Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Bodily Organs: Which One Is The Most Important And Why?

My medical student has apparently had a discussion with his classmates regarding which is the most important organ in the body. Is it the heart? The lungs? The kidneys? What do you think?

My medical student thinks it’s the kidney because of the complicated functions it must perform. I think it’s the skin because it holds everything together and keeps our economy going. What do you think? What is the most important organ in the body and why?

*This blog post was originally published at The Happy Hospitalist*

Which Five Drugs Would You Take On A Remote Desert Island?

This post follows a lengthy conversation I had with my wife, a physician-scientist, about this very topic.

Many of you who attended the ScienceOnline2010 conference here last January probably met Carmen Drahl, the Princeton-trained chemist who now writes for Chemical & Engineering News and their appropriately-named drug discovery blog, The Haystack, as well as their Newscripts feature.

For the latter, Dr. Drahl pointed us toward a recent “Crosstalks” paper in Chemistry & Biology by Thomas U. Mayer and Andreas Marx of the University of Konstanz (and her interview with the authors) who mused as follows from their abstract:

Which five molecules would you take to a remote island? If you imagine yourself as a castaway on an island you might pick water, glucose, penicillin, and ethanol in combination with aspirin. However, as a scientist, you may ask yourself which molecules impressed you most by their chemical or biological property, their impact on science, or the ingenuity and/or serendipity behind their discovery. Here, we present our personal short list comprising FK506, colchicine, imatinib, Quimi-Hib, and cidofovir. Obviously, our selection is highly subjective and, therefore, we apologize up front to our colleagues for not mentioning their favorite compounds.

The authors pose two different questions: a) Which molecules, drug or not, would you take as the sole occupant of a desert island? and b) Which drugs most impress you with their chemistry, biology, or impact on science? Read more »

*This blog post was originally published at Terra Sigillata*

Clothing Made Of Bacteria: Would You Wear It?

A British research project called BioCouture is working on clothing made out of bacterial cellulose that was grown in a hacked-together bioreactor.

As Gizmodo notes, it’s not clear what the point of the project is, seeing how we already grow cotton in a pretty efficient manner, but we kind of like the concept nevertheless. It’s sure to be a hit in biology labs everywhere.

See more pictures here: BioCouture…

*This blog post was originally published at Medgadget*

Inside The NIH Grant Review Process

The National Institutes of Health (NIH) is the world’s biggest sponsor of research in the life sciences. Today’s biologists, clinical researchers, and many others rely on the NIH for their funding.

To help people better understand how the peer review process happens within the NIH, the agency’s Center for Scientific Review created the following video that includes samples of research being openly discussed by a number of scientists:

Click here to view another video of tips for NIH grant applicants.

*This blog post was originally published at Medgadget*

Low-Dose Naltrexone: Medical Revolution Or Pseudoscience?

On SBM we have documented the many and various ways that science is abused in the pursuit of health (or making money from those who are pursuing health). One such method is to take a new, but reasonable, scientific hypothesis and run with it, long past the current state of the evidence. We see this with the many bogus stem cell therapy clinics that are popping up in parts of the world with lax regulation.

This type of medical pseudoscience is particularly challenging to deal with, because there is a scientific paper trail that seems to support many of the claims of proponents. The claims themselves may have significant plausibility, and parts of the claims may in fact be true. Efforts to educate the public about such treatments are frustrated by the mainstream media’s lazy tendency to discuss every study as if it were the definitive last word on a topic, and to site individual experts as if they represent the consensus of scientific opinion.

Recent claims made for low-dose naltrexone (LDN) fit nicely into this model –- a medical intervention with interesting research, but in a preliminary phase that does not justify clinical use. And yet proponents talk about it as if it’s a medical revolution. Read more »

*This blog post was originally published at Science-Based Medicine*

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »