practice makes perfect?

in case you were wondering if that med student or resident physician seeing you had any clue what they were doing, check it out. good to know mannequins are making it into the world of "intimate exams." we actually had the opportunity in med school to do intimate exams during our physical diagnosis class by joining groups with members of the opposite sex. needless to say, no one volunteered. talk about awkward. what would you talk about at parties? in some other classes, however, i did hear of students who were enthusiastically recruiting people for the group. yes, these same people could be your doctor. just saying.

controversy

a somewhat controversial bill quietly zipped through texas recently. check out this article. i can't say i'm all for the bill. i'll elaborate on why later but i wanted to put up the link so i wouldn't forget.

missing the point

this is crazy. there was a recent meeting at the white house consisting of "stakeholders" in the debate to lower healthcare costs. here's a link to the people who showed up to the meeting. what group is noticeably missing? how about representatives from the american bar association? i would have liked a commitment from their members to not file frivolous lawsuits against physicians but that will never happen. obama doesn't have the guts to call his own people out on it either. don't get me wrong, i know we need lawyers and there are plenty of good ones out there but isn't this a huge piece of the puzzle as to why healthcare costs are so high?! many physicians practice defensive medicine, ordering too many tests they feel they probably don't need but are afraid of missing some rare problem that can get them into trouble. and when that one-in-a-million problem occurs or the patient is the one to blame for a certain problem, bam! lawsuit. unbelievable. with socialized medicine, missed diagnoses will likely increase in frequency because not everyone with foot pain is going to be able to get an mri. plus you'll have limited access to life-saving therapies. here's a nice opinion in a recent wsj.

it's match day!

today, senior med students around the land find out where they will be going to residency courtesy of a computer somewhere out there which spits out a list combining the wishes of students and the residency programs. i think they find out at noon or sometime no too long thereafter. let the parties begin because starting july 1, your life is over. ha! good luck to all, i'll be seeing a few of you in july.

jama--journal of the american medical association ... losing relevance?

i recently read such an outlandish story, i had to come out of hiatus to report it. here's a link to an article in the wall street journal from their health blog section. apologies if you can't get to it, can't remember if you need to be a subscriber to access it. just in case you can't get to it, i have an excerpt below. as a background, there was an article in jama about using antidepressants in stroke patients prophylactically (using them to prevent depression). well, it turns out that one of the authors used to get paid by the company who manufactured the drug in the study. this information was not disclosed in the article (and it should have been) so upon discovering this, a neuro-anatomy professor from lincoln memorial university in tennessee, jonathan leo, wrote a letter to the british medical journal exposing this problem and that's when it gets interesting. the wsj folk took hold of this story and below are some quotes from the editor-in-chief of jama, dr. catherine deangelis.

from wsj.com, published march 13, 2009:

In a conversation with us, DeAngelis was none too happy to be questioned about the dust-up with Leo. “This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.

When asked if she called his superiors and what she said to them, DeAngelis said “it is none of your business.” She added that she did not threaten Leo or anyone at the school.

yes, my friends, the editor-in-chief of what is reportedly one of the most important medical journals went on the record lashing out on someone trying to set the record straight. according to leo, the executive deputy editor actually called first, essentially banning him from the journal for life. of course, the author eventually submitted a letter stating the very information dr. leo claimed (apparently an error "of memory"). if you read the wsj story, you can't believe dr. deangelis is behaving in such a manner--so defensive, angry, vindictive. even more amazing is the hypocrisy involved. read this article written by none other than dr. deangelis herself. i read many of the comments left by wsj readers. some called for dr. deangelis' resignation and cancelled their subscriptions. i feel the same way. jama and the ama has seen their day. this isn't the first time, nor will it be the last that these organizations have done questionable and unprofessional things. at the least i think physicians should call on dr. deangelis for a formal apology if not her resignation itself. this is medical arrogance at its finest.

screening

this post is in response to another post by a real medical writer friend regarding screening tests for certain diseases. see the related post here.

basically, the question is, when should you start looking for diseases in people even if they have no symptoms (hence, screening)? a reader on the other post commented about ovarian cancer. she is a little on the younger side for women who get the disease; furthermore, it seems she actually had symptoms which is a separate issue. anyway, the reader suggested getting ultrasounds on all women but the question about screening turns out to be a lot more complex than it seems.

the first problem starts with the disease itself. the earlier you catch something, the harder it is to tell if it's a real problem. is that "spot" on your lung something that will one day turn into cancer or will it just stay a "spot"? is that cyst on your kidney or ovary just a cyst or are there features that make it worrisome for something more sinister?

then it gets into the realm of the actual test and interpretation. people tend to think a ct scan or an ultrasound is foolproof. but the fact is, there is no test in medicine, blood work, scan, algorithm, prediction score, you name it, that is 100% accurate. NOTHING. not even a pathologist examining something under a microscope is 100%. sometimes things that look like cancer turn out to be nothing and things that appear harmless turn out to be malignant. and not to malign pathologists, but radiologists are probably even more notorious for disparate readings. "impression: normal ct of the aorta. addendum [days later]: aortic dissection noted." don't get me wrong, these guys are smart, usually among the smartest in their class but we all miss subtle and not-so-subtle findings.

okay, so far you have a disease you're not sure is there, a scan that you're not sure how accurate it is in picking up the disease, and a radiologist who might be reading the scan incorrectly but it gets worse!

unfortunately, then the economic side of things rears its ugly head. let's use the ovarian cancer example. this is unfortunate. we've all seen it. i've seen metastatic colon cancer in patients in their 20's although it's a disease that you typically screen for when you're 50. the question then is, when do you start screening for ovarian cancer? no matter what age you start (heck, unless you start in prepubescent kids), you will probably miss some cases. there are always outliers. so, in order to catch that one in a million patient, can you justify starting screening at, say, age 30? 25? 20? who is going to pay for all this?! that, in today's economy and presidential administration, is the million dollar question. these tests can get expensive and you simply cannot screen all people for everything without completely obliterating the finances of this country.

so you start ovarian cancer screening at age 20. then how frequently do you repeat the testing? when is it safe to stop? how do you know when to act on some small finding? this now gets into the criteria needed for a screening test to be a good one. among them, the test has to be pretty accurate (namely, good "sensitivity," meaning you minimize the number of patients who have the disease but have normal tests, i.e. "false negatives"), the test isn't too costly, there are minimal side effects from the test itself and many other criteria.

then there's the whole question of whether the disease would have killed you anyway. now, in the patient with metastatic ovarian cancer, this is not as relevant since, again, it seems the patient had symptoms already. another dirty little secret: cancers detected incidentally or by screening that are not causing any problems do not always need to be treated. now that statement at face value sounds very controversial but the fact is, it's true. check out this controversial study. furthermore, take for example prostate cancer. unfortunately, many men will die of prostate cancer but many more men will die of heart disease and other cancers and stroke. frequently, some screening blood test or exam will reveal some abnormality which then requires biopsy or some other type of treatment that frequently will lead to incontinence or impotence or a myriad of other problems when there potentially may have been little or no benefit to the screening from the beginning. this is why there is such controversy in the realm of prostate cancer screening.

i think that's enough about screening but the thing is, so much more could be written. you see why it's such a complex topic when it seems so simple. the fact is, at least with cancers, some patients will get a fairly aggressive form and at a much earlier age than expected. most, however, will not and right or wrong, the policy is to try to implement the appropriate screening programs that are most cost-effective to benefit the most number of people while leading to the least amount of harm. primum non nocere--first, do no harm.

are you ready to die?

i know that sounds a bit macabre, particularly in light of this joyous holiday season, but as the year unwinds, i think it's a question that everyone should consider, sooner rather than later. now, oddly enough, i'm not even talking about the spiritual component which is what you might expect around christmastime. i'm actually talking about the realm of living wills and advance directives.

let's talk about dnr's first. a dnr is a "do not resuscitate" order. that means, in the event of a respiratory or cardiac arrest, there will be no cpr--no intubation and hooking the patient up to a ventilator, no cardiac shocks, chest compressions, no "heroic measures" or any of the other things that occur in a "code" situation. now, in the event that you are a 90 year-old woman with metastatic breast cancer, severe dementia and so debilitated you haven't been out of your bed in the past year, the decision for you or your family to make you a dnr seems pretty easy.

however, in many situations, it's not as clear cut. i have had a number of patients who were made dnr or about to be made a dnr who ended up surviving and leaving the hospital alive. they subsequently led happy and productive lives, at least for some time after discharge.

but what if you were a 97 year-old and you developed a tear in your aorta which could only be corrected surgically? if you don't get the surgery, you will probably die. if you do get the surgery, you will probably die. would you rather die peacefully at home or on the operating room table? the answer seems to be easy, except in this case, the patient was michael debakey one of the most renowned surgeons in history. he actually pioneered the surgery that he now needed. i think i have linked to this article before but here's the link again to a fascinating article in the new york times a couple of years ago. he refused his surgery and wanted to die in peace. only after he became comatose, his wife begged his colleagues to perform the surgery and after a special ethics meeting, they agreed to proceed. he survived the surgery and lived for another couple of years, long enough to receive the congressional gold medal from president bush. the funny thing is, even though he intially refused surgery and was ready to meet his maker, after the whole ordeal he was happy his wife did what she did. if the famed dr. debakey can make a mistake regarding a dnr order, how is the average joe on the street supposed to know what to do?

that's why i feel like it's good to have a surrogate medical power of attorney or medical decision-maker. in some young patients, it's appropriate to withdraw care. in some much older patients, it's appropriate to continue fighting. i think if you have an advanced directive specifying exactly what you want or don't want done to you if you aren't conscious to make those decisions yourself, you may be potentially making a tragic mistake. would you always refuse being hooked up to a ventilator? some people specify that but what if it's just for a day or two while your lungs recover from a bad pneumonia? frequently, we have patients on ventilators only for a few days and they get better and eventually go home. however, if your advanced directive refuses this care, you could potentially succumb to a disease you shouldn't have.

the point is, each situation should be evaluated on its own, which is why i feel (at least right now) that it's best to have someone make the decision for you. hopefully that person has some type of medical knowledge or background which would make the communication and decision-making easier. naturally, one would assume that the spouse should be the one making these decisions and they probably should, but other times it might be more difficult. if your loved one is actively dying despite all medical care, it would be very difficult to tell the doctors to withdraw care. sometimes people want to make this decision on their own, sometimes they want some reassurance from someone else that this is the right decision. whatever is right for you or your family, if you don't have an advanced directive, make sure someone is designated to make those decisions. if not, what happens frequently is that family members disagree about the care and that itself eventually turns into a mess.

n'awlins

do you know what it means to miss new orleans? that's how the old line goes in a song sung by many. well, i know harry connick, jr. sang it but not sure if he originated or not. if he did, then way to go harry, i like that song. anyway, karen got us tickets to see harry at the cobb energy performing arts center (stunning name, i know) earlier this week. he has a new christmas album out which he was promoting. the holiday songs were fine (don't get me wrong, i like a good christmas tune like anyone else but as he mentioned during the concert, it does tend to get a little nauseating after a while, particularly some of the pop songs) but his jazz/blues/etc. pieces were great. i would say almost half of the concert was non-holiday music, including a little jambalaya ("crawfish pie, file gumbo") and a mardi gras piece at the end ("if you go to new orleans, you oughtta go see the mardi gras ..."). check out karen's blog for a more complete description. and yes, i agree that the concert at chastain a few years ago was one of the tops.

all that brings up the question, do you know what it means to miss new orleans? i actually do miss new orleans, having gone to college there. of course i don't want to romanticize the city too much. sure, there was a lot of crime (note these reflections are from the early '90's when i was there), lots of corruption and poverty. there was a particular stench that would roll in off the swamps a couple of times a week and give the city the smell of an outhouse. the humidity was at times unbearable. i remember the first time i ever visited. it was late august, a week before orientation (yes, i decided to go there without ever visiting! that's another story.), probably 8 pm or even later. i slid open the door to the dodge caravan and whoosh! a suffocating cloud of atmosphere invaded us and i thought i was going to pass out. kinda like houston from what i hear and it's not like it doesn't get humid in atlanta but new orleans is at another level. in addition, the city's kinda dirty and covered with potholes.

but ...

i guess those are some of the things that gives the city character. and in a weird way you kinda miss those things (okay, not the crime and poverty but you know what i mean!) ... although i probably miss the times as much as the actual things. i mean, i don't really miss getting sweaty walking a few hundred feet to class at 8 in the morning! but i do miss the people, the accents, all the great music--so much great music both big names and small, the streets lined with trees and spanish moss, the mississippi river (one of the first things i did when i got to tulane was to put my foot into the mississippi like ol' sam clemens might have done years ago), weekly crawfish boils, cheap po' boys and all the glorious food including $5 all-you-can-eat fried chicken and red beans and rice with sausage on mondays at dunbar's (!!!), mardi gras parades and mardi gras music (i love mardi gras music), streetcars, hanging out at the levee (but with my ford mustang, not a chevy) and yes, even the french quarter, beignets at the cafe du monde, and so many other things. i miss those beignets. we even got some once at a cafe du monde in a mall in nearby metairie but they weren't the same as the one in the quarter. i haven't been back since katrina and i heard things are still a bit depressing there although better. hopefully we'll be back sooner than later.

holy moly

yes my friends, i'm back. it's been almost a month since the last post. time flies when you're busy watching tv ... i mean, saving lives in the hospital.

my parents are in cancun right now. that scares me. they usually travel with friends or other korean travel groups so i don't worry about them as much but this time they're on they're own. do they speak spanish? no. fortunately it's enough of a tourist town to where enough natives speak english. is there a good chance they'll get swindled? yes. will they manage to get from the airport to the hotel in a timely fashion? not sure. what will they do while they're there? don't know either. typically koreans take food and cooking utensils (think rice cookers, pots, portable flame or electric burners, coolers, etc.) with them on trips and cook in the hotel room or wherever they're staying. it was like a freakin' korean market when we were at a marriott timeshare in california a few years ago. my brother had the timeshares and there were 2 units next to each other and the fridge was filled with korean food to cook and cook we did. i felt bad for the next occupants because the rooms stunk like korean food after a week of saturation with garlic, kimchee, fermented bean paste and other odd smells.

anyway, my parents are in cancun because my dad just wanted to go to cancun. i am my parents' unofficial travel agent. i'll get a call from them every once in a while asking me to book a flight using skymiles. of course, usually this is unsuccessful because those you-know-whats hardly ever have a flight you want. and when they do, you have to pay an extra $100 or more because you booked the flight too close to the actual departure date.

the good news for my parents' survival is that my mom did come to a tiny little town in georgia 30 some odd years ago with several other korean nurses, none of whom spoke english, and somehow made it.

which brings me to another point, no matter where you go in this world, if it's of any tourist value, you can usually find a group of koreans there. at sacre coeur on a hilltop in paris? koreans. karen freaked some of them out by saying "hi" in korean. they laughed. my parents also went with a busload to vancouver. imagine if you're minding your own business at a random ski resort in vancouver and a busload of koreans descend on your property. meals were included in this package and i remember my mom telling me that one of the restaurant people asked her if there was an egg shortage in korea because they were tearing up the hard-boiled eggs on the buffet. no, koreans just like to take advantage of free meals (e.g., me and drug rep dinners) and apparently they were taking the eggs with them to eat for later as well. this was discovered by the staff when all of the eggs were gone but there were few shells on the tables.

well, here's a glass to you mom and dad, wherever in mexico you are. here's to safe travels.

back in action

just wanted to give a quick word on an article i came across. click here for more details. basically it's a study showing larger bmi (body mass index, a measure of how "big" you are) women were sexually as active as thinner women, maybe even more so. what i love about the story is the following quote from one of the researchers: "These results were unexpected and we don't really know why this is the case," Kaneshiro said. ha ha ha! that is freakin' hilarious, nice little jab at the large people in this world.

the incredible ... kate?

check out this hilarious video of our lovechild as the incredible hulk. i used to love that show.

thank ye

props to my colleagues at the acp internist blog. i've been linked on their site (see under sept 29 post). recently i came across their "medical news of the obvious" posts and found them very entertaining. i have to say, they took an idea i'm sure many of us have had but actually put it to print. i come across a lot of articles in my weekly perusings and a number of them come to such obvious conclusions, i wonder why someone actually spent time and money to publish it. maybe that's the point, to get their name in print. heck, let's be honest, i'm mostly jealous!

"never" events

well, this is october 1. another day, another month you say? not quite, today marks the day that cms (center for medicare and medicaid services, responsible for the largest share of and policy directing physician payments) will stop paying for "never" events. what are these? these are events that in the mind of cms, they/we/the government will not pay for since they feel if proper measures are taken, they would never occur in the hospital. see among many others this site to list the events.

certainly, improved quality in the hospital has to start somewhere but to all of a sudden deny payment seems a little drastic. okay, i can understand that they wouldn't pay for complications related to a severe reaction from a blood transfusion. that is usually due to a clerical error. i can even understand that if a surgeon operated on a patient and left an instrument inside accidentally, there would not be payment to cover treatment for those complications. however, some events, no matter how vigilant or good the treatment, cannot be prevented 100%. for example, a deep vein thrombosis or pulmonary embolism (which i will discuss in a later post) after knee or hip surgery is not a completely preventable event. even if the surgeons use proper medication to prevent these clots from forming, the fact is, the medications are not 100% effective! somehow this obvious fact has escaped the mind of cms. well, more on that later. i need to eat some ice cream and go to bed.

patient behavior

at the risk of alienating some patients, check out this hilarious article on patient behavior. not sure how long the link will last but worth reading. here's the original article on medscape. there's a chance you might need to register to read it but give it a try.

"two protons walk into a black hole ... "

if you have access to the wall street journal, check out this article. pretty funny. it's about physicists taking a workshop on how to be funny. i think i like the line in the article "do my bosons give you a hadron" even better. there's no limit to how funny physicists can be. i'm sure there's an integral in there somewhere ... limit of physicists as funny approaches infinity.

all this of course is tribute to the large hadron collider, which recently went into operation. click here to get more info on this. here's another link to some physicists having a pajama party to celebrate. now that sounds like a party i don't want to miss. hey, my undergrad was in mechanical engineering so i feel i have clearance to make fun of science and engineering nerds.

ca

sure, in your science class, ca might refer to calcium or california in geography or something else in some other class but if you hear your doctors talk about ca, they're talking about cancer. sometimes we use it when we don't want to alarm patients, families or others who may be in earshot, particularly when we don't really suspect it but do need to consider it in the possibilities of what might be wrong with someone. obviously, if your doctor has a fairly low suspicion of cancer but are doing a couple of tests to "rule it out" then you don't necessarily want to worry about it for days while the tests are pending. all you want to hear is, "oh yeah, whatever you have, it's not cancer." well, not to be paternalistic, but at least to me, i certainly wouldn't want to be worrying about it.

a couple of questions came up about prior ca topics. as for screening, colon cancer seems to be more straightforward but it's certainly not the case for breast cancer. unfortunately, no matter what type of cancer, there are always particularly aggressive forms in some people that defy all screening. we see patients with no family history of cancer who come in with colon cancer diagnosed in the 20's and 30's, breast cancer in the same range too. screening would not have helped and these patients aren't usually the ones who live a long life. these are usually advanced diseases we see in the hospital. those are the unfortunate outliers. screening programs are basically a numbers game--how prevalent is the disease in a certain group, how good are the tests, how much will all of it cost, etc. if you have a strong family history of breast cancer, as far as i know of, there are no clear-cut guidelines on early screening. of course, most recommend an early baseline mammo then yearly (or every other year) starting at age 40. but what if you're 20, 25 years old? there are genetic testing options for the brca gene but that probably shouldn't be done without counseling from a medical geneticist because the answers aren't as straightforward as you might think.

a friend also commented on gene upshaw, the former nfl'er, players union director who died somewhat suddenly of pancreatic cancer. again, some cancers in some people can be particularly aggressive. he was apparently sick at least for a little while (but not too long) but didn't get seen by a doctor. some cancers don't manifest themselves until it's almost too late. that's part of the reason the mortality for ovarian cancer and pancreatic cancer are so high. i just read another nice q&a session on the scientific american website here. more good info regarding cancers, particularly pancreatic. i'll talk about prostate cancer screening later, another very controversial area.

medical myths

there was an article in the british medical journal last year about certain medical myths. i am a little jealous because i could have written the article and had my name all over google and pubmed if i had thought of the idea but i didn't. isn't that the way with most things in life? anyway, it proclaims "sometimes even doctors are duped." if that's the case, i would say find another doctor as most of the ones listed were fairly basic old wives' tales (not to say doctors aren't duped or wrong a LOT of times because they are). the problem in medicine and in life is that we don't view things with a critical eye and believe anything people tell us, even if they're a physician. anyway, the article is an interesting read. check it out here.

ha ha, this came up because of a comment on my #1 fan's blog about how maybe sitting too close to the computer all these years made her eyes bad. apparently her optometrist told her this. well, hate to break the news but this is a myth. dim light or sitting too close to the tv or other objects does not make your vision bad.

another myth i want to demythologize (i made that up) is the ol' "sugar rush" that people, particularly parents, talk about. sugar does not make you hyper! i remember reading a long time ago that kids make other kids hyper, not sugar. in other words, when kids are at parties with other crazy and rowdy kids, it's the environment that makes them hyper, not the fact they got in a few cupcakes. john stossel even had a mini-study on 20/20 recently where they gave kids junk food which was actually low in sugar but the parents thought they were high-sugar snacks. of course they all had the impression that the kids were more hyper than usual. then they gave the kids healthy food but loaded with sugar and the parents thought they were calmer than usual. of course the parents were surprised when they were let in on the experiment. hmmm, i wonder if they got informed consent from the parents for the study?

anyway, this makes sense physiologically, too. okay, if you're completely comatose and hypoglycemic, i can see how giving sugar in that instance would increase your energy level. however, excess sugar stimulates insulin which is not a hormone known for revving up the body.

"the eagle has landed"



these were the words spoken by my wife when we got our phones in the mail. now, just to be clear, there is a backlog on iphones so the phones which came were my wife's and my parents' phones (none of which are iphones and we're all on one family plan now). however, this was a big step in my iphone access process. you see, i have had sprint service for 8 years. as a matter of fact, i recently checked my last bill and had a "congratulations on your 8 year anniversary" message. however, over time, and more importantly in my current job, i have become increasingly irritated with dropped calls. this even happens at our condo. i can have 4 bars then all of a sudden lost signal. this is even more aggravating when you have to make business or professional calls. people really get annoyed when you keep cutting out. so, we made the switch to at&t which, without a doubt has better signal reliability (although still a step behind verizon). just to let you know, i'm not entirely satisfied with this move because to sprint's credit, the voice quality of their phones/lines i feel is much better than at&t. you can drive in your car with the windows down and the other person can hardly tell. with all of our at&t phones, the background noise is much worse. however, background noise with a signal is still preferred over no signal at all.

having said all that, after we made the switch, i went to the at&t store and ordered my iphone, 3G that is. the expected wait was 10-21 days but one week later, i got an email that said the phone had arrived at the store. of course, the email says to wait for a customer service person to call to schedule a pick up time but whatever! i just went right to the store and it was there ready for me.

so, the pic above is me playing with the 2 loves of my life, my baby and my iphone. ha! just kidding!!! of course my wife and kid are the real loves of my life. the iphone would be a distant, distant 3rd.

tribute to norman

on a more serious note, i just wanted to write a short tribute to my good friend's dad, norman, who died last week from metastatic lung cancer. i've known my friend since 7th grade and what i always remember about his dad is his voice because it was on their answering machine growing up: "hello, this is norman ... " i always found it funny that the greeting sounded like he lived alone and didn't really mention the family.

to be quite honest, what was most troubling about the past few months with my friend and his dad was that he was diagnosed with cancer about 2 months ago and succumbed to it fairly quickly after diagnosis. you might think that he was in some remote area or never really saw any doctors but the fact was, he lived in a suburb and was being followed by many doctors, including a pulmonologist. i don't want to criticize any of his doctors because i know nothing about his prior workup and clinical condition but what angers me is that i feel his diagnosis should have been made much earlier. it's not like he all of a sudden became sick. he has had issues for longer than the past 2 months. of course some might ask, "would it have made a difference?" in his outcome but i don't think that is a relevant question. yes, lung cancer has a high mortality rate but with earlier diagnosis, there is a high likelihood that he would have been around much longer to enjoy his life on earth. and i'm not talking about keeping alive some demented and debilitated patient a few weeks longer to prolong his misery but i'm talking about early diagnosis with hopes at cure. well,what's done is done and i pray for peace and comfort for his family and friends.

cpr article

karen's friend kristi writes for the knoxville news sentinel and has an article about cpr covering the compression-only concept that i discussed previously. (am i really "discussing" it if i'm just writing about it on the blog and not actually talking with anyone? guess not. reminds me of a friend who asked if you could be a "wino" if you drank beer or liquor and not wine. initially i thought it could apply in general to anyone who drinks a lot but then the question was asked why that person was called a "wino" and not something else to which i had no answer. i guess alcoholic, alky, etc. could apply to such a person so it does seem that wino belongs exclusively in the realm of actual wine drinkers.) i had the honor of getting quoted in the article. check it out here. i can be korea's (or shall i say "korea-america"?) answer to sanjay gupta. watch out cnn.

on oregon and death

nothing profound here, just a link to a fox news article. apparently, a guy was signing up for oregon's state-run health plan and instead of an offer to help treat his metastatic prostate cancer, he got a letter offering physician-assisted suicide! okay, there's more to it than that but that's the gist of the story.

chemo and other costly therapy for terminal illnesses or late-stage disease brings up a dilemma regarding whether patients should undergo these therapies even if they offer only minimal benefit (tack on a few months at the end of life). there was another interesting ny times article regarding this issue recently. in many places where the government is the provider, they make the decision for you--minimal benefit, we ain't gonna pay. being the capitalist that i am, it is definitely against my nature to say that having less choices makes life easier but that is the certainly the case in some situations, for sure (like oh my gosh). if you have ever shopped around for a flat-screen hdtv, you know what i'm talking about!