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    Monday, May 03, 2004

    Blog Break: I'm going to be taking a break this week from blogging. Posting will resume next Monday, May 10. Have a good week!
     

    posted by sydney on 5/03/2004 08:37:00 AM 0 comments

    Blog Break: I'm going to be taking a break this week from blogging. Posting will resume next Monday, May 10. Have a good week!
     
    posted by sydney on 5/03/2004 08:37:00 AM 0 comments

    Improv: A doctor in Idaho had to use what was at hand to save his patient recently:

    With snow preventing a LifeFlight helicopter from landing in Ketchum, Sivertson sent King south in an ambulance to Shoshone. But as he consulted with a Boise neurologist and examined lab results, he realized that King couldn't survive the blood pooling in his skull. Not only was it starting to force the brain through the bottom of King's skull but it was compromising the young man's breathing.

    Sivertson grabbed a Makita drill and a couple drill bits from the hospital's maintenance shop. Then he chased after the ambulance on the slick highway, pulling into the LDS Church parking lot in Shoshone 20 minutes after the ambulance did.

    As Melissa King watched, he drilled a tiny hole in the lower left part of Ben King's skull.

    "To an outsider it had to be pretty clear we had no idea what we were doing," Sivertson said. "But I was focused. I'd done something similar before so I had a feel or it."


    That's what we call John Wayne medicine.
     
    posted by sydney on 5/03/2004 08:34:00 AM 0 comments

    Taxing Medicine II: There have been a lot of stories in the news lately about the new Medicare discount cards which go into effect today. Most of the coverage indicates that choosing the best deal is a complicated process and that the Medicare website is error-prone. I visited the website yesterday to see what kind of a deal I could get if I were an elderly person living on $36,000 a year with $20,000 in savings and who had diabetes, hypertension, and heart disease.

    Like most of my patients with those three problems, I gave myself two diabetes medications, a blood pressure drug, a beta blocker so my doctors would be meeting the standard of care for a heart patient, and a statin. The estimated cost per month of my medications, according to the website was $350. There were no cards that covered all of them. And although one card promised to knock the monthly cost down to as low as $70 - $150, when I checked the pharmacy coverage in my area (within a 3 mile radius), the savings were less impressive, reducing the cost by $50 to $75 a month. If I made a change in any of the medication brands, the cards available to me also changed.

    This does seem rather complex, especially for an elderly person who might not be used to computers and the internet. What's more, when drugs get changed, as they often do, then the whole process has to start again. Many of the savings cards require a fee to sign up, so it's more than just a hassle. The discount cards are a good idea, but their implementation leaves a lot to be desired. After touring the site myself, I've got to wonder if many people will use them at all.

    One solution would be to have one card with a sliding scale user's fee based on income. That one card could cover a predetermined formulary of drugs, just as insurance plans and hospitals use formularies for drug savings. The sticking point may be getting pharmacies to participate in it. But there must be a better way than this.
     
    posted by sydney on 5/03/2004 07:56:00 AM 0 comments

    Taxing Medicine: Some thoughts on taxes and health from the other4876. Sydney Smith:

    The schoolboy whips his taxed top; the beardless youth manages his taxed horse with a taxed bridle on a taxed road; and the dying Englishman, pouring his medicine, which has paid seven per cent, into a spoon that has paid fifteen per cent, flings himself back upon his chintz bed which has paid twenty-two per cent, and expires in the arms of an apothecary who has paid a license of a hundred pounds for the privilege of putting him to death.
     
    posted by sydney on 5/03/2004 07:55:00 AM 0 comments

    Sunday, May 02, 2004

    Dissecting the Ads: AdWatch that scrutinizes pharmaceutical advertising run by Healthy Skepticism.
     

    posted by sydney on 5/02/2004 11:15:00 PM 0 comments

    Fame! An American woman living in England and a British man have transformed themselves into Barbie and Ken:

    Cindy Jackson and Miles Kendall have spent about $300,000 transforming themselves into copies of the best-selling dolls, undergoing 89 operations - ranging from jaw implants and chemical peels to liposuction.

    Don't they know calling someone "Barbie" or "Ken" is generally meant in a derogatory kind of way? Evidently not. Besides, they don't really look like Barbie or Ken. Here's Cindy and here's Miles. They both seem to have gotten their fifteen minutes of fame, or more, from their investment. Which seems to have been their goal.
     
    posted by sydney on 5/02/2004 10:52:00 PM 0 comments

    Recovering in Germany: Sounds like the Germans keep their patients in the hospital too long.
     
    posted by sydney on 5/02/2004 10:45:00 PM 0 comments

    Saturday, May 01, 2004

    Medicaid Action: One reader pointed out that my earlier post about Colarado and Medicaid was nothing new. And that's true. The same problem with Medicaid reimbursement plays itself out in all states. But, in some states, activist lawyers are suing the states for failing to provide healthcare to the poor as mandated by the Medicaid laws. The latest is in Chicago:

    The suit contends Illinois has violated federal law by failing to ensure poor children receive appropriate preventive medicine, from immunizations to tests for lead in their blood.

    The reason, according to the suit: Doctors refuse to treat patients whose care is paid for by the government's Medicaid program, because reimbursement rates are low, and the state is often late in paying its bills.

    The case is significant because it could compel Illinois to spend millions of additional dollars on Medicaid, the federal-state health program for poor people. But lawyers who filed the suit argue that the state could face much larger medical bills unless it improves children's Medicaid programs.


    The same thing is happening in California, but the plaintiffs are doctors. Better be careful what they wish for. If access is the problem, the government might just turn around and legislate that everyone has to accept Medicaid, regardless of the reimbursement rate.

    UPDATE: Bard-Parker says:

    In reference to your "Medicaid Action "post. Same thing going on in Georgia. Some of the surgeons in town are no longer taking Medicaid. And to comment on your last paragraph, I think such a requirement would be a NHS type system in disguise. I don't believe that it could withstand a "restraint of trade" lawsuit, but I'm not a lawyer.

    Maybe it wouldn't. But if there's one certainty in this world (besides death and taxes) it's that you can't predict what the courts will do. Get enough activist judges and maybe it would withstand a restraint of trade lawsuit. (People laughed to think tobacco companies would lose to smokers who chose to smoke of their own free will and to think that the food industry would ever be under the same assault. But, here we are.)

     

    posted by sydney on 5/01/2004 09:01:00 PM 0 comments

    Targeted Therapy: The cancer drug, Iressa, which showed promise in the treatment of hard-to-treat cancers, has turned out to work in only ten percent of patients. The answer is in their genes:

    Now scientists in Boston and Japan have discovered that patients whose tumors shrink substantially as a result of the pill-a-day therapy harbor mutations in a crucial gene.
    That gene bears the recipe for production of a key protein known as an epithelial growth factor receptor, an EGFR, as it is known in scientific shorthand. The receptor is intimately involved in relaying signals through a family of enzymes called tyrosine kinase. In the mutated form, the gene causes tyrosine kinase to be overactive.


    The drug seems to be more effective in those with mutated genes. Testing patients for the mutation before offering them treatment will improve the success of the drug, The original paper can be downloaded in pdf form here. (It includes very impressive before and after lung scans.)
     
    posted by sydney on 5/01/2004 05:33:00 PM 0 comments

    That Other Demon: When smoking was criminal:

    1633 Turkish sultan Murad IV forbids smoking with the threat of execution. He also demolishes coffee-houses in Constantinople and confiscates the assets of executed smokers.

    1640's Tsar Michael of Russia declares smoking a deadly sin. Arrested smokers are flogged or have their lips slit. A 1643 visitor to Moscow says: 'Those convicted of taking snuff, both men and women, can expect to have their noses taken away.


    Didn't work.
     
    posted by sydney on 5/01/2004 04:59:00 PM 0 comments

    Playing Their Hand: Orchestra musicians are a catty bunch. Those at the Metropolitan Opera have started a whispering campaign about the fitness of their conductor, who has essential tremors:

    The conductor James Levine has been suffering from unexplained tremors in his left arm and leg that at times impair his ability to lead the orchestra effectively, said some musicians who play under him at the Metropolitan Opera.

    ...They said Mr. Levine's condition had made his leadership of the orchestra inconsistent and even at times ineffectual.

    These musicians said Mr. Levine could be difficult to follow because he always conducted sitting down, rarely gave easily visible cues and slumped in his chair as a performance progressed, particularly during lengthy productions like Wagner's "Ring."

    His posture is a barometer, some musicians said. As the night goes on, one said, "You cannot see his baton behind the podium."

    Another said: "He drops down, and you wonder what in the world is going on, or `what do we do now?' That's when you could use cues. And we don't have them."

    Another musician added: "It's been very, very difficult. The reason the orchestra even had any glory days and rose to prominence was because of Levine. So you don't want to kick a man when he's down. Yes, there's a problem; yes, something has to be done; yes, it's the big elephant in the room, but who am I to lead the charge? I owe a lot to the man.


    But not enough to keep from stabbing him in the New York Times, evidently.
     
    posted by sydney on 5/01/2004 04:43:00 PM 0 comments

    Modern Puritanism: Our society is so very tolerant of so many vices. Drug use, drinking, sexual promiscuity are winked at by the popular culture. Gluttony, however, is another story:

    Insidious attitudes about politics, sex, race or class are at the heart of the frenzy over obesity, these scholars say, a frenzy they see as comparable to the Salem witch trials, McCarthyism and even the eugenics movement.

    "We are in a moral panic about obesity," said Sander L. Gilman, distinguished professor of liberal arts, sciences and medicine at the University of Illinois in Chicago and the author of "Fat Boys: A Slim Book," published last month by the University of Nebraska Press. "People are saying, `Fat is the doom of Western civilization.'

    ...."The current hysteria about body mass and supposedly devastating health effects is creating a stratification in the society of power and privilege based on a scientifically fallacious concept of health. What we are seeing with this moral panic over fat in many ways is comparable to what we saw with the eugenics movement in the 20's.


    There is a very definite prejudice against the overweight and obese in our society. They are often yelled at by their doctors and ridiculed by their peers. But in true Times style, that prejudice gets translated into one that disproportionately affects women and minorites:

    In a new book, "Revolting Bodies" (University of Massachusetts Press), Ms. LeBesco writes that African-American and Mexican-American women are particularly targeted as obese in contemporary culture. "All of the discourse about fatness is about pathologizing the individual," she said in an interview, also likening it to the eugenics movement.

    She refers to a study by the Centers for Disease Control in which the highest proportions of overweight people are said to be African-American women and Mexican-American women. "Is it coincidence that representatives of these two stigmatized racial and ethnic groups, as well as women, are most likely to be obese?" Ms. LeBesco writes.


    Yes, it's coincidence. The food police and health puritans know no racial or sexual bounds when it comes to obesity. They are equal opportunity demonizers.

    But, at the very end of the article is this pearl of wisdom:

    Mr. Stearns insists he is not promoting obesity but rather arguing that making people feel guilty for being fat is a useless form of weight control. In describing the contemporary ethos, he said: "If you fail to lose weight you are demonstrating you're a bad person. It's a big burden. Faced with this additional pressure you are even more likely to end up by saying: `The hell with it! I'm going to get ice cream. I am such a bad person I need to solace myself.'

    So true. So true.

     
    posted by sydney on 5/01/2004 04:35:00 PM 0 comments

    Preventive Medicine: Last night, when I found it necessary to Google "how to unclog sink" I came across this advice:

    Once every three months, fill every sink and tub in the house with water. With the help of friends or family members, simultaneously pull all of the drain stoppers up and flush all toilets in the house. This large volume of water will help flush out the larger-sized drain stacks and underground building drains.

    A house high colonic.
     
    posted by sydney on 5/01/2004 03:41:00 PM 0 comments

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