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Quote Of The Day: An Observation From Emergency Medicine

Dogs, as a general rule, do not like to be kissed on the mouth by drunk people. 

Edwin Leap, MD

h/t to Grunt Doc .

Unexpected Consequences: Wyeth Law Suit Could Limit Patient Access To Medications

Photo of Bert Rein

Bert Rein

On November 3, 2008 the US Supreme Court will hear opening arguments in the Wyeth vs. Levine case. This highly publicized lawsuit has been discussed by the New York Times and the Journal of the American Medical Association and will likely be the most important case during the upcoming Supreme Court term. However, neither source has fully explained the unexpected consequences to the consumer if Wyeth loses.

To get to the bottom of the issue, I interviewed Bert Rein, attorney for Wyeth. Bert has conducted interviews with NPR and the three major TV news networks. Please enjoy this exclusive podcast interview here at Getting Better with Dr. Val, or read my summary of our conversation below.

Dr.Val: Bert, please summarize for our listeners what has happened so far in the Wyeth vs. Levine case.

Rein: Ms. Levine is a guitarist who suffers from migraine headaches and associated nausea. One day she sought pain management therapy at a clinic in northeast Vermont – the same clinic where she regularly received care.  They elected to treat her with a combination of demerol (for pain) and phenergan (for nausea). They delivered the drugs intramuscularly, but several hours later Ms. Levine returned, complaining of an unrelieved migraine headache.

The clinic’s physician realized that the drugs would be more potent if they were injected intra-venously so he asked the PA (physician assistant) to give another dose of the drugs through Ms. Levine’s vein. Unfortunately, the PA inserted a butterfly needle (rather than the usual heplock for an IV) into what she thought was Ms. Levine’s vein, and delivered the phenergan into or near a punctured artery. Phenergan’s label clearly states that the drug can cause tissue necrosis if it comes in contact with arterial blood. Ms. Levine experienced a necrotic reaction to the medication which resulted in the eventual amputation of her arm. She sued the clinic for negligence and was awarded $700,000 dollars in a cash settlement.

Ms. Levine then brought a separate lawsuit against Wyeth, claiming that the phenergan label did not offer sufficient instructions about how to administer it safely, though the risks of necrosis from arterial blood exposure to phenergan are well known and labeled in capital letters as a warning on the drug’s label. Read more »

Hospital CEO, Paul Levy, Taking Heat For His Transparency

There is nothing concealed that will not be disclosed, or hidden that will not be made known.

– Mat 10:26

The Internet may be fueling the fulfillment of an ancient prophecy – that there will come a day when nothing can be kept hidden or secret. Of course, early adopters of full transparency are regarded as reckless by some (potentially those who have something to hide?) and laudable by others (though they may be afraid to follow suit). In today’s Boston Globe there is an article about my friend and fellow blogger, Paul Levy. Paul is the CEO of Beth Israel/Deaconess, leading the charge to make hospital errors a matter of public record.

Paul writes about the errors made at his hospital (and many other subjects) in his popular medical blog, Running A Hospital. The blog won the “Best Medical Blog of 2007” award, and he is the first (and perhaps only) hospital CEO that has adopted such a high view of transparency. And for that, I commend him.

In my experience, hospital errors are alarmingly common. Read more »

The Friday Funny: Doctors’ Handwriting

You may have seen this cartoon here before… but it did go for the highest bid (of the two I auctioned) at the National Press Club yesterday so I thought I’d make it this week’s Friday Funny. Enjoy!


A 32-Year-Old Had A Stroke: Could It Happen To You?

The Shermans

Deanna and Rebecca Sherman

As many as 15% of Americans have a blood disorder (called anti-phospholipid antibody syndrome – APS) that can increase their risk for blood clots and stroke. While these antibodies are especially common in people with certain auto-immune diseases like SLE (systemic lupus erethematosis – or “lupus”) quite a few people have them without ever knowing it. In fact, most people with APS remain asymptomatic their entire lives – but for an unlucky few, the disorder can cause devastating consequences.

I interviewed Rebecca Sherman about her recent stroke caused by APS. Listen to the podcast here.

Dr. Val: Tell me about the events leading up to your stroke.

Sherman: I was a young, healthy 32-year-old with no idea that I had anti-phospholipid antibodies in my blood. One morning when I was washing my face at my boyfriend’s house I suddenly noticed that one side of it was frozen. I was standing in front of the bathroom sink and I fell to the floor with the washcloth in my hand. I couldn’t walk or talk – the whole right side of my body didn’t do what I wanted it to do. So I threw the washcloth at my boyfriend’s head (with my left hand). Luckily my aim was good (he was asleep in bed) and the bed was near the door to the bathroom –  the cold, wet object caused him to jump out of bed and find me. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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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…

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Latest Cartoon

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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…

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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…

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