IgE Antibody Levels Double in Last 35 years

Not surprising....IgE antibody levels have doubled in patients over 50 years of age since the 1970s, and the rate of decline in IgE as we age is becoming slower than previous, this according to a NHANES study released at the recent ACAAI meeting in Phoenix. This is probably a result of the 'allergy epidemic,' although changes in assaying IgE may also account for some of the change.

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Is Allergy an Educational Disability?

That's what educational experts in the United Kingdom are asking. The journal Expert Review of Respiratory Medicine has an interesting article regarding whether allergic rhinitis (AR) could be considered a disabling disease, especially when it comes to test taking. The article cites a growing body of evidence that the high prevalence and disease burden of AR could be affecting performance on standardized testing in the United Kingdom. Such examinations are crucial in qualifying for university education in Britain and are routinely scheduled during the months of April and May, when grass pollens are at their highest. So if accommodations are made for other medical conditions (such as dyslexia), should test takers with allergic rhinitis be addressed? Solutions include moving test dates to different times of the year, identifying and treating allergy sufferers, etc. The treatment idea raises its own downsides with several allergy medications causing sedation and mental slowing as adverse effects.

Slightly Troubling News on the Use of Benadryl

A new article in Neurology claims that diphenhydramine (Benadryl) and other anticholinergic medications can have an affect on the cognitive function of ageing brains. This news is both interesting and slightly troubling. More analysis here. A bigger concern on my part would be the affect of anticholinergics on developing brains, since we use so much diphenhydramine in children.

The Vanishing Oath

I don't really know why, but I've never been impressed with the majority of blogging doctors. Whether it's the trivial complaints, the oversimplification that often comes with short blog entries or the misplaced idealism of physicians-authors, I generally avoid spending much time going through medblogs. However, DoctorWes is one writer that I follow religiously. His commentaries are enlightening and his cynical humor is funny without being derisive.

So it was with great interest that I followed his recent entries on a documentary film made last year called the Vanishing Oath. Wes had seen the film and become so compelled by its story that he hosted a local screening of it in a movie theater and actively brought physicians together to see and discuss it. Given Wes' interest, I bought myself a copy of the DVD and just finished watching it last week.

The film follows a relative young emergency room physician by the name of Ryan Flesher MD who finds that the practice of modern medicine to be lacking in terms of autonomy, benefits and lifestyle. Burnt out with fighting administrators and third party payers, Dr. Flesher takes a break to examine why he became a physician and whether the challenges of today's practice were worth the considerable investments made to get to his position in life. In his break, he travels the country to speak with former mentors, other physicians and even a medical malpractice lawyer. I will leave Dr. Flesher's conclusions to those who watch the film. But needless to say, we are left with the realization that medicine has changed, and those changes are driving away physicians from a profession that have given much of their lives to train for.

One of the most pressing scenes involved a discussion on malpractice with a primary care provider in Massachusetts. During the health care reform debate last year, I heard from so many colleagues that malpractice wasn't, in fact, a big deal.



How anyone can assert that medical malpractice doesn't lead to adverse effects on physicians or isn't a major driver of health care costs today is ignoring a very real problem. I recorded several other reactions that I had after watching the film.

1. This movie shows the double-edged sword that comes with third-party payers, whether private or public. When you don't work for the patient, the payer expects certain actions that are not always aligned with quality patient care or standard of practice.

2. Expanding the role of government in medical decision making will not make the fiduciary relationship between patients and physicians any more sound. The way I see it, such a camel in the tent will only make matters (and rationing) worse.

3. While there are many specialties where doctors have been squeezed too much, I am fortunate to be in one that is still, if only temporarily, relatively independent. However, the day after viewing this film, I received a notice from Cigna that I was not providing 'cost-effective' care. My crime, using CT scans to diagnose chronic sinusitis. The horror...the horror.

4. I tend to relate to the Italian-born physician rather than Dr. Flesher in that after studying the history of medicine I realize that for the vast majority of our profession, doctors have not been 'rich.' While that's not why I went into the profession, I did think that I would be able to at least guide my own life and my work with patients. Some of the lack of joy in medicine these days I blame on the constant second-guessing by non-medical people looking over your shoulder and trying to make decisions for you without proper training or an understanding of the patient's unique circumstances that present before you. While some of my colleagues are happy to be 'employees,' discharging medicine as to the edicts given to them by a hospital, government or insurer, I became a physician to be an advocate for my patient. And I don't appreciate people telling me what to do as long as I am not hurting or defrauding my patients.

5. While I didn't go into this profession to get rich, I can see how limiting opportunities in medicine through over-regulation will drive very talented people to choose other lines of work. With the government takeover of medicine likely on its way, I am not sure that I would recommend the medical profession to young people intersted in becoming physicians. That to me is the real tragedy represented in the film.

Please see this film.