Vol 2, No 19 is up from Down Under at Barbados Butterfly.
Australia is a beautiful country. Not that that has anything to do with how good this week’s set of the best of the medical blogosphere.
On a final note: Physiology, Biochemistry, and Human Behavior tests are done. Anatomy, Histology, and the Physiology Shelf Exam final remain for the week.
On this day in 1986 America suffered a shock when seven men and women lost their lives on the Challenger shuttle. It was not the first lives lost in pushing the boundaries of space exploration. It would not be the last.
“Don’t we all learn as we go?” said Grace Corrigan, who lost her daughter, teacher Christa McAuliffe, in the Challenger accident. “Everybody learns from their mistakes.”
That is an amazing statement. I read these syllabi and I will remember what is in them (the degree to which I do so we’ll see after I get my grades from the next round of tests).
As tests approach fast it comes to points at times where it’d be better to pound my head into a wall than continue staring blankly at the description of G-Coupled Protein Receptors or the anatomy of the pelvis.
But, it is amazing I can look at these descriptions and comprehend them. We are blessed, at such a fundamental level, with this gift. It is kind’ve hard to let that go to waste.
How do we learn? Well, that is kind’ve hard to say.
Don’t ask me for figures but plenty of medical students become little miniature 
“hypochondriacs;” especially in the early years. Actually, hypochondria is a serious condition that I shouldn’t make light of.
But really there are a lot of frightening things, not just diseases, mixed amongst the pages of our biochem and microbiology books.
Take what I’m looking at in biochemistry right now. I recently had a lecture on prostaglandins and thromboxanes.
That’s not important in and of itself. The important thing is that cyclooxygenase is an enzyme used in the production of these molecules. Efforts to inhibit a form of cyclooxygenase, COX-2, has led to Merck opening up its wallet.
These COX-2 inhibitors, such as Vioxx, were suppose to be the safer anti-inflammatory painkillers, developed to target COX-2, and spare another enzyme COX-1. They were to be our bodies’ friends, if you will, even going to far as inhibiting the development of some cancers.
Back to the story at hand. A few of your typical medicine cabinet painkillers (aspirin and ibuprofen) inhibit COX-2 and the inflammation it causes (good for reliving pain) but also its brother enzyme COX-1, which has to do with blood coagulation and gastric acid secretion.
Being the rational future physician I am I was sitting in class wondering if the next time I got a headache and then cut myself with a cheese grater (it could happen) if I was going to bleed out. And this is while I develop an ulcer from the increased acid secretion.
It turns out Tylenol (acetaminophen) is preferential for another form of cyclooxygenase, COX-3, which has nothing to do with bleeding or inflammation. Great news. No risk.
I went and bought some the next day.
Literally, twenty pages further in my biochemistry book (and several days later) I learn that this stuff is worse. Our bodies are so smart acetaminophen is metabolized, especially in the presence of alcohol, into something pretty nasty for our liver. More people make calls to poison centers involving acetaminophen than any other substance.
I think I’ll try incense from now on to help relieve minor aches and pains. I don’t know what I’m going to do however when we get to bacteriology later in the year in microbiology. All I have to say is that if Adriana Lima wants to make out with me, she better let me know before I learn what’s in her mouth.
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The Rose Bowl is January 1st and the national championship game is January 8, 2007 in Phoenix, AZ at the site of the Fiesta Bowl (after all the BCS Bowls have been played).
The lone survivor of the Sago mine accident is being slowly brought out of his coma and with incredibly promising results so far. The quotes from his neurosurgeon include:
Now if you call his name, he will [open his eyes]. He will track family members and they believe that he has some level of connectivity with them.
If you put a piece of ice in his mouth he will take it and move it around with his tongue and swallow it and chew it and swallow it.
Still it must be remembered that,
Many people with severe carbon monoxide poisoning end up with severe cognitive, personality, memory, visual, motor response deficits.
Researcher’s at Brown Univ. have modified the gut dwelling L. Lactis to produce cyanovirin, a drug which some studies from the NCI show blocks human cell infection by HIV and Herpes viruses.
I won’t call this photo fake. Instead, let’s give the benefit of the doubt, and imagine that the original caption to this photo was an overzealous mistaken on the part of the NY Times; looking to put a human touch on the perhaps dozen deaths (or more depending on who you want to believe) involved in the strike on a terrorist gathering in Pakistan. And there is strong evidence, that the strike killed foreign terrorists who were indeed at the location.
This is the original caption of the photo:
Pakistani men with the remains of a missile fired at a house in the Bajur tribal zone near the Afghan border.
However the photo was obviously staged because that is a decades old artillery shell they’re standing next to. Lots of news photos are staged, and I find nothing wrong witht that. As well the photographer knew this wasn’t a missile or American ordinance he was lining these villagers up next to (or he is an idiot).
The question is on the intention of the NY Times photographer to have this photo used as a representation of the consequences of American action in Pakistan. Or was this just a mistake by the editors back in New York confusing the photo for something else?
We may never know. However, what is troubling is when liberally leaning publications continue to print the picture, even after the NY Times correction, with the intention of portraying it as a photo of American intervention and the trouble it causes in other countries.
I’m pleased with this. I’m just not sure it was decided right.
On an sad note, the three most conservative judges - the ones I would hope would uphold the idea of federalism - were the ones who voted against Oregon.
The case was one of definition. The ruling actually centered on the U.S. Controlled Substance Act and the meaning of the act’s term, “legitimate medical purpose”. Ashcroft, in the suit, basically claimed the executive branch’s authority to provide depth to this ill defined term. It’s probably the judicial branch’s role to do so, and now they have spoken, under the CSA assisted suicide is a “legitimate medical purpose”.
Certainly it is impossible to know for certain what congress intended by this term, if it was to protect the practice of physician assisted suicide. But it is likely they didn’t intend it to do so.
In matters of definition only, shouldn’t that be the basis on which courts interpret laws? On what the legislature intended?
As Scalia said,
The court’s decision today is perhaps driven by a feeling that the subject of assisted suicide is none of the federal government’s business. It is easy to sympathize with that position
The court did not have the courage to say that assisting those who wish to die is a protected act, and instead only limited law enforcement’s ability to prosecute under current legislation. Don’t be surprised if Congress acts to specifically outlaw assisted suicide as a criminal act with new more definitive laws. Maybe that will force the court’s hand; but probably only make them shy away.
A robber took $1000 from a liquor store by threatening the owner with a needle he said had HIV infected blood on it.
I don’t like the idea that the super rich owe something more than others. I don’t even understand how the proposition is defensible.
But off my ideological thought block for a moment, there are other reasons why taxing the super rich too much is a bad idea.
Here however is a novel pragmatic argument being made that relying on the rich for too much of your tax revenue provides inadequate diversity and opens yourself up for disaster. Just take the state of California where the top 5% of earners represented almost 60% of tax revenues.
The personal income tax represented $33.7B of the $73.6B in revenues in the 03 budget, high income filers represented 58.8% of 45.8% of the budget, or 26.9% of the annual budget.
Since this represents 680,000 returns of the 13.6 million filed, it’s fair to say that half a million households provide about a quarter of the revenue to the state.
I think this is an amazingly bad idea. I don’t think that this is a bad idea because it’s unfair to the half-million rich households. I think it’s a bad idea because it builds insane levels of volatility into the state revenue stream.
There’s numbers on the site to prove it.
On the federal level the top 5% account for 38.4% of all federal tax revenue (not just income tax). Personal taxes account for almost exactly 80% of all federal revenue! 80%!
The United States government borrows and overspends obviously. But of the revenue they do bring in, around 2.2 trillion dollars, personal payments from the top 5% account for about 31%. This doesn’t even include corporate taxes, many of which the top 5% of earners are likely to have vested interests in.
Nearly a third of revenue comes directly from the earnings of the super wealthy. The question is, do recessions, in terms of percentage change in income, not absolute dollars, hurt these individuals more than other classes?
Are the income sources of these individuals diverse enough for this reliance on them by the federal government not to be an unnecessary risk?
I went in and scrubbed in for a cardiac surgery today. Apparently the left ventricle is not the most anterior chamber of the heart, as I claimed. Thank the Lord it was after the surgery and to another doctor, not the surgeon(s), but it’s not like it was a slip of the tongue. I was watching them cut into the left side of the patient’s heart and thinking, during the surgery, ‘this is really weird,’ they’re cutting into the LV. Why would you go in to close a VSD through the more muscular ventricle?
This despite the fact that I just went through this in anatomy lab a little over two months ago. It’s not like I misidentified a CA branch…I thought I was looking at the LV because it was on the left side of the patient.
Good job me.
This study involved a set of self reporting surveys that got less than 55% response. It found a number of complaints amongst academic physicians and that a significant percentage of them were clinically depressed.
While you have to have respect for the authors who are all notable academians, obviously those who feel there is something that needs to be reported, basically those who are depressed or are likely to report negatives about academic medicine are more likely to complete the survey.
Not to go into my history but I probably have as good a perspective about the condition of academic medicine as any undergraduate medical student. It has certainly been a part of my life since early childhood.
Is life as a physician really just as atrocious as this survey makes it out to be?
The term “crisis” has been used to describe the state of American medical care for a number of years.
There is stress everywhere in medicine and it goes beyond the financial situation and threat of litigation (although these are concerning) to the nature of the job. Certainly, such stress is unavoidable in academic medicine as well along with concerns that attractors for joining academic medicine - research and teaching - are being diminished. But there’s a “crisis” going on?
My perspective is limited to specific academic institutions but…these numbers seem bloated. Still, it’s not like depression manifests itself on the faces of those you pass in the hallway and it is hard to judge the situation without living it. This study could just as well be an accurate representation of the state of academic medicine.
H/T to HCRenewal.
The United Health Foundation, American Public Health Association, and Partnership for Prevention have released their annual report on how fast America’s health is improving. Apparently compared to the past 5 years the growth of America’s health has slowed down and this is an issue of grave concern. I took this from NewsRX.
Of specific concern in the report and if you visit UHF’s website is the fact that America is getting fatter. This despite the fact that plenty of reports document the fact that the health risks, in terms of absolute life expectancy, associated with being obese have been greatly overstated. Being mildly overweight appears to have no effect on life expectancy in this country. Read my previous post on this issue of reworking the numbers on obesity.
It should be noted that I’m nearly underweight, so I’m not defending myself here, I just think that America’s prevention efforts are probably misplaced in spending so much time in slowing down America’s “growth”.
America does finish 27th in life expectancy, which is of note, and apparently how quickly our life expectancy is rising compared to other leading countries is concerning. Here is a list of world life expectancies.
The argument has long been, by those I typically disagree with, that America leads the world in health spending, both on services and research, and yet if we lag behind other countries in health then there is something wrong with the model. This report certainly adds to their argument.
