A global health controversy erupted this summer when the prominent scientific journal Nature ran an article entitled “HIV trial attacked.” Within, commentators squared off over whether a huge ongoing study provides suboptimal and thus unethical treatment options to mothers with HIV in the developing world.
To read more, see my new post at Health Affairs.
I could tell I was being watched as I walked into the neonatal intensive care unit.
I took off my white coat, folded my stethoscope in a pocket, and hung the coat in a closet. In a nearby sink I washed my hands for a full minute, scrubbing between each finger before drying my hands.
I approached a high-tech isolette and leaned in to examine my patient, the pink baby within.
A voice stopped me: “Doctor!”
There were footsteps behind me. I pulled back and thought, what did I miss? I retraced each step. Coat. Stethoscope. Hands.
The desk clerk pointed a finger. “Your ring, doctor. You forgot to take off your wedding ring.”
She was right. I rolled my eyes, pocketed my ring, washed again, and went back to my little patient.
Small interactions like these make hospitals safer for children by reducing rates of hospital-acquired infections. Now a new article shows exactly how much safer.
To read more, click on my story over at The Atlantic.
Messaging about the prevention of HIV transmission is the ultimate act of cross-cultural communication. In our haste to save lives, it can be easy to make blunders.
Recently, a cross-cultural assumption about African sexual practices that was the focus of prevention messaging has been called into question. That assumption has to do with intergenerational sex, and on closer scrutiny we are reminded about how important it is to be modest in the face of cross-cultural communications.
Read more in my new post at Scientific American guest blogs.
People who contract HIV once can contract it again, often through the same risk behaviors that led to the initial infection. A long-standing question has been whether getting infected with a second strain of HIV leads to more rapid HIV disease progression than infection with a single strain.
To this point, a 24-year-old man who has sex with men recently asked me, "Doc, I already rang the bell, why do I care if I get HIV again?"
My answer is at TheBodyPro.
The Internet has lit up with news of a burgeoning Ebola virus outbreak in western Africa and the few cases that have trickled through to the United States.
This weekend, TV helicopters beat the air above the ambulance of a US doctor stricken with Ebola and transferred to Emory's high tech containment center for care. Viewers worldwide surely struggled to figure out how this was interesting, and why they were suddenly thinking about OJ Simpson.
Was this the beginning of the end? We'd all seen Gwenyth expire in Contagion so were we next?
Fortunately card-carrying epidemiologists have come to the rescue not with wonder drugs or martial law, but with the facts of the situation: this is a small epidemic largely confined to the developing world and unlikely to be a big deal in the US. It is, however, another reminder that the public health infrastructure in Africa has been neglected. They tried valiantly to placate, to reassure, and to divert the public's fickle attention back to the scarier infectious epidemics that afflict millions every year.
Amid the hubbub, I was proud to be quoted in Erin Gloria Ryan's new Jezebel piece, "The Paranoid Hypochondriac's Guide to the Ebola Outbreak." Should I be worried that the other folks quoted in the article chose to remain anonymous? Heck no! I'm going to go enjoy my ten seconds of fame, knowing full well the firestorm of corrections and trolling will begin soon. Ten. Nine. Eight...
Education has entered the era of Big Data. The Internet is teeming with stories touting the latest groundbreaking studies on the science of learning and pedagogy. Education journalists are in a race to report these findings as they search for the magic formula that will save America's schools. But while most of this research is methodologically solid, not all of it is ready for immediate deployment in the classroom.
To read the rest of my new article, written with the lovely and talented education writer Jessica Lahey, visit The Atlantic.
I stopped breathing when the syringe filled with bubbles. The resident and I stood silently for a couple of breaths, watching the syringe fill with more pink bubbles each time the patient’s chest filled with air.
“Shit,” said the resident, taking the syringe from my hand. He withdrew the syringe from the vein, and applied pressure with a gloved hand. I watched, my own carotid pulsing at my chin.
A STAT chest x-ray confirmed our worst fears...
To read more, visit my article in the Living Hand medical humanities section of the Journal of General Internal Medicine.
The MERS coronavirus has now spread from the Middle East to home town USA.
Since both US victims of this resurgent respiratory virus - one in Indiana and another in Florida - are healthcare workers, all eyes have turned to nosocomial transmission. In some locales nosocomial transmission has outpaced the former frontrunner for the MERS transmission prize: camel spit.
Proper infection control, therefore, is hugely important. The CDC recommends special airborne infection rooms, masks, eye protection, gowns and gloves. I remember taking these precautions when the SARS epidemic came through town. In some cases, patients were incredibly sick and it was scary; other times folks with SARS had the sniffles and we made a big deal over very little. Let's hope that as we learn more about MERS, the early reports of 30% case fatality will turn into less sobering statistics.
Along the way, it's good that the macho culture of medicine has been changing. When I was in training, it was common and even admirable for doctors to work sick. I remember idolizing a medicine resident who did morning rounds with an IV pole at his side. Yet now we know - how could we not have clued in then?! - that this risks spread of infectious diseases to our fragile patients.
In a nice story just out today titled "Second MERS Case Shows Hospitals Are Ground Zero for MERS," Maggie Fox of CBS News quoted me and others about MERS infection control.
In a new blog post at the HIV-related web site The Body, I recall the last few years with an HIV-positive patient, Steve. Steve and I started out with the treatment of sexually transmitted diseases and delicate discussions of safer sex. Now, Steve is on effective HIV treatment and we talked most recently about his honeymoon plans. It has been really fun to watch Steve grow, and change, and thrive.
DESPITE the intensely personal moments that happen in hospitals, patient privacy can be elusive. Hospitals are multimillion-dollar corporations that look like shopping malls and function like factories. Doctors knock on exam room doors to signal they are about to enter — not to ask permission. The curtain that encircles the hospital bed always lets in a crack of light.
Yet we do expect some degree of privacy in hospitals. We trust doctors with our secrets in part because they take a 2,000-year-old Hippocratic oath to respect our privacy, an oath enforced by laws like the Health Insurance Portability and Accountability Act. But sometimes, doctors have to weigh patients’ privacy against their health and safety, and that’s when things get complicated.
My hospital, where I am chairman of the bioethics committee, recently wrestled with the question of where patient and family privacy ends. Nurses in the neonatal intensive care unit (N.I.C.U.) worried that a premature infant, whom I’ll call Rickie to protect his identity, was being harmed by his parents.
Read my full op ed at The New York Times.
Tim Lahey, MD MMSc
An HIV doc and clinical ethicist, I write about medicine, ethics, and HIV here and in The Atlantic, Scientific American, TheBody.com, Health Affairs blog, The Conversation and The New York Times.
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