What a great read about the changes in medicine currently taking place. As always, balance is the key.

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The Wall Street Journal is reporting that emails from the 1990s show that Merck was already concerned about Vioxx’s cardiac risks back then. What a shame. I usually think of Merck as being a little more ethical than the other drug companies. Guess I was wrong.

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Peter Rost has an excellent Op-Ed in the NYT:

I have a confession to make. I am a drug company executive who believes we should legalize the reimportation of prescription drugs. I know that I have a different opinion from that of my employer on this matter, but to me, importation of drugs is about much more than money; it is about saving American lives.
According to a study by the Kaiser Family Foundation issued in 2000, 15 percent of uninsured children went without prescription medication in the previous year because of cost, 28 percent of uninsured adults went without prescription medication because of cost, and 87 percent of uninsured people with serious health problems reported trouble obtaining needed medication. We have 67 million Americans without insurance for drugs, according to the foundation. They pay cash – full price – and can’t always afford life-saving drugs. American drug prices are about 70 percent higher than in Canada and almost twice as high as in Europe…
Every day Americans die because they can’t afford life-saving drugs. Every day Americans die because Congress wants to protect the profits of giant drug corporations, half of the top 10 of which are French, British and Swiss conglomerates.
I have another confession to make. Americans are dying without the appropriate drugs because my industry and Congress are more concerned about protecting astronomical profits for conglomerates than they are about protecting the health of Americans.

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Californians, hear me roar! Vote YES on Proposition 72 to support employer-mandate health insurance. It’s going to be a very tight race, we need all the support we can get. And Wal-Mart just dumped $500,000 more toward its opposition . It’s far from perfect, but it will get California closer to having health care for all. Some facts (from Health Access ):

• Prop 72 Sets Standards in Health Care: Large and mid-sized companies are required to pay for private health insurance for employees. Companies must pay at least 80% of premiums and can pay up to 100%. Private coverage must include prescription drug, major medical and preventive care. Small businesses are exempt.
• Safeguards Private Health Insurance: 19 million Californians currently get private health insurance from their employer. Under Prop 72, employers can keep the same coverage paying as much as 100% of premiums. Employees get the added security of knowing that employers cannot pay less than 80% of premiums and must maintain preventive care, prescription drug and major medical coverage.
• Extends Health Insurance to More Working Families Under Prop 72, another 1.3 million Californians – workers and their families – will be able to see their own doctor, rather than rely on emergency rooms and clinics. Prop 72 is an important step in making sure that everyone has access to affordable health care.
• Taxpayer and Business Protections: California taxpayers pay $4.6 billion annually to cover ER and other health care bills for the uninsured. By extending health insurance to 1.3 million Californians, Prop 72 will save tax dollars and help relieve the burden on emergency rooms. Businesses benefit from a healthier, more productive workforce. Small businesses are exempt (including 93% of all restaurants and retailers). Levels the playing field by taking away the unfair competitive advantage some large corporations have because they don’t provide insurance to their employees.
• California Families will Save Money: The average family in California already pays nearly $2500 annually in premiums (KFF/HRET California Employment Health Benefit Survey). Opponents of Prop 72 estimate that 72 will cost the average family up to $1,700 per year. Even by the opposition’s own estimates, Prop 72 will save money for the average family right now.

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Not a whole lot of interest in blogging right now–in the middle of GI and wanting to do a 1,000 things, and blogging’s 1,001. Although 2nd year is a pain in the ass, and information overload, I actually feel like I’m becoming a doctor. It’s kinda cool. I know some of the most common drugs, I know most of the organ systems. What a great feeling.

Try to beef up on my auscultation (stethescope) skills, which is proving quite challenging, but here’s a couple of excellent tutorials for any students out there reading: Blaufuss Multimedia’s Heart Sounds and The Auscultation Assistant .

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We’re in GI right now, and I couldn’t be happier to learn today in lecture that “dumping” is a medical term .

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I’m not sure how my comments (“I don’t mean to be overly alarmist, as the plan is only that-initial planning-just in case Congress would ever authorize a second draft.”) were interpreted as “ sky-is-falling ,” or fearmongering for Kerry (did I ever mention Kerry or Bush?) , but apparently what I thought was cautionary concern turned into “Graham freaks out.”

In fact, I know perfectly well what military doctors do , as my father was a physician in the Air Force, and one of my other physician heroes was a medic in World War II. But I’m sorry, I don’t see this war as the same as World War II. There wouldn’t have been soldiers and Iraqis wounded (as well as tens of thousands killed, many collateral damage ) if we hadn’t have invaded Iraq.

I’m fully aware that the draft legislation failed with almost full support. But it’s more than just rumors on the internets .

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Some alert readers have recently made me aware of a frightening possibility in the future: a “skills draft” targetting Americans with certain skills, including medical training . I don’t mean to be overly alarmist, as the plan is only that–initial planning–just in case Congress would ever authorize a second draft. But the fact that it’s even being planned is a little frightening. (This draft would also include women–generally all citizens up to the age of 34.)

There’s more information at The Blatant Truth , including a PDF of a FOIA document that unearthed the information , and a great deal more at DailyKos . (And from what I’ve heard, “Don’t Ask, Don’t Tell” isn’t enforced for medical personnel.)

I would imagine a significant number of health care professionals–doctors, nurses, etc.–would fundamentally be opposed to being sent to war on ethical grounds: that whole concept of “killing people” and “causing harm” don’t really go too well with the Hippocratic Oath.

Update: Medpundit and Gruntdoc both say it’s all over-reaction. I’m sure it’s easy much easier to downplay the concerns of young polyglots, computer network engineers, and medical students when you’re over 35, and not at risk of being drafted. (And god forbid should bioterrorism occur, I hope we don’t turn so militarized that waves of physicians get drafted–add us to the Public Health Corps or the CDC, but not the Armed Services.)

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Sometimes even the AMA gets it right :

Dr. Andrew F. Calman of San Francisco, an ophthalmologist who pushed for the new policy adopted by the medical association, said: “I don’t think it’s a Democratic or a Republican issue. We have the support of doctors from different points on the political spectrum. We’re very concerned about patients’ access to affordable drugs. I have some glaucoma patients who need to take three or four different types of eye drops to avoid going blind, and each medication may cost $50 to $100 a month.”

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I was going to be sarcastic and snarky and critical in an attempt to be funny, but I don’t think it’d work.

These elementary school drawings of human anatomy are surprisingly good. You’ve got muscles attached to bones, a simplified arterial and venous circulation (the renal veins are in front of the arteries, Sarah, and I hope that’s not blood in the ureters), and a nice little kidney (renal pelvis is a bit off).

Okay, so I was still critical. I’m sure they’re better than I could’ve done at their age.

Not much worse than the first year medical students!

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