Monday, November 1, 2004
Why I'm Not Getting A Flu Shot
As a physician, excuse me, 'health care worker involved in direct patient care', I am entitled to receive a flu vaccine under the national guidelines published by the CDC. I know the nurses that work in the operating room are scrambling to 'get theirs.'
There's just one problem, though. People with influenza don't come to the operating room. Even if they did, we all wear masks, often wear gloves, and try to be diligent about washing our hands and using alcohol rubs--all the things one is encouraged to do to reduce the risk of transmission. It's hard for me to see why we'd be a population at risk compared to, say, floor nurses or ER staff.
The right things to do is skip it in order to leave more doses available for 'at-risk' groups.
Poland Attracts Plastic Surgery 'Tourism'
Poland Attracts Plastic Surgery 'Tourism'
""A rising number of Germans and others from western Europe are traveling to Poland - and other new EU members such as Hungary and Slovakia - to pay less for plastic surgery, fertility treatment and dental work."
...[snip]...
"Breast enlargement, for instance, starts at around $3,200 in Poland, but runs between $6,150 and $9,800 in Germany. A nose job costs $2,000 to $2,500 in Poland, $4,900 to $7,400 in Germany.""
[Via My Way News: ]
Sunday, October 31, 2004
Poland Attracts Plastic Surgery 'Tourism'
Poland Attracts Plastic Surgery 'Tourism'
""A rising number of Germans and others from western Europe are traveling to Poland - and other new EU members such as Hungary and Slovakia - to pay less for plastic surgery, fertility treatment and dental work."
...[snip]...
"Breast enlargement, for instance, starts at around $3,200 in Poland, but runs between $6,150 and $9,800 in Germany. A nose job costs $2,000 to $2,500 in Poland, $4,900 to $7,400 in Germany.""
[Via My Way News: ]
WHO Calls Summit to Address Flu Pandemic
WHO Calls Summit to Address Flu Pandemic:
""The World Health Organization has called an unprecedented summit meeting next week of flu vaccine makers and nations to expand plans for dealing with the growing threat of a flu pandemic.Sixteen vaccine companies and health officials from the United States and other large countries already have agreed to attend the summit in Geneva, Switzerland, on Nov. 11, said Klaus Stohr, influenza chief of the United Nations' health agency.With increasing signs that bird flu is becoming established in Asia and several worrisome human cases that can't be linked directly to exposure to infected poultry, it's only a matter of time until such a virus adapts itself to spread more easily from person to person and cause a severe worldwide outbreak, he said.""
[Via My Way News]
Are we making more terrorists?
Are we making more terrorists? Beldar's Blog handles answering the argument better than I ever could.
"
"Radical Islamic extremists are not like poison ivy — "don't scratch it, it'll only get worse!" The necessary premise of this argument is, "If we'd only — (choose one or more) — (a) let them alone, (b) treat them with due respect, (c) allow them to drive Israel into the sea, then they wouldn't keep flying airplanes into our buildings, blowing up school busses, kidnapping and beheading civilians, etc."
"These folks won't be happy until my two daughters are in burqas and they and I together are under the watchful eyes of thought-and-conduct police who'll correct any deviation from their approved path. They won't be happy until our civilization is destroyed and replaced with one that they've dictated."
"
Before you vote, please go read the rest of his essay.
And that, ladies and gentleman, is the single most important reason I am voting for George W. Bush on Tuesday despite, to quote George F. Will's column today,
"...[George W. Bush's] passivity about spending (he has vetoed nothing), his enlargement of the welfare state (the prescription drug entitlement), his expansion of inappropriate federal responsibilities (concerning education grades K-12, through No Child Left Behind) and his complicity in vandalizing the Constitution (he signed the McCain-Feingold bill that rations political speech). "
[Via BeldarBlog]
More on the Dangers of eVoting
More on the Dangers of eVoting:
Slashdot points to a scholarly article out of Yale which makes the case that "Small vote manipulations can swing elections" (registration required)
""This emphasizes the importance of a voter-verified audit trail as protection against this sort of pervasive, subtle manipulation. To guard against such an attack, the correspondence between each voter's intentions and the tally reported by the system must be made absolute by such means as the Mercuri method [8], where each voter personally verifies a machine-produced paper ballot that is then counted by machine in a reliable, repeatable manner, but can nonetheless still be counted manually.""
I'm sure there's be a chapter on this in John Fund's next edition of 'Stealing Elections' (Amazon)
[Via Slashdot]
Stop the Shakedown
WSJ: Stop the Shakedown:
""The defeat of most lawyer-curbing initiatives follows a depressing script. Armed with favorable opinion polls, confident reformers begin collecting signatures. After some time they realize that the lawyers are doing far better than they are at framing the issues in the press, polishing sympathetic anecdotes and exploiting distrust of change (especially if reforms are to be inscribed in a state constitution). While lawyers summon help from partners such as the AFL-CIO and Sierra Club, natural allies on the reform side sit things out. Soon the "No on Amendment Z" side has run the table on newspaper endorsements. Then the massive ad buys have their effect..""
[Via medpundit]
Saturday, October 30, 2004
One Shot Eases Pain After Surgery
It is well known that the injection of a small dose of morphine into the epidural space or cerebral spinal fluid can provide significant post-operative pain relief for as long as 24 hours. The FDA has approved a liposome formulation of morphine that can double that duration. DepoDur, a morphine sulfate extended-release liposome injection, was approved in May, 2004.
""The recommended dose is 10 mg for caesarean section, 10-15 mg for lower abdominal surgery and 15 mg for major orthopaedic surgery of the lower extremities. Some patients may benefit from a dose of 20 mg.
...[snip]...
The most common adverse events reported during clinical trials were decreased oxygen saturation, hypotension, urinary retention, vomiting, constipation, nausea, pruritus, pyrexia, anemia, headache and dizziness.""
More information at SkyePharma.
[Via Yahoo! News: Health]
Election Litigation Watch 2004
http://www.litigationwatch2004.com/ contains links to news coverage of lawsuits in the 2004 Elections.
Friday, October 29, 2004
Rendell Misstates The Issue
Rendell is finally doing the right thing:
""Under pressure from military voters and Republicans, [Pennsylvanie] Democratic Gov. Ed Rendell said Friday that he will ask a federal judge to extend the deadline for counting overseas ballots by one week.
Rendell told a news conference in Philadelphia that Republicans could produce only one voter - out of 26,000 overseas military and civilian voters - who failed to get the absentee ballot he requested." [
My Way News]"
The issue is not whether people got ballots, governor. The issue is the the fact that they got them late yet the deadline for their return was unaltered. It appears that will now be rectified.
Thursday, October 28, 2004
Wyoming med-mal study
Wyoming med-mal study:
""The Milliman actuarial firm projects what will happen if Wyoming enacts a cap on non-economic damages. According to
Martin Grace's summary [pdf], the study's simulation model "suggests that the cap [at a level of $250,000] will reduce losses and loss adjustmen expenses by about 15%""
[Via PointOfLaw Forum]
CME Credit: Malignant Hyperthermia
Malignant Hyperthermia:
""Should all patients with suspected malignant hyperthermia undergo a diagnostic muscle biopsy? Read this Clinical Update to learn the answer. (CME,CE)
Medscape Medical News""
[Via Medscape Headlines]
NEJM: Health Care Coverage and Drug Costs — The Candidates Speak Out
The editors asked President George W. Bush and Senator John F. Kerry to respond to two questions regarding health care in the United States. Free full text.
Mortality Rates Associated with Community-Acquired Bacterial Meningitis over the Past 90 Years.
NEJM: Mortality Rates Associated with Community-Acquired Bacterial Meningitis over the Past 90 Years
""The history of community-acquired bacterial meningitis arguably represents the best example of the salutary effect of the introduction of antimicrobial agents. Before the use of specific antiserums, the outlook for patients with bacterial meningitis was dismal (see Figure). In the 1920s, 77 of 78 children at Boston Children's Hospital who had Haemophilus influenzae meningitis died...""
Lot's of progress. Lots more work to do. Much of it by drug companies...
Wednesday, October 27, 2004
Yahoo! News - Anesthesiologists Vulnerable to Drug Abuse
Yahoo! News - Anesthesiologists Vulnerable to Drug Abuse:
""Drug abuse among some anesthesiologists may be linked to exposure to low doses of powerful anesthetic drugs administered intravenously to surgery patients, according to a University of Florida study.
Anesthesiologists who sit near a patient's head during surgery are subject to secondhand exposure to anesthetic drugs exhaled by the patient, explained Dr. Mark Gold, a distinguished professor with UF's McKnight Brain Institute.""
and
""Easy access to drugs is a current theory that seems to offer a simple explanation for higher addiction rates among anesthesiologists, said Dr. Mark Aronson, a professor of medicine at Harvard Medical School (news - web sites). However, drug usage is monitored much more closely by hospitals now. That makes access to those drugs more difficult and the easy access addiction theory less plausible.""
Wrong. (I love telling Harvard people that.) I have yet to meet a monitoring system I can't beat if I really want to divert drug.
FactCheck.org: Media Fund Twists the Truth More Than Michael Moore
Media Fund Twists the Truth More Than Michael Moore
Radio ad claims most air traffic was grounded when bin Laden's family was allowed to leave. Not true. In fact, the FBI questioned 22 of them and found no links to terrorism.
"
"Summary
This anti-Bush radio ad is among the worst distortions we've seen in what has become a very ugly campaign. It states as fact some of the most sensational falsehoods that Michael Moore merely insinuated in his anti-Bush movie Farenheit 9/11 .
The ad was released Oct. 25 by The Media Fund, an independent Democratic group run by former Clinton deputy chief of staff Harold Ickes. It falsely claims that members of the bin Laden family were allowed to fly out of the US "when most other air traffic was grounded," though in fact commercial air traffic had resumed a week earlier.
The ad also falsely claims that the bin Laden family members were not "detained," when in fact 22 of them were questioned by the FBI before being allowed to leave -- and their plane was searched as well.
And by the way, the man who gave approval for the flight wasn't Bush or even any of his close aides, it was former White House anti-terrorism chief Richard Clarke, now one of Bush's strongest critics."
"
Bob Woodward: Decision Iraq
In Decision Iraq (washingtonpost.com), Bob Woodward has 22 questions for John Kerry about Iraq: Would Kerry Have Done Things Differently?
Though Woodward has tried, the Kerry campaign is refusing to grant an interview. 'Never explain, never apologize'.
I see a problem with getting his answers now, though: hindsight bias.
[Via TechCentral Station]
Is the Hockey Stick Broken?
More on global warming science:Is the Hockey Stick Broken?
Four Myths About Social Security
Four myths about social security:
- The Pension Myth
- The Transition Cost Myth
- The Baby Boomer Myth
- The Medicare Myth
[Via Marginal Revolution]
Is Kerry Proposing Government Health Care?
Medpundit opines:
""Any plan that expands Medicaid to include over 50% of the population - which is what the Kerry plan does - is a plan that involves government take-over of the healthcare system. There's just no getting around it.UPDATE: People are asking, "where does Kerry say he's going to put over 50% of the population on Medicaid?" His healthcare plan calls for expanding Medicaid coverage to children families that make up to 300% of the federal poverty level. According to the 2004 Federal Poverty Guidelines, 300% of the federal poverty level for a family of four would be a yearly income of $56,500. And according to the U.S. Census Bureau, the median yearly income in 2003 for family households was $53,991. Assuming that the average family is a family of four, that means that over 50% of families would qualify for Medicaid. And believe me, employers won't foot the bill for healthcare insurance when they know their employees can get Medicaid. So a large segment of the population will be shifted to Medicaid, and that's a government healthcare program.""
Ramadan Thus Far
Found a great new blog written by an Army Blackhawk pilot in Iraq. His post on 'Ramadan Thus Far' contains the following line I just love about why things are harder for terrorists in the Sunni triangle:
"" It's hard to execute a good plan when you're dead.""
[Via Clayton Cramer's Blog]
Tuesday, October 26, 2004
Anesthesia Can Dim Elderly Patients' Minds (?)
'Anesthesia Can Dim Elderly Patients' Minds' or
Longitudinal Asssessment of Neurocognitive Function in Elderly Patient after Major, Noncardiac Surgery (pick your title):
""Conclusion: Elderly patients experience a high prevalence and persistence of cognitive decline after major, noncardiac surgery characterized by early improvement followed by a later decline. Cognitive impairment at hospital discharge predicts long-term cognitive impairment. Future investigations should evaluate the mechanisms responsible for postoperative cognitive decline and interventions to reduce this serious complication.""
The actual scientific abstract is here.
Though intriguing, it's only an abstract. There are so many confounding factors, it's really hard to know what to make of this on first blush. Where's the control group? Wouldn't it be better to have a control group that did NOT have surgery or anesthesia at all and see how they fared after two years?
[Via Yahoo! News: Health]
Monday, October 25, 2004
CDC: What Everyone Should Know About Flu and the Flu Vaccine
CDC: What Everyone Should Know About Flu and the Flu Vaccine
New Interim Guidelines Address Use of Antiviral Medications for Influenza
Influenza Antiviral Medications:
2004-05 Interim Chemoprophylaxis and Treatment Guidelines
""Influenza antiviral medications are an important adjunct to influenza vaccine in the prevention and treatment of influenza. In the setting of the current vaccine shortage, CDC has developed interim recommendations on the use of antiviral medications for the 2004-05 influenza season. These interim recommendations are provided, in conjunction with previously issued recommendations on use of vaccine, to reduce the impact of influenza on persons at high risk for developing severe complications secondary to infection.""
[Via Medscape Headlines]
How To Reduce The Risk Of Catching The Flu
From the JCAHO:
New National Campaign Offers Americans Three Easy Steps To Prevent Infections
The Joint Commission urges Americans to do three easy things to limit the spread of respiratory infections in health care settings and communities.
- Clean your hands – Rub hands vigorously with soap and warm water for at least 15 seconds after using the bathroom, taking out the trash, changing a diaper, or before handling food. Use of alcohol-based hand sanitizers is an acceptable alternative. Americans should also not hesitate to ask their doctors, nurses, dentists or other caregivers whether they have cleaned their hands before rendering care. It is also important that your hands be clean when caring for a sick friend or family member at home.
- Cover your mouth and nose – To stop the spread of infectious diseases through sneezes and coughs, cover your mouth and nose with a tissue, your hands, or the crook of your elbow. Then, remember to wash your hands.
- Avoid close contact – A fever or symptoms of a contagious illness are clear signs to you or your child to stay at home and away from other people, either at work or at school. If you are sick and go to work or school, you place others at risk for getting sick as well.
New site: Legal Reform Now
New site: Legal Reform Now
""
LegalReformNow.com, a new website on legal reform, was launched today. The site is managed by the Institute for Legal Reform (ILR), an arm of the United States Chamber of Commerce committed to tort reform at the state and federal level. LegalReformNow.com is intended as a "clearinghouse for legal reform information on the Web sponsored by a diverse coalition of associations, chambers of commerce, think tanks and state-based legal reform groups."""
[Via PointOfLaw Forum]
Sunday, October 24, 2004
Why Are Oil Prices High When Supply Is Ample?
Clayton Cramer: Why Are Oil Prices So High?
""....And from Adel al-Jubeir, Advisor to the Saudi Crown Prince September 28, 2004 at about 1:40 PM Pacific time, CNBC interview with Maria Bartaromo:
"We believe the price of oil should be between $22 and $28 per barrel. $25 is a good reasonable price. There is no extra demand accompanying today's very high price for oil. We are seeing no extra customers lined up and there is no shortage of supply. The high prices we are seeing are due to speculation in the oil markets."""
George Will On Voter Fraud
George F. Will at TownHall.com: How Voter Fraud Threatens Our Democracy
Medical Care Gets Outsourced, Too
Washington Post: Surgeries, Side Trips for 'Medical Tourists'
Affordable Care at India's Private Hospitals Draws Growing Number of Foreigners:
""Taking his cue from cost-cutting U.S. businesses, Staab last month flew about 7,500 miles to the Indian capital, where doctors at the Escorts Heart Institute & Research Centre -- a sleek aluminum-colored building across the street from a bicycle-rickshaw stand -- replaced his balky heart valve with one harvested from a pig. Total bill: about $10,000, including round-trip airfare and a planned side trip to the Taj Mahal.""
[Via Digital Claudio...]
Review of Pediatric Sedation
Review of Pediatric Sedation:
""Sedating children for diagnostic and therapeutic procedures remains an area of rapid change and considerable controversy. Exploration of this topic is made difficult by the fact that the reports of techniques and outcomes for pediatric sedation appear in a wide range of subspecialty publications and rarely undergo comprehensive examination. In this review article, we will touch on many aspects of the topic of pediatric sedation from the perspective of the anesthesiologist. We begin with a review of the historical role of anesthesiologists in the development of the current standards for pediatric sedation. We also examine the current status of pediatric sedation as reflected in published studies and reports. A specific review of the issues surrounding safety of sedation services is included. Current trends in sedation practice, including the expanding role of potent sedative hypnotic drugs outside the field of anesthesiology, are noted. Finally, we suggest future areas for research and clinical improvement for sedation providers.""
[Via Anesthesia and Analgesia: Current Table of Contents]
Surgical Cause of Vocal Cord Paralysis
Guilt by proximity? On more than one occasion (including one very recently), I've received calls from patients complaining of laryngeal symptoms after my general anesthetic. In every case, their surgeon suggested to them that since their symptoms are in their voice box, it must have been something the anesthesiologist did since they stuffed a tube in there. Here's a great example of why it 'ain't necessarily so:'
Vocal cord palsy as a complication of adult cardiac surgery: surgical
correlations and analysis.
Author(s): Dimarakis I; Protopapas A;
""Vocal cord palsy after adult cardiac surgery is often attributed to non-surgical
mechanisms as tracheal intubation and central venous catheterisation.It
may also be caused by injury of the recurrent laryngeal nerves by surgical
dissection. We hereby present a review of relevant clinical reports. The
cumulative incidence was 1.1% (33 in 2980). Main reported surgical mechanisms
of injury were harvesting of internal thoracic artery and topical coldcardioprotection.
Bilateral nerve palsy has been lethal on at least one occasion. Where
vocal cord injury followed harvesting of the left internal thoracic artery,
it was reported ipsilateral to the conduit."
"
European journal of cardio-thoracic surgery: official journal of the European
Association for Cardio; 2004 Oct 1;26(4) p773 - 775
[Via Journals To Go]
Saturday, October 23, 2004
Heal the Law, Then Health Care
I'm reading more about Expert Medical Courts. Although my initial reaction is to avoid the creation of a new expert medical court beurocracy, I'm beginning to see the necessity of it.
Heal the Law, Then Health Care
Troyen A. Brennan and Philip K. Howard
The Washington Post, January 25, 2004
""What's missing from the current debate is any discussion of how the legal system should work in health care. Law is not some sort of sacred mandate but a tool to serve the common good. Asking how law can best serve health care leads to an unavoidable conclusion: A system of justice must be created that makes deliberate judgments -- reliable for patients and providers alike -- with improved patient care as the primary goal.""
Deficit Decline
Jack Kemp--Deficit declines $100 billion:
""Looking ahead to the next four years, our goal should be economic growth rather than reducing deficits per se. If growth is the goal, then tax increases, trade restrictions and nationalized health care are the wrong choices. If long-term growth is our goal, then we will reject tax-and-spend redistributionist policies masquerading as fiscal discipline; and, if long-term growth is our goal, we will continue to pursue lower tax rates on all Americans, free trade, less regulation, tort reform and entitlement reform. Those are the right choices. ""
(emphasis mine)
[Via Kudlow's Money Politic$]
