CDC – Dead Bugs Don’t Mutate: Susceptibility Issues in the Emergence of Bacterial Resistance

In this interesting, but somewhat heavy paper, Dr Stratton discusses the problems with antibiotic resistance, and introduces the reader to a new calss of antibiotics – the ketolides.  There's also a nice review on medscape (ugh .. login required) that reviews telithromycin.  Unfortunately, the review misses the important differentiator for telithromycin: it is bacteriocidal at standard dosages .. while zithro and claritho are more likely to be bacteriostatic.  This is important, since, as Dr Stratton points out – dead bugs don't mutate.

A different View of Smallpox Vaccination

In this article in the New England Journal of Medicine,  Thomas Mack, an epidemiologist, questions the Bush Administration's policy for smallpox vaccination.  He's got a good point:  for every 1,000,000 people vaccinated, 3 or 4 people will die as a consequence of vaccination.  Deaths from vaccine complications would outweigh any limited increase in protection, and since smallpox could be introduced anywhere — the likelihood that the right healthcare workers would be where the outbreak occurs is small.

Dr Mack argues that a much smaller (~15,000) sulset of healthcare workers be vaccinated, and that we do a good job educating both physicians and the public about signs and symptoms of smallpox.  This group would care for smallpox victims in separate healthcare facilities – limiting the risk of spreading the disease.

The Journal : Current Issue

Form medpundit comes this interesting story of breast cancer in the 1500's. 

In addition to my work at "the big house" as Medical Director for Hospital Informatics, I work in a 3 – person (two FTE) family medicine office.  We do obstetrics and geriatrics and of course everything in-between.  It;s a new practice.  We've been open just over 18 months now, and we've had our share of pathology recently.   

Cancer is a horrible, sneaky, scary disease that reminds us of our inability to "fix" everything.    As Marian Stuart reminds us, we don't have to.  By supporting our patients and their families, we can still be good physicians — even though we can't always make people better all of the time.

Top Ten Web-Design Mistakes of 2002

Oh boy.  My second post of the day.  Jews (like me?) get  lots of work donw on December 25th.

Jakob Nielsen has release his Top Ten Web-Design Mistakes of 2002.  This year, we get funny cartoons to drive home the message.  Good work.  Required reading for anyone interested in web design or usability.

We've been working on the usability of our little intranet mini-EMR recently.  It's easy to be a critic .. hard to build something elegant and truly easy to use. 

Interactive Dermatology Atlas

A reminder that the Interactive Dermatology Atlas initially developed by my pal Richard Usatine (who has fled UCLA for greener pastures) remains a valuable resource for both patient care and medical education.  Though I will have to admit that I found better pictures .. as well as this useful little table on google.

A google search – if well done – can often get me the information that I want in less than 30 seconds.  When I'm in the room with a patient, our collective patience usually lasts ~ 30 seconds.  Beyond that, I find that we both get fidgety.  So if I can't find what I'm looking for in less than 30 seconds .. never mind.  For patient handouts, I usually do a google advanced search and set the language to English .. and filetype to .pdf.  For example, this is a search for "oral herpes."  Next, I'll click on "view as HTML" so that I can review the text of the handout briefly.  If it's got what I need … I'll go back and load (then print) the .pdf version.

Google is so good that it makes projects like the Dermatology atlas less necessary.  So long as they are indexed properly .. there may not be a need to build databases and large repositories.  For example, HEAL is a great project that aims to build larger interconnected libraries of multimedia content for medical education.

Big effort.

But if we just plop all of this on servers that google can access, and tag the files with appropriate indexing information, I suspect that google could do all of this work for us.

So what?  I've been working on a project called the FMDRL .. Family Medicine Digital Resources Library.  It's a similar idea to HEAL, but more focused on curricular materials for family medicine.  We submitted a federal grant to the National Library of Medicine.  I'll be a big effort if we get the funding, but now I wonder if the effort would be better spent at building the repository and making it easy for authors to upload files onto a central server that would be accessible to google.

Will have to think some more about this.

Fragrance allergy & perfume allergy

There are some things that we would expect medicine to understand better.  I have a patient who had a nagging cough for months last year until she figured out that she was allergic to the perfume that her husband had given her a week before the symptoms started.  I had treated her with antihistamines, inhaled steroids .. etc etc.  The pulmonologist had no idea .. nor did the ENT.

But the literature on fragrance allergy remains sparse .. and while there are a few web pages devoted to this topic .. I think that since it's so poorly understood, we physicians are not educated about it.

My perspective in this is a bit more than professional as well.  I have seasonal allergies, like many of the 300 million people in this country.  Yet when I'm around someone with perfume or cologne — or even heavily scented handcreams, lotions, etc .. I get runny eyes, sneezing, and terrible headaches.  Antihistamines (Claritin, Allegra, etc) can help proactively .. but won't help once exposure has occurred.

So I would have been more thoughtful, and perhaps I should have thought of the perfume. But this is a sensitive topic .. and people take their scents very seriously.   I often feel that I'm depriving new parents when I tell them to use baby products without dyes or perfumes. 

"But then he won't smell like a baby!"  … they tell me. 
"But at least he won't have a rash from all of the extra chemicals you're exposing him to".. I thinks to myself.

I now do take a careful "perfume allergy" history when I interview patients with recurrent symptoms such as headache, rhinitis, or cough/sneezing.  Sometimes, they simply don't believe me.  My 35 year old man with asthma stopped using his cologne for a month and got much better .. but then went back to it .. and predictably, the symptoms returned.