ahem...

Canadian WW 11 effort:

My forearms hurt from tightening bolts too much today. ugh.


In other news, this website is effing hilarious and awesome, and is starting to make me think it would be fun to attempt to recreate some childhood photos.

But maybe not the way this guy did.

The pre-pay at the pump law in BC stemmed from a pump jockey getting run-over by a gas and go offender. Over-reaction? Possibly. Will they be repealing it anytime soon? Probably not. The law has the name of the dead kid in the title, so there's too much emotional weight to go back now.

Anyone interested in checking out Electric Six when they hit town? Here's the specs:

Where: Starlite Room
When: March 19 @ 8pm
Tickets: $19, incl. service charge

(mouseover = sometimes it's better when things have a story)

Ah, post call days -- when I should be catching up on sleep, or doing the work I have to do that's piling up, or studying, but instead I'm watching TED videos.

Like this one:

Now, I'm as much of a technophile as the next guy, and I'm all for new and better gadgets and ways to improve health care and, most importantly, health outcomes, but I can't say I'm terribly excited about the applications for wireless technology that Dr. Topol presents.

Granted, there's a lot of arguments for improving access to information in health care: reducing duplication, improving accuracy of medical histories, understanding previously tried therapies, etc. And being able to get as much decision-making information as quickly as possible should, in theory, improve patient-care.

There is a flip-side, however. I think the most timely examples I think of are in breast cancer screening (about which there was a recent controversy because of new guidelines) and perinatal continuous fetal monitoring (because I started my obstetrical rotation yesterday.)

The basics of the breast cancer screening controversy is that the US Preventative Services Task Force this past year released guidelines suggesting that routine mammography for women under 50 is not recommended and that screening mammography for women 50-79 be performed every two years rather than every year. This is a huge decrease in the number recommended by the American Cancer Society. And the reason, basically, is that while the data show that screening mammography does prevent deaths from breast cancer, the magnitude of this benefit does not clearly outweigh the benefit in younger women. (Note: routine screening means testing for average-risk women with no symptoms.)

The continuous fetal monitoring issue has to do with leaving a monitor on a labouring pregnant woman to, well, continuously monitor fetal heart rates and contractions during labour. The recent trend in obstetrics in light of the evidence is that continuous monitoring should be reserved for specific circumstances and for specific periods of time. And the reason, again, is that the benefit does not clearly outweigh the harm: it does not necessarily prevent adverse events, and increases the rate of operative deliveries and caesarean sections.

What these two issues in medicine highlight is that more information does not always imply better care. In fact, in an interventionally-minded medical culture, more information can often mean unnecessary risks, unnecessary interventions and, in the end, worse outcomes.

So what does this mean for the "Smart Band-Aids" that Dr. Topol is discussing? Are they a bad thing? Should we shun them? Not necessarily. But I think, like with screening to detect serious illnesses early and trying to avert complications by gathering more data, we need to be careful about how we go about integrating increased information into practice and how we determine whether these things are beneficial.

It may be a good idea to continuously monitor someone's blood sugar. Then again, it may mean that we overtreat people who wouldn't have gone on to have complications anyway, and expose them to the risks of adverse effects of medications and insulin.

I'd be one of the first on board to get a handheld ultrasound that hooks up to my iPhone and lets me do an in-office detailed examination of my patient's heart function; or stick a bandage on them and be able to tell them "no, you're not having a heart attack; it's just your heartburn", but only with some evidence in my hand that it's not going to lead them to have a heart surgery they don't need, or start a medication that makes them worse while treating a problem that didn't exist.

(Although, the idea of a handheld ultrasound hooked up to touch-interface palm-sized technological gizmo does make my inner nerd slightly giddy.)

BC has an "always pre-pay" law, but I don't think it has to be at the pump. The motivation seems to be to prevent the pump and run situations (I assume.) I can't see what the motivation would be for forcing people to pay at the pump (except to drive the attendant even further insane with boredom.)

I concur entirely, Beck. I stop going to gas stations that have mandatory pay-at-pumps. Stupid machines.

Yeah what the dillio with paying at the pump? Especially when it's minus 29 outside the readers actually stop working.