Posts tagged “medicine”

The Defenestration of Bruce

As best as I can tell, Bruce broke into our apartment well after midnight Wednesday morning.

I should clarify. Bruce is a bat. A small bat. He is of the night, of the outdoors. He broached the boundary between inside and outside through a barely open window.

I turned in around 1:00a after a night of writing; Beth had been asleep for hours. The blinds were closed and the windows were open - a normal night for us in California. I imagine that Bruce flew in, collided with the shutters, and, little claws flailing, grabbed ahold. After catching his breath, he began to explore, to poke around his new environs.

I woke up to that: the rambunctious and clattering aftermath of Bruce’s entrance. He made his way over to the other open window, which had a screen in place. It is unclear whether he perceived this as a way out or was just seeking a cool breeze on his furry belly and wings. Regardless, this is where I found Bruce.

In the gauzy moments before adrenaline kicked in, my mind cycled through possible origins of the racket: “Moth. Rat. Bird.” It wouldn’t be the first time a winged intruder entered our home. A few years ago, a small sparrow got caught in the blinds, creating a lot more ruckus and pooping all over the place before leaving our home / exiting his toilet.

I woke Beth up, had her turn the lights on (and, in doing so, moved her away from the blinds), and took a look. My glasses were off, so all I could make out was a small black blob, the size of a small child’s fist. My first thought was large spider. But then, the blob moved in mysterious ways. Furry, winged ways.

“Bat,” I said, still half asleep.

“Bat? buhbuhBAT! BAT! BATBATBATbatbatbatbatbat!”, Beth shrieked, her voice a fading echo as she fled the room and shut the door.

I grabbed my glasses and took a closer look. Bruce came into focus, a wee bat, moving a bit and holding tightly to the aforementioned screen. A screen installed to keep pests out… and decidedly keeping Bruce in.

Beth peeked her head in and suggested we leave the room, close the door, and call maintenance. She was now fully clothed in multiple layers, scarves wrapped around her neck, head, and face. Bite protection.

I was keen on a more proactive approach and assumed we could knock the screen out the window, rid the apartment of Bruce, and not kill him. A late night defenestration.

After a few minutes of vacillating between amusement and sheer terror, I got a broom, aimed for the corner of the window shade…. and missed, putting a big hole in the screen. Bruce bobbled around a bit, spreading one wing, but not taking flight. He slowly slinked his way to the opposite corner of the screen. His wings were taut and leathery, his ears tiny, his demeanor fearless and frightening.

I slowly inserted the broom in the hole I made and decreased the width of the screen an inch. I then knocked it - and Bruce - out the window.

We heard the screen hit the ground an eternity later, closed all the windows, and took showers. We escaped unscathed… or so we thought.

The Ranbaxy Boondoggle

Cover-ups. A corporate culture not only lacking ethics but endorsing and encouraging amoral behavior. Unfettered greed. And excellent reporting by Katherine Eban at Fortune on Ranbaxy’s atrocious behavior. I remember not long ago reading about how much of a boon Ranbaxy could be for PEPFAR and for getting good medicines to those most in need.

Shameful behavior and a slow and unacceptable response from the US FDA. Kudos to the employees and auditors who brought the abuses to light.

The two men strolled into the hall to order tea from white-uniformed waiters. As they returned, Kumar said, “We are in big trouble,” and motioned for Thakur to be quiet. Back in his office, Kumar handed him a letter from the World Health Organization. It summarized the results of an inspection that WHO had done at Vimta Laboratories, an Indian company that Ranbaxy hired to administer clinical tests of its AIDS medicine. The inspection had focused on antiretroviral (ARV) drugs that Ranbaxy was selling to the South African government to save the lives of its AIDS-ravaged population.

As Thakur read, his jaw dropped. The WHO had uncovered what seemed to the two men to be astonishing fraud. The Vimta tests appeared to be fabricated. Test results from separate patients, which normally would have differed from one another, were identical, as if xeroxed.

Thakur listened intently. Kumar had not even gotten to the really bad news. On the plane back to India, his traveling companion, another Ranbaxy executive, confided that the problem was not limited to Vimta or to those ARV drugs.

“What do you mean?” asked Thakur, barely able to grasp what Kumar was saying.

The problem, said Kumar, went deeper. He directed Thakur to put aside his other responsibilities and go through the company’s portfolio — ultimately, every drug, every market, every production line — and uncover the truth about Ranbaxy’s testing practices and where the company’s liabilities lay.

Nature, Nurture, Medication, Arrogance

A pretty terrifying article from the NYT about prescriptions of psychotropics - regardless of ADHD diagnosis - in school age children. I couldn’t read the article in any light but one of utter disbelief; I’m not sure if that’s me imposing my bias on it or if its actual paints the practice as problematic.

Some excerpts below, but read the whole thing.

Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

The Drug Enforcement Administration classifies these medications as Schedule II Controlled Substances because they are particularly addictive. Long-term effects of extended use are not well understood, said many medical experts. Some of them worry that children can become dependent on the medication well into adulthood, long after any A.D.H.D. symptoms can dissipate.

According to guidelines published last year by the American Academy of Pediatrics, physicians should use one of several behavior rating scales, some of which feature dozens of categories, to make sure that a child not only fits criteria for A.D.H.D., but also has no related condition like dyslexia or oppositional defiant disorder, in which intense anger is directed toward authority figures. However, a 2010 study in the Journal of Attention Disorders suggested that at least 20 percent of doctors said they did not follow this protocol when making their A.D.H.D. diagnoses, with many of them following personal instinct.

You can argue either way about this — that helping struggling students perform is a good thing; that riddling younger kids with drugs that we know are addictive AND for which we don’t know the long-term side effects of is insane. I tend toward two seemingly sensical principles here — 1) the precautionary principle, something largely eschewed in this country and 2) finding better ways to engage students in school beyond medication. Medication is appropriate when the prescription is made with a valid medical diagnosis. In some of the cases described, however, the diagnosis is flimsy, the ethics questionable, and the end-result hardly what we want, as a society, for our youth. I can’t help but think there must be another way.

200 Years of the New England Journal of Medicine

The New England Journal of Medicine - among the most preeminent medical journals¬†- is 200 years old this year. In recognition of that two century milestone, they’ve put together a number of special (and accessible) articles available here.

In “The Burden of Disease and the Changing Task of Medicine,” authors David Jones, Scott Podolsky, and Jeremy Greene outline shifting patterns of disease and their effect on the role of medicine in society.

diseasestatuschange.gif

The article contains numerous anecdotes, some unbelievable, about diseases and disease states that were common 100 years ago. Some sound familiar; others, not so much. I find the article particularly interesting when it starts to delve into how we define and prioritize diseases, and how that ties into inequities in well-being:

A population’s disease status can also be gauged by lists of common diagnoses at clinics or hospitals, but no single measure definitively characterizes a population’s burden of disease. Choosing among metrics is as much about values and priorities as about science, and it directly affects health policy. Whereas advocates of clinical and research funding for cardiovascular disease might use mortality data to support their claims, mental health advocates can cite morbidity measures in seeking greater resources. Data on causes of childhood mortality would justify certain priorities; analyses of health care spending would justify others. An ideal, sophisticated health policy would integrate all measures to form a holistic map of the burden of disease, but in practice competing interests use different representations of disease burden to recommend particular policies.

And, later in the article:

The persistence of health inequalities challenges our scientific knowledge and political will. Can we explain them and alleviate them? Genetic variations don’t explain why mortality rates double as you cross Boston Harbor from Back Bay to Charlestown or walk up Fifth Avenue from midtown Manhattan into Harlem. Nor do they explain why Asian-American women in Bergen County, New Jersey, live 50% longer than Native American men in South Dakota. Although we know something about the relationships among poverty, stress, allostatic load, and the hypothalamic - pituitary - adrenal axis, doctors and epidemiologists need more precise models that sketch in the steps between social exposure, disease, and death. … Disparities in health and disease are outcomes that are contingent on the ways society structures the lives and risks of individuals.

In many respects, our medical systems are best suited to diseases of the past, not those of the present or future. We must continue to adapt health systems and health policy as the burden of disease evolves. But we must also do more. Diseases can never be reduced to molecular pathways, mere technical problems requiring treatments or cures. Disease is a complex domain of human experience, involving explanation, expectation, and meaning. Doctors must acknowledge this complexity and formulate theories, practices, and systems that fully address the breadth and subtlety of disease.

The article hints at the relationship between public health, health policy, and medicine, but doesn’t delve fully into how those relationships have evolved over the 200 year history of the Journal. It would be interesting to learn more along that vein - how medicine has informed policy and influenced public health measures, etc. Overall, though, an interesting, enlightening read.

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