Faculty Bibliography

Qnexa combines two drugs associated with weight loss: the appetite-suppressant phentermine and the anti-seizure drug topiramate, which appears to alter hunger hormones, decrease appetite, and adjust glucose and insulin concentrations.

Bevacizumab (Avastin) is a revolutionary drug. A monoclonal antibody against a protein called vascular endothelial growth factor, it blocks the formation of blood vessels that feed the cancer -- and is the first drug of this kind approved for use in the US. Few would say that Avastin isn't highly useful, despite such side effects as fatigue, vomiting, and blood clots. Avastin has received undue criticism for false promises, but it remains highly useful -- and counterfeit versions remind people of how important the real version is. An important arrow in the oncologist's quiver, Avastin should be championed, not undermined.

Separation [Motion Picture] -- A 2010 article in the Archives of General Psychiatry reported that depression during pregnancy (made worse by the added stressors of marital discord and poverty) may increase the risk of adverse outcomes, including preterm birth.

Phentermine is an effective weight-loss drug that suppresses appetite. Though it can increase heart rate and blood pressure and cause palpitations, for many patients, it is well tolerated. The concerns with Qnexa center on its other main ingrethent - topiramate. Those concerns caused the FDA to reject Qnexa less than two years ago. So what has changed the momentum from FDA rejection to possible approval? It surely wasn't a study, completed late last year, which showed topiramate doubles the risk of cleft lip and palate in newborns of mothers who were taking the drug. The new FDA panel virtually ignored the results of this study, accepting the reassurances of Qnexa's manufacturer, Vivus, that it will restrict the drug for pregnant women and perform studies after approval to assess heart safety.

A third way to increase donations is being pioneered in Israel. Until now, Israel ranked at the bottom of Western countries on organ donation. Jewish law proscribes desecration of the dead, which has been interpreted by many to mean that Judaism prohibits organ donation. So Israel has decided to try a new system that would give transplant priority to patients who have agreed to donate their organs. In doing so, it has become the first country in the world to incorporate "nonmedical" criteria into the priority system, though medical necessity would still be the first priority. That Haredi Jews, as the ultra-Orthodox are known in Israel, would not donate organs was well-known in the country. But this was the first time anyone had openly admitted the paradox to Dr. [Jacob Lavee]. The unfairness of a segment of society unwilling to donate organs but happy to accept them nagged at him. After he operated on both patients, giving each a new lease on life, Dr. Lavee put together a proposal that would give priority to those patients willing to donate their organs. "We were swamped," said Tamar Ashkenazi, the director of the National Transplant Center of Israel. The machine that prints the organ donation cards usually handles 3,000 a month. During the 10 weeks of the campaign, 70,000 Israelis registered for organ donation cards. Transplants have increased by more than 60 percent this year.

[...] today it was me with the white coat, and her with the death sentence. A senior resident rescued him before he had a cardiac arrest, then screamed her lungs out at me in front of the entire emergency room staff.

When [Julia] walked out of our hospital without full knowledge of her prognosis, I had been derelict in my duty as her physician. I was fully aware that my job was to have "open and honest" communication with her, in a "patient centered" manner. But I couldn't. I couldn't bring myself to tell this young mother that she was going to die. The emotional layers in medicine, however, are far more pervasive. Emotions have been described by the neuroscientist Antonio Damasio as the "continuous musical line of our minds, the unstoppable humming ..." This basso continuo thrums along, modulating doctors' actions and perceptions, while we make a steady stream of conscious medical decisions that have direct consequences for our patients. Emotions can overshadow clinical algorithms, quality control measures, even medical experience. We may never fully master them, but we must at least be conscious of them and of how they can sometimes dominate the symphony of our actions. I'd like to say that I'd handle the situation better now, with another decade of clinical experience under my belt, but I'm not sure. Today, at least, when my medical team faces the prospect of giving bad news or admitting a medical error, I try to help my students and interns pay attention to the basso continuo running underneath. I try to point out when our emotions might be impeding us, and when, as sometimes happens, they might be assisting us in caring for our patients. Doctors can't -- and shouldn't -- eradicate the emotions that grease the wheels of patient care. But being alert to them can help us minimize where we fall short, and maximize where we succeed.

[...] today it was me with the white coat, and her with the death sentence. A senior resident rescued him before he had a cardiac arrest, then screamed her lungs out at me in front of the entire emergency room staff.

Dr. Reiner has cared for Mr. Cheney for many years at George Washington University Hospital in Washington. Because that hospital does not perform heart