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Showing posts from January, 2014

Paul Lee--a Washington healthcare lobbyist talks about why it's all good

A few nights ago I attended a dinner and lecture at the local dining venue where theyserved huge hunks of prime rib and sauteed snow peas from some far away place where it's Spring, and chocolate mousse and wild rice. Global warming increased just slightly due to our excess consumption, but my portion would have been wasted had I stayed home. Beside the food, I was curious to see what the healthcare lobbyist who spoke had to say about where healthcare reform is headed. I was surprised to find that he was almost entirely positive about what was going on and that in general he said things that I agreed with.

How could this be? Healthcare lobbyists generally want the industry they represent to get as much money as possible. I generally want the healthcare industry to rein in its excesses and be more conscientious and efficient. Clearly there is some agenda here that I don't understand. Either that or efficiency and reining in excesses is beginning to align itself with the succes…

Ultrasound in South Sudan: what might it be good for?

Last month I spent 2 weeks in a small hospital in South Sudan and probably did about 100 bedside ultrasounds. The whole experience was very moving, and encompassed so much more than doing ultrasound, even though I had intended the trip to be primarily for teaching ultrasound applications. It turned out that I also had to learn as much tropical medicine as my aging brain could hold and clean up spider webs and feed people and put goop on rashes and sew up gashes and learn to say hello in Nuer and a number of other things which will occupy an important place in my heart for years.

But as an ultrasound nerd, there were many exciting nerdy moments. These were the moments that most ultrasound nerds experience when we realize, again, that this technology is totally cool and that we wish everyone could do it.

I have spent the last 2 years practicing hospital medicine and a little bit of primary care and doing thousands of bedside ultrasounds. I have taken classes and tests and spent free mo…

Smoking: A half century of knowing we should quit

In 1950 Ernst Wynder MD and colleagues began to produce convincing data that cigarette smoking caused lung cancer. Over the ensuing many years evidence has arisen linking cigarette smoking to many different cancers and conditions, chronic lung disease and heart attacks. In 1964 the surgeon general reported that cigarette smoking was the most important risk factor for development of lung cancer and that quitting smoking reduced that risk. Since that time a concerted effort to reduce tobacco smoking has been one of the most important public health agenda items for the medical profession. Since this is the 50th anniversary of organized tobacco control, the Journal of the American Medical Association has devoted an entire issue to the subject of tobacco and health.

Articles include a survey of smoking prevalence around the world: US residents smoke less than people in Europe, especially Eastern Europe. Although many Africans smoke, they don't smoke much, Women generally don't smo…

Hypertension: New (Joint National Committee 8) Recommendations for Treatment

Doctoring is a practice based in science, but at its best, attempts to treat whole complex humans to achieve goals such as health and happiness which have no good scientific definition. Good doctors practice outside of boxes, and our success or failure is scrutinized closely according to very subjective criteria by our patients and colleagues. It is nice, in this situation, to have aspects of our work be based on clearly measurable variables; blood pressure, for instance.

The concept of high blood pressure as a clinical diagnosis began to be accepted at the beginning of the last century, correlated with the invention of the blood pressure cuff. It turns out that the pressure of blood in the arteries, when elevated, can lead to heart attacks, strokes, aneurysms and kidney failure and can be an indication of other serious medical illnesses including tumors of the adrenal gland and pituitary as well as narrowing of the blood vessels to the kidneys. Controlling the blood pressure has bee…