A new wave of ingestible chemicals are on their way, and while I’m still skeptical, the active ingredient is a common molecule called AMP, found naturally in the human body as an enzyme regulator (as well as other uses of which I’m unaware).

The street name for chemicals is “bitter blockers,” because when ingested with bitter foods, bitter-detecting taste buds are less activated, making us taste less of the bitter in the foods and drinks. The New York Times has a piece on this latest biotechnology, and food and beverage companies seem to be swarming.

According to the Times:

bq(quote). While many people think sugar and salt are added to foods simply to increase flavor, often the additives mask other, less agreeable tastes. Processed foods, like canned soups, sauces and potato chips, have high amounts of salt to mask the bitter tastes that emerge during the extremely hot cooking process. Some soft drinks are filled with sugars to tone down the bitter taste of caffeine.

The product has been received well in the lab, at least, to de-bitter grapefruit juice and coffee; in an even more useful setting, the bitter blockers might be used to make drugs more tolerable to swallow, including HIV cocktails, which are infamous for their intolerable taste.

If the AMP works without side effects, I think these could be a blessing to nutritionists–allowing manufacturers to add less salt, sugar, and fat to products in order to mask unwanted flavors. Until more Americans learn to slow down or eat healthier, hopefully microwave dinners will be a little better for us. But I still tend to agree with Michael F. Jacobson, executive director of the Center for Science in the Public Interest in Washington:

bq(quote). “If companies use this to market products that are healthier, more power to them. If they used higher-quality ingredients or didn’t cook them to death, they wouldn’t taste bitter in the first place.”

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We discussed professionalism and ethics a couple days ago, and insulting physician chart code got me thinking again about the line between humor as stress relief and physician paternalism, thinking patients are “lesser” or “dumber,” leading to disrespectful behavior towards patients. (As far as I can tell, everything so far seems to be a “fine line” and “tough call” in med school; everything is also on a “case by case basis” and requires “personal judgment.”)

I don’t think most people start off trying to be disrespectful when they snicker about a patient. For some, it’s a way to deal with the emotional stress of dealing with sickness, disease and death: it’s psychologically more tolerable to deal with these serious matters if the patient isn’t as much a person with a family, but a disease to be cured. One could argue that there are better ways to deal with these issues, but I’m only arguing that the reason isn’t to be insulting to a patient or his or her life.

I think where it gets problematic is when the joking is so routine and commonplace that it becomes normal. When a doctor starts writing “FLK” for “funny-looking kid” in a chart, it makes the child not even a child anymore, but merely a joke. It removes the compassion and the empathy from the doctor. It’s similar to Freud’s concept of fetish–the fact that the object (in this case, the patient) is reduced to one representation (unattractive child), and is no longer viewed as multi-dimensional (a child that has feelings, a family, an illness, needs love, etc.).

Like most responses, I think the answer is somewhere in the middle. There are a lot worse defense mechanisms than humor, but I think it takes a fairly constant, objective self-evaluation to be sure that one’s stress relief does not interupt one’s sympathy, compassion, and caring. Sometimes it’s best to just follow Thumper’s mother’s rule: “If you don’t have anything nice to say, don’t say anything at all.”

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At one of our orientation sessions today, one of the panel members kept referring to people who see physicians as “clients,” but I’ve always been weary of the term, and terms like it. “Customers” or “clients,” to me at least, implies a level of economic or financial exchange, whereas “patients” implies some sort of medical exchange of knowledge or treatment. Sticks and stones may break your bones, but words will never hurt you couldn’t be further from the truth. The concept of a “customer” or “client” implies that one person wants the services of another–my web design clients ask me to design their websites in exchange for money. A patient, on the other hand, is someone that needs the services of a physician–it’s not an option, it’s a necessity. I understand the usage of the “client” term to promote patient empowerment and satisfactory respect and treatment, but the other meanings of the word tend to blur and confuse the reason people see doctors–because they require care.

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My normally wiseass, constantly-commenting mouth had its own blackout today; I did my first patient history. And not even a real one at that. We’re currently in 3 jam-packed days of orientation, and our class split into groups to learn about some skills we’d be doing at our local volunteer clinics . I volunteered to play doctor, and take the “patient’s” history, and well, failed miserably.

Better now than with a real person, I guess, but I had no idea how difficult it would be to delve into a stranger’s life in the course of a couple minutes. My scenario was gathering a history of a young woman in a physically abusive marriage, but I didn’t know how to phrase things without sounding rude or intrusive. I got about as far asking her reason for visiting and her age, and then wasn’t sure how to proceed. I’ve been in somewhat-similar situations before as a Resident Assistant–sometimes you have to broach difficult topics, but at least you know the person you’re talking to. In the real world, you may have to quite-quickly ask a person about their sexual history, personal relationships, and private life. I’m sure it takes some time to adjust and get used to, but I had no idea how awkward a feeling it starts out as.

And this was just with someone pretending to be a patient–I can hardly imagine the real thing. And this was just the first day. Of orientation.

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It’s a day before I leave (and my birthday!) and I’m now no longer excited about med school, since anxiousness and nervousness have taken over. It’s the whole “new life, new surroundings, new people” thing. Will they like me? Will I succeed? Will I be able to balance school with the rest of life? Nothing new, but it still makes me a little jittery. And in the end, I know it always turns out to be fine, but there’s just that little bit of self-doubt. Well, that, and the worry that I’m somehow forgetting something major in my packing.

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It looks like Dean Kamen now has two inventions that are helping people with mobility problems.

If you haven’t heard about it, the Segway Human Transporter is something like a stand-up scooter. It travels up to 12 MPH, and has 5 gyroscopic sensors that maintain balance for its rider. When I first read about it (and its hefty $5,000 price tag ), I thought it was only a device for lazy yuppies. San Francisco quickly banned the devices citing safety issues with pedestrians and public health issues with obesity, but now it seems that the Segway may end up being helpful for some multiple sclerosis, Parkinson’s, and polio patients, as well as others with limited mobility.

From a quick 5-minute search, I found a rehabilitation and disabilities services provider trying it out , a 55-year-old woman with MS who says “It has given me so much freedom” and “You know the amazing thing, I can barely walk any more – I used to walk two miles a day, and now I can be on this for two hours and I don’t get tired.” There’s also a couple postings on the Segway chat forum with some users that have and hadn’t have success with the Segway, and an entire forum about Special Needs, Mobility, and Disable Use . On the Segway site, there’s also a user with Parkinson’s who loves his transporter, too.

If you’ve never heard anything about this Dean Kamen guy , start reading . Hopefully like the rest of technology, these devices will be cheaper and more affordable in the future.

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Big Pharma plans to stop allowing Canadian pharmacies to buy their supplies of prescription drugs through wholesalers (starting with Pfizer); instead, they’ll have to buy directly, presumably causing huge cost increases. Now, the thing that I don’t get is this: Canada (as well as most countries) has been buying through bulk purchasing for years . It seems like Pfizer’s only *now* going after the pharmacies because they’re now serving Americans (and cutting into Pfizer’s profit margins from Americans who pay waaaay too much for drugs). If Pfizer wasn’t happy about Canada buying in bulk, wouldn’t they have gone after them when they started their medicare program in 1965? So what, Pfizer, you’ll allow Canadians to get their drugs cheaply, but not Americans? Call me crazy , but I think Ann Coulter would call that anti-American, unpatriotic, and treasonous.

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If you’re applying for medical school and just can’t put your feelings about medicine into words, DB’s done all the work for you . His answer (and the comment in the thread) summed up my responses pretty well, covering my knowledge and problem-solving cravings, as well as my interest in working with others and helping patients. Go read.

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Sterling over at Sawbones from the Sandbar has some comments about insurance billing, and now that I’ve overheard our billing manager’s back and forth run arounds with the insurance comapnies, I’m even more disgusted. Are we seriously using a health care system where one of the insurance approval phone prompts is “If this is an emergency, press zero?” The social worker in the office even told me of a local horror story–a man chopped off his thumb over at a friend’s house, and rushed to the hospital to get it reattached. His insurance claimed the amputation wasn’t “life threatening,” and therefore told him he had to go to an “in network” hospital.

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When you’re working in a psychiatrist’s office, you _really_ need to stop using phrases like “it’s driving me crazy,” “I’m going nuts,” “I’m going crazy,” and “Today was just crazy!” Not… good.

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