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    Friday, February 07, 2003

    Genomic Medicine: The current installment of the New England Journal of Medicine's series on genomic medicine - Inheritance and Drug Response.

    UPDATE: Here's a better article. And I suspect it was really supposed to be part of the series on genomic medicine.

    posted by Sydney on 2/07/2003 08:16:00 AM 0 comments

    Still a Mystery: Investigators still haven't figured out what those white particles in the Red Cross blood are:

    Nine days after the American Red Cross quarantined thousands of units of blood, the organization provided no new information Thursday on the nature of the strange-looking white material in the bags.

    One theory gaining steam is that something -- perhaps medication taken by blood donors or an industrial compound introduced in blood collection or manufacturing -- is causing blood components to clot and is producing unexplained smaller white particles.

    "It could be a certain new medication that we've never seen in blood before, or maybe it's an unusual synthetic food additive," said Dr. Christopher D. Hillyer, director of the Department of Pathology and Transfusion Medicine at Emory University's School of Medicine.

    Here’s what they’ve found so far:

    • Small white matter, described as "dandruff" or "snowflakes."

    • Large white matter, described as "fatty," "waxy" or "gunk."

    • Tiny bubbles that appear to be oily.

    • Yellow-and-white oily slicks.

    Of the four types, some scientists have confirmed only the large white matter as biological.

    Emory's Hillyer, who is an associate medical director of the local Red Cross but who did the testing on his own, said the biggest of the globs are "clumped-up platelets," which occur naturally in blood.

    "Platelets and white blood cells are not unexpected in a bag prepared in this way, but clumps in this size and number are atypical," Hillyer said.

    His findings are similar to those of LifeSouth, a blood collection agency headquartered in Gainesville, Fla., which visually examined about 1,000 units of its own blood and quarantined 16 "suspicious" bags. However, Bill Gair, chief operating officer for LifeSouth, said they found nothing "alarming or hazardous" in those bags.

    The particles most likely are residual fats and platelets left in blood after plasma is separated from red blood cells by spinning blood bags in a centrifuge, Gair said.

    posted by Sydney on 2/07/2003 08:14:00 AM 0 comments

    Anti-Samsons: Unshaven Welshmen, unlike the unshaven Samson, have weaker hearts and minds than their smooth-skinned brethern. Although the researchers speculate about levels of testosterone, turns out it’s more a matter of lifestyle than shaving:

    A sample of 2,438 men from Caerphilly, were asked how often they shaved. Their susceptibility to heart disease and strokes was then monitored over a 20-year period.

    While the study found that those who did not shave every day were also more likely to smoke, less likely to be married and more likely to do manual work.Even after adjusting for these factors, they were 70% more likely to suffer strokes and 30% more likely to die from any cause.

    Here are the relevant characteristics of the bearded men as given in the abstract of the study:

    The one fifth (n = 521, 21.4%) of men who shaved less frequently than daily were shorter, were less likely to be married, had a lower frequency of orgasm, and were more likely to smoke, to have angina, and to work in manual occupations than other men. Over the 20-year follow-up period from 1979–1983 to December 31, 2000, 835 men (34.3%) died. Of those who shaved less frequently than daily, 45.1% died, as compared with 31.3% among those who shaved at least daily.

    Not exactly a well-controlled study.
    posted by Sydney on 2/07/2003 08:02:00 AM 0 comments

    Med Mal Roundup: Florida doctors walk off the job, at least in one small portion of the state. But the problems aren’t confined to their geographic area, at least not according to the Florida Medical Association:

    "In Florida, we are facing a medical meltdown," said Cline, who noted that a FMA survey showed that 67 percent of physicians were either reducing their practices or leaving hospital practice and going to the office only. About 50 percent, he said, were considering moving to another state or retiring early.

    Meanwhile, New Jersey inches toward reform:

    Vitale and Sen. John Matheussen, R-Gloucester, co-chairmen of the Senate health committee that has studied the malpractice problem, announced a plan Wednesday that would protect doctors and their insurance companies from excessive pain and suffering payouts, while still providing additional money to victims awarded more in lawsuit judgments.

    And from Pennsylvania comes the tale of two senators and their personal takes on tort reform:

    Santorum believes that the proposed cap is too low.

    His wife sought a $500,000 jury award in 1999 for back injuries she said were caused by a negligent chiropractor. Karen Santorum eventually won $175,000 in damages — awarded after her husband testified for her during the Virginia trial.

    ...Specter thinks that the most egregious malpractice cases — severe bodily impairment, disfigurement, or death — should be excluded from caps.

    His son, Shanin Specter, is a prominent Philadelphia malpractice attorney who won a $49 million settlement for a client in 2000 — one of the largest medical liability judgments in state history

    Maybe we are living under a tyranny of trial lawyers.
    posted by Sydney on 2/07/2003 07:52:00 AM 0 comments

    Skating the Cutting Edge: Kaiser Permanente is planning to put their patient records on line, so that patients can access their own medical records. But, they’ll only be accessible as long as you remain with Kaiser. Switch insurance, and you have to go back to the old system of paper copies. I worry about the security of that sort of thing. Think about the potential for identity theft.
    posted by Sydney on 2/07/2003 07:47:00 AM 0 comments

    Compute for the Cure: Help find a cure for smallpox by running a screen saver. The Bloviator has more (with useful comments by tech-savvy readers.) Other distrubted computing projects can be found here, and a Mac version of the smallpox program can be found
    here. (Click download in lower right hand of screen.)
    posted by Sydney on 2/07/2003 07:43:00 AM 0 comments

    Reflections: Posted some thoughts on the Michael Jackson interview at Blogcritics.
    posted by Sydney on 2/07/2003 07:37:00 AM 0 comments

    Thursday, February 06, 2003

    More Medical Art: The winners of a migraine in art contest. My favorite is the ophthalmic migraine. As someone who gets ophthalmic migraines, I can tell you that's a realistic representation. (from The Eyes Have It)

    posted by Sydney on 2/06/2003 08:45:00 AM 0 comments

    Still a Mystery: Officials still haven't figured out what those particles in donated blood found in Georgia are. The CDC, the FDA, the Red Cross, and the manufacturer of the bags are still disagreeing. The bag producer says it isn't plastic. The Red Cross says it isn't human. A Red Cross competitor sides with the bag makers:

    Meanwhile, LifeSouth, a competing blood collection agency in Gainesville, Fla., said it has done its own investigation and consulted blood experts around the country, but found nothing dangerous in the quarantined blood.

    "They can't find anything infectious or hazardous or anything that doesn't belong in blood," said Bill Gair, chief operating officer of LifeSouth.

    LifeSouth's tests reveal that some of the particulate matter is globs of fat, derived from donors with high-fat content in their own blood -- often a result of them eating a high-fat meal prior to donation.

    Too much down home cooking? Results of official testing are expected to be released later this week. Stay tuned.
    posted by Sydney on 2/06/2003 08:34:00 AM 0 comments

    Almost a Revolution: My Tech Central Station column on the state of the genetic revolution is up.
    posted by Sydney on 2/06/2003 08:25:00 AM 0 comments

    Vaccine News: Vaccine critics are already questioning the new “5 in 1” childhood immunization, Pediarix:

    Rick Rollins, who lives near Sacramento, believes his son, Russell, developed autism as a result of a combination vaccine -- the measles-mumps-rubella shot, or MMR. What worries Rollins is the possible interaction of viruses within a vaccine and how that could affect certain genetically susceptible children.

    The new five-in-one vaccine was ''rushed through the approval process,'' Rollins says, leaving questions of long-term effects unanswered. It was licensed by the Food and Drug Administration in mid-December, after a decade in development and more than three years under federal review. But, ''with children receiving so many doses and so many at the same time, it's very concerning,'' Rollins says.

    ...The new vaccine may mean fewer shots per visit for babies, but Rollins predicts that won't last long. ''We know there are over 300 vaccines in development now, many of which will be pushed as part of the childhood vaccine program. It's an unbelievable base of business for them.'' Next up, he says, will be annual flu vaccine for kids.

    ...To Rollins, the introduction of new vaccines should move cautiously. ''We're just starting to do the research that should have been done years ago,'' he says. ''We ought to go slowly and not take chance of provoking an autoimmune response or adverse reaction from a product that, in its best description, has been developed to help save lives, not to destroy them.''

    But studies so far haven’t found any association between autism or any other chronic illness and vaccinations:

    But, says pediatrician Joel Ward, director of the University of California-Los Angeles Center for Vaccine Research, who led clinical trials of the Pediarix vaccine, vaccines are safe and don't cause long-term problems in children's health or development. For instance, he says, ''there is no evidence in scientific literature which supports the contention that vaccination causes autism, and that means any vaccine of any type in any sequence in any age group.''

    Nor does giving several vaccines on the same day or in the same syringe pose a special risk, experts say.

    In a report in January 2002 in the journal Pediatrics, Paul Offit, chief of infectious diseases at The Children's Hospital of Philadelphia, and colleagues concluded that multiple vaccines neither weaken nor overwhelm babies' immune systems. ''On the contrary,'' they write, ''young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment.''

    ...''We know the vaccine is effective. We know the vaccine is safe,'' he says. But ''you have to create an infrastructure for immunizing children with a seasonal vaccine.'' With a formal recommendation, all babies in the target age group would have to see a doctor during flu-shot season, October through December.

    Though that might take time to organize, Offit says, once accomplished it could ease the traffic in pediatricians' offices during the winter months.

    ..Says Offit: ''Everybody has biases. Mine is that I work in a hospital.'' He rarely sees children admitted because of vaccine reactions, he says, but he sees plenty of them with diseases such as flu or chicken pox or whooping cough that could have been prevented by vaccines.

    ''If you can prevent it, and prevent it safely,'' he says, ''I don't see a downside.''

    Here’s a downside - cost. Is it worth all that money to immunize against diseases that aren’t fatal, or that aren’t easily communicated to others?

    But back to the new vaccine. I’ve had a lot of parents call to see if we’re offering this new “5-in-1 shot.” Many of them aren’t even my patients. They’re just calling around to find an office in the area that’s offering it. The fact that they refer to it as the “5-in-1 shot” tells me they’ve learned about it from the company’s advertisements. They bill it as a “5-in-1 shot” because, technically that’s what it is. It combines immunizations against five diseases: diphtheria, tetanus, pertussis, polio, and hepatitis B. Most parents see the add and think it means that the new immunization combines five shots in one. But it doesn’t, it combines three shots in one: DTaP (diphtheria, tetanus and pertussis), polio and hepatitis B. The shots are given at 2,4, and 6 months. Usually, hepatitis B is already combined with the H. influenza,(Hib) immunization, so children normally get four vaccines at those visits. (Pneumonia, Hib/HepB, polio, DTaP.) With the new vaccine, that goes down to three. Eliminating the number of jabs by one may be something that parents would like to do, but I get the impression from the phone calls that they think all of those shots are going to be compressed into one by the new combination. I haven’t had to explain that yet because we don’t give the new one. We aren’t likely to until 1) we know insurance companies are going to cover the cost and 2) it’s been in use for a while and proven to have no major side effects. I learned my lesson from Rotavirus too well.

    (Hat tip to  
    posted by Sydney on 2/06/2003 08:22:00 AM 0 comments

    Aftermath: I received quite a bit of email about my Tech Central Station column on Technology and Life's Dominion, many of which mentioned the emotional aftermath of abortion. I’m ashamed to say that I hesitated to post anything about it because I assumed that there was no proven emotional impact of abortion. Thanks to an email from someone involved with a national post-abortion counseling program, I’ve rethought my position.

    My understanding was simplistic. Every medical procedure has it’s emotional aftermath, some more so than others. I’ve never had someone come in sobbing and grieving because they’ve had an abortion the way I’ve had someone come in when a family member dies or their spouse leaves them. But then, few people become openly distraught over things they’ve done to themselves. We tend to turn the things we do to ourselves into inner torments without acknowledging their cause.

    Then, too, I had in the back of mind the famous Koop Report on abortion’s consequences. I was an intern when Dr. Koop sent his summary to President Reagan. I never read the letter itself, only the media reports. It has been engraved in my conscience as declaring that there were no emotional or physical consequences of abortion. Silly me. I should have known better. Thanks to Google, I’ve now read the letter. It doesn’t quite say that at all. (I know the letter is posted at a pro-life site, but that’s no reason to doubt the authenticity of the letter itself.) Here are the pertinent findings that Dr. Koop sent to President Reagan (emphasis mine):

    But I have concluded in my review of this issue that, at this time, the available scientific evidence about the psychological sequelae of abortion simply cannot support either the preconceived beliefs of those pro-life or of those pro-choice.

    ...In their view and mine, the data do not support the premise that abortion does or does not cause or contribute to psychological problems. Anecdotal reports abound on both sides. However, individual cases cannot be used to reach scientifically sound conclusions. It is to be noted that when pregnancy, whether wanted or unwanted, comes to full term and delivery, there is a well documented, low incidence of adverse mental health effects.

    ..For the physical situation, data have been gathered on some women after abortions. It has been documented that after abortion there can be infertility, a damaged cervix, miscarriage, premature birth, low birth weight babies, etc. But, I further conclude that these events are difficult to quantify and difficult to prove as abortion sequelae for two reasons. First, these events are difficult to quantify because approximately half of abortions are done in free-standing abortion clinics where records which might have been helpful in this regard, have not been kept. Second, when compared with the number of abortions performed annually, 50 percent of women who have had an abortion apparently deny having had one when questioned.

    In other words, the data just weren’t there to make a judgement one way or the other. How different that is from the way the report was reported in the media at the time, which in my recollection was very favorable to abortion. The other eye-opener there is the high rate of denial in women who have had abortions. Makes you wonder how happy they were with that choice. Koop suggested settling the issue by launching a study:

    There has never been a prospective study on a cohort of women of child-bearing age in reference to the variable outcomes of mating. Such a study should include the psychological effects of failure to conceive, as well as the physical and mental sequelae of pregnancy, - planned and unplanned, wanted and unwanted - whether carried to delivery, miscarried, or terminated by abortion. To do such a study that would be above criticism would consume a great deal of time. The most desirable prospective study could be conducted for approximately $100 million over the next five years. A less expensive yet satisfactory study could be conducted for approximately $10 million over the same period of time. This $10 million study could start yielding data after the first year.

    There is a major design problem which must be solved before undertaking any study. It is imperative that any survey instrument be designed to eliminate the discrepancy between the number of abortions on record and the number of women who admit having an abortion on survey. It is critical that this problem of "denial" be dealt with before proceeding with further investigations.

    That study was never done, nor is it likely to be done. That’s a lot of money to put into a study that will meet with a well-funded and well-organized political resistance, not to mention the difficulty of designing it to adequately overcome the denial factor.

    There have been some studies, however, such as this one which showed higher rates of suicide in women who have had abortions, and this one which showed the same seasonal variations in abortion rates and suicide rates among women. These are nowhere near the scale of a study that Dr. Koop had in mind, but their findings should give us some pause. Abortion may be a choice, but is it a choice that everyone can live with?
    posted by Sydney on 2/06/2003 07:54:00 AM 0 comments

    Wednesday, February 05, 2003

    JAMA's weekly art history lesson.

    UPDATE: My inner soul?

    which art movement are you?

    this quiz was made by Caitlin

    (Lifted from Out of Lascaux, which by the way has an interesting post about art at the UN, and how it's being used, or not used, politically.)

    posted by Sydney on 2/05/2003 09:27:00 AM 0 comments

    New Tourist Industry: The Swiss have seen an upswing in the number of people coming to their country to be killed:

    On a Monday morning in mid-January, Reginald Crew, a retired auto worker, flew in from Liverpool to kill himself.

    The 74-year-old Englishman, who suffered from motor neurone disease, met a doctor at 10 a.m. In accordance with Switzerland's liberal euthanasia law, the doctor agreed that Mr. Crew was terminally ill and prescribed a deadly barbiturate, pentobarbital sodium.

    By 3 p.m., Mr. Crew, a wheelchair-bound paraplegic in constant pain, sipped, through a straw, some water containing the barbiturate. Four minutes later, he was dead. His wife and his daughter were at his side.

    Just five short hours to decide the quality of life of a man previously unknown to the doctor. A man from a different culture, who speaks a different language. The Swiss are right to be concerned with the rise of this cottage industry:

    Congresswoman Dorle Vallender wants to change the law to prohibit death tourism, and has proposed a bill that would regulate euthanasia groups and make the rules more cumbersome so that those wishing to die have more time to think about what they are doing.

    "I'm not against assisted suicide," Ms. Vallender said. "But with Dignitas, it all happens too fast. They come here in the morning and are dead in the afternoon."

    "We have a duty to make sure they really can't be helped and are making this decision without pressure," she said.

    As it turns out, Mr. Crew and his family were paid by the British media:

    The Crew family's travel expenses were paid for by the "Tonight With Trevor McDonald" show, broadcast on Britain's private Independent Television network, which bought exclusive rights to the story for an undisclosed sum.

    Makes you wonder why he really did it, doesn’t it? Was he like those people who try to disguise their suicides so their families will get the life insurance money? Or was he subjected to pressure from his familiy to end their misery and help them out financially at the same time? Noble sacrifice or subtle coercion? You can bet the Swiss doctor didn't take time to investigate the complexities. Not in five hours.
    posted by Sydney on 2/05/2003 09:03:00 AM 0 comments

    Little League: Researchers have teamed up with Little League baseball to make baseball safer for kids. The study looked at insurance claims for game injuries in Little League games and found that safety balls and face guards make a difference:

    The study, carried out through the University of North Carolina's Injury Prevention Research Center, involved analyzing injury information from three years' worth of insurance claims submitted to Little League, 4,233 accidents between 1997 and 1999.

    "We found that 45 percent of all the injuries were related to impacts from balls, which is a really high share for any group of injuries in a sport," Marshall said.

    Facial injuries accounted for about 4 percent of all the claims.

    The study also looked at what safety equipment each of the nation's roughly 5,000 local Little League organizations were using in each of those years, based on annual surveys conducted by Little League Baseball Inc.

    This allowed the researchers to compare injury rates for leagues that were using softer balls or the face guards in each year with those that didn't use the gear.

    "We found that 73 percent of the leagues used safety balls of some sort in at least one age division, most often for youngsters playing tee-ball, and about 34 percent used face guards in at least one division," Marshall said.

    "Unfortunately, use of the safety equipment trails off in the older youth divisions, but that's where most of the injuries happen, not tee-ball," the researcher said.

    Safety balls can range from tennis balls or light rubber balls to so-called reduced-impact balls, which are made like regular baseballs but with a rubber core center rather than traditional cork and yarn.

    "We found there was a 23 percent reduction in ball injuries from using any type of safety ball, but a 29 percent reduction in leagues that were using the reduced-impact ball," Marshall said.
    posted by Sydney on 2/05/2003 08:26:00 AM 0 comments

    What's in a Name? Apparently everything if you share a name with a virility pill. A Viagra clone, named Cialis, is offensive to the Cialis family, wherever they may be:

    The British arm of the family, which extends to Ireland, France, Canada and Australia, have spoken to lawyers and are having a family meeting soon to plan their next move.

    Ahhh. Litigation. The universal weapon of English-speaking peoples everywhere.
    posted by Sydney on 2/05/2003 08:20:00 AM 0 comments

    Dinosaurs: When it comes to joining the electronic revolution, medicine has been notoriously slow :

    Even in Boston, where world-class hospitals spare no expense to treat cancer or deliver babies, and software gurus thrive on solving complex problems, health care was left behind in the drive for efficiency that changed the face of American business in the 1990s.

    Dr. Harris A. Berman, chief executive of Tufts Health Plan, said the medical sector's failure to harness new systems is wasting a fortune: one-third of every health-care dollar is spent on administration.

    The piles of paperwork and thickets of mismatched databases make life more difficult for consumers and affect the care they receive. Bankers, car dealers, and tax collectors have all raced past health-care providers in basic technology, he said.

    That is slowly changing:

    The shift in thinking has been a long time coming. And it didn't happen purely through market forces. It took federal legislation -- and cost pressures too great to be ignored -- to get the medical arena to embrace the Internet and abandon clunky, decades-old systems.

    Much of the movement is thanks to the Health Insurance Portability and Accountability Act, or HIPPA, a law Congress passed in 1996 to help workers keep health coverage when they change jobs. The law also calls for the industry to switch entirely to electronic claims and to create a national standard for the transmission of medical data -- and to protect patient privacy at the same time. The industry is scrambling to meet an April deadline.

    Ironically, those same HIPAA regulations are spooking doctors away from electronic records in the office. Patient privacy is important to physicians, it always has been, and we do try our best to keep records confidential. But HIPAA has severe penalties for those who fail in this, regardless of how hapless the circumstances may be. That makes people leary of wireless systems, for example. It makes people leary of the potential for easy record theft.

    And those electronic medical records systems are outrageously expensive, often costing upwards of $30,000 then charging thousands more per year for system support. Then, there’s the concern about what happens to the records if those companies go bankrupt. That happened last year, leaving doctors without access to their own medical records.

    Electronic medical records would be a blessing in so many ways, but the state of the art and the regulations as they stand now make them a potential nightmare. What we need is a secure, affordable, reliable, user-friendly system. The American Academy of Family Physicians is trying to put together just such a system, but for now, the field needs a lot of work.
    posted by Sydney on 2/05/2003 08:16:00 AM 0 comments

    Tuesday, February 04, 2003

    War and Peace: The wonder-substance glycerine.

    posted by Sydney on 2/04/2003 08:02:00 AM 0 comments

    Ravages of War: In the aftermath of war, Afghanistan gets immunized against tetanus:

    Teams of female volunteers and health workers went from house to house in the Afghan capital on Sunday offering free tetanus jabs to women as part of a global U.N. campaign to cut deaths among mothers and new-born children.

    By next Saturday, the U.N. Children's Fund aims to vaccinate 740,000 Afghan women between the ages of 15 and 49 in four major cities in order to prevent the deaths of an estimated 11,000 babies from tetanus every year.

    Someone should do a comparison of the lives saved by the war in Afghanistan (via adequate healthcare, immunizations, obstetrical care, food, water, etc.) and the number of real lives lost in the war. Bet more have been saved.
    posted by Sydney on 2/04/2003 07:51:00 AM 0 comments

    Not My Cuppa: For the environmentally conscientious woman. (I have to say I share the skeptics' concerns about the potential for infection. Body fluids collected in a static pool are always a sure breeding ground for bacteria.)
    posted by Sydney on 2/04/2003 07:49:00 AM 0 comments

    Alt Med Watch: Ephedra, a stimulant herbal that’s used for weight loss, is apparently responsible for a significant number of poison-control calls:

    Researchers at the San Francisco VA Medical Center studied information phoned in to poison control centers in 2001 and found although ephedra accounted for less than 1 percent of all herbal supplement sales in the United States that year, it was responsible for 62 percent of all herb-related side effects reported.

    "We were sure ephedra would have a couple of times more calls -- more reports than other herbs -- but it was more than 100 times more calls," lead study author Dr. Stephen Bent, a staff physician at the VA center and a professor of medicine at the University of California, San Francisco, told United Press International. Bent said this is one of the first studies of its kind to examine herbs' effects by looking at poison control center data.
    posted by Sydney on 2/04/2003 07:47:00 AM 0 comments

    Jersey Strike: Well, the doctor work-stoppage in New Jersey went ahead yesterday:

    Dr. Rigolosi estimated that 70 percent of the state's 22,000 physicians took part. The doctors sought to keep the tone of their protest muted, out of respect for the space shuttle astronauts, but its message of defiance was as clear as the sign carried by a doctor at Christ Hospital in Jersey City: "When your water breaks, call your lawyer."

    Better watch it. They're starting to sound bitter. Some of the protests, though, had a distinctly New Jersey feel to them:

    ..the police had to separate doctors and a malpractice lawyer in front of the Jersey City courthouse this morning.

    Then, again, this is the sort of attitude they’re up against in trying to get their state’s leaders to take tort reform seriously:

    Governor McGreevey's chief of staff, Jamie Fox, has been dismissive of the doctors. On a New Jersey Network news program on Sunday, he said: "On Monday, they'll be striking. On Tuesday, they're going to march on the State House. And on Wednesday, they're going to play golf."

    Note to New Jersey doctors: forget about work stoppages and strikes. Just relocate to states with better tort reform laws - and better governors.
    posted by Sydney on 2/04/2003 07:42:00 AM 0 comments

    Med Mal, Muy Mal: The sad plight of one small Wyoming town thanks to escalating malpractice premiums:

    "I love delivering babies," the intense physician, 56, said. "I really love delivering the babies of women I delivered a couple of decades ago. And I know this community needs an obstetrician.

    "But you can't practice without [malpractice] insurance. And I can't get coverage for deliveries any more."

    The national malpractice insurance crisis that President Bush spoke of in his State of the Union address last week hit home for Wheatland this winter when Woods's insurance company joined a number of national malpractice carriers in declaring bankruptcy.

    That left only two firms selling malpractice insurance in Wyoming, and neither one was willing to take on new obstetrical coverage. Woods did get insurance for his gynecological practice -- a branch of medicine that spawns far fewer lawsuits than delivering babies -- but the annual premium costs him $116,000, three times what he paid a year ago.

    Whoa. $116,000 a year for malpractice in a town of 9,000. Those are New York City rates. There's no way a doctor practicing in a town of 9,000 can make enough money to cover that sort of overhead.

    Woods's problem has turned into a financial problem for Platte County Memorial Hospital, a 43-bed facility that is Wheatland's biggest building. "The economics of a rural hospital are always tight," noted hospital director Mike Matthews. "If I don't have all my physicians providing services here, I'm losing revenue. And if I have to cut back -- well, this hospital is the third-biggest employer in the county."

    Meanwhile, women with complicated pregnancies requiring the services of an obstetrician have to travel three hours round trip to find a doctor. That's just a shame.
    posted by Sydney on 2/04/2003 07:39:00 AM 0 comments

    Flash: The Annals of Internal Medicine has a nice summation of the state of affairs last summer when the great raging hormone debate was all the news:

    Although the WHI focused on prevention, not on symptom relief and other quality-of-life benefits, many members of the news media and the public did not understand that subtlety, according to Susan Dentzer from "The NewsHour with Jim Lehrer" on PBS. Although news stories were written in the context of prevention, the public was interested in stories related to quality of life and symptom relief. Neither the news organizations nor the public grasped the concepts of absolute risk and relative risk, and there was a tendency to focus mostly on sharp increases in relative risks, which were emphasized in press releases from the NIH and JAMA. Hence, the media emphasized one "side" of the story or the other---either the sharply increased relative risks or the lesser absolute risks. The differences between these two concepts are significant: Although the relative risk for breast cancer among women in the WHI study who used E P increased 26% during the 5 years of the study, the absolute risk in an individual woman was small.

    ..Future announcements of this type should be accompanied by more concerted efforts to brief the news media thoroughly, Ms. Dentzer recommended. Moreover, thoroughly briefing medical professional groups and clinicians before a major announcement would help them to provide more useful and timely information to their patients.

    And some demonstration of responsible reporting in news releases by investigators and medical journal editors would be welcome, too.
    posted by Sydney on 2/04/2003 07:36:00 AM 0 comments

    Future Wonders: Wiinds of Change has a post on using jet printers to print human tissues and the experiment on biofilm that perished aboard the shuttle, a cooperative effort by Israeli and Palestinian students, one of whom is studying biology at College Misericordia in the United States.
    posted by Sydney on 2/04/2003 07:35:00 AM 0 comments

    Monday, February 03, 2003

    Saints Days: Today is Saint Blaise Day, patron saint of throat ailments.

    posted by Sydney on 2/03/2003 08:39:00 AM 0 comments

    Choose Your Poison: Thomas Friedman on the health choices of Europeans:

    Last week I went to lunch at the Hotel Schweizerhof in Davos, Switzerland, and discovered why America and Europe are at odds. At the bottom of the lunch menu was a list of the countries that the lamb, beef and chicken came from. But next to the meat imported from the U.S. was a tiny asterisk, which warned that it might contain genetically modified organisms — G.M.O.'s.

    My initial patriotic instinct was to order the U.S. beef and ask for it "tartare," just for spite. But then I and my lunch guest just looked at each other and had a good laugh. How quaint! we said. Europeans, out of some romantic rebellion against America and high technology, were shunning U.S.-grown food containing G.M.O.'s — even though there is no scientific evidence that these are harmful. But practically everywhere we went in Davos, Europeans were smoking cigarettes — with their meals, coffee or conversation — even though there is indisputable scientific evidence that smoking can kill you. In fact, I got enough secondhand smoke just dining in Europe last week to make me want to have a chest X-ray.

    Reminds me of the guy I knew in college who smoked pot morning, noon, and night, but wouldn't take an aspirin for a headache because he didn't believe in taking drugs.
    posted by Sydney on 2/03/2003 08:38:00 AM 0 comments

    Happiness is a Warm Parent: The New York Times reviewed a book about the man and the research behind the importance of human touch - 'Love at Goon Park': The Science of Love. The book is the story of Harry Harlow and his research on baby monkeys. The photos of his experiments are famous now - little baby monkeys clinging to terry-cloth fake monkeys and cringing in the presence of chickenwire ones. The essence of the book:

    A loner in childhood, Harlow began his career as an iconoclast, mostly ignored by his colleagues at Wisconsin. Unfazed, he built a laboratory from scrap lumber and inspired a cadre of talented students, including his first wife, Clara Mears. (The lab's address was 600 N. Park, Madison, Wis., but the careless handwriting of so many of its researchers led everyone to call it Goon Park; thus Blum's title.) Intensely driven by curiosity and a desire to prove the behaviorists wrong, Harlow was a workaholic who rarely spent time with his family. After Clara left him, taking their children, intense loneliness drove him to drink for the rest of his life.

    ''It was during those . . . sleep-deprived, alcohol-inspired days,'' Blum writes, ''that Harry Harlow first started thinking about the nature of love.'' He married again, fathered two more children, worked like a maniac, lost his wife to cancer, suffered from depression relieved only slightly by electroshock therapy and created his infamous isolated-monkey model of depression.

    Blum presents the puzzle of a man who legitimated a science of love while failing those who most loved him, and the paradox of work that made baby monkeys suffer in order to sensitize people to the needs of children.

    Maybe it was that lack of love in his own life that drove him to work so obsessively on it in monkeys.
    posted by Sydney on 2/03/2003 08:37:00 AM 0 comments

    Rapid AIDS: The FDA has approved a blood test for HIV that can be done in 20 minutes in the doctor’s office:

    The new AIDS test, called OraQuick and made by OraSure Technologies Inc., has 99.6 percent accuracy from testing a drop of blood drawn from a finger and is simple to use, the Food and Drug Administration

    Don’t expect it to be available at your private physician’s office, though. The test isn’t CLIA-waived . CLIA is the Clinical Laboratory Improvement Amendments which restricts what testing doctors can do in their offices without being overseen by federal authorities. Doing tests that aren’t waived in the office is a big pain, so until or unless it gets a waived-status, it isn’t likely to be adopted by many physicians.
    posted by Sydney on 2/03/2003 08:33:00 AM 0 comments

    Military Medicine: The military, as usual, is in the vanguard of practical medical advancements:

    One new tool in medic's bag is a fast-working bandage. The new bandage contains the agent that makes blood clot. Laboratory animal tests show that when the bandage is applied for just two minutes, the clotting agent stops the bleeding.

    ....Another tool special forces will be bringing to Iraq is a one-handed tourniquet, enabling soldiers to quickly stop blood flow from a wound while still keeping one hand free.

    "I can still shoot, take a couple of shots, reach up and grab (the tourniquet), cinch it down to where I can control the hemorhage," Brochu explained.

    The military is also working on personal digital assistant which can help track medical information on soldiers in the field.

    posted by Sydney on 2/03/2003 08:28:00 AM 0 comments

    Occupational Hazards: Carbon monoxide poisoning and race car drivers.
    posted by Sydney on 2/03/2003 08:26:00 AM 0 comments

    Smallpox Round-Up: Tennessee lives up to its nickname, the volunteer state:

    About 50 public health officials from across Northeast Tennessee, including Greene County, began receiving smallpox vaccinations here on Friday.

    The vaccinations were administered at the Northeast Tennessee Regional Health Office to those public health nurses and physicians who will later be giving the same vaccinations to others.

    “Today we’re vaccinating the ‘vaccinators’ — the people who will be working in the clinics and so forth,” said Shirley Hughes, bioterrorism director for the Northeast Tennessee Regional Health Office.

    “After that, the hospital workers will receive the vaccine.”

    About 700 employees from 14 area hospitals are scheduled to receive the vaccine between Feb. 10 and March 7 at the regional health office.

    Statewide, about 5,800 health care workers are scheduled to receive the vaccine during that time.

    But, in Canada, doctors are reluctant to do anything:

    The problem is that getting the smallpox shot carries risks of a serious adverse reaction or death. Moreover, those people who get the shot can spread the vaccine running throughout their body just by touching someone else -- say a family member -- which then puts that person at risk of developing serious side-effects.

    Well, that’s not exactly true. A person has to touch the site of vaccination to risk getting infected by it. And that is easily controlled by keeping the site well-covered.

    Meanwhile, the military has vaccinated tens of thousands of soldiers with two reactions so far. One was a local skin reaction, the other encephalitis. Both are recovering uneventfully:

    Two soldiers out of "tens of thousands" who have received the smallpox vaccination have displayed "noteworthy" reactions, according to a Department of Defense statement Friday.

    One was hospitalized and the other being monitored by medical authorities, and both are said to be doing well, according to the statement.

    "Our safety experience with smallpox vaccinations to date is consistent with what we expected overall. We have seen a small number of adverse reactions to the vaccine, mostly minor," said William Winkenwerder, the assistant secretary of defense for health affairs, in the statement.

    "We can expect additional reactions to occur, some will be significant reactions," according to the statement.
    posted by Sydney on 2/03/2003 08:26:00 AM 0 comments

    New Jersey Strike: Doctors in New Jersey were going to have a work stoppage and rally this week over tort reform and malpractice premiums, but they've put their plans on hold in deference to the Columbia accident.

    posted by Sydney on 2/03/2003 08:14:00 AM 0 comments

    Riches: The next time you hear the American Trial Lawyer's Association say that lawsuits are about protecting the public, not about the money, remember this.
    posted by Sydney on 2/03/2003 07:59:00 AM 0 comments

    Sunday, February 02, 2003

    Wanted: Nominations for patron saint of the internet. I propose Patrick. Not only did he devote his life to spreading the Word, he's also the patron saint of Nigeria.

    posted by Sydney on 2/02/2003 08:18:00 AM 0 comments

    Humble and Grateful Minds Need Not Apply: (That phrase “humble and grateful mind” comes from Epictetus - “Any one thing in the creation is sufficient to demonstrate a Providence to an humble and grateful mind.”) I’m a few days late to this debate, but there’s been a mini-meme running through the blogosphere on evolutionary theory,its pertinence to the practice of medicine, and its importance for letters of recommendation from a biology professor at Texas Tech.

    The professor has a stringent set of criteria for letters of recommendation. That’s his perogative. But he puts a curiously high value on evolutionary theory, particulary macroevolution, and its importance to the practice of medicine:

    If you set up an appointment to discuss the writing of a letter of recommendation, I will ask you: "How do you think the human species originated?" If you cannot truthfully and forthrightly affirm a scientific answer to this question, then you should not seek my recommendation for admittance to further education in the biomedical sciences.

    Why do I ask this question? Let’s consider the situation of one wishing to enter medical school. Whereas medicine is historically rooted first in the practice of magic and later in religion, modern medicine is an endeavor that springs from the sciences, biology first among these. The central, unifying principle of biology is the theory of evolution, which includes both micro- and macro-evolution, and which extends to ALL species. How can someone who does not accept the most important theory in biology expect to properly practice in a field that is so heavily based on biology? It is hard to imagine how this can be so, but it is easy to imagine how physicians who ignore or neglect the Darwinian aspects of medicine or the evolutionary origin of humans can make bad clinical decisions. The current crisis in antibiotic resistance is the result of such decisions. For others, please read the citations below.

    Good medicine, like good biology, is based on the collection and evaluation of physical evidence. So much physical evidence supports the evolution of humans from non-human ancestors that one can validly refer to the "fact" of human evolution, even if all of the details are not yet known. One can deny this evidence only at the risk of calling into question one’s understanding of science and of the method of science. Such an individual has committed malpractice regarding the method of science, for good scientists would never throw out data that do not conform to their expectations or beliefs. This is the situation of those who deny the evolution of humans; such a one is throwing out information because it seems to contradict his/her cherished beliefs. Can a physician ignore data that s/he does not like and remain a physician for long? No. If modern medicine is based on the method of science, then how can someone who denies the theory of evolution -- the very pinnacle of modern biological science -- ask to be recommended into a scientific profession by a professional scientist?

    Dr. Dini states in his autobiographical sketch that evolutionary biology is one of his special interests, so it's understandable that it plays an important role in his life. But he vastly overestimates its importance to the daily practice of medicine. I can tell you exactly how many times I’ve thought about evolution, not counting exasperated forays into social Darwinism (of which I repent almost as soon as I think them) , while learning and practicing medicine - zilch. Clayton Cramer has a better understanding of the daily practice of medicine than the professor:

    Does Professor Dini think that this crisis in overprescription was because creationist doctors said to themselves, "I don't believe that we can evolve strains of antibiotic resistant bacteria, so I'm going to prescribe amoxicillin for anyone that comes into the office." This is absurd. Doctors overprescribe because they don't want to argue with a patient, because they are unsure whether a particular set of symptoms they are seeing are viral or bacterial, and because it's faster to write a prescription than to analyze the symptoms carefully.

    Perhaps I’m wrong, but I thought that the dispute between evolutionists and creationists lay in how we were created, not in how things work in the here and now. There’s no reason to think that creationists are incapable of accepting the concept of gene mutations, or of antibiotic resistance.

    And while it’s certainly his perogative to decide who he’ll honor with a letter of recommendation, it ‘s too bad that he’s decided to automatically exclude anyone who diagrees with his view of the world. Keep in mind, he doesn’t specifiy that it’s only creationists he disdains. He disdains anyone who might doubt the evolutionary theory of the origin of species. The ability to entertain possibilities that differ profoundly from the prevailing theories of the day is the hallmark of all the great scientific revolutionaries, including Darwin. One could easily imagine a long ago professor of science refusing to write a letter of recommendation to anyone who rejected the Ptolemaic model of the universe. It was proven, accepted fact. Indeed it was the cornerstone of all science. How could anyone call themselves a man of science and reject it? Just ask Copernicus. Just ask Galileo. We like to blame the Church entirely for their problems today, but in truth they were harassed just as much by their fellow scientists. Sorry to see a professor of Dr. Dini’s background continuing the tradition. He would do well to consider another quote, this time from Pope, “One science only will one genius fit; So vast is art, so narrow human wit.”

    And Besides: Dr. Dini makes a mistake when he assumes that the practicing physician is a scientist. We aren’t, really. Sure, our art is grounded in science. We have to understand fundamentals of biochemistry, physiology, molecular biology, and anatomy to practice it well. But, the actual practice of medicine is closer to what a police detective or a mechanic does everyday than to what a scientist does.

    If we were strictly scientists we would just be observing and recording things rather than intervening. But we aren’t scientists when we practice medicine. We’re humanists. If we acted as scientists, as biologists, and applied Darwinian principles to the practice of medicine, we would fail our patients miserably. In fact, some doctors have used the principles of evolution to create a theory of practice called Darwinian medicine:

    Defenses are often confused with diseases. Knowing the difference is crucial, because interfering with a defense is often unwise. Pain is a defense against tissue damage; people who lack this defense usually die by age thirty. Fever is a defense that protects against infection. The low iron levels associated with infection are the body's way of keeping iron away from invading bacteria. Nausea and vomiting and diarrhea are useful ways to rid the body of infection and toxins. The nausea that accompanies pregnancy discourages the mother from eating toxic substances that may harm her baby. Even anxiety and sadness can be useful. As for the runny nose that accompanies colds, we don't yet know if it benefits us or viruses, but we certainly need to know in order to decide if nose sprays will help or harm us. Much of clinical medicine relieves people's discomfort by blocking defenses like fever, pain, nausea and diarrhea. How can this be safe? Just as smoke detectors are designed to give many annoying but inexpensive false alarms so that they are sure to warn about any actual fire, the mechanisms that regulate the body's defenses have evolved to express defenses whenever they are possibly useful, thus causing much unnecessary suffering

    While it’s true that fever helps fight infection, it’s also true that high fevers make a person feel miserable, and sometimes make them delirious. While it’s true that diarrhea helps rid the body of the offending organism, it’s also true that severe diarrhea can kill you. While it’s true that runny noses may help shed the offending virus from the nose, it’s also true that the infected mucous helps to spread the virus to others. Our mission is to relieve the suffering, to save the life, and to prevent the spread of illness to others - so we intervene.

    We are, really, anti-evolutionary; for everything we do seeks to keep the status quo, and our greatest efforts are spent on insuring the survival of the least fit. Thanks to modern medicine, we might be the end of the line for human evolution.
    posted by Sydney on 2/02/2003 08:04:00 AM 0 comments

    Saturday, February 01, 2003

    In Memoriam

    posted by Sydney on 2/01/2003 11:03:00 AM 0 comments

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