Friday, December 26, 2008

Buying a Senate Seat

Those in the know are saying that Caroline Kennedy won't get appointed to the empty New York Senate seat because she hasn't donated that much to New York politicians.

On the other hand, Illinois governor Blagojevich is fighting to keep his job and stay out of prison after being accused of trying to sell Obama's former Senate seat.

I guess the lesson here is that if you want to buy a Senate seat, you need to start spreading the money around far in advance of the seat being open, and you can't just give money to the governor who will be appointing you, you need to spread the money around to other state officials in the governor's party. I guess it's illegal to directly buy a Senate seat, it has to be done indirectly and there can't be a quid pro quo.
One of the main problems with medicine today is that the rules are made by corrupt lawyers and politicians, and not by doctors themselves. Why is it considered improper influence if a pharm rep gives a doctor a pen (this practice will stop Jan 1, 2009), but it's perfectly fine for a lobbyist to give $1000 to a politician's re-election campaign?

Thursday, December 18, 2008

Opioids and Testosterone

Although I mainly practice sleep medicine, I have been treating patients with opioid dependence at Somnus Sleep Clinic for the last year. I prescribe suboxone. Several of my male patients have complained of decreased libido and erectile dysfunction. After checking a testosterone level and finding it to be low in several of these patients, I referred them to an endocrinologist for testosterone therapy.

Opioids can cause hypogonadism, probably by interfering with the hypothalamic-pituitary-luteinizing hormone (LH) axis.

Unfortunately, for most of these patients I checked testosterone levels after they had been taking suboxone for several months, so it wasn't clear if suboxone was causing the effect or if it was due to prior opioid abuse.

When I see male patients for their initial visit prior to initiating suboxone therapy, I think I am going to start ordering baseline testosterone levels if there are symptoms of hypogonadism present.

Monday, December 01, 2008

Shredding of the Constitution

President-elect Obama, who allegedly is not a natural born citizen and would therefore be ineligible to be President, has nominated Hillary Clinton to be Secretary of State. Hillary Clinton is ineligible to be Secretary of State due to the Constitution's emoluments clause.