Sunday, November 22, 2020

This Magnificent Dappled Sea

 by David Biro

This book is by a dermatologist and writer.  I own a copy but listened to it on Audible.com.  The story centers on an Italian boy with leukemia and his bone marrow transplant (BMT). All of the characters are alive. Especially memorable are Nina (the nurse), Luca (the patient), Joseph (the bone marrow donor). The story has many layers -- from the science of bone marrow transplantation, to complex family relationships in Italy and Brooklyn. The subplots will resonate with me for some time. I give this the strongest recommendation! 


 

Thursday, November 19, 2020

Albert R. Jonsen Obituary

Albert R. Jonsen, 89, Dies; Brought Medical Ethics to the Bedside

A former Jesuit priest and leader in bioethics, he believed that an ethicist should be part of a patient’s medical team when hard decisions have to be made.

 

By Gina Kolata

NY Times Nov. 16, 2020

 

Albert R. Jonsen, who brought the field of bioethics to the bedside and whose way of reasoning influenced generations of medical ethicists, died on Oct. 21 at his home in San Francisco.

 

His legacy is important. 


Full NY Times Obituary.  (If you can't open the link, I can send you a pdf.)



Wednesday, August 12, 2020

About Miranda-Med


Miranda by John William Waterhouse (1849 - 1017)
In 1885, when John Shaw Billings started the database which would, over time, morph into PubMed he recognized the hopelessness of trying to keep abreast of the literature.  In addition, he was cognizant of how trivial most of what passes for “the literature” is when he wrote:

There is a vast amount of effete and worthless material in the literature of medicine.  Our preparers of compilations and compendiums, big and little, acknowledged or not, are continually enlarging the collection, and for the most part with material that has been categorized as ‘superlatively middling, the quintessential extract of mediocrity.

        Over the past 132 years, the situation has only gotten worse.  Today, the National Library of Medicine (NLM) indexes over 3500 journals in MEDLINE (searchable via PubMed).  What physician could keep up with even those in his own specialty. even if all one did was pore over medical periodicals?

What we are proposing to form is a Virtual Journal Club for the medical humanities.  Each month, the members will post the one or two articles they deem most inspiring from their chosen journals.  The references will be stored on this web site (Miranda-Med) for retrieval and open-access whenever possible.

We will also include books that deal with humane aspects of health care.  There are some classics and each year a few new titles are added to the canon.

If you are interested, please consider joining our Miranda-Med Hui.

Suggested Journals
Annals of Internal Medicine
British Medical Journal
Journal of the American Medical Association
Lancet
New England Journal of Medicine
New York Times

The Miranda-Med Philosophy

As articulated by Robertson Davies, in The Cunning Man:

[We] don't decry research. Some fine things are done.

Not nearly enough for the amount of money spent. Too much machinery, too much administration, and not enough brains and intuition. Research harbors a lot of second- and third-rate people.

The huge labs are what monasteries were before Henry the VIII took the axe to them. More humanism and less science – that's what medicine needs. But humanism is hard work and a lot of science is just Tinkertoy®.

Friday, March 6, 2020

Coronavirus by the Numbers

This is a lucid article in the March 6, 2020 NY Times. Link.

A mathematician who studies the spread of disease explains some of the figures that keep popping up in coronavirus news.

The news of coronavirus epidemics around the world involves a flood of numbers that are a challenge for any nonscientist to digest. In this useful article Dr. Kucharski to help us navigate some of these numbers, and tells us which ones we should pay attention to.

The article is well-worth reading.


Also read:
Preventing a covid-19 pandemic Link.
by John Watkins, Consulting Epidemiologist, Public Health Wales, Cardiff, UK
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m810 (Published 28 February 2020) Cite this as: BMJ 2020;368:m810 

We should plan on the assumption that most of the population may contract the virus with few or no long term effects, while harnessing vital secondary healthcare resources to treat the small percentage of people who become seriously ill.

Monday, February 17, 2020

Ink Rx/Paramedical Tattoos


Using tattoos to blend in rather than stand out is a relatively new enterprise. The pigments and techniques of paramedical tattooing aren’t standardized, but paramedical tattoo artists across the country are quickly establishing reputations for using flesh-toned pigments to camouflage imperfections, scars and discolorations.

One of the most common requests is for tattoos of areolas after having mastectomies. 

Mr. Catalano doesn’t charge for paramedical tattoos. A GoFundMe page established last year brought in more than $12,000, allowing him to donate his skills — at least for the time being. Each Wednesday (called “Wellness Wednesday”), he does up to eight reconstructive tattoos in his small shop.

This is a fascinating article in the February 16, 2020  NY Times.

Fingernail Tattoos after an Industrial Accident

Tuesday, January 14, 2020

Eewy Body Dementia

by Sharon Ostfeld-Johns
Annals of Internal Medicine, January 14, 2020
Free Full Text

This is a graphic medical essay about scabies (Norwegian type) and its effects on a medical resident's life.  It brilliantly comments on scabies, health anxiety and cyberchoindria.  One can appreciate how delusional parasitophobia can be a sequela in some people.  Fortunately, the author was not one of them.  The combination of text and drawings is a great way to tell the story.

Here is the first page:

Friday, January 10, 2020

Reading Like An Osler


Adapted from Michael Lacombe’s introduction to Osler’s Bedside Library.

In Osler’s Bedside Library we cover those classics you have always intended to read.  I know, you haven't had the time.
            Osler had the time.
            You have that stack of journals.
            Osler read every scientific journal published in Canada while at McGill.
            There are students and residents to be taught.
            Osler taught them at the bedside, and what is more, gave them keys to his home, calling them his latchkey children.
            Perhaps you are writing a textbook, or rather editing one, as it is done today.
            Osler single-handedly wrote the standard medical textbook of his day, The Principles and Practice of Medicine.
            Osler was a genius, you say.  Yes, he was, but so are you.  Perhaps you can't teach or write as well as he did, but you can read, can't you?
            The book you are holding is intended to get you to read, meant to pull you away from television, set aside that modern novel, and return to the classics as you have to admit you have always intended to do.  There are thirty books and/or authors listed here in the table of contents.  They include Osler's own personal list of those ten books of which he said in Aequanimitas:

A Liberal education may be had at a very slight cost of time and money.  Well filled though the day be with appointed tasks, to make the best possible use of your one or of your ten talents, rest not satisfied with this professional training, but try to get the education, if not of a scholar, at least of a gentleman.  Before going to sleep read for half an hour, and in the morning have a book open on your dressing table.  You will be surprised to find how much can be accomplished in the course of a year.  I have put down a list of ten books which you may make close friends.  There are many others; studied carefully in your student days these will help in the inner education of which I speak.

            Osler called this list of ten books his bed-side library for medical students.  They are presented here, slightly out of order for editorial reasons to be explained below, each introduced by a scholar who will present excerpts of the work to whet, we hope, your appetite for this inner education.  Following these ten are twenty other works selected for their accessibility, their variety, and for their adjunctive supplement to this education.
This is the first such book of its nature in that it contains excerpts from pre-1913 texts that Osler had in his library, now called the Bibliotheca Osleriana at McGill, with a catalog of his collection by the same name.  But there does exist an earlier wonderful book by Wallis and Miller, 75 Books from the Osler Library containing essays of works Osler owned, treasured, and read, and I refer you to that fine text as well.
            We start with Plutarch, one of Osler's Ten, and I admit this is a personal choice.  A print of the cover illustration of this book, a painting by Alexandre-Charles Guillemot entitled Erasistratus Discovers the Cause of Antiochus' Disease, captures a moment in medical history from about 275 BC and told centuries later in Plutarch's Lives.  Next comes Browne's Religio Medici, Osler's favorite book.  At the Osler Library are over thirty editions of this work, and they are shelved next to his ashes.  Following the remaining eight of Osler's Ten come two poets, seven consummate story-tellers, six philosophers, three dramatists, one compelling journal, and then... well, I saved the best for last...
            ...were I to ask you who might have been the greatest physician of all time, whom would you name?  Who was it who memorized his bible by the age of 14, who by 18 had read all the existing medical textbooks and began practicing medicine, who cured a king and in payment was given use of the royal library, who wrote 450 books one of which, his textbook of medicine, was used by European medical schools as the standard text for seven centuries, who first described the transit of Venus observed with the naked eye, and who proved four of Euclid's Postulates (the fifth is still unproven), whose book on tonic intervals and rhythmic patterns was a standard text on musicology, and who sought to integrate all aspects of science and religion in a grand metaphysical vision?
            Unless you are Persian, you will not know the answer to this question, and yet George Sarton, arguably the greatest historian of science who ever lived, said of Avicenna:

Were you to ask historians of medicine to name the three greatest physicians who ever lived, they would all name Avicenna and argue over the other two.
           
            A word or two about the contributors to this book:
            There are at least three card-carrying Oslerians here, one member of the Baker Street Irregulars, one Aussie whose essay on Middlemarch is simply perfect for our purpose here, one Brit, several Canadians, one bona fide philosopher (Conway) and a favorite teacher of mine, Arnold Weinstein of Brown, all of whose lectures I have attended via The Teaching Company.  One contributor, Rita Charon, earned her PhD in English after her M.D. and after beginning a job in academic medicine.  Try that on for size.  The great majority of these contributors teach and/or direct programs in medical humanities at their universities.  I am humbled by their work for this book.
            Years ago I wrote a short piece about an elderly patient who goads her physician into reading Thackeray's Vanity Fair.   A cardiologist from Colorado wrote me a letter, stating that he had shown my story to his daughter, who abruptly turned to him and said, "Well, how about it, Dad?"

            And so, I ask you, how about it?



Michael A. LaCombe, MD
Augusta, Maine

Bertold Brecht: A Worker’s Speech to a Doctor

We know what makes us ill. When we’re ill word says You’re the one to make us well For ten years, so we hear You learned how to heal in ...