nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Wednesday, December 17, 2008



I’m slipping this issue in.  I can’t help it.  There are a few funny, puzzling, or infuriating things that have come along.  I’ll still be sending the silicone breast implant commentary…soon.


Surgeons perform first US face transplant.

ABC World News (12/16, story 10, 2:15, Gibson) reported, "The Cleveland Clinic announced" on Tuesday "that its surgeons have performed the nation's first near-total face transplant, only the fourth worldwide. The operation was performed on a woman earlier this month."

        The Washington Post (12/17, A4, Stein) reports, "The clinic refused to release any details other than to say that a team led by reconstructive surgeon Maria Siemionow, M.D., replaced about 80 percent of a disfigured woman's face with that of a deceased female donor within the last two weeks. Neither the recipient nor the donor" was identified. The Cleveland Clinic "plans a briefing today to release more information about the procedure, which was far more extensive than the three previous face transplants, which were performed in France and China."


Doc D:  This is a little spooky to me.  Never mind that there are ethical issues involved in putting someone on transplant rejection drugs for the rest of their life, with the risk of cancer that involves.  Proper patient selection processes will be able to balance the relative harm to operate versus not operating.  What’s spooky to me is how much our face is a representation of who we are:  I have a picture of how I look in my memory, and another picture of how I look that the mirror shows me.  They don’t match.  Now, with a face transplant, my “mirror” face gets moved to memory, and a new one replaces it.  But what happens to my original picture (“concept”) of myself?  Is it still me?  Am I different, or someone else?  Does the representation of myself, and all that entails, get modified by such an intimate change?  Philosophers love this stuff.


Court rules company is not obligated to provide experimental drug to patient with muscular dystrophy.

The AP (12/17) reports, "A pharmaceutical company does not have to provide an experimental drug to a Minnesota teen who is terminally ill with a rare form of muscular dystrophy, a federal appeals court ruled Tuesday." The ruling reversed a decision by a lower court, stating that although the court is "sympathetic to the plight of Jacob [Gunvalson] and his family," the lower court "'abused its discretion' in ordering" PTC Therapeutics "to supply the drug to Gunvalson." Jacob's family claims that "the company led them to believe that Jacob could participate in a clinical trial of the drug, which is being investigated as a possible treatment -- and that the company then went back on its word." For its part, the company said that "no promises were made, and that allowing Jacob to join the clinical trial would not be safe." PTC president and CEO Stuart Peltz released a statement calling "the ruling 'important...for the future of the clinical trial process for all experimental drugs for rare disease.'"


Doc D:  Between a rock and a hard place is no fun.  In this case, both the drug company and the patient are there.  The patient’s tragedy is evident, but the company’s is not:  do they risk legal action when they are not yet far enough along to call this drug a “treatment”?  when it’s unapproved?  The courts have sometimes not allowed a defense of impending death, or agreed that there were mitigating circumstances in the principle of “do no harm.”  The pharmaceutical industry has been whacked so many times recently for unsafe (approved) products, they’re punchy.


Investigators continue to look for new ways to ease vaccination pain.

AMNews (12/22, Elliot) reports that a paper appearing in the December issue of Family Practice reveals that "children experience less pain with a vaccination if the skin is pretreated with an anesthetic and they are taught about what to expect."


Doc D;  You know, if parents would just stop saying, “you’d better be good or the doctor will give you a shot,” a lot of the fear that magnifies the pain would go away.  It aint that painful.  I do something to myself just as painful almost every day…stub a toe, bang my head, etc  (it’s the stuff of family legend…ask the kids). 


Study suggests patients with both cancer and diabetes face increased mortality risk.

According to an article posted in the Health section of the CNN (12/16, Tamkins) website, "two of the most common diseases in the United States -- cancer and diabetes -- are not often linked together in the public mind." But a paper appearing in the Dec. 17 issue of the Journal of the American Medical Association reveals that "cancer patients who already have diabetes have a greater chance of dying of the disease than cancer patients who do not have the blood-sugar disorder."


Doc D:  Does anybody think this study should have been a high priority for funding?  That somebody with an illness is worse off if they get an additional one?


Survey shows greater number of female cardiologists, persistence of gender discrimination.

HealthDay (12/16, Preidt) reported, "The number of female cardiologists in the United States doubled in the last decade, but under-representation of women in the profession and discrimination continue to be problems," according to findings published in this week's issue of the Journal of the American College of Cardiology. Lead author Athena Poppas, M.D., of Brown University, noted that "women in cardiology continue to face the same institutional and personal roadblocks as those in other areas of medicine and science."


Doc D:  This is a touchy subject.  I’m for opportunity and against discrimination.  But things have improved, and I’m not sure we need to have parity at every level.   At my undergraduate university the percentage of women was “around” 30 when I was there,  and that was high for then.  It’s now approaching 60%, but there are still many fewer women going into math and physics.  What’s the right mix of opportunity and apportionment?  There are other medical specialties where there are more women than men, and medical student ratios in some schools have swung in favor of women.  I once had an indignant reporter how I could justify that there were fewer women colonels in the Air Force.  I asked her,  “Do you want us to commission them as colonels?  It takes 15-20 years for someone to get from lieutenant to colonel.”  So, these disparities take time to correct…and they are.  The authors above go on to say that men also suffer discrimination, so… when does a “put down”, or “harsh criticism” that singles you out transition from an unpleasant experience to discrimination?  Is it the environment; you’re the only women or man present?  Can every individual who perceives an experience as being discriminatory be the decider?  I’ve not experienced ethnic or gender discrimination, just religious, so I can’t talk about this from all perspectives.  I DO know this however:  when I was a military commander, there were just as many women dirtbags as there are men dirtbags, but to take disciplinary action against a woman was always a risk.  I had to have twice as much evidence as would satisfy disciplining a male, in order to be given permission to proceed by my superiors.  But I tried not to shirk my responsibilities, so pressed ahead.  This got me accused several times; none of them successful.  But anytime a colonel or higher is accused of discrimination, the case goes to the Secretary of the Air Force, and that’s scary:  nothing ruins your career more than getting relieved of command.  I know a few commanders who said “it’s not worth the threat” and let women get away with some things they shouldn’t have (the cowards).  Richard M. Weaver said that “Ideas Have Consequences”, the ones you want and the ones you don’t.   Despite the threat, I still think the system is good, if imperfectly implemented and burdensome.


Medical quote of the Day

“I was once requested to call on a lady suffering from nervous and other symptoms.  It came out in the preliminary conversational skirmish, half medical, half social, that I was the twenty-sixth member of the faculty into whose arms, professionally speaking, she had successively thrown herself.  Not being a believer in such a rapid rotation of scientific crops, I gently deposited the burden, commending it to the care of number twenty-seven, and, him, whoever he might be, to the care of Heaven.”--Oliver Wendell Holmes [1809-1894]


Doc D

Opinions are entirely my own.  Quotations from Kaiser Daily Health Policy Report ( © Kaiser Family Foundation), PND News Briefs – Texas Edition ( © 2008, Physician's News Digest, Inc.), and AMA Morning Rounds (© U S News Custom Briefings), and other sources in the public domain.  As always, you may share this column, with appropriate attribution (above) included.


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