Physician Assisted Dying

Share | JAMA January 19 2016 315 No 3 p 249 on the subject lists a paragraph titled Evidence Evaluating the Practice of PAD


What more can the evidence show? The morbidity and mortality of PAD is near 100%. The long term survival near zilch. We might as well be back in the days of ancient Athens when Hippocrates ranted against the charlatans, and the priests jailed him 20 years for defying their political edicts -- defining disease and directing treatments. We espouse an arrogance of modernity while in reality nothing much has changed. The question is, can we as physicians defy political dictates, correctness and greed while sustaining the Asclepian convictions and pledge of our profession. Politicians demanding PAD seems a bit like men defining women's reproductive rights, misdirected social engineering at the least. 

Heroin Addiction in New Hampture

For over a decade there has been an intense campaign to treat our patient's pain. It may have started with a successful lawsuit against a physician for not providing adequate pain relief in a suffering patient. It may have been a political thing. In any case, students are taught to always ask patients to rate their pain on a scale of 1 to 10, and meaningful use, or at least the EHR records, take up substantial space with its documentation. Doctors have seemingly lost all caution and restraint in prescribing narcotics for pain relief. We give the patient a pain delivery system affixed to their IV that gives them however much narcotic they think they need. All of this showcasing gives people the idea that any pain is a bad thing and must be eliminated.

A generation ago, two things were different: patients did not experience pain as they do today wheather due to advertising, social norms, or our preoccupation with pain management, and physicians were much more circumspect in limiting narcotics to less addicting amounts understanding that any amount is addicting and addiction is always a risk. Pain is not a bad thing, however; it is put there for a purpose. What is bad is how we interpret it. 

That is not to say we don't mitigate pain and help patients deal with it, we do and we should, but I submit, we as physicians and some of our other providers are a major root cause of the heroin epidemic. It starts with the prescription and our promotion of pain as a more important target for treatment. (And profit SIC)

Cost of Health Care

Share | How cynical is it to have the economy supported by an industry that profits from and depends on the unhealthiness of our population?


Health spending reaches 3 trillion USD with rising drug costs and the general lassie fair commercialization health care. The 3 trillion amounts to $9,523 per person and a 5.3% increase over last year.
 Washington Post

Medical Education

It requires far more medical knowledge to practice quality medicine on the front lines of clinical medicine than ever it does in the specialties. The specialist's narrow focus limits competence in other specialties and the spaces in between. The education is all backwards, the primary care physicians need a more highly advanced more extended education. A six or seven year residency with a PhD in clinical medicine would serve nicely featuring a clinically relevant discipline such as genetics or epidemiology etc.

An abundance of exceedingly well trained family/personal physicians could solve most of today's problems, but large numbers of best qualified candidates could only be attracted if given a prestigious academic challenge with the rewards to match. The midevil medical school in Sarlrno, Italy 900 AD graduated medical students with a PhD, -- a just reward -- it could work today in leading medical schools and thereby attract the numbers and quality of primary care physicians needed to set the balance strait.

Physician extenders should receive much of the training family physicians get today, but never practice independently! The algorithms provided by specialty groups, burocratic planers, drug companies and best evidence can never accommodate the complexity and multiple problems inherent in the human condition: nutrition, environment, drugs, poverty and abuse. It will require a physician and a deep and shared relationship to grasp those problems and thus elevate the sad level of health that limits much of our population, our work force, our idle youth and many of our veterans. This unbalance, this distortion in our profession is worth fixing.

Hippocrates

Medicine today suffers almost as much from political intervention as ever it did from priests, shamans and religious dogma of the past. Reform, liberalism, and political correctness marginalize Hippocrates, the hippocratic method, and with him the sacred, ethical, humanitarian and scientific charactor of the profession.

Ideals of reform, political control, regulation, commercialization, political correctness and well intended lay ideals of social progress erode the authority, self regulation and ethics of the profession. Imagine lawyers without the standards and restraints of "The Bar."

Imagine doctors without the standards and restraint of peer review, held only to the gray areas of legality with profit, cynically, the only motive. The evolution of greed seems more and more evident at many levels. I fear that medical school reform proposes to adjust curriculum in order to accommodate this sad reality.

Take the now universal after hours sign off to 911. When did local medical societies decide that a doctor no longer needed to provide after hours availability for response to after hours emergencies or complications? I think in fact it was hospitals, not the medical society that made that change. Was there economic motive? You bet. Hospitals are now a multi billion dollar monopoly with legal sanction. For myself, I thank God for the VA and trust only the mainstream medical school.

On a historical level, medicine has suffered before and recovered; it will do so again. For the medical student, read Hippocrates, travel to some of the great medical schools abroad, be a humanitarian, a poet, a musician and always a scientist. Own a microscope. Do good works.

Quantum Biology

Richard P. Feynman in his published lectures, The Strange Theory of Light and Matter QED, wrote,

"The theory of quantum mechanics ... explained all kinds of details, such as why an oxygen atom combines with two hydreegen atoms to make water and so on. Quantum mechanics thus supplied the theory behind chemistry. So, fundementally theoretical chemistry is really physics."

The parallel in molecular biology is quite obvious. We deal with DNA at the molecular level. The next great step will be a theoretical explaination of molecular biology at the electron, photon and particle level, the level of quantum intanglement. Thus the theoretical understanding of molecular biology will also really be physics.

2,450 years ago Greek medicine was called physics. Aristotle had contemplated the existence of particles. The enquiry into how things worked, especially physiology was called physics and the stem of our word physician is indeed physics. With quantum biology we have come full circle.

23 and Me

23andMe posted a letter to its customers announcing that after two years of work they are now able to  share the wellness implications of their customers DNA directly to its customers. They promis a report by year end. 

The 23andMe database appears to be the biggest in the World and academic institutions are buying into the data for research. Furthermore, the vault of stored samples remains available for further research while the data remains anomonous with the individuals information remaining the property of the individual rather than some other institution or the government.

This becomes a breakthrough for clinical medicine, which heretofore faced a roadblock over confidentiality, the position of nearly all specialty groups and the assumption that the information would be too sensitive for the patient to have access to. Now, the clinician will have access to a patient history containing multiple SPN traits that are of preventive as well as diagnostic value, a great day for translational medicine.