Friday, January 31, 2014

Are CT Scans Giving Us All Cancer? If So, Who Should We Sue?

Two doctors, a cardiologist and a radiologist, published an Op-ed in the NYT about how CT scans are giving us all cancer.  They cite a claim that in 2007 the National Cancer Institute (NCI) estimated that CT scans will cause an estimated 29,000 excess cancers and 14,500 excess deaths.  They extrapolate that this means 3 to 5 percent of all future cancers may result from exposure to medical imaging.

This to me is rather overblown.  CT scans are getting better and better, and get better images while using lower and lower doses of radiation.  The percent of cancers from medical imaging is a highly controversial topic, with recent estimates (from an admittedly biased source) coming in at .04%.  Apparently, the higher estimates from the NCI are based off of post-WW2 cancer rates in survivors of the nuclear attacks on Hiroshima and Nagasaki.

A Blow to the Self-Regulation of Medicine

The American Board of Obstetrics and Gynecology reversed itself and allowed it's members to treat more cases.  This I think is a case of a FUBAR'd attempt to take a strong and necessary step forward on self-regulation, followed by too much fall back after getting called on some mistakes.  The initial problem was that Ob/Gyns (who are specialists in child birth and women's health) were calling themselves "Board Certified" while doing cosmetic procedures.  To solve it, the Board initially ruled that 75% of someone's practice had to be Ob/Gyn (presumably the rest would be staffing the local ER/urgent care complaints), and that Ob/Gyns couldn't treat men with a few exceptions.  Unfortunately, they missed a few categories, prompting a howl of outcry from two groups:

1) Male (mainly gay) patients with HPV who are at risk for anal cancer (sometimes seen by Ob/Gyns used to treating women at high risk from cervical cancer due to HPV)

2) Male patients with pelvic pain, who are seen by Ob/Gyns used to seeing women with similar complaints

Thus, the board was forced to go back to no limits on seeing men and a "majority" of practice being Ob/Gyn.  Consequently, Ob/Gyns with terrible ethics (one of which was apparently about to sue under anti-trust regulations, according to the article) can continue to call themselves "Board Certified" while practicing medicine they are completely untrained for.  Self-regulation of the medical field takes another blow...

Wednesday, January 29, 2014

A Medical Perspective on Ohio's "Botched" Executions

The death penalty has been in the news lately, what with a "botched" execution in Ohio, using a 2 drug method that Louisiana has also recently adopted for it's administration of the death penalty.

These changes come on the heels of a new tactic by death penalty opponents: getting European countries to ban their pharmaceutical manufacturers from exporting drugs that may be used to execute people.  These bans were partially responsible for nationwide shortages of several anesthetic drugs a few years ago.  Long story short, propofol, the 'Michael Jackson drug', went into shortage due to the contamination of a major supplier, and a perfect storm of low prices( due it being a generic drug) and extreme difficulties in manufacturing it correctly and with sterility.  Sodium thiopental, the older back-up to propofol, came into demand.  Promptly thereafter, the manufacturer stopped selling it in the US due to it's use in lethal injections, leading to a nationwide shortage of anesthetic drugs and the temporary importation of drugs from Canada.

In any case because of chronic shortages and problems with vein access (more on this later) the traditional method that had been used, a three drug combo of sodium thiopental, pancuronium bromide and potassium chloride, has been abandoned in many states.

Tuesday, January 21, 2014

Primary Care vs. Specialist Pay, the RUC, and the News.

The Relative Value Scale Update Committee (RUC) of the American Medical Association (AMA) is back in the news, courtesy of the New York Times.  It's more of the usual story, published by the WSJ less than 4 years ago: specialists are paid too much, primary care physicians are paid too little, and it's all because of an evil committee of doctors who are members of the evil medical trade union group known as the AMA who set payments.  (Full disclosure, I'm a proud member of the AMA).  A good perspective on the debate from Paul Levy, a former non-physician hospital CEO, is here.

Monday, January 20, 2014

On Guns and the Misuse of Science

Part 1 of 2, on Science and Gun Control
Part 2 of 2 will focus on more on the logic (or lack thereof) behind many gun control arguments.

Guns are one of the the most emotional topics in the United States today.  They mean such different things to different people.  In a sense, it's nearly useless to use science in the debate, because rather like abortion and civil rights it's not a scientific debate in the first place.  That said, it's deeply annoying when science (or more specifically, statistics) are used to justify any proposed gun policy.  I'm going to focus more on the gun-control side here, because the pro-gun-rights side really ignores the science anyway to cite moral arguments which are futile to argue against- how do you fight with someone's claimed right to defend themselves against others/their government?  And really, it is the pro-gun control advocates who are most guilty of misusing science and really abandoning all logic in their misguided crusade.

Thursday, January 9, 2014

Olympic Advertising, Gender Norms, and Politics

Proctor and Gamble has some new ads out in their "Thank you Mom" campaign, to coincide with the Sochi Olympics.

Here's the most popular one. Here's another.

The purpose is pretty obvious: P&G makes mostly household goods, and since women still do a disproportionate share of housework, it makes total sense for P&G to appeal to "moms" who make the purchasing decisions when it comes to toothpaste (Crest), batteries (Duracell), detergent (Tide) and diapers (Pampers), etc.

While quite popular and seemingly innocuous, These ads have the insidious and toxic effect of reinforcing gender norms- with "Mom" being portrayed as being the most concerned with the children, with Dad nowhere to be found. (There isn't a single "Dad" in any of the ads).