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."


"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.
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 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.""


""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. 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.



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 (, 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

"", 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. 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

All about Kerry's health-care plan

Nicole Griffin: Kerry, Healthcare, and Unmitigated Disaster

[Via The Shape of Days]

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 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$]

Friday, October 22, 2004

UT El Paso: Herbal Safety

UT El Paso: Herbal Safety

" "In the past decade, there has been an increased interest in herbal medicines and treatments, both from the mainstream medical community and the general public. One need look no further than the cold drink section of the local supermarket to see the various herbal supplements that are prominently displayed on many drink labels. In an effort to provide critical evaluations of these various herbs and related products, the University of Texas at El Paso has created this important website in order to disseminate information about research findings related to herbal use and to provide these findings in both English and Spanish." "

[Via The Scout Report]

Medical Economics - Malpractice: Who should judge the experts?

Medical Economics - Malpractice: Who should judge the experts?:

" "Doctors who serve as expert witnesses for malpractice plaintiffs are finding themselves threatened by their state and specialty societies." "


" "...last May, the Federation of State Medical Boards adopted a resolution defining "false, fraudulent or deceptive" expert witness testimony by a physician as "unprofessional conduct." "

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!

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!
- 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." " 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.


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] Kerry Exaggerates Role in Some Key Legislative Battles 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 F