Too disgusting to ignore

Reading Ed Brayton’s discussion of the contrasting behaviors of our two presidential candidates with regards to law and Supreme Court decisions, I couldn’t resist comment.

One of the few advantages of medschool is that it keeps me from reading the news while I’m studying for exams, most recently my internal medicine shelf exam yesterday. Thus I’m protected from a state of constant fury from the idiocy of our dear leaders. This being a post-study day I unfortunately ended up reading this statement from John McCain from George Will’s article that giving Gitmo prisoners habeus rights was “one of the worst decisions in the history of this country.”

Wow. To his Will’s everlasting credit – he is a legitimate conservative and not a self-righteous hack serving a single political party – he follows this statement with what I immediately thought of in response to such an inane statement:

Does it rank with Dred Scott v. Sanford (1857), which concocted a constitutional right, unmentioned in the document, to own slaves and held that black people have no rights that white people are bound to respect? With Plessy v. Ferguson (1896), which affirmed the constitutionality of legally enforced racial segregation? With Korematsu v. United States (1944), which affirmed the wartime right to sweep American citizens of Japanese ancestry into concentration camps?

And now I’m back to fury again. A candidate for presidency of this country states that a ruling that protects a right existing since the Magna-Freaking-Carta is one of the worst ever? On the level of Dred Scott?

Time to study some pediatrics. Politics in this country is just embarrassing when we can actually be debating a 800-year-old human right.

Watch as Pfizer desperately clings to a patent…

…instead of focusing on innovation. I’ve written about Pfizer and Lipitor a few times in the last year. Now, Pfizer has found a way to extend its patent on Lipitor, a very profitable drug used in the management of heart disease and high cholesterol.

Lipitor’s a great drug. It treats high cholesterol very effectively, and is effective as both primary and secondary prevention for cardiovascular disease (there is much more to the story, but that’s it in a nutshell). It’s also costs about $120.00 for a month of therapy, and therapy is usually life-long.

In contrast, simvastatin, a generic drug, is also effective for primary and secondary prevention (once again, it’s a bit more complicated than that) but is generic and costs between $2.00 and $20.00 per month of therapy.

Not all statins are created equal. Some have better data in primary or secondary prevention, in coronary artery plaque regression, in reduction of mortality, stroke prevention, side-effect profile…you get the idea.

What we do know is that statins save lives, and cheap statins probably save lives just as well as expensive ones.

Pfizer suffered a big setback last year. A trial of a new type of cholesterol medication failed badly (link to my old blog above). Drug development is risky business. But clinging to an old drug by squeezing more time out of a patent is doomed to fail. Insurance companies put a lot of pressure on doctors and patients to prescribe generic alternatives where appropriate, and in the era of high deductibles, patients want the cheaper drug.

Hopefully, companies like Pfizer will invest more resources in drug discovery and development, and let the market do away with it’s enormous Lipitor profits. After all, if you can keep a patent forever, what use is looking for new drugs?


Primary prevention: preventing a first incident (first heart attack, stroke, etc.)

Secondary prevention
: preventing further events in established disease (subsequent heart attacks, strokes, etc.)

The Taiping Rebellion—mass murder in the name of Jesus’s crazy little brother

A number of years ago, I saw an older physician reading a book with an intriguing title—God’s Chinese Son: The Taiping Heavenly Kingdom of Hong Xiuquan, by Jonathan Spence. Like most Americans, I know very little about Chinese history. I certainly had no idea that there was a massive civil war in 19th century China that by most estimates killed around 20 million people.

Twenty. Million. People.

By comparison, the American Civil War, which took place in roughly the same time period, took around 700,000 lives (military, disease, civilian, etc.). I’m not a historian, and I read the book a long time ago, but this story sticks with you.

The leader of the Rebellion, Hong Xiuquan, was a failed civil service aspirant, from a non-dominant ethnic group. After failing his civil service exam multiple times and listening to some Christian missionaries, he had a vision that he was the younger brother of Jesus, and somehow used his insanity to capitalize on existing ethnic and economic tensions. He amassed a remarkably large, brutal, and fanatical army, replace existing religious restrictions with his own, and enforced morality where he held control.

This maniac took over most of south and central China. His “Heavenly Kingdom” ruled millions of people, and had it’s capital in Nanjing. In one battle for Nanjing 100,000 people were killed.

So, basically in modern times, out of the minds of most Westerners (who were admittedly preoccupied with killing each other), a wacko religious visionary managed to take over most of China, causing the deaths of millions of people. How do we not know about that?

Like many theocracies led by charismatic rulers, when he died, things fell apart. Military support from the West helped the Qing dynasty recapture most of the country.

The Qing re-instituted their brand of oppression (which was probably marginally better than Hong’s) and things went back to “normal” after a decade or so.


A middle-class guy declares himself Jesus’s brother, takes over the biggest country in the world, millions die. He also declared women equal, stopped foot binding, and women served in his army. Traditional Confucianism relied strongly on subjugation of women, and one thing this nut-job saw clearly was that half the population was available for recruitment.

It makes you wonder—where else are there large, poor, oppressed populations waiting for a delusional theocrat to come along and harness their power?

Pending hiatus

On Saturday, I’ll be heading up north. Way up north. To the north where the precious intertubes do not reach, where pagers are for skipping across the water, and cellphones are coasters. It’s that far north.

I’m going to take pictures, and take notes, and my plan is to have a bunch of non-medical, non-debunking posts to write when I get back. I think.

Anyway, just because we aren’t posting a ton over the next week doesn’t mean you should delete the feed.

Pain, privacy, and safety

Abel over at TerraSig dug up an interesting story about a man who was “murdered” killed rendered not-living (in the moral if not legal sense) by a “fake chiropractor” (although it’s not clear to me what science separates a “real” from a “fake” chiropractor). One of the commenters wondered if lack of health insurance had driven the man away from standard medical care. Another bemoaned the inadequacy of treatment for chronic pain conditions.

This got me thinking…
Continue reading “Pain, privacy, and safety”

Goodbye, Mr. Russert

Tim Russert died suddenly today. I admired his journalism, his ability to press questions that has become so rare. He didn’t seem to suffer from the “two-side-ism” that has become so common in today’s journalism; he realized that some issues don’t have two valid opposing views. But others will eulogize him. I’d like to talk about why he died.
Continue reading “Goodbye, Mr. Russert”