Articles, public health, medical and otherwise

When is sedation really euthanasia? -- Pretty interesting, especially considering my new understanding of end-of-life care and advance directives. From a medical ethics standpoint, it is completely OK, as a physician, to give a dying person a dose of morphine to ease his pain, if that dose might also depress his respiratory drive, and in so doing, hasten respiratory failure and death. If the goal is pain control (and if this is all done in conjunction with the patient's wishes of course), then respiratory depression is an acceptable outcome. Could doctors be overdoing it?

Guidelines for epidemics: Who gets a ventilator? In light of the (most likely) oncoming flu epidemic, as well as issues regarding intensive and end-of-life care and scarce resources, how will we allocate those resources? Health policy principles state that there are four possible goals in any situation: equity, efficiency, security, and liberty. Does everyone get a ventilator (equity)? Or do only the sickest patients who will benefit the most from one get one (efficiency)? Do we vaccinate everyone against infectious disease (security)? Or do we allow people to do what they want to do (liberty)? All four of these goals cannot be achieved in any one situation. I think it's good for people to have these discussions regarding emergency situations and healthcare resources.

TB patients chafe under lockdown in South Africa -- Speaking of security, TB is interesting because in the United States it is the only disease that we as a society have decided is severe enough to warrant DOT (directly observed therapy). That is, if you are diagnosed with active TB and there is reason to believe you will not take your medicines appropriately (see "Doctors without orders," below), public health officials can take you into temporary custody every time your dose is due and watch you swallow your pills. We have decided that security is more important than liberty when it comes to tuberculosis. What's happening in South Africa sounds horrible, though, and I hope that even if XDR-TB becomes more prevalent in the U.S., we have the resources to handle it in a way that still manages to preserve some aspects of liberty.

Doctors without orders -- Why don't patients take their prescriptions accurately? I think a lot of it has to do with patient education -- although the article points to other factors as well. A couple years ago, my mom was prescribed a prednisone taper, and messed up the regimen early on. I came home for spring break to find a mom-monster, crabby, bitchy, anxious, tearful, and I had no idea why. Finally, over the course of about 36 hours, the full story came out: she had left off at "5 pills a day" when she missed a dose, so she caught up on her extra dose, then didn't bother to read the directions again, and kept taking 5 pills at a time until she used up the whole bottle! I tried to explain what was wrong, but the steroids had made her so irrational and she just kept arguing with me. She didn't understand the mechanism by which the prednisone worked, so she assumed they were like antibiotics, and she should take a catch-up dose if she missed one. In the end it worked out, but I have seen first-hand the side effects of steroid withdrawal! I guess I can't point the finger too much, either; I know that ideally, OCPs should be taken exactly 24 hours apart every day, yet I almost never do that...

Get ready to step up, Dad -- I occasionally (OK, more than occasionally) ruminate about life after the wedding. AKA, marriage. And that frequently leads to ruminations about parenthood and career. The good news is that at least in medicine, it's not completely unheard of to negotiate less-than-full-time positions. The bad news is that I am a micro-manager when it comes to a lot of things, and I'm sure that will be true for parenting as well. The good news is that I'm apparently not alone. Also, I still have time to change my micro-managing ways (I'm working on it slowly).

Career or Family? Yes. -- Another article along the women-in-the-workplace theme. I didn't know there were headhunter services for part-time female workers; that's very cool and obviously providing a much-needed service. Hopefully I won't run into too much trouble if and when I need to negotiate a 75% contract -- that's the nice thing about having office hours; if you choose not to have them, then you choose not to have them!

The Mecca of the Mouse -- Ah, Disney World. This Slate author is spending a week there sans children, to explore what it's really about. First up, Epcot. Here's what got me: "Disney had purposefully designed [Epcot] to appeal more to young adults than to their offspring. It was bound to disappoint all but the nerdiest of children." Who loved Epcot at age 10? Yeah, that would be me...

The book of the undead -- Interesting piece from Slate about phone books and why they're still around. Ours keep piling up on the shelf in our coat closet... at least I've stopped taking them from the lobby when they get delivered. Watch all the YouTube clips; I've never seen the Tufts one, and it's a really good prank!

Getting to Europe is about to get easier -- One word: HOORAY!!! I just started reading one of our Scotland travel guides (honeymoon destination), and I've been getting nervous about the financial aspects of a honeymoon in the UK. But maybe airfares will come down?