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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Saturday, October 23, 2004

    On a Roll: Dr. Bard-Parker is back from a break, and blogging up a storm.

    posted by Sydney on 10/23/2004 10:19:00 PM 0 comments

    Cuyahoga Fall: My husband and youngest son are away at Cub Scout camp this weekend, so I took the remaining children for a hike in the Cuyahoga Valley, once the winter hunting ground of the Iroquois. Or, I should say, they took me. They're much more familiar with the trails there from hiking with their dad in the summer while I'm at work. They led me over rocks and ravines

    to their favorite place - a cave.

    But even in the cool, dark gorge,

    the leaves were beautiful, or at least the leaf litter was.

    And eventually, we did climb to places where sunlight reached the trees

    and the colors got brighter

    and more varied

    until we finally got to my favorite point on the trail.

    Happy trails to you, dear readers.

    posted by Sydney on 10/23/2004 08:38:00 PM 0 comments

    It's All Relative: How hard is hard? You've got to wonder when you read about John Kerry's "Exhibit A" of the grim economy:

    You just told our story,' she said, pointing to her 11- and 16-year-old girls. 'I'm tired of saying no to them. We say no all the time.'

    ...Ms. Sheldon has laid down the law about Christmas already - no presents for adults - but, she said, she is still having to say no to her girls. 'This is Halloween, and they like to go to haunted houses,' she said, but each one costs $12 or more. 'They just went this weekend, and were already talking about another one,' she said. 'I'm like, 'You had your thrill. Once was enough.'

    If John Kerry's elected all teenagers will have unlimited access to haunted houses, no matter what the cost. And all adults will have Christmas presents, no matter what the cost. There's no reason this great land of ours can't afford to send every teenager to a haunted house as often as they want. Haunted houses are run by over-priced, pampered special interests who have lobbied to keep their admission fees unfairly high. In John Kerry's America the government will pick up the bill, and as the only provider of haunted house tickets, they'll mandate the price of admission. No longer will teenagers be denied of the thrill of repeated haunted house scares.

    And in John Kerry's America, no one will ever have to submit to the indignity of a Christmas unmarred by the commercial.
    posted by Sydney on 10/23/2004 01:03:00 PM 0 comments

    In the Event of an Emergency: How to shelter in place in the event of a nuclear explosion.
    posted by Sydney on 10/23/2004 11:11:00 AM 0 comments

    Hope is on the Way: New technology on the horizon for flu vaccine.
    posted by Sydney on 10/23/2004 11:08:00 AM 0 comments

    Burned Out? See Notes on a Physician's Life.
    posted by Sydney on 10/23/2004 11:06:00 AM 0 comments

    Friday, October 22, 2004

    Humor: The real potential of stem cells.

    posted by Sydney on 10/22/2004 08:25:00 AM 0 comments

    Jekyll and Hyde Hormone: A couple of years ago, women were urged to stop taking estrogen because it increased the risk of heart attacks and strokes by a small amount. Now, they're saying it protects against heart attacks and strokes:

    The Wayne State University, Detroit, study contradicts previous research which suggested the Pill increased the risk of those conditions.

    However, the Detroit study - one of the largest ever done into the Pill's long term effects - shows the overall risk of developing heart disease was about 10% lower in women who've taken the pill for at least a year.

    ....Dr Rahi Victory, who led the research, said it could be the female hormone, found in many types of oral contraceptives, which is having a protective effect.

    He said: 'It is likely that oestrogen reduces the inflammation in the blood vessels. "

    The research was presented at a conference, not published in a paper, so it's impossible to give it a fair critique. But, it should give pause to all of those over-the-top concerns about estrogen. When diametrically opposed conclusions about a hormone's impact on any one disease are reached, it means it probably doesn't have much of an impact at all.
    posted by Sydney on 10/22/2004 08:16:00 AM 0 comments

    Drug Abuse: Evidently, in the 1960's and 1970's it was a commonplace practice in some parts of the world to stunt girls' growth with estrogen - in the hopes that they would remain petite husband-bait when they grew up. Yikes.
    posted by Sydney on 10/22/2004 08:04:00 AM 0 comments

    Numbers: The Washington Post says these are grim times for healthcare:

    The political debate is being waged against a grim backdrop. Since 2001, the number of people lacking health insurance has climbed by 5 million to 45 million, or 15.2 percent of the population, according to this fall's Census Bureau report. Insurance premiums are up more than 50 percent, and some employers are scaling back or dropping coverage altogether.

    That's based on this press release:

    The number of people with health insurance increased by 1.0 million to 243.3 million between 2002 and 2003, and the number without such coverage rose by 1.4 million to 45.0 million. The percentage of the nation’s population without coverage grew from 15.2 percent in 2002 to 15.6 percent in 2003.

    What the press release doesn't tell us is that according to the actual report, these are not the grimmest of times. In 1998, the uninsured rate was 16.3% (see page 53 of report), after over a decade of steady of increase. The rate declined each year from 1998 to 2001, when the economy was booming. But after the Dot-com bubble burst in 2000, the rate of the uninsured began increasing again. The other factor here is 9/11. After the terrorist attacks on the World Trade Center, insurance rates everywhere began increasing.

    You don't have to be an economist to see the link between corporate health and the uninsured rate. When times are good, companies can afford generous health insurance benefits. When times are bad, they can't. One more reason that health insurance should be divorced from employment and sold directly to the consumer.

    posted by Sydney on 10/22/2004 07:59:00 AM 0 comments

    Healthcare Debate: BoiFromTroy nails down the problems with our system:

    Our Country's health care system is far too complex to point the finger at any one group and lay the blame.

    The problem with healthcare starts with that it is not a free market system. If a person needs it, they have no choice but to get care, and it is next to impossible to compare costs and quality of services before they are delivered.

    Most Americans get their health insurance through their employer--giving them little or no choice as to what type of coverage they get. Interjecting employers into the healthcare mix only makes the system more burdensome and expensive.

    Healthcare is a necessity for Americans, like food and water, but it is likewise not a right. In order to help Americans get access to the system, health care costs should be tax deductible for all Americans--including those who do not itemize.

    Second, we need to stop the frivolous lawsuits in the system. Medical liability reform will not only eliminate about 1% in direct costs from these frivolous lawsuits, but it will also allow doctors to avoid having to take preventitive measures designed not to prevent disease, but to prevent lawsuits--which is a far greater cost to the system.

    Third, States which impose unnecessary burdens on healthcare providers, such as staffing ratios or what not, will not be reimbursed for these additional costs through Medicare. Neither their residents nor the taxpayers of other states should have to pay for needless regulations that benefit only a small group--in this case, the unions.

    Finally, we need to start making sense in health and insurance practices. An uninsured person can generally only get treatment at an emergency room, which is far more expensive. On some insurance plans, it is free to go to an emerhency room, but costly to go to an urgent care center. There is an economic incentive to the individual to choose the treatment which costs the most to the system. That is crazy and needs to be fixed.

    Although I disagree that the uninsured are forced to go to emergency rooms for care (they can just as easily go to a physician's office), his basic premise is spot on. Simplify the system. Remove the middle man.

    UPDATE: An uninsured RN disagrees:

    In response to the post, you commented: "Although I disagree that the uninsured are forced to go to emergency rooms for care (they can just as easily go to a physician's office), his basic premise is spot on. Simplify the system. Remove the middle man."

    I'm sorry, but I have to disagree with you. I'm a registered nurse AND one of the millions of uninsured. If a patient cannot pay for medical care and/or the patient has a large, outstanding bill, the physician's office can (and quite often will) refuse to see the patient until the bill is paid or other arrangements are made to pay it. Emergency departments cannot refuse treatment because of inability to pay. So yes, the uninsured are most certainly forced to choke up busy ER's for treatment.

    That's true about emergency departments being unable to refuse care. And it's true that physicians will often sever a relationship with a patient who has large outstanding bills they refuse to deal with. However, it's been my experience that most physicians are willing to work with their patients to get those bills paid. Some physicians will accept work in kind - carpentry, landscaping, lawn mowing, etc. or even produce. More commonly, they'll agree to small payments over time. I have a patient who has been paying me $5 every couple of weeks to settle his bill. And for most primary care doctors, unlike specialists, it would be pretty hard to rack up a big bill. The average office visit costs $50 to $60. Since most of the uninsured come from the ranks of the young and employed, it's hard to believe that they're the driving force behind emergency room crowding. (Unless they just haven't taken the time to find a doctor to see, which actually probably is the reason they seek care at the ER. It doesn't take any planning to just show up in the local hospital, any time, day or night. And in my experience, that's the driving force behind crowded ER's, both from the insured and the uninsured.)
    posted by Sydney on 10/22/2004 07:30:00 AM 1 comments

    In Remembrance: Michael Fumento remembers a friend and the cancer that killed her.
    posted by Sydney on 10/22/2004 07:01:00 AM 0 comments

    Thursday, October 21, 2004

    The Special Ones: Why is it not surprising that members of Congress are making sure they get flu shots, regardless of their risk?

    While many Americans search in vain for flu shots, members and employees of Congress are able to obtain them quickly and at no charge from the Capitol's attending physician, who has urged all 535 lawmakers to get the vaccines even if they are young and healthy.

    The physician's office has dispensed nearly 2,000 flu shots this fall, and doses remained available yesterday. That is a steep drop from last year's 9,000 shots, a spokesman for attending physician John F. Eisold said, because many congressional employees have voluntarily abided by federal guidelines that call for this season's limited supply to go mainly to the elderly, the very young, pregnant women, long-term-care patients and people with chronic illnesses.

    But people of all ages who are credentialed to work in the Capitol can get a shot by saying they meet the guidelines, with no further questions asked, said the spokesman, who cited office policy in demanding anonymity.

    "We leave it up to people to read the guidelines" issued by the Centers for Disease Control and Prevention and then to state whether they want the shot, Eisold's spokesman said. "We don't ask. We trust people. . . . Most of the people have been very good."

    The policy applies to thousands of legislative staffers, police officers, construction workers, restaurant employees, journalists and others who work in the Capitol complex.

    Senate Majority Leader Bill Frist (Tenn.), a heart surgeon, sent letters urging his 99 colleagues to get the shots because they mingle and shake hands with so many people, his spokeswoman, Amy Call, said. She said she did not know how many senators have taken his advice.

    Eisold "is a big believer that members of Congress are at high risk, because they shake hands with a lot of people" and then visit veterans centers and other concentrations of susceptible people, his spokesman said. Because lawmakers can be both victims and spreaders of flu, he said, Eisold urged all 535 to get the shots.

    ....The office of the Capitol's attending physician began dispensing the vaccine as soon as it arrived on Sept. 30, the spokesman said. After the CDC announced on Oct. 5 the guidelines addressing the shortage, he said, the office began asking applicants to read the guidelines and to decide whether they wanted a flu shot.

    Rep. Peter Hoekstra (R-Mich.), who is 50, said he got a flu shot as soon as it was available, 'before I knew there was a problem.'

    Sen. Joseph I. Lieberman (D-Conn.), 62, said in an interview yesterday: 'I haven't done it yet, but I want to. We're not in the priority category' set by the CDC. 'But I think the [Capitol's] doctor makes a good case. We can pick it up and spread it' through interactions with constituents.

    The Capitol's doctor's argument is a weak one. Shame on them. And shame on Bill Frist, too. He should know better.

    UPDATE: Slate's Timothy Noah says Frist isn't as irresponsible as the story made him sound, maybe.

    UPDATE II: Congress has donated their vaccine to Washington, D.C. That's good. Too bad it took an unflattering article in the Washington Post to motivate them.

    (Editorial note: This has been edited to remove the unintended double-posting earlier.)

    posted by Sydney on 10/21/2004 09:44:00 PM 0 comments

    Chill Pill Needed: The New York Times says that Manhattan's doctors are all in a fidget over the flu vaccine:

    Dr. Rodney Sherman, an oncologist on the Upper East Side of Manhattan who has 350 chronically ill patients in need of protection against the flu, is giving up on the United States government.

    After weeks of trying to get answers as to whether he is in line to get vaccine - and calm his patients' fears - he has decided to take matters into his own hands.

    This morning, he is flying to Canada, hoping to buy vaccine, even though he does not know if any will be available.

    It is a measure of how desperate private doctors in New York have become. While hospitals, clinics and nursing homes have all been surveyed by the state to determine what they need, private doctors say they have felt ignored.

    William Van Slyke, a deputy commissioner of the New York State Health Department, said that while New York's 70,000 private physicians have not been asked what they need, officials at the Centers for Disease Control in Atlanta are checking with the two major manufacturers to determine who did not receive vaccine.

    As the flu season draws nearer, Dr. Sherman said, that explanation offers little comfort.

    "I am frantic," Dr. Sherman added. "This is bordering on insanity."

    It's true that private doctors are out of the loop, as usual. But, there's no reason to go globe-trotting to scrounge up vaccine. The CDC's plan to distribute the vaccine to hospitals, nursing homes, and public health departments is a sensible one. It will insure that 1) the sickest patients get the vaccine and 2) that vaccine is available throughout the country. Every county, no matter how poor, has a health department. It makes much more sense to distribute them to the health departments than to try to ship them to every individual physician. And the six to eight week time span it's going to take to distribute it is reasonable, too. The best time to get the shot is sometime in November. Don't panic.
    posted by Sydney on 10/21/2004 09:28:00 PM 0 comments

    Fighting False Witness: The American College of Radiology once again takes action against a member who has abused the expert witness system:

    The American College of Radiology has suspended one of its fellows -- a former associate professor of radiology at the University of California, Los Angeles -- for providing what the ACR says was clinically inaccurate testimony as an expert witness against another radiologist.

    ....Hance testified that a 'double dose' of contrast agent administered to the patient led to the renal failure. The plaintiff dropped the case during trial in 2003, prior to any verdict.

    In an interview with AuntMinnie.com, Zuckerman said Hance had no medical literature to back up his 'cumulative toxicity' claim for the plaintiff. 'This is basically just a theory he made up,' Zuckerman said.

    The ACR Ethics Committee received Zuckerman's complaint in February, and referred it to an independent third party for review, according to Hoffman. In correspondence he sent to the committee, Hance maintained that his testimony was based on his own experience with contrast agents.

    But based on the third-party report and its own review of the evidence, the Ethics Committee decided at an August hearing 'that Dr. Hance's testimony was not clinically accurate,' Hoffman said.

    The ACR Code of Ethics states that, 'In providing expert medical testimony, members should exercise extreme caution to ensure that the testimony provided is nonpartisan, scientifically correct, and clinically accurate.'

    In the last year, the ACR has received 13 ethics complaints related to expert testimony, including six complaints in just the last two months. Hoffman credited the increasing pace to the publicizing of ACR actions in other cases.

    Since it began hearing complaints regarding expert testimony by ACR members two years ago, the Ethics Committee has completed reviews of five cases. The complaints have resulted in one expulsion of a member, one censure, two findings of no ethical violation, and the latest involving the suspension of Hance.

    posted by Sydney on 10/21/2004 08:43:00 PM 0 comments

    Pulse of the People, in Iraq: The Iraqi doctor bloggers:

    Meet one of those bloggers, Ali Fadhil, a key author of Iraq the Model, perhaps the best known of the blogs, with 7,000 individual visitors a day. Thirty-four years old, a Sunni, Fadhil is a cheerful Baghdad doctor who contributes news and commentary.

    Medical students in Iraq use English in their classrooms, so doctors are overrepresented among English-language bloggers, as they are among translators. All of the main contributors to Iraq the Model are young physicians who see a cross-section of Iraqi patients daily and have witnessed, Ali says, a steep improvement in medical services since Saddam was overthrown.

    Here's Ali's interview with a doctor at Abu Ghraib, who gives a picture of the prison that's much different than that portrayed in the major media here.

    UPDATE: Another Iraqi doctor blog - from a med student, and an Iraqi dentist blog. (Hat-tip Dave Schuler's Carnival of the Liberated.)

    posted by Sydney on 10/21/2004 08:06:00 AM 0 comments

    Wednesday, October 20, 2004

    All Grown Up: I used to admire Teresa Heinz-Kerry. She seems to have no patience with the artificiality of politics, a surprising trait in a woman who has been a political wife all of her life. But, in the USA Today interview, she just comes off as haughty and offensive:

    Well, you know, I don't know Laura Bush. But she seems to be calm, and she has a sparkle in her eye, which is good. But I don't know that she's ever had a real job — I mean, since she's been grown up.

    People are missing the real insult to women in that comment - the implication that you aren't grown up until you get married. What else could she have meant? People don't usually hold down "real jobs" while they're in high school or college. She knew Mrs. Bush had been a teacher, or at least a librarian, despite her subsequent apology. (And she probably doesn't consider those "real" jobs, either.) She meant what she said. Mrs. Bush stopped working when she got married, or in Heinz-Kerry parlance, "grew up."

    Of course, it's an insult to women (and men) who choose to stay home, too. But it's a broader insult to all women to insinuate that they aren't fully grown until they have a husband and children.

    posted by Sydney on 10/20/2004 07:57:00 PM 0 comments

    Drinking the Kool-Aid: Grunt Doc addresses the medical draft issue, and some of the hyperventilating that has accompanied it. I have to agree with Allen. A nation that didn't have contingency plans in place for a medical draft in this age of bioterrorism would be a foolish nation. And I think the chances of being drafted in the future to help combat a bioterrorist attack (think smallpox outbreak) is much greater than being drafted to help sew up Iraq casualties.
    posted by Sydney on 10/20/2004 08:27:00 AM 0 comments

    Medical Wonders: The miracle patch.
    posted by Sydney on 10/20/2004 08:22:00 AM 0 comments

    Flu Vaccine Update: Aventis-Pastuer, the only other company besides Chiron licensed to sell flu vaccine in the United States, will be able to produce 2.6 million more doses. The slant of the headlines everywhere has been that the new doses won't be ready until January, but the country still has 55 million doses for distribution:

    That left the United States with about 55 million doses from its second manufacturer, Aventis Pasteur. At a news conference Tuesday, Aventis Pasteur announced it could produce another 2.6 million doses.

    The extra vaccine won't be ready for distribution until January.

    That's enough for almost a quarter of the total population. Only about 12% of the population is over 65 (at least in 2000, and that percentage seems to have stayed rather stable over ten years). Shouldn't 55 million doses be enough to cover everyone who is high risk, then? It should be as long as the vaccine is given to only those who need it.
    posted by Sydney on 10/20/2004 08:16:00 AM 0 comments

    Kerry-Approved Message: Just saw a commercial for John Kerry that blames Bush for the flu vaccine shortage. (I couldn't get an internet link for the ad itself, but as of this morning, it's on the main page of the Kerry/Edwards website.) I'm pretty sure it's beyond the powers of the President, at least in the United States, to force companies to make or sell certain products.

    UPDATE: Kerry's solution.
    posted by Sydney on 10/20/2004 08:04:00 AM 0 comments

    MedicoPolitico: The physician activist group, Physicians for a National Health Program, has released a press release insinuating that no one cares about veterans. Here's the press release:

    1.694 million American veterans were uninsured in 2003, according to a study by Harvard Medical School researchers released today. Of the 1.694 million uninsured, 681,808 were Vietnam-era veterans while 999,548 were veterans who served during “other eras” (including the Persian Gulf War).

    ....Many of the 1.694 million uninsured veterans in 2003 were barred from VHA care because of a 2003 Bush Administration order that halted enrollment of most middle income veterans. Others were unable to obtain VHA care due to waiting lists at some VHA facilities, unaffordable co-payments for VHA specialty care, or the lack of VHA facilities in their communities. An additional 3.90 million members of veterans’ households were also uninsured and ineligible for VHA care. Other findings of the study include:

    *The number of uninsured veterans has increased by 235,159 since 2000, when 9.9% of non-elderly veterans were uninsured, a figure which rose to 11.9% in 2003.

    *More than one in three veterans under age 25 lacked health coverage, as did one in seven veterans age 25 to 44 and one in ten veterans age 45 to 65.

    *Many uninsured veterans had major health problems. Less than one-quarter indicated that they were in excellent health; 15.6% had a disabling chronic illness.

    *More than two-thirds of uninsured veterans were employed and 86.4% had worked within the past year; 7% of the uninsured vets worked at two or more jobs.

    A ".doc" version of their study, which is a survey of several government surveys dating from 2000 to 2004, is available on their website at the above link. They're obviously shilling for one of the candidates, and it isn't the one who wants to introduce more personal responsibility into the healthcare market.

    To begin with, if you look at the data on the uninsured by age group since 1987 (pages 71 to 74 of the pdf file) you'll see that Veteran's uninsured rates closely match or are better than that of the general population. For example, Physicians for a National Health Plan say that 11.9% of post-Vietnam era veterans are uninsured in 2003. That would presumably include veterans ranging in age from their early 20's to their early 50's. In 2003, for the general population, the uninsured rate for people ages 18-24 was 30%; for ages 25 to 34 it was 26%, for ages 35 to 44, 18%; and for ages 45 to 54, 14%.

    The PNHP were kind enough to break their data down by age. And it confirms that veterans are better off than the general population, as they themselves acknowledge:

    Younger veterans were more likely to lack coverage than older veterans. 15.1% of those age 25-44 had no health insurance, vs. 9.9% of those age 45-64. Veterans were about one third less likely to lack coverage than other persons of similar age. (emphasis mine.)

    Clearly, veterans aren't being ignored.

    As for their other points:

    Many of the 1.694 million uninsured veterans in 2003 were barred from VHA care because of a 2003 Bush Administration order that halted enrollment of most middle income veterans.

    "Most middle income veterans" already have health insurance, so they don't need the VA benefits. During the Clinton adminstration, the scope of benefits were expanded, and it didn't take long for veterans who already had generous insurance to sign up for VA benefits, too. The influx of new enrollees overwhelmed the VA system, resulting in long waits for care for those who really needed, and who had no private insurance to fall back on. Thus the need for reform in 2003.
    (There were also other benefits to the act.)

    Which brings us to PNHP's next complaint:

    Others were unable to obtain VHA care due to waiting lists at some VHA facilities, unaffordable co-payments for VHA specialty care, or the lack of VHA facilities in their communities.

    Can't win, it seems.

    An additional 3.90 million members of veterans’ households were also uninsured and ineligible for VHA care.

    It's the Veteran's Administration. The healthcare benefits always have been limited to the veterans themselves, and not extended to their families.

    The number of uninsured veterans has increased by 235,159 since 2000, when 9.9% of non-elderly veterans were uninsured, a figure which rose to 11.9% in 2003.

    The rate of uninsurance for the non-elderly has been steadily increasing since at least 1987, across all age groups. Most of that is likely due to the changing nature of our economy. The days of the The Organization Man are over. We need healthcare insurance that isn't provided by employers, but that's owned by the insured. (With a safety net for the poor, the disabled, the elderly.) PNHP recognizes that, but their solution is for the government to provide a hand out for everyone, regardless of need. And we know where that can lead.

    posted by Sydney on 10/20/2004 07:55:00 AM 1 comments

    Waiting Room Reading: Newsweek nicely sums up what's wrong with the stem cell debate:

    Stem cells may not have been the highlight of last week's presidential debate, but there in the front row, wedged between Teresa Heinz Kerry and Kerry's daughter Vanessa, sat a person who stands for the power of science better than words ever could: Michael J. Fox. Diagnosed with Parkinson's in 1991 and visibly ailing, Fox is a staunch supporter of stem-cell research and has, in recent weeks, become Sen. John Kerry's ambassador for the cause. It didn't bother Fox that the subject barely came up or that his presence was largely symbolic. "I'm happy I could do it. If anyone saw me there, they know that the issue is important to [Kerry]," he told NEWSWEEK.

    ...Watching Fox, it was impossible not to think of Christopher Reeve, who died last week at the age of 52. A tireless advocate for stem-cell research—"Superman in a wheelchair," as one friend called him—Reeve's death refocused attention on an issue that has mobilized celebrities, activists, scientists, politicians and even regular folks who barely remember their high-school biology.

    For so many people - and that includes the main stream media - it's more about emotion than science. That sweet little girl in the article's accompanying photo has diabetes, it's cruel to "deny" her a cure. Ditto Michael J. Fox. Ditto Christopher Reeve.

    You wouldn't know by reading the news stories on the issue that adult stem cells are showing more promise for diabetes therapy than embryonic stem cells. You wouldn't know that adult stem cells are showing more promise for spinal cord injuries than embryonic stem cells. You wouldn't know that adult stem cells have been beneficial for at least one person with Parkinson's.

    Why don't you hear about that? Why is the spotlight only shining on embryonic stem cell research, and not on adult stem cell research, too? Well, there are organizations whose members, have a financial interest in getting funding for embryonic stem cell research. And they know that if they went to the media and talked about the research they would put everyone to sleep. So, they hire celebrities. It works, especially when the celebrity happens to have a disease, too. But the results aren't necessarily the best for society.

    It's kind of sad to see someone like Michael J. Fox being taken advantage of by groups like this. Do you suppose he's even heard of adult stem cells? Or has he just been inundated with hype from embryonic stem cell research activists eager to use him for their own ends? Maybe he does know about adult stem cells, but just wants all of the possible options open. Hard to tell. But the fact that all of the rhetoric coming from celebrity spokespeople concentrates solely on embryonic stem cell research suggests it's the former. Shame on those research activists.
    posted by Sydney on 10/20/2004 07:51:00 AM 2 comments

    Tuesday, October 19, 2004

    Rate Your Doctor: Someone asked me what I thought about this site the physician version of Rate My Teacher. My first thought was, "Oh my God, I hope no one slammed me in it." Whew. Not listed.

    I have mixed feelings about it. On the one hand, this is something that goes on every day, albeit in face-to-face conversations between people who work together and live near one another. It just extends it beyond the local level. On the other hand, when you're getting advice about someone's bedside manner from a person you know, you can balance that information against what you know about the person giving it. For example, I recently saw a patient who had nothing good to say about any physician he had ever encountered. After he treated me to a littany of their faults, he looked at me and said, "I don't know, maybe it's just me." And you know what? I was thinking the same thing.
    That knowledge of the reviewer is completely missing from "Rate Your...." websites, and it's a major drawback.

    posted by Sydney on 10/19/2004 08:35:00 AM 0 comments

    Avoiding Resistance: Will nasal cultures one day be as common as urine cultures? Maybe they should be:

    Bhattacharyya said chronic sinusitis patients often develop resistance to key antibiotics after taking pills an average of three months during a 12-to-18-month period.

         But he said patients whose doctors first make sure bacteria is indeed causing the sinus problem, then identify the specific bacteria with a nose swab and match medicine to that bacteria are far less likely to develop an antibiotic resistance.

         Bhattacharyya and colleagues tracked 90 patients over seven years. The bacteria in their sinuses were measured with regular nose swabs and antibiotics were pinpointed to battle specific infections. Bhattacharyya said about 12 percent of patients started to develop antibiotic resistance after 18 months following this strategy. Without targeting antibiotics to the specific bugs, nearly a third of patients developed antibiotic resistance, he said.
    posted by Sydney on 10/19/2004 08:25:00 AM 0 comments

    More Flu: Maybe the real problem behind our vaccine shortages is the FDA, as Kevin Drum suggests. They also seem to be an obstacle to getting Canada's left over vaccines:

    It's also unlikely that the FDA could license new manufacturers in time for their vaccines to make it to the U.S., Butler-Jones said, adding that Health Canada's regulatory branch has dealt with some inquiries from the FDA.
    posted by Sydney on 10/19/2004 08:20:00 AM 0 comments

    Med News: Grand Rounds is up. Lots of posts about influenza, Vioxx, and gin-soaked raisins.
    posted by Sydney on 10/19/2004 08:00:00 AM 0 comments

    Readers Weigh In: On the flu shot:

    I found the issues raised by Michelle Malkin to be quite interesting. It appears that the mean risk of death from flu is pneumonia. If true, why isn't there more emphasis on the pneumonia vaccine? It would seem that would save more people. And, with the shortage of flu vaccine it seems that a program to vaccinate people with pneumonia vaccine would be appropriate. Please comment.

    Looks like officials are starting to push the pneumonia vaccine. Actually, they have been pushing it for a while. A couple of years ago the CDC began a push to expand pneumonia vaccines to people in their fifties rather than limiting it to the elderly and chronically ill. It just doesn't get as much attention because it's a shot you can get any time of the year, unlike the inlfuenza vaccine which is only effective if given a month or two before flu season.

    One other thing about the pneumonia vaccine. It only protects against one type of pneumonia - that caused by the pneumococcal bacteria. Influenza can be complicated by pneumonia caused by a wide variety of organisms, including viral and other bacteria. The pneumonia vaccine therefore isn't perfect protection, but it does confer some advantage.

    Another comment:

    Yeah I agree that the shortage is the result of governmental meddling and an extortionate legal climate. The situation also illustrates how a change can be made and take years for the predicted effects to materialize - we wake up one fine day to find that the vaccine industry is gone. Hmmm, where was John Galt when we needed him? Oh he was there all along and just like in "fiction" no one listened in real life either.

    But aren't we missing something perhaps even more fundamental? I mean, the flu is not exactly a lethal pandemic. It doesn't seriously threaten strong or healthy people. It's just a, well, a nuisance. And nuisance is the level of threat that can be brushed aside and forgotten - isn't that right?

    So what's the fuss?

    Secretary of Health and Human Services Tommy Thompson apparently agrees. The CDC is working with Aventis-Pastuer, the company that does have flu vaccine approved for use in the United States, to distribute the remaining vaccine to people who need it:

    After pairing CDC information on geographic locations of high-priority risk groups and Aventis Pasteur US information on providers scheduled to receive vaccine for the high-risk populations, this round of influenza vaccine went to:

    * Veterans Administration
    * Long-term Care Facilities/Acute Care Hospitals
    * State Public Health Officials
    * Vaccines for Children program
    * Private Providers Who Care for Young Children

    “More doses of vaccine will be going out over the next 6-7 weeks so there will be more opportunity for those who need the vaccine to get it in time for this year’s influenza season,” said CDC Director Dr. Julie Gerberding.....

    ....To ensure that providers who ordered vaccine from Chiron this year get also get some of the vaccine they need for priority populations, CDC and Aventis are taking these actions:

    * filling remaining Vaccines For Children (VFC) orders to Aventis Pasteur.
    * contacting states that ordered vaccine from Chiron distributors to begin re-directing their orders to Aventis Pasteur.
    * collaborating with Chiron distributors to identify providers to high-priority populations including long-term care facilities, hospitals, and primary care and specialty physicians.
    * working with the Visiting Nurses Association of America to ensure high-priority populations it serves are immunized as recommended.

    This is one primary care provider who ordered from Chiron and has yet to hear anything about getting flu vaccine. I suspect I'm not alone. My recommendation is to check with your health department if you're in one of the high risk groups (over 65, immunosuppressed, diabetic, chronic heart or lung disease) and your doctor hasn't gotten any vaccine.

    posted by Sydney on 10/19/2004 07:19:00 AM 0 comments

    Monday, October 18, 2004

    Follow Your Heart: Musical Medicos.

    posted by Sydney on 10/18/2004 07:51:00 PM 0 comments

    Sunday, October 17, 2004

    Garden Blogging:

    Last Bloom

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

    Never Mind: Forget about those Canadian drugs.
    posted by Sydney on 10/17/2004 10:09:00 PM 0 comments

    Unending Debate: DB at MedRants continues to spar with his prolific pro-trial lawyer commentor "Aaron." Just keep scrolling through the posts and reading the comments.
    posted by Sydney on 10/17/2004 10:01:00 PM 0 comments

    Medical Blogs: Enter the The Examining Room of Dr. Charles.
    posted by Sydney on 10/17/2004 09:53:00 PM 0 comments

    Gravity: Michelle Malkin is wondering if she was wrong to believe the CDC estimates that 36,000 people die every year of influenza. Her readers make some valid points. I've always taken it for granted that the numbers were accurate, though I was aware that the CDC lumped all "influenza-related" deaths together. So, if an elderly person catches the flu and then gets pneumonia as a complication and dies, the death is counted as an influenza-related death. This is different than the flu epidemic of 1918 when people really did die just of having influenza. It struck fast and they died fast.

    Although 36,000 people may not die of actual influenza, not having the elderly and high risk vaccinated does make a difference in hospitalizations and deaths from things like pneumonia and emphysema. A few years ago, when the flu vaccine was plentiful, there was a movement to vaccinate everyone early - too early. People were getting the vaccine in September and October, even though it would wear off by January and February when the flu season usually peaked out here in the Midwest. I remember well that year because I had a lot more people in the hospital with respiratory complications. The next year, there was a delay in getting the influenza vaccine out, and people got their shots at the appropriate time - late October to November. And my winter workload was a much easier one. Coincidence? Maybe. But there's no doubt the flu vaccine cuts down on complication rates for the elderly and those with lung diseases.

    Having said that, I have to agree that the widely quoted "36,000 dead each year" is an alarming number, and it's probably the reason that so many people, even healthy people, are over-reacting to the flu vaccine shortage. And yes, it's true that you can still get the flu even if you've had the vaccine. It only confers immunity for a few months, the immunity it does confer takes a week or two to take effect, and there's more than one variety of influenza. (The vaccine only protects against a chosen strain.) It's an imperfect vaccine, but it does make a difference for the elderly and emphysematous.
    posted by Sydney on 10/17/2004 09:45:00 PM 0 comments

    Calming the Savage Breast: Is it wrong for musicians to use beta-blockers?

    The little secret in the classical music world - dirty or not - is that the drugs have become nearly ubiquitous. So ubiquitous, in fact, that their use is starting to become a source of worry. Are the drugs a godsend or a crutch? Is there something artificial about the music they help produce? Isn't anxiety a natural part of performance? And could classical music someday join the Olympics and other athletic organizations in scandals involving performance-enhancing drugs?

    Goodness, there's nothing wrong with using a beta-blocker to quell stage-fright. If someone plays beautifully in the privacy of their own home, shouldn't they be able to share that beauty with the rest of the world, even if they are terribly shy? It isn't like taking steroids to grow stronger muscles. They don't even change one's mental state, the way valium does. All that beta-blockers do is prevent those fright/flight hormones of the sympathetic nervous system from working their mischief.

    And by the way, why was the music teacher fired for suggesting her nervous students ask their doctors about beta-blockers for performance anxiety? Public school teachers don't get fired for suggesting parents ask their kids' doctors about Ritalin. And taking a beta-blocker an hour or two before a performance is much more benign than taking an amphetamine every day.

    UPDATE: Another point of view:

    Think carefully about your comments regarding how benign you think it is to offer beta blockers for school-age musicians. Is giving a beta blocker to a music student prior to an audition or a competition that much different from giving athletes performance-enhancing drugs? Beta blockers may be more benign pharmacologically than anabolic steroids, but the message is the same. Should we be giving young people the message that drugs are the answer? As far as teachers being fired for suggesting Ritalin, I think some of them should!

    I agree I wouldn't recommend beta-blockers for children, but the teacher in the article was a college teacher. And I have to respectfully disagree about the difference between steroids and beta-blockers. Steroids enhance the performance no matter where it's done. They alter the natural ability to perform. Beta-blockers don't. They only allow a performer to overcome stage fright, letting their true talent shine.
    posted by Sydney on 10/17/2004 09:28:00 PM 0 comments

    The Price of Seduction: The Kerry plan for healthcare is so seductive. Under the Kerry plan, not only will the lame walk, but not one child will go without health insurance. And most adults will have it, too. Under Kerry's plan, all kids living in families making up to $56,500 a year will qualify for government-funded insurance. Their parents will, too, if they make up to $37,700. It's almost impossible not to fall in love with the man with a plan like that. No wonder my nurse tells me a vote for Kerry is a vote for nurses. No wonder prominent pediatricians signed on to promote Kerry.

    But like most things that sound too good to be true, it is. We don't have to imagine what would happen under Kerry's Medicaid expansion plan. All we have to do is look south, to Tennessee to see the Kerry plan in live action. Since 1994, Tennessee has provided state-funded healthcare with the same eligibility requirements as the Kerry plan. Nine years later the state's governor was calling it the dragon that eats everything, and financial management consultants were warning that by 2008 the program would consume $9 out of every $10 in new revenue taken in by the state. That's a lot of money, money that won't be available for other essential state-provided services.

    And yet, despite spending all of that money, Tenncare patients still end up getting the shaft. In the grand American tradition, the program shunned rationing, covering everything from lava lamps to MRI's. The programs generosity, however, did not include doctors and hospitals, whose reimbursement rates are so low that seeing Tenncare patients is a losing proposition. As a result, access to care is a very real problem for Tenncare patients, some of whom have to drive 40 miles just to see a doctor. (And keep in mind, those are mountain miles.)

    And what about the children? Only 19% of pediatricians in Tennessee accept Tenncare, the lowest participation rate of any state in the union. As a result, over one-third of children enrolled in Tenncare have trouble finding a doctor. That's a very real problem. And one that's much more serious and damaging to a child's health than lack of insurance.

    But under Kerry's Tenncare National, access to care would be even worse. The median family income in the U.S. is $53,991. Three hundred percent of the poverty level for the average family of four is $56,500. Under Kerry, over half of America's families would qualify for the expanded Medicaid coverage. Which would mean that doctors would see their reimbursement drop drastically - to the point that they would have trouble staying in business. You can't squeeze blood from a rock, and the fact of the matter is that the safety margin of the average physician's practice is already razor thin, thanks to the medical liability crisis. And there's no reason to think that a Kerry/Edwards administration is going to enact any meaningful medical liability reform, not with donors like these. With most of the country struggling with rising malpractice insurance premiums, there's just no room for physicians and hospitals to provide mandated charity care for the middle class. The heart may be willing, but the purse won't allow it.

    The pincer movement of Kerry's healthcare plan and trial lawyer friends would squeeze doctors right out of the picture. Those physicians who can would retire early, as many already are. Others would probably leave medicine all together. Hospitals that can't make up the difference by soaking the rich would close, as many small community hospitals did under the onslaught of managed care in the 1990's. But in this case, it wouldn't just be rural and inner city hospitals, it would also be suburban and small city hospitals. Only the large tertiary care centers, like Mass General and The Cleveland Clinic, who attract the wealthy the world over would stand a chance. And the future would be even bleaker. Who wants to invest the time and money to go to medical school if it's financially impossible to pay back student loans? The healthcare industry is leading employers in the U.S. Fewer hospitals and doctors not only means less access to care - it means higher unemployment rates. A vote for Kerry is anything but a vote for nurses. And it certainly isn't a vote for children. More people may have healthcare insurance under Kerry's plan, but they'll have a much harder time finding somewhere to use it.

    In the last debate Kerry called our current healthcare insurance system high-priced but low-benefit. The implication was that his plan would be low-priced and high-benefit. But everything has a price, and Kerry's is higher than we can afford.

    UPDATE: An email from Tennessee:

    I am a resident of Tennessee and want to thank you for talking about the TennCare debacle. The way the program is set up makes it almost impossible for the state to change the requirements. What sounded like a good idea is horrible in reality. I only hope more
    people look at what the reality of a health care plan like this is before anything is done on a national level.

    UPDATE II: And read this, too.

    MORE: From a reader:

    An unintended consequence of Kerry's Medicaid plan is that companies offering health benefit plans--and whose bulk of employees make wages of $30-40,000--would be motivated to drop coverage since the government will be picking up the tab. Why pay for benefits that the government will provide them. At some level the economics of dropping health coverage will be advantageous--adding the government roll.

    UPDATE III: Another comment from Tennessee:

    You are obviously unfamiliar with the terrain in Tennessee. The eastern section is mountainous, however I live in western Tennessee and there is not a mountain in sight -- in fact, there are few hills. I understand the tendency to paint us all as "mountain folk" (with all that implies), but it simply isn't the case.

    My apologies to the people of Tennessee, but there was no slander meant. When people travel from the flat part of Ohio to Kentucky or Tennessee, they're always struck by how much longer it seems to take go a mile. It's as if the mapmakers measured them as the crow flies instead of as the mountain road turns. And by the way, people make the same, if inverse, mistake about Ohio. It isn't all flat farmlands. Some of it is almost mountainous. (Foothillish, really.)

    posted by Sydney on 10/17/2004 08:05:00 AM 0 comments

    Topical Motrin Update: Bard-Parker tells me that topical Voltaren, (the Motrin-like arthritis drug), can also help breast pain.
    posted by Sydney on 10/17/2004 07:41:00 AM 0 comments

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