This sort of combines two recent posts of mine (here and here):

Unlike the possibility that anti-depressants may cause suicidal ideas, [addition of] the black box warning has been followed by the deterrence of non-psychiatric doctors from treating depressed people. The rate of hard outcome suicide, not just thoughts, shot up. It had been dropping prior to that.

Supporting data. Related FDA overreaction.

From an otherwise excellent article about Rudy Giuliani:

Many, perhaps most, politicians probably value competence and probity somewhat less than devotion.

Uh, how about

Perhaps most politicians value competence and probity less than devotion.

Too much hyper-editing or too little? During a visit to The New Yorker, I used the bathroom. In the next stall, there were page proofs on the floor. The occupant was studying them.

Justin Wolfers gives seven possible explanations for New Year’s resolutions. Here’s another: They improve self-image. A Catholic who has gone to confession and been granted some sort of absolution has a better self-image after confession than before. Likewise, a person who wants to do X but hasn’t (a “sin of omission”) feels better about him- or herself after making a New Year’s resolution to do X.

Mark Liberman’s resolution — surely for a different reason. I can’t imagine making a New Year’s resolution — see busman’s holiday — but if I did it would be . . . to blog less. I enjoy blogging too much.

Happy New Year!

I previously blogged about ICU checklists. Atul Gawande has written another excellent article about them, this time an editorial in the New York Times:

A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

The government’s decision was bizarre and dangerous. But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is. . . . A checklist may require even more stringent oversight [than drug tests], the [OHRP] ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk — by exposing how poorly some of them follow basic infection-prevention procedures. . . .

A large body of evidence gathered in recent years has revealed a profound failure by health-care professionals to follow basic steps proven to stop infection and other major complications. We now know that hundreds of thousands of Americans suffer serious complications or die as a result. It’s not for lack of effort. People in health care work long, hard hours. They are struggling, however, to provide increasingly complex care in the absence of effective systematization.

Excellent clinical care is no longer possible without doctors and nurses routinely using checklists and other organizational strategies and studying their results. There need to be as few barriers to such efforts as possible. Instead, the endeavor itself is treated as the danger. . . . Scientific research regulations had previously exempted efforts to improve medical quality and public health — because they hadn’t been scientific. Now that the work is becoming more systematic (and effective), the authorities have stepped in. And they’re in danger of putting ethics bureaucracy in the way of actual ethical medical care.

Not “in danger of” — they have put “ethics bureaucracy” ahead of patient safety. In a big way.

Since the 1960s, this has been the standard conversation in dermatology offices:

PATIENT I think Food X causes acne. After I eat Food X, I break out.

DOCTOR There’s no link between food and acne, but if something bothers you, don’t eat it.

Here is Governor Huckabee campaigning for President:

“If you want to believe that you and your family came from apes, that’s fine,” Huckabee said after an early debate. “I’ll accept that. I just don’t happen to think that I did.”

The dermatologists made a mountain out of a molehill (the diet/acne question hadn’t been carefully studied). Huckabee made a molehill out of a mountain.

The last issue of the BMJ each year is a “Christmas issue” with humorous and seasonally-themed articles. This year’s Christmas issue has an article about how doctors tell family members that the patient has died. The execution is very flawed; for example, it’s hard to tell how fictional it is. I mention it because a study of how doctors actually do this and how it changes with experience — comparing young and old doctors, for example — would be fascinating.

At the reception before Ken Carpenter’s talk (”When Nutritionists Go Wrong” — meaning make mistakes) at the UC Berkeley Nutrition Department, I met Lowell Moorcraft, who maintains a calendar of events called Lowell’s Listings. It is a listing of events at or near the UC Berkeley campus that are free or almost free. He compiles it from about 300 sources, he told me. Scanning recent weeks, I was very sorry to see I missed a talk by Reed Hundt. There should be an emoticon for kicks oneself in the head. He spoke at Google last year. To make up for missing the Berkeley talk, I’ll watch it again.

More localese: The Berkeley Public Library posts a shockingly good video.

My phone rang at 6 am. Who would call so early? “Hello?” I said. No answer. “Hello?” No answer. I heard people talking. A Christmas song was playing.

I kept listening. Now and then someone speed-dials me by mistake — while their cell phone is in their pocket, for example. By listening it becomes clear who it is. I heard people talking but they didn’t sound like anyone I knew. It was too early. They must be in a different time zone.

I made out bits of conversation. Something about religion. Then a voice became clearer. A woman was teaching religion. “The Constitution is based on the Law of Moses,” she said. My phone said Conference Call, I saw.

It was no accident. My phone number had been chosen at random. It was religious outreach, like Mormons knocking on doors.

A new kind of advertising.