Theranos, The Wall Street Journal, and what Everyone is Missing: the Harms of Overtesting

Theranos is a Silicon Valley start-up dedicated to revolutionizing (some would say disrupting) the medical blood testing industry.  The claim to fame of the company was to use a single drop of blood from a finger stick to run hundreds of tests.  This premise led to a $9 Billion valuation and rock-star status for it's founder, Elizabeth Holmes- and was recently threatened by a Wall Street Journal exposé, which claimed the company's tests were not that accurate and that they used traditional blood testing for most of their work.

Eko the Electronic Stethoscope: A Failure to Comprehend the Rituals of Medicine

A glowing article on electronic stethoscopes recently appeared in the Chicago Tribune.  The Eko Core is a device which, "brings the power of modern technology to an already essential device. The implications could be huge for patient care."

I am no Luddite- I chose to attend USC for medical school because of it's Health, Technology and Engineering Program- to further my interests in engineering and building new devices while going through a full, rigorous medical education.  But it pains me to say that I suspect this is yet another overhyped device that does not fulfill a true healthcare need.  It has fallen prey to a common problem- a lack of deep understanding of medical science and practice by an engineering team seeking to provide an elegant solution to a perceived technical problem.

Marijuana, Neurosurgery, and Physician Impairment

A brief article several days ago posted the name and picture of a neurosurgery resident accused of smoking marijuana on the job.  Dr. Gunjan Goel, MD is a neurosurgery resident at UC San Diego, and the list of her awards and publications alone is almost as long as my entire residency application.  The article is brief, and rather uninformative.  The only facts that are known are this: the Medical Board of California investigator demanded a hair sample, and in response Dr. Goel acknowledged smoking 3-4 occasions over a 6 month period, on her days off.  This incident touches on a lot of complicated issues- intoxication on the job, surgeon quality and competence, and not least of all anti-drug enforcement efforts.

Update:
This piece was picked up by KevinMD, and one of the commentators posted this link to the full court complaint.  The highlights are that no action was taken by the medical board for 8 months after the complaint was received, and that Dr. Goel had a negative urine test and positive hair test- a result consistent with occasional, recreational usage rather than heavy, daily use.

I will not comment further, as this piece is not so much about this individual case, but rather about the more general problem of what regulations and rules should guide the medical profession with regards to marijuana as this country increasingly moves towards legalization.

To my Fellow Medical Students: Beware before Judging your Residents, for you may Easily Become them

A recent paper in the Annals of Internal Medicine has sparked a large news media response.

In it, two incidents are described: in one, a male obstetrician-gynecologist is prepping a patient's vaginal area for surgery, which involves running a brush soaked in betadine or chloraprep solution over the labia, mons pubis, perineum, and inner thighs when the patient is already put to sleep by anesthesia.  He makes an appalling joke, "I bet she is enjoying this".

In the second, another male obstetrician-gynecology resident runs into a room with a patient bleeding to death from her vagina.  He controls the bleeding with manual pressure, putting his hand into the woman's vagina.  And then, when the crisis is over, he starts dancing and singing, while his hand is still in the woman's vagina, keeping the woman from bleeding again.

Many comments, especially from other medicals students, are condemning the behavior of these doctors and likening it to sexual assault.

I make no excuses for this behavior.  But while it is easy for us as medical students to judge, the reality is that residency will put us all at risk of becoming these doctors.  The lesson here should not be "what monsters!", but rather "I must make sure I never become them".

Medical Student Mental Health: the Root Cause is the Grading System

For two years, I served as a representative to my medical school's Student Affairs committee.  My job was to convey medical student concerns and problems.  As part of that role, I had a lot of time to think about how and why many medical students experience depression and stress, which is an incredibly large problem.  At one school, prior to intervention, 27% of students had depression and over 55% had anxiety. Two recent articles have led me to write about the issue now.

Chiropractors Must Join MDs, DOs, Podiatrists, Dentists, Nurses, OT, PT, etc. in Embracing Science

I am a pretty new 4th year medical student who has spent a grand total of 1 year on the wards. Despite this paucity of clinical experience, I have now personally seen 2 patients who have had strokes after chiropractors "adjusted" their necks. This is not an unknown phenomenon:

On Obergefell vs Hodges

I'm somewhat conflicted.  I'm very happy that marriage equality has come at last to the United States, but I am worried by the way it got here.

40 years ago, a woman's right to choose came to every citizen in this country- not by a vote, but by the Supreme Court in Roe v Wade.  In the ensuing 40 years, we have seen that right become eroded and assaulted time and time again, as the court case provided an icon to rally against.  Social conservatives who previously were more than happy to work with Planned Parenthood in it's initial incarnation which promoted eugenics and forced abortions/sterilizations now railed against abortion as an unmitigated evil.  Even now, hundreds of thousands of Texas women are on the cusp of losing their ability to access contraception, let alone abortion, because of continued resistance by social conservatives who took advantage of the ruling to roil the people and gain political power.

60 years ago, Brown v Board of Education also seemingly brought  the end of segregation in schools.  What followed was decades of unrest and resistance as communities tried to fight the busing mandate, as politicians used the ruling to roil the people and gain political power.

Compare this to the 19th Amendment- passed in 1920 by 3/4 of the states, which guaranteed all women the right to vote.  There was no backlash- and no social movement against Women's suffrage ever picked up steam.  Consider also the Civil Rights Act and the Voting Rights act.  While racism in America is hardly conquered, the principles behind the Acts have not been openly challenged for decades.  It is unacceptable to be openly racist, or openly sexist- while being openly against abortion and against affirmative action/any help for minorities disadvantaged by decades of discrimination have remained solidly part of the American mainstream.

Change that comes by the will of the courts is liable to create a backlash as politicians use the changes wrought by those decisions as a focal point to influence the people and gain political power.  Meanwhile, change that comes from Congress at the end of a long campaign that convinces the American people has proved to be more durable, widely accepted, and less vulnerable to demagogues.

At the same time, waiting for such a campaign to work would take a long time, and leave many deserving people without the dignity and joy of marrying the ones they love.  Ultimately, I can only hope that the historical parallels will prove unfounded, and marriage equality will soon become an accepted and unchallenged part of America.

Ivy League Schools face an Anti-Asian Discrimination Lawsuit, are Medical Schools next? (Spoiler: Probably Not)

In the news recently has been a complaint filed by over 60 Asian-American groups, alleging discrimination in admissions at Harvard.  They point to such statistics as this: in 2009, among accepted applicants to the Ivy League, the average SAT score on a 1600 point scale for Caucasians was 310 points higher than Hispanics and African-Americans.  Asian-Americans' average scores were 140 points above Caucasians.  Ivy League schools have long confirmed that they practice affirmative action to boost Hispanic, African-American, and other "under-represented minorities", which would explain the score gap between Hispanic/African-American applicants and white applicants.  But all have strenuously denied penalizing Asian Americans in any way, which makes the SAT score gap between Asian-American and White applicants awkward to explain.

Physician-Assisted-Suicide and Pay-for-Performance: an Unholy Union

Recently, a young woman named Brittney Maynard became a symbol for the Physician-Assisted Suicide (PAS) movement in the United States.  Brittney had been diagnosed with an incurable form of brain cancer- glioblastoma- which had recurred after an initial brain surgery.  She then moved to Oregon, one of three states where Physician-Assisted Suicide is legal by statute, and purchased the drugs which she could use to end her life.  She kept them with her until November 1st, 2014, when she took her own life.  But not before recording testimony to be played posthumously in California legislature where a bill was introduced which would legalize the practice of PAS.  The bill looks increasingly likely to pass, as the California Medical Association which killed previous versions of the bill now looks to stay neutral and sit out the fight due to changing attitudes among its member physicians.

I have serious concerns about the way PAS comes to be implemented, and how it will interact with the statistical measures that are increasingly being adapted throughout the healthcare system to "measure quality".

On Electronic Health Records and Meaningful Use Incentives

Many medical students, particularly pre-clinical medical students, do not understand the utter insanity and horror that is electronic health records/electronic medical records (EHRs/EMRs).  Instead, you will find many that endorse such programs as the be-all end-all and cure to the terrible days of handwritten records.  In such EMRs, we are promised, is the potential for limitless medical discovery and efficiency.  This ethos is shared by many in healthcare administration and others who are not clinicians.  The Federal government has bought this hook, line, and sinker and is poised to impose financial penalties upon any healthcare provider who does not use EMRs.  As an aside, this is not attributable to the ACA/Obamacare- the EHR companies have their tendrils into US Department of Health and Human Services, and it was under Bush that the first meaningful use incentives began to come out if I recall correctly.  However, Obama has continued this trend with his ACA, and his recently announced initiative to use large scale data collection from EMRs combined with genetic data- which he is calling Precision Medicine.

I fully support the use of big data, but I think EHR incentives/penalties are a terrible idea.

I support vaccines- but I am somewhat surprised that more parents don't

As a medical student, I strongly support vaccination. It works, it's safe, and it doesn't cause autism. But I also understand why many parents don't believe me and the medical community when we beg them to vaccinate their kids.

Medicine has come a long way from "Do No Harm". Now we talk about risks and benefits: and none of our tests, medicines, or procedures are without risks. Increasingly, pharmaceutical companies have been caught concealing those risks from doctors and the public.