Docnotes

AMA considers restructuring

Buried in the documents on this page is evidence of enormous changes in store the the American Medical Association.  To some degree, they are (finally?) acknowlegding that the AMA simply does not represent the physicians of this country.  Their members account for only 28% of physicians in this country.  While the AMA claims to repersent us and our patients, it is becoming increasingly obvious that they do not.    

If the business plan is adopted by the AMA House of Delegates, the AMA will transition to an organization or organizations.

By becoming an "Organization of Organizations" there may be no individual members of the AMA at all.  Other medical organizations such as the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of physicians will send delegates to the AMA meetings, where concensus will presumably be reached on what physicians think is best, and how we should best advocate for our patients and the health of our communities.

 

Pharmacteutical industry spam

In my mailbox today was spam from the folks who publish the Physicians Desk Reference.  They're offering free patient information .. stuff they would like me to share with my patients.  So I looked at their handout on ear infections.  Ugh.  it urns out that. this stuff is littered with pharmaceutical "sponsorship."  While links to medications that are related to the disease process are one things .. when the content of the medical information being provided is biased (?because of the sponsorship?) ... we have reason to worry.  In this case, there are links to a medication that should rarely (never?)  be used for middle ear infections throughout the document, and no mention is made of not treating a middle ear infection with antibiotics -- despite the fact that this is becoming commonplace.

Lyme Disease: Prevention and Control

It's Lyme disease time of year again.  Well .. not really.  It's tick bite time of year ... though we have seen lyme disease already ...

Many people are spening time outside .. so lots of people are getting bitten by something.   The CDC is talking about a way to protect mice from ticks. hmm ..

Back here on earth, I've been struggling with what to do about people with real tick bites.  Back in the dark ages, I would provide a handout, reassure the patients that they have only a 2% risk of getting lyme .. and (of course) refuse to treat with antibiotics.

Last year's article on lyme as a great imitator brings up good examples of why we can't be so careless about this diagnosis.  And of course the paper from last year's NEJM on how one dose of doxycycline prevents lyme disease.  Hmm ..

Contraceptives and the pill

The press sure had a field day with this one. It looks like a good study.   Low doses of combination pills seem to be safe.  Data on endometiral cancer are not necessarily so clear.

Searching Docnotes

I've built a (very) simple search mechanism for docnotes using coldfusion.  While I use Radio to create Docnotes, I'm not running Radio on my server .. I run Coldfusion up there .. and so I can't use anything like seth dillingham's radio search engine.  Coldfusion comes with the Verity search engine, which works OK.  I'll try to build a template soon so that it looks like the rest of the site.

Spanking Children

In the July issue of Psychological Bulletin, an age-old debate is rekindled: shoud children be spanked?  I'll admit that I sit on the "no" side of this fence .. so I am erading this with a bias .. but I do find the discussion quite interesting .. as psychologists -- like parents -- seem not to be able to agree whether this is good or bad.  The author of the study, Elizabeth Thompson Gershoff, finds that

"Parental corporal punishment was associated with all child constructs, including higher levels of immediate compliance and aggression and lower levels of moral internalization and mental health"

What's that mean?  Kids do comply promptly, but are more agressive in general.

State Governments Not funding Circumcision

This newsweek article is the most recent evidence of a trend that validates what many have been saying for years:  Newborn circumcision is a cosmetic procedure, with few medical indications.  That state governments are considering a move to stop paying for the procedure will challenge parents with the decision to pay for this procedure or not have it done.   INsurance doesn't pay for earrings?  Why SHOULD it pay for routine newborn circumcision?

saw a case of HSP

 saw a case of HSP (Henoch-Schnlein purpura ) this week.   It's always on the multiple-guess exams in medical school ... but its so rare that it always catches me by surprise when I see it in the office. 

Smoking Cessation

Dave Winer quit smoking last week.  I Didn't even know he smoked.  He's right.  Most physicians haven't smoked.  We don't know first hand how hard it is to quit.  We do know how important it is.   James Prochaska has written about how people change.  He's written "academic" books too .. but this one is better.  It looks at how real people change unhealthful behaviors.   Dave's additction, of course, is not unusual.  When I counsel patients on smoking cessation, the very first question I ask is "are you interested in quitting?'  If the answer is "no." .. I let them know that I will be here when they are interested.  If they are interested, I do offer nicotine replacement of some kind.  At frist, I was hesitant to use the nicotine inhalers .. seemed too much like cigarettes .. but I've had so many patients use them to quit that I am actually an avid prescriber of them now.   And of course Buproprion absolutely helps.  There's very good data on this.   The cool thing is that other antidepressants can help with smoking cessation .. even the very inxpensive ones like nortriptyline.  But we won't see much on TV about these alternatives, since the pharmaceutical industry has no incentive to sell it.  Nortriptyline is generic and costs about 10 cents a tablet.

The Laptop has been reassembled,

The Laptop has been reassembled, and in fact Compaq says that they'll fix it now.