27 April 2004

Do You Wish You Can Have One?

In Ohio, there is a new law that took effect weeks ago that allows Ohioans to carry concealed handguns. It is called the concealed carry law. Some 70,000 Ohioans are expected to apply for permits. Read the news report here.

I have several questions:
What society permits its citizens to carry guns?
An unsafe and crime-ridden one?

What level of maturity is needed to carry guns? How do you measure maturity?
Psychological tests? Illegal drug-screening tests? I do not think those are enough.

If I had a gun and if I were to relate it with my displeasure when I drive (with jeepney and taxi drivers) here at home, I might end up in jail as a mass murderer. Geeez, I hope they do not pass any laws like that here in Manila.

24 April 2004

Can We Heal Without Damocles' Sword On Our Heads?

Photo clip from the BBC

A Rehabilitation Medicine specialist friend of mine had coffee the other day and she told me an interesting case she recently saw. It involved a 37-year old woman who consulted her because of right foot paralysis after a myomectomy (obstetric operation that surgically removes myomas or uterine fibroids). The woman had an infertilty work-up and was diagnosed to have multiple myomas that had to be removed in order for her to conceive. Her operation lasted for 5 hours and was practically uneventful except for the right foot paralysis that developed. Asked why she had foot paralysis after the operation, the woman was told by her On-Gyn doctor that the paralysis while unfortunate, is one of the complications of the operation. She was referred to a Rehab Med specialist friend of the Ob-Gyn doctor, and was diagnosed to have partial peroneal nerve paralysis. She was assured full recovery after 1 month of physical therapy and daily taking of B-complex vitamins.

The said woman, a feisty mathematics teacher, consulted my Rehab Med friend in turn, for a 2nd opinion. My friend told her that recovery will take 3-6 months, and recovery might not be 100% anymore. The woman cried and wanted to know why she now had a foot paralysis when what she just wanted was to have her myomas removed so she can conceive. My friend, while sympathetic to the sad plight of the anxious patient, was also feeling uneasy because she felt that this might be a budding case of medical malpractice.

Physicians have an unspoken rule of protecting one another, when things go wrong. It does not matter if that doctor is from another school or hospital, or from the other side of the world; we tend to protect one another, or to play it safe, we tend not to get involved. Often this contributes more to the misery of the patient(s) involved.

Two years ago, there was much talk about House Bill 4955 and Senate Bills 2298 and 2303 which aimed to pass into law the Philippines' first Medical Malpractice Bill. I do not know what happened to this bill or if it had been passed into law. Maybe Sassy can help me on this.

What I know is that was a cannonade of position papers like this one that rained left and right from medical associations and other organizations opposed to the bill. They argued that there was no need anymore for a medical malpractice bill because Article 2176 of the Civil Code and Article 365 of the Penal Code adequately covers both the civil and criminal aspects of a negligent doctor doing wrong.

The photo above shows an X-ray film with surgical scissors noted in the patient's abdomen. I think this is really an obvious case(!!!) of medical and surgical negligence. Read the whole story here. There are other cases of medical negligence here and here. Lately in Australia, even hospitals are under fire.

My own 2-cents here is that physicians should police their own ranks, improve the quality of medical education, make continuing medical education mandatory for all doctors with periodical examinations to gauge performance, strict hospital policies on surgical operations, and some occasional lessons on empathy, for those doctors who need it the most.

22 April 2004

APRIL Strokes

I'm back.

I apologize to all my regular readers (Sassy and Bayi, in particular) and visitors for being unable to post lately. Swamped once more with patients, a good number of which are in critical condition, I hardly had the time to sit down to post my articles. Let's see if I can make it up to you in the days to come. As it is, my schedule's still tight.

Summertime in the Philippines is sweltering hot. In my medical experience, this is the time I get frequent cases of cerobrovascular stroke, heat stroke, hypertension, and heart attacks. Currently, I am also nursing a terrible cold. I think my Dad has caught it too, because of me.

Take the lady patient in the picture above, for example. She is Honeygirl De Leon, the Philippine Charity Sweepstakes Office (PCSO) Chairperson. She was speaking in Baguio City (already considered a cool place here) when she had a stroke. She had to be rushed to a nearby hospital where the doctors performed a neurosurgical operation technique that involved removing a portion of her skull and placing it in her abdomen. This neurosurgical technique became famous when Roy Horn (of the Siegfried and Roy tandem) underwent the same procedure in order to get saved from the beating he got last October 3 from one of their pet tiger's violent attack. De Leon was recently transferred to Makati Medical Center (MMC) for continuous monitoring and treament.

A portion of the skull is often removed following brain surgery, trauma, stroke or other medical problems that cause the brain to swell. Removing the skull allows the brain to expand, lessen the pressure, and minimize neurologic damage to the patient.

I do not have to look far away to find out that April has some influence on stroke occurrence. My own Dad, for the past 3-4 years, always experiences stroke attacks during the month of April. Fortunately, his strokes are mostly lacunar in nature, as opposed to the more fatal hemorrhagic type. Add to this my personal observation that there is indeed higher incidence of stroke during the summer months. Whether this is attributable to the hot temperature or not, is still debatable at this time, as there is not much local observational studies done to document this.

So how have you been doing lately? I missed weblogging. Hope I can squeeze in more time posting my articles.

10 April 2004

How Necessary Are They?

Photo courtesy of The Province

At a time when you thought that it is only adults who get depressed, comes this disquieting news questioning the scientific wisdom of prescribing anti-depressant medication to children.

Dr. Jon Jureidini, head of the department of Psychological Medicine at Adelaide's Women's and Children's Hospital in Australia, analyzed the results of several published surveys comparing children prescribed drugs like Prozac, Aropax and Zoloft with those who took a placebo, and concluded severe side-effects, including the possibility of triggering suicidal behavior. His article was written in the current issue of the British Medical Journal (subscription needed) that came out yesterday.

In one study of Aropax, of which its authors claimed "most adverse events were not serious," Dr. Jureidini found seven patients who had to be put in hospital. In a Zoloft study, while the authors described it as "an effective, safe and well tolerated short-term treatment for children and adolescents", Dr. Jureidini found dangerous side-effects that occurred twice as often as in children taking the placebo.

Dr. Jureidini's warning comes in the heels of mounting worldwide concern about prescribing antidepressants wantonly. Last Feb. 2, the FDA advisory committee discussed new concerns about the unknown effects of psychotropic drugs on children and the fear that some antidepressants may increase suicidal tendencies. The FDA is re-examining 20 studies of eight antidepressants given to children and is expected to report its findings this summer.

US doctors wrote a record number of antidepressant prescriptions for children -- about 11 million -- in 2002, according to FDA estimates, and about 2.7 million of those prescriptions were for children 11 and under. Overall, sales of antidepressant drugs in the US increased from 14 million prescriptions in 1992 to 157 million in 2002. In Britain, health authorities have already ruled that Prozac is the only selective serotonin reuptake inhibitor (SSRI) safe enough for depressed children.

In my opinion, I think it makes perfect sense and antidepressant manufacturers couldn't be happier. I mean, if indeed the FDA committee results come out this summer and they find out that there is indeed an alarming link between antidepressants and increased suicidal risks, isn't that a glorious outcome for the antidepressant makers? Why do you buy antidepressants in the first place? To prevent getting depressed, right? To prevent suicide, right? But the scenario could be that they (antidepressant makers) knew this a long time ago. Businesswise, if more people end up committing suicide, antidepressant sales will increase more (more money for them, of course!) because people will mistakenly think that taking the medicines can save them from killing themselves, even when the grim reality is that these are the very culprits of their worsening condition.

There's nothing new here. As long as greed for profits and more profits rules the minds of drug manufacturers, we will see more news like this.

Being an optimist, I still hope that the summer results of the FDA committee on antidepressants will prove me wrong.

08 April 2004

A Time To Reflect and Pray

Lenten season in the Philippines is simply exceptional. No work. No malls. No banks. No movies. No restaurants. Almost every establishment is closed. No TV shows. No radio. No newspapers. No campaigning politicians. No people loitering in the streets. A heavenly sensation of nothingness. Pure quietness. It is like waking up the day after a massive nuclear meltdown. All the structures are there and are intact, but a lot of people are gone. Its Maundy Thursday today and its already sedate here. Wait until tomorrow, which is Good Friday, and I bet you, it will get quieter.

Vacation officially started yesterday and will last up to Sunday. Actually the pilgrimage to the provinces began as early as Monday. If you are a crazy military general, this is the best time to launch a coup. If you abhor traffic, now is the time to drive around the metropolis. I can guarantee you a 99% chance that you can drive stress-free until Saturday. And if you are like me who is just tired of the daily dosage hustle and bustle, this is a huge break for you. I belong to the lucky few who has been left in the metropolis to appreciate what the Desiderata writer termed as "peace in silence." This is simply great!

Strictly speaking, the lengthy sabbatical is meant to be used to reflect on the Passion of Jesus (yes, it's not just the movie, it happens here yearly). It is a period of penance, prayers, and fasting. The ceremonial details can be read here. Much like Ramadhan for the Muslims. It is supposed to bring back to mind the essence of the sacrifices made by Jesus and in doing so, help us become better individuals.

But does that really happen?

No. The majority who trooped out of the metropolis see this as pure vacation, a time to hit the beaches like Boracay, or go to cool Baguio City, or if you are affluent enough, it is an opportunity to travel to Europe or the US, where it is spring time. There are a few who reflect on the spiritual essence of Lent, but they are just that---they're few. Meanwhile there's a lot of noise and fighting happening in another part of the globe, in far Falluja, Iraq.

The sharp contrast between peace and silence, the reality of us relaxing here in Manila while there's a lot of action in Iraq right now was editorialized today by the PDI while quoting heavily from the searing April 1st Washington Post article of Philip Kennicott in which he deplored the "dispassionate objectivity," which makes "an enemy, an occupier or an animal" capable of unlocking and proapagating "the possibility for war, revolution and genocide."

Silence and detachment indeed makes you reflect long and hard on things like "dispassionate objectivity," and why we ever tolerate it. We have lots of time to think here, and even write about what all of our thinking will reveal to us, but our brothers in Iraq have no time to do so. In hard times like these and in the light of the briliant sarcasm employed by Kennicott in his article, what can we really do?

07 April 2004

Those Breakfast Cereals Are Loaded

Recently in the UK, their Consumers' Association accused breakfast cereal giants Kellogg's and Nestle of marketing products containing excessive levels of sugar, salt and fat. Basing their data on assessments done by the their Food Standards Agency, they classified 15 out of 28 breakfast brands aimed at children as worst offenders, and these were made by either Kellogg's or Nestle. Among the 100 products surveyed, 85 contained a lot of sugar, 9 had a lot of saturated fat, and 64 contained a lot of salt.

Read the full news story here.

The breakfast cereals advertisements claim that their brands are healthy foods for children. Suddenly it turns out that's not true. We are being led as accessories to a crime of producing a new breed of kids that are soon-to-be-obese and at a high risk for heart problems, stroke, hypertension, and diabetes. Who will regulate these companies?

In my country, no one even looks at potential harmful foods. We only hear alarming reports from countries like the UK or the US, and then that's the only time we find out for ourselves.

To get fat is easy, to trim down is difficult. To gain weight requires only a hedonist attitude, to lose weight requires discipline and determination (not so fun, really). We all want to be healthy but most food companies are only concerned about how to make more money. The problem is really complicated. It gets worse when no one complains and no one cares. I know there is no easy solution, but it would be most welcome if we can somehow begin to have a collective consumer effort to challenge all the "unhealthiness" we have now.

06 April 2004


Unhappiness In Practice

April 5, 2004 print issue of the Chicago Sun-Times

The woman on the right of the picture is Dr. Eileen Murphy. She is 48 and a well-known Ob-Gyn in Chicago who has just decided to quit her practice and become a middle school science teacher instead. Read her story here.

Just like Filipino doctors who are shifting to nursing, her reasons appear to be financial and economic. And I thought Filipinos were the only ones. According to a 2002 study published in the Archives of Internal Medicine the most dissastified doctors in practice are ENT practitioners followed by OB-GYN doctors.

The biggest unsatisfaction of OB-GYNs comes from growing costs of malpractice insurance. In Cook County, for example, malpractice insurance cost an average of $140,000 according to ISMIE Mutual, the state's biggest insurer. Other reasons cited are long hours, managed-care hassles, and Medicare regulations. The news story also says "there are anecdotal reports of OB-GYNs moving to Wisconsin and Indiana, which have lower premiums, or quitting medicine altogether."

Asked for a reaction, Dr. Murphy has this to say: "But things change," she said. "You have to respond to change. I'm pretty Zen about it."

Pretty Zen about it. That sounds cool. Are the patients cool about it too?

Two More Reasons To Quit

I still find it difficult to understand why we continue doing things that have been documented to cause real harm to our bodies. Like smoking. Even doctors smoke. When we were in medschool, we were shown real lungs of people who died from lung cancer. These lungs were collapsed, soggy, and sooty. There were a lot oohs-and-aahs, but that was it. When we walked out of the Pathology laboratory, my classmates went on with their smoking. Everyday, we see patients in the wards who are chronically ill, most of them dying, partly because they smoked like chimneys for years when they were young. Yet, that did not in any way discourage them from smoking. No sir! This post is not about doctors who smoke. I am just using doctors as examples to illustrate the gravity of the problem. I mean, if health advocates cannot quit, how much expectation should we ascribe to the general population? Can this battle be won at all? Even the fact that one can indeed die from smoking is not enough to stop smokers from killing themselves.

Today, there are two more reasons to quit smoking. Read it here and here.

The first reason says there is a direct link between smoking and early deaths, while the second one shows that even passive smoking can cause reduced wound healing. One reason means harm for your own body, while the other means harm for others.

To all smokers out there, what more reason do you need to quit?

05 April 2004

A Study In Happiness

The London Free Press yesterday carried a story yesterday about the rich interplay of money and love in real people's lives. It is a drama worthy of a Hollywood dramatization.

It's funny how Canada's biggest lottery winner handles his newlyfound fortune and the love of his life. It has been a tough balancing act for him. True happiness, I guess, is truly elusive, even with love and money around.

04 April 2004

We Should Learn From Our Neighbors

I like the tenacity of Tony Abbott. He is the Australian Federal Health Minister. Last month, he stirred a hornet's nest in their country when he described the 100,000 Australian abortions each year as a "national tragedy" borne out of a culture "where people did not take responsibility seriously".

This week, he is in the news again for his proposal to give Aussie parents greater access to the health records of their children. He is heavily distressed by what he calls "open-slather sexual activity" by those younger than 16.

This is in the light of a study last year of the sexual health of 2,388 secondary school students by La Trobe University, Melbourne, in which 25% of year 10 students and more than 50% of those in year 12 were sexually active. The same study also found that 20% did not use any contraception methods.

Abbott says it was not acceptable to simply concede that 15- and 16-year-olds were sexually active.

In my opinion, Abbott should at least take into consideration the fact that when young people (12-17 year olds) experience thoughts of love and other symptoms of "sexual heat," this may be at least in part because of biological and evolutionary factors.

Hormonal changes occur a lot during the adolescent stage. The key hormone involved for both boys and girls is testosterone, which is responsible for increasing our sex drives. I do not know of any study that links sexual drive with climate, but I have a theory that just like animals, humans will have higher sexual drives (higher testosterone levels) during spring and summer. I can bet also that the period covered in the Australian study mentioned above was done during their spring-summer season.

Hormone release is associated with circadian rhythms or the body's internal clocks. In winter, for example, when nights are lengthier than days, there is more melatonin (sleep hormone) being released. People tend to sleep and oversleep. They feel lethargic, they tend to overeat, and have less interest in sex. Conversely, during spring and summer, days are lengthier than nights, and there is more light. People have trouble sleeping and getting back to sleep. Likewise, there is an increased release of testosterone which might account for the increased sexual drives and increased amorous tones in both sexes. Studies should be done to document the existence of this link.

I am also amused that while Australia (and also the Philippines) has problems on how to curb sexual activity, countries like Singapore are anxious about their dwindling population. In Singapore, they consider pregnant women as "heroes." There is even news that the Singaporean Parliament will soon dish out baby bonuses. Some have suggested cash incentives of up to $6,000 for a woman who has a second child and $12,000 for a third. Friend Batjay has posts that can attest to this fact.

Such is the beauty of our differences. Australians would love to learn from Singaporeans how to stop the itch, and consequently, Singaporeans would like to ask Australians how they can get their groove back.

02 April 2004

Mel Does It Himself

A bit of film trivia.

I do not know what his purpose was, but did you know that it was Mel Gibson's hand that drove the nails on Jesus when he was being crucified in the film? Notice the Roman band strap on his arm. I really did not notice this while watching the film, but I have this vague recollection that the scene frame involved only the hands of a Roman soldier doing it. Now we know it was Mel Gibson.

What was that for? He could have asked any other actor or extra to do it. Why him?

For impact, perhaps? To gain more media mileage?

Or did he do it to convey a message that the crucifixion of Jesus was the responsibility of everyone? In the film, all the actual physical punishment Jesus received from the scourging to the crucifixion was handed down by the Romans. Not a single Jew laid a hand on him, even if it was them who were so bloodthirsty to have Jesus' head. If there was one other Jew involved, it was Simon of Cyrene, but what he did was help Jesus, not punish him. Collective responsibility. I think this is Gibson's message.

We crucified Jesus. All of us killed him. Proponents of anti-Semitism can heave a sigh of relief now if they still think the film makes them look bad.

01 April 2004

Random Reflections On The Passion

Yesterday, my soulmate and I underwent our own version of Calvary before watching The Passion. She planed in from Palawan island and call it bad luck, there was massive power failure at the airport, and this caused her flight to be delayed by 4hours. Also, the traffic was horrendous (what's new?), I moved at turtle-pace and what was supposed to be an afternoon date became a romantic evening activity. We managed to catch the 6:45pm screening at Cinema 2 of Glorietta 4.

It was opening day yesterday and being a weekday, we were surprised to see a lot of people queuing up for tickets. The media mileage generated by the film is reaping its rewards.

The cruelty and violence starts early. After the opening scene at Gethsamene where Jesus prayed long and hard to prepare for the passion, the thrashings begin: Jesus is beaten up and slapped, struck with chains, trussed, kicked, and dangled over a wall. He is made to face Caiapha (played by Mattia Sbragia), the High Priest of the Sanhedrin, who accuses him of blasphemy because he says he is the Messiah. His co-priests rally the crowd to have Jesus delivered to Pilate (played by Hristo Naumov Shopov) and have him crucified. The film highlighted that the crucifixion was largely the outcry of Jesus own people, and not of the Roman conquerors. Pilate saw no wrong in Jesus and thought that by scourging him hard at the pillar, the people will change their minds and let him go. He was wrong. The people wanted him dead. He washes his hands and gives in to what they want. Death by crucifixion. Even during the time of Jesus, there was already the concept of mob rule.

Pilate is one troubled fellow. He was a paranoid governor and easily agitated by signs of dissent and uprisings. Jesus lived in a politically unstable environment. In fact, the Passion can also be seen under a new light: it is the story of a revolutionary fighting for a change.The Jewish community was occupied against its will by the Roman Empire, and the good news being proclaimed by Jesus was equally threatening to both sides: to the Romans, because he was a radical, and to the Sanhedrin council, because he preached a new covenant. The status quo was being threatened. The source had to be eliminated.

The word 'passion' today has a romantic connotation. The real meaning of the word, however, had always something to do with pain and suffering. This is what Gibson's film is all about. If you think this is a feel-good spiritual movie, think again. It aims to disturb the audience. It wants you to know that there is more to the agony, the scourging, the journey to Calvary, and the crucifixion. Pain is a relative word: if you have never witnessed or had little exposure to cruelty and violence in your life, you will find the film revolting. It will be like a trip to the slaughterhouse. If this be the case, pay close attention to the willingness and the obedience of Jesus in accepting his fate. He was so open to the whole idea of being reduced to a pulp that he even asked forgiveness in behalf of his tormentors. If there is anything to admire here, it is Jesus' free will to be beaten and scourged. It is also his stern resolve not to be tempted by the devil and back out from it all.

Anti-Semitic? I do not think so. Gibson merely tells the truth and nothing but. Jesus of Nazareth was crucified by a mob incited by the High Priests at the time. Out of his "own accord," he is punished for the non-existent sin of telling the truth.

If you love gore and sadomasochism and your name is Quentin Tarantino, you might find the Passion mild and boring. If this be the case, I would like you to look at the fact that the beaten victim is the one who calls himself the Son of the living God and as such, he need only to flick his fingers or whistle and he can easily wipe out his tormentors. But he does not. He accepts all the blows with no rancor, with no complaints, with no sign of anger. He even embraces his cross as if it was a long lost friend of his. He was called a "fool" by a robber who was with him. But just like pain, "fool" is also a relative term.

It was a good movie. If I were Gibson, I would have added more punishment and more gore. After all, it is what really happened. I think the world of today has gone numb and its pain threshold has become too high, that it would take so much for it to even notice. The way Gibson's cash register is sounding, however, I might be proven wrong. I hope many who watched wouldn't just let this film pass as another good movie easily toppled when Troy and SpiderMan films get to be shown soon. I hope the Passion leaves a deep scar in the minds of the audience. For me, the film can be an inspiration because it can make your your trials and problems in life seem trivial. It can make you stop complaining and whining about how difficult and complicated your life is today.

One of the most haunting scenes is this last scene in which Mary stares blankly at the audience while holding the broken and nonliving body of Jesus. It is more than a Pieta doppelganger; it is Mary asking you and me, "Look what you've done. What do you intend to do with your life now?"

Two thumbs way, way up for this film. Watch it. Share Jesus' pain and be disturbed. Be scarred. Be scarred and don't ever recover.