MD Whistleblower

We have had many family conversations about education reform over the years. Whistleblower readers have seen some of this creeping through some prior posts. It’s an issue that affects every American and deserves the efforts of our most talented and innovative thinkers to elevate the system to a higher orbit. One of the mantras of traditional reformers is that smaller classes for students are optimal. Indeed, local school boards and teachers’ unions often warn of expanding or exploding class sizes if requested levies are not passed. They know that we parents believe that class size varies inversely with the quality of education. Ask parents if they would prefer a class of 20 or a class of 30 students for their youngsters and all will opt for the former. Are smaller classes really better, or do we just believe they are because our intuition instructs us that it is? Is something true because it seems self-evident to us? I found recent New York Times article on this issue very enlig...

Fast Food or Front for Evil? As Whistleblower readers know, I have a 6 day-a-week love affair with The New York Times. I love the paper’s reportage, but not its editorial policy. However, it’s important to seek out other views on the issues of the day. This is an opportunity to defend your beliefs by disarming the opposition’s argument, or to change your mind. The news these days is very dark. There’s an apocalyptic aura as we read about terror, war and natural disasters occurring all over the globe. And, since we all like reading about villains, the news media readily supplies us with demons to root against and to distract us from more serious challenges that hover over us. In this past week, there were four prime villains that the national media offered up for us to consume. Osama bin Laden Mouammar Khadafi Mahmoud Ahmadinejad Ronald McDonald Don’t let Ronald’s sunny visage fool you. Behind his painted smile and underneath his red hair is an evil mind who is devoting his li...

Photo Credit I barely escaped from an embarrassing situation recently in the hospital. I was consulted to place a feeding tube, called a PEG, in an ICU patient. We gastroenterologists are rarely consulted for our opinion on whether these tubes make sense, which they often don’t. We are recruited to these patients simply to perform the technical function of inserting the tubes, so that Granny, or Great-Granny, or Great-Great… , won’t starve. Multiple medical studies have demonstrated that providing this nutrition to individuals with advanced dementia doesn’t benefit them. In addition, while it may seem intuitive that artificial feeding provides comfort, this may not be the case. It may provide more comfort to the physicians and family than it does to the patient. The above paragraph is not a rigid presentation. Obviously, the decision to place and accept a feeding tube must be individualized. Regardless, it is inarguable that too many of these tubes are being placed for the wrong re...

A few months ago, the publisher of my beloved New York Times issued A Letter to Our Readers , which presumably includes many Whistleblower readers. Non-subscribers to The New York Times will no longer be permitted to use the Times website without limit. I always wondered why they gave it away for free. I have paid my fair share for the past several decades as I wanted the ink and newsprint version in my hands every morning. The Times internet version has been an all-you-can-eat news smorgasbord, where everyone was invited for free. If you build it, and it’s free, they will come. And they did. Now, frequent freeloaders will have to pay $15 for a month’s subscription to the Times website, still a bargain to gain access to great reporting and hyperpartisan liberal columnists that raise my blood pressure several times weekly. The first 20 articles accessed from the website are gratis. Once you click on article #21, you will be greeted by an invitation to pony up. (Times articles access...

When the medical press seizes a story, it can become an obsession. Any physician who is reading any journal is aware of the reported interaction between clopidrogel (Plavix) and proton pump inhibitor (PPI) drugs, including Prilosec and her cousins. PPI medicines are not exotic elixirs known only to medical professionals. They are known to any person with a working TV set or who still reads a newspaper, since ads for these drugs are omnipresent. Just google ‘purple pill’ and begin your entrance into the PPI Chamber of Advertising. PPI medicines are highly effective for peptic ulcers and gastroesophageal reflux, although I suspect that most patients on these medications do not have any true indication for them. (Disclosure: I’ve pulled the PPI trigger too quickly on many patients who do clearly require acid blocking medicines.) PPI medicines are prescribed to hospitalized patients almost by reflex, and are often administered by the intravenous route, even when patients can swallow pills...