Welcome to the latest iteration of Grand Rounds. On behalf of the greedy rapacious pharmaceutical industry, I’m glad to be hosting this week. Unfortunately for everyone, the research end of the G.R.P.I. is not immersed in the ceaseless flow of promotional swag that the medical community has come to know us for. So for you practitioners dropping by today, enjoy a rare chance to interact with the drug industry with no free samples, pens, calendars, or trips to Martinique. Never been there, myself. . . (gazing at ice-covered yard). . . OK! Where were we?

Via Red State Moron, here’s a real clinical practice problem for everyone to take a crack at: what should be done for someone who’s not just endangering herself? (I’ve worked in diabetes drug discovery, and those glucose readings definitely qualify). Unbounded Medicine has an unusual clinical case for you to unravel as well. (Hoofbeats! I heard ’em!) And Intueri has a disturbing series of encounters with a psychotic patient.

Over at DB’s Medical Rants, there’s been a series of posts on “doctoring” – dealing with the different kinds of patients and understanding what they are (or may not) be trying to tell you. Here’s the latest installment. Barbados Butterfly works (gently) with a very small patient indeed, and at Mr. Hassle’s Long Underpants, a patient who’s been through a lot worse provokes some thoughts (note the new domain name there, too!)

On the other hand, last week’s host (Dr. Charles) has a handy guide which will allow any bozo from out in the parking lot to see a few patients and get away with it. Hey, I wear a white coat myself at work, and with this beard I’m pretty sure I could carry it off, especially for his offered $10 per head.

Working in the drug-discovery end of pharma, I don’t deal with the clinical trials part of the industry too often. (Not nearly as often as I’d like is a better way to put it, I guess). But Amy Tenderich at Diabetes Mine has been invited to join a trial of a new inhaled insulin, and is weighing the offer. (Hey, at least we know what insulin does, as opposed to some other pharmaceutical brainstorms I’ve been involved with). Also on the receiving end of medical care, Oasis of Sanity experiences physical therapy as a therapee.

We live in an odd country, both in terms of the rest of the world and (especially) in terms of the human historical record. “Too much to eat” hasn’t been a big problem for much of the species until very, very recently. So, asks Jon Schnaars at Treatment Online, if children are indeed getting too much high-calorie food, whose fault is it? The people who make them, or the people who feed it to them? And Insureblog points out that the consequences are financial as well as medical.

Matthew Holt of the Health Care Blog is now writing a weekly column for a site called Spot-On, and here he brings its readers up to speed on how health insurance in the US ended up the way it is. Meanwhile, Fixin’ Healthcare wonders about the transition from a system that treats illness to one that prevents it. As for the system we already have, Healthy Policy runs into someone who doesn’t seem to have a clue about just what that system is and what it means, and Sound Practice has a warning about coming changes in Medicare reimbursement costs. As A Chance to Cut. . . points out, though, it could always be worse – much worse. A roundup of the week’s news in the hospital business is here at Hospital Impact.

Now, for some technology. Niels Olson is helping some MIT folks build a web forum for Tulane’s medical school, and would appreciate some input. Tim Gee at Medical Connectivity looks at the decision on when to buy the fancy new medical device, and when to delay. Sounds like the same problem most tech-driven fields are having. Early adopters have their own problems, though: Dr. Andy has a really disturbing account of a hospital’s experience with a new CPOE (computerized physician order entry) system. But if you want to see progress, take a look at HealthyConcerns and this piece about the latest outpatient facelift technology. Yikes.

Other medical news items this week are not quite as er, revolutionary as that last one, fortunately. Kidneynotes has the word on the latest CPR guidelines. Sumer’s Radiology Site points out a recent publication on virtual bronchoscopy. As someone who could only be on the receiving end of all these flexible fiber-optic probes, allow me to cheer such techniques on. The Clinical Cases blog has a roundup (with links) of the recent news that Beethoven seems to have suffered from lead poisoning. It’s not a metal that comes up a whole lot in drug research, I can tell you, and I promise everyone that I’ll do my best to keep it that way.

Many patients need kidney transplants – but where, exactly, are we to find all those kidneys to be transplanted? Interested Participant has some thoughts. DocSurg has a look at a study on the safety of recycling unused polypropylene mesh in hernia procedures, which could come in particularly handy in countries that can’t afford to throw the stuff out. In just some of those places, notes Aetiology, there’s a strange epidemic of psychotic symptoms – an infectious disease, or not?

Chiisai Tokoro has a piece on the recent peanut allergy death by kissing. Count me with those people who’ve wondered why we never used to hear about this sort of thing. My guess is that (in places like the US) other sudden causes of death have decreased enough over the last hundred years, and we’re finally noticing the low-probability ones. Dr. Emer has a look at one of those (fortunately) decreasing causes: what really happens during stroke. The Health Business Blog has a look at celiac disease, which seems to be something you hear about a lot more in recent years.

Of course, reading my site regularly and linking back to it is always recommended (let go of that keyboard it’s – aarrgh!) Ahem. Jim Hu at Blogs For Industry noticed a piece I’d done on odd fungi and the like that are able to live in laboratory solutions that you’d swear were hostile to life, so he saw me and raised me: distilled water. We’re not the dominant life form on the planet, y’know. Of course, the news would look a little different if it were covered from the dominant life form’s perspective – Dr. Tony provides the latest bulletin.

The Christine Maggiore HIV case made clear how many people think (for no particular reason) that they know something about pathology. Trent McBride at Catallarchy actually does, though, and found a recent news treatment of the case that actually shed some light on the subject. Orac of Respectful Insolence has been covering this case as well. As it turns out, he was watching the same show, and has some penetrating comments on it, too. And Medpundit has a look at the first new medicine for gout in decades, and wonders if it’s been worth the wait or not. (Now there’s a disease indication I’ve never worked on. . .) Doc Around the Clock has a link to a recent video (Consumers Union, I think?) that whacks my industry over the head, but in a pretty funny way. Hey, at least there’s not a cartoon version of Marcia Angell in there.

Prospective immunology is one of those well-worked-out sciences, rather like organic chemistry on its better days, so Gruntdoc looks at how well this year’s flu vaccine matches up with the real antigen profile. Sticking with molecular biology (as a pharma researcher, I have little choice; those people have us hostage, y’know) Genetics and Health has a look at the recent sequencing of the dog genome, and what it could mean. We’re keeping an eye on that over here, too, since dogs are one of our key toxicology models – never forget, “drugs kill dogs and dogs kill drugs”. The Biotech Weblog has a piece on a recent genetic linkage to Alzheimer’s Disease, which is an area that can use all the help it can get (says someone who tried for seven years to develop drugs for it).

Emergiblog has some requests – polite ones, really! – for how to work with the nurses in the ER. And Ian Miller has a mood piece set outside a rainy Australian emergency room.

And finally, now that I’ve helped to demonstrate just how many active med-blogs are out there, there’s a call for a basic ethical code for health and medicine bloggers at the Medical Blog Network, and the recent NIH questionnaire is answered. (I didn’t get one of those, come to think of it).

Well, that wasn’t so bad now, was it? I appreciate the volume of submissions that came in this time, and I’ll be glad to host another Grand Rounds when Satan throws snowballs real soon now. Actually, this was fun to do, and I’m glad that we mere PhDs get a crack at it. Thanks to everyone who took the time to contribute, and remember to send links to Medpundit for the next edition.

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