Friday, June 29, 2007

NBA Draft

I love the NBA Draft. I just wish that the TNT crew did the draft show so Charles Barkley would be involved. In fact, the announcers should be Barkley, Kenny Smith, Stephen A. Smith, Dick Vitale, and Ernie Johnson. I'd TiVo the draft to hear those guys talk, but I'd keep the volume down.

I love the Oden/Durant debate. It's like Jordan vs. Olajuwon- you're going to win with either of those guys.

I love that Rice's Morris Almond was picked ahead of anyone from Duke.

I love the random foreigners who scored 9 points a game in a European "B" league. Especially when they get guaranteed money.

I love when head cases like Sean Williams get picked when they couldn't stay on their college teams. Especially when they get guaranteed money. Maybe Eddie Griffin will help coach Williams.

The one thing I would like to see the draft people do is a 5/10/15 year retrospective. It would be nice to hear what the experts were right and wrong about at different stages. That way, we can find out if the experts are really experts.

Monday, June 25, 2007

ALLI- made you look

Alli- the new FDA approved weight loss medication, is a low dose version of prescription Orlistat.

Have you noticed how many FDA approved prescriptions have gone over the counter?

Prilosec, Zantac, Pepcid, Claritin, Mucinex, Alli- just to name a few.

I think it's good that if a medication proves to be safe and effective, consumers can get them without a prescription and without having their insurance pay. It saves the system money while still helping the patient get the care they need. The only real drawback is that people think that the Over-the-counter medications are somehow now "less strong". Alli is less strong that Orlistat because it has fewer milligrams per dose.

Don't forget to stay near a restroom with Alli

Friday, June 22, 2007

Ranking hospitals and unintentional consequences

Another NY Times article about ranking hospitals. I would like to believe that there is a way to objectively rank hospitals and doctors. I want to know if I'm doing a good job and how I can improve. However, I also want to avoid being sued if I'm not THE best doctor. I'm sure most hospitals feel the same way.

But the public (rightfully) want to know which hospitals are better than others. But we don't know how to find that out, or even what questions to ask to find out. In general, hospitals in poorer areas have worse mortality scores. Is it because the patients are sicker when they arrive at the hospital, or because they receive poor care. I can think of a number of cases I have inherited where a patient who I'd never seen before is assigned to me, and they are on death's doorstep. If I continue to take these patients, my "scores" will decrease, just like for the hospital that takes these patients.

3 points I'd like to make

1. Most hospitals are average, and half are below average. The real litmus test should be "acceptable". What if the worst hospital was still acceptably good?

2. Doctors and hospitals will cherry pick the least sick patients. And death certificates will become less accurate to help "massage the data".

3. As mentioned at the end of the article, people will go to the better hospitals, leaving less resources for the "inferior" ones. So people will lose valuable time in cases of stroke, sepsis and heart attacks, while some hospitals will become more profitable.

4. Hospital systems will close their campuses in poorer areas. If poorer areas always have worse scores, and worse scores means less funding, and less funding means closing all of the hospitals.....

Thursday, June 21, 2007

Mop up duty

This is an interesting headline:

Wednesday, June 20, 2007

Bad news sells

Baytown, TX is a community east of Houston best known for its many refineries and myriad of odors. This week, 2 groups of teenagers from Baytown made the front page of the Houston Chronicle:

6 who stole a car and ended up in a wreck near some dangerous train tracks (4 died)
5 who wrote and performed a play about the lynching of Emmitt Till in the 1950's (and won a national award)

Of course, the kids who stole the car got front page headlines 3 days and articles on the first page of the City/State section, while the budding thespians got one front page and a page 2 City/State mention. The worst part is:

I read more of the kids in the stolen car stories than the playwrights. Dang it!

It's hard to be righteously indignant about not promoting good kids when I pretty much fall right in line without being prompted. I should blame others, but, um, well, it's my parents' fault!

When you ask why the news shows more tragedies and crime stories at the expense of feel good stories, check your own habits (but not mine).

Tuesday, June 19, 2007

Should your team trade for Adam Dunn?

Check out the stats here:

Adam Dunn is one of my favorite baseball players. I like guys who either hit home runs or strike out. That pretty much sums up Dunn, a 21st century Rob Deer. But if you're a major league general manage, you're not trying to keep me entertained, you're trying to get to the playoffs. So columnists weigh in on the issue, mostly commenting on his strikeouts or home runs. But which stat is more important?

There are new, trendy stats like VORP (value over replacement player). According to Baseball Prospectus, Dunn is 44th out of 753 ranked players. To compare, likely All Star Carlos Lee (El Caballo!!!!) is ranked 71st.

That being said, he hits a LOT worse away from the Great American Ballpark (home of the Cincinnati Reds). If you're trading for him, you better be the Pirates GM. I think he'll do worse post trade, especially if he goes to the American League. (;_ylt=Av6i_I4nZx3xj5Vm4bPEugqFCLcF)

Maybe he is better than Rob Deer. If I needed someone to get me in the playoffs, I'd get him (he produces more runs than the average player). But in the playoffs, his high strikeout rate would be a liability (remember, pitchers on playoff teams tend to be better than pitchers on inferior teams). I wouldn't take him (I wouldn't want a high strikeout player in my lineup).

Why Hip-Hop is dead

In 2003, Hip-Hop dominated the Billboard charts. In 2006, High School Musical ruled. What in the Sam Hill happened?

Well, I noticed that guys like Chingy and Akon were making new music instead of people with talent. Meanwhile, the people with talent were busy selling clothes with names like RocaWear, Ecko, and Apple Bottom.

In other words, the best (and business savvy) stars like Jay-Z, Eminem, and Nelly have figured out that they can make more money not making music. So the best music talent is getting paid to do non-musical things. If Elvis would have gotten a cut off of those ceramic plates, he wouldn't have had to keep touring as an overweight 40 something.

So while Hip-Hop music is suffering, Hip-Hop culture is spreading. But if the quality of music keeps dropping (not like it's hot), will the culture continue to spread?

Saturday, June 16, 2007

Insider's view of cancer

I don't know what it's like to have cancer. I don't want to know. I do know when I talk to people with cancer, I try to treat them like they are alive and normal. Because they actually are alive and normal. Even when it's obvious they only have a few hours to live, if they're conscious, I'm cracking jokes and talking about my kids or sports (note, that's all I do in general).

Anyway, I'm babbling. Just pass this along to someone you know who has cancer.

Friday, June 15, 2007

Go Spurs GO

The San Antonio Spurs just won their 4th NBA championship in 9 years. If someone were reading this, they would stop now, because no one likes or respects the Spurs. I lived in San Antonio for 4 years and couldn't become a fan. But at least I came to respect the team work, chemistry, good coaching, unselfishness, and championship rings. In an era where people complain about athletes with poor fundamentals getting arrested and having outside kids, the Spurs stand out by:

1. Winning, early and often
2. Playing team ball
3. Not getting arrested
4. Starting schools for underprivileged children
5. Marrying hot actresses

So what's not to like? People just like complaining.

But then I realized something. The Spurs are Larry Holmes. Larry Holmes won his first 47 (or so) heavyweight fights and was one fight away from tying Rocky Marciano's record when he lost his first fight. He held the Heavyweight title for 6-8 years. And no one cared because he followed the greatest era in boxing history (Ali, Frazier, Norton, Foreman- with guys like Lyle, Shaver, and Leroy Spinks playing second fiddle) while preceding the Mike Tyson era.

The Spurs missed the Bird/Magic era and the Jordan era. They even had the bad luck of missing Shaq and D. Wade in the Finals last year. LeBron, Wade, Chris Bosh, and Carmelo are coming into their own, while Kevin Durant and Greg Oden loom on the horizon. So they're playing in a lackluster era and they are the best team of that era. But we don't know how Holmes or the Spurs would stack up against the best from more competitive eras because they did not have great competition, so we denigrate their achievements.

Or, they are so much better than their contemporaries that they just make them look bad. Nah, Cleveland was bad. So was Carl "The Truth" Williams.

Note- Oh, and the middleweights and welterweights got to be very entertaining during Holmes' reign. Sugar Ray, Hagler, Hearns, Duran. They had some great fighters with compelling personalities.

Thursday, June 14, 2007

How do you quantify the cost and benefits of......

Interesting article about the cost and quality of medicine.

3 things I think I think (apologies to Sports Illustrated's Peter King)

1. OK, how do you pay for quality? And is every complication a sign of poor quality?

2. Patients who are high risk will be denied treatment. Why treat someone when you will lose money?

3. What if the hospitals that had better scores for bypass surgery did bypass surgery on people who should have had the less expensive and less risky angioplasty? Overall, their costs would have been higher as far as less effective care.

Wednesday, June 13, 2007

A bad ER outcome

Um, this is bad. I can't add anything to it.

Iraq question

Can someone define what would constitute victory for the US in Iraq?

Can someone define defeat?

I keep hearing debates about the war and people claiming victory is possible, probable, imminent or impossible. And I don't know what counts as "victory". Is there a point system or a definable goal?

History and Medicine

I was a history major. I'm now a doctor. It's good to see that I've influenced at least one university.

A history major for doctors. I'd love it if it didn't sacrifice foreign languages (which often help a person understand history better).

Monday, June 11, 2007

Poor pattern reognition

In the 1970's, the US gave financial backing to he Shah of Iran in order to keep a stabilizing ally in the Middle East. The result, the Shah was deposed and an anti-Western, Muslim government took over. With plenty of US made weapons and cash.

In the 1980's, the US supported Iraq in an effort to destabilize Iran's anti-Western Muslim government. Iraq, led by Saddam Hussein, won a brutal war over its neighbor. Then with its US made weapons they invaded Kuwait. Oops. Our occupation of Kuwait led to having US troops in Saudi Arabia, which led to various groups like al Qaida getting more recruits to fight against us.

We also supported various Afghan warlords in the 1980's against the USSR. That led to the Taliban ruling in Afghanistan. Another anti-Western, Muslim government.

So when the US is deciding to help Sunni factions to help stabilize Iraq, I have my doubts.
I think that we will be funding and training the next generation of anti-Western Muslim governments in the Middle East.

Sunday, June 10, 2007

What is love?

My internship in Family Medicine consisted of varying rotations in other departments. I witnessed this story during my second month of Obstetrics.

A 34 year old woman was admitted to the Labor and Delivery ward. She had 5 healthy children from her 5 previous pregnancies. She had minimal prenatal care. At 8 1/2 months into her pregnancy, she had an ultrasound. It was abnormal. More specifically, the baby was severely malformed- with brain and heart abnormalities that meant the baby would only be able to breathe for a few hours before dying. And the baby's face was hideously deformed. The mother told her family and elected to have the baby naturally to avoid the risk of a Caesarian section. Then she would get her tubes tied because she didn't want to risk having another genetically defective baby.

So this lady with the hideously deformed baby with no real life expectancy showed up with 15-20 family members. Sisters, parents, cousins, and a friend accompanied the woman and her husband. We treated her like any other patient- you still have to prevent infections and care for the mother. She pushed like any other patient. And she delivered a specimen I was not any other patient.

The ultrasound showed that there would be a pear shaped head with protuberant eyes. But it's different when the grainy images are flesh and blood. The top of the head was as wide as my hand down to the cheekbones. The eyes were too big for the sockets and hung loosely by the visible optic nerve in the back. The eyelids were absent, so these eyes kept staring emptily around the room. The bulbous lower face was twice as wide as the upper face. When you touched the cheeks, the top of the head expanded like a water balloon. This did not look human. I think there were more physical issues, but we wrapped to baby in a blanket to keep the baby warm. I remember the genitalia were not developed enough for us to tell if it was a girl or boy.

The family held this blob of temporary flesh, passing it around and admiring it like the Crown Jewels. They coo'd, kissed the baby, and sang lullabyes. They hugged each other and comforted each other in turn. As the baby was breathing its last breath only 45 minutes after its first, everyone began to silently cry, holding hands and praying for this poor soul. When the baby died, it's maternal grandmother, who had thanked God for her new grandchild, told us why all of these people came to see a deformed baby's birth and death.

"We knew the baby was only going to be with us for a few minutes, and we wanted it to know it was still loved while we had the chance."

And that tragic moment became beauty and love.

Go Rice

I didn't watch the Rice vs. Texas A & M game today. The best of 3 series to determine which team would advance to the College World Series in Omaha began Friday night. I didn't watch today because......


Sure, the Owls got at least one gift call from the umpires. But those umpires will not be in Omaha for the next Rice game.

Go Rice!

Whither the NAACP

Do you remember, "If a tree falls in the woods, and no one hears it, did it fall?"

Well, along a similar line of thought, I wanted to write a post about the fact that the NAACP is closing their 6 regional offices and laying off people at their Baltimore headquarters. I heard the report on the Texas Southern University radio station ( It seemed like a big deal.

So I did a search of the NAACP website and the local newspaper, the Houston Chronicle. Neither website had a relevant link to the layoffs (Google had plenty of stories, mostly internet stories, although the NY Times had an article). Apparently, the NAACP is having trouble raising funds, so like any responsible enterprise, it is scaling back its operations.

I just assumed that the NAACP would always be relevant enough to be front page news. The organization was the standard bearer for all civil rights organizations from the 1920's through the Civil Rights movement of the 1960's. However, the group was a victim of its own success, losing focus and lacking a cohesive set of goals. It's easy to get people to rally around Jim Crow laws; it's much harder to open good dialogue about affirmative action and the role of Hip Hop in society.

So a venerable oak is being pruned of a few branches. And we won't notice.

Here's a link by the way,

Wednesday, June 6, 2007

Coach Popovich

A neat article about San Antonio's 3 (soon to be 4) time NBA championship coach. It's interesting to note that top-notch college coaches usually have a rough time making the adjustment to the pro game. While coaches who do an apprenticeship with a pro team have more success. Just remember this when you are trying to evaluate future job prospects.

Adapt or die (or be bought out)

I sure hope I'm able to change and adapt with the changing times while keeping focused on my patients and their needs.

More Avandia news

There's an old saying,"There's lies, damned lies, and statistics." I think the varying reactions to the Avandia study by Glaxo show this to be true.

So who's right?

For my money- I'd like to see more studies present results with "Number Needed to Treat" and "Number Needed to Harm" data. For instance, "This study shows if you treat 50 patients with drug x- you will prevent one death and two heart attacks. You need to treat 1500 people to get liver function problems that are reversible. You need to treat 20,000 people to kill someone with drug x." Instead, I get a lot of statistical static and an editorial that emphatically states I need to prescribe more drug x.

Tuesday, June 5, 2007

A cure for the health care system

How can the US of A improve its anemic health care scores? We rank 5th among the 5 industrial nations (Canada, Great Britain, New Zealand, Germany and USA) that share data about life span, infant mortality, and cost of care. And we don't need to blame Congress, Big Pharma, Insurance companies, doctors, hospitals, or Ralph Nader.

Get a physical.

Less than half of the people with insurance get the recommended screening tests and vaccines for their age and gender. Simple things like fair skinned people getting their spouse to look at their skin once a month can save thousands of lives. Ladies, get your mammograms and Pap smears. Guys, bend over once a year- look at what ladies go through in the previous sentence. And everyone needs to get checked for colon cancer, high blood pressure, cholesterol and diabetes. Even if you believe in Alternative Medicine- go to your Alternative Medicine Practitioner once a year.

oh, and don't forget your eye doctor and dentist appointments, too.

Critical mass

Is there anything easier to do than criticize?

I notice that a lot of newspaper columnists criticize a given politician, athlete, coach, general manager, actor/actress, or director with the greatest of ease. In turn, bloggers criticize the columnists or agree with them. I guess the podcasters then follow up with more criticism.


Because it is easier to criticize than come up with your own thoughts and ideas. Also, if you have a blog, radio/TV show, column, etc., you have to fill space with something. And you can either be original, come up with a top 10 list, or criticize (plagiarize) someone else's work. It's a major part of journalism now. Heck, that's what I've been doing. Shame on me.

Saturday, June 2, 2007

Drug companies' and doctors

This is why people don't trust "Big Pharma". And why I go to Canada for their Family Medicine conference.

I found this on the KevinMD blog.

Taking a shot at shots

The anti-vaccine crowd is at it again. Although it is a known fact that there are side effects to vaccines (some of them serious or even fatal), vaccines were the leading health breakthrough of the 20th Century. I'm OK if you say antibiotics are the leading breakthrough. Either way, my generation did not have to deal with polio hospitals. Between my parents and in-laws (4 people total), 3 of them lost at least one sibling to an infectious disease that is now vaccine preventable. Simply put, the risk of taking vaccines is much lower than the risk of living in a vaccine free world.

Which makes me ask the following:
1. Since people die from peanut allergies, why aren't these people trying to get peanuts banned?
2. Do they really think drug companies ("Big Pharma") are really out to kill people with shoddy products? I mean, doesn't that lead to fewer people to purchase drugs?
3. A lot of people worry about "drugs" but not "natural" or "alternative" medications. Why don't they think that "natural" medications can have side effects?
4. Aren't bacterial and viruses natural?
5. Why don't "alternative" practitioners willing to do their own double blind/placebo controlled trials? (My guess is if they do a "scientific" study, they will be doing what they oppose, namely putting science over intuition and tradition)
6. Have you ever seen a pill, capsule, or gelcap in the wilds of nature? Me neither.

Another ethical dilemma- childern and Medicaid

This article is about Medicaid and doctors' payments. Since Medicaid has lost my application 3 times, I'm not currently accepting Medicaid patients (I won't get any money for seeing them until they complete my paperwork). They pay 25-50% less than other insurers. They require more paperwork for referrals and therefore cost me more time (and money) when I see their patients. And they kept me on their provider list after I switched jobs and had to dis-enroll from Medicaid- but medicaid staffers kept signing me up as various patients' PCP. This meant that not only would I not get paid to see the patient, but any other doctor who saw the patient would not get paid either.

At any rate, I'll have to decide whether or not to take any Medicaid patients. As much as I pride myself on accepting patients that other doctors won't, I have to be practical and stay in business, or else I ain't helping anyone.

On a related note, I'll start doing cosmetic procedures this month. I picked procedures that insurance companies do NOT cover. market economics at its best.