Faculty Bibliography

My wife was on the verge of delivering. With the nurses trying to stop me, I quickly wheeled her past the desk to a delivery room. My wife positioned herself on the table while I rushed to find an obstetrician -- any obstetrician. Fortunately, a nurse was helping my wife into a gown and getting her ready. Just then an older obstetrician whom I'd never seen before ran into the room, donned gloves and gown and, less than five minutes later, delivered a healthy child. For the first time -- this was our third child -- I wasn't asked to cut the newborn's umbilical cord. Our own obstetrician came 10 minutes later and delivered the afterbirth. I wondered if our difficulties were some kind of divine punishment for my own professional insensitivities. As a physician in a busy practice, had I really listened to my patients who complained that they weren't treated in a timely manner? That there were too many forms to fill out? That I had scared them unnecessarily about a possible illness? Patients had good reason to be frightened, and I was getting a glimpse of this now. But regular patients and their families can have it much worse than I did. Even though the chief resident had treated me disdainfully, she had been influenced enough by my rank to participate in our son's birth. And perhaps it had been professional courtesy that motivated this unknown doctor to rush in to save the day, before our regular obstetrician arrived

[Bobby Short] reportedly entered a hospital less than a week before his death, thinking his abdominal symptoms were from diverticulitis, only to be diagnosed with leukemia. He succumbed to the disease a few days later. But diverticulitis, an infected wall of the large intestine caused by an in-pocketing of the bowel lining, is not at all similar to leukemia. So were there telltale signs of leukemia overlooked in the months before Short's death?

Anabolic steroids were developed in the late 1930s, primarily to treat hypogonadism. Scientists discovered these steroids caused muscle growth in animals, which led to use of the compounds by bodybuilders. In Germany in the 1930s, experiments were conducted on dogs; steroids were subsequently given to German soldiers and prisoners during World War II. In the 1950s, Russians began to dominate the sport of power lifting, and it was shown that most of these athletes were using steroids containing testosterone. An American physician, Dr. John Ziegler, then created a selective form of anabolic steroids that was available on the open market. Not all bulking up comes from anabolic steroids. Human growth hormone, which is made by the pituitary gland in the brain and does not contain sex hormones or steroids, can cause increased muscle mass and weight gain. [Gary Wadler] says that one of the main motivations for abusing synthetic human growth hormone is that no urine tests exist, so a user may elude detection. There is a blood test for growth hormone but it's rarely used and is not mandated in professional sports. The only true medical indication for growth hormone is a deficiency in either childhood or adulthood. Studies have shown that the unregulated use of the drug as an anti-aging agent carries an increased risk of developing diabetes

Tysabri, which was a promising treatment for multiple sclerosis, Crohn's disease and rheumatoid arthritis - devastating illnesses that affect millions of people - appears to have led to two cases of deadly progressive multifocal leukoencephalopathy. The correct decision is to return the drug to the laboratory and look for a way to reintroduce it safely to the market,

Most neurologists would contend that [Terri Schiavo] cannot feel anything, even pain or thirst. The problem with this assertion is that no one has come back from such a state of neurological impairment to verify or dispute this contention. She reportedly lacks upper brain function, meaning her thinking centers are still, but it cannot be proved that the lower brain would not allow her to feel discomfort. It is generally accepted that a physician's role in health care is to prolong life or relieve undue suffering. The only time a true medical debate emerges is when these two roles come into conflict. The Schiavo case is not such a time. It is difficult to argue for euthanasia because she does not appear to be suffering. Working to prolong her life simply means providing nutrition, which physicians usually do without endless debate. The most disturbing aspect of the Schiavo case is that the doctors are portrayed as those who will simply abide by the final decision and either put the tube back in or keep it out -- a job for a medical yo-yo rather than a professional. But doctors are not court-appointed mechanics. Our own code of ethics and standards must drive us. Removing feeding tubes is not part of my job description. It should not be part of a physician's job at a Florida hospice either

The article suggests that a baby whose mother is using SSRIs may suffer withdrawal symptoms including seizures when the child is born and abruptly stops getting the drug through the mother's bloodstream. But the study -- based on a survey of reports of adverse drug reactions -- contains no definitive evidence of this effect. There has been no clinical trial comparing infants whose moms did and didn't take Paxil during pregnancy. (Paxil is available to pregnant women by prescription, though manufacturer GlaxoSmithKline says on its Web site that some complications, including seizures, have been reported in babies whose mothers had used the drug during pregnancy.) More important, numerous studies have documented the adverse effects of maternal depression on fetal and infant well-being. Untreated depression during pregnancy has been associated in several studies with premature labor and low birth weight. A Danish study published in The Lancet in 2000 reported that maternal emotional distress led ultimately to congenital malformations. A study from Emory University in 2001 revealed that infants whose mothers had been depressed during pregnancy showed a higher than normal stress response at the age of 6 months. Depressed women are also at higher risk for using alcohol, drugs and tobacco, as well as for very poor diet and sleep habits, all of which have been shown to impair fetal development more than antidepressants do. [Shari Lusskin] has identified several risk factors for depression during pregnancy, including a history of depression, a family history of mental illness, a lack of social support from spouse and friends, and anxiety about the fetus, especially if the pregnancy is unplanned. Screening for such factors is vital, Lusskin said

Drug safety is not as absolute as it has been made to appear in the media. Few drugs on the market are villains, and few are heroes.

A few months ago, one of my patients had an unexpected reaction to a statin drug, which is used to lower cholesterol levels. A routine liver test uncovered a large elevation in her enzymes. She had to be hospitalized immediately, narrowly avoided a liver transplant and has since recovered. Had she been able to obtain the drug over the counter, however, her liver problem probably wouldn't have been found in time. She might have died. Why the rush to unlimited access? Patents are running out, giving companies a financial motivation. If a drug is sold over the counter, the company can tap a market with millions of potential customers. Mevacor sales have dwindled since 2001, when it lost patent protection and was largely replaced by Lipitor and Zocor. Merck is doing what is good for business by pushing for over-the- counter Mevacor, but not necessarily what is good for the patient. Just last month, a study revealed that prolonged daily use of the arthritis drug Aleve can lead to heart disease. The FDA approved over-the-counter sales of Aleve a decade ago, despite the fact that it is prescription-only in several other countries, including Canada

What isn't clear to the public is that drugs like Celebrex are largely safe when taken for shorter periods at lower doses, which is the way they're generally intended to be used for common joint inflammation. The increased risk to the heart is a result of taking them at high doses over a prolonged period of time. Celebrex diminishes an enzyme that prevents clotting, which is associated with heart attacks. The prolonged use of Aleve, and perhaps all non- steroidal anti-inflammatory drugs, can lead to fluid retention and elevated blood pressure, itself a risk factor to the heart. Yet these drugs are being overprescribed by doctors and overused by patients who consider them safe and effective. Public expectation regarding Celebrex and Vioxx was ramped up by direct-to-consumer advertising, a process not adequately overseen by the Food and Drug Administration. The public was told these Cox 2 inhibitors protect the stomach in a way that other non-steroidal drugs, all of which can cause bleeding ulcers or gastritis, don't. Thinking of Celebrex as a wonder drug, the public feels betrayed now that it understands that the stomach-sparing qualities were not proven, and now that it knows about the elevated heart risk, which FDA scientists suspected from the outset. The FDA that engages in that analysis will have to be a much stronger and more effective agency than the one in place now. In an editorial in the Nov. 30 issue of the Journal of the American Medical Association, deputy executive editor Phil Fontanarosa discussed the creation of a new office of drug safety to ensure a more independent and extensive evaluation of drugs than the FDA can provide. It would seem that a better first step would be to try to strengthen the FDA itself, to make it a more effective regulatory agency less dependent on drug company money and political appointments