Thursday, October 21, 2004
The John Edwards Fan Club
"
"Why, I asked, should we carry a $100,000 medical school debt, stay in school for 8 to 12 years, work long hours during and after residency, and fight the bloated bureaucracy of the health care system, when we can get rich quickly by following John Edwards? So here is what I proposed. We physicians should take turns suing one another..."
"
[Via Point Of Law Forum]
BMJ Review: Risks of general anaesthesia in people with obstructive sleep apnoea
Risks of general anaesthesia in people with obstructive sleep apnoea
""Summary points
Patients with obstructive sleep apnoea are at high risk of developing complications when having surgery or other invasive interventions under general anaesthesia, whether or not the surgery is related to obstructive sleep apnoea
Surgeons of all specialties, and especially anaesthetists, should be aware that undiagnosed obstructive sleep apnoea is common
They should be alert to patients who are at risk of having obstructive sleep apnoea and be aware of the potential preoperative and postoperative complications in such patients
Management options include alternative methods of pain relief, use of nasal continuous airway pressure before and after surgery, and surveillance in an intensive care unit, especially after nasal surgery in which packs are used
An algorithm for management of difficult airways should be established""
Common Good: Expert Medical Courts: An Idea Whose Time has Come
Common Good: Expert Medical Courts: An Idea Whose Time has Come:
""A
recent editorial by Dr. Charles Lockwood, Chair of the Department of Obstetrics and Gynecology at the Yale University School of Medicine, endorses Common Good's proposal to create special health courts and calls on doctors to "rally behind [the proposal] by joining and supporting Common Good."
Lockwood lists six key benefits that a health court would produce, including "consistent judgments on standards of care by court appointed experts; accountability for negligent and reckless providers; and powerful incentives for quality improvement in medical systems."
"
Here's my litmus test for this one. Let's ask John Edwards if he thinks it's a good idea. If no, I'm for it. If yes, I'm against it
Failing the Public Health — Rofecoxib, Merck, and the FDA
Failing the Public Health — Rofecoxib, Merck, and the FDA
"
"I believe that there should be a full Congressional review of this case. The senior executives at Merck and the leadership at the FDA share responsibility for not having taken appropriate action and not recognizing that they are accountable for the public health. Sadly, it is clear to me that Merck's commercial interest in rofecoxib sales exceeded its concern about the drug's potential cardiovascular toxicity. Had the company not valued sales over safety, a suitable trial could have been initiated rapidly at a fraction of the cost of Merck's direct-to-consumer advertising campaign. Despite the best efforts of many investigators to conduct and publish meaningful independent research concerning the cardiovascular toxicity of rofecoxib, only the FDA is given the authority to act. In my view, the FDA's passive position of waiting for data to accrue is not acceptable, given the strong signals that there was a problem and the vast number of patients who were being exposed."
"
Emphasis mine.
NEJM -- Bankrolling Stem-Cell Research with California Dollars
NEJM--Bankrolling Stem-Cell Research with California Dollarscontains a very informative passage about how stem cells are obtained:
""What is at issue here is that the derivation of an embryonic stem-cell line requires the dissection and culturing of about 30 cells from the core of a blastocyst, a microscopic early-stage embryo comprising fewer than 200 cells. The derivation process kills the embryo, even as the stem cells persist and propagate. The embryos themselves are obtained from in vitro fertilization (IVF) clinics, where excess embryos are typically produced in the course of assisted-fertility procedures. An estimated 400,000 IVF embryos are currently in frozen storage and will eventually be discarded, except for those that are donated, with informed consent, for use in research. Some religious conservatives and opponents of abortion have taken a firm stance on what seems to be tenuous, ultimately unsustainable moral, ethical, or logical ground: acquiescence to the discarding of excess IVF embryos, coupled with rigid opposition to the use of embryos for biomedical research.""
The same issue contains another article titled Embryonic Stem-Cell Research — The Case for Federal Funding. Both are available free (kudos to NEJM for this).
CME Watch
CME Watch:
""Now there's a freebie,
CME Watch v0.4, to help you keep tgrack of your CME activities!
 Description:
Introducing CME Watch - Track your CME Hours Easily on your Palm.
No more worrying about whether you've accumulated enough hours.
Use the summary function to add up all the CME hours!
Useful for : Physicians, Nurses, Respiratory Therapists....anyone who needs to attend and keep track of Continuing Medical Education Time!
Featuring:
- Automatically Adds and Summarizes Total CME Hours
- Ability to also track days for CME Allowance.
|
""
[Via The Palmdoc Chronicles]
NEJM: Financing Medicare in the Next Administration
Financing Medicare in the Next Administration (free full text)
"
"Because of its size and political impact, Medicare will rank high on the domestic policy agenda of any incoming administration. When that administration assumes office in January 2005, Medicare will account for more than 13 percent of total federal expenditures; the only larger domestic program will be Social Security, which will account for 21 percent.1 By fiscal year 2007, with the phase-in of the prescription-drug benefit, Medicare's share of federal spending will increase to almost 16 percent. In short, the new administration will find the scope of any new initiatives limited by the needs of the Medicare behemoth."
"
Have You No Shame Senators? - Judson Cox
Have You No Shame Senators? - Judson Cox:
"
"Sen. Kerry also sought to take advantage of Reeve's tragedy. According to Tribune National Correspondent, Jill Zuckman, Kerry claimed Reeve called him on the night of the second debate, and left a message thanking him for supporting stem cell research. The excitement in his voice was really just palpable. He was just thrilled at where the discussion of stem cell research had come to." Reeve had already fallen in to a coma at the time Kerry claims he called. Kerry's willingness to exploit people and situations knows no bounds."
"
Bush and GOP Sites Outage, DDOS Attack Suspected
Bush and GOP Sites Outage, DDOS Attack Suspected:
""Web sites for President Bush's campaign and the Republican National Committee are investigating outages.""
[Via eWEEK Technology News]
Wednesday, October 20, 2004
Pentagon Says No Need for a U.S. Draft of Doctors (Reuters)
Pentagon Says No Need for a U.S. Draft of Doctors (Reuters):
""Reuters - The Pentagon said on Wednesday it
does not need or want a draft of doctors and other medical
workers even as another agency updates contingency plans for
such a draft in the event of a national catastrophe.""
[Via Yahoo! News: Top Stories]
Access to Physicians Figures Prominently In Complaints
Annals of Family Medicine: Patient Reports of Preventable Problems and Harms in Primary Health Care:
"
"Conclusion: The errors reported by interviewed patients suggest that breakdowns in access to and relationships with clinicians may be more prominent medical errors than are technical errors in diagnosis and treatment. Patients were more likely to report being harmed psychologically and emotionally, suggesting that the current preoccupation of the patient safety movement with adverse drug events and surgical mishaps could overlook other patient priorities."
"
[Via Science Blog - Science News Stories]
Why Do Carbs Turn To Fat?
Researchers uncover process for carb-induced fat formation:
""Researchers are one step closer to understanding how high carbohydrate diets lead to obesity and diabetes. They have shown that a single protein called carbohydrate response element binding protein activates several genes that cause cells in the liver to turn sugar into fat.""
[Via Science Blog - Science News Stories]
Medical Economics - How I pick the doctors I'll sue
Medical Economics - How I pick the doctors I'll sue:
"
"Many complaints filed against physicians are based on their miscommunication with patients, nurses, or other doctors. But even well-intentioned efforts to improve doctors' communication skills run into opposition from the medical profession. For instance, the National Board of Medical Examiners has introduced a one-day exam designed to test doctors' ability to communicate with patients, as well as their clinical skills. Unfortunately, the American Medical Association has opposed the test, and vows to block its implementation."
"
Tuesday, October 19, 2004
Must Read: Tommy Frank Sets Kerry Straight
New York Times: War of Words
"
"...But the gravest danger would result from the withdrawal of American troops before we finish our work. Today we are asking our servicemen and women to do more, in more places, than we have in decades. They deserve honest, consistent, no-spin leadership that respects them, their families and their sacrifices. The war against terrorism is the right war at the right time for the right reasons. And Iraq is one of the places that war must be fought and won. George W. Bush has his eye on that ball and Senator John Kerry does not."
"
Tommy Franks Sets Kerry Straight. 'Honest, consistent, no-spin leadership.' I love it. Hey, anybody got Chris Matthew's phone number?
[Via Captain's Quarters]
T-Line Tensymeter Instead of Arterial Lines
I remember seeing this product at an anesthesiology meeting last year and thinking how great it would be for bariatric surgery (gastric bypass operations on the morbidly obese). It's an external device which, when strapped to the wrist and calibrated, can give a very accurate blood pressure reading. Depending on their upper arm morphology, a non-invasive blood pressure cuff may not work reliably in morbidly obese patients if the upper arm is cone-shaped. I used to start arterial lines on these patients, but this device, would be an alternative.
As almost all gastric bypass operations I give anesthesia for are done laparoscopically, this is less and less of an issue for me personally.
[Via EchoJournal]
Monday, October 18, 2004
How Technology Failed In Iraq
MIT Technology Review: How Technology Failed In Iraq
"
“Next to the fall of Baghdad,” says Marcone, “that bridge was the most important piece of terrain in the theater, and no one can tell me what’s defending it. Not how many troops, what units, what tanks, anything. There is zero information getting to me. Someone may have known above me, but the information didn’t get to me on the ground.” Marcone’s men were ambushed repeatedly on the approach to the bridge. But the scale of the intelligence deficit was clear after Marcone took the bridge on April 2."
"
FactCheck.org: Kerry Falsely Claims Bush Plans To Cut Social Security Benefits
Kerry Falsely Claims Bush Plans To Cut Social Security Benefits
"
"It's not Bush's plan, and it wouldn't cut benefits.
Summary
A Kerry ad claims "Bush has a plan to cut Social Security benefits by 30 to 45 percent." That's false. Bush has proposed no such plan, and the proposal Kerry refers to would only slow down the growth of benefits, and only for future retirees. It was one of three possible "reform models" detailed by a bipartisan commission in 2001.
The ad also says nothing about what Kerry would do to address the troubled state of Social Security finances. Unless taxes are increased, the system's trustees say currently scheduled benefits would have to be cut 32%."
"
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?
