Alternative Medicine has its Limits

March 29, 2006 Issue 42•13
PORTLAND, OR—Alternative-medicine practitioner Annabeth Severin, a Portland-area acupuncturist and holistic healer, announced Tuesday that she is refusing to accept anything but conventional monetary compensation from her patients. "I'm sorry, but there just isn't any sound economic theory to support the idea that bartering or visualization of payment has the same effect as traditional cash or check up front," Severin said. Her customers are protesting her billing methods, saying that removing money from their accounts would be financially invasive and spiritually upsetting to their karmic and bank balances.
From The Onion

A message from the MPA

HAPPY DOCTORS' DAY !

FROM THE

MISSISSIPPI PSYCHIATRIC

ASSOCIATION

Yet another lawsuit

Got this link in my email today:
http://www.orthoevra-legal-center.com/

OTC Allergy Meds

I saw this article about over-the-counter allergy meds via Kevin, MD:
Over-the-counter hay fever medication works just as well as much more expensive prescription medication for seasonal allergies, according to a new study.
The research, published in the Archives of Otolaryngology -- Head & Neck Surgery, is based on a small sample and focuses exclusively on two specific drugs: a 240-milligram dose of pseudoephedrine hydrochloride (sold over the counter under the brand name Sudafed 24 Hour) and a 10-mg dose of montelukast sodium (prescription brand name Singulair). "When we compared them head-to-head, we found that for treatment of allergic rhinitis, these drugs at these doses were virtually identical," said Dr. Fuad Baroody, associate professor of surgery at the University of Chicago and the study's director. "This came as a genuine surprise."
OTC allergy drugs work great and are often more effective than perscription meds. For example, Benadryl is more effective than some perscription antihistamines. Sudafed is also very effective. The problem is that many of the OTC allergy meds have a lot of side effects. Benadryl can cause constipation, urinary retention, and confusion. Sudafed can cause hypertension and heart arrhythmias. Many of the OTC's would be considered too dangerous even for perscription status if they were being submitted to the FDA today.

NASCAR is not a sport

RangelMD states:
Then Gumbel goes after ice-skating and I began to realize that he sounds just like any American jock who can't comprehend, let alone appreciate, any sport that doesn't begin with "foot" or "basket". Apparently Bryant thinks that the triple axel is no big deal and that sport isn't really sport without the brute force of a dunk or tackle. I'd love to hear what Bryant thinks of NASCAR; "Those guys get to sit down through the entire event!"
NASCAR is not a real sport. I am sure it helps to be in good physical shape to win a NASCAR race, but it also helps to be in good shape to be an orthopedic surgeon, and I don't see anyone calling them athletes. Poker is just as much a sport as NASCAR; they even show poker on ESPN now. I hope to be in the World Series of Poker one day.
I am not originally from the South, which explains why I am not into NASCAR.

AMA Advertising Campaign

Last week I criticized some of the American Medical Association's ads. Today Medical Economics offers an explanation of the ads:
The general behind it is Gary C. Epstein, the AMA's chief marketing officer. Before joining the AMA in 2004, Epstein worked to develop "brand-building solutions" for clients like Proctor & Gamble, Kraft Foods, and Pepsi. In his new role, he hopes to do much the same for the AMA.
One of his strategies is to reach out to doctors indirectly, through their patients. In a series of consumer ads that began running last summer, the AMA pays homage to the profession's "everyday heroes"—doctors across a variety of specialties who've touched peoples' lives in ways both large and small. Both the print and broadcast versions are powerful, tug-at-your-heart messages calculated to enhance public goodwill.
Gary C. Epstein should be fired. If the AMA wants to reach out to doctors, it should lower its membership fees. It's a waste of money and insulting for the AMA to try to reach out to doctors through our patients.

Drug Voucher Programs

Kevin, MD recently wrote about drug voucher programs. In these programs, drug addicts get vouchers that are exchangeable for consumer goods in return for clean urine samples. This study, from the Archives of General Psychiatry, found that Bupropion (Wellbutrin) combined with vouchers (contingency management) reduced cocaine use in opioid addicts maintained on methadone:
Six-Month Trial of Bupropion With Contingency Management for Cocaine Dependence in a Methadone-Maintained Population
James Poling, PhD; Alison Oliveto, PhD; Nancy Petry, PhD; Mehmet Sofuoglu, MD, PhD; Kishorchandra Gonsai, MD; Gerardo Gonzalez, MD; Bridget Martell, MD; Thomas R. Kosten, MD
Arch Gen Psychiatry. 2006;63:219-228.
Context No effective pharmacotherapies exist for cocaine dependence, although contingency management (CM) has demonstrated efficacy.
Objective To compare the efficacy of bupropion hydrochloride and CM for reducing cocaine use in methadone hydrochloride–maintained individuals.
Design This 25-week, placebo-controlled, double-blind trial randomly assigned participants to 1 of 4 treatment conditions: CM and placebo (CMP), CM and 300 mg/d of bupropion hydrochloride (CMB), voucher control and placebo (VCP), or voucher control and bupropion (VCB).
Setting Outpatient clinic at the Veterans Affairs Connecticut Healthcare System.
Participants A total of 106 opiate-dependent, cocaine-abusing individuals.
Interventions All study participants received methadone hydrochloride (range, 60-120 mg). Participants receiving bupropion hydrochloride were given 300 mg/d beginning at week 3. In the CM conditions, each urine sample negative for both opioids and cocaine resulted in a monetary-based voucher that increased for consecutively drug-free urine samples during weeks 1 to 13. Completion of abstinence-related activities also resulted in a voucher. During weeks 14 to 25, only completion of activities was reinforced in the CM group, regardless of sample results. The voucher control groups received vouchers for submitting urine samples, regardless of results, throughout the study.
Main Outcome Measure Thrice-weekly urine toxicologic test results for cocaine and heroin.
Results Groups did not differ in baseline characteristics or retention rates. Opiate use decreased significantly, with all treatment groups attaining equivalent amounts of opiate use at the end of the study. In the CMB group, the proportion of cocaine-positive samples significantly decreased during weeks 3 to 13 (P<.001) relative to week 3 and remained low during weeks 14 to 25. In the CMP group, cocaine use significantly increased during weeks 3 to 13 (P<.001) relative to week 3, but then cocaine use significantly decreased relative to the initial slope during weeks 14 to 25 (P<.001). In contrast, by treatment end, the VCB and VCP groups showed no significant improvement in cocaine use.
Conclusion These findings suggest that combining CM with bupropion for the treatment of cocaine addiction may significantly improve outcomes relative to bupropion alone.
Author Affiliations: Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven (Drs Poling, Sofuoglu, Gonsai, Gonzalez, Martell, and Kosten); University of Arkansas for Medical Sciences, Little Rock (Dr Oliveto); and University of Connecticut School of Medicine, Farmington (Dr Petry).
RELATED ARTICLES
This Month in Archives of General PsychiatryArch Gen Psychiatry. 2006;63:124.

Psychotic Break

This picture is from the article that is causing such a controversy in Shrinkette (Feb 10) and other blogs. Unfortunately the online article does not give any information about the artist.
Schizophrenia frequently permanently transforms a person. You can usually get rid of the hallucinations and delusions with medications, but negative symptoms often persist and cognitive decline sometimes occurs.

It's diplomate, not diplomat

dip·lo·mate Pronunciation: 'dip-l&-"mAt Function: noun: one who holds a diploma; especially : a physician qualified to practice in a medical specialty by advanced training and experience in the specialty followed by passing an intensive examination by a national board of senior specialists
---
dip·lo·mat ( P ) Pronunciation Key (dpl-mt)n.
One, such as an ambassador, who has been appointed to represent a government in its relations with other governments.
One who uses skill and tact in dealing with others.
One of my pet peeves is when a physician mistakenly calls himself a "diplomat", as in diplomat of the American Board of Internal Medicine. It's "Diplomate." I see this mistake all the time on letterheads and cv's.

No Need to Thank Me

I saw an ad by the American Medical Association in Time magazine that said:
"...when was the last time you let your doctors know how much you appreciate all they do for you...we have created some thank you cards that you can download..."
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This makes me embarassed to be a member of the AMA, which I recently joined because it was required for a local insurance network. The AMA should not be asking patients to thank its members. A physician advocacy organization should not be going around begging patients to thank them.

Should you do Your Own Taxes

Medical Economics has an article this issue that discusses whether a doctor should do his own taxes:
The answer: It depends. Certain financial situations are sufficiently complicated that you really need an accountant's expertise. And, in many cases, the hours spent doing your own taxes could be more profitably spent seeing patients.
A doctor (post-residency) who would do his own taxes and not even have an accoutant look at the tax form before sending it in is, in my opinion, being very foolish.

Sorry

Sorry I haven't blogged much recently, I have been playing online poker. If you want to take me on, you can find me in the low-limit Texas Hold'em rooms, my screen name is michaelrack. I'll blog more after I overcome my gambling addiction. In the meantime, check out this blog by a fellow Mississippi physician blogger:
http://www.drhebert.squarespace.com/

Muslim Cartoons

Here is a link to the controversial Muhammad cartoons, so you can check them out for yourself:
http://www.brusselsjournal.com/node/698

hikikomori

One morning when he was 15, Takeshi shut the door to his bedroom, and for the next four years he did not come out. He didn't go to school. He didn't have a job. He didn't have friends. Month after month, he spent 23 hours a day in a room no bigger than a king-size mattress, where he ate dumplings, rice and other leftovers that his mother had cooked, watched TV game shows and listened to Radiohead and Nirvana.
He ...suffered from a problem known in Japan as hikikomori, which translates as "withdrawal" and refers to a person sequestered in his room for six months or longer with no social life beyond his home. (The word is a noun that describes both the problem and the person suffering from it and is also an adjective, like "alcoholic.") Some hikikomori do occasionally emerge from their rooms for meals with their parents, late-night runs to convenience stores or, in Takeshi's case, once-a-month trips to buy CD's. And though female hikikomori exist and may be undercounted, experts estimate that about 80 percent of the hikikomori are male, some as young as 13 or 14 and some who live in their rooms for 15 years or more.
South Korea and Taiwan have reported a scattering of hikikomori, and isolated cases may have always existed in Japan. But only in the last decade and only in Japan has hikikomori become a social phenomenon. Like anorexia, which has been largely limited to Western cultures, hikikomori is a culturebound syndrome that thrives in one particular country during a particular moment in its history.
Any urge a hikikomori might have to venture into the world to have a romantic relationship or sex, for instance, is overridden by his self-loathing and the need to shut his door so that his failures, real or perceived, will be cloaked from the world.
...Otherwise, the only evidence that this was a hikikomori's room were three holes in the wall - the size of fists. Shut-ins often describe punching their walls in a fit of anger or frustration at their parents or at their own lives. The holes were suggestive too of the practice of "cutting" among American adolescent girls. Both acts seemed to be attempts to infuse feeling into a numb life.

Birth Control Pills Decrease Sex Drive

Some studies have indicated that the pill can decrease the frequency of some women's sexual thoughts, make becoming aroused more difficult, or decrease lubrication, making sex painful.
Now a controversial new study suggests that the pill not only suppresses desire, but can also do so for months after a woman stops taking it, by raising levels of a certain protein. "When they stopped taking the pill, we fully expected their sexual function to recover," said Dr. Goldstein, a urologist in Boston. "But we weren't seeing that." Dr. Bancroft's research indicates that at least one user of oral contraceptives in four has sexual side effects. The effects on sexual function may stem from the effects of the pill on testosterone, which is thought to help drive women's sexual desire. Oral contraceptives block testosterone production in the ovaries and increase the production in the liver of sex hormone binding globulin, a protein that attaches to much of the free testosterone in the blood, rendering it inactive.

If I ever develop a drug problem...

...here is where I want to go for treatment.
-
got spam about this place this am

Cold and Flu Prevention Tips

Cold And Flu Prevention Tips
Sneezing into a handkerchief just redirects germs back at you. Always sneeze outward so as to shoot germs as far across the room as possible.
Pack your sinus cavities with Vicks Vap-O-Rub to fully mentholate your respiratory system.
Do not blow your stuffed nose into tissues—this is a myth! Always suck your phlegm into the back of your throat and swallow it in great, goblike mouthfuls.
You don't have to subject yourself to other people's germs. If you see someone who appears to have a cold or fever, contact your local police department.
To prevent infections, have sick people cough into your food. This light "inoculative" dose of germs will boost your body's defenses against a full-blown infection later.
If you are a sickly, anemic, weak person, you have a higher susceptibility to colds and flu. Try not to be such a pansy-ass.
Sometimes, a severe respiratory infection will cause the lungs to fill with fluid. If this occurs, flush your lungs repeatedly with boiling hot water to clear them. A hose down your windpipe will help get around the gag reflex.
Make sure your HMO package covers visits to the Halls Of Medicine.
The flu is an extremely contagious, life-threatening disease. Flu sufferers should be either shot with a silver bullet or tortured to death by a professionally shriven, church-appointed excruciator.
To keep warm in the winter, replace your blood with mom's homemade chicken soup. Noodles should be no greater than one millimeter thick to prevent coronary blockage.
Remember: Your body produces phlegm for a reason. Always save your mucous, and keep it near you in jars at all times.
Germs generally enter the body through the skin. To protect you from infection, shave yours off.
Zinc and Vitamin C help fight colds. Vitamin C can be found in oranges, but zinc is a semi-precious metal found only in Africa. If symptoms persist, organize a jungle safari to seek out the fabled Zinc Mines of Sugolahara.

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.

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)

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.