Interesting points from this small case series include the fact that IVIG and terbutaline may be effective preventive treatments, and that IgG monoclonal gammopathy was observed in 89%.
Monday, May 09, 2011
Friday, May 06, 2011
Conflict of interest in medicine: negative consequences of the inquisition
An opinion piece in Nature Medicine by Thomas Stossel and Lance Stell deals with the mounting public pressure and increasingly burdensome regulations against the medical profession's interaction with industry. They argue that the movement has gone too far and its proponents have no evidence to back up their claims. I don't have access to the full text but Thomas Sullivan parses it pretty well in a recent blog post. Concerning the lack of evidence he cites from the article thus:
In the words of the authors the inquisitors' judgments lack “quantitative rigor.”
Drs. Stell and Stossel assert that, “insinuations of corruption by those who call for increased oversight and regulation of the interaction between academia and industry require quantitative evidence—for a start, providing a denominator as well as a numerator.”...
While many critics can easily compose the numerator by mentioning “the same cases alleging corruption due to industry influence, many laced with hindsight wisdom, dredged up repeatedly and assembled into a narrative framework,” a denominator is almost always missing. In fact, “the storytelling suffers from serious ‘denominator neglect’—the non-nefarious, noncorrupt, beneficial collaborations, over decades that dwarf the comparatively few cases that populate the numerator.”
As the authors point out, “when attending to the numerator, the misconduct rate is negligible. The numerator of supposedly substantive adverse outcomes due to industry relationships (excluding relationship disclosure lapses discussed below) barely adds up to two digits. Surveys reporting that over 90% of physicians have some type of financial interaction with industry, with 18% of them engaged in consulting arrangements, indicate that the denominator is orders of magnitude greater.”
In the words of the authors the inquisitors' judgments lack “quantitative rigor.”
Thursday, May 05, 2011
Patient centered conversations about ICDs
Some wisdom from Dr. John M:
He ends with a reminder of the most pervasive conflict of interest to keep in mind when reading research reports:
In selected patients, ICDs unequivocally provide statistical benefit, but there are risks, and alternatives—as in any invasive treatment. In this way, ICDs are akin to many other expensive and invasive therapies. Cancer chemotherapies like adriamycin, with its cardiac toxicity, come to mind, for example.
He ends with a reminder of the most pervasive conflict of interest to keep in mind when reading research reports:
Most smart doctors read journal articles with a critical eye. They (should) know that the writers are passionate and convinced of their positive findings. Such is human nature.
Wednesday, May 04, 2011
Is there a dark side of altruism?
Doing something for someone else
isn't really for someone else.
It does twice as much for you
as something you do
just for yourself.
Those lyrics from Reflections sung by Sally Kellerman in the campy remake of Lost Horizon pose the question: is there such a thing as true altruism or is altruism nothing more than a means for us to feel better about ourselves?
The fascinating PJTV interview by Dr. Helen linked here (can't seem to embed it) raises additional disturbing questions about altruism. Empathy is viewed as a right brained trait on the spectrum between emotion and logic as drivers of social interaction. A proper balance between the two poles is necessary. The extreme to the right is codependency. On the other extreme are Asperger traits. Altruism can have a dark side if not tempered by logic, and vice versa. Just what is the dark side of Altruism? Do physicians have to “tamp down” their empathy to be effective?
I haven't read Dr. Oakley's books but I'm adding them to my list.
isn't really for someone else.
It does twice as much for you
as something you do
just for yourself.
Those lyrics from Reflections sung by Sally Kellerman in the campy remake of Lost Horizon pose the question: is there such a thing as true altruism or is altruism nothing more than a means for us to feel better about ourselves?
The fascinating PJTV interview by Dr. Helen linked here (can't seem to embed it) raises additional disturbing questions about altruism. Empathy is viewed as a right brained trait on the spectrum between emotion and logic as drivers of social interaction. A proper balance between the two poles is necessary. The extreme to the right is codependency. On the other extreme are Asperger traits. Altruism can have a dark side if not tempered by logic, and vice versa. Just what is the dark side of Altruism? Do physicians have to “tamp down” their empathy to be effective?
I haven't read Dr. Oakley's books but I'm adding them to my list.
Postural orthostatic tachycardia syndrome (POTs)
The above video from Mayo Clinic explains it well. (HT to Clinical Cases and Images).
Two free full text reviews are available (see here and here).
Points of interest:
POTS is a “pervasive” circulatory disease involving multiple autonomic and volume regulating mechanisms.
Ganglionic acetylcholine receptor antibodies are found in a small percentage of patients suggesting that it is an autoimmune disorder in some.
Although a genetic mechanism has been found in some patients (involving norepi re-uptake) environmental factors are suggested by the cases that follow viral illness and surgery.
In additional to circulatory symptoms a wide variety of non-circulatory symptoms (GI, constitutional) have been described as being frequent.
Tilt-table testing is the principal diagnostic modality. It can also test for vaso-vagal syncope and orthostatic hypotension, conditions which overlap considerably with POTS.
Many treatments are discussed in the review articles. The Mayo video emphasizes exercise, adequate fluid and salt intake and beta blockers as the principal therapeutic approaches. Beta blockers, however, are controversial, are down played in one of the above linked reviews and considered contraindicated in the other.
Tuesday, May 03, 2011
Do you want to be a Twitter star?
Dr. Ves, arguably THE expert on doctors' use of social media for education, shows you how.
I have been blogging for almost 6 years. I still don't Tweet. Why? A couple of observations. As Dr. Ves noted:
That's precisely the problem with using Twitter in medicine. It's an aggregator of medical “news.” Despite the daily deluge of pieces of information from the popular media and scientific literature, true advances in medicine are only rarely to be found in the medical “news of the day.” Medical science progresses in small increments, one study building on another. As Steve Milloy wrote on page 46 of his book Junk Science Judo:
When medical research is presented in the sound bite fashion of the typical Tweet it is inevitably subject to distortion because there's neither time nor space to address important nuances and background information. (Due to the constraints of time many of the posts on my blog are brief link dumps but I try to provide more depth when I can).
So I'm not Tweeting right now. That's not to say I won't find a reason to Tweet in the future. But if your objective is to drive traffic to your blog with a series of rapid fire mini posts, why not just “Tweet” on your blog? After all the blogfather himself, Instapundit, does it to great effect!
I have been blogging for almost 6 years. I still don't Tweet. Why? A couple of observations. As Dr. Ves noted:
There is a flood of medical news that hits the wires every day. I want to know what YOU think is important. Share the 3-10 news items per day that you find interesting. I will subscribe to read them. Many will do the same.
That's precisely the problem with using Twitter in medicine. It's an aggregator of medical “news.” Despite the daily deluge of pieces of information from the popular media and scientific literature, true advances in medicine are only rarely to be found in the medical “news of the day.” Medical science progresses in small increments, one study building on another. As Steve Milloy wrote on page 46 of his book Junk Science Judo:
...keep the slow, steady ho-hum scientific method in mind. Boring? Sure. Tedious? You betcha. Slow and deliberative? Be grateful.
When medical research is presented in the sound bite fashion of the typical Tweet it is inevitably subject to distortion because there's neither time nor space to address important nuances and background information. (Due to the constraints of time many of the posts on my blog are brief link dumps but I try to provide more depth when I can).
So I'm not Tweeting right now. That's not to say I won't find a reason to Tweet in the future. But if your objective is to drive traffic to your blog with a series of rapid fire mini posts, why not just “Tweet” on your blog? After all the blogfather himself, Instapundit, does it to great effect!
Implementation for implementation's sake: meaningless use?
Provocative commentary at Health Care Renewal.
Monday, May 02, 2011
CPOE accounted for the most near misses
---in this study. According to the authors CPOE is a critical vulnerability.
Friday, April 29, 2011
Introducing the Sick Hospital blog
Common sense, straight-to-the-point, very politically incorrect plain talk about hospitalists and hospital medicine. Blogrolled stat.
When is comanagement just a work-around against the global surgical fee?
More on fake-note-real-docs in Wisconsin
The UW school of medicine has reviewed the incident and is about to issue penalties:
That's about all they're saying.
Concerning one of the docs:
Well, no, not according to the new medical ethics.
The state medical board has yet to take action.
Via Health Care BS.
“Personnel action will be based on the specific nature of the offense and the level of the physician’s involvement,” the statement said. “The consequences range from written reprimand to loss of pay and leadership position.”
That's about all they're saying.
Concerning one of the docs:
Dr. Lou Sanner, a family medicine physician at UW Health, told the Associated Press he wrote hundreds of medical excuses from work for protesters because they were suffering from stress.
“Some people think it’s a nod-and-wink thing, but it’s not,” he said.
Well, no, not according to the new medical ethics.
The state medical board has yet to take action.
Via Health Care BS.
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