Enough is Enough: Cruise Goes from Bizarre to Retarded

What is going on in this world? It's not enough that Tom Cruise has more money than most small countries, but now Maverick is using it to exploit some scientology-based, bullshit treatment for 9/11 workers.

And no one is writing a thing.

The self-proclaimed president of the L. Ron Hubbard fan club (aka Hubheads) is on a fundraising mission as co-founder of the New York Rescue Workers Detoxifixation Project. Sounds legit, huh? They are advocating an untested, unreported, pseudo-medical, regimen created the by Hubbard, himself, who is about as qualified to treat toxic exposure patients as Snoop Dogg. Tickets for the April 19th gala, which will star Cruise, run as high as $100,000 for a table for eight.

And still, no one is saying a thing!

It would be one thing if Cruise preached this crap in Los Angeles where star status sometimes takes precedence over common sense and practical thinking. But he is spewing this garbage all over what I consider to be the greatest (and toughest) city in the world - a city that suffered a great tragedy but rebounded magnificently. A city that is world-renowned for its medical prowess and internationally-touted physicians and surgeons. A city that does not hide its opinion or tolerate crap from anybody.

And despite all of that - not a peep.

This detoxification process that Cruise is hawking consists of high doses of niacin, moderate aerobic exercise, intermittent dry saunas to "force sweating", and of course, vitamin supplementation. As medically sound as it seems (can you hear the sarcasm?), the detox regimen has never, ever been reported to yield any positive health effects. It is not cited in PubMed, you will not read about it in any medical journal, and it has never been reported in a case series, let alone a randomized control trial, demonstrating any therapeutic or clinical benefit.

Yet no one has come out publicly to say that this might even be harmful to men and women who made a great sacrifice for our great city.

Well, let us be the first with a medical background to shout loudly that this is a huge load of Scientologic excrement. If Travolta and Cruise and all of the other Hubheads want to donate money to the 9/11 workers, why not consult with the Mayor and ask where their dollars could be most helpful? And why hasn't Bloomberg, who usually does not hesitate to share his pragmatic opinions, weigh in on this matter?

It is completely irresponsible to offer a sham therapy in the hopes of converting some desperate folks and Cruise should be admonished for hocking his Scientologic mumbo jumbo. If he could offer even a shred of scientific evidence that this would benefit 9/11 workers we would not be so outraged but the only proof he can offer is his vacant grinning face and a wealth of scientology preachings.

Medicine in this country has shifted over the past twenty years to lean heavily on the evidence and base treatment on what has shown clincal benefit in large, multicenter trials. As physicians we have a responsibility to have an open mind but always fall back on the evidence. I have no problem with holistic forms of therapy and even placebo has shown actual clincal benefit in many forms - but using a hypothetical detoxification program to recruit new members and make promises of wellness reeks of dishonesty and ignorance.

So we said something.

The Price of Doctoring

What the f$#% is up with the ever-increasing price of study materials, test prep courses and the exam fees? Can we get a break anywhere? The test-taking business has become a lucrative for-profit industry that has ended up costing medical students and residents, already strapped by ridiculous loans, huge amounts of money.

Aren't preparation for national Board exams and USMLE tests the responsibility of medical schools and residency/fellowship programs? That's the deal we make with our benevolent program directors - we work like dogs for crappy pay and they provide us enough education to pass our tests. Lately, one party is not living up to their half of the bargain - and last time I looked residents' pay still sucked.

Prior to becoming the financial boon that it has become, the purpose of these tests were to assess the knowledge base of graduates and assure that those graduating physicians were studied enough to make reasonable decisions. Now they have become just another money-draining requirement along the way to becoming a "real" doctor. Why we need to pay hundreds of dollars just to take the test and thousands more for the numerous books, courses and additional fees is beyond me. Essentially, we're paying to be tested after paying to be educated.

When the vast majority of medical trainees are taking out more than $100,000 in loans just to attend medical school and then scraping buy during residency, they should not have to pay additional money out of their own pocket just to pass a test.

Perhaps no one ever talks about this because so many professors actually get paid by these test prep courses to teach these prep classes. But education has become exhorbitantly expensive and many of the readers of our website, an online community of medical students and residents called StopPagingMe.com, have echoed similar sentiments. Which is a nice way of saying that they don't stop bitching about paying $700 to take their medical licensing exam.

One partial solution could lie in our fantastically logical idea we fondly named: The Generous Professor Series. What is this, you ask? We have begun asking our (and your) favorite professors to make donations in the form of Boards-style test questions in their respective specialty. Of course, we credit them for their generosity and they are listed as one of the authors of this altruistic endeavor. When we have gathered enough questions in a particular residency or medical school specialty (e.g. anatomy, pathology, internal medicine) we will sell them online for super-cheap and force all of those overpriced study guides and Q&A books to match our quality and our price. This will get done much faster with your help, so if you think you're into the Generous Professor project, click here to WRITE us and start contributing questions ASAP.

The outcry against pharm reps has been a grassroots success against a major industry trying to penetrate the medical training field. Our opinion aside, a united medical student and resident voice has shooed may reps right out of their hospitals. Perhaps affordable and responsible education should be the next great cause. We don't even have to give up free lunch for it.

Cure for Your Match Day Blues

Here's what happened when we searched Google images for "The Match". Hopefully, you felt - not necessarily looked - like this guy on Monday, and not like the pic we didn't post of the girl with her head in her hands.

On Monday, March 12th, 4th year medical students all over the United States logged on to find out whether they did, or did not, match into any residency program.

For those of you who did not raise your arms with joy, keep the faith - at least you're not that dude in the picture. Also, if you want it bad enough, there are plenty of things you can do to improve your chances of matching next year or even filling an OpenSpot later on this year. Here are 4 courses of action to start:

1. Find somewhere to do research. But do your research first. Unfortunately, toiling under the assistant biochem tecaher's assistant most of the year will not serve you well. However, working for the assistant program director may yield great results.

2. Call Around - Every program that has OpenSpots does not necessarily advertise them well or enter the scramble or even try very hard to fill them. So, how hard is it to make 25 phone calls to programs in and around your area and in your specialty. Also, you might consider calling programs from a specialty that you could see yourself doing but may not have been your first choice.

3. Call a Trusted Mentor - This might be a good time to call that teacher or professor in your life that has some connections and work it! You would be amazed how much can change with a phone call from a friend. Swallow your pride, hide that ego and use every possible connection you have to see if you can get a break. Believe us, others did it!

4. Go to OpenSpots.com - Yeahg, it's a shameless plug but it's the most helpful webiste out there if you are post-scramble and pre-unemployment. We spend all the time finding these poorly advertised spots and you can view them for a paltry fee (just enuf to keep our servers functioning).

Depp's Daughter Recovering After Foot Puncture Infection

The Associated Press is reporting that Johnny Depp's 7-year-old daughter with longterm partner Vanessa Paradis is "doing much better" after a nine day hospital stay in London.


Several articles report that Lilly Rose was originally admitted for "blood poisoning" after stepping on a rusty nail at Depp's country home.


'Blood poisoning?' Another one of our favorite media pseudo-medical phrases. Why can't they use bacteremia, or infection, or even blood infection.


We decipher "blood poisoning" to mean bacterial infection disseminated to the blood causing a sepsis like picture. And considering the circumstances, i.e. rusty nail, one would have to assume that the offending bug would be Clostridium tetani, or tetanus. Or is it?


Actually, probably not. While more than 90% of pedal puncture wounds result from stepping on a nail. The most common organisms implicated in penetrating wounds are Staph aureus, beta-hemolytic streptococci, and then various anaerobic bacteria. Also, Pseudomonas aeruginosa is often responsible for infection when the injury is due to object penetration through shoes and socks.


Importantly, puncture wounds have the capability to infect deep spaces of the foot, including bones, joints, tendons, and deep fascia, and serious complications can arise. Therefore, the depth of penetration is hugely important.


The signs of more extensive injury are those typical of any infection, i.e. redness, warmth, pain, and swelling. If the offending object is still partly in there, e.g. broken glass or sea shell, it must be removed and the wound must be extensively debrided. Empiric ABx should be started to cover the most common bugs, i.e. S. aureus but anti-pseduomonals should be strongly considered as psudomonal osteomyelitis/-chondritis can be catastrophic.


It is our suspicion that Depp's daughter probably was treated inadequately or conservatively at first or perhaps even his the injury from her parents as kids can do and then presented 2-3 days after the injury with a warm, red, swollen foot. Imaging studies were performed for sure which included plain old x-rays to look for air and possibly a CT. CBC, Chem, and ESR were quite important in documenting infection and blood cultures were probably being sent every time the little one spiked a fever.



When she manifested systemic evidence of infection, broad spectrum IV antibiotics were certainly started and the wound was opened, any pus was removed, and the wound was most likely left open to heal on its own rather than sew it shut again.


Typically, in systemic bacterial infection, i.e. bacteria in the blood (bacteremia) patients will experience signs of sepsis: hypotension, tachycardia, fever, increased WBC. In addition to stroing anti-microbial therapy, IV fluids were probably used and maybe even pressors for blood pressure support.


This is a very scary situation for a little girl and her parents. We are happy to hear that she is out of the hospital and recovering. An interesting infectious disease topic nevertheless which proves our mantra: It sucks to be an interesting patient, but it's great to have an uneventful recovery.







Baldwin G, Colbourne M: Puncture wounds. Pediatr Rev 1999 Jan; 20(1): 21-3[Medline].


Patzakis MJ, Wilkins J, Brien WW, Carter VS: Wound site as a predictor of complications following deep nail punctures to the foot. West J Med 1989 May; 150(5): 545-7[Medline].

Top 5 Differential Diagnoses for Britney's Break

Despite the appearance of physical health - at least, until she shaved her head - Britney is not well. To enlighten our writers and readers we decided to enlist the help of an Ivy League-trained clincal psychologist for this special edition of Celebrity Illness. Enjoy.

1. Substance Abuse Disorder - Addiction. That’s right, you guessed it. Like we said about so many young celebs in this article: if it smells like drugs, and looks like drugs.... it’s drugs! Coke, Meth, Crack, X, Alcohol…whatever. That’s my call.

2. Borderline Personality with Psychotic Features - Altogether likely. Given the labile mood, strange and extreme behavior and chronic emptiness coupled and with pre-morbid narcissism, pattern of unstable relationships and shallow affect, BPD with psychotic features is definitely a contender for the diagnosis. It is almost a requirement for to be a Hollywood/performer type.

3. Psychotic Disorder NOS - Purely based on strange behavior and poor judgment, we don’t actually know if she has lost touch with reality (like hearing voices, seeing and/or smelling things, delusions). Unlikely since she is a bit old for a psychotic break..though still within the age range for women.

4. Postpartum Depression with Psychotic features - Britney did just have a child within the past six months so we can’t totally remove it from the differential; it is unlikely because this diagnosis is usually diagnosed within the first 6 weeks postpartum…and it is kind of like she doesn’t have any children at all…so what is she depressed about? Hormones.

5. Bipolar Disorder - High on the differential because it is so hot and hip these days with the famous set. Britney’s impulsive behavior..partying (i.e. self-medicating), flying all over the country, checking in and out of rehab within a day, hyper -sexuality, shopping, irritability. True bipolar will generally see an approx 3 months manic period followed by deep depressive period for approx 9 months. So, we could be in the downward spiral anytime.

Top 5 Most Annoying Hospital Noises

1. Telemetry – Beep, beep, beep, beep, Booonng! Booonng! Booonng! Annoyed yet? Multiply that times 400,000 and you have recreated the telemetry floor experience. Sitting next to alarming monitors and trying to write your notes is almost as torturous as resisting the urge to put your foot through one of them.

2. The Unanswered Phone – Will no one pick up that friggin phone? Nurses and ward clerks have developed some weird defense mechanism to a ringing phone. Not only do they lack the natural guilt that should go along with ignoring someone’s call but they almost relish the annoyance that others feel after the 9th, 10th and even 11th ring.

3. The Repeating Patient – I know, this one will not make the Top 5 Politically Correct list but at least we’re honest. Whether it is the aye-fibbers (“aye-aye-aye-aye”) or the Help-Me’s (no explanation needed), hearing a patient yell anything over and over and over again often makes you want to gauge your own eyes (or ears) out. If you’re lucky, they might throw in an inappropriate phrase occasionally to keep you on your toes.

4. Suction – Do we really need to elaborate on this one?

5. Pager – This website didn’t get its name for nothing. Go ahead and switch the beeper tone all you want, it won’t help. Even more annoying is when someone’s pager goes off in grand rounds and everyone in the room checks their pager, even if they are 100 yards away. Putting your pager on vibrate solves all of the above problems, except of course the annoyingness of being paged. We fear the day of downloadable pager tones.