Category: Medicine

I frequently get questions by email or by comment. If it’s simple, I might fire off an answer. If it’s about a personal medical problem, I either don’t answer, or send a standard disclaimer to seek medical care. If it’s a really interesting question, I blog. Today, I blog.

The question regarded the ubiquitous commercials for erectile dysfunction treatments (see this excellent post for an overview of the topic of ED drugs). As anyone who has a TV knows, the commercials always have the pleasant warning of “if you have an erection lasting more than four hours, seek immediate medical help.”

An erection lasting more than four hours, in the absence of sexual stimulation, is known as “priapism”. It is named after a Greco-Roman god who was usually portrayed with large, turgid phallus. Priapism is a bad thing. It can lead to permanent dysfunction of the penis, and even to gangrene.
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This comes up every day. Everyone’s afraid of the big “C”, and they should be. Smoking increases a person’s risk of dying of lung cancer by about 12-20 times (whatever that means, but it’s significant).

And while cancer may be scary, other diseases are just as bad. Lung cancers attributable to smoking cause about 125K deaths per year (all numbers US). Add in head and neck cancers, and the number goes up to about 133K. Add in cancers with less clear causative associations and we’re up to 160K.

In contrast, there are about 130K cardiovascular deaths yearly attributable to smoking, and about 100K deaths due to lung disease such as emphysema.

So let’s explore the various ways of dying of tobacco poisoning.
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DROP YOUR CELL PHONE NOW!!!!111!
(don’t send me the bill for the replacement)

I’m sure others will cover more of the scientific details, but science aside, we should examine why today’s statement on cell phones out of Pittsburgh is so ridiculous. Setting aside the lack of data connecting cell phones and health problems, this is horribly irresponsible.

Here’s the thumbnail: an alarmist report was released by the UP Cancer Institute’s Center for Environmental Oncology. It was apparently targeted at the university community, and stated that despite lack of current evidence, the community should worry about cell phones this instant.
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The folks at bloggingheads.tv whoring for some link love sent me an interesting link. They had a talking heads session (“diavlog”—damn, that’s hard to say) between John Horgan and some other guy (sorry, “Some Other Guy”). Horgan is the guy who brought us The End of Science, a book which was more widely criticized than read. I haven’t read it either, but after watching him, I think I need to do a little reading. He’s a bright guy, and interesting to listen to, but as live chats often go, there were some errors that deserve parsing, not just because they are errors of fact, but because they reveal a certain disappointing line of thought.
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I take care of my own patients in the hospital. I say that because it is not a given for internists. For a number of reasons, many having to do with time management and money, most internists utilize hospitalists, internal medicine docs who specialize in the care of hospitalized patients.

Taking care of patients in the hospital presents some unique challenges. First, they are very, very ill. You have to be pretty sick to get into a hospital these days. You must be willing to be available 24 hours a day, 7 days a week. And you have to be able to deal with some rather intractable problems.

My SciBling DrugMonkey had an interesting post about dealing with hospital patients who have addictions. This is a common, daily problem for me and other docs who see hospitalized patients.

The most common substance is tobacco, followed by alcohol, followed by “other” (pot, heroin, prescription opiates, methamphetamine, cocaine, etc.).
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I’m starting to worry about health coverage in the NY Times. Lawrence Altman is a great health reporter, and I like one of Michael Pollan’s pieces in particular, but the Times also has a bunch of those blog-thinggies, and one of the writers has disappointed me before.

Oops, she did it again…

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Look, I know no one is weeping for doctors and their complaints about payment cuts, but you should at least be concerned, and here’s why.

Some doctors are rich…very rich. Most are not. Medical education is largely financed with debt, and primary care doesn’t pay all that much. Small practices work on narrow margins, and often run “paycheck to paycheck”. For internists, a large percentage of payments come from Medicare, the national health insurance program that covers seniors. Doctors participate with Medicare voluntarily—there is no law requiring us to see Medicare patients or to bill Medicare for them.
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Sometimes things just fall into your lap. This evening I was working on a different piece, and not getting very far, when an email arrived in my in-box.

You see, when you write for the 21st most influential science blog, you get a lot of unsolicited mail (OK, fine…I get spam in my blog-related inbox. But my spam is cool.)

What’s great about a lot of this spam is that it is usually written by an actual person, and directed at me by name, which means they had to at least glance at the blog. In this case, a “glance” was all, or perhaps the writer simply suffers from poor reading comprehension. My latest correspondent is selling an herbal extract for diabetes. It seems unlikely that she’s read my writing about this particular topic. See, as an internist, I’m very well-trained in the management of diabetes. It’s what I do. And I hate, HATE, people who interfere with the treatment of this very serious disease with a bunch of cult medicine bullshit.
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