The Fly

Remember this annoying movie starring Jeff Goldblum in the mid-80s? Like many other of his movies, he plays an annoying scientist guy. But in this movie, his character's genetic makeup accidentally gets combined with that of a fly. Why am I telling you this? Because this is what I thought of when I read this next story.

Apparently, St. Georges Hospital in south London has become infested with flies. Yes, flies. (Guardian) Apparently, this has been going on for at least three months - and the hospital knew about it! Sheesh!

A hospital spokesman said: "We have had a problem with small flies in the unit recently and suspect it has to do with recent building work nearby. Our engineers and cleaners have been trying to identify the source of the problem and we hope to have eliminated it very soon. We would like to apologise to any patient who has been worried by it."

And, some people in this country would like the British model of medical care to come here? Can you imagine receiving dialysis three days a week for three months and knowing that you're going to see flies? What an odd situation.

Medical marijuana

Happy Birthday Prop 215! Don’t know what this is? This was the first medical marijuana law in the United States. It was passed in California a decade ago. (Mercury News)

Call me old fashioned, but I don’t think that marijuana should be used in the medical setting whatsoever. However, I have read and reviewed some of the medical studies which state that there could be a benefit in conditions such as cancer, anorexia, and AIDS.

The legal controversy is a little more interesting. The California law states that marijuana can be used not only for the above conditions but also "where medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit."

What does that mean? Potentially, you could get a “prescription” for marijuana for just about any reason. For example, that bunion would feel so much better if you had some pot, wouldn’t it?

The California Medical Board has tried to set up guidelines, but these will undoubtedly make their way through the courts. It may be another ten years until all that is sorted out.

Finally, did you know that there is a state funded research center at the University of California, San Diego, doing clinical trials for marijuana use?

Igor Grant, director of the Center for Medicinal Cannabis Research, said the results have been promising, in reducing inflammation and muscle spasms and treating conditions such as high blood pressure and multiple sclerosis. By studying the brain receptors that stimulate appetite when exposed to the chemicals in marijuana, scientists even are looking into possible treatments for obesity.

I think I’m having second thoughts on this. At least in California, I can’t get sued for improper use of marijuana, right? Maybe I’ll move there. NAH!

Random

This post will wander, so bear with me today...

Shopping: My dress shoes are on their last legs. So, today, I went out to the local shoe warehouse to find a nice new pair of work shoes. OMG! I can't believe all the choices out there. One thing that is good about this store is that I could roam around and try things on. I never like those stores where the clerks, er, associates (that's the PC term, right?), stalk you around the store just to get their commission. I have kind of wide feet, so it's always tough for me to find a comfortable pair of shoes. But, finally, what felt like hours later, I found a nice pair of wingtips. At least it will be months until I have to do this again. Sheesh!

Voting: I finally filled out my absentee ballot and put it in the mailbox. I kind of like it a little better, because I could at least think about the issues and the candidates a little bit more than when I was in that voting booth. I still cannot take these political ads anymore - AHHH!

Welcome to my Blog: Thanks for stopping by today. Hope you return again! Welcome to those of you from NaBloPoMo! I'm starting to see some referrals from them now. As always, I appreciate the traffic from Bobby Griffin's site (even though he's having some computer problems today - Hope you're up and running again soon, Bobby).

Blogroll Maintenance: I'm always amazed and honored by those of you out there who place me on your blogroll. I’m adding some new people today. I’ve also started to receive some spam comments. I might have to moderate comments if this is increasing. Just wanted to give all of you a heads-up if this happens this week.

Go governor

Finally, a "political" story that I can get behind. On many of the news shows this morning, I saw an interview with Governor Mike Huckabee from Arkansas. Instead of the typical partisian politics and talking points, the governor talked about running the New York City marathon this weekend. (New York Newsday)

Huckabee, who lost more than 100 pounds after being diagnosed with diabetes, has run in three marathons in the last 18 months, with his time improving to 4:26:05 this March in his second Little Rock Marathon.

He talked about how he was able to lose the weight and train for marathons despite sometimes working 16-20 hour days. He said that even with his scheduled speeches and other responsibilities being governor, just put on your own schedule what you think is important -- like exercise.

The story really inspires me. His "before" and "after" pictures are fairly impressive. I guess it would be with more than 100 pounds. Maybe I can use some of his tips in my own life. Good luck Governor Mike!

Fishy situation

I think that I might have said this during my blogcast, but I love fresh seafood. When I went to San Francisco last week, I had seafood every single day - and probably every meal if I could.

Data from the United Nations Food and Agricultural Organization (we know how reliable the UN is, right?), estimates that about one-third of edible fish and seafood species have been virtually been wiped out in the past 50 years. At this rate, all edible fish will be gone by 2048.

Fishing was only one human factor affecting marine biodiversity. Pollution, habitat destruction and climate change all took their toll of fish species. Loss of fish from oceans also had harmful repercussions, including a deterioration of water quality, less protection of shorelines, oxygen depletion, and higher numbers of toxic algal blooms.

Personally, I don't really know if I believe this. It kind of smells like the global warming debate - except that the environmental debate shifts from the air to the sea. I see this as a push from the that political group to try to further their agenda.

However, the best thing and the funniest thing about this story is the title of the article from The Age in Australia: "Get Your Fish'n'Chips Now!" HA!

Caffeine crazy

I've mentioned before about how much I like Diet Coke. My (non-blog) friends joke with me all the time about potential withdrawl symptoms if I'm not carrying my Diet Coke.

However, I had no idea what a fad and craze they are these days, especially with younger people. I remember in college a drink called Jolt cola and their claim to fame is having twice the caffeine as regular coca-cola. This definitely helped me though many an "all-nighter" preparing during final exam week.

According to Cnn.Com, "Thirty-one percent of U.S. teenagers say they drink energy drinks, according to Simmons Research. That represents 7.6 million teens, a jump of almost 3 million in three years." This fact really amazed me. This is a $3.4 Billion industry. Sheesh!

Unfortunately, caffeine overdose reports are becoming more and more frequent - mainly because of the combination of caffeine and other chemicals like alcohol and drugs. I'm just starting to see this in my small community. But, apparently, this becoming a major problem in the larger cities.

"Young people are taking caffeine to stay awake, or perhaps to get high, and many of them are ending up in the emergency department," said Dr. Danielle McCarthy of Northwestern University, who conducted the study. "Caffeine is a drug and should be treated with caution, as any drug is."

How much caffeine do energy drinks contain? A University of Florida study found that some products, although served in cans two-thirds the size of a standard can of Coke, contain two to four times the amount of caffeine as that Coke. Energy drinks are unregulated in the United States, but the authors of the University of Florida paper suggest warning labels for them.

Ok, here we go. Let's now regulate the thing by putting warning labels on them. This is an entire rant in itself. Have warning labels really been effective when placed on things like cigarette packages, alcohol bottles, and music CD covers? C'mon, gimme a break.

But, I digress. Following review of this article and talking with some of my emergency department colleagues, I was really enlightened on the increasing trend of caffeine overdose and caffeine combinations with alcohol/drugs. I think I'll try to talk with my patients to see how prevalent it is in my community.

Election day rant

I'm probably one of the approximately 40% of registered voters that will actually vote in US elections in five days. However, I just cannot take it anymore especially in these areas...

Negative Ads: I've read the studies that negative ads are more effective than the "touchy feely ads." But, every ad on television, in the newspapers, and on the radio? Every single ad is saying, "This candidate is bad because blah, blah, blah. Vote for our candidate." Did you know that $160 million has been spent on negative ads verses only $17 million on positive ads. This just makes me sick.

Special Interest Groups: These groups paint candidates one way or another on a single issue, usually a hot button or controversial issue - whether it's corruption, national security, immigration, abortion, minimum wage, stem cell research, or whatever. It really doesn't matter what the complete picture of the candidates views and beliefs are. If you disagree or agree with a particular candidate on a single issue, then you must vote for or against this person. Do politicians and election campaigns think that we're uninformed? Do they think we would base our vote on one single issue? That's a pretty arrogant view. Unfortuanately, through the years, we have been lulled into voting in this manner. I don't know how to change the tide on that.

Apathy in the Electorate: I even talk with people at work either at the hospital or at our office. No one really cares. There are actually few people going to vote. I can't understand why. Voting in this democracy is a privilege that is taken for granted. What if the government started limiting the right to vote? What kind of uproar would happen?

This is a nation of immigrants, including my parents. I remember when my parents became naturalized citizens. It was one of the most memorable days of my life and in their lives. I was in high school and we learned together about our democracy and how our government works. They have voted in every single primary election and general election since then. That started over 10 years ago. I think about that when I think about skipping an election.

"The decisions are made by the people who show up." I've heard that saying again and again in one setting or another. And, it is so true. This is my public service announcement from all of us here at the Doctor Anonymous blog (basically me) -- VOTE!

Don't be part of the problem. Be part of the solution. Be proactive. I know it's easy to complain and be frustrated and think that your vote doesn't count. It's easy to think that your vote won't make a difference. I think of all those people around the world who are told what to do, how to think, and basically how to live. I don't ever want to live like that. Go to the polls on Tuesday, you'll be glad that you did. I'm Dr. A, and I approved this message....

Quid pro quo

I just read TJ's comment about yesterday's post and I found it very interesting.

I believe that antibiotics are over prescribed in many cases; but at the same time, I also feel that many times people go to the doctor unnecessarily as well.

And since they do show up in the doctor's office, I think that pressure is then applied to the physician to make sure that the patient leaves the office with a prescription in their hand. Mostly because the patient expects to leave the 'establishment' with *something*.

Kind of like a "thanks for your business" kind of thing.

Of course, I'm sure that Dr. A doesn't do that.

Now, I may be accused of interpreting this as "a joke," but this comment brings up an interesting point that I wanted to address. According to dictionary.com, the definition of quid pro quo is something that is given or taken in return for something else.

Something physicians talk about a lot is patients expecting to receive an antibiotic. Something physicians do NOT talk about is their tendency of writing for an antibiotic instead of explaining the rationale for holding off. Less than two months ago, there was an article in a prominent primary care medical journal that sums up things very well.

In one study, up to 50 percent of parents had a previsit expectation of receiving an antibiotic prescription for their children, and one third of physicians perceived an expectation for a prescription.3 Because of these expectations and the time constraints on physicians, prescribing an antibiotic may seem preferable to explaining why an antibiotic is unnecessary. However, researchers have found no association between receiving an antibiotic prescription and satisfaction with the office visit. What does impact satisfaction is whether patients understood their illness after the visit and whether they felt that their physician spent enough time with them.

So, in a roundabout way, I'm saying, yes, some doctors, for whatever reason, decide to write for the antibiotic. I agree with TJ that some docs see it as a business move ("If I don't give them the antibiotic, then they will switch doctors to someone that will.") Some see it as a way to save time ("I'm running two hours behind. And, if I write for the antibiotic instead of explaining why not, then I can keep from getting further behind in my schedule.") Or, some other reason.

Update: Kevin, MD linked to this follow-up post as well (Thanks! That's two days in a row for me.). He also said that I "hit the nail on the head." (aw shucks). A couple of interesting comments on his site to check out.

NaBloPoMo

Thanks to rdl for the heads up on this one. Did I miss a meeting somewhere? I guess it's National Blog Posting Month - Does Hallmark make a greeting card for this? I also read about this on the Frectis blog (thanks also for the info).

I don't even know if I can still "officially" get in this, but I liked the Yoda logo. So, the logo is in my sidebar, I sent an e-mail to fussy about my interest, and here we go! I've needed a little blog motivation, and maybe this is it. I know, hard to believe from the self-proclaimed blogaholic!

In other blogging news, I'd like to thank Technorati for finally updating my blog. I contacted them again and again, but got no response. According to my latest profile, I was just updated two hours ago - after not being updated for 93 days - how does that happen?

During my first week of blogging, I was ranked at 1,382,557. Now, I'm pleasantly surprised that I have a whopping 323 links. Before today's update, my links placed me around 120,000 on their blog rankings. Now, I'm in the top 30,000. Whoo-Hoo! High fives everywhere.

Riddle me this, Batman? How do I only have 27 links on the TLB site? Interesting.

Finally, I'd like to thank Kevin, MD for picking up my post yesterday and linking it to his site. I believe that he's got about 2500 visitors a day. What an audience! I'm jealous.

Free antibiotics

You've probably have heard what Wal-mart is doing with the price of prescription drugs - Rob even talked about it yesterday.

Now, to up the ante, regional stores/pharmacies are offering FREE drugs. What do I mean? In last Friday's Columbus Dispatch, there's a story talking about Mejer and Giant Eagle (regional pharmacies), in selected parts of Ohio, offering selected free antibiotics.

Don't get me wrong, you still need a prescription from a doctor (or other health profesional with prescription writing privileges - How politically correct is that?) for this. But, apparently, you bring the prescription to the pharmacy, and BANG, here's your antibiotic - now go and feel better.

From a cost standpoint, I think this is a good thing. Generic drugs are ridulously overpriced! Some of my patients have told me that rarely the name brand drug is the SAME price as the "generic."

From a patient care standpoint, I see this as a real problem. Wal-mart had the right idea, kind of, with offering some discounted chronic medicines - like blood pressure medicines and antidepressants. But, offering antibiotics?

Many studies have shown that you don't need an antibiotic every time you get a respiratory infection. And, I even admit, if I'm on the fence for a diagnosis, I err on the side of possibly a bacterial infection, and I prescribe the antibiotic.

For years, doctors have been warned to "just say no." And, we're seeing the complications of these decisions - mainly drug resistant infections.

So, docs out there, have the courage to stand your ground and explain the difference between bacterial and viral infections. And, if you're a patient, try to hold back your wrath if your doc doesn't give you that antibiotic and wants you to have the viral infection "run its course, because antibiotcs wouldn't help anyway."