Sunday, November 28, 2010

Brain Off

I think my brain just turned off. This term is all about perservering and effeciency and not burning out. But when you can only concentrate for 20 minutes and then need 2 hours to recover - well, welcome to term 4.

I have a great big list of things I'd rather be doing, including blogging, listening to music, finding new music, reading more Lovecraft, playing with my Google Reader, watching movies (anything), playing, working on various personal projects(enviro-med school review), making some of my ideas at Global Pulse become a reality (re: map of archives), write a grant proposal to fund some of these ideas, beg the Dean for funding for another project that is somehow going to come together in 2 weeks while I'm "studying" (re: waiting for term to end). Oh, Term 4.

And there is a lot to write about what transpired over the past few months, but for some reason every time I sat down to do it I would end up passing out and then waking up with my computer asleep and the light on. But, I will update! I need to look back on this when I'm really busy and laugh...I think.

Tuesday, September 28, 2010

The Dengue

Dengue has struck Grenada in full force. The week before the Microbiology midterm, Prof. L, who was lecturing on Dengue, got the Dengue. Some classmates got it. Then this week, my lab partner gets it. Dear God, what is going on here!!

Luckily, we have the milder form so there has not been any fatalities (that I'm aware of) and everyone seems to be recovering... fingers crossed. That is not the case for other areas, especially in Asia, where it can be fatal.
If you have the time, send a report of your local Dengue cases to HealthMap and check it out to see the burden of the disease across the tropics.

In school news, I survived midterms and found them difficult but doable. Afterwards I went to the wonderful CUGH (more on this later) conference in Seattle and spent a few days at home in Boston. Looking at people in the field of Global Health and Environmental health in action, presenting on their various projects was certainly motivating and really reminded me why I'm here. The perspective helped clear my head and made me realize hey - there are only 9 weeks or so left of this semester and this time next year I'll be in clinical rotations! It's amazing how one can lose sight of that in this endless August heat.

Tuesday, September 7, 2010

You wouldn't like me when I'm Angry

4 weeks into term 4. This semester is going fast... and you really have to spend every minute just to keep up. My little sleep/workout experiment continues - I managed to consistently get up a few minutes before 6 - though exhaustion has keep me in bed until about 6:15am these days...

One thing I've noticed is the work schedule has really shortened everyone's tempers... or at least mine and my friend Ph. I feel like David Banner - especially yesterday as a variety of small nothingness made me furious - from not being allowed off the bus at the security spot, to searching for the mysterious (and non-existent) poster printer and then being late for lab for the first time only to walk in on a pop quiz (luckily did not count for credit). I still managed to pwn the quiz though. I nearly lost it on the Lab Director when he said I should just hand in a hand-drawn version of my concept maps - after I've been using (with great enjoyment) the software they posted on the website! After explaining my issues with printing on campus, Dr. W says: "why don't you just hand draw it?" and that nearly made me turn green and tear my shirt off. I started to say "First of $!%* ^*#@" but realized who I was talking to and managed to switch it up to "First of all, (catch breathe) this has been a great learning tool! And secondly you recommended it" so we managed to patch things up and I can submit electronically.

Today I am in a much better mood and I think it is because I got up at my normal time and worked out. Yesterday, I had no workout and got up kinda late (6:45 - about an hour behind schedule) so the day started off on the wrong foot. But really, the daily exercise has kept me balanced and focused -- I really think it's kept the stress level down this term... of course, we'll see how it pays off on the exams!

Otherwise, term 4 is a massive amount of very interesting and actually real medicine work. I am putting together a lot of things in my head from past experiences and thinking about future research...I love it :D

Tuesday, August 10, 2010

Term 3: A tale of two terms

I arrived in Grenada with something less than rampant enthusiasm for class. Starting a term at the end of June just felt too much like summer school - even though it is summer weather here all the time. My concentration wasn't where it needed to be and I slept late, played on facebook, and generally didn't get a lot done (adjustment disorder?).

Given this, I got the grade I deserved on the midterm... :/

Then another deadline crept up on me: my Review paper was due August 1 (more details about this later). For a long time I've wanted to switch to a morning schedule, but have always stayed up until around 12-1 and woken up 8-9, despite knowing my best studying is in the morning.
So I decided to use this to get it done - I started waking up progressively earlier over the course of the week. Putting the alarm clock in the other room helped and leaving the shades open helped with this. Once awake and after exercising, I would then go to campus to write the paper in free AC. This was a tough adjustment at first and I had to force myself to bed initially. For those considering such a switch you have to really plug through the first two weeks and do it gradually.
But by the end of week 1 I was waking around 6:30-7:30 (compared to 9am before). After another two weeks of this I am on a 6am schedule (as evidenced by writing a blogpost at 7:15am). Wake up, workout, make breakfast, pack my lunch and hit the books usually by 7:30 (when not blogging).
Another impetus was that the Term 4 Pathology class lectures will not be recorded online (audio only, no slides) - so going to class is now quasi-mandatory. Combined with the rampant rumors that Path is insanely difficult, that certainly helped.

My second exam was my highest score at SGU. Maybe the material was more interesting or I took it more seriously to avert a GPA disaster... regardless, I study more and feel better from waking up early and exercising. I hope I can keep this going for Term 4 and keep my brain and body tuned through Step 1.

Anyone else have stories of exercise/sleep schedules helping them in med school?

Friday, July 30, 2010

Swing on the Spiral

Looking forward, while looking back and spinning while standing in place.

Term 2 - Genetics, Parasitology, Community & Preventative Medicine, Neuroscience, Immunology, and Physiology.

Yet, when I think back, I just remember the bright sun. I think this was the first term I really understood it's power down in the Tropics. Living on campus gives one a false sense of the island in many senses. The AC is on everywhere, all the time and since the buildings are relatively clustered, you really don't have to go outside for a long time to traverse around. Even going to IGA (the "supermarket") and the beach was rather restricted in Term 1 (my roommate had a car, so we'd wait until HE wanted to go) and I'd go in the evenings.
But living off campus showed me this other world of Grenada. I talked to more people from the Island, learned about the weather patterns and previous droughts (it was a bad one this time), found a market that has locally produced foods and snacks (local plantain chips!!), and generally started to get a sense of the people here. They are friendly, they like to have fun, and I think, if I were back home, I could pick someone from Grenada out after talking to them for a bit, just certain mannerisms and ways they speak.
You don't get that on campus though - it's essentially a giant resort. No pool though, and you can't go to the beach on campus(2 stars). And the Grenadians play two roles: Security & Maids - which gives a distorted lens of this island as dangerous and poor. Both of which belay the diversity on the island. I know because I felt that way living on campus!
One thing that now rings quite true was when my advisor, Dr. B, said during Anatomy lecture that he walked home after dark almost all the time, and never had a problem or felt unsafe.

Oh yeah, medical school. I wish I used a quantified self tracking tool to chart my feelings towards each course over time. Initially, I thought Neuro was awesome, but then at some point it got annoying, and then fluctuated back to alright with potential for interesting subsets. I was excited about Immunology, and, as previous posts indicate, grew frustrated with how it was taught but still liked the material. Physiology was always alright at first, but then it grew on me. And Dr. H was excellent - one of the best teachers here - even if he does watch Fox & Friends every morning. I've done diabetes research in the past so that was a known interest, but I was surprised to find myself really enjoying the Endocrinology section. Parasitology gave a great global perspective and showed how debilitating certain, entirely preventable, diseases could be. Genetics went by in a flash, I just remember many of the diseases were quite rare (as opposed to parasitology - interesting what society focuses on). Community & Preventative Medicine was not taken seriously by anyone, unfortunately, though I enjoyed it - but felt that the principles of the course needed better integration with the bulk of the material we learn in medical school.

Now Term 3 is coming to a close this week and the much rumored about Term 4 is making its presence known through emails and syllabus/handouts. Term 3 is a funky combination of what I'd say is Public Health with a good chunk of Psychiatry. We learned about Malpractice, the recent health care reform, epidemiology, ethics and evidence based medicine. These things are fresher in my head and deserve their own post - so they'll get one.

While Term 3 has progressed, I've also been writing a Review paper on Electronic Health Records and Health Social Networking. This supposed to be the last part of my Research Fellowship and now I'm struggling with whether to continue with a great boss and interesting research(I'm pretty sure he wants me to stay), or find somewhere else to learn new things. I want to learn about Health Impact Assessments and maybe also about mobile health tracking devices.... nevermind all the other potential opportunities out there I haven't checked out... I don't anticipate much time to do much of these activities this semester, but I am looking at a winter break that is, at this point, open. On top of that, my current position helps me pay my rent ... not something guaranteed with other opportunities...and I've published 1 paper so far, with a second one nearly will have to do some reflecting on this... any advice appreciated!

That is Medical School Year 1 (MS1) and I'm spinning in place in Term 3 , looking at MS2 and beyond. Sometimes I get sick of being so far away, on a hot little island. But then I saw a former work colleague's IM picture of the old Map Plotter (printer) spewing paper. That made me appreciate my decision to come to Medical School on the Spice Isle.

Wednesday, July 14, 2010

Facebook Debates: Conservatives on Healthcare

An acquaintance of mine from undergrad happens to be a Republican rep. in the NH State House. We shared a good discussion on the environment and animal rights (he's an animal loving environmentalist republican!) and have kept in touch via Facebook. He likes to foster debates on topics on his page and while most of his friends are conservative, there is some variety and occasionally a few insightful words are written. Recently, a discussion started up on healthcare that I spent some time participating in and wanted to present it here. It started when ND said that her her replacement hearing aids weren't covered by her insurance. Without further ado:

ND: Tell him to make it a national law that all hearing aids are covered by insurance for all ages in every state.

BL: Judges do not make law, only legislators can do that, however there are judges that seem to forget that thier job is to decide if legislation is constitutional and if the cases before them meet those standards...

ND: Okay! Thanks for letting me know :) I'm leaving my expertise in the science fields to build up on my political knowledge! It costs $6000 for a really good pair of hearing aids. I have had them since I was 3 and have excelled with them. But my 2nd pair (and current) are starting to dwindle. I can't afford a new pair. Technically, you are supposed to receive a new pair every 3 years. I have only had two pairs. I should be on my 6th pair. Insurance companies say they are cosmetic. How is that fair? This is why I'm fighting. They cover eyeglasses, so they should cover hearing aids. I'm pretty sure it violates the Americans with Disabilities Act by not providing coverage for hearing aids.

Me: ‎@Nicole - has your physician helped in any way with this? Have you tried your local Lions Club or Sertoma Clubs, they can sometimes help.

ND: Nope! Lions club = sub-par hearing aids for the elderly that were recycled. I need higher power and better quality because I'm losing hearing as I'm getting older. And I'm still in college, with hopes to go to medical school. But yes, I tried all of my options. Now I'm taking this to a state level because everyone who has hearing loss goes through this problem. Insurance companies think HAs are cosmetic and not really important. Why do people get insurance for eyecare? That's not fair. I don't want Grandpa's hearing aids. I want my own specially fitted to my needs and power level. I can't become a Pediatric Oncologist with mediocre hearing aids. If someone is covered for eyecare, I should be covered for hearing care.

ND: Oh and insurance covers VIAGRA?! But not hearing aids... Totally messed up.

Me: That sucks, as a medical student I am continuously shocked by the behavior of insurance companies and how their actions pervert the motivations of health professionals. The government is not blameless here either, but health care does not operate as a "free market", no matter how many may wish it to - it's a societal responsibility to take care of each other!!
On the bright side, your plight should provide excellent material for medical school essays and interviews ;)
Rep. Bettencourt - are you listening?

TB: ‎"Tell him to make it a national law that all hearing aids are covered by insurance for all ages in every state." = Everything that is wrong with this country.

Skip: You are right, John - it is not a free market - it is HIGHLY distorted by Govt spending AND regulation - both based on politics rather than proper supply / demand signaling.

Sure, we should take care of others - so John, how much are you willing to pull out of your personal pocket, or how much time are you willing to devote to PRIVATELY solve Nicole's problem? Or, like many, are you simply willing to be lazy and outsource YOUR responsibility (after all, you ARE part of society, right?) to politicians and bureacrats? Why is your FIRST response - hey, let Govt solve the problem?

Sorry, dude - THAT's the base problem that GOT us into this problem - expecting that Govt can solve all ills by taking more of what others have earned simply to give to others. Man up, dude

On the other hand, Nicole, if your contract with the insurance company IS what you say, then Govt SHOULD step in (via the courts) and enforce what has legally been agreed to. what does your contract actually say (vs what a bureacrat within the insurance company is telling you)?

Me: I think a little history lesson is in order here. Blue Cross/Blue Shield started as physicians and hospitals realized that their services, due to technological and medical advances, were becoming too expensive for people to pay for out of pocket. So Hospitals contracted with teachers (Blue Cross) and had them pay $6/yr for 21 days of hospital care if needed. By having everyone pay an affordable fee, they avoided a situation where anyone had to pay an unaffordable bill. Blue Shield developed from employers contracting with groups of physicians to provide care for their employees in a similar manner.
As these plans expanded throughout the country and involved more people, a type of rating called "community rating" was used - that is everyone paid the same amount regardless of their utilization. The young businessmen paid $300/yr (even though they use less) and the older coal miner also paid $300/yr. The elderly retired person paid $300/yr as well even though they used more than that... By charging everyone the same the Blue Cross/Shield were able to afford to cover their expenses. Yes the biz guy paid more than he used but by doing so he allowed the elderly to be cared for.

The relevant part of this for our convo is that after WW2, when these plans expanded greatly, the private insurance market (professional insurers, not physicians/hospitals) got involved. Now the private insurance guys see that the businessmen only use a small amount, so they decide to offer them a plan for far less - say $100/yr. At the same time, the private insurance didn't bother with the elderly or the coal miner - they cost too much cause they actually need health services!! Now Blue Cross is stuck with the elderly etc., being more expensive users and having lost their cheaper users, they have to charge more - suddenly the elderly cannot afford health insurance and neither can those at the lower end of the economic ladder.

Hence, the 1960's we have this situation and the govt steps in to provide Medicare and Medicaid to plug the wholes in the "free market" system. This creates distortions, of course, which are then attempted to be fixed by various means, but largely ignored.

So yes, the govt did create distortions, but it was going in to correct distortions that were already present in the system. It seems to me the notion of insurance needs to be reformed - the incentives of insurers need to be fixed to provide the baseline of care for everyone at an affordable price. And the incentives for physicians and hospitals needs to be realigned to providing the best care as well as the best outcomes on a population scale - not the most care to get the most reimbursements as is currently the practice (I need to read more how the recent healthcare reform attempts to fix this - been busy with medical school - but from what I understand it doesn't do much in this regard).

You pay out of your pocket through insurance to cover those in your insurance plan that cannot afford to pay out of pocket for the entire cost of their hearing aid or the entire cost of their Chemotherapy (which can be millions of dollars). Getting donations through your social network could never make up the money needed in catastrophes for the vast majority of people - that is why we have insurance. As a medical student, I donate my time to helping others (since I live off student loans, that is the best I can do currently). Taxes do a similar thing - a community that is facing a flooding disaster could in no way afford to rebuild without assistance from wider society (taxpayers in the state/nation). We enter into the social contract of insurance or taxes in order to provide each other with the means to live healthy lives and be cared for when we need it.

Medical care is not a consumer purchase - you can choose to forgo TV or buying new furniture - with medical care, your choices are sometimes life or death, but more often you are forced into substandard living (as is the case with Nicole and her hearing aid). If someone could explain to me how medical care fits the dynamic of a free market (even if it is to reference me to texts) I am listening.

Me: no responses?? Guess you free market types prefer to outsource your arguments to Rush...

BL: Nicole, just so you know, the NH state legislature has passed a bill that requires private insurance companies to cover hearing aids. But, it does not cover those who are on medicare or medicade. I guess it is ok to require private companies to cover but not the government. If anyone wants to understand why insurance is so expensive it is the government mandating coverage for non emergency or life threatning issues.

Double standard. BTW I wear two hearing aids and have had hearing loss since I was 5. So I understand the issue.

Skip: ‎@John - your example of BC leaves out 1 thing - the voluntary nature of joining at its inception. And remember, because of wage controls instituted by Govt, "bennies" were the only way that companies could attract better workers than their compeition - thus GOVT started this snowball-from-hell down the slippery slope - and NOT the free market. It then got codified into tax law as a right off for companies but not for individuals - skewing the marketplace more and more and really making insurance prohibitively expensive over time. Add to that the politican penchant for adding mandate after mandate after mandate simply because a few people decided they wanted THEIR costs spread over eveyone else. WHY should I have to pay for someone else's treatment for alcohol addiction when I myself am a teetotaler? I have now lost the liberty to choose a plan that suits me and my family - politicians have decided they know better than I what I need or want.

Medicaid was not instituted simply to "plug holes" - review Progressive history stemming from the 1880s Frankfurt school that basically states, in a 180 from our Founders, that Govt SHOULD be in charge of the details of our lives and not we ourselves. Socialized medicine (which Medicaid and Medicare are components thereof) is simply an offshoot of that, and Statists that believe that the State is the premier entity in American life (vs the Individual primacy of the Framers of the Declaration & Constitution) are basically turning the philosophical underpinnings of our society upside down and inside out.
I disagree with your basic premise - healthcare is neither a right nor should it be an entitlement - it is a service for which one should be able to contract freely between providers and consumers. Govt, however, has made this almost impossible with "rent seekers" doing their harm as well.
And as far as "donations through your social network could never make up the money", before Govt became so bit that it crowded out private charity (see Brook's research on the inverse relationship of expanding govt & private help) - that DID happen and happened well (see de Tocqueville, commenting on how people DID take seriously their responsibilities through VOLUNTARY charity (vs what is now FORCED charity via taxes).

Me: ‎@Skip - While it is true the tax environment for benefits helped inflate health costs (something I believe the recently passed HCR bill attempted to address, not sure how that worked out), it was one of many factors - you cannot ignore that as medicine advanced and life expectancy rose the cost of care became greater and is continuing to do so, with the greatest financial burden in the last years of a patients life - again, when they are least able to afford the care (hence, Medicare).

At the heart of your argument is that the rights and freedom of individuals becomes trampled by societal (in this case government at any level) intervention into health care. I would argue that the Founders ideals, as enshrined in the Deceleration of Independence, that everyone has an inalienable right to Life, Liberty and the Pursuit of Happiness has as a pre-requisite in modern industrial society: the right to health care. The burden of poor health destroys liberty, crushes hopes of happiness and, in emergency situations, denies your right to live.

You must remember there was a difference in times between what our society is today and what it was in the time of the Founders and even Tocqueville. Jefferson even said he would rather trust to nature than his physician when he was sick - and for good reason, there wasn't much anything modern about medicine in the 18th century or most of the 19th for that matter (at least the part Tocqueville lived to see) - this was before antibiotics, before vaccines(which provide life-saving benefits to all, when all decide to take them), before modern surgery, anesthetics, before MRI, CT or even XRays! Before the germ theory of disease was accepted - Physicians believed the "four humors" were the foundation of medicine well into the 1800s!!

In todays world medicine gives people the freedom to live productive lives contributing to society. In fact, The Economist recently ran an article describing how a nations intelligence, and thus their economic development, is held back by parasites and pathogens ( ). By not giving everyone the right to accessible, quality health care, we are denying them the ability to live their lives to the fullest - these costs end up coming back to the public through violence, crime, dependency and lack of productivity among other costs. And a part of that right is affordability, not forcing choices between medicine, rent and food.

In terms of charitable giving being inversely related to government tax burden, I would invite you to review the literature (and link me to Brook's research as I could not find his/her specific work) as from what I found through Google Scholar, charitable giving may or may not be elastic regarding taxes - there are many more factors that come into play such as cultural norms, religion, societal structure and stratification, how much people control the means of their sustenance and various other influences. The economics literature, as I see it, is not in the agreement you present. And while Tocqueville certainly had some interesting things to say in his "Memoir on Pauperism" regarding dependent classes of society, his arguments are not based on any empirical observation and are clouded by selection bias as well as his own upbringing as a member of the aristocracy (hence his tendency to think of a benevolent link through charitable giving to the poor and scorn the assistance of the poor through taxation).

Regardless of any relationship, and there may be one, it is irrelevant - the cost of health care is unpredictable and can easily overwhelm any individual and their social support systems ability to cope. This is one reason why we have so many people going bankrupt from medical expenses - there is a general lack of understanding of the intrinsic nature of healthcare in todays world needs to be financed by large groups in order for any one individual to afford access to proper care. The free market system cannot operate in healthcare in a proper manner for this and many other reasons (think about the asymmetry of information between physician and patient!). Also, in a "service" one assumes there is a choice of whether or not to even have the service in the first place - that is fundamentally NOT the case with healthcare ( unless you consider death a choice). Government, as the instrument of the People, has a role to play in this. What role exactly is up for debate, but by shirking our social responsibilities to one another we hold back the potential for all of us to live freer and more productive lives.

DMK: I have been a tool-fool since my first Erector set in 1946. As a retired contractor and Master Electrician, I have many, many tools that allow me to do work that is otherwise impossible, extremely taxing or can only be done in slipshod fashion without a special tool.

Government, too, is a tool of sorts. One that was compacted to provide protection from enemies foreign and domestic ~ to protect us from others who ignore our social contact and resort to violence, deception and fraud. Not from ourselves.

It is a tool of blunt force trauma, itself, and is the only agency we allow to initiate the threat or reality of force to achieve compliance. It has more the nature of a sledge hammer, chainsaw or front-end loader than a scalpel. Only disease itself has killed more people than government in command (and not always on purpose either).

The issue is not that health care is a great and wonderful boon, nor that it becomes more & more expensive as failing bodies require more. No one disputes that sudden but unexpected illness or accident can result in the need for very expensive medical intervention that can bankrupt personal or family finances.

The real question is what tools and postures do we employ to deliver this boon to the individual. It is one of cost, to be sure, but individual choice has a huge role to play as well. One size does NOT fit all. But equal rights under the law requires just that! Not to mention the daemon of lowest common denominators, the "Problem of the Commons" and, of course, the inefficiencies of bureaucracies immune to effective feedback. The sad truth is, health care is not a task for a tool that specializes in coercion. Ask any disabled vet about the VA.
(A personal disclaimer here. I am a vet who has used the VA and have a great respect for the wonderful Nurses and Doctors who helped me. The VA made considerable progress under George Bush, but still had to accomplish its mission with a budget that failed to provide all the needed resources that were routinely available in local hospitals.)

In short, Skip is correct. Free enterprise is the way to go if you are results oriented. History, both here and abroad, makes this plain.

Me: I lean towards evidence based medicine, that is, I like to see peer-reviewed documentation that a procedure or therapy works. Even in allopathic medicine, many things we do are based on past experience of "it works, do it that way" rather than actual hard-evidence of efficacy. For instance we learned about Tube Feeding for dementia patients this morning. Surprisingly, it shows no evidence of prolonging life, decreasing infections or increasing comfort. Evidence shows it may increase discomfort and result in use of restraints. My point is that what we expect from Reasoning about a subject (tube feeding prolongs life) may not be what actually happens in the real world.

Yes, government is a blunt tool of coercion at one level - but in a democracy that tool is - when designed properly - held accountable and can be tweaked as circumstances dictate. In a decentralized state/local oriented system decisions can be adjusted to local circumstances more easily. There must be a balance though of fundamental rights guaranteed to all vs. decisions devolved to the lowest level. With private insurance, our current model, it is difficult to ensure accountability for necessary coverage except through the use of government regulations. But please feel free to present evidence to the contrary.

But the conversation seems to be going into one of cultural philosophy and further away from Outcomes - what works the best to deliver the best care, afforably for all. At my core, I'm a scientist but as a physician in training know that not everything that works is proven, but I'll ask anyway: Can anyone present evidence or examples (peer-reviewed preferable) of free market delivery of accessible, affordable, quality healthcare in a modern day setting?

Me: by the way, this is a fun and enlightening discussion - glad to see it stay civil.

Sunday, July 11, 2010

Not Dead Yet

It has somehow been 2 months (!) since my last post, but I will be picking this up again soon... Term 2 concluded successfully and Term 3 is well under way. Had a busy, productive and fun break too... and plans to think about for the year ahead... more shortly after (or before) midterm on Friday.

Monday, May 10, 2010

The Neuro of Music

Great post over at the Nature Blog network on the neuroscience of music and pleasure:

"Why do we enjoy music? Well, simply put, research shows that music elicits a number of physiological changes including increased release of dopamine from neurons originating in the ventral tegmental area, a mid-brain structure associated with the emotional reward [1]. This reward for music that we enjoy evokes an autonomic response subjectively referred to as "shivers down the spine." [2]. This is a robust and highly reproducible phenomenon."

I will have to catch up on those papers, but it is really interesting that the "shivers down the spine" you get from really good music is a real, physiological phenomenom. Makes sense. And if you've never felt it, you need to get some better music! Also note the parahippocampus is NOT correlated with pleasure, which makes sense considering it's proximity to the amygdala (fear response center). It also makes me wonder how people with Parkinson's experience music later in the course of their disease considering the lack of dopamine...
I would take issue with the implicit assumption that only "pop music" can produce such a response - although he does put the caveat of "consonant"(will have to read this more in-depth after finals!). I think it is much more tied to the emotional context of the music, state of mind of the listener and familiarity with the music being played. I can get the shivers from anything from Yo-Yo Ma to Tool and a lot in between. Most of the time it is based on my understanding of the music and/or lyrics, but the prerequisite, for me, seems to be quality musicianship.
For those floating around in the blogosphere... what music has given you the shivers?

Tuesday, May 4, 2010

Physio Testes

Or how Dr. H made physiology fun through corny jokes:

"We know that increased heat decreases the viabilty and production of sperm. Studies have shown that men sitting crosslegged with their laptop (on laps) the testicle closer to the laptop (hotter) produces less. Another quick way mentioned is to see if the male wears tightie whities. If so, tell him to change to boxers.... now, if you don't believe me consider this: ever seen batman? does batman have children? I rest my case."

Friday, April 30, 2010

Ingrown Toenails and Funny Bones

Distractable has a great post on the relevance of Physics to clinical practice - it's on old post but a good one and it came back to mind cause a friend got an ingrown toenail. Dr. Rob (distractable) discusses the physics of ingrown toenails and also gives us the following clinical rules (yes, this is on the USMLE):

This is why the presence of an ingrown toenail, which is evidence of a hyper-gravitational podiatric state, is invariably accompanied by the following:

People step on them – scientists have proven that a foot with an ingrown nail is 10 times more likely to be stepped on than those without.
Heavy objects are kicked – careful analysis has shown that objects such as coffee tables, lamps, and even large appliances move into the path of a person with an ingrown nail.

I would like to add to this the Ulnar Rule, which is observed by anyone who has taken Anatomy. Once you learn that the Ulnar nerve (or mulnar as some like to call it) is in fact your "funny bone" you are doomed to a life of hitting it at least once a week. What was once an annual event is now a regular part of your life. Thank you Gross Anatomy.

That's all for now - time to get back to Renal.

Thursday, April 29, 2010

Renal Yellow Highlighter

It seems appropriate doesn't it? What's not appropriate is how ridiculously behind I am in Physio and how I can see a train wreck of finals ahead.... if I can only switch tracks...thank big bellied buddha there is no more no material for Neuro.

Immuno... still no news on that front and no idea how I did. I'll take a pass at this point. grade just came out on Angel - and I'm happy with it. An improvement from my terrible midterm performance and keeps my GPA intact - phew! I still can't stand Dr. S though and am contemplating doing DES to alleviate the misery of others...

Also, I need some new study music. Non-lyrical music is of course key, but I've been listening to Coltrane, Air, Trainspotting/Primal Scream and Theivary Corporation way too much. Yeah I got some Yo Yo Ma in there too, but really there must be something else out there to sooth my studying brain, but I can't seem to find the time to find it. If you have suggestions, lemme know - I preciates it.

Monday, April 26, 2010

Immuno Rage

I cannot quite remember any class that has inspired such rage. It was not the material itself, which I liked, or even the obscure clinical trials, some of which were interesting but mostly boiled down to: oops, this TNF blocker for rheumatoid arthritis gives you cancer (which the FDA didn't spot until after it was approved) or uh-oh, looks like you can get progressive leukoencephalopathy from your psoriasis meds (all of which convinced me to tell everyone I know to stay away from Phase 1 and 2 trials).
I also feel like a good chunk of immunology is guesswork - we know how certain things interact and many of the big players, but ultimately it's an extermely complex system that we're just scratching the surface of. And when we mess with one thing, say nTregs, the consequences are often unexpected and vary widely from model organisms. There are many diseases that people are suffering from today and I do sympathize with the urgency to develop drugs to help them even with incomplete info. I guess that is part of the challenge of medicine: sometimes it means operating on partial info in desperate situations, especially with cancer and painful, chronic diseases.

But anyway, what really got me about this course was the questions! For some reason the way these questions were worded and presented with the material just burned me up! I have not felt this angry at a class before. I can maybe blame the heat, or that I needed on object at which to focus my unspecified rage (Dr. S), but I don't know. After the exam there were the typical discussions about questions and complaints about the course. I managed to distill my issues into two main points:

  1. The material was presented poorly from the beginning without a big picture, proper diagrams, or any good interconnection and context. We were expected to straight up memorize random letters and names with little info for how they interacted and that just don't work for me!
  2. There were major inconsistencies between the material presented in class, the notes provided and the lack of a real textbook meant we went shopping for various sources (purple book, white book, red book, brown book, HY, wikipedia) many of which gave conflicting info about basic topics (like HLAs that never showed up on the exam btw)
These two factors combined with poorly worded questions made for an extremely frustrating course. When I said this to a few people outside the test, one guy said the following "Those are two great points that, as SGA representatives, we have brought to her attention. She said you will thank me later for teaching you how to learn." Wow, haven't seen such arrogance and idiocy since the days of Bush II. Yet, if I did well and got within the grade range I think I did, I will admit that the trial by fire of having to teach myself the course did at least emphasize that I am a dedicated visual diagram learner. I understood this before, but I suppose now I know it for sure. But let's not be too conciliatory until the grades are out...

Thursday, April 22, 2010

Happy Earth Day!

Check out my post at the Global Pulse Journal blog for Earth day!

Saturday, April 17, 2010

Immunology... or how not to teach a class

I am continuously reminded of how much of a visual learner I am and perhaps this is why Dr. S's Immunology course, until this point, has been a struggle. I cannot pay attention at all during lecture and the notes, though thorough, are very text based with few diagrams. I need diagrams!
But on top of that, the order in which the material was presented just did't work for me. Immuno was a course I enjoyed in undergrad and generally found interesting (I even shadowed at an Allergy Clinic) but I found myself starting to hate the course and the professors.
I didn't realize my problem was how the material was presented until I put together T cell activation on my own. I used a combination of Wikipedia (decent article) with a copy of High Yield Immunology. I also referenced the class notes to make sure I had what I needed to know. Then I took it all and drew out a diagram with all the relevant cytokines. And it makes sense. Macrophages are cool again, CD4+ T helper cells rock and I can appreciate how HIV kills.
I've had poorly taught courses before, but never could I say exactly how to make them better. With this course, I think a better integration of cytokines into the Th section along with more and better diagrams, coupled with big picture understanding would go a long ways to improving it. And a coherent lecture would help too.

Thursday, April 15, 2010

SGU Crossroads

There are three roads from the roundabout near my apartment. One road leads to the airport, one road leads to Grenada and one road leads to Campus.
A bunch of clinical tutors live in my building. I talked to them a few times and had seen them in labs. I went to do my laundry the other night and they were having a party and invited me to join them. So I went down to enjoy some home cooked south indian meals (rasam, pulyaogre(sic) and more). Just couldn't pass that up!
Talking to some of them I learned that SGU has a program for medical graduates from other countries (in this case India obvs.) to come and teach for 2 years at SGU while they apply for residencies in the US. Turns out a lot of them do get their residencies and SGU gives them a third year to match if they need it.
It was encouraging to see that "true IMGs" that were not US citizens could make it into the states for residency through SGU. They were celebrating successful matches for four of their colleagues - all going to respectable places from Chicago, to Rochester and NYC.
It seems there are many routes to SGU, but a lot of them lead to where people want to go...

Sunday, April 4, 2010


Eh - what just happened? Oh, midterms. Compared to the other test takers out there, Term 4 and especially those who just took the boards, I feel a bit unworthy of logging any complaints about exhaustion from term 2. The exams went well but I am learning that med school tends to take your studying habit errors and magnify them.
I am always quite excited to get my score reports back. But I'm seeing a pattern - those things I knew that I did well, and those things that I did not understand so well I didn't do so well.... hmm, how does this help my inability to pick a method of studying?? I can say that my method of "no paper notes" and doing everything through annotating PDF docs has been working at least as good as scribbling a bunch of stuff on paper. So I'll stick with my... green studying.

Anyway, there was also whole healthcare stuff that passed. Yeah, about that. I think it's a good thing, but really cannot say so much in detail before I read up on it (June) and get the impression we will need to tweak the bill with add-ons in the years to come. I do intend on reading this wonderful Grand Rounds from SeeFirst though.

I also got a fan. I paid too much for this fan but since you apparently need psychic powers to predict when a fan will be posted on SGU POST and email that person the instant the put it on sale, I sucked it up and paid for it at the hardware store. Am very glad as my Midterm AC electric bill was more than the fan.

Friday, March 5, 2010


Ever feel like you need to be in three places at once? As a med student, I often feel as though I could spend my entire time on one class - and there are usually three going at a time. I also have this habit of getting myself involved in multiple activities while in school or even when I was working in cubeland. At first I wanted to dedicate myself solely to my studies, but then I noticed I have something like 4 hours of free time per week and that just needed to be filled. Which I proceeded to do with research and most recently as a new Editor at AMSA's Global Pulse Journal. Global Pulse also has a blog, and a rather addictive twitter account, so apparently my electronic life needed to reflect my real life and be split into multiple pieces.

I truly enjoy involving myself in a myriad of activities and the different perspectives it gives me at any one task. I wonder how it will play into my medical career and what specialties engender this kind of a lifestyle...Anyone have insight into that?


Oh, FYI, Global Pulse is taking submissions year-round for check out the website and submit or feel free to ask me questions. We publish lighter research (not bench stuff, but comparative studies see the site), opinion pieces, book reviews, and reflections on experiences as well as art work... pretty diverse, and we want med students (and pre-meds! and public health folks!) to contribute so send in your stuff!

Thursday, February 25, 2010

Evolutionary Medicine

Listening to lectures on sonic foundry can occasionally make me feel like a deranged hermit. I spend days alone at my apartment and venture down to interact with society only for small group discussions, the occasional DES session or a trip to IGA. The atmosphere is distraction free, which I think has made me more efficient and productive this semester (we'll see about that after midterms). The ability to set ones schedule and actually stay awake through lecture has certainly made my med school experience a lot less stressful, but it's not without its frustrations.
Listening to the Immunology lecture just the other day, our Prof. discussed the polymorphism of MHC and the various alleles for each MHC locus within the population. She then asked a simple question: how does this benefit us from an evolutionary perspective. Now, I know Sonic can be misleading but I could hear the crickets. One person ventured a guess but missed the point. Meanwhile, I immediately thought of biodiversity and the lessons I learned from my Evolution class in undergrad - one of those "I'm a biology major, not a pre-med major" classes that I took before deciding to go into medicine. So, I am sitting here screaming duh people, if you don't have a diverse recognition of antigen then a single microbe that goes unrecognized by the entire population can wipe out the whole species! The genetic bottleneck is a big problem in conservation biology. And yes, evolution applies to humans too - even more as we think.

Evolution is often a lost part of medical education. We learn a great deal about the immediate causes of a disease, or even how one can become susceptible, but we are generally not trained in the "why do we get atherosclerosis in the first place?" kind of questions. This piece in Aetiology discusses the med student mentality:

If basic biology and traditional medicine make up the plot of our disease "stories", evolutionary medicine would be somewhat like the moral. My roommate is a medical student and when asked, she can tell you how just about anything in the human body works and what is happening when things go wrong. When asked why things go wrong, her answer will refer to a proximate cause, such as certain foods leading to plaque build up which can lead to heart disease. If the question of why is rephrased, as in why does the disease even exist at all, then she's stumped. This is the question considered by evolutionary medicine. Why aren't our bodies able to repair clogged arteries? Why are we prone to infections? Why are our bodies so good at some things but so inept at others?

The post goes on to discuss the book "Why We Get Sick: The New Science of Evolutionary Medicine". Especially relevant to my fellow immunology students is the following example discussed later in the same post:

So if infections are one evolutionary explanation for disease, what's an example? I recently came across an interesting article about infection and it's relation to premenstrual syndrome. In the article Premenstrual Syndrome: an evolutionary perspective on its causes and treatment, Doyle et al. propose premenstrual syndrome is due to an exacerbation of a set of infectious diseases during cyclic changes of immunosuppression by estrogen and progesterone. While genetics and non-infectious environmental influences have been examined and found largely unable to explain PMS, infectious causes have been overlooked. However, it is know how immune function varies throughout the menstrual cycle in such a way that there could be less effective control of fungi, viruses, and intracellular bacteria, so making the leap to a persistent infection contributing to PMS doesn't seem too difficult. Supporting this hypothesis is a long list of chronic diseases with suspected infectious causes that are exacerbated premenstrually including Crohn's disease with Mycobacterium avium and juvenile onset OCD with Streptococcus pyogenes.

It's a really fascinating interplay between immunology, environment, and genetics. You can also consider the influence of epigenetics for good measure and I'm sure your head will start to spin! The book looks like a good read and hopefully something we'll see in the medical school curriculum of the future. Anyone out there read this book or ones like it?

Tuesday, February 23, 2010

Holy Ganges Gets Help

See my post about the potential health benefits of cleaning up the Ganges over at the Global Pulse Journal Blog - my first as a newly minted editor of AMSA's Global Pulse Journal :)

Note for med students and those with an interest in International Health - we're now taking submissions - check out the guidelines and please share your experiences, research and artwork!

Thursday, February 18, 2010

Blog Rounds II

Look what the Google Reader brought home, a series of articles on everything from pharmaceutical advertising to valentine's day and facebook... let's get started:

TBTAM gives pharma advertising a piece of her mind in an old post worth bringing back for those healthcare reform fanatics out there. Yes, we need to have more infromed patients and make healthcare decisions as a team. No, we do not need big pharma giving patients strategies to convince their doc to get the latest and greatest test from their company. Anyone know if the current bills in congress or any proposals for that matter, do anything about direct to consumer advertising?

Regardless of the commercials, Distractable posits that if PCP's didn't have to deal with medicare and medicaid, they would be able to have good businesses that would attract new grads and make house calls again. If any future public option looks like those programs (mountains of paperwork and restrictive reimbursements) then we're in trouble...and though it's not the direct topic posted, CC wonders how she'll choose a residency program in a rural area if she's not already married. I commented that this plays into that family medicine/rural physician shortage in unexpected ways and even relates back to medical school admissions policies favoring unmarried 22yo's that don't want to work in areas where they have no chance of meeting people.

Complicating healthcare reform further is the fact that a lot of our healthcare bills are from self-inflected wounds such as obesity. While difficult, this is an issue that will likely be solved through a cultural shift rather than left to Washington (though we'll need help) and Jamie Oliver has some ideas...

Speaking of ideas, TechCrunch wonders what the world would be like if those facebook programmers turned their talents onto social causes...a few medical ideas are mentioned, anyone out there know of other apps like those?

OK coffee is finished and I REALLY need to get to school before my sunscreen wears off... enjoy!

Friday, February 12, 2010

What's a Geographer doing in Med School?

This is what:

TEDMED: ESRI on Health and Place

I saw a similar presentation at the ESRI GIS and Health conference back in 2007. Things can get a lot more specific than the County/MSA level shown. After doing health histories last weekend at the AMSA Health Fair it made me better appreciate how this information could help piece together a diagnosis... thoughts? Anyone seen anything like this in practice?

Sunday, February 7, 2010


Neuroscience is like anatomy on steroids with less distinguishing characteristics and more interrelations. This makes it more challenging, but also more rewarding. And they said Term 2 would be easy!

In terms of the actual class at SGU, having quizzes where you must distinguish between the Anterior Commissure and Lamina Terminalis on a 200x200 pixel MRI with big thick lines drawn in MS Paint while at the same time labeling the Hypothalamus is the epitome of a throw-away question. Please, either don't label two things so closely together that the lines themselves cover the actual structures and surrounding features or just upload a higher resolution image - this doesn't help me learn anything.

Presentation complaints aside, I can already see the general direction of the class and the material fascinates me. The whole process of how your body is sensed and controlled through your cerebral hemispheres, as if your brain was a reflection of the body, is simply surreal. Though the myriad of structures can feel overwhelming, for each Netter card I memorize, I get information about structures with functions relating to language (Wernicke's Area, the S/I Colliculi's), sense of self (Precuneus), as well as the reflection of the body along the sensory cortex going down the post-central gyri (same goes for motor in the pre-central gyri). The latter formation is what gives rise to this guy which is a visual representation of the brain space we give to different parts of our body: In our case, Human evolution has strongly favored our hands - those nifty tools of ours - as well as our great communicators (larynx, tongue etc). There is a great run down of this on the NIH website with a nice detailed graphic.

For other animals, evolution obviously favored different body parts and structures based on selective pressures. Below is a representation of the mole rat, which has complete control over it's incisors.

This type of information makes for some fascinating science inspired artwork... would like to see more of it! Link if you know of some...

Wednesday, February 3, 2010

Skin in the Game

In the healthcare reform debate, one strategy potential cost containment strategy rests on the idea that patients should have a greater financial stake in their care. They reason that patients that are financially penalized for unhealthy behaviors will quickly change them and thus bring down costs (or at least pay more for their greater need for care). The idea has some merit, after all a lot of modifiable behaviors, such as smoking and diet, lead to higher health care costs.

A recent study in the NEJM analyzes this by comparing two groups of medicare enrollees: those with copayments that stayed the same and those that had their copayments doubled (to both PCP and Specialty docs). If we buy into the argument above, one expects that the higher monetary cost would provide a disincentive to overuse healthcare services.

Interestingly, the results showed the higher copay plan resulted in fewer outpatient visits but increased overall hospitilizations as well as days in the hospital. Apparently, increasing copayments created a perverse incentive: instead of making a cheap doc visit when they had a preventable or more cheaply treated condition, people waited until it got worse (hoping it would go away, which some issues probably did) and then ended up requiring more expensive care.

Caveats: this was among medicare patients, who are elderly (read:expensive) patients, but the results are compelling. If we are going to incentivize patients to take control over their healthcare costs, this doesn't seem to be the way to do it.

Perhaps as an editorial pun, the NYTimes Health section also ran an article about Henrietta Lacks, the women whose cervical cancer gave rise to the HeLa cells that revolutionized the development of numerous vaccines and medicines. A boon to research...and profits! Oddly, in this case a patient's skin was literally in the game, yet while society benefited the patient (or family) didn't see any kind of reward (the book looks really fascinating!). Another case arose later that went to court in the 80's and found that the patient in question didn't have the right to the billions of dollars made from their cells removed in a surgical procedure. The issue has not gone away though, as noted by NEJM. Perhaps some kind of mechanism to recognize the patients (and at least respect autonomy by asking!) or drive some of the profit back into controlling health care costs is in order?

It simply goes to highlight that our collective, and individual, bodies and paychecks are tied to healthcare in such intimate ways. Of course, I write this as a MS1, I wonder what I'll think of these words in a few years...

Tuesday, February 2, 2010

Blog Rounds

Edit Note: As pointed out by my former roommate and subsequently confirmed on Urban Dictionary, Gunner more appropriately means someone that will do anything to get ahead and purposely sabotage fellow students/workers to get ahead. The definition of gunner below better resembles geeky over-achiever.

Starting a new tradition to get myself to post more often: Blog Rounds. Since I am not allowed anywhere near patients for quite some time, I figured I could do a weekly webside routine with various blogs of the medical world. And yes, it was inspired by Grand Rounds except that theirs is interesting and GRAND. I'm just looking to consolidate the stories I found in Google Reader ;)

So let's begin:

The Blog that Ate Manhattan did a nice job of summarizing the med blogosphere's thoughts on the iPad as well as giving her own opinion. The tablet concept for hardware appears to have obvious uses in medicine, but the details will get worked out in the software realm.

Callous Callostomy meanwhile tackles the 'gunner' attitude head on. At any school there are people that see those that work hard academically and like to poke fun, it's the same at med school (here too). I have two thoughts on this: 1. The number of times someone uses Gunner is in direct proportion to the number of hours they are secretly studying their a** off while pretending not to be/care. 2. C'mon people! We are in med school - the harder you work the better doc you will be and people's lives depend on us knowing stuff, not just knowing enough to pass the boards.

Finally, just in time for my Neuroscience class is a nice post from Dr. Shock on the neuroscience of jazz. I plan on re-reading this once I have finished Neuro as looking at it now I see lots of terms already mentioned in class... that I should be studying!

That's all for this round... time to hit the handouts.

Monday, February 1, 2010

Medblog Mania

Stumbling around the internet, I managed to find the medGadget Medical Weblog awards finalists which listed some really great blogs that you should check out(see the website and my newly updated blogroll). One of my favorite things about blogs is the blogroll and once I found some quality medblogs from that site I started hitting up links and before I knew it I had spent hours reading about the tattoo to tooth ratio and a med student that was diagnosed with cancer (Hodgkin's) 3 weeks before USMLE Step 1. I also learned how essential Physics is to my medical career as well as found an interesting blog that details random and crazy medical inventions from the 1800's.

All this inspired me to get off my butt and update my blogroll, rss feed and other assorted details of this site. I also managed to find a bunch of SGU bloggers (see the blogroll) - none of which are officially sanctioned by the school :P

OK I finished my coffee, time to go to school...enjoy the links and leave a comment if you have some favorite medblogs!

Saturday, January 30, 2010

Parasites and Sustainability

In just 16 hours of class we learned about over 40 parasites. We covered hosts, transmission and medication in everything from Plasmodium falciparum (malaria) to Wuchereria Bancrofti (elephantitis) and loads of everyday illnesses inbetween. Luckily, we had a Professor that also covered the socio-economic implications of parasites as well. Parasites don't distinguish between the developed and developing world, with large outbreaks of Cryptosporidium affecting cities such as Milwaukee (and, I will note, not every water treatment plant in the US can eliminate Cryps!).

But, as is commonly known, parasites have a particularly devastiting effect on impoverished areas with lack of access to proper sanitation, drinking water and medications. I list those three things in order of importance, because for the majority of parasites we covered in the course were passed through improper sanitation as well as lack of clean water. Medication is important to treat those infected and in usually to stop the spread of established diseases, but for the most part if we took the first two steps many diseases would not have the means to spread or even appear in the first place.

Possibly the worst part about these parasites as their impact on mental development (especially in children), productivity and overall quality of life. Areas where parasites spread tend to be impovershed, they do not have access to the proper facilties mentioned above. Then once infected, their children and families often have trouble finding the energy or capacity to do something about their situation, in some cases are physically unable to better their situation. This in turn leads to a cycle of poverty, parasites and lack of any method to get out, generation after generation. As Bill Gates recently pointed out, this cycle also contributes to overpopulation.

This brings me to the point of sustainability, or more properly sustainable development. The goal of sustainable development is to essentially to alleviate poverty without destroying the environment through western style consumption and infrastructure patterns. When looking at impovershed areas through the lens of Parasitology, it appears there could be a way to break the cycle of poverty without massive, expensive (economically and carbon wise), and ultimately unlikely infrastructure investments. This could be done through empowering local citizens with the means to combat disease utilizing local materials and detached or standalone sustainable solutions. This is already happening as was demonstrated in the course in the case of Tsetse fly traps maintained by locals, the easily constructable and safe VIP latrines, and this neat solar-powered water purifier.

Taking this a step further with the use of renewable energy, which can be implemented locally (and in the case of some wind turbines even mainly constructed locally) and now you have detached electricity to power communication devices such as laptops and cell phones. Now, suddenly, you can communicate health problems over the web to doctors in bigger cities and feel connected socially to the world at large. And, for parasites, you can improve disease surveillance to continuously updating and mapped outbreaks on the ground. Think about education access online as well!

Back to Bill Gates. One thing he mentioned was that as people improve economically and health wise, they start to have smaller families. This is seen again and again in developed countries. So if we improve health, sanitation and education we can start to tackle that elephant in the room of sustainability: overpopulation.

These are only some of the solutions, but the understanding of the links between health, development and sustainability are crucial if we are to make it out of the 21st century with the planet intact.



I've been meaning to put up a full post on Haiti and will once I am better educated about the situation and implications. For now you can check out the coverage and links to how you can help at AMSA's Global Pulse blog and Doctors Without Borders. As in every natural disaster, there is the opportunity to rebuild in a better, more sustainable way than was done in the first place. Check out some of the emerging green plans and ideas at

Wednesday, January 20, 2010

Med Students Say Conventional Medicine Would Benefit By Integrating Alternative Therapies

Interesting study showing the future physician workforce is much more open to CAM, but the "lack of research" conundrum still exists:

" 84 percent of participants agreed to some extent that the field contains beliefs, ideas, and therapies from which conventional medicine could benefit.

- 49 percent of participating medical students indicated that they have used complementary and alternative treatments however few would recommend or use these treatments in their practice until more scientific assessment has occurred."

The problem here is that less research is done on CAM because there is less funding, in part because in many cases there is less money to be made so no individual organization will fund the research to determine efficacy, safety and drug interactions that are all done when a pharmaceutical company develops a new drug for FDA approval. The difference is the pharma company has a financial interest and seeks the financial benefit of the drug getting approved, so they put up the money to do the studies. One could argue about the rigor and speed of the pharma studies, but they are at the least uniform and provide with which to compare information about therapuetics. That, unfortunately, is not the case with the majority of CAM treatments, hence the 84% saying medicine could benefit but 49% thinking they are safe to use

Saturday, January 9, 2010

Epidemiology of Emotions

Interesting article on public reactions on the swine flu. In many ways, the it is related to the growing anxiety over vaccines, but is there a deeper undercurrent of ignorance or suspicion of medicine at work? This paragraph seemed to capture the mood nicely:

When the inoculum of dramatic illness is first introduced into society, the public psyche rapidly becomes infected. Almost like an IgE-mediated histamine release, there is an immediate flooding of fear, even if the illness — like Ebola — is infinitely less likely to cause death than, say, a run-in with the Second Avenue bus. This immediate fear of the unknown was what had all my patients demanding the as-yet-unproduced H1N1 vaccine last spring.

As the novel disease establishes itself within society, a certain amount of emotional tolerance is created. H1N1 infection waxed and waned over the summer, and my patients grew less anxious. There was, of course, no medical basis for this decreased vigilance. Unusual risk groups and atypical seasonality should, in fact, have raised concern. By late summer, the perceived mysteriousness of H1N1 had receded, and the number of messages on my clinic phone followed suit.

But emotional epidemiology does not remain static. As autumn rolled around, I sensed a peeved expectation from my patients that this swine flu problem should have been solved already. The fact that it wasn't "solved," that the medical profession seemed somehow to be dithering, created an uneasy void. Not knowing whether to succumb to panic or to indifference, patients instead grew suspicious.

No amount of rational explanation — about the natural variety of influenza strains, about the simple issue of outbreak timing that necessitated a separate H1N1 vaccine — could allay this wariness."
Aside from the vaccine angle, the idea of surveillance epidemiology applied to emotions, fears and their spread is an interesting one.... anyone out there know of more research on topics like this?