Grand Rounds

Grand Rounds 3.37 is now up and running at Inside Surgery. It's a pretty no nonsense and straightforward format this week. About 30 links which are easy to navigate and read. Great job and thanks so much for including my post...

People in the News
Doctor Anonymous writes on the Kevorkian Effect

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 Dr. Val & The Voice of Reason. What an interesting name for a blog. Want to submit to GR for June 12? Click here and read on....

Pass the chips, or not

Here's the weight loss tip for 2007 - Stop watching television. I know what you're saying - like, duh, Dr. A, we knew that. Well now there's scientific proof, and it involves late night television.

I'm a Letterman guy myself (image credit). Not that there is anything against Leno. But, being in high school in the late 1980's meant one thing to me - staying up until 12:30am to watch Late Night with David Letterman. What do these guys have to do with a weight loss study? Read on and find out...

According to this Reuters article, researchers at the Smell and Taste Treatment and Research Foundation in Chicago (no joke) took people, potato chips, and television and developed a experiment around it.

Forty-five volunteers ate as many chips as they wanted during five-minute intervals over three-week periods while they watched monologues by late-night talk show hosts David Letterman and Jay Leno.

They also were given chips to eat when the television was off. [Alan] Hirsch [neurological director of the Smell and Taste Treatment and Research Foundation] found people ate an average of 44 percent more chips while watching Letterman and 42 percent more while viewing Leno, than when they did not watch TV.

My question is what potato chips were they using. Because, for me, I'm partial to the BBQ flavor - and maybe salt and vinegar. But, other flavors, not so much....

At each session, volunteers were asked to concentrate on the sensory characteristics of the food such as taste and smell. Researchers say these sensory clues, in addition to internal body changes, signal satiety.

But when distracted, a person does not pay attention to either the body's sensations of feeling full, or to the sensory characteristics of the food. Many studies have linked obesity to watching television and that link is likely due to inactivity, Hirsch said. But perhaps entertaining shows are also contributing.

"If you want to lose weight, turn off the television or watch something boring," he said.

Something boring? I wonder what that means. I'd make some suggestions, but then, I know that dozens of Hollywood attorneys and television producers would be attacking my blog. *cough* Happy TV watching everybody!

Go Cavs!

Congrats to the Cleveland Cavaliers who are on their way to the NBA Finals. This is the first chance in a long time for Cleveland to win a major sports championship in decades. From the Associated Press, this pretty much sums up what's going on in Cleveland this morning. Good luck in the Finals!

As his teammates danced and carried on while wearing baseball caps and T-shirts proclaiming "Champions," LeBron James walked around in a daze with a smile etched across his face. "This is like a dream," he said, shaking his head. "This is probably the best feeling that I've ever had in my life." An entire city felt the same.

For the first time in a long time, championship-starved Cleveland has something to feel good about. The Cavaliers, once the punch line to jokes and Michael Jordan's favorite foil, are Eastern Conference champions — and on their way to the NBA finals.

TB Double Standard?

Last week, I was only peripherally following the case of Andrew Speaker. He's the guy who flew to Greece to get married and it was found out that he had a form of drug-resistant tuberculosis. There was a lot of media coverage about who was exposed on the airplane, and the process of contacting all these people. Apparently, Friday, he went on national television to apologize.

Right now, Speaker is under US government quarantine (the first since 1963) while he is undergoing further evaluation and treatment. His medical plan is to stay in a Denver hospital for possibly two months to receive antibiotics and possibly surgery.

As I was reading this story, there were aspects of this that sounded kind of familiar to a previous post that I wrote. Then, it hit me. I wrote two months ago about Robert Daniels (pictured above - image credit) and his ordeal in Arizona.

Daniels moved from Russia to Arizona and it was found out that he has drug resistant tuberculosis. Reports state that he refused treatment or even to wear a mask. For these reasons Daniels ended up in jail and is still there to this day (Read TB patient in jail for more details and an interesting comment section).

I started asking myself: How can one guy be under federal quarantine and placed in a hospital, and another guy be under state/local quarantine and placed in jail? As I did more research, I found this article on MSNBC/Newsweek.

Robert Daniels has been confined to his small, cinder-block room for nine months so far and he doesn’t know when his confinement will end. He has one barred window that is frosted over so little light shines through, a metal toilet with a metal sink and he spends most of his day in bed. He hasn’t had a hot shower since his detention and has to bathe with sanitary wipes, since he has only been allowed out of his room once. But Daniels is not a criminal, and has not yet been charged with any crime. Instead he is a tuberculosis patient who was quarantined at the Maricopa County hospital in Phoenix last July after failing to wear his mask in public.

While tuberculosis patient Andrew Speaker, at the center of a media storm this week, was the first person since 1963 to be quarantined by the federal government, some others, like Daniels, are detained by local and state officials.

[A]fter Speaker's case went public, [ACLU attorney Linda] Cosme says she will be filing a motion to move Daniels' case to federal jurisdiction. "Speaker's treatment is much better," Cosme says. "While Robert acknowledges that he should be quarantined, he should be allowed out to exercise his legs and be in the sun." As long as he’s wearing that mask.

Is there a double standard here with one quarantine in a hospital and the other quarantine in a jail? Well, the ACLU is going to make an argument for this. Do I agree? If these cases where similar, then I would say, yes, there has to be consistency here.

But, I think there are more differences than similarities in these two cases. Daniels was pretty adamant about not wearing a mask in public, lied about not wearing a mask, and didn't follow other public health recommendations. These choices landed him in jail.

Meanwhile, Speaker was already in Europe when he learned of his disease state. Granted, he ignored health official recommendations not to take a long flight home, but I'm willing to give him a pass on this (I'm starting to hear the hypocrite chants) because the guy was scared and thought he was going to die. Plus, since getting home, he states he's been feeling guilty about taking those long flights and has been apologizing to anyone who will listen.

Is there a double standard going on here? Am I being a hypocrite here? Well, you be the judge (and I know you'll let me know). These cases will be more and more interesting as they continue to unfold.

Flea thoughts

I just want to warn you right now. There are going to be no new relevations in this post. If you're looking to see if I have this uniquely new spin on this situation, then just click on to whatever you were going to read next. This post is going to be just rambling thoughts....

Over the past two days or so, I've been reading and reading and reading all the reactions and analysis on this situation. There are very emotional posts, there are blame directed posts, there are self-righteous posts, over what? Over a guy who got called out on having a blog...

This just happened to be a great media moment because it happened on the witness stand. Just wait, one of the fall season premiere episodes of Grey's or House or whatever medical TV show, is going to have this moment....

Some people out there in blogland are proclaiming that this case proves that there is no such thing is anonymous blogging. Heck, I could have told you that - and I have - here, here, and here....

There are even some out there who say that either any docs who blog anonymously are cowards and should blog under your real name anyway (they say this case proves that). Or, still others who say that medical bloggers should make up a set of rules and stick by them. Uh, yeah, that's a great idea (I don't think so).

Just from my personal point of view (i'm not speaking for anyone but myself), if I wanted to blog under my real name, than I would from the beginning. It took the realization about six months ago that anyone out there can find out who you are, where you are, and any kind of personal information that they want to. This really freaked me out, but I kept blogging nonetheless.

About a set of rules, I think this is great for people who use their real name blogging. I also think it's ok for those who feel the need that medical bloggers need some kind of credibility and legitimacy. However, I think this sets the bar higher than it needs to be. Just another reason for enemies to come after you and your blog.

I'm all for patient privacy, but to put all of your credentials out there, for me, I'm not sure about that. If you "anonymously" blog, if you put your credentials out there that some of these rules say, why not just use your real name anyway.

Are there any huge ramifications to the medical blogosphere because of this case? I continue to stand by my past statements in which I've said I'm concerned about the continued growth of the medical blogosphere from the grassroots. Many of these blogs will continue to go private quietly and other potential bloggers will be discouraged to even start.

You know, Flea is probably out there right now, watching all of this happen, and laughing at us for all the attention that we're giving this case. He's probably started a new blog, with a different name, with a different identity, and blogging about anything but medicine. All the best to you, Flea.

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.

Memorial Day

Never forget.
(image credit)

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!