"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
In the study, published in the September issue of the journal Pediatrics, 133 children with difficult-to-treat head lice infestations were treated with Nuvo lotion in two separate trials.
In the both trials, parents were instructed to 1) apply the lotion and wait two minutes; 2) comb out all the lotion possible; 3) dry the hair with a hand-held hair dryer; and 4) shampoo the child’s hair at least eight hours after application.
In the first trial, parents were instructed to remove nits (lice eggs) with a nit-removal comb during step two, and in the second trial parents skipped this step.
The study showed that 97 percent of the children in the first trial and 95 percent of those in the second were successfully cured of their head lice after up to three treatments with the lotion, as demonstrated by a wet combing test that showed no lice and no symptoms. The five children who were not cured after the three treatments allowed by the study were all cured by completing a total of four treatments.
The lotion supposedly suffocates the little critters - and their eggs (the nits.) This is especially welcome because so many schools have "no nit" policies. They won't let children return to school as long as there are still nits in their hair. But with many treatments, the nits remain for a while, even though they may be dead. And picking out dead nits is a very tedious process. (Come to think of it, aren't those parents nit-picking when they "comb out all the lotion possible?" Probably!)
"We got an issue in America,' he began, in a folksy diction aimed at his small-town crowd. 'Too many good docs are getting out of the business. Too many good OB/GYN's aren't able to practice their' - he paused a split second, as if searching for a word, then continued - 'their love, with women all across this country,' he said.
As someone who has to talk all day long, sometimes after nights of very little sleep, I can understand how this could happen. Heck, similar things have happened to me. I suspect he was tired. But it is a doozy.
posted by Sydney on
9/07/2004 08:09:00 PM
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Stem Cell Wonders: An Italian boy has been successfully treated for a hereditary anemia with placental stem cells from his brothers:
An Italian boy has been cured of a potentially lethal form of anaemia by a new type of stem-cell therapy, using cells from the placenta of both of his recently born twin brothers, the health ministry said on Monday.
....The innovation of this operation was that it used two different batches of placenta blood from each of the brothers.
One batch of blood was rich in stem cells -- basic cells that can grow into a variety of different cells. The other had been altered in vitro to combat the disease.
His condition, thalassemia, is caused by defective gene that codes for hemoglobin structure. In severe forms, the hemoglobin molecule is so deformed that it can't bind with oxygen, rendering the red blood cell useless. It also deforms the shape of the red blood cell enough that it's destroyed by the body, thus the anemia.
posted by Sydney on
9/07/2004 07:57:00 PM
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Barbarians: Some early work of Shamil Basayev, the al-Qaeda linked terrorist behind the Russian school massacre:
In one of the first attacks under Basayev's leadership in 1995, a rebel gang took hundreds of hostages in a hospital in the southern Russian town of Budennovsk. An estimated 139 people died during their assault and a botched Russian commando raid.
Within a year, the same tactic was used again in a hospital in Dagestan. Hundreds of hostages were taken by bus to a town on the Chechen border. Russian warplanes and artillery pounded the area, killing many of the hostages, but most rebels escaped.
Medical malpractice was his specialty, and he reportedly tried more than 60 such cases, winning more than $1 million in over half of those. Most involved Ob/gyns. Indeed, he was so feared, according to the Center for Public Integrity, that 'that doctors would settle cases for millions of dollars rather than face him at trial.
UPDATE: A long-time reader emails:
You quoted, 'that doctors would settle cases for millions of dollars rather than face him at trial "--while you might passionately disagree with his position surely you must grudgingly admire is competence--Sounds like the kind of person I want on our side negotiating with our adversaries--I would be delighted if our foes would send us millions of dollars rather than face him in what ever trials we would impose--I have bookmarks for different types of Blogs--I am thinking of moving yours from "Medical" to "Political"--you would be right there with the following, however I will put you between Instapundit and Dynamist to minimize the culture shock.
Heh. I have no doubt Edwards is an excellent lawyer, and I would hire him if I needed one. I have my doubts, however, that lawyerly skills make much of an impression on the likes of terrorists and their state sponsors, since they don't have any respect for common decency much less the law.
It's true that this blog has been too political these past few weeks. I'll try to focus more on medicine, less on politicians.
posted by Sydney on
9/07/2004 02:52:00 PM
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Cost Effectiveness: There's some evidence that the chickenpox vaccine has reduced hospital costs:
During the study time frame, hospital costs dropped from $161.1 million in 1993 to $66.3 million in 2001. Varicella-related hospital charges accounted for 0.04 percent of all annual hospitalizations in 1993, compared with 0.01 percent in 2000.
The study is here. It doesn't mention how much it cost to immunize the population during that time period. A single dose of the vaccine is $88. According to the CDC, 85% of children were vaccinated against chickenpox in 2003. According to the Census Bureau, in 2000, there were 19 million children under age 5. (I couldn't find data for 2003.) That means that 16.1 million were immunized against chickenpox, at a cost of 1.4 billion dollars. It's possible that there were fewer children under five, or that the CDC was referring to a smaller group of children. But it still appears that the vaccine costs more than it gives.
Single Payer Systems: Japanese doctors are in dire straits:
Doctors in Japan have warned that there could be an exodus from the medical profession unless the of health and welfare ministry increases the fixed fees that doctors receive for treating patients.
The ministry—in Tokyo—sets the sums that doctors and hospitals are reimbursed for consultations, treatment, and operations by the country’s social security system.
But the Japanese Medical Association says that hundreds of hospitals and general practice clinics are now facing financial ruin because they are being forced to rely on very low, government fixed prices for their income. The situation has become critical, they say, because the cost of treating patients is soaring while the fees have continued to languish at a low level for decades.
Comparison Shopping: An astute observation regarding the Bush vs. Kerry healthcare plans (emphasis mine):
Bush sees healthcare as a private business, between patient and physician. His plan is based on a simple premise: everyone should be able to choose a plan that meets their needs at a price they can afford. This is accomplished by expanding the depth and breadth of tools like Medical Savings Accounts and tax credits, encouraging the return of fee for service.
Kerry's primary focus is on ensuring that 95 percent of Americans, as well as 100 percent of children, will receive healthcare coverage. He does that through a variety of rather complicated mechanisms.
The cost — at least $653 billion — would be paid by repealing many of the Bush tax cuts. But as I re-read the Kerry healthcare plan, I realized something was missing: Physicians.
Except for a discussion of medical malpractice, physicians are mentioned only in passing references, and then as one of several players in determining patient outcomes. In Kerry's healthcare world, physicians exist implicitly, only as "providers" within the explicit world of "lawyers, insurers, and employers."
Certainly the Kerry plan is not the only place physicians are lumped in with all "providers." But in the complicated healthcare world envisioned by Kerry's plan, physicians are seemingly unimportant and invisible. Patient outcomes improve; efficiencies materialize; all without physicians. Just an oversight? In Bush's healthcare world, physicians play a leading role: As he explains: "We must reform healthcare in America ... giving patients more options, fewer orders, and strengthen the doctor-patient relationship.
Still a Good Deal If You Can Get It: Medicare's premium increase doesn't seem as bad as the headlines indicate:
Monthly payments for Part B of the government health care program for older and disabled Americans -- doctor visits and most other non-hospital expenses -- will jump to $78.20 from $66.60, a 17 percent increase, the administration said Friday.
The premiums are updated annually under a formula set by law. The federal government picks up about 75 percent of the cost of Part B benefits and beneficiaries pay the rest.
In addition, the deductible for Part B services will rise $10 next year, to $110, another change mandated by the Medicare law.
About 93 percent of Medicare's 41.8 million beneficiaries are enrolled in Part B, which helps pay for physician services, hospital outpatient care, durable medical equipment and other services, including some home health care.
What the stories don't make clear is that there are two parts to Medicare - Parts A and B. Part A is like catastrophic healthcare coverage - it covers hospitalizations, surgeries, and nursing home care (for sixty days). The deductible for that will be $912, a $36 increase. Not bad for services that can easily come in at several thousand dollars.
Part B is like supplemental insurance. It covers outpatient services like doctor's visits. Seventy-eight dollars a month and a $110 deductible is still a good price - far below market value for health insurance, especially for such a high risk group as the elderly.
Instead of whining that the elderly are getting soaked by the Medicare increases, perhaps the Democrats should suggest that deductibles and premiums be means-tested. But then, that would actually mean reforming Medicare, which no one in Washington has the courage to do. posted by Sydney on
9/05/2004 12:52:00 PM
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On a recent afternoon, Kerry was in his Russell Building office, sitting on a wing chair with his legs crossed next to a fireplace. The office is decorated with a watercolor painted by Ted Kennedy and framed $5 and $1 bills that Eugene McCarthy contributed to his first campaign. Kerry's computer screen is filled with a smiling photo of ... John Kerry.
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) (See the Swiftvets charges, the Cambodia story, and his general defensiveness re: war hero status.)
5. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations (See Do you know who I am? )
6. Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends (See wives, own and POW's)
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others (See Sampan incident.)
8. Is often envious of others or believes that others are envious of him or her. No examples come to mind.
9. Shows arrogant, haughty behaviors or attitudes SSpeaks for itself.
You only need five of those to qualify for a personality disorder. Kerry's a winner! (And this handwriting analysis agrees, for what it's worth.)
Playing spot-the-personality-disorder is an admittedly easy game to play with people one dislikes, but Kerry's public persona comes too close for comfort to those diagnosis categories. That's rather worrisome, since the fatal flaw of the narcissist is the inability to admit when he's wrong.
Mad Doctor Watch: Greek fertility specialist and cloning maverick Panayiotis Zavos says he's cloned the dead. Meanwhile, the world's still waiting for the birth of his cloned baby. posted by Sydney on
9/04/2004 07:48:00 PM
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Slaughter of the Innocents: And then there was this. Can anyone doubt the importance of the war against terrorism after reading of such brutal barbarism?
And the sense of hope that accompanied the sight of each survivor was tempered by the horrors among even the lucky. One speeding ambulance contained a girl who appeared to be about 5, blood rolling down her short and matted black hair. She stood in the back of the crowded ambulance, palms pressed against the glass, wild-eyed and screaming in a black floral print dress.
Because of the sirens and the gunfire and the roar of the overworked engine, her screams seemed soundless, drowned out by everything else. Then she was gone from sight.
....The morgue had reached capacity. Children and dead Russian fighters were arranged in rows on the grass.
One row contained 13 dead and bloodied children, aged roughly 4 to 16. The youngest, a boy, shirtless and with his hands folded neatly on his stomach, was unclaimed. A few were covered with sheets or towels, which mothers passing by lifted, to see if they hid the faces of their missing children. One girl, a young teenager in a dress, appeared to have been executed, having been shot through the eye.
The covered remains of one woman, carried out of the hospital and set in the hospital yard, told of a terrible end. Her bare feet protruded, showing soles of feet that were covered with fresh nicks and cuts, as if before she died, she had run and run and run.
My oldest son turned thirteen two days ago. I have no doubt that when he's eighteen we will still be waging this war; that it will be bloodier and more widespread; and that there's a good chance he'll be among those fighting it. But I wouldn't begrudge the nation, or the world, his service. Not with enemies like this. posted by Sydney on
9/04/2004 03:41:00 PM
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Distracted by Life: I've been distracted from blogging these past couple of weeks by the non-medical news. I've been voting in Presidential elections for twenty-four years now, and I've got to say, those Republicans put together a good convention this year. I'm not normally a political junky. In the past, I might have caught a few speeches here and there on television, but this year the networks (we don't have cable in the Medpundit household) ran the convention so late at night that I would only hear snippets on awakening to NPR's Morning Edition. But what snippets they were - Giuliani, McCain, Schwarzenegger, Zell Miller, and even Dick Cheney. Those morning NPR snippets were so tantalizing, I ended up listening to the speeches in full during lunch while finishing the morning's paperwork. It's the first time that I've felt compelled to look up political speeches that I only read about in the paper or heard in brief on the radio.
The Democratic convention speeches didn't have the same effect, even though they were also the first things I heard in the morning during their convention. Nothing new there (with the exception Barak Obama.) "Two Americas," "Hope is on the Way," Teddy Kennedy, Jimmy Carter - the message hasn't changed in the twenty-four years I've been listening. The American people are downtrodden and only the Democrats can save them. As far as I could tell, there were only passing references to the War on Terrorism, certainly nothing that would make it into those morning snippets on NPR.
And that's the problem right there, with the Democratic Party this time around. Three years ago this month, our country got a wake up call from the Islamic world. The Republicans heard it. The Democrats didn't.
Full Disclosure: I'm listed as a registered Republican, but only because I had to declare myself in the 2000 election to vote for John McCain in the primaries. This may come as a surprise to some people, but there have been only two Presidential elections in which I've voted Republican - in 1988 for George H.W. Bush, and in 2000 for George W. Bush. This will most certainly be my third. posted by Sydney on
9/04/2004 02:04:00 PM
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Senator Clinton said her husband first experienced mild chest pains and a shortness of breath on Thursday at home in Chappaqua, and went with his Secret Service escort to Northern Westchester Hospital in nearby Mount Kisco, where initial tests showed nothing extraordinary.
Mr. Clinton returned home for the night and told his wife, who had begun a three-day trip upstate on Thursday, that he "felt fine and not to worry," she recalled.
....Rising before dawn, Mr. Clinton went to the Westchester County Medical Center in Valhalla, arriving about 6 a.m. A nurse, Donna Florio-Bronen, said he walked in under his own power and was "very pleasant, very upbeat" and "looked great."
Three cardiologists were present - Dr. Ronald Wallach, Dr. Carmine A. Sorbera and Dr. Anthony L. Pucillo - and Dr. Pucillo performed an angiogram, an X-ray in which an opaque dye is injected into the blood to outline the contours of the coronary arteries. The X-rays, Dr. Pucillo said, revealed "multivessel coronary artery disease, normal heart function and no heart attack."
Mr. Clinton was taken by ambulance to Milstein Hospital, the main treatment facility at New York Presbyterian's Columbia campus, at West 168th Street and Broadway in Washington Heights. The center is a renowned medical teaching institution whose cardiovascular treatment facility is widely regarded as being among the best in the nation.
His initial tests must have shown something out of the ordinary or they wouldn't have gone right to an angiogram the next morning. And he has multi-vessel disease - also very serious. The operation he'll be having is explained in detail here. Say a prayer to St. John of God for him.
It's a Small World: A man in New Jersey has died of lassa fever, a virus that's common in West Africa, where he had recently travelled. He was asymptomatic on his flight home to New Jersey, however, so his fellow passengers should be safe:
We are comfortable that this case will remain an isolated case,'' Karabulut said.
Authorities said they were still trying to identify the flight the man was on, which landed in Newark, and that the CDC would attempt to contact those who were on the plane.
The man's family said he did not have symptoms of the disease, such as diarrhea, vomiting or coughing while on the flight, so there is little chance any other passengers were exposed, Bresnitz said.
Stem Cells and Diabetes: One of the more vocal advocacy groups on behalf of embryonic stem cell research has been Juvenile Diabetes Research Foundation. They've been very effective advocates. (It was they who introduced Nancy Reagan to the issue.) Who could be so heartless as to deny young children a cure? Today's New England Journal of Medicine has a review of recent pancreatic rejuvination research that suggests pancreatic cells replenish themselves without the help of stem cells:
Their first experiment confirmed the widely held view that normal turnover of beta cells occurs through the replication of preexisting beta cells. The second and much more intriguing result was that after partial pancreatectomy, newly formed beta cells also arose from preexisting beta cells. Does this mean that there is no such thing as a pancreatic endocrine stem cell? The answer is 'probably,'
But the authors can't resist putting in a plug for embryonic stem cell research, and a slam against adult stem cell research:
The new study places increased emphasis on promoting the replication of adult beta cells4 and the differentiation of beta cells from embryonic stem cells at the expense of pursuing research into the use of adult stem cells for beta-cell replacement.
But didn't the authors just say that it's the beta cells (the cells that produce insulin) that create new beta cells? Wouldn't it make more sense to find ways to coax the existing beta cells in diabetics to produce more of themselves, rather than try to start all over with foreign embryonic cells?
And this story from the BBC says that Canadian researchers have isolated those immature adult pancreatic cells (in mice). Amazingly, they can also be coaxed into becoming nerve cells. Their findings seem solid.
Looks like the money should definitely go toward adult pancreatic cell work. That won't be good news for the equity in PanCell, Inc. held by one of the authors of the New England Journal of Medicine article, though. It's probably not good news for their department's researchfunding, either. posted by Sydney on
9/02/2004 09:40:00 AM
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Prejudging: There's a movement in academic medicine called cultural competency that's beginning to take root. The idea is that we need to be trained to be sensitive to people from other cultures. Here's an example:
Being competent in cross–cultural functioning means learning new patterns of behavior and effectively applying them in the appropriate settings. For example, a teacher with a class of African–American children may find that a certain look sufficiently quiets most of the class. Often African–American adults use eye contact and facial expression to discipline their children. However, this is not effective with all African–Americans. Intra–group differences, such as geographic location or socioeconomic background, require practitioners to avoid overgeneralizing. With other students, one might have to use loud demanding tones, quiet non–threatening language, or whatever is appropriate for those students. The unknowing teacher might offend some students and upset others by using the wrong words, tone, or body language. Being culturally competent means having the capacity to function effectively in other cultural contexts.
This week's New England Journal of Medicineprovides more examples (subscription required):
Consider the case of a Hispanic woman with hypertension whose blood pressure had been difficult to control for more than two years. A workup had ruled out secondary causes, and she had received various antihypertensive medications. Finally, an exploration of her perception of hypertension revealed that although she said she took her medication every day, she believed she knew when her blood pressure was high and therefore took it at different times of the day and sometimes not at all. Asking this patient about her understanding of the cause of hypertension clarified her perspective. This discussion provided an opportunity for reeducation and negotiation about medication.
And then there are the Italians:
Or consider the case of an elderly Italian woman whose son asked her surgeon not to inform her that she had metastatic colon cancer. A culturally competent clinician discovered that the son thought it would "kill" his mother to know the truth. This scenario is common in many cultures, but decision-making and truth-telling processes vary from family to family. Exploring the reasons for and consequences of this preference for secrecy leads to negotiation and an ethically appropriate compromise whereby the patient may be informed of her condition in a way that is agreed on by the family.
Or the Chinese:
In response to the proper inquiry, a Chinese man with limited English proficiency who was treating his asthmatic daughter with herbal remedies (in addition to her prescribed inhalers) explained that this tradition had been passed down for generations. Once the herbal treatment was revealed, the appropriate use of inhalers could be reviewed and reemphasized.
You don't have to be "culturally competent" to tease out these kinds of details from patients' lives. You just have to be humanly competent. Each of those examples could have occurred in any ethnic group. It's a mistake to train young doctors to think of each ethnic group as a cultural stereotype. There are as many different types of families among Chinese, Italians, Hispanics, etc. as there are among Boston brahmins. It's much better to approach every patient with an open mind, and to make as few assumptions as possible about them.
Poet Laureate Greeting Cards: Did you know that Maya Angelou is doing greeting cards now? I ran across them while shopping for a sympathy card. They are less than inspiring. I ended up going with some lesser, unknown, greeting card writer who managed to express sympathy without descending to the maudlin or trite. That must be the height of frustration - to produce better work than a celebrated poet and yet remain an unknown among the rank and file of greeting card poets.
UPDATE: Blogborygmi says we bloggers could find ourselves in the same position:
I have a friend who edits children's books, and the same thing is going on in that industry. She secretly despises the recent mediocre forays into children's lit by Billy Crystal and Madonna, and wishes she could promote some stellar work by newcomers.
But the public wants brand names uber alles, it seems. And we could be in the same boat, too -- say, if Sanjay Gupta started a blog... posted by Sydney on
9/01/2004 09:43:00 PM
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The Frist Speech: Although Guiliani, McCain, and Arnold gave the most moving (and entertaining) speeches of the Republican Convention so far, Senator Bill Frist had some points worth hearing:
Our opponents have a way of confusing compassion with dependency. We believe true compassion encourages and empowers Americans to be responsible and take control of their own lives.
That's what President Bush and the Republican Congress did when we made Health Savings Accounts, HSAs, the law of the land. With an HSA you can invest tax-free in a personal savings account. You can roll it over year to year or withdraw funds if you get sick without paying a penny of tax.
You own it. You invest it. You grow it. You control it. It is yours.
So here's the choice: Do we grow the bureaucracy and gouge you with higher taxes, as Mr. Kerry will do, or do we let the American people grow their own HSAs and own their health care, as George Bush wants to do?
We've made our choice.
But I'll tell you what Senator Kerry's prescription will be: Take a handful of tax increases and don't call me in the morning.
....We have a choice. John Kerry's trillion dollar government-run plan will place your health care in the hands of others far away. President Bush's plan is patient-centered, which is the only sure prescription for superior care. Mr. Kerry will empower those who tax you. President Bush will empower those who cure you.
Batty Belfries: All you need to know about bats and rabies. Most important take home point:
People usually know when they have been bitten by a bat. However, because bats have small teeth which may leave marks that are not easily seen, there are situations in which you should seek medical advice even in the absence of an obvious bite wound. For example, if you awaken and find a bat in your room, see a bat in the room of an unattended child, or see a bat near a mentally impaired or intoxicated person, seek medical advice and have the bat tested. posted by Sydney on
9/01/2004 09:08:00 PM
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Have you taken your pet to the vet lately? Remember writing that check for $50 or $135 without flinching because you wanted the right shots and the best possible care for Fluffy?
It's probably been a long time since you wrote a check for $35 for an office visit in an MD's office.- You probably wrote only a check for a $10-15 copay. Then your insurance program (after a lot of paperwork for the doctor) reimbursed him an additional $18-25, making his total payment for your visit $28-35.
Strange, isn't it, that we think nothing of writing those big checks to the vet because we haven't been 'educated' that we're 'entitled' to veterinary care for our pets. We pay his price because we know it's the right thing to do for our pets, and we're willing to pay even a little extra for a vet with a good reputation or a helpful office staff.
Obviously we don't value our pet's health more than we do our own; so why have we been taught to balk at paying for our routine health care ourselves?
Amen, brother. And there's loads more at his home page.
