Sunday, March 25, 2007

Thogger

Alllllrright!!

I've been chosen as a Thogger by my web friend Ex Utero, as well as by Magpie. Thank you, thank you. A Thogger is a thinking blog, or a blog that makes you think, and it's a new meme started by Dr. John Crippen. Ex utero chose five blogs that make him think, and now it's my turn to do the same. Here's my dirty little secret, though. Even though I'm a blogger, I don't really read blogs that much. I would like to, but hey, life interferes sometimes. Anyway, here's five blogs I read that make me think:

1. Tales from the Womb by Ex Utero. I know, he nominated me and now I'm nominating him, but it's true that I read his blog more than any other. It's an eclectic mix of fiction and neonatology, with the occasional post about Neanderthals and Komodo dragons thrown in. (Note to Ex: I really like the Neanderthal and dragon stuff.) I'm looking forward to raising a glass with him at a conference this spring.

2. Dream Mom. Beautifully written by a mother of a special needs child, it speaks of her love for her son while still acknowledging the burden it can be caring for him.

3. Fat Doctor. She makes me laugh, and I like to laugh. When composing a description of herself for a dating service, she entitled it "Never been incarcerated." Need I say more?

4. Flea. Doesn't everyone read Flea? Or at least look at his pictures?

5. Barbados Butterfly, awarded posthumously, or postblogumously. A surgical resident or registrar in Australia (actually, I'm not really sure what a registrar is), she was the first person ever to leave a comment on my blog. Sadly, she had to shut her blog down because her hospital didn't like it. Barb, I hope you're reading this and that life is good down under.

There are many, many more I'd like to mention, but the meme limits us to five. Maybe some other time!

35 Comments:

Blogger Flea said...

The pictures are often better than the writing, sadly. thanks for the nod. I've been memed on this one already.

best,

Flea

7:05 PM  
Blogger Cathy said...

You deserve it Doc...

But, it wasn't started by Dr. Crippen. It was started here.

http://www.thethinkingblog.com/2007/02/thinking-blogger-awards_11.html

You are supposed to link to that original blog, and tell the five that you picked to also link to it.

Further, you're supposed to have an award that you can get from their site to place on your blog and then your 5 get that award from you..

Seems like alot of work to do all for winning an award...:)

7:55 PM  
Blogger Ex Utero said...

Cathy's right, I got that part wrong. You can get the award off my sight though. It's the little black and gold jpeg that anybody can lift.
Still, I thought it was a pretty cool idea just to pat each other on the back. It was a neat way of showing one another that these are the bloggers we read and care about.

9:38 PM  
Blogger Dream Mom said...

Thanks for the nod. I was wondering why I was getting a lot of links from your site tonight.

10:21 PM  
Blogger K said...

Congrats to you...I love following links from bloggers I like to others:).

11:35 PM  
Anonymous Poptart said...

Congrats and thanks for the explanation - I was wondering what happened to Barbados Butterfly.

2:06 PM  
Anonymous C & V said...

ND, how often do you check your blog posts after posting? Over the last several days, there has been some real viciousness going on r/t your Balance post.

Please, can you give some direction and some editing of the character assassination posts?
Thanks
Chris and Vic

3:23 PM  
Anonymous Elisabeth said...

ND,

I second what C & V said. It is getting nasty. The comments seem to have little to do with your original posts lately. Seems as though your blog just presents a handy forum for people to hurl insults these days.

4:46 PM  
Anonymous Anonymous said...

ND- Before you listen to these 2, please read the comments for yourself.

They are simply angry for having to read valid points that they disagree with. These arguments are being consistently and effectively presented, so of course they will say shut it down.

9:17 PM  
Anonymous Anonymous said...

Why don't you (Neonatal Doc) explain to people her why you are anonymous. Some think it is a terrible thing.

7:41 AM  
Blogger buddhist mama said...

ND.
You have a great blog, but it does hurt the quality when anonymous docs get on the air and begin to rant suggesting that others who post be killed or kill themselves. I'm sorry but that is offensive, not funny, and a bit tiring after a while..

On to the smoke/mirrors cliche (and the cliche was used twice in two posts by the same ER doc suggesting his very limited selection of cliches to choose from). An anonymous doc suggested that those of us who are not doctors can't read medical studies or comment on them.

Again, I reiterate, one does not need an MD to read medical literature. Indeed, the medical reporting one finds in many newspapers is published by journalists who may or may not have a medical degree and rarely in the specialty they are reporting on. Articles in NEJM or JAMA concerning obstetrics or neonatology are regularly broadcast to the public by such journalists. Who sometimes do a pathetic job. But nobody is questioning their right to read.

I am going to keep commenting, reading, and writing as long as I live, because I am human, a professor, a writer, a medical anthropologist, and because I think we all could broaden our minds through reading and writing.

I think those who feel otherwise, should stay away from blogs before they poison the atmosphere for all those other potential voices out there, who may be afraid to write after the abuse that some of us faced.

7:54 AM  
Anonymous Anonymous said...

ER doc:

"it is not at all easy to decide which kids to resuscitate."

As someone who flagrantly admits to violating EMTALA online, I can see why a) you are anon b) you want to shut down threads that point that out and c)are not much of a thinking blogger, unless you mean thinking about your malpractice concerns and your workload before the patient's life.

EMTALA - The Emergency Medicine Transfer AND LABOR act. Before delivery, its the OBs concern. When the baby is born, the baby has "come to the hospital" as defined by law. A medical screening exam is required to determine if there is an emergency medical condition. If there is, you must stabilize that condition without delay and without discrimination. Do you do that?

If you don't, do you chart it truthfully, or do you try to hide it by slow coding?

If you disagree with the whole concept of EMTALA and the right to emergency treatment, then does it apply everywhere? Like when an older gentleman stumbles in to the ER clutching his chest. Should I assess his age first to see if I think he has enough years left to make it worth treating him? Assess his mental and physical function to see if I think he has enough quality of life?

7:56 AM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

8:10 AM  
Anonymous Anonymous said...

Budda, who (whom?) I guess now thinks lying to make herself look better is a form of deconstruction:

"An anonymous doc suggested that those of us who are not doctors can't read medical studies or comment on them."

I will go get it and repaste if you press the issue. But, the reality is you incorrectly claimed a study put subject into two treatment groups and ranted about the ethics and informed consent or the like.

I pointed out the reality. These were patients whose docs chose whatever treatment they wanted. The two groups were created by dividing them by those treatments.

You clearly don't know enough about research to know what "prospective" means. You think it means "randomized" or "double blind" or something.

Therefore, you can't see the the conclusions are very solid and could be due to selection factors as well.

And finally, I came right out and told you, there's nothing anyone can do to stop you from posting inane interpretations. But, then you can't stop people from pointing out that it is wrong.

Those are the facts. Go deconstruct them to make yourself look better.

8:19 AM  
Anonymous C & V said...

I submit that ND's blogspot got a "thinking blogger" nomination because of the healthy debate--at least it seemed healthy until recently when the character assassination took hold.

The healthy debate is between "professionals" and lay people or parents, who the "docs" say cannot read/analyze properly the content of the research. That is arrogant rubbish--anybody can read the abstract, which is "the bottom line" and they are designed to understand the research at its most basic level. All the elements of research mentioned by the most insulting of the responders, which represent the design of the study, are necessary to DO the research but not necessary to understand the bottom line (as Buddhist mama points out).

ND, you reacted too little and too late, to my way of thinking. You simply stopped the responses to your Balanced post. I am convinced you are covering for or approving of the insulting posts to those who have "hijacked" your blogspot--and in doing so, have won you an award!!

In addition, you deleted an entire post and thread which questionned the professionalism and dedication of nurses. You alienated a lot of people, or made them suspicious by doing so.

Returning to Thinking, please THINK about this, ND. You are in charge of making this right and fair. Please, take a stand, and make it right and fair. Unless you don't want thoughtful debate . . . then, leave it alone.
Chris and Vic

8:28 AM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

8:42 AM  
Anonymous SLT said...

Doc, I think you need to close the comments for a bit. Some people don't know when to stop.

9:06 AM  
Blogger Denise said...

My name is Denise Napoli. I am an assistant editor with International Medical News Group, a division of Elsevier, which publishes monthly and biweekly magazines in different medical fields. I am trying to get in touch with a doctor/blogger who would be interested in speaking with me and possibly writing a short column for our magazines on doctors that blog about their practice and patients, and what is or isn't acceptable for them to discuss, and why. For more information, please e-mail me at d.napoli@elsevier.com. Visit our Web site at www.imng.com. Thanks for your time.

9:40 AM  
Blogger buddhist mama said...

ER doc. maybe you haven't taken your meds this morning. maybe you don't like women, maybe you don't like buddhists. maybe you just don't know how to read.

I was not referring to yoru parody. Parody is fine, when skillfully done. I was referring to your constant suggestion that H off herself or "be offed." I'm not going to go back and count how many times you repeated yourself there because I have better things to do with my time.

ER doc said: "You clearly don't know enough about research to know what "prospective" means. You think it means "randomized" or "double blind" or something."

I never said it was randomized, i never said it was double blind. I said it was prospective, meaning a "a study designed to observe outcomes or events that occur subsequent to the identification of the group of subjects to be studied."

If you read the study I was referring to, it notes "during the first 2 years of the study period...all patients at risk for preterm delivery received weekly prophylactic dosing [of betamethasone]. In response to reports of animal data that suggested increases in IUGR and central nervous system developmental delay with repeated courses, a practice of rescue or salvage therapy dosing was adopted. More recently single-course therapy has been proscribed."'

My post pointed out that women must have agreed to be in the study, but I wondered how much they knew about the ongoing debate about what kind of steriod therapy they would receive (single dose? multiple dose? weekly? fortnightly? rescue dose? betamethasone? dexamethasone?).

These musings came out of my experience when I agreed to put my twins in a clinical trail testing the comparative advantages of CPAP and intubation at birth. I was given almost no academic information on these treatments and had no chance to do the research myself as I was confined to strict bedrest.

Effectively, knowledge and clinical practices shifted regarding antenatal corticosteriods during the brief study period of 1994-1999. And it continues to shift. A randomized trial reported by Peltoniemi et. al (Pediatrics 2007 Feb; 119(2): 290-8) Pediatrics notes that RDS was increased (yes increased, not decreased) in the group that received a booster dose of betamethasone. So, there is still quite a bit of debate out there.

But I would hope to have a discussion about this rather than just random character assasinations that do nothing to further knowledge or the level of debate.

11:09 AM  
Anonymous Anonymous said...

Buddha:
"Effectively, knowledge and clinical practices shifted regarding antenatal corticosteriods during the brief study period of 1994-1999. And it continues to shift."

ER:
Which is an example of why you try to stay away from studies that are more than 5 years old - dontcha know.

11:20 AM  
Blogger buddhist mama said...

The full ref for the article I referred to in the balance post was: Vermillion St, Soper DR, Newman RB. AJOG 2000; 183(4): 810-4.

The study showed that who received multiple courses of prenatal betamethasone were:
5x more likely to have neonatal sepsis
9x more likely to have chorioamnionitis
3x more likely to have endometritis
2.9x more likely to die
than those infants receiving a single dose of steriods.

This was a prospective trial, but there have since been at least three widely cited randomized control trials studying the benefits of weekly courses of antenatal corticosteriods. To wit:

Wapner et al in AJOG 2006; 195(3): 633-42, a randomized double blind trial which was stopped after only 495 of the 2400 patients enrolled when it emerged than weekly corticosteriods were associated with harmful effects, including growth restriction and reduced head circumference.

Crowther et. al. Lancet 2006 June; 367)9526): 1913-9. Randomized, double blind trial that concluded that repeat doses of antenatal corticosteroids reduced neonatal morbidity, but did note that long-term results (ie. effects on neurodevelopment) were still pending. Intends to do 2 year follow-up. stay posted...

Guinn et. al. JAMA 2001; 286: 1581-87. A randomized, dougle blind placebo controlled ITT trial conducted in 13 academic centers in the US which found that "weekly courses of antenatal corticosteroids did not reduce composite neonatal morbidity compared with a single course of treatment."

11:30 AM  
Anonymous Anonymous said...

"If you read the study I was referring to, it notes "during the first 2 years of the study period...all patients at risk for preterm delivery received weekly prophylactic dosing [of betamethasone]."

You will never get this. No one designs a study saying "for the first two years, everyone will get treatment A, for the next two years, everyone will get b".

Treatment A was the standard of care, the protocol for these patients according to that institution and time.

THERE WAS NO TREATMENT CHOICE TO BE HAD BY THESE WOMEN. Right or wrong, what they got was the rule.


"My post pointed out that women must have agreed to be in the study,"

And I told you, their "agreement" consisted of little of a line on the general intake where they said it would be OK if at some then unknown time, some unknown researcher analyzed their chart data without any identifying information. There was NO clinical changes made due to the study.

" but I wondered how much they knew about the ongoing debate about what kind of steriod therapy they would receive"

NONE. Because, at the time they did it, people didn't think there was one. Again, there are protocols and standard treatments all over the place. It doesn't mean they are right or can't be changed.

But, you are not going to get an informed consent on the order "May have Tylenol ES 1-2 po q6" for fear that someone someday will do a chart study and find out it wasn't the best.

And now you have pointed out something further diminshing the conclusion -- it is different points in time. Many, many things could be different between the two groups. The later group might also have younger and sicker kids that weren't being saved at the earlier time period.

11:35 AM  
Anonymous Anonymous said...

Buddha:
"The full ref for the article I referred...(snip)"

The other thing that makes your posts such a joke is the fact that you can't distinguish between different protocols. You don't understand this at all.

You are light years away from the real debate on steriods and preterm. But, you don't even know it.

There isn't a dichotomy Multiple dose vs. single dose. There are different kinds of multiple dose.

You started out citing a study, that was ancient history about giving a double dose in the same episode, within about 24 hours . That's like overdosing people - Bad. Everyone (but you) has known this for a long long time.

Laugabley, you then cite a bunch of controlled studies comparing single admin one the first episode of threatened preterm with several *WEEKLY* doses thereafter. Also, old news by the way.

You are not supporting your original point at all, but you just don't know it.

No, not all repeat doses of steroids are deemed bad. The current debate is when a woman has a repeat episode of threatened preterm labor, more than a week after the first, should you give another dose? If you do, a second (a WEEK apart) is likely to be helpful. But, if this is one of many episodes, and you keep doing it, at what point is there more harm than good? Don't know. (but I'm sure you do, because the study you read on aspirin in pregnancy is just the same can be extrapolated according to you)

11:52 AM  
Anonymous Helen Harrison said...

This comment has been removed by a blog administrator.

2:25 PM  
Anonymous Anonymous said...

Oh for goodness sake! Enough already! I'm sure that ND did not stop the comments on the previous post just to have you all continue the mudslinging on this one. Could we all please be respectful of each other and stick to the topic?

Julie

2:53 PM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

2:54 PM  
Anonymous Anonymous said...

Heads up Neonatal Doc:

Directly from the Narof group today....

Re: [narof] Re: sounds like slander


Remarks about blatantly ignoring EMTALA . . . might be a hanging offense, as well.
C
----- Original Message -----
From: narofmom
To: narof@yahoogroups.com
Sent: Tuesday, March 27, 2007 4:08 PM
Subject: [narof] Re: sounds like slander


Dear Stacy,

We have a number of attorney friends and family members, but would be
grateful for 2nd, 3rd and 4th opinions here. My sister is a criminal
lawyer who handles capital cases, so this may be too minor league for
her (at least I hope it will remain minor league!)

Mostly I hope this sick individual will exhaust him/herself, feel
better, and go away.

Neonatal Doc is either not minding the blog, or not minding that the
blog is being used in this way.

And Neo Doc, who apparently is posting from Michigan, seems to be
under legal scrutiny for possible HIPAA violations:

Here's an excerpt from a recent Detroit Free Press article about
medical blogs, especially about NeoDoc's crude and insulting
protrayal of some of his patients.

"T.J. Bucholz, spokesman for the Michigan Department of Community
Health, under which the state's medical licensing board operates,
said he thought the "neonataldoc" blog stayed in bounds.
"I don't see a lot of blatant HIPAA violations," Bucholz said,
referring to the Health Insurance Portability and Accountability Act
of 1996, which established national standards to protect personal
health information. "They're using first names . . . but from my
perspective, if someone were to identify themselves in this blog, he
is looking at very serious charges, not the least of which is losing
their license."

Onward!

Helen

-- In narof@yahoogroups.com, Stacy wrote:
>
> Dear Helen,
>
> Hubby and I were talking about this last night (taking legal
action). Since
> he has specifically used your name in such a negative manner, as to
ruin
> ones character, I think you may have a case. My FIL is a lawyer-
not that
> kind though.
>
> I wonder how much longer ND will keep his site going. He has really
raised
> some eyebrows in the media. When they read what has transpired over
the next
> few days, I would imagine he will raise some more.
>
> Speaking of his site being in the media right now... that may give
you even
> more legal recourse-both against him and the "anonymous ER doc".
>
> Stacy
>
>
> On 3/27/07, narofmom wrote:
> >
> > Dear Kristina,
> >
> > I've made some moves in that direction. Not only is libel involved
> > but I believe it is against the law to make the kind of threats
this
> > person seems to be making.
> >
> > Onward!
> >
> > Helen
> >
> > --- In narof@yahoogroups.com
premieinfo@
> > wrote:
> > >
> > > If he said that in print..... get some people to print a copy of
> > the page
> > > and save it. Then tell him to take it off if he can not back it
up
> > and mention
> > > that it is liable.
> > >
> > > Just my 2 cents.
> > > Kristina

5:48 PM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

6:25 PM  
Blogger Nancy said...

Well I'm fairly certain after that display that this will surely be shut down.

I am truly amazed that because someone name calls and insults that they feel legal action is necessary. "Sticks and stones."

To each his own I suppose.

6:35 PM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

6:40 PM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

6:45 PM  
Anonymous Anonymous said...

These posts make me so sad. I come to this site for healthy debate about some serious issues. The threatening/malicious tone of things that ER doc has said about Helen Harrison are truly frightening. I think it has gone beyond "name calling." I don't always agree with Ms. Harrison but the things being said to her are quite disturbing. I hope I never end up in this ER doc's ER.

6:58 PM  
Anonymous Anonymous said...

ER doc:

Well, I have had enough of this. I'm exploring my legal options.

I am going to help Ashton's mother and all the other moms sue for falsely labeling them as being in denial - that's libel, slander, famine and pestulance.

Then I will help Ashton and all the other kids that were called "retards". Questioning whether or not their lives were worth living or saving -- there's some child abuse counts in there I'm sure.

I will sue for pain and suffering. I'm sure this crowd's response will that we should all just kill ourselves if we have pain and suffering. (Hey, but if they sue us for the same....Good for the goose, good for the gander).

Then, I will sue them for the stress of being sued, and for the stress of having to sue for being sued. And the sue of being stressed. Being libled while being sued while being slandered while stressed!!!!

And even though HIPPA doesn't have a licensure penalty (earth to loonies -- it's a federal law, licenses come from the state -- oh but you guys know everything about medicine so I don't need to tell you that) and it doesn't address people's self disclosure, I will charge them criminally with that and ask for the death penalty!!!

SO THERE. DON'T EVER ANYTHING I DON'T LIKE IN ALL OF CYBERSPACE EVER AGAIN OR ELSE!!!! ; )

7:13 PM  
Blogger neonataldoc said...

Thanks, Cathy, for setting us straight. Yes, it does seem like a lot of work, especially for us backward computer types, but that's okay, I'm still happy to get the award.

7:50 PM  
Blogger neonataldoc said...

Regarding the arguing that has been going on in the comments of this post and the previous one: I'm happy to have people comment on my post, whether they agree or disagree with it. I also don't mind if there is a little civil back and forth discourse between some commenters. But this prolonged arguing using personal slurs is offensive. I'm asking you all nicely to please refrain from doing that on this blog.

Chris and Vic, I appreciate your comments, but regarding your comment that I reacted "too little too late," here's the thing. I have a life. I simply do not have time to check my comments several times a day and police them. If someone makes a nasty comment on my blog, that is their doing, not mine.

Slt and Julie, you've got it right. Thanks.

7:57 PM  

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