Social Activists vs. Ben and Jerry's?

I agree with Peta that there is scant evidence that consuming cow's milk is necessary to sustain a healthy life-style (so long as you get your calcium elsewhere).

However, the Peta folks are off their rockers if they believe that human strangers' milk is a "safer" alternative to bovine strangers' milk, and ought to be used in Ben and Jerry's Ice Cream. BSE notwithstanding, humans are immune to most pathogens (as in Johnes Disease, Bovine Enzootic Leucosis, Bovine Virus Diarrhea) that primarily use farm animals as hosts. No matter how much we try to emphasize our differences between one another, humans have very similar immune systems. Therefore, we are much more susceptible to catching anthroponotic, rather than zoonotic infections (While HIV can be transmitted to nursing newborns, it is somewhat, but not definitively, unlikely to be transmitted through drinking human milk that has already been collected).
Additionally, for bovine diseases that can be passed to humans, it is considerably easier to control infections that erupt in populations of cattle, rather than humans, who don't have a friendly farmer to supervise, track, and test them in herds (although I suppose that such actions are what Peta objects to most, in the first place).

Additionally, if people think that the hormones they inject cows with are bad, are they really ready to ingest some of the medications transferred to breast milk, such as Phenobarbitone (anti-convulsant), Dothiepin (anti-depressant), Promethazine (anti-histamine), Doxycycline (antibiotic), and a myriad of recreational drugs?

I don't know about the rest of you ice cream enthusiasts, but I don't want my Cherry Garcia to require a visit to Quest Diagnostics before it makes it to my freezer.

Know-Nothing Pundit With Plenty to Grouch About

I can't claim to understand much about the whole bailout hullabaloo, but I certainly possess some imprecisely aimed anger toward some mysterious shadowy villain (all I know is that he is a banker by day, insurance broker in the afternoon, and congressman in the dead of night).

We regular, old, Americans are just left rubbernecking at all the chaos to patch the cracking beam that apparently suspends our entire earth, and runs only from Wall Street to the Beltway.

While this bailout may at least mean that my patients and I will be less likely to experience the nuisances of a newly-impossible-to-implement national health care plan (unless congress gets a bit of Havana fever, figuring "we've gone this far already..."), I have a feeling that this bailout business is bad for our country overall.

Yes, my knowledge of economics is rudimentary, but it's also my future three-thousand-something-plus dollars that will be used for those Damn Yankees' latest shenanigans, so I insist that even the ignorant be entitled to ask questions:

If fresh capital is necessary to resuscitate and revitalize these companies, why can't we provide be loans, which must be paid back, once the companies get back on their feet? If these businesses are so valuable, why isn't anybody, anybody (China? Bueller?) else willing to buy them, except for our government? If the companies are worthwhile enough to be "saved," why aren't they worthwhile enough to be bought? Surely someone poking around the coal mine has noticed these elusive diamonds in the rough? I've always assumed that if no one wants to buy something, that means that the something isn't actually worth anything.

Many Americans once thought they had some assets/pensions/employment in these companies, and will surely be very, very devastated to find out that, subjective Bayesians be damned, seven years of plenty doesn't imply seven more. Many might end up losing a lot of money. I say, fine, let's bail some of these people out. What I don't understand is, if the government must redistribute income, why not just:
1) Put the $100 billion on layaway,
2) Figure out who ends up the poorest after this big melt-down, and
3) then hand out the cash?
4) Re-assess the situation and see if more is needed.
5) Repeat

Why spend the money now, before we've even identified who needs it most? Last I checked, the heads of companies didn't apply for jobs at any welfare agency, so we shouldn't give the money to them to dole out. Why not knock on the doors of the Food Stamp Program and Department of Labor, hand them a few billions, along with the memo, "Expect busy day tomorrow." We'd still be helping the potential victims of the predicted meltdown, just distributing the money to those who need it, when they need it.

While most people recognize that sending good money after bad doesn't actually help "save" anything, some are conjuring up psychological explanations about why we must bailout these companies. They talk about an capital freeze that will stem from lack of "confidence" or "faith" in the market. I tend to believe businesses are generally judged based on their monetary value, rather than psychological or religious value. But in case I'm wrong, why don't we hire Dr. Phil and the Pope to ease our troubles, rather than Henry Paulson? We are constantly being told that this bailout must happen quickly, lest our country be destroyed, and all the skeptics be turned into pillars of salt. At least Pope Benedict can then intercede on all our behalves.

Today in Medical School: A Chat Between Two Representatives of the Obama Campaign

Or at least that's what the health care policy debate felt like.

My school invited E. Richard Brown Ph.D., Director of the UCLA Center for Health Policy Research and Senior advisor to the Obama campaign to debate Dr. Donald Kurth, M.D. Chief of Addiction Medicine at the Loma Linda University Behavioral Medicine Center, Mayor of Rancho Cucamonga, and Chair of the Health Care policy committee for the McCain campaign.

I don't know which speaker did more to advance Obama's ideas for increased government involvement in medicine. For those who argue that competence in running a campaign is more significant than a candidate's actual policy proposals, then today's spectacle might solidify such people's support for Obama. Let me caveat that I am a hard-core free-marketer, who believes that McCain's health care plan is actually one of the highlights of his candidacy (had he also promised to bring our soldiers home from Iraq, and had eased up on some social issues, I would have been writing this from his campaign volunteer headquarters).

Dr. Kurth seems like a kind gentleman, who cares for his patients, and supports his political positions because he believes they will improve patients' lives. Nevertheless, he presented McCain's plan by reading off the McCain/Palin brochures that had already been left on our auditorium seats. He spent a few too many minutes talking about his own professional degrees and experience. His only argument against government-controlled health care consisted of a personal story working for the U.K. National Health Service thirty years ago, in which his advisor, a surgeon, didn't make lots of money, and some patient he met had to wait a few years before receiving his hip replacement. When asked questions about the McCain plan, he admitted that he didn't know the details, and instead continuously repeated the same emotional mantra "Do you want the government to get between you and your patients?" That line was the answer to about seven different questions (admittedly challenging, sometimes antagonistic, questions- this is Obama Country, after all).

After Dr. Kurth's very short presentation, Dr. Brown barely had to open his mouth to "win" the debate. But he went much further than even describing Obama's plan. All parts of McCain's plan that Dr. Kurth was unfamiliar with were explained in detail by Dr. Brown, before he summarily refuted them with facts and figures, rather than personal experiences. It was like watching Lennox Lewis take on my old Tae-Bo instructor.

Without a real sparring partner, Mr. Brown talked for about a half-hour, and got away with quoting every questionnable statistic, and its intepretation as fact (i.e. "48 million Americans don't have health insurance," without a mention that this includes illegal immigrants, whose health costs ought not to be subsidized any more than those of any given world citizen- and I even support immigration reform). If free-marketers believe that socialists advance their causes through romantic emotionalism, rather than rational data, they would be disappointed to see who are currently carrying each movement's torch. Here was one guy, the so-called "Marxist" who came across as professional, fluent in policy, and well-prepared. Then there was the other guy, the "Capitalist," who seemed to have a verbal tic in his constant repetition of "I believe in the free market" and described, very generally, that he has some problems dealing with the government bureaucracies in his medical practice.

(As an unrelated aside, my audience question to Dr. Brown was as follows: "There are many controversial cultural issues in medicine, including abortion rights, medical futility, and transgender surgery. How do you feel that the existence of a National Health Insurance Exchange might affect the debate regarding cultural issues? More specifically, in the case of medical futility, who would decide when the plug is pulled? The patient's family or the people footing the bill, who may not have made the patient's decision for themselves?" The line to pitch questions to the Obama representative consisted of: Me. The line to ask questions of the McCain consisted of at least 6 upset people).

After the "debate," we discussed the two health care plans in our classroom. Considering the overwhelming support for Obama in my medical school, as well as the poor performance of the McCain representative, I have to give my fellow students a lot of credit. They asked a lot of the important questions that made me realize that there are knee-jerk liberals, and liberals who ask and consider probing, relevant questions. In our classroom discussion, some people queried, "How would these plans be paid for?" "How would we insure that costs don't go up if there are coverage mandates? How do we prevent increased premiums for healthy people (or a healthy person exodus from costly plans), once insurers are required to disregard "pre-existing conditions"? Would illegal immigrants be eligible for free care? If not, who would be left to pay for their medical expenses?) Despite my constant feeling of being a political minority in my medical school, I do admire and respect my classmates. It's just a shame that the one opportunity for many people to hear a cogent argument on behalf of the free market was was so devastatingly wasted.

Anesthesia Irreverence

Courtesy of the Laryngospams, a singing group of CRNAs (Certified Registered Nurse Anesthetists):





And if you mastered the breathing part, here's for the more advanced:

Pelvic Examination Training

First, a word of warning to all the women out there:
If you see a male second-year medical student with a speculum in his hand, drop everything and run.

Luckily, our victims this week were vinyl dummies, not-unlike the kind sold to lonely middle-aged men who visit unsafely-searched websites. These unenthusiastic volunteers, come with a set of interchangeable parts (Cervix with endocervical polyp! Cervix with neoplasia!, Pregnant 10 week uterus! Two adnexal masses!). The sneaky doctors mix up Eva's (as she is always called) internal organs, so we can test our abilities to palpate and identify her various pathologies. Eva does not charge by the hour, but her $597 fee ought to be returned if you diagnose her correctly.

I've noticed a bit of a difference in how we are taught to perform the male versus female pelvic exams. The gynecologist gets up, and with a soft, sympathetic voice, talks about how she carefully drapes the patient, and eases her into the examination, by first placing her hand on the patient's knee and then thigh (she recommended that all doctors do this, to comfort the patient, but I insist that any male doctor who cares about retaining his license ignore that advice), before performing the exam. All anatomy is referred to by the most professional sounding jargon we have in our medical toolbox. "Sensitivity" and "comfort" are each mentioned about 12 times during her presentation.

In contrast, the urologist is crass and bawdy, talking about his own and others' mastrubation habits, and joking about how Los Angeles doctors, many of them Jews, are clueless about the fact that patients can get severely edematous retracted foreskin, if the patients fail to put it back where they found it. He seems to imply that the most important thing is to reduce the "unmanly" factor as much as possible when you position the patient during the prostate exam ("I call this the last position any male wants to get into"). He described an inguinal hernia as "Dude, where'd my penis go?"

Of course, we are taught to interact respectfully and professionally with all of our patients. But I do wonder if there is a silent understanding among doctors, that some men prefer to have their discomforts dispelled by bluntness and Adam-Carolla-style humor, while women often prefer to be treated with sensitivity. Of course, the above observations are gross generalizations, but it's the impression I've gotten so far, watching the style and mannerisms of the gynecologists versus the urologists. During the pertinent rotations, I'll report back on whether I still find this to be the case, or if generic "doctor-speak" is employed for all.

Another Powerpoint Exhumed!

I gave this presentation last week for medical students in the training session for "Community Impact," a program in we teach about topics such as "Drugs and Alcohol," "Dating Violence" and "Contraception" to kids in Juvenile Hall. My specific topic addressed job opportunities available for teens, as part of the "Decision Making" module. So unless you happen not to know a kid in the L.A. area who just finished Juvy and is now looking for a job in the neighborhood, this widely-relevant presentation is for you!

Job Tips For Teens

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Spared from the Powerpoint Graveyard: LGBT Health Care

Each week, we have a class called "Professionalism in Medicine (PPM)," in which a group presents on a topic concerning medical ethics, health care politics, or community-specific medical needs. We also invite relevant speakers to talk about their experiences navigating our vast American medical morass. For example, this week's topic was "Patients with Disabilities." After watching excerpts from "Murderball," we listened to a man with quadriplegia speak to us about, after his accident, what the doctors did that he perceived as helpful or unhelpful (Helpful: Hooking him up with other patients in a similar situation. Also helpful: Very frank and specific talk about the potential prospects and exact methods for having sex. Unhelpful: Doing anything for the patient that he could do by himself).

When the topic was alternative medicine, our school invited naturopaths, homeopaths, chiropractors, acupuncturists, reflexologists, etc. to speak to us about their practices (Regardless of what any one feels about alternative medicine, it's important for allopathic doctors to be familiar with the practioners' interventions, and to learn how to work with patients and their other health care providers in a productive manners). Next week, representatives from the McCain and Obama campaigns will speak to our class about the candidates' various health policy proposals.

About two weeks ago, my friend and I gave a presentation concerning LGBT health care to our "Professionalism Practice in Medicine (PPM)" class. I addressed basic definitions about sexuality and gender, as well as some pertinent legal issues, while my friend focused on specific health care needs and disparities of the LGBT community. We ended up meshing both our powerpoints, but, because I am not sure if she wants her work advertised on the internet, I'm only posting my portion.

Although I enjoyed giving the presentation, as I waded through some of the many websites, books, and papers dedicated to "LGBT Health Care," I've been pondering some of the pluses an minuses of codifying such a group. In general, I maintain some reservations about addressing "Group-specific Health Care," including "LGBT Health Care." While I didn't mention such concerns in our talk, I wanted to go over some of them here:

Advantages:
1) Higher/Lower Pre-test Probabilities. Lesbian women are at increased risk for breast cancer. If we know and talk about elevated risk of gay men and lesbians for contracting certain diseases, we will be more vigilant in screening them for such diseases.

2) Unique Mental Health Issues/Addiction. Homosexuality correlates with higher rates of depression, drug addiction, and other mental illnesses. LGBT people often face disapproving families, unaccepting religious groups, or simply their own struggles with their sexuality. Knowing this, the doctor can better engage with the patient, talk to her about her troubles, and screen her treatment with anti-depressants or referral to psychotherapy.

3) Fostering Rapport. Most gay or lesbian patients do not suffer from depression or addiction. However, for some people, if the doctor doesn't address or seem to know anything about their sexuality, they may wonder what the doctor would really think about them, if she knew, and cause some distance between the doctor and her patients.

4) Unique Legal Challenges. It's important for doctors to know the laws regarding the authority of a domestic partner over end-of-life decisions, guardianship of a partner's children, extent of insurance coverage from her partner's plan, etc.

5) Possible Extra Need for Privacy. The health records of the "happily-married" senator, who is on the dl, may need to be stored in a seperate place, not to be seen by the rest of the medical staff.

6) Early Identification of Community-Specific Pandemics. Last year, an article addressing a spike in methicillin-resistant staph. aureus among gay men with HIV caused a wind-storm. Many gay activists denounced the article, especially after some Right-wing Christian groups categorized its findings as evidence of strike upon modern Gomorrah. However, fundamentalism and feelings aside, if early identification of group-concentrated pandemics can help us thumb tag each exposure on a public-health map, we can perhaps nip the outbreak in the bud a bit faster.

7) Intersex and Transgender Health: Unique Needs. It's probably a good idea for doctors about sex-reassignment surgery or MTF hormone therapy, considering that these are common procedures for trans-sexuals. Additionally, the controversy involving intersex children have prodded many doctors to take a more "let's wait and see what gender the kid ends up preferring before we chop anything off" for hermaphrodites, and to resist performing immediate surgery on the neonate.

Disadvantages:

1) Group Identity. Some people simply do not want to be classified in some group called "LGBT." They want to just be seen as "Angela" or "Bill," and as having personal health needs.

2) Sexual Fluidity. If we accept Kinsey's notion that the binary view of sexual identity (gay vs. straight) inadequately describes American's multi-layered and diffuse pattern of sexual preferences and experiences throughout life, the border between "LGBT" and "Straight" starts to become somewhat artificial.

3) Discounting Potential Health Risks. Perhaps too much emphasis on someone's sexuality can bias against certain diagnoses. While lesbian women are less likely to contract HPV, some evidence suggests that, if a lesbian develops cervical cancer, it is often diagnosed at a later age. There are many possible reasons for this (lack of medical access, the fact that lesbians don't need birth control and, therefore, see the gynecologist less often). However, some studies also suggest that lesbians are simply are not offered a pap smear at the same rate as are straight women, presumably because doctors see their risk as being low.

4) Avoiding Social Bias. When we focus on LGBT health, we run the risk of calling, for example, HIV, a "gay man's disease." Other than the fact that this could lead to all kinds "told you sos" from the peanut-gallery, some straight people may behave more recklessly, assuming that they aren't at risk for such illnesses.

5) Focusing on Risk Factors. Lesbian women are at increased risk of breast cancer, but this has nothing to do with the gender of their sex partners. Nulliparous women (women who've never given birth), as well as obese women (lesbians are more likely to be obese) are at increased risk for breast cancer. Perhaps it is most useful to focus on individuals' specific causative risk factors, which may or not be correlated with their sexual identities.

So, now that you've heard my spiel questioning the category of "LGBT Health Care," please please enjoy my presentation on that very topic:

Lgbt Health Adina Only

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