American Gadfly

Commentary, Critique, and Insight on Contemporary America

Thursday, March 16, 2006

Population growth, a huge inflationary force?

Inflation hawks might be temporarily breathing a sigh of relief over today's Labor department report of a modest 0.1% rise in consumer prices for February.
Rather than superficially celebrate this number, let's look at one of the great forces that will assuredly lead to inflation in many economies of our planet. This force is population growth, or rather, overgrowth. Anytime a region has more and more people in it, there will by definition be more demand for resources - food, water, gas, cars, homes/apartments, etc. If the population grows faster than the resources available to support it, you will get supply and demand imbalances and added pressure to consume more resources from elsewhere.
We as a country, and as denizens of this planet, are becoming more and more numerous. America will top 300 million residents this year, while our planet has 6.5 billion humans residing on it. This added to the fact that people are living longer, is leading to less elbow room in most areas of the planet. Sure, we still have vast expanses of America and our planet that are sparsely inhabited, but nevertheless, the more mouths to feed on this planet, the more demand for lots of resources, including oil.
We as humans need to start a dialogue about this issue. We need to critically look at possible benefits of having fewer children, of trying to taper population overgrowth, to help preserve the quality of life for all of us already here. The current jump in gas and oil prices in the world should be a wake up call to the magnitude of resource and other consumption in this country and our planet as a whole.

Military industrial complex mortaging our future?

Today, our government voted to raise the debt ceiling to allow our country to borrow more money to finance its operations. This should give any American resident reason to pause to ponder, what is our government spending money on? Under our current leadership, military spending has become the largest non-discretionary chunk of government spending, over $449 billion dollars!
We as a nation need to critically ask ourselves, do we really need to feed the military machine half a trillion dollars every year?
Clearly, after 9/11, the military industrial complex has seen an opportunity to force our country to open its checkbook. Any leader who proposes cutting our defense budget would easily be branded as weakening our country against potential terrorist attacks. But let us not forget what happened to us on 9/11 - we were not attacked by foreign fighter planes or bombs, we were attacked by terrorists who used our domestic airplanes as weapons, using box cutters and other implements to hijack the planes.
If we had enough information about such plans, we could have twarted them. No number of stealth fighters, F-18s, tanks, or other tools of the modern military machine could have easily changed the course of 9/11 - just a little information and intelligence could have.
We as a country need to stop letting our military industrial complex control the fate of our nation's finances. One could argue that the old Soviet Union's collapse was brought about through excessive military spending. We do not want our nation to meet a similar fate.

Sunday, March 12, 2006

The selling out of American medicine

There appears to be an upsurge these days among physicians to try to stand up against the pharmaceutical industry. Unfortunately, this effort is often focused on trivial things such as drug reps and whether it is ethical or not for physicians to accept minor gifts such as pens.
This effort could only be characterized as too little, too late. The pharmaceutical industry owns American medicine. Drug reps are merely minors pawns in this game. The real "drug reps" are academic physicians, so called "thought leaders", who are bought by drug companies every year with thousands of dollars of consulting and speaking engagements. Look at any respectable restaurant in your city, and you will probably find a "drug rep" physician giving a canned lecture, prepared by the drug company, to an impressionable audience of fellow physicians. These lectures are often little more than advertisements for a drug company's product.
Besides turning academic physicians into mouthpieces for the pharmaceutical industry, big pharma sponsors most continuing medical educations efforts in medicine today. Also, medical journals are stuffed and propped up with big pharma advertisements.
There is no longer any independent thought in American medicine today - almost no lectures that are given without drug company money involved, no "education" that takes place without drug company funds and message seeping in, no drug trial undertaken without big pharma sponsorship.
Modern day American medicine has sold out to the agenda of the pharmaceutical industry.

Friday, March 10, 2006

The horrors I've witnessed in medicine

Taking a break from politics and religion on this blog, I would like to look at the topic of mistakes in medicine. The medical profession is rife with mistakes. Though some recent press and efforts by the prestigious Institute for Medicine attempt to highlight this and initiate efforts to minimize mistakes, there are key systematic problems that will unfortunately keep mistakes as a daily part of medical practice.
As a physician myself, I have certainly committed some errors, though fortunately none that have led to any patient deaths. I have however, witnessed some medical "mistakes" that I would characterize as horrors. Here are a few of them.
I have seen a patient with syphilis who was treated with chemotherapy drugs because her doctors thought she had an autoimmune disease instead. This unfortunate patient continued receiving such therapy despite my efforts to convince her prescribing doctors otherwise. I was, unfortunately, only a resident physician at the time and powerless to stop attending staff from committing such an atrocity. This patient eventually suffered the scarring consequences of a large syphilitic gumma on her face. It is sad to see that decades after the Tuskegee syphilis study, patients with this curable condition are being abused in America today.
I have seen a patient with respiratory failure on a ventilator who, despite improvements in his condition, was withdrawn from all supportive care and died as a result. This decision was driven by a resident who was overburdened with a busy ICU service and didn't want to bother giving this patient a fighting chance at survival.
I have seen a patient who entered an emergency room with right upper quadrant pain, nausea, elevated biliary enzymes and liver tests, as well as high white count, who was mismanaged as a heart failure exacerbation rather than being identified with ascending cholangitis. She developed a gangrenous gallbladder and sepsis under everyone's watch and ultimately required ICU admission but subsequently died. This patient was managed by an emergency medicine resident who had moonlighted the night before and had worked over 24hours without sleep. Her attending physician keep giving her words of encouragement rather than ever examining the patient for himself.
Given these are but a brief snapshot in one doctor's experience with medical horrors/mistakes that have been committed, one can only wonder what other mistakes and atrocities are going on at this moment.
What solution do I have to the problem of mistakes in medicine? One is to ensure physicians are not working at the brink of exhaustion - improving physician work hours, offering guaranteed "down time" for sleep. These restrictions go for physicians in training as well as practicing physicians. Secondly, we need to train physicians on how to think. The concept of clinical reasoning is not taught to physicians today. Physicians learn lots of facts, we learn to examine patients, we learn to look at xrays and order tests, but we do not learn how to reason through all this information to develop a rational approach to diagnosis and treatment. Ensuring that a clinical reasoning curriculum is a part of every physician's training will be one step in preventing missed or mistaken diagnoses, and inappropriate lab and xray testing on many patients.

Monday, March 06, 2006

Congratulations, Mr. President

In the aftermath of Hollywood's self-congratulatory event known as the Oscars, perhaps we should reflect on what other Oscar-like performances are worthy of accolate. First that comes to mind is our executive branch, led by George W. Bush, for suckering the United States and the world into a war against invisible weapons of mass destruction, and morphing such a war into a struggle for "freedom" and "democracy." Well, now we see the fruits of such a war fought under false pretenses. Iraq stands at the brink of civil war, breaking apart into 3 separate countries divided by religious and ethnic boundaries. Now that Iraqis are free to exercise Shiite and Sunni versions of Islam, did anyone think peace would break out??
Congratulations, George W Bush, for a break-out performace. It is only after 6 years in office that the United States is waking up to your acting job and seeing things through reality based eyes. Even as the blood of our soldiers continues to spill in vain on Iraqi streets, there are holdouts who want the complete the "mission" there. Perhaps it's not so hard after all to pull the wool over America's eyes.