"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
It's All Relative: The Sunday paper here in my hometown is full of op-eds decrying the fact that exit polls showed people were motivated to vote by "moral values" - intimating that the less urban and academic areas that had a majority vote for Bush are hotbeds of homophobia, bigotry and scary religious people. The spin has been unspun elsewhere in the blogosphere. But here's something else to consider. Buried in thisNew England Journal of Medicine article is a table that ranks the most important issues for voters in previous presidential elections, from 1992 to 2000. Pollsters didn't ask about "moral values" in 1992, but they did in 1996 and 2000, and guess what? They were the most important issue in those elections, too - for 40% of voters in 1996, when President Clinton was re-elected, and for 35% in 2000, when Gore won the popular vote. Both of those are much higher percentages than the 22% of the electorate who named moral values the most important issue this election.
Does that mean Clinton and Gore relied on the homophobic, ignorant masses? Or does it mean that our moral values have changed dramatically in the past four years, from those that Democratic elites deem appropriate to ones that they deem abominable? Neither, of course. It means the phrase "moral values" is extremely nebulous and can be defined in any way one wants to suit whatever purpose one wants when intrepreting exit poll data, anyway. Chances are, when people rank "moral values" as their top reason for voting, they mean the moral values of the candidates, which basically boils down to which of the two they trust the most.
Sorry, pundocracy. The lesson of the election is that you have to convince the electorate to trust you to do a good job. Just like any other job interview. posted by Sydney on
11/07/2004 09:17:00 AM
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Superman Vision: Those X-ray glasses they used to sell in the back of comic books that promised little boys the ability to see through women's clothing are a reality:
AN X-RAY machine that sees through air passengers’ clothes has been deployed by security staff at London’s Heathrow airport for the first time.
The device at Terminal 4 produces a “naked” image of passengers by bouncing X-rays off their skin, enabling staff instantly to spot any hidden weapons or explosives.
But the graphic nature of the black and white images it generates — including revealing outlines of men and women — has raised concerns about privacy both among travellers and aviation authorities.
A British television channel is seeking a terminally ill volunteer to donate their body after death so it can be filmed as it decomposes.
Channel 4, which in 2002 broadcast Britain's first public autopsy for 170 years, said the programme was being made in association with London's Science Museum and would be a unique experiment.
"We hope the experts can learn more about the processes involved and that the data collected by the project can help forensic pathologists in murder investigations," said Simon Andreae, head of science and education at the publicly funded Channel 4.
Join Us or We'll Sue: Blue Cross/Blue Shield of Montana which already contracts with 93% of the state's doctors and covers 2/3 of the state's population is suing the only radiology group in Missoula, Monatana because they won't sign up with the plan:
Antitrust attorneys across the nation are watching the progress of the Blues' lawsuit against Missoula Radiology, the only radiology practice in Missoula, Mont. The Blues plan says the suit, which seeks to break up a 12-physician group it calls a "predatory monopoly," is about market competition, not the group's refusal to be part of the plan's network.
But many doctors say if the Blues plan is successful in its case, it could embolden other plans to sue physicians who refuse to sign a contract. In fact, after the lawsuit was filed Sept. 14, a seven-physician neurology group and a six-physician surgery group announced they would drop their Blues contracts, in part to show solidarity with Missoula Radiology.
"They're going to prove with this [suit] they can do it and then subtly make an implicit threat to other groups: 'We can do this to you if you don't join our network,' " said Nick Chandler, MD, president of Missoula Neurological Associates.
Dr. Chandler, who is also chair of InterWest Health, a Missoula PPO that competes with BlueCross, said the suit bothers him from two perspectives. "As a physician it sends chills down my spine, and as a managed care executive I think there are certain business practices that managed care organizations can't ethically adopt. posted by Sydney on
11/06/2004 12:47:00 PM
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Bird in Hand: Wesley J. Smith points out an interesting choice made by California voters:
THE PASSAGE OF PROPOSITION 71 in California (the Stem Cell Research and Cures Act) was an acute case of electoral folly. As Californians plunged headlong into a $6 billion quagmire of debt in a quixotic quest for 'miracle cures' from human cloning and embryonic stem cells, they simultaneously rejected Prop. 67, an initiative that would have added a modest tax to phone bills to keep the state's endangered emergency rooms and trauma centers from shutting down.
Golden Opportunities: So, here's where all the lawyers the Democrats had lined up for election day went. posted by Sydney on
11/05/2004 11:59:00 PM
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CDC Influenza Vaccine Update: How businesses can use their vaccine. (Here's a suggestion - give it to your public health departments so they can vaccinate the elderly.) posted by Sydney on
11/05/2004 08:22:00 PM
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Flu Vaccine Round-Up: Although the CDC has been telling us for the past month that they are helping to distribute the flu vaccine to those who need it most, providers everywhere remain left in the lurch. New Mexico and Illinois want to buy flu vaccine from abroad, even though it's technically not FDA-approved. Two counties in Ohio are completely out of vaccine and according to public health officials, they aren't expecting to get more. Even the state health department is in the dark:
The state health department said it ordered 55,000 doses of the flu vaccine, but it does not know when they will arrive or who will get them.
Wouldn't you think that the state health department, of all places, would have some info from the CDC? Meanwhile, the vaccine is being sent to clinics in Georgia, home of the CDC. There has been a stunning lack of communication between the CDC and providers - including local public health departments - during this shortage. The whole process of aquiring vaccine during the shortage remains extremely opaque.
I get weekly email updates from the CDC about the crisis, but not once have they mentioned who to call or how to sign up for flu vaccine shipments. They're just press releases about influenza surveillance and the "success" of their flu vaccine redistribution plan. Sorry, but from the ground, it looks like anything but a success.
Other news provides hope that the lack of vaccine won't be such a big deal. There's some evidence that diluted vaccine may also work, although the studies were performed on the young and healthy, not the elderly and frail who need it the most, so don't get your hopes up.
Better reason to hope is in the JAMApaper which followed elderly flu vaccine recipients over six flu seasons. Although they found that the flu vaccine certainly decreases mortality among the elderly, and especially among the sick elderly, it's somewhat reassuring how rare the flu-related deaths were. Of the 26,071 participants in the study, only 3.485 died during its course. Almost a third of those were from "natural causes" - the number one killer. (Included in that category was dementia, bed sores, and old age with no other obvious reason) Heart attacks and strokes came in second, cancer third. Infections - which are the most common complication of the flu - came in fifth, after "sudden death"(cardiac and unexplained.) Granted, the results may have been quite different if the vaccine had not been given at all, but the final conclusion is still reassuring that the flu is, in most years, not such a big deal. That conclusion? 302 people have to be vaccinated to prevent just one death from influenza. If the flu season is as mild this winter as it was in the southern hemisphere this past summer, people won't be dropping dead in great numbers. posted by Sydney on
11/05/2004 01:58:00 PM
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Regular Posting to Resume Later Today: Sorry, got side-lined by hospital duties, and blogger has been unusually slow lately. Hope to resume posting later this evening after office hours. posted by Sydney on
11/04/2004 09:32:00 AM
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Wednesday, November 03, 2004
Body Sculpting: Today, I received an invitation in the mail to learn to use Sculptra, an absorbable polymer that can be injected into the face to cosmetically treat the appearance of HIV-wasting. It increases skin thickness by about 7 mm. It's made of the same material as absorbable sutures:
Poly-L-lactic acid is the same material used in absorbable sutures and offers an excellent safety profile. It is highly biocompatible and non-allergenic; therefore, it can be used without skin testing. The material is biodegradable, yet the results achieved are relatively long-lasting.
Needless to say, dermatologists are eager to use this on non-HIV (i.e. aging) cases of facial wasting, too. No word on the price, but chances are, it isn't cheap. posted by Sydney on
11/03/2004 07:29:00 PM
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Supreme Court Medical Watch: Justice Rehnquist says he was too optimistic when he said he'd be back to work this past Monday. His thyroid cancer is, apparently, much more serious than he initially thought:
Rehnquist did not say what type of thyroid cancer he has, how far it has progressed or the prognosis. Dr. Leonard Wartofsky, a thyroid-cancer expert at Washington Hospital Center, said that the combined chemo-therapy-radiation indicates that Rehnquist has anaplastic thyroid cancer, a fast-growing form that is almost always fatal.
Patients with anaplastic thyroid cancer often have four to six weeks of daily visits for radiation, and multiple rounds of chemotherapy that can go on for several months, Wartofsky said.
Rehnquist's announcement, more somber than the one a week ago. made no mention of leaving the court.
'According to my doctors, my plan to return to the office today was too optimistic,' he said.
Terrorist Medical Watch: Depending on who's talking, Yasser Arafat is either rallying or declining further. Whatever the case (and I suspect the latter), they still "don't know" what's wrong with him:
Abu Rdeneh said final results from a battery of tests might not be available until late Wednesday or early Thursday. However, Mohammed Rashid, a close Arafat aide, said results were due Wednesday.
....Palestinian Foreign Minister Nabil Shaath said all types of cancer had been ruled out. Still, Israel Army Radio on Monday quoted a senior military intelligence official as saying Israel assumes Arafat suffers from either a severe viral infection or cancer.
...French physicians at the Hopital d'Instruction des Armees de Percy, southwest of Paris, gave Arafat a platelet transfusion shortly after his arrival.
He probably got some blood along with those platelets, which would certainly make him perk up a little bit. I'm still betting on cancer. I'd be surprised if he ever makes it back to Ramallah.
Overheard: I've been listening to a lot of commentary this evening from talking heads and radio pundits that's consisted mostly of fears that the Republicans will act as if they have a "mandate" - which always translates into - "Lookout! The religious right are going to take over!" I remember the pundits saying the same things back when Ronald Reagan was re-elected. I remember because I believed them, and I feared it. I was among those who thought Ronald Reagan's re-election was the worst thing that could possibly ever happen to our country and the world.
But obviously, the religious right didn't take over. We still have abortion. We still have a separation of church and state. And you can make a pretty good argument that Ronald Reagan's re-election was actually good for the world, what with the collapse of communism and all.
I overheard a conversation in the doctor's lounge at the hospital today that underscored this. One doctor was telling another about the years he lived in northern Germany, during the late seventies and early eighties. He said the world sensed how weak Jimmy Carter was, and that the northern Germans he knew were "quaking in their boots," for fear that the Soviet Union would pounce and cross the border. They were relieved when Reagan was elected. They felt secure again, even though they called him a "cowboy."
So, for those of you who are nervous about another four years of Bush. Relax. The "religious right" isn't any more likely to take over than twenty years ago. The world will survive, and it just might turn out a little bit better. And those pundits? Shouldn't they have just a small shred of humility given how wrong they were back then? posted by Sydney on
11/03/2004 06:58:00 PM
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News from Ohio:It looks like the Guardian's letter writing campaign to Clark county voters failed. The county went for Bush. College students in Oberlin stood in line for up to five hours to vote. Looks like their efforts paid off, as their county went solidly for Kerry. (It probably would have done so anyways. It's dominated by autoworkers and their unions.)
Tort reform hopes are higher thanks to three wins last night by non-activist judges for the Ohio Supreme Court. Things don't look too bad at the national level, either, with the Republicans capturing a majority in both the House and Senate. Of course, a President Kerry can be counted on to veto any tort reform measure coming out of Congress. I'm keeping my fingers crossed, as Ohio continues to count the votes.
UPDATE: Just heard that Kerry conceded. Glad to hear it. Let the healing begin.
Welcome to Election Day 2004 Grand Rounds, a round-up of medically related posts from around the blogosphere. Are you still among the undecided, looking for info on stem cells and healthcare? We've got posts for you. Trying to escape the frenzied election day coverage of the political blogs and mainstream media? We've got posts for you. Just pour yourself a cup of coffee and surf away your election day anxieties.
For the Undecided: Craig Westover points out that neither candidate understands the flu vaccine problem. Dr. Bradley takes a look at the stem cell debate.
But while many worry that John Kerry's healthcare plan will lead to government-run healthcare, Trent McBride argues that we already have government-run healthcare.
Sleepless Nights: Worrying about the election (and waiting for the results) will surely keep many awake tonight. Let's hope the doctors get a good night's sleep, for as the New England Journal of Medicine pointed out last week, we don't work well when sleepy. It may be hard to believe, but many doctors take exception to that assertion. Is our resistance to sleep due to a deeply ingrained medical culture, or is it essential to a good medical education? (Although, sometimes things never go right, no matter how much you sleep.) Chris Rangel hasmore. Oh, well, it may all be rendered moot in the future, as Dr. B reminds us, thanks to pharmacological mind enhancement.
Suffer the Children: Caring for children is fraught with its own special anxieties. No matter what the age, there are really two patients - the parent and the child - to consider. For example, treating maternal depression may adversely effect a newborn baby, as Shrinkette notes. Dr. Baker reflects on the blame game inherent in treating teenagers, and their parents. Dr. Winters relates a recent personal experience with the blame game.
The latest in stethoscope technology - the iSteth.
UPDATE: I inadvertently pasted the wrong link in the "Sleepless Nights" section twice. The second link should take you to this post. My apologies to all involved.
Next week's Grand Rounds will be hosted by Grunt Doc.
Previous Grand Rounds are archived here.
Grand Rounds is the brainchild of Nick at Blogborygmi. If you would like to host future Grand Rounds, drop him a line.
posted by Sydney on
11/02/2004 06:00:00 AM
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Swing State Living: Just returned from polls (in Summit county, Ohio.) The lines were longer than I've ever seen them. Had trouble finding a parking place, actually. I arrived just five minutes after they opened at 6:30 and had a one hour wait. Everyone was very polite, except a particularly demanding patient of mine who, I noticed, cut in line! Grrrrr...
The man next to me said it was like this in the LBJ vs. Goldwater election, too. One thing for sure, whatever the outcome, the loser can't claim this wasn't the will of the people. And if it isn't close, let's not hear anything more of how divided we are, please.
Addendum: There were no poll watchers at my polling place, but we aren't as contested a county as, say, Cuyahoga. There were, however, plenty of signs posted announcing that voting fraud is a federal offense, and that if you don't live in this precinct, your vote is invalid. The pollworkers seemed a little nervous and frazzled already. The volunteer signing people in (the same one who has been there every year I can remember) had trouble finding my name, which made her very nervous. She always has trouble finding my name, but she doesn't usually get so nervous about it. I hope they have enough available to work in shifts.
(Ed. note: Time stamp is incorrect so the Grand Rounds post can remain at the top of the page.) posted by Sydney on
11/02/2004 05:44:00 AM
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Monday, November 01, 2004
Grand Rounds Reminder: Just a reminder - Grand Rounds will be hosted here tomorrow. Please send your submissions to medpundit-at-ameritech.net by 9PM tonight (EST preferred). posted by Sydney on
11/01/2004 05:17:00 PM
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Mercy: Terri Schiavo's case took another turn last week, when the courts decided to allow her to continue to be fed while her parents appeal. It looks like her husband might give up:
Felos said it might be time to advise Schiavo to end his quest.
``It would appear that pursuing any remedy through the judicial system is simply a waste of time,'' Felos said. ``It is hard to see where there is any benefit in staying the course in this case.''
Friday's decision by Circuit Judge George Greer to stay the case indefinitely while the Schindlers appeal his latest ruling ``could delay this case months, even years,'' Felos said. ``I think it's outrageous.''
For those of you unfamiliar with the case, Terri Schiavo is a brain-damaged woman who is basically involved in a custody battle between her husband and her parents. Generally, absent a living will or other advance directive, a spouse assumes decision making power if someone becomes incapacitated. The problem is, what if there's a question of the spouse's motives? What if the couple were having marital problems at the time of the injury? Terri Schiavo's parents want to assume the responsibility of her care. Her husband doesn't want them to. The result has been a long, drawn out legal battle.
I've heard bits and pieces of this story and find myself looking back to a similar situation. In August 1999, my wife and I were in a motorcycle accident that left her in a coma for about four months. That June we had discussed updating our wills and what we'd like done if something like life support became an issue. We both decided we did not want to be kept alive by machines if it were determined that our brains were dead. Ironically, we were to sign those documents on a Wednesday but our accident occurred on the previous Sunday.
My wife had surgery on her brain to relieve pressure and swelling. The surgeons told me, in front of our parents at my request, that at the time no promises could be made and we should prepare for at best a lifetime of machines and various equipment or death -- only time would tell. I let our parents know of the wills and that they were not signed, so any decision I would make would be done with their considerations in mind.
I felt that even if I wanted to end this and her parents disagreed, how could I deny them the chance or hope of holding on to their daughter even if I've given up on my wife?
After 20 months of stays in various hospitals and nursing homes, I was finally able to bring my wife home. Five years later, she is still at home with me. She is totally dependent on me, the families or the nursing staff for all of her needs. I'm now her legal guardian, and we have new wills in place.
We just celebrated our 10th wedding anniversary, and we're only five years in this situation so I don't claim to know how Michael Schiavo may feel after 14 years. But if he's entered into a new relationship, and money isn't an issue, then why not return custody of his wife to her parents and let God and them decide how and when she should die? Her parents seem, after all, to be aware of what it takes to care for Terri. It takes so much to care for a loved one, and if someone is willing to do that, especially her mom and dad, they should be allowed to. They did all they could to make her worth marrying, and they should not be kept from caring for her to the end, no matter how futile it seems to courts or anyone else.
I hope and pray that Michael Schiavo would return Terri to her parents and move on with his new relationship.
Aylin Oflas couldn't afford to get the fat liposuctioned from her thighs at home in Germany. So she went back across the border to the Polish doctor who had fitted her with breast implants last year -- and asked what he could do.
It didn't take the 18-year-old Berliner long to choose Poland once again for her latest transformation.
'For what it costs in Germany to get rid of the fat in my inner thighs, the doctor here will also take out fat around my knees and in my lower back,' Oflas said after driving more than two hours to consult with her surgeon in Szczecin. 'And I'll even be able to get my lips made bigger while I'm at it.'
The price: $3,300 -- against $12,300 in Germany.
Oflas joins a rising number of Germans and others from western Europe who travel to Poland -- and other new EU members such as Hungary and Slovakia -- to pay less for plastic surgery, fertility treatment and dental work.
Kaiser Rhapsody: Is Kaiser Permanente the future of American healthcare? It sure sounds like paradise:
After 18 years in private practice, Dr. Victor Silvestre was exhausted from his lonely battle, day after day, with a health care system that seemed to be working against him. A general practitioner, Dr. Silvestre found it increasingly difficult to get his patients appointments with specialists, who tended to focus on lucrative procedures instead of routine care. Paperwork and haggling with insurance companies, he said, took more and more time. 'There just had to be a better way,' he recalled.
For Dr. Silvestre, the better way was not across the border in Canada, or in some affluent nearby suburb, but in his own backyard, in Oakland. Two years ago, he joined Kaiser Permanente, the huge health maintenance organization based here. 'So many of the solutions, the ingredients of a more rational system for delivering health care, were there,' he said.
Dr. Silvestre does look happy in that picture. Look, he even has time to shop for tomatoes. Although, not too much time. He didn't have time to take off his lab coat. One of my on-call partners fled Kaiser for a traditional practice. He hated it. The paperwork and administrative hassles were part of the reason, but he also disliked the constrained environment. His treatment had to stay within rigid guidelines, no room to tailor it to the individual patient. And continuity of care, surprisingly, was a problem. When a patient calls Kaiser for a sick appointment, at least around here, they're given an appointment with the doctor who is on duty for sick calls that day - not necessarily their own doctor. And if they're sick, but want to come in tomorrow- not today - they're told to call back tomorrow for an appointment.
What I see when I review the old records of my patients who have transferred from Kaiser is pretty good preventive care, but overall care that is very disjointed. And despite what the article says, Kaiser is very much the grandpappy of the HMO's. Didn't we try that in the 1990's and find it to be extremely unpopular?
The innovative programs the article mentions - management programs for chronic illnesses such as heart disease and diabetes - are already in use by other insurance companies. Most of my patients have enthusiastically signed up for these in areas as diverse as depression management to asthma management only to have their interest dwindle with time. They all end up complaining about the "nagging phone calls" that are an inhrent part of those programs.
You'll notice that all of the glowing comments about Kaiser in the article come from health policy analysts and experts. What do the patients think? Not much. posted by Sydney on
11/01/2004 07:21:00 AM
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