We may be seeing the end of the ubiquitous Nalgene bottle, like the one sitting on the corner of my office desk that I drink from continuously throughout the day. The Canadian government is about to declare bisphenol-a, or B.P.A, a toxic chemical:

The Nalgene is dead.

B.P.A. is widely used to make polycarbonate plastics, which are rigid and transparent like glass but very unlikely to shatter…Because animal tests have shown that even small amounts of the chemical may cause changes in the body, however, researchers have focused on food- and drink-related applications of B.P.A., like the popular Nalgene brand beverage bottles. [Link]

The US government may be moving in the same direction, albeit more slowly:

… a draft report from the United States Department of Health and Human Services’ National Toxicology Program endorsed a scientific panel’s finding that there was “some concern” about neural and behavioral changes in humans who consume B.P.A. [Link]

The debate about the health impact on humans will probably continue for a while, but one way or another, Nalgene’s days as the dominant water jug are over as people decide that they’d rather be safe than sorry. I’m probably going to be one of them, since I don’t have the expertise necessary to evaluate the health claims myself.

So how will I keep myself hydrated? Well, I’m thinking of rocking it old school. What would be better than a stainless steel jug and tumbler to keep in my office? You know, the kind with the rough edge that you can feel on the underside of your lip as you drink the water with the slightly metallic tang? Nalgene never induced nostalgia like this.

Now if only I could replace my office chair with a charpoy …

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Recently, I’ve read three articles by brown doctors (Darshak Sanghavi, Atul Gawande, and Sandeep Jauhar) all of which claim that there is something systematically wrong with the practice of medicine today. All three argue that we pay too much and get too little; Gawande goes the furthest by claiming that doctors and nurses routinely fail perform simple tasks they claim to be carrying out, thus endangering lives [Thanks Rahul].

Jauhar argues that poor incentives lead to gigantic amounts of waste in almost all medical practices:

In our health care system, where doctors are paid piecework for their services … overuse of services in health care probably cost hundreds of billions of dollars last year

Are we getting our money’s worth? Not according to the usual measures of public health. The United States ranks 45th in life expectancy, behind Bosnia and Jordan; near last, compared with other developed countries, in infant mortality; and in last place … among major industrialized countries in health-care quality, access and efficiency. [Link]

The other two go deeper than just the reimbursement system. They argue that doctors are not doing the routine tasks of their profession well, which reduces the quality of health care across the board and even kills patients:

… a team of researchers … reviewed children’s medical records from 12 major American cities and found that fewer than half of children got the correct medical care during doctor visits…A similar study of adult quality of care was published in 2003 with similar results. [Link]

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This story broke last week, but I’m just starting to catch up on it now: in Las Vegas, more than 100 people have tested positive for Hepatitis C and HIV after being treated at the Endoscopy Center of Southern Nevada. Apparently, investigators have found that anesthesia needles were re-used on different patients without adequate cleaning, and in some cases, portions of the same dose of anesthesia was injected into multiple patients.

The person who founded the Center, who has also been its majority owner, is a doctor named Dipak Desai. Three class action lawsuits have been filed against the center, with more than 100 plaintiffs total. Doctor friends tell me it might be the biggest medical malpractice case in recent history (I have not been able to directly confirm this… any docs in the house?).

I haven’t come across anyone saying that Desai himself gave the order to use the syringes this way, though I gather that the anesthetists employed at the Endoscopy center were nurses rather than doctors (might be a little corner cutting there). Since the investigations started, the nurses employed at Desai’s clinics have given up their nursing licenses. As of now Desai has not given up his own medical license, though he has voluntarily agreed to not practice medicine until the investigations are complete. My own inclination is to “wait and see” before piling on against Desai: he ran several clinics, and employed many other doctors, nurses, and technicians. This particular policy, which has caused so much harm to so many people, may not have come from him.

Before this mess started, Desai was a very well-respected doctor in the state of Nevada; he had a $1 million contract with the University Medical Center, where he directed the gastroenterology department; and the governor had appointed him to the State Board of Medical Examiners. All of that is not to excuse him; rather, it helps give us some sense of the scope of this case. Incidentally, when two doctors working at his clinics had earlier complained about unsafe hygiene with syringes, the claims weren’t investigated.

I’m curious to know what people think about this case. Obviously, it doesn’t reflect the practices of Indian doctors more broadly (and I come from a medical family, so I’m quite proud of the contributions Indian-Americans have made in medicine in the U.S.). But it does seem like a terrible tragedy, and for the employees of this particular Endoscopy Center, a huge mess. Continue reading →