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Saturday, February 25, 2006

'Walmart Death'

Such is titled a Slate article comparing the current situations of physicians refusing to help with executions and pharmacists refusing to hand out morning after pills.

It is indeed a shame that California is a state with a law on the book requiring pharmacists, despite any conscientious objector claims, to dispense morning after pills but looking like it will pass a law prohibiting physicians from taking part in executions (at the behest of the CMA). The two situations, as Slate points out, are certainly analogous, but California is close to taking two very different positions on each.

The March to the Supreme Court

In case you somehow missed it, South Dakota has sent a law to the governor which would outlaw abortions unless the mother's life was at risk.

We've got years of court battles until this thing is appealed to the Supreme Court, and certainly the first court that hears this law will strike it down (meaning it won't be enforced between now and the time the Supreme Court is petitioned to hear it).

Personally, if this was put to the Supreme Court today I'm not sure they'd even agree to hear the case. What some people fail to realize is the broad powers the justices have in actually deciding which cases they'll even hear. The court receives petitions to hear far, far, far more cases than it could ever possibly handle.

But that is right now, who knows what it will look like in a few years with this conservative court.

Friday, February 24, 2006

Prostate Cancer Virus

UCSF and Cleveland Clinic researchers have found a previously unknown virus in a significant number of men suffering from prostate cancer.
While the genetics of prostate cancer are complex, one of the first genes implicated in the process was RNaseL, which serves as an important antiviral defense mechanism. Given the anti-viral role of this gene, some scientists have speculated that a virus could be involved in a subset of prostate cancer cases.

"While we can't state that this virus causes prostate cancer, these are remarkable findings because of the association of the virus with the mutation," said Dr. Robert Silverman, collaborating investigator in the study. "This project was possible only because of the willingness of physicians and scientists in different areas of expertise at the two institutions to work closely together towards a common goal, that of identifying a new infectious agent in prostate cancer."

Don't Ask About Guns

In Virginia it may soon become illegal for pediatricians to ask parents about gun ownership or provide unsolicited counsel to parents on gun safety. Is this for real?

I am for broad gun ownership protections but this has nothing to do with firearm rights. This has to do with free speech protections and the fact that guns really do cause injuries, none of which are more tragic than when it involves a child.

If gun owners with children are really that offended they should find new pediatric care or new insurance that allows them to choose another pediatrician.

H/T Kevin, MD

Civil War Health

From AMNews (subscription required), is the summary of a study of the post-war mental problems of Civil War veterans. Being a big Civil War history buff...
Dr. Silver and fellow researchers analyzed the military and medical records of 15,027 Union Army veterans from the Civil War. They looked at cardiac, gastrointestinal and mental illnesses during the soldiers' lifetimes. Confederate soldiers did not have a comparable database for study, but researchers suspect that those troops had similar problems.

Civil War soldiers were vulnerable due to close-up combat, bloody battles and other reasons, researchers said. For one thing, family members and friends were often assigned to the same company, and when there were casualties, survivors were left with few remaining friends.

[...]

Soldiers in military companies with larger percentages of fatalities were 51% more likely to have cardiac, gastrointestinal and mental diseases, the study showed.

Walmart Insurance

No, they're not starting to sell it in store. Instead they're about to expand their notoriously poor healthcare insurance coverage provided to employees, even as they fight Fair Share Health. Although, I must say Fair Share sounds like a misguided idea.
The Fair Share Health Care Act, the first of its kind, passed recently in Maryland. The bill requires any company with 10, 000 or more workers to spend 8 percent of its payroll on health insurance. The bill inspired similar proposals in other states.

Off Topic Vidal Hazelton

The #2 wide receiver in the country, Vidal Hazelton, has signed with USC football, all that can be said is finally.

Wednesday, February 22, 2006

Off Topic Iran to The Rescue

So it begins, even as I predicted it wouldn't.
Iran pledged on Wednesday to provide financial assistance to the cash-strapped Palestinian Authority following threats by Western nations to halt aid to a Hamas-controlled government.

"We will definitely provide financial aid to this government so that they can stand up against the oppression of America," Ali Larijani, secretary of Iran's Supreme National Security Council, was quoted as saying by the semi-official ISNA students news agency.

He was speaking after a meeting with Hamas leader Khaled Meshaal, who is touring regional countries in search of financial support.

"We hope that the new Palestinian government overcomes its current problems with the help of Islamic countries, including Iran," Larijani said.

U.S. President George W. Bush on Tuesday said a Hamas-dominated Palestinian Authority should not be funded until it recognised Israel's right to exist.

U.S. and Israeli officials are concerned that Tehran, which also refuses to recognize Israel, will gain influence over a Hamas-led government, hampering efforts to reach a Middle East peace settlement.

Tuesday, February 21, 2006

Don Herbert

Trapped without oxygen for several minutes more than a decade ago, this firefighter apparently went into a coma. Ten years later he suddenly comes about and talks with family members for fourteen hours before regressing a bit and finally, yesterday, dying from pneumonia.

Ten years without a word, and then he comes to almost as if nothing was wrong. Only to be taken away months later.

Physician Assisted Execution

Okay, not quite physician assisted execution but this is pretty weird. How did I not here about this ruling by a federal judge that a physician be on hand for a California execution that was to take place last night, or the execution would violate the 8th Amendment?
The exact wording of the judge's order was not immediately available, but the anesthesiologists issued a statement through the prison saying they were concerned about a requirement that they intervene in the event that Morales woke up or appeared to be in pain.

"Any such intervention would clearly be medically unethical," said the doctors, who have not been identified. "As a result, we have withdrawn from participation in this current process."

The American Medical Association, the American Society of Anesthesiologists and the California Medical Association all opposed the anesthesiologists' participation as unethical and unprofessional.

Prison officials rescheduled the execution for 7:30 p.m. Tuesday and said they would employ a different technique: administering a fatal overdose of barbiturate in lieu of the three-drug cocktail typically used in lethal injections.

Morales' attorneys had argued that the three-part lethal injection cocktail used in California and 35 other states violated the Eighth Amendment prohibition on cruel and unusual punishment. They said a prisoner would feel excruciating pain from the last two chemicals if he were not fully sedated.

[Federal Judge] Fogel refused to derail the execution. But he gave prison officials two options: retain the doctors to ensure Morales would be properly anesthetized, or forgo the paralyzing and heart-stopping drugs and overdose him on a sedative. With the anesthesiologists withdrawing, prison officials said they would use the second option.

Arguments that lethal injection constitutes cruel and unusual punishment have been shot down for years by the courts, so I'm wondering what new enlightening information was this judge presented with that prompted this kind've bizarre ruling?

By the way I'm against the death penalty (unless the victim was someone I cared for).

Monday, February 20, 2006

The Match

Judging a residency's competitiveness is a difficult thing, except for the early match programs which release detailed statistics through the SF Match.

Still, the data I like to look at to get a general sense is the US Applicants-to-Spots ratio. There are definite shortcomings in using these numbers but I think they give a general sense of just how competitive certain specialties are right now.

As you can see Integrated Plastic Surgery takes the cake with more than 3 US medical school graduates vying for every 1 residency spot.

Integrated Plastic Surgery
US Applicants 275
Residency Spots 81
Ratio 3.39

Dermatology
US Applicants 709
Residency Spots 316
Ratio 2.24

Radiation Oncology
US Applicants 267
Residency Spots 137
Ratio 1.95

General Surgery
US Applicants 1978
Residency Spots 1051
Ratio 1.88

Orthopaedic Surgery
US Applicants 1002
Residency Spots 610
Ratio 1.64

Radiology
US Applicants 1467
Residency Spots 1018
Ratio 1.44

Anesthesia
US Applicants 1767
Residency Spots 1283
Ratio 1.38

Pediatrics
US Applicants 2394
Residency Spots 2269
Ratio 1.05

Medicine
US Applicants 4859
Residency Spots 4768
Ratio 1.02

Family Practice
US Applicants 2332
Residency Spots 2761
Ratio .84

Sunday, February 19, 2006

Medrants v. HCR

My Favorite Medical Blogger versus The Most Irksome Medical Blog. The issue is pharm pricing.

That's not to say HCR still isn't a worthy read.

Saturday, February 18, 2006

A Jury of our Peers?

Television paints the facts and looks for drama, no doubt. Still, if this jury in Missouri ever sat in judgment of me....

Asked by the NBC 48 Hours anchor about the possibility, as presented by the defense, that the State's star witness (who also was one of the perpetrators) had incorporated false memories into his testimony, one juror provided this gem:
"Not in my mind. Just common sense. What's the reason he would make something up like that?"
That is brilliant. Yes, it is just common sense.

I don't care that they found the kid guilty of murder, and I wouldn't care if they understood the scientific testimony and had reasonably dismissed it. Here however at least one juror has completely misunderstood false memory syndrome which, despite being railed against by sexual abuse victim advocates, is pretty generally accepted by the scientific community.

You can see research by one of its primary advocates, Dr. Elizabeth Loftus, here and here. Here is New Scientist summarizing how false and true memories might one day be distinguished out using brain image methods.

The jury system is the keystone around which justice is assured in this country. It is taboo to question its place. However, in cases like this, medical malpractice matters, and any case involving key scientific evidence which is not in the social conscious, there really needs to be a critical reasoning test administered to jurors before they're empaneled. Anyone who is dumb enough not to be able to get out of jury duty shouldn't be allowed to serve in these cases.

Ebola Vaccine

A vaccine for the Ebola Virus has completed initial safety screening in humans. I wonder what it would be like to be one of those 21 participants and what type of safety risks they actually face.

Friday, February 17, 2006

H5N1 Vaccine Update

First posted on here.

This vaccine is from Australia and despite recently completely a round of human trials may not be the end all.
The vaccine is based on the animal-to-human form of the virus. As a pandemic requires a human-to-human virus, the effectiveness of the vaccine in such a situation is uncertain.

Wednesday, February 15, 2006

Worst Case Scenario

142 million dead. Trade comes to a halt.

I'm wondering if this sheds any new light on the situation or was just sent directly to ABC's newsroom.

Public Health Worker #1: "Holy crap, have you seen this report?!"
Public Health Worker #2: "We better work harder!"

Tuesday, February 14, 2006

Walmart Abortions?

In a second state Walmart pharmacies are being forced to carry the morning after pill.

I understand pharmacies need to be regulated and indeed it may be considered a privilege to operate one. But detailing what a pharmacy must carry is ridiculous. There are no reasonable life or death situations that can arise from a pharmacy not stocking specific drugs and that's all the way from controversial morning after pills to vicodin.

Seriously, this is analogous to telling a physician he has to perform a specific type of elective procedure. This is a convenience issue. There are no legitimate concerns about patient care or pharmacies' ethical obligations to community health.

I'll leave you with this:
"I'm proud to be able to tell my patients that they now can go anywhere for their prescriptions," said one of the plaintiffs, Dr. Rebekah Gee, 30, of Boston. "My patients should not have to shop around."
I'll just stare dumbfounded at the quote for a while and then go back to biochemistry.

Orthopedic Insanity

An orthopedic surgeon in Hawaii apparently started an operation only to find after he had opened the patient that he didn't have the titanium rods necessary for the surgery. The solution of course was to cut apart a sterile stainless steel surgical screwdriver (say that ten times fast) and use the screwdriver shaft as a replacement rod.

At least he can cope with the stress of the suit by hanging out on the beach.

H/T to Kevin, MD

Monday, February 13, 2006

Quick, We Won't Sue

Vaccines developed against H5N1 by private pharmaceutical companies will enjoy broad liability protections in an effort to encourage the vaccine development and get the to market quicker.
In December, Congress gave [Director of Health and Human Services] Leavitt the authority to declare when products are necessary "countermeasures" for a public health emergency. The manufacturers and distributors of such products will have sweeping liability protections.

Under the protections, people injured by a vaccine against bird flu would have to prove willful misconduct to bring a claim for damages. Critics have said that such a high threshold would make it almost impossible for people injured by a drug to file a lawsuit.

Sunday, February 12, 2006

Like A Giant Magnet

I wish I had something original to post.

Here's Scott Adams on having an MRI done.
First you fill out a questionnaire designed to discover if you have any metal hidden in your body, such as shrapnel or IUDs or surgical leave-behinds and whatnot. This is important because the MRI is a gigantic magnet.

I’m almost positive that I don’t have an IUD, but the idea of metal ripping through my body and coming out of my ear really made me think about it carefully. I’m not what you call a good detail person, and it’s exactly the sort of thing I would forget having done, perhaps as a college prank. I took a chance and checked “no.”

I didn’t know how forgiving the MRI machine would be, so when I got to the question that asked if I ever worked around metal shaving, I started to panic. I spent countless hours in my youth working with an Etch-a-Sketch, and I don’t know what that grey stuff in there really is. I’d hate to die because I forgot to disclose how many times I tried and failed to draw a circle using only two knobs. But I also didn’t want to appear too concerned. For some reason I felt it was important to impress the MRI technician with my unnatural state of calm. So I took a chance and checked “no.”

SEDS

Sudden Elder Death Syndrome.
"We have no forensic explanation for it," said Dr. Martin Gerrard, chairman of the SEDS Institute. "These seemingly healthy elders—some of whom are performing such normal activities as eating liquefied food, trying to stand up, or taking frequent naps—just stop breathing."


Escapa! The Game

My school is probably far from the most technologically advanced but I think it does a nice job. We have a couple of computerized question banks for anatomy and microbiology. What's becoming common across the country but is still cool is that histology and next year pathology, all the slides are Virtual Microscopy. They're all on this portable 100 GB hard drive and you can zoom in and take screen shots and save interesting things you find. Below is an example.


The problem becomes when I'm using my computer to study I have a tendency to take "internet study breaks". Of recent this game is one of my favorite online distractions.

It is tough. I've heard some ridiculous times on this thing, heading into the minutes. I don't know if I believe that. My best time is just short of 25 seconds.

NPR

You know you're getting older when your car radio is set to NPR all the time and you look forward to Science Friday on Talk of the Nation. Although Ira Flatow's voice annoys the dickens out of me. "Uh huh"

Parasites & Schizophrenia

"On the fringes," but still pretty creepy.
Under normal circumstances, a rat steers clear of cats and their odours. But rats infected with the parasite Toxoplasma gondii develop a deadly attraction to the feline scent. This abnormal behaviour often leads them to the mouth of their predator, and allows the parasite to enter and complete its reproductive cycle in the cat.
What's a little strange is that there is some evidence linking maternal Toxoplasmosis infection with the risk of the fetus developing schizophrenia later in life. As well, anti-schizophrenic drugs were just as effective as relieving the rat attraction to feline scent as anti-parasitic drugs targeted to Toxoplasma gondii.

H/T Slashdot.

Saturday, February 11, 2006

Sharon's Colectomy

Sharon had an emergency colectomy. I'm not sure what this means for his prognosis which of course does not look terribly good.
Mr. Sharon, 77, has been in the coma since suffering a major stroke on Jan. 4, and hopes for a recovery were fading even before the latest complication.
Here's DB's Medical Rants on how Sharon's state can bring the spotlight on end of life planning.

Sharon's new party and his cabinet seem to have carried on his move towards peace well since his incapacitation but with Hamas' win, it is hard to say what the future holds.

Surely you have to applaud the application of democracy even when it brings to power those who you are opposed to. That does not mean that elections don't have consequences. Certainly the Palestinian people understood that electing Hamas had many benefits in terms of halting what they appeared to have viewed as a high level of corruption inside the PLO but that it would also negatively influence their relationship with the western world. I was for the west dramatically cutting Palestine's aid unless the new parliament majority recognized Israel. I didn't buy arguments that this was a sign of U.S. hypocrisy, as in America promotes democracy only as long as the results were favored by us. This would merely be diplomacy amongst legitimate governments.

I've heard some arguments against this course of action of late and they've certainly given me second thoughts. The major one concerns how removing aid would increase anti-western sentiment as well as radicalizing Palestinians even more, secondary to the radical Arab world stepping in with aid and influence after America and Europe removed themselves from the equation.

This doesn't make a lot of sense to me. If Hamas wanted to radicalize even more and come to rely on Iran and other Islamic nations for aid there is nothing stopping them from forgoing American aid programs and seeking closer ties to Tehran. If that resource actually existed and was a real possibility it may happen even without America withdrawing aid.

I think pressure, financial and diplomatic, may be the only thing that causes Hamas to move to the middle.

Head Transplants

Don't let me sound too much like an idiot but I don't want to write off this possibility completely. The possibility, I mean, that someday brain transplants might be possible. That term 'brain transplant' obviously isn't a well defined term. In some ways, brain cell transplant is already being done, and probably close to a breakthrough in terms of effectiveness and comprehensive use.

Dr. Evan Snyder on Time's look at the 21st Century:
Whole-brain transplants are still science fiction. "I never like to say that something's impossible," says Dr. Evan Snyder, a neuroscientist at Harvard Medical School and Children's Hospital in Boston. "I've been burned too many times by categorically ruling something out. And yet I can't imagine that 20 years from now human-brain transplants will be possible. The connections required are just too complex; they number in the millions. But the future of brain-cell transplants--that's another matter."
There are problems beyond anything that has been faced in solid organ transplantation when considering transplanting a brain. Indeed, many of the problems, if they were overcome may undermine the basic need for brain transplants.

But these are problems being worked on. Take the Miami Project To Cure Paralysis which is dedicated to finding a process in which to encourage the regrowth and connection of neurons in severed spinal cords. Such would be a key step in making any crazy-minded Doc's dream of a brain transplant a reality. And don't think there aren't physicians and scientists out there who don't want to do this.
Professor Robert White, from Cleveland Ohio, transplanted a whole monkey's head onto another monkey's body, and the animal survived for some time after the operation.

The professor told the BBC's Today programme how he believes the operation is the next step in the transplant world.

And he raised the possibility that it could be used to treat people paralysed and unable to use their limbs, and whose bodies, rather than their brains, were diseased.





"People are dying today who, if they had body transplants, in the spinal injury community would remain alive."

He said that in the experiment, his team had been able to: "transplant the brain as a separate organ into an intact animal and maintain it in a viable, or living situation for many days."

This is the guy who was featured in a chapter of the quite interesting book Stiff.

The 1st Successful U.S. Heart Transplant?

Almost without dispute the first successful heart transplant was done in South Africa on December 3, 1967 by Dr. Christiaan Barnard.

In the U.S. from what I can tell Dr. Adrian Kantrowitz in Brooklyn, NY attempted the first U.S. heart transplant just days after Barnard but failed. Here's Time Magazine's article from 1967 on the two operations.
Last week, in two hospitals separated by almost 8,000 miles of Atlantic Ocean, the historic juxtaposition happened and the heart transplants were performed. The physicians who performed them thus reached the surgical equivalent of Mount Everest, followed automatically by the medical equivalent of the problem of how to get down —in other words, how to keep the patient and transplant alive.

In this, the team at Brooklyn's Maimonides Medical Center, headed by Dr. Adrian Kantrowitz, admitted "unequivocal failure." Their patient, a 19-day-old boy, died 6-½ hours after he received a new heart.
But who performed the first successful U.S. transplant? I bring this up because Dr. Shumway, who may have the closest thing to a consensus in terms of the claiming the first U.S. heart transplant, has passed away.

However numerous sites, including a history collection at the University of Texas and St. Luke Hospital in Houston's, cite Dr. Denton Cooley as performing the first U.S. heart surgery. Certainly Dr. Cooley was and is a bit of a self promoter, even at this point in his life as I heard him speak but a couple months ago.

The date cited for Dr. Shumway's first transplant is January 1968. Dr. Cooley's first transplant was May 1968.

So what gives? Well, one thought I'm coming up with is the definition of "success". Dr. Shumay's 56 year old patient survived for only 2 weeks in pretty miserable conditions. Dr. Cooley's first attempt, just three and a half months later, lived for almost 7 months.

Wednesday, February 08, 2006

Shelf Exams

I run through the Biochemistry and Anatomy shelf exams in three weeks. These are comprehensive subject tests put out by the NBME, that mimic the questions on the basic science national board exam: USMLE Step 1. In any case, they exist for just about every basic science course and every rotation and many, if not most, schools use them for credit as final exams.

Its a tough round of tests. To top those final exams off I have my regular set of monthly basic science exams along with my first OSCE, which is not the Organization for Security and Cooperation in Europe. Basically they stick a bunch of standardized patients (read: actors) in exam rooms. On the door of every exam room is the history taking or physical exam skills I need to perform with the SP in fifteen minutes. After I'm done the patient has a little form on which s/he grades my interaction with them, how big I smiled, and whether I remembered to auscultate their back or not.

Reasonable Care

Do my arguments against health care as a right disallow standard of care principles?

I argue that defining what one has "rights" to is too inconsistent and variable for healthcare to be an inherent right. Do you get the MRI or not? And while I understand the limitations to rights, I think I've outlined well the comparative high arbitrary level of any definition of healthcare rights compared to, say, other accepted rights.

However, even without establishing health care as a right the American judicial system holds physicians to, not arbitrary, but certain arguable levels of "reasonable care". Indeed, the argument is the center piece of every medical malpractice lawsuit. If the JD's had their way bad outcomes would define negligent standards (and there is only the slightest hyperbole in that statement).

If I refuse to accept applied limits to the right of healthcare does that mean that I must argue against patient protection. I certainly don't wish to argue against standard of care measurements and I don't think I actually have to to maintain my argument.

Certainly my tirade against healthcare as a right is amateurish and has many unidentified flaws (and by that I mean unidentified by myself), some of them probably fatal. I don't think this is one of them.

In one light defining a patient's right to quality once care has commenced but denying the right to care at all seems silly. I think that is a reasonable distinction however. Certainly you'd have to search far and wide to find someone who would argue the practitioner's responsibility to take on all patients in a non-emergent scenario.

I can limit the example to that situation because I've always maintained a right to acute care and nothing more. That in and of itself is an expensive, in terms of both dollars and human life, and sometimes impractical position, and yet one I think is defensible from a more thoughtful approach. Claiming it as a defensible position may be overstating my critical reasoning skills. Enough self insults though. If there's no right to care from a single physician I don't see the argument for the right to care from the physician population.

On the other side once a patient is taken on standards of care become merely the most acceptable form of consumer protection. There's nothing wrong with the government basically dictating the most basic of terms under which a physician takes on a patient, which is basically what reasonable care thresholds are. Government's role is to protect me from you (or the patient from the physician), not to protect you from misfortune (for example, illness or death).

And blah, blah, blah, blah.

Ceragenins

I found this off a business wire, so that might say something. Still, it is novel news, these Vandy and BYU scientists speak very optimistically.
"We found that CSA-54 potently inhibits HIV infection of primary human CD4+ T cells, the virus's in vivo targets, and was not toxic to epithelial cells at concentrations significantly higher than those required to kill the virus," stated Dr. Unutmaz. "In addition, CSA-54 killed a wide range of HIV isolates, and completely blocked genetically engineered HIV that enters the cells independent of the cell surface receptor the virus normally uses. This finding indicates that CSA-54 likely attacks the viral membrane and disrupts the virus from interacting with its target cells, similar to some of the known microbicidal peptides. This is particularly important as a compound that targets the viral membrane is likely to be effective against all strains of the virus, regardless of mutations as the viral membrane remains unchanged."
The drug has no other hype beyond what was posted on the wires today. Searching Google for ceragenins turns up all of 8 results.

Monday, February 06, 2006

More Walk In Clinics

Some Publix Super Markets in Florida are getting their own walk in clinics.

Publix joins a growing list of chain retailers - Wal-Mart discount stores, CVS drugstores and Albertsons supermarkets - venturing into the health care arena by signing up pilot deals for mini-clinics. The bigger ones go by such names as RediClinic, Take Care and Minute Clinic, which uses the slogan: "You're sick. We're quick."

The latest spin on the old doc-in-the-box, walk-in clinic, mini-clinics are even more spartan. They accept Medicare cases, but are not designed strictly for the uninsured. Many negotiated with health insurance companies to be low-cost alternatives that feature lures such as $5 co-payments. Many claim doctors charge two to three times as much for the same services.

Leave It Behind

Shadowing a peds cardiac surgeon made me want to come to medical school. I understand the current status of cardiothoracic surgery (its not been so good) and I know there's much that might influence my decision that I won't experience until I get into the hospital during third year. All that being said, there's no doubt I came into medical school wanting to be a pediatric cardiac surgeon and still do.

All that to introduce an AP article about congenital heart repair patients all grown up:
Only recently have enough of the early survivors reached adulthood for doctors to notice a disturbing trend: Starting about 20 years after childhood surgery, the risk for some serious problems -- irregular heartbeats, enlarged hearts, heart failure, occasionally even sudden death -- begins to rise among people who had complex defects repaired.

Sunday, February 05, 2006

Walmart Healthcare

Are these things safe? What about continuity of care? If this becomes a large spread phenomena how does it affect physician income?

Despite the questions I'm actually not appalled; time will tell and these clinics should at least be given a chance.
"This cost and convenience trend is coming to a head and that's what is driving this trend. My prediction is that it will move quite rapidly," said Matt Eyring, managing director of Innosight, a Watertown, Massachusetts, consulting firm.

The business model is simple -- a medical clinic operated by an outside company, and generally staffed by nurses or physician assistants, offers a limited range of basic tests and treatments at a lower cost than a doctor's office.

Thursday, February 02, 2006

Cortisol & Obesity

If you've watched late night television you're seen supplements that target cortisol and report the ability to help with weight loss.

Cortisol is an adrenal hormone stimulated by ACTH from the pituitary and is related strongly with helping the body cope with stress.

While its true that people who suffer from Cushing's Syndrome (inappropriately high ACTH and Cortisol levels) display strange weight gain and distribution changes, now there's more evidence that lowering cortisol levels does little as a diet treatment. Which further exemplifies why getting your medical information from late night TV is a little shady.

Off Topic College Football Recruiting

By a number of major college football recruiting services (Rivals, Scout, ESPN) USC has ended up with the number 1 recruiting class.

The first day high school football players could commit and sign Letters of Intent was February 1st. It is not often that high profile, talented recruits let the day pass without making it known where they'll attend class and play the following fall.

This year however signing day has come and gone, but still a little bit of drama surrounds one of USC's prize recruits. The either #1 or #2 high school WR in the country (depending on who you ask), Vidal Hazelton, committed to USC but his parents refused to sign his Letter of Intent with him. A parent signature is required on a Letter of Intent until the enrolling athlete is 21 years of age of older. Vidal's parents are set on him staying close to home and attending Penn St.

All this despite the fact Vidal is an 18 year old man.

H5N1 Vaccine

A vaccine which works in mice.
Scientists have succeeded in creating a genetically engineered vaccine that protects mice from several different strains of the deadly H5N1 bird flu virus.

Experts hope the same vaccine or a similar one will one day work in humans, according to the study, which appears in the Feb. 2 issue of The Lancet.

The vaccine uses a common-cold virus, meaning it can be quickly and easily produced and, because it is active against different virus strains, can also be stockpiled for use in a future pandemic, the researchers said.

Subsidization

The House of Representatives recently passed a budget cutting package that targeted medicaid and student loans amongst other things.
The bill allows state governments to impose new co-payments and deductibles on Medicaid recipients, a power sought by governors of both political parties to try to slow the exploding costs of the health program. It makes it far more difficult for middle- and upper-income seniors to attain Medicaid coverage for nursing care by transferring assets to family members, then pleading poverty.

The bill will end federal payments to the states for the administration of child-support enforcement efforts. It will allow some interest rates on student loans to rise and fall with the market, squeezing student lenders and, in some cases, college students. And it will make changes to the basic welfare program, Temporary Assistance for Needy Families, that would push states to tighten work requirements for women on assistance, a provision pushed hard by the administration for nearly four years.

House Resolution 653 appears to have basically affirmed senate amendments, involving those issues listed above like medicaid and financial aid cuts, to a previous budget reduction passage.

It certainly got the American Medical Student Association up in a frenzy. I'll play the hypocrite however and say even though I take federally subsidized loan money I'm not sure the program is such a good thing.

As well, you have to finally be pleased that the conservatives are starting to act like conservatives. Throughout Bush's first term both chambers of the capitol were passing tax cuts but letting spending increase. Redonculus.

On a seperate note the same day the House killed a plan to cut Medicare reimbursements to physicians by 4.4%, which is extremely good news.

Wednesday, February 01, 2006

Histo Question

If a train leaves the hypothalamus and enters the hypophyseal portal system carrying a load of TRH at 9:00 pm, traveling at a rate of 30 mph and heading for the adenohypophysis then what is the capitol of Ghana?

(A) None of the below
(B) 2 hours
(C) TSH
(D) Accra
(E) Secondary Hypothyroidism