Friday, December 25, 2009

Thormahlen Family Fundraiser

A very old friend of mine, Peter Thormahlen, was shot in a convenience store robbery while buying juice for his toddler. He suffered spinal and other internal injuries. He had just started a new job, which he has since lost, along with it, all his health insurance. If you are feeling generous, please contribute below. Every penny goes to his care. Thank you.

Wednesday, December 23, 2009

On Running

I have started up a second blog (which doesn't make much sense since I don't post regularly on this one) about my attempt to run a 5k. Forgive the URL -- it is very difficult to find an original one on Blogspot.

Friday, December 11, 2009

Follow the Money

Interesting article in The Atlantic about a recent study which questions the use of tamiflu for influenza treatment. Some of my public health colleagues are quite angry about it -- they worry that people who need tamiflu will now not take it. They suggested that we use the staff of The Atlantic as a placebo group in a study testing the drug. Personally, I think The Atlantic handled the topic well. The research does raise questions about the usefulness of the drug. I know a lot of physicians who don't like to use it (especially in children) because it can cause vomiting, which in turn can lead to dehydration, which in turn can lead to hospitalization. Speaking for myself, I began taking the drug within 12 hours of onset of influenza. I felt fine the first day, but the next morning I vomited for two hours and I stopped taking it. There have been reports out of Japan of neurological side effects in children.

This post is not to bash tamiflu, nor is it to discourage people from taking the drug who need it. I would rather step away from the efficacy of the drug itself and offer the question which I have blogged on in the past -- is government policy being driven by science or by politics? Big pharma made millions (billions?) off tamiflu. Big pharma made millions (billions?) off pandemic H1N1 vaccine.

Tuesday, December 8, 2009

Stay Home When You Are Sick -- You Too Doc

I had a disturbing conversation with a colleague over breakfast this morning. She is a physician in a clinic for underserved populations. She is the only physician in that clinic, but she has a nurse practitioner who works with her. Between the two of them, they have more open charts than is advisable, but they are the only low-income clinic in their area and do the best they can to see all the folks who need care. This morning the NP called in sick. This throws a wrench in the clinic scheduling, as the NP was already overbooked with appointments all day. The doctor will now have to work her butt off to see all the patients herself. This means long waits, even less time per patient, and a very long day for her.

She explained to me that the NP felt really guilty for taking off. The NP came down with fever and chills yesterday, but worked through it. This morning, the NP could hardly get out of bed she was so sick.

“But that is what sick time is for. She will still get paid. If she is that sick, she needs to take off. Filling her slot is an administration issue. You administrator should have a back up plan,” I said. Because I am an epidemiologist, I don’t want the sick NP coming to work. I preach it all the time: Stay home when you are sick.

This was not the response the doctor was looking for. “Doctors work sick all the time. That’s what we do. We push through it,” she said. “If we don’t that’s 30, 40 people who are sick because they couldn’t see us.”

“But as a patient, I don’t want the doctor who sees me to be sick,” I said.

She looked at me like I was crazy.

“That’s nothing. You should see what they do in hospitals. It’s even worse in hospitals. No one ever calls in sick; that is unheard of. I’ve seen surgeons slap on a mask and work through it. It’s just what we do,” she said, as if this were a point of pride.

Now it was my turn to give the crazy look. “I’m sorry, but I don’t want someone cutting me open when they are sick. Send the sick one home. I want someone who is alert and paying full attention.”

Doctors should be role models for healthy behavior. They should not be operating with snot dripping into their surgical masks. This should not be a badge of honor. I understand there is a healthcare worker shortage in this country. Rather than pushing docs to work when they are sick, we should be looking for ways to increase the number of healthcare providers.

Another colleague told me about a program she worked in many years ago at a university teaching hospital. The hospital had a severe shortage of nurses. The school created a program where mothers on welfare could get an LVN on their campus for free, provided they would work in the hospital for at least one year after graduation. Tuition was free, room and board were free. Free remedial classes were offered to those who needed them. Daycare was provided. A short-term investment proved a long-term boon – the families were able to get off welfare and became tax payers. The mothers had a good source of income. A career, with benefits. The hospital had plenty of nurses. The program worked so well that they created a LVN to BA RN program for nurses who wanted to pursue it.

I have heard the psychologists say that we teach people how to treat us. If the doctor is willing to work through an illness, she has taught the administration that there is no need for a back up plan. I suppose the back up plan will be the hiring of a new doctor when that one keels over dead? A sick doctor is not fully present in their patient’s care. They run the risk of making mistakes, and we all know about the high numbers of injury and deaths due to plain old mistakes. They also run the risk of infecting their patients with whatever ailment they are carrying, and an ailment that may make the healthcare worker uncomfortable could be deadly to his ICU patient.

In the end, I think I made my friend mad.

Wednesday, December 2, 2009

What Causes Breast Cancer?

What causes breast cancer? We know there are factors which raise or lower a woman's risk of developing the disease, but what is the mechanism that causes the cancer in the first place. I recently met a woman, Dr Kathleen Ruddy, who has a viable hypothesis. Dr Ruddy is head of the Breast Health and Healing Foundation. When I met her, she invited me to spend some time on the Foundation's website. Which I did. And I have to say, it kind of pissed me off.

Dr Ruddy is interested in exploring the possible connection between breast cancer and mouse mammary tumor virus. She has written about book about it, The Pink Virus, which she was kind enough to send to me and I will be reviewing here in a few weeks.

I have long suspected there might be a virus at work in breast cancer. I have to present at a meeting this afternoon on viruses and cancer. Most of us know about human papiloma virus and cervical cancer thanks to the advertisements for the HPV vaccine (it can also cause anal and penile cancers). Hepatitis B and Hepatitis C viruses can cause liver cancer. I heard recently about a possibly connection between Xenotropic Murine Leukemia Virus-Related Virus and prostate cancer (and a possible connection between XMLV and chronic fatigue syndrome, which I blogged on in a previous post). Did you know that there are links between Epstein-Barr Virus (the virus that causes mono) and Burkitt’s Lymphoma, Hodgkin’s Lymphoma, B Lymphoproliferative Disease, and Nasopharyngeal Carcinoma? There are other viruses which have been linked to other cancers as well.

So why does the Foundation's web site irk me? Because if they are correct, if there is a link, why isn't there more research being done on this topic? If the cause is viral, there is potential to make vaccine. If the cause is viral, there is a potential to entangle the epidemiology and find different means of prevention. If it is viral, new treatment options may be available.

When I was a child, it was common knowledge that stress caused ulcers. This notion was so prevalent, I remember seeing the theme interwoven into TV shows. A character could clutch his stomach, and talk about his ulcer, and we, the viewers would accept this as a signal that he (because at that time it was always a he) was under too much stress. The antidote was to drink milk. And reduce stress. Of course now we know that many stomach ulcers are caused by a bacterial infection, H pylori, and can be treated with antibiotics.

It will be interesting to see what the research into cancer and viruses continues to discover.