Medicine: Problems for Fat Asses

We all know that obesity is bad for you. It kills your joints, stresses your pancreas and wreaks havoc on your heart. But now doctors have discovered a new problem with obese people: they don't get full doses from intramuscular injections. Yes, it turns out that the fattening of America means doctors need longer needles to give an injection.

Sounds to me like the solution isn't a longer needle, but better effort and strategies for teaching our patients healthy living. But hey, why try to help patients live better when we can just keep building things bigger?

"BEEFCAKE!"

Blogging: Within Normal Limits of Reason

A most excellent med-blog by our own Sultan of Graphs, Ming-Chi Kao.

Too Much to Blog: and no time to blog it

Internal medicine and Thanksgiving break mean my heart is elsewhere at the moment.

For those of you who don't understand the arbitrary nature of medical school evaluations, in the past week, I have received my absolute best and absolute worst evaluations from attendings during the same month. Somebody's being too nice. Somebody's being too mean. And they're all being incredibly arbitrary.

Surprise! Raising the Florida minimum wage didn't lead to massive job cuts!

Camden, NJ is the most dangerous city in the nation. Poor Detroit can't even win THAT distinction, coming in at a competitive #2.

Jerry Falwell's douchery now includes suing companies that don't wish you a Merry Christmas. Btw, My Cats play Falwell U next Friday. Having spent two summers in my youth at a brainwash Baptist camp at Liberty, this makes me sorta shudder.

Hospitals are getting noisier. If the patients would quit frigging breathing, maybe their IV wouldn't keep beeping all the damn time! Oh wait, yes it would.

And Medicare D just muddies the picture for seniors trying to get their drugs, as Barry Schwartz writes, because behavioral economics research demonstrates very clearly that having too many choices without clear distinctions can lead to market paralysis, rather than freedom.

And oh yeah, after eight years of being vegetarian, I just tried my first Tofurkey. It's absolutely amazing.

And if the drug doesn't work

Related to Garrett's previous post about the PT-141... If the drug doesn't work on you, try looking at billboards of semi-naked models. They drive British drivers to distraction.

How to die in horror movies

So, it's a bit after Halloween, but it's funny anyway...
FamilyMediaGuide.com reviewed lots of movies and saw that impaling is the most common way people die in horror flicks. Just so you know to avoid sharp objects.

Apocalypse Now: Time to Panic

The headline in today's Lexington Herald Leader shouts,

Kentucky Braces For Killer Flu Outbreak

But continues

It's been nearly 90 years since history's worst epidemic tore through Kentucky with a vengeance.The 1918 killer strain of influenza, known as the Spanish flu, often killed young, otherwise healthy adults within hours.

Despite today's medical advances, in some ways, Kentucky will be no more immune to the next worldwide outbreak of a new flu strain.

It could sicken more than 1 million Kentuckians and kill thousands, according to federal estimates.

It's a scary scenario: Packed and overwhelmed hospitals. Delays in getting vaccines and preventive medicines.

Public health experts warn that just such an outbreak will happen someday -- maybe as a result of bird flu circulating from Asia, maybe not.

"We will have another pandemic in the future," said Dr. William Hacker, commissioner of the Kentucky Department for Public Health.

I just wet myself for nothing, apparently. Are articles like this one really helpful to anyone?

Medicine: Hey baby, take a sniff

The aphrodisiac pill. And, apparently, it works on women as well as men. As if Long Island Iced Tea didn't already have that distinction.

Right now it has one of those stupid drug names: PT-141. And PT probably doesn't even stand for something cool like "penile tumescer" or something like that. And it works on melanocortan receptors. In fact, the drug's effects were discovered while working on a tanning pill, but nobody could notice if they were getting tanned or not, because they were all running to the bedroom.

This discovery falls somewhere between parlor trick and Nobel prize winner.

For the science nerds and skeptics among us (and you know that's you), here's a decent Wikipedia article on the drug and some of its pharmacologics.

And even better, here's a PDF-file FAQ from the manufacturer. Not for the consumer, mind you, but for us nerds who follow stage 2 clinical trials, this is exactly what we want to see.

And here's some lame sex psychobabble voodoo crap from the manufacturer himself:

"Sexuality isn't just a physical thing," Katz said. "In many cases, there are some underlying emotional or psychological issues, and this shouldn't be used as a Band-aid. It's something that might mask relationship problems and shouldn't be used as a shortcut."

Now, when I say this is psychobabble, I don't mean he isn't absolutely correct. Of course he is. But he's terribly simplifying the equation and being pretty dishonest about sexuality itself.

Most people, at least married people, want to be sexual. But just because they want to be sexual, doesn't mean that their bodies are going to comply in the 21st century. Lives are busy, and stresses are high. And a lack of sexual desire is probably one strong component of the 'underlying emotional and psychological issues' in a lot of otherwise healthy couples, if you allow that all couples are going to have some of these underlying issues. It's pretty hard to have a fully functioning relationship in the context of asexuality.

So PT-141 might be an abused Band-Aid? Well sure, maybe. But let's not forget this scenario:

Partner A and B have a healthy relationship, but life has been getting more stressful because, ya know, people have jobs and car payments and kids and crap like that.

Partner A starts to resent partner B because partner B is too busy and worn out to have any sexual desire. Partner A stops being as loving and supporting a partner because Partner A is really sick about the raw deal he's getting in the sex department, where Partner A's desire has not been as fully diminished by the stresses of life, seeing as this is obviously an individualized response.

Partner B recognizes the problem, feels bad about it, and wishes that there were 28 hours in the day, so there'd be time to do all the things people have to do and still have a little time to do what they want to do. Partner B feels guilty. Partner B can't turn to Partner A, who is the normal source of support.

Partner A and Partner B don't feel as close, and the relationship deteriorates. And all because our physiology was designed for the 21st century BCE, and not for the 21st century CE.

Sometimes, low sexual desire is someone's fault. And sometimes, it sure as hell isn't. Some people just don't have such strong wires between their head and their crotch as others. As all disease seems to be, its an issue of a vulnerable population exposed to environmental stressor which results in varying responses, some of which are deemed pathologic when quality of life is lowered due to the response.

Low sexual desire is not simply the product of dysfunctional relationships, although it can be.

With the exception of pedophiles whose sexual desires require the exploitation of innocense, people should be pretty free to be whatever they want to be sexually. And while the past hundred years of progressive movements have placed emphasis on demystifying the promiscuous, we shouldn't forget that the opposite end of the spectrum exists as well, often to the chagrin of the individual who would like to have greater desire. And sometimes not.

Asexuality is perfectly fine, if the partner agrees. If not, conflict ensues. Most low-desire people do not have the luxury of falling in love with other low-desire people.

And a stressor (an often unanticipated one, given our society's artificial emphasis on limiting sexual activity before commitment) is borne.

If we continue to ignore individual differences of sexual desire, we disservice individuals who could live more fulfilled lives through appropriate therapies.

So PT-141? Bring it on. But name it something better than that. And make the bottle pretty, so its presence on the night-stand beside the Astroglide doesn't feel so pharmy.

Politics: Chuck Hagel, bipartisan hero

While it's certainly not the first time, Chuck Hagel demonstrates his anti-douchery by calling out the Bushies for being fascists. Hurrah!

The Iraq war should not be debated in the United States on a partisan political platform. This debases our country, trivializes the seriousness of war and cheapens the service and sacrifices of our men and women in uniform. War is not a Republican or Democrat issue. The casualties of war are from both parties. The Bush Administration must understand that each American has a right to question our policies in Iraq and should not be demonized for disagreeing with them. Suggesting that to challenge or criticize policy is undermining and hurting our troops is not democracy nor what this country has stood for, for over 200 years. The Democrats have an obligation to challenge in a serious and responsible manner, offering solutions and alternatives to the Administration’s policies.

Fall 2005: One of the Gayest Movie Seasons Ever

This was from an article at AOL. He's not trying to say that the 2005 season will be lame (the 5th-grade homophobic-before-you-really-know-what-homophobic-is definition of gay), but is actually commenting on the large number of films with gay characters or story lines.

What's really big are the "big movies" in EW's fall preview, though -- and the big stars who play gay for pay. Hollywood is taking some risks with gay and lesbian subject matter, and not always in tired, negative or stereotypical ways. Filmmakers and studios are banking on the public's interest in movies like 'Rent,' an adaptation of the award-winning Broadway musical (watch for the lesbian love song 'Take Me or Leave Me'); 'Capote,' with the incredibly talented Philip Seymour Hoffman; and 'TransAmerica,' starring Felicity Huffman ('Desperate Housewives') as a transgendered woman.

The biggest fortune seems to be riding on Ang Lee's 'Brokeback Mountain.' Two of Hollywood's sexiest men are in a true-blue gay love story packed with so much passion that one of the guys was injured during shooting. Jake Gyllenhaal said, "Heath almost broke my nose in (a kissing) scene. He grabs me and he slams me up against the wall and kisses me. And then I grab him and I slam him up against the wall and I kiss him."

Here Comes the Science: being cold might actually lead to more colds

Proving that common sense (and your mama) may not be as dumb as EBM wants to make it (or her) seem:

Claire Johnson and Professor Ron Eccles, from Cardiff University's Common Cold Center, recruited 180 volunteers, half of whom they got to immerse their feet in ice and cold water for 20 minutes.

The other 90 in tests during the common cold "season" sat with their feet in an empty bowl.

During the next four or five days, almost a third (29 percent) of the chilled volunteers developed cold symptoms -- compared to just 9 percent in the control group, the scientists said.

Professor Eccles said there was a simple explanation as to why chilly feet could lead to the development of cold virus symptoms.

"When colds are circulating in the community many people are mildly infected but show no symptoms," he said, according to the UK's Press Association.

"If they become chilled this causes a pronounced constriction of the blood vessels in the nose and shuts off the warm blood that supplies the white cells that fight infection.

"The reduced defences in the nose allow the virus to get stronger and common cold symptoms develop.

"Although the chilled subject believes they have `caught a cold' what has in fact happened is that the dormant infection has taken hold."

Because obviously a zillion years worth of people noticing, "hey, my nose is sniffly more often when I'm stuck out in the pouring freezing rain" wasn't good enough for us "scientists."

Next study: vegetable soup (sorry, chicken noodle fans) beats Tamiflu.

Medicine: birth control patch dosing drowning you in estrogen

A little behind on this one, but ya know:

The warning from Johnson and Johnson subsidiary Ortho McNeil, makers of Ortho Evra, says women using the patch will be exposed to about 60 percent more estrogen than those using typical birth-control pills because hormones from patches get into the bloodstream and are removed from the body differently than those from pills.

Thursday's warning comes four months after reports that patch users die and suffer blood clots at a rate three times higher than women taking the pill.

So yeah, time for birth control the old-fashioned way: pills and shots and oral sex.

General Willy Wonka, Sir: (Everlasting?) Combat Chewing Gum

This sounds like a pretty viable civilian consumer product as well. And think about all the people in Britain with rotten teeth.

The gum, described at the American Association of Pharmaceutical Scientists convention this week in Nashville, would contain a special bacteria-fighting agent to prevent plaque, cavities and gum disease.

Soldiers in the field often lack the necessary time and means to brush and floss. Compounding the problem is the stress of combat, which can encourage bacterial growth in the mouth, said Col. Dennis Runyan, commander of the Army Dental and Trauma Research Detachment in Great Lakes, Illinois.

Gum was considered an ideal solution because the Army already issues gum to soldiers in their field rations.

Dr. Patrick DeLuca, a University of Kentucky drug product developer, is working to perfect the prototype, trying to make it taste better and ensure that it retains its flavor and bacteria-fighting ability for 30 minutes to an hour.

Okay, there just had to be somebody from UK working on the everlasting gum. This might be the best development out of Lexington on the horizon short of the rumored Viagra nasal spray.

Go Cats!

Medicine: Curing HIV or just a False Positive?

This article tells of a man who was previously diagnosed with HIV, but had just been named clean from any virus present in his body. Is this a real case of someone curing themselves from HIV or just one of the very few false positives from testing? Either way, I hope we learn something from this... either how to test better or how to start fighting this nasty little bugger!

TORCH: Toxo link to schizophrenia?

So it's nothing new that we've been wondering if some sort of in utero infectious particle exposure may have a hand in the development of schizophrenia. Of course, that theory has always implicated an unknown virus.

But hell, now a UW psychiatrist thinks it's toxoplasmosis!

Proving that cat owner's are nuts (or at least have nutty children).

Cats suck. Cats suck. Cats suck. Dogs rule!

Update: I wrongly assumed he was affiliated with UW, although it looks like they'd be happy to have Fuller Torrey, given the impressive resume.

Santorum: You said that irony was the shackles of youth, uh-huh

Time to be sensationalistic!

Apparently the wife of Sen. ManOnDog, R-Pa, champion of screwing patients through tort reform, sued a chiropractor for 500K and got 330K of it. For those of you who did poorly on the comparison portion of the SAT (if that still exists), 500K > 330K > 250K cap proposed by Santorum and his cronies for a tort cap.

In other news, Sen. ManOnDog's wife went to a chiropractor!!!

Anyway, should anybody be able to sue a chiropractor at all? I mean, you pay them to screw with your back, not to do anything that's ever been shown to actually be helpful for anything. So should you be able to sue them for screwing your back up, when that's what you paid them to do in the first place, just because you aren't happy with the results?

Kalamazoo: Universal Higher Education Had To Start Somewhere

The scholarship program — called the Kalamazoo Promise — will cover 100 percent of tuition and mandatory fees for children who have been enrolled in KPS since kindergarten and whose parents live in the district.

A partial scholarship will be given to students who enter after kindergarten. For instance, a child who transfers to KPS in third grade would receive a scholarship covering 90 percent of tuition, while a student who transfers in ninth grade would receive a 65-percent scholarship.

The scholarship must be used at a publicly funded institution in Michigan, and includes community colleges.

Politics: Buchanan Takes Aim at Shrub

Isn't it the first sign of the apocalypse when Pat Buchanan is the voice of reason? Or perhaps it just shows how badly this adminstration has screwed up when even a deluded idealogue like Buchanan knows Bush is a failure.

My favorite part (outside of his dead-on call about the war in Iraq):

Under Bush II, social spending has exploded to levels LBJ might envy, foreign aid has been doubled, pork-at-every-meal has become the GOP diet of choice, surpluses have vanished, and the deficit is soaring back toward 5% of GDP. Bill Clinton is starting to look like Barry Goldwater.

Now granted, I don't agree with a lot of where Buchanan would rather see this country head. But when even the crazies are saying W is leading us to disaster, maybe it's time the leaders started listening.

Health News (not so Surprising): Trauma centers ill-prepared for disaster

Emergency care is expensive, un-profitable, unpredictable, and absolutely essential. I particularly enjoyed the last part about stocking Tamiflu but not funding programs to change how ED's operate. American's trust expensive drugs over systems based clinical solutions any day. Granted I know it's no suprise that ED physicans argue they are underpaid and underresourced but they are also the first responders for any sort of mass casualty situation. When was the last time you saw Dermatologists begging for more government funding?

Trauma centers and emergency departments similarly are strained in many U.S. cities, experts say. . . "Trauma systems are never more than a couple of minor incidents from being overwhelmed," said Larry Gage, president of the National Association of Public Hospitals and Health Systems.

Trauma and emergency care is a money loser, serving many patients without health insurance. It's also expensive to maintain a round-the-clock staff of specialized surgeons and trauma-care medical workers.

In Atlanta, hospitals often pay subspecialists around $1,000 per day to take calls for trauma care. For those reasons, many hospitals have gotten out of trauma care, increasing the load on those that have stayed in that business, industry experts say.
In September, emergency physicians from across the country gathered in Washington to rally for additional government support. More than 3,000 physicians attended and spoke in favor of a measure that would increase Medicare payments to emergency doctors and hospitals by 10 percent. But the bill so far has only two sponsors. Emergency physicians say they are amazed that the Bush administration is willing to spend billions to stockpile Tamiflu for a possible super-flu outbreak -- even though it's not clear the medicine would be effective -- while showing disinterest in aiding emergency hospitals that would have to handle flu cases.

Emergency departments are the perfect cauldrons for a dangerous strain of flu to spread through large numbers of immune-compromised people, said Kellermann, the Grady physician. Emergency centers should be expanded to have respiratory isolation areas and other services, he argued.

"We're worried about a flu pandemic and we're parking patients cheek to cheek," he said. "That's just mind-bogglingly stupid."

Politics: Tom Coburn, MD/clairvoyant

Apparently Tom Coburn can read people's mind due to his medical training:

SEN. COBURN on Roberts: I've tried to use my medical skills of observation of body language to ascertain your uncomfortableness and ill at ease with questions and responses. I will tell you that I am very pleased both in my observational capabilities as a physician to know that your answers have been honest and forthright as I watch the rest of your body respond to the stress that you're under.

MR. RUSSERT: Do you believe as a physician you can tell whether a candidate for the Supreme Court is telling the truth?

SEN. COBURN: Mm-hm, I certainly have.

MR. RUSSERT: Has any--have you ever detected someone lying?

SEN. COBURN: Uh-huh, lots of times.

Wikipedia says Coburn graduated from OK State, but doesn't specify whether it means undergrad or medical school. A quick survey of the OK State medical curriculum does not reveal classes in lie detection. Maybe he did an away rotation. Or maybe this valuable educational asset was lost in subsequent curriculum revisions. Or maybe Coburn went to Voodoo Medical School in the Caribbean or something.

Geez, as if the rest of his resume wasn't already a sufficient disgrace to medicine and humanity.

Update: Coburn's Senate.gov page reveals he was a business major at OK State, but went to med school at OU, followed by a gen surg residency in Oklahoma and a family med residency in Arkansas. So basically, Tom Coburn has about the least impressive medical resume you could fathom for someone elected to national public office.

Terror: America's Secret Prisons

The CIA has been hiding and interrogating some of its most important al Qaeda captives at a Soviet-era compound in Eastern Europe, according to U.S. and foreign officials familiar with the arrangement, the Washington Post reported.

Read it all at the Washington Post if you haven't yet. Thanks to Real Live Preacher for the tip.

Six days after the Sept. 11 attacks, President Bush signed a sweeping finding that gave the CIA broad authorization to disrupt terrorist activity, including permission to kill, capture and detain members of al Qaeda anywhere in the world.

It could not be determined whether Bush approved a separate finding for the black-sites program, but the consensus among current and former intelligence and other government officials interviewed for this article is that he did not have to.

Rather, they believe that the CIA general counsel's office acted within the parameters of the Sept. 17 finding. The black-site program was approved by a small circle of White House and Justice Department lawyers and officials, according to several former and current U.S. government and intelligence officials.

This is how democratic, enlightened nations protect themselves? Try these people and give them life sentences if you will, but there is never a valid reason for "interrogations" that occur in complete secrecy and without accountability.

Time to e-mail some congresspersons...

Television: Santos for president!!!

Okay, so the live West Wing debate totally kicked unadulterated ass.

Alan Alda is a genius. Alda, a lifelong liberal democrat playing a conservative on live, unscripted television, wove a much better case for the conservative agenda than the Bush administration could ever dream. Oh wait, maybe because the Bush administration only follows a conservative agenda when its convenient, and a neo-conservative agenda when it knows no one is paying attention.

You totally cannot access the nbc.com West Wing link right now. Awesome.

For background on the whole live debate thing, here's the CNN article explaining what was going down.

Vatican: Don't Knock Science

A Vatican cardinal said Thursday the faithful should listen to what secular modern science has to offer, warning that religion risks turning into "fundamentalism" if it ignores scientific reason.

Cardinal Paul Poupard, who heads the Pontifical Council for Culture, made the comments at a news conference on a Vatican project to help end the "mutual prejudice" between religion and science that has long bedeviled the Roman Catholic Church and is part of the evolution debate in the United States.

The Vatican project was inspired by Pope John Paul II's 1992 declaration that the church's 17th-century denunciation of Galileo was an error resulting from "tragic mutual incomprehension." Galileo was condemned for supporting Nicolaus Copernicus' discovery that the Earth revolved around the sun; church teaching at the time placed Earth at the center of the universe.

"The permanent lesson that the Galileo case represents pushes us to keep alive the dialogue between the various disciplines, and in particular between theology and the natural sciences, if we want to prevent similar episodes from repeating themselves in the future," Poupard said.

Very cool. You religious fanatics all hear that? Oh, most of you don't trust the Pope either, well, okay. I should note that this wasn't as great a statement as it sounds as it was followed with this:

But he said science, too, should listen to religion.

Damn, damn, damn. You just never win with these people.

Onion News: Hanukkah Decorations Being Defaced Earlier Every Year

November 2, 2005 | Issue 41•44

NEW YORK—A report released Monday by the Anti-Defamation League confirmed the widely held perception that Hanukkah decorations are being vandalized earlier every season. "Today, we're seeing Stars of David spray-painted with swastikas before the leaves have even fallen," said ADL spokesman Avi Mendenhall. "Our research shows that, even as recently as a decade ago, a menorah wouldn't be toppled over until well after Thanksgiving." The report noted that many shopping malls have, in recent years, begun playing anti-Semitic carols just days after Halloween.

LGBT: Only in Kentucky

If you're an aide, sometimes it pays to know the difference between the forward and reply keys if you are trying to advise your state representative about an e-mail from a constituent:

A Crestwood accountant who asked her state representative to support gay and lesbian civil-rights legislation next year received a reply not from the lawmaker but from an aide, who mistakenly sent comments meant for the legislator to the constituent.

This is one of those issues where it's safe to say 'Thanks for writing, I will consider your views' and not go too far about your personal beliefs," wrote Cheryl Long of the Legislative Research Commission and an aide to Rep. David Osborne, R-Prospect. "Seriously, these people really can get out of hand! ... This particular group is much worse than pro-lifers!"

If you reply to Ms. Amanda, make sure you delete my e-mail!" Long said of answering the e-mail from Amanda McWane.

Then Long mistakenly hit "reply" instead of "forward," sending her comments to McWane and not to Osborne as Long intended.