Fall 2002 - Volume 6 Number 4

Clinical Contributions

Immediate Hypersensitivity to Methylparaben Causing False-Positive Results of Local Anesthetic Skin Testing or Provocative Dose Testing
Eric Macy, MD; Michael Schatz, MD, MS; Robert S Zeiger, MD, PhD

Parabens are commonly used preservatives in multidose vials of local anesthetics but rarely cause immediate hypersensitivity reactions. Data confirms the rarity of these reactions. Because of the possibility of false reactions, provocative positive sensitivity tests should be repeated.
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The Herbal Medicine Pharmacy Update
Phillip J Tuso, MD, FACP

Because of continued use of over-the-counter therapy and the lack of routine screening for drug interaction, it is important for physicians to understand risks and benefits of herbal treatment. This article is a partial review of selected herbal medicines with potential to harm patients.
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The 79-Year Illness
David Clarke, MD

Psychosocial stress is responsible for many primary care office visits. A case study is presented with positive outcomes.
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Jimson Weed Poisoning--A Case Report
Kit Chan, MD

The hallucinogenic effects of this common plant have been known for many centuries, and it is widely used by young people. The atropine, scopolamine, and hyoscyamine content can produce profound anticholinergic effects; recognition and management are discussed.
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Corridor Consult: How Can We Integrate Alternative Approaches and Mainstream Medicine to Treat Chronic Low Back Pain?
Lydia S Segal, MD, MPH

Using a case history as an example, this article outlines lifestyle, biosocial, and alternative measures available to treat this common condition. Skillful integration of alternative measures can bring about distinct benefit for these patients.
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The Macrobiotic Diet as Treatment for Cancer: Review of the Evidence
Joellyn Horowitz, MD; Mitsuo Tomita, MD

In this Independent Study Project by a medical student mentored by a KP physician, potential risks and benefits of a macrobiotic diet as treatment are explored.
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Special Feature

Symposium on Complementary and Alternative Medicine: In the Era of Evidence-Based Medicine, What's a Physician to Do?
Lee Jacobs, MD, Moderator
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Using Evidence to Understand New Approaches
Paul Wallace, MD
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Dietary Supplements and Botanical Medicines: A Commonsense Approach.
Tieraona Low Dog, MD.
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Integrating CAM Into a Group Practice: The Experience of The Permanente Medical Group in Northern California
Lee Ballance, MD
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Integrating CAM Into Practice: The KP Northwest Story
Charles Elder, MD
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Complementary and Alternative Medicine: Panel Discussion
Lee Jacobs, MD, Moderator
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Health Systems

Successful Practices in the Physician Work Environment: We Work Together
Karen Tallman, PhD; Jill Steinbruegge, MD; Michelle Hatzis, PhD

The Physician Work Environment Workgroup conducted focus groups to identify successful practices in the physician work environment. This article explores the practices that discriminate "highly rated" teams from "medium-rated" or "low-rated" teams.
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Clinical Information System (CIS) Baselets Help Standardize Evaluation of ADHD in the KP Colorado Region
Mark Groshek, MD

One powerful tool of CIS is the baselet, a module containing a set of prewritten items that can be inserted into a clinical progress note. This article discusses the successful use of these baselets in the KP Colorado Region.
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CPC Corner: How to Say No.
Edward Wang, MD; Andrew Golden, MD; Pamela J Butterworth, MA, MHRD

A good clinician-patient relationship is essential in determining treatment plans and goals. This article discusses the importance of this relationship when the clinician must tell the patient "no," and offers strategies for addressing these uncomfortable situations.
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Physicians as Leaders: Roundtable Discussion--Human Resource Leaders from the Permanente Medical Groups
Lee Jacobs, MD, Moderator

A panel of Permanente human resource experts, called together in a roundtable discussion, discusses the important informal leadership role physicians play in the work unit.
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Medical Ethics

To Be or Not to Be--Preimplantation Genetic Diagnosis.
Kate Scannell, MD, Editor
Commentary by Jeffrey R Botkin, MD, MPH

The rapid development of reproductive technologies has given birth to formidable ethical questions. A case study of the biologic construction of a child is presented with commentary addressing the physician's, the patients', and the unborn's positions as well as society's.
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Views and Use of Complementary and Alternative Medicine by Mid-Atlantic Permanente Medical Group Health Care Providers
By Lydia S Segal, MD, MPH
Department of Integrated Medicine
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Editorial Comments

National Institutes of Health "Oregon Center for Complementary and Alternative Medicine": Value to Permanente Medical Groups and to Kaiser Foundation Health Plan and Hospitals
Tom Janisse, MD, Editor-In-Chief
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Abstracts of articles authored or coauthored by Permanente clinicians
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Letters to the Editor

Letters from Our Readers

Book Reviews

Ophelia Speaks: Adolescent Girls Write About Their Search for Self
Sara Shandler
Review by Vincent J Felitti, MD
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Pregnancy, Birth, and the Early Months: The Thinking Woman's Guide
Richard I Feinbloom, MD
Review by Luz Garcia, PA
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Helping Your Child Lose Weight the Healthy Way: A Family Approach to Weight Control
Judith Levine, RD, MS, and Linda Bine
Review by Kathleen H Jones, MD
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Why Our Drug Laws Have Failed and What We Can Do About It: A Judicial Indictment of the War on Drugs
Judge James P Gray
Review by Jill Waalen, MD, MPH
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Soul of the Healer

"Glade Creek Grist Mill"
Ahmad Abdalla, MD

"A Gathering of Crabs"
Ahmad Abdalla, MD

"Tools of the Trade"
John J Kuiper, MD, FACP

"Spider Web"
Suzanne Ackley, MD

You Can't Go Home
Calvin Weisberger, MD
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In Memory of Carol Abramowski, RN, NP, MS
Winnie Star, RNP
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"Portland Head Light"
Ahmad Abdalla, MD

The Lighter Side of Medicine

The Humerus Zone


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The Permanente Journal (ISSN 1552-5767) is published quarterly by The Permanente Press. The Permanente Journal is available online (ISSN 1552-5775) at www.thepermanentejournal.org.


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