Planet Anonymous

I know what you're thinking. No, the planet above is not part of this week's Grand Rounds presentation. Although, I did think that the solar system theme was quite unique.

The Associated Press is reporting that astronomers have found a potentially habitable planet outside our solar system. Yes, a real planet. (Don't tell Pluto who got demoted to a dwarf planet named 134340. HA!)

"It's a significant step on the way to finding possible life in the universe," said University of Geneva astronomer Michel Mayor, one of 11 European scientists on the team that found the planet. "It's a nice discovery. We still have a lot of questions."

My question is pretty simple: What's the name of this rock, dude? There are potentially lots and lots of cool names out there to call this significant discovery. What did they come up with? Here it is -- 581 c. Doesn't that name just roll off your tongue? Sheesh!

The new planet is about five times heavier than Earth. Its discoverers aren't certain if it is rocky like Earth or if its a frozen ice ball with liquid water on the surface. If it is rocky like Earth, which is what the prevailing theory proposes, it has a diameter about 1 1/2 times bigger than our planet. If it is an iceball, as Mayor suggests, it would be even bigger.

Based on theory, 581 c should have an atmosphere, but what's in that atmosphere is still a mystery and if it's too thick that could make the planet's surface temperature too hot, Mayor said.

However, the research team believes the average temperature to be somewhere between 32 and 104 degrees and that set off celebrations among astronomers.

Until now, all 220 planets astronomers have found outside our solar system have had the "Goldilocks problem." They've been too hot, too cold or just plain too big and gaseous, like uninhabitable Jupiter.

The new planet seems just right — or at least that's what scientists think.

Is this science, or nursery rhymes? Goldilocks problem? Is that what they teach in science class or rocket science school? I should have taken more of those classes. Maybe I would have ended up at NASA. HA!

I'm going to give those guys and gals a little free advice here. I've got the name for the new planet: Planet Anonymous. It's cool. It's chic. It's hip. And, it's happening! A kind of name that's a cross between Sanjaya and Pimp My Planet - if you know what I mean.

If you look close in the picture above, you can already see that there's a McDonalds there (McBreakfasts are great for blood pressure) and a Wal-Mart (with a pharmacy and a minute clinic for all of your health needs -- NOT!). Maybe this new planet could be the site for the first interplanetary Blogaholics Anonymous meeting. What do you think?

By the way, if you look at my sidebar, you'll see that my site meter counter is getting dangerously close to 100,000 visitors. Could you be the person that sets me over the top? Check back and see. There's a secret prize for the 100,000 visitor to the Doctor Anonymous blog! (Actually not, but it sounded good, didn't it?)

Grand Rounds

Grand Rounds 3.31 is now up and running at Med Valley High. They kind of have a solar system theme this week. Liana is a first year family medicine resident (YAY!) who states, "I'll invite you now to sit back, relax and join me on a tour of the highlights of the medical blogging universe."

Thanks to Liana for including my post this week. All of the Editor's Picks had to do with the Virginia Tech shootings. I'm honored to be placed at the top of the picks for this week:

Several bloggers have reacted to this terrible incident philosophically. Doctor Anonymous asks some difficult questions about the role of the government and the role of universities to the public and to parents, respectively, in terms of issues related to mental illness.

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science?

Next week, GR moves to the esteemed group over at the Shrink Rap blog or the My Three Shrinks podcast - whatever you want to call them. HA! They just celebrated their one year blogiversary, you know! Their GR theme? BYOB: Bring Your Own Brain. Hmmmm....

Asians: The New American Villan

In today's New York Times, it reports that two CBS Radio personalities have been put on suspension following complaints from an Asian-American group concerning a six-minute prank phone call to a Chinese restaurant "peppered with ethnic and sexual slurs."

In the skit, a series of apparently unsuspecting employees of a Chinese restaurant are berated by a caller who tells one woman he would like to “come to your restaurant” to see her naked, especially a part of her body he refers to as “hot, Asian, spicy.” The caller also attempts to order “flied lice,” brags of his prowess in kung fu and repeatedly curses at several employees.

Not only was this call played the day after Imus' comments, it was also played the day after Imus was fired. How does that make sense? Now, full disclosure here, I am Asian-American, and I am offended by this skit and this story. I absolutely think these radio hosts should be fired. And, I think that CBS Radio should suffer some consequences as well.

I'm on the record saying that Imus should not have been fired. But, since he was fired, I believe that the Imus episode has set a precedent that no offensive language should not be tolerated on the radio. Or, did the Imus episode tell us that only language offensive to African-Americans and to women are not tolerated on the radio?

As it plays out, this story will demonstrate the double standard that exists against Asian-Americans. These radio hosts will not be fired and America will not ever care about this story. Here are three reasons why:

1. There is no Asian-American in the United States with the political power to gain any kind of attention (meaning press time) to this story. Many Asian-American leaders will try to make their outrage known, but after a 24-48 hour news cycle, this story will quickly lose steam in the press.

2. The Asian-American target in this prank was not someone prominent like the Rutgers Women's Basketball team - people all of America could relate to. Employees of a Chinese restaurant in New York City will probably not appeal to anyone outside of NYC.

3. The face and image of the Virginia Tech massacre is an Asian-American. Last week, America was subject to the playing and re-playing of Cho Seung-Hui's video diary. Many will have those images etched in their minds forever. And, I don't see a lot of sympathy towards Asian-Americans - at least not enough to get these two radio hosts fired.

The "rules" have already been laid out. If you make fun of African-Americans, you have the self-appointed black leaders to answer to. Mexican-Americans? You'll have groups like La Raza knocking at your door. Gays and Lesbians? Rosie has a platform everyday to attack you until you apologize and ask for forgiveness.

But, Asians? Well, I think the Asian community in America is suffering a little bit by playing fair and following the rules. Can you name any prominent Asian-American who can take up the torch for Asian advocacy? I know I can't. This is the perfect set-up for Asian racism on the radio, in television, in the movies, and wherever else it is marketable to do that.

I know, people are going to accuse be of being overly sensitive and trying to play the victim in the politically correct society that we live in. "You don't have to listen to this stuff, Dr. A. You could just turn the channel."

Well, you could have just turned off Imus or you could have walked out during Michael Richards tirade. People were outraged by them, but will probably not be outraged by these radio guys. They'll get a slap on the wrist and then go back to work. I think that's wrong, but what do I know. I'm just Asian....

Update 5/13/07: These radio hosts have been fired. Read here for details.

Mental health care delivery in US

After I finished writing my last post, I did what I needed to do, which was to stop watching and reading the news for a while. I went out of town (already scheduled outing) and didn't even bring my laptop. Quite a feat for me. I've only started catching up on the news this morning.....

As some students go back to class at Virginia Tech this morning, many questions still remain. In catching up with the news, I was pleased to see that college campuses are now starting to analyze how they deal with mental health issues. (Seattle Times)

Awareness is especially heightened at the UW [University of Washington], given a murder-suicide earlier this month, when a campus employee was killed in her office by an ex-boyfriend who then shot himself.

The UW's president and the provost on Friday formed an advisory committee on violence prevention to take a look at safety protocols across campus.

Already, a UW counselor works part time assisting resident housing advisers with student mental-health issues. In addition to its regular clinical services, the campus counseling center also operates a consultation line five days a week to handle questions from faculty, staff or students.

When the UW identifies a student who has talked about or attempted suicide, the student must see a campus psychologist. The student is then given the option of undergoing four assessments with a mental-health provider.

If the student declines to participate in those assessments, the UW can start proceedings to remove the student from school, said Eric Godfrey, vice provost for student life at the UW.

What I really hope happens is a careful look at how all mental health care is delivered in the entire country - not just on college campuses? I know, but a doc can dream can't he?

As I've talked about on this blog before, the mental health services in my little county are sparse at best. We have about 100,000 people in the entire county and about 500 square miles to cover. The number of psychiatrists I can count on one hand (and it's even less than five).

A lot of people have barked to me that only psychiatrists should be prescribing mental illness medicines and the primary care doc should be left out of it. The reason PCPs prescribe is because there is no one else to diagnose and treat these patients. It can take months to get an appointment with a psych.

Other supportive services are overloaded as well. We do not have the number of counselors that are needed to adequately services the patients of this community. So, what happens, these patients end up in the ER.

Since there is no inpatient psychiatric hospital in the county, we have to transfer out everything. And, the ER docs out there know how difficult it is to transfer out a psych patient to a different county. This patient can sit in the ER for 8-10 hours (delaying treatment) while the doc tries to get a hospital to accept them.

Or, some patients end up in jail, dealing in the legal system, and maybe dumped back into the outpatient follow-up system which I have described above. There's no good solution here. But, maybe, just maybe, some good can come out of the VT tragedy with this look at mental health care delivery in the US.

Update 4/24/07: Here is a letter to the editor from the Chicago Tribune who states as far as her state is concerned, when it comes to grading mental health care delivery, "Illinois received an F."

Privacy laws need scrutinized

I really need to stop watching the news regarding the Virginia Tech shootings. Since I can't, I'll offer some commentary on what I watched this evening on the cable news shows and what I read in some of the online news articles with reference to privacy laws and medical records.

What is the role of the university if a student is diagnosed with a mental illness? In this article from today's New York Times, it states what we already know - That they are bound by the same federal laws that pretty much everyone else has to follow.

For the most part, universities cannot tell parents about their children’s problems without the student’s consent. They cannot release any information in a student’s medical record without consent. And they cannot put students on involuntary medical leave, just because they develop a serious mental illness.

The article goes on to say that universities have quite a problem here in trying to navigate through these privacy laws.

Universities can find themselves in a double bind. On the one hand, they may be liable if they fail to prevent a suicide or murder. After the death in 2000 of Elizabeth H. Shin, a student at the Massachusetts Institute of Technology who had written several suicide notes and used the university counseling service before setting herself on fire, the Massachusetts Superior Court allowed her parents, who had not been told of her deterioration, to sue administrators for $27.7 million. The case was settled for an undisclosed amount.

On the other hand, universities may be held liable if they do take action to remove a potentially suicidal student. In August, the City University of New York agreed to pay $65,000 to a student who sued after being barred from her dormitory room at Hunter College because she was hospitalized after a suicide attempt.

What is the role of government if a citizen is diagnosed with a mental illness and would like to purchase a firearm? There has been a lot talked about and written about how easy it was for Cho to purchase a gun in Virginia. In this article from the Associated Press, they talk with the gun store owner and his impressions of Cho during the transaction.

Roanoke Firearms owner John Markell said his shop sold the Glock to Cho in March. The serial number had been scratched off, but federal agents traced it to the store using a receipt found in Cho's backpack.

"It was a very unremarkable sale," said Markell, who did not handle the sale personally. "He was a nice, clean-cut college kid. We won't sell a gun if we have any idea at all that a purchase is suspicious."

Markell said it's not unusual for college students to make purchases at his shop as long as they are old enough. Cho held a green card, meaning he was a legal, permanent resident, according to federal officials. That meant he was eligible to buy a handgun unless he had been convicted of a felony.

It has been suggested in the media that if Cho's medical records, specifically his mental illness diagnosis, was somehow made available as part of the "background check," then, possibly, he would not have been able to purchase a gun at this place. I do realize that possibly no law could have prevented this kid from getting his gun.

However, this brings up an interesting point about privacy laws. Should certain medical diagnoses be made available in a law enforcement database? If so, which diagnoses? Just mental illness diagnoses? Who decides which medical information is placed into a database like this? Would that mean that if I am pulled over for speeding that my medical record would be accessed on a police cruiser computer?

These two articles bring in some new angles to the personal privacy verses public safety debate. Where is the line drawn between the two? Who decides where the line is drawn? What are the consequences if it goes too far one way or the other. I apologize for bringing up more questions, but I think the privacy laws in this country need to be placed under a microscope and analyzed. It is long overdue....

Update: Uh oh, this post got picked up this morning by RealClearPolitics.Com and by the FoxNews.Com Buzztracker - because of my quotes from the NYT story. Yeesh! Look out! I'm not a political commentator, just a doc! Oh well....

Update 4/24/07: There's now information that he should NOT have been sold a gun because he was seen as a danger to himself and others. But, the information was never entered into the National Instant Criminal Background Check System. Read more in this cnn.com story.

Depression = Murderer?

The term psychological autopsy is now being thrown around by the talking heads on cable news shows in the analysis of Cho Seung-Hui, the Virginia Tech gunman. The first words from the TV medical experts are that this kid was not only depressed but also being treated with medications. I also found it interesting that an article from the Associated Press has this as the second paragraph...

News reports said that he may have been taking medication for depression and that he was becoming increasingly violent and erratic.

The article goes on to outline some of his other characteristics as they try to profile this individual: a loner; a writer of disturbing plays; a writer of the suicide note against "rich kids," "debauchery," and "deceitful charlatans."

I could be wrong, but I'm starting to see people in the press making the association between depression and murder. Of course, this kid had mental illness and of course he was undergoing treatment for it. But, the implication that everyone with mental illness has the potential "to snap" and kill people - as being suggested in the media - This bothers me.

With the Virginia Tech story as a backdrop, I was scanning the health headlines and ran into a different Associated Press article today with this title: Antidepressants' benefits trump risks for kids

If you remember, three years ago, the Food and Drug Administration made a statement warning the public about use of antidepressants in children and teens. At the time, they stated that there was an increased risk of suidical thoughts and behaviors. There was a huge uproar then. All my patients were talking about it - particularly parents. Now, the research is stating that those concerns are not as serious as once thought.

Researchers analyzed data on 5,310 children and teenagers from 27 studies. They found that for every 100 kids treated with antidepressants, about one additional child experienced worsening suicidal feelings above what would have happened without drug treatment. In contrast, the FDA analysis found an added risk affecting about two in 100 patients.

There were no suicides in any of the studies. The antidepressants included Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Serzone and Remeron.

"The medications are safe and effective and should be considered as an important part of treatment," said study co-author Dr. David Brent of the University of Pittsburgh School of Medicine. "The benefits seem favorable compared to the small risk of suicidal thoughts and behavior."

Now, this is by no means the final word on this issue. Some may even say this study complicates the discussion. So, what is a doctor to do? What is a parent to do?

I think this study emphasizes the close communication that is needed between docs, patients, and their parents - especially when it comes to mental illness diagnosis and treatment. I realize that's easier said than done.

But, as more of this Virginia Tech case is uncovered, it seems as if improved communication could (and I emphasize could) have changed the outcome of this tragedy. Of note, N=1's comment in my previous post makes an excellent point.

Can the cycle be broken

This is the picture on the front page of FoxNews.Com from this morning. This is Cho Seung-Hui, a student from South Korea, apparently an English major. What was the motive? I guess authorities are still trying to figure it out.

It may be too soon for a post like this, but it's what I'm thinking right now, and I just have to get it out there. Unfortunately, this is not the first shooting to occur on a school campus. Back in November, Dr. Deb wrote about a Map of School Violence between 1995 and 2005. At the end of her post, she posed this question - "What can be done to minimize such violence?" Here was my comment:

Dr. A said...

This is a very emotional issue, and the really sad part is that no one wants to take ownership of the problem. Everyone blames everyone else for the problem whether is blaming school officials to "not keeping school safe" to blaming parents for "not bring up kids right" to the media to exposing kids to too much violence.

Until someone steps up and accepts even a little responsibility for the problem, the blame game will continue and more children will be harmed - or even killed.

November 03, 2006 1:09 PM

History is repeating itself again with the blame game. There are already early articles being written asking whether there were Too Few Warnings at Virginia Tech? The outrage is beginning to build against the university and university officials.

Student Maurice Hiller said he went to a 9 a.m. class two buildings away from the engineering building, and no warnings were coming over the outdoor public address system on campus at the time.

Everett Good, junior, said of the lack of warning: "I'm trying to figure that out. Someone's head is definitely going to roll over that."

"We were kept in the dark a lot about exactly what was going on," said Andrew Capers Thompson, a 22-year-old graduate student from Walhalla, S.C.

Of course, people are outraged by this situation. I'm outraged by what happened. But, I've seen this too many times. We are shocked by what happened, we mourn the victims, we blame whomever we need to blame for what happened, then we go back to our apathy until the next tragedy happens.

Well, I'm sick and tired of this useless cycle. Instead of outrage turning into apathy, let's turn outrage into action. And, I'm not talking about knee-jerk reactions like firing some university official somewhere or a more strict student visa process or permanent resident visa process - like what's being talked about now.

Um, uh, wait a minute. As I think about things now (a couple of hours after starting to write this post), I'm thinking about what realistically can happen? Would it mean a radical change in American culture? A culture that celebrates violence? A culture that makes celebrities out of people like Eric Harris, Dylan Klebold, and Cho Seung-Hui. Here's the latest press on this killer from the Chicago Tribune:

The suspected gunman in the Virginia Tech shooting rampage, Cho Seung-Hui, was a troubled 23-year-old senior from South Korea who investigators believe left an invective-filled note in his dorm room, sources say.

The note included a rambling list of grievances, according to sources. They said Cho also died with the words "Ismail Ax" in red ink on one of his arms.

Cho had shown recent signs of violent, aberrant behavior, according to an investigative source, including setting a fire in a dorm room and allegedly stalking some women.

A note believed to have been written by Cho was found in his dorm room that railed against "rich kids," "debauchery" and "deceitful charlatans" on campus.

Unfortunately, this is a culture that shirks at the idea of accountability. A culture that believes that it's someone else's job to fix the problem. A country and culture that feels no personal investment to fix its own problems. Am I wrong here? Please tell me I'm wrong. Is there a realistic way to curb the violence on school/college campuses?

Grand Rounds

Grand Rounds 3.30 is now up and running at FD's place. There are 39 entries for your review and enjoyement. I admit I forgot to submit a post this week. That time off from blogging last week really made me forget about a lot of things.

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science? Next week, GR moves to Med Valley High.

Sicko

The film called Sicko has been two years in the making, and those in the medical industry have been closely watching Michael Moore and what kind of antics that he was going to try to pull.

There have been rumors that his film crew have been going to medical conventions and filming the pharmaceutical displays and trying to get docs on film talking about their free pens.

In Sunday's New York Post, there is a new twist. According to the report, he took ailing Ground Zero responders to Cuba to film how (in his opinion) Castro's socialized medicine is superior to the medical care in the United States.

Responders were told Cuban doctors had developed new techniques for treating lung cancer and other respiratory illness, and that health care in the communist country was free, according to those offered the two-week February trip.

Cuba has made recent advancements in biotechnology and exports its cancer treatments to 40 countries around the world, raking in an estimated $100 million a year, according to The Associated Press.

In 2004 the U.S. government granted an exception to its economic embargo against Cuba and allowed a California drug company to test three cancer vaccines developed in Havana, according to the AP.

Naturally, some people are upset by this and see this as exploitation....

"He's using people that are in a bad situation and that's wrong, that's morally wrong," railed Jeff Endean, a former SWAT commander from Morris County, N.J., who spent a month at Ground Zero and suffers from respiratory problems.

The article goes on to mention one 9/11 worker who didn't want to go on the Cuba trip and another worker who states me was left behind by the filmmaker. I love the closing paragraphs of this article.

"From what I heard through the grapevine, those people that went are utterly happy," said John Feal, who runs the Fealgood Foundation to help raise money for responders and was approached by Moore to find responders willing to take the trip.

"They got the Elvis treatment."

Although he has been a critic of Cuba, Moore grew popular there after a pirated version of his movie, "Fahrenheit 9/11," was played on state-owned TV.

I usually don't dignify garbage like this with a post, but it's going to be a news story eventually - especially with the slated premiere at the Cannes Film Festival in about four weeks. It's definitely going to be hit piece on the pharmaceutical industry with docs being another target.

The press love to spin things up into a frenzy - the recent Imus story is a prime example. I'll have more to say over the next four weeks as the hype increases. I just wanted to get you ready, because the medical industry is going to take more of a beating in the press than usual (and probably from the US presidential candidates as well)....

House of God

I've been catching up on my Bloglines this past weekend, and I was taken by a quote from Dr. Wes' post called, "Welcome to My World."

Remember the first rule of ER medicine: Take your own pulse first.

Of course, the quote is self-evident to most people reading this blog. But, to me, I've been racking my brain to figure out where I heard/read this quote before. Then, it came to me, House of God by Samuel Shem.

This is a great book and highly recommended to Doctor Anonymous blog readers and anyone else who likes reading medical blogs and medicine in general. The book speaks of the Laws of the House of God. And, for those of you who haven't read the book for the while, they are listed below. Enjoy!

1. Gomers don't die.
2. Gomers go to ground.
3. At a cardiac arrest, the first procedure is to take your own pulse.
4. The patient is the one with the disease.
5. Placement comes first.
6. There is no body cavity that cannot be reached with a #14 needle and a good strong arm.
7. Age + BUN = lasix dose.
8. They can always hurt you more.
9. The only good admission is a dead admission.
10. If you don't take a temperature, you can't find a fever.
11. Show me a medical student who only triples my work and I will kiss his feet.
12. If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion there.
13. The delivery of good medical care is to do as much nothing as possible.