"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
I initially had no intention of blogging anything about September 11 today, but I was sitting here in the office catching up on paperwork, listening to The Rising as my own private memorial service when I surfed over to Instapundit as a reprieve from cholesterol levels and worker's comp forms and came across this.
It brought my paperwork to a halt. Watching all those images from that day, I remembered how, when that first plane hit and we were all wondering how on earth a pilot could be so off the mark as to hit the World Trade Center, then the second plane hit and we knew then it wasn't an accident. I remembered thinking how could the hospitals in the city possibly handle all the wounded. Then, by the end of the day, it was clear the hospitals had no trouble handling the wounded. There weren't many wounded. All those people were just.....gone. It was the funeral parlors and the gravediggers and the clergy who would have trouble handling the surge in business in the days to come. But not the hospitals.
And I remembered the anger and the grief of those days. Then I went over to Lileks and was reminded of just how measured our response to the horror:
I’ve no doubt that if Seattle or Boston or Manhattan goes up in a bright white flash there will be those who blame it all on Bush. We squandered the world’s good will. We threw away the opportunity to atone, and lashed out. Really? You want to see lashing out? Imagine Kabul and Mecca and Baghdad and Tehran on 9/14 crowned with mushroom clouds: that’s lashing out. Imagine the President in the National Cathedral castigating Islam instead of sitting next to an Imam who's giving a homily. Mosques burned, oil fields occupied, smart bombs slamming into Syrian palaces. We could have gone full Roman on anyone we wanted, but we didn’t. And we won’t.
No, we won't. But we must keep up the steady fight.
Celebrity Medical News: John Ritter's family is suing the hospital that treated him:
The suit, brought by Ritter's widow, actress Amy Yasbeck, and his four children, alleges that doctors initially misdiagnosed Ritter's condition as a heart attack. It seeks unspecified damages against the hospital and its medical staff.
'Mr. Ritter's doctors, failed to properly and timely diagnose and treat an aortic aneurysm, which would have prevented his death,' said Yasbeck's spokeswoman, Lisa Kasteler, in a statement.
This is a good example of the difficulties doctors face in making the correct diagnosis sometimes. Aneurysms of the thoracic aorta present just like heart attacks. It's almost impossible to tell the difference, unless you're lucky enough to see the aneurysm on a chest x-ray:
No single criterion or group of criteria clearly distinguishes TAD (thoracic aortic dissection -ed.) from AMI (acute myocardial infarction, or heart attack - ed). Physicians must rely on varying their level of clinical suspicion based on findings in the history, physical examination, and clinical tests.
Was it malpractice? I don't think so. He was just unfortunate enough to have a fatal condition that doesn't pronounce itself clearly and unambiguously.
MMR vs. Autism: The MMR vaccine has been vindicated - again:
The Medical Research Council team looked at the vaccination records of 1,294 children diagnosed with autism or other conditions they termed pervasive development disorders (PDDs) between 1987 and 2001 in England and Wales.
PDDs are a range of conditions first seen in childhood that include abnormalities in language development, communication abilities and social interactions, and a rigid, repetitive pattern of behaviours and interests.
These children were compared with 4,469 children of the same sex and similar age who were registered with the same GP surgeries but did not have autism or PDDs.
Dr Liam Smeeth and his colleagues from the London School of Hygiene and Tropical Medicine were unable to find any evidence to support an association between the triple measles, mumps and rubella vaccine and autism or other PDDs.
Overall, 78% of the children with autism or a PDD had received MMR. Similarly, 82% of the other children had been given MMR.
Wages vs. Premiums: Anyone who buys their own health insurance won't be surprised to hear that premiums rose this year. But isn't this self-evident?
The increase, tracked in a survey released yesterday by the Kaiser Family Foundation Health Research and Educational Trust, was lower than the 13.9 percent increase in 2003 but five times higher than the average increase in wages.
Where do they think the money for those premiums come from? They come from the wages of workers, or at least from money that would be used to give them raises if it weren't being used for their health insurance premiums. posted by Sydney on
9/10/2004 07:32:00 AM
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Wellville: John Kerry recently expounded on his plans for the healthcare system:
.....Kerry endorsed the creation of a new federal department. "What I want to do, what I'm determined to do, and it's in my health-care plan, is refocus America on something that can reduce the cost of health care significantly for all Americans, which is wellness and prevention...And I intend to have not just a Department of Health and Human Services, but a Department of Wellness.
Just what we need. A bureaucracy devoted to telling us how we should be living.
Misperceptions: An Akron man has managed to get people to pay $500 a piece for a tour of the city. He had to bill it as a "mystery tour" and not tell them where they were going, largely because of misperceptions like this:
"What have you heard about Akron, Ohio?'' he asks rhetorically.
He mentions tires, the stench of rubber, smokestack grime and the phrase ``sick and dying,'' and gets a moan of quiet consensus.
I thought the same thing before moving here. I also thought of it as the white bread capital of the world thanks to Martin Mull's mockumentary The History of White People in America, which had the Institute for White Studies located in Akron. (Or maybe it was the museum of white culture, can't remember.) I really didn't want to come here, and only agreed to come out for a job interview because I really hated my previous job and was looking for just about any way out of it. But, when I came here for a job interview I was pleasantly surprised by the city's diversity. I haven't regretted moving here yet. posted by Sydney on
9/09/2004 08:57:00 AM
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Two influential studies released yesterday offer contradictory results about the importance of obesity and exercise for health.
...Both sides of the dispute will find new evidence to support their views in the studies. "This is a fiercely debated topic," said Steven Blair, president and chief executive of The Cooper Institute, a Dallas-based center that studies living habits and health. "There are very prominent people on both sides of the issue.
The two studies aren't really contradictory. The study that says weight doesn't matter but exercise does, looked at the relationship between weight, exercise and heart disease:
Overweight women were more likely than normal weight women to have CAD risk factors, but neither BMI nor abdominal obesity measures were significantly associated with obstructive CAD [cornary artery disease - ed.] or adverse CV [cardiovascular - ed.] events after adjusting for other risk factors (P = .05 to .88). Conversely, women with lower DASI [a measure of physical activity] scores were significantly more likely to have CAD risk factors and obstructive CAD (44% vs 26%) at baseline, and each 1-MET increase in DASI score was independently associated with an 8% decrease in risk of major adverse CV events during follow-up.
The study that says weight matters more than exercise looked at the relationship between weight, exercise and diabetes. (Here it should be noted that the inactive were also more predisposed to diabetes than the active. They just found that weight had a stronger correlation than activity.)
The two studies were measuring two different diseases. You can't compare them and say that they're contradictory. That's like saying that because cigarette smoking increases the risk of heart disease but not of diabetes, the effects of smoking on your health are controversial. Of course, there's this confusion about obesity only because the CDC and the HHS has made a campaign of blaming obesity for every ill imaginable - from diabetes to cancer to heart failure. Clearly, it's an important factor in diabetes. It isn't such a clear cut factor in other diseases. posted by Sydney on
9/09/2004 08:03:00 AM
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They've Got to Be Kidding: There's a new medical drama on television this month, Medical Investigation, about a "mobile NIH medical team" that's based on the CSI model:
McDonough is Dr. Stephen Connor, the obsessively dedicated head of an NIH mobile medical team. We know he's obsessive because he's willing to disappoint his son by flying off in the middle of the kid's baseball game, though you have to wonder what kid wouldn't think it was kind of cool to see his game called on account of a military chopper landing in the outfield.
Whoa. I thought the NIH was more of a research-oriented bureaucacy. Isn't it the CDC that has the mobile investigative team to make on the spot diagnoses? Yes, that's correct. "Sorry, kid. Gotta go. Senator Byrd wants me to open a new hospital in Rockville, West Virginia, right away!"
UPDATE: Ross at Public Health Press says that the show's creaters chose the NIH to add flexibility. He points out this article:
Laurence Andries, the show's producer, emphasizes that the series is intended as fiction, and the hybrid NIH and CDC agency will work well with a plot line that includes a participant in a clinical trial, which is an NIH specialty.
Hmm. But if you're going to be "creative" doesn't it make more sense to use the CDC team as the basis of the show and just sometimes have them look at clinical trial subjects? I suspect they didn't realize the difference between the CDC and the NIH until the pilot was in the can. posted by Sydney on
9/09/2004 07:02:00 AM
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Poetic Justice: One of the constant tensions between specialists and generalists (pediatrics, internal medicine, and family medicine), is the battle of the admission. Many times, when a patient with a known problem that is followed and treated by a specialist, comes to the emergency room with an exacerbation of that problem, the specialist refuses to admit the patient. Instead, they request that the primary care doctor admit the patient and "they'd be happy to provide a consult." They do this because payments for consulting are higher than payments for admitting, and because consulting requires much less paperwork. It's very aggravating from the generalists' viewpoint. The specialist makes all the treatment decisions. The generalist is just left with meaninigless paperwork. And because most insurance companies won't pay two doctors to see the same patient the same day for the same diagnosis, they often don't get paid at all.
So, it was no suprise early this morning when the emergency room called about a man with a long history of coronary artery disease who had come in with chest pain. He was fine now, and everything looked OK on his testing, but he really needed to come in for observation and more testing to make sure his coronary artery disease wasn't getting worse. When I asked the emergency room physician if she had contacted his cardiologist, I could hear the exasperation in her voice. You know how they are. They won't admit. They only want to be consulted. I gave in and accepted the admission, more than a little exasperated myself.
But then, fifteen minutes later comes another call. The patient left against medical advice. He had a bankruptcy hearing to go to this morning that he couldn't miss. He said he'd just stop by his cardiologist's office after the hearing. Ha.
That made up for the 2AM call about insect bites. A mother had taken her child to her physician and to the emergency room about these bites and just couldn't understand why the child was still getting them.(I don't know. Maybe because there are still insects in the world?) posted by Sydney on
9/09/2004 06:35:00 AM
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Scientists presenting research at the First International Scientific Conference on Childhood Leukemia on Wednesday said that light at night (LAN) and working shifts, which disrupts the body's internal clock, have been associated with an raised risk of breast and colorectal cancer.
"We don't know whether abnormal light exposure is generating this higher incidence of childhood leukemia or not, but in view of what we know of other forms of cancer this is not unreasonable," Russell Foster, a molecular neuroscientist at Imperial College London, said in an interview.
Hmmm. Sounds like it's all speculation and theory. Now excuse me. I've got to go turn off my children's night lights. posted by Sydney on
9/08/2004 11:46:00 PM
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Blog Trouble: Blogger's having publishing trouble today. (Which is why the below posts are timed much earlier than they actually published) Expect posts to be sporadic. posted by Sydney on
9/08/2004 03:03:00 PM
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Irena Medavoy — former model, actress and now wife of movie producer Mike Medavoy — filed a lawsuit against one of tinseltown's top dermatologists, Dr. Arnold Klein.
After using Botox for her wrinkles, Medavoy says Klein suggested using Botox for her migraine headaches.
While Botox has been approved by the Food and Drug Administration for the treatment of wrinkles, it is not yet approved for migraine treatment.
Medavoy says she didn't know that her famous doctor was making money from the company that makes Botox. The former model says Dr. Klein was on the company payroll as a $100,000-a-year consultant.
She also claims she didn't know that other people treated with Botox had reported traumatic experiences.
Medavoy says she told Klein to go ahead with the treatments. But after they were complete, she claimed Klein gave her too much of the drug, resulting in an unrelenting headache that made her too ill to play with her son or go out with her husband.
"I couldn't hold my head up," she said on ABC News' Good Morning America. "My neck muscle, where it was injected in my neck, could not support my head. It was like a bowling ball on a pin. I couldn't sleep. I, when I laid down, it was as if someone was torturing me. I was bedridden. I couldn't function. I had a fever of 102. I had breathing problems. I had difficulty swallowing."
Wow. $100,000 a year as a consultant? How many researchers could a drug company hire for that? Right out of graduate school, I would think at least two, no?
Botox is a potential treatment for chronic headaches. It's experimental, however. The doctor had a duty to make sure his patient realized that. It doesn't appear that he did.
I attended a conference last month and heard a neurologist say that the evidence for the effectiveness of Botox in headaches was mixed, at best. But a PubMed search shows only optimism on the subject. On the other hand this review of the evidence says there's "insufficient positive evidence" to support its use for headaches. Sounds like it might help some, but not many chronic headache sufferers. As is so often the case with therapies for chronic pain. posted by Sydney on
9/08/2004 07:21:00 AM
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Public Health Crisis: According to this CNN story public hospitals are in crisis, even the famous ones. The article goes on in great detail about long waits for treatment, pharmacy lines that "begin at dawn," etc, and blames recent cuts in government funding. But charity hospitals (both public and private) have been in trouble for a very long time. In the 1990's when HMO's become popular and the reimbursement power balance became heavily weighted toward the third party payer - be it an insurance company or the government, the number of charity care hospitals rapidly declined. Cities had to give up, Catholic orders had to give up. They could no longer charge the well-off enough to compensate for the charity care. In my city, there is no more public hospital, and no more Catholic hospitals, either (except in name only.) It's been that way since at least the mid-'90's. They're run as not-for-profits now. And they're run by businessmen rather than nuns and city counsels. The Parkland story is just the last gasps of that saga. posted by Sydney on
9/08/2004 06:45:00 AM
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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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