Thursday, December 22, 2011

Take 2 of these and try and get a human on the line through my cold and uncaring automated call system in the morning

A couple of months ago I was talking with a professor at school about the pharmaceutical industry, and he mentioned that the Pfizer had recently lost $20 billion in valuation due to a new drug in trial phase III being shut down. This particular drug was going to be a follow up to Lipitor, in that it was a specific cholesterol drug, one that of course, should be taken for life. Here is a great article about not only the failure of the drug, but our misguided relationship of causation and correlation: link to worthwhile article. The author of this article has some very interesting points, and many of them tie in directly to things that I find myself contemplating quite often. The vehicle of reductionism in the realm of science has wrought answers by increasingly breaking down the physical world into smaller and smaller pieces and, admittedly has brought us to amazing places. Think of Star Trek. For the most part, Star Trek is based on a premise that technology will save us, and through the advancement of technology humans will become better people with a more benevolent society to boot. Many of the people in research are people who probably like Star Trek, and this is why we've reached this point of diminished returns in scientific advancements.

Of course, if you had read that article that I linked to you're probably saying, "wait a minute, the correlation of the concentration of Trekkies in fields of biotechnological research is not a causative element for the relative diminished returns in said field!" I can't pull anything past you guys. As a society we need to ask ourselves what kind of valuation we put on this type of research. Drug companies are finding themselves in a position that where they can not justify continuing this research. As is mentioned in the article, a couple of the largest pharmaceutical companies are discontinuing research in brain related therapeutics, because the darn thing is just too complicated. One has to wonder what important, quality of life improving drugs will be left undiscovered simply due to financial risk and/or limited payoff and benefit to shareholders.

As is the case in so many other areas of healthcare (indeed, our increasing capitalization of everything in society) we must come to a place where profit is in balance with overall societal benefits.

I can become discouraged when thinking about these seemingly insurmountable larger issues. But, then there are times when I'm reminded what kind of impact I can have, as a doctor, especially as a D.O. Learning how to treat people with my hands, to reduce people's immediate pain with tried and true manipulative treatment is a lesson in the power of non-reductionist means of treatment modalities. I don't mean that there hasn't or won't be research into OMM, but for the most part, the techniques that we have been taught feel good. Massage therapy feels good too, right? Yes, of course, and I might argue that patients with any number of ailments would benefit from a session with a masseuse. However, being a physician provides for the best of both worlds, in that many of the benefits that come from seeing a massage therapist are also gained from having a DO treat you with OMT. This is just the baseline benefit, however, in that laying hands on a person is therapeutic in and of itself, but having the knowledge of how to improve the function of the patient stemming from diagnostic criteria is in the realm of the physician. It may be as simple as recognizing that some lymphatic vessels need help draining, but the point is that it doesn't take $25 billion to figure out if this works or not. I feel obligated to say that, I am thankful for many of the agents that do take billions of dollars to develop, and they will be a major and sometimes inclusive part of how I treat patients, but in no way do I wish to be limited in my treatment options, in all situations, to these drugs.

I would not have known that lower back pain has been proven to have, in most cases, no correlation with lumbar spine abnormalities had I not read that article. Most people still talk about bulging discs and pinched nerves being the cause of lower back pain, when in fact it has been shown not to be the cause. I can only hope to appropriately navigate that future technologies that take us down the false causation path, but in many cases I will be following the guidelines set forth by knowledgeable people, but people nonetheless. I guess I can be happy that I'm not going to be practicing in the time when bleeding was proven to be a unhealthy (if not fatal, as in the case of George Washington) practice. Acceptance of the idea that I had done major harm to my patients while trying to bleed out the "bad blood" would be a difficult pill to swallow, hopefully I can, in some way, mitigate the pills that are akin to "bleeding" of the patient.

Saturday, December 17, 2011

Sorry LMA, my mind decompresses in strange ways.

The semester is complete. I don't even have to go back to school until 2012!

I had a dream last night in which LaMarcus Aldridge, an NBA basketball player for the Portland Trail Blazers passed away. It was nothing against LMA, but more the fact that I was catching up on the NBA news of the past 3 months before going to sleep. However, it wouldn't be all that surprising if something happened that kept Aldridge from playing this year; granted, he doesn't need to die or anything for that to occur.

Next semester we jump in to Cardiovascular/Respiration/Renal systems right away. I think I'm gonna start listening to the Goljan lectures a little early. I started listening to them at the end of last semester and not only found them helpful, but they were enjoyable to listen to. I suggest them to anyone who is in or hopes to be in med school. Viewing my peformance last semester, I find it interesting that in the practical side, where the grade is derived from "treating" and/or interacting with a "patient" (who thus far, with one exception has been a fellow student we were paired up with) my marks have consistently been significantly better than the "theory" examination grades. Last week we saw an actor who played the role of the patient as we gave them a timed physical examination. I just about earned a perfect score, and received positive feedback regarding my communication skills and interaction with the "patient." Now, we were actually supposed to exam this person, and report any irregularities but these were screened actors and any thing beyond a slight or minor deviation from the norm presenting was minimal. So, my good score was earned by memorizing the lines I was supposed to use to report back to the proctor and by being able to bury the nervousness and put on the smile and charm with the patient.

I think this skill to deal with people in stressful situations (usually -- there has been many times where I've lost it as well, as I'm sure many of you reading this could attest to) was honed by working in the ED. But, I think the foundation for it came from working customer service at a coffee shop/roaster. Granted, there were many days that I was thankful to spend my days roasting coffee instead of making it, I really enjoyed the customers who came in there, many of them regulars from before my 8 year career there. In fact, one of the influences that led to my choice to go to college came from the customers. The shop that I worked for was located a block or two from a good sized private university, and I think getting to know the different professors and students helped me realize that I really wanted to go to school, and for that, as a collective whole, I thank you, former customer.

Wednesday, December 7, 2011

No Steve Perry-oral cyanosis noted.

Today was my first exam performed on a stranger. Granted, the "patient" was a paid actor that the school brought in. It was the final practical for our doctoring course (which means 1 out of 4 final exams is out of the way!) and as always, is a timed, monitored exam. I've grown to like these practicals, as I think one of my strengths is being able to communicate and perform under pressure. The "patient" feedback included that I made her feel comfortable and that I seemed calm and confident, which was nice to hear. However, when I asked her what arm she preferred to have her blood pressure taken from, I proceeded to take it on the other arm, oopsy. But, that was the biggest mistake I made. If I do as well on all my other exams this will be a triumphant first semester indeed.

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