The Forecast

By Clay Bennett

Choose Your Own Adventure!

Click Below to see the image full size.
Which path best describes your situation.......?!

Promotional Spending for Prescription Drugs

Yesterday the Congressional Budget Office released a brief highlighting trends in promotional spending for prescription drugs and market characteristics that influence promotional strategies.

    The way that pharmaceutical manufacturers promote prescription drugs has changed significantly in the past decade. Up until the late 1990s, pharmaceutical manufacturers confined their marketing efforts largely to just doctors and other health care providers.
    In the late 1990s, the Food and Drug Administration changed its advertising guidelines and drugmakers then began marketing directly to consumers—a practice known as direct-to-consumer (DTC) advertising.
     Since then, the manufacturers of many prescription drugs have increased their purchases of air time on television and of advertising space in newspapers and magazines.
     This year, drug companies are no longer allowed to give out pens, notepads, refrigerator magnets (just kidding about the magnets...kinda...), or any other kind of product that promotes their drug.
    Many studies prove that that kind of "subliminal advertising" actually does persuade doctors to prescribe more of that particular drug, but I still say I wouldn't feel "guilted into" prescribing a drug just because I was given a free ink pen with that drug's name on it.
    So basically I've waited all these years to be a doctor and get free pens, and now they've outlawed it!


Today in History: The Iron Lung

On this day in 1928, an iron lung medical ventilator, designed by Philip Drinker and colleagues at Children's Hospital, Boston, was used for the first time in the treatment of polio victims.

The 2 min. video below talks about a woman who has had to rely on an iron lung for over 50 years, after catching polio as a little girl.

So, Mark, just what is an Iron Lung?
An iron lung is a machine that enables a person to breathe when normal muscle control has been lost or the work of breathing is too much for the person to handle.

OK. Well, what is Polio?
Polio, caused by the RNA virus named Poliovirus, first enters the body through the mouth, infects a person's bloodstream, and then sneaks into the central nervous system by getting into the spinal cord.
[Read more about Poliovirus pathophysiology]
When the virus enters the nervous system, it damages the nerves that control your body's muscles, and thus it causes rapid paralysis.
Overall, 5–10% of patients with paralytic polio die due to the paralysis of muscles used for breathing.

How did the iron lung help polio patients?
Now it all starts coming together! As you now know, polio can cause your breathing muscles to be paralyzed, which would quickly lead to death.
With the iron lung, the patient lies within a sealed chamber and provides an effective oscillating atmospheric pressure. The pressure inside the machine goes up and down, just like the muscles in your chest cause the pressure in your lungs to go up and down, causing you to breathe.







Poliovirus


Electron micrograph of poliovirus virions.



An Iron Lung Ward filled with Polio patients, Rancho Los Amigos Hospital, California (1953)

Much respect.

An AL deputy has his hand reattached at UAB Hospital after an arrest this past weekend....

http://bit.ly/Ml0vw

I can run into burning buildings, but there's no way I could be a cop.
I've got so much respect for those who serve and protect us.

“American Values” — A Smoke Screen in the Debate on Health Care Reform | Health Care Reform 2009

“American Values” — A Smoke Screen in the Debate on Health Care Reform | Health Care Reform 2009

Posted using ShareThis

Protect Our Insurance Companies

Insurance company CEOs have a right to THEIR American Dreams!


Featuring: Will Ferrell, Linda Cardellini, Jon Hamm, Olivia Wilde, Thomas Lennon, Robert Ben Garant, Masi Oka, Jordana Spiro, Donald Faison

Race

A frustrating article from the Miami Herald newspaper:

In the pre-dawn hours of last Nov. 5, while much of the nation celebrated Barack Obama's election as the nation's first black president, three white men in Springfield, Mass., doused the partially completed Macedonia Church of God in Christ with gasoline and burned it to the ground.

After their arrest, the men told police they had torched the black church because they were angry about Obama's election and feared minorities would be given more rights.

At about the same time, newspaper Web sites were filled with millions of hateful messages about Obama, and the computer servers of two large white supremacist groups, the Council of Conservative Citizens and Stormfront.org, crashed because they got so much traffic. 


Continue Reading..

This is why we're fat

This is perhaps man's greatest achievement, or evidence of our civilization's impending doom. Maybe it's both.
Meet the KFC "double down."




That's correct-- It's a bacon sandwich that uses fried chicken as "bread."
(Which, from a guy's point of view, sounds INCREDIBLE!)
As a future physician, however, I would have to say it's probably not a good idea to eat this very often.
Has anyone tried it yet?
Pictures below...











Seven Falsehoods About Health Care


From Newsweek.com

Power

    Wow. I knew it before, but this is the first time I've seen it with my own eyes. Insurance companies have so much power.Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells.
     A few weeks ago I went to the doctor for my yearly physical/checkup. They routinely drew some blood (standard practice to make sure everything is normal) and had it sent off to the hospital's lab to be processed.
     The cost for the lab technicians and/or the laboratory doctor to examine the blood smear and run other tests on it came out to be $55.
     Fifty five dollars. That's a very reasonable price to have multiple sets of eyes (and computers) look at my cells and perform other tests on my blood to make sure I'm in good health!
Blue Cross Blue Shield apparently disagrees.
     Check out the "Processed Insurance Claim Report" I received in the mail today from Blue Cross. It's simple, but suprising.
Right next to the hospital's requested $55 fee for the blood work (circled in blue below) is how much money Blue Cross told the hospital it would get paid instead: $12.10

Twelve dollars and ten cents!
So this gigantic corporation is able to smugly tell doctors/hospitals/lab technicians (aka "Providers") "Welllll, we think we'll just pay you twelve dollars for doing that work-- take it or leave it."

I'm pretty sure if I tried that at the Wal-Mart checkout the cashier would laugh at me. If I tried it at Zale's Diamonds I'd probably get arrested.
If I was an insurance company, I could get away with it.
     That's quite some power.

Make Something Cool Every Day

I found these daily entries by Olly Moss, who decided at the beginning of 2009 she would start the Make Something Cool Every Day (MSCED) project where she attempts to, well, make or do something cool .....you guessed it- every day.


2/28/09: the simpsons
2/28/09: the simpsons


3/01/09: burt and ernie making out while cookie monster watches
3/01/09: burt and ernie making out while cookie monster watches


3/2/09: the blue man group carving a pumpkin
3/2/09: the blue man group carving a pumpkin


3/3/09: kermit the frog about to walk across hot coals
3/3/09: kermit the frog about to walk across hot coals


3/4/09: papa smurf gets angry, turns into the hulk
3/4/09: papa smurf gets angry, turns into the hulk

Birthmarks and Skin markings


From an article on "Vascular Anomalies" (skin markings) that are usually present at birth:

Most vascular anomalies involve the skin, the largest organ of the body, and, therefore, are notable at birth. For centuries, vascular birthmarks (nevi) were referred to by colorful names derived from false traditional beliefs that a mother’s emotions or types of food she ate could "mark" the skin of her unborn fetus. Old medicals texts are dotted with references to brightly colored foods that best described the appearance of an unusual cutaneous lesion ("lesion"= any abnormal change in the body).Depending on the culture, the mother was blamed for eating too much or too little red fruit during her pregnancy. The modern use of such terms as ‘‘cherry,’’ ‘‘port wine stain,’’ and ‘‘strawberry’’ to describe various skin findings in a newborn can be referenced to that old belief.
From: Christison-Lagay ER -Surgical Clinics of North America - 01-APR-006



Strawberry NevusPort-Wine Stain

Week in Images

Rounding on patients in the pediatrics ward.



On Call

Tonight is my first "real" on-call night of my medical school career. I'm on the Pediatrics rotation for the next two months, and I have call every 5 days or so at the hospital.
I thought I'd let you follow me around...
(The next few posts might all be seperate ones until I can sit down another day this week and condense them all into one long "First On Call" post).

3 pm, Tuesday: Call officially begins.

4:34 pm: I'm told to head down to the Emergency Department to check on an 18 month old girl having asthma complications. When I get down there, she's already been given a breathing treatment and is looking much better! I interview the father (...by the way...I'm noticing a trend in Pediatrics that fathers often know FAR LESS about their babies than the mothers do!) who says he doesn't know how bad the girl was before the treatments because he just got to the ED to sit with the kid.
She seems to have improved a lot, but just to be cautious the Attending decides to admit the girl to our Pediatrics floor for overnight observation.

5:10 pm: Two hours into this and I'm already missing Heather, so I con her into meeting me for a quick dinner at Chipotle (cool website by the way).

5:40 pm: Back in the medical student lounge.

7 pm: A patient who has been in the hospital for 2 days because of Diabetic Ketoacidosis (due to lack of insulin production, which makes these kids have really, really high blood sugar) supposedly just ate dinner and now has a blood glucose of 430 mg/dL
That's really, really high.
[Normal should be anywhere from 80 to 120].
I go check on him and make sure he's not having any problems, and I explain to Mom that the high sugar is probably because he just ate dinner.
"I'll come back in a few hours to check on him again," I say, as I leave the room and head back upstairs.

9:08 pm: Headed to the newborn nursery to see if there are any new babies to examine and writeup.
Edit- no new babies.

10:33 pm: The OB/GYN resident informs me that they just delivered a baby. I'm headed down to the nursery to look over the chart and begin writing a Newborn Hospital Admission Note. Guidelines say that you should wait 4 hours to perform an exam on the baby, because their breathing, pulse, etc are still a bit crazy from the birthing process itself. If you wait about 4 hours, you'll be able to decide if the breathing, pulse, etc are normal or not.


12:30 am: Back in the student room. The new baby definitely has a working set of lungs. I wrote as much of the Admission Note as I could without examining the baby, and will go back down after 2am to do the physical exam and use the information gained from it to finish the Admission Note.
I guess it's time for a quick nap until then....

8am, Wednesday: Went to bed at 3am. Another baby was born at 3:05am. What luck. Now it's time to present my patients from last night to the Pediatric team at "Morning Rounds"






Went to bed at 3am. Another baby was born at 3:05am. What luck. Now it's time to present my patients from last night to the Pediatric team at "Morning Rounds"
12:30 am Back in the student room. The new baby definitely has a working set of lungs. I wrote as much of the Admission Note as I could without examining the baby, and will go back down after 2am to do the physical exam and use the information gained from it to finish the Admission Note.
I guess it's time for a quick nap until then....
9:08 pm Headed to the newborn nursery to see if there are any new babies to examine and writeup.
Edit- no new babies.

10:33 pm The OB/GYN resident informs me that they just delivered a baby. I'm headed down to the nursery to look over the chart and begin writing a Newborn Hospital Admission Note. Guidelines say that you should wait 4 hours to perform an exam on the baby, because their breathing, pulse, etc are still a bit crazy from the birthing process itself. If you wait about 4 hours, you'll be able to decide if the breathing, pulse, etc are normal or not.

On-Call

Tonight is my first "real" on-call night of my medical school career. I'm on the Pediatrics rotation for the next two months, and I have call every 5 days or so at the hospital.
I thought I'd let you follow me around...
(The next few posts might all be seperate ones until I can sit down another day this week and condense them all into one long "First On Call" post).

3 pm, Tuesday: Call officially begins.

4:34 pm: I'm told to head down to the Emergency Department to check on an 18 month old girl having asthma complications. When I get down there, she's already been given a breathing treatment and is looking much better! I interview the father (...by the way...I'm noticing a trend in Pediatrics that fathers often know FAR LESS about their babies than the mothers do!) who says he doesn't know how bad the girl was before the treatments because he just got to the ED to sit with the kid.
She seems to have improved a lot, but just to be cautious the Attending decides to admit the girl to our Pediatrics floor for overnight observation.

5:10 pm: Two hours into this and I'm already missing Heather, so I con her into meeting me for a quick dinner at Chipotle (cool website by the way).

5:40 pm: Back in the medical student lounge.

7 pm: A patient who has been in the hospital for 2 days because of Diabetic Ketoacidosis (due to lack of insulin production, which makes these kids have really, really high blood sugar) supposedly just ate dinner and now has a blood glucose of 430 mg/dL
That's really, really high.
[Normal should be anywhere from 80 to 120].
I go check on him and make sure he's not having any problems, and I explain to Mom that the high sugar is probably because he just ate dinner.
"I'll come back in a few hours to check on him again," I say, as I leave the room and head back upstairs.

9:08 pm: Headed to the newborn nursery to see if there are any new babies to examine and writeup.
Edit- no new babies.

10:33 pm: The OB/GYN resident informs me that they just delivered a baby. I'm headed down to the nursery to look over the chart and begin writing a Newborn Hospital Admission Note. Guidelines say that you should wait 4 hours to perform an exam on the baby, because their breathing, pulse, etc are still a bit crazy from the birthing process itself. If you wait about 4 hours, you'll be able to decide if the breathing, pulse, etc are normal or not.


12:30 am: Back in the student room. The new baby definitely has a working set of lungs. I wrote as much of the Admission Note as I could without examining the baby, and will go back down after 2am to do the physical exam and use the information gained from it to finish the Admission Note.
I guess it's time for a quick nap until then....

8am, Wednesday: Went to bed at 3am. Another baby was born at 3:05am. What luck. Now it's time to present my patients from last night to the Pediatric team at "Morning Rounds"






New Design

So with my last day of absolute freedom before I start a 2 month grueling rotation in Surgery, I decided to re-design things around here in preparation for posting all of the interesting cases and people I'll come across in the next few years.

On the right is a YouTube feed of whatever topic I set up. Right now it's showing the most relevant videos about "swine flu."
(Question: Video Bar- Keep it or Toss it?)

I've also added a calendar so you can follow along with what rotation (also called a "clerkship") I'm currently on.

What do you think about the new design? What would you change?

What would make you want to read a blog like this regularly?
What would make this blog better? (Be honest. I really am looking for constructive criticism here.)

Here's Something You May Not Have Known...

A baby born in the United States is more likely to die before its first birthday than a child born in almost any other developed country. Among developed nations, only Latvia has a higher death rate for newborns than the United States.


Find out more @ the National Public Health Week official website.

Learn about Public Health

National Public Health Week 2009

The best license plate on the road

Standing in line yesterday to renew my car registration (or "renew the tags" as I've always heard growing up) I spotted this gem of a license plate casually displayed with 30-or-so other specialty plates available for purchase.

I then decided that this is HANDS DOWN, *THE* MOST AMAZING LICENSE PLATE IN THE ENTIRE UNITED STATES.

After further research, The Wall Street Journal wrote a story in 2001 [note to self- why did it take you 8 years to find out about such a cool tag?!] about license plates across the US and briefly mentioned the "nuked veteran" tag:
"Alabama offers what has to be the single most bizarre plate on the road today, a tag that reads "Atomic Nuked Veteran." Those who would like to advertise this particular fact of their personal history must get a letter of verification from the Defense Nuclear Agency proving that they "were exposed to dangerous levels of radiation due to atomic bomb and weapons tested from 1946 to 1962."

Of note: Even though I think you should never, ever be given a traffic ticket if you are one of the few surviving people in this world with this plate, apparently you still have to follow all the rules. On top of that, you also have to pay a "...commemorative tag annual fee of $3.00 plus the normal tag and issuance fee and ad valorem taxes."

Couldn't someone have gotten that waived for these guys?!!?......

Unfortunately, The Answer Is "Yes..."

Let's Learn about Hemochromatosis!


I came across this fact while studying a few minutes ago and thought it was pretty cool. I knew about the disease already, but never knew about the airports!

"Hemochromatosis is a disease caused by the buildup of hemosiderin (iron) in the body.
In these patients, the Total Body Iron content may reach 50 grams.....
enough to set off metal detectors at airports."

Here is a really good link to the CDC's page about Hemochromatosis. It's not too technical, and it has some good information about getting tested for the disease (it runs in families) and how it's treated (treatment is phlebotomy-- the same procedure as when you donate blood).

Figure to the Right: Some crazy sketch I found on Google Images that made me laugh a little..

Figure Below: The main events in the causation of Hemochromatosis

Studying Begins...

Today marks the beginning of my official studying for USMLE Step 1.
I thought I would kick things off for everyone with just one simple concept to memorize for the test. This will get you one....maybe two...answers on the entire 8-hour-long exam.
Click on the image to view it in all its glory so you can see every wonderful enzyme.
Study hard--there will be a pop quiz tomorrow!

Clowns Eating Lunch

I ate lunch at Children's Hospital today and had to snap a quick camera pic of two bright-pink clowns that sat nearby.