narrative medicine · news

The smell of racism in the morning

I love it when reporters reproduce stereotypes, don’t you?

Will the older generation pay for educating a younger generation that looks less like itself? And while the young population is a potential engine of growth for the economy, will it be a burden if it does not have access to adequate education?

I’m just surprised that they didn’t include a picture of an older, portly, white man sitting in a leather armchair, holding a cigar and haw-hawing about the time when Odysseus went to…

The relative increase in the growth rate among non-whites does not mean these young people “do not have access to adequate education.” Yes, race and social class are historically linked in this country — but they don’t have to be. My magnet public high school, far south of the Mason-Dixon line, had been predominantly non-white for years. Going to college actually felt like a step down in diversity. Perpetuating the Hispanic laborer stereotype — especially in major news media — only reinforces it.

This edition of “The Armchair Sociologist” brought to you by Too Much Coffee, Inc., and the letter P. (P is for Procrastination, that’s good enough for me!)

ethics · narrative medicine · news · pharm

Finally, the Well blog, that bastion of doctor-bashing, has a pro-allopathic medicine article.

As with all posts on Well, the comments are where the real money’s at.  People share their encounters with physicians that are (usually) related to the topic at hand. Usually these are negative, because complaining is more fun than being supportive.  (I know. I complain a lot.)

Today’s are negative as well, but for once they are pointing out the problems with the quackery of alternative medicine.  Not all alternative medicine is crap (e.g. acupuncture for relief of nausea during chemo, which one of the comments mentions), but as people point out, but when you start to say that you can move energy spheres around, and don’t back it up with a study — I’m sorry, you’ve lost me.  There’s not a lot of difference between a GNC herbalist store and the patent medicines that peddlers sold at the beginning of the 20th century.

The article itself talks about the problem with celebrity endorsement of alternative medicine. For sure, celebrities are very visible, and people are sheep (including myself; I pretty much want to beEmma Thompson when I grow up) but taking a single person’s anecdotal experience over the recommendation of someone who has studied a subject for 15 years seems … idiotic. I would be like me telling someone that I won the lottery by framing the card upside down and dancing a jig — so you should too!

Emma Thompson approves of my plan to take over her life

(I probably just pissed some people off by implying that alternative medicine is doohickey. But here’s the thing: medications and procedures proposed by Western medicine have to be carefully studied to see if they are safe and effective. This process often takes years, especially to study long-term effects. Alternative medicine people, bring me your evidence. Then we’ll talk.)

Actually, I’m just glad — especially after the disability studies talk — to see that there’s still support for the type of medicine I’m learning: evidence-based, pro-patient, let’s-not-kill-people medicine.

health policy · narrative medicine · news

Uphill in the snow, both ways

How Millennial physicians will impact disease management (opens in a new tab).

Apparently “Millennial” is the name for my generation, the post-Vietnam, post-modern, post-racism kids who grew up in the financial bubble of the 80s and 90s, watching Sesame Street and texting their little hearts out.  And according to this article, we are single-handedly responsible for the death of medicine.

Buh?

Honestly, this Dr. Sidorov comes across as more than a little curmudgeonly.

They don’t know about bomb shelters, walking to school, tape decks or having to get up to change a TV channel.

Oh, no!  Obviously we are inferior human beings because we don’t duck and cover.

(I will say, though, that this video made me feel very old.  But then, the kids are Canadian…. 🙂 )

I do think the author has a point about this generation being less concerned about rank, which doesn’t jive well with medicine’s rather entrenched hierarchy.  But then the rest of the article discusses how self-absorbed we supposedly are, how we will compromise patient care in the name of work-life balance.

I posted a comment on Kevin MD, but I think this deserves a longer rebuttal.

Continue reading “Uphill in the snow, both ways”

health policy · infectious disease · news · pediatrics

Vaccine Hoax

According to the NY Times, there’s a new report discrediting the Wakefield study.  Andrew Wakefield’s unethical science — including undisclosed financial gain and altered data — is one of the worst medical moments of the modern era, right up there with Tuskegee.

I once reported on an anti-vax rally for a summer internship, and it was one of the saddest moments of my medical education.  Hundreds of parents swarming around Capitol Hill, listening to Jenny McCarthy and Jim Carrey blather on about medicogovernmental conspiracy.  Oh no!  We actually want to prevent diseases that kill more than three-quarters of the world’s children! (Fun fact: Did you know that measles kills more children under age 5 than HIV/AIDS?)

Once, a long time ago, when I was in India, I saw a man crouching by the tourist gate of the Mughal fort we had just visited.  Then I looked again and saw that he wasn’t crouching at all.  His right leg was withered away, a crumpled bit of skin lying uselessly at his side.  Polio.  It seems like something so far away, so ancient. Until suddenly you see it and smell it and then somehow it’s not so far away at all.

health policy · narrative medicine · news

Plus ça change

House Approves Senate’s 1-Month Medicare Doc Fix.

This dance happens with startling regularity, like the cycles of the moon or the flowering of the sukebind.  Medicare payment cuts are always looming; Congress always dallies; and at the last minute: swoop! cut revoked — until next month.  It’s Victorian melodrama for a the social network age, and we’re all Pauline, tied to the tracks.

This is the worst possible way to address the Medicare expense issue. According to the article above, Medicare is based on a 1997 formula tying Medicare payments to a percentage of the GDP. That’s crap. Why should physician payments be artificially pegged to the GDP? Shouldn’t the formula be revised to account for the technology-and-pharmaceutical explosion since 1997?  And would someone show me a breakdown of Actual Cost — of every health care dollar, how many cents go to prescription drugs, how many to running an office, etc? The whole process is shrouded, even from one who is in it and is actively seeking this information.

Lydgate, whose primary quality is his ability to rock some snazzy suspenders

Over Thanksgiving, I read Middlemarch, a provincial epic by George Eliot. (As I said to myold-lady-television-watching buddy, Cranford on steroids.) One of the characters, Tertius Lydgate, is a young physician, new in town and full of ambitious plans for revitalizing the practice of medicine. He’s a decent doctor and even manages (by luck or skill, it’s never quite clear) to save a young man from typhoid. But then he incurs the wrath of the town when he decides to charge for his services!  The nerve!   Apparently in the early 19th century, physicians would charge for the drugs they dispensed, but Lydgate prefers to leave that to the apothecary (pharmacist) and focus on what he has been trained to do: diagnosis.  But the town is up in arms about his chutzpah of demanding payment for something intangible like thought. (Never mind that Fred Vincy, the patient, is walking around town as tangible as you please.) The whole episode sounded exactly like the debates on health care reform.

Plus c’est la même chose.

narrative medicine · news

Just listen

Illustration of Electric Acoustic Stimulation,...
Wikipedia

For one of my classes about a week ago, we read and discussed a series of articles on cochlear implants.  I realized that despite a week of ENT during third year, I knew next to nothing about these devices (prosthetics?) so in true medical student fashion, I went a-hunting in the New England Journal.

This is what I came across.

Now, I have no doubt that the pathophys is correct here.  Hair cells, basilar membrane, cortical circuitry…. But check out this choice phrase on neural encoding of stimuli: “aberrant developmental steps in synaptic counts, plasticity, and network properties have taken place without hearing.”

Aberrant?  Really, now?

The article is peppered with instances like these, where the authors have chosen a negative word where a neutral one would have served as well.  The authors’ disdain for deafness and Deafness is palpable.  As a matter of fact, this journal article explains to me far better why Deaf culture is so antagonistic to the idea of cochlear implants. (And it’s hardly a surprise that the authors both receive money from makers of cochlear implants.)

This, my friends, is why narrative medicine matters. If I’d read this article last year, I would likely have simply absorbed it without further reflection.  It is attention to the word choices — which comes from a weekend of writing poetry for a different class — that helps me see the subtext of this article, and make me question why the editor of the NEJM (generally a very strong publication) let this slide.

Drs. Kral and O’Donoghue should listen to Joshua Bennett, a spoken word poet I had the great privilege of meeting in September, as he tells of his own struggle and realization of Deaf culture.

 

(In the news this morning: Cochlear Implants Recalled)

neuro · news · pharm

A pill for MS

First off, thanks to Chenoa, Lila, and MedZag for the kind words on the last post. It’s good to know that other people care about this stuff too.  I’ll keep you all updated in how the year goes.

Fingolimod
This is fingolimod; ain't it a beaut? (Image from Wikipedia)

In happier news, the FDA approved fingolimod in the treatment of multiple sclerosis! Up till now, MS treatment has been all intramuscular or intravenous. So this is an exciting step forward, to have an oral medication.  What’s more, a trial published in the New England Journal in February showed that fingolimod was actually superior to interferon in one-year follow-up. (PDF link; you’ll need Acrobat Reader and possibly a subscription to the NEJM.)

I had a patient with a new diagnosis of MS during my neurology sub-internship. (She had likely been living with the disease and its aftereffects for decades, but had never been diagnosed.) She was very squirrely around needles — we actually had to LP her under fluoroscopy because she couldn’t keep still.  My attending, resident, and I discussed her long-term medication plan, and I decided on weekly interferon as the best compromise between injections and relapses.  But I kind of want to track her down and say, “Look! We can do something to help you!”

Yes, yes, there may be long-term side effects.  In the trial, the high-dose of fingolimod was associated with two fatal infections, both herpesvirus.  This new treatment is not a panacea, and it may well turn out to be the new Tysabri, another highly-anticipated MS drug that led to progressive multifocal leukoencephalopathy. (I had a patient with that, too. It was ugly.)

But for now, at least, a very tentative thumbs-up to Novartis.

(Disclaimer: I don’t work for Novartis, and I don’t think I own their stock, but I’m not a medical professional yet either. This is not intended to be medical advice. Please don’t go to your neurologist and demand fingolimod; or if you do, at least have a better citation than “some med student blog on the internet.”)