This is just sort of a journal entry slash excuse to waste some time after my huge Microbiology final. It was only 65 questions but covered some 50+ antibiotic drugs and their clinical uses and major side effects, plus some 50+ obscure bacterial and fungal pathogens, their epidemiology, transmission, clinical disease, diagnosis, and treatment. Parts of the class I really enjoyed, such as the tuberculosis (TB) section, but much of it was so obscure and detailed that it required rote memorization. This is probably, for me, the most difficult part of medical school. It often makes me think holistically about how medical schools came about, why we learn it how we do, and what we could do to make medical school easier or more effective.
We spend two full years studying almost entirely from our books, handouts, and powerpoint slides, with very limited clinical contact, and are required to retain the anatomy, biochemistry, physiology, pathology, microbiology, pharmacology, etc. so that we can enter the 3rd year with the tools necessary to treat and manage patients of all kinds largely on our own. During almost every lecture, I find myself just wishing I could meet someone suffering from a Borrelia burgdorferi (Lyme disease) infection so that I could relate more to the humanistic side of the disease, and understand the importance of the antibiotic regimen that will ease their pain, restore their sanity and perhaps save their lives.
I anticipate the satisfaction and excitement of 3rd year that will solidify my clinical reasoning and help elucidate my specific interests in specialties, but dread the upcoming boards (USMLE Step 1 of 3) that function as the gateway into 3rd year, the judgment bar of med school, the standard of comparison by which our future opportunities in residencies will, in part, be determined. My goal is simply to keep as many doors open for as long as possible, because currently I have no idea what specialty I will choose, though I know at least it will be one that allows for more family time. That's what matters most to us.
Monday, December 17, 2007
Sunday, December 9, 2007
Our year-round fresh fruit source
Heather and I make smoothies all the time. They're great! They're usually something like 1 and 1/2 cups frozen fruit, a 6 oz yogurt, 1 cup milk, a banana, a spoonful or two of sugar (sometimes), and sometimes some vanilla. We wait for the big sales on frozen berries and then stock up, blueberries are my favorite! Partly because they taste so good, partly because they're packed full of cancer-fighting antioxidants and other fun vitamins. My favorite thing about smoothies, though, is they make Heather cold, and then she has to cuddle with me until she gets warm again.
Friday, December 7, 2007
I LOVE kids!!!
I have some of the cutest nephews and nieces in the world, and TONS of them! I love to hang out with them. There are 5 on my side and more than 20 on my wife's side. I can't wait to have kids of my own!! Sometimes I just stare at photos of Heather and I when we were little so I can kind of imagine what our own kids will look like. I'm so glad I married such a beautiful girl!
Wednesday, December 5, 2007
Unbiased Sources for Prescription Drug Info
Suppose your heartburn is acting up lately and your antacids just aren't cutting it. You visit a doctor for it. He/she happens to have some Nexium (the purple pill) samples and gives you a few saying, "Try these, this drug is more expensive than the other proton pump inhibitors, but it's also a little more effective." The purple pill with three neat little yellow stripes on it works like magic--your heartburn disappears completely. So, you get a prescription for it and order it at your local Walgreens. The one-month supply runs you a whopping $193. You think, "well, hey, it works wonders, I've never slept better. It's worth it."
Why do so many people prefer the purple pill? It's ALL marketing. They've simply taken the cheaper, equally effective OTC PPI named Prilosec (omeprazole, $19-26 for 1 mo.) and found a way to purify it differently so that the final product only contains the active form (they call it esomeprazole), and not its inactive enantiomeric mirror image. In other words, they're the SAME drug with different names. Their elegant studies show a slightly higher effectiveness with Nexium vs. Prilosec while other studies show no difference. More than half of the $193 per month you pay for Nexium goes directly into marketing for Nexium. This is the main reason it costs so much!
If you had taken a few minutes to visit www.crbestbuydrugs.com (consumer reports for drugs), you would've realized that you were spending TEN TIMES more than you needed to for this medication!
This situation is based on a visit with a patient that I had last week. A single working mother who was most likely on Medicaid, and she swore that the only thing that works for her heartburn is Nexium. So I asked, "Well, have you tried Prilosec?" She hadn't.
In summary: Why do we need unbiased sources?
Why do so many people prefer the purple pill? It's ALL marketing. They've simply taken the cheaper, equally effective OTC PPI named Prilosec (omeprazole, $19-26 for 1 mo.) and found a way to purify it differently so that the final product only contains the active form (they call it esomeprazole), and not its inactive enantiomeric mirror image. In other words, they're the SAME drug with different names. Their elegant studies show a slightly higher effectiveness with Nexium vs. Prilosec while other studies show no difference. More than half of the $193 per month you pay for Nexium goes directly into marketing for Nexium. This is the main reason it costs so much!
If you had taken a few minutes to visit www.crbestbuydrugs.com (consumer reports for drugs), you would've realized that you were spending TEN TIMES more than you needed to for this medication!
This situation is based on a visit with a patient that I had last week. A single working mother who was most likely on Medicaid, and she swore that the only thing that works for her heartburn is Nexium. So I asked, "Well, have you tried Prilosec?" She hadn't.
In summary: Why do we need unbiased sources?
- Doctors are influenced ... even if you don't think so
- Drug reps are factually inaccurate
- Articles funded by drug companies show bias
- Most Continuing Medical Education (for doctors) publications and seminars are sponsored by drug companies, and the data presented is often biased and skewed.
- Consumer Union Best Buy Drugs -- www.crbestbuydrugs.com This website fills a gap in the public's knowledge about the effectiveness and safety of prescription drugs and how drugs given for a particular illness compare with each other. It gives patients a better idea about how much drugs cost, including the comparative value of various drugs, with condensed and long reports.
- www.guidelines.gov -- evidence-based clinical practice guidelines
- www.medletter.com
- www.prescribersletter.com
- www.dtb.org.uk
- www.cochrane.org/reviews/clibintro.htm
- www.rxfiles.ca
- www.nofreelunch.org
Increasing Access to Essential Medicines
Drug companies, like other businesses, are profit-driven. They pour their billions of dollars into marketing and research of whatever we consumers will pay for. This is why they put more research and marketing into things such as "erectile dysfunction" and common ailments of old age (restless leg syndrome) instead of things that affect the younger and less fortunate in society.
Some more interesting facts:
Some more interesting facts:
- The Pharm. Industry spends about $19 billion on gifts to physicians every year.
- "Free Samples" greatly influence physicians' prescribing practices and negatively influence the care patients receive.
- The pharmaceutical industry collectively spends more on marketing than on research and development.
- The cost of marketing is passed onto patients in the form of higher drug prices
- Worldwide, only 25% of HIV+ patients needing treatment actually are receiving the life-saving medications that have been developed
- Many of the diseases that affect 90% of the world's population only receive 10% of the research and development funds because they predominantly affect poor people (the so-called "neglected diseases")
- The price of existing medicines remains one of the major barriers to access around the world.
Monday, December 3, 2007
update
Just trying to get this blog going here... so here's a quick update. I'm almost done with my 3rd semester of medical school at the University of Wisconsin in Madison. Heather supports us well by working as a scheduler at the brand new American Family Children's Hospital. We consider this job of hers to be a great blessing in our marriage because we now ride the same bus to work/school, and not only eat breakfast and dinner together, but also lunch!
We savor each day of this simple life of ours, with few responsibilities or expenses, plenty of time together, great friends, and good health, knowing it simply won't last because life goes on! We still live in a pathetically tiny old 1-bedroom apartment that is (just) big enough for our needs. Somehow, though, we continue to accumulate new things, and we're quickly running out of space!
Well, that's about it. My life is consumed by studying diseases that plague the human body. About 30-35 hours a week in class and lab, and then that much studying. I am also involved in interviewing med school applicants and help out with a few student organizations. I usually exercise on a regular basis, although my "runner's knee" has continued to preclude running from my routine (sad, because I believe running is the most convenient, most enjoyable, and most effective exercise) and so I've taken up swimming, road biking, and weight lifting. Last year Heather and I had membership at the local climbing gym and went religiously 3 times a week, but it's a 20-minute commute and not cheap, so we haven't been doing that this year.
We savor each day of this simple life of ours, with few responsibilities or expenses, plenty of time together, great friends, and good health, knowing it simply won't last because life goes on! We still live in a pathetically tiny old 1-bedroom apartment that is (just) big enough for our needs. Somehow, though, we continue to accumulate new things, and we're quickly running out of space!
Well, that's about it. My life is consumed by studying diseases that plague the human body. About 30-35 hours a week in class and lab, and then that much studying. I am also involved in interviewing med school applicants and help out with a few student organizations. I usually exercise on a regular basis, although my "runner's knee" has continued to preclude running from my routine (sad, because I believe running is the most convenient, most enjoyable, and most effective exercise) and so I've taken up swimming, road biking, and weight lifting. Last year Heather and I had membership at the local climbing gym and went religiously 3 times a week, but it's a 20-minute commute and not cheap, so we haven't been doing that this year.
Sunday, December 2, 2007
butter vs. margarine
Every day presents us with many, many little choices. I like to think that most of my choices are between good, better, and best, but sometimes they're between bad, worse, and worst. Yesterday, at the grocery store, I spent nearly 5 minutes of precious time debating which type of fat to buy for the chocolate cookies Heather made for us. None of the margarine selections were trans-fat free, and so I chose real butter, despite the fact that 1 tablespoon contains nearly 50% RDI of saturated fat, not to mention plenty of cholesterol as well (note: trans-fat free margarine IS undoubtedly the healthiest choice, but isn't usually available in stick form).
I was raised on real butter, and also plenty of cheese, sour cream, cream cheese, 2% milk, and other high-fat dairy products. I've since learned of the complex biochemical pathways of human metabolism that have singled out saturated fats and trans fats as the one dietary component that contributes more to the processes of atherosclerosis than any other thing. Yet, my logic comes full circle in re-realizing that it's not as important which type of fat you consume, but rather how much you consume, and whether you balance it with plenty of fresh fruits and vegetables, and, of course, regular exercise.
So anyway, I grabbed the butter, and then headed back to the fresh produce section in search of some spinach, or asparagus, or maybe even avocados. Despite the ridiculously high prices on some things, I remind myself that our health insurance is costing a lot more than this, but the money invested into good food choices is probably doing more for our health than the thousands we spend on health insurance each year.
I was raised on real butter, and also plenty of cheese, sour cream, cream cheese, 2% milk, and other high-fat dairy products. I've since learned of the complex biochemical pathways of human metabolism that have singled out saturated fats and trans fats as the one dietary component that contributes more to the processes of atherosclerosis than any other thing. Yet, my logic comes full circle in re-realizing that it's not as important which type of fat you consume, but rather how much you consume, and whether you balance it with plenty of fresh fruits and vegetables, and, of course, regular exercise.
So anyway, I grabbed the butter, and then headed back to the fresh produce section in search of some spinach, or asparagus, or maybe even avocados. Despite the ridiculously high prices on some things, I remind myself that our health insurance is costing a lot more than this, but the money invested into good food choices is probably doing more for our health than the thousands we spend on health insurance each year.
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