Plane crash out of Lexington

Mark at BlueGrassReport is giving excellent coverage of all info developing re: the crash this AM. I've already received an email from at least one friend who has been affected by a death in the crash.

The running theory right now is that the pilot somehow used the wrong runway, the shorter of two, when the longer one would have been required for a safe takeoff. People in medicine are obsessed with system error over human error, but this sounds like a pretty terrible example of one or the other, likely the former. One survivor is in critical condition at UK Hospital. The other 49 folks didn't fare so well.

Sadness.

Medicine: Punchdrunk GenMed Singalong Redux

Hours worked on General Medicine Sub-I = 297, only 92.8% of what's allowed maximum under law for residents! Now, had my senior been mean and actually made me take call this weekend, I would have bumped up to 328, so I only stayed legal by the grace of a benevolent resident. Finis Est!

MedSciPol: il buono, il brutto, il cattivo

The Good: Plan B going over the counter

The Bad: Pluto is just a dog now

The Ugly: Charges dismissed against Ernie Fletcher after settlement

Medicine: ADHD stimulants getting black box for heart problems, psychotic behavior

The FDA has become trigger-happy with its cute little black box warnings. Here's a sample from one of their latest meetings.

FDA wanker 1: Oh know! People shouldn't take these really important psychiatric medications! It might have a 1 in 100,000 chance of making them piss themselves on Tuesday nights! And I'm basing this statement off really lousy data, but it's better than we had for Vioxx!

FDA wanker 2: I know! I mean, Johnny might have a 1 in 50 chance of blowing his brains out with his dad's Glock, but if he takes this anti-depressant, he'll have a 1 in 50,000 chance of thinking about shooting himself more than he would have!

FDA wanker 3: And fuck stimulants. God knows that people with ADHD are just lazy assholes who should learn how to drink coffee like the rest of us!

FDA wanker 2: Any new ideas on how to osbtruct plan B?

FDA wanker 1: They should have to shoot their babies with Glocks like the rest of us instead of getting to avoid the consequences of being dumb enough to get raped. That girl should have known better than to walk around the streets at 7pm without her burka on...

FDA wanker 3: Sorry, I wasn't paying attention. What did you say? Oh, look at the bird in the tree!

I'm all for informing patients (and parents of patients) about the reality of being on psychotropic medications. Sure, stimulants are overused by primary care docs who have rich white patients who are getting B+'s instead of A-'s and only got a 1900 on their SAT because they couldn't pay attention well enough to study after playing World of Warcraft for six hours every night.

However, scaring patients is not the same thing as educating them. If the FDA is going to add a black-box label to a psychiatric medication, it should say a little more than "Abandon hope, all ye who enter here!"

Patients are okay at saying that they don't want to take lisinopril to lower their blood pressure if it might wipe out their last little bit of kidney function. Patients are okay at saying they don't want to take their coumadin to keep from having a stroke if it means that when they fall next week they're going to bleed to death.

But parents aren't good at saying, "Well, if my child isn't on this medication, they might wind up flunking out of high school and smoking crack, but if they are, they have this theoretical risk of a heart problem. Hmm." Parents are scared of giving their kids ANYTHING with a risk, because if a kid gets hurt by a disease, that's the disease's fault. If a kid gets hurt by a drug, that's the doctor and the parent's fault for letting the kid take the drug.

Bottomline of this angry ramble: Yes, psychiatric medications have significant and important medical risks. But, yes, untreated psychiatric disease can be fatal in and of itself and has immense functional consequences for the future. Psych meds for serious psychopathology are no more "optional" than are antihypertensives for folks with high blood pressure.

We owe our patients, and especially their parents in the case of kids, a full education concerning the benefits and risks of putting their kids with real psychopathology on powerful medications that haven't been studied as well as we'd all like. I don't care if the rich, white B+ students get their Concerta or not. But I'm scared to death that a poorly educated parent could make a completely uninformed decision about their children's future because the FDA wants to freak them out with a big black box.

Bad FDA. No Plan B for you.

Medicine: HIV developments

As reported in this month's issue of JAMA, there is some indication that routine circumicision of all African men "could prevent 2 million new HIV infections and avert 300,000 deaths over the next 10 years". Why could this be? Well, Australian researchers have discovered that Langerhans cells on the inner surface of foreskin have a thinner keratin layer that may be more susceptible to the virus.

Medicine: Managing the violent kids

Excellent NPR segment on some research at CHA looking at school-based interventions for children with serious behavior problems, and the cost (so far, about 2k per kid) and benefits (so far, a lot more than that, in improved attendance, fewer distractions, et al.) of interventions.

Medicine et al: the Survey says

Random survey results amok in the news today:

Unlikely: High school kids aren't doing it as much. Doesn't assess oral or anal or DVDA.

Maybe: Zogby says 80% of dems nationwide were happy to see the Putz defeated in CT, support Lamont. For some reason I can't get the details to pop up about sampling procedures, but that's surprising to me.

No shit: Out of 34 countries surveyed, only the Turks were more ignorant with regards to evolution than Americans. Beautiful quote included:

“American Protestantism is more fundamentalist than anybody except perhaps the Islamic fundamentalist, which is why Turkey and we are so close,” said study co-author Jon Miller of Michigan State University.

SMACK!!!

Thank you, Onion.

Politics: Clearing up Connecticut

After reading a few zillion convoluted analyses of Ned Lamont sticking his thumb up Joe Lieberman's ass, I figured I'd break it down for everybody into its most fundamental portions.

#1: Joe Lieberman is a selfish douche bag.

#2: Joe Lieberman is a selfish douche bag who votes as a Democrat for setting senatorial agenda and committee membership.

#3: The Democratic party needs senatorial votes.

#4: Ned Lamont is a hippy opportunist, who, unlike Lieberman, at least pretends to not support pure evil superficially, while remaining willfully ignorant of the way the bloated American legislative branch works to the point of being as useless as a blind mohel.

#5: Ned Lamont could not possibly win a general election if Joe Lieberman were running as an independent.

#6: Joe Lieberman will run as an independent because he is a selfish douche bag who takes his foreign policy notes from twenty-year old neocons smoking clove cigarettes in coffee shops in New Haven. And from his mother, that told him to protect Israel even if Israel decided to throw flaming shit at its neighbors because somebody sneezed across the Gaza border without using a tissue.

#7: Welcome to the Senate, Mr. Republican from Connecticut, even if 79% of the state thinks you suck matzo, and didn't vote for you the last three times you failed to win a seat in Congress.

That is all. Save your time for important articles about Lindsay Lohan wanting to blow up Iraqis for funsies.

Update: If for some strange reason you require more nuance than the Sparkgrass 7 points, Jacob Weisberg's take, as well as an MSNBC article on how Republicans will now be able to paint Dems as pansies, should round out your education.

Labor: how I learned to hate Ronald Reagan and stop worrying

Twenty-five years ago, on Aug. 3, 1981, more than 12,000 members of the Professional Air Traffic Controllers Organization walked off the job, setting off a chain of events that would redefine labor relations in America.

In response to the walkout, President Ronald Reagan issued one of the defining statements of his presidency. He said the striking air-traffic controllers were in violation of the law; if they did not report to work within 48 hours, their jobs would be terminated.

Reagan carried out his threat.

I was just a few days old when Reagan decided to fuck labor in the ass for all time.

NPR covers the 25 year anniversary of the greatest single blow of destruction to progressive economics in my generation.

Medicine: who knew you could crap out an unscientific phone poll and Pediatrics would still publish it and pretend it was research?

Teens whose iPods are full of music with raunchy, sexual lyrics start having sex sooner than those who prefer other songs, a study found.

In other news, people who think food taste good are more likely to get fat. And people who like to lick tables at McDonalds are more likely to get sick. And people who do really horrible research and make a career getting published by being political hack douchebags producing unnuanced research with pitifully obvious conclusions based on poorly collected correlational data will enter a special level of hell where they will be forced to read colorless statistical manuals until their ocular globes rupture.

Maybe it's just me, but the Rand Corporation looks like a scary group of folk. Condi Rice interned there.

Medicine: Adventures with an Ice Pick

You've been waiting for it for years. A short history of lobotomy.


As an extra bonus: I really appreciated the Google link from below all about how much of a creep Dick DeVos is.

Medicine: Punchdrunk GenMed Singalong

Maximum number of hours a resident can work each week before program gets into trouble = 80.

Maximum number of hours a student can work each week before program gets into trouble = 168.

So, with precisely four weeks scheduled for my general medicine sub-internship this month (07.31 - 08.27), I just want to track whether I'll make it under the resident cap.

28 days, minus four days off, so 24 days, working an average of 13 hours and 20 minutes a day, would do the trick. Right now, I'm right on track.

To be clear, I'm not complaining. That's what a sub-internship is, and I don't think I could have hand-picked a more pleasant team to be paired with. But no matter how Panglossian I get describing the experience, it's no vacation. It's also by no means even one of the worse sub-internships that a fourth year medical student could take, and there are worse things to be doing than tucking sick people into their hospital care.

Watching FoxNews, for example. Or being constipated. Those things are much worse. I could also be on the rectal exam service with my GI/Liver colleagues. I prefer to stick that finger into my nose rather than a sick person's ass. A healthy person, that's a different story. But these people have blood in their asses. Ew!

I'll keep updating this everday, for those random folks who might care. If I can get one person randomly googling into Sparkgrass to go to cooking school instead of medical school, I will have done my job.

07.31 0830 - 1730 9 hours
08.01 0630 - 1600 9.5 hours
08.02 0630 - 2400 17.5 hours
08.03 0000 - 1430 14.5 hours
08.04 0600 - 1830 12.5 hours
08.05 0000 - 0000 Day off!
08.06 0600 - 2400 18 hours
08.07 0000 - 1300 13 hours
08.08 0600 - 1800 12 hours
08.09 0630 - 1500 8.5 hours
08.10 0600 - 2400 18 hours
08.11 0000 - 1500 15 hours
08.12 0600 - 1100 5 hours
08.13 0000 - 0000 Day off!
08.14 0600 - 2400 18 hours
08.15 0000 - 1300 13 hours
08.16 0630 - 0630 12 hours
08.17 0630 - 1500 8.5 hours
08.18 0600 - 2400 18 hours
08.19 0000 - 1400 14 hours
08.20 0630 - 1530 9 hours
08.21 0000 - 0000 Day off!
08.22 0600 - 2400 18 hours
08.23 0000 - 1300 13 hours
08.24 0630 - 1830 12 hours
08.25 0630 - 1530 9 hours
08.26 0000 - 0000 Switch Weekend
08.27 0000 - 0000 Switch Weekend
Total 297 / 320 (92.8% max)

Comedy: the Axis of Evil Comedy Tour

More than worth a listen. An Egyptian, a Palestinian, and an Iranian walk into a bar, and make fun of you.

Politics: Minimum Wage Whiskey Tango Foxtrot

Republicans muscled the first minimum wage increase in a decade through the House of Representatives early Saturday after pairing it with a cut in inheritance taxes on multimillion-dollar estates.

WHAT???

Harry Reid calls it blackmail. Generally, when Harry Reid calls something blackmail, I scoff at him. He's a little histrionic.

If I needed any one instance to demonstrate everything about the Republican party that is wrong for America, I now have it.

"Just think of what it is to have a bill that says to minimum wage workers, 'We'll raise your minimum wage but only if we can give an estate tax cut to the 7,500 wealthiest families in America,"' said Minority Leader Nancy Pelosi, a Democrat.

Again, when Nancy Pelosi opens her mouth, I usually roll my eyes, knowing that I probably agree with her in principle, but that she'll try to figure out a way to make liberalism sound even whinier than it did before.

But this time, right on, Nancy. Fight the disgusting F-tards.

Medicine: Teenagers bagging mothballs

Since asking about huffing isn't enough anymore. Mothballs. Yuck.

Medicine: drunken mice and serotonin

From Nature Neuroscience:

We all know that consumption of alcohol can lead to changes in mood, cognition and motor behaviour, but how ethanol affects neuronal function is not so well understood. A new study shows that ethanol inhibits clearance of the neurotransmitter serotonin (5-HT) from the extracellular fluid in the mouse hippocampus, and that, surprisingly, this occurs through a mechanism that is independent of the serotonin transporter (5-HTT).

Beyond just being interesting for the exact cellular mechanisms of alcohol intoxication (which have amazingly eluded researchers for the most part), it's dually interesting that increasing serotonin concentrations with more alcohol produces a CNS depressive effect, which seems paradoxical in the light of SSRIs. Further in the the study, fluvoxamine was found to have similar effects acutely on the hippocampal serotonergic neurons. Of course, being an SSRI probably has nothing to do with being an antidepressant in the short run.

The serotonin transporter doesn't tell us the whole story, but does offer at least some clue as to part of the genetic basis of alcoholism, as the ability to clear 5HT (which attributes at least somewhat to intoxicating effects) gives a mechanism for subjective differences in experience. The study does not address changes in regulation of the 5HTT chronically with alcohol abuse, but we could speculate that, most importantly, there could be genetic differences predisposing some to more maladaptive physiology.

But the 5HT transporter isn't the whole story, as a hippocampal NE-T might contribute. Imagine that, no clean mechanisms.

This work clearly establishes that blocking the removal of 5-HT underlies, at least in part, the effects of ethanol in the brain. It remains to be determined exactly how ethanol inhibits 5-HT removal from the extracellular fluid. The noradrenaline transporter, which also transports serotonin and is expressed in the hippocampus, is one candidate site of action. However, more work will be required to confirm a role for this transporter in the influence of alcohol on neuronal function and behaviour. These findings could help to explain the positive association between a polymorphism in the promoter region of human 5-HTT, which confers low-expression of 5-HTT, and alcoholism.

With alcoholism, our primitive understanding has continued to limit our therapeutic approaches to a problem that, intuitively, an outsider would expect wouldn't be all that terribly difficult to hash out.

My undergrad research PI sent me the article, making me nostalgic for my invertebrate neurotransmitter research days. Sigh.

(Note: the other Sparks GM with the ophthy article from 1967 obviously isn't me)

MedPol: Bush uses first veto on stem cells, will trade get out of jail free card for immunity on Water Works for three turns

I have nothing to say about Bush vetoing federal funding for stem cell research. Nothing polite, anyway.

I just wonder why he didn't just sign it with a signing statement reading, "NOT!"

In more positive Bush news, John Dickerson laments that Bush doesn't swear more. He sounds so much more nuanced when cursing. In his convo with Blair, he actually sounded like someone with a vested interest in foreign policy and, more importantly, in the role of the UN in international diplomacy.

MedPol: some of the good and bad of the Fletcher administration

Bo links a nice article featuring his papa's role as a policy wonk, rather than a politico, in KY governor Ernie Fletcher's administration. It's good to hear about sensible, results-driven policy work on the other side of the aisle (or either side, for that matter). The article mentions some KY medicaid reforms of which I am entirely ignorant, but I emailed to see if I can get some more info.

As far as I can tell, the simplest way to sum up conflicts between conservative and liberal economics is that liberals want to split up the pie evenly, and conservatives want to make the pie bigger, figuring that there will be enough to go around for everybody, and some leftovers (whether it matters if everyone gets a piece or not is a moral question not necessarily addressed).

But with something like the internal management of Medicaid, essentially the size of the pie is fixed. Management becomes a matter of optimization, of getting the most bang for the buck, the greatest good for the greatest number of folks. Market principals become tools to make those things happen rather than ideals to which to aspire. That's number-crunching and policy work, not necessarily politics. And that's the point where I feel comfortable posting about an article hopeful of the work of even the most arrogant Republican administration.

My understanding of Cowgill's work is obviously superficial at best; I know some friends doing advocacy work with leftist orgs were highly critical of the tax reforms mentioned in the article Bo cites for not doing enough to update KY tax laws that were horribly out of date. However, it's also noteable to say that those tax laws became absurdly out of date under the watch of multiple previous Democratic administrations that did little to address tax fairness in Kentucky. So whatever failings may have been present in KY tax reform, it seems like there was a lot less being done by Paul Patton and Brereton Jones and Co long before Fletcher's crew was faced with the task.

In an administration of so much unadulterated jack-assery, I'm happy to be able to link to some good things going on back home in the Bluegrass.