More Allergies

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Sure: "Naprosyn."

Dr. Grumpy: "What happens when you take Naprosyn?"

Mr. Sure: "My armpit deodorant doesn't last as long as it should."

How does pointless research get published?

In light of my many posts on obvious and/or stupid research, quite a few of you have written in with that question.

There are several answers, but the most common one is busy work. And I am my own best example.

I am not an academic/research person. I have nothing against those who are, it's just not my thing. One of my career goals was to die unpublished. I didn't ever want my name in any journal, anywhere.

But when I was doing my fellowship, the chairman was of the opinion that it was critically important that everyone get published at some point, regardless of the quality of the research involved. So he came up with an absolutely bullshit project for me. And I was faced with the options of doing it or failing the fellowship.

So I did the project. It was remarkably stupid and pointless. it consisted of me reading through MOUNTAINS of old charts, going back several years, and making notes. For the record, a lot of BS research is done this way. Some poor sucker in training is forced to tediously analyze endless piles of old charts or videos or patient forms or something, to come up with worthless information, under the threat of failing out of their program.

Let's face it. You can get pointless data out of anything: "Our chart review found that people who saw the original release of The Wizard of Oz in 1939 were more likely to have Alzheimer's disease in 2009 then those who'd seen the original release of Star Wars in 1977. This suggests an unidentified risk factor for dementia in seeing MGM films vs. those made by 20th Century Fox."

And these studies are generally cheap to do, because you're already paying the salary of the resident or fellow involved (even cheaper for med students, since they work for brownie points).

And there's always a crappy journal out there, trying to get advertising dollars and willing to publish anything to get readers.

So I found some meaningless data, and at a weekly division meeting I presented it. There were 4 attending physicians and 2 fellows in my subspecialty at the time. 3 of the attendings, and both of the fellows (including me) agreed the paper and it's findings were meaningless drivel.

Unfortunately, the only person who disagreed was the chairman. And since he was editor at the time of some desperate medical journal, he got my paper published there.

To make matters worse, he then got me a poster spot at the annual neurology meeting that year. So I had to go to this meeting, set up a poster with my worthless data on it and then STAND BY IT wearing a badge that identified me as the author.

So for the required 2 hours I stood there, trying to smile at all the big league academics going by. Most looked at my poster and politely didn't say a word. A few gave me sympathetic looks. 3 made comments about how worthless it was (I silently agreed). Only one said something kind.

I left the poster hanging in the meeting hall. I think I was the only person who didn't take theirs home. I assume it's in a landfill by now.

My shitty article got published a few months later, and several intelligent neurologists (who I assume were reading in a hot tub) found my paper to be such absolute garbage that they felt the need to write to the journal to complain. And the journal editor, my chairman, forwarded the letters to me to write a rebuttal.

How do you defend the indefensible? Hell, I agreed with them.

But by this point I'd completed the fellowship, and was an attending physician. And I didn't care. So I just tossed his requests in the trash.

So my sole contribution to the medical literature is out there. Fortunately, as the years go by, it will continually be buried under newer (though equally worthless) data.

And that's where at least some crappy research comes from. And I suspect most of it has similar origins. Some poor sap who's under pressure to publish something, anything, regardless of how stupid or obvious it is, or people trying to pad their resume, or someone with way too much time on their hands and absolutely no life (if you're in the last category, get a dog. Or join Facebook. Or do ANYTHING to waste your time in a more useful way), and crappy journals willing to publish anything.

And that's the way it is.

Sunday hot tub reading

Okay, I polished off a few more journals to help keep up-to-date this afternoon, and have learned that:


People who use excessive amounts of salt have increased risks of stroke and heart disease (WOW! I've never heard that one before!). British Medical Journal, November 24, 2009.

Excedrin Migraine is effective for some patients with migraines (when compared to placebo), but not for others. Paper presented at the 14th Congress of the International Headache Society.

People who have severe migraines on workdays are more likely to miss work due to migraines, than people who don't have migraines during those times. Another paper presented at the 14th Congress of the International Headache Society.

Dr. Grumpy's Rules, #1024

No good will EVER come out of returning a Sunday morning message that begins with:

"Yeah, I have an appointment with Dr. Grumpy this morning, and your office building is all locked up."

Breaking Medical News

I was relaxing in the hot tub today, catching up on cutting edge medical literature.

I learned that:

Patients on sedating drugs have a higher risk of falling than those not taking sedatives.

Patients with imbalance from inner ear problems are more likely to fall than those without balance problems.

(Archives of Internal Medicine, May 25, 2009)


I also learned:

People with a stroke, and poor blood flow to the area of brain involved, are more likely to have another stroke then people with normal blood flow to that area.

(Brain, April, 2009)

My readers write

This photo was submitted by reader Francine, who says she took it in a hospital ER.

For all the advice painted on the top and bottom of the machine, I have to say I don't see anything remotely healthy in there.


(click to enlarge)




And thank you Francine for sending this in!

Friday afternoon insanity

Dr. Grumpy: "Let me fill out an MRI form... Are you claustrophobic?"

Ms. Bright: "No. My period started yesterday."

Mystery solved

Last night I was at a dinner meeting for a research company. These things are always held at some swanky overpriced steakhouse.

Dr. Duffel is a local neurologist who drags around the biggest damn purse in the world. It's HUGE, and goes everywhere with her. For years many of us have wondered what's in it: a complete set of every neurology journal ever written? Jimmy Hoffa? the Bermuda Triangle?

So last night she came in late to the dinner, and sat down next to me. She put el monstro humungo purse on the floor next to me, so I had to move over a bit.

The meeting dragged on. One slide after another. The occasional cell phone ringing. The speaker droning. Food courses.

At some point I wandered out to stretch and empty myself of biologically-filtered Diet Coke. When I came back and sat down I stepped in a puddle on the floor. I figured someone must have spilled water or something while I was out of the room, and refocused my attention on the speaker.

A minute later a waitress came by to refill my Diet Coke, and stumbled over the giant purse.

And the purse started barking.

The waitress screamed and leaped back, dropping the pitcher on the purse, which only got it snarling at her.

Dr. Duffel jumped up, grabbed her cell phone (which hadn't rung), mumbled "I have to answer this outside" and dragged her growling purse out of the room. I'm pretty sure it wasn't her ringtone.

She never came back.

I rinsed off my shoes when I got home.

Whatever

Mrs. Sad: "Some days I feel like I have no one to talk to."

Dr. Grumpy: "What do you do when that happens?"

Mrs. Sad: "You mean when I have no one to talk to?"

Dr. Grumpy: "Yes"

Mrs. Sad: "I talk to someone about it."

Plumbing FAIL!

"I know I have bleeding somewhere in my colon, because every time I urinate bright red blood comes out."

(yeah, I'm sure someone will write in that maybe the patient has a fistula, but trust me, that ain't the case)

Things that make me grumpy

YOU!

Yes, you. You make me grumpy. Pissed off. Wanting to leap across my desk at you, if you were to ever come back here again, which you won't.

You were here last week for a disability evaluation. You looked miserable. Your friend pushed you up here in a wheelchair, and you used a cane to get from the chair into my office.

You were very polite. You told me how nice I was. You said that I "wasn't like the other insurance company docs" you'd been sent to. You even brought Mary some chocolate-covered berries for working you in so quickly.

I could see you were trying to butter us up. I'm not that stupid. But you did seem legitimately suffering, and were quite patient while I reviewed the boatload of test results your company had sent me.

I've been doing this long enough that I could see you were exaggerating some things, but you did seem to have some real limitations.

Anyway, I didn't complete your disability report over the weekend. Sorry, but I was on call. I put it off until this week, and boy, am I glad I did.

A DVD from your insurance company showed up in my mail yesterday. I've been watching it.

It's kind of interesting. It actually shows you leaving my medical building last week, after the appointment. I guess you were in too much pain to see the camera guy following you around, huh?

It was kind of neat how you stood up and began walking as soon as you got to the parking garage. I kind of expected you to yell "Hallelujah! It's a miracle!" like they do on TV, but you didn't. You just folded up the wheelchair, handed the cane to your friend, and walked over to your car.

You'd told me that you hadn't been able to drive for a year, so it was kind of surprising watching you get behind the wheel. I guess with your miraculous recovery you had an itching to try out the old motoring skills, huh?

I then watched a boring clip of you going over to Local Grocery. No biggie. But I loved it when you drove to Home Depot. You told me you couldn't lift more then 5 pounds at a time. I haven't bought paint in a few years, but those big metal cans, I'm pretty sure, weigh more than that. And you were carrying one in each hand.

After you got home there's a few hours missing. Maybe you were inside recovering from the horrible pain you'd suffered heroically buying salad dressing and paint. But when you emerged carrying a ladder, and began painting your front porch, I just lost it.

So, as you requested, I've now completed the forms listing my findings and what I think the extent of your disability is. And I personally faxed them to your company. And called to make sure they got them.

Have a nice day.

WTF were they thinking?

As an Apple fan going back over 25 years, I have to wonder WHAT THE HELL WERE YOU THINKING? "iPAD" WAS THE BEST FUCKING NAME YOUR BILLION DOLLAR MARKETING DIVISION COULD COME UP WITH?

What the hell, Steve? What about iTop? or iScreen ("i scream, you scream, we all scream for iScreen")? or iANYTHINGELSEBUTIPAD?

Even Failblog got into the joke today.

Mary's Desk, January 27, 2010

Dr. Grumpy: "Have you sent those reports over to Dr. Freek yet?"

Mary: "I've been trying, but they're not going through. And it's been busy today."

Dr. Grumpy: "A lot of calls?"

Mary: "Yeah, but most are hang-ups or a fax or something."

Dr. Grumpy: "Why aren't the reports going through to Dr. Freek?"

Mary: "I have no idea. They just aren't. Are you sure about the fax number you gave me?"

Dr. Grumpy: "I think so, let me see it... Yeah, that looks familiar, I think it's his number."

Mary: "Okay, I'll keep trying... HEY!"

Dr. Grumpy: "What?"

Mary: "You dipshit! That's OUR phone number you told me to fax it to."


(long pause)


Dr. Grumpy: "Well, you didn't catch it either."

Mary: "You wrote it down! Not me!"


(another pause)


Dr. Grumpy: "Well, at least now we know why you're getting so many hang-ups today."

Mary: "Go back to your office! I'll tell you when you're allowed to come back out!"

Go Away!

I wandered up front to see my least-favorite drug rep, Rikki Phoneysmile, standing there.


Rikki: "Hi, Dr. Grumpy! Do you need any samples of Fukitol today?"

Dr. Grumpy: "Actually, yes, I'm all out."

Rikki: "I don't have any right now! Sorry!"