H/T to Geoffrey for keeping me up on the news. The Bush Administration today issued an expansion of what are called "right of conscience" laws, which allows individuals to refuse treatment on the basis of religious or moral grounds.
From the article in The Washington Post:
"Doctors and other health-care providers should not be forced to choose between good professional standing and violating their conscience," said Mike Leavitt, secretary of the Department Health and Human Services, which issued the regulation.
Some Thoughts:
This is a sticky wicket. It is the opinion of most, that this action is to protect those pharmacies that wish to not have the "morning after" pill on their shelves; that they may do so without fear of retribution. Individual right of conscience legislation regarding abortion has been around and sufficient for many years. The current wording is simply god-awful for a few reasons:
1. Way too broad- it's a sledgehammer, when a scalpel is needed. It encompasses too large a group of providers.
2. It does not differentiate between the individual vs. the corporation. A mom and pop pharmacy does not have to stock the shelves with everything. But denial of treatment is not denial of access there, as it would be if a clinic group was the only one available within a certain radius. If there are sufficient available alternatives, then this could be viable in small numbers.
3. There are insufficient parameters regarding the specifics of the religious beliefs and types of procedures. I see nothing that prevents me from becoming a Christian Scientist or (gasp) Scientologist, and refusing to give care that I am being paid to give. A company that fires me for that would potentially face loss of federal funding. I hope that all hospitals will be prepared to have husbands or unmarriageable male relatives on staff in case their female Muslim physicians are required to treat a male.
4. It is unethical to knowingly deny information to a patient. Refusal to directly treat on the basis of ethical grounds has been fairly well protected, but refusal to provide known information and referral is a violation of allowing access, and against medical ethics and duty to treat. From Laura Katz, in a Physicians News Digest article on ethics of termination and refusal of care:
"If a physician decides not to provide services to a patient on religious, ethical or moral grounds, the physician should discuss the reasons for the refusal with the patient, inform the patient of other resources or providers that can competently respond to the patient’s needs, and document the discussion with the patient in the patient’s medical record."
5. It conflicts with other legislation, such as the Americans with Disabilities Act (ADA). In several cases, the courts have addressed the application of the ADA to a physician’s decision to refuse to treat a patient. For example, in the case of Bragdon v. Abbott, decided by the Supreme Court in 1998, the court found that asymptotic HIV infection is a disability under the ADA. Bragdon involved a dentist’s refusal to fill a cavity of an asymptotic HIV patient in his office, although the dentist was willing to treat the patient in a hospital at a higher cost to the patient. The patient sued Bragdon for violation of the ADA. The court ruled that asymptotic HIV constitutes a disability. The court’s decision speaks to health care providers’ legal obligation to treat HIV infected patients along with patients with other disabilities. Similar diseases or conditions could easily constitute a disability.
It is likely that this regulation will be short-lived. Although the issue will continue. We are seeing a greater number of physicians from different religious backgrounds. We continue to answer questions old (physician assisted suicide) and new (cloning, gene therapy). Defining the balance of a physicians individual beliefs vs. duty to provide treatment will spark debate for generations to come.
Friday, December 19, 2008
Tuesday, December 16, 2008
Rudy's Little Secret?
Source: Multiple websites- orig. unknown- (feel free to provide citation)Got a better caption? Do share.
Friday, December 12, 2008
The Skinny on Zoloft
Dr. Ajit, in his quest to educate the general public about medications, one drug at a time, has given an excellent review of Zoloft.
Philkynopy?
A recent conversation regarding altruism has been playing in the back of my head this past week, as the actions of various canines have made their way to prominent (and perhaps not so prominent) news stories. The coincidence of similarly themed news articles could be an interesting topic in and of itself (anyone remember the shark bite stories of early 2001?), but whether coincidental or not, the following have got me wondering about the altruism of man's best friend (the dates given are when I saw the reports on TV or the internet):
Dec. 5th: The most popular story involved a stray dog crossing a busy highway in an attempt to rescue an injured dog. The homeless dog is seen on camera dragging the injured dog across the highway to the safety of a median.
Dec. 8th: A local story here in Virginia about a three year old toddler that wandered off into the woods from the babysitters house. The child would have likely died from exposure overnight, if not for the two 12 week old puppies following him and cuddling up with him to keep him warm overnight.
Dec. 9th: Oklahoma. A dog takes three bullets to the head in chasing off a home intruder.
Dec. 10th: A research team in Austria have determined that dogs have a sense of fairness. The test involved getting dogs to shake hands for a reward. When one dog got a reward and the other didn't, the unrewarded animal stopped playing.
In the discussion I recently had, my friend and I were contemplating if there is a "true" altruism, or if altruism is only a very high defense mechanism borne out of selfishness, insecurity, or both. The actions of our four legged friends may have provided me with a bit of an answer.
Perhaps we humans can learn a bit from them:
Dec. 11th: Chicago: Jogger, dog owner jump in lake to rescue dog.
Dec. 5th: The most popular story involved a stray dog crossing a busy highway in an attempt to rescue an injured dog. The homeless dog is seen on camera dragging the injured dog across the highway to the safety of a median.
Dec. 8th: A local story here in Virginia about a three year old toddler that wandered off into the woods from the babysitters house. The child would have likely died from exposure overnight, if not for the two 12 week old puppies following him and cuddling up with him to keep him warm overnight.
Dec. 9th: Oklahoma. A dog takes three bullets to the head in chasing off a home intruder.
Dec. 10th: A research team in Austria have determined that dogs have a sense of fairness. The test involved getting dogs to shake hands for a reward. When one dog got a reward and the other didn't, the unrewarded animal stopped playing.
In the discussion I recently had, my friend and I were contemplating if there is a "true" altruism, or if altruism is only a very high defense mechanism borne out of selfishness, insecurity, or both. The actions of our four legged friends may have provided me with a bit of an answer.
Perhaps we humans can learn a bit from them:
Dec. 11th: Chicago: Jogger, dog owner jump in lake to rescue dog.
Thursday, November 27, 2008
A Thanksgiving Tribute
Curled up with a good book, by the fire, chatting with family, watching football, eating Aunt C's famous cheese soup, getting sore in the annual football game with the cousins. It's all Thanksgiving, and it's all good! Just for fun, here's a few clips related to my favorite holiday.
Let's remember the story of the first Thanksgiving; the story of tolerance and good will, and uh, politics? I'm thankful that we don't have the turkey as our national bird, as proposed by Ben Franklin:
I'm Thankful that we were able to get our turkey at the local grocery store this year:
I'm thankful for the wonderful spread on this year's table. And on the table we have a few wonderful traditions. Turkey with Stuffing, and of course, we have to do the Mashed Potato:
And, of course, Cranberries:
Gotta scoop up all that gravy! We could have Portishead with "Biscuit," The White Stripes' "Ball and Biscuit," or even Fred Durst and Limp Bizkit. But the best biscuits bounce, and The Blues Brothers bring the bounce with "Rubber Biscuit" (although "corn bread" seems more appropriate for this music):
Finally for dessert! Mincemeat? Pumpkin? Apple? Nah....:
Watch more Pop music videos at EZ-Tracks
Happy Thanksgiving to you and yours!
Let's remember the story of the first Thanksgiving; the story of tolerance and good will, and uh, politics? I'm thankful that we don't have the turkey as our national bird, as proposed by Ben Franklin:
I'm Thankful that we were able to get our turkey at the local grocery store this year:
I'm thankful for the wonderful spread on this year's table. And on the table we have a few wonderful traditions. Turkey with Stuffing, and of course, we have to do the Mashed Potato:
And, of course, Cranberries:
Gotta scoop up all that gravy! We could have Portishead with "Biscuit," The White Stripes' "Ball and Biscuit," or even Fred Durst and Limp Bizkit. But the best biscuits bounce, and The Blues Brothers bring the bounce with "Rubber Biscuit" (although "corn bread" seems more appropriate for this music):
Finally for dessert! Mincemeat? Pumpkin? Apple? Nah....:
Watch more Pop music videos at EZ-Tracks
Happy Thanksgiving to you and yours!
Tuesday, November 11, 2008
Thirsty?
Dr. Ajit has posted a nice article on good old H20. For those of us who are not imbibing enough agua-- we should be ashamed.
Drinking Water
Drinking Water
Veterans Day
Take time out and thank a Veteran today.
As we remember our Veterans today, those who served, those who fought, and those who died in the service of their country, let us also remember that many of our Veterans are carrying physical and emotional scars. To that end, this bit of historical and educational information is dedicated to the walking wounded....
Today we call it Post-traumatic Stress Disorder (PTSD). It has gone by many names. In the U.S. Civil War, it was "nostalgia," "soldier's heart," and "Swiss disease." Its symptoms are not new. The ancient Egyptians, Greeks and Romans all write of severe anxiety attacks, and physical symptoms associated with battle. Herodotus, writing in the 5th century BCE, tells of somatic symptoms of blindness of a soldier who witnesses the death of a comrade. Herodotus also tells of a Spartan who was so anxious as to be nicknamed "The Trembler;" a soldier who later hanged himself, presumably in shame.
As the 19th century approached, psychology was beginning to gain acceptance in the medical community, and terms like "traumatic neurasthenia" became known in the doctor's offices. World War I gave us "shell shock," a term specifically for those with neurological/physical symptoms, but without overt physical injury. Contrary to the image created by the term, most cases were not due to any actual explosions, but just exposure to the trauma of the battlefield. This was not always diagnosis of understanding: Frederick Parsons, a commanding officer at U.S. military hospital Number 117, said "a war neurosis which persists is not a creditable disease to have ... as it indicates in practically every case a lack of the soldierly qualities which have distinguished the Allied Armies." And that "no one should be permitted to glorify himself as a case of 'shell shock.'"
By World War II, the diagnosis of "combat fatigue" was given to those with a set of symptoms most similar to our current diagnosis. The numbers from WWII are quite impressive. Of the 800,000 or so direct combat troops, greater than 35% required discharge due to psychiatric reasons. Over 1 million American Soldiers suffered some psychiatric debilitation for some period of time, and over 500,000 were discharged or hospitalized due to psychiatric reasons.
Somewhere between the Korean and Vietnam War, the term "Combat Stress Reaction" gradually made its way into the medical parlance. This description was used somewhat interchangeably with Combat Fatigue, and PTSD, although it became further defined as a more acute process, rather than a persistent and recurrent anxiety state. It was Vietnam, though, that ushered in the PTSD diagnosis. Some studies have shown estimates of 400,000+, out of 2.8 million who served, as having PTSD. PTSD was added to the DSM-III in 1980. The wars in Iraq and Afghanistan have brought a new generation of service personnel affected with PTSD.
The DSM-IV criteria for PTSD are quoted as follows:
Medication and therapy are common treatments for PTSD. Our local VA (like many others) has therapy groups specifically designed for veterans with PTSD. These are mostly in the "support group" modality, and often coincide with other treatments, such as individual therapy.
From an analytic point of view, I have always thought of PTSD as being a very dichotomous state. The cognitive component of the anxiety appears to be definable in two opposite areas: "Destroy" or "Be Destroyed." Both components are often present in the veteran with PTSD. They have not only the fear of harm, but a fear of loss of control, and with that, the potential harm they present to others. This often differentiates (from a therapy standpoint) the PTSD of the veteran from other traumatic sources, such as those who have been in severe car accidents.
Families and friends are often dramatically affected by the chaos that PTSD presents. It is important to be consistent, calm, patient, and supportive of loved ones as they go through the symptoms. Encouragement to seek help, and educating veterans that they are not alone in their struggle is what usually has led most veterans on their path of recovery. Many programs for veterans support exist. Now, more than anytime in the past, the Department of Veterans Affairs has taken a proactive approach to PTSD treatment.
For the rest of us, again, if you know a Veteran, call them, see them, thank them.
As we remember our Veterans today, those who served, those who fought, and those who died in the service of their country, let us also remember that many of our Veterans are carrying physical and emotional scars. To that end, this bit of historical and educational information is dedicated to the walking wounded....
Today we call it Post-traumatic Stress Disorder (PTSD). It has gone by many names. In the U.S. Civil War, it was "nostalgia," "soldier's heart," and "Swiss disease." Its symptoms are not new. The ancient Egyptians, Greeks and Romans all write of severe anxiety attacks, and physical symptoms associated with battle. Herodotus, writing in the 5th century BCE, tells of somatic symptoms of blindness of a soldier who witnesses the death of a comrade. Herodotus also tells of a Spartan who was so anxious as to be nicknamed "The Trembler;" a soldier who later hanged himself, presumably in shame.
As the 19th century approached, psychology was beginning to gain acceptance in the medical community, and terms like "traumatic neurasthenia" became known in the doctor's offices. World War I gave us "shell shock," a term specifically for those with neurological/physical symptoms, but without overt physical injury. Contrary to the image created by the term, most cases were not due to any actual explosions, but just exposure to the trauma of the battlefield. This was not always diagnosis of understanding: Frederick Parsons, a commanding officer at U.S. military hospital Number 117, said "a war neurosis which persists is not a creditable disease to have ... as it indicates in practically every case a lack of the soldierly qualities which have distinguished the Allied Armies." And that "no one should be permitted to glorify himself as a case of 'shell shock.'"
By World War II, the diagnosis of "combat fatigue" was given to those with a set of symptoms most similar to our current diagnosis. The numbers from WWII are quite impressive. Of the 800,000 or so direct combat troops, greater than 35% required discharge due to psychiatric reasons. Over 1 million American Soldiers suffered some psychiatric debilitation for some period of time, and over 500,000 were discharged or hospitalized due to psychiatric reasons.
Somewhere between the Korean and Vietnam War, the term "Combat Stress Reaction" gradually made its way into the medical parlance. This description was used somewhat interchangeably with Combat Fatigue, and PTSD, although it became further defined as a more acute process, rather than a persistent and recurrent anxiety state. It was Vietnam, though, that ushered in the PTSD diagnosis. Some studies have shown estimates of 400,000+, out of 2.8 million who served, as having PTSD. PTSD was added to the DSM-III in 1980. The wars in Iraq and Afghanistan have brought a new generation of service personnel affected with PTSD.
The DSM-IV criteria for PTSD are quoted as follows:
- A. Exposure to a traumatic event
- B. Persistent reexperience (e.g. flashbacks, nightmares)
- C. Persistent avoidance of stimuli associated with the trauma (e.g. inability to talk about things even related to the experience, avoidance of things and discussions that trigger flashbacks and re-experiencing symptoms fear of losing control)
- D. Persistent symptoms of increased arousal (e.g. difficulty falling or staying asleep, anger and hypervigilence )
- E. Duration of symptoms more than 1 month
- F. Significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.)
Medication and therapy are common treatments for PTSD. Our local VA (like many others) has therapy groups specifically designed for veterans with PTSD. These are mostly in the "support group" modality, and often coincide with other treatments, such as individual therapy.
From an analytic point of view, I have always thought of PTSD as being a very dichotomous state. The cognitive component of the anxiety appears to be definable in two opposite areas: "Destroy" or "Be Destroyed." Both components are often present in the veteran with PTSD. They have not only the fear of harm, but a fear of loss of control, and with that, the potential harm they present to others. This often differentiates (from a therapy standpoint) the PTSD of the veteran from other traumatic sources, such as those who have been in severe car accidents.
Families and friends are often dramatically affected by the chaos that PTSD presents. It is important to be consistent, calm, patient, and supportive of loved ones as they go through the symptoms. Encouragement to seek help, and educating veterans that they are not alone in their struggle is what usually has led most veterans on their path of recovery. Many programs for veterans support exist. Now, more than anytime in the past, the Department of Veterans Affairs has taken a proactive approach to PTSD treatment.
For the rest of us, again, if you know a Veteran, call them, see them, thank them.
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