Sunday, March 27, 2016

Plan to Steal the Nomination from Trump - Chicanery in Cleveland

Trump is roaring toward securing the GOP nomination in Cleveland this summer.  While I am excited that the convention will occur in my city, I expect chaos and gridlock downtown.  I won’t be visiting the Rock and Roll Hall of Fame, or any of our city’s other outstanding attractions, during that week.

I think that Trump may garner the necessary 1237 delegates prior to the convention.  For self-serving reasons, the trailing 2 candidates are stating that no candidate will meet the required threshold and that the convention will select the nominee according to rules, yet to be decided.  My candidate Kasich – who has won only Ohio – crows that it’s now a 3 man race!  Sorry, John.  Wining 1 out of 32 states, while Cruz and Trump have won 9 and 19 states respectively, does not make this a 3-way tug of war.

The New White House?

The media is preoccupied to determine if the candidates and the GOP establishment will award Trump the nomination if he falls a few delegates shy and the 2nd place finisher, likely Cruz, is several hundred delegates behind.  Cruz and Kasich maintain that rules are rules and unless Trump reaches 1237, then the nomination becomes an open contest.

Is this fair?  If a candidate has won more states than his competitors, and has nearly reached the 1237 delegate level, then shouldn’t the system bend in his favor?  If not, wouldn’t his millions of voters feel disenfranchised?   Should a candidate be nominated based on his electability in a general election rather than on voter preference?  If we opt for the former, then why have primaries at all?  We could simply select the most electable candidate through an elaborate polling process. 

I’m not offering a firm opinion here on how this process should be handled.  We all know that if Trump is very close and the nomination is snatched away – even if done by the books – that this will generate anger in a large segment of the population who are already disgusted with establishment politics.  Additionally, I wonder if Cruz and Kasich would have the same view on an open convention if their situations were reversed with Trump’s.  I’ll offer my opinion here.  No. 

Life beyond politics often has seemingly unfair processes and results.  Consider these scenarios.
  • A baseball team at bat loads the bases. The next 3 batters strike out and the inning ends.  Why shouldn’t the team get some credit for putting 3 men on base? 
  • A man misses winning the lottery by a single digit.  Should he get nothing when he was so close?  Shouldn’t he be rewarded more than a ticket that was a complete miss?
  • A hospital requires that a surgeon who is applying for privileges for a specific operation must have performed 50 of these surgeries.  If he has only done 48 with perfect outcomes, should he be denied privileges as if he has done none at all?
Cleveland will be on public display this summer.  But, what may really matter is what will be happening under cover. 

Sunday, March 20, 2016

Is Uterus Transplantation Ethical?

I am not a woman.  I cannot contemplate the physical and emotional experience of carrying a pregnancy and birthing a child.  I imagine that it is a singular experience that is as deep and awesome today as it has always been.  We have all seen the explosion in reproductive technology with in vitro fertilization, surrogate mothers, fertility agents and other emerging techniques.  This process, beyond the high costs, can create anguish for those who are on this journey.

I have felt in many instances that the ethical ramifications of some of these techniques are minimized or dismissed.  Sadly, we often do stuff because we can, not because we should.  Do we really think we can stop human cloning?

Recently, a woman in Cleveland had a cadaver uterus placed during an extremely demanding 9 hour operation on 2/24/16.  This was the first time this was performed in the United States.  Only a handful of these operations have been performed worldwide.  This woman, who has adopted children, was born without a uterus and yearned to carry a pregnancy.  As this operation was part of a clinical trial, I assume that it was paid for out of grant funds.  Shortly after surgery, a complication developed and the uterus was urgently removed. 

Transplanting a Uterus and our Ethics?

A uterine transplant is not a one day affair.  To prepare, the recipient’s eggs are harvested and then embryos are created and frozen.  Then, the complex process of finding a donor is triggered.  The donor organ is harvested and must be transported to the recipient.  Then, the all-day transplant surgery occurs.  The patient is then kept on anti-rejection drugs.   A year later, the embryos are implanted.  Deliveries are performed by Caesarean sections.  After the desired number of pregnancies, the uterus is removed so that the anti-rejection drugs can be withdrawn.

The cost of all this is unfathomable, assuming that no complications occur that would require additional care.  It is certainly possible that a woman could go through the entire process and not carry a baby to term.  Indeed, very few successful pregnancies have occurred worldwide.

I request that readers contemplate the following concerns regarding uterine transplant.
  • Can society justify this massive cost for a procedure that is not necessary to save a life or cure a disease?
  • Is it ethical to risk a healthy patient’s life with highly complex surgery even if she consents to it?
  • Is it ethical to maintain anti-rejection drugs, which has risks of severe complications, for years to preserve the transplanted uterus?
  • Is there a right to pregnancy that the medical profession is obligated to satisfy regardless of the financial, emotional and ethical costs? 
If this technique gets perfected, then it might become possible to implant a uterus in a man.  Then, perhaps, I will have the opportunity to experience the profound wonder that has eluded my gender since the beginning of time. 

Sunday, March 13, 2016

Do Nexium and Heartburn Medicines Cause Dementia?

Proton pump inhibitors, or PPIs, are among the most common drugs prescribed in the United States.  They are extremely safe and highly effective for gastroesophageal reflux disease (GERD).  Are there potential side-effects?  Of course.  Look up the side effects of any of your medicines and you will soon need an anxiety medicine to relieve you of side-effect stress.  The side-effect lists of even our safest medicines are daunting. 

PPIs are associated with a growing list of potential serious side-effects, at least according to the lay press.  A few clicks on your computer, and you will find that these medicines can cause pneumonia, C difficile colitis, malabsorption of nutrients, bone fractures and anemia.   The latest report to emerge links these drugs with dementia.  In the past two weeks, I’ve been questioned about this repeatedly by my patients.  One stopped her medication from fear that her heartburn medicine might be incinerating her neurons.

Enemy of Heartburn Medicines?

While no drug, including PPIs, is entirely safe, I have never seen a serious PPI side-effect having prescribed them to thousands of patients.  I’ll bet that your gastroenterologist and internist can boast a similar track record.  Doesn’t that experience mean something? 

The lay press, in my view, often covers medical science carelessly and without context.  The science underlying the above listed PPI side-effects is extremely thin.  Yet, the headlines describing them can sound authoritative and persuasive.  Remember the adage of local TV news, if it bleeds it leads?  Same concept.

Which of these two headlines or sound bites would be more likely to appear?

Nexium, superb heartburn fighter, may have questionable effect on bones, although results preliminary.

Nexium leads to hip fractures!

The scientific studies that link PPIs to bone disease or dementia are not high quality research studies.  These studies are done on large populations of individuals and do not demonstrate any actual causative effects of the medicines.  When you read the word associated, as in Nexium is associated with cognitive decline, you can accurately interpret that statement to mean there is no proof that Nexium causes dementia.  Association is a weak link which has results from a weak study.

For the same reason, favorable results from similar studies should be viewed with great skepticism.  Next year we may read that Nexium is associated with a reversal of male pattern baldness and enhanced libido.  (If this hypothetical were to truly occur, then I hope that I can time my stock purchase just prior to the announcement.)

So, if heartburn patients have forgotten their keys somewhere, there is no need to flush your heartburn medicines down the toilet.  You are not losing your mind, just your keys.  Remember, much of what we read and hear in the lay press is associated with ignorance.

Sunday, March 6, 2016

Are GMO Foods Safe?

The nutrition police are at it again.  They demand that food products that use genetically modified organisms (GMOs) in their processing inform us of this on the product’s label.  They argue, not only that consumers have a right to know how their food is prepared, but also that manufacturers should be required to disclose when evil GMOs are utilized.  (Keep in mind that most of the food that we consume includes GMOs, a fact likely unknown by most of us.)

Proposed Label For GMO Foods

This labeling demand from the nutritionistas is a little hard for me to swallow. 

I don’t want to hear about polling that demonstrates that most American favor mandatory labeling.  I guess we cite poll results when they support our views and dismiss them when we don’t.  Donald Trump is ahead in every poll.  See my point?

There is no scientific evidence that GMOs harm our health.  Fear is not evidence.  Political correctness is not evidence.  Indeed, the Food and Drug Administration requires no GMO labeling as it has concluded that these foods are safe.  

What’s at stake here?  Just a small trifle called freedom of speech.  I don’t think a person or a business should be forced to ‘speak’ just because a vocal constituency demands it, in the absence of any pressing public need for this.  Obviously, I support labeling that highlights specific known dangers of a product.  If a food item, for example, contains peanuts, then this should appear on the label to protect individuals who have a peanut allergy. 

Why should we stop with just GMO labeling?  Why not force food companies to include on their labels what cleaning supplies the companies use so the public can be reassured that they are environmentally friendly?   Should a coffee shop be mandated to label their coffee as made with tap water because the filtered-water crowd believes this to be toxic?  Should vegetables be required to have labels that specify that this product is not organic?

If a consumer wants to know if their Pop Tarts are tainted with GMOs, then he should feel free to call the 1-800 number on the label to inquire. 

What if everyone could be forced to label ourselves according to the whims of others?  How ‘bout if the nutrition police had to wear the following label:


I think this is totally reasonable and reasonable.  Maybe this individual is harboring a serious communicable disease and is simply unaware that he is infected.  Just because there isn’t a shred of medical evidence behind this, doesn’t mean we can’t mandate a public warning.  Absurd?  Of course.  

There's right to free speech.  There's also a right to remain silent.  You have no right to make me say what you want to hear.