Toxicology: Not a CSI Be RIght Back With the Results After the Commerical Break Process

Rest In Peace, Ms. Winehouse- I'll always love your music.

In light of Amy Winehouse's sudden death on Sunday and inconclusive autopsy on Monday, toxicology tests are now going to be performed to determine the young singer's cause of death. But many have been wondering why the results will not be known until a month later, at the earliest. Scotland Yard covering up? Probably not, as the simple reason is that toxicology tests take quite a long time. Besides toxicology tests being multi-step analyses, Douglas Rohde, supervisor of chemistry and toxicology at the Lake County Crime Lab in Ohio, describes the process as, "searching for five black marbles in a pile of 1 million white marbles." For more information regarding toxicology tests and Amy Winehouse go here.

Doctors Behaving Badly? William Heisel's Antidote

If you are looking for an interesting read healthcare reporter William Heisel's blog: The Antidote provides just that- the antidote. I forgot how I stumbled onto his page, but nevertheless it has been ctrled +D into my bookmarks. He has an interesting series of articles regarding medical scandals entitled "Doctors Behaving Badly". Although we often find such reads as interesting and as fleeting as a good celebrity gossip, I feel that there is perhaps more to learn from these situations that have occurred at the expense of society in order to improve it- and Heisel does address this fact too (a main reason why I enjoy his articles).

Krokodil: The Russian Deisgner Drug that Eats You from the Inside Out

Though Krokodil, the street name for desomorphine,was discovered about four years ago, it has recently spiked in its use among the youth of Russia. It is viewed as a heroin addict's last choice when cash is low; it can be made simply with over the counter codeine headache pills, iodine, and few other household chemicals to produce a high that lasts about 90 minutes (the cooking time is about an hour- many addicts describe their addictions as 24 hour jobs that alternated between cooking and shooting the drug). The cheapness of producing krokodil has increased the problem among the poorest of neighborhoods. But while cheap, the household desomorphine is a crude toxic product that when shot into tissue (a missed vein) immediately causes abscess formation and when shot into the blood stream causes gangrene and tissue necrosis over time- thus the name "Crocodile". With such resulting complications the average lifespan of a krokodil addict is anywhere from one to three years. Although there are survivors, almost none escape the addiction without permanent damages both physiologically and psychologically. Also the resources such as live in rehab centers are few in number and are mostly run by church organizations and not the government.

The trademark bite of the krokodil

The recent krokodil problem comes on top of Russia's longstanding and widespread problem with heroin addiction (30,000 annual deaths from heroin compose about 1/3 of the international deaths from heroin). In response, the Russian government has made the possession and production of krokodil illegal,  but it still has not made codeine a prescription drug. This has many people wondering if the government's inaction is being swayed by Russian pharmaceuticals who are not so supportive of a restriction on a product whose sales have skyrocketed. I'll be sure to keep my eye out for developments in this Russian drug addiction epidemic. For more information, go here and here.

Annals of Internal Medicine: The Wrong Patient

What do you mean I'm scheduled for open heart surgery?

This is an interesting article I stumbled upon a few days ago. It's a quick read (only 8 pages) on research done regarding how complex healthcare organizations (hospitals) can make mistakes such as performing the wrong operation on the wrong patient. The study follows the case of two patients, Joan Morris and Jane Morrison, the former being a patient who was arranged to undergo a cerebral angiography but mistakenly underwent an invasive cardiac electrophysiology exam the next morning that was scheduled, in fact, for the latter. We might go, "How could they have not possibly seen that the patients' names, albeit somewhat similar, were not the same?" We also might go blaming the nurses, doctors, and even the patients who all seemingly suffered from a bad case of bad communication-itis in this case. But the study sheds light on how such an "obvious" mistake really isn't that obvious at all in practice. Throughout the study there were a total of seventeen discrete mistakes documented that were made within the time from when Morris was taken in for the study to the point where the staff realized that they had operated on the wrong individual. Ultimately the study demonstrates that it is the collective culmination of all these individual errors that led to the operation on the wrong patient, and that none of these mistakes by themselves could have resulted in such an error. The study further discusses lack of systematic protocol for admitting patients in some hospitals and how the "culture of low expectations" leads hospital staff to overlook the details that could have prevented such scenarios from happening. For the full study, go here.