Fallacies in Conservative Logic

I have to say that I find this article rather appalling [Sorry, Peter]. Let’s be real here for a moment. How can anyone even consider that argument poignant? Personally, I don’t care what the reasoning was for Palin or her daughter’s decision to keep their babies. The point is that both of them were free to make their choices. The problem is (and the reason things like this repeatedly get brought up is) that Palin stands firmly that all abortions should be illegal (even in the case of rape).

“Pro-life” conservatives need to get off their high horses in thinking that all “pro-choice” people want an abortion. They don’t. They just want the ability to make the decision that’s best for them and their families and not be told what to do with their own body. The real argument of the article basically states that the “pro-choice” folks are appalled that she didn’t have an abortion, despite the fact that her child would likely have Down Syndrome. My response: Who cares whether she had him or not? My issue is with the argument being made. Despite the snarky article, I find it highly suspect that it’s the “pro-choice” crowd actually making that argument. The “pro-life” crowd, on the other hand, putting words in the “pro-choice” folks’ mouths? Now that I can believe. Plus, they can use this to shove in the faces of anyone considering an abortion. I could easily see some conservatives making this argument: “Look, she had her baby even though it is going to have Down Syndrome. Now suck it up, have your baby, and be glad yours was lucky enough to be relatively healthy”. Gimme a break, folks. You’re obviously qualified to make that decision for me because your side is “more moral.” And do you really think that outlawing abortions is going to make everything all better? Many of our patients are still going to try to get them, just by other means. Wire coat hanger anyone? Does that sound safe?

And then in the end, DrRich tries to further tweak the argument by making some sort of appalling, hyperbolic statement like “Down Syndrome babies will be a burden on the health care economy.” Please. Do you really think that people will start making decisions on whether or not to terminate a pregnancy depending on how much it will cost for health care (which most people are not even cognizant enough to think about it for themselves) or whether they “want to have” a sick baby? Don’t minimize the decision of having an abortion. It’s not one to be taken lightly, and I don’t think it is by almost anyone who makes it.

If moral conservatives want to reduce the number of abortions in this country, why not encourage better sex education instead of hiding behind their shroud of preaching abstinence and then wondering why there are so many “unwanted” pregnancies. But that’s not their bag. They’d rather just tell you not to have sex, and when you do and get pregnant, they’ll tell you how to handle it from there, too.

Disease-specific Stem Cells

A recent post on Ars Technica explains how researchers are converting adult stem cells from patients with certain diseases into embryonic stem cells. This will hopefully make studying the cellular basis of diseases like Parkinson’s easier by providing a virtually unlimited supply of tissue, which was previously difficult to come by. This technique was developed for ALS, and it’s been applied to 10 new diseases.

The full list of diseases represented: adenosine deaminase deficiency-related severe combined immunodeficiency (ADA-SCID), Shwachman-Bodian-Diamond syndrome (SBDS), Gaucher disease (GD) type III, Duchenne (DMD) and Becker muscular dystrophy (BMD), Parkinson disease (PD), Huntington disease (HD), juvenile-onset, type 1 diabetes mellitus (JDM), Down syndrome (DS)/trisomy 21, and the carrier state of Lesch-Nyhan syndrome.

Sound like a list of diseases we studied in class, anyone?

The Inner Life of a Cell

Harvard made a great video called The Inner Life of a Cell a couple of years ago using some great computer graphics [hat tip Sadie]. It tells a brief story of the mechanism of inflammation being activated in a leukocyte. It was put to some great music by Studio Daily. I highly recommend you check it out.

If you’re wondering what all that stuff is, you can check out one of Harvard’s versions, which contain a play-by-play. I must admit that (having no real idea of what I was looking at) I got a little bit lost in the video, so Harvard’s version definitely helped clear up a few things. But Sadie and I agree that it’s pretty cool that we can watch a video like that and actually mostly understand it. After spending years studying something like bio, you forget how much you know about it that the average Joe has never even considered.

Summer Research

science-xkcdI’ve started a new research project this summer in Marcello Del Carlo‘s lab. Dr. Del Carlo is a new faculty member at Rush in the Department of Biochemistry. Our lab is affiliated with a clinical urologist faculty and we’re researching a urological disease called Peyronie’s Disease (PD) [Warning: male nudity]. From a biochemical perspective, we’re studying the process of growth and formation of a fibrous plaque underneath the skin of the male penis in a layer of connective tissue called the tunica albuginea. Currently, we’re analyzing both diseased and non-diseased tissue samples that have been surgically removed from patients with PD. In the future, we’ll also be working with a cultured fibroblast cell line doing similar work. So far we’re using Western Blots to identify and characterize proteins that are up- or down-regulated in diseased tissue compared to that of non-diseased. Our hope is that the studies will lead to a better understanding of PD and how the plaques form to aid in treatment.

In addition to research, Dr. Del Carlo is very interested in using FOSS as it relates to scientific research. By the time I met with him, he had already set up a database using PASSIM in order to keep track of tissue samples from patients. He also had the idea of using a WordPress blog as a sort of “online laboratory notebook”. I thought this seemed very in line with the Science Commons project, a derivative of Creative Commons. Science Commons is attempting to lower the barriers of scientific research, which is currently not nearly as “open” as it should be, considering almost all of it is funded by the U.S. Government. Most people believe that the fruits of governmentally funded projects should be available to the general public. In many cases, however, scientific research is locked down (for varying periods of time) due to copyright after being published in scientific journals. Since a scientist’s credibility is often judged by previous publications in journals, Science Commons is working to reduce the hold of copyright on this process, so that labs can publish data immediately to the web, allowing it to be indexed, freely searchable, and available immediately to anyone wanting to read it. This will continue to be an uphill battle since journals make a large amount of their money by licensing access to large academic institutions for their faculty. The idea that labs can make their data freely available on their own personal websites is being met with resistance. Still, I feel as a society we must push forward, despite the corporate interests, in order to do what’s best for the public. Plus, my thought is that journals will not suffer any major economic hardship. Their “seal of approval” by publishing the content will continue to be the scale by which research is judged. They would also continue to act as a collecting ground so that researchers looking for the latest data don’t need to worry about sorting through Google search results to find the latest findings in a field. Instead, some publishing groups have the gall to say that in order to publish in their journal you must leave the rights to your work on their doorstep, no matter who did the experiments. This will continue to be a very important issue in the scientific community in the future, and I’m hoping to gain a keener understanding of it over the next few weeks and months.

At least for now, I am the only one updating the Peyronie’s Disease Information Repository and it contains all of our experiments and results to date. Feel free to check it out, but unless it’s scientifically relevant, keep personal comments to my site.

Panda Throws in the Towel

Well after years of writing, it appears that Panda Bear, M.D. is throwing in the towel on his blog. His was one of the few blogs I read regularly, and it’s one that no doubt has left an impact on my past and future as a physician. He says that he’ll be working on a book at some point in the future, and that’s one I’ll definitely look forward to reading. So long, Dr. Bear. Your insight, honesty, and sardonic humor will truly be missed, especially by the up-and-coming who have not yet encountered your work. His “My Personal Statement” is a classic Panda take on the AMCAS Personal Statement for medical school applications.

Medical Pastiche

I learned that a friend of mine at Rush, Peter Zavislak, has a few websites. The most notable is his current work, Medical Pastiche. I don’t encourage you to read it though, or you’ll quickly figure out how silly my blog is. (Just kidding, check it out even though it makes me look bad!). Why do I waste so much time writing about computer-related crap?

Portable Electronic Medical Records

I have been meaning to do a long post on EMRs for a while. After reading a recent post on Ars Technica on this issue, I decided this is as good of a time as any.

Although Mr. Gitlin readily admits that EMRs are unlikely to solve the problems of “inefficiency” in the medical community within the US, he claims it will decrease cost in the end. He disdainfully alludes to “high cost” in the US system without ever questioning why the costs are so high besides noting that our focus is generally on emergent and not preventive care. Now we can argue this point to death, but if you’d like an enlightened point of view on this subject, I suggest you read any number of PandaBear, M.D.‘s blog posts. I’ll leave this one lie.

My next issue was the fact that Gitlin is actually making two very distinct arguments for EMRs without differentiating the two. First, he argues that EMRs are a perfect way to organize an office. They free the workplace of excess paperwork and can make an efficient way to keep track of “billable” services, something very important to physicians. This much I can definitely support. There are considerations, but I think in the long run, physicians will be better off doing more on computers and less on paper. At the same time he alludes to EMR portability, which is a whole separate can of worms.

The long and short of it is, people need to decide what they want. Currently HIPAA dictates that medical records are on lock-down, and the only people who have access to them are are you and those whom you designate. These “others” could be someone like a spouse or a parent or another physician. I think preserving this privacy is (at least mildly) important from a patient’s perspective. After all, it’s not everyone’s business what your latest test results are or what diseases you’ve been diagnosed with or what medications you’re on. However, from a health care professional’s perspective, this is a frustrating impediment. It does matter to them what your test results were last Monday in the E.R. It’s helping dictate your treatment. Acting like electronic medical records are going to magically make that red tape junkie HIPAA disappear is naive. They might make it easier to transport the information once approval has been given, though.

If people are treating their medical records with that kind of security, then the security vulnerabilities exposed by making things electronic are significant. Even the most secure computer systems are vulnerable to attacks, and considering that many of these systems will be running on Microsoft platforms, there is an increased risk to any data on entire computer networks. If the secretary opens a bad email attachment, is it going to worm its way into the EMR database server and start uploading all the records to someone else’s computer? My point is not that the type of security necessary to run such a system is impossible. Just that it will be a lot of work for everyone, including patients. If a patient needs to “grant access” to their health care providers, they are going to be the gateway into administering their electronic medical record. This means strong passwords, which will probably need to be changed frequently. Are they going to want to do that? How about health care providers? Sure most hospitals have a (probably sub-standard) IT department, but what about your average medical practice? Are they going to be able to employ an IT professional (or pay for the temporary services of one) to set up and maintain these records? All of this is simply going to add cost and overhead to a community that is already overly criticized for how “inefficiently” it works.

The business model that will probably end up working is one where large companies are in charge of the records and medical practices pay fees for the use of their services. In other words, Dr. Jones pays $X every month to have his patients’ health records stored online by a company. When he needs to view the patient’s records, he simply logs in from his office computers (or even from home) and downloads the information. If he has new test results, they would be uploaded. This actually could be a fairly profitable market. It’s basically what’s being set up by Google. For this to be successful, they would still need cooperation from the patient, however, and there would still be security issues. While there would be IT professionals in charge of keeping the data secure, the centralization of data would make it more of a target for criminals. There probably aren’t very many people who would try to break in to Dr. Jones’ patient EMR database since it’s only for a small number of patients. If a large company was hosting hundreds of thousands of patient records, it’s more of a target.

My biggest issue with Gitlin’s argument is that he claims portable EMRs will eliminate (or even significantly reduce) the amount of duplicate testing that is performed and thus save everyone money. See this is an issue that people have to deal with concerning health care in the US. Doctors are skilled professionals. If someone comes to them (especially a specialist) with a problem, they’re going to want their own x-rays and CT scans, not ones from another facility. That’s not to say that they shouldn’t be using them, but considering there’s no incentive for them to work any differently, I highly doubt whether implementing portable EMRs is going to change things. After all, today doctors can get x-rays and CT scans from other institutions if their patients say it’s ok. They just don’t use them.

Gitlin did address my main concern with EMR portability, which is a less concrete aspect: the standards. See right now, there are no standards set in the US for electronic medical records. There’s no “right way” for information to be stored in EMRs, so if you want to transmit information from one doctor’s office to another, they probably need to be using the same program on their end as you are on your end. This is a really bad way to deal with any sort of information. The government has laid some loose guidelines, but nothing really telling people what should be done. They want the market to sort it out. The problem is businesses are all going to try to come up with a proprietary format that will gain a significant market share. This way, everyone has to use their software and their databases. In other words, all the businesses are competing to see who’s going to “win” this race to control everyone’s medical records, and by “winning” the market, they will control the standard and thus the future of the industry. This is a “great” way to form an industry from a business perspective (lock everyone into your format) but a horrible way from an end user’s perspective (doctors and patients). It would be really great if we could nip this issue in the bud now, before any one company has a market share. This way there won’t be a fight to get one big company to relinquish it’s power. Plus, it would be great if EMRs used an open standard so we can continue to have cross-platform competition in the future. We can learn a lot from the mistakes of the past on issues like this.

Look for a future post on FOSS operating systems and EMR programs to tackle some of the issues I brought up here.

Futile care

PandaBear made a good point about the incentives for terminating futile medical care:

My third point is that there is no incentive at any level of the medical industry to use a little common sense. At the high end, physicians risk severe legal consequences for not doing exactly what the family wants no matter how unrealistic. So dangerous is the legal terrain in this area of medicine that most hospitals have an ethics committee part of whose purpose is to spread legal responsibility. In many cases, however, there is no financial incentive to withdraw care as Medicare makes no distinction between the living and the living dead. At the patient end, the families have no financial stake in any of the decisions they make. If we but charged the families a small fraction of the cost for futile care or, more diabolically, had payment garnished from the patient’s estate upon their death, the families would be looking for the plug, especially in the cases where the ICU serves as an expensive funeral home where families can meet to see the body. If the family ever says, “We want to keep Uncle Joe on the ventilator until the rest of the family can fly in from Seattle,” they should be responsible for the full cost of the additional stay. –PandaBear, M.D.

I thought it was important that he emphasized that this is futile medical care and not simply medical care for the elderly as it may seem in some of his other posts. The point being that this is wasting a lot of money!