"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
Bird Flu Update: The Turkish family that lost two children to avian flu has lost a third. That must be devastating. Pray for them.
However, infectious disease sorts believe the children caught it from the family chickens rather than each other:
"While we are concerned about (the) report of human cases of H5N1 influenza in Eastern Turkey, there is no evidence of sustained human-to-human transmission, which is the hallmark of a potential pandemic."
Turkish officials said that in the family where three children died, they had been playing with the severed heads of chickens slaughtered after they became ill.
"It is inevitable when you have kids playing with (infected) chicken parts that you are going to have transmission," Fauci said in a telephone interview.
"You will have to assume that the chickens are pooping around outside the house, if not in the house," he said. "The children will be playing around that, getting it on their feet, under their fingernails, and then they will be bringing it in the house, hugging their mother and father," he said.
Meanwhile, here in the United States, chicken producers have begun testing their flocks for the virus, and the Department of Health and Human Services says to stock up on basic supplies and be prepared. Here are their recommendations. Actually, it's not a bad idea to think about things like this. It makes one more prepared for such things as natural disasters, too.
There are, however, no tips for healthcare providers, at least as of this writing. I've often wondered what I would do if I found myself in the midst of a full-fledged infectious disease epidemic, like doctors long ago often found themselves. Would I continue to see patients? I probably would, but I would stay away from my family until it passed. posted by Sydney on
1/07/2006 09:48:00 PM
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Napoleon Dynamite: Last week, Japanese scientists explaced... placed explosive detonators at the bottom of Lake Loch Ness to blow Nessie out of the water. Sir Godfrey of the Nessie Alliance summoned the help of Scotland's local wizards to cast a protective spell over the lake and its local residents and all those who seek for the peaceful existence of our underwater ally.
Newly released files show that officials working under the Thatcher government feared that there would be nothing to prevent poachers and trophy hunters killing it, were Nessie to emerge from the depths.
The documents, released under the Freedom of Information Act, show a flurry of consultations, meetings and briefings between the Scottish Office and the Foreign Office.
Eventually it was decided that no new act of parliament was needed and that the 1981 Wildlife and Countryside Act made it an offence for anyone to snare, shoot or blow up Nessie with explosives.
An October survey by Public Opinion Strategies shows that patients like the retail clinic concept. Fifty-nine percent said they would be likely to use such a service, and nearly half said they were "very likely" to go to a retail health clinic. Why? No appointments, short waits, less expense, better hours and closeness to home, said survey respondents.
They say their fees are less than doctors, but according to this story, the average fee is higher than my average reimbursement:
For an average fee of $59, patients can get care from a family nurse practitioner --- without an appointment --- from 8 a.m. to 8 p.m. on weekdays and from 10 a.m. to 4 p.m. on weekends.
I assume most of those are paid by the patients out-of-pocket, and not insurance or Medicare reimbursed. The reimbursement I get for an average office visit here in Northeast Ohio? - $48 - 54, depending on the third party payer as of January 1.
UPDATE: Some more thoughts here. I have to say, I'm not taken aback by the idea, I just don't think they're actually cheaper than I am - which is what they're advertised as being. Evidently people are willing to pay extra for the convenience of popping in while they're at the retailer. Still, I find it surprising that a lot of people would prefer to pay $59 out of pocket when their co-pay at the doctor's office is only $10-20. That seems like a hefty price for convenience. But then, perhaps I'm overly frugal. posted by Sydney on
1/07/2006 04:08:00 PM
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Ugh: I just spent the better part of the afternoon doing my least favorite task - reveiwing the financials of my practice. It doesn't look pretty. With Congress electing to decrease my pay by 4%, and my malpractice premium set to increase by 30% you can see it's not going to be a good year. The cost of supplies has been steadily going up, too, as have the cost of services. My medical waste haulers upped their fees by 20% in the past six months due to rising gas prices.
The Medicare cut may not sound like much, but it translates into a loss of about $2-3 per patient visit. And it isn't just limited to Medicare patients. Insurance companies base their rate of reimbursement as a percentage of Medicare fees. They might, say, pay 110% of whatever the fee Medicare pays. A practice that sees 25-30 patients a day will make $50-$90 less a day in 2006. That adds up quickly. Assuming a five-day work week, that adds up to $13,000 to $23,000 less over the course of the year. And despite what you might read in the newspapers, the majority of patients who pass through a doctor's office have health insurance - so the cut goes across the board.
How does that translate into day to day life? It means that my staff didn't get a cost of living raise this year. It means that I'll have to drop their health insurance if the premiums increase. And it means that I'm working harder - double booking patients when I can and adding an extra half day to my work week. Hopefully, I'll break even and avoid a decline in my own wages.
I resent terribly the fact that Congress controls my pay. I'm a virtual civil servant - without the generous pension and benefits. And it doesn't help when they turn around and give themselves a pay raise. My only consolation is, that by making less, I'll be paying them less in taxes.
The United States Postal Service, after a fashion, announced weeks ago that the price of a first-class postage stamp was going up to 39 cents, a 2-cent increase. Tomorrow.
....At the Farley Post Office, one of the nation's largest, there were no signs announcing the increase, which the Postal Service said was a result of a Congressional act in 2003 requiring it to put aside more than $3 billion each year into escrow, beginning this year. Congress has not yet decided what the rainy-day fund should be used for.
The Postal Service, which last raised rates in 2002, posted a profit of $1.4 billion last year. Without the extra money required by Congress, the service said in a news release, "postage rates most likely would have remained at current levels until 2007."
Faster than a New York Minute: The diabetes drug, Avandia, which is known to cause problems in some people with fluid retention, also may cause fluid build up in the retina - a condition known as macular edema. The company sent out a letter about it last month I don't remember seeing it. It might have been mistaken for junk mail, but the only reference to it I could find on the internet was the letter sent to Canadian doctors. The AP ran the story today, but the trial lawyers are already on the case.
There's no way to tell what the likelihood of this happening with Avandia is, but it does push it down to a choice of last resort - especially since diabetics tend to have eye problems anyway. posted by Sydney on
1/06/2006 01:22:00 PM
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Root Causes: Is breast cancer caused by stem cells?
Recurring breast cancer could be caused by newly discovered rare stem cells transformed into a 'tumour factory' by genetic errors, scientists have said.
Researchers believe that as well as driving all breast development, the cells may have a key role in cancer.
The Australian team transplanted the cells into mice tissue and were able to grow a fully-functioning breast.
Writing in Nature, they say they also found the key stem cells were more numerous in pre-cancerous tissue.
Very interesting, but no one yet knows if the same sorts of cells exist in humans. If they do exist in humans, however, which do you think will happen first - we learn to turn them off to treat cancer, or we learn to turn them on to make breasts bigger without surgery? posted by Sydney on
1/06/2006 08:51:00 AM
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How Not To: The Medicare hierarchy thinks they've done a good job with Medicare Part D:
'If Congress had listened to the independent experts about what the benefit would cost and how to design it, we'd have people a lot less happy,' says Mark McClellan, who oversees Medicare. 'The drug benefit is going to cost a lot less' -- about 15% less than projected -- 'and people are going to get coverage a lot more like they want, because they have choice.'
But the Medicare people disagree:
A Wall Street Journal/NBC News poll finds 40% of Americans 65 and over have an unfavorable opinion of the benefit and 23% a favorable one, with a sizable 37% undecided. Three-quarters deemed the plan 'too complicated and confusing.'
And, the government says that of the roughly 17 million Americans for whom the stand-alone drug insurance makes sense, only about one million have signed up. (Another 20 million, many of whom already had drug insurance, will get government-subsidized coverage through employers, health-maintenance organizations or programs for the poor.)
This market-friendly expansion of Medicare doesn't seem to be paying political dividends or attracting much consumer interest so far. 'This is a test case,' says Jonathan Oberlander, a University of North Carolina political scientist. 'It's a theory in search of population, and they've found the wrong population. A lot of what you're seeing is what happens when you try to turn seniors and people with disabilities into computer-linked consumers. It's insanity.'
Exactly. As the article points out, there is such a thing as too much choice, and it offers this advice for Congress and bureaucrats:
......the relevant lessons are: (1) When options are overwhelming, people are likely not to choose; (2) When everyone in the society, not just one segment, is offered a choice, and there is a lot of media attention and advice, more will choose; and (3) The government must devise a sound option for people who can't make up their minds. To which I'd add (4) Don't make the choice look even more complicated than it truly is. posted by Sydney on
1/06/2006 08:44:00 AM
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Reality Coach: The Queen's labor coach (definitely not Philip) turns 90 this month. That's "labor" as in "labor and delivery," not politics. Here's her take on educating mothers-to-be:
Betty was all for modern obstetrics, and saw a lot of women in the 1960s traumatised by the whole ‘natural’ childbirth movement: ‘If you want an epidural, have one.’ Betty would sleep on a camp bed at the mum’s side, if this was wanted. Betty was all for husbands being there but was just as happy if they weren’t. Betty never taught couples together because, as she rightly puts it, ‘most men do not want to know about vaginal discharge’. Betty has seen a lot of changes in her time. ‘When I was pregnant, you never went out in the evening with your bulge.’ Betty never pretended having a baby is anything that it isn’t. ‘I mean, is it the most wonderful, magical, fantastic thing you have ever experienced?’ Certainly not. ‘Quite.’ posted by Sydney on
1/05/2006 10:07:00 PM
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Avian Flu Update: Two siblings in Turkey have succumbed:
Bird flu killed a second teenager in eastern Turkey early Thursday, one day after health officials confirmed her brother as the first fatality by the virus outside of East Asia.
...The health minister, Recep Akdag, said Muhammet Ali Kocyigit apparently contracted the virus from ailing chickens at his family's home in the shadow of Mount Ararat, near the Armenian border. Lung tissue from the boy tested positive for the H5N1 virus at two Turkish labs and was being sent to a World Health Organization laboratory in London for more tests.
The boy was one of a dozen people with similar symptoms admitted to the hospital in recent days.
Officials say that there's still no indication that this is being transmitted from person-to-person, but another one of their siblings was also admitted to the hospital with the same symptoms, and what of the others? It's possible that they all caught it from their chickens, and let us hope that's the case.
It is reassuring that all of this attention is being paid to the subject. It should make it easier to contain the virus when and if it does become transmissible between people. Ten years ago, we probably wouldn't have been as aware of what was happening in a small village in the shadows of Moutn Ararat. posted by Sydney on
1/05/2006 09:23:00 AM
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Rota Rooter: One of the (many) scourges of the developing world is the virus that causes seasonal diarrhea in children - the rotavirus. While it's mostly a nuisance here in the States, it can be deadly in countries where access to clean water and adequate medical care is poor. Even here, it causes a spike in hospitalizations for dehydration every year. A successful vaccine for it, therefore, could make a world of difference in the world. The newspapers announced today that we just may have that:
Two new vaccines appear safe and very effective against rotavirus, a major diarrheal killer of young children in poor countries, two huge studies show.
The impressive results prompted two government doctors to call for making routine immunization 'a global priority.
The first vaccine is an oral vaccine made of live human rotavirus that was altered to make it less infectious and less potent. It's a well-designed study, following equal numbers of vaccine recipients and controls for a ten month period. However, in exploring the adverse effects, they only followed them for 100 days. The vaccine was given in two stages - the first dose at age 6-13 weeks and the booster dose two months later.
The good news is that it didn't have the side effect of the old rotavirus vaccine (a mixture of monkey and human rotavirus) that was taken off the market several years ago. That side effect was intussusception. It's success is decidedly mixed, however. The new vaccine did reduce hospitalizations for diarrhea, but not by much - 2.7% of the kids who were vaccinated were hospitalized compared to 3.1% of the controls. There was a greater difference in hospitalization rates in the children followed for the full ten months, but again, not a dramatic one - 0.1% of the vaccine recipients were hospitalized during those ten months compared to 0.7% of the controls. The death rates in the two groups were the same - so the vaccine didn't make much of a dent in the things that count. In addition, there were more cases of pnuemonia in vaccinated children than in controls - 16 vaccine recipients (0.05%) and 6 in the control group (0.02%) - also very small absolute differences, not enough to get anxious about.
The second vaccine is a combination of human rotavirus and cow rotavirus. It, too, found no difference in intussusception rates, but it only observed side effects for 42 days, less than half the time the other study devoted to following adverse effects. Over the course of a full rotavirus season, the cow/human vaccine made a more noticeable difference in hospitalization and emergency room visits than the strictly human virus vaccine did. Among vaccinated children, only 0.04% went to the emergency room for rotavirus-related illness compared to 0.6% of the control group. For hospitalizations, it was 0.02% compared to 0.5%.
So, it appears that the bovine-human form of the vaccine confers more of a benefit than the strictly human one, though we're talking about large changes in very small numbers. Of course, multiplying those small numbers by the billions of children in the world, results in a large number of children worldwide who could benefit from the vaccine. That is, if they can afford it, and if they live in societies receptive to vaccines.
In the developed world, where access to a hospital is easy to come by, those small increments of change may not be worth the cost. posted by Sydney on
1/05/2006 09:13:00 AM
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Change of Address:: Chronicles of a Medical Madhouse has moved to a new site, simply called Doctor. He's grown up and left the Madhouse behind. (Though there will always be days when practicing medicine feels like being in the madhouse.) posted by Sydney on
1/05/2006 07:50:00 AM
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Not So Miraculous: Statins, those popular cholesterol lowering drugs, were once hoped (and hyped) to be potential cancer-preventers. Looks like that hope just died:
Two new studies deal a double blow to hopes that cholesterol-lowering statin drugs could help prevent cancer in addition to heart disease.
In one report, researchers analyzed 26 rigorous, randomized studies involving more than 73,000 patients and concluded that drugs such as top-selling Lipitor and Zocor had no effect on the risk of developing or dying from any form of cancer.
The findings appear in Wednesday's Journal of the American Medical Association.
The other study, published in the Journal of the National Cancer Institute, found that cholesterol-lowering drugs, including statins, were of no benefit for preventing colorectal cancer.
"We were very hopeful that we would verify there was an anti-cancer effect," said C. Michael White of the University of Connecticut School of Pharmacy, who led the analysis appearing in JAMA. "We ended up showing no change in cancer or cancer death."
At least they didn't increase the risk of cancer, which has been a concern about them in the past. posted by Sydney on
1/04/2006 08:14:00 AM
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Photo Medicine: How do you tell if a child being adopted internationally is healthy? Some doctors are turning to photographs as a substitute for examination:
Dr. Johnson, a pioneer in the growing field of adoption medicine, is trying to assess the health and well-being of Dmitry for a family considering adopting him. Given the increasing understanding among adoption experts of the health risks facing orphans in certain developing countries, scanning a photo of a child has become a common practice, more reliable for finding abnormalities like fetal alcohol syndrome, which smooths the groove between mouth and nose, than for detecting imperceptible risks, like attention deficit disorder.
Those are generally hidden in the incomplete or incomprehensible medical records sent from orphanages. Dmitry's file is a litany of indiscriminate labels like "pyramidal insufficiency" - a red flag for cerebral palsy - that Russian doctors put on all infants born prematurely to impoverished mothers, Dr. Johnson said. Equally useless is Dmitry's hepatitis B test, administered too early to be of value.
International records, especially those from orphanages, are extremely unreliable. They often use archaic and ambiguous terms that are hard to interpret. But a photograph isn't much of a substitute for a physical exam. One of my children had very slanty eyes when he was an infant, and I found more than one doctor discreetly checking the palms of his hands for a simian crease when they examined him. They may have been tempted to call him Down's if all they had was a photograph. posted by Sydney on
1/03/2006 08:02:00 AM
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No Magic Bullets: Thinking of having weight loss surgery to help you meet that New Years resolution of attaining a healthy weight? Just remember, it's no panacea:
But regardless of which method is used, studies show an inescapable reality: No surgery gives lasting results unless people also change eating and exercising habits.
"The body just has many ways of compensating, even after something as drastic as surgery," said Dr. Louis Aronne, director of the weight loss program at Weill-Cornell Medical College.
The body is very good at adapting to changes, and weight will come back on if attention to diet and exercise aren't maintained. posted by Sydney on
1/03/2006 07:48:00 AM
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Much Ado About Nothing: Experts are warning the the birth control pill can decrease libido:
Women who use oral contraceptives could suffer a long-term loss of sex drive after coming off the pill, according to new research
...Panzer's research, published this month in the Journal of Sexual Medicine, was based on 124 pre-menopausal women attending a clinic for sexual dysfunctions.
Half the women had used the pill, 39 had stopped using it and 23 had never taken it. Scientists measured their SHBG levels every three months for a year.
A spokeswoman for the UK Family Planning Association urged caution in interpreting the findings. "It is difficult to quantify what a person's sex drive is," she said.
Not only that, but if the women were drawn from a sexual dysfunction clinic, aren't they all suffering from decreased libido? Even those who weren't taking the pill?
It's hard to believe that there's anything of clinical significance here, beyond the amount of sex-binding proteins circulating in pill users. Testosterone levels are only weakly associated with sex drive to begin with, which is why giving women testosterone creams isn't all that effective in improving libido. A stronger determinant of libido is overall well-being and the level of emotional interest ( or lack thereof). posted by Sydney on
1/03/2006 07:40:00 AM
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A record-breaking number of patients, most with flu and pneumonia, caused east Mesa's Banner Baywood Medical Center to close its emergency department for about three hours New Year's Day.
Outside the medical center, paramedics from the Mesa Fire Department assessed potential patients, referring them to other hospitals as Baywood surged to capacity.
"You try everything you can creatively to help patients," said the hospital's public relations director, Coiya Lynne. "This flu is just killing us." Baywood's emergency department closed at 11:30 a.m. after more than 90 patients needed immediate attention. Fifty still needed to be seen when the department closed and another 43 patients were waiting for beds. The department reopened about 2:30 p.m., Lynne said.
Officials did not know how many patients may have been turned away when Baywood closed for three hours. The medical center partnered with the fire department to help potential patients requiring emergency treatment and to offer suggestions on where else to go.
It doesn't say whether all 90 of those patients had the flu and pneumonia, or if they were just unusually busy this long holiday weekend - when many doctors offices were closed. But, this kind of scenario isn't unusual at most hospitals - even outside of flu season. Our hospital often has to close its emergency room doors and reroute ambulances to other hospitals. It tends to happen when there are no more rooms available and people end up sitting in the emergency room waiting to be admitted to the hospital. It also happened routinely in Syracuse, where I did my residency training - for the same reasons.
The article doesn't say whether this was an unusual situation for the hospitals in the town, or just a situation the reporter never heard of before. I suspect the latter. posted by Sydney on
1/02/2006 07:28:00 PM
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Benefits of Illness: Post-traumatic stress disorder has been gaining momentum in the media lately. Doonesbury has been highlighting it for some time in the cartoon character of B.D., who lost his job and a leg in Iraq. And the December issue of the American Journal of Psychiatry is largely devoted to the issue. Last week, Dr. Helen noted the impending politicization of post-traumatic stress disorder heralded by this article from the Washignton Post. Most of the article focuses on the question of paying out disability benefits for the disorder. No one questions the disorder exists, but like other illnesses that are entirely dependent on subjective information and come with their own special financial compensation (such as work-related or accident-related chronic back pain, whiplash, and repetitive motion injuries), it is easily exaggerated - and sometimes out and out faked. What's more, since it's a purely psychological disorder, recovery from post-traumatic stress disorder is determined more by the psychology of the patient and his environment than by the extent of the trauma. As Dr. Helen points out, if a sufferer of PTSD is told he'll never recover, then he won't. If he resents the circumstances that put him in the way of trauma, if he's encouraged to assume the role of passive victim, whether by a therapist or by family and friends or by the conventional wisdom of society at large, then the recovery will be harder. Which is why the prospect of politicization is especially disheartening. And why this statement by a VA official in The Washington Post is especially concerning:
The growing national debate over the Iraq war has changed the nature of the discussion over PTSD, some participants said. 'It has become a pro-war-versus-antiwar issue,' said one VA official who spoke on the condition of anonymity because politics is not supposed to enter the debate. 'If we show that PTSD is prevalent and severe, that becomes one more little reason we should stop waging war. If, on the other hand, PTSD rates are low . . . that is convenient for the Bush administration.'
What side of the issue do you suppose he's on? And which side of the war debate stands to profit more by politicizing post-traumatic stress? No surprise, then, that there were not one, but two stories about PTSD in today's local paper - each with a local angle. One is the story of a reluctant soldier who says that no one is helping him, and the other is an interview with a psychologist who specializes in its treatment, and who believes it is the major morbidity of the war in Iraq, and that we'll be seeing an upsurge of cases locally as men and women return from the war. (They've been going and returning from the war for a couple of years now, so you would think there would be some concrete data instead of speculation, but never mind.)
Expect the media to continue to pound this meme. And as they do, remember that post-traumatic stress disorder is not unique to soldiers. Policemen and firemen suffer from it, too. Yet no one expects us to stop policing our streets or fighting fires to avoid psychological suffering in our police and fire departments. And most of all, let's not forget that those who live under a reign of terror can also suffer from post-traumatic stress disorder. I suspect that most of our soldiers recognize this. If only our politicians, and politicized VA officials, recognized it, too.
UPDATE: From a reader:
It is unfortunate that there is no commonly recognized way to rank the severity of PTSD. It leads to misunderstandings.
The experience from World War I, World War II, and Vietnam was that 2-5 percent per year of combat troops would require hospitalization for PTSD. This is not the few months rest and therapeutic conversations that was needed by nearly 100 percent of combat veterans, and that suffices for the more common PTSD of civilian life. You do not find 2-5 percent per year of police or firefighters needing hospitalization to deal with psychotic breakdowns due to PTSD.
It is also unfortunate that the politicians seem to be making this into a pro-war or anti-war thing rather than a support the troops issue. It was upsetting to see that at the same time we went into war the administration decided to cut VA medical funding. A more competent administration might realize that war means wounded soldiers, and wounded soldiers need medical treatment. When you go to war you need to increase VA medical funding because the seriously wounded veterans will be needing VA services for many years after their return. posted by Sydney on
1/02/2006 05:28:00 PM
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New York Letters: Today's New York Times has some good, astute letters to the editors today. First, insight into the South Korean cloning scandal:
The scientific scandal involving Dr. Hwang Woo Suk of Seoul National University raises another issue with very serious implications.
The article states that Dr. Hwang's "research on stem cells and cloning propelled him to international stardom." Such "stardom" is not possible without the complicity of the news media.
The media don't create outsized egos in all-too-human scientists, but they feed them. This "cult of personality" is not benign. It perverts science. It is particularly insidious in forensic science, where the media-anointed "experts" become unassailable and testify with someone's life and liberty in the balance.
The measure of accomplishment in science is the long-term respect of qualified peers, not media glorification.
Exactly. If the media scrutinized the claims of scientists and researchers with half the zeal they scrutinize CEO's and [some] politicians, fewer would grasp so meanly at glory.
Then, there are several responses to Paul Krugman's take on healthcare in the United States. His solution is to have government take over. Readers disagree:
Paul Krugman proposes that "to get health reform right," decisions about which treatments are provided should be entrusted to the public sector.
While the power of the government to intrude on the doctor-patient relationship might solve budgetary problems, Mr. Krugman's proposal would no doubt result in decreased options for patients. If this prescription were followed, we would ultimately have a one-size-fits-all, Wal-Mart-style health care system.
Whatever the conflicts and biases of physicians, their underlying priority is the welfare of patients. The priority of a public-sector system that controls health care decisions would be budgets, not patients.
Another points out that we already have government-driven healthcare:
Paul Krugman calls for government to be the referee in our enormously expensive health care system, but doesn't mention that government already makes most of the calls through Medicare price controls affecting hospitals and doctors.
These decisions affect much more than the roughly 50 percent of health care provided by government programs, because Medicare has provisions that limit physicians' ability to care for non-Medicare patients of Medicare age and because private insurance companies adopt Medicare fee schedules.
It is a mistake to think that even more government intervention is the key to solving a crisis that has been made worse by an already ambitious system of government price controls.
(Since insurance companies base their payments to doctors and hospitals as a percentage of Medicare's reimbursement, the fact is we already have a system controlled by the government.)
And who trusts politicians?
Paul Krugman argues that "ordinary citizens" do not "have enough medical expertise" to make their own decisions about their health care. But he does not explain why the government would be any better.
If individuals don't know enough about their own bodies to decide among the many doctors, drugs and treatments available, why would a bunch of politicians?
Which is one reason health savings accounts are a better option:
Paul Krugman dismisses health savings accounts, but my personal experience suggests that they do indeed cut down on frivolous visits to the doctor - for instance, when my child has a cold.
My high-deductible insurance policy, about 50 percent cheaper than a traditional one, protects me from big-ticket items.
If every American were enrolled in this system, health care consumption and insurance premiums would drop even further, and perhaps the government would have a role in helping the poor pay for these plans.
But now, a large-scale, federally funded study suggests that the suicide fears may be largely unfounded. The study of 65,000 adults, adolescents, and children being treated for depression found that suicides were extremely rare and the number of serious attempts immediately dropped by more than 50 percent compared with the month before patients began taking antidepressants.
The real problem is that they don't work so great:
''Keeping a close watch on patients after they begin taking these drugs is a good idea, although not because these medicines are especially risky or dangerous," said Dr. Greg Simon, a psychiatrist at Group Health Cooperative in Seattle and lead author of the suicide study. ''The real problem with antidepressants is that they don't work right away, they have side effects, and . . . unfortunately, doing miserably is common."
Neither the paper nor its abstract is available online yet, just its title. The Boston Globe reporters must have gotten their issue early. posted by Sydney on
1/02/2006 08:22:00 AM
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Christ's circumcision was done within a religious and cultural context, but most Americans have theirs performed within a medical and cultural context. The current consensus is that we suspect there are health benefits to the procedure, but we can't prove it, so we leave the decision entirely to the parents, who more often than not base their decisions on cultural grounds. If the men in the family are circumcised, they tend to go with circumcision.
