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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Friday, January 30, 2009

WHO'S MY DOC? HOW MANY LIVES PER KIDNEY? AND "THE TOBACCO INDUSTRY MADE ME SMOKE" (HACK, HACK...)

Before talking about medicine and healthcare, I want to offer this anecdote, and debate, that’s worth pondering. For me it started with an email blurb that said the former Vice President, Al Gore, was testifying to Congress this week on global climate change. The blurb alleged that Al said the carbon dioxide (CO2) in Venus’ atmosphere magnifies the greenhouse effect, resulting in surface temperatures of about 870 degree. He alleged that it’s not Venus’ closeness to the Sun that makes the planet much warmer than the Earth, because Mercury, which is even closer to the Sun, is cooler than Venus. Based on this rationale, then, Al said we need to stop emitting CO2 into our own atmosphere.

Well, I was doubtful he said that. I’ve read parts of “Earth In the Balance” and found it unconvincing--other academics I’ve talked to consider it a joke. His arguments about ice cores and short term temperature records have already been attacked, successfully I think. But, fair is fair…I went to the Senate Foreign Relations Committee web site and watched the video. You can see it here http://www.senate.gov/fplayers/CommPlayer/commFlashPlayer.cfm?fn=foreign012809&st=435 …long and mostly boring.

But the Veep’s whole slide show is there. What makes this all so incredible is the series of false analogies in his argument. While it’s true that CO2 in the atmosphere contributes to warming a planet, the atmosphere of Venus is 97% CO2. The atmosphere of Earth is 0.038% CO2 (380 parts per million). From the models produced by the Climate Change advocates, the CO2 level on earth is increasing at about 2 parts per million per year (but according to scientists has been several times higher in the distant past). So, I’m not sure where the comparison is. Also, the comparison with Mercury is inappropriate, since Mercury has no greenhouse gases in its paltry atmosphere. Mercury gets as hot as Venus, but its “average” temperature is much lower because the temp varies so widely on Mercury (from 800 to -275). And guess why it varies so widely there, and not on Venus…yep, CO2. CO2 cushions the planet from wild swings in temp. You can read about this science stuff here http://en.wikipedia.org/wiki/Atmosphere_of_Venus and here http://en.wikipedia.org/wiki/Atmosphere_of_Mercury.

Am I missing something here in not being able to link these observations together into an argument for decreasing CO2 emissions?

I think I’m as concerned as the next person about global warming, but it’s garbage like this…from both sides…that makes it impossible to find the truth. Although the IPCC (Intergovernmental Panel on Climate Change) says that “global warming is now firmly established,” there are 30,000 scientists, physicians, engineers, and other researchers who have signed a petition saying that the evidence does not support it. The public has been inundated with so much opinion in favor of the hazard that they take it for granted, and the media is no help (“Global Warming Not True” doesn’t sell a lot of newspapers). And, there is a multibillion dollar industry out there lobbying for adoption of CO2 mitigation, which stands to profit Big Time. How do we, as concerned citizens, make sense of all this, and support the right choice? If you figure it out, let me know.

This YouTube video, by JunkScience.com publisher Steven Milloy, helped put the different arguments in perspective. I recommend it (only 9 min long). http://www.youtube.com/watch?v=XDI2NVTYRXU

According to the psychologist authors of a SUPERB book I just read, “Mistakes Were Made (but not by me),” you will hear and view this debate in accordance with your pre-determined position on the question, and will engage in self-justification. I challenge you to step outside the cycle of confirming everything you already believe and grant that the situation is complex, ambiguous, and rife with misdirection. (Read the book, highly recommended.)

Back to medical.

Study indicates 75 percent of hospital patients may be unable to identify their physicians.

The New York Times (1/30, Barrow) reports, "Hospital patients are rarely able to identify their doctors by name or to describe their roles in the patients' care," according to a study published Monday in the Archives of Internal Medicine. Researchers found that an estimated "75 percent of the patients were unable to name a single doctor assigned to their care." Furthermore, "of the 25 percent who responded with a name, only 40 percent were correct." Some experts, however, disagree on "whether patients need to be familiar with hospital staff." Dr. Ernest Moy, medical officer at the federal Agency for Healthcare Research and Quality, questioned whether knowing about "processes that will help" patients "get at the information [they] need" is "more important" than physicians' names.

Doc D: Maybe people have something else on their mind when they’re in the hospital.

Researchers say people who donate kidneys have normal life spans, few kidney problems.

The Los Angeles Times (1/29, Maugh II) reports that, according to a study published in

the New England Journal of Medicine, "people who give kidneys to others not only have a normal life span, they also have fewer kidney problems than the general population -- perhaps because they are healthier to begin with."

Doc D: I guess this doesn’t mean that since I have two kidneys I’ll live twice as long, hunh?

First of 8,000 lawsuits against tobacco industry to begin.

Christian Science Monitor (1/29, Luscombe) reports, "A civil case that begins Thursday...not only brands Florida as a hotbed of tobacco litigation, but also marks the advance of a huge stream of lawsuits against America's largest cigarette manufacturers." An estimated 8,000 plaintiffs have filed a "wave of lawsuits," stemming "from a 2006 ruling in the Florida Supreme Court that broke up a class action suit of more than 700,000 plaintiffs and quashed a $145 billion award against the tobacco industry." The justices gave "all plaintiffs one year to file an individual claim for damages against cigarette-makers," and under the ruling, "each case will start from the same premise: that cigarette-makers were aware their products were 'defective' yet misled the public over their health effects."

Doc D: I’m sensitive to the plight of patients with tobacco-related illness, but there’s a fact that’s been nagging at me for years. That fact is, that tobacco smoking has been known to be injurious, and yes, even cause death, for at least two hundred years. There are newspaper articles in Victorian England that talk about the lung disease that ensues. Couple this historical evidence with the average consumer’s skepticism about advertising--just because Ford says the Bronco is the best truck, doesn’t mean I believe them—and I wonder why smokers have decided that they were fooled. Finally, most smokers I know (and I used to be one) have some justification for why they keep smoking, and it’s never that “the tobacco companies said it’s safe.”

In the preventive medicine world, to even bring this up means I’m a traitor to the cause.

Medical quote of the Day:

As is your sort of mind,

So is your sort of search—you’ll find

What you desire.

--Robert Browning [1812-1889]

Nature Note: A senior executive of the world's largest autism charity has resigned in a dispute about whether vaccinations could be a cause of the developmental disorder that affects an estimated one in 100 children. Alison Singer says that numerous scientific studies have disproved the link first suggested more than a decade ago and that Autism Speaks, a US-based organization committed to funding further research, needs to "move on". "If you keep looking under the same rock, you're going to keep finding the same thing," said Singer. "Over and over, the science has shown there is no causal link between vaccines and autism. It's time to look for answers in new and different places." (The Observer, 25 Jan 2009)

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.), AMA Morning Rounds (© U S News Custom Briefings), The Observer (© Guardian News and Media Limited) and other sources in the public domain. As always, you may share this column, with appropriate attribution (here and in the text) included.

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