Archives for September 2004

Vioxx Pulled has the best summary I’ve seen about Merck killing their golden goose. Read his post for the why, and the backstory on current drug marketing.

Merck stock fell 27% and they lost $25 BILLION of their worth, and that’s before they see their first suit. Ohh, and there will be suits.

Free exams might not be free – Fake gynecologist accused of offering free exams

DALLAS – Authorities on Wednesday were looking for women who may have been taken advantage of by a man accused of posing as a doctor and offering free gynecological services.

OK, right there I have a problem. Free GYN services? GYN’s aren’t in medicine to give their services away. This was an attempt to take advantage of the something for nothing crowd. It worked.
[Read more…]

Great Surgical Post

A Chance to Cut is a Chance to Cure

More Tales From the Operating Room…..
Teenaged male presents with three day h/o severe abdominal pain. Crampy in nature and it awoke him from sleep. Positive for nausea and vomiting. No BM since onset of pain. Admitted to the hospital by his pediatrician. WBC at that time was 12 with 90 neutrophils, no segs…

For the unexpected conclusion, and for photos, click on through.

Great case. Fun to have a blogging general surgeon.

also posted at LingualNerve

Mount St. Helens VolcanoCam

Mount St. Helens VolcanoCam – Mount St. Helens National Volcanic Monument

This is an image of Mount St. Helens, taken from the Johnston Ridge Observatory. The Observatory and VolcanoCam are located at an elevation of approximately 4,500 feet, about five miles from the volcano. You are looking approximately south-southeast across the North Fork Toutle River Valley.

It refreshes every five minutes, so you’re not going to see an eruption happen here, but it’s interesting to see what it looks like now.

via Instapundit

Grand Rounds


Welcome to the debut of Grand Rounds, the weekly summary of the best of the medical blogosphere. It’s our hope that this new feature will introduce a wider audience to the expanding array of talented doctors, nurses, techs and students writing online today.

Nick, over at Blogborygmi, decided the medical bloggers needed a “Carnival of the Vanities” thing, but with our topics, and wow, did he deliver. I count four big sections with twenty entries, enough to keep even me reading for a good while. Have a look, follow the links, and you may just find a couple of blogs you want to read again.

And, many thanks to Nick for kicking this off!

CAF Airshow this weekend

AIRSHO Official Home Page
The Commemorative Air Force (CAF) is having their annual airshow this coming weekend in Midland, Texas. I don’t much care for the ‘Commemorative’ swap for the founding ‘Confederate’, but even hard core Colonels can fall victim to political correctness.

The airshow itself is impressive, and the static displays are great, with many people who want, very badly, to answer your questions about all those great old warbirds.

And now, for my best recollection of the airshow, in 2001. I was walking the flightline with my then 10 y/o daughter, well away from the speakers’ stand and the big crowds. There were many folks in the grandstands, and we’d gotten there late, so we passed on the narrated flybys. That was our big mistake. No warning.

We’re walking along, and I’m wowing her with my airplane knowledge (no, honey, that’s a jet), when I hear the loudest single sound I’ve ever heard. I saw a blur go by on my left, and immediately knew what it was: a sonic boom by an F-18 flyby, about 200 yards off.

The effect on my daughter was those embarrased sobs that happen when they know they shouldn’t be crying, but the scared part of them won out, and now it won’t stop. This made a couple of very nice CAF Colonels come over and tell her it scared them, too, and she appreciated all the attention, tears and all. We still talk about the big boom.

Anyway, it’s a good show, and they literally aren’t making any more of these old warbirds. Go see it while you can.

NHS critic killed by medical error

So, irony isn’t just for stateside medicine:

Telegraph | News | Patient’s liver ‘saturated’ with iron after hospital confusion over dosage

Patient’s liver ‘saturated’ with iron after hospital confusion over dosage
By Daniel Foggo

A critic of declining standards in the National Health Service died after being given a large overdose of iron by a hospital doctor who did not read the instructions on the drug’s label properly.

Carys Pugh, 63, a former president of a patients’ association in Wales, was taken to casualty at the Royal Glamorgan Hospital after the blunder turned her skin brown and “saturated” her liver with iron.

While she fought for survival in hospital for seven weeks, Mrs Pugh suffered a heart attack and contracted deep vein thrombosis in both legs, a chest infection and then E.coli. Finally, she suffered a second heart attack that killed her.

When her daughter, Hawys Pugh, complained to the hospital authorities about what had gone wrong she was told that the doctor who had carried out the routine infusion for suspected anaemia had found the instructions difficult to decipher and that he had only read half of them.

“They told me that because the text was in two columns instead of one, the doctor just read the section on how much to give, but didn’t bother reading the rest which said over what duration it should be given,” Miss Pugh said.

“Instead, he just put the entire dose into her system in one go. They suggested it was the manufacturer’s fault and said they would be contacting them.

(emphasis added).
Medication errors happen everywhere, it’s human nature. It’s human, but probably not terribly professional, to blame a manufacturer for having not bothered to read the instructions.

cross posted on TheLingualNerve
thanks to reader Jim for the steer


Update: Fake! The original photo is here, along with a discussion of most of the same concerns about fakery. Again, reader Jim is the source (Jim needs a blog). Thanks, Jim!

This necessitated a new engine, and new underwear for the passengers
on the left side of the plane.....

This has been floating around the internet for a bit, and I finally got a copy forwarded to me. I think it’s a full-on engine fire, but it could be a compressor stall. Either way, what a picture!

Charitable Servitude

Medpundit on the experience of being expected, nee, required, to care for patients for free:

The most frustrating aspect of it all is that I have no choice. I have to give and give again, even if the giving exceeds my capacity. Charity given freely is at least attended by some warm and fuzzy feelings. But forced charity feels more like being robbed.

Welcome to the ED.

Surgical Strike in Maryland

and it has nothing to do with bombing…
A Chance to Cut is a Chance to Cure

Surgeons in Washington County will begin turning away patients whose conditions are not life-threatening in hopes of forcing insurers to lower their malpractice premiums.

The work stoppage is scheduled to begin Nov. 15 with a majority of the county’s general surgeons, who handle a variety of procedures from appendectomies to vascular repairs.

But dozens of surgeons and physicians in other specialties are expected to announce soon that they also will begin turning down non-emergency work in November, said Dr. Karl P. Riggle, a spokesman for the Washington County Surgical Association.

The move could be the most drastic yet taken by medical doctors in Maryland, most of whom face a 33 percent increase in their insurance premiums. Doctors claim the rising rates are caused by large malpractice award payouts and threaten to drive them out of business, but their call for tort reform has been opposed by trial lawyers.

Of course, this will unfortunately result in is a few surgical emergencies from incarcerated hernias and the like, increasing the workload of ER docs in the area (“I couldn’t get in to see my surgeon…”). In this country we won’t see ER docs striking, as we’re nearly all either independent contractors with a no-due-process clause for firing (or not being scheduled, which is the same thing), or employees with just a straight up ‘you’re not working out…’. Surgeons are the best organized when motivated, and more power to them.

This is, unfortunately, the wave of the (near) future in medicine, voluntary strikes by docs to try to get the populace to influence legislators about malpractice legislation.

I’m thinking that lotteries really are bad for a culture: everything becomes an opportunity to get rich without actually having to earn it. The plaintiff standard of care now is perfection, and a bad or even sub-optimal outcome means a suit.

Good luck, surgeons. I hope it works for you, as the trickle-down helps us all. And, it might just be some Senators’ family member who gets cancelled, then something will happen nationally.

Underwear Drawer interviews for Queer Eye

the underwear drawer (no permalink; entry dated Wednesday, Sept 22).

Interesting, and she’s also one of the best writers in the medical blogosphere. She additionally spills the beans: it doesn’t all happen in one day! Read her post to find out how long it takes (longer then I thought).

Soldier Blogs Detail Life in Iraq : Soldier Blogs Detail Life in Iraq

Iraq war blogs are as varied as the soldiers who write them. Some sites feature practical news, war pictures and advice. Some are overtly political, with more slanting to the right than to the left. Some question the war, some cheer it. While some military bloggers (or milbloggers) say their commanders have encouraged their online literary ventures, a few say their commanders have shut them down.

For the folks back home, soldier blogs offer details of war that don’t make it into most news dispatches: The smell of rotten milk lingering in a poor neighborhood. The shepherd boys standing at the foot of a guard tower yelling requests for toothbrushes and sweets. The giant camel spiders. The tedium of long walks to get anything from a shower to a meal. A burning oil refinery a hundred miles away blocking the sun. A terrifying night raid surprised by armed enemies dressed in black.

Overall, quite a nice article on bloggers there, or who’ve been there. And it only took the mainstream media about a year to “discover” them.

via BLTB

CT scans and the news

Cut to Cure and Rangel have both commented on the “I’ll get a CT a year to screen for disease” fad/industry that has sprung up recently, and the concerns that the radiation dose of total body CT’s, especially repetitively, could be harmful.

Interestingly, a couple of days ago a colleague ordered a CT scan of the abdomen and pelvis on a patient. The patient refused the CT, citing the recent article in the paper about “the risks of radiation from CT’s”, and no amount of explanation would assuage this patients’ fear (irrational as I think they are). The patient said they’d bring the article up so we could read it, as we were obviously unaware of it, with not just a little condecension. The treating doc and nurse both relayed that we’d read it, and didn’t need to read again. Attempts to explain why this CT was needed were made, to no avail. The patient left without getting the CT to look for acute disease.

Yes, CT’s deliver radiation to the body. A whole-body CT is pretty rare in acute-care medicine (except in the multiply injured trauma patient), so although I think about radiation exposure, my worries are always acute-injury-or-illness diagnosis, which allows me to justify the risks involved.

I hope that patient gets their CT in the very near future, and I don’t know how we’d practice medicine without them. Well, I do know. We’d get 1970’s medicine. Anyone want that?

Mother of the Year candidate More Boortz A Great Mother
Go and see the picture, and savor the irony. I know the photo editor did.

Official Charity of GruntDoc

Navy-Marine Corps Relief Society I have always had a lot of respect for the Navy-Marine Corps Relief Society, whose mission is:

The mission of the Navy-Marine Corps Relief Society is to provide, in partnership with the Navy and Marine Corps, financial, educational, and other assistance to members of the Naval Services of the United States, eligible family members, and survivors when in need; and to receive and manage funds to administer these programs.

My wife spent about a year volunteering for the NMCRS while we were at Camp Pendleton, and found it to be rewarding work. They provide a tremendous array of services, and really help the sea services keep their people on the job by assisting with all those strange occurrences of life away from family.

And it’s a family affair: my mom has made about a metric ton of baby blankets for them, and has a couple of thank yous from the General in command of the Camp Pendleton group.

I cannot think of a charity that better fits my desire to help Marines, Sailors and their families, and I’m very proud to endorse the NMCRS as my “Official Charity”.