If you’re looking for the best biomedical journals that have a presence on Twitter.com as well, here is a list that will help you find what you need.
*This blog post was originally published at ScienceRoll*
Ask almost any surgeon and he will tell you your chances of surviving a catastrophe are inversely proportional to your usefulness to society. This sentiment is expressed in different ways by different surgeons but the basic message is the same. If two people come in with exactly the same injuries and one is a teacher who spends his extra time in community upliftment projects and the other is an armed robber, the armed robber will sail through treatment and be back on the streets in no time, but the teacher will slowly waste away in ICU and finally die. Unfortunately it seems to be true.
There was a super clever cardiologist friend of mine who speculated as to why this was the case. He basically divided people into two groups, those with over active immune systems and those with just the basic immune system. The first group would tend to be allergic to everything and be over protected by their mothers. They would tend to grow up in a protected environment devoting their time to inside activities (safe from the dangers of the outside world, including grass and pollen and dog hairs and the like) reading and bettering themselves. The latter group would be immunologically free to run around like wild things doing whatever they liked.
He then extrapolated this to the likelihood that the first group possibly had a higher chance of developing SIRS (systemic inflammatory response syndrome) after major trauma and it was in fact their own immunity’s overreaction that finally brought them down. Amazingly enough this theory is based on logical scientific thought.
Like all surgeons I too tend to think that the good guy will probably die and the bad guy will survive. I have seen it too often. But unlike my boffin cardiology friend I think it is just some sort of evil cosmic reverse karma that is out to destroy all good people in this world. This makes much more sense to me than actually trying to understand immunology. And that is why I try to do at least one bad thing a day so that if something does befall me I at least have a chance of surviving. But there are always limits.
A few years ago our hospital organised a weekend away for all the doctors and their families. It was at a really nice lodge here in the Lowveld and truth be told, it was great. The days were pretty much spent lounging around the pool. That is of course if you didn’t play golf. I don’t play golf.
Anyway, there I was producing vitamin D for all I was worth when I glanced over at the pool. One of the other doctors had a small boy of about 4 years old that had been running around all day like a mad thing. But at that moment, as I looked at him leaning over the edge of the pool he toppled in. I was about 10 meters away so I first looked to see who was closer that would respond. No one moved. No one had seen him fall in except me.
Then everything went into slow motion. I could see that he could clearly not swim. His eyes were wide open as his arms an legs flayed about helplessly not bringing his head any closer to the surface. He was clearly in trouble. Then a strange thought went through my mind based on my above mentioned philosophy.
“If I leave him, that is bad enough that I will probably live forever.”
Who actually wants to live forever?
So I rushed over and pulled the kid out.
His mother seemed pleased.
*This blog post was originally published at other things amanzi*
With healthcare costs spiraling out of control, and major rationing efforts under consideration – can we really afford to allow purveyors of pseudoscience to use up scarce Medicare/Medicaid resources? It’s hard to imagine that Obama’s administration would approve of extending “health professional” status to people with an online degree and a belief in magic – but a new amendment would allow just that. What happened to our “restoring science to its rightful place” and why are we emphasizing comparative effectiveness research if we will use tax dollars to pay for things that are known to be ineffective?
I hope someone reads and removes this amendment pronto (h/t to David Gorski at Science Based Medicine):
Here’s the language that Sen. Harkin has slipped into the 615 page Senate version of the health care reform bill:
HEALTH PROFESSIONALS.—The term “health professionals” includes—
(A) dentists, dental hygienists, primary 25 care providers, specialty physicians, nurses, nurse practitioners, physician assistants, psychologists and other behavioral and mental health professionals, social workers, physical therapists, public health professionals, clinical pharmacists, allied health professionals, chiropractors, community health workers, school nurses, certified nurse midwives, podiatrists, licensed complementary and alternative medicine providers, and integrative health practitioners;
Background Reading:
What Do Chiropractors Believe?
Come on Shadowfax, you’re blogging about this stuff and you stand to make A TON of money if it goes through…for awhile…until insurance companies decrease your compensation since you’re making more per patient. I know you mentioned this before in like a comment or something, but ER docs stand to benefit (temporarily) probably more than anyone else. HUGE bias on your part.
Much as I (really, really) hate to admit it, she’s absolutely right. In fact, I’ll go one further: I first got interested in this part of medicine policy because I was mad that I was seeing all these uninsured patients and wasn’t getting paid a thing for my efforts. I started keeping track of the number of uninsured I saw every day, just as a pet obsession. It was a sobering number. After that I started getting a little perspective, talking to patients and seeing their bigger picture, understanding why they were uninsured, learning the particular challenges they faced getting health care, etc. For me, this cause became something beyond the personal a long time ago and became a moral imperative.
But K is right to note the potential for bias, and it’s fair for me to acknowledge it. I hope that my integrity on this point is evident. The fact that I argued in the New York Times for an increase in primary care compensation, with an attendant decrease in the compensation of specialists, including Emergency Medicine, should speak well for my ability to see beyond personal self-interest. (God knows it didn’t make me popular in EM circles!)
This is something which struck me yesterday, reading the med blogs reaction to Obama’s presser. Quite a few docs mounted their high horse and with great indignation denounced this:
Doctors are forced to make decisions based on a fee payment schedule that’s out there. So they’re looking… if you come in with a sore throat or your child comes in with a sore throat, has repeated sore throats, a doctor may look at the reimbursement system and say to himself, “I’d make a lot more money if I took this kids tonsils out.” Now that might be the right thing to do, but I’d rather have that doctor making those decisions based on whether you need your kids tonsils out…
Now it’s a clumsy clinical scenario written by someone who has no clue about medicine. But it’s a damned fair point. Bias comes writ large, as in the Walter Reed orthopod who pocket $850K and falsified his research to benefit Medtronic, and it comes writ small, as in the ER doc who sees a small lac and has to decide whether to use a band-aid or a stitch, knowing that the stitches will pay 10x more. It comes with the cardiologist who has to decide whether to take a low-grade troponin leak to the cath lab. It comes with the surgeon seeing a patient with unusual abdominal pain and a slightly enlarged appendix on CT (you can observe or just take out the appy; guess which pays more).
Whether there’s a “fix” for that in the current reforms is debatable. It harms our standing, however, to deny the possible existence of bias and to claim a moral purity that, as a profession, is not justified. I think and hope that most of us in these ambiguous situations are able to come to the right decision for the patient the vast majority of the time regardless of our economic interests. The best way to remain credible is to acknowledge the mere potential for bias and move on and debate the salient point. Making counter-factual arguments that biases do not exist or that we physicians are too awesomely altruistic to ever be influenced by them does nobody any good.
*This blog post was originally published at Movin' Meat*
Orthorexia is a term coined by Dr. Steven Bratman. “Ortho” simply means straight or correct, while “orexia” refers to appetite. Orthorexia nervosa refers to a nervous obsession with eating proper foods. While anorexia nervosa is an obsession with the quantity, orthorexia is an obsession with the quality of the food consumed.
Given how heavy people seem to be getting in our country, focusing on health should not be a bad thing. However, while it is normal for people to change what they eat to improve their health, treat an illness, or lose weight, orthorectics may take the concern too far. While it is normal for people switching diets to be concerned with what types of food they are eating, this concern should quickly decrease, as the diet becomes normal. Orthorexia, in contrast, is when a person is consumed with what types of food they are allowed to eat and feel badly about their selves if they fail to stick with their regimen.
People suffering with this obsession about what they eat may find themselves:
• Spending more than three hours a day thinking about healthy food.
• Planning tomorrow’s menu today.
• Feeling virtuous about what they eat, but not enjoying it much.
• Continually limiting the number of foods they eat.
• Experiencing a reduced quality of life or social isolation (because their diet makes it difficult for them to eat anywhere but at home).
• Feeling critical of others who do not eat as well they do.
• Skipping foods they once enjoyed to eat the “right’ foods.
• Feeling guilt or self-loathing when they stray from their diet.
• Feeling in “total” control when they eat the correct diet.
Often orthorectics will “punish” themselves by doing a penance of some sort, if this “fall from grace” does occur. While orthorexia nervosa isn’t yet a formal medical condition, many professionals do feel that it does explain an important health phenomenon. If you or someone you know suffers from something that sounds or feels like this description of orthorexia nervosa, you should go visit either a nutritionist or doctor.
References
1) Bratman, Steve. “Health Food Junkie–Orthorexia Nervosa, the New Eating Disorder.” 1997.
2) Billings, Tom. “Clarifying Orthorexia: Obsession with Dietary Purity as an Eating Disorder.” 1997
3) Davis, Jeanie. “Orthorexia: Good Diets Gone Bad.” November, 2000.
4) Fugh-Berman, Adriane. “Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating–A Book Review.” May 2001.
5) Dennis, Tamie. “Booster Shots.” Los Angeles Times, 7/09
Photo credit: Meg and Rahul
This post, The Newest Eating Disorder: Orthorexia Nervosa, was originally published on Healthine.com by Nancy Brown, Ph.D..
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