"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
But the inhibitions of a secrecy-bound political system, with officials suppressing bad news from higher-ups to avoid being blamed, has been shown in the handling of the death of 12-year-old He Yin, who died on October 13 after her family cooked and ate one of their chickens that had died, despite a bird flu outbreak in their region of central Hunan province.
After Hong Kong newspapers reported the death two weeks later, Hunan health officials insisted no sign of the H5N1 avian flu virus had been found in either the girl or her brother, who also fell ill with flu-like symptoms. They also dismissed any infection of a teacher who developed flu after chopping raw chicken while he had a small cut on one hand.
Last week central government officials decided to call in help.On Sunday the official news agency reported that bird flu 'had not been ruled out' in the three cases.
At least the government is trying to act responsibly rather than cover up their deficiencies. That's a step forward. Now, they just have to convince everyone else on the lower rungs of officialdom to do the same. posted by Sydney on
11/07/2005 08:37:00 AM
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Bursting Bubbles: Here's another reason to curb the enthusiasm over electronic medical records. They don't necessarily increase efficiency. In this study, doctors actually spent more time documenting and writing orders when they moved to a computerized system:
Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%).
The efficiency depends on the doctor and the system. Having to move from the patient's bedside to the nursing station to enter orders and notes is extremely inefficient. It breaks the chain of thought, creates a back-up at the shared computer, and requires more time to go from room to station to room to station again and again.
I've found that my electronic record hasn't saved me any time. It's faster for writing my notes and answering phone messages, but it's slower when it comes to letting me review and respond to labs and test results. It's hard to get any quicker than the old paper system. The labs, x-ray results, and daily letters from consultants would arrive on my desk in a folder. I would glance through them, sign off on all the normals, and put aside all the abnormals to have their charts pulled. It meant more time for my staff in pulling the charts, but I could do my part in a matter of minutes. Now, the staff scans the results into the patient record as they arrive. It takes longer to click and open the lab in the computer's "To Do List," read it, and sign off on it, than it does to eyeball a piece of paper and scribble my initials on it. It also takes longer to go through the various screens to review prior labs and notes when a result is abnormal than it did with the paper chart.
In the long-run, it's a trade-off I find acceptable. I probably end up spending the same amount of time with paperwork (although now it's pixel work), but the computerized system does have the added advantage of getting the information filed in the charts in a timely fashion. (With the paper method, those normal labs and letters would sit in a "to be filed" pile for weeks until I nagged the staff to file them.)
The Big Plan: Meet the man whose job it is to nationalize healthcare records. Good luck with that. The article leaves the impression that doctors and hospitals are going to have make the large payout to invest in the computers and software, but all of the monetary rewards will be reaped by insurance companies, Medicare/Medicaid (i.e. the government) and corporate America. (Also see this graphic.)
Much of the promise of computerized records is being over-hyped. Yes, it's a more efficient method of storing and retrieving information. And yes, it's a method of reducing errors, although it also introduces new system-specific errors. The government's paramount goal in pushing a nationally-connected healthcare record is to be able to monitor and prescribe what kind of treatment everyone gets. You might be 85 years old and not want a mammogram, but too bad. The system will make sure you are harassed until you get one.
Something like this happens already with insurance companies that have "disease management" programs. One of my patients was enrolled in one for diabetes, but along the way he developed liver failure from cirrhosis. He was so malnourished from his liver disease that he no longer needed his diabetic medications and it was a total waste of time and money to order his diabetic labs. But, once a diabetic, always a diabetic, and I couldn't get him disenrolled. They kept bugging me and bugging me for his labs until I just did them. And every time I filled out their forms, I would write on the bottom - "patient severely malnourished from end-stage liver disease." It didn't matter. They didn't care about the patient. They just cared that their parameters didn't set empty in their database.
Count me unconvinced that computerized records will be the savior of medicine. It's just managed care in another guise. posted by Sydney on
11/07/2005 08:08:00 AM
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Power Women: Like most of the blogosphere, I read last Sunday's Maureen Dowd anti-man polemic, but didn't blog about because it left me with such a bad feeling I didn't want to address it. I couldn't put my finger on what it was that bothered me so much, but it kept floating up to my conscience throughout the week. Why should I care whether or not Maureen Dowd finds conjugal happiness? But now I know what it is that was so irksome about the whole thing - Maureen Dowd, and women like her who blame their success on their failure with men, simply don't consider men their equals. And for any relationship to work, the two people have to share a mutual respect. As Dr. Helen notes:
The truth is, most men like women who like men (except for some psychological cripples). I am opinionated, have a PHD and (hopefully), a decent IQ. I rarely meet a man who minds this. Why? Because I like men, enjoy their company and treat them as fellow human beings. These are the ingredients that many of these 'feminist' women are missing in their interactions with men. They believe that because they are women, they can get away with saying anything and others should think they are enlightened, instead of just bullies or jerks. That's what they think men are--and that is why they will remain dateless. posted by Sydney on
11/06/2005 02:42:00 PM
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The cigarettes use “trionic” filters with three layers, each of which removes a different set of toxic compounds, while still allowing nicotine — the main addictive element in tobacco — to enter the lungs. The tobacco is also mixed with an inert “chalky” substance to retain more of the toxins in the ash.
BAT also claims to have improved the way it dries tobacco leaves to reduce cancer-causing toxins when burnt.
Sounds a like New Age hocus pocus, like those ionic air filters. I may be remembering my biochemistry incorrectly, but nicotine does more than stimulate the nervous system. It also inhibits the body's ability to destroy defective cells, one of our natural defenses for the prevention of cancer.
This critic has it right:
John Britton, professor of epidemiology at Nottingham University, said: "Anything involving inhaling smoke is unsafe. These new cigarettes could be more like jumping from the 15th floor instead of the 20th: theoretically the risk is less but you still die." posted by Sydney on
11/06/2005 08:29:00 AM
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I Got Mine, Who Cares About You: Retired autoworkers aren't happy about UAW health insurance concessions. Active workers - people who are working to feed and clothe their families - began voting this weekend on the concessions, which will also affect retirees. A sample of some retirees' thoughts:
A group called the Fairness for Retirees Committee of Northwest and Southeast Ohio organized the luncheon to press UAW locals for more benefits for retirees, such as cost-of-living allowances for pensions. "Why should we have to give up anything?" said Eddie Toles, a 73-year-old Ford retiree who heads the group.
"We did more than our part to save Chrysler," said Rach. He was a union official at UAW Local 122 in Twinsburg, Ohio, in the early 1980s when Chrysler won wage cuts from workers to help keep it out of bankruptcy.
But Rach, now a vice chairman of the retiree committee at his local, admits he's worried. "We did our part then. We're very concerned. We don't want anything touched."
No one ever seems to point out that the men and women breaking their backs every day to earn a living wage are working to support those retirees as much as they're working to support their families.
And what is it that the retirees are being asked to do?
"If the plan wins final approval and is confirmed in U.S. District Court, retirees would pay a maximum of $752 per family each year for health care, or $370 annually for an individual, plus co-payments for prescription drugs."
Most auto-worker retirees have been sheltered from the real world of health insurance costs for so long, they probably have no idea that most people pay more than that per month for health insurance. posted by Sydney on
11/06/2005 08:10:00 AM
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My Body, My Flora: Here's a story that didn't get much attention in the press last week, probably because it involves malodorous body fluids from the nether regions. But researchers have discovered several new species of bacteria in vaginal flora:
Despite being one of the most common infections among women, scientists and doctors know little about the causes of bacterial vaginosis (BV), a usually benign disease that is also linked to serious health problems including pelvic inflammatory disease, an increase in the viral load of HIV from infected women and a two-fold increase in risk for pre-term labor and delivery.
Now researchers at the Fred Hutchinson Cancer Research Center have shed new light on BV by using genetic-sequencing technology to detect several new bacterial species -- enough to almost double the number of known strains associated with the infection.
....."Numerous bacterial genera identified in this study have not, to our knowledge, been previously detected in the vaginal milieu with the use of cultivation methods," researchers said.
Bacterial vaginosis, also known more colorfully as Gardnerella (after a man named Gardner who identified a bacteria in the 1950's that was thought to be the cause of the infection), is common and can at times be difficult to eradicate. It isn't so much an infection that is "caught" from someone else as it is a bacterial coup de'tat. Events conspire within the vaginal environment to allow bacteria normally in the minority to overwhelm the vaginal flora. So much so, that one of the ways we diagnose the infection is by identifying vaginal cells under the microscope that are covered with bacteria clinging to their surfaces.The events that make the coup possible are often things that change the alkalinity of the vagina - things like hormonal changes, the presence of semen, diet, douching, and other factors yet unrealized.
It's odd that such a common infection in such a small pocket of the body is yet so little understood. But a paper in this week's New England Journal of Medicinesheds some more light in its dark corners. Researchers found the new species of bacteria by finding their DNA in the vaginal fluids of afflicted women. Using polymerase chain reactions and fluorescence in situ hybridization, they were able to identify bacteria that would be difficult to identify by traditional methods, such as coaxing them to grow in a petri dish and identifying them by sight under a microscope.
And what a variety they identified. And what exotic names. In addition to the expected lactobacilli and Gardnerella vaginalis, there were Atopobium vaginae, Leptotrichia amnionii, Sneathia sanguinegens, Porphyromonas asaccharolytica, and a "bacterium distantly related to Eggerthella hongkongensis." The vaginal tract must be a microbiologist's dream.
Most interestingly, however, was the identification of three as yet never known members of the Clostridium family (technically it's a phylum, not a family, but you get the idea. They're related.) The Clostridia have already have a reputation as an opportunistic clan. It's a Clostridium that's responsible for C. diff colitis, a Clostridium that's responsible for gas gangrene, a Clostridium that's responsible for botulism, and a Clostridium that's responsible for tetanus. They can be nasty brutes. Luckily, the members of the family that dwell in the reproductive tract are tame by comparison.
So what does it mean for patients? Probably not much. We already use Flagyl for bacterial vaginosis, a drug which is effective against clostridium. But it may help us understand the role bacterial vaginosis can play in pelvic inflammatory disease and uterine infections. posted by Sydney on
11/06/2005 07:48:00 AM
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Tamiflu Fever: A feared shortage of the anti-influenza drug, Tamiflu, is becoming more of a source of panic than the feared outbreak of bird flu. It's throwing some of the usual suspects into fevered conspiracy theories (read the comments) even though the drug doesn't cure or prevent the disease.
Today's New York Times takes a look at the chemistry behind the Tamiflu production:
Roche has said the manufacturing process requires 10 steps that take six to eight months once the raw materials are in hand. It also says that some steps in production are potentially hazardous because they involve the use of sodium azide, the chemical that makes automobile air bags inflate in an explosive rush. The company says it would take a newcomer two to three years to be able to start production.
....Part of the disagreement about the difficulty might stem from the difference between making small quantities in the laboratory, which can be done quite easily, and producing large amounts commercially. Ernie Prisbe, vice president for chemical development at Gilead Sciences, which invented Tamiflu and licensed it to Roche, said an industry rule of thumb is that each step, even if well defined, takes one month to six weeks to put into practice. Tamiflu manufacturing, by his count, involves 12 steps.
And it takes an awful lot of star anise to make a little bit of Tamiflu:
According to a presentation at a conference last year by a Roche chemist, it takes 13 grams of star anise to make 1.3 grams of shikimic acid, which in turn can be made into 10 Tamiflu capsules - enough to treat one person. By that reckoning, one ton of shikimic acid would be enough for 770,000 people.
But Mr. Hamied, a chemist, disputed that, saying one ton of shikimic acid would yield enough for only 300,000 people at most. And newcomers are not likely to have the same production efficiency as Roche, he said.
It's an interesting article that explores other methods of producing the key ingredient, shikimic acid, as well. A lot of the work is outsourced to other companies, including some in the fermentation and explosives industry.
That means quite a few businesses have to be convinced that it's worth their while to ramp up production for a product that right now is enjoying a bubble only because of hype. posted by Sydney on
11/05/2005 01:35:00 PM
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Friday, November 04, 2005
Coming Home to Roost: Is the national bird flu plan up to snuff? Local and state health departments say nope. They're basically left on their own to implement the national plan with little to no help from the feds:
'I appreciate that the feds want to stockpile anti-viral drugs and improve the work toward getting a vaccine, but we also need basic support for state and local public health departments,' said Mary Selecky, secretary of the Washington State Department of Health. She said the proposal appears to represent a $30 million reduction in direct funding for preparedness at the state and local level.
'There seems to be a lack of connection between the strategy and recognition of what it takes to pull off these plans on the ground,' agreed Dorothy Teeter, acting director of Public Health -- Seattle & King County.
'It's not that there's too much money being put into (drugs and vaccines),' Teeter said. 'It's that there's not enough resources being directed to those who will be responsible for making this work.'
The president's strategy earmarks $100 million of the $7.1 billion proposal for state and local preparedness. But the administration's budget had already reduced funding for state and local health departments by $130 million so the proposal actually still represents a cut in funding of some $30 million, Selecky said.
I've only started to read through the plan (it's over 300 pages), but it does seem rather vague on the particulars that have to happen at a local level if it's going to work - crucial things like vaccine distribution and administration.
" posted by Sydney on
11/04/2005 08:59:00 AM
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The Atlantic City case revolved around Humeston's reaction to Vioxx after he took it for about two months to alleviate pain in his left knee, which was injured by shrapnel during his service as a Marine in Vietnam.
The drug helped with the pain. But hours after taking two pills on Sept. 18, 2001, he suffered a mild heart attack.
Humeston's lawyers blamed the drug, saying that he had no history of heart disease. They sought to show that Merck rushed Vioxx to the market, manipulating data given to the Food and Drug Administration and training salespeople to dodge questions about the drug.
But Merck's legal team - which noted the federal FDA had rule the drug safe - said Humeston's attack was prompted by other factors.
They said he had elevated blood pressure and high stress, especially after he got into a dispute with his employer, the U.S. Postal Service.
Juror Vickie Heintz, 40, of Mays Landing agreed with that assessment.
'I thought he had way too many other health issues,' Heintz said. 'His medical records were riddled with many medicines.'
As does most of the population who took Vioxx for pain. Merck is smart to fight each case in court. To claim that Vioxx, which increased the risk of heart attacks by one or two percentage points, caused the heart attacks of people already at risk for heart disease is ludicrous. The trial lawyers deserve to be called out on this one. posted by Sydney on
11/04/2005 08:52:00 AM
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So where did this 'cure' talk come from? Don't blame Herceptin maker Genentech, which issued an appropriately milquetoast press release. This disinformation was your tax dollars at work.
It originated with Dr. Jo Anne Zujewski head of breast-cancer therapeutics at the government's National Cancer Institute. 'In 1991, I didn't know that we would cure breast cancer,' she exclaimed of the studies, 'and in 2005, I'm convinced we have.' The Associated Press shot that line 'round the world and ('investigative reporter' having become essentially oxymoronic) it was repeated endlessly. Why read a study when you can just quote somebody? posted by Sydney on
11/04/2005 08:29:00 AM
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From the Archives: What we were saying about bird flu...:
Meanwhile, 'What is frightening about this flu strain is that it is unlike any that has infected people before,' NBC News tells us. We repeatedly hear of this new 'deadly flu,' or 'killer flu,' or to cite one headline: 'Mutant Killer Virus.'
Gullibility Exposed: An article in this week's JAMA exposes a disturbing trend among treatment trials to stop research early - claiming the trial has found a benefit when in fact, it hasn't:
Unfortunately, what looks too good to be true often is, Montori's team writes. The authors cite a 1999 study of a beta blocker drug in vascular surgery patients at risk for a heart attack. No one on the beta blocker had a non-fatal heart attack, and only two died of heart problems. Of those not on the drug, nine had a non-fatal heart attack and nine died. Montori calls that "an unbelievably large treatment effect" because the study was halted after only 20 patients had had a heart attack or died.
Subsequent similar trials of beta blockers that enrolled more patients and therefore saw more deaths and heart attacks have not found a benefit, let alone such a dramatic one, Montori says. But based on the 1999 study's findings, patients at risk for a heart attack are routinely given beta blockers before surgery.
The authors found that the fewer "events," such as heart attacks, the greater the benefit. Researchers must resist looking at their data too early, Montori says, "because you will pick up trends, not truth."
Why do doctors fall for it? For one, we aren't trained very well in statistics, so we aren't likely to sift through these papers with a critical eye. For another, the majority of these misleading studies were published in "high impact journals". According to the authors the majority of the articles came from the five leading lights of medical journals: Lancet, The New England Journal of Medicine, The Journal of the American Medical Association, Annals of Internal Medicine, and the British Medical Journal. A busy practicing physician rarely has time to sit down and read the journals carefully. So, as a group, we tend to take the papers at face value - especially if they've appeared in a prestigious journal. Shame on us and shame on the editors of the journals for not scrutinizing the results before publishing them and swallowing them whole.
Uses of Fear:The Wall Street Journal's Numbers Guy looks at the Spanish influenza numbers. Here's a disturbing quote from one analyst:
Yet Dr. Meltzer says he has received a few requests from reporters and public-health officials to help them tune his computer model projecting flu deaths based on prior pandemics. (He emphasizes that the model's output should be treated as an illustration, not a prediction.) 'They ask, 'How can I crank up numbers to scare people?' ' While he's careful not to say whether he shares this opinion, he adds, 'There's a sense from some that 1918 doesn't help the planning process because it causes more panic than clear-headed thinking.'
Careful, reporters and public health officials. Exaggerate too much and people stop trusting you.
posted by Sydney on
11/03/2005 07:10:00 AM
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Saddam Hussein's unwatched arsenal of poisons and germs can redouble the threat to America, and the terrorists are already among us. That message fairly screamed at Americans last week. In the shadow of the World Trade Center, the target of a bombing in 1993, New York City began the week with a drill involving 600 police, fire fighters and FBI agents responding to a mock attack by terrorists supposedly using deadly VX nerve gas, which Iraq has produced in vast quantities. The following day, in Fairfax, Va., a jury convicted Mir Aimal Kasi, a Pakistani, of assassinating two CIA employees in 1993.
Potential Spaces: Theodore Dalrymple crawls inside the minds of suicide bombers:
The mere contemplation of a suicide bomber’s state of mind is deeply unsettling, even without considering its practical consequences. I have met a would-be suicide bomber who had not yet had the chance to put his thanatological daydream into practice. What could possibly have produced as embittered a mentality as his—what experience of life, what thoughts, what doctrines? What fathomless depths of self-pity led him to the conclusion that only by killing himself and others could he give a noble and transcendent meaning to his existence?
Make-up, scientists believe, interferes with the most basic and instinctive lines of communication between male and female.
It masks the natural feminine glow which, through centuries of evolution, has been the signal to a man that a woman is fertile.
....They found that make-up could improve the appearance of the less attractive woman, thus confusing the instincts of the male into thinking she was more fertile than she actually was.
But on the good-looking woman, it did not improve her chances of attracting a partner. She would be just as successful relying on her natural beauty.
Heh.
Alas, their research methods seem a little iffy:
The researchers took 56 female students, photographed them over four weeks and also monitored their levels of the hormones oestrogen and progesterone, which are key indicators of female fertility.
They used a computer to morph faces into composite photographs of women with high fertility and others of those with low, then showed them to a panel of men and women and asked them to say how attractive each woman was.
The high-hormone composites were universally preferred, thus proving the link between beauty and fertility. They then showed the panel the true faces of the volunteers, some of whom wore make-up and others who did not.
Among those not wearing make up, the ones with higher levels of oestrogen were significantly more likely to be considered attractive.
...Among those with make-up, the pattern was lost and the results far more random, suggesting that the cosmetics acted as a leveller, cancelling out the natural advantage of the attractive volunteers.
This, however, is a much more reliable indicator that make-up is not all it's cracked up to be:
In a poll of 10,000 single men, 68 per cent preferred natural beauty to women who were plastered in cosmetics. posted by Sydney on
11/02/2005 07:19:00 AM
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Creative Thinking: Worried about a Tamiflu shortage? Consider the gout medication Probenecid, says an Oregon doctor:
Recently, I was reviewing the studies and also Tamiflu, and I found that they talk about being careful when you use Probenecid with also Tamiflu, because it raises the drug level. And I thought about it from the opposite perspective - well this is great, this a wonderful side effect, why don't we consider using Probenecid to, exactly for that reason, we have this tremendous shortage of the drug.
And there was one study in 2002 that documented the profound effect of Probenecid on Tamiflu, it, actually it increased the level by two and a half times, and at that time it wasn't really being looked at as an issue of, you know, something to use during a shortage. But if you look at Tamiflu the same way we looked at penicillin during World War II, and penicillin was in very short supply, and as a result we gave Probenecid with penicillin to enhance the effect and extend the supplies, why not use that same idea for Tamiflu.
Probenecid decreases the body's ability to metabolize Tamiflu, increasing the amount circulating in the blood. It's an idea to consider, and one that could be put into effect much faster than building more plants to make more Tamiflu.
However, Tamiflu is not the key to preventing or stemming an influenza outbreak. Only an effective immunization can do that - and that's something we won't even know how to make until (and if) the virus mutates. posted by Sydney on
11/02/2005 07:10:00 AM
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Tuesday, November 01, 2005
Lawyer Pandemic: A lawyer known for his creative ways sends out a mass email today on the legal repurcussions of an avian flu pandemic:
Legal experts claim that hospitals could be sued for failing to admit sick patients, or for releasing them before they are fully stabilized, under a federal law which requires anyone arriving at a hospital in need of treatment to be stabilized. Although some courts might be sympathetic to the argument that the hospital was overwhelmed by a pandemic, others might not, and the possibility of such a defense might not prevent nuisance law suits and settlements.
Companies hit by massive absenteeism could also be sued for failure to provide the goods or services which they had contracted to provide. Although they could argue the defense of "force majeure'" -- that a sudden and overwhelming natural disaster made compliance impossible -- it's not clear that the defense would be viable.
Force majeure has often been held to apply only to an event which is both sudden and unforeseeable, and lawyers can now argue -- especially after Bush's speech -- that a pandemic is entirely foreseeable, and that companies with contractual obligations should have anticipated the pandemic and prepared for it.
Still another basis for possible legal liability is "negligent failure to anticipate and prepare." For example, after the first wave of the SARS virus, Canadian nurses who subsequently contracted the virus sued the government, arguing that they should have foreseen a new wave of the virus and prepared for it. The same argument could obviously be made against many private businesses, non-profit hospitals, etc.
He concludes that "for better or worse" lawyers will be playing a significant role in any pandemic we may have. I'm guessing it will be for the worse.
posted by Sydney on
11/01/2005 11:04:00 PM
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The only serious harm associated with the mumps-measles-rubella (MMR) vaccine is the risk to the health of children who don't receive it... posted by Sydney on
11/01/2005 10:56:00 PM
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The critical role of individuals and families in controlling a pandemic cannot be overstated. Modeling of the transmission of influenza vividly illustrates the impact of one individual's behavior on the spread of disease, by showing that an infection carried by one person can be transmitted to tens or hundreds of others. For this reason, individual action is perhaps the most important element of pandemic preparedness and response.
Education on pandemic preparedness for the population should begin before a pandemic, should be provided by all levels of government and the private sector, and should occur in the context of preventing the transmission of any infection, such as the annual influenza or the common cold. Responsibilities of the individual and families include:
* Taking precautions to prevent the spread of infection to others if an individual or a family member has symptoms of influenza.
* Being prepared to follow public health guidance that may include limitation of attendance at public gatherings and non-essential travel for several days or weeks.
* Keeping supplies of materials at home, as recommended by authorities, to support essential needs of the household for several days if necessary.
And don't forget your anti-viral Kleenex! It might not do a whole lot to prevent the spread of influenza, but it will make you look like a good citizen. posted by Sydney on
11/01/2005 10:16:00 PM
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Useful Illnesses: Usually, when an employee claims a work-related injury, it's the employer who is resentful and suspicious that the injury is not all that it's claimed to be. But in the world of professional basketball, it's just the opposite (requires free registration):
At one time, and for a long time, the injury list was just that, a separate roster for players recovering from injury. But as teams started carrying more than the required 12 players and continued to draft younger players with the intention of developing them, the injury list became the unofficial back burner.
.....Players used to spend months on the list with ``patella tendinitis'' or ``thigh contusions,'' not because they were in pain but because they were in vain.
Some players got a standard sprain or strain, others were labeled with some sort of inflammation, mostly of the ego.
``I never knew what they said I had until I read it in the paper,'' said Cavaliers guard Luke Jackson, who was shuffled on and off the injury list with alleged injuries last season when he was a rookie. ``People who didn't know what was going on would come up to me and ask me about my knee or say, `Oh, looks like that ankle's getting better.' I mean people thought I was injury-prone.''
...It wasn't just a game. The team had to make sure the listed injuries didn't somehow interfere with the insurance the club carried on the player's contract. They had to steer clear of past problem areas while still trying to come up with some sort of viable injury they could report with a semi-straight face.
Evidently they've changed the rules so teams no longer have to fake injuries to bench a player.
Unexpected Complications: A tale of mammograms and pacemakers. The story of a woman whose pacemaker lead was inexplicably found to be broken in half. Inexplicably, that is, until she remembered her mammogram:
When I saw her in my office five days later, she recalled that she had had screening mammography on December 21, 2004 (the same date that the lead warning had occurred). She recalled that, when her right breast was firmly compressed between the radiography plate and the upper plate, the pain was so excruciating that she screamed, and the procedure was aborted until the pain resolved. Bilateral mammography was then carried out uneventfully. Given the coincident timing of this patient's mammogram and the lead fracture, it is likely that the lead was crushed during the initial attempted mammography. Mammography and pacemaker implantation are both common procedures. More than 30 million women in the United States have mammograms annually; there are also 3 million American women with cardiac pacemakers.
In conclusion, damage to a permanent pacing lead occurred during mammography. During mammographic examination in women with cardiac pacemakers, strict attention must be paid to avoiding damage to the pacemaker.
Honoring Franklin: The Royal Society of Medicine, of all places, is honoring anti-royalist Benjamin Franklin. Franklin's accomplishments were so numbered and so varied, it shouldn't be surprising that a medical society would be honoring him. Here's an interesting tidbit:
He was also one of the first to observe that prolonged exposure to lead would cause sickness.
While working as a printer he noticed that some of his colleagues had a condition that they called "The Dangles" - wrist drop caused by lead poisoning associated with this occupation. posted by Sydney on
11/01/2005 03:04:00 PM
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