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Saturday, October 26, 2002posted by Sydney on 10/26/2002 10:30:00 PM 0 comments
The WHI study that set off the controversy found that for every 10,000 women who swallow estrogen-and-progestin pills, each year there will be eight more breast cancers, seven more heart attacks, eight more strokes, and eight more life-threatening blood clots in the lungs than in women not taking the pills. The heart risks occurred in the first year of treatment; other risks increased with time. Yet many physicians are advising patients to stop taking estrogen, and the media can't let go of the story. Estrogen remains the only effective treatment we have for hot flashes and for painful aging changes in the vagina. For some women, it's the only treatment that helps for a general dysphoria that comes over them after menopause. It's a pity that the WHI study has been blown out of such proportion. A lot of women are being deprived of a good therapeutic option because of the hysteria. posted by Sydney on 10/26/2002 09:24:00 PM 0 comments
In the first group, parts of the brain called temporal lobes were smaller. They also transmitted fewer chemicals in these areas, which are linked to language and memory. They had problems paying attention, organising their thoughts and expressing ideas in a logical and coherent way. They were mostly young males who had been diagnosed with schizophrenia at an early age. It affected almost one in five of those with the disease involved in the study. In the second group, doctors discovered changes in the frontal-striatal region of the brain. They had less grey matter in the frontal lobes and had enlarged ventricles. This area affects cognition and motor function. Their temporal lobes were normal. Almost one in three of those with the disease who were involved in the study fitted into this category. More than half of the remaining patients had mild memory problems. Damage to their temporal lobes or frontal lobes was not as great as those included in the other two groups. It's not too surprising that what we call schizophrenia is really more than one physiological disorder. That's probably true about most disorders of the mind. In many ways the brain is the body's last frontier - the one organ we understand the least. The categories we have to describe its disorders are based only on the symptoms. As our understanding of the brain and its inner workings improve, we can expect our ability to treat and to accurately diagnose its disorders to improve, too. posted by Sydney on 10/26/2002 09:02:00 PM 0 comments
Friday, October 25, 2002This survey paints a bleak picture of the state of academic–industrial contracting. According to the results, very few centers included standard language in their contracts that guaranteed the investigators at a given center access to the primary data from the entire study. Without such a guarantee, the entities sponsoring the research can effectively implement a "divide and conquer" strategy that allows each group of investigators access to their own data, but makes analysis of all the data in a multicenter trial a virtual impossibility. The one encouraging piece of news is that nearly all centers incorporated into their contracts language that gives investigators the right to submit data from their own center for publication. ...As new ideas are brought from the bench to the bedside, there will be more translational clinical research. There will be unexpected toxic effects and poor results with treatment strategies that initially seem promising. It is not a failure of the research system when such unexpected events occur. Rather, it is a failure of the system when a summons to court or the threat of being fired silences the voice of an investigator posted by Sydney on 10/25/2002 06:30:00 AM 0 comments
posted by Sydney on 10/25/2002 05:56:00 AM 0 comments
As the country remains mired in economic chaos, at least two-thirds of litigation was regarded by the meeting as frivolous claims by Argentines desperate for cash. Most savings have been frozen by the government and money in circulation has been devalued to a quarter of its pre-2001 value. Participants at the Association of Private Clinics, Sanatoria and Hospitals conference (Adecra) in Buenos Aires heard that litigation has increased from a few hundred cases a year to 10,000 pending claims. Current cases involve practitioners, dentists, and nurses, as well as health establishments. Many of the cases are being handled by lawyers working on a no-win, no-fee basis--in Argentina, allegations of medical malpractice/ negligence are a matter for the judicial system, rather than professional disciplinary bodies. ...The surge in litigation has prompted most major insurance companies to withdraw professional liability policies. Adecra's president, Francisco Diaz reported that one insurer pulled out of the professional liability market after 1,469 claims in 2001, amounting to US$529 million. Sky-high premiums demanded by the few insurers still prepared to offer cover are beyond what many health establishments and practitioners can afford, leaving clinicians to operate without insurance. It’s the same the whole world over. In Canada, a large malpractice insurer has announced they will no longer provide coverage for those who treat professional athletes: The Canadian Medical Protective Association, which represents 62,000 physicians across the country, has told its members it will no longer provide coverage for those who work for NHL, NBA, NFL and Major League Baseball teams. "Even unknown athletes and retired athletes are receiving financial awards and settlements of $3 million to $5 million (U.S.)," the association said in a letter sent this month to doctors. The association said a recent review of medical legal actions in the United States reveals "an alarming trend of increasingly expensive actions against physicians providing care to professional athletes." posted by Sydney on 10/25/2002 05:52:00 AM 0 comments
Lev noted that 10,000 "first responders" have already been vaccinated, and they had fewer side effects from the immunization than anticipated, according to studies. We should watch and learn. posted by Sydney on 10/25/2002 05:49:00 AM 0 comments
posted by Sydney on 10/25/2002 05:48:00 AM 0 comments
Priests are one thing, but in Israel, they've gone down a slightly different path, and are incorporating clowns in their medical teams. Training is just beginning: The 80 hour, six month course is presently training doctors, nurses, physiotherapists, actors, a school principal, and even a bank clerk in the art of clowning. The five top graduates will receive scholarships and jobs at the Assaf Harofe Hospital, financed by a voluntary organisation called Joy in the Heart. ...Some performing clowns who applied for the course withdrew when they realised that graduates would not simply be performing before audiences of patients. Instead students are learning techniques in which the patient is the "star" and clowns are integrated into the medical team. Priest, clown, it doesn't matter. They both serve the spirit. posted by Sydney on 10/25/2002 05:40:00 AM 0 comments
posted by Sydney on 10/25/2002 05:39:00 AM 0 comments
posted by Sydney on 10/25/2002 05:39:00 AM 0 comments
Thursday, October 24, 2002posted by Sydney on 10/24/2002 08:56:00 AM 0 comments
In agreeing to testify, the Chicago expert, Dr. Schmidt, did not exactly praise the mammograms. But he said he could have read most of them; more significantly, he said, they were not unusual for this type of clinic — no "Madison Avenue kind of practice, where you're trying to get the absolute perfect, perfect image." One judge asked, "You don't mean to imply if you have more money you'd get better films?" Dr. Schmidt answered, "Yes, I do." Why is that so surprising? Radiology equipment is like any other equipment. You get what you pay for. Yet, the state can’t seem to come to terms with this economic reality: In its closing arguments, the state deplored such a two-tier system; the minimum standards, officials argued, allow far too much variability in quality, depending on the patient's wealth, the clinic's assiduousness and the doctor's expertise. But the medical board ruled that the state had gone too far. "Simply put," the judges concluded, "petitioner may not prosecute a licensee for failing to perform above minimum standards." Looks like the state should change its standards. Of course, that would mean that they couldn’t get mammograms as cheaply as they want. The more tragic aspect of this case, however, is the women who have been led to believe that a mammogram is the final word on whether or not they have breast cancer. Mammograms have been hyped to such an extent that people believe they’re infallible. They interpret a negative mammogram to mean they don’t have cancer, even if there’s a large palpable mass sitting in their breast, as the woman highlighted in the article did. This just simply isn’t the case. Any breast mass should be evaluated, regardless of the mammography results. This is what comes of hyping a screening instrument of questionable benefit. All of those advocacy groups and politicians who are so quick to trumpet the value of mammography despite all the evidence of its limitations bear some responsibility for this. posted by Sydney on 10/24/2002 08:52:00 AM 0 comments
posted by Sydney on 10/24/2002 08:03:00 AM 0 comments
posted by Sydney on 10/24/2002 07:48:00 AM 0 comments
posted by Sydney on 10/24/2002 07:48:00 AM 0 comments
Wednesday, October 23, 2002posted by Sydney on 10/23/2002 09:07:00 AM 0 comments
Not surprisingly, the researchers who have invested their life’s work in elevated homcysteine levels and their contribution to heart disease are skeptical, yet their comments to the press underscore frailty of the association of high homocysteine levels with the risk of heart disease: After allowing for other risk factors like high blood pressure and smoking, Dr. Clarke's team found that a person who lowered his homocysteine level 25 percent cut the heart-attack risk 11 percent and the stroke risk 19 percent. "That's still a significant association," said Dr. Paul F. Jacques, chief of nutritional epidemiology for the Human Nutrition Research Center on Aging at Tufts University, part of the Agriculture Department. "It's a modest predictor. But it's all in how you define modest." Is it all that significant to reduce the risk, not the incidence, by 8 percentage points? Not really. By any definition, it’s a modest decrease. Then there’s this: Dr. Stampfer cited a study in the journal of the medical association in August. In it, half of 553 heart patients in Switzerland who had operations to reopen clogged arteries were randomly assigned to receive six months of vitamin B therapy. Those who took the therapy had significantly fewer deaths and heart attacks. In the group that took the vitamins, 2.6 percent had nonfatal heart attacks versus 4.3 percent in the control group. Again, a decrease of what amounts to a little more than one percentage point in incidence isn’t really significant in any sense other than the statistical one. This may seem to be a tempest in a teapot, since homocysteine levels can be altered with diet and with folic acid supplements, but there is a growing movement among cardiologists to use statins, the cholesterol drugs, to treat high homocysteine levels, too. Before that move is made, they’d better make sure there’s a truly clinically significant role for them in heart disease. posted by Sydney on 10/23/2002 09:04:00 AM 0 comments
posted by Sydney on 10/23/2002 07:42:00 AM 0 comments
The scientific method does not mean, "Hypothesis -- study -- results -- the end"! Usually the process goes along the lines of "hypothesis -- study -- results -- controversy -- debate -- new study -- theory -- more studies -- more debate -- altered theory -- more studies -- new theories -- and on and on until at some point the vast majority of scientists agree that the data support the current theory". Usually these studies are not intended for direct public consumption and real-world application. That's part of the reason people consult physicians. Unfortunately, a lot of physicians are no better at applying the studies than the media or the general public. I’m beginning to see a lot of women return from visits with cardiologists, endocrinologists, and gynecologists who tell me the doctors told them to stop their hormone replacement therapy because it caused heart attacks and breast cancer. In all the cases it was done without discussing the patient’s preferences, or the actual results of the Women’s Health Initiative study. Too often, doctors get lazy and adopt the media’s interpretation of study results. posted by Sydney on 10/23/2002 07:41:00 AM 0 comments
Your article in Tech Central Station fails to acknowledge the negative impact of controlling health care costs by erecting financial barriers to care, a characteristic of the consumer-driven health care movement. The sole "benefit" is to reduce health care spending. But the health policy literature contains innumerable studies confirming impaired outcomes when patient cost-sharing is used to control utilization. As you are aware, the market competition model has failed to control costs, but the single payer model has been proven to be effective. The California Health Care Options Project has confirmed that it would also be effective in the United States (www.healthcareoptions.ca.gov). The reason queues would not be a significant problem is that we already spend $5757 per capita (CMS), more than enough to assure adequate capacity in our system. Now, more than ever, is the time to look at all models of reform. No model is perfect, but they vary tremendously in their impact on the health care of the nation. Well, I don’t think that having patients pay for run-of-the-mill care counts as “erecting financial barriers to care.” I’m not at all aware that the market competition model has failed to control costs or that the single payer model has proven to be effective. We haven’t had a purely market competition model in this country for over fifty years, and other countries (scroll down to "For Example") who have single payer systems don’t seem to be doing so well. England has to recruit doctors from overseas, and many patients travel outside of Britain for procedures, at great expense to themselves. Australian doctors and New Zealand doctors are unhappy, as are the patients. And Canada is having trouble recruiting and keeping doctors. I’m not so sure about those studies that show impaired outcomes when patient’s share the cost of their care, either. What studies are those? We may spend $5757 per capita now on healthcare, but you can bet that in a single-payer system that spending would go up. There's just no incentive for anyone to pay attention to the cost of their choices when a third party pays. No incentive for the doctor. No incentive for the patient. And a large part of modern medicine is about choices. Do you want to be on an $80 a month cholesterol-lowering medication to reduce your chances of a heart attack from 15% to 12%? In today's climate, your doctor will just tell you to take it, it's good for you. Any risk reduction, no matter how small, is good, especially when no one but an insurance company has to consider the cost. In a cost-sharing model the doctor, as well as the patient, would be forced to honestly examine the cost involved in taking that medicine. My correspondent would probably categorize that as a barrier to good care, but it's really just an honest acknowledgement of its marginal worth. As for the California Health Care Options Project, it deals largely with the issue of the uninsured and assumes that the greater good is to have universal insurance coverage. (warning: pdf file) Interestingly, the uninsured interviewed for the report don’t seem all that eager to have health insurance. Thirty-three percent of the uninsured interviewed said that they “can get needed care for less than the cost of insurance.” And furthermore: Over 40% of respondents agreed with a statement "Health insurance is not a very good value for the money", while almost 40% agreed with a statement "Going to public or free clinics for my medical care is just fine with me." (At most public health clinics and “free” clinics the working poor are charged a nominal fee or a sliding scale fee based on their ability to pay, something that every doctor used to do once upon a time. Now, however, most doctors, rightly or wrongly, interpret Medicare rules as saying that you can't charge one person less than another without committing fraud.) The other side of the coin came from the Cascade Policy Institute, based in Oregon, which sent along a link to a very well-written article on the economics of health care, First, Do No Harm(warning: pdf file). It’s a remarkably good read, although I don’t agree with all of his positions on the pharmaceutical industry. The author, an economist, puts to rest several myths about healthcare costs, including several of those mentioned above. The most salient: ....many health events are so common and minor that they are likely to befall most everyone in the population, with the consequence that there is little advantage of risk sharing through insurance. Specifically, the pro-rata cost of sharing the burden of common and minor events through private or public insurance will actually be greater than the cost of bearing it individually because of the administrative cost of the insurance. In such cases, there is no natural insurance market. This is why routine house painting costs are not insurable, but a house fire is. And that’s why health insurance costs are so high today, and why the ranks of the uninsured are growing. We’re paying for the medical equivalent of house painting. It's also why the uninsured have trouble paying for the healthcare that's available today: If the inflation rate in medical services exceeds the nominal rate of income growth of low-income households, the result can be an absolute reduction in the ability of poor households to afford health care services. Read it all, it’s well worth the time. posted by Sydney on 10/23/2002 06:41:00 AM 0 comments
Tuesday, October 22, 2002In the meantime, I can offer my column at Tech Central Station. (Henry Miller also has an excellent piece on the failings of the National Academy of Sciences.) In a completely unrelated vein, there's this review of spooky string quartets at Blogcritics. posted by Sydney on 10/22/2002 08:32:00 AM 0 comments
posted by Sydney on 10/22/2002 06:34:00 AM 0 comments
posted by Sydney on 10/22/2002 06:32:00 AM 0 comments
posted by Sydney on 10/22/2002 06:31:00 AM 0 comments
Choice is everything. It’s when we strongly recommend treatments without giving people a choice that we take the greatest risk. Leave the choice to have the vaccine up to the individual, bar advertising for the vaccine, both by physicians and by the companies who make it, (advertising always glosses over the risks and touts the benefits), educate the public about the risks of the vaccine, and the risk of lawsuits would be substantially reduced. Pass tort reform and the damages from those lawsuits would be substantially curtailed, too. UPDATE: Ditto and Double Ditto. posted by Sydney on 10/22/2002 06:26:00 AM 0 comments
Monday, October 21, 2002She's worried that his anti-abortion stance will endanger the future availability of abortifacients as over the counter medication, and the future of RU-486 to be used for other purposes: Today mifepristone is not only used for early abortions and other treatments but it's on the FDA's fast track for use as an antipsychotic, especially for post-partum depression. Anyone wonder why Hager's, um, profile, is high? ''Anyone who can say RU-486 is dangerous and should be overturned is ignoring the science,'' says Pearson. First of all, being pro-life doesn't mean that Hager will object to RU-486 for purposes other than abortion. We have plenty of drugs out there that can kill a fetus that we use for other purposes, and Dr. Hager has probably used them in his practice. Secondly, to say that having concerns about the safety of RU-486 is to "ignore science" is itself to ignore science, and reality. It's a drug that causes unpleasant side effects and complications that can potentially require surgery to correct. Just a few weeks ago, the media were reporting that the drug wasn't used much, even at abortion clinics, for that very reason. Goodman goes on to make a comment about the drugs Dr. Hager "uses and denies." That word, "denies," reveals her bias. Choosing not to use a therapy because of potential side effects is not "denying" a patient anything. It's using medical judgement to practice good medicine. Goodman's right. There's an ideological bias here, but the only proof I've seen of it is in the words of those opposed to Dr. Hager's appointment, not in those who nominated him. posted by Sydney on 10/21/2002 06:48:00 AM 0 comments
posted by Sydney on 10/21/2002 06:06:00 AM 0 comments
At the time, health officials and some clinicians speculated that an ``overdiagnosis'' of autism cases or an influx of families seeking services could be to blame. Instead, Byrd and his colleagues were surprised to find that diagnosis of autism appeared to hold constant, and that 90 percent of children receiving services were born in California. Maybe I’m just dense, but if the number of cases of autism has increased, then by definition, hasn’t the diagnosis of autism also increased? Evidently the answer is “yes”: One autism expert disputed the survey's results, however, noting that criteria for diagnosing autism have changed over time. ``I don't think there are more kids with autism,'' said Bryna Siegel, a UC-San Francisco child psychiatrist who heads the university's autism clinic. ``There are more labels of autism.'' ``There are a lot of problems with how autism is diagnosed in California,'' Siegel added, noting that the state Department of Developmental Services is trying to standardize diagnoses. Yet, resources and federal money are being funneled into the problem: Research into the causes of California's autism spike is ongoing. A state team will spend five years investigating new cases in six Bay Area counties with a $3.5 million grant from the U.S. Centers for Disease Control and Prevention. It would be a shame, and a monumental waste of money, if the supposed increase in the incidence of autism turns out to be just a matter of semantics. posted by Sydney on 10/21/2002 06:02:00 AM 0 comments
"If we were to have, say, 10 deaths, I am concerned not only that it would impugn the smallpox program but all the immunization and vaccination programs," Levin said. "They are really the flower of medical science in this country and the whole thing could be affected." If citizens suffer complications from smallpox vaccine even after choosing to take it, "trust me, they'll blame us," said Bonnie M. Word, a committee member and pediatrician in private practice in New Jersey. "They'll blame the government." This really isn’t a justified fear. As long as people are told of the risk, they aren’t likely to blame the government or the medical profession. It’s when we blithely tell people that things are safe and then discover their life-threatening adverse effects, that we get blamed. It happened not too long ago with the rotavirus vaccine. It was the Advisory Panel on Immunization Practices who recommended the rotavirus vaccine be given to everyone, and who vouched for its safety. Could it be that they’re gun-shy from that experience? But smallpox vaccine isn’t the same at all. It was used for years, so we’re quite knowledgable about its adverse effects. The fact that isn’t licensed by the FDA is a caution that everyone opposed to it keeps bringing up, but it isn’t licensed because its license lapsed when it was discontinued. It’s still the same vaccine. This licensing issue is a red herring, and it isn’t at all the same issue that it would be for a new never-before-used vaccine. posted by Sydney on 10/21/2002 05:59:00 AM 0 comments
The aptly named Clinician's Biodefense Network will connect physicians with biodefense experts and provide them with information about treating and recognizing symptoms caused by biological weapons such as smallpox, anthrax and botulism, Lew Radonovich, team leader of the project and senior fellow at the Center for Civilian Biodefense Strategies at Johns Hopkins in Baltimore, told UPI. There is a desperate need for such a system because "a number of physicians have gone on record as saying their best source of (medical) information was CNN" during the anthrax attacks last fall, Radonovich said. "Doctors just didn't know where to turn to find out what to do." And not all of us can rely on our public health departments. Now, how do I sign up? posted by Sydney on 10/21/2002 05:58:00 AM 0 comments
posted by Sydney on 10/21/2002 05:57:00 AM 0 comments
Of combined high-risk specialties, including orthopedics, obstetrics/gynecology and neurosurgery, up to 87 percent of residents and fellows trained in Pennsylvania are settling outside of the state, according to the Pennsylvania Orthopedic Society. There are 30 percent fewer neurosurgeons in Pennsylvania than in 1998, according to the neurosurgical specialty society. Pottstown neurosurgeon Gregory Lignelli retired three years ago, and a replacement surgeon has not yet been recruited. His partner, Dr. Richard C. Mendel, moved to South Carolina in August 2001. His insurance premiums are now about $22,000 annually. In Pottstown, insurance cost him at least $100,000 more. From 1997 to 2000, the number of obstetricians in Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton and Philadelphia counties decreased by 18 percent even before malpractice premiums began their 21 to 60 percent increases in January 2001, according to figures from the Pennsylvania Medical Malpractice CAT Fund and the US Census Bureau. The number of orthopedic surgeons from the same area and time frame decreased 20 percent. posted by Sydney on 10/21/2002 05:56:00 AM 0 comments
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