Polite Dissent

Welcome to Polite Dissent, my medical/television/comic book blog.

For medical reviews of the television show House, this is the best place to start. Reviews of the new season will start on September 21st, with the first review posted a few hours after the season opener airs.

For medical review of comic books, stroll through the archives, or start here. A look back at the classic medical comics of the ’50s and ’60s can be found during my annual Flashback Weeks.

Finally, for some true stories of medical training, look here.

I was getting some ice from the break room and one of the receptionist was reading about Nikki McKibbin (an ex-American Idol finalist, apparently) who will be appearing on the upcoming season of Celebrity [sic] Rehab [sic] with Dr. Drew. “That’s sad,” I said as I walked by. “Yes,” the receptionist agreed. “Poor girl, she must be addicted to something nasty.” “No, not that. She’s got a bad case of Tinea Versicolor — I can’t believe her publicist let her go out like that. See all those white spots on her shoulder and chest? That’s a fungal infection. She should have had that treated — or at least covered up — before she went got herself photographed.”

I’ve discussed commotio cordis a couple of times, most recently in relation to Batman #672-674.

Commotio cordis is a rare and frequently fatal condition. It occurs when an individual receives a direct blow (blunt trauma) to the chest at precisely the right time in the cardiac cycle to stop the heart and cause a cardiac arrest. Children are more susceptible to the condition than adults.

Sports injuries are a common cause of commotio cordis, particularly thrown baseballs and softballs. Other causes include physical blows to the chest during a fight, steering wheel impact in motor vehicle accidents, and even the blunt force of bullets stopped by body armor.

The best, and really only, treatment for commotio cordis is immediate cardiopulmonay resuscitation, usually requiring defibrillation and cardiac medications.

Wikipedia has a good write up on commotio cordis

Commotio cordis has been in the news recently because of a lawsuit filed by a New Jersey family against several groups: a maker of aluminum baseball bats, the Sports Authority*, and Little League Baseball**. It’s an unfortunate story on many levels: Twelve year-old Steven was pitching in a baseball game when a line drive hit by the batter caught him square in the chest, causing his heart to stop beating. He was eventually revived, but remained in a coma for several weeks, and now has severe brain damage.

It’s a sad story and an unfortunate case, but personally I think it’s a stretch to treat it as cause for a lawsuit. I know that we Americans always like to blame someone when something goes wrong, but there are times that it’s not appropriate. This is one of those times.
There is no hard evidence that aluminum bats are any more dangerous than wooden ones, particularly in cases of commutio cordis (remember, it’s an issue of timing, not an issue of force).
There is an inherent risk of injury in playing any sport. Proper safety precautions will minimize this, but never eliminate it entirely. I am well aware of this whenever I go for a bike ride on the back country roads near me. Who knows what drunk-driving redneck may be out there weaving across the center line?***
And suing Little League because they endorsed the bat? Give me a break.

*The store where the bat was purchased
**Not because it was a Little League game — it was not — but because they “endorsed” the bat as safe.
***It would be like me, after getting hit by a reckless driver, suing Ford because the person was driving a Mustang and those can go faster than other cars. It may be true (arguably), but it really has nothing to do with the accident and injury.

Just so everyone doesn’t think I just pick on comic books and television (and the occasional movie), today’s Picture Quiz comes straight from the pages of this week’s Newsweek.

What are the error(s) in the image reproduced above? It comes from the article “A New Reason to Frown” and is about potential problems recently discovered with Botox injections. For those of you who want to play along at home, it’s on page 45 of the April 21st edition of the magazine.

Previous picture quizzes

An emergency room encounter between an inexperienced physician and a patient with chronic pain. (link: Dr. Val and the Voice of Reason) A couple of brief stories from an emergency room chaplain. (link: Rickety Contrivances of Doing Good) What can only be described as poor resuscitation technique (link: other things amanzi) The title of the post sums it up nicely: The Nurse as Ogre. (link: Digital Doorway) A look at NIH funding (link: Highlight Health) A law to limit teen scents (not “teen sense”, as that would be an oxymoron) (link: Health Business Blog) The failure of the single payer plan in the United States. (link: Insureblog) The ethics of newborn screening and the collection of genetic material from newborns. (link: Junkfood Science) Comparing car insurance to health insurance. (link: Diabetes Mine) The average retired couple should have $225,000 socked away to cover health care costs. (link: In Sickness and In Health) Thoughts on health care reform at the state and federal levels. (link:HealthBlawg) Abdominal muscles, a common cause of back pain with walking and running. (link: The Fitness Fixer) Can physical exercise help brain function, particularly over the long haul? (link: Sharp Brains) The Health Concerns of Prostitutes (link: Healthline Connects) Pain management in remote locations and other difficult situations. (link: Medicine for the Outdoors) Which diet programs keep the weight off in the long term? (link: On The Wards) Making thing’s easier for doctors and patients: Healthline’s new drug search tool. (link: Tech Medicine) Changes in CPR and minimally interrupted cardiac resuscitation (MICR) (link: Not Totally Rad) How writing about chronic illness helps. (link: A Chronic Dose) A new book club about — and for — doctors who write. (link: Canadian Medicine)

This coming week, I’ll be hosting Grand Rounds here at Polite Dissent. Please send all submissions for Grand Rounds to grand@politedissent.com by Sunday, 16 March, no later than 6PM (Central Time).

With the U.S. Navy scheduled to shoot down an errant satellite later this week, I thought this would be a good time for a space-related PSA. This Captain America/Young Astronaut Council ad is from the back pages of Captain American #307, an otherwise forgettable issue featuring Nomad and Madcap.

The Young Astronaut Council was formed in 1984 to get children interested in space and science. According to their article on Wikipedia, they are “the largest youth aerospace organization in the world” (though I’m not sure that’s a title with a lot of competition). As far as I can know, the Young Astronaut Council is still in operation today, though you couldn’t tell it from their website, which I seem to be unable to access.

Click on the image to the right for the full ad.

For another relevant PSA, check out this one from Airboy #22 (May 1987) which takes an unkind look at the SDI program (”Strategic Defense Initiative” — i.e. the “Star Wars” program — a plan to shoot incoming enemy ballistic missiles out of the sky).

More PSAs

Tags: comics psa space captain america young astronaut council sdi

Remember the two-part episode of House late in the second season where Foreman developed meningitis? Meningitis that was ultimately revealed to be caused by the amoeba Naegleria fowleri, an extremely rare disease with only 24 recorded cases in the last 18 years?

Make that 27, because there have been 3 cases reported this summer related to freshwater lakes in Florida — and possibly more unreported cases.

Links:
My reviews of House, Season 2, episode 20 and episode 21
CDC fact sheet on Naegleria infection.
CNN article: “Deadly amoeba lurks in Florida lakes”

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Speaking of House, the first episode of Season Four starts next Tuesday, September 25th.

Take a look at the first couple of paragraphs from the Associated Press article “Bacterial Outbreak Sickens Missouri Tots” and tell me what the mistake is:

Youngsters in the St. Louis area have been hit hard in the last six months by an outbreak of shigellosis, an infectious disease that isn’t typically life-threatening but can cause severe flu-like symptoms.

Since Nov. 1, 648 people statewide _ primarily kids ages 4 and younger and their caregivers _ have come down with shigellosis, and most of the children attend day care centers. All but about 100 were in the region that includes St. Louis and surrounding counties, said Larry Phelan, an epidemiologist for the Missouri Department of Health and Senior Services.

The disease is typically characterized by diarrhea, headaches, nausea, vomiting, stomach aches and cramps.

Link to the full article at seattlepi.com
Other quizzes

I absolutely loathe the use of misleading statistics or poorly-interpreted results to prove a point. I don’t care if I agree with the argument in question or not, bad statistics are bad statistics and should be addressed whenever and wherever they are found. News reports yesterday provided us a good example of this:

Fox TV: Sexual Song Lyrics Prompt Teens to Have Sex Sooner
MSNBC: Raunchy Songs Can Prompt Earlier Teen Sex
CNN: Study: Sexy Music Sexy Music Triggers Teen Sex

It was hard to miss those headlines. A recently published study, partially funded by the “think tank” Rand Corporation, addresses the subject of teens, musical choice, and sexual behavior, but the actual results are not nearly as dramatic as the media outlets — or even the study authors — would have you believe.

The article, “Exposure to Degrading Versus Nondegrading Music Lyrics and Sexual Behavior Among Youth“, is published in the most recent issue of Pediatrics, a well-respected medical journal – though it is toward the back of the issue.

In the study, researchers questioned teenagers by phone at three instances over a period of several years about their musical preferences and their sexual behaviors. The results suggest that there is a correlation between listening to music with degrading sexual lyrics and earlier initiation of sexual intercourse. That’s pretty much all the study shows: adolescents that listen to sexually charged music tend to experience sex earlier.

Note that the study does not demonstrate causation, it only shows correlation. It does not show that listening to sexual music causes or is responsible for this sexual behavior. The authors would like us to think that they’ve controlled for every other possible variable that could explain sexual behavior, but given that we don’t know all these variables, it’s hard to see how they could control for them. In fact, at the end of the article, the authors hedge their bets and admit this very fact.

The bottom line is that the authors and reporters are reading entirely too much into the study. It’s yet another example of the post hoc ergo proctor hoc fallacy equating correlation with causation. I’ve seen this behavior frequently from the media, but I become concerned when I see authors who should know better using the same poor logic. This is a study published to justify a point of view, not advance science.

A few final thoughts:

• Teenagers lie, particularly about sex, even to researchers on the phone. I see no mention of whether this was addressed at all.
• The study only addresses a strictly heterosexual definition of sex. Going simply by the numbers, several hundred of their respondants were likely to be homosexual.
• The musical grading of “sexual vs non-sexual” and “degrading vs non-degrading” is entirely subjective.
• The researchers only asked about an extremely limited number of performers (16).
• Many of the p values (the measure of the likelihood that the results were obtained purely by chance and not by correlation) are too high to be making such strong pronouncements. Strangley, no r values (the measure of correlation) are listed.
• Personally, I’m always suspicious of reports that come out of “think tanks” (though at least this one was published in a peer-reviewed journal).

Yesterday’s post dealt with a fictional unscrupulous obstetrician; today’s will focus on a real world case.

Dr. Cecil Jacobson ran an infertility clinic in an upper-class area of northern Virginia. He deserves to be on my Bad Doctor list for two reasons:

In the mid-1960s, Jacobson was a researcher at George Washington University Medical School when he claimed to have successfully impregnated a male baboon by transplanting a fertilized egg from a female baboon into the male’s abdominal cavity. Allegedly, the male baboon remained “in the family way” for four months until Dr. Jacobson terminated the pregnancy. Jacobson never published any data, research, or other information on this experiment, so his results are best viewed with heavy skepticism.

Jacobson’s real claim to infamy came in the 1991. At this time, Jacobson ran the Reproductive Genetics Center (an infertility clinic) that specialized in infertility counseling, in-vitro fertilization, and semen for artificial insemination. Jacobson claimed to use a specialized screening program to identify sperm donors who were the most similar to his patients’ husbands, but in reality he used his own sperm. His scheme came to light when one of his former patients noted that her child bore an uncanny resemblance to the doctor. It is believed that 75 of his patients received IVF using Jacobson’s “personal samples.” Only seven submitted to genetics testing, and all seven were indeed fathered by Jacobson. He was charged with 53 counts of fraud and served five years in prison.

• The Wikipedia article on Dr. Cecil Jacobson
• Script of the hilarious Saturday Night Live skit “My 75 Kids” starring John Goodman as Dr. Jacobson.
• Dr. Jacobson earns two coveted spots on the Museum of Hoxes page on “Birth Hoaxes.”
• The case appears in an article concerning “Natural Selection in Family Law: Legal Cases and Materials” (third paragraph down).
• A press release on the 1992 IgNobel Prize Ceremony, which included a prize won by Dr. Jacobson for “devising a simple, single-handed method of quality control.”
• IMDB entry on The Babymaker: The Dr. Cecil Jacobson Story, starring Melissa Gilbert, Shanna Reed, and George Dzundza as Dr. Jacobson.

Tags:medicine news cecil jacobson infertility.

A real world case this time: Michael Swango’s troubles were first noticeable during medical school at Southern Illinois University. Swango’s demeanor was brusque and he had no bedside manners to speak of. He seemed to have a peculiar fascination with dying patients. He also liked to take the easy way out, and was nearly expelled after being caught cheating during his OB/GYN rotation. In the end, the school let him graduate if he repeated the course work.

Despite a poor recommendation from the dean at the SIU School of Medicine, Swango was selected for a surgical internship at Ohio State University. That’s where the trouble really started. Nurses noticed that healthy patients on the floors where he was assigned happened to die…frequently. One nurse even caught him injecting some medicine into a patient who later became ill. The nurses reported their concerns to the administration, but they were brushed aside and only a superficial investigation was carried out. Despite being cleared by this investigation, Swango was not asked back to OSU because there were concerns about his skills as a physician and surgeon.

Swango returned home to Illinois and started working as a paramedic. Within a few months, the rest of the paramedics noticed that they would get violently ill whenever Swango brought any food in, or prepared the coffee. They investigated and found arsenic and other poisons in his possession, along with a book about poisoning. He was arrested, tried, and imprisoned for these poisonings.

After being released from prison, Swango worked various medical related odd jobs for a while, but eventually managed to bluff his way into a residency program in Sioux Falls. Things went well at first, but then he tried to join the American Medical Association. Unlike the hospital, the AMA performed a background check and discovered that Swango had no medical license and had a past felony conviction. About the same time, the ABC television show 20/20 aired a segment on Swangoand his poisoning conviction. When these were reported to the Dean of the University of South Dakota, Swango was summarily dismissed.

A short time later, Swango surfaced in New York at Stony Brook Medical School where he had been admitted as a psychiatry resident. Once again, his patients started dying for no apparent reason. When the dean at South Dakota heard that Swango had moved to New York, he called the administration at Stony Brook and Swango’s full history came to light. He was fired from yet another residency position. This time, the residency director learned from past mistakes and mailed a warning about Swango to every other residency in the nation.

A year later, Swango surfaced in Africa working as a physician in a rural hospital in Zimbabwe. True to form, his patients again started dying mysteriously. This time the police stepped in and he was arrested, but he skipped town before his trial date came. He hid out elsewhere in Africa and Europe and was close to taking another job as a doctor in Saudi Arabia when he was arrested at O’Hare Airport in Chicago.

Swango was extradited to New York where he was charged and convicted of practicing medicine without a license and fraud. While in prison for those charges, police were building other cases and he ultimately pled guilty to four counts of first-degree murder and was sentenced to life in prison with no possibility of parole. This plea bargain allowed him to avoid the death penalty and extradition to Zimbabwe. All told, it is estimated that Michael Swango killed thirty to sixty patients.

• The Crime Library report on Michael Swango (like all Crime Library articles I’ve read, this one is full of hypebole and trips over its own attempts at flowerly language. Still it’s chock full of good information.)
• Timeline and Documents of the Michael Swango case from CourtTV
• CNN article on Michael Swango.
• An AMA Op-Ed about Swango.

Tags:medicine news michael swango.

Starting tomorrow, it’s Bad Doctor Week, with daily looks at infamous physicians — both real and imagined. I’ll focus on doctors that have been rarely, if ever, been mentioned here before. Stay tuned…

Tonight’s House episodes are repeats of the seventh and eighth episodes of the second season of House. Both are watchable, if not outstanding episodes.

The first, Hunting, deals with a young man infected with HIV who appears to be stalking House. Unsurprisingly, the culprit ends up being an obscue parasite, but the medicine is generally handled well and earns the episode a B+. For those of you who are interested in such things (and based on the number of times this search has appeared in my site statistics, there are a whole bunch of you), this is the episode that features the Cameron and Chase sex.

The second episode, The Mistake, is told mainly in flashbacks and deals primarily with Chase and whether or not his treatment killed a young mother. If you haven’t seen it, it’s worth watching. It also earned a B+ in my initial review.

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Still in search of good medical entertainment and education? Grand Rounds is the weekly collection of the best medical blogging on the ‘net. It always features fascinating stories, advice, and insight into the medical field. Check it out this week at MedViews.

Tags: television medicine house grand rounds.

Olga Pyleva, the Russian biathelete who won Silver in the 15km biathalon was disqualified and stripped of her medal today after her urine revealed traces of the banned drug carphedon.

Developed in the USSR, carphedon was developed to treat certain neurological conditions such as amnesia. There are claims that it also increases stamina and makes a person more resistant to the cold, though evidence for these effects are sketchy at best. Carphedon is banned by the IOC and other sports organizations just in case it actually works.

The defense of Pyleva mounted by the Russian team raises more questions than it answers.

As is usual in these cases, the athlete always denies any personal responsibility and blames their physician or trainer. In this case, the blame is being placed on her doctor. “This was 100 percent the physician’s mistake,” states Dr. Nikolai Durmanov, the head of the Russian Anti-Doping Agency. He defends Pyleva, saying that the doctor that treated her for a sprained ankle gave her an over-the-counter medicine that contained carphedon, yet it failed to list the substance in question as an ingredient.

I find this statement interesting because several months ago a similar allegation surfaced in professional cycling and one of their physicians stated that carphedon was not available in any drug on the market. According to that report, carphedon is only available in its pure form, and then only from certain web sites. It’s also interesting that a doctor is being blamed for presribing an over-the-counter drug, and a drug that was mislabeled at that. Did this doctor know this drug he supposedly prescibed contained carphedon or not? If so, what’s he doing treating Olympic athletes? If not, then it’s hardly his fault. That is if this “over-the-counter-drug-containing-carphedon-but-not-labeled-as-such” actually exists. (Yes, I know that doctors routinely suggest over-the-counter medications; I certainly do. But in this instance it smacks of a team frantically trying to set up several layers of deniability between their athlete and a positive drug test.)

Durmanov continues: “She used this product openly. She thought it was a vitamin. It’s an accident.” Again, an interesting statement. Durmanov is now saying saying that Pyleva was using the medicine — given to treat a sprained ankle — as a vitamin. While this doesn’t necessarily contradict what he said earlier, it doesn’t make a great deal of sense either.

In all fairness, Pyleva did pass two urine tests in January. However, given her team’s patchwork defense of her most recent test, color me very suspicious.

Links:

• The MSNBC News article about Olga Pyleva
• The Wikipedia entry on carphedon (updated today!)
• A Cyclingnews.com article about Danilo Hondo’s positive drug test

Tags: medicine news sports olga pyleva olympics carphedon

We spent the first night in Las Vegas (Henderson, Nevada, really) at the in-laws. Early the next morning, we headed for the airport, met up with the two other couple vacationing with us, and flew to Honolulu. We checked into the hotel, then hopped a bus down to Waikiki and enjoyed an afternoon of beach and sushi (and shopping, for the Polite-Wife). The next morning we traveled to Pearl Harbor to see the USS Arizona Memorial. Due to time constraints, we were unable to tour the USS Missouri, but did get to climb through the USS Bowfin (a WWII submarine).

Back to the airport and on a hop to Kauai. We stayed in a very nice rental house in Poipu for the next week. The house was about two blocks from the beach and had a big yard with a pool and hot tub (and geckos). To be honest, most of our time in Kauai we were pretty lazy — lots of sun, sand and reading. The other couples spent an afternoon zip-lining down one of the island’s canyons. Since neither of us is particularly fond of heights, the Polite-Wife and I sat that afternoon out. The kayaking was fun — I’ve always liked canoeing and kayaking — and I wish we could have gone on a longer excursion. My favorite was our last afternoon where we inner-tubed down the irrigation canals of an old sugarcane plantation – including about a mile of tunnels hand-carved into the volcanic rock over a century ago. We had to wear hard-hats with lights, and the water was ice cold, but it was like a good amusement park water ride — only real and a lot more fun.

We returned to Las Vegas, spent another day and a half with the in-laws, and then returned to central Illinois last night.