palmd | April 27, 2010Next week I'm going to be giving a talk at the 2010 Great Lakes Homeland Security Training Conference & Expo. The title of the talk will be "Medical Blogs: An Under-Recognized Resource for Public Health Awareness and Communication", but I'll probably speak more broadly about web 2.0. In preparation for the talk, I'd like you to help me with an exercise.
One possible ways to enlist blogs and social media in disaster response is to direct people to a specific link where official information can be found. As an experiment, I'd like use this post to see how disaster information might be…
palmd | April 26, 2010A few years ago I was walking through a local mall with my daughter and saw a kid about her age wearing a backpack and holding hands with a young woman. He was a gorgeous little boy, with black hair and huge black eyes. His eyes reminded me of my daughter's. There was a name tag on the backpack. The last name was unusual but one that I recognized as that of a guy I grew up with---and this little boy looked just like him.
So I politely asked the woman if she was D's wife. She laughed and introduced herself as a family friend. My friend D and his wife were in California getting her cancer…
palmd | April 19, 2010I never thought it would happen, but here we are. I can smell the ocean, hear the wind in the coconut palms. My arms are leaden from swimming, my shoulders reddened by the sun.
A little while ago, I was body surfing. When you catch a wave---really catch it---you are weightless, and it is magnificent. But even the missed waves have their surprises. A large breaker sneaked up behind me, brown with sand, capped with white, and tried to take me. It could have---if the ocean wants someone, it will take them. But it didn't, and after it passed, it left a pool of calm. Out of this pool…
palmd | April 14, 2010A young relative of mine recently asked me my thoughts about medicine as a career. It's a relatively common question in my mail bag, and a tough one to answer, especially when asked by strangers. Career choices are very personal, so I don't like to give advice as much as let people know what they can expect from a career in medicine. Here's one of the latest letters to show up in my inbox (edited by me for anonymity, etc.).
Dear Pal,
I'm a third year medical student at the end of my clerkships now, and I've found that I pretty well like everything. I did my pediatrics rotation early and…
palmd | April 13, 2010A few months ago, DrugMonkey reported on a study about how we as health care workers view narcotic users. Narcotic use and abuse is something we deal with every day and presents many challenges. Narcotics are an important tool for controlling pain and many different strategies have been used to try to prevent their legitimate use from changing to abuse. Despite this, prescription narcotic abuse is very common.
But narcotics are not the most frequently used addictive substances. For example, about a fifth of Americans smoke. But we as health care providers react differently to different…
palmd | April 12, 2010In the Soviet Union, party membership was everything. Your job, your access to food and other consumer goods, and your apartment all depended on your standing with the party. And votes were simply a tool to provide a patina of legitimacy. No one who liked warm weather voted against the Party.
One of the many advantages of the protections provided by the U.S. constitution is that we generally cannot be hired or fired based on our personal or political beliefs. We also get to elect our leaders frequently. So it should be with a great sense of irony that various teabagger groups shout and…
palmd | April 10, 2010Right now I'm feeling rather civilized. I had a yummy brick-oven pizza with my family, including my parents and one of my sisters, and I just finished getting my cranky, over-tired child to sleep. Now I'm sitting at my kitchen table drinking some seriously killer single-malt bought for me by my loving spouse, and listening to a Haydn string quartet.
Just what the doctor ordered
All was well until my buddy Isis, who is several orders of magnitude hotter and smarter than I, noticed a disturbance in the force (as manifested by a google alert, the tool of internet narcissists everywhere).…
palmd | April 8, 2010
As an internist, my specialty is the prevention and treatment of adult diseases. One of the most common of these diseases is diabetes.
There are two main variants of diabetes: Type I (juvenile) and Type II. Type II accounts for about 95% of the 20 million cases of diabetes in the U.S. Diabetes is can be a disabling and deadly disease, but not because of the blood sugar fluctuations per se. High blood sugar damages blood vessels, which in turn damages the organs they supply.
We generally divide diabetic complications into two categories: microvascular (small blood vessel), and macrovascular…
palmd | April 6, 2010Bad medical ideas often start with good intentions. Most doctors are interested in preventing and treating disease, and some diseases are particularly challenging. Some rise to this challenge, forming clever hypotheses and finding accurate ways to test them, but others aren't so successful. Sometimes, hypotheses are too implausible to be worth spending much time on. Sometimes, the method used to test a hypothesis is simply not valid.
This story begins on the website Age of Autism. AoA is one of the homes of the antivaccination movement and gives a lot of time to those who still believe…
palmd | April 3, 2010Some crazy, currently unbloggable crap is going down around Casa Pal this week, so I'm going to have to open up a bloggy doggy bag for you. I have a nice piece in the works for Sunday or Monday which is brand, spanking new. This was originally published on 5/6/2009. --PalMD
Some bad ideas refuse to die. Others die and then come back to eat your brains. Of course, zombies don't just rise from the grave for no reason. They need some sort of animating principle, like meteors, puffer fish toxin, a voodoo priestess, or all three.
Brain-eating, measles-promoting zombies. Not pictured:…
palmd | March 31, 2010The recent arrests of the Hutaree cult here in Michigan are part of a tradition of militant separatism in this part of the country, beginning with the militia movements in the late 20th century and climaxing (hopefully) in the terrorist acts of Timothy McVeigh and Terry Nichols. This latest incident is interesting in that it appears to share some qualities of the militia movement, the Christian Identity movement, and the Tea Party movement (although what sorts of ideologic connections there really are will take some time to figure out.)
Cults in general scare me. They scare me not just…
palmd | March 27, 2010I love Icelandic names. Just reading them makes me think of Vikings and valkyries. One name that I can't get out of my head right now is "Iris Erlingsdottir". She's an Icelandic journalist who put up a pro-vaccine piece on Huffington Post. Not only is the piece pro-vaccine, but it is quite critical of her fellow HuffPo blogger "Dr." Jenny McCarthy, the actress who, after having a child and doing a lot of googling, decided that vaccines are evil. She is so convinced of the danger of vaccine that she explicitly wishes our children to suffer from vaccine-preventable diseases to try to prove…
palmd | March 24, 2010It has been alleged by Great Minds such as Jenny McCarthy (D.Goog.) that the US recommends far more vaccinations than other countries. Her precise statement was, "How come many other countries give their kids one-third as many shots as we do?" She put this into the context of wondering if our current vaccine schedule should be less rigid. The entire piece was filled with what could charitably called less-than-truthful assertions, but I'm not feeling that charitable: they are lies (or the rantings of an idiot, or the delusions of lunatic. There are probably other possibilities that I haven'…
palmd | March 22, 2010It's hard to imagine the that the hyperbolic rhetoric that characterized the health care reform debate could get any worse (death panels, etc.). But it will. Representative John Boehner (Asshat-OH) started it of last night with what amounted to a call for the overthrow of our democracy.
"Today we stand here amidst the wreckage of what was once the respect and honor that this House was held in by our fellow citizens.
"And we all know why it is so.
"We have failed to listen to America.
"And we have failed to reflect the will of our constituents.
"And when we fail to reflect that will - we fail…
palmd | March 21, 2010After a week of fine weather, the first weekend of spring was forecast to be cold, rainy, and snowy. I love it when they're wrong.
I would love to be able to sleep in, but if I can't sleep in, I don't mind the sound of tiny footsteps. After whipping up a batch of heart-shaped Daddy pancakes, the kiddo and I took off for work. It wasn't looking good out---cloudy, windy, a little bitter.
Rounds were brief, and we had time for a stop at the bookstore before lunch. PalKid loves to go to our local sushi joint for rice, edemame, and udon soup, and to watch me eat various raw and wriggly things…
palmd | March 21, 2010Early in the prolonged economic crisis a patient who had lost his factory job came to see me. He no longer had insurance, but he had plenty of health problems. Our office normally doesn't see uninsured patients (we simply can't afford to) but from time to time we make exceptions. I changed his prescriptions to the cheapest possible effective medications and gave him an online resource for the meds that did not have inexpensive alternatives. I referred him to a clinic that has the resources to care for the uninsured and that may be able to help him get his diabetic supplies.
By doing this…
palmd | March 18, 2010
A physician friend asked me today if I had seen the survey in the New England Journal of Medicine that says nearly half of us will quit medicine if health care reform passes. My fried, a life-long Republican, found the numbers difficult to believe. So did I.
The New England Journal of Medicine (NEJM), one of medicine's most respected journals, did not publish such a poll. Apparently, in an earlier version of a web-based story posted on their jobs page, they reported the results of a poll conducted by a physician recruitment firm. Partisan bloggers and networks jumped on the story as…
palmd | March 17, 2010One of the things I love about the blogosphere is the give and take, the ability of people to comment on each others' work, and the diversity of topics. The conversations that take place in the blogosphere have real value (a value which is so far under-recognized and under-utilized). Without the blogosphere, I would never be exposed to many of the things I read online, such as basic research in neuroanatomy and drug abuse, physiology, and primatology.
Interest in primatology is sort of like love of chocolate---I suspect most of us are born with it. As the Bare Naked Ladies sang, "Haven't…
palmd | March 17, 2010(This piece appears today at Science-Based Medicine and is re-posted here today because I like it and I'm lazy. --PalMD)
A couple of years ago, a number of us raised concerns about an "investigative reporter" at a Detroit television station. Â At the time I noted that investigative reporters serve an important role in a democracy, but that they can also do great harm, as when Channel 7's Steve Wilson parroted the talking points of the anti-vaccine movement. Â Wilson has since been canned but apparently, not much has changed. Â While performing my evening ablutions, I stumbled upon the latest…
palmd | March 15, 2010The work up of "fever of unknown origin" (FUO) is a classic exercise in internal medicine. Originally defined as a temperature greater than 38.3°C (101°F) on several occasions for more than three weeks with no diagnosis after one week of inpatient study, the definition has shifted. This reflects the dramatic increase in the sophistication of outpatient work ups in the fifty or so years since the term was formally defined. About a third of cases turn out to be infection, another third cancer, a smaller percentage so-called collagen vascular diseases such as lupus. A significant percentage…