CodeBlueBlog

New Year's Carnival

Vanity, Thy Name is Carnival

After the balloons are deflated and you need to rest and reflect, where should you go this weekend? For all the fanfare without the foofaraw, you can click over to The Radical Centrist and read the posts of some the web's best bloggers.

It's the 119th Carnival of The Vanities, and you will find posts from CodeBlueBlog as well as Dr. Charles there.

The Carnival of The Vanitities was started by Bigwig at Silflay Hraka -- a website that always has great posts, and you can read the most recent one here.

Also, for your reading pleasure, in case you missed it, you can read my full-length article on the Yushchenko poisoning case -- including evaluation of the official medical report on Yushchenko from the Rudolfinerhaus clinic -- published by the Libertarian newsletter AntiWar. Read it here.

Happy New Year, everyone.

Magnets, Arthritis, And A Spot of Tea

British Study Supports Treating Arthritis With Magnets

  Will the British next turn their attention to tickle therapy?

______________________________________________________________________________________________________________

CodeBlueBlog STAT Summary Box

If you don't want to read the whole post

1. As reported this month in The British Medical Journal, magnetic bracelets were effective in reducing patient discomfort in osteoarthritis.

2. No one should mistake osteoarthritis for rheumatoid arthritis or any other inflammatory arthritis. Make sure you know the difference.

3. Can magnets on the wrist actually be doing something medically here to reduce pain in osteoarthritis of the hip and knee? My answer: ABSOLUTELY NOT (did anyone think they could...really?). This study has an enormous error that everyone missed which completely invalidates the hypothesis. So don't go spending any money on magnets for pain.

4. Just remember, if magnets can have effects AWAY from where they are worn, then who's to say magnets cannot, in 20 years cause leukemia or lymphoma?  

5. The patients in this study were experiencing the placebo effect.

6. Why does The British Medical Journal that touts itself as one of "the world's top four general medical journals" proffer this watery porridge while the prestigious American journals are serving steak and lobster? 

7. As I pointed out last week in this post, degradation of the quality of research and fewer important medical breakthroughs are among the long term consequences of nationalizing  health care.

__________________________________________________________________________

The Long Story: A Magnet a Day...

Last week in its special "double" Christmas edition, The British Medical Journal (BMJ) published this study as one of its headliners:

"Randomized controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee."

The press scooped it up (I should say out). This study was quickly trumpeted, especially in the British press, as showing -- finally -- that the promulgators of therapeutic magnetic jewelry have been right all along...just as everyone suspected. The Mirror said:

Doctors have long derided the benefits of the bracelets, which many patients insist give some relief, calling it a figment of the imagination.

The press went along with the study because of the BMJ's publishing pedigree, and even Medscape posted up the study without critique, claiming:

Magnetic bracelets may reduce the pain associated with osteoarthritis of the hip and knee, suggest the results of a multicenter, randomized, placebo-controlled study published in the December issue of the British Medical Journal.

For this study, researchers from The Peninsular Medical School located patients with documented osteoarthritis of the hip or knee.  Patients then got one of three bracelets to wear: a strong magnet, a weak magnet, or a dummy magnet. After wearing the bracelets, researchers had the patients fill out standard questionnaires concerning pain perception in the hip and knee. The results indicated that patients wearing the strong magnets had relief of pain that is attributable to the magnet itself.

The researchers don't discuss  how it might be that magnets achieve this astounding effect.

Osteoarthritis is NOT Rheumatoid Arthritis

Of first importance for all non medical people reading this, is to distinguish osteoarthritis from other arthritis diseases.

Osteoarthritis is a wear-and-tear disease involving the gradual erosion of cartilage and underlying bone in work-performing joints. This type of arthritis is associated with aging and/or overuse and trauma.

Rheumatoid arthritis is an autoimmune (body "attacking" itself) disease where the cartilage and bone of joints is destroyed prematurely by inflammation in the joint.

So no matter what you believe or take home from this or any other article, you should never confuse these types of arthritis. Rheumatoid arthritis, and other types of inflammatory arthritis -- must be treated by a physician and must never be treated by magnets or any other bogus (homeopathic, manipulative, etc) therapy.  You will lose the function of your joints completely if inflammatory arthritis is treated inadequately.

Unfortunately, I saw no media report that made this important point to its readers.

FANTASTIC VOYAGE

Most of the work I could find concerning magnets and treatment of...anything...dealt with the local effects of the magnet. In other words, the magnets are supposed to help the area they cover, physically. Because tyhe boys from Peninsular Medical School didn't tell us how this magnet might effect changes in the underlying flesh and blood, I tried to research the proposed mechanisms of local magnetism (electromagnetic effects not included), and here's what I came up with:

1. Magnets affect the flow of blood because blood contains iron

2. Magnets affect temperature locally (secondary to #1)

3. Magnets affect ion flow

All of these effects are local, i.e. directly underneath or near the bracelet.

What is a bracelet?

                        Bracelet                            

  Noun               

   1. An ornamental band or chain encircling the wrist

So these magnetic bracelets encircle the wrist. And the proposed effects of static magnets are local (i.e. in the general body area of the magnet). How then are these wrist magnets affecting the hip or knee? The British magnet researchers don't even tell us in the study if patients wore the bracelets on the same side as their osteoarthritic joints! So could a bracelet on the right wrist improve osteoarthritis pain in the left knee?

Here's the Fantastic Voyage a red blood cell (or ion) has to travel to get from the wrist to the knee:

...from the wrist the cell travels to the fingers, crosses to the veins, goes up the arm, into the chest, into the right heart, out to the lungs, back to the left heart, out to the chest, down through the belly, out through the groin, down the thigh, HOME (to the knee).

In anatomic mileage, the distance from the right wrist to the left knee is like driving from Bangor Maine to Amarillo, Texas. Could this tired, road-beaten red cell then have any effect on that distant anatomic colossus, the knee? No way.

Even if the researchers could propose some mechanism for this effect then I would counter propose that any such highly-potent, long-lasting effect on cells, cell metabolism, or function, needs to be studied. Because who is to say that such a potent influence -- when applied over years -- would not give these patients cancer  down the line. Especially blood cancers like lymphoma and leukemia. Bracelet emptor.

Placebo Effect

Definition: The beneficial effect in a patient following a particular treatment that arises from the patient's expectations concerning the treatment rather than from the treatment itself.

The British researchers tried to weakly refute the placebo effect with a few twists in their study. I found these to be dodges. I won't go into their methodology here, but even they thought it was unconvincing, saying, finally, in their conclusion to the study

It is uncertain whether this response is due to specific or non-specific (placebo) effects

Think of it this way. The magnet used in this study was TWENTY times stronger than an average bar magnet (see photo, top of post); or 170 to 200 mT (bracelet) versus  10 mT (bar magnet). Ever see what a bar magnet does when you pass it through your junk drawer at home? It picks up all the little metal objects it approaches. Now make that magnet twenty times stronger. What do you think was happening?

These patients were probably stuck to their refrigerators and car doors for hours until help arrived. They were probably local sources for paper clips and penny nails. The patients had to believe that there was a mighty potent magic going on there. This in contradistinction to the patients with weakly magnetic and dummy bracelets -- they were likely  unimpressed.

The Quality of Their Research

As discussed in CodeBlueBlog last week, nationalized health care systems tend to produce inferior research and fewer significant medical breakthroughs.

One window for viewing such degradation, real-time, is a system's major medical periodicals -- where fundamental research and ground-breaking studies are first published.

The British Medical Journal is a window into research and innovation in health care in Great Britain. And this highly touted article from the special Christmas edition -- which cites as its most relevant sources several papers from a journal called Alternative & Complementary Therapies -- is a good example of the type and kind of research we would hate to see in The New England Journal of Medicine. It's inexpensive. It's shoddy. It makes conclusions that don't cost the system money, and it eventually hurts patients.

We don't want that here. Let them keep their magnetic bracelets over there, where they can't hurt us.

Grand Rounds is up. The  weekly compendium of health care blogs can be found this week with a lilting holiday theme at codeblog: tales of a nurse.

Look for it next Tuesday at RangelMD.

CSI Medblogs: Dissecting the Cadaver: Yushchenko's Official Medical Record

In today's edition, the Libertarian Newsletter, AntiWar.com,  published the complete account of my evaluation of the official medical report from Viktor Yushchenko's medical admission to the Rudolfinerhaus clinic on September 10th, 2004. The report is analyzed and positioned within the context of Yushchenko's story. For CodeBlueBlog's previous articles about the Yushchenko incident go here and here;  here, here, and here -- as well as other intervening posts.

Today's news brings word of Viktor Yushchenko's victory in the Ukraine. As I mentioned in the Antiwar.com story, let's hope we don't witness another pitiful and disgraceful public deterioration, as we saw with Boris Yeltsin, from what most likely is Viktor's biggest health problem, alcoholism.

Paralyzed, Mute, and Immobile Patients Manage to File Suits in Faux Botox Case

You Don't Have To Move To Sue

  Eric and Bonnie Kaplan are paralyzed, mute, and immobile in a West Palm Beach hospital. Yet last week this couple, who cannot speak -- and communicate only minutely with their son through brief finger gestures -- filed a lawsuit against the makers and distributors of a botulism toxin they received as a wrinkle treatment, instead of Botox.

Tort lawyers in Florida, innumerable and diabolically nimble, have blown another hole in the once rock-solid wall of limits that used to stand around the good sense of our society.

You can now sue even if you can't move or talk.

But if they could move and talk, it might be worse for the Kaplans -- thus the strategy of the timing of this suit -- for Eric and Bonnie Kaplan are victims of their own bad judgment and possibly their own greed.

Kaplan's Choice

Kaplan is a successful chiropractor and entrepreneur. He lives in an expensive home in a posh neighborhood. He could easily afford the medically unnecessary wrinkle-smoothing cosmetic Botox injections performed by a licensed, board-certified plastic surgeon. But he would have to pay top dollar for those services by that professional in that town.

So Eric made a decision to go an alternate route for his treatment.

An educated, informed, successful health care professional can reasonably be assumed to understand the risks and benefits of obtaining sophisticated care by a local board certified plastic surgeon versus traveling 60 miles to a medical mill lodged in a congested urban strip mall.

Kaplan chose to travel the sixty miles south on I-95 (a dubious judgment itself) where he and his wife received those injections from a defrocked and delicensed osteopath -- a physician who was under investigation for the deaths of five patients. It is not a far leap to speculate that these injections were obtained in this way because it was a financially attractive alternative to the Kaplans.

With Friends Like These...

Kaplan knew McComb personally, so he was not unaware of the man's training, background, ability, and legal problems. Yet he and his wife still chose to take the injections.

Furthermore, when Eric and his wife began to experience light-headedness, double-vision,  paresthesias (numbness), and a faltering ability to talk-- some particularly alarming symptoms in my mind-- they called the owner of the Fort Lauderdale "clinic", another chiropractor, Thomas Toia.

Toia and his son (a medical "technician") drove to the Kaplan's home where one report describes the Kaplans as "panicked." The Toias, however, reassured the poisoned couple that they were "dehydrated" and then decided upon a holistic therapy called a "Myer's cocktail" consisting of vitamin C, magnesium and other vitamins. This bogus therapeutic intervention delayed the Kaplans from seeking legitimate medical care, it seems, for up to a day.

Rather a Martini

But if you were experiencing trouble speaking, and seeing double, would you call a chiropractor? A back cracker? And if you happened to be availed of such a person in that situation and his remedy was a Myer's cocktail, would you drink it? Would you allow the Myer's cocktail to prevent you from seeking legitimate medical care?

Of course not.

The Kaplans chose to call Thomas Toia and they chose to drink his ridiculous cocktail for their dramatic symptoms. It is entirely the fault of the Kaplans. They decided to trust the medical advice of a non physician -- a professional, I might add, who is given license and legitimacy by our society.  And let me tell you, there are chiropractors out there every day giving people similar drinks and performing back cracking maneuvers for all kinds of maladies.  We, as a society, have said that this is okay. So how is Toia at fault?

No doubt, Eric and Bonnie Kaplan are unlucky, and I do not mean to make light of the severity of their catastrophic illnesses, but they put themselves in the position to be unlucky. There would have been much less chance of such unluck in a plastic surgeon's office, but the Kaplans chose to trade that risk for a savings in price. It was the risk they chose to run. And by no definition can Kaplan be defined as an uninformed or unwary consumer.

The Bar Isn't Lowered, It's Been Thrown Away

But does any of this matter? Not in our world of civil litigation. You don't have to be able to move, speak, think for yourself, use your expertise or be responsible for your choices. You don't have to make reasonable decisions or be responsible. You don't even have to get out of bed. All you have to do is wiggle your fingers and you're suing.

CSI MEDBLOGS: YUSHCHENKO'S DISEASE: A TALE OF TWO POISONS

YUSHCHENKO'S DISEASE : A TALE OF TWO POISONS

 

STAT CodeBlueBlog SUMMARY

If you don't want to read the whole post

• Yushchenko seems to have been exposed to a large amount of Dioxin (barring outright medical fraud at multiple locations). This was not why he was admitted to Rudolfinerhaus
• The chronology of the exposure to Dioxin, the manifestation of symptoms, and the appearance of Chloracne does not fit the chronology of the claims made by Yushchenko and the Rudolfinerhaus clinic
• Yushchenko drank too much the night of September 5th 2004, and he likely drinks too much frequently
• Actual test results obtained from Rudolfinerhaus show conclusively that Yushchenko had pancreatitis and an enlarged liver, both of which are common sequelae of alcoholism
• Rudolfinerhaus tried to cover these findings with inaccurate press releases and a grossly misleading clinical report "conclusion" 
• If Yushchenko keeps drinking, it is NOT UNLIKELY that his liver and pancreatic disease will progress and he will be left with chronic pancreatitis (which can lead to diabetes and insulin dependence) and/or cirrhosis (which can lead to death by numerous pathways)

Here's The Long Version

A Tale of Two Poisons: An Unwritten Dickens Novel?

1. First Admission to Rudolfinerhaus not due to Dioxin poisoning

If we concede the issue that Yushchenko has a blood test demonstrating severely elevated Dioxin levels AND we concede that he has chloracne as a result of Dioxin exposure then Yushchenko was not admitted to the Rudolfinerhaus clinic in September for acute Dioxin poisoning four days earlier during his meal with the Ukraine Secret Service.

Chloracne develops months after exposure to Dioxin (italics mine):

Chloracne is a rare acne-like skin condition caused by certain toxic chemicals including the dioxins. It develops a few months after swallowing, inhaling or touching the responsible agent.

2. Yushchenko drinks too much

The New York Times reported that, according to their investigation, on the night of September 5th, 2004, Yushchenko ate with top Ukrainian Secret Service agents and, in the course of the dinner, he consumed: beer, vodka, and cognac.

Yushchenko arrived at the dinner around 11 P.M. By the time they got to cognac, it must have been the middle of the night (maybe Katerina was smelling Louis XIII cognac instead of Dioxin?):

The four men drank beer and ate boiled crayfish from a common bowl, as well as a salad made of tomatoes, cucumbers and corn. Later, they selected vodka and meats, and then cognacs for a last drink.

This is an abnormal drinking pattern:

The US Government defines moderation as no more than one drink per day for women and no more than two drinks per day for men

3. Yushchenko was admitted to Rudolfinerhaus for signs and symptoms related to pancreatitis -- a disease usually caused by alcohol

Thanks to reader and commentator pythagoras, here is an amazing link containing the official report of Yushchenko's hospitalization at Rudolfinerhaus. It states as diagnostic imaging findings:

Ultrasound:

Diffusive enlargement of the liver

CT Scan:

Pancreas intermittently massive without clearly-defined edges, peripancreatitis

Liver enlargement (hepatomegaly) is a frequent finding in alcoholics and can be a precursor to cirrhosis (= often fatal, end-stage liver disease). Pancreatitis is a frequent complication of alcohol over-indulgence (acute or chronic) and MASSIVE enlargement of this organ associated with blurred edges is diagnostic for pancreatitis (and a bad case of the disease at that). See my illustrative CT images here.

So the physicians at Rudolfinerhaus officially gave Yushchenko the same diagnosis  I gave him on November 30th, 2004 (see here).

The Ulcer Connection

Much was made of a NY Times report that endoscopy of Yushchenko at Rudolfinerhaus purportedly demonstrated that:

his digestive tract was dotted with ulcers from top to bottom

As it turns out, this was probably a cleverly manipulated phrase designed to obscure the fact that the fiber optic examination of Yushchenko's gastrointestinal tract revealed ulcers only at the top and bottom of Viktor's digestive tract, namely his stomach (=Gastritis) and his rectum (= the very terminal part of the GI tract; this is called "proctitis").

Again, according to the Rudolfinerhaus' own report Yushchenko demonstrated:

Acute active eruption of stomach ulcers, reflux gastritis of II degree

and

Acute proctolitis

Gastritis and its most severe manifestation (ulceration) is not uncommonly caused by alcohol:

Common culprits include alcohol... Although gastritis can occur in people of all ages and backgrounds, it is especially common in:

• People over age 60
• People who drink alcohol excessively
• Smokers
• People who routinely use NSAIDs, especially at high doses

Proctitis is inflammation of the lining of the rectum, called the rectal mucosa. As to why Yushchenko should have proctitis, I will not speculate, but he is know to have had both gastritis and colon ulcers before, according to the on-line newsletter Counterpunch (no source given):

Yushchenko's medical records show that from 1994 to 2004 he had the following diseases: chronic gastritis, chronic cholecystitis, chronic colitis, chronic gastroduodenitis, infection of the bowels, and Type II diabetes.

The salient point is that the ulcerations at the time of Yushchenko's Rudolfinerhaus visit, were not as extensive as initially indicated AND they can be explained away by both alcohol ingestion (a known and given here) and/or previously diagnosed conditions.

4. Rudolfinerhaus Clinic: A Place for Diagnostic Mysteries?

The Rudolfinerhaus clinic advertises itself as a discrete and posh clinic. I have questioned, right from the beginning, the rationale for Yushchenko entering this medical facility if he truly had a mysterious ailment or he needed high-end care. One of my readers, a computer scientist and an "ex-pat Austrian," by his own description, commented:

Had I an actual health problem, I would prefer, say, the U of Vienna's teaching hospital (for most things), or the Lorenz-Boehler (trauma, accidents), and so on.

A few years ago, the Rudolfinerhaus had the reputation of a Betty-Ford-clinic for the affluent, with an add-on wing for the yearly check-ups of rich oil sheikhs. Unless that rep has experienced a sea change since then, I must ask: Why would someone who claims to have been poisoned check into the place when the AKH is a stone's throw away?

More has been learned about goings-on at Rudolfinerhaus that deepen the mystery of Yushchenko's choice of treatment centers. As first reported in the Transatlantic Intelligencer, and then the on-line magazine, Antiwar.com, there were some serious behind-the-scenes internecine struggles at the Rudolfinerhaus Clinic after Yushchenko's visit. Apparently, the real "head" of the clinic, a Doctor Lothar Wicke resigned and according Antiwar:

It seems that his skeptical remarks concerning the unproven status of the "poisoning" accusations had proved injurious to his health. At a news conference held just after Yushchenko's first visit to Rudolfinerhaus, Dr. Wicke had accused unnamed individuals not on the medical staff of spreading "medically falsified diagnoses concerning the condition of Mr. Yushchenko." He also pointed to the complete lack of any evidence that the candidate had been poisoned, either deliberately or otherwise. This did not endear him to the Yushchenko crowd.

Quoting the Frankfurter Allgemeine Zeitung (FAZ), a leading German newspaper, and Austrian magazine Profil, Antiwar reports that Dr. Wicke received numerous death threats and explicit warnings from the "Yushchenko clan."

The author of this article, Justin Raimondo, goes on to quote this source (a pay link, in German):

"Thereafter Yushchenko's people made clear to Wicke that he should not say anything more concerning the affair, since otherwise [as Wicke puts it] 'one would resort to other means against me and the hospital.' Dr. Wicke is also supposed to have received death threats at the time."

Add to these new revelations the obviously staged drama of Yushchenko's brief return to the clinic for a diagnosis (see here), and previously noted inconsistencies in their reports, it is clear that the Rudolfinerhaus Clinic needs to be viewed as a hospital chosen by Yushchenko to protect the public from the full knowledge of his condition and its origins.

Punctuating this claim is the conclusion of the Rudolfinerhaus' clinical report which almost negligently does not mention the findings of pancreatitis and gastritis (both of which can be linked to alcohol ingestion) and instead, lists the one asymmetric finding : proctitis.

Conclusion: Acute proctolitis on the left side.

The negative general and alimentary condition could have been caused by either an acute viral infection or by chemical substances that are not generally found in food products.

Unless there is a translation snafu, the clinic's description of Yushenko's alimentary (gastro-intestinal tract) condition as negative is a flat-out lie. Worse, it is followed by the nonsequitor disclaimer that whatever he suffers from, it is caused by substances not generally found in food products (like grain alcohol?).

Thus the Rudolfinerhaus Clinic deflects alcoholism and implicates something nefarious -- like poisoning. This is the type of report one would expect from a fawning celebrity half-way house, not a significant or major medical center.

5. Poisoned? NOT

From the beginning I have said that it seems ridiculous to imagine that anyone with any amount of sophistication or purpose would have dosed Yushchenko with poison. Detractors of this theory write variously that I don't understand how backward, stupid and incompetent these spies are and/or life in the Ukraine is. I can't buy that. And neither can most other reputable sources and experts.

The New Scientist

Murder by poison has largely been relegated to the history pages, principally because it is now so easy to detect

But why dioxin? "If you really want to kill someone, you use cyanide or ricin or strychnine," Dr. Andrea Sella of University College London wrote in thenewscientist.com

The New York Times

Murder by poison has largely been relegated to the history pages, principally because science has overtaken the great advantage that the poisoner of old had over his pursuers: the ability to hide his work beneath the normal calamities that afflict human life

Similar comments are noted throughout the net and the media.

Finally, there is the theory that Yushchenko was poisoned not to kill him but only to disfigure him. This is a dubious proposition; because, a moment's reflection would lead to the conclusion that the disfigurement could (and did) have the opposite effect. Also, Chloracne can not be predicted as a definite complication of poisoning and its exact manifestation -- given the rarity of its occurrence -- also could not be predicted.

What are we left with?

Yushchenko seems to have been exposed to a large amount of Dioxin (barring outright medical fraud at multiple locations). This was not why he was admitted to Rudolfinerhaus.

The chronology of the exposure to Dioxin, the manifestation of symptoms, and the appearance of Chloracne does not fit the chronology of the claims made by Yushchenko and the Rudolfinerhaus clinic.

Yushchenko drank too much the night of September 5th 2004, and he likely drinks too much frequently.

Test results released from Rudolfinerhaus show conclusively that Yushchenko had pancreatitis and an enlarged liver, both of which are common sequrelae of alcoholism.

Rudolfinerhaus tried to cover these findings with inaccurate press releases and a grossly misleading clinical report "conclusion." 

If Yushchenko keeps drinking, it is NOT UNLIKELY that his liver and pancreatic disease will progress and he will be left with chronic pancreatitis (which can lead to diabetes and insulin dependence) and/or cirrhosis (which can lead to death by numerous pathways.

Stay Tuned

ADDENDUM: A NOTE TO MY READERS

CodeBlueBlog has not dropped the Yushchenko story. Neither have I dropped the other CSI Medblogs cases which remain open and will be revisited, when appropriate. At least two of the previous CSI Medblogs cases are actively under pursuit, and one of those cases may have a reemergence with important new findings soon.

I suffer from lack of personnel, researchers, editing crew, letter readers/writers blog maintenance staff, and HTML coding experts (I sent myself a memo to do better).

That being said, some of the topicality of the Yushchenko story is diminished, but there remain many questions. Enough so that "America's Best Political Newsletter," Counterpunch would take a lot of my story and write a feature article without attribution (let alone directly quoting me and attributing it elsewhere!).

The "Comments" section of the Yushchenko posts has been overheating, and there are two points, brought to my attention, that need rewording. #1. Although Chlorine products stink -- as I said -- Dioxin doesn't stink. Sorry. #2. Although Dioxin needs to be dissolved in fat, one would need only a small amount to do the damage seen, so it would not be hard to administer this dose.

Many thanks to a commenter pythagoras who has furnished me with important references, and has kept my position viable while I have been manning the furnace.

THE SEX OF MEDICAL BLOGS: GRAND ROUNDS #13

Welcome to Grand Rounds # 13

The Editor's Take

In the beginning I believed that the geometric proliferation of medical blogs indicated strict reproduction by cellular division. It looked like the simple production of two progeny produced by one parental act of division. I now realize that there is something more going on. A sort of medical blog meiosis that assures the mixing of information, the distribution of characteristics, and the spontaneity provided by point mutations.

These are not just clones budding throughout the medical blogosphere; rather, we are watching unique individuals produced with information crossed, passed, and punctuated by bloggists who are inhabitants all over the map of modern health care. It's a remarkable phenomenon -- an evolution in front of our eyes...so keep watching. It's sure to produce many new beings. here's a sampling of this week's best.

Clinical Corner

Men...Fear the tonsure? What are your options, scalp reduction? Kevin,M.D. prefers you consider modern medical therapeutics to combat your baldness and he succinctly spells out the options.

Clockwork not orange? If your biological timepiece is not recording 12 o'clock twice a day, maybe it needs to be reset? Michael Rack is a physician who specializes in sleep disorders and psychiatry (so he'll talk you through it as well), and he discusses the possible use (or not) of melatonin to grease the gears of your aging mechanism.

For mysterious reasons it is always hard to sort out the data laid out in "alternative" medicine studies. Many times the authors just wish you would jump to the "discussion" and read their conclusions without analyzing their facts. That's why we have The Journal Club to sort these studies out., and Michael Jacobsen does it again this week regarding acupuncture and osteoarthritis.

Daniel Boone as M.D.? Medrants draws the analogy in a brief but pithy plea for patients to get informed and take responsibility for their own care. It's the difference, the author says, between treating and recommending treatment.

Policy Analysis and Public Health

A doctor in pain gets pain...The DEA won their drug-trafficking case against pain specialist William Hurwitz. But everyone else lost. Trent McBride tells us the tale straight from "The War on Drugs," at Callarchy.

Do you want the same medical treatment Bobby Bonds gets (are you sure?)? Some providers are counting on it (just read the label on the cream before you spread it, okay?). Nick at blogborygmi has original thoughts and analysis on the subject.

Will intubation be a luxury tax? A Chance to Cut is a Chance to Cure explains the proposal of a trauma tax to help defray the costs of emergency medical care, which, according to his analysis, will save lives.

They may not eat what they kill, but now ER doctors can at least see what they bagged. Grunt Doc explains a small but important regulation that will wild ED physicians evaluate their productivity and it's worth. As a former contract physician, at the mercy of a contract holder, I especially relate to the plight of the ED docs and the type of moral victory this new regulation represents.

For those physicians out there who want to limit BIG PHARMA's advertising to the vulnerable masses, are you willing to similarly limit alternative medicine from promulgating dubious therapies? A new medical blogger, orac, at Respectful Insolence lays out a lengthy case concerning the pitfalls of alternative therapy and the dishonesty of associated advertising, especially for major diseases.

The obesity police state is  coming in a snack pack: isemmelweiss analogizes the public health wars -- like that now raging against obesity -- to real war at his blog. Put down that Crispy Kreme and raise your sticky hands in the air!

I always thought it was home cooking, but apparently there are lots of reasons being married keeps your engine humming sweetly. The details of a recent report are enumerated by emer (and there are several follow-up posts along a similar line worth reading).

When consumers aren't informed they make bad decisions. A perfect example is the selling of whole body scans as reported by enoch choi at Medmusings. I could tell you first hand many unfortunate anecdotes associated with these rip-offs, but this article is a better place to start.

Friends, Final Thoughts

Recognition for the medical blogosphere will grow if we can attract more non medical contributors -- so I encourage everyone to spread the word and invite their blogger friends.

One of our good friends, Mike Pechar, at Interested-Participant consistently forwards his medically-related posts, and they are always well done, as is his site, which I recommend to all. This week Mike reports on a Chinese patent awarded to a professor at Fudan University in Shanghai, allowing the use of a traditional Chinese medicine as a rat poison.

Most physicians I know are interested in the insights of oncologists, and the public will be too when the read The Cheerful Oncologist as he explains the hard-won struggle to cheerfulness in a profession that bestrides death.

Got Blue? It's common during the holidays. Although normal, the holiday blues can be made a lot worse when family embers impose their expectations upon one another. Dr. Baker shares a case of a husband who needs to back off a bit from his expectations this holiday season.

Is there really a madman across the water? The Medical Madman instructs medical practice to a student who lives where yet there is no Internet access.

And Stories to Tell

Dr. Charles unearthing an article written by Mark Twain, opens a worm hole back into the year 1740, and does his best to cure a headache with leeches.

A new blogger, Bronwyn, graces us with a poem on one of my favorite little fellow, the homunculus.

And Diana, RN was kind enough to note and comment upon Gollum as seen through the eyes of some British medical students.

Finally, we will attempt to entertain you aurally, with an audio link from the Xiphoid Process, written by a third year medical student.

With the bang of a gavel I bring this Grand Rounds to a close. Want to host? Contact the gifted and talented GR progenitor, Nick, at Blogborygmi.

Check out the next rounds at Code Blog: tales of a nurse 12/28/04.

Grand rounds...One Last Reminder

Grand Rounds will be held right here, at CodeBlueBlog, on 12/21/04. Submissions need to be mailed by 9 PM tomorrow night, Monday, 12/20/04.

The format for submission is (roughly):

Title of post

Short description of post

URL of website

Permalink of submission

Trackback (if possible) of post

email submission to: [email protected]

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British Medical Journal Editor Calls George Bush's Americans: Crippled, Lonely, and Loveless

This week, The British Medical Journal (BMJ) published it's "Christmas Double Issue." Excited?

Here's how this highly regarded and prestigious BMJ describes itself:

The BMJ is one of the world's top four general medical journals... (the others being)...The Lancet,  The New England Journal of Medicine and The Journal of the American Medical Association.

Well, I'm glad to see that, in a country with nationalized health insurance, the BMJ has managed to avoid the excesses of political budgetary exigencies, and continues to maintain the high standards of original research and reporting one would expect from "one of the world's top four general medical journals." Aren't you?

Because Chicken Littles in the United States are always warning that if one nationalizes health care, dollars will be cut from research and the quality of research -- the bed rock of medical advancements that help sick people -- will be vitiated and patients will eventually suffer in a way that is insidious and hard to see: They will get fewer innovations and therapies, fewer new treatments and diagnostic methods.

There is also the danger that, eager for funding, medical journals will become politicized, taking sides with those ideas and rulers currently in power. Editorials and even the tone and tenor of the academic presentations might stray from the empirical and wander towards polemic serrving as a grinding stone for political axes.

So here is the cover of the much anticipated BMJ's "Double Christmas Issue":

And here is the accompanying blurb:

The citizens of Havana went wild with joy as they greeted Castro's revolutionary army, which liberated the city from dictator Fulgancio Batista in early January 1959.

Havana? Liberated? Christmas double issue? Why is this the cover of a medical journal? What's this all about? Sadly, it becomes obvious when reading the issue's editorial:

Freedom has become the political buzzword of the 21st century. George Bush's agenda is to bring democracy and freedom to the rest of the peoples of the world, while his own are slaves to work, crippled by personal debt, and trapped in loneliness or loveless relationships—the shackles of the rich. Now that the surviving Afghanis and Iraqis are enjoying the benefits of Western freedoms, what will this mean for their health? No empirical studies have explored the relation between the extent of freedom allowed by political regimes and the effect on a nation's health—until now. 

Wow! Is that The BMJ or The Nation? He's calling us (that's you and me, fellow citizens) crippled, lonely and...loveless! And he's doing that under the aegis of the BMJ, where we would expect to be reading reports of the latest brilliant British discoveries: new epidemiological data; the latest empirical slant on arthitidies and polyneuropathies; cerebral encephalomalcia, and therapies derived from Limulus polyphemus. The editor, rather, is blasting fatuous buckshot over our loveless relationships.

Who in Sam Hill is this editor?

Kamran Abbasi.

Who is he? The Chief of Surgery at London's Winston Churchill Cardiothoracic Clinic? The head of Hematology-Oncology at St. Paul's Cathedral?

No, Kamran Abbasi is a London-based cricket writer and acting editor of the British Medical Journal (italics mine).

A cricket writer.

You mean he's a biologist? An invertebrate zoologist?

No. He's a sports writer...AND acting editor of the British Medical Journal.

Well, maybe they just let hacks in once and a while to spice up the editorials, right? They still have the original research and articles that make them one of the four best medical journals in the world, right?

Well, let's find out. Because it doesn't matter if the BMJ has a kooky Marxist editor as long as the science lies within the magazine. As long as the clever, original research is there. Important studies designed to ferret out the truth and bring to light the clinical and research data that will put another brick down, and cement it into the wall of our knowledge about health and disease. Let's look at a representative sample of the table of contents of the special Christmas double issue:

• Magnetic bracelets relieve pain in osteoarthritis

• Amnesia in the movies bears little relation to reality

• Why the human eye cannot detect offside in football

• A field guide to experts: Are you Peacock, turkey, or dodo?

• Can you tell your clunis from your cubitus

• Polymeal reduces cardiovascular disease by more than 50%

Here's the cover of the most recent New England Journal of Medicine

Sorry. It's not very impressive. No photographs or drawings. But it does have list of the contained articles and report. Here's a sample:

• Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery
• Palifermin for Oral Mucositis after Intensive Therapy for Hematologic Cancers
• Inflammatory Markers and the Risk of Coronary Heart Disease in Men and Women

• Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination

• Hypogonadism in a Patient with a Mutation in the Luteinizing Hormone Beta-Subunit Gene

And the editorials?

• Vaginal Birth after Cesarean Revisited
• Oral Mucositis--The Search for a Solution

  

  It's a good comparison. And in the comparing of agendas and content, one can get a fair idea of what happens to the iceberg of health care when it comes under attack by the budgetary ice-picks of politicans. At first there are chips and divots. But the assault is continual, ever enlarging, and never ending. Death by a million blows. Large blocks crack and fall. The contours change, the essence evolves.

  Eventually, your iceberg is whittled down to something else. A parody of itself, or a useless remnant. In the case of the British system, it's a small frozen figurine of a nasty cricket.

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