February 7th, 2007 by Dr. Val Jones in Opinion
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As I read the opinion piece in the New York Times about fertility clinics that permit parents to choose the sex of their baby before pregnancy, I was suddenly aware that I had strong feelings about this. As I tried to analyze my indignation, I realized that my emotions came from a place beyond mere reason.
Although technically, this issue could be reduced to a matter of sperm sorting – we all know it’s much more than that. Choosing the sex of your unborn child wanders into an unexplainably uncomfortable territory – swirling unconscious feelings about the value of human life, sexual equality, and the pain of sexism that many have experienced. We have heard the horrible stories about female babies being selectively aborted, or left to die in the elements in India and China, and we wonder if choosing the sex of a baby is somehow part of the same phenomenon.
Why should it matter which sex the baby is? Why is “family balance” cited as a reason to sex select? Perhaps the balance comes from the makeup of the individual personalities in a family, or maybe from parents who plan for the right number of children, not the gender of them.
Personally, I cannot support the practice of sex selection for anything other than sex-linked genetic disease prevention (and even this makes me feel a little uncomfortable, frankly).
I’m curious to know if men and women are equally disturbed by the practice of sex selection… What do you think?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 5th, 2007 by Dr. Val Jones in News
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Makes being a nurse in the US seem like a cake walk, right?
“The son of Libyan leader Moammar Gadaffi said five Bulgarian nurses and a Palestinian doctor condemned to death by a Libyan court had received unjust verdicts and that they would not be executed, a Bulgarian newspaper reported on Monday.
A Libyan court last month convicted the five Bulgarian nurses and a Palestinian doctor of intentionally infecting more than 400 Libyan children with HIV, despite scientific evidence that the youngsters had the virus before the medical workers arrived in Libya. It sentenced all the medical personnel to death.
‘The original files were manipulated and there were many mistakes, but it was the fault of the police officers and investigators who handled the case at the initial stage.’”
As I was thinking about how these relief workers were “ambushed” I imagined that the parents of the HIV positive children were looking for a scapegoat – there is a lot of stigma associated with HIV, and in a country where mere finger pointing can result in the death penalty… taking care of those infected with the virus can be more deadly than the virus itself.
The article also hinted that if it weren’t for the Bulgarian embassy publicizing the unjust executions, they would have occurred without a second thought.
Let’s hear it for the healthcare workers out there who put their lives in harms way to treat the innocent and helpless. Do you know of other examples?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 4th, 2007 by Dr. Val Jones in News
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Gone are the days of Beaver Cleaver – and apparently the days of Mickey & Minnie mouse are numbered as well.
In this new study, humans give LSD to the little rodents:
“Of course, we don’t know what the mice experience when they are treated with these drugs,” Sealfon said. “But we do know that there is a head twitch response in the mice that provides a good correlation with drugs that are known to be hallucinogenic in humans.”
So um… why are we doing this?
The Onion spoofed animal research very nicely, picturing an obesity study lab rat nestled among snickers bars and M&Ms.
And in another recent study, we gave mad cow disease to our furry friends:
“As expected… at 9 weeks of age they developed sponginess in the brain tissue, all the mice developed behavior and memory problems, for example they stopped burrowing.”
Hey, I have an idea for a new study – let’s see what mice infected with mad cow disease do if we also give them LSD?
I feel a bit sad for the tiny critters, don’t you?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 3rd, 2007 by Dr. Val Jones in Opinion
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A member of our editorial team kindly brought me some blog fodder last week – a recent article from the New Yorker. It was an inflammatory piece, describing four types of errors that doctors make in diagnosing patients:
- Representativeness error – when a physician fails to consider diagnoses that contradict their mental templates of a disease. E.g. thin, fit, young male with chest pain – unlikely to have heart attack, but did have one.
- Availability error – the tendency to judge the likelihood of an event by the ease with which relevant examples come to mind. E.g. a patient coming to the ER in the middle of a flu epidemic, with flu-like symptoms was diagnosed with flu but actually had aspirin poisoning.
- Confirmation bias – confirming what one expects to find by selectively accepting or ignoring information. E.g. “sub-clinical pneumonia” diagnosis given even though lungs are clear.
- Affective error – the tendency to make decisions based on what physicians wish were true. E.g. nice young patient has mild fever – physician presumes it’s a typical post-op fever rather than early sepsis.
Although these biases (I wouldn’t really call them “errors”) are indeed real, I thought the author went a little too far, finishing his article with a scathing quote from a Canadian physician:
“The implicit assumption in medicine is that we know how to think. But we don’t.”
Ouch.
I have mixed feelings about this – for as many examples they can think of that demonstrate how physicians got the wrong diagnosis, I can also think of examples of physicians getting the right diagnosis against all odds.
Consider the middle aged woman who came to the ER with a headache – one sharp physician had a “gut feeling” that this headache was not typical, and resisted the protocol to do a head CT to rule out a sub-arachnoid hemorrhage and send her home. Instead he got blood tests that revealed the underlying diagnosis: advanced leukemia. Her blood was so thick with dividing leukemia cells that it was causing her to have a headache. She underwent immediate dialysis and survived what could have killed her.
Or what about the man who complained of chronic sinusitis? Instead of giving him an antibiotic with outpatient follow up, one physician took a detailed history and realized that this man had been having sinus pain since a recent fall from a ladder (while using a nail gun) at a construction site. The doc got a head X-ray and found a nail lodged in his sinus! During the fall the nail gun had shot a nail into the corner of his eye, leaving no entrance wound. Because of the jarring nature of the fall, the man didn’t even realize he had been shot. The man had an ENT surgeon remove the nail, and she also cleaned out what could have become a life threatening abscess.
The truth is that doctors (like anyone else) are vulnerable to making false assumptions about people – and that we would all benefit from using a software program that would automatically generate a large differential diagnosis to consider each time we see a patient (just to keep other possibilities in the forefront of our minds). However, if you ask patients if they’d rather be treated by a machine or a human being – I’m sure the majority would choose the latter. I think we can all agree that instinct and judgment still have value in this information age. The trick is to marry accurate information with good instincts without ordering every single test in the book to rule out rare diagnoses on everyone! That’s a tough balance to achieve.
Do you know of any examples of a physician making an unexpected diagnosis based on gut instincts? I’d love to hear about it.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 1st, 2007 by Dr. Val Jones in Opinion, True Stories
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My dad is 76 years old. He takes one baby aspirin a day and has no medical conditions. He looks about 10 years younger than his age, and his mind is sharp and clear. How does he do it?
I think the secret is the time he spent working on a farm. At age 40 he retired from his consulting firm in Manhattan and bought some land in rural Canada. Without realizing what he was getting himself into, my dad bought some cattle to work the farm. When winter came he had to keep the animals in the barn, and he soon discovered that each steer and cow produced its own weight in manure every 2 weeks (that’s about a half ton for those of you city slickers out there). So all winter long my dad shoveled manure. He did this for 35 years.
My dad now keeps fit with regular sit ups and push ups in the morning and long walks every day. But to me, the secret to his success was the shoveling. Life is full of little ironies – sometimes “crappy work” can result in amazing health benefits.
Although the New York Times wrote a fairly scathing review of my mom’s book about their adventures in shoveling (which ultimately led to a yogurt business) – I think my dad got the last laugh. Healthy and well, he can look forward to a long and enjoyable retirement. I wonder if the folks in Manhattan (who choose to spend their lives shoveling a less physically challenging BS) can say the same?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
