Grand rounds #3

It is my pleasure to host the third edition of Grand Rounds, a weekly best of the medical weblogs. The blog format provides a unique and powerful opportunity to bring medicine, “behind-the-scenes”, to light.

This edition features a diverse collection of voices – ranging from physician commentary on breaking medical news to personal stories from nurses, EMTs, and medical house staff. I invite you to browse and read the other excellent medical blogs.

Editor’s pick

Over at Azygos, a wonderful piece on “just” being a nurse. As a physician, I can appreciate that you are only as good as your nursing staff.

Issues in the news

Dr. Chris Rangel with insight on what John Edwards said about malpractice and tort reform during the vice-presidential debate.

The big news this week is the flu vaccine shortage. Galen’s Log discusses the problems behind this and possible solutions.

I also wrote an article detailing the repercussions of the flu vaccine shortage, examining the data behind the vaccine’s efficacy.

Dr. Bob, a physician living the Pacific northwest, certainly can see first-hand the effects of drug re-importation from Canada. He writes about the possible dangers of this practice.

At A Chance to Cut is a Chance to Cure, our surgical colleague writes about the effects of caps for non-economic damages, which have been instituted in Texas.

The Vioxx Recall

Dr. Centor, over at Medrants, writes two articles on the Vioxx debacle. The first encouraging physicians to objectively consider the data before prescribing new medication. The second wondering if the Vioxx effects apply to other COX-2 medications. The latter article provides valid commentary on direct-to-consumer (DTC) advertising.

Medpundit goes against the grain and writes a dissenting opinion against cardiologist Dr. Eric Topol’s editorial in the NY Times about Vioxx.

Chris Rangel again, with his take on the need for lawsuit reform and the Vioxx recall.

The Lingual Nerve also chips in with their perspective on Vioxx incident.

Experiences

The Coronary Care Unit (CCU) can be an intimidating place for an intern. Michael Chaplin writes on his blog, The Chaplin.News, about a particularly harrowing night of call.

Maria is an intern who blogs at intueri: to contemplate. She writes about a day in the life on the house staff.

Over at code blog: tales of a nurse, the importance of living wills and advance directives are highlighted.

Dr. Craig Hildreth, who writes The Cheerful Oncologist, blogs about facing death – especially poignant in the field of oncology.

Tom Reynolds, an EMT working in England, writes about his experiences at Random Acts of Kindness. He details the dangers of his profession with a picture and a story.

Graham is a medical student who writes at over my med body! He writes about his recent experience with online medicine.

GruntDoc writes about his experiences as an ER physician. He observes the effects that crack cocaine has decision-making ability.

Opinion

Dr. James Baker is a psychiatrist practicing in Texas. Writing in his blog, Mental Notes, he opines on the fallout of the concerns over antidepressant use in children.

The Public Health Press comments on a case chronicled in the NY Times, where a physician overrules the wishes of a patient.

Vertical Mattress, written by a medical student in NYC, gives some thought about selective inattention, and its potential effects when working up a patient case.

shrinkette, a psychiatrist in the Pacific northwest, pleads for the political candidates to stop the psychiatric mudslinging.

An intensive-care nurse at code: theWebSocket; writes about the effect that non-economic caps are having on malpractice lawyers. He proposes nationalized legal care as a solution.

Nick is a medical student who writes at Blogborygmi. His article compares journalists’ and physicians’ attitudes towards bias.

Miscellany

Over at Galen’s Log, one can only imagine the perils of blogging during a patient visit.

A clinical nurse instructor at Top of My Head writes about a growing infectious disease problem seen in hospitals and long-term care facilities – and a simple way to help prevent its spread.

Interested-Participant points to a bizarre story – an organ donor who had his organs removed before he was properly declared dead.

Next week’s host, EchoJournal, wants to spread the word for a worthy cause: “Bloggers Against Smoking”.

Upcoming schedule

Please email Nick at Blogborygmi if you are interested in hosting future Grand Rounds.

Next week:

October 19 EchoJournal

October 26 code blog

November 2 Medpundit

November 9 GruntDoc

November 16 DB’s Medical Rants

November 23 Shrinkette

Previous Grand Rounds are archived here.

Comments are moderated before they are published. Please read the comment policy.

  • __Carol

    To hell with the flu vaccine shortage–what about the PRILOSEC OTC shortage? This is Armageddon! Have you seen anything? Googling
    just seems to bring up more complaints.

    Thanks!

  • Anonymous

    I am a physician, and was for some time on the Merck speaker’s bureau (not for rofecoxib/Vioxx), until that is, the release of the VIGOR data.

    I am what is called a “thought leader” by the Pharmaceutical Industry, someone who is a (sub)specialty doctor whose clinical practice and opinions hold sway over his/her colleagues.

    I feel I must post anonymously because of the charge I level below.

    In my opinion, not only did Merck intentionally try to spin the VIGOR data to their advantage at every level, including their medical liaison group, but their subsequent attempts at linking the negative or adverse events to the “cardioprotective” effects of naproxen sodium and their tarring of all COX-II inhibitors as potentially dangerous, was done with the knowledge that rofecoxib (Vioxx) was a badly flawed product.

    After I reviewed VIGOR as well as the FDA response as was posted on the Internet, all queries I made to Merck as to their explanation for the increased adverse cardiothrombotic events were ignored, deflected, and left ultimately unanswered.

    As far as a “class effect” goes, there are no data to conclude, as was the case of rofecoxib (Vioxx), that either celecoxib (Celebrex) or valdecoxib (Bextra) have similar negative cardiothrombotic effects. I would go as far as to suggest, or challenge anyone to produce those data.

    In no clinical trial with either celecoxib or valdecoxib does one see similar negative events.

    It appears, or is at least theorized, that rofecoxib has a unique active metabolite or binding effect outside the COX-II enzyme site to explain the adverse event profile.

    In any case, Merck’s gamble appeared to pay off, in as far as they were able to sell an additional $4-5 Billion of Vioxx after VIGOR was released and commented upon by the FDA, and after Vioxx received a black-box warning in its package insert.

    I am glad to have resigned as a Merck speaker after VIGOR.

  • AnneAtFibroFix

    Maybe not negative cardiothrombotic effect, but Celebrex ruined me.

    In April, 2000, I was dropped to my knees after taking Celebrex for only 4 days.

    I have fought for my life every day since then. Celebrex caused Extremely Severe Fibromyalgia. My body can no longer maintain Saliva pH at 7.4, but only at 4.5 You cannot sustain life at that level. The liver cannot process enzymes correctly.

    During the search for a diagnosis and effective treatment for the FMS, I discovered a malfunction in the natural flow of Serous Fluid body wide.

    An all free, public domain web site explains what happened, what is keeping me alive and what this discovery, and the treatment we are using to reverse all symptoms on a daily basis, means to millions who have Fibromyalgia, Restless Leg Syndrome, IBS, and other related illnesses.

    http://www.FibroFix.com

    Anne Hillebrand
    Orlando, FL

    annehillebrand@bellsouth.net
    407-925-4139