Doctors and Speeding

“The officer proceeded to pull out his gun, point it at my face, and told me to lay face down on the ground, which I did. At this point, my ID card dropped on the floor and I remember him stepping on me, probably putting his knee on my back, and then cuffed me.”

This is how a Dr. Ziworitin of UMC describes his encounter with a cop, after the physician was stopped for speeding, while rushing to hospital for an emergency.
Radley Balko writes, "Even if the cop doubted this guy was a doctor, the cuffs, gunpoint, and a boot in the back all seem more than a little excessive, no?"

The shear theater and spectacle of the violent assertion of power certainly makes ones bristle. However, the outrage over this incident, as well as the outcome of the DPD PR disaster, both make me a bit uncomfortable. Certainly, cops ought to exhibit some common sense. However, people should know that one's emergency does not confer an implicit right to put other people's lives in danger. If we express only populist outrage, (which is distinct from genuine sympathy for the driver's misfortune), we may forget to communicate that it is perfectly reasonable for a cop to stop a car, and tell the driver to slow down (pulling out the gun is...unnecessary).

I don't know how things work here in the U.S., but when I worked as an EMT for the Red Star of David in Israel, we were explicitly forbidden from going beyond a particular speed, even if the patient was in cardiac arrest. So if people facing tragedy deserve to not be harassed and threatened by the cops, the police, in turn, deserve increased public awareness that sensible traffic rules aren't conditional to one's personal, or even tragic, circumstances.

Medical Research Fraud

Because of "Scrotumgate,", my favorite medical resource, The Thackery T Lambshead Pocket Guide to Eccentric & Discredited Diseases, requires an update.
HT: My Pharm Prof

Grand Rounds is Up!

Leslie at "Getting Closer to Myself" did a fantastic job of organizing all the posts submitted by a motley crew of medical bloggers. The theme is "Reflections on the way life used to be."
And I got a star next to my name! If I still got stars for doing good work, I'd be on dean's list.

In other world wide web-related news, I have a post up about medical licensure at the "Students for Liberty" blog. It features a sweet parking spot (these things matter to L.A. girls).

The Banality of Marijuana in Medical Education

In one of our GI lectures, among the interminable pharmacology powerpoint slides that address anti-emetic drugs, the following information appeared:
If an alien guest to our planet perused a pocket pharmacopeia, and had to guess which drug would be "fetishized" over all others, I doubt he'd pick marijuana. Mind you, I'm not convinced that there are many positive benefits for healthy people to take marijuana (and smoking a combustion product is more carcinogenic than using a vaporizer). Yet cannaboids strike me as just another class of drugs with certain indications and side effects, some known, some perhaps unknown. Another anti-vomiting drug, metoclopramide, can lead to tardive dyskinesia (Parkinsonism). Scopalamine, yet another, features a whole slew of anti-cholinergic (antagonistic to the parasympathetic nervous system) effects, and can cause delirium in overdose.

However, when patients with cancer obtain the latter two drugs, we praise modern medicine's ability to provide some alleviation to the horrible side effects of chemotherapy. When patients happen to select the former, we convict their state-law-compliant medical dispensers of crimes punishable by up to 100 years in prison.

Taleb and Pre-test Probabilities

Arnold Kling comments about Russ Roberts' conversation with economist Nassim Taleb:

I was most interested in the latter third of the conversation, where Taleb talks about his radical empiricism. For example, he argues that medicine makes more progress with trial-and-error than with knowledge of biological processes.

Trial and error would require taking a drug already known to be ineffective, adding a methyl group, testing the new molecule on a statistically significant number of patients, and then methylating again, until we've tested infinite permutations of "little-value-added" functional groups. We'd be bored sick.

One of the reasons why many empiricists object to all the funding that goes into certain alternative medicine projects, such as magnet therapy or reiki, is that, based on our understanding of physiological or biochemical principles, the pre-test probability of such treatments being effective is pretty low. An extreme Popperian would object, insisting that we can't truly know if anything works, before testing it, (and once experiment concludes, we still couldn't be sure). Such agents of uncertainty would be technically correct.

However, science does not mean claiming omniscience nor capitulating to any smidgen of doubt. Science involves taking the information that lies before us, determining what phenomenon is most likely, and using these findings to develop a testable hypothesis. We are occasionally lucky enough to discover a drug whose mechanism of action we do not fully understand (such as in the case of Topirimate for epilepsy, or the prevalent use of beta-blockers of hypertension, long before we knew how it worked). Yet relying on lucky breaks, or "trial and error," rather than "hot on the trail" paths gleaned from discoveries in biology, is like searching for a bank robber by starting with the As in the phone book. Or like seeking out a black swan, by beginning the expedition at a local Los Angeles lake.

Med Students Lobby Congress for Tuition Breaks

People, I know that we aspiring physicians are all in major debt, but some Americans can't afford the rent for their trailer homes. Let's leave the welfare-for-the-well-to-do-groveling to the AIG execs.

Ross Douthat is Trying to Murder Michael Kinsley! (Or Some other Distortion of Douthat's Views)

Brad Delong links to "The Daily Beast" and writes:

Michael Kinsley confronts the fact that Ross Douthat doesn't care more than a smidgeon about whether Kinsley lives or dies from Parkinson's disease.

If Kinsley were facing imminent death, and the only guaranteed antidote was a destroyed embryonic stem cell, I'm sure Douthat would fly over in a crimson-colored-cape and perform the destruction necessary to save the day. The fact that Douthat opposes federal funding for promising basic science research, that may one day be used treat PD, is far removed from the notion that Douthat doesn't care whether Kinsley lives or dies. If all of us were certain that could automatically save a life by sponsoring a certain magnitude of stem cell research, most of us would wire donations overnight. We don't do this, and thus admit that Kinsley's life is not immediately and urgently dependent on it. Reducing the situation to two variables (Kinsley's life versus stem cell funding), as well as admitting no degree of uncertainty about the potential effects of both the research and its related public policies, is innacurately simplistic.

Ok, I stood up for the social conservative.

Now, let's get the pluripotent blastocyst-derived inner cell mass differentiation party started!

Update: Before writing this post, I had written the first paragraph, as a comment in Brad Delong's blog (it did not include the more bellicose title of this post). It was taken down, after a few hours. Brad Delong has the right to do whatever he wants on his blog. However, I am disappointed by an academic who is unwilling to tolerate reasonably polite critique.