Friday, May 16, 2008

the genetics of race

When I was in high school, I got into a debate at school. I said that if different races were separated long enough to evolve different skin colors, then other things could have evolved differently too. For example, blacks are stereotypically thought of as good athletes. Asians are thought of as good at math. I know this is really oversimplifying it, but it's certainly possible that over time, blacks developed a "strong muscle" gene (or set of genes) or maybe a "hand-eye coordination gene" and Asians developed a "math" gene (or set of genes). I'm not saying that's what happened... it's just what is possible.

I was watching a TV show (I think it was Without a Trace) and although I'm sure nobody really picked up on it, there was this one part that I think really made this statement. In this episode, there was this white kid who disappeared, partly because he was having an identity crisis. His mother was white and the father who raised him with his mother was white, and the kid looked white, but his father was black, and he just found that out. In one of the flashback scenes, they show the kid when he really young, and he's talking to his adopted father, saying that he doesn't "feel right". I'm not getting the words completely right, but he basically says that he feels different from his father and all the other (white) kids - they don't like the same things, act the same way, or even look the same. And after the flashback, the father says about his adopted son, "he always knew" (that he was different).

Now at first glance, this doesn't seem to mean much. But actually, what's it's saying is that even though there was no difference in skin color for this kid, there were other characteristics - facial or other body features, personality, attitudes, etc. - that made him feel different. And then he finds out he's half-black. The point is that this one scene in the show is suggesting that there may be other differences to race than skin color (whether genetic or otherwise). It's interesting to me that this was brought up, albeit in a very subtle way, on TV, while in reality, it's something that society as a whole isn't really ready to talk about yet.

Tuesday, May 13, 2008

Free pens and pizza for doctors

A couple of years ago, my hospital banned any sort of pharmaceutical advertising, including free pens, lunches, dinners, prescription pads, drug samples, anything. This was a huge deal. Half the resident lunches were paid for by pharma, and they always coincided with mandatory meetings and conferences, so residents could eat while the attended and knock out two birds with one stone. I certainly understand. For one, without the free lunches at these meetings, residents often don't have time to get lunch! They don't even take the time to go the cafeteria and grab something to go. Even from an outsider's perspective, I think this is understandable - why feed yourself when you could work more on your patients and provide better care? Perhaps even save a life? Secondly, residents do not make a lot of money. They make about $40-45K a year ($30K after taxes), and many of them have $200K in debt after medical school. They haven't saved anything for retirement yet, and some of them have kids and families to support, so the loans are often just gathering interest during residency. So actually, these free meals were a source of income for the residents! Sure you can bring food and eat cheaply (and be much more healthy too) but the average resident does not have time to do this. The alternative is eating at the cafeteria or elsewhere, where an average meal probably costs $5-7. However, if you eat a free lunch off of the drug company (which usually is just pizza or ordered in chinese food or sandwiches), you save that money. You may even have enough left over for dinner if you're working late, which you usually are. Taken over a week, that's $20-$30 you save. Taken over a year, that's $1000-1500 you save, which for a resident, is a lot of money.

Despite these reasons, I've always been hugely for this. I've always thought these free pens and everything else could easily influence (hopefully subconsciously) doctors' prescriptions of these drugs. For example, say you want to prescribe a proton pump inhibitor to a patient, and in your line of sight is your clipboard, with "Protonix" all over it. You might not even realize that you saw it, but the next thing that happens is that you prescribe Protonix for your patient, and they're on that for life... not a bad way for the company to get a patient for 30 or 40 years, huh? And it's even worse with the free samples. I completely understand that free samples are how a lot of poorer people get their medications, and I think that's certainly a benefit. However, if you have a sample of drug X, and it works for a certain patient, even after they stop giving out free samples, that patient is probably going to stick with it, even though it might be 10 times as expensive as drug Y. It's also a huge source of medication confusion - so many patients I've seen have switched from medication to medication, for, say, their hypertension. And it's basically because they switch to whatever is being given out for free for that particular month. That is bad medicine, and bad for the patient.

Of course, we never knew if this was true or not. These are just theories. But why would pharma keep doing this if it didn't work, right? I'm sure they've done their research, and I've actually heard statistics from some ex-drug reps about it. So it's real. And hospitals and practices should ban pharma from advertising in their space. Of course, that's just my opinion, and there are plenty of differing views on this.

Here's an interesting recent article by Art Caplan, a pretty well known medical ethicist.

Sunday, May 11, 2008

Food and Personality

I think how and what someone eats is incredibly indicative of their character. In fact, in the past, I've used it as a way to decide whether or not I'll go on a second date with someone.

The trend I see is that the more adventurous someone is at the restaurant, the more adventurous the character. Someone who orders chicken all the time is not that adventurous. Somebody who decides to try the goat or the alligator (and they do not have to like it!) probably has a more adventurous personality.

I love to eat, and I love to try different foods - there's no way I could date or see anybody long term who didn't share those interests. For example, I could never date a vegetarian, or somebody who didn't like seafood or red meat or something. Even somebody who was allergic to nuts, or shellfish, or something like that - I would get so frustrated! But that's just me.

I guess I actually know plenty of adventurous people who place limits on their food - often that's health-related, or because they're concerned about the environment, or religious. Sometimes it's because of taste, which I think is fair. And those people are fine - I can like them just fine. But I could never date somebody like that. :)

Friday, May 9, 2008

Tonight's Menu

Appetizer: cheese, crackers, and olives
First course: Mushroom soup (yum!)
Main course: Prime rib, with sauteed spicy broccoli and asiago cheese potatoes
Dessert: summer berry gratin