Here is my newest favourite medical blog, NCBI ROFL where you will find the funniest peer-reviewed articles published day-by-day. Just e-mail them the PubMed link and your discovery could appear there. A few examples:
*This blog post was originally published at ScienceRoll*
DrRich’s valued colleague R. W. Donnell, who writes Notes From Dr. RW, has responded to a recent post in which DrRich bravely came out in favor of Comparative Effectiveness Research, even at the cost (DrRich asserted) of alienating the majority of the more conservative-leaning components of his readership.
Dr. RW, noting DrRich’s claim that conservatives have laid out a formal policy of opposition to CER, says:
“OK, stop. Where are these people, conservatives or those of any ilk, who have taken a position against CER? Dr. Rich cites groups who are skeptical and very concerned about the new political agenda for CER, not CER itself.”
Dr. RW is, of course, correct. Research that compares the relative effectiveness of medical procedures or treatments is not only inherently a very good thing, but also is a form of research that has a long and proud history. Healthcare would be an even more dire activity than it is today without the large body of research that guides physicians in making recommendations to their patients when more than one option is available. So yes, comparative effectiveness research is obviously a valuable and time-honored endeavor, and for anyone (conservatives or anyone else) to come out against it would be akin to coming out against babies, or bunnies. (Though, as one whose effort to grow vegetables has been severely challenged each year by a pride of aggressive rabbits, DrRich, as it happens, is indeed against bunnies.)
So, to reiterate, neither conservatives nor anyone else are really against comparative effectiveness research, just as Dr. RW asserts.
What they are against is Comparative Effectiveness Research. They are against a new government bureaucracy that sets the CER agenda, whose stated goal is to create a more efficient and less expensive healthcare system, and that will have the authority to determine what gets reimbursed and what doesn’t.
Dr. RW has made it plain that he is not confused about the following point, but many are: There is a difference between comparative effectiveness research (whose unambiguous goal is to compare the clinical effectiveness among different treatment options, so as to offer physicians objective guidance in making clinical decisions, and which is as unassailable as babies and bunnies), and Comparative Effectiveness Research (which is to be operated by a new government bureaucracy, whose agenda regarding what kind of effectiveness is actually to be compared is intentionally ambiguous).
The ambiguity of CER (as compared to cer) was made clear recently when Peter Orszag testified on behalf of the administration before the Senate Finance Committee. When queried by skeptical Republicans on the ultimate goal of the proposed CER board, Mr. Orszag was evasive. Specifically, when asked by Senator Kyle (R-Arizona) whether the CER board would be empowered to make decisions on which medical services will be reimbursed, Mr. Orszag finally replied, “Not at this point,” a reply which did not alleviate the suspicions of the minority party.
To state the ambiguity more plainly, it is clear that while the CER board will mainly be concerned about comparing “cost effectiveness” (which is the only way they can potentially achieve their main goal of reducing healthcare costs), the only kind of effectiveness they are willing to discuss publicly is “clinical effectiveness.”
This studied ambiguity allows proponents of the new government plan to paint opponents of the CER board as being against the “babies and bunnies” form of comparative effectiveness research, and thus reveal those nay-sayers as being beneath contempt, unworthy of anyone’s attention. Meanwhile they will be free to advance their real “cost effectiveness” agenda.
DrRich agrees with conservatives that this kind of deceptive ambiguity is indeed contemptible. But really, it is no more contemptible than the thousands of other forms of covert healthcare rationing we see all around us. (Covert rationing inherently relies on ambiguity – saying we’re doing one thing while all the time we’re doing another.)
Having tried to clarify this distinction between cer and CER, DrRich will now repeat that his prior post was not merely to express support for the “babies and bunnies” variety. As Dr. RW points out, everybody is in favor of that kind of comparative effectiveness research.
Rather – and this is where he further jeopardizes his continued tolerance by his conservative readers – DrRich is offering his support to the other kind of CER, the kind described in the stimulus bill, which (though the administration will not say it publicly) will undoubtedly use comparative effectiveness research to perform cost effectiveness calculations, then coerce physicians, through one form of federal subterfuge and intimidation or another, to employ the least expensive therapies. The government bureaucrats, just as they are doing today but with less muscle, will shout “quality” while enforcing “cost.”
DrRich supports this kind of CER not because it is a good thing – it decidedly is not. He supports it because here is a form of covert rationing that will at last effect everyone, and will be so blatant that after a time even us Americans will no longer be able to ignore it, try as we might. DrRich believes that relatively soon, we would notice that here is a cadre of unelected bureaucrats rationing our healthcare – determining which of us lives and dies – through some opaque process, and lying to us about it the whole time. He believes this to be the pathway most likely to get the American people to finally face the fact of healthcare rationing, and to goad them into an open debate on the best and least harmful way to accomplish it.
Go ahead. Call him a cock-eyed optimist.
*This blog post was originally published at The Covert Rationing Blog*
Triumph of the Heart, as its name does not suggest, is about science. The book’s author, Jie Jack Li, is a medicinal chemist who meticulously reviews the history relevant to the discovery of lipid-lowering drugs. He spares no details, even recounting the amusing quarrels and quirks of the scientists engaged in the “apocryphal showdowns” leading to the manufacture of cholesterol in a laboratory.
The personalities of the various scientists and Nobel laureates described in the book are highly entertaining. From beating one another with umbrellas, to insisting on wearing blue clothing only, to egos so large and unappealing as to empty an entire academic center of all its promising young recruits, one has the distinct impression that brilliance does not go hand-in-hand with grace.
That being said, each of these scientists did seem to share a common approach to research: carefully testing hypotheses, repeating peer study results to confirm them, and patiently exploring complex biochemical pathways over periods of decades. The physicians, physicists, and chemists showed an incredible ability to doggedly pursue answers to specific questions – understanding that the results might influence human health. But even more importantly, they were each willing to invest their careers in analysis that may never lead to anything more than a dead end. In fact, the book is full of examples of great ideas, developed over decades, that did not lead to a marketable drug. In some cases the research was halted due to lack of efficacy, in others political forces or personal whims influenced the course.
What strikes me about the scientists described in Triumph of the Heart, is how rare it is nowadays for people to have the sort of patience required for laboratory work. In an age where kids suffer from iPhone and video game addictions, young adults expect a relaxed work environment with high salaries and no accountability, and adults are flummoxed by stores that are not open 24 hours… who has time for the hard work of science? Even The Onion, my favorite spoof newspaper, mocks modern attention spans calling science “hard.”
Triumph of the Heart is about much more than the discovery and development of statins. It traces the historical development of the first antibiotics, pain medicines, diuretics, and steroids, the rise, fall and merger of drug companies, patent wars, the unethical conduct of some researchers, and the financial pressures that shaped the industry, both in the U.S. and abroad. Other than Mr. Li’s inability to resist his chemist’s urge to delve into advanced concepts in organic chemistry (around mid-book) as a physician I found Triumph of the Heart to be quite interesting, and well researched.
The most important take away, however, is that science is about hard work, attention to detail, innovative thinking, advanced analytic skills, serendipity, and the patience of Job. Triumph of the Heart reminds us all what good science is about, and how life-saving discoveries are made.
By Stacy Beller Stryer, M.D.
I vividly remember my firsts in medical school – my first patient with cystic fibrosis who was so air hungry that he couldn’t even speak, my first teen who was constantly admitted to the hospital with an infection due to a genetic disorder that would eventually kill him, and my first 3 year-old patient with sickle cell anemia who almost died because her spleen decided to sequester many of her red cells. They were my firsts, but they certainly won’t be my lasts.
On March 9th, however, President Obama took a major step toward helping these children and so many others just like them. It gives me hope that someday there will be a few lasts. On Monday, he signed an executive order which relaxed restrictions on embryonic stem cell research and allowed federal funding for such projects. This is big. It reverses an almost 8 year policy that severely restricted such funding and the ability to use embryonic stem cells.
Embryonic stem cell research will open up the doors for potential cures and treatments for diseases such as Parkinson’s and Alzheimer’s, and for traumatic injuries, such as those that involve the brain and spinal cord. But the potential benefit of stem cells isn’t just for adults. Discoveries from embryonic stem cell research could save many lives and significantly reduce the suffering of children with a whole variety of diseases. Many medical centers, such as the University of Cincinnati, are or will soon be greatly expanding their stem cell research programs because of this policy change.
Why are embryonic stem cells so important for research? These cells are truly amazing because they have the ability to turn into any other cell in the body, such as blood cells, nerve cells, islet cells (which make insulin in the pancreas), or even entire organs. Plus, these cells can continue to duplicate, or make more of themselves, which is wonderful for both research and eventual treatment. Think about a newborn, that starts out as a single cell which then continues to replicate and differentiate until it becomes a fetus. It is truly a miracle and is the reason embryonic stem cells are so important.
Researchers at the University of Cincinnati want, through new research, to successfully treat fatal and other serious genetic disorders. Other medical centers will use embryonic stem cells to search for treatments for illnesses such as cancer, cystic fibrosis, diabetes, muscular dystrophy, and traumatic injury. The list goes on and on. Results will not occur overnight. It will be a long, expensive time intensive process. Through this process, researchers hope to learn how cells differentiate into specific types of cells and how genes turn certain cells on and off. The ultimate goal is to successfully repair or even replace ineffective, damaged and abnormal cells.
Some people are against the use of embryonic stem cells in research and treatment because they believe that, even though it can save lives, it also ends a life. This is an issue everybody has to think about on a personal and individual level. Currently, federal guidelines require embryo stem cells to come from extra embryos that were made when a couple underwent in vitro fertilization but were not used and, if not used for research, would simply be thrown away.
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I’m grateful to the Happy Hospitalist for pointing out that color matters when it comes to food consumption. As it turns out, blue light can be an appetite suppressant. And I actually know about this first hand.
I helped to design a research study in connection with Architectural Digest and the Parsons School of Design several years ago. I was a volunteer instructor for a hospital design course in NYC, and wanted to show the students that lighting could influence eating patterns. As it happened, there was a big gala event at a local convention center, and so I worked with my friend Shashi Caan to set up three identical rooms bathed in three different colored lights (yellow, blue, and red).
We had all the gala attendees dress up in white bunny suits (you know, the kind you let patients wear in the OR) and shuttled them through the 3 rooms at regular intervals. The rooms could each hold about 40 guests and copious identical hors d’oeurves were offered.
Guess what we found? The most food was consumed in the yellow room, followed by red, and then a distant third was blue. About 33% fewer snacks were consumed in the blue room during the event (and yes we controlled the number of people in each room so they’d be equal). I found this quite fascinating, but unfortunately never published the results. You see, I didn’t receive IRB approval for any of it.
But the experiment did leave an indelible impression on my mind. As I thought about it, I realized that most fast food restaurants have yellowish interiors. From the golden arches to the lighting – companies like McDonald’s probably recognized (long before I did) that color influences purchasing and eating behavior.
Yep, I’m late to this party – and I’m not painting my kitchen yellow.
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