"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
Valentine: It's a little late in the day, but in honor Valentine's Day, here's the story of Daniel Boone and his love for his wife, Rebecca, from Daniel Boone : The Life and Legend of an American Pioneer by John Mack Faragher. Daniel Boone was gone from home a lot, hunting and exploring the American frontier. Sometimes he was gone for several years at a time. Upon one of his returns after a couple of years absence his wife greets him:
When Boone returned home, so the story goes, Rebecca meets him, weeping. "What's the matter?" asks Boone. "You was gone so long," says she, "we supposed you dead." In her sorrow, she had found company with another man, and now there was a new baby in the house. "Oh well," sighs Boone after a considerable pause. "The race will be continued. Whose is it?" "Why," says she, lowering her head in shame, "it's your brother's."
She claimed that the other Boone looked so much like Daniel, she couldn't help herself. And legend has it that Daniel told her to dry her eyes and welcome him home. After all, he had been obliged to "marry in Indian fashion" a couple of times himself. They lived the rest of their lives happily married and the child was raised as his own. True, selfless, love. Happy Valentine's Day! posted by Sydney on
2/14/2004 08:31:00 PM
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Eye of the Storm:DB has been posting away about the medical malpractice crisis, including efforts here in Ohio to reign in shot-gun lawsuits such as this one against an intensive care specialist whose only contact with the patient was after he died (she ran the the resuscitation attempt):
A helicopter transferred the patient from Cleveland to Columbus. Blood was not flowing properly to his lower extremities; he had cardiovascular disease and diabetes.
He went to the intensive care unit in the middle of the night. Dr. Ruff said she was involved with the patient for 15 minutes before he died.
Months later, she became one of 23 people in Columbus and Cleveland named in a lawsuit. Immediately, she asked her lawyer to get her removed. It took 17 months, six motions and a deposition during which she told the plaintiffs attorneys she had nothing to add to the case before her name was dropped.
During that time, though, her medical liability insurance came up for renewal. And she was named in another lawsuit and again removed before the case went to trial.
The insurer told her and her partners that it would not renew their contract. They had to scramble to find a new insurer. When they signed with the new company, they had to switch from a less expensive occurrence policy to a more expensive claims-made policy. Dr. Ruff's premiums doubled after the first year and continue to climb. Also, the new policy would require her to pay tail coverage if she decides to change companies again.
Consequently, Dr. Ruff can show financial damage for having been named in two lawsuits that were ultimately dropped.
In addition to Dr. Ruff's case, OSMA expects to get involved in a second case in coming months, Cooper said.
OSMA says it isn't suggesting that there aren't legitimate cases in which it might not be clear-cut whether a certain physician should be named in a lawsuit.
But 'when someone brings a shotgun lawsuit, the lawyer doesn't make a good-faith effort to find out what happened before it is filed,' Cooper said. 'In the past, there hasn't been any disincentive for lawyers to do this.'
OSMA knows that proving these cases is often difficult. Courts want plaintiffs to be able to bring claims in good faith without the fear of being sanctioned. That is why they are looking for the most egregious examples.
It's good to see the OSMA taking aim at frivolous suits, because things are really getting bad in Ohio. Especially in Northeast Ohio. One malpractice insurance company has decided not to renew anyone's policy who has two claims against them - even shot-gun claims like the one outlined above. Other companies won't write new policies here at all. Others have had their financial ratings dropped to "B+" or lower, which means the doctors insured by them can't see patients at hospitals, which require staff to have coverage from companies with "A-" or higher ratings. Anything less, and the hospital begins to have malpractice issues of its own.
The most frustating thing about all of this is how oblivious the public seems to be. It doesn't dawn on them how serious the crisis is until they lose their own physician. Even then, it doesn't always dawn on them. Another family physician in my town had to abruptly close his practice a couple of months ago when his insurance carrier declined to renew his policy. Some of his patients have become my patients, and a lot of him seem to think it's his fault that he lost his policy. It isn't. He's a very good physician, and if they've been his patient as long as most of them have, they must know that. I've been telling them that any doctor in our town could find themselves in his position tomorrow. But they shrug me off. They just don't care. posted by Sydney on
2/14/2004 05:00:00 PM
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Universal Bankruptcy: Bard Parker relates his experience with Georgia's Medicaid program. It isn't pretty. Lawmakers took the Medicaid money from the budget and applied it to their pet projects, leaving the program under-funded. Now they're asking doctors to give them back their money. Dr. Parker asks, when it comes to a single-payer healthcare system, the question isn't can we do it, but do we want to do it? posted by Sydney on
2/14/2004 03:37:00 PM
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Spellbound: I went to a spelling bee the other night, my very first. I was surprised at how entertaining it was. I can see why it was so popular in nineteenth century America. And, like the movie, Spellbound, many of the kids were immigrants - Egyptians, East Indians, Central Americans - most of whom live in families where English is not the first language. (I know this because a lot of them are my patients.)
It's amazing how similar so many of our words are. Watching (or listening to) that spelling bee made me realize how difficult it must be to learn our language. One child (born to the language) went down when he spelled "beating" for "beading" and many more went down when they confused words ending with "-man" and "-men." And my own son? His Italian grandfather will be grieved to hear that "polenta" took him down. posted by Sydney on
2/14/2004 01:10:00 PM
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Friday, February 13, 2004
Do As We Say:Not as we do. And you know what else happens at medical conferences? They feed us between-meal snacks! And we don't exercise! We sit for eight to ten hours every day listening to lectures. posted by Sydney on
2/13/2004 08:41:00 AM
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Edwardian Healthcare, Firsthand: An obstetrician who used to do consultant work for John Edwards confirms my point about Edwards and colleagues and their influence on medicine :
A former North Carolina obstetrician who served as an expert witness and consultant to Sen. John Edwards during his days as a trial lawyer, now accuses the Democratic presidential candidate of increasing the cost of medicine and forcing doctors into retirement in the senator's home state.
'What he has done with those lawsuits is increased the cost of medicine, and he has not changed the practice of medicine in a way that you can see that there are fewer cases of cerebral palsy."
...Brannan believes that Edwards did his part to contribute to the American Medical Association's listing of North Carolina as one of the "crisis states" for rising liability insurance.
Many physicians in the state are opting to quit their practices because they cannot afford the insurance premiums, according to Brannan.
The hospital that Brannan now serves as the chief medical officer also has been the target of Edwards and his law firm.
"Our hospital (Mission Hospitals, formerly St Joseph's) had two major suits brought by [Edwards's] law firm -- one of which he was able to prevail and got a judgment, and another one his firm lost," Brannan noted.
Brannan said he personally was forced to stop his obstetrics practice when his insurance premiums shot up.
"My premium two years ago was $44,000 a year, and my insurance carrier notified me that if I wished to continue practicing, it was going up to $68,000 for this year," Brannan said.
"I chose to discontinue my Ob privileges, because I would have to deliver 68 babies just to pay the premium before being able to pay any office expenses." He also said that his premiums were lower than those of many other doctors because of his affiliation with a hospital.
The small practitioners are hit the hardest by rising insurance, Brannan said.
"Liability premiums are the same whether you deliver one baby a year or 300 babies a year," he explained.
"The town of Franklin, North Carolina, lost their sole Ob/Gyn practitioner, so now the women in that town are having to travel over a mountain pass to a neighboring city in order to get obstetrical care," Brannan said.
Hmmm. On second thought, maybe that's why our infant mortality rate increased slightly. Fewer obstetricians to deliver babies.
posted by Sydney on
2/13/2004 08:31:00 AM
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Food labels today set maximum daily sodium consumption at 2,400 milligrams, about a heaping teaspoon of salt. The new recommendation is that most people get just 1,500 milligrams a day. Yet women today eat, on average, twice that amount, and men eat even more.
But not enough potassium:
The panel's report urges Americans to eat more potassium: 4,700 milligrams a day, roughly double current consumption. Potassium lowers blood pressure and reduces the risk of kidney stones and bone loss.
Between counting the carbohydrates and the fats and the calories, and now the salt, what is an average person to do? Well, evidently, drink all the beer and coffee you want:
The institute, an independent body that advises the federal government on health matters, set general recommendations for water intake based on dozens of studies that show women on average need about 91 ounces of water a day and men about 125 ounces.
Food, coffee and even beer or other drinks all contribute, so it is impossible to say how many glasses of plain water someone should drink, the panel said. Only those who are very physically active or who live in hot climates may need to drink more water, the researchers said.
That's the ticket. The full liquid diet. (Just joking. I don't time to go look up the data. Paperwork beckons....)
UPDATE: That should have been "don't have the time..." I was more rushed than I thought. posted by Sydney on
2/12/2004 08:50:00 AM
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Shocking: The infant mortality rate has increased, reports the CDC:
Health experts said they were shocked by the rise in the number and rate of infants dying. The United States already trails most industrial countries in infant mortality.
``We're perturbed,'' said Dr. Nancy Green, medical director of the March of Dimes, a New York-based children's health advocacy group. ``It reflects a movement in the wrong direction in child health in this country. Infant mortality is a major indicator in child health.''
How shocking is the increase?
According to preliminary data released Wednesday by Washington-based statisticians for the Centers for Disease Control and Prevention, the nation's infant mortality rate in 2002 was 7.0 per 1,000 births. That's up from 6.8 in 2001.
Um, excuse me, but isn't 7/1,000 basically the same as 6.8/1,000?
UPDATE: A statistician says:
Speaking as a statistician? No, not at all. There are about 4,000,000 births in the US every year. That means approximately 2,000 more infants died in 2002 than in 2001. The 7/1,000 number comes from looking at just about every infant death, so the sample size is the full 4,000,000. It's a statistically significant figure to whatever level of significance you want. Saying that these two numbers are "basically the same" is the sort of statement I would expect from a student in my introductory statistics class, and only then at the beginning of the semester. The numbers sound similar, but they are different enough to indicate a real change in US infant mortality rates.
Or consider it this way. Last year, 0.7% of infants died. The year before that, only 0.68% died. In terms of real significance, it's the same.
MORE: From a reader:
We can speculate as to why the US's is as high as it is--unequal access to health care, lack of personal responsibility, poor prenatal care, substantial economic disparity, substance abuse, an ethnically and culturally heterogeneous society, political inertia and/or indifference, on and on--the bottom line is that is disappointing and ,for me embarrassing given our wealth, spending on health care, and general compassion as a country--on the flip side we are well below the third world nations and not in the 100 countries with the highest infant mortality
Rank Country Rate (1998) or see CDC link below which confirms rates with more recent data
1 Hong Kong 3.2
2 Sweden 3.5
3 Japan 3.6
4 Norway 4.0
5 Finland 4.1
6 Singapore 4.2
7 France 4.6
7 Germany 4.6
9 Denmark 4.7
10 Switzerland 4.8
11 Austria 4.9
12 Australia 5.0
13 Netherlands 5.2
13 Czech Republic 5.2
15 Canada 5.3
15 Italy 5.3
17 Scotland 5.5
17 New Zealand 5.5
19 Belgium 5.6
19 Northern Ireland 5.6
21 England and Wales 5.7
21 Greece 5.7
21 Israel 5.7
21 Spain 5.7
25 Portugal 5.9
26 Ireland 6.2
27 Cuba 7.1
28 UNITED STATES
These are from 1998, so presumably we've made an improvement since then. But, I would point out, as the original article I linked to also did, that our higher infant mortality rate is thought to be due not to medical neglect of healthy infants, but to a greater number of premature infants and high-risk pregnancies. These high risk pregnancies are not necessarily caused by medical neglect of pregnant mothers, but by too much healthcare - such as higher rates of hightech infertility procedures. That isn't necessarily a bad thing. But, we can't assume any longer that infant mortality reflects the status of a nation's healthcare. At least not in developed nations that don't ration healthcare.
posted by Sydney on
2/12/2004 08:41:00 AM
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Desparados: As the baby boomers enter old age, we can expect healthcare costs to continue to escalate, although the rate of that escalation slowed a little this year. We can expect this escalation to be more of an issue as the baby-boomers get older and older. (Imagine what spending is going to be when they're of nursing home age!) Unfortunately, the usual response of insurers and government is to just pay less for services. They believe that doctors and hospitals and nursing homes can make up their losses in volume. But one nurse can only care for so many people at any one time. Ditto doctors. It doesn't bode well for healthcare -no matter what the system.
Meanwhile, this elderly couple took an innovative approach to financing their healthcare. They robbed a bank. But before you feel too much sympathy for them, consider this:
James Clark has a significant federal criminal history dating back to 1954, Kameg said. Charges include bank robbery, mail fraud and conspiracy to grow and distribute marijuana, officers reported. He also had been sentenced in 1992 to 12 years in a federal prison on bank robbery charges. posted by Sydney on
2/12/2004 08:27:00 AM
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Clone Alert: South Korea has cloned human embryos. Details to be published tomorrow in Science. Evidently, there's some mystery as to where they got all their eggs:
They were particularly surprised that the researchers had managed to assemble so many unfertilized human eggs, 247 in all.
Advanced Cell Technology, the lone American company that has tried to conduct similar research, went through a long and arduous debate with its ethics board before recruiting young women to donate eggs. The board eventually decided that a fair payment for a woman's time and effort would be $4,000.
To donate eggs, women have to inject themselves with hormones to stimulate their ovaries, be monitored with ultrasound to see when the eggs are ready to emerge from the ovaries and then allow doctors to extract the eggs with a thin needle. Advanced Cell Technology advertised for donors and paid them the fee, but ended up with just 19 eggs. The company restarted its program in June, Dr. Lanza said, with "just a few donors.".
In South Korea, Dr. Moon said in a telephone interview, there was no advertising for egg donors and no payments. The 16 women who donated the 242 eggs were "personal contacts," he said, declining to elaborate. posted by Sydney on
2/11/2004 11:44:00 PM
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HIPAA Violation: Everyone's fussing about Dr. Atkins's weight, but the fact that his medical records were given to an anti-Atkins group is outrageous. (We have laws against that sort of thing, you know.):
The medical examiner's office said this week that Dr Atkins's medical report was "sent in error" to Richard Fleming, a member of the Physicians Committee for Responsible Medicine, which runs an anti-Atkins website.
Dr Fleming last year released the diet book Stop Inflammation Now!, which promotes a diet that is all fruit, vegetables and whole grains.
The Atkins company deplored the leaking of Dr Atkins's medical records to "a known group of vegan and animal rights extremists".
Doesn't HIPAA apply to medical examiners? Especially when there's no crime involved?
UPDATE II: A reader has looked up the relevant New York law:
Not being an attorney I did a bit of research (googling)--to summarize--legislation varies from State to State and considerable judicial and executive discretion exists as to what can be released to whom. In many cases summary data including such things as height, weight, cause of death, age, sex, etc. is considered part of the "public record" as are death certificates which might also include this information Note, a medical examiner's findings are usually not treated the same as physician or hospital record. As the executive of a behavioral healthcare organization I know we have had relatively easy access to autopsy reports of patients who had been receiving care (or recently received care) @ our agency even though the cause of death was unrelated to the treatment they were receiving.
Below is a brief summary of NY's law--NY County Law ยง677:
Autopsy reports available under following circumstances: 1) upon application of personal representative; 2) upon proper application of any person who is or may be affected in a civil or criminal action by the contents of the investigation; or 3) upon application of any person having a substantial interest.
A court will find substantial interest where there is adequate reason to obtain the report. The court will balance privacy concerns and other factors.
The Court has held there is a substantial interest where doctors and medical personnel use records for educational tool and/or in cases to prove one did not commit a crime.
Sounds like she may have a case. The medical examiner's report isn't being put to any of those uses. Although death certificates are a matter of public record, they generally don't include height and weight. At least not in the two states in which I've signed them - one of which is New York. They just have date of birth, date and time of death, place of death (sometimes), and cause of death.
UPDATE III: Another reader says there's plenty of culpability to go around here:
Considering all the stupid little diddly things we now do to protect patient's information from essentially non existent threats, this bit of news sounds like exactly what this law was created to prevent. In fact, yesterday I sent an email to the Atkins site, expressing my dismay and stating that I thought the Atkins family had a real breach of rights on this one. (I have too much free time on my hands on days off.)
While I absolutely hold the medical examiner culpable, it is highly likely that they were tricked into providing this information, and perhaps some responsible minimal investigation on their part might have prevented this whole debacle. They were negligent, but most likely not malicious.
However, I believe there is even more responsibility on the part of the requesting physician who should have clearly known he was breaking federal law in requesting this information dishonestly and clearly his motives in what he wanted to do with this information were malicious. Secondly, I hold our news agencies, including the newspapers and television news shows responsible for broadcasting what turned out to be very incomplete and private information, without family permission. Isn't this a breach of privacy without signed permission from the family or estate? Shouldn't they be held responsible too for perpetuating this in violation of federal law? posted by Sydney on
2/11/2004 08:31:00 AM
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Asians Need Not Apply: The Institute of Medicine issued another report calling for more minorities in healthcare. They say it would be a prescription for better health:
America's fast-growing minority population isn't fully represented in the health care professions, according to a new study that urges government and educators to encourage more blacks, Latinos and others to enter medical fields.
''Racial and ethnic minority clinicians are significantly more likely than their white peers to serve minority and medically underserved communities,'' the prestigious Institute of Medicine said in a study released Thursday.
The Institute found that while Latinos constitute 12 percent of the population, they make up only 2 percent of registered nurses, 3.4 percent of psychologists and 3.5 percent of physicians.
And while one in eight Americans is black, fewer than one in 20 physicians or dentists is black, according to the study, ''In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce.''
In particular, the report said, language barriers for Latinos and others can limit their access to mental health care as well as medical and dental attention.
But other minority groups should consider a different career:
The committee defined underrepresented minorities as blacks, Latinos and Native Americans. While Asians and Pacific Islanders make up 19.8 percent of medical school graduates -- more than their share of the population.....
PC Nursing School: The Times of London ran a column that says political correctness is poisoning the country's nursing profession (I can't link to it because they charge foreigners):
This trend away from old-fashioned caring started with theSalmon report of 1966. Ostensibly, it wanted to improve the status of nurses by regarding them as market professionals. So the hierarchical and disciplined Nightingale ward system was abolished in favour of a "modernised" approach; overnight sisters were transformed into ward managers.
The RCN, forty years on, is Salmon supercharged. It uses the management babble of service providers and care users with a big twist of political correctness and status obsession. However, devotion to caring for patients is crowded out by the new verities of nursing. Hence Malone's odd contention that choosing one's working hours is a "basic human right". But then, this is the same institution that defined harassment to me a few months ago as "being made to feel inferior, or not being invited to meetings".
Then there's Project 2000, which has done a great deal to poison nursing's culture. Conceived in 1988 by the Department of Health again to improve the standing of the nurse, Project 2000 meant that by 1995 all the traditional, hospital-based nursing schools were closed. Instead training for nurses was moved from the bedside, and taught in higher education colleges and universities.
The teaching is founded on bogus sociology, which emphasises racism, sexism and inequality ? as if social reform would cure disease, and anti-discrimination practice were more important than caring for the ill soul in the bed in front of you. A young person who wants to nurse must now endure courses such as "ethnographic differences in first-time mothers in East London" or "ageism and the NHS" at King's College, London.
I don't know how much political correctness like this goes on in American nursing education, but we, too, have seen a move from hospital based nursing education to university-based. I have to think that the move the university has had a significant impact on the career decisions of the nursing school graduates - many of whom go into research or teaching or for advanced practice degrees than true nursing (i.e. caring for the sick.) Hospitals end up having to rely more and more on nurses aides for the care duties while the few RN's they have serve as floor managers and medication passers. It's a pity, because good nursing care is essential to good hospital care.
Although I don't know much about nursing education in Britain, I can give you my perspective on nursing education in the US. I went to an associate's degree program to get my RN, then a few years later got my bachelor's and then master's (nurse practitioner) degrees in nursing. The associate's degree program was the only one I liked, because it was clinically focused and practical. I was not entirely surprised to find that I learned almost nothing valuable in the process of getting my bachelor's degree, and the faculty of my nurse practitioner program had no qualms about wasting our time with endless 'soft' classes' like nursing theory, while the students were literally begging for more clinically relevant content. Most nurse practitioners I have spoken to have the same complaint about their educational programs.
It seems to me that the higher you progress in nursing education, the higher the proportion of baloney. There is an attitude in nursing academia which is frankly anti-scientific, putting a higher emphasis on spirituality, intuition, "lived experience", Rogerian theory (don't even get me started on this pseudoscience) etc. This can really be seen in nursing theory and nursing research. Although there are a lot of people with phDs in nursing, you may have noticed that they don't produce much clinically useful research.
I suppose the good news is that nursing academia is almost completely out of touch with working nurses, who, in my experience, have no interest in the academic world.
Love Among the Ruins: Andrew Sullivan points to a romantic story about an Iraqi doctor who married an American soldier. It appears to be a story of star-crossed lovers thwarted by Iraqi provincialism and American military rigidity, but this bodes ill:
Blackwell's first marriage had collapsed and he had two daughters by two different women, but he insisted he was ready to start again.
Hope the new Mrs. Blackwell has better luck with him than the other women had. posted by Sydney on
2/11/2004 07:08:00 AM
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Tuesday, February 10, 2004
Prevention: Recent research suggests that one drug, nevirapine, used to prevent HIV infection in babies born to HIV postive women has unintended consequences for the mothers:
After six months of antiretroviral therapy, 75 percent of the women who had not taken nevirapine at delivery had no detectable HIV in their bloodstreams. Of the women who had taken the drug but showed no viral resistance to it, 53 percent had undetectable "viral loads." However, among those who had been given the drug and whose virus had developed resistance to it soon after delivery, only 34 percent had no detectable HIV.
Not enough time has passed to know whether the women who got nevirapine will ultimately decline faster and die earlier than women who did not get the drug.
But, all is not lost for mothers and babies. The article also mentions the success rate of various regimens now used to prevent neonatal infection:
The researchers reported that women who took both AZT and nevirapine transmitted HIV to their infants only about 2 percent of the time. That is below the 7 percent rate seen with AZT alone and far below the 15 percent seen with nevirapine alone. Several experts here said they expect AZT will now be added to nevirapine-alone regimens in Africa and elsewhere, provided women come for prenatal care in time
Given the high rates of resistance in mothers who got nevirapine, maybe it's better to use AZT alone. That extra 5% performance of a combined regimen just doesn't seem worth the risk. posted by Sydney on
2/10/2004 09:12:00 AM
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All in the Angle: I have a patient who obsesses about his blood pressure. Recently, he's been coming in every week with a list of blood pressure readings that are much higher at home than they turn out to be in my office. He showed me how he took his blood pressure, with his arm hanging straight down by his side. I told him that's why his blood pressure readings at home were higher than in the office, where we take it with his arm at heart level and perpendicular to his body. It was nice to see my advice vindicated in today's newspaper:
Dr. David Guss, director of emergency room services at UC San Diego, oversaw the study of 100 emergency room patients with signs of cardiovascular problems. Two medical students took readings from the left arm when the patients were standing, sitting or lying down, first with the arm perpendicular to the body, then with the arm parallel to the body.
Among patients who were seated, readings taken in the perpendicular position showed hypertension in 22. Readings from arms held parallel showed hypertension in 41. In every body position, the upper (systolic) and lower (diastolic) blood pressure readings were from 8.8 to 14.4 points lower with a perpendicular arm than with a parallel arm. Previous studies found that 73 percent of health-care workers don't properly position arms.
Socialized Medicine: A reminder of what truly socialized medicine is like. Interestingly, the author says he knows of American doctors who are looking for a better system elsewhere:
But I personally know fine Canadian physicians who emigrated to America when socialized medicine was imposed there -- and Canadian patients who spend their own money to visit America for our superior care, rather than dying as they wait for the rationed 'free services' now offered in the land of our increasingly fascist and fuzzy-minded neighbors to the north.
Some of those same emigre Canadian physicians are now talking about building clinics in northern Mexico, where they'll again be free to offer their services on a cash basis -- or else going into the hawking of vitamins and nutritional supplements, abandoning their life-saving medical specialties entirely in order to escape the increasing regulation of a more straightforward medical practice.
What a loss.
I haven't heard many of my colleagues talk about moving to Mexico. (There are a lot of other downsides to it. Police and government corruption, for one.) But, you never know.
Wholesale vs. Retail: A reader did some research on wholesale vs. retail pricing of drugs and finds that there isn't such a mark-up, as an article from a previous post suggests:
In your item "Two for the Price of One" posted on 2/5, you quoted from a Detroit Free Press article:
"Thirty Lipitor tablets sell for about $60 wholesale or about $260 retail while 30 tablets of Norvasc sell for about $45 or $200 retail, various Internet sites show."
Your comment was "That's quite a mark-up from wholesale to retail. Maybe it's not the drug companies but the drug stores that are the source of our drug pricing woes."
I wouldn't rely on Mr. Bennett's (the Detroit Free Press writer) Internet price checking. I don't know what Internet sites he checked but drugstore.com shows the following:
Lipitor 10 mg 62.99 for 30
Lipitor 20, 40, or 80 mg 94.99 for 30
A little different than $260
Norvasc 2.5 or 5 mg $42.99 for 30
Norvasc 10 mg $59.99 for 30
Not even close to $200
The Walgreens.com prices were exactly the same for Norvasc as the above and for Lipitor about $5 higher on the 10 mg and 80 mg strengths.
I sent Mr. Bennett an e-mail with much of this same information.
Evolution of the Heart: I saw a truly tough case this past weekend when covering for a colleague. The patient had been in the hospital for abdominal pain for two weeks. One test after another suggested she had this or that disease, but each test in turn ended in a blind alley. She still had no diagnosis for her pain, and her inability to eat. Except, just before she got sick her husband announced that he no longer loved her and he was leaving her for another woman. In all likelihood when all the other tests have been exhausted, depression will be her final diagnosis. Some would say a broken heart.
But, here's the amazing thing. Her hospital room has to be the happiest room in the hospital. The walls are covered with pictures and photographs and large hand-made greeting cards from her family and friends. The centerpoint of the display was a large painting, on posterboard, of a smiling woman standing in a shower of hearts - painted by one of her co-workers. There was a whole lot of love on display in that room. And I wondered, if she hadn't gotten so sick with her broken heart, would all of that love have remained unspoken?
Evolutionary anthropologist Helen Fisher would say this sort of depression serves an evolutionary purpose. It gave our ancestors clear signals that a depressed member of their clan or tribe or whatever needed help. I reviewed her book, Why We Love : The Nature and Chemistry of Romantic Love, over at Blogcritics.
Romantically satisfied women and men showed a preference for love-celebrating music, whereas discontented women and men preferred love-lamenting music. Romantically discontent women and men preferred love-lamenting music presented by performers of their own sex. The findings indicate young adults' inclination to match emotions expressed in music about love with the emotions experienced in their own romantic situation. posted by Sydney on
2/08/2004 09:44:00 PM
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More Babies: Interesting paper in the BMJ on the use of water augmentation in difficult labors. Instead of using drugs to help contractions, they immersed the mother in a water bath. The bathing mothers required fewer interventions during their labor, but more of their babies had to go to special care nurseries for observation afterward:
Women randomised to immersion in water had a lower rate of epidural analgesia than women allocated to augmentation (47% v 66%, relative risk 0.71 (95% confidence interval 0.49 to 1.01), number needed to treat for benefit (NNT) 5). They showed no difference in rates of operative delivery (49% v 50%, 0.98 (0.65 to 1.47), NNT 98), but significantly fewer received augmentation (71% v 96%, 0.74 (0.59 to 0.88), NNT 4) or any form of obstetric intervention (amniotomy, oxytocin, epidural, or operative delivery) (80% v 98%, 0.81 (0.67 to 0.92), NNT 5). More neonates of women in the water group were admitted to the neonatal unit (6 v 0, P = 0.013), but there was no difference in Apgar score, infection rates, or umbilical cord pH.
The higher rate of admission to neonatal units for the water group could have been a function of the pediatricians' discomfort with water-birthed babies. Just wanted to watch them carefully to make sure they were OK.
Still, the sample size was small, so it's impossible to generalize from it. Water births aren't likely to become the standard of care any time soon. Besides, how many pregnant women would feel comfortable sitting fully naked in a bath in front of all those people involved in delivering a baby?
UPDATE: A reader notes:
How much different would that be than what we do now? I mean, I had half a dozen people poking in my prominently displayed nether regions for 3 hours of pushing. If jumping in a bath full of water would have helped, I'd be the first one stripping me. Heck, I would have done anything to get that baby OUT.
I had given up all self-consiousness after I'd been in labor at home for 30 hours (contractiosn still ony 7-10 minutes apart). By the time I got to the hospital, I was running around in a hospital gown with my rear end hanging out in front of my dad. ;) And it only got worse from there!
Of course, I think water births sound silly, messy and uncomfortable but hey...
We're all different, of course. But I always feel less vulnerable around strangers if I can keep at least some piece of clothing on - be at a hospital gown or a pair of socks. posted by Sydney on
2/08/2004 09:43:00 PM
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