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Shelby Foote, The Civil War

Herman Melville, Moby-Dick, or the Whale

Michael Punke, The Revenant

Bill Bryson, Notes from a Small Island



The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Katrina Blog Project

My Christmas Op-Ed

Yesteday (December 22), the New Orleans Times-Picayune kindly ran an essay of mine on its Op-Ed page. It is about an experience I had with a patient in Chalmette, Louisiana and how it affected me through Katrina. You can read it here.


True Office Stories, Part 1

I once had a patient, Dan (not his real name), who lived with a woman and her two twin daughters. The daughters were terribly spoiled and gave Dan a miserable time. They wouldn't listen to him, they trashed his house, and refused to show him any respect. After about a year of living with the three of them, he got sick of the insolence, flew into a rage, and threw them out.

A few days later his girlfriend called him. "You need to tell your doctor when you see him that your Zoloft isn't working."

"My Zoloft is working fine," he said. "I threw all three of you out and I don't give a s**t."


Katrina #3: Help Out Storm Victims and Make Money, Too

So you want to help the folks who are suffering from Hurricane Katrina. What if you could do that and make money too? You might not think that is possible, but it is, and it is very easy to do.

The Gulf Coast will need a lot of money to rebuild. Not just public tax dollars, but also private investment. Much of this private investment money will come from banks. To help support this process of private investment, you, the private citizen, can lend money to the backs involved in the recovery effort. You do this by buying certificates of deposit in Gulf Coast banks.

CDs, or certificates of deposit, are bank accounts that you agree not to take money out of for a specific length of time. You can create CDs for 7 days, 1 month, 3 months, 6 months, 1 year, or even longer at most banks. When the time period expires, the bank adds the interest you have earned to your initial deposit, and then asks you if you want to renew your CD for another period of time. Say yes, and the bank puts the money in a renewed CD account. Say no, and it returns your initial investment, plus your interest.

CD interest rates are pretty good right now. Most 1 year certificates are going for about 4%, which means for every $1000 you leave with the bank you will get $40 back after a year.

Banks use CD deposits to make loans to clients. If lots of people buy CDs, the bank has more money to lend, and can charge lower interest rates. If not many people buy CDs, interest rates tend to rise and banks end up turning many borrowers away.

The goal, if you want to help storm victims, is to buy a CD from a bank that has lots of branches in storm ravaged areas. If you buy from a bank based outside of the Gulf Coast, most of your money will go elsewhere. For Mississippians, I would suggest Trustmark Bank. For Lousisiana and New Orleans, try Gulf Coast Bank and Whitney Bank.

This same technique could work for any disaster region. Just look for a local bank in the affected area, and buy a CD from them. You will be helping out, and it won't cost you any money to do it.


Pens, Pens, Everywhere

I am just starting up my medical practice here in McComb, and on slow days I get more drug reps than patients. For the uninitiated, a "drug rep" is an employee of a pharmaceutical company who visits my office with the purpose of convincing me to write more prescriptions of their product.

There are many thorny issues to explore in this subject, and I will touch on all of them over time. But today I want to tackle the subject of gifts.

Drug reps usually come bearing gifts. They give me something free, which theoretically makes me better disposed towards them and more likely to give them more of my time. Gifts come in many forms but professional ethics dictate a price limit. So they bring cheap stuff -- a few books, post-it notes, a clock or two, all with the name of their drug emblazoned on it. And they bring pens. Lots and lots of pens.

There are people who have the time to worry about such things who argue that accepting pens is a kind of bribery. That when I hold the pen in my hand and see the logo there that it kindles a fire in my soul to write prescriptions for that medication with the passion of a spurned lover. I like to think that the pens aren't worth that much and are not enough to sway me from prescribing the appropriate medication instead of the one on the pen.

I think ethics is very important in medicine. But there is no need for us to be so fastidious that we fuss over every tiny potential for error. I believe in robust ethics -- that is, an ethical outlook that can tolerate the little scrapes and bumps in the road that are normal to life. If my moral code is so weak that I would sacrifice quality patient care for a nice pen, then I have no business living in the world. Sure, the reps want me to write their product. And yes, the pens remind me of their product. But I cannot be so ethically feeble that a simple pen will cause me to disregard all my medical training, as well as my ability to make a rational decision.

If I am that weak, God forbid that someone should present me with a bribe of real value, say, a freshly smoked Christmas turkey, and then ask me to blow up a bridge, because I might do it. A pen is to a prescription as a turkey is to a bridge, or something like that.

Luckily, I am a bit less suggestible than that. I try to be always mindful of the influence of advertising. Accepting a pen is a way of playing ball with the drug reps. They talk to me, and give me useful information about their products. And they also bring free samples, which helps my patients. I think the benefits of the information and the free samples outweighs the drawbacks of accepting a trinket as a gift. And if you've ever gotten a free drug sample from your doctor, I'll bet you do too.


The Genetically Identical Anecdote

Very often lately I have come across the Genetically Identical Anecdote. You've heard it -- this is the argument that a human is 97% genetically identical to a chimpanzee, or an orangutan, or a dolphin, or whatever animal species happens to be of interest at the moment. Usually the statement is made by a naturalist or environmentalist who wants the stress the point that humans are  closely related to animals, or that humans are no better than animals. The argument, while a little jarring, is nonetheless scientifically true: Over 97% of the genes found in the chimpanzee can also be found in our own genomes.

I consider myself an environmentalist, and do not object to people pointing out our kinship with them. But Genetically Identical Anecdote has been overused, and the observation now seems stretched. Most of all, I am bothered by its underlying assumption, that genetic similarity necessarily equates with identity. Genetics, by its very nature, implies a biological determinism. But while many of our characteristics certainly are genetically determined, it is important to note the biological research is now showing that our genetic codes are not necessarily the unalterable script of our lives. There may yet be room for free will after all.

Some genes are expressed only with the right environmental stimulation. For example, you may have genes that help your brain respond to and analyze music. However, if you never hear a musical instrument in your lifetime, these genes may never activate. On the other hand, if your parents drag you to every opera that comes to town, or if you choose to educate yourself in music as you grow up, this stimulation may trigger these genes to express themselves, and you could develop a musical talent that you otherwise would not have had. There is clear evidence that what you are in part is determined by what you expose yourself to. Thus humans, while 97% genetically the same as chimps, nonetheless are different not only because of the 3% genetic difference but also because as humans we expose our genomes to all kinds of stimulations that chimps can't.

There is another problem in the heart of the Genetically Identical Anecdote, and this problem lies with the scientific tendency to stress quantitative versus qualitative observations. It is axiomatic that scientists like to measure things. Scientists are very good at drawing conclusions about observations that can be easily measured, and not so good at evaluating observations that are subjective. It is well known, for instance, that the human body is about 60% water by volume. Yet it would be absurd to conclude from that that a 100 pound woman is 60% identical to a 100 pound bucket of water. Absurd but quantitatively accurate. What makes the woman different from the bucket of water is primarily qualitative, that is, subjective. You cannot put a number or a value on the distinction, but it is bluntly obvious.

In the same way, the Genetically Identical Anecdote stresses what can be measured, genetic material, and ignores what cannot, clear subjective differences between ourselves and other higher primates. While the Anecdote is clearly scientifically accurate, repeatedly stressing it tends to reinforce an argument that may not be true -- that our genes are the only things that make us what we are.