Chris Rangel, MD

Nicotine vaccine to treat tobacco abuse and nicotine addiction

Chris Rangel, MD

Meds

January 25, 2011

Antibodies are complex proteins created by immune cells that are targeted to very specific parts of other large and complex molecules called antigens.

Much smaller molecules like nicotine, called haptens, do not normally induce any significant immunologic response so researchers chemically bound several nicotine molecules to a large protein to form an adduct. This combined molecule does induce an immune response, i.e, causes immune cells to produce antibodies targeted to the …

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Old doctors who continue to treat patients

Kevin Pho, MD

KevinMD

January 25, 2011

Did you know that one-third of the country’s physicians are over the age of 65?

That’s right, there’s a good chance that your doctor is on Medicare. That’s a concern, because physicians aren’t immune to the ails of aging, and are just as prone as patients to succumb to the effects of Parkinson’s or various types of dementias.

Not comforting if you’re about to undergo an operation, for instance. And absolutely frightening when …

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What your medical office can learn from Norman Rockwell

Brandon Betancourt

Physician

January 24, 2011

This past summer I got a chance to visit Washington DC. While I was there, I saw a Norman Rockwell exhibition at the Smithsonian American Art Museum. As it turned out, the exhibition was the private collection of George Lucas and Steven Spielberg. The exhibition highlighted Rockwell’s masterful storytelling.

I didn’t know much about Norman Rockwell before that day. I knew he was a famous American painter and I had seen …

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Adherence to HIV treatment in Africa

Paul Sax, MD

Patient

January 24, 2011

There has been an irresistible urge for people — doctors, public health officers, politicians, journalists, the usual pundits — to compare adherence to HIV treatment in resource-rich vs. resource-limited setting.

I suspect this is because the whole issue got off to a famously bad start in 2001, when then-head of the U.S. Agency for International Development (USAID) Andrew Natsios said in an interview with the Boston Globe that Africans,

don’t know what Western time …

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Guns and why doctors should partner with the National Rifle Association

George Lundberg, MD

Policy

January 24, 2011

Is there anything that we physicians can and should be doing to help with the huge problem of gun violence in America?

We all know it is nuts to sell guns and ammo to nuts, yet as a country we do it every day.

We all know that, in contrast to rifles and shotguns, the only moving targets for hand guns are people; that the Congress and president in this century legislated …

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Create a disease to market a new drug

Kevin

Meds

January 24, 2011

An excerpt from White Coat, Black Hat.

by Carl Elliott

Many of us have a relatively simple, commonsense view of the way that drug development and marketing work.

People get diseases; scientists develop drugs to treat those diseases; and marketers sell the drugs by showing that the drugs work better than their competitors. Sometimes, however, this pattern works in reverse. Drug company scientists develop a drug …

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Can a doctor and a nurse be friends in the OR?

Anesthesioboist T., MD

Physician

January 23, 2011

One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven’t seen her since I was in school, we’re still in touch and expect to be seeing each other at last in a couple of months.

By some coincidence one of my best friends now is also an O.B. nurse. I’ll call her Ziva (yes, I …

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Should obesity be classified as a brain disease?

Michele R. Berman, MD

Conditions

January 23, 2011

Many of our most popular stories are about diets and weight management.

Did you know that some psychologists and psychiatrists would like to classify obesity as a brain disease? The reason for this is that there is mounting evidence that food, or certain types of food, can trigger the same addictive effects in the brain as drugs like heroin and cocaine. There is also substantial evidence that some people lose control over …

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KevinMD posts of the week, ending January 23, 2011

Kevin

Potpourri

January 23, 2011

Here are the top posts from this past week, based on the number of times they were viewed.

1. Why doctors should profit from dispensing medications. Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.

2. Patients …

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How MD anesthesiologists have become victims of their own excellence

Jeffrey Parks, MD

Physician

January 22, 2011

The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.

Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …

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Problems with the connection between thimerosal and autism

Kevin

Meds

January 22, 2011

An excerpt from Tabloid Medicine: How the Internet is Being Used to Hijack Medical Science for Fear and Profit.

by Robert Goldberg, PhD

From the beginning, there were two problems with the connection between thimerosal and autism. The first problem with was that thimerosal, while about half mercury, contains ethyl mercury, for which there were no exposure guidelines. So the scientists used the ones for methyl mercury. However, the ethyl mercury …

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Payment systems must take into account the art of medicine

Marya Zilberberg, MD, MPH

Policy

January 22, 2011

You know that joke about the farmer whose cows are not producing enough milk? A university panel gathers under the leadership of a theoretical physicist. They analyze each aspect of the problem thoroughly and carefully, and after much deliberation produce a report, the first line of which is “First, assume a spherical cow in a vacuum.”

This joke has become short-hand for some of the reductionist thinking in theoretical physics, but …

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Malpractice fails when it comes to medical errors

Jan Gurley, MD

Physician

January 21, 2011

Here’s your multiple choice question to set the stage: what percentage of all physicians do you think should be sued for malpractice?

Would you say one-in-ten doctors ought to be sued? Or one-third? How about every single one of them? Let’s make it one claim per doctor, nationwide. Does that sound reasonable? Keep in mind that even defending yourself against a suit will cost on average $40,649 per claim, ranging from …

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Are parents to blame for childhood obesity?

Dr. Joe Kosterich

Patient

January 21, 2011

Childhood obesity is a problem. It is a function of the foods children eat both at home and at school. The people responsible for feeding children are parents not advertisers. Running the line that it is all to do with advertising allows adults to run a “Johnny told me to” line, which would not be accepted as an excuse from a child.

It is not about blaming parents. It is about …

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How effective will the physician payment national database be?

Merrill Goozner

Policy

January 21, 2011

ProPublica.org did some interesting frontrunning on the physician payment national database that will become operable sometime around 2013 as part of health care reform.

In the first of a series of stories that has been picked up by several mainstream media outlets, the New York-based investigative journalism non-profit culled all the physician payments that have been publicly posted by seven drug companies to date. It aggregated the dollars to …

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Menopause and cancer: What women should know

Therese B. Bevers, MD

Conditions

January 21, 2011

Menopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.

Below, I’ve compiled some of the questions I frequently hear from patients about menopause and cancer. I hope these answers will help other women start informed conversations with their doctors about menopause-related concerns.

How does menopause affect a woman’s cancer risk?

Menopause does not cause cancer. But your risk of developing cancer increases …

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Mental illness in the college student

Emily Gibson, MD

Conditions

January 21, 2011

Along with millions of Americans, I’ve tried to comprehend the tragic shootings in Tucson, reaching deep within myself to find compassion for a young man who has forever changed the world for himself and so many others through his actions.

For those of us who assess, diagnose and treat college students struggling with mental illness while trying to succeed in their academic pursuits, the events leading up to his impulsive killings …

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Compassion and decency overwhelmed by fear

Kevin

Patient

January 20, 2011

by Eileen M.K. Bobek, MD

The year after I finished my emergency medicine residency, I had all four of my wisdom teeth pulled.

Afterwards, I looked as if I had taken several punches to my face. My jaw was swollen, my skin a cornucopia of muddied blues, purples, greens, yellows and reds. If people didn’t know better, I told my husband with a laugh, they might think that I’d …

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Personal responsibility and societal structure changes that reduce obesity

Allen Perkins, MD

Policy

January 20, 2011

I visited my parents this past week. The are both in their 80s and in relatively good health although my mother received a diagnosis of diabetes while having a medical exam for an unrelated problem. I spent some time educating her about Type 2 Diabetes, the causes (genetics and weight gain) and the options (medication and/or weight loss and exercise). I stayed with my brother-in-law and sister and the conversation …

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