Epilogue: Dr. A Live - Episode 5

What's up with the picture above? We'll you'll have to listen to the show to figure it out. HA! Listening to the show is as easy as going to my blog sidebar and hitting play. Or, you can even download and subscribe to the show via iTunes.

You can also visit my Blog Talk Radio site. While there, don't forget to pick up a promo button to place on your blog for me (please!). Also on the site you can give a rating to my show, leave a comment, make me a BTR friend and BTR favorite. Thanks!

Thanks so much to Dr. Rob for joining me on the show. I never actually knew what his voice sounded like until the show tonight - so that was exciting.

Definitely write a post and send it over to Dr. Rob for his Grand Rounds on Tuesday. I also have to tell you that he might have given a hint on his GR theme during the show. But, of course, I'm not going to tell you. You have to listen to the show. HA!

Thanks also to those who called in and those in the chat room during the show. Right now, I'm going to plan for Thursday nights at 10pm and see how that works. I still my try a different day/time. But, we'll see how this works for now. Have a great weekend everybody!

Update: Thanks to Scan Man and JMB for letting me know that the show is NOT available on iTunes site outside the USA. Bummer. However, all is not lost. The show IS available via RSS feed. Just click here or here and download away!

The Dr. Rob Interview (maybe)

Thursday, September 27, 2007 from 10:00-10:30pm Eastern Time

Show Link - Chat Room Link - Archive Link

I'm happy to announce that the one and only Dr. Rob from Musings of a Distractible Mind is scheduled to appear on the Doctor Anonymous Live show tonight. Dr. Rob is going to be the host for Grand Rounds next week.

What are we going to talk about? You'll get some insight on how it is being a GR host. We'll also talk about his blog. I've enjoyed his physical exam series and his Ask Dr. Rob posts. I'm also curious about his recent blog troubles (even last night, his new site and old site were down for a little while).

We'll also be taking your phone calls and hoping you join the chat room. If you can't listen live, that's ok. This show will always be available via the archives. (see the links above)

Disclaimer: This appearance was just set up yesterday. Dr. Rob told me that he's at a conference today and would probably be available at 10PM tonight for the show. If he can't make it for one reason or another, it's just going to be me. So, you'll have to tune in to see what happens!

Dr. Dork is back

Welcome back! We missed you! What happened? Read here....

Flu shots: Built up and torn down

I know, I know. People are sick and tired of me blogging about flu shots. But, hey, it's my blog and I'll write what I want to - HA! Anyway, here's another chapter in the ongoing saga of the flu shot story arc.

When we last left flu shots, they were being celebrated as not having a shortage. I remember even one source touting that there would a "record" number of flu vaccine available for this year's flu season. So, all is well and good, right?

Apparently not. As fast as our dear friends in the press are talking up the flu shots, the tone this week has changed. According to this article from the Seattle Times, they ask this question, "Is the flu shot benefit overstated?"

The benefits of flu shots for elderly people have been greatly exaggerated, according to researchers at Seattle's Group Health Center for Health Studies and George Washington University in Washington, D.C.

I made reference to questionable data in my previous post. Apparently, these researchers are pointing out questionable benefit data for elderly patients to receive the flu shot.

"We find it peculiar that the claims that influenza vaccination can prevent half — or more — of all winter deaths in elderly people have not been more vigorously debated," wrote Jackson and Dr. Lone Simonsen of George Washington University, the lead author of their report, "Mortality benefits of influenza vaccination of elderly people: an ongoing controversy."

So, in a week or two, the positive spin for flu shots will begin again. And, then the week after that, there will be negative stories again. Sure, this sells papers and gets ratings. But, how are patients supposed to decode all this conflicting and confusing information? That's easy. Make an appointment with your physician to talk about it.

Fake acupuncture works

Here's a headline: "Fake Acupuncture Is Still Better than Western Medicine." Uh, I may get in trouble for this post. This AP article reports on a German study where they took patients with back pain and divided them into three groups.

In the largest experiment on acupuncture for back pain to date, more than 1,100 patients were randomly assigned to receive either acupuncture, sham acupuncture or conventional therapy. For the sham acupuncture, needles were inserted, but not as deeply as for the real thing. The sham acupuncture also did not insert needles in traditional acupuncture points on the body and the needles were not manually moved and rotated.

After six months, patients answered questions about pain and functional ability and their scores determined how well each of the therapies worked. In the real acupuncture group, 47 percent of patients improved. In the sham acupuncture group, 44 percent did. In the usual care group, 27 percent got relief.

Now, why did this happen? Could it be that acupuncture is better than "usual care?" If that was the case then why did the fake acupuncture group still score better than the usual care group? Two words: Placebo Effect. Here is how WebMD defines it.

A placebo effect is an improvement in the symptoms of a disease or condition when a person is treated with a drug or other treatment that he or she expects to work, even though the treatment has not been proven effective. When a drug or treatment seems to work for some people but has not been scientifically proven to be any more effective than a "sugar pill" or placebo, it may be said to have a placebo effect.

Getting back to the AP article, it even outlines the bias limitation that this study has, while still trying to persuade you that their theory are still correct (nice try).

Positive expectations the patients held about acupuncture -- or negative expectations about conventional medicine -- also could have led to a placebo effect and explain the findings, [the study co-author] said.

Although the study was not designed to determine how acupuncture works, [the study co-author] said, its findings are in line with a theory that pain messages to the brain can be blocked by competing stimuli.

So, this is another research study in which the results (the facts) did not prove their theory, the most important take away point they want you to know is that acupuncture, whether real or fake, is still better than Western medicine and that insurance companies should pay for it - as exhibited by the last two paragraphs of the article.

Funding came from German health insurance companies, and the findings already have led to more coverage in Germany of acupuncture.

In the United States, some health plans cover acupuncture for some conditions, but may require pre-approval, according to the National Center for Complementary and Alternative Medicine. An acupuncture session can cost $45 (euro32) to $100 (euro71).

C'mon, gimme a break! Don't get me wrong, I'm not dissing acupuncture. I think this treatment has value. But to make policy changes based on this bad data? That's irresponsible. Either get better data or just acknowledge your bias toward acupuncture (or against Western medicine), make your policy decision (insurance companies should pay for acupuncture), and move on.

Update (10:32pm 10/26): Here's something interesting. This post got picked up overseas. To see what this post looks like in German, just click here. Enjoy!

Grand Rounds

Grand Rounds 4.01 is now up and running (early) over at Kevin, MD. With the turn of the digit, could it be that the great Grand Rounds is four years old? Yeesh! I remember reading my first GR about a year and a half ago and wondering whether I could even post over there. How time flies when you're having fun. Thanks to Kevin for including my post this week:

Doctor Anonymous notes the importance of washing your hands.

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science? Next week, GR moves to Dr. Rob's new site over at Musings of a Distractible Mind. He had a blog meltdown recently. But now, his new blog is up and running nicely. Enjoy Grand Rounds!

MyBlogLog now on Yahoo

I don't know who turned me onto MyBlogLog, but I think this is a great service. I like how you can put this widget onto your sidebar to see who has stopped by your blog (presuming they have a MBL account as well). I even tried a pro account for a while, because I liked looking at the stats (imagine that).

But, tonight, I'm trying to log into the site, and it asks me for my Yahoo ID. Huh? What's up with that? Apparently, MBL is now a Yahoo company and they are integrating things. Now, there is one problem (at least for me). I don't want to create another account ID for myself on Yahoo. Why they can't they just leave things the way that they are. Sheesh!

If you're on MyBlogLog, what do you think of this new thing with Yahoo? If you don't currently have an Yahoo ID, will you create one just to continue on MBL? Just curious.

Sorry for the whining. I think I'm done now. By the way, the latest edition of the Dr. A show is now archived and ready for you to listen to. You can either listen in my sidebar at this very blog or listen to it at my BTL site. I already got a four star rating! Thanks coaster1robert! Enjoy the show!

Listen Live Today @ 3pm

Thursday, September 20, 2007 from 3:00-3:30 Eastern Time

Something came up today in my schedule that almost made me cancel the show. But, I managed to work it out. The only thing is I had to move the show to an hour earlier at 3pm ET. If you're able to listen live, even with the time change, I invite you to check things out on the new BlogTalkRadio group chat room.

I apologize for throwing off the time for the live show. Hopefully, you'll at least be able to catch Doctor Anonymous Live on the archive. You can even listen to the archived show right here in the sidebar about an hour after the live show is completed. I'm still trying to find a consistent date and time for the show. I've been told that the same day and time is one of the best ways to try to build an audience. Enjoy the show!

Update (1:15pm ET): The BlogTalkRadio site is currently down. Why is that? So, maybe there may not be a show today anyway. This is starting to feel like two weeks ago when the show was messed up because of technical difficulties. We'll have to see what happens in the next hour or so.

Update (1:38pm ET): In looking at the above graphic, they say that they will be back up and running 9/17 which was three days ago. This graphic was from Sunday night when they had scheduled maintenance until the next morning. 

Now, there is the graphic below. That's telling me that there is something wrong going on and it's probably going to be an extended period of time. I'll keep checking things out, but it's looking more likely that there will be no show today. Yeesh! I think I'm cursed for a Thursday afternoon show. Maybe it's time to consider moving the show to an evening prime time slot - and maybe on a different night. Ahhhh!

Purging Disorder

When I first saw the title of this AP article, I said to myself, "I know what this is. It's the binging and purging thing, right." Eating disorders is something I've written before on this blog. Pro-ana and pro-mia sites continues to be one of the most visited posts on this blog.

But, what I didn't realize is that the term purging disorder talks about being "compelled to purge, usually by vomiting, even after eating only a small or normal amount of food."

Apparently, purging disorder is not an officially recognized diagnosis according to the American Psychiatric Association. However, further study and research on this topic may support changing of the criteria for diagnosing eating disorders.

The dangers of purging disorder are similar to those of bulimia: psychological problems, dehydration, electrolyte imbalances that can affect the heart and kidneys, and potential dental problems because of self-induced vomiting.

Here is a pretty good link talking about eating disorders from WebMD. I didn't know that it's hard to even put a number on how many people suffer from eating disorders. Many of these are sad stories. Hopefully, more effective treatments can be developed to address this problem.

I'm A Web Resource!

I received an e-mail from Jimmy Atkinson who is from the Nursing Online Education Database. Apparently, they just put together 100 web resources for medical professionals. I was pleasantly surprised that this blog made the cut:

91. Doctor Anonymous — This is a humorous blog written anonymously by a doctor. It covers medicine in relation to politics, life and beyond. Doctor Anonymous also has an online radio show, broadcast from this blog.

Thanks so much to NOEDb for placing the blog on their list. I really appreciate it. I've even received some traffic from over there today - so thanks! I encourage you to check out this list. It's a pretty good group of links divided into 12 categories. Check it out!

Don't tase me, bro!

What is up with this? Apparently, this incident has received over a million views on youtube already. If you haven't heard about this already, here's an article from the Gainesville Sun. As I have said before, this not a political blog. I only make observations. And, this video is interesting on so many levels.

Wash Your Hands!

Do you wash your hands before your leave the restroom? C'mon, be honest. I won't tell anyone. Well, it seems that in a recent study, less people are washing their hands compared to 2005. Ew! What's up with that? The article is from WebMD.

Researchers who discretely observed men and women in public restrooms found that only 77% washed their hands with soap and water -- a 6% decline from 2005.

But not many people are admitting to slipping up: In a separate telephone survey, 92% of Americans claimed they always lather up in public restrooms. The findings were reported at a meeting of the American Society for Microbiology (ASM).

Who is more to blame? Men or women? What do you think? Here's the answer from the article.

The blame lies squarely with the men, says Brian Sansoni, a spokesman at the Soap and Detergent Association, which cosponsored the survey with the ASM.

The percentage of men observed washing their hands fell from 75% in 2005 to 66% in 2007. In contrast, hygiene habits basically stalled among women: 90% washed up in 2005, compared with 88% in 2007.

Now, as compared to yesterday when I talked about things like lab coats and neckties potentially spreading bacteria, I'm a huge advocate of hand washing in the hospital setting, before leaving the restroom, and other situations where bugs can spread. So, do us all a favor and just wash your hands, would ya?

Dr. A Live - 9/20 @ 4pm ET

I'm happy to announce that the next edition on the Doctor Anonymous Live show will occur on Thursday at 4pm ET. Mark your calendars now! I think (finally) that I've worked out the technical glitches so that I can focus (mostly) on show content. I'm excited about this project again!

Blog Talk Radio unveiled an entirely overhauled site on Monday morning (like the new logo?). I have got to tell you that it looks very nice! I encourage you to check it out.

There are also a few new features that I hope to be trying out for the show on Thursday. For example, they have installed a group chat function. Now you'll have to register as a BTR listener to enter the chat, but I think it would be fun if we got a few people in there chatting away during the show.

BTL has really added a social networking feel to their site now. You can now designate "friends" and sign up as "listeners" to specific shows (don't forget to do that to me when you get your BTL name!). You can also add text comments to specific shows and to my profile, if you like. Plus, there's a rating system for individual shows from 1-5. Hope you can join me in a couple of days!

Grand Rounds

Grand Rounds 3.52 is now up and running over at Six Until Me. Kerri has done a great job at putting this together. I encourage you to head on over there and check it out. It's been a while since I have submitted anything to GR. Thanks so much for including my post this week...

I need to warm up. Off to the bakery, where I can grab a nice, hot coffee. The lady in front of me is yapping away on her cell phone - doesn't she know too much cell phone use could cause cancer? Dr. Anonymous should give this lady a call (on her landline).

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science? Next week, GR moves to the one and only Kevin, M.D. Enjoy!

Doctors failing pregnant patients

Here's another glowing review of American health care. This time, docs fail to warn pregnant patients of the dangers of continuing prescription medications during pregnancy. (image credit) Here's the start of this AP article:

Philadelphia - Doctors aren't doing a very good job of warning young women to avoid getting pregnant when they're taking prescription drugs that can cause birth defects, a new study suggests.

Nearly half of the women taking the medicines didn't get counseling from their doctor about using contraceptives or other birth control measures, University of Pittsburgh Medical Center researchers found in a study of nearly 500,000 women.

Now, this didn't make any sense to me. I get asked a lot about prescription meds during pregnancy by my patients. And, I know during medical school and residency training, the issue of meds during pregnancy is emphasized heavily.

Later in the article, the glaring limitation of this study is exposed...

The researchers noted that the study might overestimate the problem because the data is from health plan billing codes, which don't have the same detailed medical histories as patient medical charts. Some doctors may have provided counseling but didn't bother to mark it with a billing code.

Ah HA! Of course, this study overestimates the problem - thereby falsifying their data. What kind of researcher would use billing codes from a physician office to track counseling? Everyone knows that insurance companies do not pay for most (if not all) counseling sessions done my medical physicians. That's the reason they're on on the billing form.

Now, some of you out there are probably saying, "Those greedy doctors. If they don't get paid for counseling, then they won't do it." On the contrary, counseling does happen. It's documented in the medical record (which the researchers here didn't bother to check). In addition, since insurance companies don't pay a counseling charge, as with other charges not paid by insurance, the bill would subsequently go to the patient. Who wants that to happen?

Don't get me wrong. Docs can do a better job in discussing medication reactions in pregnant patient. But, to come out and accuse docs of doing a bad job for patients and then have bad research data? That's disingenuous and lying to the public, but par for the course for the American press.

UK Physician Fashion Police

If you're a doctor in a British hospital, don't even think about wearing a necktie, long sleeves and jewelry to work. You can't even wear your traditional white coat. I've talked about docs wearing ties and lab coats in the past.

According to this AP article, the Department of Health in England issued a hospital dress code on Monday banning the above clothing. They say that it will decrease the spread of infection.

"Ties are rarely laundered but worn daily," the Department of Health said in a statement. "They perform no beneficial function in patient care and have been shown to be colonized by pathogens."

The new regulations taking effect next year mean an end to doctors' traditional long-sleeved white coats, Health Secretary Alan Johnson said. Fake nails, jewelry and watches, which the department warned could harbor germs, are also out.

I guess docs will have to dress like Dr. McDreamy above. (You knew I just had to bring back that picture at some point. Remember this post?) Getting back to this article, US physicians will not have to worry about silly dress codes like this...

Infection control societies in the U.S. don't recommend similar dress restrictions because there is no strong evidence that health care workers who don't wear ties or jewelry reduce the risk of infection, said Dr. James Steinberg, an Emory University infectious disease specialist.

Steinberg said that doctors and nurses who don't adequately wash their hands pose a far bigger risk to patients and that hand-washing should be the focus of infection control efforts in hospitals.

The [CDC] does have guidelines advising doctors and nurses against wearing artificial nails in operating rooms and around high-risk patients. It says there is evidence that health care workers who wear fake nails have more germs on their fingertips both before and after hand-washing than those with natural nails.

Now, let me get this straight. I can keep my tie and lab coat. But, I have to get rid of my artificial nails? What's up with that?

Hillary health care (part 2)

The press is abuzz today hyping up the fact that Hillary is going to unveil her health care plan today. (Of course, I'm a hypocrite for not only point this out but also making this a post of my own.) Here's the beginning of the AP article.

Des Moines, Iowa - Democratic presidential candidate Hillary Rodham Clinton is unveiling a sweeping health care proposal Monday that would require everyone to carry health insurance and offer federal subsidies to help reduce the cost of coverage.

Fulfilling a pledge to bring health care to all, Clinton's "American Health Choices Plan" has a price tag of about $110 billion per year. It represents her first major effort to achieve universal health coverage since 1994, when the plan she authored during her husband's first term collapsed.

Here's an interesting quote from today's CNN article citing why her first plan didn't work out...

As first lady in 1993 and 1994, Clinton spearheaded an effort that would have overhauled the provision of health care. Critics compared her plan to socialized medicine, and it was killed by opposition from special-interest groups -- including doctors and pharmaceutical companies.

I just love when docs are lumped together with pharmaceutical companies - and then blamed for the reason that the United States does not have "universal" health care - this is very Michael Moore-like. (Aside: It's always enjoyable to see MM being taken on by the main stream media like CNN and ABC.)

In case you were wondering, here is a decent AP article outlining the stated positions of the other presidential candidates. I'm no political pundit. But in just talking with people around town (supposed grassroots America), I believe that health care is the number one domestic issue that will shape next year's presidential election.

Terry Fox

Before I even thought of making medicine a career -- before I even was a teenager -- I remember seeing this movie about a guy - an amputee -- try to run across Canada -- for cancer research. "What's cancer?" I asked my parents.

They gave me some kind of explanation which I could not understand. What I did know is that "the cancer" caused this guy to lose his leg. I still remember this story, even today.

According to this article from CTV, the 27th annual Terry Fox Run was today in Toronto. I didn't know this, but his foundation has raised over $400 million worldwide for cancer research. Here is some background information, if you're not familiar with this story.

Fox set out on his Marathon of Hope in St. John's on April 12, 1980, to raise awareness for amputee capability and cancer funds. Born in Winnipeg and raised in Port Coquitlam, B.C., he was first diagnosed with bone cancer at the age of 18.

Three years before he started his run, Fox's right leg was amputated 15 centimetres above the knee, in an attempt to stop the disease from spreading throughout his body. He ran 42 kilometres a day through the Atlantic Provinces, Quebec and Ontario; the equivalent of a full marathon everyday.

After 143 days on Canadian roads, Fox was forced to stop running near Thunder Bay, Ont., because the cancer had reached his lungs. He passed away in June of 1981 at the age of 22.

Even as a child, I didn't understand why someone so young had to pass away from an illness. The youtube video above tells a little more of the inspiring, yet tragic story of this Canadian hero.

Dr. A Live: The Stealth Show

I just finished the latest edition of the Doctor Anonymous Live show. What? You didn't hear about it? Well, that's because I didn't advertise it. To be honest, I was embarrassed by the last show and the technical difficulties that I had.

I think I isolated what the problem, because I did not get kicked off the site this time. I only did a 15 minute show tonight to test things out and everything seemed ok. So, check it out in the sidebar and leave a comment to let me know what you think. Hopefully, next week, I can get back to full steam ahead!

Cell phones cause cancer?

These rumors have been flying around for years. Over the past ten years or so (maybe even longer than that), study after study has been released that proves or disproves the assertion that cell phones cause cancer. The latest study has been done in the UK. This is actually an interesting article from BBC News.

The long-term cancer risk of mobile phone use cannot be ruled out, experts have concluded. A major six-year research programme found a "hint" of a higher cancer risk.

But the UK Mobile Telecommunications and Health Research Programme (MTHRP) did rule out short-term adverse effects to brain and cell function.

Researchers are now expanding the programme to look at phone use over 10 years, and the specific impact on children, which has not been studied.

Research is a funny business in that if you don't like the result, you either extend out the time of the study until you get the result that you want. Or, you amplify the very small results that you have and hypothesize the results that you really wanted in the first place.

In this article, since the six year data didn't get them their result, the article states things like "Cancers do not normally appear until ten to 15 years after exposure." I also love this quote, "With smoking there was no link of any lung cancer until after ten years." Here is the key passage to the entire article:

The team found that there was a slight excess reporting of brain and acoustic neuroma (ear) cancers. Researchers said this was on the borderline of statistical significance.

Translation: "Borderline of statistical significance" means no statistical significance. So, at this point in time, this study failed to make the connection between cell phone use and cancer. The debate will definitely continue. But for now, feel free to continue using that cell phone! But, please, be careful text messaging while driving.

Conservative/Liberal brain activity

Now, I know the most cynical of you out there are saying, "In politics, there is no brain activity." (image credit) And, I bet there are a good percentage of Americans that agree with you. But, I thought that this was an interesting study reported by AFP.

Conservatives tend to crave order and structure in their lives, and are more consistent in the way they make decisions. Liberals, by contrast, show a higher tolerance for ambiguity and complexity, and adapt more easily to unexpected circumstances.

The affinity between political views and "cognitive style" has also been shown to be heritable, handed down from parents to children, said the study, published in the British journal Nature Neuroscience.

In this study, they took 43 right-handed subjects and asked them to perform a series of computer tasks to see how they would do when they had to break from a well-established routine.

The match-up was unmistakable: respondents who had described themselves as liberals showed "significantly greater conflict-related neural activity" when the hypothetical situation called for an unscheduled break in routine.

Conservatives, however, were less flexible, refusing to deviate from old habits "despite signals that this ... should be changed."

Whether that is good or bad, of course, depends on one's perspective: one could interpret the results to mean that liberals are nimble-minded and conservatives rigid and stubborn.

Or one could, with equal justice, conclude that wishy-washy liberals don't stick to their guns, while conservatives and steadfast and loyal.

The late night comedians will have a field day with this. For me, there are just too many jokes around (pointed both at conservatives and liberals) for me to pick from. Maybe I'll come up with something later....

Chip implants: Linked to animal tumor

Back on May 21st, I wrote a post called Chip Implants: Ethical or not? It talked about the use of an implantable chip in the arm of Alzheimer's patients. This chip would have all the medical information necessary for an emergency room physician or other health care professional who needed it. This post generated a great discussion on this topic.

This morning, the AP has an article which states that chips like this have been associated with tumor production in animal studies. What's interesting is that the companies involved knew this information when they went before the FDA for approval. The FDA approved the use of the chips in 1995.

"The transponders were the cause of the tumors," said Keith Johnson, a retired toxicologic pathologist, explaining in a phone interview the findings of a 1996 study he led at the Dow Chemical Co. in Midland, Mich.

Leading cancer specialists reviewed the research for The Associated Press and, while cautioning that animal test results do not necessarily apply to humans, said the findings troubled them. Some said they would not allow family members to receive implants, and all urged further research before the glass-encased transponders are widely implanted in people.

This definitely adds fuel to the fire of the debate of use of this chip in humans. Despite this AP article, I continue to hold the position that these chips should be used. As stated above, animal studies do not necessarily translate into human studies. Keep a close eye on this story. I imagine that there will be more coming from both sides of this debate.

Lazy Saturday

I have to tell you that I'm really going to enjoy today. This is the first Saturday in a long time where there is actually nothing scheduled. I was on call last weekend, and this is actually the first day in about two weeks in which I have absolutely no work responsibilities. It's actually kind of weird. What the heck am I going to do? Well, blog, of course! Here are some things going through my head right now:

The Office Season 3 DVD: I bought this on Tuesday when it was released and I've been looking forward to watching this for a long time. The season 4 premiere is coming up in a few weeks, and I'm looking forward to that. I'm really mad at NBC for not continuing to offer the show on iTunes. However, I think this is contract/negotiation posturing and The Office and other NBC shows will get back on iTunes when NBC figures out that iTunes actually helped their shows (like The Office) become successful.

iPhone whining wins: You may have read my post earlier this week that there was an outcry among iPhone early adopters that it was unfair for Apple to lower the price of the iPhone $200 only after 69 days after its release. Well, Uncle Steve apparently heard those people and posted an open letter on the Apple website saying that there will be a $100 credit coming their way as soon as Apple figures out how to do that. I guess they heard their angry base of supporters and responded. Maybe the political parties and US presidential candidates should learn from this.

Dr. A Live Update: After the debacle of the Thursday show, the Doctor Anonymous engineers and I have been doing a post-mortem of what happened which lead to the early termination of the show. Of course, the first place to start is the ISP itself, and I'm trying to figure out if anything happened there. Other leading candidates are the cable modem or my wireless router. It couldn't be my trusty Mac, HA! Hope you're having a great weekend!

Too hot to fly?

Is this flight attendant dressed appropriately to go to work? Apparently not, according to Southwest Airlines. Kyla Ebbert took her case to the court of public opinion by making an exclusive *cough* appearance on the Today show. (MSNBC)

It was a lot more clothing than the 23-year-old college student wears on her job as a Hooters waitress. Her mother, Michele Ebbert, said she would have told her daughter if the outfit was inappropriate.

“But her outfit is fine, Michele Ebbert told TODAY co-host Matt Lauer. “She looks like every other college girl in San Diego.”

Not according to a Southwest employee identified only as “Keith,” who approached Ebbert after she had taken her seat on the plane and was listening to the flight attendants go through their pre-departure routine.

“He told me, ‘I’m sorry, but you’re going to have to take a later flight. You’re dressed inappropriately. This is a family airline. You’re dressed too provocative to fly on this flight,’ ” she told Lauer.

This is too funny for me. A "family airline?" The term family is used in so many contexts that even I don't know what it means anymore. But, you be the judge. I know employers can interpret their company policies however they want. But, for what this person was allegedly wearing above to be a flight attendant? C'mon, gimme a break....

Listen Live Today @ 4pm

Doctor Anonymous Live! Sept 6th (today!) from 4-4:30pm Eastern Time

I usually try to rehearse for the show with a kind of "test" podcast. But, with my busy schedule this week, I haven't had time to do that. So, this will definitely be a fun show today!

You can also participate in the show! That's one of the fun things about this. I'm going to be logged into google talk before the show. So, if you'd like to say hi before/during the show, you can find me there. You can also send me an e-mail or leave a comment here. Finally, the fun part is that you can call into the show. Just click here for the number.

Can't listen live? Well, that's ok. One of the cool things about BlogTalkRadio is that they record their shows so that you can listen to them later. Starting at about 5pm eastern time, you can click here and listen to the recorded show.

It's just a few hours away now. I hope that you'll be able to join me - either live or listening on the archives. What am I going to talk about? Who knows? You'll have to tune in to find out. I'm just a blogaholic, you know....

Update: Thanks to Cathy for the plug for today's show!

Update 2 (3:15pm): My internet connection just came back after being off for 30 minutes. Hopefully that won't happen again. If it does, then there may be no show for today. Cross your fingers for me!

Update 3 (4:18pm): I give up! My internet has kicked me off about five times in the last 18 minutes. Thanks to all of you who tuned in today to the show. But, for whatever reason, I don't think it was meant to happen today. I'll try again soon for another show.....

Suicides rise as SSRI use falls

Anyone who takes care of children and adolescents remembers the big bruhaha about the use of antidepressant medications and their association with suicides. This was in the context of a huge drug recall at the time (I don't remember which one) and the FDA getting politically killed in the press for (at the time) not being able to protect America's children. (image credit)

Now, we're starting to see the unintended consequences of the black box FDA warning that was placed on these SSRI medications. According to this article from today's Washington Post, as use of the SSRI medications decreased, there was actually and INCREASE in suicides in children.

From 2003 to 2004, the suicide rate among Americans younger than 19 rose 14 percent, the most dramatic one-year change since the government started collecting suicide statistics in 1979, the study found. The rise followed a sharp decrease in the prescribing of antidepressants such as Prozac, Zoloft and Paxil after parents and physicians were confronted by a barrage of warnings from the Food and Drug Administration and international agencies.

The data suggest that for every 20 percent decline in antidepressant use among patients of all ages in the United States, an additional 3,040 suicides per year would occur, said Robert Gibbons, a professor of biostatistics and psychiatry at the University of Illinois at Chicago, who did the study. About 32,000 Americans commit suicide each year.

Now, I admit that I'm not the smartest dude, but even I can connect the dots here. Many docs are afraid to prescribe these SSRI meds, especially to adolescents, because of the huge black box warning - which basically tells docs that they are taking their legal life into their own hands if they prescribe this drug.

Now, some out there are not willing to admit this association. In fact, there are some out there who are aiming the blame at another set of medications as the cause of the increase in suicides.

David Healy, a British psychiatrist who has been critical of the drugs, disagrees. He said that the increase in suicides was more likely caused by the growing use of antipsychotic drugs among children rather than a decline in antidepressant use. "I would be absolutely certain that the increase is not because kids are not being treated," he said. "They may not be getting SSRIs, but they are getting psychotropics."

Of course these kids are not being treated. People like this are making docs think twice about using the best medications (in my opinion) for children and adolesents. I'll be curious to see other reactions to these findings.

Update: Roy from My Three Shrinks just posted on this topic.

Resident work hours

Resident work hours is a buzz phrase used in medical education. About two years following the completion of my residency, there were new rules implemented to try to limit the hours worked my interns/residents. (image credit)

The theory behind this was that interns/residents would not be as tired and would make less mistakes. And, less mistakes would mean less patient deaths (less mortality).

Data just published from the University of Pennsylvania state that since the implementation of resident work hours, mortality rates have not decreased as expected. (WebMD)

The findings "reinforce the impression that there is still not clear evidence for an effect of duty hour reforms on [patient] mortality," suggests an editorial in The Journal of the American Medical Association by David O. Meltzer, MD, PhD, and Vineet M. Arora, MD, of the University of Chicago.

Now, I wouldn't consider myself "old school," but (cue old guy accent) when I was in residency, we didn't have these resident work hour rules. We were on duty until the work was done.

I know that I probably have talked about this before on the blog, but working all those hours during residency really got me ready for my practice now. To be honest, I think I'm working more hours now than I did in residency.

Not only did I learn about clinical issues and diseases in residency, I learned how to try to balance life at work and life at home. I learned how to try to function on less hours of sleep. And, most important, I learned my limitations when I was feeling fatigued.

I could be wrong, but I think these residents being trained today are being sheltered too much and not getting a true taste of what life will be following residency. When they get in the real world, they're going to learn very quickly that there are no work hour rules.

I feel that the American health care system will not feel the real impact of these resident work hour changes for many years. What kind of American medical workforce will have been created with these rules in place? I guess we'll just have to see.

Avoid the popcorn!

I remember when mom and dad got their first microwave oven. I think I was eight years old. When I asked mom what this thing could do, the very first thing she did was put a bag of microwave popcorn in there and turned it on. I was hypnotized by watching and hearing the kernels pop. (image credit)

Now, according to this article from the AP, it is being learned that frequent use of microwave popcorn could put you at risk for a type of lung disease called "popcorn lung."

[A patient] described progressively worsening respiratory symptoms of coughing and shortness of breath. Tests found his ability to exhale was deteriorating, [Dr. Cecile] Rose [pulmonary specialist] said, although his condition seemed to stabilize after he quit using microwave popcorn.

The article goes on to say that more study and research needs to be done to confirm these findings. But, can you imagine the implications if a definite connection is made? This is really making me think twice. Maybe I should opt more for milk duds rather than popcorn while watching my fave DVDs.

iPhone price drops

In San Francisco today, Steve Jobs introduced new models of iPods - Yay! To me, they look cool and I can't wait to head up to my nearest Apple store to check them out.

In a surprise move at the end of his presentation, Jobs also announced a $200 price drop in the iPhone. So, there is no more excuse for you out there on the fence thinking about getting this nifty device. Now, there is some considerable whining out there in some areas of Apple nation. There's this post: "Apple screwed you: So now what?"

Some people out there who stood in line in late June for this thing are talking about how to get refunds. "The early adopter tax" one person is calling it. All I have to say is this: Stop the whining!

Just admit that you had an urge to get the hottest piece of tech out there and told yourself you had to have it. I bought mine about a month ago and I don't think Apple screwed me with the price. If I thought it was too expensive then, I just wouldn't have bought the thing. Gimme a break!

Dr. A Live Tomorrow!

I'm happy to announce that I've been able to work out in my schedule the time for the next Dr. A show. It will be Thursday, September 6th, 2007 at 4pm Eastern Time.

I was pleasantly surprised how many people listened live and listened on the archives. Thanks so much for your support of the show. (image credit)

The official/unofficial title of this week's show is "The Doctor Anonymous Challenge." Hmmm.... What could that be? I'm not going to explain it at all before the show on Thursday.

The possibilities are endless and I'll let all of you speculate on what it could be. What I can tell you is that I think it will be fun and a unique way for you to participate in the show.

So, write it in your calendar, or put the date and time in your PDA. Me? It's already in my trusty iPhone so that I don't forget.

What? You haven't checked out the first show yet? (Thanks SeaSpray for the review!) Well, just check out this link or simply hit the play button in my sidebar below the BlogTalkRadio button. And, enjoy! See you tomorrow.....

TV linked to ADD?

You're probably aware of the links that have been made between television (image credit) and a sedentary lifestyle, obesity, and diabetes. Now, there is new data stating that children who watch 2-3 hours of TV a day - early in life - may lead to attention problems later in life. (Reuters)

The link was established by a long-term study of the habits and behaviors of more than 1,000 children born in Dunedin, New Zealand, between April 1972 and March 1973.

The children aged 5 to 11 watched an average of 2.05 hours of weekday television. From age 13 to 15, time spent in front of the tube rose to an average of 3.1 hours a day.

"Those who watched more than two hours, and particularly those who watched more than three hours, of television per day during childhood had above-average symptoms of attention problems in adolescence," Carl Landhuis of the University of Otago in Dunedin wrote in his report, published in the journal Pediatrics.

Personally, I find this study interesting because I was born around the time frame in which this study was done. Can I draw any conclusions to my own life or the lives of my peers growing up? Hmmmmmm.....

Now, I do admit that I probably watched the same amount of television at the study participants (does video game playing count in that number?). Here is one of the theories reviewed in the article for this association.

One was that the rapid scene changes common to many TV programs may overstimulate the developing brain of a young child, and could make reality seem boring by comparison.

"Hence, children who watch a lot of television may become less tolerant of slower-paced and more mundane tasks, such as school work," [Landhuis] wrote.

It was also possible that TV viewing may supplant other activities that promote concentration, such as reading, games, sports and play, [Landhuis] said. The lack of participation inherent in TV watching might also condition children when it comes to other activities.

The study was not proof that TV viewing causes attention problems, Landhuis said, because it may be that children prone to attention problems may be drawn to watching television.

Attention deficit disorder (ADD) is so multifactorial, it's very difficult to pin one thing down as THE cause. However, I do admit that sometimes I "become less tolerant of slower-paced and more mundane tasks." Maybe I should watch less television and, say, blog more. What you do think?

Flu Shots: Kudos to Sanofi Pasteur

As many of you know who regularly read this blog, my pulse rises a little bit when talking about flu shots. (image credit) I admit that I directed much of this frustration at the companies who produce the flu shots. Check out my posts - Flu Shot Rant and Flu Shot Rant: Part Deux.

Someone in my office mentioned flu shots last week. As my almost started another rant right there in the office, my staff told me that we just received our first partial shipment of flu shots from Sanofi Pasteur. Hmmmm.... That's interesting.

As I did some investigating on this, I found this news story from the AP and I also found a press release from about three weeks ago.

Swiftwater, PA. - Sanofi Pasteur, the vaccines division of Sanofi-Aventis SA, has started shipping the first of about 50 million doses of flu vaccine it expects to produce this season.

The first doses are being shipped to the Centers for Disease Control and Prevention to support the Vaccines For Children program and to private doctors and other health care providers.

Sanofi Pasteur makes about half the worldwide supply of influenza vaccine and more than 40 percent of the U.S. supply, the company said in a statement.

The distribution, sent to providers in partial shipments, is scheduled to continue through the end of October. Influenza rates typically peak in February, according to CDC data.

So, I'm going to give credit where credit is due. Of course, there was very little press at the time. News is only made when the flu shots are late as they have been the past few years. However, congratulations to Sanofi Pasteur for being ahead of the curve this year.

Here are the big questions that my office is now asking: When should we announce to our patients that we have some flu shots? What date should be pick to give out the flu shots? What happens when our patients find out when we have some flu shots?

As stated by the Centers for Disease Control, an influenza season may extend as far as the late spring. So, theoretically, someone could get the flu shot too early and not be protected for a possible late influenza epidemic.

Of course, when our office begins giving the flu shot will be determined by market forces. This means that when some of the supermarkets and other retailers start giving out their shots, that's definitely when our office will be getting the phone calls.

But, getting back to my point, I'm glad that we received a partial supply in August. If your office ordered flu shots this year, have you received a partial shipment yet?

Parents blamed for pre-school stress

In many communities across the United States, the first day of school is usually the day after the Labor Day weekend. (image credit) As (some) parents rejoice and (some) kids dread the start of another school year, there is new research data being released stating that parents cause kids more stress when starting school.

Before all the parents who read my blog start to throw things at me, I'm just reporting a news story here (smile). This study is from the UK and courtesy of icWales. The study looked at kids who are starting school for the first time.

Scientists measured the levels of the stress hormone cortisol in children two weeks after they had started primary school and then again six months later. They also took cortisol measurements three to six months before the children started school to provide baseline levels for comparison.

The researchers said they were surprised to find that, far from providing a baseline, children’s cortisol levels were already high several months before the start of the school term.

High rates of the hormone can even make children more susceptible to colds and other minor illnesses.

Dr Julie Turner-Cobb, from Bath University, who led the research, said, “This suggests that stress levels in anticipation of starting school begin to rise much earlier than we expected.”

Dr Turner-Cobb said it was unclear why pre-school children would become anxious so far in advance, but suggested that parents were getting stressed about their children starting school and were passing those fears onto their children.

The article goes on to talk about how things were easier when they had an older sibling who already went through the "starting school" process. The article also talks about how the first day of school can also be tough on parents.

Now, it doesn't take a rocket scientist to make some of these assumptions. But, I thought the cortisol data was interesting. Any thoughts out there on the stress level of kids and parents when it comes to the first day of school?

Dr. A with My Three Shrinks

My Three Shrinks from the Shrink Rap blog (say that fast three times) just posted their latest podcast. And, I'm happy to say that I was honored for them to ask me to be on their podcast. We have been working for weeks to try to match up our schedules and it finally happened.

From the "computer geeky" aspect, it was really cool. We used skype to conduct the interview, which I've never done before. And, just FYI, they are about 300 miles away and the connection was so clear that it sounded like they were just in the room next door.

From a professional point of view, it was quite exciting to actually talk and interact with the people that I've only had one-way electronic communication with in the past. At one point in the podcast, Roy encourages me to interject myself into the conversation because I may not get a word in during a spirited part of the conversation.

I know that I had a lot of fun being on their show, and I hope that another opportunity comes up in the future to do that again. I hope you enjoy the podcast. Here is My Three Shrinks #32.