Friday, December 30, 2005

Patch Adams

The meeting brought together some 9,000 psychologists, social workers and students, along with many of the world's most celebrated living therapists...
In the opening convocation, Dr. Hunter "Patch" Adams - the charismatic therapist played on screen by Robin Williams - displayed on a giant projection screen photos from around the world of burned children, starving children, diseased children, some lying in their own filth.
He called for a "last stand of loving care" to prevail over the misery in the world, its wars and "our fascistic government." Overcome by his own message, Dr. Adams eventually fell to the floor of the stage in tears.
Many in the audience of thousands were deeply moved; many others were bewildered. Some left the arena.

This guy is bizarre.

Tuesday, December 27, 2005

PTSD in Combat Veterans

There has been a dramatic increase in PTSD claims for Vietnam Veterans:
In the past five years, the number of veterans receiving compensation for the disorder commonly called PTSD has grown nearly seven times as fast as the number receiving benefits for disabilities in general, according to a report this year by the inspector general of the Department of Veterans Affairs. A total of 215,871 veterans received PTSD benefit payments last year at a cost of $4.3 billion, up from $1.7 billion in 1999 -- a jump of more than 150 percent.
Experts say the sharp increase does not begin to factor in the potential impact of the wars in Iraq and Afghanistan, because the increase is largely the result of Vietnam War vets seeking treatment decades after their combat experiences.

I recommend reading the whole article; there is a good discussion about the large number of Veterans who are not being treated for their PTSD, as well as a discussion about the financial implications of a diagnosis of PTSD for an individual Veteran sometimes leading to exaggeration of symptoms or an unwillingness to get well (which is often unconscious)

Sunday, December 18, 2005

Disclosure for Medical Bloggers

Dr. Hsien-Hsien Lei writes (via Shrinkette):
I encourage all science and health bloggers to write a post answering the following 10 questions posed by The National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health:
1. Who runs this site?

Michael Rack, MD
2. Who pays for the site?
The site is provided free by Blogger. I get about 15 cents a day from google adsense for this site and sleepdoctor combined. I often work on this site on "company time" (East Mississippi Medical Center)
3. What is the purpose of the site?
To provide medical information and commentary to doctors, medical students, and patients. I also publish this site to gratify my ego.
4. Where does the information come from?
Some of the info comes from what I learned in medical school, residency, and in my medical practice. Other information comes from various newspapers and industry publications.
5. What is the basis of the information?
See #4
6. How is the information selected?
I link to interesting articles I see on-line, often in the New York Times. I sometimes comment on what I read in other medical blogs.
7. How current is the information?
It is fairly up to date
8. How does the site choose links to other sites?
I try to link to reliable information- medical blogs with good reputations, notable newspapers.
9. What information about you does the site collect, and why?
I check google adsense several times a week to see how many visitors there are and how much money I have made.
10. How does the site manage interactions with visitors?
Visitors can leave comments to each post. I try to answer each serious comment. In the near future I will try to learn how to delete spam comments.

Theater owners want cell phones blocked

The UPI reports:
SANTA MONICA, Calif., Dec. 17 (UPI) -- The National Association of Theater Owners wants the Federal Communications Commission to allow the blocking of cell phone signals in theaters.
John Fithian, the president of the trade organization, told the Los Angeles Times theater owners "have to block rude behavior" as the industry tries to come up with ways to bring people back to the cinemas.
Fithian said his group would petition the FCC for permission to block cell phone signals within movie theaters.
Some theaters already have no cell phone policies and ask moviegoers to check their phones at the door, Fithian said.
The Cellular Telecommunications and Internet Association -- a Washington-based cell phone lobby that is also known as CTIA-the Wireless Association -- said it would fight any move to block cell phone signals.
"We're opposed to the use of any blocking technology, because it interferes with people's ability to use a wireless device in an emergency situation," CTIA spokesman Joseph Farren told the Times.

As a physician who does a combination of private practice, clinical research, and state hospital hospital work, I am on 24 hour/7 day a week call. This is very light call, and on most days I am not called at all. However, I need to be available pretty much all of the time. A policy such as the one the National Association of Theatre Owners proposes would make it more difficult for a physician in my position to lead a normal life.

Saturday, December 10, 2005

Get a Life

A man obsessed with Paris Hilton has created a holiday shrine to her:
See Paris Hilton in all her seductive splendor, striking a provocative pose for passing motorists and spreading hot Christmas cheer in a chilly Rhode Island winter.
Blown-up images of Hilton and strings of pink Christmas lights adorn the front lawn of a home in a middle-class neighborhood of this city, part of a head-turning holiday display that pays homage to the famed hotel heiress.
The over-the-top pictorial is the work of Joe Moretti, a 38-year-old designer who was arrested last year for trespassing on Martha Stewart's property in Maine.

From Dell News, via Snopes

Richard Pryor dies

Richard Pryor, the caustic yet perceptive actor-comedian who lived dangerously close to the edge both on stage and off, died Saturday. He was 65.
Pryor died shortly before 8 a.m. of a heart attack after being taken to a hospital from his home in the San Fernando Valley, said his business manager, Karen Finch. He had been ill for years with multiple sclerosis, a degenerative disease of the nervous system.

From the New York Times

Sunday, November 27, 2005

A Simple Solution to the Transplant Organ Shortage

thousands of people die each year awaiting organs for transplant. This organ shortage would be better addressed if ....organs of the deceased were routinely used, excluding only those from people who explicitly refuse to be donors, in contrast to the current system that requires donors to actively enlist.
From The Ethicist, New York Times

Sunday, November 20, 2005

A Disturbing Report about Abilify (Aripiprazole)

A recent study found that Abilify reduced symptoms such as aggression, hyperactivity, and impulsivity in 56% of 32 children with developmental disabilities.
Unfortunately weight gain occurred in all the children during the course of the study, and three discontinued the medication because of weight gain. The mean body mass index increased from 22.5 to 24.1 kg/m2 during the follow-up period.
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This is the first report I have seen about Abilify causing weight gain. Abilify, along with Geodon, was supposed to be a weight-neutral antipsychotic. I find this study especially concerning because a large part of my practice is treating the devolpmentally disabled, the population treated in this study.

Tuesday, October 25, 2005

An Update on What I've Been Doing

Sorry about the lack of posts recently. I have been pretty busy. I left the U of MS on October 3rd. I started working at East Mississippi State Hospital ( 3 days a week) on October 4th. It's over 90 miles between my house in Jackson, MS and East Mississippi State Hospital in Meridian, MS. My new sleep clinic opens up November 1st. I still go to Boswell Regional Center several times per month.

Thursday, September 15, 2005

Malpractice Insurers Faulted

From the September 2005 issue of Cortlandt Forum
The nation’s 15 largest malpractice insurance carriers took in three times as much in premiums last year as they paid out in claims. And over the past five years, their premiums have doubled while their payouts have remained flat, according to a newly released study.
“Doctors have been overcharged for several years,” said Jay Angoff, a former Missouri insurance commissioner who conducted the study, which was based on the insurance companies’ own data. “The numbers underscore the need for tougher oversight to prevent profiteering,” adds Richard Blumenthal, Connecticut attorney general, who joined Angoff at the New York City press conference where the study was presented.
Angoff contrasted his data with those used by insurance companies to justify rate increases or lobby for caps on malpractice awards. “Their figures are largely estimated or are unverifiable or both. They’ve been off by up to 40%,” he said. Angoff’s data come from either the companies’ annual reports or filings with state authorities — “figures that haven’t been comprehensively analyzed before,” Angoff says. The companies include AIG, HCI, The Doctors Company, American Physicians Capital, GE Medical Protective, and Continental Casualty.
Angoff found that several insurers increased their premiums even though their claims payments actually fell, in some cases substantially. ProNational and Medical Assurance, both affiliates of the ProAssurance Corporation, as well as the AIG affiliate Lexington Insurance, were among the worst offenders. Medical Assurance, for example, increased its premiums 89% in 2004 even though its payments decreased by a third. The company paid out only 10 cents in claims for each premium dollar collected. ProNational paid out 13 cents and Lexington 14 cents.
“Perhaps most striking,” said Angoff, “in 2004, these 15 insurers increased their earned premium by 9.3%, even though the amount they estimated they would pay out in the future declined by 21.1%.”
The 25-page study, Falling Claims and Rising Premiums in the Medical Malpractice Insurance Industry, is available from the Center for Justice & Democracy in New York City (
www.centerjd/ANGOFFReport.pdf. Accessed August 15, 2005).

Friday, September 02, 2005

Mississippi Psychiatric Association Katrina site

Mississippi psychiatrists needed. See this new blog:
http://mpakatrina.blogspot.com/

Quest for Gas (part 2)

For those 2-3 people out there who are curious, I was able to get a rental car today at the Jackson MS airport with a full tank of gas (call ahead if you are thinking of doing this, most of the agencies are out of cars and gas, and many cars have been reserved by FEMA).
Still no electricity.

APA backs same-sex civil marriages

From Psychiatric News:
The APA Board of Trustees took a historic step at its July meeting when it made APA the first medical specialty society to support legal recognition of same-sex civil marriage.
Such a position statement had been endorsed by the Assembly at its May meeting in Atlanta (Psychiatric News, June 17). It expands APA's existing position in support of same-sex civil unions and emphasizes the mental health consequences of denying same-sex couples the same legal rights as their heterosexual counterparts. The legal rights to which these couples do not have access can include visiting an ill partner in the hospital, making health care decisions for a disabled partner, financial and retirement planning to prepare for emergencies or a financially secure future, and, in the case of parents, being able to raise a child when the biological parent is unable.
The statement, which applies to civil and not religious marriage, notes that same-sex couples "experience several kinds of state-sanctioned discrimination that can adversely affect the stability of their relationships and their mental health." It also points out that "there is ample evidence that long-term spousal and family support enhances physical and mental health at all stages of development."

I'll leave it for others to comment on this as I don't want to jeopardize my current job or my 2 future jobs.

Thursday, September 01, 2005

Legendary jazz musicians missing

Fox News reports that several notable New Orleans musicians, including "Fats" Domino, are missing.

The Quest for Gas (Jackson, Mississippi)

This morning I got into a line for gasoline that was almost a quarter of a mile long. After going about 30 yards in 30 minutes, I left.
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Most of the pumps have electricity now, the problem is a fuel shortage. Most of the gas stations in the Jackson area are out of gas. I heard that there is gas in Canton (about 20-30 miles north of Jackson), but I only have enough gas in the tank to drive 10-15 miles.
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Earlier today, I thought that the easiest way to get gas might be to get a rental car with a full tank. I reserved a rental car at the local airport on-line, and even arranged a ride from a resident to pick it up tomorow morning. However, it turns out that the car rental companies are out of gas too.
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Little work is being done today at the hospital. Everyone (including myself) is obsessed with electricity, gas, and ice. Some areas are starting to get electricity (not me), but the gas situation is not expected to get better until after the Labor Day holiday.

Wednesday, August 31, 2005

Mississippi has become a 3rd World Nation

In the aftermath of Katrina, most of Jackson, the capital of Mississippi, remains without power- see this article. Some of the gas stations have gas; some have the power necessary to run the pumps; only a few have both. As described here, lines at the few open gas stations are long. As bad as things are in the capital, it is even worse in outlying areas. Some rural areas in central Mississippi will not get electric power back for several months. As I have mentioned in previous posts, if a Mississippian is lucky enough to find an open store or gas station, he better have cash. Credit cards are not usually accepted- see here.
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I feel bad about whining as plenty of people have it worse than me, especially those living to the south of me. But with the destroyed infrastructure, it is becoming increasingly difficult to function as a physician. With the power out, I have no way of doing laundry at home. Today, for the first time, I wore a t-shirt to work instead of a shirt with a collar. I guess I could ask a resident where they keep the scrubs. I run out of underwear and socks on Friday- at that point I will need to wash them in a bucket. Another option is sneaking my laundry into the hospital and using the washer on the psych ward.
I am on call (psychiatry attending call) Thursday. Since phone service is out, I will have to spend the night in the hospital to answer the pages (I am one of the few physicians in the country without a cell phone)
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I have decided that tomorrow (Thursday) I will leave the hospital in the early afternoon to get gas. For anyone that is interested, I will post my adventure tomorrow night.
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That's it for now. Sorry about the whining. Thanks to Dr. Parker for the plug. Read about the situation in Alabama here. Donate to the American Sleep Medicine Foundation Hurricane Disaster Relief Fund here.

Mississippi Katrina Update

It's a sunny, warm day here in Jackson, MS. The power is still out in most residential areas. Some gas stations are open, but lines are an hour long and it's cash only. ATM machines are down but most banks are reportedly open. My wife is planning to walk to AmSouth bank later on today to get money. I hope power comes back soon, I am running out of things to wear. Large fallen trees still block most of the streets that lead to my house.
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The situation is much worse in southern Mississippi, Louisiana, and Alabama as described in this report. Good luck to those of you living on the Gulfcoast.

Tuesday, August 30, 2005

Katrina Report from Ground Zero

Power began to fail at noon yesterday in central Mississippi, and pretty much went out for good at 6pm. Today (tuesday) power is still out in most parts of central Mississippi, though as of noon today a few gas stations and large grocery stores in Jackson had power.
Trees are down all over my neighborhood.
At least 80 people are dead in Mississippi, most in southern parts of the state.
Interstate 20, running east-West between Jackson and Meridian, is basically clear- but make sure you have gas before starting the trip as none of the surrounding gas stations have power.
Here is a report of the condition in Hattiesburg, which is 90 miles south of Jackson, MS.
The University of Mississippi Medical Center is fully operational for clinical care, but nonessential personnel will not return until tomorrow.

Friday, August 26, 2005

Jet Lag

ATLANTA—Already hard hit by labor strife and escalating fuel costs, the commercial airline industry faces a new crisis: an epidemic of jet lag caused by a powerful strain that is highly resistant to regular remedies like catnaps.
Airlines have set up napping-triage centers in major airports in response to the "Super Lag," but are unable to keep up with the rising tide of severely weary passengers, who number in the thousands nationwide.
"Infected travelers are really tired out, whether they're on long international flights or domestic flights as short as an hour and a half," said Delta Airlines ticket agent Olivia Gage at Atlanta International Airport, which has seen some of the most advanced cases of Super Lag. "Our supplies of thin blankets and miniature pillows are running dangerously low."
FEMA, the Federal Exhaustion Management Association, has shipped army-surplus cots and urns of hot coffee to several major hubs, but airlines continue to report record dozings. Minneapolis resident Belinda Haynes, 26, is just one of tens of thousands of Americans whose travel plans are affected.
"I'm going to go to Tampa Bay and be asleep through most of my flight," Haynes said. "That means I'm at risk for catching Super Lag and being totally tired all through my sister's whole wedding."
At the Atlanta airport Tuesday afternoon, an estimated 900 Super Lag sufferers could be seen stretched across the molded seats of gate waiting areas. The infected travelers, distinguishable by their testy demeanors and heavy eyelids, argued with ticket agents, slumped listlessly in their seats, and stared blankly at Au Bon Pain pastry displays.
Untreated victims can find themselves sleeping for hours on a plane, then sleeping soundly at night, yet still performing poorly in important business meetings or feeling too fatigued to enjoy their vacations.
Dr. Robert Sanders is one of hundreds of volunteer physicians treating Super Lag sufferers at airports nationwide.
"Jet lag was first documented in the late '50s," Sanders said. "Over the years, we've developed band-aid solutions to combat the disorder—neck pillows, laptops, in-flight movies—but it was really only a matter of time before jet lag mutated into a more virulent strain."
Despite volunteer efforts, the burden of treating Super Lag sufferers has fallen largely on flight attendants who, with little training in this area, are reporting great difficulties.
"One passenger who sleeps through the beverage service and wakes up irritated and thirsty is bad," said Midwest Airlines flight attendant Sandy Wolchek. "You multiply that by five on a Milwaukee-to-Minneapolis flight, and you're talking about a serious disruption."
Prolonged rest is the only known remedy for Super Lag, according to Bill Ziegler of the Centers For Fatigue Control. "Victims can also alleviate their symptoms by wadding jackets or sweaters into makeshift pillows," he said. "And we're recommending that airlines loosen their restriction on reclining cabin seats during the ascent and descent phases of flights."
Scientists at the CFC are working around the clock to find a Super Lag cure, but so far, they have made little progress. For now, they recommend that air-travel passengers look out for Super Lag's warning signs: irritability, an unwillingness to engage in small talk with persons in adjoining seats, and a tendency to doze off while reading in-flight magazines.

From The Onion

Monday, August 22, 2005

Weight Loss Secrets

PURCHASE, NY—Joining a field already crowded with such non-caloric beverages as Coke Steam and Hollo Yello, PepsiCo announced the creation Monday of Pepsi Negative-220, a diet cola that burns twice the calories it contains. "You'll love PN-220 for the super-slimming rush of thyrotropin, PC1 enzymes, and that zesty hint of lemony leptin that zaps away fat, muscle tissue, and some nerve sheathing," PepsiCo spokesperson Ned Caen said. "But you'll drink it for that refreshing cola taste." Despite an FDA label warning of potential cardiac arrhythmia, renal shutdown, intestinal necrosis, and spontaneous erosion of the meninges, plans are underway to debut Pepsi Negative-220 in early October. "For radical and uncompromising weight loss, it's the cola," Caen said.
From The Onion