"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Bioterror Preparedness Update: A perusal of local newspapers from throughout the country confirms that the state of smallpox preparedness is mostly dismal. One community in Michigan equates infectious disease with toxic chemicals and has armed themselves with committees:
University Hospitals are equipped with a hazardous materials team trained to investigate and isolate toxic exposures before they spread.
In addition, UHS organized a terrorism task force shortly after the terrorist attacks last September to help make decisions about the proper course of action in the event of exposure to smallpox, Winfield said.
Reedy said the Washtenaw County Public Health Department has been keeping on top of the smallpox risk with a committee of health professionals who rigorously investigate bioterrorism issues.
No word on whether they’ve actually come up with any plans.
In Ohio, they’ve been distracted by West Nile virus hysteria:
But state and local officials are still wrestling with how and where to quarantine victims who come in contact with the virus and which hospitals to designate as isolation units for people who become sick.
Most local health departments have been too overwhelmed with West Nile virus this summer to spend much time on smallpox. And with winter approaching, their attention has turned to influenza.
There’s not much health departments can do about West Nile, other than recommend mosquito control, and all they can do about influenza is give their routine immunization clinics - clinics so longstanding that they should be able to function on autopilot. They hardly require the full attention of the public health authorities.
In West Virginia, and many other places, they aren’t sure whether to vaccinate their heatlhcare responders before or after the event:
As with federal officials, determinations also need to be made as to whether some individuals should receive precautionary vaccinations and if so, who those might be, Mercer said.
They’re also a little hazy on the natural history of smallpox infection:
Despite the long incubation period for smallpox, Mercer said patients do not become contagious until the lesions occur. But at that point, there is an opportunity to slow the spread of the disease. Patients, he said, are extremely ill and not likely to be out in public.
Virus titers in saliva are highest during the first week of illness,corresponding with the period during which patients are most infectious.
That means that there’s a two to three day period when people are infectious but don’t have the tell-tale rash. It’s excessively optimistic to think that everyone with fever and malaise would stay home. The reality is that people push themselves all the time to work through their illnesses, especially if they think it’s just the “flu”.
In North Carolina, things are even worse. They’re planning to rely on the pretty much discredited “ring vaccination theory” :
For someone who hasn't been exposed to smallpox, "the risks of the vaccine outweigh the benefits," said Dr. James Kirkpatrick, bioterrorism coordinator for the state of North Carolina.
The first response to any smallpox outbreak would be "ring vaccination," or vaccination of family members and close contacts, Kirkpatrick said.
Many health officials believe the vaccine can protect those who have been exposed to the virus if the vaccine is given four to five days after exposure.
Looks like Surgeon General Carmona is right to be “concerned because America isn't quite prepared for anything, at least not yet.”
There is one county in Maryland , however, that’s been working hard on preparedness:
In a simulation of what public health experts and government leaders fear could be a real-life nightmare, a woman walked into a Frederick emergency room yesterday displaying symptoms of history's most virulent disease: smallpox.
About 2 p.m., actress Amanda Strand told doctors in the fake emergency room that she had a rash and a 103-degree fever. Within 20 minutes, a SWAT team in dark-blue body armor had stormed in, barred the doors, and duct-taped the vents.
A helmeted doctor with a pistol strapped to his thigh informed everyone they would be unable to leave for eight to 10 hours and would then be quarantined or monitored by health officials for at least 17 days.
The pistol-toting may be a bit much, but at least the county has thought things through and run a mock emergency to discover their deficiencies:
“They were amazed at the scope of the undertaking -- isolating the initial victim and all those potentially exposed, creating vaccination and quarantine centers, closing off roads, communicating with the press and with state and federal officials.
..."You'll be amazed at what you discover when you practice, silly little things that just blow your plans to shreds," said state health Secretary Dr. Georges Benjamin.
..County officials said the planning and drill have helped identify several potential problems.
The county did not have enough protective suits for workers who would have to treat the infected or enough respirators for patients.
Potential quarantine sites had improper ventilation. The county also had no written plans to provide linens or food to quarantined patients. Vitarello and friends have solved those problems.
It also became apparent that the county's public health staff, with only a few doctors and about 50 nurses, would not be able to run both quarantine and vaccination centers.
So Frederick officials included plans to shift scores of doctors from Frederick Memorial to the centers and to enlist hoards of retired nurses, doctors and veterinarians to give vaccinations and monitor the potentially infected.
The most dismaying thing about this story is that the efforts at preparedness weren’t initiated by the public health department, but by a local cardiologist who was concerned enough to devote his time and energy to organizing a plan. Luckily, his public health officials were willing to work with him. I have the feeling that there are a lot of public health departments out there who aren’t taking the threat of bioterrism seriously. posted by Sydney on
9/28/2002 08:53:00 AM
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Mini-Antibiotics and AIDS: Researchers think they might have stumbled upon tiny proteins that slow the progress of HIV. The proteins, called defensins, have been around for a while:
Defensins are one of the weapons of "innate" immunity, the ancient biological armament -- shared by insects, reptiles, birds and mammals -- that attacks many forms of microbial invaders. Innate immunity doesn't entail the elaborate work of identifying and processing that is required to make microbe-specific weapons, such as antibodies and killer cells.
They’re apparently produced in greater quantity by some people than by others. Maybe this gene has something to do with it. posted by Sydney on
9/28/2002 07:42:00 AM
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The Bush administration has yet to make final decisions or announce plans for what is called "pre-attack" smallpox vaccination. But administration officials say the consensus is to begin vaccinating those at greatest risk of encountering a highly contagious smallpox patient, such as hospital emergency room workers. That could total a half million people. Then the vaccine would be offered to non-hospital health workers, such as primary care doctors, and to police, firefighters and other emergency workers.
At some point after that, it would be offered to the general public.
"You start with one group and based on their potential risk, you keep expanding," one administration official said Thursday, speaking on condition of anonymity.
..Other issues are logistical, such as how states and cities prepare large vaccination clinics and train people to give the shots, and how to deal with people who get sick from the vaccine and the publicity likely to surround such an incident.
Those questions get more complicated as the number of people vaccinated increases.
...Some health officials are counseling a slower approach, in which they could analyze the results of the first round of vaccinations before moving to the next.
Hmmm. Where have I heard this before? Advantage: Medpundit!
Meanwhile: The states seem to be having mixed responses to the CDC guidelines. Oklahoma doesn’t appear to be planning to vaccinate anyone, healthcare workers included, unless there’s an attack, and Florida will model its response on its hurricane response program. (They’re used to handling disasters down there). Elsewhere, the Association of American Physicians and Surgeons has blasted the CDC for not recommending voluntary pre-attack mass vaccination. (They come across as a little shrill, but their points are valid.)
Congress Wises Up: For some reason, the House Government Reform Committee was debating Ritalin yesterday. Whatever their reasons for holding hearings, they at least did their homework enough to avoid being bamboozled by advocacy groups. First, the anti-Ritalin camp:
But Rep. Constance Morella (R-MD) pointed out that the Citizen's Commission for Human Rights (CCHR) was founded in 1969 by the Church of Scientology, a religious group known both for attracting celebrity members and for vehement opposition to all of psychiatry.
...Morella also challenged Dr. Mary Ann Block, a board member who treats ADHD children with nutritional and anti-allergy interventions instead of drugs. Block accused psychiatrists and other doctors of prescribing ADHD drugs for financial gain.
"You'd probably gain a little bit too if people were scared away from psychiatric drugs," Morella said.
And on the other side of the fence we have Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD):
[Rep. Benjamin] Gilman [R-NY] quoted a Drug Enforcement Administration study concluding that Ritalin maker Ciba-Geigy, now known as Novartis, had given CHAAD over $700,000 in grants over five years in the 1990's. The agency expressed concern in the report that CHAAD and similar groups serve as front organizations for drug makers.
"Here we have a drug company that is influencing a parental group, and that drug company has a strong financial interest," Gilman said.
Unfortunately, Gilman also thinks that ADD is caused by childhood vaccines. But there’s hope for our lawmakers. Now that they’re questioning the motives of the groups testifying before them, maybe someday they’ll come to the realization that politicians have no business debating medical treatments.
posted by Sydney on
9/27/2002 06:16:00 AM
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The Prozac Nation Goes to College: College counselors have noticed an alarming increase in the number of students on psychoactive drugs:
Antidepressant prescriptions to children increased three- to five-fold between 1988 and 1994, with the steepest increases among students ages 15 to 19, said Dr. Julie Magno Zito, associate professor of pharmacy and medicine at the University of Maryland.
Nationwide, mental health services in large colleges report that 1 to 60 percent of their clients are using psychoactive medications, said Gregory Snodgrass, president of the Association of University and College Counseling Center Directors.
It isn’t that kids are crazier today, as one counselor at Bennington College pointed out:
''I haven't seen sicker students,'' Carter said. ''I've seen students labeled as sicker.”
Exactly. This is the blowback from all those aggressive public health campaigns that tout the importance of mental health care. Although there are some serious mental health problems that require and deserve attention, there are also a lot of more mundane emotional problems that are nothing more than a part of the human condition. Many begin to believe that every little problem requires professional intervention and that a pill is the answer to everything. Child acting up in school? Forget about addressing problems at home, or taking responsibility for disciplining them, just push for Ritalin. Have a moody teenager? Get them as perky as Gidget with Prozac. It’s not unusual for a parent to end a long litany of behavior complaints about their child and then sum it all up by looking pointedly at me and saying, “Something has got to be done.” Our modern psychiatric pharmacopoeia has made it too easy for parents and children to escape their own responsibilities. And, as the counselors point out, medicating children and adolescents so freely deprives them of finding their own inner strengths:
Steeped in the tradition of psychotherapy, the health counselors said that some students may avoid fully experiencing the emotional milestones of young adulthood: the first great romantic disappointment, separation from family, and churning identity questions. Adolescents who don't learn coping skills could run into worse challenges later, they warn.
Wacky Tobaccy:Andrew Sullivan has been wondering aloud with his readers about the medicinal effects of tobacco (really, the nicotine in tobacco). I’ve touched on this before, but the knowledge that nicotine has potential medical benefits is nothing new. It was that very quality that allowed the weed to gain admittance into European high society in the 16th century. Juan de Cardenas, a Spanish physician, sold Queen Isabella on its inherit worthiness by telling her, “To seek to tell the virtues and greatness of this holy herb, the ailments which can be cured by it, and have been, the evils from which it has saved thousands would be to go on to infinity . . . this precious herb [tobacco] is so general a human need not only for the sick but for the healthy." She bought into it, and the rest, as they say, is history. Even as late as the mid-twentieth century, tobacco was promoted for its beneficial effects on the gastrointestinal system.
There is a physiological basis to its medicinal effects. The cells in the brain and in the gut have receptors that respond to nicotine. They’re even called nicotinic receptors because nicotine was used to study them before chemists were able to synthesize the biological transmitters in the lab. Recently ,studies have been done to test nicotine's effectiveness in gastroinestinal illnesses such as inflammatory bowel disease and in neurological illness, such as Parkinson's disease. The results as they pertain to nicotine’s effectiveness can be summed up as: “Maybe yes. Maybe no. You know what? We don’t know.”
The question becomes, is it more effective than the therapy we already have, and is it worth the risks. Nicotine patches make its use as therapy more acceptable, and the studies I mentioned above relied on them, not cigarettes. Smoking tobacco for its potential health benefits, however, can’t be recommended. It’s far more harmful in terms of causing emphysema and lung cancer than it is beneficial.
OOPS: That wasn't Queen Isabella the sixteenth century physician and tobacco promoter was talking to. I got my queens and promoters mixed up. It was a Frenchman, Nicot,(from whom the word nicotine is derived) who sold Catherine de Medici, the queen of France, on tobacco. It cured her son's migraine headaches, so she promoted it to the court of France and thus to the rest of Europe,since France was the cultural leader of the time. posted by Sydney on
9/26/2002 08:22:00 AM
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Smallpox Preparedness:The Bloviator pointed me to this piece in the NY Times that gave voice to concerns about smallpox preparedness by public health officials at the state level, the people who will be responsible for administering the plan. As I suspected ,they’ve got more unanswered questions about the whole thing than answered questions.
Dr. Mack Sewell, New Mexico's state epidemiologist, said achieving that level of readiness "is a matter of time, attention and resources," all of which are uncertain at this point.
Earlier this summer, federal officials said they would recommend "preattack" vaccination for up to 500,000 emergency workers, but state officials complain that they have received little or no guidance on the critical question of how much vaccine will be made available, and when, or who will have to be immunized ahead of time so they can carry out the mass vaccinations.
"They've really been bobbing and weaving on this," said Gary L. Simpson, director of the New Mexico infectious disease bureau. "We've looked at numbers that range from 500 up to 50,000 people, and that's just in New Mexico."
Federal officials said a plan for vaccinating emergency health care workers, after repeated delays, was to be made public by month's end.
Judging from my email discussion groups, this is widespread. Nothing has been communicated to the local departments on vaccination of healthcare workers.
Dr. Tucker added that good public communication, vital to the plan's success, seemed to be an afterthought. "It's very unclear whether C.D.C. or the states are developing the necessary communication strategy to prevent panic in the event of an outbreak," he said.
Again, my email discussion groups indicated that no communication strategy is in the works. The public health doctors say across the board that they feel educating local physicians is the duty of professional societies, not the health department. They only consider it their responsibility to administer the vaccine. Yet, even one case of smallpox is a devastating public health problem. We practicing physicians have to know what to do if a case walks into the office. Do we lock everyone in the building until they can be vaccinated to ensure that they don’t carry it out to the community? Where does the patient go for quarantine? Who do we call to find out, especially if you’re in an emergency room at 2AM? These things need to be answered if the CDC approach of mass voluntary vaccination only after an attack is to be effective. posted by Sydney on
9/26/2002 07:34:00 AM
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To Hell With Experience: Experience and evidence apparently aren't the same, especially when it comes to small pox vaccine and children:
Though doctors administered the vaccine successfully in children for two centuries before the disease was eradicated, a formal controlled clinical trial had not been performed even in the 1960s, a period within the era of evidenced-based medicine.
The vaccine was used to successfully eradicate the disease around the globe, but we need a clinical trial of its effectiveness? I guess the collective memory needs refreshing posted by Sydney on
9/26/2002 06:57:00 AM
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Abortion Pill Fizzles: It’s been on the market for two years, but the pill formerly known as RU-486 just isn’t catching on. Doctors who perform abortion prefer the surgical approach because it’s cleaner and quicker. And other physicians just don’t like it:
It's not the social revolution that people predicted," said Ron Fitzsimmons, the executive director of the National Coalition of Abortion Providers, which represents about 150 independent abortion clinics. "There were all these predictions that doctors would come out of the woodwork and offer it. We haven't seen it. We haven't seen people who do not do surgical abortions offer it. There were predictions that this would get the protesters away from the clinics. It hasn't panned out that way."
The article points out that private physicians shy away from it because it requires three separate office visits to administer and because they have to be able to provide back-up surgical abortions if it fails. There’s another reason it hasn’t caught on amongst non-abortion providing doctors - a lot of us have moral qualms about abortion. posted by Sydney on
9/26/2002 06:55:00 AM
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In Defense of the FDA A certain research chemist has this to say about the FDA:
Speaking as a researcher in the industry, I can say that the FDA drives us all nuts, but we need them. We need people to poke holes in the studies, to question the data, to give us a hard time. It's called science. It's how we've made it as far as we have.
Read his whole post about the pharma companies' use of statistics to hedge their research results. Unfortunately, this kind of numerical manipulation happens all to commonly in medical research of all stripes. posted by Sydney on
9/26/2002 06:54:00 AM
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Being There:Richard[WINTERS] has an all too common tale of being on the receiving end of a malpractice suit, just for being in the presence of the patient at some point in their hospitalization. I had a similar experience a few months ago. My only crime was to have the misfortune of having my name appear legibly in the chart. The nursing staff called me late one night to ask for Tylenol for the patient for arthritits pain. I ordered it. She died two weeks later from complications of surgery. It had nothing to do with her Tylenol, but nonetheless, I was sued, as was everyone else who ever touched her chart or spoke a word to a nurse about her. Even those whose names were illegible were sued - they were "Doctors John Doe 1 - 20." (I suspect many of 1-20 were the same doctor with the same illegible signature.) The suit was dropped for lack of merit, but I still had to take time to go over the records and meet with the attorney to mount a defense before it was finally dropped, as did everyone else who was named. posted by Sydney on
9/25/2002 06:48:00 AM
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Medical Error Myth:The Bloviator had a post yesterday that highlighted a speech by Treasury Secretary O’Neill about cutting healthcare costs by cutting medical error rates. Now, I sincerely believe that medical errors are bad and should be eliminated as much as possible, but I take exception to comments like this:
At least 100,000 Americans every year die because of medical errors and mistakes. A just released study by the Archives of Internal Medicine indicates that medication errors alone occur 2 times a day, per patient, in a typical hospital. -from Secretary O’Neill’s speach
That figure of 100,000 people dying each year comes from the Institute of Medicine’s study on medical errors from a couple of years ago. The study was poorly designed and its results have been largely discredited, but the IOM did such a fine job of grandstanding that their exaggerated and incorrect figure has taken on a life of its own. The Republicans repeat it, the Democrats repeat it, the HHS repeats it, advocacy groups like Public Citizen repeat it, and worst of all the American Trial Lawyers repeat it - again and again.
Counting errors is an imprecise science. The results depend on how errors are defined, and in the IOM report they were defined as any adverse event. Every medical decision, even when it’s the right decision, has the potential to have an adverse effect. For example, an antibiotic might be chosen for a deadly infection because it’s the one that offers the best chance of survival for the patient. The patient lives, but has an allergic reaction to the antibiotic. By the IOM standards this would count as a mistake. What it really is, is an adverse reaction, and one that we have no way of predicting. Similarly, the quote on medication dosing errors includes failures to deliver medication on time. This isn’t necessarily a mistake - the patient could be off the floor for testing when their scheduled dose is due, or the nurse could be busy attending to another critically ill patient and miss the scheduled dose. Getting your medicine an hour later than scheduled isn’t really an error, and it isn’t likely to make a difference in the course of an illness. posted by Sydney on
9/25/2002 06:45:00 AM
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West Nile Update: The NIH and the FDA are working on an easy blood test for West Nile virus so they can test the blood supply, and on a vaccine for the disease:
The National Institutes of Health is developing a vaccine against West Nile virus and could have one ready in as little as three years, Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, told senators.
Here’s the problem, though, with a vaccine:
The CDC reported as of Tuesday the number of West Nile cases topped the 2,000 mark, confirming 98 deaths in 2,072 cases. Illinois, the state reporting the most cases and deaths, upped its death toll to 29 in 518 cases after the CDC figures were released. Indiana reported its third probable West Nile death and Virginia reported its first -- all of which have yet to be counted by the CDC.
Two thousand cases out of a population of 290 million is hardly a blip as far as disease goes. To be profitable, a vaccine has to have a market. With such a low rate of infection and an even lower rate of mortality, it will be hard to justify the cost of manufacturing it. Who would want to undergo the inconvenience of a vaccine when the odds of getting the disease are so slim? One need look no further than the now defunct Lyme Disease vaccine to answer that question. posted by Sydney on
9/25/2002 06:39:00 AM
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Influenza Preparedness: The time is fast approaching when those at highest risk (asthma, elderly, babies and toddlers, and the immunosuppressed) should be thinking about getting flu vaccines. The CDC says that no shortages are anticipated this year, thank goodness, but just to make sure, only the highest risk patients should be immunized first. The rest of you can wait until November. posted by Sydney on
9/25/2002 06:35:00 AM
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Girl Interrupted: The story of one bipolar woman and her search for the right drug:
... the number of drugs used and the combinations that are possible are mind-boggling: There are the other anticonvulsants, including Tegretol, Lamictal, Neurontin and Topomax. There are the antipsychotics Zyprexa, Risperdal, Seroquel and Geodon. And there are the antidepressants, like Prozac, Zoloft, Luvox, Paxil and Celexa, as well as Effexor and Serzone.
And guess what: I've tried most of them over the past seven years, often multiple times in different combinations with a range of reactions from severe to benign.
"It's trial and error," one doctor after another has blithely told me each time a medication has run amok through my system and, sometimes, my life. This even included the doctor who put me on Lamictal, which resulted in vomiting, flu-like symptoms and eventually a body rash and lips so swollen they looked like they'd been pumped full of collagen.
For other bipolar people, Lamictal works very well.
Unfortunately, the state of the art is trial and error with this and with many other chronic diseases. Someday we might have the means to design treatment specifically for each individual based on their genetic map, but that day has not yet arrived. I would admonish her for being so disdainful of her physicians and their efforts to treat her, but then, she’s bipolar, she probably can’t help herself. posted by Sydney on
9/25/2002 06:34:00 AM
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Blog-InBlogcritics is having a big blog-in today. Everyone's posting something. Go on over. You're bound to hit on something interesting.
Smallpox Vaccine Plan: The CDC’s guidelines for public health clinics on how to handle a smallpox epidemic are on line now. (Warning: pdf file) The plan is really geared only to the logistics of providing the vaccine to a large number of people in the event of an attack. They also deal with the issue of quarantine and provide instructions on what to do with a suspected case. (Warning: both are pdf files). They strike me as woefully inadequate. There’s no mention at all of the necessity of educating physicians on bioterror preparedness. The quarantine is to take place at a designated quarantine facility, something which few places have up and running. It isn’t clear whether the healthcare providers will be vaccinated before an attack or at the first sign of a case.
A defense is only as strong as its weakest link, and in this case the weakest link is the people who are going to be the first responders - practicing physicians and their staffs. Waiting until smallpox is upon us to begin vaccinating invites chaos and panic. A couple of years ago, there was an outbreak of meningitis in our area. Now, this is a disease that is far less contagious than smallpox, but the response to it was horrible:
And if people are panicked about meningitis, imagine what would happen in the event of a smallpox outbreak. In Alliance, thousands of people lined up at Alliance Community Hospital hoping to get antibiotics, even though CDC guidelines, at that point, suggested against antibiotic use.
The reason panic set in was that the first responder responded incorrectly by holding a news conference and recommending that everyone in the town take antibiotics. This sort of thing could be prevented if the CDC and state health departments would take the initiative and educate practicing physicians on how to handle a case. If someone walked into my office today with smallpox, I wouldn’t know what to do with them. I suppose I’d have to lock everyone in the office until the health department officials could respond and help me out. And I’ve been trying to keep up on the topic. Imagine what it would be like for someone who hasn’t been.
UPDATE: A good and worthwhile discussion of the role of antiviral drugs in a smallpox outbreak can be found here. (via Instapundit). An antiviral may be helpful to curb the spread and the complications of the disease, but it shouldn't be relied on as a line of first defense. We have no experience with them for smallpox, and the antivirals we do use for other conditions are never curative. They only reduce the duration and severity of symptoms. The effectiveness of vaccination, on the other hand, is proven. And it confers immunity from future infection. posted by Sydney on
9/24/2002 07:17:00 AM
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CDC Condescension : The CDC continues its condescending attitude toward the American public, in this comment from one of their officials on the smallpox vaccine:
Our impression is the public doesn't understand the side-effects of smallpox,'' Dr. Walter Orenstein, director of the CDC's National Immunization Program, said in a recent interview.
Explain the side-effects then, honestly, of both the vaccine and the disease and let people decide for themselves if they want to take the risk. But don’t act as if we’re too stupid to comprehend it. posted by Sydney on
9/24/2002 06:45:00 AM
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Plugging a Worthwhile Program: This has nothing to do with medicine, but I wanted to give the EAA Young Eagle program a plug. It's an association of private pilots that introduces children ages 8 to 17 to flying. My kids went on their first flight yesterday thanks to the program, and they loved it. posted by Sydney on
9/24/2002 06:42:00 AM
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Every Minute Counts: There is a debate going on in pubic health about public access to automatic defibrillators to improve cardiac arrest survival. The devices are simple to use once the proper training is received, but they’re expensive. A recent study in the BMJ argued that it wasn’t cost effective to have them in every public place, but it was based only on statistical supposition rather than direct observation. In most cardiac arrests the heart goes into a chaotic electrical disturbance called ventricular fibrillation. The best corrective to this is a quick electrical jolt to the heart - the quicker the better. But most heart attacks occur in the home, not in public places, so them in homes may save more lives than having them in malls, which is a question that will soon be looked into:
Next month, researchers in an $18 million study in the United States, Canada, Britain, New Zealand and Australia will start distributing defibrillators to 3,500 heart patients and train their partners to use them. Their survival rates will be compared with those of 3,500 other heart patients whose partners receive only CPR training. posted by Sydney on
9/24/2002 06:33:00 AM
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Competition: A competitor to Viagra, called Levitra is being readied for the market. The name doesn't have quite the punch as Viagra, but maybe it will be cheaper than Viagra which averages about $10 a pill. posted by Sydney on
9/24/2002 06:07:00 AM
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The Medicare payment for a unit of red blood cells — about a pint — would be cut 39 percent, to $83 next year, from $137 this year.
...The payment for inserting a battery-operated pacemaker and defibrillator would be cut 59 percent, to $12,102, from $29,360
...The Medicare payment for a breast biopsy would be cut 27.5 percent, to $290 from $400. For injection of cisplatin, a commonly used cancer drug, the payment would be reduced 43 percent, to $24 from $42.
For Remicade, a drug given intravenously to people with rheumatoid arthritis, the payment would be cut 39 percent, to $38.50 from $63. For Avonex, an injectable, genetically engineered drug used by people with multiple sclerosis, the payment would be reduced 36 percent, to $144 from $225.
Hospitals would get 67 percent less for implanting an infusion pump, used to deliver medication for severe intractable pain. The payment would be cut to $1,346 from $4,079.
...For the blood-clotting factor most widely used by people with hemophilia, the payment would be cut 54 percent, to 52 cents a unit from $1.12. This would reduce to $1,300, from $2,800, the payment for a typical infusion provided to a hemophiliac in a hospital outpatient department.
The government has decided that they get too many bills for outpatient procedures, so their response is to cut payment. They’re wrong to assume that the hospitals are marking up their charges. Reimbursement is already miserably low, there’s just more people out there who require the services. The problem is compounded by the fact that private insurance companies base their fees on Medicare, so they’ll be sure to follow suit. If these cuts take effect, hospitals will have no choice but to stop offering services. Between the malpractice insurance crisis and poor reimbursement, hospitals and doctors are going to be squeezed out of business.
Smallpox Vaccine Update: The federal government is sending its plan for dealing with a smallpox attack out to state health departments today. As The Bloviator pointed out last week, all preparedness is local:
At the first hint of a smallpox case, the CDC in Atlanta would begin dispatching emergency teams to the area to confirm the outbreak and begin vaccination.
Yet the suspicion that terrorists would strike more than one location "would require us to be in many, many places simultaneously," one federal planner said. "That would completely deplete our assets."
Instead of sending its staff to every corner of the country, the CDC plans to ship the vaccine and let states handle inoculation, Osterholm said. The National Pharmaceutical Stockpile, he said, "can be at any hamlet in this country in 12 hours." Officials have not said how much it would cost or how it would be paid for.
HHS has received assurance that even if air traffic were halted, as it was immediately after the Sept. 11 attacks, planes transporting vaccine would have clearance. Vaccine would be delivered in waves much the way a grocery store receives its weekly shipment of milk in batches.
This reliance on local health departments to carry out the plan is more than a little worrisome. Not all public health departments are created equally, and many of them are little more than well child and sexually transmitted disease clinics. Last week, I got an inkling of what ours is probably doing with their bioterrorism money. I received a slick package on preventing falls in the elderly. It came in a nice folder with nice, glossy handouts and reminder cards for patients. Normally our health department provides handouts on xeroxed sheets, and it never presents them in a package like this. I could be wrong, but I have to wonder where they suddenly got the money for public relations.
Ross is right, too, about the need for a more centralized approach to public health in the event of a bioterrorist attack. The CDC needs to educate the rest of the nation’s physicians about bioterror threats. They could do this by educating the state health departments and charging them with holding local educational conferences for physicians on how to recognize and respond to a bioterrorist attack. So far, nothing like this has been done.
Me First: Yesterday’s New York Times Magazine’s “Endpaper” made a curious argument for preferential smallpox vaccination in Native Americans. Even though many (but by no means all) Native Americans live in remote, rural, and less populated areas where they would be at lower risk of contracting the disease in the event of a bioterror attack, the writer feels they deserve priority over other ethnic groups because they were devastated by the disease two hundred or more years ago. Well, we’re all equally vulnerable now. And we all deserve the opportunity to protect ourselves against the disease, regardless of ethnic group. posted by Sydney on
9/23/2002 06:43:00 AM
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Statin Scrutiny: Looks like the popular anti-cholesterol drugs may be in for some closer scrutiny. Unfortunately, I can’t look up the paper the article refers to. It says it’s coming out in October, which is two weeks away. Someone in the news business must have an inside scoop. posted by Sydney on
9/23/2002 06:42:00 AM
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Cold Comfort: A patient in Britain sued his doctor for having a cold when she treated him. (via Overlawyered). He lost and had to pay a penalty for filing the suit , proving that there is some justice in this world, after all. posted by Sydney on
9/23/2002 06:41:00 AM
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Poetic Death: The Israeli poet/warrior Abba Kovner’s final collection of poems, entitled 'Sloan-Kettering', was reviewed yesterday in the New York Times. The poems deal with his throat cancer, hospitals, and dying:
“Sloan-Kettering'' is a work of self-commemoration that takes the side of continuing existence, ''of life flowing beneath the surface of all / the words, like a fountain flowing, cascading / with confidence, telling no lies.'' It has the distinctive air of a book written from the far side of alienation, from the vanishing point of life, and it shimmers with the dark radiance -- the stark beauty -- of last things. posted by Sydney on
9/23/2002 06:17:00 AM
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Baby Walkers: I don't know what it is about babywalkers, but they certainly stir up passions in people. Most research suggests that they're a hazard to babies. They make them prone to accidents and they may delay their development, yet people still love them. They're banned in Canada, but many parents import them from elsewhere. Their appeal, of course, is that they keep a child happy and amused, freeing the adult in their lives to do their own thing. That’s not meant as a condemnation of the harried modern parent. The things have been around for ages. Just use them with caution if you must use them at all. posted by Sydney on
9/22/2002 12:10:00 PM
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Insurance Innovations: A new twist on health insurance, employee-driven health plans, that put more financial responsibility on the patient:
Workers get a yearly contribution of, say, $2,000 from their employer that goes into a personal care account for their family. Workers then can use the money any way they want for medical expenses, with any money that's leftover rolling into their account for the next year.
Employers typically couple that personal care account with a high-deductible insurance policy that will cover expenses above a certain level, for example, $3,000. Workers are responsible for paying out of their own pocket the $1,000 in medical expenses before the insurance coverage kicks in. The insurance policy typically would pay 80 percent to 90 percent of covered medical expenses, leaving workers subject to further out-of-pocket costs.
This is a welcome step forward for the financially responsible practice of medicine. Patients do need to be made aware more aware of the costs of their choices. The most highly advertised and expensive drug isn't necessarily the best drug, and using the most sophisticated technological test at the immediate onset of an illness isn't necessarily the best care. Not every cough requires a chest x-ray, and not every low back pain requires an MRI. It'll be interesting to see how this pans out. posted by Sydney on
9/22/2002 11:45:00 AM
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Malpracitce Crisis Update: A doctor-owned malpractice insurance company that insures 2,200 Mississippi physicians has announced that it will have to increase premiums by 45% as of January. This is in a state where malpractice premiums have already gone up by 40% this past year. The results will be predictable:
Dr. Tom Carey, an obstetrician/gynecologist in Natchez, said the rate increase will force him to limit himself to gynecological coverage, work for a county-owned hospital where doctors have more protection from lawsuits, or leave the state.
It's a decision he'll now have to make before Jan. 1, when the new rate takes effect, he said.
"We were expecting a raise, but I don't think we were expecting quite 45 percent."
The hike will make his payments go from $60,250 to about $87,000, he said.
There are currently three obstetricians in the area, all of whom are covered by MACM. The rate increase could leave the Natchez area with none, Carey said.
Meanwhile, the Mississippi legislature has stalled in their efforts to reform the system:
House and Senate negotiators discussed point-by-point Thursday morning the obstacles to reaching a consensus, but they made no progress toward an agreement. The 15-day session has cost $484,128.
Mississippi legislators have received over $700,000 this year from trial lawyers. They’re still ahead.
It Takes a Village: After 9/11, a Masai village was so moved, that they gave fourteen blessed cows to the United States - gift that was very expensive and dear for them. Citizens of a town in Virginia have reciprocated. They flew a child from the village with a fatal heart condition to their hospital for corrective heart surgery. posted by Sydney on
9/22/2002 08:50:00 AM
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Joined the Fray: I’ve joined the fray over at Blogcritics. Eric Olsen really hit on something with this idea of a "blog central" of book, movie, and music reviews. You can find reviews of things there that you wouldn't find in the traditional mainstream media. And Eric Olsen has made it his blog home so media news and interviews can be found there, too.
My first attempt at a book review is up now. (I haven't mastered the art of the lede.) It’s a review of a children’s book,So You Want to Be President?, by Judith St. George and illustrated by one of my favorite children’s book illustrators, David Small. (The Library, George Washington's Cows) My daughter brought the book home from the library a couple of weeks ago, and everyone was captivated by it. Each of her brothers read it without any parental prodding. In fact, they recommended that we read it, they thought it was so good. And it was. The cover illustration alone is worth the price of the book - a rendering of Mount Rushmore with the faces looking as if they’re sharing a good joke, or as if they’ve just read Judith St. George’s Presidential anecdotes.
Instead of presenting the Presidents and their histories in chronological order, which runs the risk of being a great yawn, the book ties the Presidents together by commonalities. Thus, we have all the Georges, all the Williams and Johns and and all the Jameses together in a discussion of the most common Presidential names; Lincoln and Harding together in a discussion of the ugliest and the prettiest, (When accused of being two-faced Lincoln once quipped, “If I am two-faced, would I wear the face that I have now?”); and Taft and Madison in a discussion of the biggest and the smallest. But the author doesn’t limit herself to trivia. She also touches on their personalities, their educations, their motivations, and their honesty - or lack thereof. One of the best illustrations (though Clintonites would disagree) is of Bill Clinton and Richard Nixon descending the steps of the Lincoln Memorial, their heads bent in shame as Abraham Lincoln sternly looks down upon them. Finally, she quotes Abraham Lincoln in a message that every child should take to heart, no matter what they want to be when they grow up:
“I know very well that many other might in this matter as in others, do better than I can. But...I am here. I must do the best I can, and bear the responsibility of taking the course which I feel I ought to take.”
Come to think of it, that’s a message all adults should take to heart, too. posted by Sydney on
9/22/2002 08:44:00 AM
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