Feeds:
Posts
Comments

Posts Tagged ‘medical ethics’

A new “Null Hypothesis” in medical research !

Posted in bio ethics, medical quotes, Two line sermons in cardiology, tagged , , , , , on December 21, 2014| 1 Comment »

Picture4

After nearly three decades of , treating patients , teaching students and little involvement in research , created a new definition for null hypothesis in medical research  !

Picture7

Read Full Post »

Why big doctors adore “science” more than their patients ?

Posted in bio ethics, Cardiology -Emerging technology, Cardiology -guidelines, Cardiology -Interventional -PCI, Cardiology -Patient page, Cardiology -Therapeutic dilemma, Cardiology -unresolved questions, medical quotes, tagged , , , on August 31, 2014| Leave a Comment »

As the medical care advances  human care  has taken the back seat. It is said super specialists  read more and more about less and less ! In the  process they  fail to see the  patients  as a single biological unit  instead as collection of organs .

While  organs in turn are looked as  pile of data.Hence the  treatment they provide lack the soul !

In the prevailing circumstances , how do we ensure  modern medicine  does not interfere with  these vulnerable souls,either to live in peace or leave in peace ?

Medical Ethics

Image : Source and Courtesy of http://illuminationstudios.com

It appears doctors are not at fault . The system is  biased towards raw science .Highly trained  doctors are tied down by  both  true and pseudo  scientific Intellect .Often  times they are compelled to do some procedure or interventions  just to  justify  the  premier status of the hospital  .While few do it  to show off  their expertise or  to impress  their peers   others are simply bound by rigid and obsessive  protocols and guidelines . Few others do it  for the burning  desire  of  scientific accomplishment .

One can offer hundred reasons for doing a procedure . . . but we always struggle to justify  with a valid reason for not doing a investigation or  procedure !

In fact , the  concept of appropriateness  criteria came out with good intention .But , it had failed miserably.

The irony is  . . . we need to indulge in something to avoid something.

Example 1 If homocystiene and  hsCRP vanish from the CAD screening industry   Adiponectin and Vitamin D3 comes in with a thunderous applause like a new Hollywood movie  !

Example 2: In cath lab  for leaving alone an insignificant  coronary stenosis , we have to do  another procedure  called FFR to satisfy  scientific ego ! (I know one senior doctor , who left a 80% LAD  lesion for medical management without FFR ( with all his clinical acumen )  was ridiculed for being unscientific !)

Here is a recent perspective article NEJM has discussed  this  important issue that plague us

Why should big  Tertiary  teaching hospital  are  flooded  with super specialists  which by default shun basic human care ?

Read this article*

Super specialist tertiary care hospital NEJM

*The article I have quoted  may  not  be completely relevant here  . . . It  answers  few of the queries raised!

Read Full Post »

Why some “Medical Truths” need to be so brutal ?

Posted in bio ethics, medical quotes, Two line sermons in cardiology, Venkat quotes, tagged , , , on July 10, 2014| 3 Comments »

I frequently  refer to one of the most famous  medical quotes made in last century by a Harvard professor Dr Herbert Lay  in 1969.

 

medical quote herbert lay fda modern medicine Five  decades have gone since this observation was made by Dr Ley .Mind you ,Dr Ley is not a lay person , he was heading the same FDA  which  he targeted ! I guess when Dr Ley made this  statement  there was  little commercialization in  pharma Industry . Now along with it  an entirely  new field of medical device industry has grown to gargantuan proportions !

I  wonder what Dr Herbert Ley would have to say as on 2014 !

Many modern  medical  professionals would   shrug these views  as controversial , pessimistic and negative forces of science !

Here I borrow my own quote from venkat@thoughts

medical quotes venkatesan ethics

 

Read Full Post »

Best solution to all your complex medical problems !

Posted in bio ethics, Cardiology -Mechnisms of disease, Cardiology -Therapeutic dilemma, cardiology -Therapeutics, Cardiology -unresolved questions, medical quotes, tagged , , , , , , , , , , , , , , , , , , on June 8, 2014| Leave a Comment »

critical decision making cardiology cath lab tricks coronary angiogram primary angioplasty ptca vs cabg acc aha guidelines esc guidelines

Answer

While our brain perceives  whatever option  we  choose is the best for the patient  , in reality it is rarely true !

The only comment I wish to make,  there is nothing called standard guidelines for complex and unusual problems .We need not be obsessed with protocols  !

Please remember , If you apply standard guidelines  in  non-standard situations  9/10 times we  are going to err !

So my  choice  would be, to  go with your gut feeling , of course  your gut should  be alive ,  up to date and periodically maintained !

If you don’t have the guts  . . . don’t worry  you have plenty of other options !

 

Read Full Post »

Why Nobel prize in medicine is not given for clinical science ?

Posted in bio ethics, Cardiology - Clinical, Clinical cardiology, medical quotes, Two line sermons in cardiology, tagged , , , , , on May 23, 2014| Leave a Comment »

nobel prize in medicine 2

Why not Nobel prize for clinical  science ?

 

nobel prize for medicine

Nobel prize was constituted  to reward people or organisation  who make a  huge impact on the welfare of man kind. It is given in various categories  for  outstanding contributions in Physics, Chemistry, Literature, Peace, Physiology or Medicine, and Economic Sciences

Unfortunately,  there is a strong bias towards  raw basic science when it is given in the filed of medicine.Do you know  ,there is no Nobel prize exclusive  for medical science ? It shares with human physiology the only field included for Nobel prize in medicine.

Evolution of human  history reveals it is not the stunning  scientific discoveries that impact the mankind . It is  largely dependent  on how we  use them . It is true and natural ,invention of  sub atomic particles , decoding  quantum mechanics  and  trans-cellular  signals always generate great interest  than others.

In medical science, time and again we have seen problems arise in  applying fruits of scientific  research into  practical  usage in the patient domain  in the bedside.

What is use of rewarding inventor of  nitric oxide with a  Nobel prize , when billion-dollar nitrate  industry is thriving on a non existing  life long indication of  stable angina .

It is  surprising  to note ,  Nobel  committee does  give credit to wisdom &  intellect  while awarding  prize in  peace,  literary  or  economic sciences. For some reason it lacks  such a vision when it comes to medical sciences !

We have seen Nobel prize being  awarded to organization that strive for peace and welfare of society and community like UN ,EU  etc.The world health organization is the premier power supposed to provide and  regulate the health in this planet.I do not recall any time WHO  was close to  considered for the  Noble prize in medicine  !

Nobel Ironies

Nobel committee rewards  economists who point out lacunae in vital world macro and micro economics  theories.

Dubious men(Heads of state )  are decorated with Noble peace prizes  for preventing a war in  one geographical area while doing exactly the  opposite elsewhere !

In this modern  millennium  where scientific pursuits are contaminated and  many of the  research questions are misdirected or irrelevant , Nobel committee needs a through rejig in the manner in which  medical  Nobel prize is  being awarded. We know ,Noble’s death wish was to award the brightest mind with highest scientific  breakthroughs in those world . . . but

I guess Alfred Nobel if alive would have changed his rules .He wouldn’t  have imagined modern science would systematically devalue common sense and reinventing it would also deserve an award equivalent to Nobel !

Some of the medical  discoveries that deserve noble medical prize

  • States which excel in   school health nutrition and  other basic health programs  for the downtrodden
  • Doctors who promote bed side clinical skills
  • Tobacco eradication networks
  • Organisations like medicine san-frontiers which strives for basic life saving medication for all
  • Journal houses that specialise  on Medical ethics and clinical sciences
  • Medical professionals and institutions provide value education
  • Medical economists who expose the wasted financial resources that  widen the gap between sick and rich

How about    Nobel prize in cardiology  for preventive cardiologist  who successfully terminates a million statin prescription and restoring natural exercise directed lipid regulation in them  ?

How about  Noble prize for a noble  physician sitting in corporate hospital infested with all commercial ingredients who could resist and argue successfully  against   inappropriate tonsillectomies  and appendectomies ?

I am sure , such a man will be a  laughing stock  for most of us !

An appeal to Nobel committee

It is a wish , Noble prize  in medicine is to be included for people who do yeomen services in preventive and  clinical care and professional who carry forward the legacy of  caring for the sick with  clinical application of available scientific wisdom !

In this scientifically obsessed world , It will be a new beginning in the  way future medical research will be directed and nurtured ! Only then the true power of Noble prize in medicine will be  realised !

Reference

Link to Wikipedia Nobel prize in Medicine

 

Read Full Post »

When medical morality . . . becomes a casuality !

Posted in bio ethics, cardiology -Preventive, medical quotes, Two line sermons in cardiology, tagged , , , , , , , , , , , , , , , , on April 14, 2014| Leave a Comment »

medical morality

Tree of life : When professional morality suffers a mortality . . . human health becomes a causality !

Greatest threat to the future of  human health is  . . .

  • Not from  exotic  infectious agents , bird flu  or  mosquito  fevers
  • Not from  epidemic of cardio vascular disease
  • Not from  thousands of  published  diseases in ICD code
  • Not from  aging population and failing  vital  organs
  • Not from  lack of availability of life saving  drugs and devices
  • Not from  lack of  hospital beds.
  • Not from  good sanitation
  • Not from  hunger and poverty
  • Not from  lack of para medical workers
  • Not from  lack of health awareness and education

But from  . . .

  • The way  health care is administered in this planet .
  • The way  noble professionals are created .
  • The way  trivial health  issues prevail over  major  health crises  that  wallop the health budgets.
  • The way by which  medical morality is systematically destroyed
  • The way   “concept of  health” is  sold  as a  buyable  commodity by insurance companies.
  • The way  medical journals churns out  junk articles in the name of research.
  • The way corporates indulge in  delirious pursuit  to  increase  bed occupancy rate of their  patient  ware houses (Also called Hospitals)
  • The  way greedy drug companies aim to increase the per capita drug consumption of  ill informed  homo-sapiens  by discovering  pseudo  drugs for pseudo  illness
  • The way   health insurance policies are misused
  • The way  rich spend billions for reconstructive  cosmetic  surgery while the poor die for want of basic medicines !

 

Link to a wonderful  article  on moral education for our kids in medical school !

Read Full Post »

How to debate a medical argument ?

Posted in bio ethics, medical quotes, tagged , , , , , , , , , , , on July 31, 2013| Leave a Comment »

Medical facts  exist in a  dynamic  fluid state . Finding the truth is often a herculean  task .Disagreeing is  easy . ( Proving  a point  may require   a hundred  experiments   . . .  but  for disproving  needs only one !)

Still , the essence of medical knowledge  is about distillation of medical facts and myths and extracting the truth.

Do  you  know  the levels of  scientific  argument ?

There are seven levels  of  arguing .

Argument , agreement and disagreement are central to the growth  of science  especially so in medical science. It can vary between polite  refusal  to blunt antagonism . Graham’s levels  of disagreement  throws light  on this aspect of human intellect .

grahams grading og disagrrement argument–

By default , most human brains live in the bottom of this triangle. Where  does the  medical professionals stand  in academic forums ?  I am afraid  they show  little  difference  from  that of  lay public . Ad Hominem is extremely common in medical journalism . I have  personally experienced  this from elite peers ! A paper sent from   a  third world country like India  is straightaway  rejected or regretted  without even  looking at  core content .

By  the way   . . . where do you like to  stand on Graham’s scale ?

Read Full Post »

A chill in Cardiologist’s spine : Unnecessary intervention becomes a definite crime !

Posted in Cardiology -guidelines, Cardiology -Interventional -PCI, cardiology-ethics, Uncategorized, tagged , , , , , on February 28, 2013| Leave a Comment »

The irony of modern medical care is  9/10 times  medical negligence is  defined in terms of  acts of omission  in  required  level of care . In reality  most medical negligence acts are related to knowingly overdoing a futile diagnostic or therapeutic modality.

This irony was never understood by the public, the professionals or  even the judiciary .This remains  the most dangerous issue  facing modern medicine !

Finally some light is appearing in the horizon . A Missouri  Cardiologist is suspended for overdoing things he knows best  . . . namely coronary stenting ! 

This may bring chills over many cardiologist’s spine .

cardiologist stents inappropriate use interventional

http://www.stltoday.com/news/local/metro/missouri-healing-arts-board-issues-first-emergency-suspension-of-doctor/article_205eaffd-1825-5d7d-a9de-a289c010fd65.html

Read Full Post »

The most important medical research article published for over 100 years !

Posted in bio ethics, cardiology journal club, tagged , , , , , , on December 31, 2012| 1 Comment »

If you are a doctor  and  whatever  be your specialty   . . .  if you do  not read this article  and understand the nuances  probably you  will not become a   complete medical professional !

Master health check up futility general health check

master health check up geenral health checks bmj british medical journal cohcrane nordic

 

While  BMJ  struggles to  propagate  a vital truth , this  banner on a  Indian  high way   tempted the public  to go for 64 slice CT scan   . . .just like that !

Master health check up 2

Final message

Accruing medical knowledge and skills is only one aspect of medical profession. Applying it properly in our patient population is entirely  different ball game . Let us be disease curers and not disease hunters . This is important because disease  hunting is  a dangerous  game ,  where victims can be innocent  bystanders. This  is exactly same thing  Hippocrates  refered to as  Primum non nocere  1000 years ago.  It  has required  a huge statistical study to RE-INVENT  this universal fact !

Read Full Post »

A truth about half truths . . .

Posted in dr s venkatesan -Personal, Venkat quotes, tagged , , , , on October 31, 2012| Leave a Comment »

A truth about half truths!

Arthur  Garson  explores further  .  Click on the Image to get a sample page from Amazon

Read Full Post »

« Newer Posts - Older Posts »