Transferred! - [2003-08-16]

The URL for this blog has changed to http://evilresident.fatoprofugus.net. Adjust your links and/or bookmarks as necessary.

- [2003-08-14] permalink

The Question of Race - [2003-08-13]

Now I don't want to get tarred and feathered as a racist (which would be most ironic since I am a person-of-color) but I find it even more ironic that our politically-correct society has tried to teach that race shouldn't matter. (Level playing field, my ass.) When in fact, it does, at least from a medical standpoint.

(DISCLAIMER: seeing as how I am a liberal€€although possibly bordering on being a communist and/or anarchist€€I have no truck with any social theories about race. Social Darwinism has been debunked a long time ago by a lot better minds than mine as having very little to do with actually biology, for example. The so-called scientific studies discerning a difference in intelligence between white people and people of color have all failed to eliminate the enormous confounding factors of socioeconomic class and access to education. Anyone trying to use social sciences to promote social engineering is, frankly, on the spectrum of things, tending towards the Nazis.)

(On a deeper, epistemological level, I don't believe in discrete categories, anyway. Quantum mechanics notwithstanding, most everything else exists in spectra that defy easy, unambiguous classification. But this is turning into serious meta-drivel.)

For example, clearly, black people are more likely to have sickle cell disease. Ashkenazi Jews are more likely to have Tay-Sachs disease. White people in general are more likely to have cystic fibrosis. Japanese people (but NOT Japanese Americans) are more likely to die of stomach cancer. Asians can be afflicted with thalassemia (and so can people of Mediterranean descent.)

Especially when it comes to an exam such as step 2 of the USMLE when you can't actually see the patient (or when you are doing a consult and you're being a stupidly lazy bastard and don't bother to see the patient before making recommendations€€a very bad practice that is likely to get you sued big time, although, let me tell you, it happens), it makes a big difference on what the answer is going to be depending on the patient's race.

So for high blood pressure, they teach us that black people respond better to hydrochlorothiazide, while with white people you might go with beta-blockers, and with Asians, you might consider calcium-channel blockers. Also, on an electrocardiogram, black people are more likely to have this harmless anomaly in the ST segment called J-point elevation, which is due to early repolarization. This should never be confused with the ST elevation of a heart attack.

There are a lot of racial tidbits here and there, and the politically-correctness in me kind of squirms, but then again, it can have serious ramifications on a person's health.

Still, it pays to be skeptical. After all, it's not like I've actually read the studies that claim these things. For all I know, they could be as equally flawed as the aforementioned study on intelligence across races. And, as the generations pass, at least here in America (unless the facists really do take over and start enforcing racial purity) the American people will become more and more mixed-race. For example, I remember listening to a Chicano comedian comment that, someday, everyone will have a Mexican relative. It'll happen to you. I remember Time magazine doing a cover story on the inevitability of miscegenation a few years ago.

And finally, miscegenation is just good for the gene pool. While those recessive genes I mentioned above will never go away, having kids with someone not of the same race as you dramatically decreases the chances that your kids will have these diseases.

Still, though. These bits of medical trivia aren't all that makes race matter. It's not like we have the vaunted (at least by white conservatives) "level playing field" anyway. On a sociopoliticoeconomic level, race matters for all the wrong reasons. And, really, we, as health care professionals, cannot fool ourselves into thinking that these issues don't impact the delivery of health care as well. Just go to a county hospital, and then go to a private hospital out in the suburbs. Let's see if you can straight-faced tell me that none of this matters.

More Career Options - [2003-08-10]

How about sleep medicine? According to this pdf that describes guidelines for fellowship training in sleep medicine, you can combine it with pulmonology or clinical neurophysiology.

On a related note, I think there should be an obesity medicine specialty, if there isn't one already. Like you would probably need some training in endocrinology (diabetes), pulmonology/sleep medicine (sleep apnea€€that Pickwickian body habitus), cardiology (given the risk of coronary artery disease), maybe even PM&R [physical medicine and rehabilitation], and some psychiatry for sure. Then again, given the incidence of obesity in the U.S., what I've basically described is primary care.

No Escape for the Damned - [2003-08-10]

So me and two of my classmates decide to take it easy this Saturday night and just watch an independent or foreign movie, and we decide to watch "Dirty Pretty Things," which, among others, stars Audrey Tatou. Of course, leave it to the three medical students to pick the movie that is inured with medical references. The lead character, played by Chiwetel Ejiofor is a doctor, and everything else sort of stems from that. In any case, it was a good movie, and, when contrasting our lives to the characters who are illegal immigrants, it reminded us that, well, despite our bitching and whining, our lives are pretty good. To riff off of something a friend of mine consoled me with: at least I'm not getting deported, I'm not working in a sweatshop, I'm not having to perform sexual favors to prevent myself from getting deported, I'm not worried about how I'm going to have money to eat tomorrow, I'm not going to get sent to prison and raped. Or, to bite off what a psychiatry resident once told another friend of mine: at least I don't have lymphoma.

Heh. Optimism is all relative.