Saturday, September 30, 2006

A2: Never going back

So, after the latest in a series of extremely frustrating experiences with the dollar movie theater in Ann Arbor at the Briarwood Mall, Courtney has vowed that we will never set foot in the place again.

Among the biggest complaints include the bathrooms being not fit for the third world, and the employees that work there generally being either obviously lazy, incompetent, or just flat out rude.

For example, once an employee basically dumped half of an ICEE on all over me and the counter, and just sort of laughed and left me to clean it up. She had overfilled it ridiculously, and as soon as I tried to pick it up, red sugar water went flying. That was months ago, after I'd waited in line for about twenty minutes because only one employee was working at the combined concession stand/ticketbooth, while another employee sat beside that employee telling her about how big of an ass her boyfriend was while a line of fifteen people waited for popcorn. Never mind maybe opening up a second register.

I won't detail yesterday's event, because I'd probably pop a blood vessel describing it. Or Courtney would hit something reading it over my shoulder. GRRR!!!

I love cheap movie theaters. But I don't like incompetent businesses, and I'd rather not support the incompetency of the Briarwood Dollar Movies or the pieces of shit that they've hired to work there.

Jesus Hates Online Gaming, Part I

In an attempt to placate a shadow constituency, Capitol Hill scumbags tacked on a self-serving online gambling ban to a port security bill that passed Friday night. Silly since, in reality, this issue is not even at the top of the extreme Christian right agenda (the only group of simpletons who could be pushing for such a ban).

This measure essentially makes it illegal for financial institutions to transfer money to internet gaming sites. Actually, this is funny since major credit card companies stopped transferring into gaming sites several years ago by their own decision. The perceived outcome from the gaming community is that the seasoned online gambler will not be too troubled, but that the casual player (read "dead money") will cower away. This is not an unreasonable assumption given our uncanny ability to lay down to scare tactics.

The bill has several carve outs for certain types of gambling including horse betting. That makes sense though, because the Bible says betting is ok as long as you bet on animals. I think this begs the question, "What would Jesus ban next?" And I'm crossing my fingers that the answer is Starbucks.

Friday, September 29, 2006

LGBT: Out of state couple to wed in Mass

A Mass. supreme court justice has just ruled that two women from Rhode Island can get married in Mass. because their state does not have laws preventing same-sex legal unions. This could be a another important step toward spreading the legal right of marriage to those who live outside Mass. Of course it doesn't help us here in MI (thanks Prop 2), but if it helps someone, I'm all for it!

Thursday, September 28, 2006

Not your cousin's microbrew

Salon has an interesting story on the Taybeh brewing company. This West Bank microbrew seems to be uniting Palestinians and Israeli's on both sides of the border. But the story of the business is typically Mid-East

They opened the brewery with the blessing of then Palestinian President Yasser Arafat, whose picture still adorns the buildings of the Fatah-run council in Taybeh. To ensure sales in Israel, the Khourys obtained a kosher certificate for the beer from the rabbi at the neighbouring Jewish settlement of Ofra (with which relations cannot otherwise be described as very good).
And now, with the rise of Hamas they are considering a non-alcoholic beer with a green Hamas label. It's free enterprise, it's beer, it's a beautiful thing.
"We don't have a country yet," he added, "but we have our own beer."

Wednesday, September 27, 2006

Health: A Trans Fat Free Dining Experience

NYC is proposing a prohibition on Trans Fats in its 24,000+ resturaunts and fast food joints. This could be a HUGE step into government regulation of food health. Why the physician in me applauds this potential move, the french fry lover in me is a bit more cautious. I agree we need to find healthier alternatives to fast food and maybe it'll take a bold statement like this to get it done - but I'm just concerned that such an imposing law could set a precident for other similar laws that may be seen as "out of bounds." Only time will tell!!

Sunday, September 24, 2006

LGBT: Being a gay frat brother

Here is a very interesting article about one man's experience coming out while in a fraternity at Yale. Somehow situations like this have a way of working themselves out for the best.

Friday, September 22, 2006

Medicine: Luxury Child Psych Care: Value or Class Privilege?

NPR covers the story of Amy, a 16-year old rich kid who was severely depressed. Amy, fragile in her middle-upper class menagerie, couldn't handle what sounds like a pretty dungeonesque child psych wing of a general hospital. Her rich parents found Sheppard Pratt's Overlook program. Overlook is $1700/ day, and doesn't take insurance, because, well, insurance won't pay $1700/day for psychiatric care.

My gut reaction, which isn't my final reaction, is a general a resounding WTF?!?! What business does an academic medical center have creating psychiatric hotels? Why is an academic medical center filling a luxury-care market niche? Why does Amy get to be "Amy times ten," as she says, while kid in the ghetto can't even be "Kid in the Ghetto times one."?

But class-warfare Sparky loses out to cost-efficiency Sparky every time:

Psychiatrist Vaeth doesn't have the data, but he thinks Overlook could prove cheaper than multiple short-term stays at other hospitals, and that insurers might learn from some of Overlook's approaches.

"If this program flourishes and does well and people say, 'Wow, if you have $1,700 a day, you will do well psychiatrically,' then why couldn't we develop a similar program but maybe scaled down to $1,000 a day?

That's closer to what insurance companies might be willing to pay.

Right now, Overlook is half full, and some other hospitals are considering luxury care, such as the Harvard-affiliated MacLean, which already offers an intensive therapy program. That program has fewer amenities like private rooms, but it is sometimes covered by insurance.

Amy left Overlook after four months, at a cost of about $200,000. Her aunt says her niece has gained enormous perspective and strength. Amy thinks so, too.
I admit that I'm not particularly going into child psychiatry to treat the children of parents who can afford 200k out of pocket hospital expenses and not launch the entire family into a deep, dark depression (which isn't to say I wouldn't happily treat them, or that I wouldn't accept out of pocket payment!). For 200k, I bet I could gain enormous perspective and strength too.

But Vaeth has a point that I can't even start to deny, which is that luxury psychiatric care (or at least a lot nicer than the white-walled dungeon Amy describes in the audio clip) might very well be a lot cheaper to the system if it allows a child to be accurately diagnosed and started on a treatment plan that will allow them to avoid multiple hospitalizations (and lost childhood to mental illness) in the future.

So, let's get NIMH to fund a study where poor kids can go to Overlook as well. Let's follow them for a few years, and let's find out if it pays for itself, or not. If not, let's at least leave the mint-on-pillow approach to the private sector.

Public Health: HIV tests for everyone?

The USCDCP has announced plans to encourage widespread HIV testing, just like we have widespread cholesterol screening and pap smears. I think this is a great plan. It will help to identify those who are infected and don't know it while also working to remove some of the stigma associated with getting tested for fear of getting a positive result. They key is to identify those who need treatment and get them on a cocktail before they can unknowingly infect some one else.

Your thoughts?

Wednesday, September 13, 2006

Medicine: Stanford behind again, gets coastal bonus points for banning freebies

I'm not sure why Stanford and UofM seem so intimately linked in so many ways. Both are perennial low top-10s that steeplechase each other based on who can lobby U.S. News the hardest to change the formula to benefit them. Our deans have been seemingly buddy-buddy on a variety of issues. They're both in uber-rich snotty liberal college towns. And now, just now, they both have a ban on freebies from drug companies.

The difference? Stanford's is new. WTF? How does Stanford get a headline for doing something that many other sensical academic medical centers figured out a long time ago? Yale and UPenn are mentioned just over the past few years as well. How about some love for the Marxists in Ann Arbor?!?!

Friday, September 8, 2006

Medicine: do we really need another SSRI for PE?

Johnson and Johnson and Ortho-McNeil think so, and are, of course, wrong money-grubbing ass-tards.

We know SSRIs delay ejaculation (and suppress libido). We know that SSRIs plus Viagra help premature ejaculation. SSRIs aren't amazingly benign drugs to take, but PE isn't necessarily a very benign condition for psychosexual well-being which is probably vastly underestimated in its importance in the mental health of a variety of populations.

Dapoxetine is theoretically short-acting, but its side effect profile doesn't look different from any other SSRI. The shameless dapoxetine business website goes to great lengths to classify PE as a psychological, not an organic, disease, which is pretty dinosaur-ish in many ways. The logical derivation from their own statements is that we should then treat the underlying psychopathology, not band-aid it with some short-acting SSRI not dosed in such a way that it could actually treat depression or other underlying psychiatric comorbidities.

PE is undertreated, and I'm not sad that research is being performed for better therapies, pharmaceutical or otherwise, to address it. But taking a bad solution to market isn't progress, despite what our business colleagues would like us to believe.

Thursday, September 7, 2006

Medicine: Academic Doping

I stand proudly above my soapbox and scream about how poor kids don't get the treatment they need for ADHD, while rich kids take Ritalin like a multi-vitamin because they got a B in math on their last report card. And at least MSNBC agrees. As evidenced by some of the obvious misinformation of belief held by some of those in my mental health policy course with regards to whether ADHD is even a real disease, we face a reverse mythology about the condition that somehow drug companies or script-happy docs have made up a disorder to fund business, when it's in fact pretty tough to get a real diagnosis backed with neuropsychiatric testing and evidence of a real neuropsychiatric condition in more than one setting.

And maybe it does happen some places. Obviously it does. Every med student knew at least one chode when we were studying for the MCAT that was popping Adderall like it was going to make up for 21 years of academic jerking off in six weeks time. They obviously got their amphetamine salts from somewhere, and it probably wasn't Columbia.

So summary: soapbox = rich kids on Ritalin + poor kids on crack = SparkWrath!

Monday, September 4, 2006

Medicine: All meds unhealthy, if you listen to Tom Cruise's douchebag spokesperson

So Tom Cruise apologizes to Brook Shields for playing (anti-)psychiatrist without a license. And then his douchebag mouthpiece has this to say:

"(But) he has not changed his position about anti-depressants, which as evidenced by the black label warnings issued by the FDA on these types of drugs, are unhealthy."
The following is a list of other medications (maintained by Joyce Generali at Kansas Med) which must be unhealthy as well, as they carry FDA black box warnings:
Point taken, I'm sure. That is all.