Alan Blum

A bedside conversation with Wilder Penfield

From July 1, 1975 to June 30, 1976, I served as an intern in internal medicine at the Royal Victoria Hospital in Montreal, Quebec after graduating from Emory University School of Medicine. At that time, interns were still given their own on-call room. My pre-morning rounds ritual consisted of a

What Does ‘Unpaid Consultant’ Signify? A Survey of Euphemistic Language in Conflict of Interest Declarations

Background and ObjectiveInadequate competing interest declarations present interpretive challenges for editors, reviewers, and readers. We systematically studied a common euphemism, ‘unpaid consultant,’ to determine its occurrence in declarations and its association with vested interests, authors, and journals.MethodsWe used Google Scholar, a search engine that routinely includes disclosures, to identify 1164 occurrences and 787 unique biomedical journal publications between 1994 and 2014 that included one or more authors declaring themselves as an “unpaid consultant.” Changes over time were reckoned with absolute and relative yearly rates, the latter normalized by overall biomedical publication volumes. We further analyzed declarations according to author, consultancy recipient, and journal.ResultsWe demonstrate increases in the use of “unpaid consultant” since 2004 and show that such uninformative declarations are overwhelmingly (801/865, 92.6%) associated with for-profit companies and other vested interests, most notably in the pharmaceutical, device, and biotech industries.ConclusionsDisclosing ‘unpaid’ relationships with for-profit companies typically signals but does not explain competing interests. Our findings challenge editors to respond to the increasing use of language that may conceal rather than illuminate conflicts of interest.

Iatrogenic hyponatremic seizures after routine pelvic ultrasonic imaging.

We report the unusual case of a woman who suffered grand mal seizures in the emergency department after ingesting approximately 6 L of water in the course of preparing for a pelvic ultrasound examination. The cause appears to have been due to dilutional hyponatremia, despite normal renal function, caused by the rapid ingestion of a large volume of water. We believe the practice of encouraging patients to drink a large quantity of water to distend the bladder ought to be more precisely communicated.

A Review of Divestment by Medical Organizations and Academic Institutions of Shareholdings in Tobacco Companies

Over the past twenty years, various individuals and organizations, most notably in the health professions, have aired concerns about the ethics of profiting from investments in tobacco. The accepted definition of social investing is the integration of financial and social criteria when making investment decisions. The premise is that investing is not “value neutral,” meaning that ethical and social criteria should be considered in how we use our money and profit from an investment. Proponents of social investing believe that one can feel good about the nature of an investment and derive profit at the same time.

No use for this foot

“Tell me a story.” I learned the importance of listening closely to the patient from my father, who felt that to be a good doctor meant learning from patients through the stories they shared with him. As an intern at the Royal Victoria Hospital in Montreal from 1975 to 1976, I began sketching

What the surgeon said

![Figure][1] > You won’t believe what that surgeon > > told me after the surgery. > > I have to laugh. > > “I enjoyed it,” he said. See other sketches and notes by this author at cmaj.ca. This sketch and note date back more than three decades. [1]: pending:yes

Secret of a long life

![Figure][1] > I asked her the secret of her long life. She > > thought a few seconds and then said: > I tended a cow, > > and I’d be out in the open a lot. > > Was name’ Mollie. > She also said: > That doctor I saw > > didn’t know anything about polio. > > Said it just weren’

Chance of a Hearing Aid

![Figure][1] > Government gave me a chance > > to get a hearing aid fo’ free, > > but when I went to the doctor, > > he say, “Well, Captain, > > there’s going to be a lot of things > > you don’t want to hear.” See other sketches and notes by this author at cmaj.ca. This

Conversation au chevet de Wilder Penfield

Du 1er juillet 1975 au 30 juin 1976, j’ai fait mon internat en medecine interne a l’Hopital Royal Victoria de Montreal, au Quebec, apres avoir termine mes etudes en medecine a l’Universite Emory. A cette epoque la, les internes se voyaient encore attribuer une salle de garde1976, I served as an intern in internal medicine at the Royal Victoria Hospital in Montréal, Quebec after graduating from Emory University School of Medicine. At that time, interns were still given their own on-call room. My pre-morning rounds ritual consisted of a maple donut and orange juice at the hospital coffee shop, while also devouring The Star, The Gazette and La Presse. Olympic fever was in the air. Separatist tensions were still palpable and René Lévesque, the charismatic, chain-smoking leader of the separatist Parti Québécois dominated the news. I was fascinated by the renowned Montréal Neurological Institute, where I once went to watch neurosurgery through opera glasses from an enclosed observation area above the operating room. Recently, I came across six prescription-size pages of handwritten notes from an hour-long conversation I had with the Institute’s founder, Dr. Wilder Penfield on the morning of Apr. 3, 1976, when he was a patient in the Ross Pavillion at the Royal Vic. Having hoped to meet him since the start of my training, I stopped off at my room after completing night-call and signout to muster the courage to introduce myself and to pick up my copy of The Torch, his novel about Hippocrates’ battle to lay the foundations of medicine. On that sunny Saturday morning, Dr. Penfield, age 85, was alone in his room, looking wan and tired, but serene. When I tapped on the open door, he graciously invited me to sit by him at his bedside, adding, “I’m an interesting case, you know. Inflammatory myopathy, inclusion body myositis type. Have you read my chart? This damn myositis. Weakness. Can’t do a thing. And on top, there’s that cancer.” I told him I’d met a former patient of his, an attendant at the Veteran’s Hospital who’d had viral encephalitis 30 years before and on whom he’d operated. “Don’t expect I did him much good,” he quipped. He beamed when I showed him my paperback copy of The Torch. “I had such fun writing it,” he said. “It’s the right way, really, the novelist approach. When you write imaginatively, you know what’s right. The historian can’t do that when he says such and such happened.”

Guidelines for Policy: Is It Really Possible to Eliminate Tobacco Advertising and Promotion?

The thesis of this paper is that the development, introduction, implementation, and enforcement of policies intended to ban tobacco advertising and promotion have been misguided and have failed to diminish the industry’s influence among consumers and potential consumers. For the most part, proponents of the prohibition of tobacco advertising do not understand the importance of an ethnographic approach to the subject (ie, loosely translated, the ability to think like the tobacco industry thinks) and the cultural contexts in which such policies are being designed. In effect, these policies remain an ideal and not a real inhibitory force. Our use of the term “guidelines” is not intended as a formula for enacting such policies but rather as a means of standardizing the terms of discussion and enhancing awareness of the many variables involved in confronting tobacco advertising and promotion.