Friday, February 29, 2008

Men and Women, different?

Tonight we have the pleasure of seeing Walt Larimore, MD, talk about "His Brain, Her Brain." I've run into a bunch of things recently on this subject, and thought I'd list some resources for you.

1. Great YouTube video on "Two Brains." Everyone I've shared this with loves it.
2. Walt's new book, His Brain, Her Brain, How Divinely Designed Differences can Strengthen Your Marriage
. (I think it's at Tattered Cover, or you can Amazon it.)
3. Another pair of books, For Men Only and For Women Only, gave to my daughter and future Son-in law. Terrific resource, easy to read, funny, dead on.
4. Any of the Men are from Mars, Women are from Venus books. I'm reading the most recent, Why Mars and Venus Collide. Interesting discussion about the differences between testosterone and oxytocin as stress reducers in male and female physiology.
5. Dennis Prager, radio talk show host, often discusses the differences between men and women and is sympathetic to both. He for example has a theory that the essential male nature seeks sexual variety while the essential female nature seeks intimacy and closeness, and how marriage has to occur for both to grow up. He also has a great saying: "Only people with advanced degrees from Ivy League institutions are stupid enough to believe that men and women are basically the same." He is on the web, on 710 AM during the day, and you can podcast his stuff. The weekly Ultimate Issues Hour and Happiness Hour broadcasts are wonderful, and he is planning a Man-Woman hour soon.



Monday, February 11, 2008

Guilt and Pain

Guilt and Pain have a lot in common. Both are unpleasant, both are sometimes unnecessary, and yet both sometimes keep us out of trouble.

Pain often acts as a warning. We know not to touch a hot stove, run a knife over our hands, or drink bad water because we know it will hurt us. Pain prevents us from overstretching muscles, and it can let us know that there may be an internal problem like gallstones before they become dangerous.

Pain also, though, may not be so useful. The pancreatic cancer patient in pain doesn't need the warning. What warning does fibromyalgia pain bring?

We treat pain, trying to be wise and not suppress the pain that is a warning, but at the same time treating the pain enough to prevent useless suffering.

I think of guilty feelings as a sort of spiritual pain. In its useful form, guilt helps to prevent evil, hurtful, harmful, cruel actions. In its gratuitous form, guilt can be as pathological as other types of pain, leading to avoidance of behavior because of imagined transgressions.

I think a lot of us moderns think of guilt as always pathological, always to be suppressed, treated, medicated. That idea ignores the useful, warning aspect of guilt/pain. Of course, the modern or secularist really doesn't have much to offer the guilty person. As John Patrick MD says, the treatment of guilt really involves words like confession, repentance, penance, restitution, and forgiveness rather than words like antidepressants, antipsychotics, or psychotherapy.

Do you or your patients have guilty feelings? Perhaps the treatment really is spiritual?

Sunday, February 03, 2008

Kidney Thefts in India

Seems a ring of docs and others have been kidnapping poor Indian people and forcibly taking a kidney from them. The story is in AP, here. We've heard similar stories from China, where there are rumors of prisoners being used as organ donors.

Terrible stories. I guess I have a little caution to inject. While the stories may be true, how big a moral leap is it from forcible kidnapping and surgery to just murdering the poor guy and getting two kidneys and a heart? I wonder if that is going on, triple the profits? And if it is OK to kidnap someone and do violence to them, removing organs, how long until they decide it is just cleaner to take this homeless person and have them disappear? You know, no witnesses...

Blood Donor Madness

The national CMDA called me to do an interview about this article. Seems the president of San Jose State University has suspended all blood donor drives on campus. Why, you ask? Because the FDA regulations discriminate against gay men and the college has a nondiscrimination policy.

I'm a pathologist and we oversee blood banks and donor centers. We nearly always have a blood shortage in this country that puts surgical patients, cancer patients, and victims of trauma at risk. Back in the 70's the FDA put in a restriction on donations from gay men, or "men who have sex with men (MSM)". What an interesting coincidence that MSM is also "Main Stream Media", someone wasn't thinking!

The restrictions were based on observations that gay men had a higher statistical risk of having hepatitis which at that time was a big problem with transfusions. The advent of the HIV epidemic certainly did not give any reason to change the regulations.

FDA has a lot of restrictions on donors. IV drugs, taking or giving money for sex, travel to Malaria zones, having lived in Europe for five years (mad cow, don't you know), any contact with a hepatitis patient, tatoos, transplants, prior transfusions, prior receipt of clotting factor concentrates, all join men having sex with men as deferrals of donations for various periods of time. All of these have rational justifications based on risk, in a society that does not consider any risk acceptable.

Blood brothers. Blood is thicker than water. Washed in the blood. Blood sacrifice. Life-blood. Our very language shows the emotional impact of blood. Many more die from medication errors than transfusion problems, but I had to go on national news to explain why one patient died of an ABO mismatch at one of my hospitals. (It was a clerical error by a nurse in a hurry.)

Are all the FDA's regulations totally rational? Please. It's a Federal agency! Of course in light of the amazing recent advances in infectious disease testing for HIV and Hepatitis, it is possible that some of the restrictions need to be updated. It is a scientific and medical question, NOT a political one.

Back to San Jose State. They claim to have talked to AIDS experts, blood bankers, etc. before making their "momentous" decision. Apparently not looking like they might be discriminating is more important than helping the sick and hurt in their community. Those people, of course, will weaken and die silently in ICU's and ER's and this guy won't ever know that his feel-good policy caused their suffering. Is it arrogant of me to think that his judgement day could be, uh, real bad?

Dangers in Oral Sex

We as a society have laid aside centuries of wisdom, thinking we know it all. One of the things we decided probably in the 60's was that oral sex was safe, entertaining, you couldn't get all those awful diseases, couldn't get pregnant.

Now it looks like despite decreasing smoking and alcohol-related oral cavity squamous carcinoma, HPV-related oral cancer is increasing to take its place. I wonder where us guys are getting HPV from?

I've actually, as a pathologist, recently seen a tongue squamous cell carcinoma in a 19 year old woman! She did not smoke and was in training to become a singer. I've seen a few carcinomas in men with no smoking history, too.

Sexual guidelines are like guardrails to keep us safe. I'd be the last to say to follow all traditions blindly. Remember, however, that our ancestors were just as intelligent as we are and we ignore their observations and experience, which after all is the definition of tradition, at our peril.

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