Dateline 3/30/07

Well spring break is off to a very rough start. I think I did alright on my neuroanatomy practical this morning and we got to tour the mint without being hassled by homeland security agents. Also i picked up a Ikea dresser from someone moving out of my building. We also saw my new apartment with no problems other than getting stuck in traffic going there. Everything was going fine until me and my mother started heading out of Philly. We did not get far.

While driving up the Blue Route (I-476) towards the turnpike, the car suddenly stalled out. It just completely cut out while I was driving. Without much breaks or power steering, I was able to get it safely to the side of the highway, and we got towed about an hour later. Unfortunately it was now around 3:30 on a Friday, so the shop told us they would not get around to fixing the car until Monday at the earliest. At least the shop was at the end of a bus line that went right back to my apartment in CC. Of course this was also the bus that picks up the students from the Philly agricultural charter school, so I got an hour long bus ride with 50 high school students and my mother. By the time we got back to the city, my mother decided that she was going back to the hotel, and had talked my father into driving down and picking her up the next day. So the plan seems to be that I will stay in Philly and wait for the car to be fixed, then drive it back to Rochester. So I am not going anywhere at the moment.

Dateline 3/26/07

This has been a good couple of weeks. After a lot of searching, i finally signed for an apt. today at this place: www.empiriantowers.com. It is in a beautiful area and with in walking distance of the Drexel Queen lane shuttle so I can commute to Center city for free. They approved my credit in only 20 mins., apparently i have some of the best credit they have ever seen (I didn't even need to fill in all the references). Hopefully I will start moving in on the 15th. Drexel had the brilliant idea of forcing its undergraduate housing schedule on its graduate students, so I have to move out of here by May 5th, despite the fact that my classes go until June 1st. This is a nice apt, but it is small and very overpriced.

As a side effect of moving, i now also can get my car back on the road. Spring break is next week, so I am going back to Rochester to pick it up and get it registered and everything. I managed to get a car insurance quote from Geico for only $23 a month (and that is with optional medical coverage) For the record, that saved me about 78% over progressive and over 80% over esurance. WOW! For the record, I hit the comparison button on the progressive site and it claimed Geico would charge me between 200-600 (actual range 100-150) so they recommended I should go with them. Someone should sue those lying SOB's out of buisiness....

Also this week, I am starting my new job as an admissions counselor for Drexel's post-bac medical sciences program. should be an interesting summer job.

Dateline 3/25/07

I have a unusual problem...I can't gain any weight. I seem to be stuck around 150lbs. I am skinny and wanted to put on some lean mass so I stopped running as much and started doing weights seriously (maxing out with 2 sets for each major muscle group). I am aware that to gain lean mass, you need to gain weight in general, so I have been eating a little more, especially more protein. After about 2 weeks of this, i have noticed that I was able to lift slightly more weight (10% gains in some cases) but on the scale I noticed: no change. This is sort of frustrating...I even baked and then ate a whole cake this weekend, but to no avail. I eat healthy, but I am not at a loss for calories and spend most of my time sitting in front of a computer or a text book. I have no idea what to do...

Opinion : The cost of eating healthy

Dr Nunez, a brilliant womens health researcher, gave a great speech about health issues to my class today. There is one assertion in her lecture that I have to take issue with, however. This is the idea the the current economic incentive is for people to eat unhealthy foods, ie. fatty processed foods are cheaper than healthy items (fruits and veggies, etc).

This idea is pushed and reinforced by popular media, and especially retailers like Whole Foods, who clearly profit from it (generally by marking up prices on healthy items to increase their retail margin). This idea is also inferred based on epidemiological research showing that more poor people are overweight. (which is what I believe Dr. Nunez was referring to) Is it true though? Like so many other issues, the reality does not live up to the hype.

Take for instance my recent trip to the Reading Terminal market. A week's worth of fruits and veggies costs about $8. Apples were 59 cents /lb. , banannas were 39 cents/lb., and oranges were a quarter each. On the way out, I stopped to get a Philly cheese steak and some soda, total cost: $8.50. I was surprised that one unhealthy sandwich cost more than a week's worth of fruit. Also compare the fruit prices to red meat (2.99/lb and up), cheese (3.99/lb and up) and chocolate (8.99/lb and up). These prices are not much different from stores nearby such as Trader Joe's or Wegmans. Also at Trader Joes, fruit jerky bars at the counter (49 cents, I am eating one as I write this) are cheaper than chocolate bars (69 cents) . In Wegmans, the enriched wheat bread costs the same as the processed sugary white one. In Philadelphia at least, it seems to be much cheaper to eat a healthy diet of fruits and vegetables than junk foods. While certain types of healthy food (anything sold at whole foods) certainly costs a lot, Food prices and economics do not account for the reason that poor people have unhealthy diets.

Now I can't resist speculating on why poorer people would eat less healthy against their best interests. I suspect it has primarily to do with a lack of education among this demographic. When you don't know whats best for you, you will probably just take what tastes good. It may seem logical to pay more for foods that taste better, and if you are not concerned/educated about your health, you will make poor choices. Clearly advertising and fast food are contributing. I also suspect that there is a lack of access to healthy foods for poor individuals, as supermarkets tend to avoid impoverished areas (although both Trader Joes and the Wegmans near me border bad neighborhoods) It is easier to make bad choices when you are only faced with bad options.
A final reason for obesity among poor people may simply be a lack of self control. Quite frankly, if these people were more motivated and disciplined, they probably wouldn't be that poor in the first place. Of course public health researchers would never accept that reason because it shifts the blame to the people themselves, and for some reason, being poor alleviates personal responsibility...but that is another rant for another time....

Advice : Good food fast

If you ever eat frozen prepared food, you have probably run into this dilema: Microwave it and get the food fast but soggy, or bake it and get it tasting good but having to wait 10 times as long. Despite the saying "good things come to those who wait", I am going to reveal a shortcut that I have been using to solve this evil tasty problem.

When faced with a frozen bakable product, simply do the following:

1. Microwave product for 1-2 minutes (or half its actual mwave cooking time, whichever is less)

This should leave the food soggy but thawed to approx. room temperature

2. Put product in toaster oven (use small baking tray if necessary, although best is on rack)
Toast on high for one cycle (but watch to make sure no burning)

3. let stand for a few minutes. after the outside cools, product should now be cooked warm on the inside and crispy on the outside (in only 5-10 minutes)


This technique has been tested on and worked for:
-tater tots and french fries
-burritos
-any type of breaded chicken
-pizza squares/bagels
-hot pockets


Bonus: Hershey's Dark chocolate bars have 50% more dietary fiber than Nature Valley granola bars. (and more antioxidants, and only 30 more calories). Regularity is about to ensue...

Opinion : High infant mortality rates in the US

Fact: The US has almost the worst infant Mortality rates in the developed world.


Proposed solution from healthcare industry: Throw money at it.

Proposed solution from liberal journalists: Universal healthcare

Reality check from pediatrician: (great article) Those two proposals would make the problem worse.

My take: That pediatrician is exactly right. Throwing money is not going to solve the problem, its going to make the system less efficient. The majority of infant mortality in the US is the result of premature birth or defects. The reality is that premature birth is caused by many random things, few of them medical. The most likely culprits for premies are underage mothers, obesity, and smoking. My question for the NY times would be:
What does fat, smoking teenage mothers have to do with healthcare financing?

Opinion : Physician's role in preventing violence

Submitted for a grade as part of my medical ethics class:

There is a serious crime problem in the United States. Crime rates are much higher in the US than in other developed countries. (Mercy et.al., 10). It has been proposed that action should be taken at all areas of society, and that physicians have a significant part to play.(Mercy et.al., 1) To determine this part, it has been proposed that violence should be treated as a public health problem. This distinction of violence as a public health crisis is dubious however, as it misrepresents the purpose of medicine and distracts attention and money away from those whose job it is to fix the problem. Physicians do not have the time, resources, or enforcement power to treat the violence problem, nor do they provide an efficient means to do so.
The role of doctors in treating society's problem is controversial. People are always trying to expand physician's roles past their obvious expertise. It has been suggested in Medicine and Society this year that physicians should try to fix the problems of poor education, wage disparity, drug use, and sexual promiscuity among others; and now we are adding violence. As a caring human being, physicians should certainly be concerned about all these issues, but fixing abstract social problems is not what medicine is about. Medicine is about diagnosing and treating illness acutely, not eradicating the long-term, possible causes of illness. Our society trains and maintains a large number of police officers, social workers, public health authorities, legal advocates, therapists, teachers, and councilors whose job it is to fix these problems. Just as social workers should not administer therapy for lead poisoning or be resetting broken arms, physicians should not be deciding if a child is fit to live in a certain household.
One major reason that physicians should be a focus of violence prevention programs is simply that other trained professionals would likely do a better job working on the problem. The constraints of modern medical practice would make physicians an inefficient resource for identifying, counseling, or intervening in situations where violence is involved. The time limits placed on doctor and clinic visits make physicians unable to provide proper support and counseling to victims (psychologists should do this). Inability to track patients outside of their practices also does not allow physicians to identify of those at risk (social workers should do this).
Some studies claim that physicians should help to prevent gun violence and take steps to help patients who may show risk factors towards violence (Christoffel et.al). This can be counter productive and even unethical for physicians, however. The researchers claim that physicians can help by sharing data on the effects of gun violence and modifying their treatment for those who may be at risk (Christoffel et.al). Sharing patient data violates patient privacy, however. In addition, treating a patient differently because of a risk factor based on other people, or that you are only assuming is discrimination. It is not a physician's place to judge patients or their family's behavior and social situations, and to the extent that it can be avoided, these factors should not influence routine medical care.
Violence is a problem that society needs to deal with, but not by throwing medical resources at it. Society should work to solve the problem through trained dedicated professionals whose concentrate on this area. Physicians should not encroach on the territory of social workers, therapists, and law enforcement. A focused campaign is needed to end violence, with moral support from the community for the directed actions of those trained to intervene.

Opinion : Research on vulnerable populations

Submitted for a grade as part of my medical ethics class:

Medical research in the western world (supposedly everywhere) is bound by local laws to adhere to a set of human rights protection guidelines modeled after the Nuremberg code. (Murray 792) In the United States, these ethics laws are also supplemented with rules to prevent egregious cases of misconduct such as the Tuskegee trials. (London 790) The general aim of these laws is that the researchers should always minimize the harm to potential subjects. (Friedman et. al 805) The problem is that these laws are too restrictive and can get in the way of beneficial research. This becomes an issue when a small amount of potential harm can bring a large amount of potential good, a classic "the ends justify the means" problem.
The first group of vulnerable subjects is children. It is clearly necessary to determine the effects of medicine or treatments on children before it is given to them, but to determine these effects, clinical trials are needed. Clinical trials all carry some level of risk, and therefore the trial can be generally defined as child endangerment. This line of reasoning however leads to the absurd view that it is not ethical to give any medical treatment to children, yet of course, it is not ethical to let them suffer either. Edward Jenner's vaccine experiments on local children would now be considered a serious ethical violation, yet that violation has saved millions of lives. The key to vulnerable populations who are mentally incapable of consenting themselves (children, mentally handicapped), is who should be allowed to consent for them. (Murray 794) The clear answer should be someone who has the child's best interests in mind. This can be the parents, government social workers, or an independent counsel appointed on behalf of the child. It should not be someone who has a financial stake in the outcome of the trial, however. The problem is that parents may second-guess themselves (as in the KKI trial) and an independent advocate should see little reason to put a child in a potentially risk experiment. When the researchers pay the family on behalf of the children, this just further complicates the issue. A possible solution to this problem is to pay the child with a deferred annuity (maturing when the child turns 18 or so) so that the financial incentive is for the subject and the guardian's actions are forced to be altruistic.
Another population of vulnerable subjects is prisoners. This is different from children in two key ways: first, the prisoners do have the ability to consent, but second, their personal freedom is restricted. The freedom restriction gives the researchers a greater level of control, even if that control is only perceived. Unlike the children, the prisoners cannot simply walk away from the experiments, and their level of personal responsibility is diminished. On the other hand, prisoners have other civil rights restricted, such as the rights of privacy, freedom, voting, and in some cases life. As society already considers prisoners less "human" than the general population, it may be justifiable to use this population for particularly high-risk trials. The only way to justify any clinical trial, or any action that can cause harm for that matter, is that the outcome will be of a greater good. In this light, the intentions of the researcher must be benevolent. The intent or the researcher is how a trial should ultimately be judged. If unexpected side effects occur, if mistakes are made, if the treatment does not work, or even if a vulnerable population was exploited, this is the inevitable consequences of scientific-medical progress. As long as the mistakes and exploitation was not driven by greed or anger, then the researchers should take note and not be held liable.

Disclaimer: I am currently NIH certified in human clinical trials and have helped to conduct trials in children

Opinion : Physician addicts

Submitted for a grade as part of my medical ethics class:

Drug addiction is a serious problem in all parts of society, and medicine is no exception. Despite the image of a noble and beneficial profession, physicians frequently become addicts. These addictions are fueled by stressful jobs, easy access to narcotics, and often an irrational sense that their use is not a problem. Considering these factors, more needs to be done to eliminate this problem so that both patients and physicians are protected from the horrible struggle that characterizes addiction.

To understand why a successful, benevolent person would turn to drugs, we must consider the risk factors that are inherent in medical practice. First of all, there is the stress and negative emotional toll that comes with the job. Everyone responds to stress differently, and some people will respond by self-medicating. Stress is a problem with almost any job, yet the impulse towards self-medication is particularly a problem in physicians because they have easy access to powerful narcotics. If a lawyer or pilot was stressed for instance, they may have a drink after work or take too many aspirin, but it is unlikely that they would have Vicadin or codeine readily available at their workplace. This access lowers the opportunity barrier to addictions for physicians and often starts them along a downward spiral.

Once they are addicted to drugs, being a physician can also hinder the ability for others to help. Physicians are generally respected and trusted in the community so outsiders are often reluctant to step in. Physicians can be insulated from the consequences of their actions by the work of their colleagues (to fix mistakes) or their licensure (to mitigate legal consequences). There is often a culture of acceptance among colleagues who want to help, but not hurt, their friends. The stereotypes surrounding drug addicts will also help to defer suspicion and give the impression that the drug habit is not a problem. A physician who is addicted may feel that as long as they can pay their bills and do their job, there is no problem. Addiction is ultimately a downward spiral, however, and the earlier the intervention, the better it is for everyone involved.

Everyone will agree that this drug problem needs to be wiped out, but there is little agreement or action on the subject. One reason for the inaction is that outing large numbers of physician addicts would damage reputations, and no one from hospitals to medical schools to the AMA wants to do that. To solve the problem, however, reputations will need to be damaged. Patient safety is simply more important than reputation, and any short-term damage will be outweighed by the long-term benefits of deterrence and breaking the culture of acceptance. First there needs to be a system of random drug tests to catch physicians in the act. Second, hospitals or other employers must be required to report the results of these tests (unlike baseball) and the hospitals must be held accountable for their employees. Finally, a system of amnesty must be in place to encourage physicians to seek rehab treatments. Physicians should be allowed to resume practice as long as they can stay clean. In addition, the systems to track and distribute medicines in a hospital should be revised so that the pharmacy can keep tighter control on supplies and drugs can be tracked more readily. Electronic prescription dispensing should help reduce the opportunity that physicians have to take the first fateful hit, and also catch the problem sooner.

Addicted physicians are a serious problem, but a solvable one. If the medical establishment puts aside its ego and reputation and implements specific and strict policies, this problem can be greatly reduced, and many lives will be saved.

Opinion : Hard work

Slate has an interesting article about how lower wage people have more free time then the wealthy. The author describes the problem in detail and makes jokes about solving closing the gap, but he never considers one of the most obvious reasons for the gap: The first thing that occurred to me is that the gap was caused by the fact that successful people generally work harder. I might even go as far as saying that this study proves that people who make less money do so because they are lazy, and therefore deserve their low incomes.