Monday, September 05, 2005

It's GRL Time!

Grand Rounds #L, or 50, is finally here.  For newcomers, a little explanation is in order.  Grand Rounds is a creaky old tradition that doctors have.  Once a week, they get together and talk about one "case" (which is actually a person) in agonizing detail.  Then they try to impress each other by recalling incredibly obscure details about related cases (people).  

George Washington University Department of Medicine

Actually, it is not always that bad.  Sometimes it gets a little stuffy, but it is an important part of medical education.  And some people try to lighten things up a little, as seen in this real example from SUNY-Buffalo.  

Grand Rounds in the Blogosphere has evolved such that it includes things written by doctors, nurses, EMT's, scientists, and a variety of others.  Some of the posts are presentations of clinical cases (people), others are explainers about medical science, and some are human interest stories.  We always get some commentary on health policy and a few other related topics.  The schedule is always posted here, the submission guidelines are here, and the Google Group for discussion about Grand Rounds is here.  

Looking at the schedule, it appears that we could use a few volunteers to host subsequent iterations of GR. (If we don't get any, I'll be hacking into people's blogs and spreading dancing flamingos everywhere.)  

One rule about real-life Grand Rounds is that they always must start with a really boring introduction.  Now that we've gotten that out of the way, here are the cases (people):

#0 The zero entry is from your host, Joseph j7uy5.  In case you were wondering, j7uy5 was derived by randomly striking the tips of the fingers of one hand, all together, vaguely in the middle of the keyboard.  It doesn't mean anything.  

My post is about the rationale for universal health coverage in the United States of America.  Please help me accomplish my goal of having a better-informed citizenry, by taking the time to read the sources that I linked to in the post.

#1 Our first entry is from Arnold Kling, Ph.D., posting on EconLog: Grey-area Medicine and Non-monetary Costs.  The economics of health care is a complex and under-appreciated issue.  Dr. Kling does a nice job of summarizing one important point: there are costs associated with the provision of health care that are not direct monetary costs.  This, of course, is one of the reasons that the health care market operates in ways that defy traditional economic models.  

#2 The second entry comes to us from the Philippines, courtesy of Mic Agbayani, MD.  Dr. Agbayani has a good idea, proposing a brief code of ethics for medbloggers.  This actually would be a good topic to discuss in the Google Group that I linked to up above, somewhere.  There already is something called the HONcode, which is a set of guidelines for health-related websites.  The HONcode would not be appropriate for medbloggers, but it does have some ideas that we might decide to add to Dr. Agbayani's proposal.  

#3 This next one is a thought piece regarding genetics and genetic testing.  Posting on Insureblog, Henry Stern, LUTCF, discusses a study about the relationship between intelligence and Tay-Sachs disease in Ashkenazim:
The study "hypothesizes that the genetic disorders could be the unfortunate side effects of genes that facilitate intelligence." In fact, the authors of the study had some difficulty even getting it published in the first place. There is a very real concern that some in the lunatic fringe would find great joy in using the results of the study for their own nefarious goals.
This actually is not a new topic; I remember hearing about it in Anthro #4-somethingorother when I was a senior undergrad.  (That was in 1980; I'm glad to see that more progress has been made.)  The link to the Economist article on the topic is here.  What they are talking about is the concept of a balanced polymorphism.  
Buy Now
#4 Dr. Charles tries something cool in his submission, Legends of the Examining Room.  He's published a compilation of his best blogging and would like people to consider buying it.  In his e-mail to me, he called it "shameless self-promotion."  I assured him it is nothing of the sort.  Anything that promotes considered and informed discussion about health topics is sorely needed in our society.  Plus, he's going to donate 25% of profits to medical relief efforts.  For now, that will be the Katrina relief effort.

#5 Back to the realm of genetics, Hsien-Hsien Lei, PhD, presents us with an update on one of my favorite topics, Genetics of Post-Traumatic Stress Disorder.  It was Katrina that got her thinking about the subject.  I'm happy to see that Dr. Lei points out how common PTSD is, contrary to common belief.  In fact, some people do not believe that PTSD even exists.  Those people might want to take a look at one of my earlier posts on the subject.  

I'm going to take the editorial liberty of linking to another one of her posts, to be found on the July 2005 Tangled Bank:  Infectious Disease Genetics.  Why?  As we are going to learn from Katrina, massive climate change brings about a reshuffling as ecological niches.  Each shuffle of the deck brings a new opportunity for disease to spread from animal hosts to humans.  The world is going to need more scientists studying this kind of thing.  And more politicians paying attention.
Del Rio
#6 Longtime contributor and former Del Rio aficionado, Orac, displays some backbone while he serves up a sobering treatment about vertebroplasty: Avoiding scientific delusions.  Like a good medblogger, he is not content with just echoing the news: he gives us a good background on the concept of evidence-based medicine, and its practical application; he also illustrates what kind of nonsense ensues when medical practice is not based upon good evidence.  

#7 Drunken Lagomorph, who has the most hilarious "about me" page I've ever seen, has a cute story about nursing in a correctional facility.  Having spent time in one myself (on the "right" side of the bars) I can say this is probably pretty typical.

#8 Posting on the MSSP Nexus Blog, Rita Schwab puts up a tribute to those medical professionals who are helping out in Katrina's wake.  
Among the heroes of New Orleans, Biloxi, Mobile, and beyond, are the doctors, nurses, technicians, and others who stayed behind to face a devastating storm and its aftermath in order to provide care and comfort to their patients.  As we've watched events unfold this week we've come to have a new appreciation for their training, dedication, and endurance in the face of overwhelming obstacles.   
This tribute is a nice touch, since it is mostly the looters, snipers, news pundits, politicians, and other riffraff who have been getting the spotlight.  We must not forget that the majority of people involved are doing their heroic best.

#9 & #9.5 The authors have a couple of posts on the Clinical Cases and Images Blog, which is put up by a group at Case Western University.  One post is: Who Are the Medical Bloggers and Where to Find Them?  As the name suggests, the author gives suggestions on how to find medical blogs.  For one, he suggests using Technorati and searching for the tag, medicine.  

Personally, I've started using the tag medblogger, which hardly anyone else uses, and which seems less likely to attract spam posts.  

ClinicalCases' second entry is this: Calculate Your Life Expectancy.  The idea of having people calculate their life expectancy is a clever way to point out to people what impact their lifestyle has on their mortality.  Anything that might encourage salubrious lifestyle changes is welcome.  

#10 Kim McAllister, an ED RN, sent her first GR submission: Backpack Your Way Through a Disaster.  The Katrina disaster got her to thinking that, since she lives on a geological fault line, she ought to get an emergency preparedness kit for herself.  She provides tips on where to get the necessary supplies, and what to include.

#11 David Williams, MBA, posting on Health Business Blog, has some advice for Delivering Operational Excellence.  This is a good reminder that professionals outside of the health care area do have something to offer.  In this case, he discusses lessons learned from the Institute for Healthcare Improvement.

#12 Medpundit presents a postmortem of the emergency preparedness planning and its failures in the aftermath of Katrina.  Like most autopsies, this one is not fun, but it is necessary.

#13 & 13.5 Elisa Camahort, last week's GR host, somehow had the stamina to submit two entries from her Worker Bees blog, Healthy Concerns.  First, she gives a good example of bureaucratic inefficiency, that takes place in an organization that is supposedly one of the more efficient around.  She then makes the point:
It seems so inefficient. What a waste of paper, of stamps, of administrative effort. Multiply that by the thousands and you begin to understand why tort reform is not the biggest part of increases in health care costs, administrative costs and overhead are.
She's absolutely right about that, as we shall see later.  Her second entry echoes one of my own concerns, that of political influence inside the FDA: You Wonder if it's Political?  This pertains to the seemingly-endless delays in the approval of OTC status for emergency contraception.  

I know I've posted this before, but here is the info for circumventing the bureaucratic stonewall:
Meanwhile, women who find themselves in need of EC can call 888-NOT-2-LATE or go to www.themorningafterpill.net.
#14 Hospital Impact submitted a post: Recent Deluge of coverage on physicians saying "I'm Sorry".  
As most of you have seen, a lot has been written recently on the "the power of apology" from physicians. This is an overdue & healthy development that could make a huge impact. It's a shame that it took data "that it pays to be honest" to get people's attention. But hey, regardless, this is better for the patient, better for the physician, and better for our healthcare system. [...]
Tony reviews some of the posts my other medbloggers, as well as a book, and some news articles.  Well done.

#15 Dr. Tony (a different Tony than the one above) provides us with a dramatic-but-true story of rescue (nothing to do with Katrina).
I don't think we pay our emergency services personnel nearly enough. These folks are true heroes. Thank you.
#16 Dr. Emer happens to have been one of the first people ever to visit Corpus Callosum (other than family and friends).  He makes a return visit with Baking 'Human Body Parts'.  One of the things I really like about medicine is that you can never say "Now I've seen it all."  Just when you think you couldn't possibly be surprised by whatever comes along next, something totally unexpected comes along.  (Note: it isn't really as bad as it sounds.)

#17 Another first-time GR participant, Ruth Schaffer, MS, submitted a nice basic science article (we should get more of these, in my opinion):  GRN163L: Drug Candidate Against Lung Adenocarcinoma.  She gives us some information about why cancer cells can divide indefinitely, and what can be done about it.  

#18 Mike, posting at Interested-Participant, brings us all some relief with news of a study that fails to find a link between cell phone use and brain cancer.  
This is obviously good news in the interim before the results of another study indicate differently, which seems to happen with regularity.
#19 Dr. Andrew MacGinnitie, posting on Dr. Andy, provides us with a good basic-->applied science post: Graft versus Leukemia.  It's all about bone marrow transplants.  He gives us some hope-inspiring news:
Oncologists are now trying to take advantage of this graft versus tumor effect and expanding it from blood cancers to solid tumors (that primarily arise from internal organs).
This is far from being ready for routine clinical use.  However, in light of the progress made in transplant medicine and oncology in the past thirty years, I suspect that we will see some significant progress here, too.

#20 Red State Moron (obviously, he's actually quite bright) chimes in with some information about VBAC: vaginal birth after a C-section.  He gives a thoughtful perspective on this controversial topic.  

#21 Medmusings ponders volunteering to help survivors of Katrina:  
What's been most convincing are the firsthand accounts of nurses at medscape's blog

Now, for some entries that I nominated myself.  

# Dr. Deborah Serani has a post that outlines psychological reactions to disaster.  She also tells us what to do about it.  

# Dr. Mark Kleiman links to a paper he wrote for the Congressional Research Service on the implications of the terrorist threat for drug policy.

#Anthony Cox, at Black Triangle, tells us about the unfortunate effects of a shortage of diamorphine in the UK.  This illustrates the enormity of the problem of opiate dependence.

# Continuing with the drug theme, Dr. Mike Lee informs us of an option for the treatment of opiate addiction: Suboxone.  Suboxone is a combination of buprenorphine hydrochloride and naloxone hydrochloride.  A similar drug, Subutex, has buprenorphine without naloxone.  Subutex also is used for treatment of chronic pain.  For many people, it is a better choice that methadone etc., although it takes a bit of expertise to prescribe it safely.  Perhaps I'll expand on this topic at some point.  Until then, see the FDA page for more information.

# Finally, I would like to introduce a group blog, put up mostly by U of Michigan med students: The Sparkgrass Community.  Sort of like CC, they tend to post about political issues that are of interest to medical folks.  Oh, and they seem a bit left of center.  And humanistic, too.  Just what the world needs...

Categories: science, medicine
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