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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, October 16, 2004

    More Canadians: They may have to wait on a bench outside for emergency care, but Canadians feel healthy. Eighty-four percent rate their health as excellent or generally good, but they'd still like some of their money back:

    If Canadians could change or add something to their current lifestyle, 72 per cent said they would want more money. This was followed by more travel (55 per cent), energy (53 per cent), and less stress (43 per cent).

    But of these, the greatest personal worry among Canadians is money.

    More than two-thirds of us (67 per cent) say we worry about money frequently, followed by worry over family and friends (63 per cent) and health care (49 per cent).

    posted by Sydney on 10/16/2004 08:48:00 PM 1 comments

    Pity the Drug Reps: Last week, two drug reps from Pfizer were eager to sell me on the safety of the company's two Cox-2 inhibitors - Bextra and Celebrex. Pfizer wasn't like Merck, (the maker of Vioxx), they told me. Pfizer is scrupulous about testing its drugs and owning up to their risks. Pfizer hasn't found any problems with Bextra or Celebrex in all of the studies they've done. Unlike Merck, Pfizer keeps their drug reps up to date with the all of the latest research findings. You can safely recommend Bextra and Celebrex. Bextra and Celebrex won't be taken off the market. You won't be taken by surprise by any Pfizer drug, no sirree. Ahem:

    Pfizer warned doctors yesterday that one of its best-selling painkillers, Bextra, might increase the risk of heart attack or stroke in coronary artery bypass surgery patients. The announcement comes just two weeks after Merck removed from the market its painkiller, Vioxx, which is in the same class of medicines as Bextra, because a study showed that the risk of heart attacks doubled for patients who had taken Vioxx 18 months or longer.

    Pfizer said a clinical study involving more than 1,500 patients showed that those who had undergone bypass surgery and had taken Bextra intravenously and orally were at higher risk for heart attacks. An initial study last year raised similar concerns in the same kinds of patients.

    Poor drug reps. I know they're just doing their jobs, but it really is hard to take anything they say seriously.
    posted by Sydney on 10/16/2004 08:27:00 PM 0 comments

    Level the Playing Field: An excellent review of the drug reimportation issue at the New York Times.
    posted by Sydney on 10/16/2004 08:13:00 PM 0 comments

    Uptown Seniors: The oh-so-civil behavior of the Upper West Side:

    In Manhattan there was even an ugly confrontation. The police were called to quiet a crowd of angry, mostly elderly people who sought flu shots at Project Pilot, a social services center on West 91st Street on the Upper West Side. The center inoculated 180 people, but 80 more still wanted shots when an attendant announced at 4 p.m. that there was no more vaccine, and tried to close.

    John Gruen, 77, a writer-photographer, put his foot in the door.

    "You can't do this to people, especially the elderly," someone shouted. "It's criminal!"

    It was Mr. Gruen, not the clinic, who called the police. But there was nothing - beyond calming people down - that anyone could do.

    I have to say, everyone's been civil and understanding about the shortage around here. But then, Ohioans are more civil than New Yorkers on average.
    posted by Sydney on 10/16/2004 08:09:00 PM 0 comments

    Thank the Lawyers: The forces behind the flu vaccine shortage:

    Vaccines are the one area of medicine where trial lawyers are almost completely responsible for the problem. No one can plausibly point a finger at insurance companies, drug companies, or doctors. Lawyers have won the vaccine game so completely that nobody wants to play.

    ...So why is it that 100 percent of our flu vaccines are now made by two companies in Europe? The answer is simple. Trial lawyers drove the American manufacturers out of the business.

    As they say, read the whole thing.
    posted by Sydney on 10/16/2004 03:43:00 PM 0 comments

    Over Reacting: Some states have decided to ccriminilaize the flu vaccine:

    Gov. Jim Doyle issued an emergency order notifying health care providers to limit administering flu vaccines to residents who fall into high-risk categories, in response to the nationwide vaccine shortage.

    Failure to heed the order could result in a jail sentence of up to 30 days and a $500 fine under Wisconsin law.

    Other states have issued smilar directives. The CDC has a running tally.
    posted by Sydney on 10/16/2004 08:43:00 AM 0 comments

    Influenza Update: Chiron can forget about the rest of its vaccine:

    Today, we are announcing that none of the influenza vaccine manufactured by the Chiron Corporation for the US market is safe for use. This determination is based on FDA's evaluation and inspection of Chiron's influenza vaccine manufacturing plant in Liverpool, England, which concluded this afternoon.

    The purpose of the FDA inspection was both to evaluate Chiron's investigation, testing and assessment of the defects detected in nine of the one hundred lots of their finished flu vaccine (Fluvirin) manufactured for this year's flu season and also to evaluate their determination that the risk of defects was confined to those specific lots.

    posted by Sydney on 10/16/2004 08:22:00 AM 0 comments

    Friday, October 15, 2004

    Oh,Canada: Mark Steyn gets to the heart of the matter of government-funded healthcare:

    Medicare isn’t a moral enterprise: what’s moral about removing a citizen’s responsibility for his and his dependents’ health care and entrusting it to the state? If free citizens of advanced, wealthy economies are not prepared to make provision for their own health care, what other basic responsibilities are they likely to forego?

    And he has plenty of examples of what happens when you show up in a Canadian ER without your national health card.

    And then, there's the sick man who had to lie on a bench outside a crowded ER while he waited his turn.

    I have to admit, I have no first hand experience with Canadian healthcare, but Mark Steyn's stories and the bench sitter's tale echo the healthcare system that was portrayed in the Canadian film Jesus of Montreal. When the main character is knocked in the head his friends take him to the hospital, but he has to wait for so long - on a stretcher in a hallway - that he leaves without ever being seen, only to die later from a brain hemorrhage. I know, it's just a movie, but there's usually a kernel of truth hidden in drama. There has to be, to make it believable.

    posted by Sydney on 10/15/2004 11:12:00 PM 0 comments

    Topical Motrin: The Archives of Internal Medicine has an interesting study suggesting that topical NSAIDs may be helpful in arthritis pain and stiffness:

    The researchers treated 228 men and women with osteoarthritis in at least one knee. They used a topical NSAID solution containing diclofenac sodium. [Voltaren - ed.]

    Patients using the solution experienced a 45.7 percent reduction in knee pain, a 36.7 percent improvement in physical function and a 35.1 percent reduction in knee stiffness, according to the research team at Arizona Research & Education in Phoenix. The patients also reported a 45 percent reduction in pain while walking.

    The adverse effects of the solution were mostly limited to minor skin irritation, with 41.5 percent of the patients reporting some sort of skin problem. Dry skin and rash were the most frequent complaints.
    The abstract is here, but the full paper requires a subscription. It's hard to say how significant the pain and function improvement is, since pain, like depression, is highly subject to the placebo effect.

    Topical NSAIDs are sometimes used on the eye, but in that case they're delivered directly to the site of inflammation. In the case of arthritis, the inflammation is occurring deep within the joint, not on the skin's surface, which makes you wonder about the mechanism of action - placebo or physiologic?
    posted by Sydney on 10/15/2004 08:43:00 AM 0 comments

    Activism: One of the major problems with government-funded healthcare is that the decision about what does and doesn't get covered is too easily influenced by politics, as the blog Dead Armadillos points out.

    ADDENDUM: Michael Fumento looks at the same trend in research funding.
    posted by Sydney on 10/15/2004 08:04:00 AM 0 comments

    Thursday, October 14, 2004

    Grain of Truth: This pretty much sums up the whole underlying philosophy of expanding Medicaid to include those who make 300% of the federal poverty level:

    Essentially, we’ll lose on every transaction, but we’ll make it up in volume!

    posted by Sydney on 10/14/2004 09:31:00 AM 0 comments

    Woes of the Empathic: I hear more stories like this than I care to tell.
    posted by Sydney on 10/14/2004 08:10:00 AM 0 comments

    The Quick Fix: Obesity surgery, the cure for what ails you:

    Diabetes was eliminated in nearly 77 percent of the affected patients; high blood pressure was eliminated in nearly 62 percent; cholesterol improved in at least 70 percent; and obstructive sleep apnea -- episodes when breathing stops during sleep -- disappeared in almost 86 percent. All four conditions are strongly linked to obesity and can have lethal consequences.

    What the study doesn't look at is the complication rates of the surgery. Doesn't look at them at all. Becoming a heroine addict will also lead to a dramatic weight loss, and probably a reduction in the same comorbidities. But we all know the downside of heroine addiction. Do we know the downside of bariatric surgery? Not as well, I'm afraid.

    FREUDIAN SLIP CORRECTION: That should have been "heroin" not "heroine." Nothing wrong with heroine addiction. (Thanks to richard[WINTERS]md for pointing that out.)
    posted by Sydney on 10/14/2004 08:07:00 AM 0 comments

    Freedom: It comes in all guises.
    posted by Sydney on 10/14/2004 07:55:00 AM 0 comments

    The Inner Ear: Researchers think they've found the transducer that changes sound waves to electrical impulses in the ear:

    The remarkable, almost Rube Goldberg-like progression of sound through the human ear leads to a snail-like structure in the inner ear known as the cochlea.

    Lining the cochlea's inward spiral is a very narrow and very long ribbon of hair cells. Scientists have named these hair cells for their tufts of up to 300 microscopic cilia that sway back and forth in response to vibrations, almost like sea anemones waving in the ocean. Tiny strings linking the hairs together loosen and tense in response to the movement, Corey said, effectively opening and closing small channels.

    When open, the channels allow ions like potassium to rush in and create an electrical voltage, creating a signal that zips from connected neurons to the brain, which then perceives the signal as sound.

    But researchers couldn't pinpoint the agent of the transformation from sound vibrations to nerve impulses until the completed DNA sequences of fruit flies, mice and humans revealed candidates in a family of related ion channels. In mice and frogs, molecular probes revealed that one candidate protein localized to the tips of the hair cell's cilia, where scientists knew the mystery channel ought to be. And when the researchers blocked production of that protein, TRPA1, hair cells in both zebrafish and mice no longer responded to mechanical vibrations.

    posted by Sydney on 10/14/2004 07:53:00 AM 0 comments

    Price Gougers: The news that some medical supply wholesalers are price gouging the flu vaccine probably shouldn't come as a surprise, human nature being what it is. But I doubt the practice is as widespread as the media reports are making it sound. I, for one, haven't received a single fax offering flu vaccine. And the offices and drug stores in our area who have the vaccine seem to be acting responsibly by only giving it to those who are at high risk. At the original price.
    posted by Sydney on 10/14/2004 07:38:00 AM 0 comments

    Repped Up: In his post on Cox-2 inhibitors, the class that counts as one of its members the now widely disparaged Vioxx, Derek Lowe notes that Pfizer, maker of the other two members of the class, Bextra and Celebrex, saw its shares go down with the news of Vioxx's demise. That explains why not one, but two, drug reps came to my office yesterday, both eager to explain to me why Celebrex and Bextra are safe.
    posted by Sydney on 10/14/2004 07:32:00 AM 0 comments

    Brain Dead: Turns out that there were indeed a lot of unanswered questions in the story of the coroner from Colorado who said an organ donor was murdered by the doctors who harvested his organs (See this post.) The coroner didn't know what he was talking about:

    Although he is the elected County Coroner, Mr. Young is not a medical doctor. He also conceded that he had no prior training or experience in the declaration of brain death. He indicated that he was learning about brain death through the internet commencing on or about September 28, 2004. The committee understands that Mr. Young had a conversation with a neurosurgeon regarding a 'hypothetical case.' That neurosurgeon was not directly involved in the case, nor did the neurosurgeon have the benefit of reviewing any of the medical records related to Mr. Rardin's case.

    Mr Young says he was motivated by a concern for the process, which evidently leaves the family with a large financial burden if the death pronouncement is delayed. Maybe county coroners shouldn't be elected. And maybe they should have some medical experience.
    posted by Sydney on 10/14/2004 07:30:00 AM 0 comments

    Wednesday, October 13, 2004

    Final Debate: Watching the debate on NBC, Bob Schieffer is much older than I remember. It's been a very long time since I've watched television news. My pro-Kerry spouse isn't here, he's at a meeting, but I am joined by my 13 year old son who has to watch it for school. He's not happy about it. He says he doesn't learn anything about it, since the candidates only repeat the same positions you can read about in the paper.

    First Question: Silly question. Did Bush, Kerry, and Schieffer grow up in a world that's more secure than the one we live in now? Schieffer looks old enough to have been a child in World War II. When Americans had to put up black out curtains and practiced air drills. When German subs were caught off the coast?

    Second Question: Flu vaccine - how on earth did that happen? Good question. We were caught off guard. Public service announcement probably not needed. Linking it to tort reform - good, could have expanded on that more. Kerry's way off base. The current healthcare insurance situation has absolutely nothing to do with the current flu vaccine situation. Those who need the flu vaccine, especially the elderly, get their flu vaccine covered. "A plan is not a litany of complaints" - good comeback on Bush's part. This has devolved into nothing about the availability of vaccines and how to make sure we have those we need to insure the public health. Insurance companies aren't going to make that happen.

    Third Question: How are you going to pay for all of this? Kerry's multiple plans will paid for by tax increases. I don't know enough about tax loopholes to know what Kerry's talking about except that he's going to increase taxes for those making over $200,000. Bush is on a roll. "Pay as you go means you pay and he goes and spends." Ha. Made my son laugh.

    Fourth Question: What would you say to a worker who lost his job to cheaper overseas workers? My son wants to know why everyone's named "Bob." Bush says we need to foster jobs for the 21st century, and that includes education reform. Good answer. Kerry doesn't see the link between jobs and education. Kerry makes a joke about the Sopranos (He must have read the new Kitty Kelly Bush book.) For Kerry, jobs are related to healthcare.

    Fifth Question: Is the President really at fault for job losses? Kerry's going on about loopholes again. What loophole is that? I'm still not clear on that. Kerry's going to fight for the American worker, for a fair playing field. Again, no one's answering this question. Bush is on Pell Grants and tax cuts rather than answering the question. Kerry says he voted for tax cuts over 600 times. That needs to be fact checked. (The pro-Kerry spouse is home. Says Bush should have jumped on "nanosecond" and pointed out that it's awfully French sounding.) Bush fact checks the tax cut votes.

    Sixth Question: Is homosexuality a choice? Bush is doing well with this answer, explaining the concern about activist judges. Kerry is channeling a gospel singer - "We're all God's children." Acknowledges he shares the same belief that marriage is between a man and woman with Bush.

    Seventh Question: Senator Kerry, what do you think about those bishops who are telling Catholics that voting for you would be a sin? He respects their feelings. Says his other votes - for the environment, etc. outweighs his abortion and stem-cell positions. Only someone who doesn't really believe that life begins at conception could feel that the other positions outweigh a culture of life. Bush's answer is better - fostering policies that help reduce abortions, the importance of a culture of life. Even his rhetoric is better, but then again, I agree with the position.

    Eighth Question: The healthcare issue. Exactly right that one of the biggest problems with our system is that the consumer of the service is completely divorced from the cost. And yes, the runaway litigation is also a part of the problem. I'm not so sure about the electronic medical record suddenly making everything better. Those systems are very, very expensive.
    Kerry says that Bush has forbidden reimportation of drugs from Canada (But wait a minute, my patients are getting drugs from Canada. Are they all criminals?) Kerry says he wrote 56 bills as a Senator on healthcare. That, too, needs to be fact checked.

    Ninth Question: What is the Kerry healthcare plan? His plan is better than most people's health insurance - better benefits at lower price. Now he's covering people up to 300% of the poverty level. (That's up from 200%) Also will open up Medicare to younger people (middle-aged.) Bush points out that this will be expensive, that 8 million people will likely switch from private insurance to government insurance under Kerry's plan. Will lead to rationing. (I would add that shifting that many people to government-run healthcare will also restrict access because the reimbursement is so low.) Bush is fact-checking Kerry again re: VA funding. I have to agree. Many of my patients go to the VA for their chronic healthcare needs and only see me for acute illnesses. They don't complain about those VA benefits at all.

    Tenth Question: Social Security. I've long ago accepted the fact that social security won't be around when I'm old. Haven't you?

    Eleventh Question: Social security, again. Senator Kerry are you just going to leave this social security problem for future generations? Raise taxes and we can save it. Those taxes on people making over $200,000 are going to have to be pretty big to pay for all of this stuff, aren't they? Kerry also ignores the fact that the baby-boom generation is going to be an extreme burden on the younger non-boomers if the current social security system stays the same.

    Twelfth Question: Immigration. Are our borders protected? Interesting Bush answer. Open up legal immigration so border patrols can concentrate on illegal immigration. For Kerry, somehow, immigration is the fault of the richest 1% of Americans and their tax burden. Oh, now he's back to the borders. He's got a plan to tighten the borders. Says there are 4,000 people a day coming across the borders, including people from the Middle East. Is that true? Have no idea. Another fact-check moment for Kerry.

    Thirteen Question: Minimum wage. It has a been a long time since the minimum wage was increased. It wouldn't hurt to increase it. I don't buy Kerry's argument that women get paid less for the same work. There are usually other factors - part time, maternity leave, lifestyle choices, that artificially lower women's wages.

    Fourteenth Question: Mr. President, will you overturn Roe v. Wade? Bush rightly says that judicial appointees will not be put to a litmus test. Kerry basically says that he will use a pro-abortion litmus test for his judicial nominees. Somehow, for Kerry, this, too, goes back to the rich and their tax cuts.

    Fifteenth Question: Troop strength. Kerry will double the number of special forces and keep the national guard and reserve in country. Oh, yeah, and get other countries to commit their troops, too. We're back on foreign policy now. Thought that was the first debate.

    Sixteenth Question: Assault Weapons Ban. Kerry would have gotten an assaults weapon ban passed with the shear force of his personality.

    Seventeenth Question: Affirmative Action. It will stay as is under a Kerry Presidency. Oh, and George Bush is a racist. Bush says Kerry's a liar, he's not a racist. Rightly emphasizes the importance of early education, encouraging an ownership society.

    Eighteenth Question: What role does faith play in your job? (Of course that was asked of Bush) Bush obviously feels much stronger about his faith than Kerry does. He's very warm and emotional when talking about it. Kerry sounds like he does when he's talking about any other political issue. With the same hand gestures.

    Nineteenth Question: I missed the question, but Kerry's addressing the political divisions that seem to have widened in our country since the last election. He's more passionate about this than he was about his religion. He and John McCain will work on campaign finance reform, but isn't that one of the things that led to the current divisiveness and nastiness? Bush: Hey, McCain is supporting me!

    Twentieth Question: What have each of you learned from the strong women in your lives? Bush: "To listen to them. And to stand up straight and don't scowl... And she speaks English better than I do." He's really good at self-depracating humor. Kerry, too, for the first time I can remember also made a very good joke at his own expense. "We all married up. Some would say I did more than others." I think this is the most human I've seen him.

    Closing Statements: God bless us, everyone.

    Impressions: A much better performance all around by George Bush than the two previous debates. But, like the last debate, I doubt if it changed many minds. I'd say it was a draw. And I have to wonder how many people watched this one. My son left half way through, too tired to stay up any longer. Same with my husband. Not much about tort reform, other than as asides during answers to other questions. Of the three debates, the best questions came from the average citizens of the second debate. Maybe they should let average citizens ask the questions in all the debates.

    UPDATE: And just remember this advice from a reader:

    One of the main requirements for a successful debater is to be able to argue any position, regardless of one's actual beliefs. Kerry certainly fits the bill; he's argued every side of the coin since declaring himself a candidate. Is that part of the "plan?"

    And, if being a proficient debater were the prime requirement for the office, then a pimply 14 year-old high school student would undoubtedly be the next president.

    UPDATE II: Reader analysis:

    Oh, my.

    I never realized that you were such a partisan. Your laughably slanted
    debate "analysis" is hardly worthy of you otherwise excellent blog.

    posted by Sydney on 10/13/2004 09:00:00 PM 0 comments

    Tonight's Debate: I plan to live blog the debate tonight. Since it's devoted to domestic issues, I'm sure we'll be hearing something about tort reform, Medicare, the uninsured, and drug reimportation.
    posted by Sydney on 10/13/2004 08:39:00 AM 0 comments

    Protecting Young Minds: Although sudden cardiac death gets all the media attention, a far more common danger for high school and college athletes are head injuries. Researchers are looking for ways to intervene early:

    At Simbex, a Lebanon, N.H.-based company, researchers have developed a wired helmet system called HITS — Head Impact Telemetry System — that reads the intensity of impacts in terms of "G," or gravity forces, and alerts trainers when a player has taken a strong hit to the head.

    "We put six sensors in the helmet that have little springs so it measures the movement of the head, not the helmet, during impact," explained Rick Greenwald, president of the company.
    The data is stored in the helmet after a hit and then beamed by radio waves to a computer on the sidelines. If the computer senses that the impact is over a certain level, it will send a beeper signal to the trainer. Then the trainer can decide whether or not to pull a player from the game to examine him.

    "Most football players won't tell their trainers that they got hit," said Greenwald. "They don't want to come out of the game. But this lets the trainer know directly."

    And then there's a computer test that screens the mental functioning of the athlete after an injury, a system that's used at our town's high school this year:

    The 20-minute program, called ImPACT, measures verbal and visual memory, reaction time and processing time. Trainers have athletes take the test before the season begins to learn their baseline and then look for differences in their score following an injury or incident on the field.

    This way trainers can pick up on any small change in the mental performances of their athletes and hopefully detect any concussion. Meanwhile, Lovell is trying to understand the exact effects of a football-related concussion on the brain.

    posted by Sydney on 10/13/2004 08:34:00 AM 0 comments

    Winning Hearts and Minds: The stem cell issue wins a convert.
    posted by Sydney on 10/13/2004 08:26:00 AM 0 comments

    Flu Vaccine Update: The CDC is working closely with Aventis Pasteur, the other supplier of flu vaccine for the United States, to make sure the flu vaccine goes where it's needed:

    The Centers for Disease Control and Prevention (CDC) and Aventis Pasteur announced today the first phase of the plan to allocate influenza vaccine in response to the recently announced loss of half of the nation's expected flu vaccine supply for the 2004-2005 season. The plan, announced by CDC Director Dr. Julie Gerberding and Aventis Pasteur US President Damian Braga, calls for CDC to work closely with Aventis to distribute in phases 22.4 million doses of unshipped vaccine to identified areas of need throughout the country.

    Beginning immediately, about 14.2 million doses of vaccine will be allocated over the next 6-8 weeks through Aventis Pasteur contracts directly to high-priority vaccine providers, including hospitals, long-term care facilities, nursing homes, and private providers who care for young children.

    Meanwhile, Chiron, the company that had trouble with this year's vaccine batch, received a federal grand jury subpoena to investigate the matter. Does that mean the U.S. Attorney's office in Southern New York thinks this was done intentionally? Evidently::

    Says Robert Salcido, partner at law firm Akin Gump Strauss Hauer & Feld: Generally such subpoenas are not issued to "gain leverage in a civil suit. So, when you get a grand jury subpoena, one thing you know is that the investigation has to do with [the potential] violation of criminal laws."

    Not sure what criminal laws those would be, but civil lawsuits might be around the corner:

    And shareholders will almost certainly file civil suits against Chiron in coming months as well. In late September, CEO Pien had commented to a congressional committee as well as to investors at an investment-banking conference that recent manufacturing glitches would not prevent Chiron from meeting expectations for production of 46 million to 48 million flu shot doses. Reports have also surfaced that Chiron had quality control issues with its Liverpool flu-vaccine plant well before this summer.

    ...Distributors and vendors for Chiron's flu shot may also resort to legal action. "Depending on what the contract says, you could anticipate exposure for Chiron," says Salcido.

    I have to confess, I don't understand that, either. Isn't risk an inherent part of investing?

    posted by Sydney on 10/13/2004 08:22:00 AM 0 comments

    Tort Reform: Michigan has passed a law that bars suing restuarants for obesity. This seems sensible, for as Health Facts and Fears notes:

    We have long wondered why burgers purchased at McDonald's or Burger King might be intrinsically more fattening than burgers produced in the home or in the corner diner.
    posted by Sydney on 10/13/2004 07:56:00 AM 0 comments

    Tuesday, October 12, 2004

    Grand Rounds: The third installment of Medical Grand Rounds is up - all the healthcare blogging you can stand, and then some.

    posted by Sydney on 10/12/2004 07:45:00 AM 0 comments

    Kerry Plan in Action: John Kerry's plan to expand Medicaid to include the uninsured is already being done in Tennessee, as Doctor Mental has noted before. It isn't going well:

    In January 1994 - on McWherter's watch - TennCare replaced Medicaid as the state's health insurance program for poor and uninsured Tennesseans. It operates through a system of managed care organizations.

    Doctors and hospitals have complained ever since that the now $5.1 billion program has been underfunded by the state and federal governments, forcing them to carry too much of the cost. Citing inadequate compensation and paperwork hassles, many doctors and hospitals have dropped out of certain managed care organizations, and some have dropped TennCare altogether.

    Tennessee is trying to make things better by increasing funding to the managed care companies handling the Medicaid business, but doctors aren't optimistic it will make much of a difference on their side:

    ...But Dr. Charles White of Lexington isn't as hopeful. His office has accepted TennCare through four MCOs. He's dropped two MCOs - including TLC - and is considering dropping a third, Access Med Plus.

    "Just the fact of the state pumping more money into the program really doesn't mean anything that I can see because so far the managed care organizations have not improved their reimbursements to us," White said. "And again, reimbursement is secondary to these office hassles that we have to go through."

    White's office has had problems with MCOs contesting "clean" claim forms and not paying in a timely fashion, he said. Sometimes, a worker in his office is "on the phone for hours trying to get a referral or prior approval."

    "They just put you on hold and let you sit there - forever," White added.

    ...He also said some MCOs have a poor network of specialists. When they need to refer patients, it's difficult for doctors to find a specialist who will take TennCare.

    The problem of access isn't limited to specialists:

    ...The MCO-provider problems affect recipients like Ross. Reggie Henderson, who works out of White's office, had been Ross's doctor for eight years. But when the office stopped accepting TLC, Ross had to find another physician who would. TennCare recipients are required to have a single doctor or primary care provider. That provider does any necessary referrals.

    Ross now drives about 40 minutes from his home in Lexington to Decaturville to see a doctor.

    ...While Ross and Hatchett love TennCare, there have been cases of patients getting services they don't need, and cases of employers and insurance companies dumping patients into the TennCare program.

    Since Tennessee's program is basically the same program that Kerry wants to make national, it really should be getting more attention. It sounds good on paper, but in practice it's a nightmare.

    posted by Sydney on 10/12/2004 07:41:00 AM 0 comments

    Competitve Edginess: Were productivity bonuses responsible for the flu vaccine shortage?

    Chiron (CHIR), the company at the center of the USA's burgeoning flu vaccine crisis, thought it had a winning formula this year.

    Managers would boost vaccine production 37% at its aging British factory to grab a bigger slice of the U.S. market, growing amid fears of vaccine shortages.

    "Last influenza season hit early and hit hard," CEO Howard Pien said in a news release just three months ago. "Our manufacturing teams have worked hard to increase production to record levels."

    The strategy worked during last year's flu season, when Chiron trumpeted a 50% vaccine production bump through "efficiency measures" that added $245 million to annual revenue.

    Now the company faces tough questions from Wall Street to Washington about whether this year's push played a role in the contamination and presumed loss of Chiron's vaccine for the USA — nearly half the nation's supply. "Whether or not corners were cut in order to achieve that goal is unclear," says analyst Jennifer Chao of Deutsche Bank. "I think that's entirely possible."
    posted by Sydney on 10/12/2004 07:29:00 AM 0 comments

    Ye Olde Receipt: How to remove a tooth:

    Take some newts, by some called lizards, and those nasty beetles which are found in fens during the summer time, calcine them in an iron pot and make a powder thereof.

    'Wet the forefinger of the right hand, insert it in the powder, and apply it to the tooth frequently, refraining from spitting it off, when the tooth will fall away without pain. It is proven.

    "It is proven." The 12th century version of evidence based medicine.
    posted by Sydney on 10/12/2004 07:26:00 AM 0 comments

    Lost in Translation: What does it mean to pop your clog?
    posted by Sydney on 10/12/2004 07:24:00 AM 0 comments

    Spines and Space: Looking for ways to keep astronauts strong.
    posted by Sydney on 10/12/2004 07:23:00 AM 0 comments

    Resistance is Futile: Are we Borg?
    posted by Sydney on 10/12/2004 07:21:00 AM 0 comments

    Monday, October 11, 2004

    John Wayne Medicine: Medicine in the American frontier.

    posted by Sydney on 10/11/2004 08:33:00 PM 0 comments

    More Flu News: GlaxoSmithKline is sending out feelers about shipping some vaccine our way, although it would be limited quantity:

    GSK said it was talking with FDA officials about the possibility of granting Fluarix speedy approval for sale in the U.S. this season -- although it is unlikely this will make a significant difference to the supply picture.

    The vast majority of the company's flu vaccine is already committed to customers under long-term contract, leaving perhaps only around 200,000 doses available for shipment elsewhere.

    posted by Sydney on 10/11/2004 05:17:00 PM 0 comments

    Flu Vaccine Update: Bad news. The FDA isn't likely to let Chiron's flu vaccine in the country:

    The Food and Drug Administration is unlikely to clear influenza vaccine made by Chiron Corp. as safe for Americans to use this flu season, Dr. Lester M. Crawford, the agency's acting commissioner, said Friday.

    Crawford's pessimism came as FDA officials in England met with Chiron officials and were poised to begin an in-depth inspection of the company's Liverpool vaccine production facility on Saturday and Sunday.

    Crawford was asked at a congressional hearing whether the agency was likely to coax free 40 million impounded doses of flu vaccine that Chiron testing indicated were free of contamination with the bacteria.

    'It's not possible to say if any of them are salvageable at this point,' Crawford testified. 'I have to present to you a pessimistic point of view ... I'd like to be able to say that there is some optimism.'

    Crawford told reporters afterward that the FDA likely would have made the same decision its British counterparts did: suspending Chiron's vaccine production and exports due to manufacturing problems.

    But maybe if the vaccine had been produced on our shores rather than overseas, we could have taken steps to have a back-up supply when problems first became evident - like the British reportedly did.
    posted by Sydney on 10/11/2004 08:47:00 AM 0 comments

    Rest in Peace: Christopher Reeve, dead at 52, from complications of bed sores.
    posted by Sydney on 10/11/2004 08:27:00 AM 0 comments

    Vioxx Vexation: A reader on the Vioxx controversy:

    I've been reading about the Cox-2 inhibitors, and the entire thing
    depresses me. I took Vioxx for four years, and the only problem I had was an irregular heartbeat - that I had before I started taking Vioxx (my doctor prescribed a half of a 50mg tablet of Atenolol - it stabilized my heartrate at about 62, my blood pressure at about 120/65). I've been switched to Bextra, which may or may not be any "better". I can't take Celebrex for the same reason I can't take Motrin or aspirin - I end up with a massive nosebleed that takes five or six hours to stabilize, and I lose about a pint of blood.

    With a bad neck (degenerative problems at C3-T1, a two-level fusion at C-4/C5, C5/C6, an internal annulus at C4, C6, and C7, bone spurs, and degeneration to the disks at C4, C6, C7, and T1); facet joint at 12
    locations between C4 and L5, a herniated disk at L5-S1, bulging disks at L3-4, L4-5, evidence of an old break at T12, some bone spurs at various other places, and something that's causing myofascial pain in the Thoracic region, I want something that will make my day livable, not constantly filled with pain. I also don't want to be so doped up I don't know what I'm doing, which is what the Oxycontin I took for eight months did to me. ...I've faced deadly threats before,
    and frequently without my prior consent. I'd rather take a few minor risks than hurt. I wish that some of the people making these extreme decisions could feel what I feel for a few days - it may change their
    opinion. Unfortunately, like the punch line in the old anti-doctor joke,
    "funny, I didn't feel a thing", neither do those who make a lot of these
    arbitrary rules.

    posted by Sydney on 10/11/2004 08:24:00 AM 0 comments

    The Fine Line: Neurotic Poets - "stories about and works by several widely admired poets who courted emotional disaster throughout their lives."
    posted by Sydney on 10/11/2004 08:04:00 AM 0 comments

    Sunday, October 10, 2004

    Living Wills: This is why I tell my kids to make sure I get a private room in the nursing home.

    posted by Sydney on 10/10/2004 10:17:00 PM 0 comments

    Something About Brits: So is this why the British always seem so polite?
    posted by Sydney on 10/10/2004 12:57:00 PM 0 comments

    Anglospheric Habits: Merck is facing another lawsuit over Vioxx, this time from Canadians.
    posted by Sydney on 10/10/2004 08:39:00 AM 0 comments

    Abandonment or Futility? The response of trial lawyers to pain and suffering - when pain and suffering isn't profitable.
    posted by Sydney on 10/10/2004 01:01:00 AM 0 comments

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