August 2010 MDNG: Primary Care/Cardiology Check Up

MDNG Primary CareAugust 2010
Volume 12
Issue 8

PC Beat

Learning How to Die

Atul Gawande, MD, MPH, centers this tragic and uplifting New Yorker piece around the story of Sara Thomas Monopoli, who finds out in her 39th week of pregnancy that she has non-small cell lung cancer that has “metastasized to multiple lymph nodes in her chest and its lining.” She and her family struggle to balance the competing desires for survival and quality of life, a dynamic that spirals out of control as Thomas Monopoli’s condition worsens and all involved find themselves unprepared to make end-of-life decisions on the fly. Gawande, who is the Associate Director of Brigham and Women’s Hospital’s Center for Surgery and Public Health, was one of the unprepared, having seen Thomas Monopoli for an unrelated thyroid cancer. “Given the extent of the surgery that would have been required, and the potential complications, the best course was to do nothing. But explaining my reasoning to Sara meant confronting the mortality of her lung cancer, something that I felt ill-prepared to do.” The moral of the story? Have these discussions before you get sick, and if you get sick and haven’t, start talking early. No one wants family members to have to decide by committee in an ICU whether you’d be better off dying.

“What Went Wrong?”

Some of the greatest technological marvels ever created were born out of the conversations that follow this question, which unfortunately is typically asked in the wake of a major disaster. Bridges collapse and we get safer bridges; food becomes contaminated and we get better manufacturing processes; prisoners escape and we get more secure prisons. So if there’s any silver lining to the oil spill in the Gulf of Mexico, it’s that in the future, offshore oil exploration will come with more stringent safeguards. Your patients can benefit too. A bad experience with one informs the changes that allow you to deliver better care with every one after.

It Don’t Matter if You’re Black or White

What’s in the water over there in crazy old England? Am I right? Am I right? *elbow nudge* Quite a few stories have cropped up in recent years about both black and white children being born to the same mixed race parents (, including two sets of twins born of the same mother (, and the strange case of a blond-haired white-skinned child born to two Nigerian parents with no mixedrace ancestry. Experts chalk it up to the mysterious ways of genetics, but remain baffled by the blond hair. “The hair is extremely unusual. Even many blond children don’t have blond hair like this at birth,” said Professor Bryan Sykes, head of Human Genetics at Oxford University.

In the Public Interest

The Radiation Boom

In a confluence of ineptitude, CT brain perfusion scanners nationwide are delivering far more radiation (as much as 13 times the typical amount) than is indicated or necessary because of a desire for clearer images, a “counterintuitive” scanner feature intended to lower radiation that actually increases levels, and a lack of standards on both state and federal levels. Case in point: Alabama (where more than 10% of cases occurred) “does not define an acceptable dosing level. ‘No such thing as an overdose,’ said James L. McNees, director of the Alabama Office of Radiation Control.” Meanwhile, patients are left with thick bands of missing hair on their heads, other associated conditions, and no apologies.

A Good Night’s Sleep? Seven Hours

“Independent of age, smoking, alcohol intake, physical activity, diabetes mellitus, hypertension, and depression,” getting more or less than seven hours of sleep was associated with cardiovascular disease in a West Virginia University School of Medicine study published in Sleep. The association “persisted in subgroup analyses by gender, race-ethnicity, and body mass index categories. Also, similar associations were observed when we examined myocardial infarction and stroke separately.”

These Pretzels Are Making Me Thirsty…and Nauseous…and Incontinent

So what’s in Kellogg’s cereal that’s making everyone sick? Why, 2-methylnaphthalene, that’s what! Or, at least that’s what health officials suspect, because neither the FDA nor the EPA has any “basic health and safety data for 2-methylnaphthalene.” This stems from a clause in the Toxic Substance Control Act which “exempted from regulation about 62,000 chemicals that were in commercial use.” Tragicomically, “In 1994, the EPA invited the chemical industry to submit health and safety data for 2-methylnaphthalene because it was being produced in large quantities,” said Mary F. Dominiak of the EPA. “Chemical manufacturers have yet to disclose that information.”

Sitting Equals Death

If your job requires you to sit for most of the day, you might want to get up and take a jaunt around the office a couple of times an hour. A recent study ( found that sitting for 6 hours per day increases a woman’s risk of death by 37% (17% for men). Researchers found that the risk factor remained high even for those that exercise, though the probability skyrockets for those that don’t: “94 percent for women and 48 percent for men.”

Gadget Watch

Pen Doubles as Hippocampus

Livescribe’s Echo Smartpen allows you to record page-specific audio as you take notes in a specially designed notebook. “Tap record, write down your key points, tap stop, tap your notes,” and everything spoken during the time spent taking down notes will be played back to you. Each pen can store content for up to eight notebooks simultaneously, the data of which can be uploaded to Livescribe Desktop, which stores both audio files and scanned copies of notebook pages. While useful, Echo ownership can be expensive over time, as a two-pack of 100-sheet notebooks costs $24.95.

Dictation Tool Doesn’t Eliminate Typing, but Comes Close

Nuance recently released version 11 of its highly successful Dragon NaturallySpeaking dictation software that boasts 99.6% accuracy, which, according to a New York Times review, means users no longer have to read training text in order to acclimate to the product and vice versa ( Beyond simple dictation, the program allows users to control computer functions to the extent that you can tell it to Google something or search through your e-mail. NaturallySpeaking is a bit pricey (up to $799.99 for the Legal version), but with performance “three times faster than typing” and an automatic algorithm that learns from transcription errors to improve accuracy even further, you’ll more than make up for the outlay in increased productivity.

Social Media Notebook

Mayo Clinic Unveils Healthcare-first Social Media Center

On July 27, the Mayo Clinic announced the debut of a healthcare-first Social Media Center (, a tool the organization hopes will “accelerate effective application of social media tools throughout Mayo Clinic and spur broader and deeper engagement in social media by hospitals, medical professionals and patients to improve health globally.” For now, the site basically houses a (very informative) blog discussing topics such as keeping staff in the loop, dealing with the legal issues surrounding social media, and the importance of asking for forgiveness rather than permission. Mayo Clinic will reveal more about the Social Media Center when it hosts its second Social Media Summit, September 27-29 in Jacksonville, Florida.

How Using Social Media Benefits Physicians: A Mind Map

Jaquelyn Kittredge created this “mind map” as a way to explain all the “different possibilities” available to a “healthcare client” looking to get into the social media game. If you’re still hesitant or trying to convince colleagues to jump on the bandwagon, take a look at this; it might help make your case.


Free Tax Prep? But That Doesn’t Benefit Us!

If your state operates an easy-file tax program, watch out, because Intuit could be gunning to gut it. Despite “user satisfaction above 98%” for California’s free ReadyReturn and CalFile programs, and annual savings to taxpayers and the state of $4-$10 million and $500,000, respectively, the makers of TurboTax have spent $3.37 million since 2005 lobbying politicians to end the free program and replace it with their own, which costs more and provides less. Though their lobbying has been unsuccessful thus far, legislators aligned with Intuit “held back votes on 20 bills [in 2009]…kill[ing] funding for domestic violence shelters, police and fire departments, and prevention of swine flu outbreaks.”

111-year-old Man Actually 81…and Dead

We at MDNG don’t like to make fun of death (other than when it tries to take us from our beds at night while we’re hiding in the closet), but when egg-faced government officials are involved, we can’t help but snicker. Tokyo authorities, looking to congratulate the city’s oldest man, Sogen Kato, on his 111th birthday, went to his house and found a paja-maed mummy that had been lying in bed for 30 years. Whoops! The family, of course, had been collecting his pension all the while. Naturally, this revelation initiated a meeting with Tokyo’s oldest woman, 113-year-old Fusa Furuya, who, it turns out, hasn’t been seen since 1986 ( Might want to tighten up the record-keeping system.


Your Favorite Dinosaur

May Never Have Existed

Younger brothers everywhere are going to have to change their dinosaur vocabulary a bit. Now when gutting their T. rex older brothers with three massive horns, they’ll have to go by the name Torosaurus, because, according to a new paleontological theory (, “as many as a third of all known dinosaur species” are actually juvenile forms of other dinosaurs. Even worse, the horns may just have been for sex appeal ( “I don’t imagine holding up a thin bony shield that can gush blood would be a very effective means of defense,” said researcher John Scannella.

Airlines Fees: The Ultimate Guide

Use these spreadsheets to figure out which airlines will rob you of the least amount of money on your next vacation. Smarter Travel has guides to overall fee schedules for American and European carriers, frequent flyer fees, carry-on bags, and a not-so-related-but-still-helpful guide to tipping.

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