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The Big Donor Show


Just when I think I've seen it all in reality television, Amsterdam, Netherlands has something totally new and off-the-wall. The prize is not $1,000,000 or glamorous trips around the world. The prize? A kidney. Yes, that's right, a kidney.

According to this Associated Press story, the show centers around a person that they're calling "Lisa." Lisa is a 37 year-old with an inoperable brain tumor and subsequent terminal illness. During the show, she will talk with and interact with three individuals who are candidates for kidney transplants.

Producers of the telecast (called the "Big Donor Show") want to highlight the shortage of kidney and other organ donors. One government official would like the Dutch parliament to block the broadcast. A network official had this to say...

"We know that this program is super controversial and some people will think it's tasteless, but we think the reality is even more shocking and tasteless: waiting for an organ is just like playing the lottery," Laurens Drillich, chairman of the BNN network, said in a statement.

He said waiting lists in the Netherlands are more than four years long and 200 patients die annually for lack of a donor.

If that's not bad enough, the article goes on to say that "Lisa's" wishes may not even be observed and carried out...
A spokeswoman for BNN said that there could be no guarantees the donation would actually be made, "but the intention is" Lisa's donation would be carried out before she died.

That is because her wish to donate to a particular candidate "wouldn't be valid anymore after her death" under Dutch donation rules, Marieke Saly said. If Lisa does donate one kidney while living, the other kidney may still be awarded to someone else on a national donation waiting list under the country's organ allotment system.

Wait. It gets even better and more outrageous than that. If you can believe this, government weezels are hesitant to block the broadcast in the following statement in the AP article.
Education Minister Ronald Plasterk, addressing parliament on behalf of the government because the health minister was ill, replied that there were serious questions about whether the transplant would actually go through as BNN has advertised it — but that there was no way to stop the program from airing.

"The information I have right now tells me that the program is unfitting and unethical, especially due to the competitive element, but it's up to program makers to make their choices," he said.

"The constitution forbids me from interfering in the content of programs: let there be no mistake about that, that would be censorship."

Censorship? Are they kidding? Is it censorship to have a game show to determine who gets the kidney of a terminally ill patient? Is it censorship to parade out a terminally ill patient, and have her interview three individuals with kidney failure, only to have her wishes potentially denied?

This is ridiculous and scary if you ask me. It will be interesting to see how this Big Donor Show all plays out. I wonder if network executives in this country would touch a concept like this one. What's sad is that they are probably watching this Dutch story closely to see if there is any public outrage over there. If not so much, then maybe someone in the US would try this stunt of a game show.

Fat Doctor Is Back


If you haven't heard already, Fat Doctor, the self-described famine resistant family physician, is now back up and running over on wordpress. In case you haven't seen, she's also posted on the I'm A Blogaholic blog as well in the past week. So, head on over and say hello. She'll be glad to hear from you.


In other news, I joined twitter.com this evening. At the request of my fair lady FD, I checked it out. It looks like of interesting. I don't know if I'll use it that much, but we'll see. I'll even put it in my sidebar like other people have done to see how much interest there is. I would encourage you to check it out, and check out my twitter profile as well.

The Kevorkian Effect


To some, Dr. Jack Kevorkian is a hero, and to others he is a villain. But, no one can dispute that he brought the issues of end-of-life care and physician-assisted suicide into public debate.

According to this article from the Associated Press, he will be released from prison on June 1st after serving more than eight years of a 10-25 year sentence for the death of a Michigan man.

He used a machine he'd invented to administer fatal drugs and dropped off bodies at hospital emergency rooms or coroner's offices, or left them to be discovered in the motel rooms where he often met those who wanted his help.

At the time, some doctors didn't want to give dying patients too much pain medication, fearing they'd be accused of hastening death.

Kevorkian said that he would be happy to go to jail for his beliefs. But, what effect has he really had in the area of physician-assisted suicide? Up to this day, only one state, Oregon, has a law allowing physician assisted suicide.
Experts say that's because abortion opponents, Catholic leaders, advocates for the disabled and often doctors have fought the efforts of other states to follow the lead of Oregon, where the law took effect in late 1997.

Opponents defeated a measure in Vermont this year and are fighting similar efforts in California. Bills have failed in recent years in Hawaii, Wisconsin and Washington state, and ballot measures were defeated earlier by voters in Washington, California, Michigan and Maine.

I remember having pretty heated debates in my medical ethics classes while in college in the early 1990's. "Kevorkian" not only was a name, but also used as a verb - both positively and negatively - depending on which side of the debate you were on. Back then, predictions were made that a majority of the states would eventually have physician-assisted suicide laws.

As one looks back over the past 10 years or so, you have to ask yourself this question: What was the real effect of Jack Kevorkian? Personally, I think he did raise awareness of end-of-life issues - although in kind of shocking way.

But, did he really influence public policy? I guess that will be debatable for a long time. Some will say he is a failure because only one state has physician-assisted suicide legislation. Others will say that he indirectly influenced other legislation having do with end-of-life issues. We'll have to see how history ultimately judges Dr. Jack Kevorkian.

Don't brush your teeth


Yes, you heard me right. Don't even think about brushing your teeth, that is, if you have toothpaste that originated in China. The New York Times is reporting in today's paper that Chinese authorities are investigating whether two companies exported tainted toothpaste overseas.

No tainted toothpaste has been found in the United States, but a spokesman for the Food and Drug Administration said yesterday that the agency would be taking “a hard look” at whether to issue an import alert.

Authorities in the Dominican Republic said they seized 36,000 tubes of toothpaste suspected of containing diethylene glycol, an industrial solvent and prime ingredient in some antifreeze. Included were tubes of toothpaste marketed for children with bubble gum and strawberry flavors sold under the name of Mr. Cool Junior.

I guess Mr. Cool is not so cool after all. The article gets better. Apparently, people in the country of Panama are very familiar with the substance called diethylene glycol.
Diethylene glycol is the same poison that the Panamanian government unwittingly mixed into cold medicine last year, killing at least 100 people. In that case, the poison, falsely labeled as glycerin, a harmless syrup, originated in China, shipping records show. Diethylene glycol is generally less expensive than its chemical cousin glycerin.
Not to worry, US authorities are all over this situation and are giving brilliant insight on how children could possibly ingest poisonous toothpaste from China (allegedly).
Dr. Douglas Throckmorton, deputy director for the Center for Drug Evaluation and Research at the F.D.A., said diethylene glycol levels found in some Panamanian toothpaste were nearly 50 times what is deemed safe. “Kids swallow toothpaste,” Dr. Throckmorton said. “That is going to be a concern to you.”
Let this serve as a warning to all of you out there in blogland. In case you go to your local discount store and pharmacy and see that "Mr. Cool Junior" toothpaste on sale - think twice. Avoid the "good tasting" bubble gum and strawberry flavors - stick to the yucky stuff. It'll be safer for your kids. HA!

Chip Implants: Ethical or not?


Would you want your loved one to have a radio frequency identification chip placed in her/his forearm? This is the debate that is going on at Alzheimer's Community Care in West Palm Beach, Florida. (AbcNews.Com)

The chip, which is slightly larger than a grain of rice, is implanted under the skin of the right forearm. Each chip will contain a unique 16-digit number that, when scanned in an emergency room, will link to the patient's medical records.
Seems pretty simple and straightforward to me. Taking care of Alzheimer's patients, I've always found it difficult to try to get all the information that I need when the patient presents to the emergency room in the early hours of the morning. Going through photocopies of information from the nursing home can be very confusing and time consuming. And, family members are not always available immediately to answer questions.
"This whole medical trial … really raises some pretty important issues about informed consent," said Katherine Albrecht, the founder of the advocacy group Consumers Against Supermarket Privacy Invasion and Numbering.
Officials at the facility state that this program is voluntary and issues of informed consent will be addressed with the patient and families before any procedure is performed. Ms. Albrecht continues...
"There are other technologies that are far less invasive and can achieve the same goal," she said.

Albrecht promotes the MedicAlert bracelet as the ideal way to solve the problem of Alzheimer's patients who cannot relay their medical information reliably. MedicAlert bracelets bear a recognizable medical symbol on the outside and have the patient's medical conditions listed on the back.

The article goes on to interview a couple of medical ethicists about their opinions about the placement of an identification chip.
But he [Jeffrey Spike of Florida State University] worries because the chip program has not yet been evaluated by a review board. Such a board, Spike said, would need to look at potential risks both physical and psychological -- and let prospective participants know their right to withdraw by having their chip removed or deactivated.

"If this has not been reviewed by [a review board], then it's natural to be suspicious that it has been carefully thought out," said Spike.

Presuming that the ethical and logistical details can be worked out (and I assume that they will), I don't see a problem with placing these identification chips in these patients. The wave of the future will be to somehow have your entire medical history easily accessible. I don't know if these ID chips are the answer, but they are certainly worth a try.

Going home


It's been a long week here in Lexington. And, it was a great conference. I didn't talk about it much more because of all the other stuff going on this week.

And, what a week for the "other stuff." What happened this week in the medical blogosphere is going to have repercussions for a long time. The silver lining is that there is more of an awareness now than ever before of the benefits and risks of medical blogging.

In case you were curious, I believe that the new blog is going well. If you haven't had a chance to check it out, I would encourage you to do so. We're accumulating quite a troupe over there and it's a good time. Join us for the fun!

Have a great weekend! It's time to head home (image credit). Hopefully, I'll be resuming "normal" blogging (whatever normal is) next week. Ek! I have to go back to work next week. That'll be fun....

Midwife reality check


Although I do not deliver babies or perform prenatal care, many of my family physician colleagues do. Some even perform C-sections. You probably didn't know family docs could do all that, huh. Well, with malpractice premiums going up and payment/reimbursment going down, it's getting harder and harder to find any docs doing maternity care. Even some ob/gyn docs are dropping the ob (obstetrics/maternity care) part and doing more gyn (gynecology).

A story in today's Washington Post is outlining the reality of the medical economic environment for midwifes. Apparently, there are two huge birthing centers that are going to be closing in the Washington area. Seven other birth centers have closed their doors over the past decade.

"There are countless women scrambling to find out-of-hospital birth support," said Mary Beth Hastings, 39, a board member of the new Birth Options Alliance. The group, with about 300 members, will advocate "for a full range of birth options" in the Washington area...
Now, in my experience, most women I've talked with have no problem giving birth at the hospital with their midwife at their side. What's interesting about this article is that it highlights the small percentage of women who are anti-hospital, anti-doctor, pro-birthing center, and pro-midwife. Here is the reporter's bias coming out...
For a relatively small but devoted group of women, the idea of giving birth in a hospital with a physician connotes unwelcome images of being tethered to machines, talked out of natural childbirth or talked into a non-emergency Cesarean section.

A birth center, they say, provides a more relaxed, homelike environment without anesthesia or C-sections. Others say they want the option of an epidural for pain relief in a hospital but believe midwives will provide more personal support and be less likely than physicians to intervene with machines, surgery or medication.

Like I said above, I don't deliver babies nor do I perform C-sections. But, I'm definitely insulted by the statements above. These people want it both ways. Sure, treat my pain and/or if there is a problem - well then I'll see a doctor. Other than that, keep doctors away from me. Why is the perception that midwifes are "better?" Well, it's because they see the less complicated cases - thus the birthing experience may be seen as "easier."
Most midwives treat only healthy women with low-risk pregnancies. Anesthesia, such as an epidural block, and medications to speed up labor are available only in hospitals, and only physicians may perform C-sections.
Here we go. You saw this coming. Starting to make the case for "those bad doctors." It's the bad doctors who are driving the midwifes out of business. Yes, it's the doctor's fault. Here is more bias...
Those same [financial] pressures are felt throughout the health-care industry, but birth centers are particularly hard hit because they operate on slimmer profit margins than most physicians, midwives said. Several also cited problems unique to midwifery, including the growing popularity of C-sections, which they don't perform. Moreover, unlike obstetricians and gynecologists, midwives can't offset lower health insurance reimbursements for office visits with higher-paying surgeries.
This article is so politically motivated it makes me sick. The columnist wants you to think that there is a lack of access to maternity care in the Washington area and that physicians are to blame for this. With smoke and mirrors, it's subtily making the case that midwifes, in an effort to increase access to maternity care, should be given everything from C-section to epidural privileges.

And, oh by the way, doctors should decrease midwife malpractice premiums and increase payment/reimbursement to midwifes. Like physicians have any control over that. Want to make an impact in that, well do what everybody else does and go up to Capitol Hill and lobby Congress like the rest of us have to. Good luck with that.

For too long, physicians have always been the punching bag for the press - and I'm sick and tired of that. Physicians have been the target of every "health care provider" and the reason why physician's scope of practice has slowly been eroded away - especially in primary care. I'd better get off my soapbox now. Suffice to say, I didn't like this Post article and I hope people see through it for what it really is.

Dr. Dork goes private


Very quietly this morning, Dr. Dork now is "open to invited readers only." Am I still an alarmist? Do people still think I'm making up the seriousness of this situation? You be the judge....