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    "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



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    Saturday, June 19, 2004

    Silver Linings: Believe it or not, the medical malpractice crisis in northeast Ohio may have thwarted terrorist funding. From a conversation between Imam Fawaz Damra, leader of the largest mosque in Cleveland, and Sami Al-Arian, the leader of Palestinian Islamic Jihad in the United States:

    "By God, I'm going to speak to Azzam about it," Damra tells al-Arian, referring to the gynecologist. "If he agrees to it, I'll let you know."

    ....Al-Arian said he would deliver some of the money from Chicago to Damra, who would arrange for Ahmed and other wealthy people in the mosque to take it and then donate it back to al-Arian's group. The doctors, all of whom earned more than $200,000, could use it as a tax write-off. The savings then would be donated back to the group.

    Damra said if al-Arian sent $20,000 to him, the imam would return $30,000.

    "You will give how much?" al- Arian asks.

    "Thirty," the cleric says.

    "Are you sure?"

    "Bring [the money] to us."

    ...A week later, Damra tells al- Arian that he doubts the scheme will work, as some of the doctors had just noticed a jump in their malpractice insurance.


    The Lord works in mysterious ways.

     

    posted by Sydney on 6/19/2004 11:37:00 PM 0 comments

    Medpundit Father's Day Cooking - Colonoscopy Chicken: The absolute best grilled chicken ever has to be beer can chicken (also called "beer butt chicken" or "drunken chicken.") It's fast. It's easy. And it's the best tasting grilled chicken ever. First, you get one whole roasting chicken. My recipe says that the best size is 3.5 pounds, but I used a 7.75 pound roaster tonight with good results. Get rid of the bag of internal organs. Brine the chicken by soaking it in salt water (one cup of kosher salt in 2 quarts of water) for one hour in the refigerator. If you don't have time to do that, just rub the bird liberally inside and out with kosher salt. Then, rub the chicken with your favorite barbecue rub.

    Take a 12 oz. can of beer. Any brand will do. The cheapest domestic is just as good as the most expensive imported beer. Drink two ounces of it. Leave the rest of it in the can. Place the can right side up, inside the chicken's rectal cavity. The chicken should sit upright supported by the beer can. Grill it indirectly for 70 to 90 minutes at about 350 degrees or until the chicken is 170 degrees Farenheit at the thickest part of its thigh. On our gas grill (a cheap Kenmore), that translates into turning two of the three burners on high and placing the chicken on the middle, turned-off burner. Close the grill and go do whatever you want for the next one to one and half hours.

    Remove the chicken from the grill, remove the beer can from the chicken, and serve with a Pinot Grigio or the rest of the six pack of that beer. Moist and tender and foolproof.
     
    posted by Sydney on 6/19/2004 09:57:00 PM 0 comments

    Friday, June 18, 2004

    Educating Doctors: The seamy side of 19th century medical education.
     

    posted by Sydney on 6/18/2004 11:51:00 PM 0 comments

    $849,596,000: The amount of money the government just gave state departments of health to strengthen bioterror preparedness. Here's hoping they actually use it for those purposes. Does anyone check up on where the money goes?
     
    posted by Sydney on 6/18/2004 11:31:00 PM 0 comments

    Supplement vs. Drug: If you put a drug in a fish before you eat it, is it classified as a food or a drug?
     
    posted by Sydney on 6/18/2004 11:12:00 PM 0 comments

    Taking Risks: What if the precautionary principle had been around at the turn of the 20th century?

    ....if the precautionary principle had been about for the past 200 years rather than the past 20, breakthroughs such as blood transfusions would ever have been made. 'I certainly don't think we would have radiotherapy or the various applications of x-rays if Marie Curie had been under pressure to comply with the precautionary principle', he says. In the early twentieth century, Polish-born physicist and chemist Curie devoted her working life to the study of radium, paving the way for nuclear physics and the treatment of cancer. It cost her her life - she died from leukaemia in 1934, almost blind, her fingers burned by radium. 'Curie's work caused her 'irreversible harm'', says Berry. 'The precautionary principle would not have permitted her to take such risks, and the world would have been a worse place for it.'

    No guts no glory.
     
    posted by Sydney on 6/18/2004 11:03:00 PM 0 comments

    Enabling: Black Triangle asks an important question about the psychology of victimizationbehind some of our more dubious public health problems, such as the MMR vaccine-neurological damage links :

    It may be that the attempt to blame a specific cause is psychologically useful for the individuals concerned, since it gives a focus for the frustration and anger that illness brings with it.

    Yet, can society afford to pander to this emotional need for recognition, and a causation, when the consequences may be detrimental to public health or future rational policy decisions?


    I'd say the answer is a clear, resounding, "no."
     
    posted by Sydney on 6/18/2004 10:42:00 PM 0 comments

    Breaking Up is Hard to Do: Two personal injury lawyers in Cleveland sued each other when their relationship went sour. The trial included these details about their lucrative winnings:

    Trial evidence indicated Kampinski earned about $36 million between 1997 and 2001 - $15.8 million in 2000 alone. Mellino, his longtime sidekick, raked in some $5.5 million over that span - peaking at $2.53 million in 2000 - under a pay scale that gave him 1 percent of the firm's net fees for every year he worked there.

    And Mr. Kampinski only works six months out of the year.

     
    posted by Sydney on 6/18/2004 10:08:00 PM 0 comments

    Thursday, June 17, 2004

    Insta-Opinions: Kevin, M.D. notes the many misuses of emergency care, and wonders if it isn't mostly about poor access to specialist and primary care. That may be part of it, but most of it is sheer convenience. Some people would rather go to the ER at nine or ten o'clock at night because it's more convenient - the malls are closed, school's out, work's over, and seeing the doctor then won't cut into more valuable time.

    And there's the use of the ER for a quick second opinion, or third, or fourth. The nice thing about the ER from the this perspective is that everytime you go there you get a different doctor. And you get all the tests you need in one place. In fact, you don't even have to walk to your tests. You get rolled to them in a wheelchair or gurney. I recall one guy who had been to the ER five times in one week for a rash he had for months. Not only had he already seen his primary care doctor, he had also seen a dermatologist. Just shopping for an agreeable diagnosis.
     

    posted by Sydney on 6/17/2004 11:01:00 PM 0 comments

    Fools for Love: Why we're blindsided by love:

    Scientists have shown that there is a degree of truth in the old adage that love is blind.

    They have found that feelings of love lead to a suppression of activity in the areas of the brain controlling critical thought.


    Is that love or passion? (via Future Pundit.)
     
    posted by Sydney on 6/17/2004 10:33:00 PM 0 comments

    Interpreting Shadows: CodeBlueBlog gives a primer on reading mammograms.
     
    posted by Sydney on 6/17/2004 10:27:00 PM 0 comments

    The Next Big Suit: A group of lawyers has hit on a solution to the plight of the uninsured: sue the hospitals. They're the ones charging the uninsured for the services they provide, so they must be the root cause of the problem (the online version is seriously truncated. What follows is from the print version of The New York Times' story:

    The lawyers, some of whom were involved in litigation against the tobacco companies in the 1990's, are calling for the creation of a trust that would be financed by the hospitals and would ensure affordable medical care for those without insurance. Because the hospitals have tax-exempt status and other benefits as non-profit organizations, the lawyers argue that they have an obligation to provide affordable care to the uninsured.

    Two problems. 1) Being uninsured is not necessarily the same as being poor. 2) If the hospitals are sued out of business then where are the uninsured (and everyone else, including the actual poor) going to get care?
     
    posted by Sydney on 6/17/2004 09:01:00 PM 0 comments

    Beauty Isn't Everything: Liposuction may remove ugly fat, but it doesn't improve health. Figures. There's no fast and easy road to good health for the overweight. It's a rough, hard slog of exercise and appetite denial.
     
    posted by Sydney on 6/17/2004 10:09:00 AM 0 comments

    Projection: A Washington psychiatrist has analyzed President Bush and written a book about it called Bush On the Couch. Only trouble is, he's never met the President, let alone spent the time with him needed to make a real psychiatric judgement.

    Pin the psychiatric diagnosis is a fun game to play, though it usually reveals more about the players than it does their victims. We used to love to play it in medical school. And it's fair to say it we never played it against someone we liked.
     
    posted by Sydney on 6/17/2004 10:05:00 AM 0 comments

    Strike: The nurses at my hospital are on strike. This won't endear me to any of them who happen to read this blog, but my first thought when I heard they were thinking of striking was, "Who would notice?" Admittedly, I thought this after a tortuous weekend of call when I heard too many times from nurses calling me about a hospital patient, "Oh, I don't know, the nurses' aide is taking care of him."

    As in "Mr. Jones has a fever of 102."

    "How's the rest of him? Is he shaking with rigors, is he awake and alert and comfortable, or is he lethargic? Is his blood pressure normal, or low?"

    "I don't know. The nurses' aide is taking care of him."

    Granted, this state of affairs is more the hospital's fault than the nurses. They've cut costs by hiring cheaper nurses' aides and spreading the nurses too thin. But, the nurses aren't striking because they want more nurses on staff. They're striking because they want more money. This in a time when other people in healthcare (i.e. doctors and hospitals) are making less than they have in previous years.

    Then, too, there was the union member I saw in action recently. I was seeing a patient on the psychiatric floor. The hospital has two psychiatric units. One for patients who are docile and can be trusted. I was rounding in the other, where patients are prone to violence and attempts to run away. There were three staff members there when I arrived at about six in the morning. Two were running back and forth from patient rooms to the nurses' station taking care of patients. Another was on the phone complaining loudly to the nursing supervisor that someone on the next shift had called off sick and that she was being asked to remain on duty until they found a substitute. She kept mentioning a baby in the nursery she wanted to visit before it was discharged. Over and over again, "the baby, the baby, the baby, not right, not fair," and finally, "I'm calling my union rep."

    By the time I finished seeing my patient and writing my note, the other two nurses were still running their butts off doing their jobs. The union nurse was sitting at the nurses' station working on a cross-word puzzle. What professionalism.

    Of course, she's by no means representative of all union nurses, or even most, but there is a tendency among certain people to misuse the power of the union. And I have to wonder if that isn't being done here. The hospital has been selling off assets at a rapid rate these past couple of years to try to recoup losses, so chances are it doesn't have the money to provide the wage and benefits increases the nurses want.

    And despite my initial cavalier thought, the strike will be noticeable. It's the nurses who make sure medicines are administered appropriately, who make sure surgeons have the proper equipment at hand, and that patients are prepped properly for tests and procedures. And the hospital says it will only keep half of its inpatient beds open during the strike. That's going to hurt. Especially when patients have an insurance plan that requires they go to that hospital and only that hospital. And yet, you can't get blood from a stone. What will the hospital have to cut to meet the nurses' demands?

    UPDATE: On call again tonight, and just got a call from one of the Scab nurses. Would you believe it? She knew everything she needed to know about the patients, and then some.

     
    posted by Sydney on 6/17/2004 10:02:00 AM 0 comments

    Wednesday, June 16, 2004

    Jackpot: I completely missed this story, but Geoffrey Fieger, the Michigan lawyer best known as Dr. Kevorkian's attorney, has hit the jackpot in Ohio, winning a record $30 million dollars for a boy with cerebral palsy:

    Defense lawyers argued that Walter's injuries were caused by acts of God, not the doctor or the hospital staff, and they asked the jury to give him nothing. But most of the jurors disagreed.

    'We felt the injuries to Walter could have been prevented if the necessary steps had been taken by the doctor and the hospital staff,' jury foreman Sammie McClarin of Cleveland said afterward.

    The windfall award might dominate today's headlines, but he considered it secondary to the pain that Walter and his mother have endured.

    Timothy Irving of Parma Heights, one of two jurors to vote against the verdict, said he sympathized with Walter but couldn't blame the medical staff. 'It's just a wrong thing that happened,' he said. 'Nobody could have helped it.'

    Jordan declined to comment. His lawyer, Joseph Farchione, who also represented the Northeast Ohio Neighborhood Health Services clinic where Jordan works, said the verdict was not supported by the evidence, and he said he would appeal.

    'Dr. Jordan provided good care to Walter and his mom,' Farchione said. 'This child's injuries developed in utero well before the delivery.'

    The majority of the jurors, Farchione said, were swayed by emotion and Fieger's theatrics. Fieger, who is best known for defending Dr. Jack Kevorkian, the assisted-suicide doctor, said the case should never have gone to trial. He blamed the defendants' insurance companies for delaying the case since it was filed in 1997, and for refusing to consider an out-of-court settlement.


    Blaming insurance companies these days seems a sure-fire way to win. Nobody likes insurance companies. Besides, it's only insurance company money, right?

    Although Mt. Sinai no longer exists, a $77 million insurance fund remains to be tapped for damages, Fieger said. Fieger and Harris said they are resigned to spending the next several years defending the record verdict in courts on appeal.

    'The people who did this to Walter are insured,' Fieger said. 'The taxpayers are the ones who will continue to support Walter until this is resolved.'


    But until then, who will support Geoffrey Fieger?
     

    posted by Sydney on 6/16/2004 01:08:00 PM 0 comments

    Statin Warning: The FDA has issued an advisory for one of the newest statins, Crestor, which has been under scrutiny in England and Europe. And in the process, they remind us that statins aren't as safe as their promoters like to portray them:

    Healthcare professionals prescribing Crestor are reminded of the following key safety messages from the Crestor label: start doses and maintenance doses of drug should be based on individual cholesterol goals and apparent risks for side-effects; all patients should be informed that statins can cause muscle injury, which in rare, severe cases, can cause kidney damage and other organ failure that are potentially life-threatening; and patients should be told to promptly report to their physician signs or symptoms of muscle pain and weakness, malaise, fever, dark urine, nausea, or vomiting.
     
    posted by Sydney on 6/16/2004 07:47:00 AM 0 comments

    It's All in the Genes: How your cholesterol-making enzymes are encoded determines how you responde to cholesterol-lowering medication:

    Researchers at Harvard Medical School found patients with either of two mutations--single-letter changes in their DNA--saw their cholesterol decrease by about 20% less than other patients when they took the same cholesterol-lowering drug, Bristol-Myers Squibb's Pravachol.

    In actuality, the differences in cholesterol levels were very small between the two groups, indicating either that we have a lot more to learn about the genetics of the cholesterol-producing enzyme or that the drug interacts with the enzyme in a way that allows a lot of leeway for structural variations. Probably both. Someday we'll be able to test for genes that determine to which drugs we'll respond best, but that day's not here yet.
     
    posted by Sydney on 6/16/2004 07:34:00 AM 0 comments

    Root Causes: In other epidemic news, another study in this week's JAMA found that
    heavy kids have bigger appetites. They attempt to blame the over-eating on fast food, but the heavy kids consumed more calories than the skinny kids, regardless of where they took their meals. The heavier kids did consume more calories when they were at the fast food court, but consider how they were tempted:

    In the second part of the study, the teens came to a food court, where they were offered an extra-large order of fries, chicken nuggets, chocolate chip cookies and a 20-ounce soda.

    They were given refills when they had consumed three-quarters of their food. Empty soda containers were replaced with full ones. They were told to eat as much or as little as they wanted during the one-hour meal.


    That's kind of like putting a bunch of smokers and non-smokers in a room full of free cigarettes, telling them to smoke as much as they want, then marvelling at the difference in smoking rates between the two.
     
    posted by Sydney on 6/16/2004 07:12:00 AM 0 comments

    Epidemic! Sometimes reading the health news headlines makes me feel as if I'm living in a 1970's disaster movie. Its title would be Obesity!:

    The latest snapshot of US obesity rates shows no let-up in the epidemic that has gripped the nation over the past two decades and panicked public health authorities, a study said.

    Public health authorities are in a panic now because they haven't succeeded in getting the public to lose weight as fast as they hoped, failing to recognize the fundamental reality that no one ever succeeds in getting someone else to lose weight (unless they lock them in a room and deny and starve them):  

    The US Department of Health and Human Services had hoped to slash the percentages of seriously overweight adults and children/adolescents to 15 and five percent of the population respectively by 2010, as part of a broader disease-prevention program.


    The study found that we're about the same as we ever were:

    Between 1999-2000 and 2001-2002, there were no significant changes among adults in the prevalence of overweight or obesity (64.5% vs 65.7%), obesity (30.5% vs 30.6%), or extreme obesity (4.7% vs 5.1%), or among children aged 6 through 19 years in the prevalence of at risk for overweight or overweight (29.9% vs 31.5%) or overweight (15.0% vs 16.5%). Overall, among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese. Among children aged 6 through 19 years in 1999-2002, 31.0% were at risk for overweight or overweight and 16.0% were overweight.

    "At risk" for obesity means that the child is within the upper limits of normal. The fact that public health authorities consider this a disease category should give us pause. It's almost as chilling as this idea that they can control what other people eat and how much activity they pursue. If they ever do succeed in getting the population to lose weight, where will it stop? Will "normalcy" be shifted ever downward until we're a nation of near-anorexics?
     
    posted by Sydney on 6/16/2004 06:55:00 AM 0 comments

    Tuesday, June 15, 2004

    Sea Screen: An Israeli company is working on an ointment to ward off jellyfish:

    The ingredients of the cream are proprietary, but Kimball said she believes the inhibitor works in several ways. For one, it naturally repels water, making it difficult for the jellyfish to make contact with the skin, she said. It also contains a mixture of sugar and protein that is similar to a substance found in the jellyfish bell. Jellyfish use their bells as a recognition system, so that when the creature comes into contact with the substance, it thinks it's found itself instead of some tempting human flesh. Finally, the cream is believed to disrupt the jellyfish's communication system so that it doesn't get the signal to release its venom, she said.

    Does it work?

    Kimball said the study doesn't settle the question of whether the cream works in open water, though anecdotal evidence suggests it might.

    Paul Auerbach, MD, former chief of emergency medicine at Stanford and one of the researchers, said he initially tried the cream about five years ago by smearing some on half of his neck and then jumping into the Mexican ocean awash in thimble jellyfish.

    "The side I painted had two little red bumps on it, and the side I didn't paint looked like a road map of Florida. That's what convinced me we should do the studies."


    The studies in question were done on land, not the sea. It remains to be seen how well the stuff will stay on in pounding surf.
    But it's already for sale.

    Jellyfish certainly can be dangerous (first aid tips for stings here), but they're also beautiful.
     

    posted by Sydney on 6/15/2004 10:46:00 PM 0 comments

    Garden Blogging:



    Nasturtium, Jewel


    Nasturtiums are wonderful flowers. They're the Franciscans of the garden - they love poverty. No loamy, moist soil for them. They take their dirt dry and poor. Which is why I love them. They thrive on neglect.

    They are a New World flower, native to Peru and the West Indies, and made popular in Europe by the physician and botanist Nicholas Monardes, in his delightfully named herbal JOYFUL NEWS OUT OF THE NEWE FOUNDE WORLDE. That joyful news also included tobacco and cocaine, but that's another story.

    The name nasturtium (Latin for "twisted nose") is somewhat of a misnomer, those who have eaten them say they do have a nose-twisting peppery taste. Their seeds can be pickled like capers, and their flowers can be used in salad dressings. And for naturopaths, they have medicinal value. Myself, I've never eaten them or prescribed them, so I can vouch for neither. But they are lovely and fragrant when they're in full bloom.



     
    posted by Sydney on 6/15/2004 09:24:00 PM 0 comments

    Questioning the Uninsured: David Hogbert scrutinizes the statistics of healthcare insurance.
     
    posted by Sydney on 6/15/2004 08:40:00 PM 0 comments

    Full Disclosure: Michelle Malkin notes efforts by medical journals to make drug companies more accountable by encouraging them to reveal the design of their studies before they start them. It wouldn't be a bad idea to extend that to all medical research.
     
    posted by Sydney on 6/15/2004 07:54:00 AM 0 comments

    Ah, Italia: The Italian approach to a mosquito problem:

    Towns have set up teams to fight the infestation - but everybody seems to agree that the tiger mosquito is here to stay.

    Tigers have also invaded America's southern states.

    Surfing the internet, I came across the website of an American town that, by a judicious campaign of civic spraying and public mobilization, has completely eliminated the pest.

    I had this in mind when, last week, our local team of tiger hunters arrived on my front door step.

    The man and woman, very friendly, wandered round my garden for half an hour explaining that standing water of any kind - and even damp grass - is enough for the mosquitoes to breed.

    'So what's the town doing to eliminate them?' I asked.

    They gave exagerrated, Italian shrugs. 'There's very little we can do,' they replied.

    So I mentioned the town I had read about where the tiger mosquito has been eliminated.

    'Oh, but that's America,' they told me, 'it would never work in Italy.'

    'But why ever not?' I asked.

    'Oh because we're not well enough organised,' they said, as though Italy was some banana republic that could only dream about north American efficiency.

    Seeing the confusion on my face, they added that as in the matter of paying taxes, or observing road signs, Italians never do anything they are told to - it would be enough for the government to order everyone to spray their gardens for most people to decide to do nothing of the kind.


    Their ancestors must be spinning in their graves.
     
    posted by Sydney on 6/15/2004 07:39:00 AM 0 comments

    More Expert Revelations: Angry men shouldn't drink.
     
    posted by Sydney on 6/15/2004 07:32:00 AM 0 comments

    Discount Drug Cards: Press reports suggest that the Medicare discount drug cards aren't being widely adopted, and I've got to admit I've found the same thing with my patients. The reason? They don't feel they particularly need them:

    "People tell me that it's very confusing, that they don't want to get into it yet, and they've been counseled to wait until it shakes out because there may be adjustments,' said Commission on Aging Director Sam Deibler, one of 12 senior-services providers who attended a Center for Medicare Advocacy training session in Bridgeport last month. "Others tell us they are already getting a discount through their pharmacy or, in some cases, that they get their drugs from Canada."

    And a lot of patients have secondary insurance that picks up the cost of their drugs. Maybe this drug-price-crisis isn't such a crisis after all.
     
    posted by Sydney on 6/15/2004 07:28:00 AM 0 comments

    No Time to Lose: As Best of the Web often asks, what would we do without experts? Experts warn delayed aid damages hearts.
     
    posted by Sydney on 6/15/2004 07:17:00 AM 0 comments

    Aching Heads: In ground-breaking work, a group of neurologists announced at the American Headache Society's annual meeting that not every headache is a sinus headache:

    In their study, Eross and his colleagues examined 100 people who answered a newspaper ad seeking people who thought they had sinus headache. Each patient had an extensive evaluation and some had imaging tests.

    The researchers found that 63 percent were actually suffering from migraines, 23 percent had probable migraine and 9 percent had headaches that couldn't be classified. The patients with unclassified headaches probably have sinus headache, Eross noted.

    In addition, 3 percent had headaches secondary to a sinus infection, 1 percent had cluster headaches and 1 percent had hemicrania continua, a rare type of chronic headache, he added.

    On average, the people who actually had migraine had gone 25 years without a correct diagnosis, Eross said. About 28 million Americans suffer from migraines.

    'Most folks who think they have sinus headache are most likely using sinus medication to treat what is really migraine, and so they are not getting the appropriate and most effective treatment,' Eross said.


    Their solution? Get headache treatment only from neurologists:

    If you think that you have sinus headaches, he said, most probably you have migraines. "Make sure you see someone who specializes in headache, either a headache specialist or neurologist," he stressed.

    There aren't enough neurologists to take care of every headache patient. Not only that, but their "discovery" really isn't news. Here's a pediatrician making the same observation in May 2001, and here's a group of otolaryngologists making the same point. The bottom line is, if you don't have other respiratory symptoms with your headache (runny nose, cough, watery or itchy eyes, etc.), you probably don't have a sinus headache.
     
    posted by Sydney on 6/15/2004 07:07:00 AM 1 comments

    Internet Solutions: Online Sex Therapy. Not a bad idea. It isn't easy to find counselors who have expertise in the subject.
     
    posted by Sydney on 6/15/2004 06:42:00 AM 0 comments

    Monday, June 14, 2004

    Wandering Hearts: The Lost Dauphin has been laid to rest. Or at least his wandering heart has. May it rest in more peace than the head of Oliver Plunkett.
     

    posted by Sydney on 6/14/2004 08:43:00 AM 0 comments

    Beware Hot Microwaves: From the crime doesn't pay department.
     
    posted by Sydney on 6/14/2004 08:42:00 AM 0 comments

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