Long term use of antidepressants is associated with an increased risk of Diabetes Mellitus.
This is especially true of 2 antidepressants likely to cause weight gain, Paxil (paroxetine) and Elavil (amitryptiline).
No need to take immediate action:
Dr. Andersohn stressed that because the risk for diabetes develops slowly, doctors should not take immediate action in treating individual patients. "Abrupt withdrawal of antidepressants might cause unintended effects."
Friday, April 10, 2009
Sunday, March 15, 2009
Legal Male Prostitution in San Francisco
The New York Times reports today on a commune, "One Taste," in San Francisco in which female members are manually stimulated by men:
At 7 a.m. each day, as the rest of America is eating Cheerios or trying to face gridlock without hyperventilating, about a dozen women, naked from the waist down, lie with eyes closed in a velvet-curtained room, while clothed men huddle over them, stroking them in a ritual known as orgasmic meditation
How is this legal? Female members of the commune don't pay directly for the sexual activity, instead they pay for the "course":
She resisted offers to pursue further courses (for a fee), deleting the center’s incessant e-mail messages. But on the cusp of her 29th birthday, she tentatively returned. “I was scared to open up my life that much, but I was more scared not to,” she said.
Now an instructor herself, Ms. Crittenden talks about “the lingering velocity of my desire and my hesitation to give into it.”
In my opinion, California authorities should shut down this commune. They should treat it in the same manner they would a "massage parlor" that offers erotic activities (of course, I have nothing against legitimate massage therapists).
At 7 a.m. each day, as the rest of America is eating Cheerios or trying to face gridlock without hyperventilating, about a dozen women, naked from the waist down, lie with eyes closed in a velvet-curtained room, while clothed men huddle over them, stroking them in a ritual known as orgasmic meditation
How is this legal? Female members of the commune don't pay directly for the sexual activity, instead they pay for the "course":
She resisted offers to pursue further courses (for a fee), deleting the center’s incessant e-mail messages. But on the cusp of her 29th birthday, she tentatively returned. “I was scared to open up my life that much, but I was more scared not to,” she said.
Now an instructor herself, Ms. Crittenden talks about “the lingering velocity of my desire and my hesitation to give into it.”
In my opinion, California authorities should shut down this commune. They should treat it in the same manner they would a "massage parlor" that offers erotic activities (of course, I have nothing against legitimate massage therapists).
Organic Psychosis
The NY Times Sunday Magazine presents an interesting case of psychosis due to a combination of Concerta (long-acting ritalin) and pheochromacytoma:
http://www.nytimes.com/2009/03/15/magazine/15wwln-diagnosis-t.html?ref=magazine
http://www.nytimes.com/2009/03/15/magazine/15wwln-diagnosis-t.html?ref=magazine
Wednesday, March 11, 2009
Why I am not Depressed
I eat a lot of salt:
A study at the University of Iowa found that rats that were deficient in salt did not participate in activities they normally enjoy -- one of the hallmarks of depression. Salt's mood-altering effect may explain why many people consume too much of it even when they know it's unhealthy -- almost like an addictive drug, researchers said.
A study at the University of Iowa found that rats that were deficient in salt did not participate in activities they normally enjoy -- one of the hallmarks of depression. Salt's mood-altering effect may explain why many people consume too much of it even when they know it's unhealthy -- almost like an addictive drug, researchers said.
Sunday, March 08, 2009
Bad-Beat Stories
Apparently there's an art to writing about these losing poker hands:
Granting, then, that the primary goal of a bad-beat story is to get something off your chest, there are narrative strategies you can employ to make sure other posters don’t yawn you off a board. To win sympathy and kudos, according to at least one bad-beat narratologist, you have only to make clear how focused and intelligent you were, how high the stakes, how slim your odds of losing, how vile your opponent was and how well you command the idiom of your game
Granting, then, that the primary goal of a bad-beat story is to get something off your chest, there are narrative strategies you can employ to make sure other posters don’t yawn you off a board. To win sympathy and kudos, according to at least one bad-beat narratologist, you have only to make clear how focused and intelligent you were, how high the stakes, how slim your odds of losing, how vile your opponent was and how well you command the idiom of your game
Who Stole our Country?
Every wonder who got the hundreds of billions of dollars (180 billion at lost count) that Bush and Obama gave to AIG?
It turns out that much of the money is going to foreigners (though exactly who is getting how much money hasn't been released):
some of the banks paid by AIG since the insurer started getting taxpayer funds were: Goldman Sachs Group Inc, Deutsche Bank AG, Merrill Lynch, Societe Generale, Calyon, Barclays Plc, Rabobank, Danske, HSBC, Royal Bank of Scotland, Banco Santander, Morgan Stanley, Wachovia, Bank of America, and Lloyds Banking Group.
"That's why we could not allow AIG to fail as we allowed Lehman to fail, because that would have precipitated the failure of the European banking system," said Kanjorski, a Democrat from Pennsylvania who chairs the House Insurance Subcommittee.
U.S. lawmakers have said they are running out of patience with regulators' refusal to identify AIG's counterparties.
On Thursday, Richard Shelby, the top Republican on the banking committee, said: "The Fed and Treasury can be secretive for a while but not forever."
It turns out that much of the money is going to foreigners (though exactly who is getting how much money hasn't been released):
some of the banks paid by AIG since the insurer started getting taxpayer funds were: Goldman Sachs Group Inc, Deutsche Bank AG, Merrill Lynch, Societe Generale, Calyon, Barclays Plc, Rabobank, Danske, HSBC, Royal Bank of Scotland, Banco Santander, Morgan Stanley, Wachovia, Bank of America, and Lloyds Banking Group.
"That's why we could not allow AIG to fail as we allowed Lehman to fail, because that would have precipitated the failure of the European banking system," said Kanjorski, a Democrat from Pennsylvania who chairs the House Insurance Subcommittee.
U.S. lawmakers have said they are running out of patience with regulators' refusal to identify AIG's counterparties.
On Thursday, Richard Shelby, the top Republican on the banking committee, said: "The Fed and Treasury can be secretive for a while but not forever."
Politics at Mississippi's State Psychiatric Hospital
The Clarion-Ledger, Mississippi's main newspaper, reports today on a courageous psychiatrist, Dr. Stept, who allegedly was forced from his job at Mississippi State Hospital at Whitfield for refusing to discharge dangerous patients:
In a quest to reduce long-term beds, state mental health officials are releasing some psychotic and potentially violent patients, says a psychiatrist who was transferred after he said he refused to follow those plans.
"I was asked to discharge patients I thought should not be discharged.
"I felt they were too psychotic."
In fact, some of these patients had "killed people in psychotic states," he said.
The psychiatrist said he refused to discharge a patient in 2007 for medical reasons, telling Whitfield officials if they wanted the patient discharged, the clinical director would have to sign the papers.
Days after this, Stept said he was told he was being transferred to another building.
Not long after this, Whitfield officials threatened to bring him before the peer review committee without telling him why, he said. "When I called and said I was retiring, the process of bringing me before a peer review committee was dropped."
I worked at Whitfield from mid-2006 to mid-2007. I was part-time and wasn't aware any of this was going on. I don't know Dr. Stept.
In a quest to reduce long-term beds, state mental health officials are releasing some psychotic and potentially violent patients, says a psychiatrist who was transferred after he said he refused to follow those plans.
"I was asked to discharge patients I thought should not be discharged.
"I felt they were too psychotic."
In fact, some of these patients had "killed people in psychotic states," he said.
The psychiatrist said he refused to discharge a patient in 2007 for medical reasons, telling Whitfield officials if they wanted the patient discharged, the clinical director would have to sign the papers.
Days after this, Stept said he was told he was being transferred to another building.
Not long after this, Whitfield officials threatened to bring him before the peer review committee without telling him why, he said. "When I called and said I was retiring, the process of bringing me before a peer review committee was dropped."
I worked at Whitfield from mid-2006 to mid-2007. I was part-time and wasn't aware any of this was going on. I don't know Dr. Stept.
Friday, February 27, 2009
The Obama Panic
Dick Morris, on Obama:
The crash of the stock market in the days since he took power (indeed, from the moment he won the election) can increasingly be attributed to his own failure to lead us in the right direction, his failed policies in addressing the recession and his own spreading of panic and fear. The market collapse makes it evident that it is Obama who is the problem....
The crash of the stock market in the days since he took power (indeed, from the moment he won the election) can increasingly be attributed to his own failure to lead us in the right direction, his failed policies in addressing the recession and his own spreading of panic and fear. The market collapse makes it evident that it is Obama who is the problem....
Monday, February 16, 2009
We're Screwed
Senator Graham (R, South Carolina) on the Stimulus Bill:
"If I may say, if this is going to be bipartisanship, the country's screwed"
"If I may say, if this is going to be bipartisanship, the country's screwed"
Saturday, February 14, 2009
The Man Who Sold the World
As the Obama administration pushes through Congress its $800 billion deficit-spending economic stimulus plan, the American public is largely unaware that the true deficit of the federal government already is measured in trillions of dollars, and in fact its $65.5 trillion in total obligations exceeds the gross domestic product of the world.
Monday, February 09, 2009
The 9.7 Trillion Dollar Bailout
A trillion here, and a trillion there, and soon you're talking about real money.
http://www.bloomberg.com/apps/news?pid=washingtonstory&sid=aGq2B3XeGKok
http://www.bloomberg.com/apps/news?pid=washingtonstory&sid=aGq2B3XeGKok
Monday, January 19, 2009
Another Senate Seat for Sale
Rumor has it that New York Governor Paterson will give Hillary's Senate seat to Caroline Kennedy in exchange for a job:
US Rep. Carolyn Maloney of Manhattan, a would-be Clinton replacement who is backed by several women's organizations, was the most publicly adamant in saying the fix was in, citing a scenario - first outlined in last week's Village Voice - under which Paterson, in a deal with Mayor Bloomberg, a Kennedy friend, selects Kennedy in exchange for help for his own election bid next year.
US Rep. Carolyn Maloney of Manhattan, a would-be Clinton replacement who is backed by several women's organizations, was the most publicly adamant in saying the fix was in, citing a scenario - first outlined in last week's Village Voice - under which Paterson, in a deal with Mayor Bloomberg, a Kennedy friend, selects Kennedy in exchange for help for his own election bid next year.
Sunday, January 11, 2009
The Ice Age is Coming
The Russians think Al Gore was wrong about Global Warming:
The data from paleoclimatology, including ice cores, sea sediments, geology, paleobotany and zoology, indicate that we are on the verge of entering another Ice Age, and the data also shows that severe and lasting climate change can occur within only a few years. While concern over the dubious threat of Anthropogenic Global Warming continues to distract the attention of people throughout the world, the very real threat of the approaching and inevitable Ice Age, which will render large parts of the Northern Hemisphere uninhabitable, is being foolishly ignored.
The data from paleoclimatology, including ice cores, sea sediments, geology, paleobotany and zoology, indicate that we are on the verge of entering another Ice Age, and the data also shows that severe and lasting climate change can occur within only a few years. While concern over the dubious threat of Anthropogenic Global Warming continues to distract the attention of people throughout the world, the very real threat of the approaching and inevitable Ice Age, which will render large parts of the Northern Hemisphere uninhabitable, is being foolishly ignored.
Saturday, January 10, 2009
Obesity Continues to Increase
Numbers posted by the National Center for Health Statistics show that more than 34 percent of Americans are obese, compared to 32.7 percent who are overweight. It said just under 6 percent are "extremely" obese.
For the first time, obesity is more common than being merely overweight.
http://www.reuters.com/article/domesticNews/idUSTRE50863H20090109?feedType=RSS&feedName=domesticNews
For the first time, obesity is more common than being merely overweight.
http://www.reuters.com/article/domesticNews/idUSTRE50863H20090109?feedType=RSS&feedName=domesticNews
Friday, January 09, 2009
Funding Retirement, Building Wealth
Many, but not all, doctors make high incomes. Most doctors are not wealthy. This blog post at Liberated Doc discusses why having successful medical practice often does not translate into the conversion of income to wealth:
the limited or complete lack of equity that physicians have an opportunity to build is a major shortcoming of clinical practice....
The money left after direct expenses are paid and that is left for the partners is equal to what it would cost to hire other doctors to do the work in place of the partners. In other words, the partners often don’t make much more than if they were just receiving a salary as an employee.
The days when doctors could hope to fund retirement by selling a medical practice are long over.
Personally, I'm hoping that my investment in junk bonds (within retirement accounts, primarily a Vanguard SIMPLE IRA) will pay off. I started gradually investing in high yield bond funds in Mid-December and have done well so far. I have sold a portion of my holdings over the last several days and now plan to monitor market conditions for a few days before deciding whether to stay in junk bonds or switch back into a money market fund.
the limited or complete lack of equity that physicians have an opportunity to build is a major shortcoming of clinical practice....
The money left after direct expenses are paid and that is left for the partners is equal to what it would cost to hire other doctors to do the work in place of the partners. In other words, the partners often don’t make much more than if they were just receiving a salary as an employee.
The days when doctors could hope to fund retirement by selling a medical practice are long over.
Personally, I'm hoping that my investment in junk bonds (within retirement accounts, primarily a Vanguard SIMPLE IRA) will pay off. I started gradually investing in high yield bond funds in Mid-December and have done well so far. I have sold a portion of my holdings over the last several days and now plan to monitor market conditions for a few days before deciding whether to stay in junk bonds or switch back into a money market fund.
Autoenucleation
And if thy eye scandalize thee, pluck it out, and cast it from thee. It is better for thee having one eye to enter into life, than having two eyes to be cast into hell fire.
Matthew 18:9.
AOL news reports :
A Texas death row inmate with a history of mental problems pulled out his only good eye and told authorities he ate it.
Matthew 18:9 is occasionally misinterpreted by those with schizophrenia and other psychotic illnesses, with drastic resuls. The AOL article doesn't mention any citation of this Bible verse by Andre Thomas, the Texas inmate. Perhaps Matthew 18:9 was not involved in this instance, as ingesting the eye goes against the phrase "and cast it from thee."
Matthew 18:9.
AOL news reports :
A Texas death row inmate with a history of mental problems pulled out his only good eye and told authorities he ate it.
Matthew 18:9 is occasionally misinterpreted by those with schizophrenia and other psychotic illnesses, with drastic resuls. The AOL article doesn't mention any citation of this Bible verse by Andre Thomas, the Texas inmate. Perhaps Matthew 18:9 was not involved in this instance, as ingesting the eye goes against the phrase "and cast it from thee."
Saturday, January 03, 2009
Abuse of Power by Democratic Senator Reid
CNN reports that Senate Democrats plan to block Roland Burris, Blagojevich's appointee to Obama's vacated Senate seat, from entering the Senate floor:
The aide familiar with Senate Democratic leaders' plans said if Burris tries to enter the Senate chamber, the Senate doorkeeper will stop Burris. If Burris were to persist, either trying to force his way onto the Senate floor or refusing to leave and causing a scene, U.S. Capitol Police would stop him, said the aide.
What right do Harry Reid and the rest of the Senate Democrats have to keep Burris from entering the Senate floor? The Constitution gives the Senate, not Reid or the Democrats, the right to determine its members. Until the 111th Congress formally meets, and until the Senate formally votes to deny Burris his seat in the Senate, Burris has as much right to enter the Senate floor as any other new member of the Senate.
It is an abuse of his power for Reid to use the Senate doorkeeper or the U.S. Capitol Police against Burris until a vote by the full Senate is taken to deny Burris his lawfully appointed seat.
EDIT (1/4/09): Reid and the Senate Democrats have softened their stance a little. It appears that if he has a valid certicate of appointment, he will be allowed on the Senate floor. This new stance seems valid to me. According to Fox news:
The certificate of appointment must bare the signatures of both the governor and the secretary of state. Secretary of State Jesse White who has refused to sign the document because of the allegations of corruption against the governor.
Should the Illinois Supreme Court force White to sign the document, a move Burris is seeking, Burris would be allowed on the Senate floor. Reid or some other Democrat would then have to object to Burris being seated and call up a resolution that would send his credentials to the Rules Committee pending an investigation.
EDIT (1/5/09): The Wall Street Journal published an editorial 1/3/09 stating that according to the Supreme Court's opinion in Powell v. McCormack (1969), the Senate must seat Burris but can then expel him with a 2/3 rds vote.
Assuming that Burris obtains certification by the Illinois secretary of state (which is a nodiscretionary duty and will probably be compelled by the Illinois state courts), the Senate must seat him and can then expel him if they wish.
The aide familiar with Senate Democratic leaders' plans said if Burris tries to enter the Senate chamber, the Senate doorkeeper will stop Burris. If Burris were to persist, either trying to force his way onto the Senate floor or refusing to leave and causing a scene, U.S. Capitol Police would stop him, said the aide.
What right do Harry Reid and the rest of the Senate Democrats have to keep Burris from entering the Senate floor? The Constitution gives the Senate, not Reid or the Democrats, the right to determine its members. Until the 111th Congress formally meets, and until the Senate formally votes to deny Burris his seat in the Senate, Burris has as much right to enter the Senate floor as any other new member of the Senate.
It is an abuse of his power for Reid to use the Senate doorkeeper or the U.S. Capitol Police against Burris until a vote by the full Senate is taken to deny Burris his lawfully appointed seat.
EDIT (1/4/09): Reid and the Senate Democrats have softened their stance a little. It appears that if he has a valid certicate of appointment, he will be allowed on the Senate floor. This new stance seems valid to me. According to Fox news:
The certificate of appointment must bare the signatures of both the governor and the secretary of state. Secretary of State Jesse White who has refused to sign the document because of the allegations of corruption against the governor.
Should the Illinois Supreme Court force White to sign the document, a move Burris is seeking, Burris would be allowed on the Senate floor. Reid or some other Democrat would then have to object to Burris being seated and call up a resolution that would send his credentials to the Rules Committee pending an investigation.
EDIT (1/5/09): The Wall Street Journal published an editorial 1/3/09 stating that according to the Supreme Court's opinion in Powell v. McCormack (1969), the Senate must seat Burris but can then expel him with a 2/3 rds vote.
Assuming that Burris obtains certification by the Illinois secretary of state (which is a nodiscretionary duty and will probably be compelled by the Illinois state courts), the Senate must seat him and can then expel him if they wish.
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?
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.
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.
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