We were talking today about opportunistic infections (infections you get when you’re immunocompromised, due to HIV, on steroids, or you’ve received a transplant), and specifically about the effects of anti-retroviral therapy on changing the course of disease in patients with HIV.

Our lecturer, Dr. Montoya, mentioned something that I don’t think I’ve ever heard from another lecturer: he said that during the 1980s, the staff would meet once a month to mourn the loss of their AIDS patients, and to remember them. Rarely do we ever hear mention of patients dying, and even more sparse is the admission from a doctor that their patients affected them. That we’re not robots of information and treatment. We’re people, our patients are people, and that medicine is a human interaction. It was really refreshing to know that there’s emotion involved-or at least, there should be. All too often physicians are noted for their detachment, or at least, their ability to detach-to be objective in a time of crisis or emergency. But I think if you don’t let your patients get to you-or at least some of them-you lose something key to what drives you to continue practicing to the best of your ability.

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Herpes virus infections (oral, genital herpes, EBV – the virus that causes mono, VZV – the virus that causes chickenpox, and others) can never be cleared; they live in your cells until you die.

So, of course, the associated joke:

Q: What’s the difference between love and herpes?

A: Herpes is forever.

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“We cannot solve the problems that face Medicare without dealing with the broader problems that face health care in America,” said Robert Reischauer, president of the nonpartisan Urban Institute — a Washington think tank — and former director of the Congressional Budget Office.

…Reischauer at the Urban Institute “>said single-payer may ultimately hold the answers not just for Medicare but also covering the 45 million Americans now lacking health insurance.

“If push came to shove, I would want a single-payer system instead of the system we have now,” he said. “But the political obstacles to that are considerable.”

[via Don McCanne’s Quote of the Day]

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Sometimes I’m so amazed with the human body that I really start to think that there had to be some level of intelligent design in us. But Jim Holt makes some great, amusing points against the rise of “intelligent design” theory in today’s Sunday Magazine New York Times:

In mammals, for instance, the recurrent laryngeal nerve does not go directly from the cranium to the larynx, the way any competent engineer would have arranged it. Instead, it extends down the neck to the chest, loops around a lung ligament and then runs back up the neck to the larynx. In a giraffe, that means a 20-foot length of nerve where 1 foot would have done. If this is evidence of design, it would seem to be of the unintelligent variety.

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“The US food and drug administration has given the go-ahead for the soldiers to be included in an experiment to see if MDMA, the active ingredient in ecstasy, can treat post-traumatic stress disorder,” from a Guardian article.

Nice to see a little rationality and science surrounding an illegal drug. You don’t really get that with marijuana.

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I almost forgot. I’m the opening line in the latest Stanford Medicine magazine. Always happy to serve as the big, fat Commie Pinko.

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Us young folk are hot on your trail.

While I must agree that the tech changes even in the past 10 years of medicine have revolutionized the practice of medicine, I’m not so willing to give up on an older’s doctor’s level of experience. I may know the latest guidelines, and practice more evidence-based medicine, but until I’ve got a couple thousand patients under my belt, I’d much rather see someone older than a bright-eyed, bushy-tailed just-out-of-residency hooligan like myself in half a decade.

But now here’s the question: will it be easier for my generation to keep up, or harder? Now that we’re being trained in a computer and tech-aware world, will it be easier for us to a) keep up with change, b) learn faster and easier, or c) understand the new lab data and treatment options? That is, will we be just making more different types of antibodies, or will treatments become even more novel and hard to learn the second time around?

I’m hoping, of course, it’ll be easier. It’s like computers; we grew up with them, so we’ll (hopefully) always we able to understand the interface. Then again, I grew up with a Nintendo, and I can’t play anything more advanced than that worth a damn.

[via kevinmd]

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Recently, AMA President John Nelson, a Mormon ob-gyn, spoke out in support of The New York Medical College, which recently de-recognized an LGBT student group.

Dr. Nelson compared “it to Brigham Young University’s decisions to ban Coca-Cola from campus and to suspend four athletes accused of raping a 17-year-old girl.”

This makes me angry down to my core, for so many reasons. Dr. Nelson’s words are ignorant at best, bigoted and homophobic more likely. He’s a hypocrite, and he should apologize or give up his position.

Y’know, I thought when I chose medicine, I’d be among educated, informed people, working with the brightest minds. Nelson is clearly here to remind me that there are idiots everywhere. I find it a little confusing that just 2 weeks ago, Nelson spoke about racial disparities in health care, and said that there was ” “a generalized distrust” of doctors by many minority patients.” Does Dr. Nelson not see any connection?

Let’s have it your way, Dr. Nelson. Would it be okay for any private institution to choose not to allow blacks? Or females? Or people with color-blindness? What side of the line would you stand on in that case-the private institution’s rights, or equality’s?

The AMA’s official position is that “the physician’s nonjudgmental recognition of sexual orientation and behavior enhances the ability to render optimal patient care in health as well as in illness.” Now, is Dr. Nelson really speaking for the AMA, or is he speaking as a Mormon?

If you believe that Dr. Nelson’s comments are as offensive as I do, please contact the AMA and voice your opinion-as a medical professional, AMA member, or just as a human being. Or even a patient. The number’s 800-621-8335 (hit 2 then 6), or email [email protected]. People used to defend racism and segregation on similar grounds, if you don’t recall.

My letter:

Dear Dr. Nelson,

I’m a medical student and son of a physician, and I was stupefied by your comments supporting The New York Medical College’s decision to ban a gay student group.

You spoke on February 1st on racial inequalities and distrust some minorities have with the health care system, and I can’t possibly understand how you fail to see the similarities between these two issues. If on one hand, you’re speaking out against racial inequalities, but on the other, you’re defending an institution’s right to deny equality to a minority group, it’s hard to really see where you stand. 50 years ago, the same “private institution” arguments were made to justify banning blacks from schools and lunch counters; if The New York Medical College wanted to ban an African-American group, or a Jewish group, or a Mormon one, would that be okay? Or what about one only for short people? Or the color-blind?

Your own AMA policy statements say that “the physician’s nonjudgmental recognition of sexual orientation and behavior enhances the ability to render optimal patient care in health as well as in illness,” but I can’t help but describe the NYMC’s decision as judgmental. And by banning the group, the NYMC is implicitly telling its students that it’s okay to judge, it’s okay to discriminate, as long as you have a justification for it. And by supporting the ban, you’re telling doctors that it’s okay, too.

Discrimination by any other name is still discrimination, Dr. Nelson, and it still smells just as rotten. You have a responsibility to uphold the values of your organization, and to encourage progress in medicine, as well as promote cultural sensitivity as you spoke about two weeks ago. I hope that you will see the inconsistencies in your positions and realize that the NYMC’s decision is not in the best interest of its students, its physicians, or its patients, and it is certainly against the ethical values of the AMA.

God bless,
Graham Walker
MII, Stanford University

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Binge drinking 5 drinks in an hour gets you much more drunk than if you were to have the 5 drinks over the course of a night-but why?

It turns out that the enzymes that allow you to digest alcohol get fully saturated when you drink. So once you have your first drink, any more that you have sits around in your body, making you that much drunker, raising your blood alcohol level that much higher, making your hangover that much nastier, and making potential mates that much hotter. All because your body can’t process the alcohol any faster. It’s like pouring more water into a funnel than the funnel can drain out the bottom: the excess water starts to fill up the funnel. This, my chemistry kiddies, is zero-order kinetics.

It also happens with aspirin and phenytoin (Dilantin), an anti-seizure drug.

Graham Walker. Taking the fun out of drinking since 2005.

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5-10% of alcohol is removed from the body through the breath. This fact, of course, lead a classmate to ask if you can sober-up by hyperventilating. “Theoretically, yes,” said the lecturer.

Seeing as though this’ll be Valentine’s Day #2 without a significant other, I may just have to try it.

Speaking of V-Day, there’s a really nice piece at the end of this week’s This American Life about Johnny Cash, his wife, and the song Ring of Fire. Told by Sarah Jewell, one of my favorite contributors. It starts at about 47 minutes in, and it’s so sweet and romantic that it even made me feel a little less jaded and bitter about the whole thing.

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