o my nurse calls me and says, “[NAME REDACTED] just called. She says the medicines are controlling her nausea enough to stop throwing up, but she’s still too nauseous to eat much. She wants you to write a note to her probation officer telling him it’s okay for her to smoke marijuana so to expect it in her urine drug test.”

And, just to be clear, I do not live in a state where medical marijuana is legal.

When Jonathan Leo, a neuro-anatomy professor, pointed out that a JAMA article not only failed to disclose financial bias but also incorrectly implied that a pharmaceutical therapy was better than a non-drug one, the Journal of the AMA (of which I have not been a member since fresh out of medical school) flashed its true colors:

Leo says he received an angry call from JAMA executive deputy editor Phil Fontanarosa last week, shortly after Leo’s article was published on the BMJ Web site. “He said, ‘Who do you think you are,’ ” says Leo. “He then said, ‘You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry.” Fontanarosa referred a call for comment to a JAMA spokeswoman, who said Leo’s retelling of the conversation was “inaccurate.”

Then, the editor-in-chief of JAMA, as cited by the Wall Street Journal, showed her own lack of class:

“This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.”

When asked if she called his superiors and what she said to them, DeAngelis said “it is none of your business.”

Maybe we need Jon Stewart to interview her.

Pediatrician Anne Armstrong-Coben offered a bit of editorial comment on electronic medical records in the New York Times last week. Almost all of her comments raise issues which are, I agree, areas of concern. The electronic medical record our hospital and medical school are using, while elegant in some ways, is clunky in others and the cluttered output of its notes makes it particularly susceptible to Armstrong-Coben’s hypothetical point about how difficult it is to read the note after it’s created.

Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer’s font, important points often get lost. I have half-joked with residents that they could type “child has no head” in the middle of a computer record — and it might be missed.

Electronic medical records are not the panacea that the federal government would have us believe, nor are they as clever or usable as computer geek doctors like me assume they should be. Further, don’t forget privacy issues; you don’t want your whole health history trusted to 2009′s state of the art version of a national electronic chart. This could make Facebook privacy concerns look trivial by comparison. And while the web is evolving sets of microformats, medical informatics is mired in a messy muck of interoperability called HL7, a set of standards that don’t seem to understand what standard even means.

Still, when I was seeing a patient for an ER follow-up this morning, I was able to review all his labs and view his CT scan reports and images in less than 60 seconds. I asked him what the ER thought was wrong with him, he wasn’t really sure, but 15 seconds later I was reviewing the ER doctor’s chart from Jan 28. I ordered a follow-up lab and the by the time the results popped into my inbox scarcely an hour later, he might not even have made it back home. Electronic medical records are far from mature or ready for unified national rollout, and they are indeed fraught with their own set of shortcomings, but don’t doubt that those cons are accompanied by a long list of pros; the benefits of computer medical charting are real.

Conclusion. Medical Informatics is mostly just out of beta, but we’re making slow progress, and our 2.0 version will arrive some day. But, in the meantime, if you request your kid’s medical records, and happen to read that he or she has no head, before you call 911 or run into the street screaming in panic, I’d go down to their bedroom and verify the presence of a noggin. More than likely, all is fine.

Great New York Times article on the pharmaceutical industry influence at Harvard Medical School.

But no one disputes that many individual Harvard Medical faculty members receive tens or even hundreds of thousands of dollars a year through industry consulting and speaking fees.

Here’s proof that the industry is all up in the grill of patient-centric scientific recommendations. The body which makes recommendations on treating elevated cholesterol with drugs is the National Cholesterol Education Program, which publishes the Adult Treatment Panel guidelines (most recently ATP III) which are what we as physicians are supposed to use to decide which patients to treat (and we as medical school faculty are supposed to use to train Residents and Medical Students).

Of the nine doctors on the panel making the recommendations, eight receive money from pharmaceutical companies which sell cholesterol lowering drugs, most from several different companies.

Drs. Grundy, Merz, Brewer, Clark, Hunninghake, Pasternak, Smith, and Stone; you should be ashamed of yourselves. Grow some stones.