Savoring Uncertainty.

The first quantification of neural discharge from the carotid body of cats in response to hypoxia, hypercapnic acidosis, and their combination discovered a strong potentiating effect of hypoxia and hypercapnic acidosis combined as compared to either alone. This paper was the start of a research journey that eventually examined the regulation of blood and cerebrospinal pH by peripheral and central chemoreceptors in the setting of systemic acid-base alterations. This research focus was the result of the author's personal fascination with mountains and human adaptation to high altitude-an interest that led to his own ascent of Mount Everest in 1963. The inherent uncertainty and challenge involved with climbing high mountains has served as a metaphor and inspiration for his life, including his career in academic medicine.

Risk factors for relapse in health care professionals with substance use disorders.

CONTEXT: Substance use disorders among physicians are important and persistent problems. Considerable debate exists over whether use of major opioids, especially among anesthesiologists, is associated with a higher relapse rate compared with alcohol and nonopioids. Moreover, the risk factors for relapse with current treatment and monitoring strategies are unknown. OBJECTIVE: To test the hypothesis that chemically dependent health care professionals using a major opioid (eg, fentanyl, sufentanil, morphine, meperidine) as drug of choice are at higher risk of relapse. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 292 health care professionals enrolled in the Washington Physicians Health Program, an independent posttreatment monitoring program, followed up between January 1, 1991, and December 31, 2001. MAIN OUTCOME MEASURE: Factors associated with relapse, defined as the resumption of substance use after initial diagnosis and completion of primary treatment for chemical dependency. RESULTS: Twenty-five percent (74 of 292 individuals) had at least 1 relapse. A family history of a substance use disorder increased the risk of relapse (hazard ratio [HR], 2.29; 95% confidence interval [CI], 1.44-3.64). The use of a major opioid increased the risk of relapse significantly in the presence of a coexisting psychiatric disorder (HR, 5.79; 95% CI, 2.89-11.42) but not in the absence of a coexisting psychiatric disorder (HR, 0.85; 95% CI, 0.33-2.17). The presence of all 3 factors--major opioid use, dual diagnosis, and family history--markedly increased the risk of relapse (HR, 13.25; 95% CI, 5.22-33.59). The risk of subsequent relapses increased after the first relapse (HR, 1.69; 95% CI, 1.13-2.53). CONCLUSIONS: The risk of relapse with substance use was increased in health care professionals who used a major opioid or had a coexisting psychiatric illness or a family history of a substance use disorder. The presence of more than 1 of these risk factors and previous relapse further increased the likelihood of relapse. These observations should be considered in monitoring the recovery of health care professionals.