Monthly Archives: February, 2010

Canadian Celebrations Create Controversy

The Canadian women’s ice hockey team won the gold medal at the Vancouver Winter Olympics when they beat the US 2-0 yesterday. Well done! But few expected the whole team to re-enter the rink some 30 minutes later for a victory party that featured champagne, beer…and cigars!

The victory celebrations prompted the IOC president to launch an enquiry  soon after, but officials do not expect any official censure. After all, these were a group of youngsters toiling hard for 4 years to reach the pinnacle of success and they had to let off steam.

But many felt that the party was going overboard. OK, even the Formula One drivers indulge in champagne on the victors’ podium. But cigars? Its an undisputed fact that these are the harbingers of many lethal diseases! What kind of message are these athletes sending out to the youngsters? Some observers felt that it was ok to party once they have changed out of their team jerseys and doing it away from the glare of the media. But youthful enthusiasm knows no barriers. However, the team did issue an apology much later.

After all, who could blame them for their attention-seeking behaviour when the IOC President had earlier threatened  that if womens’ hockey did not improve and become more attractive, it would be axed at the next Games?

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And Now..Cholesterol Pills for those with Normal Cholesterol!

In a decision which raised the eyebrow of many doctors as well as patients, a popular cholesterol pill Crestor (rosuvastatin) has now been approved by the US FDA for use in healthy people with normal cholesterol…well, not just anybody, but for those with all of the following 3 features: increasing age + high CRP + one traditional risk factor (either smoking, high blood pressure, positive family history, low HDL-cholesterol).

At US$2 a pill, its wider usage can mean big bucks for big pharmas

In a recent bulletin, the FDA took pains to say that this was based on a clinical study (the Jupiter Trial) which showed that those who took Crestor for two years experienced less heart attacks, strokes and needed fewer heart operations.

Even so, a few cardiologists, including yours truly, have some trepidation in unreservedly recommending Crestor for such people with normal cholesterol. In the first place, no amount of medication is going to substitute for adopting a healthy lifestyle (in other words, regular exercise,proper dieting, weight reduction and getting rid of the fags). Both need to go hand in hand in order to achieve any benefit.

Erectile dysfuction -a real problem with drugs like Crestor

The other downside in taking these pills is the risk of side-effects, most notably generalised muscle and joint pains and..listen up, you men..poor erection! Yes, many patients feel shy to bring this up with their doctor but it seems to be more common than reported. The good thing about this problem is that its “business as usual” once the pills are withdrawn. Recently, news reports have even implied that statins (like Crestor) can lead to diabetes.

There are many who suspect that promoting this use of  Crestor is big pharma’s way of enhancing sales in these troubled times..not to mention giving private insurance companies a valid reason for raising your premiums because you’re on medications.

The issue sure is getting more complicated nowadays; with a diabetes drug supposed to cause heart attacks (Avandia) and conversely, a heart attack drug that may cause  diabetes (Crestor) !! If its any indication, 4 of the 12 members in the FDA Drug Committee objected to this new indication for its use..

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Hypersexuality – Tiger Wood’s diagnosis?

With changing times come changing social patterns and different behavior traits. So much so, psychiatrists worldwide are to give official labels to dozens of new  mental disorders. Many such mood disorders and personality traits  are likely to be added to the next edition of Diagnostic and Statistical Manual of Mental Disorders, a book which is considered  the  psychiatrists’ bible for more than 50 years.

According to The Times, when it is finally published in 2013, it will contain some of the following diagnoses which are present in the draft copy:

Hypersexuality-the name of the game

Hypersexuality– the desire for multiple partners, as characterised by Tiger Woods.

Absexuality- also called the “Mary Whitehouse Syndrome” after the campaigner who declared war on pornography on TV; to denote the thrill of being appalled by smut and other obscenities.

Relational Disorder – a condition when 2 people – usually a separating couple – struggle to get on together.

Constantly whinging?

Negativistic Personality Disorder – people who whinge constantly.

Intermittent Explosive Disorder – also known as adult tantrums and best exemplified by road-rage and domestic abuse.

Road Rage -today's phenomenon

Many will not begrudge psychiatrists from giving new labels to ‘new’ mental disorders, but critics believe that with more new labels, there will be many more new business for those in private practice, as well as the possibility of exploitation for profit by drug companies..

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The Greenest Olympics Ever..Well, Almost!

The 2010 Winter Olympics, now being held in Vancouver, Canada promises to be the most eco-friendly Olympics ever held. Take a look at some of the measures undertaken during its preparation:

  • free public transport to all its venues, in an effort to reduce the carbon footprint.
  • all new buildings, including the athlete’s village has been built to meet top green standards for energy and water.
  • the Media Center has a living roof of 400,000 native plants that capture and reuse rainwater. It also has seawater heating and cooling and an on-site water treatment plant.
  • The athletes’ village will be turned into a mixed-used sustainable community of stores, housing, daycare and community center after the games. You can see a slide show of the village’s green features here.

Green: 2010 Winter Olympic medals are made from recycled electronic parts

The Vancouver Olympic Oval -its roof is from wood salvaged after pine-beetle infestation

However, despite the organiser’s noble intentions, they did not contend with Mother Nature itself. The unusually warm and rainy weather at one of its venues, Cypress Hills (for skateboarding and freestyle skiing) has resulted in insufficient snow, causing the organisers to bring truckloads of imported snow from British Columbia as well as using helicopters to dump snow at the affected site.

Truckloads of Snow Imported into Vancouver from British Columbia

Cypress Hills, a main venue, literally green as a result of scant snow.

Despite its eco-efforts, some environmentalists  wonder whether this will be the greenest Olympics ever,  given the carbon-emitting truck-and plane-loads of snow that had to be carried in to skiing and snowboarding venues. Don’t blame Vancouver – the Winter Olympics isn’t exactly that without enough snow,after all!


Its tragic when young athletes who participate for their passion in sport end up losing their lives. As a doctor, the tragedy takes on an added dimension as, accident or not, a life has been lost, despite valiant prompt action by the medical staff. On 12th February, Georgian Olympian Nodar Kumarittashivi died during luge practice after suffering from head injury. Our condolences to his family. ABC News has a video of the incident here.

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At $282 Million an Hour, It Ain’t Cheap!

The US spent $2.472 trillion on healthcare in 2009..that works out to $282 million an hour, give or take some loose change.

According to this article in the Journal of Health Affairs, this means that the healthcare portion of the GDP rose to an all-time high 17.3%, more than double of that of most other countries.

No wonder President Obama is placing healthcare reforms as a top priority – at the rate its going, healthcare expenditure will soon burst at its seams. Even more alarming is the fact that, for the first time in the next few years, public spending for healthcare services (Medicare, Mediaid, Veteran hospitals, children insurance program) will outstrip the largely private-sector driven healthcare expenditure. Put in another way, by 2012, public (government) spending will account for more than half of the total healthcare spending in the US.

In the US by 2012, the dark blue and yellow portions of the pie will shrink to less than half

Why is this so?

The main reason appears to be that healthcare spending continued to rise despite the recession that resulted in reduced spending in other areas of the economy.. After all, people do continue to get sick, in good times or bad.

This healthcare spending continued to rise partly due to the aging population; but the real reason is due to increasing prices (3.2% a year) and increasing use  –utilisation  in tech-jargon – at 1.5% annually.

Quite naturally, President Obama is looking at cutting expenditure like reducing Medicare costs, but this has not gone down well with the Democrats, creating delays in approval at Congress. Already, the President has backed down quite a bit from his original proposals and the way ahead appears to be for the Democrats and the Republicans to work together for a common solution – which is easier said than done.

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A Tale of Three Doctors

Woke up one day this week to read about how the medical profession was  put in a rather unfavorable light, in various parts of the globe.

In Los Angeles,USA, it was reported that the late Michael Jackson’s doctor, Dr Conrad Murray, who practises in Houston was going to be charged in a few days time  for involuntary manslaughter. It was alleged that the doctor had administered the powerful anaesthetic drug, propafol, plus two other sedatives in a concerted attempt to make the pop star go to sleep. Propafol needs to be administered intravenously by an anaesthesiologist in a hospital setting and requires continuous monitoring as the drug can cause suppression of breathing, lowering of heart-rate and blood pressure. See my earlier posting “MJ’s Death Explained for details.

Dr Daniel Ubani - still practising in Germany

In Cambridge,UK, a foreign-trained doctor, on his first work assignment for the NHS after arriving in the UK the day before, administered an injection of diamorphine (an opioid used for pain relief) of twenty times the recommended dose to an elderly patient at his home for relief of kidney pain. Not surprisingly, the patient stopped breathing soon after the doctor had left. At the coroner’s enquiry, it was discovered that the doctor, originally from Germany, had failed his English test earlier and had never given the drug before. It was also not possible to extradite the doctor from Germany to face charges, where latest reports say he is still practising.

Dr Suresh Nair -1991 Sydney Uni graduation pic

Meanwhile, in Sydney,Australia, a neurosurgeon has been charged over the cocaine-related deaths, in November 2009, of two young women who had visited his apartment. Post-mortem results showed both women had died of cocaine toxicity. Having been suspended by the New South Wales Medical Board, he now remains in custody pending trial. Some unanswered questions remain, like having been a known cocaine abuser since 2004, why was he still allowed to practise by the Medical Board?

Having read these stories, I just wonder whether this is a trend of things to come, or whether the virtues of a noble profession are being eroded in the face of changing times? Perhaps, most tellingly, when I asked a student who had aspirations of being a doctor, why he had chosen the profession, his answer was, So that I can make a lot of money!”

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So What Errors Can Hospitals Make?

An article in the Los Angeles Times attracted my attention recently. Datelined January 28 2010, it reported that the California State Department of Health had fined 13 hospitals for committing medical errors  that in some cases seriously injured and even killed patients.

Some of the errors included:

-the death of a patient  who was supposed to be restrained and supervised, but was instead left to repeatedly pull out his tracheotomy tube until he was found unresponsive in his bed.

ICU Monitors are Indispensable..but require monitoring too!

-intensive care nurses failing to monitor a woman’s oxygen levels; the patient passed out and had to be placed on a ventilator.

-the death of a patient treated in the emergency room for a heart attack where nurses failed to notice that the man’s heart monitor had disconnected and the volume on the patient’s heart monitor alarm was not loud enough to alert staff.

-staff leaving a surgical sponge in a patient. She got so sick she had to undergo a second operation.(Yes,people, it also happens in the US!)

But perhaps the most bizarre medical error reported was the case of a patient on a metal stretcher being sucked in by an MRI machine’s magnetic force, resulting in the patient  fracturing her leg and foot. Just so to remind ourselves that such MRI-related injuries are not uncommon, a similar incident was shown in Episode 15 of ER which was screened a year earlier in 2008!

Clip from ER,episode 15: note the patient sandwiched between the metal stretcher and the MRI machine

MRI scans have gained in popularity in the last decade with its crystal-clear images and with no radiation involved. It uses magnetic waves instead, but the strength of these waves can be as much as 50,000 times the earth’s gravity. So much so, any metal objects within distance can be pulled with such force to the machine’s magnets to be able to cause serious injuries. Incidents such as scissors flying and oxygen canisters hitting with such force to cause fatal injury have been reported. Not to mention the data on credit-cards being wiped out  to render them useless! In fact, those with heart pacemakers and certain artificial heart-valves are usually not permitted to undergo MRI scans.

Yet, despite risk reduction strategies and safety protocols, such untoward incidents do continue to happen. One of the main reasons for this is that many – including healthcare workers -are unaware that the magnets in the MRI scanner are always “on” even though there are no patients inside.

Read here to find out more on the Joint Commission’s recommendations for MRI safety procedures for healthcare workers.

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