I don't remember the first book I read. My memory is good but unfortunately not that good. I am sure, though, that my first reading experience was probably different from my son's. Like his mother and I, little buddy enjoys good literature. It's fun to watch him rifle through his collection until he finds the perfect one that he is looking for. Usually a squeal of delight follows, and he sits down to enjoy himself.
Some of you probably can harken back to the good old elementary school days and remember "that kid that read aloud." You know the one I'm talking about. The teacher gave out an in-class reading assignment. You'd settle down in your desk to get started and realize that some kid is just yammering away next to you. You turn to tell him to be quiet and realize that he's not talking, he's reading. I had several of these in my classes throughout the years. Invariably, the teacher would bring it up to the kid's parents, and they would proudly say that they taught him that! I understand that you want your kid to enjoy to read, but we have some social constraints that should at least be considered along the way.
Given my experience with these kids at an early age, you can imagine my feeling when I see my kid doing this:
Yep, my kid is a loud reader. This feels like God laughing at me right now. He is, isn't He? Needless to say, we have a few things to work on here in the HumorMD household. I must say that I suddenly feel much more sympathetic to those parents that were pulled aside by the teacher back in my day. Hey, at least the kid is reading, right?
Monday, March 17, 2014
Monday, March 10, 2014
Innovate and Palliate
If I was a pure businessman, cancer drugs would be an interesting market niche to occupy. Research and development would be a potential problem. How many people in the world have the knowledge required to develop new cancer drugs? Not many. To top it off, most of them have no understanding or passion for business. Many of these scientists work in universities so as to not be bothered by corporate executives and the like.
On the other hand, you don't really have to accomplish much to hit it big. What happens if you come up with a drug that extends life by three months in metastatic lung cancer? Currently, that would probably make you a billionaire. That's right. Billion with a capital B. We simply don't have any great treatments for this, so anything that gives people longer survival by any length of time is pure gold.
The funny part is that we actually have a product that can increase survival by a few months without any of the nasty side effects of chemo. In fact, patients that use this product have drastically improved quality of life. What is this wonder drug, you might ask? Where can I buy stock in this? Actually, you can't buy stock in it at all. It's palliative care.
You can bet that us medical folk were a wee bit surprised when we found out that palliative care extends life in advanced lung cancer. The article was published in the New England Journal of medicine in 2010 (link here). Most physicians and patients think of palliative care as a fancy way of saying "we surrender." Nothing could be further from the truth. Early involvement of palliative care generally results in symptoms that are better managed and patients with better quality of life, regardless of whether curative treatment is being offered.
In general, the medical community doesn't get palliative care involved early enough. The aforementioned "we surrender" attitude means that physicians won't consult palliative care until the very end, which doesn't allow the time necessary for palliative care's full benefits to come to fruition. If we withheld a similarly performing medication, then it would be on the front page of CNN that physicians across America were being negligent. Would they be wrong? I don't like to think about the answer to that question...
On the other hand, you don't really have to accomplish much to hit it big. What happens if you come up with a drug that extends life by three months in metastatic lung cancer? Currently, that would probably make you a billionaire. That's right. Billion with a capital B. We simply don't have any great treatments for this, so anything that gives people longer survival by any length of time is pure gold.
The funny part is that we actually have a product that can increase survival by a few months without any of the nasty side effects of chemo. In fact, patients that use this product have drastically improved quality of life. What is this wonder drug, you might ask? Where can I buy stock in this? Actually, you can't buy stock in it at all. It's palliative care.
You can bet that us medical folk were a wee bit surprised when we found out that palliative care extends life in advanced lung cancer. The article was published in the New England Journal of medicine in 2010 (link here). Most physicians and patients think of palliative care as a fancy way of saying "we surrender." Nothing could be further from the truth. Early involvement of palliative care generally results in symptoms that are better managed and patients with better quality of life, regardless of whether curative treatment is being offered.
In general, the medical community doesn't get palliative care involved early enough. The aforementioned "we surrender" attitude means that physicians won't consult palliative care until the very end, which doesn't allow the time necessary for palliative care's full benefits to come to fruition. If we withheld a similarly performing medication, then it would be on the front page of CNN that physicians across America were being negligent. Would they be wrong? I don't like to think about the answer to that question...
Sunday, March 9, 2014
This Just Feels Like a Circus
I know. I went back to my old blog address. I'm sorry. The confusion will stop here fairly soon. Most of you click through from Facebook to get here anyway, so it shouldn't be too big of a deal. I was thinking that I would start fresh with a brand new blog address, but I soon realized that was dumb. I already have so much chronicled on this blog. Why put similar content in a completely separate place? There's no reason for foolishness like that.
On a more fun note, we took little man to the circus this weekend. We have quickly discovered that he LOVES shows of any kind. We've seen several live performances of his favorite TV shows, and he always enjoys it. The circus was no exception. He was riveted the entire time, in between squeals of delight that is. This should give you an idea of just how fixated he was:
On a more fun note, we took little man to the circus this weekend. We have quickly discovered that he LOVES shows of any kind. We've seen several live performances of his favorite TV shows, and he always enjoys it. The circus was no exception. He was riveted the entire time, in between squeals of delight that is. This should give you an idea of just how fixated he was:
You will also note that the circus is entertaining for all ages, which I can attest to. His grandparents found it just as thrilling as he did. You may wonder what they're looking at that would be so astonishing...
Now, this is impressive in its own right, but you have to think about this from a toddler's perspective. He has never seen an elephant before about twenty seconds ago, and now they are dancing to techno music in front of him. Mind=blown. I think he stared at that exact same spot for about ten minutes even after the elephant act was over.
We're really in a bind for figuring out how to top this next weekend. How do you get any better than pachyderms doing the polka? I'm thinking maybe order something from Amazon, have their fancy new drone system deliver it, and then tell him that the drone is part of Santa's new gift delivery system. Then, we can tell him drones will stop coming if he misbehaves. Move over Elf on the Shelf. That's next generation parenting for you.
Stocks 101
I've been actively watching the stock market for about a year and a half now. I like this phrase, actively watching. It means I pay close attention, but I'm not out there trading. The money that I have in the stock market is in my retirement account, and it's currently in index funds.
My realization that I was going to be throwing a significant portion of each pay check into this "retirement account" thing was what spawned my interest to know exactly what was happening with that money. It's been an eye-opening experience to say the least. The stock market is a lesson in humanity in it's most primal state. Profit, loss, fear, greed, elation, disappointment, power. Just a few things you can readily identify when looking at a basic stock chart.
With all of my reading, I've come across a few initial take home points to share. First, most of the money being made in the stock market is not being made by people actively trading stocks. Most of the money being made is going to people that have actually built these companies. If you want to hit it big on Wall Street, then build a Fortune 500 company. Surefire way to make millions. Go...
Second, online stock trading seems to be a lesson in how technology has made things easier but not necessarily better. Buying shares in companies used to be a deliberate, thoughtful act that required much thought and effort to even get your order to the trading floor. Now, you can spend millions buying stocks in seconds. Is this really better? Has using technology to chase quick profits really been a good addition to our culture? I think not.
Even more ironic is how the appeal of online stock trading has stacked the deck even further against the individual, if you fall into the trap. Ever tried to day trade against a multi-billion dollar corporation with supercomputers and countless Ivy League trained mathematicians and businessmen? Swing for the fences Average Joe. Just make sure you don't get that uniform dirty because you are going to be out of the game quick.
I'm going to be writing more about stocks in the future. It's a subject that I really enjoy. Though it may sound like I dislike the entire system, I actually support the idea of buying and selling ownership in a company. Only in America can you find a company you like and hitch your financial wagon to them. You also might be able to buy a naked put option and lose your shirt when the stock crashes, but you never get the good without the bad. Welcome to life.
On Top of My Game
My son has some unusual habits sometimes. Nothing out of the ordinary for any other toddler figuring life out. But it can be pretty entertaining. For instance, his latest dance move is simply spinning around over and over again in the middle of the living room floor. This is usually followed by him falling down and being unable to get back up. Baby dizziness can take quite the toll. I've gotten a few good videos so far, but all of them feature his parents in their pajamas. Not exactly world wide web material.
He also has a penchant for playing ON things rather than IN them. A while back, we bought a little blow up ball pit. He LOVES this. He would spend twenty-four hours a day there if we would let him. Despite it's design to draw toddlers inside the structure, he has devised an alternative way of playing with the ball pit, as illustrated here:
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The FDA Doesn't Regulate Health
Little man and I went to Wal-Mart today. We were on a mission to pick up a
new black ink cartridge for our printer. Since little buddy loves to ride in
the cart, I decided to take a little stroll around Wally World. One area I
enjoy visiting in particular is the pharmacy section. Some of you may be
familiar with my fondness for the store pharmacy aisle. With the proper
knowledge, this aisle can be a veritable treasure trove of disease killing power.
There is danger there, however. I can usually find a few chuckles about whatever the latest and greatest over the counter supplement may be. These new products are usually some of the same old things re-branded as something new. As soon as the TV infomercials go out, people dash for the store to pick it up or call their physician demanding to know why they weren't advised to take this amazing new medication.
Many of these supplements are advertised as substances that can improve some form of "health." I've seen advertisements for things that will improve brain health, liver health, immune system health, and even prostate health. Many people don't bat an eye at this phrasing. It's incredible important, though, that little word. When consumers think of the word health, they think of models in jogging clothes that smile and hold up a bottle of whatever product it may be. Do you know what I think of when I see a product designed to improve some type of "health?" Pure junk.
When a regular medication is approved by the FDA, this approval is backed up by clinical studies that prove efficacy in some way. There are also studies reviewed by the FDA that prove the medication is safe. Guess how many safety and efficacy studies the FDA reviews before a dietary supplement hits the market? Zero. Nada. Dietary supplements fall under a completely different set of rules. It is the manufacturer's responsibility to make sure a dietary supplement is safe, not the FDA. Therefore, the FDA reviews nothing and will only step in if some type of adverse event occurs.
When advertising, these supplements are not allowed to say that they do anything specific, such as actually help with your chronic fatigue, because there have been no studies verifying this. They are allowed to use general phrases, however, and "improving health" is a common go to.
Some of you probably think that I'm being a bit harsh. How do I know that these drugs don't actually work? No studies means you don't know either way, right? Unfortunately not. These manufacturers are in business to make money. Do you know what kind of money they are giving up by not being FDA approved? To put it in perspective, it costs about $1 billion on average to bring an FDA approved drug to the market, and companies like Pfizer and Merck are some of the richest in the world. Think about that. $1 billion up front cost, and they are still making tons of money. If you sell your drug as a dietary supplement, it probably doesn't mean you chose to. It means that you know the FDA won't approve it.
I want to be clear that I'm not disparaging drug companies. Many people don't see or don't take advantage of a lot of the good work that many of these companies do for folks that can't afford different medications. To be fair, very few of the major drug companies are in the dietary supplement business either. Would you jeopardize your reputation and excellent business model by being involved with this? I wouldn't. They already know what I know. What comes out of your GI tract after you take that "gastrointestinal health" pill is exactly equivalent to it's value. Crap.
There is danger there, however. I can usually find a few chuckles about whatever the latest and greatest over the counter supplement may be. These new products are usually some of the same old things re-branded as something new. As soon as the TV infomercials go out, people dash for the store to pick it up or call their physician demanding to know why they weren't advised to take this amazing new medication.
Many of these supplements are advertised as substances that can improve some form of "health." I've seen advertisements for things that will improve brain health, liver health, immune system health, and even prostate health. Many people don't bat an eye at this phrasing. It's incredible important, though, that little word. When consumers think of the word health, they think of models in jogging clothes that smile and hold up a bottle of whatever product it may be. Do you know what I think of when I see a product designed to improve some type of "health?" Pure junk.
When a regular medication is approved by the FDA, this approval is backed up by clinical studies that prove efficacy in some way. There are also studies reviewed by the FDA that prove the medication is safe. Guess how many safety and efficacy studies the FDA reviews before a dietary supplement hits the market? Zero. Nada. Dietary supplements fall under a completely different set of rules. It is the manufacturer's responsibility to make sure a dietary supplement is safe, not the FDA. Therefore, the FDA reviews nothing and will only step in if some type of adverse event occurs.
When advertising, these supplements are not allowed to say that they do anything specific, such as actually help with your chronic fatigue, because there have been no studies verifying this. They are allowed to use general phrases, however, and "improving health" is a common go to.
Some of you probably think that I'm being a bit harsh. How do I know that these drugs don't actually work? No studies means you don't know either way, right? Unfortunately not. These manufacturers are in business to make money. Do you know what kind of money they are giving up by not being FDA approved? To put it in perspective, it costs about $1 billion on average to bring an FDA approved drug to the market, and companies like Pfizer and Merck are some of the richest in the world. Think about that. $1 billion up front cost, and they are still making tons of money. If you sell your drug as a dietary supplement, it probably doesn't mean you chose to. It means that you know the FDA won't approve it.
I want to be clear that I'm not disparaging drug companies. Many people don't see or don't take advantage of a lot of the good work that many of these companies do for folks that can't afford different medications. To be fair, very few of the major drug companies are in the dietary supplement business either. Would you jeopardize your reputation and excellent business model by being involved with this? I wouldn't. They already know what I know. What comes out of your GI tract after you take that "gastrointestinal health" pill is exactly equivalent to it's value. Crap.
Just Around the River Bend
If residency were a train ride, I'd be rounding the final bend right about now. Nearly all of the difficult months are behind me, and with the exception of a few random swing shifts, I am in the process of transitioning to a work schedule that closely resembles that of a normal person. This transition is partially to blame for my re-entry into blog world. I have a little more time now, and I should be able to put something up every now and then without staying up too late at night. Quite frankly, I also just enjoy it. It's nice to have an outlet for your thoughts.
It really is amazing how much residency changes you. I'm now part of the "old man crew." I was standing in the elevator this past week with three other third year guys. When we started a little less than three years ago, there wasn't a gray hair in the bunch. Now, all of us have a few silver (or even white) hairs in our heads. Incredible. Those before and after shots of Presidents that I used to cackle at are no longer funny. Long term stress can really do a number on you.
Despite my occasional old man ways, little man is still keeping me young. He has blossomed into a full scale toddler, and he is...active. I spend a lot of my time at home chasing balls, running laps around the kitchen, and shutting doors that I swore were already locked. The kid is a magician. Here is a list of current skills that will probably be worthy of further posts:
-Draining his own bath water when he's ready to get out
-Perfecting the poop toss
-Finding his own TV channels
-Texting and Driving
That should be enough to keep us busy for a little while. I'll throw in a few medical topics along the way as well that might be useful. I'm still a fan of the four dollar med list. I'm still a fan of providing as much value as possible to patients. What if I told you that I could achieve the same benefit with a four dollar medication as a heart cath? It would be interesting, wouldn't it? Well don't worry. I still have a few of these tricks up my sleeve...
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