We got the following statement the other day, and I’m having a little trouble getting it to add up.
Maybe I’m just a little slow.
Ramblings of an Emergency Physician in Texas
We got the following statement the other day, and I’m having a little trouble getting it to add up.
Maybe I’m just a little slow.
The rumors of my demise are greatly exaggerated…
I’ve had a lot on my little plate recently, which is why the dearth of postings. In the last week I’ve had to prepare a lecture for a neuroscience meeting (1 hour, powerpoints, diverse group so something for everyone) and started a second, ‘moonlighting’ job. The combination means the blog has suffered, sorry.
Life smooths out for a bit starting tonight, so the old, irritable self will be back soon.
It’s been 4 years, and I can finally talk about it. Some.
Todd Treadway was my best friend. I’m odd, in the I have very few close friends and a lot of acquaintances. Todd was a friend, but not just to me, to everyone. He was that kind of guy. Everybody liked him. My brother counted him best friend as well, and there was no rivalry over it. He was just a terrific fellow.
We went to HS together, graduated together, and started JC together. Neither of us moved on or out of out little West Texas town. Friday and Saturday nights, when not accompanied by the Distractions of Women, were spent together. Usually playing cards. Dull, wholesome bunch, we were. Engines were rebuilt, time was spent. A whole lot of time was spent, in the way that friends do. The kind of ‘there’s always tomorrow, and we’re all in this together’ way friends have.
Todd was the photographer at my wedding (I was broke, and he volunteered). He was a big part of my life.
He worked hard, in a copy shop for as long as I could remember until he got a Masters degree, then went into social work in the State’s psychiatry wing, and eventually became a licensed psychologist. He married a wonderful psychologist, and they had a good life together. They were as happy as married people with jobs and careers can be, maybe a little happier.
He loved the Mercury Cyclone, so much so that he had two of them: one to drive and another to restore, when he finally got around to it.
A motorcycle killed him. Well, technically it was the pickup running a stop sign that killed him, but since he entered that space and time on a bike, the motorcycle did him in. The helmet didn’t help. It was quick, which is some solace, but not much.
Maybe by accident and maybe on purpose, he made my brother and I smile at his funeral. He once told his wife in passing “I want Wagner at my funeral”, and she asked if we knew what he meant. We did; nobody watched Apocalypse Now with Todd as many times as we did and doesn’t recognize his affinity for the Ride of the Valkyries. We played it. It sounded good in a big Lutheran Church.
They say time heals wounds.
I really hope so.
In the “FDA is getting serious, finally” category (via Medscape):
Dec. 19, 2005 “The US Food and Drug Administration (FDA), Mallinckrodt, and Palatin Technologies, Inc, have notified healthcare professionals regarding the immediate suspension of technetium [99m Tc] fanolesomab (NeutroSpec) from the market pending further investigation into reports of cardiopulmonary reactions associated with its use.
The action was based on the serious and potentially fatal nature of these adverse events and the availability of safer methods for diagnosing appendicitis, according to an alert sent today from MedWatch, the FDA’s safety information and adverse event reporting program.
There is no evidence of long-term risk among those who have safely received the product, according to the FDA.
The FDA has received postmarketing reports of 2 deaths and 15 life-threatening adverse events after administration of technetium [99m Tc] fanolesomab. Onset of these events occurred within minutes of injection and included cardiac arrest, hypoxia, dyspnea and hypotension requiring resuscitation with fluids, vasopressors, and oxygen.
A review of all postmarketing reports has yielded an additional 46 cases of similar but less severe adverse reactions, all occurring within minutes of technetium [99m Tc] fanolesomab administration. According to the FDA, the consistent characteristics and rapid onset of these events suggest that a causal role for the antibody component of the product is likely.
Technetium fanolesomab is a radiolabeled murine IgM monoclonal antibody indicated for use in the scintigraphic imaging of patients aged 5 years and older with equivocal signs and symptoms of appendicitis.
NeutroSpec has been taking out full-page ads in the EM trade journals touting its intended use in the diagnosis of ‘equivocal’ appendicitis. To my knowledge nobody at our joint ever used it. (And it’s too bad it’s gone, I was hoping it’d be useful in the pregnant RLQ-pain patient in which a sono didn’t help).
And, on to the rant: 10 years ago there was an ‘acceptable rate’ of about 10% for the removal of normal appendixes from patients with right lower quadrant abdominal pain. Since then there seems to be a major push to never take out an appendix without a CT or a sono confirming the appendix is the answer. This doesn’t sound like medical progress to me, it sounds a lot like CYA testing.
(We have one crusty surgeon who used to go ballistic when called that we have a positive appy on CT: “So, you had a patient with RLQ abdominal pain, rebound and guarding, and you got a CT instead of just calling me?”). He tries to assure us that none of the surgeons want a CT for appy, and we tell him, politely, that our experience with that same telephone call doesn’t bear out his assertion. (I want the crusty guy to just take mine out, thanks).
Yes, minimizing trips to the OR is arguably a good thing, and I’m not advocating needless surgery, but this is one example of the increasing applications of technology in medicine, whether it’s really needed or not.
Oh, and if you google for NeutroSpec, there’s already plaintiff atty. ads over on the right. And they have the gall to wonder why they aren’t well-regarded.
As a refinement to the Medgadget MedBlog Awards, Rita at MSSP has an idea:
Since MedGadget started this, the onus is on them to create, manage, and of course fund the Academy of Blogging Arts and Sciences.
Nominations shall be restricted to select members of the Academy. I’m not sure how they’ll be selected, that would be Medgadget’s problem to figure out. (That’ll teach you for coming up with a good concept!) Once the field has been narrowed to no more than five nominees in each category, all members of the Academy of Blogging Arts and Sciences shall be permitted to vote for one Bloscar winner in each category.
I think it’ll get somebody a nice cease-and-desist letter from the Oscar folks, but as there’s only about 30 of us, what are the chances of that?
And now, for something completely different.
Waiting for dinner the other night, my wife and I were entertaining each other with items from a local very-small-town paper, but this is the one we talked about a lot:
“Want to give a meaningful gift that won’t be forgotten or stashed away after the holidays?
Heifer International, an organization working to fight hunger worldwide has a solution: livestock.
By donating a sheep, cow or any other farm animal in honor of a loved one through Heifer International, people can help impoverished families get the resources they need to get out of poverty and become self-reliant.
The farm animals provided by Heifer International give families wool, milk, eggs, transportation and other necessities. Families can sell their surplus products and use the money for school supplies, medicine, farming supplies, and housing improvements.
A goat, for example, can supply a family with several quarts of milk each day. Extra milk can be sold by the family or made into cheese, butter or yogurt.
Heifer International also provides Llamas, water buffalos, heifers, chicks, ducks, geese and hives of honeybees – to name a few. For more information, visit www.Heifer.org…”
That’s not something you read every day. I’m not sure about the “…in honor of a loved one..” thing, but suspect it’s a holidays appeal, and it doesn’t detract from the overall effort.
From their website:
Bringing an End to World Hunger Through Unimaginable Blessings
Today, millions of people who were once hungry will be nourished by milk, eggs and fresh vegetables.self-reliance
Families who for generations knew only poverty will be building new homes and starting businesses.
Children who once headed out to the fields to do backbreaking work will be heading into schoolrooms to learn to read.
And people who never thought they’d be in a position to help someone else will be experiencing the joy of charitable giving.
How is this possible?
With Heifer’s proven approach – almost 60 years in the making – to helping people obtain a sustainable source of food and income
In case you’re wondering, a full heifer is $500, but a heifer-share is $50. Water Buffalo are undervalued, at $250 with Llamas going for $150. You get the picture, and here’s the Gift Page.
This is terrific, and if you’re looking for a way to help people in the underdeveloped world, you could do a lot worse.
Well, it seems sanity will break out now and then…
Notes from Dr. RW: AAFP changes its mind about No Free Lunch
AAFP changes its mind about No Free Lunch
The AAFP apparently did an about face and decided to open its doors to No Free Lunch. I’ll have more to say about this soon.
Let’s see how this turns out.
Well, now. I like the No Free Lunch idea, but haven’t seem anything organized where I am. However, Dr. RW has, and it seems at least a couple of professional societies have some explaining to do:
No Free Lunch
has been knocking on the doors of exhibit halls at national doctors’
meetings lately. They believe the abundance of pharmaceutical company
displays, gifts and “detailing” at these meetings could have a bad
influence on doctors and would like an opportunity to do some counter-detailing, but so far the doctors have said “no, thanks.”
Recently the American Academy of Family Physicians refused to allow No
Free Lunch to operate an exhibit at its upcoming annual meeting.
this year the American College of Physicians (ACP) refused a similar
request from No Free Lunch to exhibit at its meeting….
Go read the whole thing. I’m pretty sure my professional societies wouldn’t fare much better.
This is really strange, and I wonder if anyone can help me figure it out.
Scanning my Technorati watchlist (vanity: it tells bloggers who is linking to them) today I noticed quite a lot of links from a site called "Physician-Desk-Reference", which is apparently not associated with the actual PDR that’s used as a source of last resort when looking up medications.
Looking at the site it occurred to me that I’d seen these posts before, ALL of them, as I’d written them. This site is reposting my posts with about a 5 day delay, then linking to me as "more" at the end of the entry. I have no idea why anyone would do this. The contact info on the front page is blank, so I cannot ask whoever set this up. (I didn’t and this isn’t an inside job if you’re wondering).
Here’s a screenshot of one entry there:
So, help a blogger out. Why would anyone do this, and what should I do about it? It’s not really ‘objectionable content’ from the Blogger standpoint (my writing style and topics notwithstanding), so I haven’t reported the site to blogger. Let me know why someone would do this and what, if anything, I should do about it?
Medicine is notoriously short on cures. Oh, we can treat symptoms, but cures for most things are hard to come by. But, now a cure is at hand for "Adult ADHD":
One of the
toughest things about being a teacher is dealing with all the latest ‘syndromes’
in our culture of victimization. Whenever a real problem like racism diminishes,
there is always someone willing to redefine the problem to help maintain the
population of ‘disadvantaged’ Americans. This is usually followed by the
invention of a new problem that actually increases the population of
‘disadvantaged’ Americans. Consequently, victimization has become a growth
industry that supplies more jobs for social workers despite their increasing
irrelevance in relation to the real problems of modern society.
Often those fictional problems take the form of ‘disorders’ like adult ADHD.
I always know which of my students have been told that they suffer from adult
ADHD. They are often late and sometimes leave class early to go potty, unlike
most students who go potty before class begins. They blurt out the answers to my
questions constantly – always without the courtesy of a raised hand. And,
usually, they fall asleep in class (probably from exhaustion) after the
fifteenth or twentieth interruption. Later, they are awakened by the cell phone
they forgot to turn off before arriving in class.
But, fortunately, I have discovered a cure for students with this so-called
disorder, which I am now sharing (free of charge, mind you) with my readers.
Here’s how it works.
You’ll have to read it to find out.
via Shrinkette, whose carpal tunnel must be getting better (but probably not cured).
Update 5-4-06: The url moved: http://www.townhall.com/opinion/columns/mikeadams/2005/09/07/155358.html In case it moves again, I’ll put the whole thing in the extended entry.
From a social science standpoint, we are seeing a transformation in attitude
among many of our new citizen guests, only about 4000 of whom remain on site.
They have been totally treated with respect, and they are changing many mental
attitudes. Some who come from three generations of parents who cannot read or
write, are now saying, “You have treated me as a human for the first time in my
life, I wish to be a contributing member of society, can you enroll me in
school?” We then enroll them. Someone who is much smarter than me MUST began to
write up the social science part of this operation, There is an ACUTE change, an
intermediate development, and then we must monitor what is happening long term.
I recognize that there are pessimists and skeptics on this list server, but
believe me, I think this is a fantastic new beginning of a whole new wave of
social change. If we assume a welfare state, it will happen. If we assume that
with the destruction of a city (like the burning of Atlanta during the war
between the states) a new and even better society can be developed, then the
appropriate changes can occur, in health care, economics, government. Who knows,
the Napoleanic code of Louisiana government may be changed.
Go and read the whole thing. He’s also very skeptical of the research going on now with the evacuees, and that’s worth noting, too.
(hehe. the spellchecker doesn’t like "thewebsocket", and recommended "thwacked" as a replacement).
Doctors have long accepted that their patients share opinions about the care they have received, knowing that satisfied patients will refer others while those not so happy with their bedside manner might encourage prospective customers to seek treatment elsewhere. But when William Boothe, an ophthalmologist in Texas, saw that one disgruntled former patient was posting his complaints on the Internet, he launched an aggressive response. He sued for libel and other claims, and earlier this year a state judge ordered the material removed from the Web.
The case is one of a growing number of legal battles being waged over Internet postings about medical complaints. More patients are taking their opinions of their local doctors to the Internet, and a wider audience, and that has some medical providers on edge. Several Web sites have sprung up that encourage patients to post anonymous reviews of doctors and dentists, and some frustrated patients have created entire Web sites to criticize specific physicians.
"The potential problems are huge," said Matt Messina, a dentist in Fairview Park, Ohio, and a spokesman for the American Dental Association. "My reputation is my stock in trade … and we work years and years to build that reputation. To have that shattered potentially [by an Internet posting] is a concern."
Patient advocates, meanwhile, say patients have First Amendment rights to describe their experiences with physicians. "Blogs and personal Web sites are no different than talking over the back fence," said Charles Inlander, president of People’s Medical Society, a patient advocacy group in Allentown, Pa. "Those who read it have to take it with whatever grain of salt you would take, just like a neighbor. It’s too bad if doctors are insulted by this."
I think we all have a very negative view of ‘silencing’ speech, which to me always sounds like bullying. But, there is speech that needs to be held to a higher standard, and that’s what this is about.
OK, I’m not a lawyer, nor do I pretend to be. However, writing about specific, identifiable people on the internet is, to me, a First Amendment right. It’s also confers a responsibility to get facts right, and that’s where the libel thing comes into play. (I think chatting over the fence is fine, and that’s slander, and nobody really cares about that providing it doesn’t make a ot of waves; when your libel about a professional with a reputation at stake shows up in a Google search, that’s a whole other level).
Read the article, which except for a sexed-up title isn’t badly done at all.
via MedPundit, here are several reports from medical relief workers in the Katrina area: Real Stories of Hurricane Katrina, by WebMD, which seems to be taking off. It’s certainly supplanted the late amednews.com News for me. (Background on the AMA snark here).
Orac has put more thought into the out-of-left-field tale of active euthanasia allegedly occurring in New Orleans hospitals during the flood : Respectful Insolence (a.k.a. "Orac Knows"): Active euthanasia in New Orleans: An urban legend in the making?.
I am in agreement with him, that a lot of this just doesn’t pass the smell test, and that’s not a New Orleans clean-up joke.
ACEP’s recovery website: After the Storm.
ACEP continues to be concerned about its members and their families who have been affected by Hurricane Katrina. Now that the storm is over and the recovery phase is beginning, we will provide you with information to help you regain your footing, find employment, relocate, and other resources as you recover from this disaster.
It’s pretty good, and there’s lots of good information and links in there for the EM docs and residents affected, or who want to help.
Contrast that with my preferred organization, AAEM, and this terrificly informative bit on their site:
AAEM Board of Directors is meeting in Nice, France as part of the Third
Mediterranean Emergency Medicine Congress. A statement to the
membership about the AAEM planned relief efforts for hurricane Katrina
will be posted next week. Please stay tuned to our website for more
So, ACEP’s site is filled with useful links, and AAEM wants everyone to know they’re thinking about it from France. Not a good way to recruit.