Grand rounds #9

Welcome to Grand Rounds, a rotating compendium of new and noteworthy posts from health-related weblogs. Medical blogs continue to proliferate, and you'll meet some new ones here. DoctorMental hosts next week.

Top story: Safety of medications. An FDA regulator believes that five FDA-approved drugs need closer scrutiny. Medpundit shares her opinions of these meds. Dr. Bob Centor notes:

"On the heels of the recent Vioxx withdrawal this testimony certainly fans the flames of drug safety concern. We would like the FDA to insure safety. However, we also would like the FDA to rapidly approve new helpful drugs. This tension defines the problem. The faster we approve new drugs, the more likely we would miss a safety concern."

Message from the front lines: Geena, a registered nurse, writes codeblog. She implores doctors to tell patients about their plans, before asking nurses to carry them out:

"...I do not relish the look of ... weirdness that comes on my patient's face when he finds out that I'm about to administer treatments that he isn't expecting and hasn't been prepared for..."

Making meds: Dr. Derek Lowe is a pharmaceutical chemist who blogs for Corante. He discusses the perils and promise of RNA interference:

"...I've said for several years now that this field is the most obvious handful of tickets to Stockholm that I've ever seen. (Naturally, there are some worries that the whole field has perhaps been a bit over-promoted. . .)"

Selling meds: Kevin, MD debates direct-to-consumer advertising.

If the majority of DTC marketing were based on sound evidence-based medical principles, I would be in strong favor of it. After all, the more information patients have at their disposal, the better.
However, this is simply not the case...

Reconsidering meds: Is it time to reconsider atenolol, one of the most commonly prescribed antihypertensives? Journalclub reviews a recent Lancet article. The methods aren't his favorites, but he's intrigued by the study. And in another post, he cautions us about the response of drug companies to the demand for evidence-based medicine:

"...armies of drug reps sally forth armed with reprints, while researchers are sent out to spread the gospel of statistical significance. EBM has made us particularly avid of hard data (while relegating clinical significance to a somewhat subordinate role)..."

Using our best judgement: Dr. Bob Centor writes on making medical decisions under conditions of uncertainty.

"As physicians we rarely know answers definitively. We make our best probabilistic guesses, and then hope for the best. But given the uncertainty, we have results that we question in retrospect.
"I doubt that we will ever rid medicine of that uncertainty. The uncertainty attracts me. The quest to make the best decisions (while never really knowing that we did) is a quest worth taking."

A first (and a fifth): Dr. Jacob Reider's medblogging podcast about a day-in-the-life of a family practitioner. (Happy fifth blogging anniversary, doctor, and thanks for medlogs!)

Pathology: Anne, a physician in the Netherlands, submits a post about Lyme disease from her Illness Alphabet. Dr. Charles describes his encounter with a patient with herpes. (No comment on his reaction; I think he's figured it out. Don't miss Dr. Charles here and here.) Codeblueblog speculates on what may have killed ODB...and how he might have been saved. Trent McBride has "fun with microbes." (Warning: not for the queasy!)

Meet the Rebel Doctor: A new medical weblog. Dr. Michael Rack is an academic internist, sleep specialist, and psychiatrist in Mississippi. He sends us a post about treating developmentally-disabled adults.

Mind control: Alarming news, via Book of Joe. Minds out of control: Dr. James Baker, at Mental Notes, brings surprising news about an under-reported culprit at the recent Pacers-Pistons game.

Going the extra mile: At "Morning Retort," a med student delves into complex psychosocial issues of his patient, only to see them ignored by his resident. At "Chronicles of a Medical Madhouse," a resident tries to convince a frightened, unwilling young mother to continue life-saving treatment...and succeeds.

Man with a mission. Codeblueblog is passionately "pro-vaccine", and he'll tell you why:

"...iron lungs -- once ubiquitous in hospital wards...actually became relics of an era gone by because of the polio vaccine which mostly eradicated the major cause of paralytic weakness of the respiratory muscles..."

What is reasonable compensation for a doctor? What is reasonable for patients to pay? At Kevin M.D., the debate goes on. Scroll down, and down:

"...I'm just sick of seeing people like my second cousin (30 years old)-- a guy who makes $140K per year, dines out at the finest restaurants each week for $400, has an extensive wine collection valued at $60K, two plasma TV's valued at $16K, a summer home in the Hamptons worth $1 million etc.-- yet who sees nothing wrong with forking over a paltry $10 to his physician for their services. There is something entirely BROKEN with this picture. How can you not see it?"

Medbloggers at Bloggercon III: Dr. Enoch Choi graciously shares his notes. One participant, a patient, likens physician bloggers to the old Soviet underground press(!).

They're kidding, right? GruntDoc sends word that learning-disabled students want special accommodations for the medical school entrance exam, including more time for the the test:

"The MCAT is many things, but any med school admissions director will tell you those scores do not correlate with success or class rank in med school, but they're really handy to weed out people who have no business being there in the first place."

Choking hazard: Put your coffee down before reading this Public Health Press post about health care policy. The Bush team's plans may end private insurance as we know it.

Hospice Guy makes enemies with his bold advice about hospice and nursing homes:

"Almost every big nursing home company owns their own hospice. Why?...They know the dirty secret. Medicare is paying too much for hospice/nursing home patients..."

Weight loss tips? Dr. Emer, at Parallel Universes, ponders the relationship between obesity and sleep.

Safety of blogging is scandalously under-researched, says Trent McBride. Doctors prescribe blogging at their peril, exposing patients to unknown risks, despite anecdotal reports of efficacy. (Prolonged computer work may harm eyes; as Medpundit says, "uh-oh...")

Such abundance! That's it...my carpal tunnel is asking me to stop.
Prior Grand Rounds here. Contact Nick at Blogborygmi and tell him that you want to host Grand Rounds.

Addendum! Late-breaking news from Matthew Holt:

Shrinkette
Apologies for the late entry (still before Midnight on the west coast!!)
anyway http://www.matthewholt.net/2004_11_14_archive.html
takes you to The Health Care Blog's first ever live (with photos) blogging of the Health Information Technology conference hosted by the California Health Care Foundation. The subject was health IT for chronic care, and it was attended by most of the good and the great of health care IT from across the land.
Thanks and I hope this isn't too late
cheers
Matthew