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Sunday, April 30, 2006

Fatal Contact: Bird Flu In America

A movie-of-the-week (MOW) as a public service announcement is ridiculous.
"We feel we're providing a level of awareness and we've gone to great effort to make sure the film is accurate," co-producer Judith Verno said. "We've included a lot of information we believe people need to know."

"We had wonderful consultants who were actually ahead of the [bird-flu] curve," Kerew said. "The way the disease popped up in China, then moved to Turkey and Africa, were things we already knew about."

This is irresponsible and inflamitory and the previews for the movie only heighten my feelings. Its written by Ron McGee ("Atomic Twister" is another of his 'real world' disaster pieces) so you can start questioning Fatal Contact's accuracy without even watching it.

Part of the irresponsibility lays with the worst case scenario approach and passing it off as education. But such a scenario even from the mouth's of the most extreme alarmist is a far fetched one.

The threat of H5N1 is overstated. It is a media darling and they can't report anything but the worst.

"It is impossible to predict whether we're going to have an H5N1 pandemic and, if so, how severe it's going to be," Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told HealthDay.

Fauci had earlier told the Associated Press that he thought it "very unlikely that there is going to be the type of situation [here that] we see everywhere, from Nigeria to Indonesia."

That sentiment was echoed by Dr. Julie Gerberding, head of the U.S. Centers for Disease Control and Prevention. Speaking to attendees at a recent meeting in Tacoma, Wash., she said "there is no evidence it will be the next pandemic."

If you must watch it airs on ABC May 9th.

Patient History

Chief Complaint
Location - Where is it? Does it radiate?
Quality - What does it feel like? Dull? Sharp? Aching?
Quantity - On a scale of 1 to 10 how bad is it? Does it disrupt your daily activities?
Onset - When did it start? What were you doing when it first began?
Duration - How long have you had these symptoms? If it comes and goes how long does it last?
Frequency - Is it all the time or does it come and come?
Progression - Has it gotten better or worse?
Setting - Is it associated with any place or action?
Relieving or Exacerbating - Does anything make it better or worse?
Manifestations - Are there other symptoms?


Regenerative Abilities of Cutaneous Nerves

Woman Says She Has Feeling in New Face
The French woman who received the world's first partial face transplant has complete feeling in the new tissue five months after the operation, she told a Sunday newspaper.
Dr. Oliver says bogus.

Saturday, April 29, 2006

Off Topic I Play Too Many Hands

I'm a pretty poor poker player. If I had more free time maybe I'd be better. :)

I'm playing at Full Tilt in a no limit tournemant. Its pretty early, at the second level. I've got about the tourney average at the time.

I'm the small blind with A5s. It comes around with a bunch of calls and I make it 3.5x the BB. BB folds. Button + 3 calls and two middle position players call. Well spit on me, that ain't so great four handed.

The flop comes

Ah 4h 10d

Why the hell am I sitting there thinking I need to show strength or that I can take this pot? I bet the pot, more than a third of my stack. Two of three call and I know I'm hosed with a 5 kicker. The turn comes


I check, the next player makes this odd bet just about a tenth of the pot. It gets called and comes to me.

I figure the guy to my left has a solid Ace, and the elephant in the middle position I'm not so sure on. Heart draw? I can win this thing with a five I figure which is what? 6 or 7% to come? Maybe just two outs if I think the five of hearts will make one of the others a flush. The pot is about 12 to 1 to this small bet from my left. Right more than what I need to make the call but I gamble, albeit not much.

The river comes Queen.

I check the guy next to me makes an identical bet to last time. The middle position raises allin (which ain't much at this point) and I finally bail out.

Turns out the middle position had a Q4 and called a pot sized bet (with fewer chips than myself at the time, perhaps half his stack) with bottom pair and then stuck around to sucker out a full house. The guy to my left had AK.

Why the hell did I make that huge bet as the first to act with a 5 kicker four handed? I'm in fine positions with the blinds, I made a steal attempt pre-flop that was valid, considering big slick merely called the big blind, but then put a bluff at it that wrecked my stack. I should a made a smaller post flop bet just to figure out where I was with that garbage hole card sitting next to my Ace.

Off Topic Trojans Get Creamed In The Draft

As I've mentioned Reggie Bush got sucker punched in a Sam Bowie over Michael Jordan kind've moment for the Houston Texans. Matt Leinart (a potential Top 3 pick) fell all the way to #10 and late in the third round Dominique Byrd and Darnell Bing (once scouted as a potential first rounder) still have not gone.

The other Trojans who haven't gone are a little more understandable.

The draft picks so far are:

Reggie Bush - 1st Round, 2nd Pick - New Orleans Saints
Matt Leinart - 1st Round, 10th Pick - Arizona Cardinals
Winston Justice - 2nd Round, 7th Pick - Philadelphia Eagles
Deuce Lutui - 2nd Round, 9th Pick - Arizona Cardinals
Lendale White - 2nd Round, 13th Pick - Tennessee Titans
Dominique Byrd - Should've been second round
Darnell Bing - Sould've been second round

Friday, April 28, 2006

Off Topic Bob McNair = Mr. Magoo

Pasquarelli on why the Houston Texans have made a catastrophic mistake. They need a play maker and they choose DE Mario Williams. Laughable.
[W]hither the Texans at this point? Well, nothing against Williams, but it's going to take blind loyalty for a fan base already smarting from the franchise's snub of popular hometown star Vince Young to understand Friday evening's decision.

Scientists Behind The Iron Curtain Are On It

Personally I think Russia is relapsing a bit, into its paranoid Soviet self. Western culture and thought process are just too different; for all of history Russia has been its own and not part of Europe or the west. They simply cannot understand a life and culture so different from what they have experienced. My favorite example is when Putin asked Bush why he fired Dan Rather.
It's not clear how well Putin understands the controversy that led to the dismissal of four CBS journalists over the discredited report on Bush's National Guard service. Yet it's all too clear how Putin sees the relationship between Bush and the American media -- just like his own. Bush's aides have long feared that former KGB officers in Putin's inner circle are painting a twisted picture of U.S. policy.
The opinion of the west is no different in the general population, many of whom mistake how the west and America function for their own methods of doing thing.

Now we have very confident word that any bird flu pandemic will be squashed by a Russian made vaccine.

"Only when a pandemic virus strain develops will a vaccine be created, and it will not take long - only about a month," Mikhail Zurabov said after a meeting of health ministers of the Group of Eight (G8) industrial nations in Moscow.

He said Russian scientists were working on two potential vaccines.

Pretty sketchy rhetoric, but I guess we'll see.

Off Topic Mario Williams = Sam Bowie

What more can said? The Houston Texans are fools for passing on both Reggie Bush and Vince Young for DE Mario Williams. This will go down as one of the biggest blunders in NFL draft history.
The Houston Texans have signed North Carolina State defensive end Mario Williams, making him the No. 1 pick in the NFL draft Saturday.

Texans general manager Charley Casserly had cautioned earlier in the week that anyone concluding the team had decided on Southern California tailback and Heisman Trophy winner Reggie Bush and was only using Williams as leverage was mistaken.

The choice of Williams by the Texans could dramatically alter the landscape of the early segment of the first round. The New Orleans Saints, with the second choice, have indicated they would snap up Bush if he fell to their slot. But the Saints had hinted, in general, that they might entertain trade offers for their pick.

The availability of Bush at the No. 2 spot would almost certainly elicit trade offers.

Stolen Body Parts Made Me Sick

I don't know what they expect to collect. Still this has been a pretty gruesom story over the past several months. But as the AP story says,
Lawsuits have been filed for two men, one in Nebraska and one in Ohio. Each contends he caught a hepatitis virus from tissue implanted in back and spine operations -- an assertion that lawyers acknowledge will be difficult to prove.
Its hard to prove what caused these diseases.

Legalized Drugs A Stroll Away

Mexico has legalized a broad range of street drugs. But it might not be as dramatic as the headline makes it seem.

I believe in the legalization of most drugs for personal use. I'm just wondering how the legalization of just about every drug (just not marijuana) will affect health in the Mexico - Texas border region, where my school has a huge presence.
Mexico's Congress approved a bill Friday decriminalizing possession of small amounts of marijuana, ecstasy, cocaine and heroin for personal use— a measure sure to raise questions in Washington about Mexico's commitment to the war on drugs.

If signed into law, the bill could have an impact on Mexico's relationship with the United States— and on the vast numbers of vacationing students who visit Mexico, often to take advantage of its rarely enforced drinking age of 18.

The bill says criminal charges will no longer be brought for possession of up to 25 milligrams of heroin, five grams of marijuana about one-fifth of an ounce, or about four joints and half a gram of cocaine about half the standard street-size quantity, which is enough for several lines of the drug.

"No charges will be brought against ... addicts or consumers who are found in possession of any narcotic for personal use," the Senate bill reads. It also lays out allowable quantities for a large array of other drugs, including LSD, MDA, ecstasy about two pills' worth and amphetamines.

Sale of all drugs would remain illegal under the proposed law, unlike the Netherlands, where the sale of marijuana for medical use is legal and it can be bought with a prescription in pharmacies.

While Dutch authorities look the other way regarding the open sale of cannabis in designated coffee shops something Mexican police seem unlikely to do the Dutch have zero tolerance for heroin and cocaine. In both countries, commercial growing of marijuana is outlawed.

Off Topic Durham Jury May Not Hear Previous Claims

Rape shield laws may prevent a jury for the Duke lacrosse rape case from hearing the victim's previous claim of rape. But from the same story we have the most eyebrow raising comment,
A phone number for the accuser has been disconnected, and her father said Thursday night he remembered little about the incident except going with police to a home where he said his daughter was being held "against her will."

Asked Thursday if she was sexually assaulted, her father said, "I can't remember." In an interview with the News & Observer of Raleigh, posted Thursday night on the newspaper's Web site, he said the men "didn't do anything to her."
What is up with this family and accuser? Her father doesn't remember his daughter's first rape? Are you kidding me? Is this just like for giggles? Are we witnessing a trend here?

The Face of the Commonwealth Fund

I used the Commonwealth Fund, a non-profit organization dedicated to healthcare for all (read: government funded universal coverage) as an example of taking agenda driven information and studies with a grain of salt. I understand the Commonwealth Fund is a charitable organization especially in regards to giving to medical centers and schools around New York but they're certainly on a mission for universal healthcare.

Now you can watch the current president of the Commonwealth Fund discussing the Massachusetts plan for providing healthcare for all.

Complex Case

I've been arguing a lot of late about complex case exemptions to the 7th amendment. I will be honest, while I support caps on punitive awards in medical malpractice cases they make me uneasy. Let the injured collect what they deserve. I just don't think the current system does a very good job of actually identifying those who actually deserve per physician negligence. While information on actual jury verdicts is scarce, there is plenty of evidence to imply that for any number of reasons the current system simply doesn't compensate the right people.

Looks at healthcare claims in New York and then in Utah/Colorado both turned up statistics that showed 90+ percent of patients who suffer negligence never get compensated, either because they never seek to or because they fail in their claims. Meanwhile in the Utah/Colorado study 77% of those who collected on claims did so absent of negligence. It doesn't distinguish if the insurance companies settled in these cases (highly likely) or the amount was won by verdict at trial. I contend it is outrageous, no matter if the insurance company paid them off or not.

Part, albeit not of the all problem, is that juries are incapable of deciphering complex medical or pharmaceutical suits for the technical nature of them. The unreliability of the system to seek out true negligence forces insurance companies to settle non-negligent cases at a higher rate than they otherwise would. I think the single greatest thing that can be done to solve this problem isn't caps on awards but healthcare courts.

On the issue of jury compentency I appreciate John Calfee's New York Sun piece. It comments on the recent Vioxx jury award for the 77-year-old diabetic.
Essentially, the jury had to decide three things. One was whether Vioxx was a substantially contributing factor to the heart attack suffered by an elderly ex-smoker with diabetes and coronary artery disease. Unfortunately, science can't give us a good answer. Mr. McDarby was clearly at great risk for a heart attack. But there is no way to know which of a multitude of precipitating factors tipped the balance on that terrible day. We don't even have reliable data indicating an extra probability of a heart attack in the relevant circumstances.

The jury simply had no way to determine whether the plaintiff would have had a heart attack if he had used a different pain reliever. Relying on an unpredictable mix of intuition and emotion, the jury simply guessed.

The second issue was failure-to-warn. The plaintiff argued that in addition to complying with all FDA regulations about warnings, Merck should have specifically warned the doctor not to prescribe Vioxx to this patient. What warning, we should ask, and to what effect? Here, the jury had even less foundation than when deciding causation. The most important data about Vioxx and heart attacks had long since been published and widely discussed in medical circles. Moreover, Vioxx was a lifesaver for patients with a propensity toward fatal ulcers, which every year kill thousands of patients taking older drugs that Vioxx replaced. Whether more warnings would have pushed the patient toward more safety or just rearranged Mr. McDarby's numerous various risk factors was something the jury could not possibly discern. No scientifically based warning could have said something like "there is a so-and-so percent extra chance of a heart attack." A warning would presumably have said something like "don't prescribe this to patients with a high risk of heart attack," but what good would that have done in the absence of information about whether the obvious alternative treatments were better?

Again, the jury had to guess. And again, there is no reason to think its guess would have been better than the FDA's own expert assessment.

The third question was whether to award punitive damages, something never before done to a pharmaceutical manufacturer liability case in New Jersey. Under New Jersey law, the jury had to find that Merck had withheld information from the FDA in a "wanton and willful" manner. Again, a problem for the jury was the FDA itself. As a former FDA staffer testified, the FDA was satisfied that Merck had turned over all the information it needed. How did the jury reach a conclusion so different from the FDA's own? Here lies one of the most unsettling parts of this trial. Merck, like all responsible manufacturers, massaged the Vioxx data as it arrived, trying to get a fix on the true heart-attack risk and other matters in a diverse mix of patients. The FDA has to know that firms do that kind of analysis all the time. The jury said Merck should have shared its own preliminary assessment of the data with the FDA even though the FDA famously makes up its own mind about such things and the underlying data had in fact already been given to the FDA. Had Merck not undertaken its analysis, there would have been nothing to keep from the FDA.
Indeed, I agree that the decision on the punitive award was most troubling. The data had been turned over for the FDA to do their own analysis. Such was the final word. As well, the data was from studies unrelated to the heart risks of Vioxx. And yet, the fact that the analysis, which Merck was under no obligation to do, was slow in being turned over to the FDA (because it was preliminary) they were found against.

Ridiculous, you can't win. Either you refuse to perform your own analysis (which certainly wasn't required of Merck as the FDA had all the data) and the jury hears how you should have. Or you do, and the jury hears how it is evidence you knew your drug was dangerous and maybe even covered it up. How is the FDA not the final authority on this?

Healthcare courts would put decisions in the hands or jurists with medical training. Not necessarily biased physicians but not the mechanic down the street either.

I would not trust myself to come to a fair conclusion on the issue of a manufacturer's fault during a plane crash. I don't trust an engineer to come to a fair conclusion on the issue of my medical competence.

A New Public Campaign Against HIV

In some African countries there is a growing spread of circumcision.

Armed with new studies suggesting that male circumcision can reduce the chance of H.I.V. infection in men, and perhaps in women, health workers in two southern African nations are pressing to make circumcisions broadly available to meet what they call a burgeoning demand.

The most striking studies suggest that men can lower their own risk of infection by roughly two-thirds, and that infected men can reduce the odds of transmitting the virus to their partners by about 30 percent, simply by undergoing circumcision. Research suggests that the cells on the underside of the foreskin are prime targets for the virus and that tears and abrasions in the foreskin can invite the infection.

Off Topic Given The World With a Side of Controversy

The angry owner of the house USC star tailback Reggie Bush's family was living in, says he knew about his relationship with his parents and that the family skipped out on rent.

The landlord, Michael Michaels, said that Bush's mother and stepfather agreed to pay $4,500 in monthly rent when they moved into the Spring Valley house he bought for $757,000 in March 2005, the San Diego Union-Tribune reported Friday.

They didn't pay for the first few months but promised to pay when the Heisman Trophy-winner started earning millions of dollars after turning pro, said Michaels, who described himself as a real estate investor.

Michaels' attorney, Brian Watkins, claimed that Bush was made aware of the situation and also promised to repay the debt when he turned professional, according to a report in Friday's Los Angeles Times.

A source close to Bush told ESPN's Joe Schad that while the family had at first agreed to pay rent on the San Diego home, they quickly realized there was no way they could afford to. After falling behind on payments, the family will claim, however, that they were repeatedly told not to worry, that they would not be evicted.

"Originally there was a rental agreement, but they never paid a dime," Watkins told the Times. "It was always, 'Don't worry, we'll pay you -- you can take it out of our profits."'

Bush, however, did not sign with Michaels' firm, New Era Sports & Entertainment LLC, which Watkins said the running back's stepfather helped found. Relations with the family deteriorated and Watkins sent the player's parents an eviction notice on April 3, a copy of which he showed the Union-Tribune.

Bush's parents, LaMar and Denise Griffin, moved out of the house last week. Bush has said his parents left because they found another place to live.

Watkins said he plans to file a $3.2 million fraud lawsuit against Bush's parents and possibly Bush. The sum includes $300,000 in money that Michaels claims he and another investor, a documented gang member named Lloyd Lake, put into the business, plus punitive damages.

Bush turns around and says Michaels and his marketing firm threatened him when he refused to be represented by them for his NFL debut.

The NFL Players Association and NFL Security have concluded that sports agent David Caravantes and fledgling marketing company New Era Sports used an attorney to try and force USC running back Reggie Bush to pay them $3.2 million after Bush decided not to sign with the group, sources told ESPN's Joe Schad on Thursday.

According to the sources, Caravantes threatened to reveal embarrassing personal information about the Bush family if he did not receive the money. Sources also say Caravantes tried to evict the family from a San Diego house they rented from his business associate Michael Michaels.

Meanwhile, Irish Trojan sums up the Mark Sanchez rape allegation.

He apparently enters the only bar within walking distance of USC (which is notorious for letting in underage drinkers) around 11:20. He leaves, alone, around 1:00 am and is next seen when he, clearly drunk, offers to help two fellow students help push their car which has run out of gas. This is around 1:30 am.
Earlier reports stated that the alleged victim says Sanchez [assaulted her] at or around 12:30 a.m. But the Daily News says he met her at Cardinal Gardens around 1:30 a.m. or shortly thereafter. So, there is an inconsistency in the timeline there. What conclusions we should draw from that is anybody's’ guess at this point.
He must have met her around or after 1:30 am seeing that the 9-0 and then two students can attest to his actions and whereabouts before then.

In anycase there's some reports that the rape may lead to Mark Sanchez losing his eligibility under NCAA rules. Such is a minor side effect obviously in the big scheme of things.

What a mess for everyone involved.

Thursday, April 27, 2006

Off Topic Duke Accuser's Previous Accusations

Certainly doesn't make the current rape claim false...
The woman who says she was raped by three members of Duke's lacrosse team also told police 10 years ago she was raped by three men, filing a 1996 complaint claiming she had been assaulted three years earlier when she was 14.

According to the Creedmoor police report in August 1996, when the woman was 18, she told officers she was raped and beaten by three men "for a continual time" in 1993, when she was 14. She told police she was attacked at an "unspecified location" on a street in Creedmoor, a town 15 miles northeast of Durham.

Attorney Joe Cheshire, who represents one of the uncharged players on the team, said he wants to know if prosecutors in the current case knew about the earlier allegation, or if the accuser told them about it.

He added that he found it notable that authorities apparently declined to prosecute the earlier case.

Wednesday, April 26, 2006

Off Topic Bad Week For USC

First, Reggie Bush's family is living in some guy's home, who wanted to be one of Bush's marketing representatives. This could be a major NCAA no-no.

Now, Mark Sanchez, the incredibly hyped redshirt freshman QB, who was competing to start for USC has been arrested for sexual assault. I hope the fellow student who leveled the accusations is alright.

Do programs peak and decline over a mere five years? Are scandals such as these the beginning of the end of USC's recent success?

Off Topic Durham Cabdriver Speaks...Some More

It is still a good alibi for one of the two defendants in this rape case.
Called in by investigators in the Duke rape case for the first time Tuesday, taxi driver Moez Mostafa told TIME in an exclusive interview, he stated he saw exotic dancer Kim Roberts exchange angry words with lacrosse players, enter "an old white car" and speed away from the scene. While Mostafa told Durham police detective and lead case investigator Benjamin Himan he could not swear a second dancer, who is accusing players of rape, was already in the car, it’s clear from a subsequent 911 call and police dispatch transcript call that the two women were together.
That could mean anything, the fact he took one of the two players, Seligmann, away during the time the rape was supposed to have occured (if the time of the rape has been established so specifically) is way more damning than this is helpful for Nifrong.

Start Poor

An interesting and slightly disheartening study. The American Dream is dead.

The likelihood that a child born into a poor family will make it into the top five percent is just one percent, according to "Understanding Mobility in America", a study by economist Tom Hertz from American University.

He also found the United States had one of the lowest levels of inter-generational mobility in the wealthy world, on a par with Britain but way behind most of Europe.

"Consider a rich and poor family in the United States and a similar pair of families in Denmark, and ask how much of the difference in the parents' incomes would be transmitted, on average, to their grandchildren," Hertz said.

Checking Blood Pressure

In the exam rooms where I do my standardized patient exams the blood pressure cuff is attached to the wall. Pretty typical. However, because of its position the only place you can take blood pressure is with the standardized patient sitting on the exam table. Now there's some evidence the BP you get with the patient sitting unsupported on the exam table is off.
Systolic blood pressure -- the top number in a blood pressure reading -- was lower when sitting in a chair compared with sitting on a table.

Slightly Safer

You're now slightly safer standing next to me if you go into cardiopulmonary arrest. I finally completed my Basic Life Support training, something I have to have before I go within five feet of real patients (which I will do some of next year and will basically be my life my third year of medical school when I'm actually on the wards).

The Commonwealth Fund Says...

An agenda group has a new study saying that there's been a massive rise in the number of middle class uninsured.

From the Houston Chronicle:
The percentage of working-age Americans with moderate to middle incomes who lacked health insurance for at least part of the year rose to 41 percent in 2005, a dramatic increase from the 28 percent in 2001 without coverage, a study released on Wednesday found.

Moreover, more than half of the uninsured adults said they were having problems paying their medical bills or had incurred debt to cover their expenses, according to a report by the Commonwealth Fund, a New York-based private, health care policy foundation. The study of 4,350 adults also found that people without insurance were more likely to forgo recommended health screenings such as mammograms than those with coverage, and were less likely to have a regular doctor than their insured counterparts.

As we know, the vast majority of Americans consider themselves "middle class". It is a meaningless term and while the survey conducted obviously is specific for actual incomes the fact that the Commonwealth Fund's press release and the AP article would use that term is biased and bogus and used to elicit affect from the reader, since most Americans consider themselves such. They can sit there and think, "Well, I'm working or middle class as well..." but that could actually differ considerably from what the study says.

You have to take with a grain of salt any survey conducted by those with an agenda (the way questions are phrased influences the results SO much), and we can show as much with "evidence" from parties on the other end of the spectrum.

The fact that "working class" families have fallen more and more often into the realm of the uninsured might be alarming if not for information that implies that, if not in total numbers, then in percentages, the class entering the uninsured rolls the quickest (growing 114% from the early 90s to the early 2000s) were families making more than $75,000. I think we can agree that this is circumstantial evidence to the large number of those who choose to be uninsured.

What has not changed seriously over the years is the age breakdown of the uninsured, which lends, once again, considerable support to the argument that the uninsured population is largely those that choose not to seek it out.

Young adults (18-24) are less likely than other age groups to have health insurance, averaging 70.4 percent in 2002, compared with 82.0 percent of those 25 to 64 and 99.2 percent of those aged 65 and above. Indeed, according to the Census Bureau, 41 percent of the uninsured (17.9 million) are between the ages of 18 and 34. Good health is common in younger people, which may help explain why so many of them don’t obtain health insurance. They consider other uses of their money more valuable.

But really the point of this post isn't an impeachment of the Commonwealth Fund's survey, it should really be read more as a warning on using agenda driven non-profits as a source of information. You can no more trust the National Center for Policy Analysis' look at the "uninsured by choice" as you can the Commonwealth Fund's newly published survey on the plight of the uninsured. They are intended to sway you, there was never any doubt before the Commonwealth Fund's survey was undertaken that its results would be alarming.

Off Topic Early College Football Look

Stewart Mandel has a little bit of flawed pre-season ranking up.

1. Ohio St.
2. Texas
3. Notre Dame
4. West Virginia
5. LSU
6. Oklahoma
7. USC

I don't care how many "skilled players" Texas has returning there was no single player more important to their team than Vince Young. Their zone read option offense was set up for a mobile quarterback. I don't care how much the UT offensive coordinator says they won't have to change the offense. By the end of the season, after some struggles, the UT offense will look nothing like the one with Vince Young in it.

So, they're going to be playing against Ohio St. the first game of the season, with a new offense, and a freshman QB whose never taken a snap. Good luck.

The rankings should read:

1. Ohio St.
2. West Virginia
3. LSU
4. Notre Dame
5. Oklahoma
6. USC
13 or 14. Texas

Caffine Not Linked To Heart Risk

Whew, this is a relief.
According to a new study on more than 120,000 people over a period of twenty years, there is no link between heavy coffee drinking and a raised risk of coronary heart disease. Heavy coffee drinking means you consume six or more cups per day. The study found that the heart risks for heavy coffee drinkers is no different from those who only have one cup or less per month.
But I'm not out of the woods yet.
The researchers pointed out that there may be some groups of people who are still susceptible to heart risk from drinking too much coffee. Some people carry a gene that makes it more difficult for the body to metabolise caffeine.

Tuesday, April 25, 2006

Off Topic Court = Justice?

If you remember one of the Duke lacrosse players alleged of rape had previously entered a plea and been given community service on an unrelated assault charge. Well now that plea has been set aside by the judge in Washington D.C.

Collin Finnerty, 19, appeared in D.C. Superior Court for a hearing in which a judge determined he had violated the conditions of a diversion program he entered after being charged in a November assault in Georgetown.

Finnerty and two friends had been accused of punching a man after he told them to "stop calling him gay and other derogatory names,'' according to court documents.

The charges would have been dismissed under the terms of the diversion program once Finnerty completed 25 hours of community service, but the terms also required he stay out of trouble and not commit any criminal offenses.

Finnerty remains free pending a July 10 trial date in the Georgetown case. He could face up to six months in jail and a fine of up to $1,000 if convicted of simple assault. Judge John Bayly also set a 9 p.m. curfew, ordered him to report by phone to court officials every Friday, and required that he stay away from places that sell alcohol.

Are you kidding me? Because he didn't "stay out of trouble" and became embroiled in this rape allegation his other sentence is set aside? Absolutely ridiculous, the court system should at least pretend to value the ideals of justice, namely innocent until proven guilty.

Under the definition of "trouble" defined by this judge, anyone who didn't like the kid could ruin his life.

Don't like the kid? Accuse him of slapping you or say you saw him driving without a seatbelt. It doesn't matter if he'll never be convicted on your specific claim because it turns out "trouble" is a violation of a previous plea agreement. Bam, straight to trial and a possible 6 month jail sentence.

The Count So Far

A look at Merck's bold (and appluadable) refusal to go to class action, and thus to try every Vioxx case seperately.
[Y]ou can be sure that with ten thousand or so suits that have been filed against the company so far, that the eventual record is not going to be five thousand up and five thousand down. These things don't take place independently, and there's eventually going to be a run to one side or the other. If Merck starts knocking down some more cases, that'll gradually increase the pressure for settlements in many of the remaining cases (and many others will just evaporate). But if they hit a big losing streak, not only will the existing plaintiffs and their lawyers be more motivated to hang in there, but even more cases will condense out of the vapor phase.

Small Talk

Monday, April 24, 2006

Waiting For A Cure

If I was paralyzed, I would damn sure shell out $20,000, if I had it, and risk life to let some quack in China implant aborted fetus olfactory neurons in my spinal the off chance it might work. There's a nice editorial why this man doesn't.
I have long been skeptical of offshore treatments promising magical results. Most reasonable people would be. But people facing a life confined to a wheelchair, or perhaps the end of their life, are, understandably, not always reasonable. I certainly have moments when I seriously contemplate signing up for Huang's surgery -- usually when I'm considering the toll my paralysis exacts on my parents, or the sheer frustration of being completely dependent on others.

Here are some other reasons why I don't buy a ticket to China: Receiving the treatment could exclude me from future clinical trials. Clinicians running studies have strict criteria regarding who they can include, so they typically want the purest patient they can find, i.e., one that is "normal," so they can be sure any results they see are due specifically to their treatment. Having had fetal cells implanted in my spinal cord would not qualify as normal.

Off Topic Creepy in Durham

I know all of these quotes are from court filed papers, and not press releases, or directly from the defense attorney's mouth but still attacking the credibility of the witness (which even I think is suspect) so vehemetly can backfire. It just doesn't sound good.
The attorney for one of two Duke lacrosse players charged with raping a stripper demanded on Monday that prosecutors turn over the accuser's medical, legal and education records for use in attacking her credibility.

Kirk Osborn, who represents player Reade Seligmann, said the material will provide "rich sources of information for impeaching the complaining witnesses."

Osborn also asked a judge to hold a pretrial hearing to "determine if the complaining witness is even credible enough to provide reliable testimony."

"This request is based on the fact that the complaining witness has a history of criminal activity and behavior, which includes alcohol abuse, drug abuse, and dishonesty, all conduct which indicate mental, emotional and/or physical problems, which affect her credibility as a witness," the defense said in court papers.

Off Topic Maybe Its Good We Didn't Win...

If USC had won the Rose Bowl they might have had to forfeit it. Star running back Reggie Bush's family has been living in a house owned by an agent who was trying to recruit Bush, a major no-no under NCAA rules.
Documents reviewed by The Miami Herald show that the $757,000 house at the corner of Apple and Luther streets was purchased by Michael Michaels, a member and employee of a prominent Indian tribe in the San Diego area. Two sources said Michaels was planning to form a marketing and contract agency that would feature Bush as a client.

The connection between Michaels and the Griffins and how the family came to live in the home could constitute a violation of NCAA eligibility rules for Bush and Southern California, which came within 19 seconds of winning a third consecutive national championship in January.

According to NCAA guidelines, the relationship between the family and Michaels could constitute a violation, even if Bush had no knowledge of the relationship.

An NCAA rules guide designed for student-athletes states: ``Nor may your relatives or friends accept benefits from an agent, financial advisor, runner or any other person associated with an agency business. (Benefits include but are not limited to transportation, money and gifts, regardless of the value of the benefit or if it is used.)''

That refers to NCAA bylaw 12.3.1, which further states that ''an individual shall be ineligible if he or she (or his or her relatives or friends) accepts such benefits.'' Thus, Bush might have been ineligible for the entire season.

Sunday, April 23, 2006

Off Topic Defend Thyself

The New York Times pats itself on the back for its coverage for the Duke lacrosse scandal. Many bloggers and news sources have been critical of it.
Based on the close look I have given The Times's coverage in response to these messages, the soundness of the news judgment reflected in the paper's performance so far deserves a decent grade. The coverage has been basically fair, I think, with a few miscues mainly related to the placement and the space given articles.
I guess you can judge for yourself.

Under Pressure

A hospital in Nepal struggles with the current unrest there.

The hospital has not been exempt from the state's heavy-handed methods. Last Thursday, security forces encircled the hospital compound as the police marched in, broke the locks of the mortuary door and hauled out the bodies of three people killed in the demonstrations, according to hospital officials. The victims had been shot in the head, chest and abdomen.

Saturday, April 22, 2006

Nails To The Head

So, this guy tried to commit suicide, didn't die, and then walked around with these things in his head for a considerable period of time.

The unidentified 33-year-old man was suicidal and high on methamphetamine last year when he fired the nails - up to 2 inches in length - into his head one by one.

The nails were not visible when doctors first examined the man in the emergency room of an unidentified Oregon hospital a day later. Doctors were surprised when X-rays revealed six nails clustered between his right eye and ear, two below his right ear and four on the left side of his head.

The study did not say how long the nails were, and a hospital spokeswoman refused to release that information. A photo published in the study suggests the nails range from 1 1/2 to 2 inches long.

Politics Trumps Science

The FDA says that marijuana has no legitimate medical uses.
A Food and Drug Administration statement on Thursday denying any medical benefits of marijuana reinforced the divide between federal officials and the states that have approved the drug's use to ease some medical conditions.

[A] 1999 review by the National Institute of Medicine, part of the National Academy of Sciences, the nation's most prestigious scientific advisory panel...found marijuana to be "moderately well-suited" to some conditions, including wasting disease from AIDS and the nausea that often results from chemotherapy.
I say marijuana is no more dangerous than alcohol to its users or others. If you want to make the choice to use it, and not endanger others, I don't understand the resistance to such. Especially in a case where you feel it helps you deal with terrible discomfort associated with a medical condition.

Friday, April 21, 2006

End Approaching

Kind've amazing to think I'm almost through with a year of medical school. In the literally three weeks I have left however, I have two neuroscience exams, a microbiology lab exam, the national microbiology shelf exam, a human behavior exam, and one final standardized patient OSCE (which if you haven't read previously...I have trouble with despite efforts).

I probably shouldn't get too excited until I actually pass that OSCE.

Idiots and Juries...

...go together apparently.

A 71 year old man who was a lifelong smoker, with previous heart disease and a quadruple bypass who had taken Vioxx for a month won his case against Merck in Texas. I'm terribly embarrassed for my home, south Texas.

Attorneys for Garza's family asked the jury to award $22 million in compensatory damages and $1 billion in punitive damages.

The key argument from Mr. Garza's family and their lawyers were that he had been cured by the procedures he had undergone and that a stress test soon before he started Vioxx showed he had only a 2% chance of having a heart attack in the next year.

No evidence has shown any risk with less than 18 months of continuous use of Vioxx.
"He had every single risk factor that you can have...The idea that Mr. Garza was in good health and only had a 1 percent chance of having a heart attack is science fiction."

Off Topic I Saw Nothing

Both sides are playing with people's reputations and lives to better their position. The other stripper at the Duke lacrosse party has spoken out again and the defense has responded.
The attorneys claim [the other stripper] at first told a member of the defense team that she did not believe the accuser's allegations. They say she has changed her story to gain favorable treatment in a criminal case against her. They note she also e-mailed a New York public relations firm, asking in her letter for advice on "how to spin this to my advantage."

"We believe ... her story has been motivated by her own self-interest," said attorney Bill Thomas, who represents one of the uncharged players. "I think that a jury will ultimately have to decide the question of her credibility."

[The other stripper], Roberts, 31, was arrested on March 22 -- eight days after the party -- on a probation violation from a 2001 conviction for embezzling $25,000 from a photofinishing company in Durham where she was a payroll specialist, according to documents obtained by the AP.

Thursday, April 20, 2006

Off Topic Evidence That Means Nothing

It's good evidence for the newspapers, but not for the jury.
[T]he time stamps are only as accurate as the clock in your camera; if you forgot to set it an hour ahead for daylight savings, your metadata would be an hour off. You can also modify any of the metadata with a simple computer command if you have the right software.
Still it doesn't seem likely that these digital photos of the stripper released by the defense are forged or terribly inaccurate but obviously it is of little value except in the court of public opinion.

Some of alibi evidence presented to the media so far for the two accused may be more helpful however.

A neighbor who reportedly saw what was going on said that interaction took place about 12:30 a.m., according to a written statement to police that was provided to CNN by a source with knowledge of the case.

The district attorney has said that the woman was raped afterward.

Mostafa told CNN he got a call at 12:14 a.m. March 14 to pick up two people at 610 North Buchanan Blvd. in Durham. He got there about 12:18 a.m., he said.

Two young men got into his taxi -- one of whom was Seligmann, he said -- and he drove them to a bank branch to get money.

Defense attorneys say an ATM receipt will show he withdrew cash at 12:24 a.m. (Full story)

Mostafa said he next drove the lacrosse player and his companion to a restaurant, then back to a dorm.

During the 35 minutes the two men were in his cab, Mostafa said, he didn't notice anything unusual.

"[They were] joking and laughing, making different conversation," he said. "I did not pay attention. ... [They were] just like talking, like joking, like any kids."

Cost of Healthcare

From NEJM's article 'Private Healthcare in Canada'

Off Topic Trail By Newspaper

High profile cases are so difficult
The fairness of a trial-by-newspaper, of course, depends on how closely a news organization apes the practices of official courts. Fairness requires it to consider not only the statements and evidence of the accuser, but that of the accused, no matter how heinous the charge. By that measure, the New York Times has failed the two Duke University lacrosse players who were indicted Tuesday of raping a woman during a party in an off-campus house on March 13.

Off Topic On Campus

Duke Students Are Sick of the Story
[S]tudents around here are anything but reveling in the media's glare. They want to stay as far away from the cameras and reporters as possible. For many students, it borders on invasive. The reality is that campus reaction cannot be summed up in two sound bites of a simplistic divide — one pro and one con

Wednesday, April 19, 2006

Off Topic Defense Speculation

Now we're just getting down to mind games.
The attorney said that when 46 members of the lacrosse team submitted court-ordered DNA samples last month, they were also photographed without their shirts.

The attorney said that is possibly how Reade Seligmann, 20, and Collin Finnerty, 19, were identified by the alleged victim, who told police she was gang-raped, sodomized and beaten for 30 minutes at a lacrosse-team party on March 14.
While certainly if this were true it would seem it would be a major discrediting factor but obviously the defense is just throwing stuff out there. I would hope the Durham police made the accuser identify her assailants by their faces. While other identifications can be useful (especially in sexual assault cases) they obviously should and do hold less weight and can be prejudicial as in this case.

You can watch video of the report on the defense's allegation.

Blame Others

The standardized patient experience in medical school is an odd one. I have a lot of criticisms of it, and I'll list those in their time, but the more and more I think about it, I the more and more I feel like such thoughts and displeasure on my part are really hiding my own faults and what I can do to make the situation better.

A standardized patient is usually a retired individual who is paid to come in and have physical exams performed on them by preclinical medical students (first and second years).

After some labs where you practice on them, you then have exams. I've already described the horrors of my first OSCE (Objective Standard Clinical Exam). The OSCE works such that you have stations and you are told before you enter what you're suppose to do with the standardized patient in that exam room. It is typically a focused exam. For example, it may say perform a respiratory exam.

Today, I had another type of exam which my school calls a CAST. It is a head to toe physical, although the time allotted is too short for such and real goal is to get as far as you can. I tried so hard not to be nervous leading up to the test, because I felt that was the most damning thing during my OSCE. I got flustered and I couldn't think and it turned into a deer in the headlights situation.

I walk into my CAST and the standardized patient there is one I had during my OSCE. One who was very critical of my performance after my OSCE (which he had a complete right to be). One who had a very, very low opinion of me.

I could not have had a worse standardized patient for my CAST lab. My jaw nearly dropped.

The man had only criticism for me at the end of the exam, and I think it is an accurate self assessment to say that all but one of them were invalid.

  • Need to study more to know what valve I'm listening to in the heart
    • I started off wrong, told him I was listening to the pulmonic first and then without prompting immediately corrected myself and described correctly what I was listening for in all four locations (Aortic, Pulmonic, Tricupsid, Mitral)
  • Need to compare sides when percussing the lungs
    • Just inaccurate on his part. I did. Granted I forgot to when I examined him for my OSCE but I certainly remembered this time.
  • Need to learn to drape better as he was exposed briefly when I tried to cover him
    • Well he had shorts on but this is the single valid criticism. If I'm going to pretend to use the drape even when he has shorts I should use it appropriately.
  • Need to practice with the blood pressure cuff so I don't get flustered
    • Please, the damn thing got tangled up. It is attached to the wall and he insisted on sitting so I had to stretch it all the way to him.
  • Inappropriately felt the radial pulse with my thumb
    • Just inaccurate. When I was counting his pulse I used the pads of my fingers. I was feeling with my thumb only to check for when the radial pulse disappeared when I expanded the blood pressure cuff, which is appropriate considering I don't HAVE to even do that.
  • Moved on without actually feeling the pulse in inguinal area
    • This is an odd one. I never told him I was trying to feel a pulse down there, I told him I was feeling for lymph nodes. Even if I had, I don't know what this type of complaint is...he doesn't think I actually found it? Actually he doesn't think I found something I wasn't looking for.
There were plenty of things, while he was evaluating, that I knew I missed. If he thinks he knows so much he can criticize me for using my thumb on his radial artery then maybe he should've mentioned my failure to palpate the thyroid gland or to percuss his costovertebral angle when I was at the back. I also forgot to palpate his tongue and floor of his mouth or to test his hypoglossal nerve (stick out your tongue and move it side to side). I was flustered, I apologized too often and asked his permission to do just about everything which probably would've been a valid criticism as well.

All he can make are inappropriate criticisms and not one encouraging thing. That is all I could think about as I left the clinical skills building.

I miss half of what I do because of nerves. Having this particular standardized patient for my CAST obviously didn't help.

That being said, nerves around standardized patients and nerves around real patients don't originate from the same source, at least in my experience. Judging me on how long it takes to unravel the blood pressure cuff with a standardized patient is a poor measure of how I'll perform in the clinic or hospital. What makes me anxious about seeing standardized patients doesn't translate over to interactions with real patients. This is what makes me upset about the whole standardized patient experience.

I am anxious around standardized patients because they're the authority figures. They're grading me. I want something from them.

When I was working in the ophthalmology clinic taking fundus photos, I screwed up a lot when I started, as might be expected. But I was a lot less nervous every time I had to correct myself because I knew the patients had come in for a reason. They wanted something from me. I was trying to help them.

Being flustered around standardized patients may correlate well to how poorly I'll perform when I'm presenting patients to my attendings or getting pimped or basically dealing with the people who will be judging on the spot during my clinical years. It will not correlate well to my interactions with real patients.

And yet, while I believe everything I've written above really I'm not sure it really matters. I can't do anything about the complaints I've listed above. Why would I put my nervousness and my inadequate (in my eyes) performance on anyone else? Yes, the standardized patient exam lacks in its mimicry of the real thing but it is merely a tool. It certainly has its own unique benefits and if I'm missing out on those it is nothing that can be changed by anyone but myself.

Just take deep breaths, realize the standardized patient OSCE for what it is, open the door, introduce yourself and get to work.

Tuesday, April 18, 2006

Off Topic What Is Victory In Duke Case?

Both sides are playing out evidence in the media in the Duke lacrosse rape case. One of the two charged has a previous history of violence and even what has the makings of a prejudice based crime.
On the same day Duke University lacrosse player Collin H. Finnerty was ordered to provide DNA samples in a rape investigation, he was in Washington to face charges that he assaulted a man last fall.

A man told a police officer who was driving by The Georgetown Inn on Wisconsin Avenue about 2:30 a.m. Nov. 5 that Finnerty and his co-defendants assaulted him, court documents said.

The man said he was minding his own business when the three men started picking on him. The man told them to stop "calling him gay and ... derogatory names." Then they attacked him, he said, "busting his lip and bruising his chin," court records say.

Finnerty was ordered to perform 25 hours of community service in Washington by fall, McCool said. If he performs the service and avoids new arrests, the charges will be dropped, McCool said.

His attorney in the Durham matter must be running his finger under his collar. Still, 25 hours of community service says something -- either there wasn't much of a case here or Finnerty's lawyer was really expensive.

The evidence of the day however may belong to the defense. If the time of the attack has been pinpointed to within some certainty by the alleged victim then the following is newsworthy.

"The two that they indicted had no contact with this woman whatsoever," he said. "We are shocked, absolutely shocked. We always thought she would pick out someone who at least had a conversation with her."

Sources close to the investigation said Tuesday that the defense will present evidence -- including ATM receipts -- that neither Seligmann, 20, nor Finnerty, 19, were at the team party at the time the alleged rape took place.

A cab driver allegedly carried one of the young men to an ATM, where a security camera captured his picture, the sources said, and the other man was reportedly at a restaurant.

A nice summary article of the twists and turns of the case so far can be found at Fox News.

I shouldn't be judging this evidence before a trial, something I've been a little guilty of all along. Certainly, however, not as guilty as Mr. Nifong. Even with the prior incidents for Finnerty and the lacrosse team's poor behavior in the past per the Duke administration, I don't see how Nifong gets a conviction unless new evidence shows up or the jury is rabidly inflamed.

But that might not matter. Sadly, a conviction might not be what defines victory for the election seeking Nifong. Even if he fails, in some ways he has already endeared himself to this largely African American community for his "efforts". Sure it took a month to bring charges, but Nifong was never shy about inflaming the situation by talking to media and making it clear whose side he was on. And it wasn't the side of justice or the side of those wealthy, white, spoiled, out of towners come down to Durham to play lacrosse and wear the collars of their Polo shirts popped up.

Changing topics, at CNNSI a columnist breaks down what he thinks are important in making a rape case.

  • Injury to Victim
  • Brevity of Encounter
  • Brutality of Sex
  • Outcry Witnesses
  • Previous Predatory Conduct
  • Prosecutorial Skill

Well, I'm Out of Here

Not sure how seriously to take this.
With many Americans worried about their safety should a flu pandemic occur, there's little reassurance from a survey that finds that close to half of U.S. public health-care workers would not show up for work if such a pandemic occurred.

In fact, two-thirds of the 308 employees polled said their work would put them at risk of contracting the potentially deadly flu should an outbreak come to pass.

"Forty-two percent of the health care workers surveyed said they would not respond in the event of a flu pandemic," said study co-author Dr. Daniel J. Barnett, an instructor at the Johns Hopkins University Center for Public Health Preparedness in Baltimore.

"The most important factor, in terms of showing up for work, was how much the individual employee perceived his or her role [to be] in the agency's response," he added. The less important an employee thought his or her role was, the less likely they were to report for work, Barrett said.

Monday, April 17, 2006

Bird Flu Plan

In the post-Katrina world the government needs all the disaster planning it can get. The Federal Government is about to formally announce its plan in case of a bird flu pandemic.
The Treasury Department is poised to sign agreements with other nations to produce currency if U.S. mints cannot operate. The Pentagon, anticipating difficulties acquiring supplies from the Far East, is considering stockpiling millions of latex gloves. And the Department of Veterans Affairs has developed a drive-through medical exam to quickly assess patients who suspect they have been infected.

Off Topic Rolling Blackouts

We've had some rolling blackouts across my region. Reminds me of my time in Los Angeles, except the damn electircal utility here should be expecting 95+ degree weather and massive power consumption in the late afternoon. Well, at least they should be in summer...I guess it is kind've unpredictable in mid-April.

Off Topic Awaiting The Grand Jury

Two Duke lacrosse players (not three) indicted under seal by the grand jury.
A grand jury issued sealed indictments Monday against two members of the Duke University lacrosse team in connection with allegations that a stripper was raped last month at a team party, NBC News’ Dan Abrams reported, citing two unnamed defense sources.

The charges against the two players are unclear, Abrams reported.

The Durham DA is relying on the physical exam of the alleged victim, in which signs consistent with rape were found, and her identification of her alleged attackers.
Earlier, the exotic dancer identified two players with 100 percent certainty and a third at 90 percent as having raped her at a party last month, ABC News reported Monday, citing what Durham County prosecutors told the players' attorneys.
I guess 90% on the third alleged assaulter wasn't quite good enough.

You can watch an interview with the second exotic dancer who was at the Duke lacrosse party at the MSNBC site, in which she appears to believe the allegations but admits to have no specific knowledge of the attack. This contrasts with
what defense attorney investigators who questioned the woman were told,
Defense attorneys, however, have said the women told them she didn't believe the allegations.

"She did tell us that she didn't have any reason to believe the woman's story, and if she's changing her story yet again, it will be interesting to see what she told the police," defense attorney Joe Cheshire said Monday.
As well, again from the MSNBC site, investigators for the defense have released an interview with the security guard who called 911 says that the "passed out drunk" victim never mentioned being raped.
ABC News also obtained an audio recording in which a female security guard, who possibly was the first person to see the alleged victim, said she did not mention anything about a rape and that there were no signs that a sexual assault occurred.

"There ain't no way she was raped; ain't no way, no way that happened," the guard purportedly tells a private investigator in the recording, ABC News reported. The guard had called 911, after which police found the alleged victim at a grocery store parking lot, where the guard was working.

Saturday, April 15, 2006

The Mass. Experiment

The New York Times on Massachusetts plan to provide healthcare for all.
The move is already raising hackles among libertarians, who consider it an unwarranted government intrusion into decisions that should be personal. But the truth is, very few of the uninsured go entirely without medical care. When they get sick, they typically show up at emergency rooms, where they get very expensive care without paying.

By forcing all residents to assume responsibility for their own health coverage, Massachusetts should largely solve this "free rider" problem and tilt treatments back toward routine and preventive care and away from emergency care.

I agree with this assessment; compromise has to be made on both sides and I hope that this experiment yields some useful results. Still, as I've commented on before, the editorial's "46 million" uninsured figure is probably overstating it, as several government studies have suggested.

Off Topic Durham Police Go Fishing

The Durham police have been accused by defense attorneys of resorting to some shady practices to gather some last minute evidence before DA Nifong goes before a grand jury on Monday.

In case you haven't been keeping up an exotic dancer alleged she was raped and degraded as an African American by white members of Duke's highly ranked lacrosse team at a party. The lacrosse season was canceled and the coach lost his job. Here is Talk Left summarizing the rape allegations and subsequent situation, albeit with a lot of Op/Ed thrown in.

With the next grand jury date next Monday, the Durham police apparently have stepped up their efforts to give the Durham District Attorney more than the accusers' statement to hang his hat on.

First, despite all members of the lacrosse team having already lawyered up the Durham police go to dorms and try to interview Duke lacrosse players without notifying their attorneys.
The players contacted their lawyers, who advised them not to answer the questions, said Kerry Sutton, an attorney for one of the lacrosse team captains.

"They didn't ask to search the rooms; they wanted to ask some questions," Sutton said. "After the guys in question said, 'No, thank you,' the officers went away."

She called the attempted interviews, conducted late in the investigation and without attorneys present, "another poor choice by the investigation team."

Second, the Durham police are being accused of running an email sting to get the players to incriminate themselves. I'm not sure there's anything wrong with such an deceptive attempt, but if they're going to such lengths it does raise questions about the current strength of their case. The case certainly became weaker after the DNA evidence came back and didn't implicate any of the lacrosse players.

The explosive allegations stem from an e-mail message sent in the last few days to several players from the e-mail address of another player, stating he was going to tell the police a crime occurred and implicate key players. The player denies he sent it

"The police said (the new e-mail) came from a confidential informant, but we have reason to believe it came from the police, hoping it would make all the players nervous," says one defense lawyer.

In another blow to the prosecution, the radio recordings of the police band were released to the AP and show the condition of the alleged victim at the time she made the rape allegations.

A woman who claims she was sexually assaulted by members of Duke University's lacrosse team was described as "just passed-out drunk" by one of the first police officers to see her, according to a recording of radio traffic released by Durham police on Thursday and obtained by The Associated Press.

The conversation between the officer and a police dispatcher took place about 1:30 a.m. March 14, about five minutes after a grocery store security guard called 911 to report a woman in the parking lot who would not get out of someone else's car.

The officer gave the dispatcher the police code for an intoxicated person and said the woman was unconscious. When asked whether she needed medical help, the officer said: "She's breathing and appears to be fine. She's not in distress. She's just passed-out drunk."

Want Medicaid?

A new law to go into effect will save the federal government nearly three quarters of a billion dollars over ten years, by requiring proof of U.S. Citizenship to enroll in Medicaid. Of course, I'm unsure of the cost of the bueacracy to implement this requirement which will probably be shelled out by the states. This New York Times article however is critical of the new requirement.
"This provision is misguided and will serve as a barrier to health care for otherwise eligible United States citizens," said Gov. Chris Gregoire of Washington, a Democrat.

Ms. Gregoire said the provision would cause hardship for many older African-Americans who never received birth certificates and for homeless people who did not have ready access to family records.

Thursday, April 13, 2006

Beer Causes Cancer...

...luckily, "eating fruits and vegetables regularly seemed to counteract the carcinogenic effect of beer." Uh...okay.

H/T Slate

Off Topic Texas Crackdown on Drunks in Bars Over

I bemoaned my home state cracking down on being drunk in a private bar earlier. Well, so did the rest of the public and now the program has ended.

Wednesday, April 12, 2006

Off Topic Global Warming Alarmism

The MIT Alfred P. Sloan Professor of Atmospheric Science claims climate research funding is driven by alarmism and the idea that it is necessary because doom is imminent. While global warming may be happening, the consequences of it will be much less dramatic than what some would have us believe. Predictions of such doom are based on junk science or none at all, but they're necessary to achieve the next grant.

Basically, a State of Fear exists around the exaggerated predicted consequences of global warming.


The risk of breast cancer with estrogen therapy is minor or non-existent.
Taking estrogen does not increase the risk of breast cancer for most women who have an intact uterus. That's the final word from the Women's Health Initiative (WHI), which is the largest, most scientifically rigorous research program ever to look at hormone therapy. The results are being published in the April 12 issue of the Journal of the American Medical Association. Preliminary results from the same study came to a similar conclusion in 2004.

Tuesday, April 11, 2006

Vioxx with Devil Horns

The 77-year-old diabetic gets another 9 million in a punitive award. This on top of an original 4.5 million dollar verdict.
In order to award punitive damages, the jury of six women and two men in New Jersey Superior Court needed to find that Merck withheld material information on Vioxx from the U.S. Food and Drug Administration, and that the company's actions were deliberately meant to harm.

What exactly did Merck hide? Well, not much actually. There are really no damning memos, no smokey room meetings. Seeing that this seems a requirement for punitive damages in New Jersey, Merck is looking to appeal.

[T]he $9 million punitive damages award was unsupported by New Jersey law, which allows punitive damages only where there is clear and convincing evidence that (1) Merck knowingly withheld or misrepresented (2) information required to be submitted to the FDA under the FDA regulations (3) which information was material and relevant to the harm in question. The Shapiro analysis on which plaintiffs rely flunks all three requirements; only the slimmest of evidence (a deposition slip by Edward Skolnick) supports the first prong, and the other two prongs are completely naked.

No, the criticism of Merck is based only on a number of studies that people can now look at and say, 'you should've known.' You can find a Power Point summary of the history of our understanding of the risks of Vioxx here.

What the study data even shows is up for debate, although there is some statistically significant increase in the risk for cardiovascular disease in all of the three major studies which have been done. The VIGOR study, the Lancet study, and the APPROVe study which led to Merck voluntarily pulling Vioxx.

It should be pointed out that these risk factors in and of themself aren't suprising. These are virtually the same risk factors associated with some other cyclooxygenase inhibitors.

Almost every NSAID holds some life threatening risk factors. Even good ol' aspirin, which, because of its blood thinning properties, has been touted as a savior during a heart attack (seemingly paradoxical when looking at its COX-2 inhibitor cousins as causes of heart attacks), can be dangerous.

Non-steroidal anti-inflammatory drugs (NSAIDs), including low-dose aspirin, are behind a third of all hospitalizations and deaths associated with GI bleeding, according to two Spanish studies.

Low-dose aspirin alone accounted for between 8.2% and 12.2% of all GI complications and deaths, the research team reported in the August issue of the American Journal of Gastroenterology.

The most damning reports center around the 2000 VIGOR study which looked at gastrointestinal problems associated with Vioxx use, and was published in the New England Journal of Medicine. That the researchers had excluded and even deleted some cardiovascular events from the VIGOR study suddenly became a hot topic once Vioxx was actually pulled,

"I was somewhere between surprised and stunned," Dr. Gregory Curfman, executive editor of The Journal, says. "They allowed us to publish an article that was just incomplete and inaccurate in some respects and was misleading and may have contributed to the detriment to the public health."

The Forbes article (link above), like so much media makes it sound like the data was covered up. What a bunch of baloney. Two points must be made:

  1. Everyone knew the figures from the VIGOR data. The NEJM had them by 2001 (it takes them 4 years to get outraged) and the FDA had them, even if they were left out of the publication. Yet now they pretend it was some kind've cover up.
  2. The data did not make the statistical conclusions of the study any different.

Here's Rangel MD at the time of NEJM's editorial (subscription required) on the VIGOR study and just what is significant and isn't.

The three cases of heart attack (which have been known since 2001) increase the statistical power of the VIGOR results which showed an increased risk of heart attack in the Vioxx taking patients but they do not at all change the conclusions. Why the VIGOR authors would withhold data on three cases from the Journal when it would not have made a difference is beyond me. This is like accusing the government of trying to cover up the fact that 9/11 even happened by showing that they tried to cover up the evidence of United flight 93 which crashed in Pennsylvania.

That is because they didn't. The three heart attacks fell outside the time frame of the study, fell outside the specifics of the study, didn't effect the conclusions, and there is no evidence their lack of appearance was mediated by Merck action or persuasion on the University of Toronto researchers. Yet it is some type of outrage that they were left out and proves Merck was hiding the terrible dangers of Vioxx all along.

[The researchers] say the heart attacks and strokes in question were not included because they were reported in a two-week period after the study termination date.

"Even if that data had been included, they would not have changed the results," Dr. Bombardier said in an e-mail interview yesterday.

Dr. Bombardier defends the study saying it was not designed to draw findings about the heart or the cardiovascular system.

"It was designed to draw statistically significant data about the effects of Vioxx on the gastro-intestinal system," she said.

As if anyone would've looked at Vioxx differently if the data had been included. Yet, this is the scenario upon which the NEJM basically condemned Merck to failure in the most important court of all, that of public opinion.

Such public misconception and media driven opinion makes 9 million dollar punitive awards, for 77 year olds with other significant risk factors for myocardial infarct, possible.

Here's a breakdown of Mark Lanier's, the defendant's attorney, favorite piece of evidence, the Lancet published Kaiser Permanente study, by an economist blogging over at Econobrowser:

1.39-fold increase risk of heart attack from taking rofecoxib [Vioxx] compared to no NSAID. Is that statistically significant, in other words, can you rule out that you'd see a difference of that size just by chance? Yes, the study claimed, but just barely.

The obvious question here is whether in fact the authors were able to observe all the relevant risk factors. The study openly acknowledged that it did not, missing such important information as smoking and family history of myocardial infarction.

How is a jury member with a high school diploma suppose to crunch this stuff? You better dumb it down into analogies everyone can understand. Here is an expert at it:

[R]esponding to witness Gilmartin'’s argument that the results of a study showing Vioxx users had six episodes of heart attacks or strokes to one for placebo users were not statistically significant, [Mark Lanier] asked:

"have you got $6 on you? I'm going to give you a dollar and you give me the six. It is not statistically significant in the difference. What do you think, are you in or out?"

But as Econobrowser points out, while that is a folksy way to package the statistics and bring them down to a level, it is misleading.

[H]ere's how the deal actually works-- you give me the dollar, but you don't know whether I give you $6 or I give you nothing. Or, to be a little more accurate, even if there actually is an elevated risk of the magnitude the studies suggest but can't prove, the question is whether I might want to accept a 1 in 4,000 risk of dying from a heart attack in order to get the only medication that makes my pain bearable and a mobile life livable.

And saying the public and their physicians weren't informed enough to make that risk-reward analysis because Merck maliciously withheld three heart attacks from a study is baloney. Saying, even if data had no releavance, that by putting themselves in a situation where subversion could be inferred (say by deleting data), that they brought this upon themselves is baloney. I'm sure every plantiff is suing to make drug research more transparent. *Rolls Eyes*

No, what this is, is the expectations game again. The same game that drives medical malpractice lawsuits (instead of actual negligence).

The truth is there is no such thing as the perfect drug. They all carry risks, and there are things that can be done, from all sides, to lessen those risks and make drugs with both great risks and great benefits available to patients who understand the balance. From the patient/plantiff's point, stop asking your doctor for everything that shows up in DTC advertising and popping it into your mouth. Just respect these drugs a little more. They've become far too common. Realize the very basic truth that you are putting foreign chemicals into your body, and bad things can happen.

Monday, April 10, 2006

"Judges Go To School"

From Medrants quoting an AMNews article. Educating judges on medical practice is a great idea.

Off Topic Jumping to Conclusions

DNA evidence has failed to point to rape by any member of the lacrosse team. You can watch the words directly from the horses' mouth.

Certainly this isn't the nail in the coffin of a possible prosecution. The lip flapping prosecutor, who couldn't seem to shut up earlier in this investigation, has made that clear. It has to be posturing for his upcoming election.
“I’m not saying it’s over. If that’s what they expect, they will be sadly disappointed,” Nifong said at a candidate forum Monday night. “They can say anything they want, but I’m still in the middle of my investigation. … I believe a sexual assault took place.”
He can talk all he wants, this result is a major, major blow. Along with released time stamped photos from the defense team which show the bruising and the bad shape the stripper/escort is in at the time of her arrival to the party, this DNA evidence cast some serious doubt on the guilt of these young men. These signs of trauma were a major part of the announcement by her examiners, after her accusation, that she had physical signs consistent with sexual assault and they appear to have occurred prior to her arrival at the lacrosse party.

Although the lacrosse players themselves have kept relatively quite, motives, such as anger over money and maybe even racial slurs directed towards the alleged victim, have been leaked out about why a false accusation may have been made. Talk Left probably has the most likely scenario down,
Bottom line in my opinion: The accuser got to the party at 11:30 pm. The evidence of sexual activity which the rape exam nurse found to be merely "consistent with" forcible sex, likely happened before she arrived, as did her physical injuries. There was a dispute (and possibly) a scuffle over the money - the players felt ripped off that the girls stopped dancing after just a few minutes and that one of them (the accuser) was too drunk to dance.

If the accuser made up the rape claim, the damage she caused to these young players, to the lacrosse team which had its season cancelled, to Duke University and its reputation and to the team's coach is incalculable. And, it will be a huge stab in the back to true rape victims everywhere, who already fear they won't be believed if they come forward.

Even with the underage drinking, the alleged racial slurs which in themselves may not be true, and the vile disgusting email, these players have been forever demonized beyond their guilt, which is unfortunate. It will horrify me anytime I read about how they brought it upon themselves.

What we have here is a party with underage drinking and strippers, something that, while a mistake and wrong, happens thousands of times over every weekend across the universities of this country. What we have here is a single disgusting drunken email, from a lone individual, not the other 45 men. But even this young man didn't deserve what these accusations have cost him.

If the accusations turn out to be lies, the real villain here is the "victim"...if anyone has the guts to step back from the conclusions they immediately jumped to and realize that. But I'll be surprised if I see half the editorials written about this new turn of events as I did when the victim was a sympathetic African-American mother of two trying to put herself through college by working hard at the only profession that paid well enough to do it.

And as always, if despite the lack of evidence, this woman was raped then let those who did it rot in prison.

Here's Captain's Quarters take on it. Here is Lashawn Barber with great coverage of the scandal and commentary on the portrait of racial crimes in the media.

Sunday, April 09, 2006

Need a Liver in Orange County

The University of California, Irvine Medical School's liver transplant program which was just one of a number of problem transplant programs for the health science center before being shut down recently is being investigated by the FBI.

While the exact scope of the federal investigation is not known, recent federal healthcare prosecutions have centered on insurance fraud and unreported income by doctors.

Federal health insurance plans were a key source of funding for the UCI transplant program, public records show. Most patients treated at the liver program were insured by either the federal government's Medicare program, the state's MediCal program, or the county's Cal-Optima program, which relies on both state and federal funds.