Nursing textbooks: cleaning out after graduation

Is everyone stuck with a bunch of textbooks after graduation? I keep wondering if the folding legs on my table/desk are going to collapse. I've been looking forward to getting rid of a bunch of these and the day has finally come. So, here are my nursing texts divvied up by post-schooling usefulness...

Books I'm getting rid of immediately



Mosby's 2005 Drug Consult: I bought an old copy of a drug consult to save money. This one was a stinker. Very little info and difficult to read and look things up. The hospital where we did clinicals uses a different publisher's drug consult, and it was much better. Avoid Mosby's Drug Consult. Besides, in today's clinical environment, who needs one at all (Hint: go PDA)? Unless the computers go down, or you want to look something up at home... It's a good thing to have, I think.
Lab and Diagnostic Test Guide: I bought an old copy of this to get one that was co-authored by one of my professors. Not a bad choice, but in general the lab and diagnostic guide was not needed. Does anyone actually use this in school? All the information is available on the web, now, anyhow. Assigning it was not a good use of resources.
Nine Hills to Nambonkaha: ugh. Read my Amazon review.
Masting Project Management: double ugh. When I read books like this, I imagine people in lower and middle management jobs desperately looking for something, anything to escape. It depresses me. If you can't project manage intuitively, you're not going to be promoted much unless you kiss butt, period.
From Silence to Voice: I wanted to like this book, but in the end I thought it was mostly just a guide to common sense political wrangling and English composition. Better to get Strunk & White's and be done with it.
Nursing Diagnosis Handbook: I wrote a poor review for Amazon, although after I was forced to use this book more, I found it handy for school. However, I am still very skeptical about the entire nursing diagnosis project. Creating this entire system that's taught in school and then discarded in clinical practice just for the purpose of demonstrating "professional knowledge" seems like a waste. Plus, I'm not sure it does a good job of what it's supposed to do, which is describe nursing practice. In cardiac and critical care, there are plenty of assessments and interventions that nurses make that are essentially medical in nature.
Essential Drug Dosage Calculations: The math that nurses need to know is very elementary, however important it might be. Even more so now that so many products come pre-measured and pre-drawn. Buying this book was not useful for me, although, inexplicably, many of my classmates had difficulty with the simple math needed for nursing. In fact, there were even errors in the answer keys for some of our quizzes. I don't think this book was necessary, though, unless problem sets were going to be assigned from it.
Clinical Nursing Skills & Techniques: A fine textbook from which we did not have enough reading or test assessments. I am getting rid of it because it is out of date, but I may get another. The only thing is, all this information should be online for free!
Nutrition From Science to Life: The hokey title says it all. It was out of date when I bought it and would have been a waste of money anyhow. The science of nutrition is a lot more undecided and unknown than nutritionists would like to think, although there seem to have been great strides in the last 5-10 years. If I had to teach a nutrition course, I think I would make students more aware of the controversies rather than teaching "best diet" and "best weight."
Sociology in Our Times: Okay book, but I am outraged that this discipline is still teaching discredited crap like The Authoritarian Personality. This textbook has citations from the '50s and '60s. What a joke!
Understanding Psychology: Whatever. Didn't really need it for the Intro Psych class.
A Topical Approach to Life-Span Development: It aims low, but is a well-constructed text from which I was able to learn a lot. As with sociology, psychology has some sacred cows, like Piaget, that seem to me to be almost certainly wrong, although they are still taught without addressing issues like Piaget's out-of-date research techniques and lack of grounding in biopsych. All the background psychology a nurse needs is available online now.
Professional Nursing Practice: Read my Amazon review--this was a real, true waste of money.
Public Health Nursing: I think there was one reading assigned from this book in my community health course. Could have easily taught the course without this book. I think I may change my mind and keep it, though, as a reference. Public health nursing seems labyrinthine to me.
Wong's Nursing Care of Infants and Children: I hated this book. I hated everything about it. The prose, the design, the illustrations--it was all awful. It was almost unreadable, and I stopped trying when I discovered that it was still teaching Freud's developmental levels. These should be relegated to courses on history of psychology rather than being included in practical textbooks. The actual useful material in this book could have been condensed to a text maybe a quarter to a third the size.


Books I'm getting rid of soon



NCLEX review books: I'm tempted to keep Saunders' Comprehensive Review since it has a nice outline, but realistically, I'll never look at it again after the boards. These can all go to next year's students. Gone after the NCLEX.
Medical-Surgical Nursing: an okay text. It needs better design/layout. I couldn't really figure out how to use it efficiently until the course was almost through. Gone after the NCLEX.
Fundamentals of Nursing: why this text and the Med-Surg one? Too much duplication. If I ever want to refer to theory, I can find this in a library. Gone after the NCLEX.
Procedures and Techniques in Intensive Care Medicine: Well, this one wasn't assigned, but I'm getting rid of it after I read about a few of the procedures, like echocardiography. It's out of date, now, I think.
Psychiatric Nursing: Way too based in Freudianism and psychotherapy, but my impression is that without hanging on to these, psychiatric nurses wouldn't have anything to do except pass meds. The "decade of the brain" material seems like an add-on. Good layout, though, and easy to read. I came to enjoy this book.
Ethical Decisionmaking in Nursing and Healthcare: Arrrrrrrggghhhhhhhh!!! As soon as I find a way to make a formal and comprehensive critique of this book, it's going in the trash. What a boondoggle! Instructors can use it to justify any ethical/political opinion, and the book is so circular that they can get away with it.
The Complexities of Care: I read one of the chapters in the library and liked it a lot, so I purchased the book. Then after looking at a couple more, I am less enthusiastic, but I will read it before giving it to somebody else.


Books I'm keeping



Diagnostix: I got my blood pressure cuff out of the box once, when I first got it, to put it together and test it out. Why was this required for school? I will keep it for an emergency kit for the car, however.
Taber's: Whatever. All the terms are available on the web now, but I'll keep it. It was a waste of money to make it a required text, though. Books should be assigned thus: "Here are the web resources, but if Internet access goes down, you might need these."
Essentials of Nursing Research: Not much in here that couldn't be found in a library or online, but if you intend to pursue any research, it might be useful to keep in mind the standards that reviewers and editors will be looking to.
General, Organic and Biochemistry: I never learned this well enough before so will start reviewing after the NCLEX.
Critical Care Nursing A Holistic Approach: I thought this was a good book. I intend to read it cover to cover after the NCLEX. And if I'm going to start studying for the CCRN exam, it may come in handy.
Introduction to Microbiology: From our micro class, apparently a good intro textbook, although I have nothing to compare it to. I wish the micro class was aimed more at nursing and medicine, though if I were to pursue infection control, this will be a good review/reference work.
Pharmacology for Nursing Care: What can I say? I liked it. Others didn't. I want to keep it and compare it with other pharmacology textbooks in the future. I also want to review the material from time to time.
Physical Examination & Health Assessment: As with the pharmacology book, useful review material and I'd like to compare it to other assessment texts in the future.


Books for elective courses



Biopsychology: It was an okay course, but I was hoping for something sexier. I thought the Pinel textbook was weak and hard to read. Useful information is all on the web and changing very quickly anyhow. Getting rid of it.
Essentials of Strength Training and Conditioning: I think this book is outdated. Advice on workout design, nutrition, etc. seems old-fashioned. Getting rid of it.
Fundamentals of Molecular Virology: At first I liked this book, which is organized by viral family, but after getting into the course more, I wished I had a textbook that was organized differently--say, a chapter on known/common methods of cell entry, etc. This would have been better for long-term retention, I think. Keeping it.
Medical Microbiology: This was also the name of the course this textbook was for. It was a good course, and I squandered time and energy that semester being stressed out about Nursing Fundamentals, which turned out to be not much a challenge. Although much of the information in this text can be found online, it is not easy to access as it's in image databases, etc. This would be a good text to have on hand if you were working in a tropical area or even the south. Keeping it.
Emergency Care: I just discovered last week that my EMT license is still good. I thought it had expired, but apparently it's good for three years rather than two. The text is useful since it presents information in the way the EMS system utilizes it, which is different from nursing. Hopefully, I'll be accepted at a volunteer service after I get established in a nursing job. Keeping it.
Biochemistry: This text was for a course that I didn't actually get to take. When I was taking Biopsychology, I tried to get the professor for Biochemistry to let me into the course without the prerequisites. He said no, but I bought the book and started attending the classes anyhow, hoping he would let me in. He didn't. However, even without doing the reading, I was able to follow what was going on well enough, and I got to see a guest speaker who was a VP at a pharmaceutical company give a talk on the drug approval process. Very informative. Keeping it.


Books I bought for my own edification



Physiology: At the beginning of nursing school, I assumed that medical schools must use one, or a couple, standard physiology texts. I couldn't really determine whether this is true from looking on Amazon. However, Berne and Levy seem to be well-regarded authors. So, I got this text thinking that we would be studying physiology in more depth than we had in A&P (buahahaha) and that I would simply read from the Berne and Levy rather than from the nursing textbook. You can imagine how this worked out. Keeping it, though, and may start reading.
Renal Pathophysiology, Primer on Kidney Diseases, Clinical Physiology of Acid-Base and Electrolyte Disorders, Mosby's Fluid, Electrolyte, and Acid-Base Balance, Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple: Somehow, I had the idea that these books were going to help me get way ahead on renal and acid-base info. Somehow, I had the idea we had to know a lot more about these topics than we actually did. Getting rid of them.
PDR Nurses Drug Handbook Cardiovascular Edition: This was a give-away from Bristol-Myers Squibb. Not much better than a standard drug guide. Getting rid of it.
Cardiovascular Physiology: This is the Berne and Levy, cardiovascular chapter only. A great little book that every cardiac, ICU and PCU nurse should read. Keeping it.
Principles of Physiology: A slightly less technical (dumbed down) version of Berne and Levy. Since I didn't have an A&P book, only an A book, this serves very well as a reference for physiology. Keeping it.
Core Curriculum for Critical Care Nursing: As soon as I get my "sea legs" in my first job, will start reviewing this to prepare for the CCRN exam, which I think can be taken after the equivalent bedside hours to about one year of full-time work. Keeping it.
Basic Arrhythmias: For when I thought I would get cross-trained as a telemetry technician a few years ago. Oh well. Keeping it, though.
Color Atlas of Anatomy: This is an amazing book that is actually photos of cadavers. This is about as close as I'll probably come to a gross anatomy clinic. Keeping it.
Atlas of Human Anatomy: Since I borrowed someone else's book for A&P, I don't have an A&P text. At first, when I still remembered all the anatomy from A&P, I didn't think that mattered. But I've forgotten a lot over time, so I needed a reference. I think this one is okay, although its low price and high volume at Border's made me wonder whether or not it might have some mistakes. I'm taking my chances.
Clinically Oriented Anatomy: I bought this after A&P thinking I would get a different perspective. This is a good text, but it's not an armchair book. It really needs to be used in a classroom setting. Still, keeping it.

Well, that's it. Really, there should be a single reference text that nurses could buy to support their practice. Classroom textbooks don't cut it as they present all information with equal emphasis, whereas some things will no doubt be easy to remember after starting practice, while others will not. Something to think about...

Post revised July 2009...

PSU 2009 commencement

In theory, I've now graduated from nursing school with a BSN. In fact, I've completed only the commencement ceremony today, and the actual graduation won't be finalized until after this semester's grades are turned in and all the i's are dotted and t's crossed. My name wasn't in the program for the commencement, but I assume this is because I turned in my graduation application to the registrar too late. Am I concerned? A little. The professor for the Community Health course is not trustworthy in my opinion, and we don't have tests in that course. Instead the final grade is based on her assessment of an overall portfolio of your work that is turned in at the end of the semester. The syllabus was a mess, and I'm not sure I turned in all the work for the course. Even so, I should be okay as long as she decides I'm sufficiently socialist for her liking. Anyhow...

Saturday started sunny but steadily descended into a drizzle with heavy rain later in the day. The commencement ceremony at PSU is split into a morning session--for the schools of education, health, and business--and an afternoon session--for the schools of art and sciences. We started gathering in the ice hockey arena at an overcast 9:30 for a 10:00am ceremony.



Commencement takes place in the gym of the college's field house--the only indoor venue large enough. It's pretty standard decorating fair, although they do well for a gym. A few years ago, a bagpipe band started leading the processional and recessional, which is a nice touch.



The student commencement address was given by a nursing student this year. The practice of choosing a commencement speaker based on grades is fairly dubious. My fellow nursing grad was smart enough but mostly just studied a lot, and her speech reflected that. It was schlock about going beyond your career path to become the type of person you want to be. Spoken like someone who has spent her entire life locked in an academic prison. Most of the grads there were, instead, in the position of having to face a career after spending the last four years exploring what type of person they were! We also had a speaker who's a star on some TV show and came back to college to finish his degree, but I don't watch enough to have any sense of his importance.

Then it was on to filing across the dais to shake the president's hand...



A family friend who is a professor was sitting in the front row as I came across the dais and gave me an embrace, which was really both unexpected and affecting as the rest of the ceremony was both anti-climactic and overshadowed by the aforementioned Community Health question as well as the upcoming NCLEX exam. For myself--and I sense this is the case for most nursing grads--passing the NCLEX is going to mean a lot more to me than graduating from nursing school.

Actually, if I'm honest, I'd have to say that nursing school, despite being in a BSN rather than ADN program, bears so little resemblance to the academic experience that I had in previous university study that I don't feel as though I've finished what I started and finally graduated from college per se. It was more like some sort of boot-camp-college-game-show amalgam for which you had to jump through successive hoops while attending classes and keeping the drill instructors happy. Although I have a full grab-bag of skills and disparate formal training, I don't feel that I've acquired a consistent body of knowledge or methodology. (The "nursing process" is too generalized and accessible to common sense to justify four years at university and tens of thousands of dollars.) At the outset, I was expecting to receive knowledge of "people as patients" and "patient care." Instead, it's a little petite medicine training, a little management, a little social science research... This makes me a little despondent. I came only for job training, but I got something else very different that's supposed to be academic and professional, but I can't define it well.

At end of the ceremony, the mace recesses down the aisle followed by the honored guests and faculty. Then the pipe band leaves followed by the newly graduated students. I had intended to get just a 30 second clip of the pipe band, but since I didn't know where they were in the line, I ended up taping the entire recessional. This has the advantage of showing almost everyone in the ceremony. The original .MOV file can be downloaded from the Vimeo site, and it should have better quality, I think.



The one part of the day I was really looking forward to was having my photo taken outside after the ceremony. Over the years, my father has brought home a stream of photos taken outside in the same place with his graduating students, so I thought it would have been nice for him to have one of me with him as the parent instead of the professor. Alas, it was not to be. By the time we got outside after the ceremony, the rain was coming down quite hard. As my mother pointed out, it was the exact same weather as the day I graduated from high school. I hope that's not an ill omen, as my post-high school plans didn't play out very well. Anyhow, family photos got relegated to the living room.



During lunch that day ("Tuscan tuna salad"--tuna, beans, onions, olive oil, wine vinegar, spring greens--it's nice to be back off the studying/library habits), I asked my father whether he had heard of artist Catherine Hartung, who I mentioned a couple posts back. He said, "Oh, you mean Kate?" It turns out she used to babysit me! The world is a small place, especially in upstate New York.

My brother had told one of the waitresses that he was going to McSweeney's that evening for dinner, so we decided to all go and then on to Harrigan's for dessert. It was a real north country eating out experience.

So now what?

...well, the first thing is to lie low until grades are finalized. Then, after I'm sure I've graduated for real, it's a marathon study session for the NCLEX. Of course, I have to figure out what I'm going to do with my life, too.

Post revised July 2009...

PSU 2009 pinning ceremony

Earlier this Friday evening was my university's nursing graduation pinning ceremony. I guess this is supposed to be a big traditional deal for nurses. I didn't go through the ceremony for a variety of reasons (e.g.: didn't want to do the whole flowers/parents/awards thing; not sure I'm actually graduating; perpetually feel excluded by, and thus resentful of, the class), but I did go to the ceremony and sit in the audience (high up in the back of the auditorium)...



Afterward, my parents and I went out to Arnie's for dinner.



Post revised July 2009...

Google Reader biased toward local news outlets?



I had this strange experience with Google's RSS Reader today. As you can see from the image, I got something from North Country Public Radio in my Google Reader inbox. What's strange is that NCPR is a fairly small-time local-ish public radio station. Their front page was pointing to an NPR report about Margaret Hamburg. Now, there must be NPR affiliates all over North America that use automatic news updates that were re-directing to the NPR report. So what are the chances that my local station's website would show up in my RSS Reader but not other ones? I wonder if this means Google pushes news to you in certain ways, such as preferring to show you websites with local affiliation over others. I think that's pretty problematic and should be transparent if it's happening.

ACLS certified



I passed the AHA's Advanced Cardiac Life-Saving course today, and am now re-certified in ACLS til May 2011. Shown above are George, who ran the course, Dr. Hartung, and Linda, who tested my mega-code. (Dr. Hartung's wife is a fairly good painter.)

I got a 100 on the written exam, and think I did pretty well on the mega-code relative to the PCU and ER nurses who were with me. I didn't make any mistakes (though I lost my 95 year old female patient after she was pronounced following a normal sinus PEA that wouldn't respond with a pulse), and I was able to correct some in the nurses while performing CPR, etc. (Note to providers: you don't convert nor defibrillate a sinus tachycardic rhythm. Sinus tach and SVT are not the same.) I was maybe a little more nervous and less in control of the situation at the beginning, but that's okay as I'm new (not even an RN yet).

Passing was a real confidence booster after my disasterous clinical immersion practicum and the Nur464 final yesterday. Linda is a former ICU manager, so I was pretty happy to get kudos from her.

Shoe captures tone of graduating


This
Shoe cartoon pretty much captures the way I feel about graduating after yesterday's Nur464 final fiasco.

HELP: Margaret Hamburg approved

The Senate HELP Committee voted to approve hottie Hamburg for FDA Commissioner. I thought this had already been done, but apparently during their previous session, they only "failed to voice opposition." Now it's official and goes to the full Senate, I suppose. From Reuters:

By Susan Heavey

WASHINGTON (Reuters) - A U.S. Senate committee approved President Barack Obama's pick to lead the U.S. Food and Drug Administration, sending Dr. Margaret Hamburg's nomination one step closer to final approval.

The Senate Health, Education, Labor and Pensions Committee approved Hamburg in a voice vote, said Melissa Wagoner, spokeswoman for panel chairman Senator Edward Kennedy.

The full Senate must still vote on Hamburg, a Harvard-trained doctor and former New York City health commissioner known for her work in bioterrorism preparations and other public health issues.

A Senate leadership aide said it was not clear when the floor vote would happen, although the staffer ruled out any further action on Wednesday.

The FDA is grappling with issues ranging from food contamination and drug safety concerns to the recent H1N1 swine flu outbreak.

Senator Mike Enzi, the committee's top Republican, urged party colleagues to support Hamburg, saying "she will face unprecedented challenges to public health, from medical product development and biopreparedness to import safety."


update: BTW, isn't this a stunning photo of her?

Nur464 Final: big time suck

Today (Wed, May 13) was the final in the Nur464 Care of the Adult III (critical care) course. This was my last final for the semester, and will hopefully be my last final of nursing school, assuming I pass everything, which I should (fingersXd!). The final sucked big time. It was a computerized final, so I received my grade immediately--72. That's a failure. Now, the final was non-cumulative, and, as far as I know, counted the same as the other tests in the course. So, I should pass the course anyhow, but I have done weakly in the last half of the semester. The topics for this exam were burns, chest and abdominal trauma, and organ donation/immune suppression. It shouldn't have been that hard. A couple questions I intuited correctly and then talked myself out of. One I missed because I purposefully didn't memorize a formula for calculating fluids in a burn victim (there being multiple formulas, with the assumption the formula would be given on the test, and fluids being an MD order anyhow). A couple I missed because of skipping subsections of reading I didn't think were relevant. A couple I missed due to simple lack of memory. But the ones that really bother me are the ones where I used bad judgment to arrive at the wrong answer. That was probably 1/3-1/2 of them. That sucks.

After the test, right to ACLS class, then back to the library to study for the mega-code for tomorrow.

Happy International Nurses' Day

It's today, May 12.

Australasiangate: Elsevier's publishing fiasco widens

The story about biomedical publisher Elsevier's unethical publishing practices, previously reported on here, is expanding. Instead of just one fake peer-reviewed journal, it turns out there were at least six. Pretty much any article you read in an Elsevier journal called The Australasian Jounral of... is suspect. It would be tempting to call this "Australasiangate," but that would imply (1) that this was a fake scandal, and (2) that Elsevier will suffer consequences appropriately for its ethical lapses. Probably, neither one is true.

Elsevier released a Press-Release, but to recover their credibility, they need to release specific names and remedies taken, rather than just saying that everything is better now.

"sane and rational": an approach to swine flu


Despite the deaths, the swine flu has not been without its humorous side. For example, in Afghanistan, Kabul Zoo quarantined that nation's only pig. The pig was a gift from China, which has taken the slightly less humorous action of quarantining a number of visitors from the Americas. Where does public health wisdom lie?

Writing in Virology Journal, William R. Gallagher of the Louisiana State University Health Sciences Center has reviewed the situation up to the current time and makes recommendations based on a skeptical view of the severity of the current outbreak but a healthy respect for the future of H1N1. The current form of the virus has more animal amino acid sequences than sequences from successfully pathogenic human strains. Nevertheless, the hemagglutinin sequence has shifted 27.2% from its 2008 cousin, and the neuraminidase has shifted 18.2%, leaving open the possibility that new rearrangements might incorporate more pathogenic human sequences along with these new H and N sequences to create a strain with greater pandemic potential.

Gallagher takes the sensible positions that shutting public services because of a suspected case, having elected officials override considered public health judgements, or bringing political agendas into the situation are all counterproductive. While I agree in large part, I'm not sure I can accept his argument that there's no sense in a quarantine focused on specific nations due to the fact that the specific H and N sequences arose elsewhere. It's true that some people have made uninformed calls for border closings, but I think the accusatory finger of political agenda should fall on Gallagher as well. The theoretical possibility of a future spontaneous re-arrangement is not an equivalent threat to an existing, spreading re-arrangement, especially when it's not clear, by Gallagher's admission, whether the pandemic nature of the outbreak might have been supressed due to natural seasonal variations, only to expose itself again next season. In any case, the current best course of action would seem to be to start working on a vaccine for this strain for next season.

Gallaher, W. (2009). Towards a sane and rational approach to management of Influenza H1N1 2009 Virology Journal, 6 (1) DOI: 10.1186/1743-422X-6-51

Pallimed blog: fake spit should be nursing measure

I want to draw your attention to a blog I just found. Pallimed is focused on palliative care and hospice. Yesterday's post focused on research on taste alteration in oncology patients, including nurses' aversion to administering fake spit:
I do not know why nurses and doctors can do so many other 'gross' things in medicine, but there is a severe and general aversion to writing for or administering saliva substitutes. It is more than just lack of knowledge, because even when informed, I have had nurses basically say, "I'm not giving that to them, That's disgusting!" Yet when I go in the room and have the patient try it, the patient exclaims (with a smile and a much louder voice) "My mouth feels alive again. Thank you so much."
That's pathetic, folks. He goes on to say that fake spit shouldn't even need a doctor's order. More nursing measures!

Hamburg nomination report, with video

Today, the NY Times weighs in with an article on Dr. Margaret Hamburg's nomination as FDA commissioner, and the Wall Street Journal blog points us to a video of the hearing, and a PDF of hottie's statement. Around 98:00-99:00, Senator Sanders essentially suggests that the FDA should regulate food and/or regulate food advertising not just for quality but for its health value. Dr. Hamburg replies that she thinks that's outside the job description, but she's too smart to say otherwise in a nomination hearing, so who knows. I would hope that she's not interested in getting the federal government involved in dictating diets.


update: video not working here, but that's okay, as Senate hearing is snooooooooore....

Hamburg nomination report, including new photos

Dr. Margaret Hamburg's nomination hearing for FDA commissioner took place earlier today, May 7. Reuters filed a report already, as did the AP several hours ago, along with photos:



By RICARDO ALONSO-ZALDIVAR

WASHINGTON (AP) — President Barack Obama's pick to oversee food and drug safety pledged on Thursday to revamp protection of the nation's food supply to help prevent future disease outbreaks.

Dr. Margaret Hamburg, a bioterrorism expert who once served as New York City health commissioner, breezed through her confirmation hearing before the Senate Health, Education, Labor and Pensions committee, with no senators expressing opposition.

Hamburg, 53, said she wants to restore public confidence in the Food and Drug Administration by putting science first and running an open and accountable operation.

The full Senate is expected to vote on her nomination before Memorial Day. If confirmed, Hamburg's most immediate task will be to oversee development of a vaccine for the new swine flu. But she said food safety will be her major ongoing project.

"The agency is facing a range of new and daunting challenges," Hamburg told senators. "These include the globalization of food and drug production, the emergence of new and complex medical technologies, and the risk of adulteration or deliberate terror attacks on our food and drug supplies."

The FDA oversees products ranging from peanut butter to cancer drugs to medical imaging machines — a portfolio that represents about a quarter of consumer products. A few years ago, it was shaken by the withdrawal from the market of Vioxx, a painkiller that turned out to have serious heart risks. More recently, outbreaks of foodborne illness have exposed haphazard oversight of the nation's far-flung food supply chain. Within the agency, scientists in the medical devices center are in revolt over what they say is management interference. And a federal judge recently ruled that the FDA improperly politicized a decision on emergency birth control during the Bush administration.

On top of all that, the FDA must play a critical role in developing a vaccine for the new swine flu virus and ensuring that enough vaccine can be made to protect the public.

Hamburg, as an assistant health secretary under President Bill Clinton, helped lay the groundwork for the government's bioterrorism and flu pandemic preparations.

The swine flu vaccine will be her first task. "I look forward to being actively involved in discussion on such critical issues as how much vaccine to make, whether to alter seasonal vaccine manufacturing, and, ultimately, whether to recommend vaccination for the American people," Hamburg said.

Vaccinating the entire population for swine flu would be a huge undertaking, and might require more than one shot. It would also have to be coordinated with preparations for the regular flu season. But such a large scale effort may not be needed if the virus turns out to be mild.

Turning to food safety, Hamburg said it will require sustained effort, more money, and stronger laws to improve the situation. She wants to shift from chasing outbreaks after they have broken out to preventing them first. That would require all food companies to follow written safety plans, overseen by federal and state inspectors. Traceability and import safety — weak links in the system — would have to be strengthened.

Obama's budget, released Thursday, calls for a $260-million increase for the FDA's food safety program. Past budget cuts have hit the food inspection program hard, and part of the new funding would go to rebuild the ranks of inspectors.

Hamburg said she supports FDA regulation of tobacco and allowing Americans to import low-cost brand name prescription drugs from abroad, positions consistent with Obama's.




Hamburg in 1 hour 15 minutes

The US Senate HELP Committee's website has the following notice for today:
Full Committee Hearing - Hearing on the Nomination of Margaret A. Hamburg for Commissioner of the Food and Drug Administration; SD-430, 2:00 p.m.
I can't find an available TV or webcast. C-SPAN is supposed to have a webcast at CapitolHearings.org, but I can't get the RealPlayer link to work. But if you're free in an hour, switch on the boob-tube.

Margaret Hamburg: Senate confirmation tomorrow


Dr. Margaret "Peggy" Hamburg (or "hottie Hamburg" as I like to call her), Obama's pick for FDA commissioner, has had her confirmation hearing moved up to tomorrow due to the swine flu. Actually, in this case the hype is accurate, and her credentials and background make her perfect for dealing with a food industry/epidemic mash-up like the swine flu. Good luck, hottie!

(If I can stay awake tomorrow after being up all night tongiht, and if I can find a TV to watch C-SPAN, I'll try my first live-blogging, but no promises.)

Medical schools shooting for the middle

KevinMD has a post up about some people wondering whether it wouldn't be better to admit to med school those who do not get top scores. This reminds of a legal case I saw on TV a number of years ago about a police department that rejected an applicant who had scored too high. They won the case based on the fact that research shows those who score too highly under-perform as police officers. Something to do with boredom, I think.

Anyhow, I think this is interesting because I've been wondering for a while whether doctors aren't overtrained or overselected. This topic comes up indirectly at Happy Hospitalist frequently in the form of arguments over the place of MLPs. The question in my mind isn't whether PAs are adequately trained but whether it isn't possible that our current educational structure doesn't include what's really needed--something in between a PA and MD. Wasn't med school designed for a circumstance where doctors had to rely much more on their innate knowledge and intelligence and participated in a lot more guesswork? Does it make sense to train MDs for a technological and knowledge context decades old? I don't really know, but as I've written before, the experienced nurses on my unit can predict what a doctor is going to order for patients 90% of the time. If a nurse can obtain this level understanding with so little educational background, do we need all the MDs to be trained at the same level or could we get by with a mix of some with less training?

Pandora is wow on little sleep

For those of you still in the academic world, you know it's finals time, and I've got all that crap going on. Right now, I'm going on just a little sleep and staying awake with Sudafed, caffeine pills, and polacrilex gum. This is an effective combination, and since my PA wouldn't prescribe me modafinil (I have diagnosed OSA, so don't get all self-righteous on me), it's about as good as I can do.

So, anyhow, I was starting to fall asleep a little while ago, so I switched on Pandora, starting with "Riders on the Storm", and it's taken me through stuff I've never heard before like Cream's Crossroads and Led Zeppelin's Nobody's Fault But Mine. Never having used "hard" drugs before, I don't know that feels like, but with the sleep deficit, nicotine, and whatnot, the music sounds pretty good.

Of course, give me a few days with sleep, treadmill, salmon, and water in place of coffee, and I'll probably be back to preferring Bach and Handel.

Plavix inhibited by Nexium?

Practicing my nursing response: "Well, I haven't heard about that, but it would be a good question for your doctor."

CE for bioterrorism

For Community Health course, I just took a CE course from the U of Albany called Terrorism, Preparedness, and Public Health: An Introduction. Two interesting illustrations: