weekly rounds

  • This week was a bit abbreviated due to the Thanksgiving holiday, and I’ve just returned from my southern Ohio homeland, where the obligations of family, rest, and celebration were somewhat barely balanced. It is now time, as they say, to get back at it.

weekly rounds

  • I’ve just collapsed at home after returning from Philcon, which was a damn fun time. More on that will surface this coming week.
  • After some consideration, I’ve decided to crosspost my medical thoughts both at Lifebridge Heath’s blog and here, as I did earlier this week. In the style of Orac, the version that shows up here may be a bit more “colorful” than the other, which is just how I roll.

John Cmar 360

I was recently interviewed by Philip and Lisa Mulford for this week’s episode of their audio show, Communication 360. From the episode description:

Every day [swine flu] is in the news, often with conflicting information. Even the medical community is inconsistent. So what do you do? And more importantly what is the best decision for your child? Having already experienced the H1N1 with both their boys, Philip & Lisa are joined by infectious disease specialist Dr. John Cmar to identify the fact from the myth and put the H1N1 back in perspective.

Communication 360 in general focuses on the different roles that communication has in relationships, understanding how it can break down, and ways to mediate it after it has. Given how much of the recent “swine flu” hysteria has been due to often poor communication from news media and medical authorities to the general public, I was eager to explore influenza from this perspective.

Our hour chat was fun, and ended up covering a lot of ground. We had a good discussion of how many aspects of talking about influenza – such as basic questions like “is this a bad flu season?” or “is there more than one H1N1?” – are not straightforward, and require a nuanced discussion that is often difficult to communicate to laypersons in limited time. There were many questions raised that I didn’t have a chance to discuss in detail, including some aspects of influenza vaccines and overhyped side effect possibilities. Now that some of the reactionary influenza coverage has died down a bit in the media at large, I’ll be taking a closer look at some of these issues in future posts.

Go here to listen to the program, and remember: wash your hands, people.

(Please note that I was accidentally credited as being an “infectious diseases specialist at Johns Hopkins” early in the episode, but this was corrected later on in the program to reflect my infectious diseases and clinical work at Sinai Hospital of Baltimore, and my teaching appointments through Johns Hopkins University.)

Philcon 2009 schedule

And here, I thought the convention season had ended…

A few weeks back, Laura happened to be perusing the guest list for this year’s Philcon (including Cory Doctorow, among esteemed others), and suggested that it might be a fun way to round out November. I agreed, and lo and behold – we are headed up to Philcon this coming weekend. Or, rather, CherryHillNewJerseyCon, based on the actual location of the hotel, but I digress…

We both have the pleasure of contributing to the science track as guests. Given the lateness of our declared attendance, the more infection and zombie-related panels were already gobbled up (heh, and drat), so my schedule includes some interesting but decidedly different panels than the norm:

Sat 1:00 PM in Crystal Ballroom Three (1 hour)
STEM CELLS: RESEARCH AND PROGRESS (171)

[Panelists: Jed Shumsky (mod), JJ Brannon, John Cmar, Jay Wile]

There has been much progress in stem cell research in recent years, with new discoveries coming regularly. In January 2009, Geron received FDA clearance to begin the first human clinical trial using human embryonic stem cells. What is happening today and what still remains to be done before the promise of stem cell therapy becomes reality?

Sat 6:00 PM in Crystal Ballroom Two (1 hour)
GREAT MYSTERIES OF SCIENCE (169)

[Panelists: Eric Kotani (mod), Eric Schulman, David Goldberg, John Cmar, Frank O’Brien]

What are the most important unsolved mysteries and unanswered questions in science? Which are closest to being solved?

Sun 12:00 PM in Plaza I (One) (1 hour)
THE BIOLOGY OF OBESITY (166)

[Panelists: John Cmar (mod), Muriel Hykes, Jed Shumsky, James Prego, Lawrence Kramer]

Obesity is a growing problem around the world, and increasing research has revealed the causes to be much more complex than just “eating too much.” Medicine now recognizes that some people will
gain more fat from the same amount of calories than others. Hormones, gut bacteria, brown fat, neurotransmitters, metabolic pathways, viral infections, circadian rythms and many other factors
are all now implicated in weight gain and loss. Are we closer to understanding the causes of and solutions to the obesity epidemic?

And Laura’s schedule:

Sat 1:00 PM in Plaza VI (Six) (1 hour)
NASA FOR KIDS (154)

[Panelists: Andre Lieven (mod), Laura Burns]

A fun and educational discussion about the U.S. space program.

Sat 3:00 PM in Crystal Ballroom Three (1 hour)
SPACE INC.: IS PRIVATE ENTERPRISE THE FUTURE OF SPACE DEVELOPMENT? (183)

[Panelists: Laura Burns (mod), Mark Wolverton, Frank O’Brien, Dr. H. Paul Shuch, Karl Kofoed]

With NASA struggling with budget restrictions, and other governments around the world facing economic crises, the private sector may now be poised to become the main route to space. What is happening in private space development? What’s planned? What’s likely and what’s not? And is this a good or bad thing for the future of space exploration and development?

Sat 5:00 PM in Crystal Ballroom Two (1 hour)
SCIENCE AT THE HEART OF SCIENCE FICTION (87)

[Panelists: Bud Sparhawk (mod), Caroline Cox, David Goldberg, Dr. H. Paul Shuch, Jerome Stueart, Laura Burns]

How has Hard Science Fiction changed in the last decade? Is Science Fiction still predominantly the literature of scientific ideas?

Sun 11:00 AM in Plaza II (Two) (1 hour)
THE WEIRD SCIENCE FAIR! (125)

[Panelists: Christopher Gay (mod), Mark Wolverton, Laura Burns, Eric Schulman, Caroline Cox]

Death rays.  Earthquake generators.  Ice Ages that cover New York in 24 hours.  SF books, movies, and TV have offered up some STRANGE science over the years.  Here’s a panel to talk about some of the
Weird Science we’ve seen.

If you are at the con on Saturday or Sunday, feel free to say hi. I’ll be plugged in via Twitter, and may attempt daily bloggage while there. *gasp* (Hm… I never did post my Dragon*con post-mortem…)

weekly rounds

  • My three-part “state of the flu” series over at Lifebridge Health I mentioned last time didn’t materialize for several excellent reasons, but I look forward to it showing up in the coming week.
  • Laura and I will be attending Philcon next weekend as science guests. It will be great fun, and more on that is forthcoming.

tales of healthcare pre-reform

It has become in-vogue for insurance “providers” to contract with a third party company to review (i.e. deny) radiologic studies, such as MRIs, for medical necessity and appropriateness. If they deem that such a study is “not medically necessary,” the process for a physician and patient to overcome it is purposefully onerous and requires a disrespectfully time-wasting amount of phone calls and paperwork.

Approximately one month ago, I saw a 40’s year-old-woman who’s main complaint was knee pain and decreased range of motion. On exam, there was a weird tender lump jutting out from the side of her knee (what I, in medical parlance, described as a “lateral joint deformity”), and I detected some degree of possible meniscal instability on manipulation of the joint. All of this would lead most people with medical training, and some without, to come to the conclusion that an MRI of the knee to specifically examine the soft tissue structures is the appropriate next diagnostic step.

What follows is the phone conversation I had earlier with the third party company involved after fighting with them for four weeks, and subsequently being denied, for the test:

[called  main number, on-hold for 16 minutes]

Operator: “Hello, this is xxx, may I have your patient’s account number please.”

Me: “Hi, this is Dr. John Cmar at Sinai Hospital of Baltimore, how are you doing this evening?”

Operator: “Um… fine. You patient’s account number, please.”

Me: [account number given] “I’m calling to appeal a decision for coverage on an MRI for a patient of mine.”

[information is exchanged]

Operator: “I’ll need to locate a Medical Account Manager for you. Please hold for the physician.”

[on-hold for 22 minutes]

Operator: “Um, I’m sorry sir, but it appears that we no longer service insurance company yyyy. I can’t help you.”

Me: “Really? But I’ve been dealing with you for four weeks. When did this change occur?”

Operator: “November 1st.”

Me: “But I have a letter here from you issuing a final denial on November 4.”

Operator: “Yes… I’m sorry, but I can’t explain it. It makes no sense.”

Me: “I agree. So, what’s my next step? Start from square one and four weeks ago, and issue another referral?”

Operator: “That’s as good an idea as any. I really don’t know. I’m sorry.”

Me: “I’m sure you understand this isn’t satisfactory. Do you have a manager I can speak with?”

Operator: “Sure. Please hold so that I can locate a manager for you.”

[on-hold for 18 minutes]

Operator: “I’m sorry sir, but there’s no manager available right now.”

Me: “… really?”

Operator: “Yes, sir, I’m very sorry.”

Me: “Well… thanks for your help, then. I’ll reissue the referral to the insurance company.”

Operator: “Is there anything else I can help you with today?”

Me: “You… have got to be kidding.”

From a purely practical standpoint, that was from ~6pm to 7pm wasted on fighting futily for coverage of a medically indicated study for one patient, that has been previously delayed for four weeks and will continue to be delayed further. For me as a salaried hospital employee, that’s a personal debt in time and energy… but for a private practitioner, that would be a direct loss of livelihood, and for the patient, an inexcusable delay in specific diagnosis and accurate treatment.

I am thankful that it only took an hour of my time. Oddly, however, I happen to have more than one patient.

weekly rounds

  • In what I do find on some level to be amusing, both Laura and I have been waylaid over the last week by what is very likely influenza due to the novel H1N1 virus. Things are returning slowly to a better state of health, and I’m planning a three-part “state of the flu” series over at Lifebridge Health for the coming week.

Happy Saganday!

“Science is more than a body of knowledge – it’s a way of thinking, of skeptically interrogating the universe with a fine understanding of human fallibility.”

Today is the first annual Carl Sagan Day event, which is being held to celebrate his life and contributions in conjunction with the 75th anniversary of his birth coming up on Monday. A full roster of the day’s events at Broward College in Davie, FL, can be found here, and many of the goings-on will be streaming live here.

Carl’s perspective as a humble scientist and a captivating storyteller is an inspiration to many, myself included. Even narrowly looking at my own field, many challenges that I face in my work with infectious diseases – public perceptions of the nature of the influenza virus, or unfounded vaccine fears, for two of many examples – are a directly tied to many of the issues Sagan was passionate about, including a global lack of critical thinking education, and an almost willful misunderstanding of science and medicine by some segments of the public. Continuing his work is critical not only for the betterment of public health, but also for the well-being of our global society as we continue to move into a more scientifically nuanced and technologically advanced era.

Below, in three sections, is Carl’s last televised interview. It touches on many topics, including pseudo-science in a scientifically-driven world, critical thinking v. belief, and his own illness. As with any video he was involved with, it is entertaining and thought-provoking. The quote above, and those below, are taken from this interview. Enjoy, and happy Saganday!

“We’ve arraigned a society based on science and technology, in which nobody understands anything about science and technology, and this combustible mix of ignorance and power is soon going to blow up in our faces… who is running the science and technology in a democracy if the people don’t know anything about it?”

“People read stock market quotations and financial pages, look at how complex that is… people are able to look at sports statistics… understanding science is not more difficult.”

“Science is after the way the universe really is, and not what makes us feel good… a lot of the “competing” doctrines are after what feels good, and not what is true.”

“If the universe does not comply with our predispositions, we have the wrenching obligation to accommodate to the way the universe really is.”

The Secret Lair Special Episode: Dr. Cmar on H1N1

The Secret Lair

The latest episode of The Secret Lair is up, which is the first ever special episode of the show. Partially inspired by this set of musings, Overlords Miller and Johnson had me on as a guest to chat about various aspects of the novel H1N1 pandemic, including media hype, some of the science behind it, and prevention. Influenza this season is a sprawling topic, but we were able to hit on a few of the most important aspects, and incorporate some listener questions as well. I’ve done many influenza-related interviews this season, but I can say that this one was the best – the combination of intelligent and witty interviewers without a time limit or agenda resulted in the quite the meaningful and entertaining discussion. It was a blast to do, and hopefully we’ll be able to arrange more of these types of episodes in the future.

Go here and listen, else when the Overlords’ time comes, you will be the first into servitude.

Radio Isopod #11: All Hallow’s Eve

Radio Isopod is an audio podcast that is on my “must-listen” roster of shows. Created and produced by the exquisitely talented Natalie and Andy, I give you the official show summary from their site:

Radio Isopod is about the misadventures of the crew of the submarine, the S.S. Isopod. The S.S. Isopod’s primary mission is a safe haven for mad scientists to conduct their mad experiments in relative peace. When they aren’t working on their own diabolical projects, they contract out their services to evil overlords and other interested parties in need of some covert scientific work.

However, it’s not just all work and no play aboard the Isopod. The scientists as well as the rest of the crew make it a point to keep things fun and… interesting.

Radio Isopod brings some of the happenings aboard the ship to the world while still maintaining their super secret location. The show includes discussion on the daily trials and tribulations aboard the ship, updates from the scientists themselves, a bit of music to lighten the mood, and the occasional intergalactic transmission from parallel universes.

The crew of the S.S. Isopod would like to welcome you aboard, for about a half an hour per episode, as they do their best to entertain and enlighten your mad science deprived life.

They have pulled out all the stops for their Halloween episode, including a submission from yours truly. It is best to have listened to The Secret Lair #29 before this show, as the technology exchange between the Lair and the Isopod noted therein is both referenced and strengthened in this episode. In addition to two holiday-appropriate tunes, segments include:

  • Captain Tortuga and Pi discussing Pi’s Halloween excitement, costume choice, octo-lanterns, and mergoat ailments, among other mischief.
  • The Lair’s Overlord Miller giving a brilliant reading of Darkness, by Lord Byron.
  • A lab report from Dr. Gestalt, concerning her extra-curricular use of the mini-sub to hunt for alien life.
  • The Lair’s Commandant Moore discusses some unusual properties of the moon water he recently acquired on a mission for the Lair, and makes an offer.
  • A lab report from my alter-ego, Dr. Chancerous, details his attempt to allow the Isopod’s crew to participate in trick-or-treating while remaining at sea through the zombification of candy.

Go here and listen, else when mad scientist-pirates’ time comes, you will be the first taken by the press gang.