Medicine Undefined

March 20, 2008

The purpose of medicine is twofold. First to prolong life, ie to prevent premature death from disease. The second is to relieve pain and suffering from disease. To many medical “experts” it also appears to include the alleviation of just about anything that can cause distress of any sort. War, murder, crime, poverty are among the myriad of mankind’s misfortunes that have been trivialized into diseases. Soon to be a medical problem is the anguish of a falling stock portfolio.

This approach to healing is taken in the piece in the New England Journal of Medicine – Guns, Fear, the Constitution, and the Public’s Health. Its by Garen J Wintermute, MD, MPH who is professor of public health and director of the Violence Prevention Center at UC Davis.

The article has nothing to do with medicine, at least as I have defined it above. It is an argument in favor of gun control laws. Dr Perlmute’s expertise on the subject seems to involve sneaking around gun shows looking for evidence of illicit sales of weapons. He’s obviously a true believer. He’s committed to a cause; as are all true believers, its merits are irrelevant. He believes. I’m not saying he is wrong, just that he’s not critical.

That guns kill people seems trite. That they should or should not be more or less regulated seems to me to be a political issue that should be debated in those organs created for that purpose and decided by courts and legislatures. That the piece appears in the NEJM says more about the current state of the medical press than it does about gun control.

The article presents a lot of dire sounding statistics that are either unreferenced or which cite a whole book – both are sloppy scientific practices which would never be tolerated in the “real” part of the journal; ie the part that contains the science. The editorial rush to territory not really medical is exemplified by the next article in the same issue of the NEJM; it’s by a lawyer. It discusses the implications the Supreme Court’s upcoming ruling on whether there is an individual right to bears arms given in the second amendment to the US Constitution. There is nothing objectionable in it. It seems to adequately and fairly cover the subject, but what’s it doing in a medical journal? It not as if medicine doesn’t have a full plate without rushing into politics.

Editing a medical journal or practicing medicine conveys no more standing on issues like gun control than that borne by any other citizen. Dr Perlmute, though it hasn’t prevented him from bursting into the medical press, seems to subliminally recognize the futility or inappropriateness of what he’s up to: “It’s unlikely that health care professionals will soon prevent a greater proportion of shooting victims from dying [Does he want to close trauma units? Stop research on gun shot wounds? Stop the spread of trauma units and emergency services?]; rather, we as a society must prevent shooting from occurring in the first place.” Then why doesn’t he run for office or write for the NY Times? Health care professionals of course can prevent people from dying from shootings. We can treat them. They have a disease. It’s called trauma. Dr Perlmute seems so obsessed with guns that he forgets he’s a doctor.

You may think it harmless and a little laughable when doctors puff themselves up with righteous self importance and medicalize anything they don’t like, but there’s more to it than pomposity. The urge to fix thing you don’t really understand more often breaks them. It’s the same impulse that leads to the pursuit of the ideal that worried Isaiah Berlin so much. Gun control is a serious issue and it deserves serious discussion. A medical journal is not the best place for it.


Bicarbonate Therapy in Severe Metabolic Acidosis

March 9, 2008

This is a PowerPoint presentation of a talk given at the annual meeting of the Southern Society for Clinical Investigation – February 23, 2008. It can be used for any noncommercial purpose as long as the original source is acknowledged. Also listed below is a pdf file of a paper on the same subject that was published in The Journal of the American Society of Nephrology.

J Am Soc Nephrol 20: 692-695, 2009

Bicarbonate Therapy in Severe Metabolic Acidosis.ppt

Bicarbonate Therapy in Severe Metabolic Acidosis.pdf

Pippo’s Met Debut

March 5, 2008

“His musical merits have mostly to do with style, for the voice, though neither small nor ugly,is not an organ of great beauty.”

Virgil Thomson in the New York Herald Tribune reviewing GDS’s Met debut on February 25, 1948

How would you like to have this brilliant insight following you through all eternity?

Giuseppe Di Stefano 1921-2008

March 4, 2008


No great tenor seems to have spawned the ambivalence among opera lovers than the late Giuseppe Di Stefano. Even I’m showing it by leading with a negative. So let’s get it out in the open. He was the greatest Italian tenor I ever heard in performance. That he’s not a household name as are Callas and Pavarotti is because there were no critics constantly reminding the public that he was a once in a century artist.

His flaws vocal and personal matter not a whit. That he was at his best for barely a decade is irrelevant. He was a phenomenon. The most beautiful tenor voice I ever heard live or on record. His vocal insights and characterizations were unique. He found meaning in every syllable. You didn’t have to understand the language he was singing to understand what he was singing.

What made him a miracle was the combination of a voice of molten beauty combined with the emotional insight of the greatest of poets. Those who possess the one almost never have the other. That he had both sets him apart from all his coevals. It’s not that they don’t make ’em like this anymore, they didn’t make ’em like this before he was around.

Two of the performances I heard him sing at the old Met will probably defeat dementia. The first was Dec 9, 1955 – Faust. Monteux was the conductor. The diminuendo on the climactic high C caused pandemonium. Monteux put his baton on his lap and calmly sat on his stool until the audience cheered itself hoarse. The other was just a month later, January 13, 1956 – Tosca. The third act aria sounded just the way it does on the great recording under De Sabata. It was inimitable.

Ernest Hemingway once remarked that there was no order among great masterpieces. This is equally true of great performers, but Pippo was in a special category inhabited only by himself. When time permits I will post some sound files of those little bits singing that show his unique ability to find meaning in what seemed to others mundane.


Educational Thought of the Day

March 1, 2008

Nobody can teach you nothing. You got to learn for yourself.

Willie Mays