Monday, November 28, 2005

A belly-dancing surgeon

Meet Dr. Marguerite P. Barnett, plastic surgeon and belly dancer extraordinaire, who practices in Florida. (How does she balance that sword?)

She's featured in...what's this? article about how docs can prepare for their retirement.

It helps to have a hobby, and Dr. Barnett has several: she specializes in "East Indian, Indonesian, and Polynesian sacred temple dances." "In retirement, 'I could conceivably fill my time with the dance world, either teaching or performing,' she said."

There are a few common-sense financial tips, but the gist of the article seems to be: stretch your imagination when considering your retirement. Think beyond the financial necessities. They quote a vascular surgeon who earned a law degree (in his 70's!) when he retired from medicine. Now he's thinking about a graduate degree in history...

"Film pirates sunk by the real thing"

Times Online:
PRODUCTION on two new Pirates of the Caribbean films, starring Keira Knightley, has been halted because of raids by real-life brigands, according to reports from the Bahamas.

Two cast members have been forced to flee for their lives after a series of robberies at the Grand Bahama island location, producers of the Disney film said...

“They [the robbers] were able to get into the room with a key and stole everything from laptops, passports, cheques and other equipment. The money they stole was actually the actors’ pay cheques.”

Some actors and crew members have been robbed four times in a month. The last incident happened on November 11. It is claimed that $20,000 (£11,500) in cash and equipment was taken.

Mr Kakebeen, chief executive of Jemini Seven Entertainment, declined to say whether any of the film’s stars had been targeted. But he said that two actors had left the island in fear of their lives as a result of the robberies. The equipment and cast losses have brought production to a standstill.

The Pirates shoot ran into controversy earlier this year when members of the Carib tribe on the island of Dominica accused Disney of perpetuating the myth that locals were cannibals. A scene in which Depp’s Captain Sparrow is tied to a skewer with vegetables and roasted on a spit “like a shish kebab” provoked calls for local people working as extras to boycott the filming. Nevertheless, hundreds of Grand Bahama residents have signed up to work as £50-a-day extras, answering a call for “sailors, pirates and Asian seamen”...

Sunday, November 27, 2005

A guide to debate on the Internet

From the Dilbert Blog:
If you are new to the Internet, allow me to explain how to debate in this medium. When one person makes any kind of statement, all you need to do is apply one of these methods to make it sound stupid. Then go on the offensive.

1. Turn someone’s generality into an absolute. For example, if someone makes a general statement that Americans celebrate Christmas, point out that some people are Jewish and so anyone who thinks that ALL Americans celebrate Christmas is stupid. (Bonus points for accusing the person of being anti-Semitic.)

2. Turn someone’s factual statements into implied preferences. For example, if someone mentions that not all Catholic priests are pedophiles, accuse the person who said it of siding with pedophiles.

3. Turn factual statements into implied equivalents. For example, if someone says that Ghandi didn’t eat cows, accuse the person of stupidly implying that cows deserve equal billing with Gandhi.

4. Omit key words. For example, if someone says that people can’t eat rocks, accuse the person of being stupid for suggesting that people can’t eat. Bonus points for arguing that some people CAN eat pebbles if they try hard enough.

5. Assume the dumbest interpretation. For example, if someone says that he can run a mile in 12 minutes, assume he means it happens underwater and argue that no one can hold his breath that long.

6. Hallucinate entirely different points. For example, if someone says apples grow on trees, accuse him of saying snakes have arms and then point out how stupid that is.

7. Use the intellectual laziness card. For example, if someone says that ice is cold, recommend that he take graduate courses in chemistry and meteorology before jumping to stupid conclusions that display a complete ignorance of the complexity of ice...

Friday, November 25, 2005

Patients respond to "Coping with a malpractice suit"

My post described a physician's viewpoint. But blogging opens a window to viewpoints far different from our own. How many doctors have heard this from a patient?
Weirdly enough, if you substituted "doctor" for "lawyer" in most of that article, you'd pretty much have the reaction of non-medical people to dealing with illness, or even a simple doctor's visit.

Or just about any other stressful issue.

No one wants to be sued wrongfully or maliciously, of course. And no doubt doctors by the nature of their practices are in danger of such suits more than the rest of us. There medical folks have my sympathy.

But I'm not sure why these reactions or feelings about being sued for malpractice should surprise anyone in any way.
Or this:
I completely agree with the anonymous person who said that you can substitute any of the physician's feelings listed above for the patient's feelings or the feelings of the patient's lawyer---surprise, shock, outrage, anxiety, dread, etc. I was at this point in the late 1990's because of an incompetent neurosurgeon I had. Due to my family, (none of whom have ever been employed in the medical profession), taking me to a completely different hospital in a completely different geographical area, I am fully functional today. But I lost an extremely good job I had recently acquired while I was waiting for the clown to diagnose me properly, and I've never been able to get another job as good since then...(And, yes, the condition I have is a neurological condition that he should easily figured out.)
If we were more aware of our patients' emotions, would we practice differently...and would we be sued less frequently?

Thursday, November 24, 2005

A Thanksgiving blesssing from the Cheerful Oncologist

"To all those who awakened today under the cloud of cancer, whether as a patient fighting hard, or as a family member, or as a diligent caregiver, or a nurse, doctor, neighbor, friend from church or even just one who read a touching story in the newspaper - may you be strengthened and uplifted by the massive power that resides within the hearts of all those around you who love. They have given so much, yet each sacrifice made, each act of kindness is but a mere grain of sand removed from the boundless water’s edge..."

May every patient be so blessed. (We are very blessed here today. Mike is back from China!) Happy Thanksgiving, everyone.

Post-Thanksgiving shopping: message from the front lines

Jeepers Sleepers, originally uploaded by judge_mental.

Judge Mental sends word that the Third Infantry Serotonin Reuptake Inhibitory Battalion has taken up positions for the "forthcoming Battle of Christmas Shopping."

"Troops working out of a field hopital set up in British Home Stores will distribute emergency supplies of antidepressants to parents and children while maintaining crowd control operations..."

Extreme measures, to be sure. (Mental note: avoid shopping today.) But the meds don't quite work that way. If anyone started an SSRI today, they probably wouldn't notice any benefit for a few weeks...

Wednesday, November 23, 2005

Coping with a medical malpractice suit

Dear Madhouse Madman is served with a complaint. My heart goes out to him! Sara Charles, MD, describes the devastating impact of litigation on physicians:
The reaction to being sued often is prefaced by a period of emotional turmoil following the catastrophic event or negative outcome. The physician may feel unduly responsible or guilty, genuine sorrow for the persons involved, dread, anxiety, and fear of being sued. These feelings may not resolve in any way until the statute of limitations expires or a suit is filed.

More than 95% of physicians react to being sued by experiencing periods of emotional distress during all or portions of the lengthy process of litigation. This may begin immediately on being served with the complaint by a sense of outrage, shock, or dread about the personal and financial effects of the eventual outcome. This is the first reaction in a series that is similar to those that accompany any major life event...Feelings of intense anger, frustration, inner tension, and insomnia are frequent throughout this period.

Symptoms of major depressive disorder (prevalence, 27%-39%), adjustment disorder (20%-53%), and the onset or exacerbation of a physical illness (2%-15%) occur, although fewer than 2% acknowledge drug or alcohol misuse. A general internist, for example, described awakening with his first episode of atrial fibrillation after being served with his first malpractice suit the previous afternoon. This generated emergency medical consultation accompanied by profound psychological effects on the physician. Some 2 years later, it figured prominently in his decision to settle and to retire earlier than he had originally planned...
Symptoms may develop during any of these stages when adequate coping fails:
The complaint is served: initial feelings of surprise, shock, outrage, anxiety, or dread

Consultation with lawyer: depending on the initial assessment of the case, reactions of anger, denial, concern, reassurance, panic

Lengthy period of denials and intrusions: active attempts to erase thoughts about the case, followed by automatic reminders and intrusive thoughts about it; becoming preoccupied by ruminating excessively—exacerbated whenever case-related activity increases, such as before the deposition, when experts testify, and before and during the trial

Working through the lengthy process, during which physicians psychologically and intellectually “process” the meaning of the case, their role in it, and their approach to their own defense...

What do you believe is true, even though you cannot prove it?

That's what John Brockman asked scientists, futurists and other creative thinkers. Some replies:
Randolph Nesse, University of Michigan: 'I'm pretty sure that people gain a selective advantage from believing in things they can't prove. Those who are occasionally consumed by false beliefs do better in life than those who insist on evidence before they believe and act.'

Stanislas Dehaene, Institut National de la Sant, Paris: 'We vastly underestimate the differences that set the human brain apart from the brains of other primates.''

Carlo Rovelli, Centre de Physique Thorique, Marseille: 'Time does not exist.'

Seth Lloyd, Massachusetts Institute of Technology: 'I believe in science. Unlike mathematical theorems, scientific results can't be proved. They can only be tested again and again, until only a fool would refuse to believe in them.'

Daniel Hillis, chairman, Applied Minds Inc: 'I know that it sounds corny, but I believe that people are getting better. In other words, I believe in moral progress.'

Craig Venter, president, J Craig Venter Science Foundation: 'Life is ubiquitous in the universe.'

Janna Levin, Columbia University: 'I believe that there is an external reality, and you are not all figments of my imagination.'"
I wonder if he talked to any psychiatrists. We can't prove any of our theories. But I do believe in unconscious drives, and in defense mechanisms. I think that denial may be one of the strongest forces on earth!

How would you answer Mr. Brockman?

New Scientist: "Hope for man stuck in space"

Stranded American astronaut Bill McArthur may finally be able to return home from the International Space Station after US policymakers agreed to change a law preventing NASA from purchasing rides on Russian spacecraft.

In 2000, the US passed the Iran Nonproliferation Act (INA), which was designed to prevent the spread of nuclear technologies from Russia to Iran. One clause makes it illegal for the US to pay for rides to the ISS unless the White House is satisfied that Russia is not selling nuclear technologies to Iran.

Since then, a pact between NASA and the Russian Space Agency, made before the INA was passed, has permitted Russia to provide 11 Soyuz spacecraft for astronauts and cosmonauts to reach the station. But the last of those was launched in September, with McArthur on board. It is due to return to Earth in April, but possibly without McArthur.

With the shuttles grounded, McArthur's predicament has forced a rethink...On 26 October, the US House of Representatives decided to change the act to allow further Soyuz flights.

But if the details are not ironed out in time, McArthur may still have to wait for the next space shuttle, currently expected to launch no earlier than May.

From issue 2524 of New Scientist magazine, 05 November 2005, page 4

Tuesday, November 22, 2005

China hearts Mike

My husband is working in China this week. He e-mails:
Du Yu, the engineer who works for our distributor here in China, is always translating for me: that girl says you look like Karl Marx. It happens wherever we go. It means, he says, that you are an amiable person, not to mention that you really look like him. Chinese people learn in grade school that Karl Marx is the “real” Santa Claus. So, I bask in the glow of the masses, they warm to my gaze like dumplings in a bamboo steamer. I probably could take advantage of this...
But the translator goes home. Here's Mike, on his own, in a restaurant:
The waitresses wanted to put the cork back in the bottle after I poured myself a glass of the Cal Red and taken a sip. I tried to tell them that no, you don’t put the cork back in. They just did not understand what I was telling them. So, I pointed to the bottle and tried to pantomime that the wine needed to breathe.

Well, they thought I was telling them that the wine was causing me to suffer an attack of hyperventilation. They became quite serious, concluding that I didn’t like it, that it was killing me. They wanted to take it away! I had to keep repeating “that’s okay” as I grasped the neck of the bottle reassuringly. Then they went to get someone in uniform, who stood in front of my table silently for a while, then blurted out “ice?” -jerking her finger at my glass. “No, no ice, that’s okay, that’s okay”.

I could tell at that point they had concluded that I was crazy. Not putting ice in the Cal Red, not putting the cork back in the bottle to preserve its essence, pretending to hyperventilate for no apparent reason. After that, they left me alone, but I was observed from a distance with fairly unrelenting interest.

It’s around 10:45 pm now. We fly to Xi’an tomorrow afternoon, where the entombed warriors await us. Hainan Airlines, flight 7862, departing 14:45. KFC is going out of business in China. No one is eating chicken because of bird flu.

Code blog: Grand Rounds 2.09

Geena, RN, presents our favorite medical blogging from the past week. She's done a wonderful job. Don't miss Nick's article on Medscape, describing and linking to our Grand Rounds!

Saturday, November 19, 2005

So far away...

My husband's job has sent him around the world for the last few weeks. Every time the phone rings, my heart jumps.

Last night he called me from a McDonald's in China. The noise in the background was deafening. "It's wild here...China is's the wild west," he shouted into the phone. "And the coffee is hot! The Chinese characters on the McDonald's coffee...they say, 'Danger! Very hot!'"

I asked: Why are you in a McDonald's in China?

I couldn't make out his reply. It was all static. It sounds like he's in transit. He promised to send photos and e-mail as soon as he can get connected somewhere.


Psychiatry: "How it all went wrong."

In the New Scientist: An interview with Dr. Nancy Andreasen, professor of psychiatry and an author of DSM3. She's quite critical of modern psychiatry:
There is less emphasis on careful observation. The fundamental point is that the individual patient and his or her uniqueness should form the centrepiece of clinical practice...There is an increased tendency to make diagnosis through checklists, with less emphasis on the interesting uniqueness of each individual patient and on the humanism that lay at the heart of early psychiatry. We tend to over-biologise, we oversimplify the mechanisms of mental illness: in a reductionist framework, depression is a serotonin disease, schizophrenia a dopamine disease. But if we look only at brains, we fail to recognise the important role that personal life experiences may play in losing our minds.

It's useful for psychiatrists to remember that the word comes from the Greek psyche, which means breath, life, animating principle or spirit. Contrast that with the Greek word for mind, which is nous, or the word for brain, which is encephalon. Literally, a psychiatrist is a healer of the spirit, not of the mind or brain.

Does that explain why patients are prescribed so many drugs?

Doctors and patients began to think that most problems could be solved by popping a pill. In the US, at least, we have had some serious over-prescribing for conditions such as attention deficit disorders, anxiety and depression. Sometimes people see medicines as cosmetic surgery for the mind.

And some of those drugs can be a very mixed blessing?

Almost all medications have some side effects. The art of medicine, so to speak, is finding the right balance of dose and side effect. Some of the older antipsychotics did have side effects to do with the motor system: tremors, shuffling gait, restlessness. Newer antipsychotics have fewer of those side effects but have a tendency to produce weight gain. Some believe that modern antidepressants can cause suicide.

What's the solution to the problem of modern psychiatry?

What we need to do is collect data from all levels: molecules, cells, tissues, organs, cognitive and emotional systems, behaviour, exposure to environmental influences. This is going to require rather a lot of data. I love psychiatry because when we do it right, it is the only speciality that emphasises the understanding of individual human beings within the context of a unique environment and personal life history.

Thursday, November 17, 2005

Via BoingBoing: Salford University scientists search for the worst sound in the world.
Fingernails scraping down a blackboard…the scream of a baby…your neighbour’s dog barking: what’s the worst sound in the world?

BadVibes is a new science project from Salford University
that aims to find out just that. People can log on to the BadVibes website at where they listen and vote on a collection of awful sounds, use the horrible sound mixer and even download horrible sound effects as ringtones.

But as Professor Trevor Cox from the University’s Acoustics Research Centre explained, there’s a serious side to the research as well.

"The idea behind the project is to get people thinking about the complex way we listen to and interpret sounds. For instance, you can find out why we find the sound of retching horrible.

By examining people’s voting patterns we will learn more about people's perception of horrible sounds. We hope to learn about what is the worst sound in the world, and maybe why it is the worst sound...

Skeleton with a cigarette

Schedel - Blue, originally uploaded by Pettefletpluk.

Today is the "Great American Smoke-out." Evy's line-and-gouache portrait sends a perfect message, don't you think?

Emergency "Energy Medicine"

A helpful guide, for the mystified: What an "Energy Medicine Specialist" does for a suspected heart attack, until the paramedics arrive.
Medical Necessities:
If the person has stopped breathing, administer CPR, including chest compressions if there is no pulse. This is the top priority!
Common Sense:
Make the person as comfortable as possible.

ENERGY METHODS to support the heart (presented in the suggested order, but like all energy medicine interventions, use with an experimental attitude—they won’t hurt, they probably will help, energy test your results when appropriate, stay attuned to your intuition, not every technique listed will be necessary, innovate):
  1. Do a "hook-up" (one hand in navel, one hand on third eye, push in and pull up).
  2. Strengthen the heart meridian by tracing it forward. As you come to the end of the meridian, rapidly twist the ends of the little fingers back and forth with some pressure.
  3. Deeply and vigorously massage the heart neurolymphatic points between the 2nd and 3rd ribs, just below where the collarbone and breastbone meet, especially if the person is unconscious. Do not do this massage for more than 10 to 15 seconds.
  4. Hold one hand over the heart area and press deeply into the top of the pubic bone with the other hand for about 30 to 60 seconds (re-establishes electrical energy in the body and stimulates the penetrating flow)
  5. Hold the triple warmer strengthening points (TW3 & GB41, then TW2 & BL66) if the person appears to be leaving the body. Speak calmly and ask the person to stay with you. If you have help available, have another person pulse the K1 points on the bottom of the feet.
  6. Hold the spleen meridian strengthening points (Sp2 & H8, then Sp1 & Lv1).
  7. If the heartbeat is erratic or if the heart is beating too strong, hold the small intestine meridian strengthening points (GB41 & SI3, then B66 & SI2)...
  8. If the person is conscious, stable and resting comfortably, hold the frontal neurovascular points to offer comfort until help arrives...
"Reactions that may be caused by energy intervention:"
...The person may enter an altered state of consciousness and, rarely, appear to have left the body. Initially, if the person is in an altered state but conversant, ask if help or assistance is desired. Sometimes a productive and even precious inner journey is underway...

Glowing pork chops alarm Australians

BBC News:
Australians have been told there is no need to panic after a recent "glow-in-the-dark pork chop" scare.

A caller to a Sydney radio talk show sparked fears of radioactive contamination in the meat supply.

The New South Wales Food Authority said the glow was caused by the harmless Pseudomonas fluorescens bacteria.

Food authority head George Davey said he understood people would be "shocked" to see their meat glowing in the fridge but said the bacteria were safe.

"It is important to remember that the micro organism responsible for the glow is not known to cause food poisoning," he said.

The bacteria are naturally present in meat and fish but they multiply quickly if food is not stored at the correct temperature.

So the glowing can be a sign that the food is starting to go off and Mr Davey recommends consumers throw any luminous pork chops - or other cuts of meat - straight into the dustbin.

Mighty Medpundit weighs in

…on the NYT article that ignited my rant:
It's impossible to discern whether this is a true trend or just a New York Times trend. That is, an editor or reporter has a friend or aquaintance who does something or believes something and then writes a whole front page story on the 'trend' based on interviews of the friend and the friend's friends. I suspect the latter, but it's disturbing nonetheless...

They possess two of the worst possible traits that when combined are often fatal - arrogance and stupidity. (Or, as one of my uncles used to say, 'It's not a crime to be stupid, but it is to abuse the privilege.')
The NYT article presents a mishmash of behaviors - some healthy (researching meds, making informed choices) and some dangerous (conning the doctor, practicing ignorant polypharmacy on oneself).

The diagnoses of the patients are never clear. How many are substance abusers? How many are hypomanic, and grandiosely playing doctor, with reckless impulsivity and poor judgment? How many are hypomanic because of their underlying illness, or because of the antidepressants and stimulants that they are recklessly self-prescribing?

How many are paranoid because of their illness and/or amphetamines, and are therefore not trusting of anyone except themselves? How many are in withdrawal from addictive meds? Are their anxiety and insomnia a result of their withdrawal?

There is no better way to sabotage one's treatment than to self-prescribe and not tell your doctor what you're doing. In a way, these patients are letting their doctors off the hook, even as they express their contempt. "Of course the doc can't help me, he doesn't even know what I'm doing behind his back."

Our clinic sees patients who've tried everything described in the article. Some are so addicted to their online meds, or so addled by impulsive, erratic med-and-substance-use, that they don't know where to turn. I ask them to bring in everything they've been taking for the last few months.

"I can't," they might say. "I don't have the bottles, I don't have the pills, I think it was Trazodone. Or Trileptal. Or Tranxene. It had a 'T' in it." They might bring in a baggie full of pills, which we send to our pharmacy for identification. An agitated pharmacist calls back: Where did they get this? What are they doing? Good question, I reply. That’s why they’re here.

The good news is that, if patients can trust us enough to tell us what they're doing, we can usually sort it out, and the patient can usually feel better. There are multiple things to sort through: the diagnosis; the meds taken and not taken; the self-prescribing; the issues that motivated the self-prescribing; and the doctor-patient relationship.

Tuesday, November 15, 2005

Heinous, deplorable, contemptible NYT article

Strong words from Shrinkette, no? Here...partake of this (go ahead, register). Count the ways in which this article is unambiguously wrong and bad. Not just a little bad...I mean, a breathtaking level of badness. Bad, as in dangerous.

Start with the title. "Playing pharmacist." These patients are playing doctor. And they're doing an execrably bad job at it. They say they're dictating treatments to doctors, lying to doctors, conning and manipulating doctors. They're sharing meds, selling meds, prescribing meds, and donating meds...things they've "prescribed," based on their own "research" and personal experience. What do they think these pills are? A doctor with intensive training can have trouble with these meds...and these patients are going to do better on their own? Think mega-side-effects. Think addiction and withdrawal. Think drug interactions. Think organ damage.

"They are as careful with themselves, they say, as any doctor would be with a patient." No doubt, that's true...if their doctor is an incompetent criminal. Pardon me, but these patients are unequivocally endangering themselves...and others.

"Unlikely to be prosecuted" for illegal use of controlled substances? That is absolutely, unequivocally untrue. Did the journalist even try to talk to anyone who's been prosecuted for this behavior? Did she talk to any psychiatrists whose patients have been prosecuted for misusing controlled substances? I can't find a single quote from a psychiatrist (although there are plenty of derogatory quotes about psychiatists). What are the actual diagnoses of the patients who were interviewed? Might not this behavior be part of their pathology? Was there any attempt to find out?

Let the comments begin. Rants welcome.

The Mission: Make a town happy

Psychologists test theories of happiness in a "dull British town." John Nash, in Times Online:
If you were searching for the path to lasting happiness, Slough probably wouldn’t be the place you’d start. But for Richard Stevens, a leading psychologist, the Berkshire town proved the ideal location for a pioneering experiment: take all the theory and speculation about what makes human beings happy and test it over ten weeks on people in an ordinary British town. He believes he now knows what works.

Poor old Slough: it was the running gag in The Office; John Bunyan linked it irrevocably with “despond” in The Pilgrim’s Progress; and Betjeman famously pleaded: “Come, friendly bombs and fall on Slough/It isn’t fit for humans now.” Stuck under a Heathrow flightpath and beset by roundabouts and soulless concrete buildings, it is an emblem of the sadder aspects of modern Britain. But Stevens, along with a team of shrinks, counsellors, an economist and a film crew, found it fertile ground for emotional uplifts.

The team recruited 50 local volunteers, aged from 17 to 78, spanning the racial spectrum, and with occupations from housewives to local councillors and university tutors. The mission: Make Slough Happy. With a four-part BBC television series on the completed project starting next week, Stevens, the avuncular chair of the Open University’s social psychology course, claims to have found the path to happiness in everyday modern life . . . and it isn’t more money.

His formula splits into four general categories: physical, relationships, work and community. But if there is a keyword, it is connectedness...
The BBC will soon air a documentary about this experiment. Here's the "Happiness Manifesto," according to the Times:
Plant something and keep it alive.
Count your blessings — think of at least five — at the end of every day.
Have an hour-long uninterrupted conversation with your partner each week.
Telephone a friend.
Give yourself a regular treat.
Have a good laugh each day.
Take regular exercise.
Smile at strangers, or talk to them.
Cut your television viewing by half.
Perform an act of kindness every day.
I see several that I'm doing already (exercising, conversing with my spouse, and watching almost no TV.) Shall I try the rest of them? Hmmm...

Monday, November 14, 2005

Portrait of a gadfly

Dr. David Healy is well known for his views on the dangers of antidepressants. Has he been stigmatized and shunned for his views? Lori Waselchuk, for The New York Times:
Dr. David Healy, a psychiatrist at the University of Cardiff and a vocal critic of his profession's overselling of psychiatric drugs, has achieved a rare kind of scientific celebrity: he is internationally known as both a scholar and a pariah.

In 1997 he established himself as a leading historian of modern psychiatry with the book "The Antidepressant Era." Around the same time, he became more prominent for insisting in news media interviews and scientific papers that antidepressants could increase the risk of suicide, an unpopular position among his psychiatric colleagues, most of whom denied any link. By 2004, British and American drug regulators, responding in part to Dr. Healy and other critics, issued strong warnings that the drugs could cause suicidal thinking and behavior in some children and adolescents.

But Dr. Healy went still further, accusing academic psychiatry of being complicit, wittingly or not, with the pharmaceutical industry in portraying many drugs as more effective and safer than the data showed.

He regularly gets invitations to lecture around the world. But virtually none of his colleagues publicly take his side, at least not in North America.

"It's strange. I don't even know about friends, what they think about me," Dr. Healy said in New York, as he waited for a flight after giving a lecture at Columbia. "You don't really know who you can trust."

Because of his controversial views, Dr. Healy has lost at least one job opportunity, at the University of Toronto in 2001. In some circles, his name has become so radioactive that it shuts down discussion altogether.

"People have called it the Healy effect," said Dr. Jane Garland, chief of the Mood and Anxiety Disorders Clinic at British Columbia Children's Hospital in Vancouver, who shares some of Dr. Healy's concerns about drug risks. "If you even raise the same issues he does, you're classified as being with David Healy and that makes people very reluctant to talk. He has become very isolated."

Some colleagues have called him reckless, a false martyr whose grandstanding in the news media has driven away patients who need help. But they cannot dismiss him entirely. And for those who wish to understand what it takes to defy a scientific fraternity without entirely losing one's standing - or nerve - he has become a case study...

"An abridged life"

From Ms. Ditz (thanks, again!): Howard Dully describes the transorbital lobotomy that he received at the age of twelve.
"You'd probably never know what happened to me if I didn't tell you,'' Dully said in an interview. "But I felt I was not who I was supposed to be anymore. You can't put your finger on it, but something's been taken away. Something's been altered or changed. It's very frustrating.''
In a radio documentary that airs on NPR this Wednesday, "he talks to his father for the first time about the procedure that changed his life. And he finds his medical file among the archived papers of Dr. Walter J. Freeman, the doctor who gave him the lobotomy -- years after it had been discarded as a treatment for mental illness."
"My file has everything -- a photo of me with the ice-picks in my eyes, medical bills,'' Dully says on the broadcast. ``But all I care about are the notes. I want to understand why this was done to me.''

He reads one of the entries. It's from his birthday, Nov. 30, 1960: ``Mrs. Dully came in for a talk about Howard. Things have gotten much worse and she can barely endure it. I explained to Mrs. Dully that the family should consider the possibility of changing Howard's personality by means of transorbital lobotomy. Mrs. Dully said it was up to her husband, that I would have to talk with him and make it stick.''

At the archives Dully also found a pair of leucotomes, the instruments that had been driven into his eye sockets.

The lobotomy was introduced in 1936 by a Portuguese physician, Dr. Egas Moniz. It won him the 1949 Nobel Prize in Medicine. Some 50,000 lobotomies were performed in the United States from the 1930s to the 1970s.

The original method, called prefrontal lobotomy, involved boring open the patient's skull to cut the connection between the prefrontal region -- an area concerned with emotion, learning, memory and social behavior -- and the rest of the brain. While it often relieved symptoms of severe mental illness, it also blunted emotion, leaving patients listless, apathetic and childlike.

Freeman invented an easier way, the transorbital or ``jiffy'' lobotomy, which left no obvious scars. It could be done in a few minutes as an outpatient procedure.

He traveled the country promoting the technique, performing up to 25 lobotomies per day -- some 3,400 of them in the course of his career, according to Jack El-Hai, whose biography of Freeman came out this year...

Sunday, November 13, 2005

"A Rude Awakening"

"Hypnosis Can Help With Treatment of Numerous Medical Conditions. Unfortunately, Existential Dread Isn't One of Them." Simon Busch, in WAPO:
I don't know what was wrong with me: a case of ill fit with the world, I guess. I suddenly kept being confronted by the fact of my own mortality, like a glacier in my path, and seizing up with panic.

I told my doctor and, as luck would have it, he was branching into hypnotherapy and wanted to try it out on me. He was quite the evangelist for the treatment. Hypnosis was no mere stage trick, he insisted: A patient of his had recently had major dental surgery -- I imagined pile drivers and a building site -- solely anesthetized by the doctor's suggestion. As for quitting smoking, why, the cigarettes virtually extinguished themselves. My panic attacks should likewise succumb to the powers of his mind.

On my next appointment, he led me to a room where he gestured for me to lie down on a very purple, soft leather couch while he took the armchair opposite. He put a CD of New Age mood music on the stereo -- some sort of ode to aquatic life-forms, I noticed by the cover -- and told me to focus on a psychedelic spiral pattern inscribed on a small piece of paper attached to the ceiling, while simultaneously concentrating on the sound of his voice...

The hypnosis was a course of treatment and was supposed to proceed through several stages. Its goal was to get my everyday, humdrum, conscious mind off guard and sleepy, and thus penetrate to the real, traumatized meat of my unconscious to apply the salve of suggestion.

That is its proponents' explanation. An alternative, uncharitable view is that hypnotherapy, if it works at all, does so by appealing to people's deep-seated slavishness, such that they will deny -- including to themselves -- great pain or even, placebo-like, achieve some kind of recovery in order to please the authority figure of the doctor. It is supposedly this same mechanism that causes the subjects of stage hypnotism to go along with pretending to be Elvis or a teapot, or whatever -- just in order not to rock the boat. A third view has it that hypnotherapy has no place other than on the traveling huckster's hoarding, next to snake oil...
I know that I'm hypnotizable. During residency, I watched an attending psychiatrist "try out an idea" - a hypnotic suggestion - on a patient. To this day, I don't know whether he induced a trance in the patient, but he certainly induced one in me!

Later, he told me a story about a patient with hysterical paralysis. His doctor hypnotized him and said, when we're done, you'll be able to walk. Sure enough, when the patient awoke, he was no longer paralyzed...but he was blind! "Hypnosis didn't solve his basic problem, the problem of needing to be disabled," said the attending. "Remember, we have to try to figure out the problem."

Thursday, November 10, 2005

"Satanic abuse victim" recants

E-mail from Liz Ditz, of "I Speak of Dreams!" She writes,
"I thought this would interest you. The McMartin preschool case was notorious."

"Twenty-one years ago, a child then known as Kyle Sapp told police that he had been the victim of sexual abuse at the McMartin Pre-School in Manhattan Beach. Sapp, who attended the preschool from 1979 to 1980, was 8 when he first talked to authorities in 1984. He and hundreds of other South Bay children made allegations against the family who ran McMartin and against the employees who worked there. School administrator Peggy McMartin Buckey, her son Ray, daughter Peggy Ann, mother Virginia McMartin and three female teachers were accused of fondling and raping youngsters over a period of years, and of threatening them with death if they told. The scandal eventually resulted in criminal trials against Ray and his mother. By the time the trials came to an end in 1990—with acquittals and hung juries—"McMartin" was a household word. The case had turned into one of the longest and costliest criminal proceedings in U.S. history."

McMartin Pre-Schooler: 'I Lied'
# A long-delayed apology from one of the accusers in the notorious McMartin Pre-School molestation case

By Kyle Zirpolo, as told to Debbie Nathan

"I remember them asking extremely uncomfortable questions about whether Ray touched me and about all the teachers and what they did—and I remember telling them nothing happened to me. I remember them almost giggling and laughing, saying, "Oh, we know these things happened to you. Why don't you just go ahead and tell us? Use these dolls if you're scared."

Anytime I would give them an answer that they didn't like, they would ask again and encourage me to give them the answer they were looking for. It was really obvious what they wanted. I know the types of language they used on me: things like I was smart, or I could help the other kids who were scared.

I felt uncomfortable and a little ashamed that I was being dishonest. But at the same time, being the type of person I was, whatever my parents wanted me to do, I would do. And I thought they wanted me to help protect my little brother and sister who went to McMartin."

Liz Ditz
Thank you, Liz! I was still in training during that trial. I recall that I was deeply suspicious of the children's testimony, as well as the adults' behavior. Kyle feels guilty and apologizes, but note:
"Ray Buckey and his sister, Peggy Ann, as well as a former McMartin teacher, Babette Spitler, declined to meet with Zirpolo. They've always staunchly proclaimed their innocence, and say they don't need apologies from former students, who were children and couldn't help themselves. Peggy Ann has said that they would rather hear from the police, social workers, therapists, prosecutors, doctors and parents who fueled the case."

Times Online: Author and journalist A. A. Gill, on alcoholism.

I was, in English terms, very good at drinking. Too good. I had a substantial capacity for absorbing the stuff and had worked out the Dumb Crambo of moving around when your internal gyroscope has fallen over. I learnt to enunciate when my mouth felt like it was made out of putty and my teeth had all changed places and I had the tongue of the dog whose hair I’d consumed.

I drank steadily, with a steely determination. I drank on and through peripheral neuritis, alcoholic gastritis, an atrophied brain, an enlarged liver, a damaged pancreas, blackouts, suicidal depression, anonymous bloody sores and DTs so severe that I would have to take the first drink of the morning using a towel hooked round my neck as a pulley, because I was frightened of knocking my teeth out with the glass.

I went for help one April and the doctor said that I’d better be serious about stopping, because if I didn’t I was unlikely to see another Christmas. Incredulous friends said they couldn’t believe I had a problem as they’d never seen me drunk. The truth was, they’d never seen me sober, I’d just woven drink into the fabric of who I was and I had to unpick it...

"Does this therapist have...issues?"

Reader "Bill" sends this e-mail:
I am trying to choose a new therapist. One has good qualifications, but I'm concerned because she is very overweight. Please, don't take this as criticizing anyone overweight. I have troubles with that myself. But does it indicate the therapist has issues and I should avoid her? you may blog this
It's not easy to choose a therapist. Degrees, certifications, work history, and recommendations can indicate competence. But patients must ask themselves: am I comfortable sharing thoughts with this therapist? Do we connect? Can I trust this person? What sort of help can this therapist give me? Therapists are prepared to address these questions with new clients. Sometimes patients interview several therapists before finding the right "fit."

I think you'd be hard pressed to find a therapist who hasn't grappled with personal challenges. The question becomes, how have they coped with their issues? What have they learned, and how can they use what they've learned to help others? If this therapist's credentials are truly impeccable, I'd certainly consider starting therapy and giving it a try. You may find that she has particular strengths that are helpful.

Other questions I'd consider: "What is it about this therapist's weight, that's giving me pause? Is it suggesting issues in my own life that are difficult for me to face? Is she reminding me of other important people in my life, and am I reacting to her in ways that I might react to them? Would I feel comfortable discussing the whole issue of obesity with this therapist? And...what issues am I possibly avoiding, by focusing on weight?"

What do you think? Comments are welcome!

Monday, November 07, 2005

"Grand Rounds - Stardate 2.07"

Dr. Leonard "Bones" McCoy tours Rita's hospital at this week's Carnival of the Caregivers. Don't miss Dr. Helen's compelling post about her experiences as a young patient with heart disease.

(And to hear Rita's thoughts on medicine,
here's her podcast interview at!)

Saturday, November 05, 2005

Death by caffeine?

This site purports to calculate the lethal dose of one's favorite caffeinated beverage.

I have a quibble, though. Beverages with low caffeine content would have to be taken in massive quantities. For example, the site reports that "after 1638 glasses of chocolate milk, I'd be pushing up daisies." I believe that my daisy-pushing would begin at a much lower dose, and that caffeine would be the least of my problems. Depending on the rate of ingestion, I'm thinking that "death by chocolate milk" involves volume overload, glucose abnormality, and electrolyte imbalance. Clearly, "Energy Fiend" would benefit from a medical consult. (Paging Dr. KidneyNotes!)

The biggest problem, of course, is that the patient tried this in the first place. The differential diagnosis might include psychotic mood disorders, thought disorders, cognitive disorders, and personality disorders. There would be plenty to keep a psychiatrist busy...

-via Boing-Boing.

Med update: "Panexa"

They might have called it "DTC-exa." From the "Much-Truth-In-Jest" Department:
"No matter what you do or where you go, you're always going to be yourself. And Panexa knows this. Your lifestyle is one of the biggest factors in choosing how to live. Why trust it to anything less? Panexa is proven to provide more medication to those who take it than any other comparable solution. Panexa is the right choice, the safe choice. The only choice..."
Half the samples in our cabinets come with promotional leaflets that aren't far removed from this! (Let me guess: does it contain Paxil, Xanax, and Zyprexa?) I won't be surprised if patients start asking for this! But wait, there are cautions:

There are no known medical circumstances (based on extensive internal testing) in which PANEXA cannot be used. However, PANEXA is not quite as aggressively recommended in the following circumstances:

* PANEXA should not be used as a physical aid to set a broken bone, as in the case of a splint;
* PANEXA should not be used as a substitute for real human relationships; the tablets (and gel-coated caplets) are incapable of displaying any real emotion, and would prove to be dissatisfying friends or mates;
* PANEXA should not be used to soak up spills or remove stains. This is disrespectful to PANEXA;
* PANEXA should not be resold with the intent of generating a personal profit;
* PANEXA should not be used a form of motive transport, as it lacks the government regulated (US DOT 1445/88-4557) safety lights and reflectors;
* Women with uteruses should consider avoiding PANEXA or moving to a state or province where the concentration of PANEXA is lesser;
* Do not taunt PANEXA.
-via "Mindhacks."

Thursday, November 03, 2005

Don't bet on it...

In the Guardian:
"Michael O'Leary, the founder of Ryanair, yesterday announced plans to introduce in-flight gambling by 2007 and said it could eventually help the airline to offer free tickets for all. He admitted it could change the image of airlines but insisted it could only be for the better as the traditional industry appeared to be built around high-cost tickets and terrible food."
One can only admire his creativity. Health professionals could learn so much from this approach! I can see it now, in my own practice:

"Good morning, patients, and welcome to Group Therapy. Due to budget cuts and insurance issues, we're trying something different today. Is the door closed...tightly? Must maintain confidentiality! Good. Let's begin, shall we? Let's form a circle with our chairs, while we set up the 'Big Wheel' in this corner...

"All right, ladies and gentlemen, please lay your money down! One personal issue per bet, that's one issue per bet, and we start the wheel, and the wheel is...rolling! There's a vibration, can you feel it, can you feel it, everybody lay your money down! This is the last call for bets, and the winner is...Anger Management Issues! Who has an Anger Management Issue in this room? Nobody? Well, I guess the house wins.

"Don't be discouraged, because we start the wheel again, like so, and the wheel is turning, and the wheel is turning. Let's have a big win now! Any bets overlapping two issues is...disqualified, but we'll have a private therapy session to cope with the loss! There's a winner coming, there's a winner coming, there's a winner coming, and the winner is...

"Problems with Authority Figures!
Who has a problem with...Wait, you're an authority figure? You're the authority figure?

"What do you mean, I'm under arrest?"

(with apologies and thanks to John C. McGrath and the 1977 Integral)

Wednesday, November 02, 2005

"Planning for the pandemic"

The Onion, via

"As the threat of avian influenza looms, federal and state officials are preparing for a possible pandemic...Here's what they're doing:

Removing all flagpoles, streetlights, power lines, branches, and anything else that could be used as a perch

Warning nation's children to stay away from any and all flu pandemics

If roasted chicken becomes infected, instructing families to build mashed-potato wall to prevent contamination of peas..."
Click for Eugene, Oregon Forecast