President Trump is Ignoring America’s Trump Card in the Conflict with China

President Trump recently announced a series of harsh measures against China, including the suspension of entry of all graduate and post-graduate students into the United States.  I can understand the desire to protect American intellectual property by preventing students from learning skills and intellectual property and then returning to China and making use of them without royalties.  But a blanket ban on the entry of Chinese students ignores how the fields of medicine, science, and engineering really work and is likely to backfire spectacularly.

Governor Northam's Comments about Abortion, Explained, and a Proposal for Compromise

Democrats in Virgina made a massive own goal this week- and that was before Governor Northam, a renowned pediatric neurologist, was possibly found to have done blackface OR dressed up in a KKK outfit 30 years ago at a Halloween party.

As their roles change, Pharmacists need new Regulations, Norms, and Freedom from Corporate Interests

Pharmacists play an essential role in the healthcare system today, one that is ever-expanding.  They check for drug interactions, watch for signs of opioid over-prescribing, and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has.  In hospital units, their roles have become yet more complex- often serving on various quality committees, managing daily dosages of medications like warfarin and vancomycin, and more.  I rely upon them in the hospital daily- to catch mistakes, and to advise on drug dosages and choices.  Many in the community give flu vaccinations, and some are even trying to gain "provider" status under Medicare, allowing them bill directly for treating patients.  This has been accompanied by a drastic change in the preparation of the average pharmacist- where once it was a 5 year bachelor's degree, now it is a graduate degree- a change recent enough that as of 2014, over 60% of pharmacists practicing had trained under the old system.

The strange saga of Dr. Eugene Gu- #Resistance hero to accused Rapist

To many active on social media the saga of Dr. Eugene Gu, from #Resistance figure to accused rapist, is a long and strange one that holds some lessons for many physicians in the social media age.

Is the FDA's "Ban" on Gay Men Donating their Blood Discriminatory?

In the wake of the horrific Orlando shootings, there has been renewed attention given to the US Food and Drug Administration's (FDA) so-called ban on blood donations from Gay men.  A congressman called the ban discriminatory, and demanded it's repeal- a call joined by the American Medical Student Association and many others.

Trump's 7 point healthcare plan is actually just as stupid as everything else he says

Donald Trump's healthcare plan has started to make the rounds.  People are impressed!  It seems simple.  It seems to make sense.  It gives hope to those who hate Democrats but are disheartened by Trump's stated policies to ban Muslims from the US, build an ineffective wall to keep out Hispanics, torture prisoners, and commit war crimes by targeting the families of suspected terrorists.  I am actually no fan of the ACA, but Trump's healthcare plan is far, far more dumb than most people realize- like almost everything else he does and says.

Politics and Medicine: Hillary Clinton's Health Risks

This presidential campaign has been alternately amusing and terrifying, courtesy of the antics of Donald Trump.  The prospect of someone who feels the need to boast about the size of his penis during a presidential debate having his small, small hands on the button to launch our nuclear arsenal does not inspire feelings of security.

He is looking increasingly likely to be nominated by the Republican Party.  Many however console themselves by thinking, "Well, now Hillary Clinton will definitely win!", given her increasing likelihood of winning the Democratic nomination.

Unfortunately, Secretary Clinton's health records reveal some cause for concern.

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.

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.

A Medical Perspective on the Negligent Homicide of Eric Garner

I am not going to get into the larger sociopolitical issues surrounding the death of Eric Garner.  I don't want anything to distract from sharing one observation that has not been widely reported, and which may lead to at least one change that every police department in the country should implement.

Is Obesity more like Crime, Cigarettes, or Sex?

Obesity is a massive problem.  35℅ of America is obese.  Democrats are worried that their prized social welfare programs will collapse under the weight of the problem.  Republicans are worried that they will only be able to invade 1 country every 8 years, as the military finds itself forced to accept increasingly sluggish recruits.  Regardless of how you look at it (and how many puns I can make), this is a serious issue.  But how to frame it makes a massive difference in what tactics and tools it makes sense to pursue.

The Coming Downfall of Medicine: Scientific Corruption

Some recent news about a(nother) scandal in the pharmaceutical industry has led me to post on something that is critical to the future of medicine and science.

Let me start off by saying that I believe strongly in most medicines. I think the data behind their safety is incontrovertible. But for medicines that were invented recently, that same data would still leave me quite suspicious.

Here's why.

America Doesn't Have a Gun Violence Epidemic- We Have a Poverty Epidemic and an Outbreak of School Shootings

Many people are talking about a gun violence epidemic.  This is understandable, in light of what seems like a never-ending stream of horrific school shootings.  Sandy Hook Elementary School, Santa Monica Community College, Arapahoe High School, UC Santa Barbara- the list goes on and on.

Those with more liberal views are responding to all this chaos and violence by going so far as to call for a repeal of the 2nd Amendment.  As you can imagine, this has predictably gone over quite well with the NRA and it's allies.  These are the folks who, in the immortal and inconceivably badly phrased words of President Obama, "cling to their guns and religion."  Matching the President's lack of tact with an insensitivity that borders on psychopathy, Joe the Plumber addressed the parents of the kids killed at UCSB by declaring, "your dead kids don't trump my constitutional rights."

Amidst all this back and forth between right and left is a shared delusion:  There IS NO gun violence epidemic.  There IS a school shooting epidemic.  These two problems are not the same.  And the solutions that can actually save hundreds if not thousands of lives become clear once the problems have been elicited and defined

Why Colleges Fail at Punishing Rapists, and a Radical Idea for Justice

Sexual Assault on campus is problem that has been receiving unprecedented amounts of attention lately.  Just a few days ago, it was announced that 55 colleges are under investigation for failing to adequately handle sexual assault and create a non-discriminatory environment under Title IX, a federal law that prohibits discrimination based on sex in all institutions that receive federal funding.  It is commonly held that 1 in 4 female students will be assaulted during their time in college, though it must be acknowledged that all such statistics are disputed.  Nevertheless, it is increasingly clear that no American college does anything approaching a decent job of punishing rapists and doing justice to survivors.

Why Your Doctor Doesn’t Work For You

Many doctors are ambivalent about the Affordable Care Act. This is not due to the primary aims of the bill- after all, more people with health insurance means more paying patients, so what’s not to like? Rather, doctors are worried about the other, less publicized pieces of the bill, and related changes to Medicare and Medicaid that have quietly reshaped medicine- and often not for the better.

The Political Picking of a Surgeon General

There's a bit of buzz in the news recently over President Obama's nominee for Surgeon General, Dr. Vivek Murthy.

What's Going on in Ukraine, and Why?

There's been a lot of uproar recently over Ukraine.

Cliff notes version: Pro-Russian dictator in the making was driven out by protesters longing for closer ties with the US/EU, and Russia responded by sending in troops to its existing military bases.  War is imminent.  Pro-democracy protesters vs. autocrats is always a sure draw for readers, so journalists are trying to catch every minute of it in any way possible.

(Only Slightly) Longer version:

Gay Marriage, "Drawing the Line", and the Media

EDIT: I suggest you all read to the end- I'm not making the point you may think I am making.

I'd like to preface this post by saying that I fully support gay marriage.

A Tea Party-backed Senatorial candidate in Kentucky, Matt Bevin, was doing an interview, and giving a rather typical anti-gay marriage stock answer.   Surprisingly, it had less direct gay-bashing than usual for a Southern Tea Party candidate- Bevin mostly made points about state's rights.

Of course, we have to remember here that historically, racist policies and segregation were defended by southern (then-Democratic) politicians under the guise of state's rights.  Starting with Nixon, the Republican party purposefully adapted the rhetoric of "state's rights" as a code word for segregation, to attract white southerners who became disaffected from the Democratic Party after President Lyndon Johnson passed the Civil Rights Act and the Voting Rights Act.  This was the infamous "Southern Strategy", and has been publicly confirmed by a recording of the late, great GOP strategist Lee Atwater.

Back to Bevin.