"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
Robert Downey, Jr. plays an embittered writer of detective novels (Dan Dark in this version, but the better named Philip Marlow in the original.) Dan Dark is a nasty man. He has nothing but contempt for everyone. He is incapable of either receiving or giving love. And he looks every bit as horrible as he is. For Dan Dark has a severe form of psoriasis that leaves him red, raw, and oozing. It also leaves him riddled with pain and crippled with arthritis. He is an untouchable.
One premise of the movie is that Dan Dark's disease is exacerbated by his inner demons. He is the picture of Dorian Gray come to life. During the course of the movie, as he comes to terms with those demons, he becomes both a better man and a better looking man. Beauty is truth and truth is beauty after all. But in real life, beauty and truth aren't always compatible, and the disease is far more likely to make the man than the other way around.
It's true that psoriasis can be aggravated by psychological factors. It's an itchy, autoimmune disorder of the skin. The more stress, the greater the itch. Greater itching means more scratching. And scratching only makes the disease worse. That aspect alone can be hell on earth, but in its severest forms it's also disfiguring and painful. It renders its victim a social outcast, which in turn only further exacerbates the disease cycle. And it's this aspect of it that makes it a particularly psychologically devastating disease.
Watching the movie, I kept thinking of a patient I met in medical school. She was a constant presence in the dermatology clinics, and during other clinical rotations, she could often be found in the hospital, admitted for one of her endless bouts of skin infections. She was just a child, perhaps six or seven. But she was the least lovable child you ever could meet. Her skin was always broken out in a large, open sores. She hated to be touched, because it hurt so much. To keep her disease at bay, she had to be lathered liberally with the greasiest ointments imaginable. She always wore grubby clothes because the grease ruined clothing. Her hair was always a mess, all spiked up from the ointments in her scalp. She whined constantly. She threw temper tantrums. She looked and acted the perfect picture of complete misery. In contrast, her sister was the perfect picture of, well, the perfect child - always dressed immaculately, hair in place, obedient, and obviously favored by their mother. It was heartbreaking to watch what that disease was doing to their family, despite their best efforts.
While watching the movie, I kept wondering what ever became of her. Did she outgrow her disease? And if so, was she able to outgrow its devastating impact on her formative years? I hope so, but I fear not. Real life isn't as easily overcome as Hollywood would have us believe. posted by Sydney on
3/27/2004 10:56:00 PM
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MMR Controversy Continues: More details on the accusations of unethical conduct against the MMR-autism researchers by a British MP:
Dr Harris said: 'In the scandal over Dr Andrew Wakefield's failure to declare financial and conflicts of interest when his research group's article was published in the Lancet six years ago, the welfare of the children who were his research subjects seems to have been forgotten.
'In 1996, and subsequently, researchers in the inflammatory bowel disease study group subjected children to a battery of invasive tests.' These included upper gastrointestinal endoscopy, ileocolonoscopy, and lumbar punctures, he said. 'Those procedures are not trivial on consenting adults, let alone autistic children, who must be heavily sedated or even anaesthetised.'
Dr Harris said that guidelines from the British Paediatric Association (now the Royal College of Paediatrics and Child Health), the General Medical Council, and other bodies at the time laid down that research where there was no likely clinical benefit to children should not involve anything worse than a blood test, and that prior approval from an ethics committee was necessary. posted by Sydney on
3/27/2004 08:36:00 AM
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Friday, March 26, 2004
Medicare Responsibility: Medicare premiums are going to go up by a whopping $11.50 per month and whose fault is it? The doctors:
Medicare chief actuary Richard S. Foster said the increase would be due primarily to Congress' decision last year to block a scheduled 4.5 percent cut in doctors' fees for 2004 and 2005. Instead, as part of the Medicare prescription drug bill, Congress mandated that doctors' payments would increase by 1.5 percent each year.
The $11.50 raise is the highest increase the program has ever seen since its inception, according to the article. But ask yourself this, where else can you get such generous health insurance for $78.10 a month, the cost of a Medicare premium after the increase? Given that the senior population is growing rapidly and has more medical needs than others, they're still getting an unbelievable bargain. posted by Sydney on
3/26/2004 08:44:00 AM
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Men who have been circumcised may be six times less likely to contract the HIV virus than uncircumcised men, research carried out in India suggests.
The study in the Lancet journal says that the thin foreskin tissue could be highly prone to HIV infection.
However, the study isn't a very definitive one. There were only 191 circumcised men compared to 2107 uncircumcised ones. The rate of HIV infection in the uncircumcised was 0.07%. The rate in the circumcised was 0.01%. There's a difference to be sure, but a very, very small one. Don't expect circumcision to be the definitive defense against HIV infection. posted by Sydney on
3/26/2004 08:32:00 AM
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MedMal Update: Pennsylvania saw a 30% decrease in malpractice cases last year, just by limiting the reach of lawyers:
...the state's high court instituted a rule change that governed venues. It required cases to be filed in the county where the alleged malpractice occurred. Kelchner said attorneys had been going out of their way to file all the cases they could in Philadelphia -- where jury awards were more generous. posted by Sydney on
3/26/2004 08:19:00 AM
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Thursday, March 25, 2004
Saddam's Executioners: A survey published in this week's JAMA confirms that Iraqi doctors were useful tools for the Baathist regime:
"Physicians for Human Rights conducted the survey over two weeks in June and July at three hospitals in Najaf and Nasiriyah. Most of the 98 doctors interviewed were male. Nearly all identified themselves as Shiite Muslims, who represent the majority of Iraqis but were generally shut out of power under Hussein's rule.
About half said that physicians were "extremely" or "quite a bit" involved in the amputation of ears as a means of punishment and the falsification of reports involving torture victims. Nearly a third said the same regarding falsifying death certificates and releasing medical records to government officials without a patient's permission.
Other abuses, which physicians said occurred less frequently, included removing the organs of a patient - dead or alive - without consent, participating in torture and administering "mercy" bullets to kill people who had survived torture or ill treatment.
The Iraqi doctors aren't the first, and they certainly won't be the last to participate in torture. Doctor's don't operate in a vacuum, and they aren't saints. Like any group, there are among them bigots, sociopaths, and moral cowards. And under regimes like Saddam Hussein's, it's the bigots, sociopaths and moral cowards who flourish. How can we avoid such moral outrages among the ranks of the profession? The authors of the study have a solution:
The authors also suggest that ethics education for physicians could play a pivotal role in preventing future abuses.
Disadvantages: Being born premature is a disadvantage in itself, but now research says that our treatment of preemies makes them even more disadvantaged:
All premature babies are at risk for brain damage. But the 72 children who had been given dexamethasone had IQs an average of five points lower than the 74 who had received the dummy shots. They were also more easily distracted and scored an average of three points lower on a 36-point arithmetic test.
Those differences did not affect the youngsters' schoolwork. That is probably because many Taiwanese families with disabled children hire tutors or send them to special classes to help them catch up, Yeh said.
Dexamethasone is a steroid given to premature babies whose lungs haven't developed properly. It's supposed to improve their survival. But this study, which requires a subscription for full access, doesn't come close to proving that the therapy is bad. For one thing, the IQ difference betweent the two groups is very small. And it's even less consequential when you consider that the margin of error in the IQ of the kids in the study ranged from 12 to 15 points.
The study also mentions that kids who got dexamethasone were on average one and a half inches shorter than those who didn't. But, the graphic accompanying the paper undermines that claim. It's a plot of height vs. age with the control group being represented by white dots and the dexamethasone group being represented by black dots. The black and white dots are evenly distributed about the graph, all mixed up together like a melting pot, except for one or two outliers. (I wish I could reproduce it, it's such a classic, but I don't want to violate copyright laws.) You have to wonder if the few kids at the extreme might not have had other complicating factors that account for their height.
Can't Get No Satisfaction: A reader of the New England Journal of Medicine responded to an article on physician dissatisfaction (requires subscription) with this observation:
Dr. Zuger mentions that 'the recent interest in identifying and preventing medical errors has magnified feelings of insecurity.' This is actually the tip of an iceberg: the beating we regularly take from within the medical establishment. Regarding issues such as racial disparities in care, sexual disparities, noncompliance with medications, or adherence to guidelines, our 'colleagues' in academe tell us we are racists, sexists, ignoramuses who never read a journal, or lousy communicators. Meanwhile, the 'noncompliant patient' is an evil construct born of paternalism. In short, everything that is not ideal is directly our fault, and this in an age when we have less control than ever over patients' behavior.
Privacy Matters: A woman in Montana is suing an abortion clinic doctor for perforating her uterus. Her lawyers say that the procedure was performed without informed consent (the patient never even had the opportunity to meet the doctor before the procedure.) Amazingly, Montana does not require informed consent for abortions:
In the mid 1990s, the Montana legislature put an informed consent law for abortion on the books, but it was struck down by the Montana Supreme Court. The high court said the law was unconstitutional because it violated a privacy provision in the state constitution.
Can that be true, or are they confusing informed consent with consent for minors?
UPDATE: An obstetrician/gynecologist from Montana clarifies:
I'm an OB/GYN who lives in Billings, and the law in question has to do with a very detailed informed consent law that was struck down in 1999. Montana doctors are held to the same standards as doctors everywhere. There is no law requiring informed consent for medical procedures in virtually ANY state, except for special laws dealing with abortion; and reproductive care of minors. Almost all medical/legal guidelines are promulgated by standard of care or "case law", not laws passed by the legislature. So you can't find informed consent "laws" by looking them up chapter and verse- but they are definitely there.
The law also included a 24 hour waiting period. The consent law included a great deal of detail not typically offered prior to abortion. The following is from the National Abortion Rights League website (don't you love the sneer quotes around "unborn child" and "father"):
."...The unenforceable law also provides that at least 24 hours prior to an abortion the woman must receive a state-mandated lecture by the physician or physician’s agent, which may be by tape recording, that includes: (1) that medical assistance benefits may be available for prenatal care, childbirth, and neonatal care; (2) that the “father” is liable for child support even when he has offered to pay for the abortion; and (3) that she has a right to review state-prepared materials.
The state-prepared materials must: (1) describe with pictures or drawings the anatomical and physiological characteristics of the “unborn child” at two-week gestational increments, including the possibility of survival; (2) describe the methods of abortion and the risks commonly associated with each, the “possible detrimental psychological effects” of abortion and adoption, and the medical risks associated with carrying a pregnancy to term; (3) state that the law allows adoptive parents to pay the costs of prenatal care, childbirth, and neonatal care;....."
Mont. Code Ann. §§ 50-20-104, -106, -301 to -304 (WESTLAW through 2003 Reg. Sess.).
The point of this law was to go far above and beyond the usual medical counseling for a procedure, as you can see. It was struck down in 1999. Note, however, that if the woman in question was made to wait the 24 hours, she may have changed her mind and not had the regrets she clearly has now. I'm anti-abortion, but in general the non-abortion care provided by Planned Parenthood in Billings is good.
UPDATE II: An attorney from out West says that there are laws in some states requiring informed consent:
I am a med mal & professional discipline lawyer. Drs are my clients. And, as it happens, I have a connection to Montana -- my Mom was raised on a cattle ranch in Fergus County.
Your MT OB-Gyn is mistaken on one peripheral point. Washington, my state, DOES have a statute defining informed consent. It has another defining medical negligence. To wit (I have waited 25 years for the opportunity to use that phrase):
RCW 7.70.050
Failure to secure informed consent -- Necessary elements of proof -- Emergency situations.
(1) The following shall be necessary elements of proof that injury resulted from health care in a civil negligence case or arbitration involving the issue of the alleged breach of the duty to secure an informed consent by a patient or his representatives against a health care provider:
(a) That the health care provider failed to inform the patient of a material fact or facts relating to the treatment;
(b) That the patient consented to the treatment without being aware of or fully informed of such material fact or facts;
(c) That a reasonably prudent patient under similar circumstances would not have consented to the treatment if informed of such material fact or facts;
(d) That the treatment in question proximately caused injury to the patient.
(2) Under the provisions of this section a fact is defined as or considered to be a material fact, if a reasonably prudent person in the position of the patient or his representative would attach significance to it deciding whether or not to submit to the proposed treatment.
(3) Material facts under the provisions of this section which must be established by expert testimony shall be either:
(a) The nature and character of the treatment proposed and administered;
(b) The anticipated results of the treatment proposed and administered;
(c) The recognized possible alternative forms of treatment; or
(d) The recognized serious possible risks, complications, and anticipated benefits involved in the treatment administered and in the recognized possible alternative forms of treatment, including nontreatment.
(4) If a recognized health care emergency exists and the patient is not legally competent to give an informed consent and/or a person legally authorized to consent on behalf of the patient is not readily available, his consent to required treatment will be implied.
RCW 7.70.040
Necessary elements of proof that injury resulted from failure to follow accepted standard of care.
The following shall be necessary elements of proof that injury resulted from the failure of the health care provider to follow the accepted standard of care:
(1) The health care provider failed to exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider at that time in the profession or class to which he belongs, in the state of Washington, acting in the same or similar circumstances;
(2) Such failure was a proximate cause of the injury complained of. posted by Sydney on
3/25/2004 10:09:00 AM
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About 90% of hysterectomies are performed before menopause for abnormal uterine bleeding and other non-life-threatening reasons, according to one of two studies on the subject in today's Journal of the American Medical Association.
That study enrolled 63 U.S. women, ages 30 to 50, who on average had been experiencing abnormal uterine bleeding for four years. They all had tried at least one hormonal treatment, called medroxyprogesterone, without success.
The women were randomly assigned to have a hysterectomy or go on other hormonal medications, such as birth control pills, for bleeding.
Six months into the study, the hysterectomy group reported greater improvement in quality of life than the medical treatment group.
By the end of two years, half of the women randomly assigned to take pills had opted for a hysterectomy, so most differences between the treatment groups disappeared.
"Perhaps these data show that physicians don't need to be so afraid of raising hysterectomy as an option early on," says lead author Miriam Kuppermann of the University of California-San Francisco.
Or, perhaps this study shows that women who are unhappy with medical therapy want surgery. Not only was the sample size very small, but it was a very small sample of a very select group:
A multicenter, randomized controlled trial (August 1997–December 2000) of 63 premenopausal women, aged 30 to 50 years, with abnormal uterine bleeding for a median of 4 years who were dissatisfied with medical treatments (emphasis mine)
It really isn't surprising that these women felt better after having a hysterectomy. They have already said they don't care for medical therapy. Treating them with hormones when they've already expressed their dissatisfaction with that approach isn't likely to make them like it more. It's only going to increase their dissatisfaction. A better study would have been to look at a diverse patient population rather than focusing on those who are already predisposed to want surgery. posted by Sydney on
3/25/2004 10:07:00 AM
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Wednesday, March 24, 2004
Gross-Out Moment of the Day: My office shares a back terrace with another medical office next door. There's a picnic table there, where the staff from that office sit and smoke during their breaks. This morning, the picnic table had a sign posted on it: "This is private property. Anyone who steals cigarette butts from it will be reported to the police."
I don't know which is worse - that someone actually smokes used butts, or that the owners of said butts care. posted by Sydney on
3/24/2004 09:41:00 PM
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Divine Philosophy: There's a movement afoot to have philosophers recognized as mental health counselors (read: have insurance pay for their services.) The leader of the movement is fighting for recognition:
The lawsuit is only one of several fronts in Marinoff's crusade to make philosophical counseling a mainstream profession, and to make himself its public face. His message, spoken in a defensive staccato, goes like this: Americans are tired of psychologists dwelling on our every painful feeling, we're sick of psychiatrists prescribing a new drug every time we feel confused and many of our most pressing problems aren't even emotional or chemical to begin with -- they're philosophical. To wit: You don't have to be clinically depressed or burdened by childhood guilt to want help with the timeless questions of the human condition -- the persistence of suffering and the inevitability of death, the need for a reliable ethics. ''Even sane, functional people need principles to live by,'' Marinoff told me, his voice lowering without slowing in the sun-flooded courtroom, ''so we are offering what Socrates called the examined life, the chance to sit with a philosopher and ask what you really believe and make sure it's working for you.''
It's hard to believe they could be any worse at counseling than what passes for professional counseling in a lot of cases. And goodness knows, the philosophy majors could use the work. But he's got much bigger plans than that. Philosophers can be the saviors of the world:
....Describing his grand -- even grandiose -- plans for a philosophical-counseling empire fills Marinoff with a combative intensity. ''We are already training and certifying practitioners,'' he said, his voice gaining speed. ''We could have them delivering services in prisons and elder-care facilities and hospitals working alongside of doctors. We could have ethicists helping people make difficult end-of-life decisions. We could be rendering services to governments all over the world. We could basically make philosophy more popular than it's been since the days of the agora, in ancient Greece.'' (emphasis mine)
Root Causes: The New York Times and a Kennedy find "suprising" roots of evil:
Robert Oliver, age 7, is a problem child. He has killed several cats and dogs, his grandmother says, and has attempted suicide. As a result he is on Ritalin for attention-deficit disorder and BuSpar for depression.
Rory Kennedy and her cinematographer, Nick Doob, have come to Eupora, Miss., a tiny town with a median household income under $25,000 a year, to follow Robert's progress. Their intention is to make a film about how social services programs affect the lives of American children living in poverty. But the resulting gripping documentary, "A Boy's Life," on HBO tonight, turns out to be about a wicked witch.
...."A Boy's Life" first visits Robert at home, where he pounds on the floor and bangs his head against the wall. When someone mentions that his little dog is adorable, he replies, "But sometimes he can be a little devil and bite you with his sharp teeth." Robert does seem hyperactive, practically bouncing off the walls, despite the Ritalin.
Then the film follows Robert to school. He sings "My Country 'Tis of Thee" along with his classmates, he reads more than competently, he says "Yes, ma'am" to his teachers, and — can this be? — he makes the honor roll.
"I think what we've got here is two Roberts," his principal, Vicky Beckham, tells Anna Threadgill, Robert's grandmother, during a home visit. Anna is not pleased by the suggestion that her grandson's teachers can control him but she cannot, and she reacts with a veiled version of her deadly modus operandi.
When Ms. Beckham assures Robert that he has everything he needs for success, and specifically that he is intelligent and nice-looking, Anna responds immediately, taking on her grandson's voice: " `I'm good-looking, and all the kids are jealous of me, and they all call me ugly,' " she says. "But say, `I know I'm good-looking.' "
If this is Anna's good behavior for the camera, one shudders to imagine how she treats Robert when Ms. Kennedy and Mr. Doob leave.
Indeed. And unfortunately, the theme is an all too common one when it comes to kids with behavioral problems. Meanness begets meanness. And it's a lot harder to cure than poverty. posted by Sydney on
3/24/2004 08:32:00 PM
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More Bad Science: Iain Murray looks at the misuse of science in (surprise!) politics and argues that sticking to sound scientific principles would protect us from the abuse of power. posted by Sydney on
3/24/2004 08:58:00 AM
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Homefront Measles: Ross at The Bloviator notes that measles came to Iowa recently via an unimmunized college student who just returned from a visit to India. Even worse, he was probably contagious during his flight back home, exposing a lot of unwary fellow passengers. posted by Sydney on
3/24/2004 08:34:00 AM
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More MMR Flap: The head of the British Medical Association has accused the physicians behind the MMR-causes-autism paper of severe ethical lapses:
He said: “I do not make these allegations lightly . . . but there is very clear evidence pointing towards unethical conduct by the researchers — or by one or some of them — and equally strong evidence of failure and incompetence by the research ethics committee.” He said Dr Wakefield’s receipt of the payment did not appear to have been declared to the ethics committee, which could invalidate the approval he received for the original study protocol.
Documents also show that the original protocol suggested that the team would investigate children with disintegrative disorder, an extreme, late-onset form of autism known as DD. As lumbar punctures would normally be conducted on these patients, there were good grounds for authorising the study.
In the event, only one of the 12 children studied had a possible diagnosis of DD. The others were diagnosed with other conditions, none of which would normally provide grounds for a spinal tap. posted by Sydney on
3/24/2004 08:31:00 AM
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Medicare will go broke by 2019 without changes, 11 years sooner than its trustees projected two years ago -- a deterioration the White House blames on rising health care costs, but that Democrats attribute to failed economic policies.
The government health care program for older and disabled Americans will have to take $7.5 billion from its reserves this year to meet its expenses, government trustees said Tuesday in their annual report.
...The six trustees -- four of whom are senior Bush administration officials -- said that projected lower tax receipts devoted to the program and higher expenditures for hospital care have contributed to the growing financial problem for two years in a row.
In addition, aspects of the new Medicare prescription drug law signed by President Bush in December also will drain the program's trust fund, devoted primarily to paying beneficiaries' hospital bills.
....Government officials have been predicting for years that the retirement insurance and health care funds for the elderly -- both financed through payroll taxes -- will be pushed toward insolvency as more post-World War II baby boomers reach 65.
By 2078, the trustees said, the gap between revenues and spending would be $31.4 trillion for the two programs. Looking even further into the future, the trustees said the gap would be $72 trillion.
Winter Was Hard: It's been just a little over six months now that I've been in solo practice, and if there's one piece of advice I would give to others planning to start a practice, it would be not to start it in the last business quarter of the year - unless you're a cash only practice. Most medical practices see very little money the first three months in business because it takes about ninety days for insurance companies to process payments. But in December, insurance companies also stop paying their bills. It makes their budgets look better. And, although they pay them finally in the first weeks of January, things slow down again the first three months of the year because patient deductibles start all over again. So, a practice that begins billing in September doesn't start to see a good cash flow until March or April.
But now, Spring is around the corner. The snow is melting, the sweet pea seeds the kids have been nurturing on the kitchen counter have sprouted, and the dirt in the garden is visible for the first time since December. The cash flow is beginning to move in the right direction, and, like a lot of other people, we're expecting a nice tax refund that will help pay for our winter debts. Here's to Spring! posted by Sydney on
3/24/2004 08:11:00 AM
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Soft Science: My Tech Central Station column about the shoddy science of medicine is up. Judging by this comment, things are worse than I thought:
I was a review editor for a prestigious medical journal. As I had a PhD I was asked to review certain classes of submitted papers. In 90% of the papers there were such serious flaws that the validity of the research was nil. The flaws included: lack of statistical soundness, unfounded assumptions, plain errors in interpreting data etc. In a word - shoddy science. All of the papers were published. I asked the editor what was going on. His reply: 'If we turned away papers based on shoddy work we would have none to publish at all!' I resigned.
I'm afraid that might be true. Doctors don't get a lot of training in scientific principles or statistics in medical school. When it comes to basic science, our training is largely memorization. Unfortunately, this ends up being the case in a lot of premed curricula, too. And when medical students grow up to be medical researchers they don't analyze their results themselves. They give their data to a statistician to interpret. We could do a lot better.
posted by Sydney on
3/23/2004 07:21:00 PM
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Dr. Welch also has much to say about those who perform the testing. In a discussion of false-positive results, which plague all common screening tests, he writes, 'No one knows for sure, but I suspect that most American radiologists err on the side of calling things abnormal, in part for fear of being sued, which in turns leads to higher false-positive rates.'
On the P.S.A. blood test for prostate cancer, he notes that the most common cause of false positives is an enlarged prostate. But, he adds, 'Because the prostate tends to enlarge with age, P.S.A.'s tend to rise with age. Therefore, false-positives are less common in younger men and more common in older men.'
Pathologists' role in diagnosing cancer is also problem. They may disagree on a diagnosis because they look at different things, Dr. Welch surmises, 'or they look at the same thing and see something different.'
There's a cardiologist at my hospital who is incapable of interpreting a test as normal. If she reads an echocardiogram or a stress test, there's always some equivocation - the images are of poor quality, or the patient's stress test was "suboptimal," or she mentions some non-specific finding that needs "clinical corelation." It's maddening. posted by Sydney on
3/23/2004 02:56:00 PM
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"Surreal'' is a term seldom applied to debates among accountants over statistical projections, but it is becoming increasingly appropriate to Washington's magical Medicare movie.
Think for a moment about those Republicans who say they relied on the lower cost estimate in supporting Medicare's expansion.
Estimating costs for any entitlement program is difficult because consumer demand for something with no cost to the consumer will prove to be infinitely elastic. Entitlements for medical care are even more uncertain, thanks to the constant and unforeseeable introduction of costly innovations, including new drugs.
That's why actuaries have never reliably predicted Medicare costs. Steven Hayward, an analyst with the Washington-based American Enterprise Institute, notes that in 1966 congressional accountants estimated the total program would cost $12 billion in 1990, allowing for inflation. Then reality intervened. In 1990 Medicare cost $107 billion. Oops, indeed.
"The $400 billion price tag is almost certainly a complete fiction,'' said a news story in Congressional Quarterly last fall. Analysts from the Cato Institute, the Heritage Foundation, and other research groups sympathetic to Republicans said the same. Any member of Congress or senator claiming ignorance of this history should be dismissed for negligence or stupidity."
Yep. They aren't so much upset by the actual estimated cost as they are by the fact that the actual estimated cost has been made public.
posted by Sydney on
3/23/2004 08:19:00 AM
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Oops: I triple posted that last post. It's fixed now. My excuse is fatigue. I was blogging on the couch and fell asleep right after the post. (Thanks to Al Hawkins, RN for pointing it out.) posted by Sydney on
3/23/2004 07:32:00 AM
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Monday, March 22, 2004
Noble Savage Medicine: An excellent editorial on alternative medicine, from the UK:
That the public should apply different standards of expectation to alternative medicine than they do to conventional medicine is pure Luddism. It is to believe that natural is necessarily superior to synthetic, that the pre-industrial societies (from which come many alternative therapies) were intrinsically wiser than our own. The difference between cancer-sufferers who shun conventional medicine and the Luddites who took to smashing machines in the early industrial age is that today's non-believers in progress tend to be drawn from the higher social classes and they include, as we have said before, the heir to the throne.
Equality: Check out The Viagra Monologues. Predictably, the sexual monologists from the other side aren't amused:
"This guy has the right to have any kind of a play that he wants. What I do find offensive is that he is playing off the name of the 'Vagina Monologues,' which has a lot to do with women's freedom and sexuality, but also has a lot to do with sexual abuse, which really isn't that funny. So the play on the name is not very funny at all, and in fact is offensive." posted by Sydney on
3/21/2004 05:28:00 PM
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