Oxymoron

Before I leave the hotel for my DC day, here's a quick news story. The US Food and Drug Administration could do a better job at reviewing drugs. No, that's not news.

Here's the news story: The Institute of Medicine, the people who stated that between 50-98 thousand people die each year from hospital errors, released a report Friday criticizing the FDA about how it reviews drugs, according to this report. Don't get me wrong, the FDA itself ask for the review.

Newly approved drugs in the U.S. should carry a warning that their safety isn't guaranteed, the medications should be reviewed in five years, and they shouldn't be advertised for two years, according to a report released Friday.

The report, released by the U.S. Institute of Medicine, said the Food and Drug Administration hasn't done enough to oversee new drug safety. The institute said the medications should carry a symbol, such as a black triangle, indicating they might not be safe. It also suggests agency rules be enforceable with fines.

Ok, let me get this straight. They want to put a warning that the safety isn't guaranteed? Why not put the same statement here that's on all herbal medicines: "This medication is not intended to diagnose, treat, cure, or prevent any disease." In fact, I believe that this puts more regulations than on herbal medicines.

"This report should be a watershed moment for FDA reform," said [Iowa Senator Charles] Grassley. "Public safety is at stake, along with the credibility of our nation's drug-safety agency."

FDA reform? Gimme a break. This is government bureaucracy. No one in this town that I'm sitting in right now has the courage and the political clout to do anything about it. The FDA is a good punching bag and the status quo will remain after all the hype. It's kind of like saying United Nations reform. Yeah right...

On the road

So, I've been in DC for about three hours already. I thought about walking around a little bit, but I was a little tired when I got here. For those of you with Google Earth, you can find my exact location. I'm at 775 12th street NW. Do you see me waving?

Some people detest driving longer distances. I thrive on it. I had my iPod going and I may have driven a little above the speed limit a few times *smile*. Plus, people may think I'm nuts, but I enjoy big city driving - except for all the one way streets. For those who are not familiar with Washington, DC, there is a huge highway that goes around the city called the beltway.

I'm from a small town, and traffic to me is driving around my town at lunch time where the one main street has cars all over. But, some people would say that the DC beltway is nuts. Cars and trucks everywhere - weaving in and out and across three lanes of traffic. For me, really a good time! Don't worry, I got here safe.

The first thing I had to do was blog about it. I do admit that I felt like quite the loser sitting in the bar virtually by myself having my chicken sandwich and beer. No sympathy, please. This is only night one. There are a lot of good times to come (I hope).

Tomorrow, I'm going to try to visit with some friends that I have here. If that doesn't happen, then I'll walk around the city a bit. I haven't been here since I was a little kid. Right now, instead of getting needed sleep, I'm going to check my e-mail now and read through some of my comments, which I have neglected for the past few days - I'm Dr. A and I'm a blogaholic. Thanks for everybody checking in. I appreciate it!

Grand Rounds

Grand Rounds 2.52 is up and running at Tundra Medicine Dreams. Actually, it was up and running yesterday, and I'm a little slow in posting this. The Tundra PA is from Alaska and has done a great job of organizing all those links and adding some fabulous pics from tundra land.

In case you don't know, Grand Rounds is the showcase of the medical blogosphere and it's posted every Tuesday. It's so good, I'm not allowed to post anything there. HA! Just kidding. If you've never experienced GR before, I encourage you to check it out.

As usual, on call was busy last night. If I'm up to it, maybe I'll bring a story to my blog later. Feel like I'm running on empty a little bit. Should be an interesting day. Is it the weekend yet?

Transplant

You're definitely going to think that I'm making this one up...

The Seattle Post-Intelligencer posted on their website the first successful penis transplant ever reported in a medical journal. This occurred in China and here's the quote from the article itself.

The Chinese doctors could not be reached for comment, and their report does not explain how the 44-year-old man lost his penis. It says only that "an unfortunate traumatic accident" left him with a small stump, unable to urinate or have sex normally.

Surgeons led by Dr. Hu Weilie at Guangzhou General Hospital performed the transplant in September 2005, a hospital spokesperson said Tuesday. The penis came from a 22-year-old brain-dead man whose parents agreed to donate his organ.

Update: MSNBC is now reporting that the transplant had to be removed because of "severe psychological problems experienced by the man and his wife." Oh well...

In a related story, Lorena Bobbit announced the opening of her first beauty salon in Beijing last weekend. When asked about the city's nightlife, she said, "I've had a great time here. The men in China are kind of kinky and I like that."

Hospice

Work has been especially tough the last couple of weeks or so, because I've had three patients who eventually requested and received hospice care. A very simplistic way of putting it is that hospice care is end of life care.

Sometimes there is an acute event, like a stroke, and sometimes it's a long drawn out illness, like dementia/Alzheimers. Trying to guide a patient and family through this process takes a lot of time, patience, and emotion. It's not an easy process, but a necessary one.

Not everything is wrapped up in 30 or 60 minutes like you see on television. In some cases, this process can take days and even weeks. I constantly have to remind myself to report the facts of the case. For example, "the heart/kidney function is improved or worse verses yesterday," or, "it is a significant stroke affecting motor and/or sensory and/or speech function."

I can't even imagine what my families are going through, because it's not my loved one in that hospital bed. My job is to stay as objective as I can in reporting the medical condition of their family member.

Things can get a little tricky when I'm asked something like, "What if this was your mother or grandmother, what would you do?" Or, "What if I was your mother or grandmother, what would you do?"

When the patient or family open the door for me, I try to be as honest with she/he/them as I can. Even though it may sound like I'm giving up when I recommend something like hospice, if I believe the long term prognosis is poor, they deserve to know that. If there is possibility for recovery from their illness, I'm honest and let them know that as well. Hospice is not appropriate for everybody.

It's even tougher when it's one of your long time patients whom you have seen slowly deteriorate or someone whom you saw last week in your office who had an acute event and no longer the person you remember. In most cases, a rapport was built so that I had an understanding of how heroic/aggressive the patient wanted to be close to the end of life. Obviously, one of the tougher parts of my job.

I do have the satisfaction in that for most of my patients I will do what they want me to do, because we've talked about it. My tribute to them will be to carry out their final health care wishes whatever they may be...

I'm on call today/tonight. You know the drill by now. I'll be back in a day or so to pick up where I left off. Keep on blogging for me. More soon...

Balance

Ran across this great post today from my new blog friend, The Curmudgeon, who is a lawyer. Imagine that, a lawyer and a doctor agreeing on something - call the papers. Anyway, he was wondering of striking a balance between blog life and real life.

Since I'm self-employed, there's no one except me to tell me to stop reading other people's blogs and get back to work. I have noticed that my productivity is not what I would hope it should be some days, especially when I read on too long, chasing link after link. (Of course, my productivity is never what I think it should be... and it's been like this for years, even before I ever heard about blogging... but, you see? I'm already digressing....)

Since some of you who've stopped by here recently are far more experienced at blogging than I, I'd love to hear how you balance blog life... and real life.

I'll hang up now and wait for your answers.

Great question - worthy of a BA meeting. I encourage you to stop by there and give Atty Curmudgeon some feedback. I'd rather you leave your comments over there rather than here. I'm curious to see what people say.

Error

Two premature infants died over the weekend in an Indianapolis hospital neonatal intensive care unit after receiving an overdose of a blood thinner called heparin -- this is according to a news report from the Indianapolis Star.

You're probably asking yourself, why would premature babies be on a blood thinner in the first place? (Apologies to those of you who already know this.)

Anyone who has an IV, whether it's an adult or child, has the potential for the IV to get blocked. To prevent this, it is standard procedure to inject heparin into the IV to keep it open. There are protocols for this and a small dose of heparin is used (especially for premature infants). For those in the intensive care unit, whether it be in neonatal or pediatric or adult ICU, patients usually has a number of IVs for things like medications, nutrition, etc.

Don't get me wrong. I'm not defending the hospital nor am I excusing their behavior. But, in reading the article, in cases like this, there is some kind of system breakdown to cause this tragedy to happen. I'm not looking to assign blame, I'm looking for a way to prevent this from happening again in the future. From the article:

Odle [hospital president/CEO] said the preliminary investigation showed a staff member, likely with the pharmacy department, placed a vial of the wrong concentration of the anti-coagulant drug heparin in a drawer of a drug cabinet at the nurses' station of the neonatal unit.

Subsequently, at least one other staff member -- probably a nurse or several nurses -- removed the vial from the computer-controlled cabinet and did not double-check to make sure the vial matched the concentration listed on the cabinet drawer before withdrawing the liquid drug into a syringe. The babies then were given an overdose.

My sympathies go out to this family. Obviously, this is something that should not have occurred. According to the article, police have ended a criminal investigation ruling it an accidental death. However, the family and the community will demand some kind of accountability. We'll have to see how this story plays out.

Yearly drug

Happy birthday, now take your medicine. Can you ever imagine saying this to someone? Well, it may actually happen. Swiss drugmaker Novartis announced over the weekend that it is in final development of a yearly medication to treat osteoporosis, according to this article from the Sydney Morning Herald. As you know, osteoporosis is a condition in which the bones become brittle and in some cases break or fracture.

I really try to keep up on this stuff. Because even though this drug is still in clinical trials and not able to be prescribed yet, I guarantee I will get questions about this in my office. Even though it sounds promising, here's the rub...

The most common side-effects associated with intravenous injection of Aclasta included fever, muscle pain, flu-like symptoms and bone pain. Most occurred within three days of administration of the drug and were resolved within three days of onset, Novartis said.

Potential side effects is one of the major stumbling blocks for drugs succeeding. There's already a drug out now for osteoporosis which you only take once a month. "Does this mean that if I have side effects, they will last a month?" patients ask me. I then quote them the info from the company, but the perception is there. Yes, it's good that you only have to take it once a month. But, it's bad if you have a problem.

The other major stumbling block is cost. No one knows how much this whiz-bang new drug is going to cost. I'm definitely sensitive to the cost of meds for my patients. In my practice, the typical patient who would get this drug will already be on between 5-8 other prescription medications, in addition to over the counter and herbal meds. The cost adds up quickly.

I understand that companies want to generate buzz and attention for new drugs in their pipeline. But, it does cut both ways. And, sometimes, the negative press can overwhelm anything positive. We'll have to see what happens with this medication.

Play that funky music

Ouch! I've been tagged. What's up with that? I'm just here, minding my own business, just blogging, and Cathy comes up and tags me. Gee, thanks.

According to my instructions, I have to list seven songs. This actually perfect because I'm picking songs for my trip to DC. Health Psych will like this, because she has been trying to get me to put back up my iPod song list. So, here are seven songs at the top of my list going with me to DC.

"Waiting On The World To Change" by John Mayer
"Is It Any Wonder" by Keane
"Crazy" by Gnarls Barkley
"Chasing Cars" by Snow Patrol
"The Riddle" by Five For Fighting
"The Hardest Part" by Coldplay
"Tell Me Baby" by the Red Hot Chili Peppers

Next victims: *sinister laugh*
Carrie (I predict something by John Mayer, maybe even an English group)
FD (you can even pick Yaz if you like)
Jordan (and no, nothing my Shakira, just kidding)
Morgen (I don't even know what kind of music you like. Please enlighten me.)
Ladybug (by request, go for it!)

Here’s what you do. List seven songs you are into right now. No matter what the genre, whether they have words or even if they're not any good, but they must be songs you're really enjoying now. Post these instructions in your blog along with your seven songs. Then tag seven other people to see what they're listening to. (I know I was supposed to tag seven, but, oh well.)

Sunday

Kind of a lazy day today, which is good because I get so few of these. I'm going to admit up front that this post may not go anywhere. But, hey, I'm a blogaholic. I have no problem just writing about anything.

Had lunch with mom and dad. Mum's birthday is coming up this week and we went to one of her favorite restaurants. I don't get to see my parents that much these days, mainly because of schedules. I try to get to see them every couple of months or so, and call a little more often than that. They're going with some friends of theirs to Las Vegas next month. It's always enjoyable hearing my parents tell their stories -- maybe I was lucky enough to get some of those genes.

I do admit that I could not stay away from the office. There's always paperwork to do, so I went there for a couple of hours. I like to try to clean up my desk as much as I can before starting off the week.

Oh yeah, next weekend, I'm going to be going to Washington, DC, for a meeting. I haven't been there for a number of years. I'll take my camera and my laptop. Surely some things to blog about there. I'm looking forward to that.

Finally, did some more tinkering with my sidebar over the weekend, as I'm watching golf. Ahhh, how relaxing is this. I usually blog when I'm stressed or tired or both. Great to blog when I'm feeling pretty good. Hope you're having/had a great weekend!