Harm Reduction

It is a common human problem not being able to see the forest for the trees. The other day Senator Claire McCaskill was choking at a lunch with colleagues. She couldn’t breathe, turned color and 911 was called as the situation grew very “scary.” Senator Joe Manchin stepped in and successfully performed the Heimlich maneuver. Then came the media headlines, among them: CNN “McCaskill suffers broken rib,” CNBC “Colleague cracks Sen. McCaskill’s rib…,” USA Today “...McCaskill has cracked rib.”

This left me puzzled. Joe Manchin saved her life. With such swift action,...

Vaping continues to be a controversial topic pitting harm reduction against harm elimination; two goals that seem incompatible. But in writing about the effect of tobacco flavor on our blood vessels I discovered that vaping as practiced is not necessarily vaping as discussed. My initial response to the study of tobacco flavors was that studying the effect of flavors was too reductionist; you need to consider the impact of flavoring in the context of smoking or vaping to understanding how all the chemicals interact. After all, who just vapes flavor?

As it turns out, quite a few teens. Most teens are vaping flavor alone, not tobacco or nicotine. An NIH study [1] found that among the 28%...

It was such a privilege and honor for me to be invited by the incomparable Suzi Abrams and Jewish Family & Children’s Services of Southern New Jersey to present on how to be an advocate for yourself or a loved one in the medical realm. To inform from a physician's perspective, I put together a guide on the subject that can be found by scrolling down in this article. The topic of patient advocacy is very close to my heart, so when I was invited to speak by someone I deeply admire who runs an effective, successful program the community vitally needs,...

Humans, it seems, are susceptible to DSS -- "do something syndrome."

Described by economist John Maynard Keynes as a desire for action over inaction, it partially explains why politicians insist on passing thousands of new laws every single year. It even explains why goalkeepers dive left or right during a soccer penalty kick, when remaining in the middle of the goal is a better decision. Doing something is preferable to not doing something.

That human urge also applies to our healthcare. A sick patient expects the doctor to do something, even if nothing useful can be done. This point has been underscored by new research scheduled to be published in the Journal of...

The “opioid epidemic” consistently addressed in the news, by politicians and throughout social media conflates many aspects of the issue, often speaking interchangeably about prescription medications and illicit drugs. When the narrative and identifying of the problems get so confused and blurred or legal and political grandstanding becomes more about virtue signaling than honest analysis of multifactorial causal agents and helpful action, the solutions get further and further out of reach. As does the suffering.

The mere existence of an opioid pill is not why there is a crisis.

Myths abound in the public forum surrounding who caused it, what “it” actually is, how we got here, what it will take to fix it and who we can blame for the totality of a truly complex situation....

Everyone agrees smoking is bad these days but how to end it has become its own cultural war, and the warring sides have come down along predictable lines. Some believe in abstinence only, some only think there should be products that are for quitting (cessation) while some believe smokers should have options for that which can also help with harm reduction while they quit. Like other cultural wars related to science and health, the sides can now be predicted politically.

It's also no surprise that one side of the culture war has flipped the narrative and declared that smoking cessation and harm reduction using e-cigarettes ("vaping") don't do anything of the kind, they instead create nicotine addiction - just like cigarettes. Even if there is no nicotine. ...

We always knew when our PhD advisor was applying for a grant. He would pace the hallways, then go outside and smoke. A lot. (Thankfully, he's quit since then.)

Why do smokers find such solace in cigarettes? It may be the nicotine. Several years ago, a (very) small experiment suggested that people who were intentionally provoked into becoming angry were less likely to retaliate if they were wearing a nicotine patch.

That's an interesting finding because, as the original study explains, "Deficits in anger management may be a risk factor for smoking initiation and...

Nowadays, some folks are raising alarm about "third-hand" smoke—residual chemicals, essentially particulate matter, left on indoor surfaces by tobacco smoke. The claim is that residues from smoking can be absorbed through the skin, ingested and inhaled months and even years after the smoke has dissipated. The alarmists say that just because you're in a non-smoking environment, it doesn't mean you aren't exposed to harmful tobacco products. (1)

No one is in favor of smoking and the real worry is that by constantly ratcheting up the hype, people will assume studies on smoking itself are also exaggerated. And that is the real problem with third-hand smoke, which isn't smoke at all. As Sandy Szwarc said, “The healthiest thing for all of us might be a helpful dose of common sense and...

The Europeanesthesia Conference had a poster/abstract [1] addressing a phenomenon “barely known by health workers,” being the second victim. The first victim is the patient who suffers an adverse outcome, for which presumably the second victim, the doctor, was in part or totally responsible. I always thought of those feelings as regret or even guilt, but I am not sure victimhood came to mind.

The Study

This was a simple survey of 34 Spanish anesthesiologists, predominantly working in tertiary referral hospitals, so no need to worry about statistics, this is just a set of quantified observations.

  • 91% felt responsible for medical errors [2] - 26% of those errors resulting in severe injury
  • Emotional responses were the most common - 84%...

Medical training involves both the learning of information and skills and because the practice of medicine can unintentionally harm individuals, supervision, and oversight. But as with riding a bike, to be truly autonomous, at some point, one has the remove the training wheels and act on their own. A study in JAMA Internal Medicine looks at the effect of closer supervision on medical error and autonomy. When residents care for hospitalized patients they participate in two team meetings, the first with supervising “attending” physicians who discuss patients and treatment plans; the second, without those supervisors, where the work of patient care is allocated, discussed and advanced – work rounds.

The study carried out at Massachusetts General Hospital internal medicine program...