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Now that the 2008 summer olympics are upon us, I thought I'd take the opprotunity make clear my stance on the use of performance-enhancing drugs. I'm 100% for it.

There are a number of problems with making performance-enhancing substances illegal - the most significant, to my mind, being that there is no clear boundary between what is medically indicated and what is indicated only for performance-enhancing purposes. For example, in weight lifting it is prohibited to use furosemide in order to pee off some fluid and make your weight class. Perhaps HCTZ is also banned. Should it be? What if an athlete has hypertension? Should he be consigned to suboptimal blood pressure control while in active competition? Or perhaps the athlete will only be allowed to choose from a pre-approved list of medications that are sufficient to control his illness but, at the same time, will not offer him a competitive advantage. Caffeine also acts as a diuretic, as does alcohol. Should we test for these substances as well? Surely, if a patient has asthma, we can't ban his steroid inhaler. His inhaler does not represent an exogenous, performance-enhancing substance but rather we prescribe it in order to correct an underlying pathology; although, if the athlete happens to be a distance runner, his inhaler will undoubtedly have the side-effect (intended or otherwise) of improving his performance. Stimulants like pseudoephedrine can help correct the symptoms of an underlying pathology (like a cold). If the athlete has a cold, can he take a Sudafed®? What if he's just a little bit congested? What if he's not really congested, but he just needs that extra little boost? Should a female-to-male transsexual be denied her hormone therapy? Should she/he be barred from competing altogether? Endocrinologists have even proposed the use of human growth hormone for use in children who "fall off the growth curve." How does one determine who has normal shortness versus pathological short stature? My point is that I believe it doesn't matter what you or I think about these questions but that they are questions which the patient-athlete must approach jointly with his or her doctor.

Now, you may object, citing that some doctors are clearly more liberal than others. If you have chronic pain, some doctors will give you enough pain medication to sedate an elephant for a month (trusting you to take it only as prescribed), others only enough to get a very small rodent sleepy for a few days. The same will naturally be true of drugs that have the ability to enhance an athlete's performance. If you have iron deficiency anemia with an hemoglobin of 11.2, some docs may just give you iron supplements. Maybe a female athlete with this condition can start to cycle her oral contraceptives with the provision that she go back to having regular periods once her hemoglobin returns to an acceptable level. But, then again, there may be one or two female athletes who have had their uterus removed for one reason or another, or who have congenital absence of uterus, putting them at a possible relative advantage. Does taking erythropoietin give you an unfair advantage if it only brings your hemoglobin up to the level of your competitor who trains at high altitude, or your other competitor who happens to have hereditary polycythemia?

As you can see, any attempt to create a set of uniform standards of practice when it comes to using medical therapy in professional athletes descends quickly into absurdity. This is why, in order to level the playing field, all athletes must be given complete access to whatever substances are available. We need to stop the testing of athletes and the banning of substances altogether. Yes, by taking advantage of this, professional athletes would potentially be taking on some serious additional health risks. But they are already taking on a number of additional health risks that the rest of us don't face just by making the decision to be an athlete in the first place! It's not for you or I to decide how much additional risk to one's health is tolerable in order to improve athletic performance. It is a personal decision to be made by the individual patient-athlete in conjunction with his or her doctor.

Sometimes I look inside my head and see a violent, stormy ocean of ideas such that I need a life jacket in order to stay afloat and to make some kind of sense of things so as not to unleash fragmented bits of unfettered emotion onto the world. Other times, there are nothing but sand dunes as far as the eye can see; even the rare oasis quickly drained before it can quench anyone's intellectual thirst. After staring off into space for about 10 minutes, realizing that I am clearly in a state of mind more closely resembling the latter, I came upon this article: Mary-Kate Olsen Wants Immunity in Heath Ledger Case. What was more interesting to me than whether or not Mary-Kate is going to cooperate was the following quote, "Investigators have interviewed Ledger's doctors and found prescriptions for every drug so far except Oxycodone and Vicodin, two powerful and often-abused painkillers..." So, is it malpractice if a patient overdoses on a drug that I prescribe? Any real attempt to answer this question would require far more brainpower than the wasteland inside my head is going to provide me with. What's your answer?

Now that I have your attention, let me start by saying that restricting access to contraception is precisely what the new federal policy proposed by the Bush administration does not do. By defining emergency contraception and IUD's as "abortion," what the administration wants you and your grandmother to think they're doing is restricting access to abortion services. Please explain to your grandmother that they are doing no such thing. It's nothing more than a political gimmick to energize the right wing, conservative Christian base. What this new policy would actually do is to restrict federal funding for hospitals that refuse to hire personnel who refuse to provide abortion services. Sound confusing? In other words, this means is that if you're a hospital who receives any federal funds, you cannot discriminate against health care providers who refuse to provide abortion services (abortion being defined as noted previously). But, there are already federal laws prohibiting such discrimination in place! The only additional requirement that this new rule imposes is to force these hospitals (if they want to keep their funding) to certify in writing that they are in compliance with federal laws already in place. It is a proposal that is very carefully crafted to do NOTHING!

The aftermath has played out in the fashion of a Shakespearean farce. Rather than ignoring this proposed nonregulation, the democrats have seized on it as an opportunity to lash back - calling it "...A dangerous assault on women's health."

Nobody is more in favor of providing contraception and family planning services than I am. But please, let's make sure the battles we fight are meaningful ones. A federal ban on partial birth abortion, for example, could potentially have the effect of seriously limiting the medical options available to a woman for managing complications during the second trimester of her pregnancy. This current proposal does not mess with the legality of abortion, or birth control or with the laws that are currently in place in 14 states guaranteeing women who are in need access to emergency contraception. It may keep one or two reactionary pharmacists from losing their jobs and will certainly generate extra paperwork but, in the grand scheme of things, I think us progressives can live with that.

Does race make a difference or does it not make a difference?
I remember a time, a simpler time, long ago, when the common wisdom was that the solution to the problem of racism was to achieve a color-blind society - a society in which a person's skin color made no more difference to anyone than the color of his eyes. We seem to have lost our way at some point, deciding that we, as a society, believe that race does make a difference. As another example of this fact, the AMA has recently apologized for racial disparities in the provision of health care in this country.

I have to wonder, do they really understand what they've done? A perfectly analogous situation would be if the justice department were to apologize for the disparity between the number of blacks and whites on death row. Can you imagine the public outcry if that happened? I mean, we already knew that there way more blacks were convicted of murder but we didn't realize that you guys were preferentially convicting them on purpose! Why were you doing that? And if that's what you're doing, don't apologize, just stop doing it!

Likewise, the AMA's apology amounts to an admission of racism. They have apparently been intentionally giving inferior care to their African American patients. Again, rather than apologize, why not simply stop doing it? The answer, of course, is that they really aren't responsible. With rare exceptions (the Tuskegee experiment, comes to mind) you won't find any doctor who makes it part of his practice to provide one level of care to members of one race and another level of care to another race. Nor are any such health care policies in place, nor has the AMA issued any such guidelines. Are there disparities in the levels of care that blacks and whites receive in this country? Absolutely, there are! Just as there are huge disparities in income, level of education, crime etc. But for the AMA to say, "Yeah, sorry. These disparities exist because we fucked up. We've been giving shitty care to blacks while giving excellent care to whites, " is obviously ludicrous. If this were the case then the solution, as I have said, would be simple - STOP DOING IT! But, even though the AMA has apologized for these disparities, I'm pretty confident they will persist - at least for the short term. Which means that either a) the AMA was never responsible for these disparities in health care to begin with or b) they were responsible, but are going to choose to go on providing disparate care based on their patient's race.

We need to put aside this issue once and for all. The simple existence of racial disparity would not be a problem if race made no more difference to people than hair or eye color. Can you imagine anyone studying whether blue-eyed people received the same level of health care as brown-eyed people? If there are systematic ways in which our society is treating whites differently from blacks the solution is to seek out these injustices and to fight them. But the simple existence of these disparities does not necessarily point to any such injustice. And, if we are serious about achieving a color-blind society, the question of racial disparity is one that we need to stop asking.

In addition to Caroline Kennedy, who is the daughter of the late President John F. Kennedy, former Deputy Attorney General Eric Holder and longtime Washington insider Jim Johnson, I - James Logan, M.D. - have been chosen to assist in the search for a running mate for Barack Obama. Here are a few names we've been kicking around.

After a long and contentionus fight, Barack Obama is the presumptive Democratic nominee. But who will be his running mate?
	PROS	CONS
Hillary Clinton	Has excellent policy credentials - supports universal healthcare. May help sway a large number of democratic voters who said they would not support Obama if he beat out Clinton as the nominee.	Her high percieved negatives make her a divisive figure which is at odds with Obama's message of unity and hope. With Bill back in the Whitehouse, high potential for shennigans that will distract from the issues. Won't make racist, blue-collar white voters from Kentucky any less racist. Would be second in line to the presidency
Joe Lieberman	Would help to quiet fears that Obama is a closet Muslim who wants to destroy Isreal.	Unacceptably high liklihood that he would take the nomination as a Republican double-agent, bent on destroying the democratic party.
Wesley Clark	Outstanding military service record Outstanding military service record Looks great in a suit.	Could be taken down easily in a barfight.
Dr. Pacman	Can adapt well to an ever changing political landscape. Expected to help Obama carry 95% of the Donkey Kong supporters.	Economic stimulus plan has been criticized for "lacking depth." Colored ghosts have not registerd with the general public as a significant national security threat since 1968.

I promise to keep my readers updated on the process, as more candidates are vetted.

Remember that Simpsons Halloween special where Kang and Kodos try to take over the Earth by posing as Bob Dole and Bill Clinton during the 1996 election? In yet another demonstration of how The Simpsons was ahead of it's time, Kodos/Bob Dole has the following line, "I hope we achieve a fair result in the election, eliminating the need for a violent bloodbath."

The movie Recount, which premiered on HBO on May 25, portrays the events surrounding the contested results of Florida's vote in the 2000 election. Though it tends to give me atrial flutter whenever I revisit those events, I very much enjoyed the movie. Kevin Spacey stars as Ron Klain, Gore's former chief of staff, who was largely in charge of the legal effort to get the votes in Florida recounted. On May 9, Charlie Rose talked to Kevin Spacey about his role. Although Spacey went on record as disagreeing with this assertion, the film is clearly biased in favor of those who would have liked to see the Florida recount proceed. It would be pretty poor storytelling to portray it any other way. However, there is a speech by James Baker's character towards the end (played by Tom Wilkinson) that I liked very much. His point is that, whatever you can say about the 2000 election, we followed a proper, legal process. The tension that our country experienced could have easily escalated to the level of a national crisis, perhaps even civil war. But the legal process was followed, the various Florida courts as well as the Supreme Court made their respective rulings and those rulings were respected. There were no tanks in the streets, no riots, no armed insurgency.

So, for those of you - like me - for whom the past eight years have been a perpetual nightmare, I recommend this movie. If you compare ourselves to countries like Kenya or Zimbabwe, who couldn't make a peaceful transition of power if their lives depended on it, this movie may restore some of your faith in our democracy.

Charlie's interview with Kevin Spacey can be seen here:

Marketingservicestalk blog recently published some statistics on how bloggers perceive themselves with respect to the news media. According to a report from a legal services organization called DLA Piper, "Only 5 per cent of internet users are clear on their legal rights and responsibilities when posting comment online." Their research also showed that, while 42 per cent of internet users believe that bloggers should be held to the same standards as journalists, only 27 per cent of actual bloggers agreed.

I'm not particularly hung up on whether or not bloggers are journalists - logging into their free account a few times a week in order to commit random acts of journalism. Certainly, very few of them are good journalists. And virtually none of them are engaged in anything remotely resembling real, investigative reporting - something that is slowing going the way of the dodo in today's media markets.

I do truly applaud the men and women on the ground with real jobs, earning real salaries, with real professional standards, who keep me informed about what's actually going on in the world. However, I am not one of them. We at jamesloganmd.com are not journalists. We do not report news, nor do we hold ourselves to any standards whatsoever. Anything you read here has equal chances of being either real or fictional, truth or falsehood, fact or opinion. The author of what you read here may be James Logan, M.D., or it may be someone else. Or it may be no one at all! We cannot verify any facts or claims made or not made herein; neither can we verify the existence of jamesloganmd.com nor its readers.