Ed’s corner of the web

Let me set the record straight first: I’m a huge NPR fan.  I think I first got hooked around 9/11, and I’ve been an avid listener ever since.  Of the six preset stations on the car radio, the other five combined don’t get half as much playtime as NPR, which in my neck of the woods is 90.9 WBUR.  I enjoy the high-quality reporting, the engaging interviews, and even the fun weekend shows like Wait Wait Don’t Tell Me.  I enjoy the whole affair so much that a couple years ago, I felt bad being a freeloader and started making yearly contributions.  And beyond simple enjoyment, I also find myself learning a lot from listening.  It’s become a significant and trusted source of information for me.

You can imagine my consternation, then, when a couple weeks ago my morning commute with WBUR was interrupted by an ad for a company providing ”detoxifying” services with “ionic energy fields”, oxygen supplementation, and nutrient supplementation.  I won’t give the name here for fear of upping the company’s notoriety somehow.  It was a rude, jarring, pseudoscientific intrusion into what was typically a very informative drive.  How could WBUR advertise this crap?  I knew they needed sponsors, as any public radio station does, but surely this was bending too low.

I almost blogged about my dismay that day, but work soon had me running around enough to forget that morning’s insult.  My wedding and honeymoon came and went shortly thereafter, and I returned to my happy NPR listening habits, past injuries forgotten.

Until today.

I’m driving up Route 2 towards Concord, enjoying ”Only a Game”.  The usual WBUR sponsor bit comes on, but this time instead of Landry and Arcari or the MFA, the nice female radio voice spits out the name of a school of homeopathy!  Let me say that again - homeopathy.  You have got to be kidding me.  What’s next - sponsorship from a Boston psychics organization?  Noni juice manufacturers?  WBUR already broadcasts Science Friday.  Maybe they should add Woo Wednesday to attract more sponsors.

So I’m calling out WBUR on this one, and I hope others do, as well.  And remember, WBUR, it’s only because I love you.  I know public radio money is not exactly overflowing, but there have to be some standards on who it’s ok to take money from.  Those who make their living duping their customers with potentially harmful pseudoscience should not be given the opportunity to spread their message on stations such as WBUR, stations that exist to educate and provide information.

In preparation for our honeymoon trip to Australia, Carisa wanted to get me scuba-certified. I admit to having been a little apprehensive about the whole thing, as I am - at best - a poor swimmer. Still, I’m a confident and strong snorkeler, and scuba seemed the next step if I was going to scratch my underwater photography itch. So, we did our course work and pool work through Mass Diving (highly recommended), and we booked a trip to Turks and Caicos to do our checkout dives.

Our destination in Turks and Caicos was Salt Cay (pronounced “key”), a remote little blip of an island measuring about 2 miles long and having a little over 60 year-round inhabitants. To get there, we flew from Boston to Miami, then Miami to Providenciales, then Providenciales to Grand Turk, and then finally Grand Turk to Salt Cay. If you can imagine in your mind a quiet, tropical backwater where time and worries blow away on gentle ocean breezes, then you pretty much have a good idea of what this place is all about. Well that and really great diving.

Can you believe it? Me!

Of course, having only dove in a YMCA pool prior to this, I didn’t have much to compare it to. But still, I thought it was really great regardless, and Carisa - who has a little experience diving elsewhere - also gave it high marks.

The birding was fun, too, as you can see from the rest of the photo library. But I think coolest of all (along with the diving) were the people on the island. Comprising a mixture of native Belongers, immigrants from other Caribbean countries, and ex-pats from the States and the UK, the unifying traits among the island’s inhabitants were openness and friendliness. Everyone waves at everyone as they pass. People stop and chat with complete strangers. Even the dogs are super friendly.

We also ate surprisingly well for being so far off the beaten path. Special thanks here go to Porter Williams and Miss Nettie.

So bottom line is we had a truly wonderful and restful time while we were there. We felt like we had slipped a little off the map and out of the normal flow of time. It was a very nice feeling.

After an almost two-month hiatus, I’m taking another plunge with the blog.  I’ll admit, I was this close to giving up on it entirely.  It wasn’t the writing requirements, it was the incessant blog spam.  Tramadol.  Soma.  Phentermine.  It got to be too much to keep up with in late March/early April, so I stopped blogging entirely to see if anything changed.  The spam still kept flowing into my moderation list for a couple weeks, but then it seemed to taper off a bit.  A couple days ago, I returned from being out of the country for two weeks (more on that later), and what am I greeted by but - amazingly - no additional spam!  So I have a little hope now that maybe this little blog has fallen off the radar of the zombie comment spam engines.  Anyone know how to avoid this crap?  I enjoy blogging and would like to continue doing it, but if it means sifting daily through the mountain of spam I was getting before, then I honestly won’t be able to justify the time.  So anyway, here goes again…

For all of the ridiculousness that seems to happen in Massachusetts (stupid bomb scares, gorillas on the loose, the Big Dig, Mitt Romney, I do like to think that we’re ahead of the curve overall. So I was pleased to read that our state legislature was seeking to ban gifts to doctors.

Coming up through the ranks, it was easy to see the pervasiveness of drug company marketing in the form of gifts and freebies. Pens, notepads, microfiber lens cloths, and the occasional pocket guide were just the tip of the iceberg. The “Cipro breakfast” was well known among the medical students as a good place for a nice free meal. Drug-sponsored lunch conferences were always popular, and the exalted drug dinner, which we were rarely privy to as mere medical students, was sought after highly. Luckily, the idea that accepting these sort of inducements was, at best, ethically iffy and, at worst, altering our medical decision-making was filtering up through the medical school and medical staff. The behavior, if not frowned upon sternly, was at least questioned.

Unfortunately, here I am almost ten years later watching the same conflict play out. We already have a strong inkling that pharmaceutical company contact with physicians changes prescribing practices. Indeed, one would hardly expect the pharmaceutical companies to continue pursuing this expensive tactic if it didn’t work. Yet still we allow them easy access to medical students (this thread is disturbing to me), residents, and physicians through free meals, freebie items, drug samples, sponsored CME, and other such means. And even if you don’t believe a simple logo pen could affect someone’s medical practice, you have to admit it looks really fishy to a patient when you sign a prescription for them using a pen with the same drug’s logo on it. It’s just a bad idea medically and ethically.

So I, for one, will cheer on Therese Murray’s efforts in this regard, and I support other states’ efforts with similar measures. If you, as a physician, would rather not see the government stepping in in this way, then alter your actions so they don’t see the need to step in. As a practicing physician, I’ve tried hard to refuse any and all gifts or inducements from drug companies, even pens. I’m such a bastard that when I cover for another doc’s primary care practice, I won’t even sign for the practice’s drug samples. (And it even turns out that free drug samples aren’t the safety net we like to believe they are.) I think if everyone moves in a similar fashion to stem the tide of these inducements, the end result may very well be the better practice of medicine - based on the best scientific evidence, not on what ad we last saw - and possibly more cost-efficient medicine as we forego the latest shiny name brand drug for the generic that works just as well.

I blogged about this story when it first came up back in August.  I knew it was going to be bad news, and sure enough, it is.  Now the surgeon is facing criminal charges - three felony counts, at that.  Dependent adult abuse, administering a harmful substance, and unlawful controlled substance prescription are the criminal counts, and on top of that there’s the wrongful death suit from the mother.  While it seems pretty apparent that this surgeon crossed over some ethical boundaries, the weight of the criminal charges seems a little hefty to me.  I wish I knew more of the facts of the case.  Don’t get me wrong - the surgeon committed some rather egregious errors and should be firmly sanctioned for them, but I don’t think his overzealousness to help someone else should land him in prison.  Of course, the damage to the transplant community has been done and will likely only spread over the next couple years as this case plays out.  That is probably the biggest loss of all.

With all of today’s talk about ricin found in Las Vegas, I have to tell a little story. I remember first learning about ricin way back in Prof. Krieger’s 7.20 class (Human Physiology) in college. The class distinguished itself from most other biology-major fare by being immediately and directly applicable to real life. The mention of ricin, however, was especially memorable to me because it was mentioned in the setting of the Bulgarian umbrella murder. It wasn’t a particularly positive use of biology, but I was pretty impressed. Espionage! Assassination! Secret spy gadgets! All made possible with science. If I remember correctly, one single molecule of ricin was capable of killing a human cell. That’ll make you pay attention.

I knew that there was a lunar eclipse that was supposed to happen, but I wasn’t sure I’d be able to see it from my Boston apartment. Still, when 10 pm rolled around, I walked outside, looked straight up, and was pleasantly surprised to see this:

I ran upstairs, grabbed my camera, and grabbed a few shots.  I had only seen one lunar eclipse previously, one summer night many years ago when I lived in Michigan.  I was excited to see one again.  I even dragged Carisa downstairs in her pajamas to see it, and she appreciated the sight nonetheless.  Astronomical events like this make me want to get a place out in the boonies and shoot cool pictures of the sky all night.  Maybe someday.

Every now and then I’m asked to cover a local solo pediatrics practice for a day or two. As a hospitalist, I have to dust off my primary care cap before I go in. I have to admit, I find it challenging. I deal with sick - sometimes very sick - kids on a daily basis as a hospitalist. While the kids aren’t (usually) as sick in primary care clinic, the pace is unrelenting. I barely have time to think before I have to run and see the next patient double-booked into a 15-minute slot. Fortunately, there is often not a ton of thinking involved, as a primary care pediatrics practice in winter involves a lot of runny noses and earaches. For those patients that require a little more thought than a simple cold, though, the stress level amps up. At least as a hospitalist I can pause between patients to look up an article or refresh my memory about a drug dose. In primary care clinic, I’m backed up 45 minutes and 6 patients if I so much as stop to pee. The challenge, then, becomes one of providing good, thoughtful, compassionate care in a time-limited setting.  Some days I do better than others.  I know I couldn’t do it for a career, but that makes me appreciate all the more those that do.  So to all you overworked, frazzled, brilliant primary care pediatricians out there, I tip my hat to all of you.

Man - I was doing so well, too.

A not insignificant portion of my pediatric practice is doing small procedures - blood draws, IV’s, lumbar punctures, etc.  Some of these - like lumbar puctures - go straight to me, while more routine procedures like blood draws usually go through nursing first.  Only when nursing has had their shot does the buck get passed to me.  Recently I had been on a bit of a roll with these little procedures.  It had been a long time since I hadn’t been able to get an IV, and my lumbar punctures had been single-shot affairs going way back.  Now I knew intellectually that this was just the vagaries of chance and probability, and that this streak would all come screeching to a halt soon.  But I was proud of myself nevertheless, and I allowed myself the luxury of enjoying the streak.  Just like the basket seems bigger to a shooter who’s on a roll, those little baby veins looked like huge pipes, and I almost felt I could do an LP blindfolded.

Then last week I flub two shots at what should have been a not particularly difficult IV.  Then on my last shift I get nothing but blood on three attempts at an LP.  Damn damn damn.  I feel like I’m an intern again.  Just like the basketball player, I know intellectually that I have to keep on shooting for the slump to pass, but I’d be lying if I said that those last procedures wouldn’t be on my mind when I’m doing my next ones.

I kicked off this wedding season with the nuptials of Tom Alexander and Laura Crotty this last weekend (which also prevented my blogging). I say wedding season because from now until August, I have a total of five weddings to attend, including my own. Crazy.

Tom and Laura are friends of mine from med school. Tom’s finishing up an ENT residency out in UCSD, and Laura recently ditched us here in Boston (sniff!) to be with Tom and finish her pulmonary fellowship on the west coast. Several other Dukies were invited to the wedding, not to mention a couple who were even in the wedding party, so I was looking forward to the weekend a lot.

The weekend did not disappoint. The festivities were all in La Jolla, which I had not had the pleasure of visiting before. Our little reunion group had a great time strolling the city, walking at the water’s edge, and trying out a few of the numerous restaurants. Tom and Laura had also been considerate enough to keep everything very localized; Carisa and I were able to get a room right in town and walk to both the wedding and the reception.

The wedding took place in Cuvier Park, right overlooking the ocean.

It being a public park, we attracted quite the peanut gallery.

I just like this photo.

See the rest of my meager photos here.

The ceremony location was beautiful, the bride and groom looked great, and everyone had a wonderful time at the reception. It was a great wedding. Congrats to Tom and Laura, best of luck for all your years ahead, and we look forward to seeing you again soon.