the Natural Condition

“Count something.”

This keen piece of advice comes from Dr. Atul Gawande, as espoused in his most recent book, Better: A Surgeon’s Notes on Performance. Gawande is a general and endocrine surgeon at the Brigham and Women’s Hospital in Boston, MA. Although he is a surgical fledgling, completing his residency in 2003, Dr. Gawande’s insights blossom from his experience in public health issues, at one point serving as a senior health policy adviser for the Clinton administration.¹

The thesis of Better is that, while advances in medical technology, new drugs, and the like can lead to an overall healthier humanity, the most effective — and commonly overlooked — way to improve well-being is to make better use of what we already have. When he proposes that everyone in the healthcare community ‘count something,’ he means that evaluation and reevaluation of current methodology and practice are the true keys to success. We must measure ourselves, and then use those measurements to understand where shortcomings occur. He also makes it gravely clear that all doctors are not created equal in their ability to treat patients.
… (Read the rest of this article »)

Health Affairs, a journal dedicated to health policy, published an article today that reports on the forecast for healthcare spending in the US. In 2007, America spent about 16% of its Gross Domestic Product on healthcare. By 2017, that number is expected to rise to about 20% of GDP (a total of about $4.3 trillion). A 4% increase may not seem like much, but it represents a proportional growth that outpaces the adjusted growth for the 2017 GDP. By my calculations, the dollar amount of a 4% increase in healthcare-spending-as-proportion-of-GDP would cost more than current budgets for the Department of Defense, Homeland Security, Education, and Energy, combined.¹ The following chart shows the forecast for this increase:

^{Image courtesy of Health Affairs.}

This growth is equivalent to about a 6.7% increase in … (Read the rest of this article »)

The situation: you are by yourself, and you begin to have severe chest pain, followed by acute vertigo. You are having a heart attack, and moments later you feel like you are about to faint. With a few seconds left before you lose consciousness, what do you do?

In truth, you should dial 911 on your cell phone. But after that… cough, deeply and forecefully, about once every 1 to 3 seconds. Long derailed as a hype product of the devious “world-wide web,” improvised ‘cough CPR’ may actually have some merit, according to some cardiovascular researchers. The idea of coughing to sustain arterial pressure and to induce blood flow first appeared in the Journal of the American Medical Association in 1976¹. Therein, the authors purported that coughing during ventricular fibrillation not only kept several patients conscious for up to 39 seconds after the onset of VF, but that coughing maintained arterial pressure at almost 140mmHg, compared to only 60mmHg for traditional chest compressions. That is, they indicated that ‘cough-CPR’ could have advantages over normal CPR.

And while the American Heart Association, formally and adamantly, does not endorse the maneuver², scientists continue to demonstrate that coughing during a heart attack can actually help blood circulate. The picture below shows the EKG … (Read the rest of this article »)

The Washington Post published a blunt, acrimonious, and utterly superb article by Susan Jacoby this past weekend, which took aim — and hit the mark — at the demise of true intellectualism in the nation. A National Science Foundation poll observed that as many as one in five Americans believes that the sun revolves around the earth. Shocking¹. Jacoby writes that the dumbing-down of America is the inevitable byproduct of a culture who will not tolerate any source of information besides fast-paced, sound-bite-ridden visual media². People have become wholly uninformed, and even graduates of higher education are complicit, reading less frequently and watching obsessively. What is worse, she notes that the citizenry does not seem to care. The blend of ignorance and indifference is of greatest, and gravest, concern.

An exemplary excerpt:

Not knowing a foreign language or the location of an important country is … (Read the rest of this article »)

The New England Journal of Medicine recently conducted a panel discussion on the issue of Physicians and Execution. The panel members consisted of a general surgeon as the moderator (Dr. Atul Gawande from the Brigham and Women’s Hospital in Boston, a notable author)¹, a law professor (Deborah W. Denno, Ph.D., J.D.), and two anesthesiologists (Dr. Robert Truog and Dr. David Waisel). As individuals who know the science and have researched the ethics behind the topic of execution, one should duly consider their opinions.

Dr. Waisel outlined that the typical lethal concoction consists of 3 drugs. The first drug, sodium thiopental, is a barbituate whose aim is “to put you to sleep, create amnesia and anesthesia.” The second drug, pancuronium bromide, causes muscle paralysis. While anesthesiologists often use both of these drugs to sedate patients in the operating room, the lethal injection doses are necessarily much larger. The third and final drug, however, is not part of a doctor’s toolbox. Potassium chloride … (Read the rest of this article »)

Today I attended a forum on genetic testing for the Massachusetts General Hospital’s weekly Breast Rounds (I do research in breast oncology at the MGH). This week’s lecture, presented by Joseph D. McInerney, the Director of the National Coalition for Health Professional Education in Genetics, considered various aspects of the new wave of direct-to-consumer genetic testing. Genetic testing for specific gene markers¹ has been available for many years, and the results are primarily used by doctors and genetic counselors to determine the relative risks of disease onset and/or recurrence. This information allows the healthcare team to plan a course of treatment or preventative measures for a patient under supervised, knowledgeable care.

However, unlike “traditional” genetic testing, the professional health world does not filter this new era of direct-to-consumer genetic testing before it reaches the “consumers” (read: patients). Sites such as 23andMe.com and Navigenics.com advertise that anyone can obtain a complete genetic profile for as little as $999, which will outline propensity for certain diseases, among other recreational identifiers, like food preference. A most important note about these sorts of health-related tests: the FDA … (Read the rest of this article »)

To doubt everything or to believe everything are two equally convenient truths; both dispense with the necessity of reflection.

Jules Henri Poincaré (familiarly, Henri Poincaré) was a 19th century mathematician, theoretical physicist, and scientific philosopher. He worked in pure and applied mathematics, celestial mechanics, and he laid the groundwork for what would become modern chaos theory.¹

The Swiss Federal Commission for HIV/AIDS recently released a public statement, indicating that there is no plausible threat of sexual transmission of HIV for HIV+ persons undergoing antiretroviral therapy. Of course, there are several caveats to this rather consequential statement. For example, the person must receive active physician-supervised antiretroviral therapy, and must demonstrate low levels of virus in the blood consistent with an effective therapy for at least six months (viral load less than 40 copies/ml). Most importantly, the individual must not have an STI (sexually transmitted infection), which would exclude patients with AIDS from this zero-risk group.

This is a promising piece of news that may allow HIV+ people to lead more normal lives. However, do recall that the good news only benefits patients who have access to the expensive antiretroviral regimens. In poor countries, only 1 in 4 people has such access.¹

References: (1)

As I sat eating some potato chips off my sandwich plate this evening, I observed a curious phenomenon. And while I tell this story from only my own experience, I have collaborated with other quirky friends who concur that I am not alone in my habit. So here goes.

I noticed that, when given a portion of potato chips, all visible and available for consumption, I always choose the better-looking chip to eat first, thinking that I wouldn’t dare eat those nasty-looking ones. By “better” I mean the chips that aren’t transparent with oil. In a self-righteous attempt to convert the truly unhealthy nutritional value of potato chips into an edifying, “it’s full of potato,” attitude, I have myself think that the opaque chips aren’t going to lead to coronary artery disease nearly as quickly as the clear ones. And that might be true; the oily chips probably do contain much more unhealthy fats, and I might be marginally justified in my reasoning. So there I sit, eating only the “good” chips, one at a time.

But the funny part is, by the end of the meal, they’re all gone. By comparing each chip … (Read the rest of this article »)