type of situation has been done to death, but since the parents are about to go on trial, let's review the responsibilities of the state…
palmd | January 21, 2009Jake over at Pure Pedantry has a post up about eCards used to warn of sexually transmitted infections (STIs), and while the idea is certainly humorous, it's probably a really good idea. The story has popped up a few times in the last several months, most recently in the New York Times. The basic idea is this: you hook up with someone, find out you have and STI, and then email them anonymously through a third party service to let them know they've been exposed and need to get checked out. These third party services usually provide health care links as well.
Anonymous internet hook-ups…
palmd | January 20, 2009If you like the new banner, kudos goes to Matt Yarbrough. I don't really know who he is, but he was kind enough to design a banner and work with the picky blogger on a font. For the rest of the info on the image and copyrights, see the About page.
palmd | January 20, 2009Make no little plans; they have no power to stir men's blood.
---Daniel Burnham
The last eight years have seen subtle and not-so subtle predations on the practice of medicine. Will the new administration be able to promote the kind of change we need? Let's review some of the challenges facing the Obama administration.
Ethical apocalypse
Bush's evisceration of the Constitution of the United States has affected health care professionals. For example, the military has likely always used psychologists to assist with interrogations, but the last eight years has seen a huge increase in the…
palmd | January 19, 2009You've probably read about the current Salmonella outbreak. It's a fine example of what can happen when food is produced and distributed on an industrial scale---even one small contamination event can spread widely in the food supply, and there isn't much of a system in place to follow the trail of contaminants. Others have covered the public health implications of this outbreak, so I'd like to examine some other facts that make this outbreak disturbing.
Salmonella likes non-human animals
Some species of Salmonella cause typhoid fever. Typhoid fever, a nasty epidemic disease of humans, is…