MedBlogs Grand Rounds XXXIX, or 1:39

It’s that time again: A Chance to Cut is a Chance to Cure.

Grand Rounds XXXIX or 1:39……
Welcome to Grand Rounds, the weekly collection of the best of the medical blogosphere. Over the past few weeks medical bloggers have been getting a lot of exposure in the lay press. With the recentLA Times article and the guest editorial in USA Today penned by DB:

Drug advertising results in more costly prescriptions. Few inexpensive drugs are advertised on TV. The commercials don’t educate patients. Rather, they create a demand for a product based on an effective commercial rather than the patient’s medical need.

Another excellent compendium of links to the best in the Medical Blogosphere.

F1 Stinks in US

You’ve got to be kidding me: SI.com – Racing – Michelin tells teams not to race U.S. Grand Prix – Sunday June 19, 2005 6:16PM.

INDIANAPOLIS (AP) — Michael Schumacher climbed from his car to a chorus of boos, the die-hard Formula One fans unable to accept his first victory of the season after more than two-thirds of the field quit in protest over tire safety.

Sparking a fiasco for a series desperate to capture the American audience, Michelin advised the 14 cars it supplies that its tires were unsafe for the final banked turn at Indianapolis Motor Speedway.

Unable to forge a compromise, all 14 Michelin teams ducked off the track after the warmup lap Sunday, leaving Schumacher and the five other drivers who use Bridgestone tires to race among themselves.

I’m watching this on Tivo after a shift, and am just heartsick.

Seems to me that open wheel racing is run, everywhere, by utter morons. 
F1 was my last hope, having been a big fan of CART racing, which threw a little fit when Tony George invented the IRL, took all the talent and the best teams away, and managed to screw it up so badly the best teams went crawling back to the IRL.  (I’m a fan and can’t find their races to record; tell me where this series is going).  And don’t get me started on IRL; if they’re the future, it’s not going to be fun or entertaining.

At least there was F1, astonishing drivers and cutting edge technology, until today.  (I was willing to forgive the Schumacher/Barichello switcheroo here at Indy last year, as team payback for Ferrari making Barichello yield to team orders earlier in the season). 

I was seriously considering a family trip to Indy for the next F1 race, and now I guarantee I won’t go, and won’t spend a buck on F1 for a long, long time.

An additional thought: Perhaps the Gods of Racing as as pissed at Tony George as I am.

Best Chief Complaint of the Day

"The daddy of my sister’s baby hit me.  Oh, and I want to be checked for chlamydia."

I couldn’t make this up if I tried.

EMedForum

EMedForum in an interesting site, kind of like the old bulletin boards, with open conversations about (mostly) emergency Medicine topics.

Have a look.

Best Read This Month

I just finished an excellent compendium of medical humor:
The Placebo Chronicles : Strange But True Tales From the Doctors’ Lounge, by Dr. Douglas Farrago with some very funny illustrations.

The articles are appropriately long for, well, short periods of sitting and reading.

Shazam is done with her Residency

And, like most last shifts, it was no better or worse than any other: Mr. Hassle’s Long Underpants.

Go and wish her luck on her first ‘real doctor’ job.

Flushability

Ever wonder how toilet flushability is measured? 

Wonder no more.

Short answer, golf balls.

Guidant Recall

FDA Issues Nationwide Notification of Recall of Certain Guidant Implantable Defibrillators and Cardiac Resynchronization Therapy Defibrillators.

FDA is notifying health care providers and patients that the Guidant Corporation is recalling certain of its implantable defibrillators and cardiac resynchronization therapy defibrillators. These devices can develop an internal short circuit without warning, resulting in failure to deliver a shock when needed.

The devices affected by this notification are:

   
* PRIZM 2 DR, Model 1861, manufactured on or before April 16, 2002   
* CONTAK RENEWAL, Model H135, manufactured on or before August 26, 2004   
* CONTAK RENEWAL 2, Model H155, manufactured on or before August 26, 2004

The devices are surgically implanted in persons who have a type of heart disease that creates the risk of a life-threatening heart arrhythmia (abnormal rhythm). The devices deliver an electrical shock to the heart to restore normal heart rhythm.

The PRIZM 2 and RENEWAL devices are subject to different failures, resulting in the devices’ inability to deliver an electrical shock during episodes of arrhythmia — which could lead to a serious, life-threatening event for a patient. There have been two deaths reported to FDA suspected to be associated with this malfunction.

So, if you happen to have one of these, get out that wallet card and compare models and manufacturing dates.  Then, call your cardiologist!

Mr. Sun!: The boys get a check-up.

Another in my series of links to Public Health Initiatives : Mr. Sun!: The boys get a check-up..

When a man reaches a certain age, it’s time to give the boys a thorough look-see. You don’t need to wait until your nights are a series of five minute naps interrupted by five minutes of standing in the bathroom praying for rain, if you get my drift. I feel it is very important for men to be examined regularly, so I’d like to take this opportunity to walk everyone through the process I just completed in the hopes it will lower the barriers of fear surrounding this very necessary medical procedure. 

I went directly to the Ball Appproval Laboratory, and said goodbye to the boys. They paint them greenish-yellow and spray on some kind of fuzzy ointment. I’m not sure why. I was sorry to see them go, but I knew it was important they get acclimatised:

emphasis mine

Trust me, this stuff is important, and has never been presented in such an excellent manner.

Nailguns

Kneenails

…what would we do without them?

TennCare and the Future of Single Payor

He was gone for a while, but now comes roaring back with another excellent post!   RangelMD.com first gives a good history lesson about TennCare, and its impending demise, then projects the lessons not learned there to the national stage:

So if ever they try and impose a nationalized health care system on the United States it is very likely to evolve in much the same way that Tenncare did. It is likely to look something like this;

1. In 2009 President Hillary Clinton will resurrect her long dead dream of nationalized government health insurance. Medicare and Medicaid will be combined and expanded into a massive program that will cover every American. It will be administered by the states and further subdivided into "managed care regions" which will act similar to the old HMOs.

It goes on, and makes me apprehensive about the future of medicine.

Setting the Record Straight: Kathleen Whitney and CNN

I am acquainted with an excellent ER nurse, who was recently made mildly famous in a CNN profile for being recalled to active duty.  However, while she knew she was being interviewed for an article about the difficulties of family separation, she expressed to me that the article was edited in a way that made her sound less than committed  (‘sandbagged by the editor’ is how it was put to me), and wants to set the record straight.

I asked her to write whatever she wished regarding the CNN piece, and here’s what she has to say:

My name is Kathleen Whitney and I am an emergency room nurse and a 1st Lieutenant in the Army reserve.  A few weeks ago I was featured in a story on CNN.com.  Let me start out by saying that the author of that article was my aunt, and I don’t believe she would ever intentionally misrepresent me.  However by the time the story got through the editors there was a definite liberal slant to it.

It is true that my plan when I became an officer was to remain in an army reserve unit until I became pregnant and then transfer to the IRR – (Inactive ready reserve) until my children were old enough to understand if I had to be deployed.  So when I got the letter calling me out of the IRR it was quite a shock and I was a little angry.  However what the article does not go on to say is that after much worrying and soul searching I came to this conclusion.  It’s a war.  It wasn’t meant to be easy on anyone.  Many, countless people have already sacrificed more than I have even begun to.  So right now my family and I just focus on ways to make things easier on my little boy, Matthew, if I do have to deploy somewhere.  I feel no animosity towards the military or President Bush for recalling me and others out of the IRR. The needs of the country have to come first.  And part of being a good parent, I think, means helping to make the world a better place for our children.  I remember Sept. 11.  I hope Matthew never lives to  see another day like that – where Americans are attacked on our own soil. 
 
One other thing that they neglected to mention in the article which I talked about in my interview was the guilt I already feel for not having been deployed.  When I was eight months pregnant my unit deployed to Baghdad, Iraq.  Of course there was no way I could have gone with them at eight months pregnant.  So I kept in touch with them as best I could via e-mail and care packages.  It never slipped my mind that while I was sitting in my air conditioned house rocking my new baby, my unit- the people I trained with, some of my best friends- were baking in the hot desert, enduring untold hardships.  It is hard to describe the feeling I had then, and still have now.  If I don’t deploy I am abandoning my country and my unit.  If I do deploy I am abandoning my family.  I am truly torn.  In the end if I am called to go, I will go and be happy to serve.  But I can not volunteer.  Because me volunteering would also mean volunteering my mother to take care of my child full time.  It would also mean volunteering my child to do without one of his parents for a year a more. 
   
I hope that this rebuttal or addendum to the CNN article will clear up any questions of my loyalty that may have been brought up.  Only time can tell what will happen from here.

emphasis mine

Good to hear from the source, we never questioned your patriotism.  And, thank you for your service to our country.

AAEM Proposes Merger with ACEP

…where their interests are similar:

At its board meeting on May 26, 2005, the AAEM board of directors passed the following resolution to promote unity in organized emergency medicine.  It is recognized that much common ground exists between the two major EM organizations regarding federal and state legislative issues such as the malpractice crisis and ED crowding.  It is also evident that each national organization has important activities that are best carried out by that organization alone.  It is the belief of the AAEM board of directors that the described steps will be good for the specialty of Emergency Medicine while preserving the integrity of the original AAEM mission.  We are interested in your feedback and will keep you informed as to progress related to this matter.  Thank you for your support.

Then to the actual proposal:

Proposal to Promote Unity in Organized EM Passed by the AAEM Board of Directors on May 26, 2005

Whereas, there now exists two competing general professional societies, the AAEM and the ACEP, in the specialty of Emergency Medicine; and

Whereas, at the federal and state level there exist certain issues where the specialty and the organizations would mutually benefit from a cooperative effort; and

Whereas, there exist other issues mostly internal to the specialty of EM that are best handled by one or the other organization; therefore be it

Resolved, that the AAEM board of directors approves of the below steps and will request of the ACEP that the two organizations take the following steps towards greater unity between these societies:

1.      The organizations will unify federal political efforts by contributing on a per full member basis equal funds to federal legislative action that will be pursued out of a unified Washington, D.C. office.
2.      The organizations will establish one government affairs committee with membership proportionate to the number of full members.
3.      The organizations will unify their political action committees with that board’s representation on a proportionate basis to the number of full members and each organization will recommend this as the preferred vehicle for PAC donations by their members.
4.      The organizations will institute by-laws changes to allow for the restructuring and renaming of the state chapters of ACEP and AAEM to allow for unified state ACEP/AAEM chapters that will require national membership in at least one of the organizations.

Machiavelli could learn at the feet of Robert McNamara, who basically invented AAEM, and who was their first president.   (Full disclosure: I’m a fellow of both AAEM and ACEP, but beyond general membership I’m just a grunt; I don’t go to special meetings or sit on committees, though I’m on email lists for two ACEP interest groups).  Also, I’ve had a nice dinner with Dr. McNamara and a bunch of colleagues when I was a resident, and he’s very passionate about EM docs not being taken advantage of (there’s a heck of a long story there).

As I see it, the spider has invited the fly to dinner; I expect the fly to demurrer.  AAEM, the underdog (and the one I like a little more,  as they have taken firm stands for EM docs against The Machine) has invited the very much bigger ACEP to join in Federal legislative initiatives.  Though I’m sure they have a lot of goals in common, there is so much acrimony between the two leaderships this has to be a political move to show, ‘hey, we’re trying to be colleagues’.

It’ll be interesting to see where this goes.  I’ll tell you when I know.

Update: fixed spelling.

Welcome D Magazine/Frontburner Readers

GruntDoc got a Link from the D Magazine online presence, which I frankly didn’t know existed:  DMagazine: Frontburner.

Look around, enjoy!  Here’s the post they linked to.

(Is it odd that I refer to my blog in the third person?)

Update: broken link now fixed.

DB?s Medical Rants: db gets published!!

Dr. Centor appears in USA Today: DB?s Medical Rants: db gets published!!.

I suspect that most bloggers would like to have an editorial published. Two weeks ago I received a phone call from USA today inviting me to write an opposing viewpoint. Since the topic was DTC drug advertising, I jumped at the chance. Today my thoughts appear in print!

I couldn’t give a hoot about appearing in a dead tree publication, but I salute Dr. Centor’s publication!

via Graham