Dr Saul Schanberg: neuroscientist, physician, mentor, teacher, father, husband

Saul and Rachel.JPGAlthough I saw this obituary over the weekend, I didn’t get to posting it until today. I was reminded by a local friend, an outstanding young scientist in her own right, of the impact that Dr Schanberg had made on so, so many lives in science, medicine, and our larger community.
I only had the honor of meeting Dr Schanberg once, shortly after his cancer diagnosis, while we were at a Duke Cancer Patient Support Center fundraising dinner. His wife of over 50 years, Rachel, is founder and former director of the organization which they started following the loss of their own daughter.
Among the many scientists and physicians that were mentored by Dr Schanberg is my dear friend and colleagues, Dr Cindy Kuhn. I knew that Dr Kuhn had worked with Dr Schanberg extensively, having co-authored 83 publications. What I had not appreciated previously was that Cindy had also done her PhD work with Saul – so much for that rule of distancing oneself from one’s mentor.
I can’t do any better than the obituary that follows.

“Saul was a warm and wonderful, high-spirited, opinionated and good humored man much loved for his infectious enthusiasm for science, his love of Duke (and Duke basketball) and most importantly his commitment to his family and friends.”

And I couldn’t live a life any better than that.

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In praise of physicians/surgeons

The other day I wrote about a really nice post someone wrote about a cardiologist with whom I have had a relationship since postdoc years.
I also have several physician friends and colleagues IRL and on these interblogs who must constantly be questioned about their motives, their pharma connections, etc.
Let me state from this place and time: t
There are far more physicians who uphold our idealistic Rockwellian view of them than not.
Two years ago, I shared a cab with a doc on his way to a basic and clinical cancer research meeting focused on an organ we both study. Good guy. I might have seen him one more time in the intervening years.
Recently, a friend of mine had a parent with cancer in said organ. I e-mailed Cab Doc and asked for a referral. He said he’d take care of my friend’s parent himself.
Cab Doc operated on my friend’s parent. Successfully, with a good prognosis.
I wrote to thank Cab Doc.
He wrote me back to thank ME for caring so much about my friend and his parent.
Good guy, eh?

How to save a life: physician humanity

Bear with me this morning because I am growing very weary of my physician colleagues enduring all sorts of haranguing for being hateful, pharma shills who only want to cut, burn, and poison.
I was extremely fortunate, personally and professionally, to train in two clinical units with strong basic science programs. As such, I worked at the bench with MD fellows and we schooled each other on our respective strengths. I loved when when my colleagues would come back from clinic and tell me of experiences that put our bench work in real world perspective. Yes, not all bench work is immediately applicable clinically, but these day-to-day experiences influenced how I view basic research. Moreover, these relationships continue to serve me and my laboratory today.
Reusch 5280.jpgOne of my most meaningful relationships was with the wife and husband MD partnership described in this post by Alittleclarity about her father’s cardiac surgery consultation. My old buddy, Dr John (Jay) Reusch Jr, is pretty well-known in the Colorado Front Range having been on the cover of last year’s Top Docs issue of Denver’s 5280 magazine. He taught me a great deal about life, fatherhood, music, and humanity. And if I ever needed cardiac surgery, I’d be at his clinic in a heartbeat – as it were.
So, I loved stumbling on this post that compared and contrasted how different physicians view the same patient.

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“Complementary and alternative medicine (CAM)” is not a single “thing”

I just had a chance to check in on a triad of posts by Prof Janet Stemwedel at Adventures in Ethics and Science (1, 2, 3) on the ethical issues of the conduct of studies, particularly clinical trials, supported by the US NIH’s National Center for Complementary and Alternative Medicine (NCCAM).
For background, NCCAM was originally established for political, not scientific reasons, as the NIH Office of Alternative Medicine in October 1991. It received a token budget of $2 million at the time. They still only get $120-ish million; modest by NIH standards as compared, say, with the 2007 NCI budget of about $4.8 billion. But that $120-125 million is pretty significant in that it could fund about 60 independent researchers and their laboratory groups for five full years.
How was alternative medicine defined then? Primarily as folk and cultural modalities not incorporated into conventional Western medicine but used and promoted for disease treatment or prevention without statistically-defined efficacy and safety. The net was cast very wide, from “energy therapies” that defy the basic tenets of physics to herbal medicines that have given rise to 25% of prescription medicines.
Hence, CAM is not one modality. It is a term used to describe a wide spectrum of health-promoting approaches that have not been evaluated previously under rigorous, controlled basic or clinical science standards.
CAM is a terrible term. It is NOT medicine. Modalities proven to work are medicine. Modalities that don’t work are not medicine. There is no complement to medicine. Medicine is medicine. There is no integrative medicine, either. Medicine already takes advantage of all modalities: surgical, pharmacological, radiological, physical, psychological, nutritional – if a clear benefit can be offered to a patient that outweighs the risk.
So-called integrative medicine gurus have adopted proven, preventive medicine techniques – diet, exercise, meditation, yoga – and have used them 1) to justify that “CAM” works and 2) that the efficacy of these approaches justifies study and implementation of approaches that have absolutely no scientific basis.
Oh yeah, often with substantive personal financial benefit.

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It’s this kind of stuff that gives pharma a bad name: selling fibromyalgia

I know that many of you have seen this article by Matthew Perronne since it was picked up by the majority of AP outlets this morning:

Two drugmakers spent hundreds of millions of dollars last year to raise awareness of a murky illness, helping boost sales of pills recently approved as treatments and drowning out unresolved questions — including whether it’s a real disease at all.
Key components of the industry-funded buzz over the pain-and-fatigue ailment fibromyalgia are grants — more than $6 million donated by drugmakers Eli Lilly and Pfizer in the first three quarters of 2008 — to nonprofit groups for medical conferences and educational campaigns, an Associated Press analysis found.
That’s more than they gave for more accepted ailments such as diabetes and Alzheimer’s. Among grants tied to specific diseases, fibromyalgia ranked third for each company, behind only cancer and AIDS for Pfizer and cancer and depression for Lilly.

The physician credited as lead author of the fibromyalgia diagnostic guidelines in 1990, Dr Frederick Wolfe, is now one of the disorder’s most vocal skeptics:

“I think the purpose of most pharmaceutical company efforts is to do a little disease-mongering and to have people use their drugs.”

Wolfe is now with the National Data Bank for Rheumatic Disorders in Wichita, KS.

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Doctor, doctor, give me the news*

I’ve been having this 3:30 am (EST) insomnia for about the last two months, so I often pull the laptop up and survey the blogosphere in the still of the night. A simple look at the Last 24 Hours at ScienceBlogs and elsewhere in the blogosphere tells me that some knuckleheads in the mainstream press have taken issue with Dr Jill Biden, doctor of education, using the honorific, “Dr.”
Keep in mind that the article in question comes from the L.A. Times – the very same paper that graces my e-mail account weekly humping their fishwrapper’s science and environment coverage. I did just look up some of these articles and while some folks are referred to as Senator or General, professionals who earned PhDs carry no honorific.
My dear colleagues below have done a collectively admirable job on addressing the historical use of “doctor” for PhDs, even before physicians used the term “medical doctor.” (However, I do believe that while physicians in Great Britain use “Dr,” it is more honorable to use “Mr” if one is a surgeon.)
But because my pharmaceutical and herbal medicine work causes me to straddle different worlds, here are my two contributions to raise more ire regarding who should or shouldn’t be using the honorific, “Dr”:
N.D. – Doctor of Naturopathy
Pharm.D. – Doctor of Pharmacy

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Not Mr Kotter, but PalMD’s White Coat Underground: Welcome Back!

Let me just start off this post by thanking Mark and Chris Hoofnagle for inviting PalMD to join them at denialism blog. Through Orac, I had followed Pal at his White Coat Underground and was delighted when the Hoof-gents invited PalMD to a bigger forum in their ScienceBlogs digs.
PalMD has now metamorphosized with his old blog now on ScienceBlogs. Congratulations, friend!
My Mom, a retired nurse, will understand completely when I say that PalMD is the kind of doc I once thought I could be (and Mom, you’ve got to put this guy in your bookmarks!).
Many speak of Pal’s criticism of pseudoscience as his strength. Perhaps.
Instead, I admire even more Pal’s treatment of the human side of medicine. With the loss of Dr Charles and The Cheerful Oncologist, the med blogosphere has been left wanting for a physician writer of the humanistic and reflective side of medicine. Signout has this gift as well but her current position in training makes it difficult to keep a consistent blog (I submit that she will give Pal a run for his money once she has more time.).
But since I never became a physician, I still admire the profession and even married a doc. For those who deeply and reverently appreciate the responsibilities to humanity with which they are charged, I am in awe.
PalMD goes for the jugular on when pseudoscience jeopardizes patient well-being, and rightly so.
However, I most enjoy his passionate and moving examinations of the physician experience and the physician-patient relationship. His recent account of the loss of a family member but honoring him for his place in the world reminds us all of how most doctors approach their families, their patients, and, if not spoken explicitly, their own limitations.

Earlier in the day, my wife was spending time with him, listening to his confused moans, and when she got up to say goodbye, he said, “you have a beautiful smile. Where did you get such a beautiful smile?”
Dick, she got her smile from you, her passion from you. How could you even wonder?

Best of all, I get to meet PalMD in person this weekend at ScienceOnline’09. But I’ve been enriched greatly by his writing on the web.
I hope that you will be as well.

Kev Leitch (LeftBrainRightBrain) live-twitters his vasectomy

With tears in my eyes and my head bowed in deep respect, I share with you the account of Kevin Leitch’s vasectomy via Twitter:
kevleitch.jpgKev is an autism and manic depression advocate in West Midlands, UK, who blogs at LeftBrainRightBrain and was one of my earliest followers on Twitter. (P.S. you can follow me on Twitter at http://twitter.com/abelpharmboy)
All Twittering in response, which includes Kev’s own tweets, can be found using the hashtag, #kevsnip.
I first learned of his plans via Twitter but he also posted his scheme here. I am largely credited with the first vasectomy liveblog but readers will recall that my Treo 700p didn’t render the MovableType blogging platform. So, I had to post in real-time to a discussion forum and then put the entire accumulated account up on the blog. If I had my iPhone, I would have directly live-blogged or Twittered. Kev has a Blackberry Storm which allowed him to Twitter using TwitterBerry.
Kev appears to have had a bit of a complication with his right vas deferens and bled more than the average patient, but he now appears to be home and resting. I send him my warmest best wishes for a quick recovery – please feel free to do so yourself.
I posted on my own procedure back in February largely to get men discussing their concerns and apprehensions, encouraging my brethren to do this as a favor to their wives who suffered far far more in bringing their offspring into this world.
Where do we go from here as an online vasectomy community? Perhaps the real coup de grâce would be to have a physician blogger perform a vasectomy on another science blogger, then have each blog from their perspectives.

Refining thoughts on Sanjay Gupta – gravitas

Just another quick note reflecting further on my 8-minute gut reaction yesterday to word that Sanjay Gupta might be nominated as Surgeon General in the Obama administration.
I still contend he’s a great communicator but realize that the “both sides of the story” aspect of journalism has made some uneasy about where he’d actually stand on issues as a government leader of public health. In my post yesterday, I also neglected to consider some of the more controversial moments in Gupta’s past stories as elegantly and comprehensively pointed out by my colleague and surgeon, Orac.
I was also delighted to see Dr Val’s scoop in interviewing the current SG, Dr Richard Carmona, on just what the job of Surgeon General entails (megaprops to Val Jones for getting Carmona before even CNN!). I did not truly appreciate the comprehensive responsibilities, especially the military leadership position, of the SG as described by Carmona at Better Health:

The Surgeon General is the commander of the US Public Health Service Commissioned Corps, which consists of thousands of officers in hundreds of locations around the world working anonymously to keep our nation and our world safe. The Surgeon General interfaces on a daily basis with the NIH, CDC, SAMHSA, HRSA, and all of the federally related health agencies as well as global health organizations like the World Health Organization, Pan American Health Association, and the American Public Health Association. The Surgeon General provides in-depth analysis of health policy for every cabinet minister, including the Interior, Commerce, and Homeland Security. It’s a very visible, credible, and iconic position.

The primary concern that many in the blogosphere have expressed is that Gupta lacks the seniority, respect – gravitas – to assume such a senior position. Here, again, Orac’s analysis is quite valuable in noting that Gupta, while a neurosurgeon, is even fairly junior to mid-career by academic standards (Assistant Prof of Neurosurgery at Emory, Associate Chief of Neurosurgery at Grady Memorial Hospital), although I suspect that he’d be higher in the academic ladder if he wasn’t a full-time journalist.

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Why I think Sanjay Gupta is a good pick for Surgeon General

PharmGirl just sent me this tip after I got out of a meeting but I see that some bloggers have already weighed in about Obama’s apparent selection of Dr Sanjay Gupta for Surgeon General.
PalMD was briefly positive but PZ is concerned that Gupta is merely a talking head or placeholder and an apologist for the US health care system. However, I see two main advantages.
1. He knows firsthand the limitations of the US health care system, especially in poor rural and urban areas where access to care is a challenge even under normal circumstances. Gupta has also been on-site for several of the most challenging medical emergencies the US has faced in recent years, most significantly the aftermath of Hurricane Katrina in New Orleans.
2. Literally millions of Americans already trust him for health care information. Some may consider this a detriment but let me frame this in the context of the recent brouhaha between science bloggers and traditional science journalists: as accurate and influential as science bloggers or top-tier science journalists think we may be, the vast majority of Americans still obtain health information from television, again, in poor or rural areas where internet access is limited or too expensive. The Sanjay Gupta’s of television play an incredible role in dissemination health information to much of this country.
Be thankful Obama didn’t pick Dr Phil.
The primary question is how Gupta would use this position in the Obama cabinet to promote health care reform and improved access to care for the indigent and the increasing number of un- or underinsured. But he is an expert in framing messages and complex medical issues to a diverse audience. This could be very good, if the position is used wisely to effect health care reform and improved public health.
Addendum: My dear friend and colleague, Dr Val, levies her disappointment at Better Health.