Your Dangerous Drugstore

An interesting article by Dr. Marcia Angell in the New York Review of Books that I saw posted on World Health News. There is a lot of debate these days about how effective the FDA is in regulating the drug approval and monitoring process.

The concern centers around whether scientists at the FDA are impartial enough, especially given that many have financial relationships with the companies they oversee. Public opinion is turning against both the FDA and the pharmaceutical industry in the wake of recent high-profile recalls like Vioxx and Bextra.

While the consistent, and often impressive, profitability of the pharmaceutical industry certainly suggests that these companies are recovering more than the cost of R&D in the prices of the drugs and devices they manufacture, it is hard for me to come down on them for making money. What's wrong with making a profit?

On the other hand, we do need to care for those unable to afford treatment. I think we can go a long way towards accomplishing this if we reform how the government purchases drugs from the industry. Medicare, for instance, cannot use its purchasing power to bargain for lower rates like other countries do. This type of practice runs counter to free market price setting and artificially inflates prices.

If Medicare were free to bargain for better prices, then we would see drugs costs more in line with what other countries pay. While this may cut down on the amount of profit pharmaceutical companies receive, I'd find it hard to believe that it would make them unprofitable.

Of course, the industry has one of the most powerful lobbies in the country and likely has no intention of sending their golden goose to slaughter. As long as they can market directly to patients and maintain the current Medicare payment system, their corner offices with views are not likely in any danger.

In our zeal to reform the industry, however, we must be careful not to stifle it. The pharmaceutical industry remains a vital source of funding for research studies and the consequent medical breakthroughs. A balance between the profit motive and public health needs must be struck in a way that rewards innovation while not sacrificing the health of those most in need.

Throw Down

Today Ahmed challenged by brothers and me to a game of basketball in an email that defiantly stated: Bring it!

Such innocent exuberance is something I've come to expect from AJ, but I had a feeling he was not all sugar and spice when he included the following image in the email:

Indeed, this picture was worth a thousand words. AJ was putting the world on notice that he was Jordan to the Shakur Brothers Reece Gaines. In fact, he felt so bad for us, he was even giving us an autographed jersey before the game, like a pre-emptive parting gift for people who come to game shows and win nothing.

Imran, perpetually clueless, responded to this email with, "LOL. Dorkistani." The true nature of the insult had clearly flown way over his rather large head. He thought AJ was merely being cute, in a yuppie Lincoln Park sort of way.

But I knew better. Having been schooled during my formative periods on the South Side of Chicago, I knew a throw down when I saw one. AJ was calling us out, and it was time for us to respond. So I did, not visually, but lyrically, in the only way a South Sider knows how:

You tell me to bring it,
You, who play so half bit,

Watch my defense rip
as your shots slip

Mine fall down like rain
Proclaiming my righteous reign

Peace out,

Shakfoo

To this lyrical onslaught, even AJ had to submit, saying only:

Dang! Kamikaze Ninja Wu-Tang Shaolin Rajpoothi Jigga Wigga Ill-Will up in 'dis.

What else can one say? Unfortunately, the game tonight was cancelled, but soon enough we shall see how this battle of wits plays out on the court...

President Bush Impersonation

You've all probably seen this by now, but it is still quite funny...

Mentally Unfit, Forced to Fight

A fascinating investigative news story by the Hartford Courant, which was posted in the latest issue of Harvard's World Health News.  Here is an excerpt:

These practices, which have received little public scrutiny and in some cases violate the military's own policies, have helped to fuel an increase in the suicide rate among troops serving in Iraq, which reached an all-time high in 2005 when 22 soldiers killed themselves -- accounting for nearly one in five of all Army non-combat deaths.

The Courant's investigation found that at least 11 service members who committed suicide in Iraq in 2004 and 2005 were kept on duty despite exhibiting signs of significant psychological distress. In at least seven of the cases, superiors were aware of the problems, military investigative records and interviews with families indicate.

World Health News also posted a link to a story by ABC News, based on the Courant's investigation.

The Courant reports that the Army is satisfied with efforts it launched two years ago to improve mental health among troops, and that they expect some "variation" in suicide rates among troops. 

Hardly a comforting voice of support for our troops.  Those who do seek help likely do so with much stigma and belittling of their condition, problems even civilians face in coping with mental illness.  Yet our troops can ill afford the impact of mental illness in a place where uncertainty is palpable and the line between life and death is so thin...

In related news, HBO is set to launch a documentary called "Baghdad ER" which, according to Lieutenant-General Kevin Kiley (Army Surgeon General), shows, "the ravages and anguish of war." The military, initially supportive of the show, is now distancing itself from it -- one wonders if it is not doing the same with respect to the mental health of its soldiers...

How the Winds do Change

The sun is shining through some thick white clouds as I help my mother spread some gravel in the front yard. After a few minutes, I take a casual look up into the sky and notice that there are huge, dark storm clouds coming from the north advancing, rather rapidly, towards the south and directly over us. As I looked south into the sky, the sun was still shining bright and the sky was blue and clear with some thick puffy white clouds. I called out, a little nervously, to my Mom and said it looked like some storm clouds were headed our way. Without looking up from her work, she said she heard something about 70 mph winds in Chicago on the local news.

Less than a minute after that, we felt the wind pick up tremendously and now the sky, which was previously half clear and half dark, was now completely dark above us and the wind started whipping everything around us. Trees were starting to shake and we grabbed all the tools and ran into the garage. Moments later, the rain started thundering down and pelting the windows in our house.

View from my garage.

There is something about thunderstorms that always evokes a sense of fear and trepidation within me. There is a verse in the Qur'an,

"The thunder hymneth His praise and (so do) the angels for awe of Him."

My Mom always taught me to pray, whenever it looked like it would rain, that it would be a blessed and merciful rain, one with which God revives and restores the land, not one bearing His punishment. The suddenness, and intensity, of the storm reminded me of how tenuous our hold is and how indebted we are to Him.

Now, as I look through the window, the rain has settled into a soft drizzle and the sun is starting to peek back through the clouds...the storm is gone, as quick as it had come...

Coming to America

There is a long-standing academic debate going on as to whether or not Muslims came to America before Columbus did in 1492. Some argue that Muslims from Islamic Spain or West Africa came centuries before Columbus and point to historical accounts of such voyages in Arabic texts as well as linguistic clues in the names of places. While the case has not been convincingly made, a summary of the debate is provided by Rebecca Fachner on the History News Network.

What I found interesting in Fachner's article was her reference to Leo Wiener, founder of the Slavic Language Department at Harvard, who made an argument for African Muslims arriving before Columbus (Africa & the Discovery of America). When I looked up Professor Wiener, I found links to some of his published works and discovered that he also made an argument that Germanic languages owe their origins, in large part, to Arabic.

In his, "Commentary to the Germanic Laws and Mediaeval Documents," Professor Wiener states:

The second volume will discuss the more than two hundred words of Arabic origin in the Gothic Bible and in all the Germanic languages. I will also show that the Naples and Arezzo Gothic documents are late eighth century forgeries, that Jordanes has come down to us in manuscripts interpolated about the same time, that Germanic mythology is of a literary Gothic origin, based on Arabic sources, and that no literary documents in Anglo-Saxon, Norse, and Old High German exist which do not show the influence of the Arabicised Gothic language.

Professor Wiener also wrote a four-volume text called, "Contributions Toward a History of Arabico-Gothic Culture ," which further develops the above thesis.

It's always interesting to me to find scholars who demonstrate such historical links between Islam and the West. Many historians, in fact, have made the assertion that Europe's Renaissance was fueled by the transfer of knowledge from Islamic civilization through 12th century translation movements (Arabic to Latin) in Europe. It would perhaps go a long way to helping resolve current "ideological" debates if both sides realized how connected they are to one another...

Below I've included links to additional sources that make a claim for Muslim discovery of the New World.

Sources:
1. They Came Before Columbus: The African Presence in Ancient America by Ivan Van Sertima (Professor at Rutgers University)
2. Unexpected Faces in Ancient America by Alexander Von Wuthenau (Professor of Art History at Mexico's University of the Americas)

The following contain detailed bibliographies for further reading:
3. Exploration in Texas by John L. Davis (online version of his book containing an impressive bibliography)
4. Online bibliography by Karl Schwerin, Dept. of Anthropology, University of New Mexico

The End is Only the Beginning

 

I'm doing family medicine at Michael Reese hospital these days, my last rotation as a medical student.  I graduate at the end of May and then start my internal medicine residency in Milwaukee in July, God willing.  While finishing medical school will be the end of formal schooling, it really is only the beginning of the intensive training process that occurs during residency.  I'm somewhat nervous about the transition, both because it is the next level of patient care and because I'll be in a new city, but I'm also looking forward to the chance to do what I've always wanted to do.  It's strange to think the moment is at hand...

 

Michael Reese is an interesting hospital.  In the past, it was a major academic center, producing physicians like Dr. Milzer who helped design an effective vaccine for polio and Drs. Pick and Lagendorf, who helped develop the EKG.  There are other big names as well, but, unfortunately, the hospital lost much of its luster when it was taken over by a for-profit hospital chain. They failed to transform Michael Reese into a profitable hospital, a model that seems inappropriate anyway for the patient population Michael Reesee serves.  They are now owned in part by Doctors Community Healthcare Corporation which partners with physicians to run the hospital.  Apparently, they have made some progress and still maintain a residency program in internal medicine.

 

The weird thing is how underutilized the hospital is, with entire floors abandoned and empty.  You can walk through and see patient rooms that haven't been used in years, where the only activity is the dust settling down on countertops and window sills.  The family medicine clinic that I'm at takes up an entire floor though we clearly do not need so much space.  One of the other med students told me that it used to be a wing of the hospital and that our exam rooms actually used to be inpatient rooms.  If they were patient rooms in the past, the rooms were likely a little snug...  

 

The physicians at Michael Reese, however, are doing a real service to the community by seeing largely uninsured patients and taking care of them.  And I'm sure the residents see more than enough interesting cases, as many patients have advanced stages of various diseases like diabetes, high blood pressure and the like.  

 

The frustrating part about working with a low-income population are the patients who simply refuse to take care of themselves.  I saw one patient, a woman in her late 40s/early 50s, who weighed over 300 pounds, total cholesterol over 300 (over 200 is bad), and blood pressure above 160/90 (called stage 2 hypertension).  She was prescribed a variety of medicines to help control her blood pressure and cholesterol but only takes one of the medicines, at half the dose prescribed.  This, despite the fact that Medicaid covers the expenses for all her medicines.  On top of all that, she smokes.  I talked to her for a while about the serious implications of her illnesses (heart attack and stroke) and tried to encourage her to take her medicines, but I have a feeling she is out there somewhere having a cigarette and eating one too many items off the dollar menu... sigh...  

 

There are, of course, many patients that do a great job of adhering to their medicines and following up with doctor visits, and those are the patients that make you feel like you're doing some good, that the struggle is worth the effort.  We certainly cannot force people to do what we think is best for them, no matter how sincere our intentions, and developing the patience and discipline to understand that is a lifelong challenge.  At least, for the likes of me...

 

On that, adieu