Psychiatrist Meme - What others think I do

Prologue (to my medical murder mystery)

             Marcus Donovan squeezed his eyes shut so tight that his vision blurred when he opened them again.  His eyes slowly came back into focus, and he stared at the man in the mirror.  When had the bags formed under his eyes? He couldn’t remember. For that matter, he couldn’t remember when the stomach ulcers had developed, or the spare tire around his mid-section, or the gray hairs at his temples.  His eyes were bloodshot, and the alcohol wasn’t helping. 

            He couldn’t go back.  He often pondered now what life might have been like with Rachel.  He imagined what their kids would have looked like.  He tried to imagine himself driving a mini-van with 3 kids in the back.  It was hard to imagine, his life was too different.

            He hadn’t had many regrets in life; he was always working too hard and running too fast to bother with the past.  He knew how long patents lasted, and that thought was paramount.  Once you got one product on the market, you had to start working on the next, or you would fall behind.  Someone else would copy your idea, and then sell it for cheaper than you ever could, to cover costs.  That’s why he had to be smarter than the rest, always a step ahead, and he always had to do everything exactly by the book.  Litigation was rampant in his business, and that was the only way to survive.

            This time was different.  He had made a mistake.  He had been sure everything was going to work.  He had done the research himself, he had developed it himself, and set up the experiments.  Then he had started making promises, a little too early.  His company had already signed government contracts, and already started receiving payment.  The ball was rolling, but the ball was defective.  He had made sure all quality controls were double blind studies so that no one could claim bias or data manipulation.  No one who did the tests could see the results, and vice-versa; no one except him.  He was the gatekeeper, the supposed “control” among all the variables.  He was the only one who could ensure everything was accurate, and therefore he was only one who could manipulate things without getting caught.

            His conscience had finally caught up with him.  Was he going to get fired?  There was really no question there.  Was he going to jail? Probably.  Once he went public the company was through.  They had spent over 5 years on development; the amount invested was now reaching billions.  Yet tomorrow it would all be for naught. 

            Marcus walked into the kitchen and went through his evening ritual.  He pulled out his half empty bottle of Chateau Margaux 1995.  He poured a glass and sniffed once before drinking.  He loved the smell of blackberry and the deep ruby color of his $800 wine.  After finishing the glass he sat in his overstuffed recliner and turned on ESPN.  After a few sips of his wine he began drinking larger and larger glasses till he eventually put his lips to the bottle and downed the rest.  He was sick of the mundane sports highlights and he was finally feeling the alcohol settle on his brain.  He wished the bottle had been full so he were a little more drunk before doing this, but no amount of alcohol could stop the crushing avalanche he was about to unleash.  He pulled his laptop out of the drawer and prepared to send his e-mail to his CEO, shareholders, and six different newspapers.  He felt a tingle on his lips and didn’t think much of it.

            As the computer booted up, he noticed his tongue was starting to go numb.  He put his laptop on the coffee table and went to look in the mirror.  As he walked he felt lightheaded.  His limbs began to give out on him, and he fell to the floor.  He pushed on his temples, trying to relieve the developing headache.  As he thought his head was clearing he suddenly felt his stomach burning.  He felt like he was going to vomit.  He now regretted all the coffee and alcohol.  His stomach ulcer was acting up, and the alcohol was finally getting to him.  He felt nauseated once again, and decided he better get himself to the bathroom before the vomited all over his plush carpet.

            He tried to get up, but his legs were no longer numb, they were paralyzed.  He started becoming nervous, and decided he’d better call out for help.  He tried, but his lips wouldn’t form the words.  He couldn’t even manage enough breath to scream.  This was no stomach ulcer, he realized.  What was going on?  He felt himself shake and convulse a few times, then he was still.  He was still conscious, but could do nothing.  He couldn’t flex a muscle in his body, even his eyes had trouble moving in their sockets.  His mind was reeling.  Had he eaten something he shouldn’t have?  Had he ingested something on accident?  He knew chemistry, he knew poisons, and he started to think through his symptoms, trying to figure out if he was going to recover, or if this was the end. 

            Was it botulism toxin?  No – then I would be limp, not rigid and paralyzed. 

            Tetanus?  He hadn’t felt the back spasms, and he didn’t remember tetanus causing numbness or tingling.  His mind was starting to fade.  He tried with all his might to move any part of his body, but nothing worked.  He felt like he was being buried alive, but in his own body, not a tomb. 

            Then it hit him, tetrodotoxin, the poison found in pufferfish.  He knew the signs and symptoms because he had to review them once a year.  It was work policy; you had to know what was in every lab, and the dangers of each substance.   Tetrodotoxin was used in the lab next door to his. It takes its effect in less than half an hour, but he had been home longer than that.  So he hadn’t been exposed at work.  He hadn’t eaten any pufferfish tonight; he hadn’t even been near seafood.  Where had he… then he saw the empty bottle of wine. 

            Rage began swelling inside him.  They already knew.  They knew that all the results were wrong, that their product didn’t work, and that he was going to tell all. Now he was going to die  for it.  In less than a minute his diaphragm and all breathing muscles would be paralyzed, then his heart.  All he could do, was think. 

            They’ll make millions!  Everyone will want it, and no one will know that it doesn’t work.  His e-mail had not been sent, the evidence was still hidden away.  The world would have no idea they were vulnerable.  No one would know…until it was too late.

Reducing Salt Intake Could Kill You Faster

Everyone knows you should eat less salt...right?  Salt makes you retain water, it increases your blood pressure, it makes you more likely to have a heart attack or stroke...right?

The Mayo Clinic says the average American eats 3.4 grams per day, and should eat <2.3 grams (and <1.5 grams if you have high blood pressure)

Livestrong reiterates this same information, as does the CDC.  The CDC goes on to states that lowering sodium could save thousands of lives annually because there are 400,000 deaths per year attributed to high blood pressure.

They can't all be wrong...right?

The problem is - they are all assuming they understand cause and effect.  They assume that lower sodium decreases blood pressure, and that lowering blood pressure in that way decreases deaths.

Sadly the ACTUAL RESEARCH does not verify their claims or assumptions.

The latest research, published in July 2011 shows something quite interesting.  It shows that as expected, decreasing salt intake can help the healthy American decrease their risk (a little) of dying by a cardiovascular accident.

That's not the interesting part.  Guess what the data show when you look at patients who have high blood pressure or already have heart failure?

If you already have high blood pressure - decreasing salt intake will have no effect whatsoever on your chances of dying by stroke or heart attack.

If you already have heart failure - lowering salt intake will kill you faster.

SO......if this article and research are accurate that means the CDC, Mayo Clinic, Livestrong, and all cardiologists and family docs should be telling you:

Everyone out there reading this who is healthy - decrease your salt.  (yeah, because that's gonna happen)

Everyone who has high blood pressure - don't change your salt intake at all.

Everyone who has heart failure - Don't you dare decrease your salt intake or you're even MORE likely to die of a heart attack or stroke!

I am getting to enjoy reviewing medical research literature more and more.  Each time I go to research conferences I learn more and more about how the conventional wisdom and even medical advice is completely wrong.
If anyone is curious - the source for this information is pretty much the best source there is.  It's almost universally agreed that the Cochrane Database is THE database for information.

A Mormon President?

This week I read two interesting viewpoints on "Mormons"

The NY Times article

Obviously I have an inherent bias - but I honestly found this article to be very short sighted and immature.  When Mr. Williams said "Mormons see the world, but they don't get it" I wished he could have a mirror.  I believe he is just as deceived and blinded as any Mormon ever was.

Searching the blogosphere I found this response.  It isn't nearly as concise, but at least it seems to take more than a shallow glance at the subject.

Medications Likely Do You No Good

You might freak out when you realize how likely it is that your medication will do you no good.
There’s a very important term in medicine that is often ignored, it is “Number Needed to Treat.”
It means, how many people have to take the medication for one of them to avoid the bad outcome.

For example – why do people take Lipitor?
 - So they don’t have a heart attack or stroke and then die or become seriously impaired.
What does Lipitor do?
 - It lowers cholesterol
Why lower Cholesterol?
 - To avoid clogging arteries.
Why avoid clogged arteries?
 - To prevent a heart attack or stroke
Why prevent a heart attack or stroke?
 - to prevent death or serious impairment.
How many people have to take Lipitor to prevent one of them from dying or becoming seriously impaired?
 - 500. 

Okay – forget death or impairment, let’s just talk about a heart attack
How many people have to take Lipitor to prevent one of them from having a heart attack?
- 100.  Yeah.  One hundred people have to take Lipitor for 3 years in order to prevent one heart attack.

And Lipitor isn’t the worst drug, not by far.

Zetia is also taken to lower cholesterol – but it’s NNT is so high it isn’t shown to prevent any heart attacks at all.  Over 1000 people have to take it just to avoid heart disease.
How about aspirin?  Its NNT is 350.

Well what about exercise?  What is exercise’s NNT for preventing a heart attack? 
 - 3.  For every three people who exercise regularly, one of them will be saved from having a heart attack.

All of these number are speaking about healthy people, but it’s still poor even for those who already have disease.
Take people who already have heart disease or have had a heart attack.  How many of them have to take Lipitor to prevent one heart attack?  20.

You’ve had a heart attack, is it worth the 1 in 20 chance to pay for and take a pill every single day?
You just have high blood pressure, is it worth the 1 in 250 chance then?  Is it worth $500-$1000 per year to take a pill that has a 1/250 chance of helping you?
Okay  - forget the money.  What about the side effects?  Lipitor can cause diarrhea, muscle pain, nausea, headache, etc…  Is it worth it to take a pill knowing that the only effect it will most likely have is negative?
Remember, Lipitor is one of the BEST drugs that way.  It's side effects are fairly mild and what it prevents is fatal.  Even so, with such a small chance of benefit, is it worth it?

My point is this.  Medications cost money and they have side effects.  They work, but not nearly as well as most people think.  They bring peace of mind, they correct lab values, and for a small number of people, they prevent a bad outcome.
I am not callous or disinterested.  I prescribe medications every day with this knowledge.  I know my own family history and I’m going to be watching my cholesterol levels like a hawk the rest of my life.  Nevertheless, it is disheartening to know that for the HUGE majority of people taking medication, it will have no positive effect in their life whatsoever.

Climate Change Science is Crap

Does it seem to anyone else like climate change scientist are just sitting in a room using a magic 8 ball to predict the earths future? (assuming you don't think they are politically motivated)

Their science is about that accurate.  Here's the latest example:

They estimated ice melt in the Himalayas 2 years ago. They just got the actual results published yesterday.
They overestimated the ice loss by 1250%
Not 12%, not 100%, 1250%.

My point isn't that we shouldn't work to reduce pollution, my point is that climate change science is crap. 

Nature Research Article

(I didn't link to the Fox News article because I figured it's better to read the original research rather than someone else's interpretation)

Book Review: The Myth of Multitasking

This is a very simple and straight forward book.  It takes about one hour to read it, and it has the potential to vastly improve ones effectiveness, time management, and personal relationships.  It confirmed to me what I've thought for a long time.  There is no such thing as multitasking.  You can only actively pay attention to one thing at a time. 

For example: You can drive and also have a conversation with a passenger, but the driving doesn't take any active thought most of the time, it's a background task.  Then when you try to merge into rush hour traffic or the car in front of you hits the brakes, suddenly driving becomes the active task and you stop hearing the passenger.  A moment later you have ask your passenger "I'm sorry, what was that?"

You can either background task something which takes very little thought, or you can "switchtask" very quickly between two things that demand attention.  Unfortunately, the more you switch , you more you have to play catch up because it takes a moment to pick up where you left off.

The example the book gives is simple.  On one line write the sentence: "Multitasking is worse than a lie"  Then below it write out the numbers from 1-27. 

Okay, now do it again, but switch back and forth writing one letter on the top line, then one number on the bottom line till you've written all 27 numbers and letters, switching back and forth between each one.  You'll be surprised how much longer it takes to do it switching between the two rather than completing one then the other.  You'll also likely make a few mistakes when doing the two back and forth rather than one after the other.

Anyway - you get the point.  And if you think I'm lying and that you work better getting text messages and e-mails all the time in the middle of your conversations then think about how many times you've read a message then had to ask the person in front of you to repeat themselves.  It's like the book says:

“Multitasking: A polite way of telling someone you haven’t heard a word they’ve said.” 

Here's a few more of my favorite quotes:

“The people we live with and work with on a daily basis deserve our full attention.  When we give people segmented attention, piecemeal time, switching back and forth, the switching cost is higher than just the time involved.  We end up damaging relationships.”

”Never commit to something without your calendar in hand.”

“Helping people understand the simple truth will help them change their behavior faster than simply trying to get them to change their behavior.”