Archive for the Rants and Raves Category

The Dalai Lama goes to Mayo

Posted in Preventive Medicine, Rants and Raves with tags , , , , on April 16, 2008 by Dr. CJ

Here’s the type of news piece that gives me a good, long laugh – another worldly figure travels across the world to get an annual physical exam at the Mayo Clinic

No doubt, the Mayo Clinic is capable of doing great things – they have specialists so specialized that they have forgotten how to treat a common cold.  Who wouldn’t want an “expert” to manage an unusual condition?  Few people have unusual conditions, though.

I’ve seen patients in my clinic who go there for their annual exam.  For some reason, they feel that getting a clean bill of health from Mayo is some kind of blessing for eternal wellness.  Mayo is, in fact, good at coordinating a ridiculous number of labs, imaging, diagnostic tests, and doctor visits into a comprehensive day-long physical exam.  They are masters at communication and planning, apparently.  However, is there any benefit to this kind of overwhelmingly thorough evaluation?

This shotgun approach to an annual health exam is a dangerous venture for a few reasons. 

  1. It’s expensive.  I’d hate to be your insurance company staring at a list of charges you rack up on that one day.
  2. It cultivates a sense of urgency to “do everything” all the time.  People love to feel pampered – talk to your insurance company or whoever is actually paying for those charges.
  3. It leads to unnecessary follow-up testing.  Not all “abnormal” results are necessarily abnormal.  But, if you go fishing for everything when there’s no focus on a particular problem, you’re going to find a lot of junk, and you won’t know how to interpret it.
  4. It’s a poor use of resources.  Common things being common, most people don’t have “rare” diagnoses that require an expert on minutiae.  In an ideal world, we could find a way to maximize the efforts of the highly-specialized physicians who really don’t need to be dealing with routine conditions that could be managed by any other competent physician.  Do you need a world expert on obesity and metabolism to tell you that you need to eat better and exercise more? 

I don’t question their value in managing rare or difficult-to-treat conditions, but for the average individual it’s a complete waste of time and money.  It’s all about perspective – the things that are going to kill you are staring you in the face every day and are simple to manage.  There’s nothing glamorous about searching high and low to come up with weird explanations for common problems. 

Then again, I don’t know Buddha’s take on health.


Food shortage

Posted in Rants and Raves on March 13, 2008 by Dr. CJ

You may have caught the recent news releases that predict a food shortage in the US, due to the growing population in developing countries and their growing desire for certain foods.  I’d say that the obesity epidemic in the US suggests that there is actually plenty of fod to go around and more – it’s just not used wisely.  Also, think about how much food gets thrown out: at the end of a night by a restaurant, unsold items at the grocery store, in nearly every household after meals, etc.  Sounds like someone has an agenda.

Keep in mind, our government is intent on producing ethanol as a renewable energy source, which of course is processed from corn.  It’s not an efficient energy source, otherwise it wouldn’t require government subsidies and initiatives to encourage its use.  But now we’re burning our food supply, when that food supply is supposedly at high risk of depletion.  Some days I just wanna move outta here.

Finally I found a no-nonsense article that touches on this contradiction, or is it just a dilemma?  I don’t know – I hate politics.

Inhaled insulin was doomed from the start

Posted in Diabetes, Rants and Raves with tags , , on March 8, 2008 by Dr. CJ

This recent news blip about a new inhaled insulin failing caught my attention, months after the big flop of Exubera, Pfizer’s inhaled insulin product. It was meant as an alternative delivery method of insulin for individuals with diabetes mellitus who were resistant to the use of injections. Interesting idea, in theory, but in practice is a mess.

I had the delightful opportunity (read sarcasm) to discuss this product with some Pfizer pharmaceutical reps who of course were pushing it as the latest, greatest insulin product. Not to pat myself on the back, but I told them it wouldn’t catch on like they were hoping . . . for a few reasons.

  • The apparatus was apparently difficult to use. It was a clumsy-looking handheld canister, into which packets of inhalable insulin were dispersed, and then the contents of that chamber were inhaled. Dosing was very limited due to the sizes of the insulin packets, which would then require multiple inhalations to receive one “dose”. How’s that any easier?!?
  • My biggest grudge with it was that insulin is not meant to be dispensed into the lungs and thus posed grave danger. Insulin is a tumor growth factor [note: “tumor” not necessarily being a malignant process]. An example of this function in action is the deposit of tissue beneath the skin where frequent injections are performed. Why would anyone put that product in their lungs, with potential for decreased lung function and inappropriate tissue growth? * Part of my duty to my patients is to protect them from these marketing blunders. Last thing I want is a surge in lung cancer cases.

I hope my intellectual assaults on the Exubera reps played a little role in hurrying Exubera off the market. There are a few other new drugs I’ve recently heard about that should also provide me good fodder to toy with the pharmaceutical reps.

* “Growth for the sake of growth is the ideology of the cancer cell.” – Edward Abbey

Dirty clinic

Posted in Rants and Raves with tags on March 6, 2008 by Dr. CJ

Is this for real? 

Endoscopy clinic re-uses syringes 

 I can’t even fathom this happening for so long and not being reported until now.  Maybe someone would have been suspicious that none of the employees would get their own endoscopies done there, knowing the disgusting practices they allowed.

Throw the book at ’em – they make everyone look bad.

“The Biggest Loser” and reality TV deception

Posted in "The Biggest Loser", Rants and Raves with tags , , on February 25, 2008 by Dr. CJ

Television is notorious for its sensationalist approach to presenting news and other programming.  When in the business to keep people glued to the screen, they are going to use nonsense teasers and other trickery to keep viewers glued to the screen through another set of sponsor’s commercials in order to get to the punch line.  This situation has been rampant for years.

Then came so-called “reality TV“.  Obviously a misnomer, there is nothing “realistic” about “reality TV”.  Examples abound.  These so-called “reality” TV shows have rightfully come under scrutiny for their contrived scenes that are obviously intent on stirring up some controversy and drama in an attempt to retain viewers.

The producers have to appeal to the voyeuristic nature of TV viewers – plenty of people apparently live lives that are so boring that they need to live vicariously through their television.  In a sense, then, they are asking for this fake portrayal of human experience.

So, what about “The Biggest Loser“, a hit amongst those interested in weight loss and fitness for whatever reasons?  How much goes on behind the scenes when you’re watching someone waste away on the TV screen weekly?  An editorial in the Journal of the American Dietetic Association titled “When Overweight and Obesity become ‘Reality’” describes some of the sly production waves-of-the-hand that occur unbeknownst to the viewers, without specific reference to a particular show but instead making vague references.

The author references reports by participants of a particular weight-loss show who describe severe weakness and dehydration, while the viewers only saw their dedicated diet and exercise habits portrayed in a healthy light.  Also, the winner of the first season allegedly regained 7 pounds within days of the finale by simply rehydrating with water. (See links at end of post

Obviously, there are unhealthy weight-loss methods being employed in a situation like this where individuals are competing for a significant monetary prize.  Of course the networks and the shows cannot outright encourage these methods, but they are creating an unhealthy competitive environment that all but encourages these drastic methods.

Here, the producers have a unique opportunity to provide an educational service to the viewers, to offer a glimpse into what it takes to change one’s life by diet and exercise.  Unfortunately, it is instead a bit of a freakshow due to the sensationalist perspective that is presented to the viewers rather than the real-life perspective.  

Most viewers should be savvy enough to detect the fraudulent presentation of these stories – we know when we’re getting real “reality” programming – I’ve yet to see it.

Time article

Seattle Times article

Finally the end of this week

Posted in Rants and Raves on February 9, 2008 by Dr. CJ

Had an especially rotten week.  I’m definitely welcoming the opportunity to kick back this weekend.  That’s all I have the energy to say today.

When heartburn is not heartburn, and be careful whom you challenge

Posted in Heart Disease, Rants and Raves with tags , on February 5, 2008 by Dr. CJ

Sure enough, there might have been something to say for the prediction of an increased incidence of heart attacks around a major sporting event.

A 50-something gentleman came into clinic yesterday with “burning around my heart”. [side note: I’m always intrigued by the choice of words used in an individuals “chief complaint” – there’s something about that phrase that just has to make you feel uneasy. Reminds me of an amazing patient I had in residency – that’s for another day.] The guy has a history of heart problems – which I later realized when I finally got my hands on the archaic stone tablet, er . . . paper chart. His pain was actually quite unusual to be blamed on the heart, in the sense that he has huge physical demands on his job that never exacerbated the pain. Interestingly, the pain had been stuttering along for a few days and he just wasn’t his normal self for the Super Bowl party he attended. I requested an EKG on him right away because it just didn’t sound right.

EKG looked like an early MI (heart attack), with a finding that is a bit subtle, but nonetheless inexcusable to miss. An ambulance was summoned, and the daft baboons on the ambulance squad had the nerve to argue with me about whether or not the EKG was concerning for heart disease. [insert deep inner rage] Here I spend 40 minutes with the guy and have a ridiculous number of years of training, and some poser medic with no real patient care experience tries to tell me I’m wrong. If I wanted help reading an EKG, the paramedics would be among the last people I would ever ask – pick him up and get out of here. Now, ask me if I would feel comfortable with these baboons caring for my family in an emergency. . . yikes!

Lo and behold, he had an MI, went to the cath lab immediately, and had a near-total occlusion of the dominant heart vessel that got the “roto-rooter” treatment and was stented. I’ll be having a [not-so-kind] word with the ambulance company later today.