Wednesday, January 31, 2007

Is Dr. A a quack?

It has definitely been an interesting seven days. You may have been wondering why the comment moderation has now been turned on. I talk about what's been happening in a video I recorded over the weekend while I was out of town.

I apologize for the fair quality of the video. I had my laptop last weekend. And, of course, it's not a fast as the home desktop. The audio is pretty clear and that's what's most important.

There have been many questions (via e-mail and comments) on whether I'm actually a real physician or not. Get ready, because this is the only post I'm ever going to talk about this. And then, I'm moving on with my life.

For those without high speed internet capability, you should know that this video lasts about eight minutes and on my computer the file is about 8 MB. Hopefully, that will give you an idea how long the download time will be.

So, without further ado, and for those who are interested, Doctor Anonymous answers his critics in this video I'm calling, "Duped by Dr. A?" (link removed)

Tuesday, January 30, 2007

Grand Rounds

Grand Rounds 3.19 is now up and running at the blog called Envisioning 2.0. The theme is consumer driven health care. Because I was so busy last week, I didn't have an opportunity to submit anything.

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 Tales from the Emergency Room.

Monday, January 29, 2007

The Carmela Treatment

No, the above picture is not Carmela. More on him later....

Carmela Bousada is believed to be the world's oldest mother. The beginning of this Associated Press story is very uplifting. Her dream has always been to have a child. She sold her house in Spain to raise the money to pay for fertility treatments in California. She gave birth to twins on December 29th.
"I think everyone should become a mother at the right time for them," Bousada said in a video of the interview provided to Associated Press Television News.
Happily ever after, right? Not quite. Here's the rest of the story....

The Pacific Fertility Center in Los Angeles has a policy which states that anyone over the age of 55 years old cannot receive treatment. How old was Carmella when she became a patient there? She was 66 years old! And, she just turned 67 years old this month.

How could this happen? There are many angles on this story. I will only analyze two (or three) of them below...

Fertility Center Responsibility: This is the obvious place to point the finger. According to clinic policies, presentation of a passport is required before any treatments are started. In the article, the clinic director is quoted as saying, "We do check identity." Is it me, or does anyone else think that this clinic will not be open much longer?
"Often circumstances put you between a rock and a hard place and maybe things shouldn't have been done in the way they were done but that was the only way to achieve the thing I had always dreamed of and I did it," she [Bousada] said.
Personal Responsibility: How many times have I talked about personal patient responsibility on this blog? To lie to get what you want? Sheesh! That's a great first lesson to teach your twins.

"Mommy, tell me the story of how we came into the world?" Does Carmella think that she can tell her twins any 'ol story about how she started in Spain by selling her house to come to the land of opporunity. Then, she LIED to get what she wants? Does she think they'll never know? What's up with that?

The gentleman pictured above is Niccolò Machiavelli. Sound vaguely familiar? Many associate him with the phrase "the ends justify the means."

I try to understand the passion people have about becoming a parent and being a parent. (Full disclosure: I am not a parent myself). But, for someone to do this, and for the clinic to allow this to happen. I just don't get it.

People are probably asking why I even care about this story. What's done is done, right? My question is if this person will take responsibility for what she's done. Yes, she has twins now, and that's enough. Or, is it?

Yes, she sold her house for her dream. But, who is paying for the care of her twins who were born seven weeks premature? This is not a political blog, but if the tax payers of California are subsidizing people who lie to get fertility treatment, and are paying for neonatal intensive care for her twins, wouldn't people want to know about that? Does the end justify the means?

Sunday, January 28, 2007

Dr. A Revealed

So, I did it. I took a small step out of the shadows of anonymous-ness (is that a word?). In the midst of my blog funk, I tried out video blogging. I have to tell you, it was an interesting experience. Don't get me wrong, my blogging home is still here. I don't know how much I'll vblog, but we'll see.

Why reveal my big mug now and in the past be reluctant to even show my face in a picture? I dunno. As I say in the video, I've been looking at vblogs for about a month now. And, I've been really taken by them.

It was kind of like the feeling I had when I first started looking at text blogs. It took me six months to get up the courage to start this blog here. During my blog funk this month, I told myself that I was not going to wait that long again to try something new.

So, I recorded it, and waited. I thought about it and thought about it and thought about it. Should I really post this thing up there? Am I ready to really do this? Is this the right thing to do? We'll see. Check out my first vblog called, "Help! I'm a Blogaholic!" (link removed)

Friday, January 26, 2007 features Doctor Anonymous

Who is this guy? Well, he is my new best friend. LOL. I just learned that this very blog was featured in a story by Dr. Manny Alvarez who is the Health News Managing Editor.
Is there a Blogger in the House? Five Great Doctor Blogs

Dr. Blog Please Report to the Internet, Dr. Blog Please Report to the Internet...

The prescription slip with the chicken scratch you're holding may suggest otherwise, but let it be known that some doctors can actually write, and write well. You can thank the computer for the legibility, but the content comes from somewhere else.

In today's column we're featuring blogs written by doctors themselves. Doctors from all medical disciplines are blogging about their areas of expertise, their thoughts on popular health news items, as well as those appearing in medical journals, and anything else that tickles their fancy.

You may be a little more knowledgeable before the next visit to your doctor after your first visit to one of these web sites.
I remember reading about when Emergiblog was mentioned last month.
I am humbled to be included in the same article as Flea, Surgeonsblog, Neonatal Doc, and the Cheerful Oncologist.
Doctor Anonymous: Don't be fooled by the picture of McDreamy from the hit ABC medical drama "Grey's Anatomy." Just because actor Patrick Dempsey supposedly saved a life recently, that doesn't make him a real doctor. Sorry, ladies.

Doctor Anonymous reveals that the blogger is a physician and a blogoholic. Good thing for his readers, because he provides interesting perspective on a wide variety of health topics (and frequent off-topics, if you will) including children's health, Alzheimer's, medication, and the latest health headlines.
Well, I'm definitely out of my blog funk now, huh? Thanks so much to Dr. Manny and for the plug. I really appreciate it. Welcome to those of you who have clicked on over from there. I invite you to my sidebar to check out my favorite posts. Thanks for stopping by....

Thursday, January 25, 2007

Conflict of Interest

Ok, ok. I guess I started this hot button topic. So, I should at least follow through on it. I should preface this post by saying that I am in no way, shape, or form - in a position of power in any health care policy organization. So, don't expect a polished statement. I'm just a peon in this mammoth health care system.

In discussions like this these, three questions always come up: How much does pharmaceutical marketing tactics make you prescribe their drug? Is this fair or unfair for your patient? Is this a conflict of interest?

Of course marketing tactics influence my prescribing habits! There have been many studies done to confirm this fact. This data is used by this medical school to forbid its docs from accepting any freebies from drug reps. This data is also used by this organization to advance its agenda of a zero tolerance policy of any acceptance of drug company free stuff.

Don't get me wrong, these are not the only groups who have this point of view. In every major medical organization in the US, there is a group of docs who want to absolve themselves and all medical organizations (like the American Medical Association) from all pharmaceutical funding - meaning that organizations like the AMA should accept NO FUNDING whatsoever from drug companies - because of conflict of interest.

While I understand these arguments, I disagree with them. (And, no, I'm not on the payroll of any drug company.) I think taking such an extreme point of view is not going to help them achieve their goal. I'll be curious to see follow-up studies at "that medical school" to see if removing drug rep freebies changed prescribing habits.

Drug reps and drug company marketing are always going to be there. There is no avoiding it. A few years ago, drug companies wised up and marketed directly to consumers - taking the doc right out of the loop. So, even if you ban drug reps from your office, patients always come in saying, "I heard on television to ask you about drug X." That's marketing getting at you a different way.

Even though I had my pissy rant yesterday, drug reps definitely do serve a purpose (and not just to give samples of meds). If for anything else, they serve as an information resource for me. Now, this is a biased resource. But, I know that going in. I work 12-14 hour days sometimes. I don't have the time to keep up on the latest medical research. I'm a clinician, not a researcher.

Through my medical school training, I've been taught to question all information that is given to me - whether it's a patient's vital signs, or physical exam, or lab work, or whatever. These skills I use when talking with reps about data they give to me. The pearls of info I receive during these interactions help me to make a more informed decision on prescription drug selection.

Finally, is this fair for patients? Fairness is always in the eye of the beholder. In my opinion, when you boil down the issue to its essence, it just comes down to the strength or weakness of the patient-physician relationship. Not only should the patient feel comfortable enough to express their feelings on this topic, the physician should be ready to listen and explain her/his point of view in a non-judgemental way. I didn't say it was easy, but it is necessary.

Tuesday, January 23, 2007

Drug Rep Rant

I'm not a big fan of pharmaceutical reps. I make no secret of that. I know that they have their place in the huge (failing) US health care system. If for anything else, they bring sample meds for those of my patients who cannot afford them and who do not qualify for indigent medication programs.

I think my real issue is that I have never liked sales people whether it's selling me a car, or selling me a pair of shoes, or selling me a drug. For the most part, sales people don't really care about you and they don't care about my patient. All they care about is one thing - Dr. A prescribing their product.

Our office has drug reps bring in lunch 2-3 days a week. For me, I'd rather go home for lunch, and not have any drug rep lunches - EVER. But, out of courtesy for bringing lunch for the office, I go into our lunch room with a smile on my face.

The rep then starts with her dog and pony show. The product today is insulin. I get to see all the funky charts and graphs of why their product is better than the others. I'm also shown the recommendation THE some ivory tower commission recommending starting insulin earlier in the treatment course for diabetes.

Then, as I'm quickly eating my lunch, I feel my muscles tense up a little bit as they reach "the ask" where they try to get a committment from you to at least give their product a try. I always hate this part of the lunch.

I inform them how difficult it is to at least talk about insulin with some of my patients. There's a lot of myths that I have to deal with when it comes to insulin therapy.

"But Doctor A, my product is so easy for patients to use. You can proudly tell them that they hardly ever feel the needle. And, isn't my product so much easier to take than the many pills that you have your patient on?"

As I always do, I give a fake laugh and tell them that they have made good points. I also tell them that I will keep their product in mind. Then I scurry out of the room....

I get back to my office and close the door. I'm fuming at this point. How dare this rep come in my office and push a product on me! Of course, I know that insulin is better to start earlier rather than later. I've seen the data on this.

One of the things I've always wanted to do is to bring in a rep with me and say, "Ok, Mr. V is in room 3 and I think he needs to be on insulin. I don't want you to come out of that room until he's agreeable to start insulin." See what I go through everyday, not just once a day, but several times a day.

"But, Mr. V, you won't even feel the needle. And, it's so much easier than all the pills that you're taking." That thought makes me chuckle.

Good primary care docs have a rapport with patients. The age of paternalistic medicine is over. Gone are the days where the doc says take this medicine and the patient did it. Patients are more knowledgable about medicine and the meds that they take. They hear about side effects from friends, from drug store printouts, from television, and other sources. Don't get me wrong, more knowledge is good.

There's also a lot of misinformation and myths out there, especially about insulin. Many of my patients think insulin therapy is equal to hospice care - means that nothing else can be done and they will die soon. Many cringe at the thought of giving themselves an injectable medicine.

Sometimes, it can take months and months of communication. I have to understand where the patient is at and hopefully they understand my point of view when it comes to insulin. Drug reps have this TV show mentality that everything is solved during the 10 minute office visit with a prescription for their product in hand. Sorry, it doesn't work that way.

Grand Rounds

Grand Rounds 3.18 is now up and running at Signout. Dr. Signout is a first-year resident (ie - intern) in an internal medicine residency in the US. She moved her blog recently to the scienceblogs family. Thanks to Dr. Signout for including my submission this week...
For Dr. Anonymous, uterus transplants provoke many questions, but few answers.
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?

I have no idea how Dr. Signout managed to put together GR and be an intern. I know it was crazy for me when I hosted. Nonethless, great job! Next week, Grand Rounds moves to Envisioning 2.0.

Addendum: Hmmmmm... I tried to leave a comment of congrats over there and it told me I was "forbidden" to leave a comment. That's interesting. Maybe someone over there at scienceblogs just doesn't like me. Anyway, congrats on GR, Dr. Signout.

Monday, January 22, 2007

Queen Meme Speaks

If you don't already know, a meme is a list of questions that is passed around the blogosphere to the delight or detriment of those who are "tagged" by their "friends" to share in the fun. I get tagged a lot. Maybe it's because I have a lot of friends. HA!

Anyway, today, Mimi Lenox, the proclaimed Queen of Memes, has the latest edition of the Bestest Blog Carnival. She titled it, "My Favorite Meme Carnival."

Thanks to Mimi for including my submission called the Christmas Song Meme. It was quite fun to start and see it pop up in different places in the blogosphere. Thanks to all who participated in my meme.

If you don't know, a blog carnival is an accumulation of posts from different writers usually with a theme. All of these posts are placed on one site for everyone to enjoy. So, if you haven't checked out Mimi's site today, I encourage you to do so. You won't be disappointed.

Blog funk

First of all, thanks so much for everyone's comments and suggestions on how to try to get out of my blog block. I really appreciate it. Unfortunately, I'm in full blog funk mode.

For your entertainment, I have nine-and-a-half minutes of the pure funk experience above. But, that's good funk. Me, I'm in that bad funk place. The rest of this post is going to be rambling (and maybe whining also). So, feel free to click off at anytime....

I've been trying all weekend to change over to the dreaded blogger beta. For some reason, I'm still not allowed to do that. I'm starting to get a complex. Does someone not want me to join the rest of you over there? One day am I going to find my account deleted because I didn't change over? Strange.

And, everytime I get that rejection page, the thought always goes through my mind that I should just switch over to somewhere like wordpress, or typepad, or another blog host. I don't have the technical know-how to set up my own site and server. But, I've had many offers to take care of that for me and to leave blogger.

Maybe I just need to get out of Dodge and take a little break. I am going out of town this coming weekend for a meeting. Maybe that's the spark I'll need to get out of this funk.

Ever get in a rut? I mean, not just blogging, but in life? Kind of getting caught up in the rat race of everyday life - just trying to keep your head above water with everything that is going on. Don't get me wrong, I'm very lucky to have the life that I do.

But, something just doesn't feel right lately. And, I haven't figured out what it is. I dunno. Maybe I'm sick of the cold weather around here and can't wait for the warmer temperatures of spring. Maybe it's the fatigue catching up to me. Or, maybe, just maybe, I just need to relax and stop being such a worry wart.

Thanks for tolerating this post. I know whatever is going on will work it's way out of my system and my psyche. Till then, I'll use the many of your suggestions to get out of this blogblock and blogfunk. Thanks for sticking with me....

Friday, January 19, 2007

Blog Block

I got that blog writer's block virus. (Cartoon credit: A Perfect World) Don't know where I got it or how I got it, but I got it. Maybe an antibiotic will make it go away? Maybe I need to go to the blog block doc? Maybe I need Jenny from the block? Maybe I need to plan a blog block party?
What do you do when you're hit with writer's block?

Wednesday, January 17, 2007

I hate American Idol

I actually don't. I was just being provocative. I admit I didn't watch the show last night. But, when I came into work this morning, AI is the only thing that anyone would talk about. How this person was an awful singer and how that person was yelled at. I'm just standing there saying - Huh?

I'm ignorant on this. I have never watched the show. I don't get the show. What's the appeal of the show? I mean, it's just a super-hyped talent show, right? Is a shortcut to fame and celebrity now the goal? Maybe this is a sign of me getting old, but doesn't anyone want to "pay their dues" anymore and take years of hard work to achieve your goal? I know people will put me in my place and put me on the right track. I guess I just don't get American Idol...

Six words meme

I was tagged by my good friend Difficult Patient (did you know she's blogging again?) for a meme that goes like this: Tell a story in six words, no more, no less. There's a very good group of these at a blog called change therapy. DP also used a library card graphic which I have seen in different places out there in blogland. For my story, I'm going to borrow an phrase from yesterday's post....

Grand Rounds

Grand Rounds 3.17 is up and running at Kerri's site called Six Until Me. She has a theme this week and it's called "Emotions in Healthcare." And, she has put together in a very creative poem encompassing her theme. Thanks to Kerri for including my submission.

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? A very interesting and well done edition of GR this week. Great job Kerri! Next week, Grand Rounds moves to the blog called Signout.

Tuesday, January 16, 2007

Almost Famous

Anyone remember this movie? I love those Cameron Crowe movies (see Say Anything). This was the first time I saw Kate Hudson (Kate, call me!) on screen. I feel like I'm having my almost famous moment...

So, I'm fulfilling my sitemeter addiction this morning, when I see a link from a Seattle newspaper. When I click over and see what that is, I see my blog and URL on the screen. Sheesh! Here it is...
What's Online: HEALTH

A family guy and medical know-it-all, Doctor Anonymous prescribes wellness wisdom with a dose of domesticity.
I've never had a byline before. So, at first, I thought it was a joke. I looked around the page to see if it was actually real. And, this page IS real. Wow!

Thanks to the Seattle Post-Intelligencer and whomever submitted my blog to their paper. I really appreciate it. Welcome to those of you who have clicked on over from the SeattlePI site. Excuse me as I do my happy dance...

Uterus transplant

A hospital in New York is looking into offering the first uterus transplant in the United States. Ok, before you jump to conclusions, this is not a comedy post. I know a lot of you out there in blogland are reaching down deep for that late night talk show joke and punchline, but this thing is seriously being talked about as a possibility.

According to the article, the hospital ethics board has conditionally signed off on these preliminary plans. As you already know, ethics boards sometimes make divisive decisions - just ask the hospital board who decided on The Ashley Treatment.
Organ transplants usually are performed to save lives, but increasingly they are being done to improve quality of life. Hand transplants and the recent partial face transplant of a woman in France are examples.
There are many questions that need to be answered before this possibility becomes a reality. When asked if it could be done, lead physician Dr. Giuseppe Del Priore said, "I believe it's technically possible to do." But, just because we CAN do this from a technical standpoint, does this mean we SHOULD do this? That's my ethical question. I also have the following questions.

Medical questions: Anti-rejection transplant drugs are powerful stuff. Yes, we have some data which states that the pregnancy rate for transplant patients are "not much worse than for the general population." Can this data be correlated to uterine transplant patients? How much do anti-rejection drugs cross the placenta barrier? What would be the effect to the fetus/baby?

Moral questions: You have to know that this will be another platform for the abortion debate to take place. (By the way, welcome to those of you out there who found this post from a Google search). Presuming the transplant goes ok (and that's a big IF at this point), what if the pregnancy goes awry? What if the life of the mother is at risk and/or the life of the fetus/baby is at risk? Both sides of this debate will definitely make their point of view known.

Legal questions: The malpractice attorneys are preying, er, praying that this procedure becomes a reality. The liability here is huge. The potential for medical problems are everywhere starting with the transplant itself, then the pregnancy, then the potential complications of anti-rejection transplant drugs.
The cost is unknown but could top $500,000, including two weeks of hospitalization, Del Priore said. He expects the cost to be shared by the hospital, charities that support infertility research, the patient, and insurers who cover the embryo creation part.
My final question is a financial question. I know I'm going to be attacked for this comment, but here goes: Is all of this worth $500,000? I know people are going to say, "Well, Dr. A, isn't life priceless to you?" Or, "You don't know what it's like to be told that from a medical standpoint, you can NEVER have the possibility of the pregnancy and childbirth experience."

Those are good points. But, you sense my pessimism here. Personally, I don't think uterus transplants will ever happen. Even if they could be technically done, I don't think they should be done. My 2 cents worth...

Monday, January 15, 2007

Remembering MLK

I have a dream that my four little children will one day
live in a nation where they will not be judged
by the color of their skin but by the content of their character.
Dr. Martin Luther King, Jr - August 28, 1963

Addendum: I had some e-mail questions concerning my post today. For those around the world who may not know, today is a national holiday in the US in observance of the birthday of Dr. King. He would have turned 78 years old this year. You can read more in this article from CNN.Com.

Sunday, January 14, 2007

Bestest Blog

Thanks to Bobby for re-posting by bestest blog bio from last September. Welcome to all of you who have clicked on over to check out my blog. I hope you like what you read. Please leave comments and give me some feedback.

For those of you who don't know what bestest blog is, the concept is simple. You put a link to Bestest Blog of All-Time to your site, and Bobby will put a link of your blog on his site. Bestest blog has definitely helped me gain more traffic. Want proof? Just click on my sitemeter graphic at the bottom of this page. Thanks Bobby and Bestest Blog!

Saturday, January 13, 2007

Miracle in Missouri

Short post today. All morning I've been watching the news about these two boys, Shawn Hornbeck and Ben Ownby, who were kidnapped and miraculously found this week. I can't even imagine what that must have felt like both for these kids and for their families.

There have been many references to the Elizabeth Smart kidnapping as well. I remember when that was in the news - both her being missing and her being found. I can't help but wonder how this shocking experience will mold their lives. I guess we won't know for a number of years.

Here's one thing that really gets me upset in uplifting news stories like this one. Once the "feel good" feelings wear off, which usually take a day or two, the news then focuses on the perpetrator. This guy will become the celebrity criminal of the week. The press will "try to get into the head of" whomever this guy is.

Then, the TV movie will be made which will somehow rationalize this guy's behavior with some kind of story of a tragic childhood. Don't get me wrong. Guys like this never have a "normal" upringing. But, as always happens, the press (and probably Hollywood) will somehow remove the personal accountability for his actions by making excuses and make this guy famous. Really burns me up sometimes. I guess this post wasn't so short after all...

Friday, January 12, 2007

Ben & Bennie on CNN

Thanks to all of you who have clicked on over to read my post on The Ashley Treatment. I really appreciate it. Ben & Bennie, from the blog called A Work of Art: Raising Our Exceptional Son, has raised comments on this site along with other sites. They has been following this case very closely.

On their blog this morning, it announced that Ben and Bennie will be on television tonight to talk about Ashley's case. They will be on Paula Zahn's show on CNN sometime between 8-9pm eastern time Friday night.

Click on over to their blog and wish them luck. I'm sure they'll do well. It'll be interesting seeing how the words on the page of a blog translate into television.

$25 million meaningless

Oh this is just stupid. If half the energy that went into discovering pills and medications like this were to go into ways to change the diet industry from money sucking attention glommers full of fad diets, there would be so much less obesity in the American culture, animals included.

The above comment is from Andrea from my post on the new diet pill for Fat Fido, er, Plus Sized Pooch. This is a perfect segue into today's topic of human diet pills.

Last week, the US Federal Trade Commission took a bold step (yeah right) and fined the marketers of four weight loss drugs a collective total of $25 million for false claims.

A commercial for one of the drugs, Trimspa, is seen above with its spokesperson at the time, Anna Nicole Smith. The commercial is really pathethic. It makes me laugh every time I see it. "Trimspa, baby." Too funny.
"Testimonials from individuals are not a substitute for science," [FTC Chairman Deborah Platt] Majoras said. "And that's what Americans need to understand."

The FTC investigated a variety of claims, including rapid weight loss and reduction in the risk of osteoporosis, Alzheimer's and even cancer, Majoras noted.
Did I mention that even though these companies were fined, these "weight loss" products are remaining on the market? What kind of a joke is that? How many millions of dollars a year do these companies rake in? I believe that this fine is just a slap on the wrist. It's a completely meaningless gesture that will have no impact whatsoever.

That's the problem with these so-called dietary supplements. They can claim whatever they want. All they have to do is pay a fine and continue to spread their propaganda and sell their product.

Now, if prescription drugs made false claims, well that's another story. That's a big story. The drug would be removed from the market. It would be painted as another failure of the FDA and that's front page news. Also, another hit piece media story against pharmaceutical companies. Doctors would not be immune to this fall out as well - "How could doctors willingly particpate in the deception of patients?"

But, since it's products like, TrimSpa and Cortislim, well, they're not really medications, are they? They're just supplements. Everyone knows that they say their weight loss drugs, but they really don't mean it. It's just a marketing thing.

The lack of accountibility and the double standard here really get me upset. If the federal government wants to send the right message and to make an impact, they should remove these "diet pills" from the market. Oh yeah, I forgot. This is the federal government where bureaucracy, politics, and the status quo rule. Thanks for tolerating my whining once again. Have a great weekend!

Wednesday, January 10, 2007

Apple iPhone

After weeks of speculation and expectation, Steve Jobs introduced the Apple iPhone at the Macworld Conference and Expo in San Francisco yesterday. I've already confessed my obsession for gadgets like this one.

This is a really cool product. Not only is it a phone, but also an iPod and an internet browser as well. For more details, check out the iPhone site and even watch the Steve Jobs presentation of the iPhone.

The thing is not going to be available until June. So, I have a little time to talk myself out of buying this cool gadget. But, well see....

Tuesday, January 09, 2007

Fat Fido

It would be safe to say that that some people out there, and you know who you are, love their dogs more than they love their kids. No one ever talks about that in public, but all of us know people who take care of their pet better than their kid.

Well, the US FDA is following suit, because last week they announced the first prescription drug to treat dog obesity. Yes, that's right, dog obesity. The drug is called Slentrol and is brought to you by Pfizer. You know, the same company that manufactures Lipitor.

According to this article, the problem of dog obesity is so prevalent a whopping FIVE percent of dogs are considered obese. This equals about 4 million dogs. And, another 20-30 percent are considered overweight.
``This is a welcome addition to animal therapies, because dog obesity appears to be increasing,'' said Dr. Stephen Sundlof, director of the food and drug agency's Center for Veterinary Medicine, announcing the approval of the drug.
Now, not everyone is excited about this new medication. (Imagine that.) In fact, some people are outraged that Fido has the same opportunity that many Americans have to lose weight so that Fido can squeeze into that Speedo for summertime.
That is a shame, but here's something to think about: Why don't dog owners - the people theoretically in charge of feeding said chunky canines - just feed them less and exercise them more? Or, perhaps in extreme cases, try any one of dozens of weight-restricting food products for dogs on the market? The whole thing is just ridiculous.
Oh yeah, the drug maker, in full disclosure stated that the drug will cost $1-2 a day and has the potential to cause liver problems. Side effects may include vomiting, diarrhea, lethargy, and loss of appetite.

Before I close, I would like to apologize for using the characterization of "Fat Fido." I don't want to be targeted by Rosie. So, maybe I should instead say "Plus Size Pooches" now have a drug to help them remove the plus. HA!

Grand Rounds

Dr. John Lapuma has Grand Rounds 3.16 this week. He calls his theme "food as medicine." An interesting batch of posts this week. I tried to leave a comment over there and you have to be "logged in" to leave a comment. Oh well.

If you have no idea what Grand Rounds is, it is a collection of posts collected every week from the medical blogosphere. Next week, GR moves to Kerri's blog called Six Until Me....

Another tag

I guess I'm feeling the love this week. SuperStenoGirl tagged me with this random meme. And NotFearingChange tagged me with the "five things" meme, which I already did. Sheesh!

I have to apologize if I'm a little fiesty while answering these questions...

1. What is your name? Dr. A - also known as Brad Pitt.
2. What is your quest? Are you kidding, the Holy Grail!
3. What is the air speed velocity of an unladen swallow? Um, is this a dirty joke?
4. Do you know why I asked those questions? No, not really...
5. Is there someone that you think about all the time? Yes, Trump and Rosie. Can't they just work something out?
6. What is your view on gay marriage? Some people support it and some people oppose it.
7. What is your favourite colour? Blue, or sometimes Red...
8. Do you like green eggs and ham? Yes, Sam I Am.
9. If you had to choose, would you rather be blind or deaf? Neither.
10. What are you wearing? Uh, what are you wearing... Hmmmmm...
11. Are you attractive? Have you seen my geek profile?
12. Are you smart? Have you seen my geek profile?
13. If you could have any job in the world, what would it be? The job that makes me happy...
14. Mmm, scented candles smell good don't they? Yes, they cover up the stinky neighbor smells...
15. Do you still put bubbles in your baths? Uh, do you like bats in your belfry?
16. Finish this sentence: when life hands you lemons... -- Hand them back for a refund...
17. Do you speak any other languages? Yes, English...
18. Are you a role model? Ask this guy...
19. Do you have any nicknames? Yes, people often call me Dr. McDreamy for obvious reasons...
20. What is your biggest fear? To get tagged again this week with another meme.
21. Do you believe in life after death? I hope to be in that big golf course in the sky some day...
22. If there is a God, what do you hope he says to you as you arrive at the pearly gates? This is a weird question. I feel like I'm on that show with the actor people. Do want to know my favorite curse word now?
23. Quote me a line from a song that has important meaning to you. Click here.
24. What is your biggest pet peeve? Asking personal questions...
25. Aren't puppies just oh so cute? Especially if they're pitbulls.
26. If Elvis hadn't died young, what do you think he'd be doing today? Hosting American Idol.
27. Ever wish on falling stars? It's too cloudy here to see falling stars.
28. What is your favourite thing to do on a rainy day? Uh, blog...
29. Do you do any winter sports? Sleep. Isn't that a sport?
30. Did you like this survey? Um, what do you think?

Monday, January 08, 2007

Taser for sale

I'm definitely what you would call an electronic gadget guy. I'm sitting in front of my Mac at work which is next to my pager, my RAZR cell phone, and my Palm PDA. Are you sickened yet? Plus, you know the car that I drive (scroll below).

I'm always excited this time of year because it's the annual Consumer Electronics Show in Las Vegas. It's a gadget guy's paradise. Did you know that there's a huge 63 inch plasma TV that they're marketing out there? That is, if you're into that sort of thing.

Something that did catch my eye was in today's USA Today. Apparently, there is going to be a new version of the controversial taser stun gun that's going to be put on sale (pictured above).

What's new about this? Well, this is a smaller version that previous that can be stored in a purse or a backpack. Curious yet? The older model is big and bulky and cost about $1000. This newer version is coming in at a cool $300.
Taser [International] says the C2, less powerful than the police version, is designed to stun for 30 seconds, providing enough time for the shooter to flee from danger.

"It's a terrible idea. It's a dangerous idea," says Larry Cox, executive director of Amnesty International USA, which says there have been 200 Taser-related deaths. "I can't think of any reason you would want these out in public."

Daniel Garza, 42, was glad he bought the civilian Taser when a man climbed in the back seat of his truck Dec. 17 at a Yuba City, Calif., Wal-Mart. Garza zapped the intruder, who was arrested. "The Taser did the job," Garza says.
Although I do not own a gun myself, I definitely support the second amendment to bear arms. However, should the public have easier access to a weapon like this? I would probably have to say no. I think that only law enforcement authorities should have access to taser like weapons.

This is probably a bad analogy, but I think about the public's access to medications. There's a certain group of meds that people should have access to (called over the counter meds). Then, there's the group of meds that should be prescription only and managed by those "medical professionals" (I think that's the politically correct term) who have prescriptive authority.

I could be wrong on the taser thing and on the prescription medicine thing. But, I know you'll let me know where I'm going wrong on this. Would you buy one of these things? What if your neighbor bought one of these?

Hang on sloopy

I believe in recycling so much that I'm recycling this post from last November in honor of Monday night's National Championship Game between THE Ohio State University Buckeyes and Florida Gators.

Also, please say hello to a couple of new bloggers who are off to great starts on their blogs: ID Crossroads and Professional Dreamer.
And, don't forget to tell them that Dr. A sent ya!

Sunday, January 07, 2007

Tagged again and again

Ok, I admit it. I've been a bad boy. I've been tagged three times in the last two weeks or so, and I haven't gotten around to responding to them. Bad Dr. A!

Lady Aeval and Moof tagged me on "5 things you don't know about me." Then, Fat Doctor tagged me for "7 musicals for 2007." If anyone else tagged me, I totally forgot. So, I apologize if I forgot you.

Since it's my blog, I'm going to give you a modified meme or sorts. It's a pictoral list of things you may not know about me. And, I throw in a little musical thing at the end. Hope you enjoy it...

The car I drive: Chrysler PT Cruiser Convertible
I've never had a convertible before. And, for the five sunny days each year in Ohio, I actually have the top down. Kind of fits my personality, don't you think?

My current computer: iMac G4
I'm hoping to upgrade soon. This thing is a tad bit on the slow side,
but still, in my opinion, the most stylish looking computer on the market.
Also, gotta love those Mac commercials.

My dream golf destination: Pebble Beach
I've actually "played" this course on computer games. But, I'd love to be there in real life someday. Everyone I've talked to say that even though TV shows the beauty and majesty of the course, there's nothing like being there in person.

One of my favorite movies ever: Say Anything
So many memories (good and bad) from high school when I watch
this movie again and again. I can still recall many of those
quirky Say Anything quotes, even today.

One of my favorite songs ever: End of the Innocence
Who knows how long this will last
Now weve come so far, so fast
But, somewhere back there in the dust
That same small town in each of us
I need to remember this
So baby give me just one kiss
And let me take a long last look
Before we say good bye

Friday, January 05, 2007

The Ashley Treatment

Ashley is a 9 year old who lives in the Western United States (picture from a Daily Mail article). Her case has sparked a huge medical ethics debate having to do with rare medical conditions and parent's medical decision making ability for a child.

Ashley was born with a rare condition of the brain called static encephalopathy. What does this mean? The best way I've seen it described is a type of permanent brain damage. This type of condition is associated with a lot of disabilities like mental retardation, cerebral palsy, autism, and other similar conditions. It's been reported that she currently has the mental capacity of a three month old baby.

Ashley's parents, like other parents, were concerned about how they would care for a special needs child like this. But, unlike other parents, they took an unprecedented step to ask her Seattle doctors to perform what was described as "growth-attenuated" treatment.

Essentially, this type of treatment, prevents physical growth and keeps Ashley in her physical child-like state. Her parents made the argument that Ashley could be more easily cared for in this state. Ashley could be moved easily from place to place and she'll have a better opportunity to interact with other family members.

Who approved this radical treatment? Well, this was reviewed and approved by the hospital ethics committee before the treatments were done - including hysterectomy, removal of breast buds, and high does of estrogen to stunt her growth.

I just read an interesting article by Arthur Caplan, PhD, who is the director of the Center for Bioethics at the University of Pennsylvania:
I believe it is true that it is easier to move Ashley about if she is the size of a 6-year-old. But I also believe that a decent society should be able to provide appropriately sized wheelchairs and bathtubs and home-health assistance to families like this one. Keeping Ashley small is a pharmacological solution for a social failure — the fact that American society does not do what it should to help severely disabled children and their families.
Ashley's parents have a blog called The Ashley Treatment. I encourage you to check it out. As of this writing there are 568 comments, and the site states that they have had more than 400,000 hits in 24 hours:
We hope that by now it is clear that the “Ashley Treatment” is about improving Ashley’s quality of life and not about convenience to her caregivers. Ashley’s biggest challenge is discomfort and boredom and the “Ashley Treatment” goes straight to the heart of this challenge. It is common for Ashley to be uncomfortable or to be bored.

Even though Ashley’s level of tolerance has increased along the years, she is helpless when bothered and her only recourse is to cry until someone comes to her rescue. These episodes are triggered by something as simple as sliding off the pillow or a hair landing on her face and tickling/bothering her, let alone menstrual cramps, adult-level bed sores, and discomfort caused by large breasts. Also, without the treatment, Ashley could not be moved as frequently or be as included in family life, and we would not experience the joy of being an intact family as often.
I admit that my experience with this story is only the last hour since I've been reading up on this case. Plus, what you hear in the press never paints the entire picture. Who really knows what this family is going through?

But, I do know that a case like this could set a dangerous precedent. The first groundbreaking case usually is the most straight forward - and even that is debatable in this case. Now, people, particularly the legal system (sorry counselor curmudgeon), will start finding the grey areas.

Even though the parents deny it, the case will be built that Ashley was treated in this manner as a matter of convenience for the caregiver. So, the next child who is deemed to have "brain damage" and will be difficult to care for will now be eligible for The Ashley Treatment. Think I'm crazy? Possibly. But, mark my words, this story is just starting and will play itself out throughout 2007.

Ethics always lags behind science. When that happens, the legal system and possibly even the government get involved. And, that's where things get ugly. Things get more political. The activists with political agendas get energized. I won't be surprised if this very issue is inserted into the 2008 US Presidental campaign - Remember Terri Schiavo and the end of life debate? Remember Michael J. Fox and the stem cell debate?

I'd better stop before I really get going on a politics/government rant. I mean, this is a medical blog, ya know. Sheesh! Have a nice weekend!

Update 5/9/07: The hospital admitted that it should have obtained a court order before proceeding with the surgery. Read the update here.

Thursday, January 04, 2007

Vote for Dr. A!

The polls are now open over at for the 2006 Medical Weblog Awards. I've been nominated in two categories, but I'm only focusing my efforts on one category.

Vote for Doctor Anonymous for Best New Medical Weblog (established in 2006). I encourage you to check out my favorite posts (the links are in my sidebar) from the past six months. Those will definitely convince you to vote for me. I think I have a good mix of patient stories, current events coverage, opinion pieces, and some humorous posts to be considered for best new medical weblog of the year.

I've also been nominated for Best Overall Medical Weblog. While I appreciate the nomination, I feel I'm definitely outclassed in this strong field. Maybe one day, I'll be ready to compete with this group, but not at this point in my blog life.

According to MedGadget, here are the rules for voting and counting:
Judges will conduct a review of each blog submitted and will vote to sort out those blogs that don't belong to a particular category, or simply splogs (spam blogs.) Furthermore, judges will vote for blogs. Your votes and judges' votes are counted as 50% to 50%. Such a voting system was held at a recent TV show Dancing with the Stars, and details on how the counting was done can be found here.

Voting for the awards will be open to all, but you will only be able to vote once. (No hacking or cookie manipulation will be tolerated -- only one vote for each category from a particular IP address.)
The polls will close on Sunday, January 14, 2007 at midnight PST. But, don't wait until then! Cast your vote right now. Vote Doctor Anonymous for Best New Medical Weblog (established in 2006). Don't forget to vote in the other categories. Thanks so much for your consideration!

Wednesday, January 03, 2007

Stop Reading Diet Articles

Want to lose weight? Well, then one thing you absolultely should NOT do is read articles about diet and weight loss. This is according to a new study from the University of Minnesota.

Huh? That doesn't make sense. Well, I did leave something out. This study talked about teenage girls reading about dieting and weight loss in magazine articles. To me, this is kind of the first step before going to the pro-ana and pro-mia sites which I have talked about before.

The AP article describes some of the results of the Univ of Minn. study:
It didn't seem to matter whether the girls were overweight when they started reading about weight loss, nor whether they considered their weight important. After taking those factors into account, researchers still found reading articles about dieting predicted later unhealthy weight loss behavior.

Girls in middle school who read dieting articles were twice as likely five years later to try to lose weight by fasting or smoking cigarettes, compared to girls who never read such articles. They were three times more likely to use measures such as vomiting or taking laxatives, the study found.
I admit that I'm seeing this already in my office only a couple of days into the new year. Teenage girls asking about dietary tips. The study even points a finger at doctors offices...
"Doctors' waiting rooms are no place for magazines promoting diet and weight loss," [Co-author Patricia van den Berg] said, "in the same way you don't have materials promoting smoking in waiting rooms."
Usually, the most common complaint was have about our waiting room magazines is how old they are (meaning from 1-2 years ago). But, now I'll have to see what's out there. It's definitely a slippery slope. If I take out everything that is potentially objectionable to anyone, there will be no magazines left. Sheesh!

Tuesday, January 02, 2007

Kick out the kids

How are those new year's resolutions going? For me, after day one, I'm still hanging in there. However, are you already finding it difficult to keep that resolution of eating right? I've got an idea: Get rid of your kids!

This article from The Daily Mail describes that researchers at the University of Iowa have shown that living with children also means you are more likely to eat foods such as cheese, ice cream, beef, pizza and salty snacks.

This adds up to five extra grams of fat each day. And, taken over an entire week, this is equivalent to to a pepperoni pizza a week in saturated fat alone. The leader of the study said this:
"An important implication of the study is that healthy changes in eating need to focus on the entire household, not just individuals, especially when there is so much obesity among the young."

"Often children demand these less healthy foods but everyone's eating them and it's a pattern we've got to change by helping everyone think more about their dietary choices," she added.
I suppose that making healthy dietary changes for the entire family is better than showing your kids the door. You probably saw this study last week talking about Pre-school Obesity. But, the next time you're craving really fatty food and faced with the choice of getting rid of your pizza or your kid, which would you choose? HA!

Grand Rounds

Doctor Rob over at Musings of a Distractible Mind has Grand Rounds 3.15 now up and running. A rather explosive theme this week - literally. A creative mix of pictures and music intermixed among this weeks postings.

If you've never heard of Grand Rounds before, it's a weekly collection of the best posts that the medical blogsosphere has to offer. Are you interested in medical topics? Well, who isn't? I encourage you to head on over to Dr. Rob's site and check it out. It's Grand Rounds!

Monday, January 01, 2007

That's So 2006

Many people believe that we should leave The Donald and The Rosie and their war of words back in 2006. I would tend to agree with that.

But, on Sunday, Lake Superior State University released its annual List of Words and Phrases Banished from the Queen's English for Mis-Use, Over-Use and General Uselessness." Their current list includes gems like, "show me the money, "erectile dysfunction" and "holiday tree."

This AP article reviews some of the words on the 2007 list:
Critics piled on the media's practice of combined celebrity names such as "TomKat" or "Brangelina." One said, "It's so annoying, idiotic and so lame and pathetic that it's "lamethetic.'"

Take "ask your doctor," the mantra of pharmaceutical commercials. The university called it "the chewable vitamin morphine of marketing."

The university's word watchers had no use for "truthiness," the word popularized by Comedy Central satirist Stephen Colbert. It was selected as the word that best summed up 2006 in an online survey by dictionary publisher Merriam-Webster.
So, as you're walking around today and writing your blog posts, make sure that you stay away from these banished words. Need the complete list? Well, here is the complete list of 2007 List of Banished Words. Enjoy!