As a hematologist, I had many patients with severe, life-threatening blood malignancies, such as acute myeloid leukemia. I also consulted on patients with less advanced blood and bone marrow disorders of the type which predicted "there is a high likelihood that this person's bone marrow has been severely injured and will eventually develop leukemic changes". There was a startlingly common denominator: even with extensive and repeated history-taking, most of the patients could not provide a history of toxic exposure which might have damaged their bone marrow. Sometimes their occupations shed light on a petrochemical cause: commercial painters, workers (often undocumented immigrants working for construction contractors) who crawled under houses to spray for insects, farmers who worked land that had been contaminated by the dumping of insecticides years earlier), shoe-makers, and artists using oil-based patients and solvents. But even homemakers with no commercial exposure to high levels of petrochemical based products came to my examining room with the story that they had "sprayed" in a closed area (their homes' crawl-spaces) to rid their homes of destructive or annoying insect pests. Sometimes children who lived in residential communities not far from what we later learned was toxic industrial contamination of local water supplies presented with fatal acute leukemias. In each and every case, the person affected lacked information which would have aided him, her or parents to accept or avoid a life-threatening toxic exposure.
As I listen to the story of BP and the oceanic flood of raw oil contaminating the ocean, shore and coastal environment, I find it disturbing that there is no reliable information coming from the federal government about the level of highly toxic oil-based environmental contaminants to which adults and children are being exposed every day on the streets, at work, in their homes and in their schools. Why is this information not being obtained and distributed to the media for public knowledge? How are people in the areas affected to know whether they and their families are being exposed to a high risk of bone marrow damage from raw oil and its airborne fumes?
This is serious business. The Obama administration needs to treat its citizens as sensible adults and not dummies. The Obama administration should give the people facts about the very real and serious exposure to toxic materials spewing from BP's disastrous oil well and let the people decide what is in their - and their families' - best interests. Should there be evacuation of entire shoreline communities? Should hospitals be gearing-up for an eventual flood of patients with petroleum-based bone marrow toxic effects, such as acute myeloid leukemia? Or is BP's calamity truly benign?
Have our public health authorities been gagged or do they just not know? And is finding out and disseminating information about toxic exposure a high priority or have the massive political contributions of the petroleum industry set the priorities to favor industry concerns over citizens' welfare?
Monday, May 31, 2010
Sunday, May 16, 2010
The Answers Weren't In Any Computer
Some examples may help you to understand why I, and many experienced physicians, am dubious about reliance on computerized medical records.
Case 1: A 16 year-old food service worker in a nursing home who underwent a periodic employment exam. During the 5 minute examination, she was found to have a tiny lump in her thyroid. A medical record indicating that the thyroid was previously normal would have been irrelevant. She was referred back to her physician, was sent to a surgeon and had her thyroid cancer cured.
Case 2: A 21 year-old male presented for a brief pre-employment physical examination. He had a lump in one testicle. A medical record indicating that his testicle was previously normal would have been irrelevant. He was referred to a urologist and had his cancerous testicle removed. He died of metasatic testicular cancer about ten years later.
Case 3: A patient in her late 40s sought medical advice for her upper respiratory infection. She previously had a mastectomy for breast cancer. She was examined that morning by her very competent Ob/Gyn doctor and no breast lump was found and the chart entry was of benign breast findings. On examination that afternoon a small breast lump was found. Several days later, her second breast was removed for cancer.
Case 4: A 25 year old male presented with an upper respiratory infection. On examining his lungs, the physician noted a grayish black mole on his back, which the patient denied ever being told of before. The following week his malignant melanoma was removed.
Case 5: A 30 year old man with Hodgkin Disease was followed with frequent visits at a university clinic. Regular reports were mailed to his primary physician. No one at the university clinic had asked the patient to remove his shoes and socks and no one observed the large malignant melanoma under his toenail. The medical record led readers to believe that the patient had been successfully treated for his malignant lymphoma, but no one looked past the chart to actually examine the patient's cancerous foot. He died of malignant melanoma, not of his well-charted Hodgkin Disease.
A physician's time spent in data entry clerical duties would be better spent in talking with and examining the patient.
Case 1: A 16 year-old food service worker in a nursing home who underwent a periodic employment exam. During the 5 minute examination, she was found to have a tiny lump in her thyroid. A medical record indicating that the thyroid was previously normal would have been irrelevant. She was referred back to her physician, was sent to a surgeon and had her thyroid cancer cured.
Case 2: A 21 year-old male presented for a brief pre-employment physical examination. He had a lump in one testicle. A medical record indicating that his testicle was previously normal would have been irrelevant. He was referred to a urologist and had his cancerous testicle removed. He died of metasatic testicular cancer about ten years later.
Case 3: A patient in her late 40s sought medical advice for her upper respiratory infection. She previously had a mastectomy for breast cancer. She was examined that morning by her very competent Ob/Gyn doctor and no breast lump was found and the chart entry was of benign breast findings. On examination that afternoon a small breast lump was found. Several days later, her second breast was removed for cancer.
Case 4: A 25 year old male presented with an upper respiratory infection. On examining his lungs, the physician noted a grayish black mole on his back, which the patient denied ever being told of before. The following week his malignant melanoma was removed.
Case 5: A 30 year old man with Hodgkin Disease was followed with frequent visits at a university clinic. Regular reports were mailed to his primary physician. No one at the university clinic had asked the patient to remove his shoes and socks and no one observed the large malignant melanoma under his toenail. The medical record led readers to believe that the patient had been successfully treated for his malignant lymphoma, but no one looked past the chart to actually examine the patient's cancerous foot. He died of malignant melanoma, not of his well-charted Hodgkin Disease.
A physician's time spent in data entry clerical duties would be better spent in talking with and examining the patient.
Tuesday, May 4, 2010
The Seventh Doctor
In 1965, when I began my internal medicine training at Stanford University's Hospital, life expectancy after treatment for a patient with acute leukemia was 69 days. Times have changed and now I receive notes from patients whom I treated for their leukemias and malignant lymphomas more than twenty years ago. Millions of dollars invested in research and therapy has allowed fathers to survive and be there to parent their famiies and help their children grow to responsible adulthood. Millions invested in research and treatment has allowed women with malignant blood disorders to become active grandmothers, rather than just distant unfamiliar names in the family tree.
When I served on the national board of directors of the Wilson's Disease Association, I learned that many of our members with adolescent liver disease, severe depression, speech difficulties and neurologic disability were seen by six doctors before the seventh doctor recognized the symptoms, obtained appropriate tests, established the diagnosis and began treatment. Early diagnosis and treatment of Wilson's Disease leads to prevention or minimization of copper accumulation in these genetically affected patients at minimal expense. Early diagnosis and treatment saves lives, preserves function and allows them to have fully productive lives at a cost of a few cents a day for safe and effective medicine.
Your interest and investment will help to prevent a a child with Wilson Disease from dying in adolescence of liver disease, or becoming disabled by severe depression, or becoming unable to speak intelligibly, or developing severe depression, or becoming unable to walk. Your appropriate investment will prevent the untreated disease from proceeding to destruction of health, normal life and of economic loss.
What if, through the Wilson Disease Association public service and investment in training and education of physicians and other providers of health services (geneticists, physical therapists, psychologists,occupational therapists, nurses dieticians, eye doctors) it was the first doctor, not the seventh who recognized the disease and prescribed proper treatment?
The Wilson Disease Association works with medical training programs and physicians throughout the United States (and internationally) to make that happen. They need your support. And the results of their work are spectacular.
UPDATED CONTACT INFORMATION
Wilson DiseaseAssociation
5572 North Diversey Blvd.Milwaukee, WI 53217
Fax: 414-962-3886
email: membership@wilsonsdisease.org
When I served on the national board of directors of the Wilson's Disease Association, I learned that many of our members with adolescent liver disease, severe depression, speech difficulties and neurologic disability were seen by six doctors before the seventh doctor recognized the symptoms, obtained appropriate tests, established the diagnosis and began treatment. Early diagnosis and treatment of Wilson's Disease leads to prevention or minimization of copper accumulation in these genetically affected patients at minimal expense. Early diagnosis and treatment saves lives, preserves function and allows them to have fully productive lives at a cost of a few cents a day for safe and effective medicine.
Your interest and investment will help to prevent a a child with Wilson Disease from dying in adolescence of liver disease, or becoming disabled by severe depression, or becoming unable to speak intelligibly, or developing severe depression, or becoming unable to walk. Your appropriate investment will prevent the untreated disease from proceeding to destruction of health, normal life and of economic loss.
What if, through the Wilson Disease Association public service and investment in training and education of physicians and other providers of health services (geneticists, physical therapists, psychologists,occupational therapists, nurses dieticians, eye doctors) it was the first doctor, not the seventh who recognized the disease and prescribed proper treatment?
The Wilson Disease Association works with medical training programs and physicians throughout the United States (and internationally) to make that happen. They need your support. And the results of their work are spectacular.
UPDATED CONTACT INFORMATION
Wilson DiseaseAssociation
5572 North Diversey Blvd.Milwaukee, WI 53217
Fax: 414-962-3886
email: membership@wilsonsdisease.org
Sunday, May 2, 2010
The Past, Remembered
Today's Saratoga California Rotary Art show, at a nearby public community college was wonderful. All of the usual arts were represented and my wife and I enjoyed our walk through the displays on a warm sunny Spring day. Until we smelled a really foul cigar smoked by a chubby late-middle aged man in a straw hat. We checked with the art show staff, where others were making the same complaint about the same person, and were told that there were many signs indicating that smoking was prohibited anywhere on the public campus. When we later ran into this smoker again and told him what we had learned he waved at us, indicating that we were the ones who should leave.
As one who formerly smoked, I understood the cigar smoker's addiction (and the rudeness which he used to ward off any threats to his denial of addiction). I also remembered seeing acutely sick patients of all ages in hospital emergency rooms, brought there by the toxic effects of alcohol and tobacco. Tobacco and alcohol are major factors in the cost of United States health care and we will not succeed in "health care reform" until we reign-in the use of these dangerous drugs.
A number of years ago my wife and I attended a conference on the USSR presented by a noted Harvard professor who told us that the USSR was dependent on its revenue from taxing alcohol (primarily Vodka) for many of its national expenditures, including defense. He should have gone further to indicate that America and its individual states also have an ambivalent approach to smoking and drinking because the nation and its political subdivisions derive substantial revenues from alcohol and tobacco.
If we want health reform, and individual health improvement, we need to resolve our national ambivalence and convince Americans to stop smoking, stop using "chewing" or "mouth" tobacco, and stop drinking to excess. If we divert money from our unsuccessful narcotics interdiction programs to high-power campaigns to deglamorize tobacco , alcohol and other controlled substances, maybe we could really cut health care costs and improve results.
That cigar, today, smelled awful.
As one who formerly smoked, I understood the cigar smoker's addiction (and the rudeness which he used to ward off any threats to his denial of addiction). I also remembered seeing acutely sick patients of all ages in hospital emergency rooms, brought there by the toxic effects of alcohol and tobacco. Tobacco and alcohol are major factors in the cost of United States health care and we will not succeed in "health care reform" until we reign-in the use of these dangerous drugs.
A number of years ago my wife and I attended a conference on the USSR presented by a noted Harvard professor who told us that the USSR was dependent on its revenue from taxing alcohol (primarily Vodka) for many of its national expenditures, including defense. He should have gone further to indicate that America and its individual states also have an ambivalent approach to smoking and drinking because the nation and its political subdivisions derive substantial revenues from alcohol and tobacco.
If we want health reform, and individual health improvement, we need to resolve our national ambivalence and convince Americans to stop smoking, stop using "chewing" or "mouth" tobacco, and stop drinking to excess. If we divert money from our unsuccessful narcotics interdiction programs to high-power campaigns to deglamorize tobacco , alcohol and other controlled substances, maybe we could really cut health care costs and improve results.
That cigar, today, smelled awful.
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