End of FP?

Wednesday, May 31st 2006
Health News • Training

Duke closes it’s Family Medicine residency. Kind’ve sad.

H/T Kevin, MD

Don’t Ask, Don’t Tell

Healthcare Policy • Health News • Uninsured • Law

New York City is trying to distribute its message to illegal immigrant populations that hospitals will not ask or record their immigration status if they come in for treatment.

AIDS Growth Slowing

Tuesday, May 30th 2006
Health News

The U.N. Aids program says the new infection rate for HIV is slowing.

The progress against AIDS in some regions represents dividends from a surge in financing since 2001, when the United Nations pledged its commitment to stem the epidemic by 2010. That declaration called for countries to report regularly on their responses to AIDS. This week, the General Assembly will review the progress that 126 countries have said they have made.

A Year

Sunday, May 28th 2006
Miscellaneous

I’ve been blogging for over a year (May 27, 2005 - May 28, 2006).

HIV From A Stab Wound

Health News • Miscellaneous

A teenager went on a stabbing rampage in Berlin, and one of the victims was HIV+. Now all those stabbed after that victim are getting prophylactic anti-retroviral drugs.

“The chance of an HIV infection through a knife wound is three in 1,000. The prophylaxis can reduce the risk by another 80%,” he said.

I’ve mentioned it before, but long ago. One of the worst stories I heard during first was the FP doctor helping run an HIV clinic. She came in and talked to us during our medical ethics class. Che contracted HIV from a needle stick. It was a terrible story as well, because she had gone over to the home of a patient who had been sent home for hospice (a decision she didn’t agree with) to check his CD4 count one last time, and there was no sharps container in the home so she stuck the used needle in a bag and took it back to the clinic.

She reaches in for the vials when she gets back and the rest is obvious.

Why Does Healthcare Cost So Much?

Friday, May 26th 2006
Healthcare Policy • Healthcare Costs

Previously I argued that perhaps we’re putting the chicken before the egg…or something like that, excuse the screwed up analogy. In anycase, perhaps healthcare in this country is ‘worse’ and yet costs more because we’re a comparatively unhealthy country. Indeed there’s some evidence for that.

Now, thanks to Kevin, M.D., I’ve had a little look at the breakdown of who, based on costs, consumes the most healthcare.

1% of all Americans consume, in terms of cost, more than a fifth of all healthcare. These are the sickest Americans, and you might imagine that very accute diseases or trauma might be contributing to massive one time costs. But, what is more remarkable is that of those roughly 2.5 million Americans of which 22% of healthcare expenditures are made for, more than 25% of them were in the top 1% of all healthcare consumers the previous year. These are chronic patients, consuming hugely disproportionate healthcare resources year after year.

Healthcare largely doesn’t cost more in this country because the system is poor or ineffective. It costs more because this country is unhealthy.

Can Greg Garber Write Anything But Fluff?

Thursday, May 25th 2006
Uncategorized

The social perception of lacrosse.

Cloaking

Miscellaneous

A cloaking devide which works like water flowing around a pencil.

Two separate teams, including Professor Pendry’s, have outlined ways to cloak objects in the journal Science.

These research papers present the maths required to verify that the concept could work. But developing an invisibility cloak is likely to pose significant challenges.

Both groups propose methods using the unusual properties of so-called “metamaterials” to build a cloak.

“Water behaves a little differently to light. If you put a pencil in water that’s moving, the water naturally flows around the pencil. When it gets to the other side, the water closes up,” Professor Pendry told the BBC.

“A little way downstream, you’d never know that you’d put a pencil in the water - it’s flowing smoothly again.

“Light doesn’t do that of course, it hits the pencil and scatters. So you want to put a coating around the pencil that allows light to flow around it like water, in a nice, curved way.”

HIV Origin

Innovations • Health News

The source of the AIDs epidemic has been found. The direct Simian Immunodeficiency Virus that gave rise to HIV in humans has finally been found in west Africa.

Scientists have long suspected that HIV had its in origins in wild chimp populations. But previously SIV had been found only in some captive chimps.

The virus was found in chimpanzees in southeastern Cameroon, where SIV infection rates were as high as 35 percent in some chimp populations.

Further genetic analysis linked these chimps to the source of the main strain of HIV-1, the most prevalent form of HIV. The team’s findings are to be published tomorrow in the journal Science.

“Eventually the virus ended up in a major metropolitan area, which would either be Kinshasa [Democratic Republic of the Congo]or Brazzaville [Republic of the Congo],” Hahn added. “That’s where we believe the AIDS pandemic really started.”

“We now know there are more than 30 species of monkeys across Africa which have their own forms of SIVs,” said Sharp, who was also involved with the new study.

Cancer & Marijuana

Wednesday, May 24th 2006
Innovations • Health News

An AP story reports on a recent paper presented at the American Thoracic Society meeting which found no increased lung cancer risk for heavy marijuana users.

Previous studies showed marijuana tar contained about 50 percent more of the chemicals linked to lung cancer, compared with tobacco tar, Tashkin said. In addition, smoking a marijuana joint deposits four times more tar in the lungs than smoking an equivalent amount of tobacco.

“Marijuana is packed more loosely than tobacco, so there’s less filtration through the rod of the cigarette, so more particles will be inhaled,” Tashkin said in a statement. “And marijuana smokers typically smoke differently than tobacco smokers — they hold their breath about four times longer, allowing more time for extra fine particles to deposit in the lung.”

He theorized that tetrahydrocannabinol, or THC, a chemical in marijuana smoke that produces its psychotropic effect, may encourage aging, damaged cells to die off before they become cancerous.

Women’s Duke Lacrosse Team

Uncategorized

Is showing support for the men’s team.

In a show of solidarity with the Duke University’s men’s lacrosse team, members of the school’s women’s team plan to wear sweatbands with the word “Innocent” written on them.

Video Games

Innovations • Miscellaneous

Surgeons performing laproscopic training drills made fewer errors and were quicker if they played video games for thrity minutes before the procedure. As well,

The results supported findings from a small study conducted by Rosser in 2003, which showed that doctors who grew up playing video games tended to be more efficient and less error-prone in laparoscopic training drills.

National Organization of Women

Tuesday, May 23rd 2006
Uncategorized • Miscellaneous

The California chapter of the National Organization of Women has gotten involved, per Dr. Blaine’s urging apparently, in Mark Sanchez’s rape case. They sent a letter to USC protesting USC football players getting away with sexual assault, as if all those accusations were without question valid and real. The complete letter is here. I thought we had a judicial system for a reason.

USC responded with a reply letter. They’re clearly the voice of reason in this debate. Speaking of things that don’t “hold a lot of water,” the Mark Sanchez case which specifically prompted the reaction by NOW doesn’t seem to be standing on its own. I hope, despite his talent, that if he’s guilty of the crime then he suffers for it, but if these accusations are false that pressure from organizations like NOW don’t affect the outcome of the investigation surrounding him.

Human to Human Transmission…

Health News • Avian Flu

…of H5N1, is being suspected in Indonesia in a cluster of 7 cases (6 of them fatal).

A team of international experts has been unable to find animals that might have infected the people, the World Health Organization said in a statement today. In one case, a 10-year- old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said. Six of the seven people have died.

“Teaching Doctors To Care”

Medical School • Training

It’s exactly what the title of the Time article says.

Claire Brickell, 25, an aspiring neurologist in her third year at Harvard Medical School, already knows far more about health care than most of us…But when it comes to communicating with patients, Brickell has a problem: she’s too healthy. Like most of her classmates, she has spent very little time as a patient. She has never had to weigh the advice of a trusted friend against conflicting orders given by a cold and distant doctor.

Enter Santa Ocasio, 56, a Dominican immigrant who is fighting a protracted battle with Type 2 diabetes. In a pilot program that is the leading edge of a broad curriculum overhaul at Harvard Medical School, Brickell has been paired with Ocasio for nearly five months. She sees her as a patient every week at the Spanish Clinic of Boston’s Brigham and Women’s Hospital and tags along on visits to her specialists. In fact, the goal is for Brickell to be there every time Ocasio encounters the health-care system. It’s not just a way to learn about treating diabetes; it’s a crash course in the myriad frustrations of a patient caught in the maw of modern medicine–confusing prescriptions, language barriers and an endless parade of strangers in white coats.

Can you really teach empathy? This is a lovely program, but it accomplishes only in allowing the medical student to get up close to a single patient’s experience. And of course there are similarities in the ways most patients deal with chronic conditions (such as diabetes). But it isn’t cut and paste. I don’t think we need to be taught empathy; if the school’s are doing their jobs effectively they graded that on admission.

It is just that over the time of our training it appears to die. Part of that is habituation. Part of that is emotional necessity. Part of that is the training itself. Empathy is not sympathy, it is the actual ability to put oneself in someone else’s emotional shoes. For people witnessing suffering that is quite a burden over the long run it seems to me.

The training itself, while getting better, is still, in many specialties, centered around turning out a kind’ve Type A physician. In some ways a too touchy feely neurosurgeon would be a little concerning to me, right before I went into the OR. Give me someone confident, with great hands, whose going to fix the problem and move on; but maybe that’s not exclusive of what Harvard is trying to do.