Sunday, October 17, 2004
Coping Strategy For Lack Of Flu Vaccinations
In discussing the issue of influenza vaccinations with your doctor, you should be aware that there are ways to treat the flu once you get it. One drug is called Tamiflu (oseltamivir phosphate). Relenza (Zanamivir) is another. Tamiflu comes in capsule and oral suspension form whereas Relenza is inhaled via 'diskhaler'. These drugs interfere with the ability of Influenza A and B to aggregate and be released from cells. Both are 'designer drugs' in that their molecular structures were created in the lab specifically for their anti-neuraminidase activity:
""What is Tamiflu used for?
Tamiflu is for treating adults, adolescents, and pediatric patients 1year of age and older with the flu whose flu symptoms started within the last day or two. Tamiflu is also used to reduce the chance of getting the flu in people age 13 and older who have a higher chance of getting the flu because they spend time with someone who has the flu. Tamiflu can also reduce the chance of getting the flu if there is a flu outbreak in the community."
"
Though clearly not a substitute for flu shots, their lack of availability makes having a 'Plan B' necessary. If history is any guide, Tamiflu and Relenza will become commodity drugs just like ciprofloxacin was after the Anthrax scare.
Rush Limbaugh Is Playing The Blame Game
Michelle Malkin has a quick note on the flu vaccine shortage, and points to a Rush Limbaugh piece: Clintons Ruined Vaccine Industry. Rush basically argues that it's all Hillary's fault because of her role in the Government Vaccine Buying Program. This is a classic case of hindsight bias; the tendency of people with outcome knowledge to exaggerate the extent to which they would have predicted the event beforehand. Yes, I'm sticking up for Hillary here. It IS a powerful example of why the approach taken by the vaccine buying program is flawed. What we should be doing is asking ourselves whether we need to make changes vis-a-vis our other vaccine programs.
The October 14, 2004 Wall Street Journal editorial 'Infectious Politics' (reproduced here) has some disturbing statistics:
- Hib1 3
- Influenza 2
- Hepatitis A 2
- Hepatitis B 2
- DTaP2 2
- Measles, mumps, rubella 1
- Tetanus 1
- Tetanus-diphtheria 1
- Polio 1
- Chickenpox 1
- Pneumococcal conjugate (children) 1
- Pneumococcal polysaccharide (adults) 1
- Meningococcal 1
and asks the question:
"
"Whether or not Chiron disclosed enough about its manufacturing woes is an issue of financial regulation. The main question for public health ought to be how did we arrive at a place where closing a single plant can endanger so many people?"
"
Let's stop playing the blame game and figure out how to improve our vaccine production system. To again quote the WSJ piece:
"
"There's no shortage of ideas for how to promote greater vaccine production, with many of the best ideas coming from the few manufacturers that remain. Now would be a good time to hear them out. As deadly as the flu is, consider the dangers of such infectious diseases as measles or whooping cough. Those are the next outbreaks to worry about if Washington keeps blaming everyone but itself for the vaccine crisis."
"
Lancet: Summary of Flu Vaccine Woes
The Lancet: Vaccine preparedness, or not:
The problem
"
"So, what went wrong at Chiron's production plant in Liverpool, UK? On Aug 26, according to Chiron, Serratia marcescens was found in a "small number of lots". The company informed health agencies in the UK and USA, and planned to delay release of the vaccine until early October while it tried to resolve the contamination issue. S marcescens is an important human pathogen because of the growing number of cases of infection by this organism, its virulence, and its increasing resistance to antibiotics. MHRA visited the Liverpool site, and Chiron thought it could address the concerns of the inspectors. The problem, says MHRA, is that the contaminated lots cannot be separated from the whole batch."
"
The lesson:
"
"There is a lesson here, about vaccine supply. It is not sensible to restrict manufacturing licences, in the case of influenza vaccine and especially in the USA, to two suppliers. At a blow, half this year's stocks were impounded. The risk (of faulty batches) should be spread across several manufacturers."
"
Saturday, October 16, 2004
Kerry Blames Bush For......Vaccine Shortage?
I sense the Kerry campaign is growing desperate.
"
"Kerry accused Bush of missing signs that a flu vaccine shortage was imminent."
"
Okay, Senator, but only if you promise to accept responsibility for every bad outcome, drug shortage, and lack of promised savings on importing drugs from Canada.
[Via Yahoo News]
New CryptoGram
Bruce Schneier on:
- Keeping Network Outages Secret
- RFID Passports
- Disrupting Air Travel with Arabic Writing
- Crypto-Gram Reprints
- News
- Counterpane News
- The Legacy of DES
- The Doghouse: Lexar JumpDrives
- License Plate "Guns" and Privacy
- Aerial Surveillance to Detect Building Code Violations
- Terror Threat Alerts
- Academic Freedom and Security
in the latest
CryptoGram.
[RSS]
FactCheck.org: Kerry Exaggerates Role in Some Key Legislative Battles
FactCheck.org Kerry Exaggerates Role in Some Key Legislative Battles
"
"The Associated Press last July found that only eight laws had Kerry as their lead sponsor, five of them "ceremonial," two relating to the fishing industry, and one providing federal grants to support small businesses owned by women."
"
Twenty years. Part of why Democrats are so upset is that their primary system left them with a loser like this. I'd be upset, too.
New Blog. Same (Power) Tools.
As I was explaining to a colleague how I write my blog, I realized that I have not explained how this effort works to anyone and some might find it interesting (at the very least, the people who make the tools will).
This web site (or blog) is a Conversant site. That means it's backed up by a content management system per excellence (and I don't use even 5% of that functionality in this weblog--though others do) from Macrobyte Resources. Rather than a dedicated blogging system, Conversant is the super Swiss Army knife of web groupware and the tool I'm using is it's Weblog II tool. I don't write each web page, Conversant does. I don't write all the links, Conversant does. I don't organize things into subject-specific pages, Conversant does. I don't worry about creating a searchable database. Conversant does. Got it?
A brief word about the appearance of this site. I didn't think of it and it's not one of the Conversant built-in templates (though there are many of those, too). It's a theme used with permission drawn by well known weblog designer Bryan Bell called Brushed Adamant. I've simply adapted it to Conversant, so 'thanks' Brian! The only way to describe this is 'generous.'
Posting to this weblog can be accomplished in many ways: WYSIWYG browser-based editor, e-mail (!), and an application that interacts with weblogging software via something called XML-RPC. In my case, I use MarsEdit for OS X from Ranchero Software:
"
"MarsEdit is a weblog editor for Mac OS X that makes weblog writing like writing email—with spell-checking, drafts, multiple windows, and even AppleScript support.
It works with various weblog systems: Blosxom, Conversant, Manila, Movable Type, Radio UserLand, TypePad, WordPress, and others.
It’s currently in beta."
"
It makes blogging, especially if you have multiple blogs as I do, exceedingly easy.
Ranchero also makes NetNewsWire Pro for OS X, my 'aggregator'. An aggregator goes to a list of sites you specify, requests a special kind of file (an RSS file) that lists any changes made to the site and displays them in a nice interface for the user to browse. It makes it easy to keep track of over 90 sites and what's being posted. Once I identify an item I want to add to my own blog and comment on, it's just one click to get it into MarsEdit. Within NetNewsWire, I've used the smart lists to alert me to posts and news items that relate to categories in this weblog for special attention.
The MacOS X community is still small. The author of NetNewsWire Pro and MarsEdit, Brent Simmons, used to work for UserLand software, the company that created Frontier, the application on which Conversant is built. I've never met Brent face-to-face, but you get a feel for a person through beta testing for them, e-mailing, et-cetera, and he's 'good people,' as we used to say in Montana. Bryan Bell, the graphics designer, has created many themes for Userland and, in fact, drew the icons used in NetNewsWire and MarsEdit. Seth Dillingham of Macrobyte/Converant is a personal friend, a Frontier developer, and a friend of Brent Simmon's. It's really, really neat to use software written by people you feel you know. Almost as neat as using
and paying for software written by people you feel you know.
Bill Kristol: 'Fair Game'
"Fair Game"
"
"Does he really think they will believe that he singled out Mary Cheney because he "was trying to say something positive about the way strong families deal with this issue?" Does he think they will accept his claim that he was saying something about the Cheneys' "love of their daughter"? Of course, he wasn't. In his answer, he never mentioned or came close to mentioning the Cheney family, or the Cheneys' love. He merely brought up Mary Cheney as a lesbian, out of left field, in order to get her name and sexual orientation into an answer where no such citation was expected, called for, or remotely appropriate. His campaign manager let slip the truth when after the debate she told Fox News's Chris Wallace that Mary Cheney was "fair game."
"
Just How Many Bills Has Kerry "Passed?"
FactCheck.org:Bush said Kerry passed five bills. Kerry said he's passed 56. Who's right? That depends on the definition of "passed" and "bills."
Morning Java: Crop Circles, Space Aliens, and a Draft
Morning Java: Crop Circles, Space Aliens, and a Draft:
""What do you say to someone who continues to believe that the sky is green, even when presented with a color wheel, a scientific explanation, and perhaps 264 signed affadavits to the contrary?
What do you say to someone who continues to defend his theory that crop circles are a warning system sent by aliens, even when presented with video evidence of "crop artists" caught in the act of creating said crop circles, admissions of guilt as to when, where, and how the circles were created, and perhaps 264 affadavits signed by witnesses to said crop circle creation?
What do you say to someone who continues to believe that a liar and a traitor is a "war hero," even when presented with documentation, audio and video recordings, numerous witness testimonials, and 264 signed affadavits to the contrary?
I think you'd have to say either "You obviously are not interested in the truth" or "You've obviously lost your marbles."""
[Via Shape of Days]
Luscious Lips
For longer general anesthetics, anesthesiologists often place a lubricant on the eyes before taping them closed. We tape them closed to avoid corneal abrasions and prevent drying. Lacrilube is the product most commonly used and it contains white soft paraffin, liquid paraffin and lanolin alcohols. Here's the hint: it works great as a lip balm, too! Just a dab on the lips and your patients will roll into the recovery room with shiny, luscious smackers and you'll earn yourself five easy style points, too.
Don't Get Admitted On The Weekend
Effects of weekend admission and hospital teaching status on in-hospital mortality.
The American Journal of Medicine.; 2004 Aug 1;117(3) p151 - 157
Conclusion: Patients admitted to hospitals on weekends
experienced slightly higher risk-adjusted mortality than did patients
admitted on weekdays. While overall mortality was similar for patients
admitted to all hospital categories, the weekend effect was larger in
major teaching hospitals and is cause for concern.
St. Caffeine and Anesthesia
If you're an anesthesiologist or surgeon, a significant number of your patients are caffeine dependent. Being aware of this fact and planning for it will significantly improve your patient's operative experience. In fact, if you're an anesthesiologist or a surgeon, you're probably caffeine dependent, but that another blog post. In my pre-op visits with patients, I ask if they are regular caffeine drinkers, if so, how much, and what happens if they don't have any caffeine on a given day. For patients that report headaches without daily caffeine intake, I plan on administering caffeine.
The most convenient form pre-op is injectible Caffeine and Sodium Benzoate (though tablets are also available). Our formulation comes in a 2 cc vial, of which each cc contains 121mg of anhydrous caffeine. I think of each cc as being the equivalent of one cup of coffee or one can of Diet Coke. Yes, there are studies. Here's one of them: Prophylactic intravenous administration of caffeine and recovery after ambulatory surgical procedures. The cost? About $3.50 per vial. About the same as a tall latte with extra foam (in Europe). I typically administer one cc IV very slow push, and squirt the other cc into the iv bag.
You know what I think the biggest benefit is? It's not just the lack of headache (they weren't expecting a headache when they came in) it's the feeling that they're being well cared for. Sort of like bringing them a warm blanket. Oh, and the nurses will be very impressed, too.
p.s. the title of this post refers to a song by John Gorka called St. Caffeine:
I've seen the light, oh the light I've seen
I've seen the light of St. Caffeine
Of other drugs I am clean
I pray to you St. Caffeine
I moved this over from my personal blog
State Limiting Obesity Lawsuits
Obesity lawsuits:
"
"Michigan becomes the thirteenth state to ban civil lawsuits 'against restaurants and other sectors of the food industry for serving or making food that made people fat' by way of specific legislation. The Michigan Trial Lawyers Association opposed the measure...."
"
[Via PointOfLaw Forum]
Retired Gen. Franks On The Violence In Iraq
Yahoo! News - Retired Gen. Franks Criticizes Kerry:
""In an interview before the rally, Franks said he doesn't foresee an endless cycle of violence in Iraq, and he thinks violence will diminish after the Nov. 2 election.
"I believe they (insurgents) are influenced by what they see in our media," he told The Associated Press. "They see if they blow something up it's front-page news ... (and) the presidential candidates will talk about it.
"After Nov. 2, that dynamic will leave. The problem won't go away, but it'll be diminished ... This will be a long process, but there will come a time when the insurgents have less opportunity to create mischief for us," he said.""
[Via Beldar Blog]
Vaccines: The Long Run
Vaccines: The Long Run:
"
"Yesterday
I discussed some of the reasons for the current shortage. Today, I will discuss an
important paper by Michael Kremer and Christopher Snyder. Kremer and Snyder argue that for the same cost and effectiveness drugs are more profitable to produce than vaccines. As a result, private incentives bias the market against vaccines."
"
[Via Marginal Revolution]
Charles Krauthammer on Spinal Cord Injury and Campaigns
Charles Krauthammer weighs in on the Edward's 'Promising the Sky':
"
"In my 25 years in Washington, I have never seen a more loathsome display of demagoguery. Hope is good. False hope is bad. Deliberately, for personal gain, raising false hope in the catastrophically afflicted is despicable."
"
[Via PRESTOPUNDIT]
A Little Friendly Family Election Competition: Part II
My Bush sign is basically a plastic bag with writing on it. My spouse's Kerry sign is made of cardboard and will likely not last through the first rain storm.
Advantage: Bush (again)
Friday, October 15, 2004
Pennsylvania: Court Strikes Nader From Pennsylvania Ballot
The New York Times > Washington > Campaign 2004 > Pennsylvania: Court Strikes Nader From Pennsylvania Ballot:
"
"In reviewing signatures, it became apparent that in addition to signing names such as Mickey Mouse, Fred Flintstone, John Kerry and the ubiquitous Ralph Nader, there were thousands of names that were created at random and then randomly assigned either existent or nonexistent addresses by the circulators."
"
Embarrassing for my state.
Yahoo! News - No Chance of Chiron Vaccine, U.S. Says
Yahoo! News - No Chance of Chiron Vaccine, U.S. Says:
"
"None of Chiron Corp.'s flu vaccine made at a British plant is safe, which means the U.S. flu vaccine supply will be half of what was expected, U.S. health officials said on Friday."
"
Serratia contamination.
Yahoo! News - Fines, Jail Used to Enforce Flu Shot Rules
Yahoo! News - Fines, Jail Used to Enforce Flu Shot Rules:
"
"As the vaccine shortage hits home and long lines queue around the supermarket, a handful of states and the nation's capital are threatening doctors and nurses with fines or even jail if they give flu shots to healthy, low-risk people.
Health care violators in Michigan face a misdemeanor punishable by up to six months in jail and a $200 fine if convicted, the health director said.
At least four other states %u2014 Massachusetts, New Mexico, Oregon and Wisconsin %u2014 and Washington, D.C., have issued similar orders with varying penalties."
"
MIT Technology Review: Global Warming Bombshell
""Suddenly the hockey stick, the poster-child of the global warming community, turns out to be an artifact of poor mathematics.""
See the analysis at http://www.uoguelph.ca/~rmckitri/research/trc.html. Why not in a major scientific journal? Because Nature rejected it. You decide.
[From MIT Technology Review]
Thursday, October 14, 2004
Vaccines: The Short Run
From a new weblog I discovered today:
Vaccines: The Short Run:
""President Bush was correct when he said that liability risk is one factor in the recurrent shortage of vaccines...
...
[snip]
...
Liability is not the only issue, however. Costly FDA regulations and requirements, for example to remove thimerosal from vaccines despite no evidence of safety problems, have pushed firms out of the industry.
A further problem is that the federal government is the major purchaser of vaccines, although not the flu vaccine, and it uses its monopsony powers and the law to require companies to sell at low prices. Firms have left the industry because they are squeezed on one end by regulation and on the other by low prices and, for vaccines like the flu vaccine not covered by VICP, potential liability. Note that even if the prices are high enough to earn the company a modest profit the point is that they are not high enough to make it worthwhile to make a surplus of vaccine that can be sold in the event of a contamination problem, as has happened this year. If the firms can't price high during a shortage then there is no incentive to plan for a shortage.""
[Via Marginal Revolution]
BMJ--Lessons from the withdrawal of rofecoxib
British Medical Journal: Lessons from the withdrawal of rofecoxib:
""Suggested measures to ensure drug safety before definite licensing of a drug:
- Legal requirement for drug companies to register all randomised controlled trials prospectively
- Legal requirement for drug companies to make all data on serious adverse events from clinical studies publicly available immediately after study completion
- Continuously updated systematic reviews of adverse events based on published and unpublished data from randomised controlled trials and observational studies
- Phased introduction of new interventions in independent, large scale, randomised trials before definite drug licensing
- Clear cut financial firewalls between pharmaceutical companies and researchers performing systematic reviews and clinical studies
""
New FactCheck.org Document
New And Recycled Distortions At Final Presidential Debate
""The debates are over and the results are clear: both candidates are incorrigible fact-twisters.
"Bush said most of his tax cuts went to "low- and middle-income Americans" when independent calculations show most went to the richest 10 percent. Kerry claims Bush "cut the Pell Grants" when they've actually increased. Both men repeated misstatements made in earlier debates, and added a few new ones.""
Wednesday, October 13, 2004
Two New Swiftvets Ads
Swiftboat Veterans and POW's for Truth have released two more ads titled "They Served" and "Why" and both feature Bud Day. These are the most powerful ads to date.
NEJM -- Controlling Health Care Costs
Just released by the New England Journal of Medicine--Controlling Health Care Costs (no registration required for this article):
""Every year, without fail, spending for services covered by private health insurance increases. Sometimes health care spending grows slowly, as it did in the mid-1990s during the managed-care boom. But more often, it increases rapidly, as it is doing now--in part because of the managed-care bust. Presidential candidates do not want to venture beyond platitudes concerning costs because they risk being accused of taking things away from people. Both President George W. Bush and Senator John F. Kerry have served up proposals designed to ease voters' angst about the affordability of health care, but neither proposal, as it has been elaborated through September, gets at the core issues involved in controlling the growth of health care costs.""
New York Expands Drug Pricing Website
New York Expands Drug Pricing Website:
""
New York State Attorney General Eliot Spitzer rolled out an expanded version of his
drug pricing Web site yesterday, hoping to assist those New Yorkers lacking
health insurance or prescription drug benefits to comparison shop. From Long Island
Newsday:
The online reference guide includes the 25 most popular prescription drugs on the market, and, for the first
time, has prices from pharmacies in all of the state’s 62 counties.
”With information from this Web site, consumers, especially seniors on fixed incomes, the uninsured and those
lacking adequate prescription drug coverage, can comparison shop and keep their costs as low as possible,” Spitzer
said in a prepared statement.
Under current New York State law, each pharmacy is required to carry an expanded version of this guide, known as
the Drug Retail Price List, which covers nearly 150 prescription drugs, and customers are able to view it at any
time.
""
[Via The Medical Informatics Weblog]
Tuesday, October 12, 2004
Nobel laureate calls for steeper tax cuts in US
Yahoo! News - Nobel laureate calls for steeper tax cuts in US:
""Edward Prescott, who picked up the Nobel Prize for Economics, said President George W. Bush's tax rate cuts were "pretty small" and should have been bigger.
"What Bush has done has been not very big, it's pretty small," Prescott told CNBC financial news television.
"Tax rates were not cut enough," he said. Lower tax rates provided an incentive to work, Prescott said.
Prescott and Norwegian Finn Kydland won the 2004 Nobel Economics Prize for research into the forces behind business cycles."
"
Reminder: Afghanistan is free now
Jeff Harrell reminds us that Afghanistan is free now!:
""[Afghanistan's free elections] is the kind of story that America is going to forget about quickly. There are no lurid pictures, there's no ongoing scandal … there's no angle at all, really. A bunch of people got together and elected their president. The fact that it's for the first time ever and that it couldn't have happened if not for the sacrifice of the men and women, both American and Afghan, who participated in Operation Enduring Freedom is just a footnote.
I don't think that's right. I think liberating — not "liberating" as a euphemism, but literally liberating, literally making free — a country of 20 million people is the sort of thing that we need to keep talking about for a while. I think it's something we need to remind ourselves of periodically, lest we forget about it.""
[Via The Shape of Days]
Promising the Sky
Promising the sky just to get elected...
""When John Kerry is president, people like Christopher Reeve are going get up out of that wheelchair and walk again.'
- --John Edwards, 11 October, 2004"
"
And he knows this how, exactly? If, as Richard Feynman said, 'a scientist looking at nonscientific problems is just as dumb as the next guy', what about a medical malpractice attorney-turned-politician looking at a medical problem? I'll let you answer that for yourself. I knew when I heard that Christopher Reeve had died, that we'd be hearing about it from the Kerry/Edwards campaign somehow. I had no idea they would use the occasion to try to create such false hope.
I'm sure Charles Krauthammer will have plenty to say on this quote in an article I bet he's preparing right now.
10-15-2004: And here it is.
[Via Froggy Ruminations]
U.S. FDA Tried to Block Vioxx Results: Lawmaker
U.S. FDA Tried to Block Vioxx Results: Lawmaker:
""U.S. Food and Drug Administration officials pressured an agency safety official to keep quiet or water down his findings that the now-withdrawn arthritis drug Vioxx was dangerous to the heart, a leading Senate Republican charged on Thursday.
Senate Finance Committee Chairman Charles Grassley said he interviewed FDA scientist David Graham as part of the committee's probe of how the agency handled the Merck & Co. Inc. drug, which the company pulled a week ago.
According to a statement from Grassley, Graham said he had been "ostracized" and subject to "veiled threats" and "intimidation" from within the FDA when he tried to get his research published in the weeks before Merck acknowledged Vioxx's risks.""
U.S. Health Officials Release National Flu Pandemic Plan
U.S. Health Officials Release National Flu Pandemic Plan:
""The Dept of Health and Human Services recently released its plan to respond to and prepare for an influenza pandemic, detailing domestic actions as well as its role in the global health community.
The Nation's Health""
[Via Medscape Headlines]
Project Vote Smart
Project Vote Smart:
""
Thousands of candidates and elected officials. Who works for you? Who is seeking your vote? Project Vote Smart, a citizen's organization, has developed a Voter's Self-Defense system to provide you with the necessary tools to self-govern effectively: abundant, accurate, unbiased and relevant information. As a national library of factual information, Project Vote Smart covers your candidates and elected officials in five basic categories: biographical information, issue positions, voting records, campaign finances and interest group ratings. What would you like to know?"
"
[Via The Shape of Days]
Pennsylvania Medical Society | Medical Society Project Helps Stop Frivolous Lawsuits
Pennsylvania Medical Society | Medical Society Project Helps Stop Frivolous Lawsuits:
""In May of 2004, the first case was settled by the Society’s project against frivolous lawsuits, resulting in an apology from the offending attorney and an agreement to make an undisclosed monetary payment.
The countersuit was brought by Dr. Charles Dunton, a gynecological oncologist from Delaware County against Diane Rice, Esq., of Bucks County. Ms. Rice had filed a medical malpractice action on behalf of her client against Dr. Dunton, in which she accused him of providing inadequate care. That action was eventually resolved in Dr. Dunton’s favor when the Ms. Rice was unable to produce an expert to support her allegations.
In her apology Ms. Rice admitted she did not obtain an opinion from a qualified medical expert prior to filing the suit."
"
Pennsylvania Medical Society | FAQ: Act 13 Physician Self-reporting Rules
Pennsylvania Medical Society | FAQ: Act 13 Physician Self-reporting Rules:
- How did the physician reporting provisions come to be included in the law?
- What tort and insurance reforms were created by Act 13?
- What patient safety elements were included in the law in exchange for these reforms?
- What are the physician reporting requirements under Act 13, and should physicians be alarmed by these or by the State Board’s investigation process?
- How does the State Board determine which cases warrant an investigation?
Monday, October 11, 2004
Swift Vets Lock and Load
The Swift Boat Veterans for Truth are preparing several more TV ads to feature Bud Day, winner of the Congressional Medal of Honor. If you haven't yet, read the book and make up your own mind about whether these guys have a point.
[Via Michelle Malkin]
Halliburton Speaks (at last)
A Tough Job, and Halliburton Does It:
"" As the rhetoric heats up further in the few weeks before the election, we hope you will ask yourself: Do I have all the facts?
For instance, there are frequent references to our "no-bid" contract to support the U.S. soldiers in Iraq. The fact is that after a fully competitive and open bid process we were awarded a contract in 2001, well before the war in Iraq, to provide logistical support for U.S. soldiers wherever they might be deployed.
KBR did receive, at the outbreak of the war, a sole-source contract issued under urgent conditions to quickly restore the flow of Iraqi oil. But what you will not often read is that the independent General Accounting Office has since reviewed the contract and reported that it was "properly awarded … to the only contractor [the Defense Department] had determined was in a position to provide the services within the required time frame given classified prewar planning requirements." And you will almost never read that profit margins on these contracts are extremely low and that the oil contract was replaced early this year by one that was competitively bid.
Mischaracterizations and incomplete facts do a grave disservice to the employees and subcontractors who are working in Iraq. Never before has any contractor worked in as dangerous a situation as they are. Halliburton is providing jobs for Americans, and we are supporting the troops with the largest civilian workforce ever assembled in support of a military operation.""
[Via INTEL DUMP]
Sunday, October 10, 2004
JCAHO Sentinel Event Alert: Intraoperative Awareness
Sentinel Event Alert, Issue 32 - October 6, 2004: Preventing, and managing the impact of, anesthesia awareness
"
"Anesthesia awareness is under-recognized and under-treated in health care organizations. The Joint Commission recommends that health care organizations which perform procedures under general anesthesia do the following to help prevent and manage anesthesia awareness:
1) Develop and implement an anesthesia awareness policy that addresses the following:
- Education of clinical staff about anesthesia awareness and how to manage patients who have experienced awareness.
- Identification of patients at proportionately higher risk for an awareness experience, and discussion with such patients, before surgery, of the potential for anesthesia awareness.
- The effective application of available anesthesia monitoring techniques, including the timely maintenance of anesthesia equipment.
- Appropriate post-operative follow-up of all patients who have undergone general anesthesia, including children.
- The identification, management and, if appropriate, referral of patients who have experienced awareness.
2) Assure access to necessary counseling or other support for patients who are experiencing post-traumatic stress syndrome or other mental distress."
"
That Dog Don't Hunt
Huntin' Dawg:
"
"If there is some kind of award given for the most derisive and biting political advertisement of the campaign, then
this one from the NRA has my vote. "
"
Warning: be sure your mouth does not have coffee in it before looking at the ad.
[Via Froggy Ruminations]
You Can Run But You Can't Hide
Power Line explains the origin of the line Bush used on Kerry--'You Can Run But You Can't Hide'
""At one time, everyone would have known the source of that line; today I'm sure most people do, but probably not all... For those who may have forgotten, Joe Louis was preparing for a title bout against Billy Conn, and a reporter asked Louis how he planned to deal with Conn's speed. (Conn was, in fact, a terrific boxer.) Louis replied, unforgettably: "He can run, but he can't hide.""
Can We Learn Something From The Flu Vaccine Shortage?
I hadn't thought of this until Michelle Malkin pointed it out in her excellent weblog:
""Why on earth does the U.S. get virtually all of its flu vaccine supply from just two manufacturers? Because federal bulk purchase of vaccines at government-controlled prices has made the vaccine market a market that few drug companies want to be in.
[snip]
...the flawed approach used by the CDC--that is, using its buying clout to extract deep discounts from manufacturers--is exactly the same approach that John Kerry
thinks the Medicare program should use for
all prescription drugs, not just vaccines. More on our flawed vaccine policy
here and
here.""
[Via Michelle Malkin]
JibJab: It's Good to be in DC
It's Good to be in DC:
[Via Morning Java]
Saturday, October 9, 2004
Are Drug Company Profits Really That Fat?
Drug companies are widely perceived by the public to make huge amounts of money for their investors. Is that true? Well, it depends....
New England Journal of Medicine, August 26, 2004, 'The Pharmaceutical Industry--Prices and Progress':
"
"Year after year, the pharmaceutical industry has ranked at or near the top of Fortune magazine’s annual list of the most profitable American industries, which are rated in terms of accounting returns as a percentage of either stockholders’ equity or total assets. But here, too, there is an element of fallacy. Under standard accounting practice, outlays for research and development are written off in the year they occur. But, in fact, such expenditures are an investment, yielding fruit many years after they are incurred. They ought, in principle, to be included in the company’s assets and then depreciated over an appropriate time period. When they are not, the capital base to which profits are related in standard measures tends to be undervalued, and percentage returns on that capital base are overstated. A
government study found that, when appropriate corrections were made, the true returns on investment by the pharmaceutical industry during the 1980s were only 2 to 3 percent higher, on average, than “normal” competitive rates of return, which were estimated to average roughly 10 percent (excluding the effects of inflation). 19,20 This differential of 2 to 3 percent might have been attributable, at least in part, to technological risks not readily avoided through the portfolio strategies available to financial market investors. 21 Whether the differential has remained within that range in recent years has not been tested by broadly accepted analyses."
--F.M. Scherer, Ph.D., Kennedy School of Government
"
Given that the pharmaceutical industry does its R&D from private funds, is the most research intensive of all industries, and has improved our quality of life like few industries have or ever will.....'the first thing we do, let's kill all the lawyers'.
Device To Improve Venipuncture Accuracy
Vein contrast enhancer improves chances you'll get stuck only once:
"
"Herbert Zeman has invented a device he calls the vein contrast enhancer (VCE) that is aimed at reducing failed
attempts at hitting the vein the first time during blood tests, injections, and IV drip insertions. The device
uses infrared LEDs to point out areas of high blood concentration, which, if the patient is in fact human, are
veins. The LEDs illuminate the skin at a wavelength of 740 nanometers which is highly-absorbed by blood and
dispered by fat and other tissue. The result is an image that represents the location of veins. This image
is then projected back onto the skin using a “hot mirror” that ensures accuracy within 0.06mm.""
[Via Engadget]
Media Underplaying Duelfer Report
Michael Barone joins with David Brooks in...:
""U.S. 'Almost All Wrong' on Weapons" read the headline on the October 7 Washington Post. "Report on Iraq Contradicts Bush Administration Claims" read the subhead. But these headlines conceal the real news in the report of Iraq Survey Group head Charles Duelfer. For the report makes it plain that George W. Bush had good reason to go to war in Iraq and end the regime of Saddam Hussein...."
[
read the rest]"
Like I said, don't just be content to let some reporter tell you what is says. Go look for yourself...
[Via Instapundit.com]
David Brooks: The Report That Nails Saddam
The Report That Nails Saddam:
"" ...I have never in my life seen a government report so distorted by partisan passions. The fact that Saddam had no W.M.D. in 2001 has been amply reported, but it's been isolated from the more important and complicated fact of Saddam's nature and intent.
But we know where things were headed. Sanctions would have been lifted. Saddam, rich, triumphant and unbalanced, would have reconstituted his W.M.D. Perhaps he would have joined a nuclear arms race with Iran. Perhaps he would have left it all to his pathological heir Qusay.
We can argue about what would have been the best way to depose Saddam, but this report makes it crystal clear that this insatiable tyrant needed to be deposed. He was the menace, and, as the world dithered, he was winning his struggle. He was on the verge of greatness. We would all now be living in his nightmare."
"
[Via Bush-Cheney '04 Blog]
Friday, October 8, 2004
Kerry's Malpractice Reforms Would Do Little
Kerry once again referred to the 'plan' he and his doctor-suing trial lawyer running will implement as tort reform. Declarations and Exclusions disarticulates his 'plan' nicely:
""Pre-filing certification is already required in some states, and there is nothing here to suggest any safeguards to ensure that the reviewing doctors are themselves objective and reliable. Under current law a medical malpractice case is generally not viable without at least one expert witness who will opine that the defendant doctor fell beneath accepted practice standards. Pre-screening may simply require the plaintiff's attorney to find that expert sooner rather than later.
"Most courts encourage mediation in all cases, not just medical malpractice claims, in an effort to reduce crowded courtroom dockets. Mediation is almost always a preferable alternative to litigation, but the quality of mediators is variable and resolution always depends on both sides taking a realistic approach to the claim. There is, sadly, no way to legislate reason or good sense if any of the parties or lawyers don't have it to begin with.
"The proposal for barring attorneys who file multiple "frivolous" suits is likely to prove illusory. "Frivolous" is a high standard, generally requiring a showing that no reasonable attorney would ever have believed that the claim had merit. If a pre-screening requirement is also in place, the allegedly frivolous advocate will likely be able to escape by the simple expedient of having "reasonably relied" on the opinion of the reviewing doctor.
"In many states, the proposed changes to punitive damage law would be no change at all, while in others a "gross negligence" standard would actually expand punitive damage claims. Under current California law, for instance, "negligence" no matter how gross will not support a claim for punitive damages, which are permitted almost exclusively in cases of intentional wrongdoing and "despicable" conduct.""
Importing drugs from Canada, which imports drugs from, where?
Watching the second presidential debate tonight, one question the voters need more information on is importation of drugs from Canada. Allow me to quote a letter to the editor of the New England Journal of Medicine:
""Pharmaceuticals valued at approximately $300 million (all amounts are expressed in U.S. dollars) were imported into Canada in 2002 [
reference] from countries without mutual-recognition agreements about manufacturing practices. [
reference] Twenty-five such countries (including China, India, Brazil, Hungary, Slovenia, Ecuador, Thailand, Croatia, Chile, South Africa, Argentina, and Indonesia) each exported $300,000 to $59 million worth of pharmaceuticals to Canada. [
reference] In 2002, the value of imports from Thailand, Indonesia, Argentina, Ecuador, Chile, and Brazil were 264 percent, 296 percent, 500 percent, 501 percent, 512 percent, and 3270 percent higher, respectively, than they were in 1999. In the first three quarters of 2003, the value of imports from Iran increased to $1.5 million (a 2372 percent increase over the total value in 2002).
"Because drugs from Internet suppliers may originate outside Canada and the United States, neither government takes responsibility for their safety. Canada should take prompt action to prevent large-scale, unregulated, cross-border sales to avoid any negative outcomes from drugs whose origin is unclear and whose quality is unknown.""
Contrary to what Senator Kerry would have you think, drugs purchases in Canada are not necessarily made in the Unites States. You're indirectly buying them from Thailand, Indonesia, Argentina, Ecuador, Chile, Brazil, and Iran.
Consider the following as well: is importation of drugs from Canada sustainable? There's good reason to think not:
""The mass exportation of prescription medication to the United States threatens the preferential pricing set by the Patented Medicine Prices Review Board.2 Companies may also choose not to market medication in Canada in order to protect the larger and more lucrative U.S. market.3 At risk is nothing less than the ability of countries to set their own policy regarding pharmaceuticals. The availability of Canadian medication is not a viable long-term solution to the problems of drug costs in the United States and represents a substantial threat to the access and affordability of drugs in Canada." [
NEJM]"
12 October 2004: Brian Carnell responds here.
NEJM -- Prescription-Drug Prices
NEJM -- Election 2004: Prescription-Drug Prices (available free):
""At first blush, Kerry's positions appear to be more "consumer friendly" than Bush's. Kerry supports policies that create stronger downward pressure on prescription-drug prices than Bush's policies do. This more aggressive stance toward controlling today's drug prices must be considered in light of the effect of lower prices on the flow of new drugs that will be available to the next generation of consumers. Bush supports policies that protect the existing drug-price structures in the name of ensuring adequate economic incentives to innovate.
"The United States is entering uncharted waters in both of these key areas — the importation of prescription drugs and the role of the government in controlling their cost. A voter's choice between the candidates might well be guided by philosophy and a sense of whether profits in the pharmaceutical industry are high enough so that reductions in drug prices would not substantially impede the development of future drugs.
"Importation would have some predictable consequences: U.S. prices would decrease, the world would move toward a single price for a given drug, and Canada and Europe would probably make larger contributions toward the cost of research and development. The magnitude of the financial gain in the United States, however, is uncertain; my guess is that there would be modest price reductions for consumers in the United States and substantial price increases for Europeans and Canadians."
"
The fly in the ointment here is the American health consumer's desire to have the best medical care in the world, have it for free, and have it now. I think they like the idea that drugs will be cheaper---even if it means having fewer 'new' drugs going forward. There are great drugs in the pipeline. Great new ideas for how to better treat asthma and diabetes and heart disease. They'll still be there, but will it be as soon if we reduce the premium drug companies charge for new drugs? I don't think so. I personally would favor streamlining the drug approval process and shortening the time until generics are available first.
