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CUE THE APOCALYPSE, THE AMA RECOGNIZES THE IMPORTANCE OF CLIMATE CHANGE IN MEDICINE
The April 11th 2011 editorial in the AMA News, titled “Confronting Health Issues of Climate Change”, invokes global warming to motivate physicians to address the fact that “patients are sicker or developing new conditions as a result of changes in the weather.” AMA news April 11, 2011 p 23)
Fine. So what?
2500 years ago, Hippocrates described the observation that “the factors which enable us to distinguish disease are as follows: first, we must consider the nature of man in general and of each individual and the characteristics of each disease,
Then, we must consider the patient, what food is given to him and who gives it –for this may make it easier for him to take or more difficult – the conditions of climate and locality both in general and in particular, the patient’s customs, mode of life, pursuits and age.” (Epidemics, Book I: Hippocratic Writings, Chadwick 1950).
Hippocrates also touched on the science of bioclimatology in his treatise on Air, Waters, and Places: De aëre, aquis et locis
Greek medicine is still practiced in the world as Unani-Tibb, but it is unlikely that the AMA sees any value to educating students and physicians how doctors of the past addressed the constantly changing climate factors that influence disease.
Traditional Chinese and Tibetan medicines also offer insights into sophisticated strategies to manage diseases affected by environmental factors, yet no medical school in the United States offers any credible training in these systems, some forty years after James Reston received acupuncture anesthesia in China.
I was recently contacted by a student at Case Western Reserve Medical School, curious to learn something about the vast heritage of medicine that cumulated in the system that he is now entering.
Unfortunately what he will learn has been stripped of the individualization of diagnosis and treatment that was the hallmark of the Hippocratic revolution: The insights of this powerful system will never be part of his education.
A brief and pointless ritual with an insipid and uninspired, fake, “Hippocratic Oath” is the closest any modern medical student will come to the profound contribution that this vast intellect made to medicine.
The AMA has hosted four state based CME courses on climate change. Of course the focus is less on correct diagnosis and treatment than the message that physicians should “help fight the problem at the source by reducing waste and energy consumption through recycling and improving office energy efficiency.”
Yes, and further, doctors can “encourage employees to walk, bike or take public transportation to work.”
Thanks, AMA! I am sure that patients will appreciate these efforts, even as they would secretly wish that their doctor could actually treat the effects of climate imbalances on their symptoms and suffering. More atriums and waterfalls, please!
Feng shui in the waiting room is more important than seeing patients on time. Who knew that patients really wanted their physicians to have awareness of global warming instead of relief from their symptoms?
The AMA, as well as a variety of bloated, tax payer funded, do-gooder organizations, should be commended for diverting time and money away from clinical medicine and into climate change awareness. http://www.noharm.org/lib/downloads/climate/Addressing_Climate_Change.pdf
GOVERNMENT MANDATED MONOPOLIES ENHANCE INSURER PROFITS
Profits at the nation’s seven largest publically traded insurers went up in 2010 as plans spent less on care and used income to buy back their stock to boost per-share earnings.
Medical loss ratios - the percentage of each premium dollar spent on medical care dropped for six of the seven biggest health insurers in the fourth quarter of 2010 compared with the fourth quarter of 2009.
“The operating environment for commercial insurers continues to improve as federal agencies issue guidelines with softer language and delayed compliance dates” said Dave Shove, a health care investment analyst with BMO Capital Markets. (AMA News)
VASCULAR CAUSES OF DEPRESSION
The pathophysiology of major depressive disorder (MDD) is still unknown, but a number of mechanisms have been identified that impact its development. One subtype of depression appears to be related to vascular changes and vascular disease.
This type of depression, sometimes called vascular depression, is particularly common in older patients as they are more likely to have underlying vascular disease. It appears to be associated with all types of vascular disease, including cerebrovascular disease, coronary artery disease, metabolic syndrome, angina, and high hemoglobin A1C.
Elderly patients with four or more vascular conditions are two times more likely to have depressive symptoms compared with those with no or one vascular condition.
The clinical picture is similar to other types of depression but with increased rates of fatigue, difficulty concentrating, and poor executive functioning. (ACP Medicine 10.2310/7900.1021).
(Ed.) Chinese medical theory has long recognized the connection between the cardiovascular system and mental disorders, and how cardiovascular disease can create depression and vice-versa.
Many drugs used to treat depression have been found to have toxic side effects for the heart, and treatments for heart disease can similarly worsen depression.
Sophisticated treatment using these insights of traditional medicine is not taught at any medical school in the United States, and most Western trained psychiatrists and cardiologists are inadequately trained to utilize these insights in clinical practice.
DRUG SHORTAGES WORSENING IN THE U.S.
Oncology practices and their patients have been negatively affected by record shortages of chemotherapy drugs that are medical necessities, among them bleomycin, carboplatin, cisplatin, cytarabine, doxorubicin, etoposide, leucovorin, mechlorethamine, vinblastine, and vincristine.
"This is the worst it's been in my career," says Joseph Coyne, RPh, Vice President of Pharmacy Services at Cancer Treatment Centers of America (CTCA), a multi-state network of cancer treatment hospitals and outpatient oncology clinics headquartered in Schaumburg, Illinois. "It's a real challenge."
The reasons for the drug shortages are varied. In some cases, manufacturers can't find enough raw products to meet the rising demand for their drugs. In other cases regulatory issues, such as a failed inspection, delay the manufacturing process.
A recent wave of pharmaceutical company mergers and subsequent belt-tightening also slashed the industry's drug-making capacity -- particularly for older, generic drugs.
"They don't have a big profit margin, I'm sure," said Dr. Edward Greeno, medical director at the Masonic Cancer Clinic at the University of Minnesota. "They're small manufacturers making them. So they're often not the things that are being made by the huge pharma companies”
The drug shortages are having an "alarming impact on hospitals and patients throughout the country," according to the Institute for Safe Medication Practices (ISMP) president Michael Cohen, RPh, MS, ScD, FASHP.
A recent survey of 1800 health professionals conducted by the ISMP found that 20% of practitioners reported that their hospital has experienced medication errors due to drug shortages, and that 19% of these errors resulted in adverse patient outcomes. In some cases, patients have died. (Medscape Medical News “Cancer Drug Shortages Are Placing Patients at Risk” November 19, 2010).
ANOTHER QUESTION TO ASK YOUR HOSPITAL DOCTOR: HOW MANY HOURS HAVE YOU BEEN AWAKE?
Revised work hour limitations will be going into effect in July 2011. First year residents can work a maximum of 16 hours, and other residents can work up to 24 hours at a time, with an additional four hours to “manage transitions in care”.
As I suggested in the May 2010 editorial, there is no evidence that physicians can maintain alertness and clinical competence for 16, let alone 28 hours of wakefulness.
24 hours is a workday that is more than three times longer than airline pilots are permitted.
Flying a plane, though it requires good judgment and motor skills, is much more predictable than practicing medicine, and pilots have a co- pilot to assist them.. There is no “automatic pilot” for physicians (yet).
In an era of so called “evidence based medicine”, where is the data that physicians maintain the intellectual and emotional skills to practice medicine effectively without sleep? Where is the evidence that a second year resident can magically work 12 hours longer than a first year resident?
Doctors are well aware of the increased disease and accident risk associated with sleep deprivation in their patients, but apparently the economic benefits of forced labor outweighs this concern for hospital workers:
A Harvard study suggests that inadequate sleep results in psychological disorders and memory problems, but these are apparently not of concern to medical educators.
Everyone from new mothers to combat veterans to shift workers recognize the hazards of inadequate sleep and the rapid deterioration of intellectual and emotional skills that result. But, there simply are not enough residents to safely and humanely treat patients in our billion dollar health cathedrals if they were afforded correct sleep schedules and nutrition.
Medical care is risky enough when it is performed properly. Understaffed hospitals and residency programs would like to continue to amass profit from underpaid and overworked “student” physicians, and “professional” organizations and education “thought leaders” are happy to oblige. (American Medical News October 2010 p 18).
"Is Anyone Thinking?" Department
VAMPIRES AND WEREWOLVES AND GHOSTS, OH MY
Is no one besides me tired of the endless assault of fictional monsters across the land? What’s worse, instead of real monsters, they are huggable and sensitive monsters who endlessly pursue a cliché ridden search to find their “humanity”.
Horrible and frightening on the outside, their true inner nature is exactly the opposite – warm, caring and sensitive – but, oh so misunderstood.
Book and screenwriters have the situation completely wrong. The misunderstood monster with a heart of gold or the angst filled “I can’t help myself but I hate what I do” monster endlessly portrayed by fifth rate fiction writers does not exist, and is a bad role model to boot.
Real monsters look just like everyone else, but they have no humanity on the inside. Their heartlessness is what makes them monsters, not their canines or fur or decaying flesh. They are insensitive to other’s suffering, and sometimes their own, and their repulsive acts and despicable behavior defines their monstrosity.
Because they are heartless, they have no moral compass. Remorse, if seen, is acted rather than felt. There is no hesitation to commit horrific crimes against their fellow men and women, friends, strangers, wives, husbands, children, parents, family members. It makes no difference.
In fact, the modern monster is much too easily understood. But true human beings, those who do have a heart and are saddened and shocked by the carnage of modern monsters, live mostly in denial that such monsters live all around them.
They remain in denial as mutilated and decaying bodies fill the case files of detectives in tiny hamlets, rural outposts, and enormous cities.
They remain in denial even as sensationalist print and screen media exploits an endless and burgeoning parade of those few degenerates who are actually caught, repackaging their passage through our feckless legal system as entertainment.
They remain in denial despite revelations that for every monster, the most recent horror is not the first, and that previous efforts at isolation, therapy, or rehabilitation, have failed, and monsters were released to prey again.
And, to no one’s surprise, monstrous acts were again the result. Monsters don't rehabilitate.
Monsters don’t indulge their urges every day. They are opportunists that slink beyond the glare of light, camouflaged by their ability to appear to be human beings. But, there are ways to tell.
Monsters delight at killing or torturing animals as children or adults.
Monsters are inventive at cruelty.
Not all narcissists are monsters, but all monsters are narcissists.
Monsters do not display humility, appreciation, or gratitude.
A great many monsters have mastered charm and their victims remain unaware of their peril until it is too late.
And, like their fictional counterparts, monsters are extremely dangerous. Even as individuals, their accumulated toll of horrors is too great to list.
Given power and position, they have covered the globe with blood and suffering, and continue to do so today.
Screen based fiction is a pleasant opiate for our society. Its success at lulling people into passivity, sleep and confusion is truly awesome.
Its negative effects on attention and intellect are evident in every corner of the United States.
Who is left who has the courage to identify, oppose and destroy the monsters? "Rampant" by Elixir. Visit their website for sample tracks and to buy their CDs.
Featured Music at the Office
Who is left who has the courage to identify, oppose and destroy the monsters?
"Rampant" by Elixir. Visit their website for sample tracks and to buy their CDs.