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Wednesday, May 31, 2006

End of FP?

Don't Ask, Don't Tell

New York City is trying to distribute its message to illegal immigrant populations that hospitals will not ask or record their immigration status if they come in for treatment.

Tuesday, May 30, 2006

AIDS Growth Slowing

The U.N. Aids program says the new infection rate for HIV is slowing.
The progress against AIDS in some regions represents dividends from a surge in financing since 2001, when the United Nations pledged its commitment to stem the epidemic by 2010. That declaration called for countries to report regularly on their responses to AIDS. This week, the General Assembly will review the progress that 126 countries have said they have made.

Loop de Loop

A new study says that Americans are also sicker than Canadians.

The cause and effect relationship here is NOT...America's Poor Healthcare system & Number of Uninsured ---> Poor National Health.

It is...America's poor health ---> Increased healthcare costs & lower average life spans.

You want to improve the health of this country? Stop arguing that we spend too much and that the piles or paper and health insurer greed is causing a crisis and a single payor system will reduce costs and improve the demographics by providing care for the uninsured. Instead, PUT DOWN THE BIG MAC AND GET ON A TREADMILL. That will do far more for the health of this nation than insuring all the uninsured.

Sunday, May 28, 2006

A Year

I've been blogging for over a year (May 27, 2005 - May 28, 2006).

HIV From A Stab Wound

A teenager went on a stabbing rampage in Berlin, and one of the victims was HIV+. Now all those stabbed after that victim are getting prophylactic anti-retroviral drugs.
"The chance of an HIV infection through a knife wound is three in 1,000. The prophylaxis can reduce the risk by another 80%," he said.
I've mentioned it before, but long ago. One of the worst stories I heard during first was the FP doctor helping run an HIV clinic. She came in and talked to us during our medical ethics class. Che contracted HIV from a needle stick. It was a terrible story as well, because she had gone over to the home of a patient who had been sent home for hospice (a decision she didn't agree with) to check his CD4 count one last time, and there was no sharps container in the home so she stuck the used needle in a bag and took it back to the clinic.

She reaches in for the vials when she gets back and the rest is obvious.

Friday, May 26, 2006

Why Does Healthcare Cost So Much?

Previously I argued that perhaps we're putting the chicken before the egg...or something like that, excuse the screwed up analogy. In anycase, perhaps healthcare in this country is 'worse' and yet costs more because we're a comparatively unhealthy country. Indeed there's some evidence for that.

Now, thanks to Kevin, M.D., I've had a little look at the breakdown of who, based on costs, consumes the most healthcare.

1% of all Americans consume, in terms of cost, more than a fifth of all healthcare. These are the sickest Americans, and you might imagine that very accute diseases or trauma might be contributing to massive one time costs. But, what is more remarkable is that of those roughly 2.5 million Americans of which 22% of healthcare expenditures are made for, more than 25% of them were in the top 1% of all healthcare consumers the previous year. These are chronic patients, consuming hugely disproportionate healthcare resources year after year.

Healthcare largely doesn't cost more in this country because the system is poor or ineffective. It costs more because this country is unhealthy.

Thursday, May 25, 2006

Can Greg Garber Write Anything But Fluff?

Cloaking

A cloaking devide which works like water flowing around a pencil.
Two separate teams, including Professor Pendry's, have outlined ways to cloak objects in the journal Science.

These research papers present the maths required to verify that the concept could work. But developing an invisibility cloak is likely to pose significant challenges.

Both groups propose methods using the unusual properties of so-called "metamaterials" to build a cloak.

"Water behaves a little differently to light. If you put a pencil in water that's moving, the water naturally flows around the pencil. When it gets to the other side, the water closes up," Professor Pendry told the BBC.

"A little way downstream, you'd never know that you'd put a pencil in the water - it's flowing smoothly again.

"Light doesn't do that of course, it hits the pencil and scatters. So you want to put a coating around the pencil that allows light to flow around it like water, in a nice, curved way."

HIV Origin

The source of the AIDs epidemic has been found. The direct Simian Immunodeficiency Virus that gave rise to HIV in humans has finally been found in west Africa.
Scientists have long suspected that HIV had its in origins in wild chimp populations. But previously SIV had been found only in some captive chimps.

The virus was found in chimpanzees in southeastern Cameroon, where SIV infection rates were as high as 35 percent in some chimp populations.

Further genetic analysis linked these chimps to the source of the main strain of HIV-1, the most prevalent form of HIV. The team's findings are to be published tomorrow in the journal Science.

"Eventually the virus ended up in a major metropolitan area, which would either be Kinshasa [Democratic Republic of the Congo]or Brazzaville [Republic of the Congo]," Hahn added. "That's where we believe the AIDS pandemic really started."

"We now know there are more than 30 species of monkeys across Africa which have their own forms of SIVs," said Sharp, who was also involved with the new study.

Wednesday, May 24, 2006

Cancer & Marijuana

An AP story reports on a recent paper presented at the American Thoracic Society meeting which found no increased lung cancer risk for heavy marijuana users.

Previous studies showed marijuana tar contained about 50 percent more of the chemicals linked to lung cancer, compared with tobacco tar, Tashkin said. In addition, smoking a marijuana joint deposits four times more tar in the lungs than smoking an equivalent amount of tobacco.

"Marijuana is packed more loosely than tobacco, so there's less filtration through the rod of the cigarette, so more particles will be inhaled," Tashkin said in a statement. "And marijuana smokers typically smoke differently than tobacco smokers -- they hold their breath about four times longer, allowing more time for extra fine particles to deposit in the lung."

He theorized that tetrahydrocannabinol, or THC, a chemical in marijuana smoke that produces its psychotropic effect, may encourage aging, damaged cells to die off before they become cancerous.

Women's Duke Lacrosse Team

Is showing support for the men's team.
In a show of solidarity with the Duke University's men's lacrosse team, members of the school's women's team plan to wear sweatbands with the word "Innocent" written on them.

Video Games

Surgeons performing laproscopic training drills made fewer errors and were quicker if they played video games for thrity minutes before the procedure. As well,
The results supported findings from a small study conducted by Rosser in 2003, which showed that doctors who grew up playing video games tended to be more efficient and less error-prone in laparoscopic training drills.

Tuesday, May 23, 2006

National Organization of Women

The California chapter of the National Organization of Women has gotten involved, per Dr. Blaine's urging apparently, in Mark Sanchez's rape case. They sent a letter to USC protesting USC football players getting away with sexual assault, as if all those accusations were without question valid and real. The complete letter is here. I thought we had a judicial system for a reason.

USC responded with a reply letter. They're clearly the voice of reason in this debate. Speaking of things that don't "hold a lot of water," the Mark Sanchez case which specifically prompted the reaction by NOW doesn't seem to be standing on its own. I hope, despite his talent, that if he's guilty of the crime then he suffers for it, but if these accusations are false that pressure from organizations like NOW don't affect the outcome of the investigation surrounding him.

Human to Human Transmission...

...of H5N1, is being suspected in Indonesia in a cluster of 7 cases (6 of them fatal).

A team of international experts has been unable to find animals that might have infected the people, the World Health Organization said in a statement today. In one case, a 10-year- old boy who caught the virus from his aunt may have passed it to his father, the first time officials have seen evidence of a three-person chain of infection, an agency spokeswoman said. Six of the seven people have died.

"Teaching Doctors To Care"

It's exactly what the title of the Time article says.
Claire Brickell, 25, an aspiring neurologist in her third year at Harvard Medical School, already knows far more about health care than most of us...But when it comes to communicating with patients, Brickell has a problem: she's too healthy. Like most of her classmates, she has spent very little time as a patient. She has never had to weigh the advice of a trusted friend against conflicting orders given by a cold and distant doctor.

Enter Santa Ocasio, 56, a Dominican immigrant who is fighting a protracted battle with Type 2 diabetes. In a pilot program that is the leading edge of a broad curriculum overhaul at Harvard Medical School, Brickell has been paired with Ocasio for nearly five months. She sees her as a patient every week at the Spanish Clinic of Boston's Brigham and Women's Hospital and tags along on visits to her specialists. In fact, the goal is for Brickell to be there every time Ocasio encounters the health-care system. It's not just a way to learn about treating diabetes; it's a crash course in the myriad frustrations of a patient caught in the maw of modern medicine--confusing prescriptions, language barriers and an endless parade of strangers in white coats.
Can you really teach empathy? This is a lovely program, but it accomplishes only in allowing the medical student to get up close to a single patient's experience. And of course there are similarities in the ways most patients deal with chronic conditions (such as diabetes). But it isn't cut and paste. I don't think we need to be taught empathy; if the school's are doing their jobs effectively they graded that on admission.

It is just that over the time of our training it appears to die. Part of that is habituation. Part of that is emotional necessity. Part of that is the training itself. Empathy is not sympathy, it is the actual ability to put oneself in someone else's emotional shoes. For people witnessing suffering that is quite a burden over the long run it seems to me.

The training itself, while getting better, is still, in many specialties, centered around turning out a kind've Type A physician. In some ways a too touchy feely neurosurgeon would be a little concerning to me, right before I went into the OR. Give me someone confident, with great hands, whose going to fix the problem and move on; but maybe that's not exclusive of what Harvard is trying to do.

Merck Looks Guilty

Why Merck looks guilty and juries can't be trusted with technical cases from In The Pipleline.
The problem is, the data look as if they're trending worse from a much earlier stage, and finally reach significance at the later time points. No lawyer in the world is going to walk away from that without driving it into the jury's heads that the danger is plain to see, yes, right there from the beginning, and don't talk to me about p-values when anyone can just look at this chart - your chart! - and see what's really going on. . .etc. We live by statistical arguments in the drug industry, but the people who are being called to jury duty sure don't.

Monday, May 22, 2006

Thus Ends

What to say? The calls weren't even close to level for the first three quarters of Game 7. The sad thing is, is that they were clearly in favor of the Spurs. The Mavericks shooting like 70% in the first half however easily negated that. Pretty impressive.

Despite so many early games being decided by the refs, Game 7 was the Spurs' to win and they didn't. Well, they did end up in a huge hole with the Mavs incredible shooting which was more a testament to the Mavs than a lack of Spurs defense. But at the end of the game, and then into overtime after the Mavericks cooled down and the Spurs tied it, the Spurs had chances to win and simply didn't finish. There was a great look to win it at the end of regulation, and then Tim Duncan must've missed six or seven shots at the basket in overtime. With the refs decidedly on their side for three of four quarters the Spurs fell just short. Pretty bitter pill to swallow, especially considering the owner of the team we lost to. His team's well earned success tonight changes nothing about his character or class. Screw you, Mark Cuban.

WHO Head Dies

Director General of the World Health Organization has died in Switzerland.
Dr. Lee fell ill at a luncheon on Saturday in Geneva at the beginning of the weeklong meeting, called the World Health Assembly. He complained of a severe headache, took an analgesic, and later vomited, an official who was present said. Paramedics took him to the Cantonal Hospital in Geneva. Surgeons found that he had a blood clot on the brain known as a subdural hematoma and removed it.

Such clots often follow injuries to the head like those from a fall. But the W.H.O. said Dr. Lee had been in good health and was not known to have had any such injury. The clot also could have resulted from a bleeding artery in his brain.

Almost all subdural hematomas result from a bleeding artery, the vast majority of the time the middle meningeal artery which runs in the dura that encloses the brain just inside the skull. Bleeding from the middle meningeal artery however is almost always associated with some sort of trauma.

Spontaneous subdural hematomas are rare, probably much rarer than the spontaneous causes of epidural hematomas. As well, I suppose they don't arise from middle meningeal bleeds like the much more common trauma subdural clots. Here's eMedicine on it.

Spontaneous subdural hematoma is rare. The literature is limited to sporadic case reports. These cases often have an arterial source, because they are usually associated with the same pathology as that involved in subarachnoid or intracerebral hemorrhage. The blood from a ruptured aneurysm may dissect through the brain parenchyma or subarachnoid space into the subdural space. Likewise, the blood released from a "hypertensive" intracerebral hemorrhage can dissect into the subdural space. In fact, a case has been reported of an acute spontaneous subdural hematoma precipitated by cocaine abuse.

He Just Keeps Typing

The Opacity of Cost

Via Kevin, M.D. we have a look at the true cost of procedures by USA Today, and how difficult it is to discover insurance reimbursement rates for physicians. This is a load of crock. Insurers even differ in what they reimburse for the same procedure to different physicians.

The illegality of disclosing seems like it accomplishes the same thing as collusion amongst the insurance companies. There is nothing open or free about this market.

To The Table

In India the government is finally going to the negotiating table with striking residents and medical students. If you remember the strike centers over an affirmative action plan for medical schools over there.

Sunday, May 21, 2006

Signature Try


Saturday, May 20, 2006

Mark Cuban Sucks

I swear I'll get off the Spurs as soon as this series is over. But, here we have Mark Cuban going off again. Of course you can visit Blogmaverick for the source.
"Then there are cities with zero sense of humor. No originality when it comes to heckling and often are just plane rude."

[Editor's Note: Yes, he did write "plane" not "plain]

"The worst ? San Antonio," writes Cuban. "There isnt even a close 2nd. The bleacher bums have filtered down to the lower bowl and they are living up to their past."
The editor's note is from the guys at SpursReport.com

Once again I am mystified this man is a billionaire. The entire foundation of my political philosophy, the idea of free markets bringing forth the cream of the crop, is being challenged. I mean is Indiana really graduating morons like this? Anyway, Cuban just called Spurs fans, culled from one of the most conservative, nicest towns in America, the rudest in the NBA? Really?

He used some antecedent about his pregnant wife being insulted. He's turned this into a fourth grade, "you started it" battle. As if insulting our town is justified by bizarre claims that San Antonio fans are the worst ever.

As I linked to above there is actual circumstantial data on this that he could've looked at rather then regaling us with supposed horror stories as "evidence". Dallas appears nowhere in Travel and Leisure's rankings of America's cities. San Antonio obviously does but the most noticeable ranking is it places second in the nation in terms of how nice our citizens are.

Thank you Mark Cuban for making dumb ass claims founded on singular experiences.

I don't think this man has any credibility or fans outside Dallas. I'll give him some credit though, his post in which he insulted San Antonio was about the greatness of rivalries. He's certainly on his way to accomplishing that; the city of San Antonio vs. Mark Cuban; the Dallas Mavericks vs. the San Antonio Spurs. I've always disliked the Mavs but they were kind've push overs, second fiddle in the division. This series and Cuban's blabering have made them enemy #1 in my eyes, replacing the Los Angeles Lakers (I was in an LA bar for Fisher's shot).

I guess we'll see who gets to laugh for the next several months come Monday. My only request for the game, which I'll be at, is that Cuban please refrain from doing this.

Maybe he thinks avid is synonymous with rude. In any case I don't see Dallas anywhere in the top 5.

Mike Finley to Mark Cuban, "Sit Down"


Michael Finley played the first nine seasons of his career in Dallas before he was released by Mark Cuban for financial reasons before the start of this season. What is amazing is that Cuban still has to pay Finley 14 million dollars this season despite the fact he's playing for the Spurs.

Finley has been playing exceptionally well against his former team. The stunned guy in the blue shirt in the background is Mark Cuban.

Where Mark Cuban Learns About Class...

Tim Duncan was asked by a reporter, after Game 6, if he had any restaurant suggestions for Mark Cuban on the Riverwalk. Instead of going off he replies, "I have nothing to say to Mark Cuban. Not a thing."

You could just sense the dislike in his voice but he restrained himself. Way to go Timmy.

Friday, May 19, 2006

Wow...

...SportsCenter just cut Avery Johnson off as he was complaining about the calls NOT going the Mavericks way. This after the Spurs won Game 6. I love the "Lil' General" but that is bullshit.

Angry

I understand the Spurs have shot more free throws but that doesn't speak of the non-calls or the targeting of fouls (Tim Duncan). I write this at halftime of Game 6. This is the worst officiated game of the series. If the Mavs can't win with the stripes on their side like this then...well, it speaks for itself.

Mark Cuban

This piece of trash business plan made Mark Cuban a billionaire? Let us go over it - he never turned a profit with it, it no longer exists, its services are no longer offered and its technology basically is no longer utilized by the company that bought it from him just 7 years ago, and yet he sold it for billions of dollars. I guess someone has to win the lottery. And make no mistake that is, for all intents and purposes, what he did. I wouldn't trust Mark Cuban to manage an Exxon station. Nice Glamor shot.

In any case, I just watched Mark Cuban insult the San Antonio Riverwalk on SportsCenter. Read his comment here. It's lovely for a man making his living in "Big D" to be insulting San Antonio. One Yahoo Travel reviewer put it perfectly:
Dallas is to travel destinations what Wonder Bread is to baked goods: it's bland, it's predictable, and some people really like it. Dallas has no significant museums, no historic attractions, no interesting architecture, no attractive green spaces, very little in the way of vibrant city life, relatively little arts and culture...
San Antonio isn't for everyone, our museum scene is even worse than Dallas', but despite that single let down it is a beautiful tourist destination. It is certainly not bland or predictable in its culture. It is a unique city in the way it celebrates and displays its Latino heritage, it has rich history centering around Spanish colonization and later the fight for Texas' independence, large open park areas downtown and nature destinations outside the city. For the mini-van driving crowd Fiesta Texas, one of three Sea Worlds, and the country's best waterpark - Schlitterbahn, in New Braunfels, certainly kick Six Flags Over Texas' offerings. I don't know where Mark Cuban gets off trashing the Riverwalk. I mean, the only side of a vacation Dallas has my home town beat is maybe shopping. But hell, why go to Dallas if that is your motivation for travel? Fly to New York or Los Angeles or San Francisco. Plus this Jason Terry suspension which got Mark all angry and prompted his insult, only evens what so far has been an unjust series. I posted on that issue just recently.

Call me a whiner. I'm comfortable with that title because it doesn't change the fact that Dallas is bland and Mark Cuban and Jason Terry are classless bums.

David Stern and Stu Jackson should be ashamed of themselves for the way Mark Cuban has influenced the officiating in this series. They can deny it, but they can also point at an apple and call it an "orange." Like the apple, all you need to see otherwise in this series is your eyes. Might as well replace David Stern with Vince McMahon if this is going to go on. Might as well rig the game so it's New York v. Los Angeles in every NBA Finals if they'ree going to let this type of officiating go.

Go Spurs Go

Thursday, May 18, 2006

A New Antibiotic

And when I say new, I actually mean new. Any microbiology course reveals the growing prevalence of antibiotic resistant bugs to its students including MRSA and VRE (and God forbid, for the future, VRSA). It also teaches that despite the plethora of names and labels, most antibiotics work by a set of very similiar, very specific functions. Change one atom here, another there then change the name but the antibiotic still works basically the same as its "first generation" cousin.

One of my lecturers even predicted that the era of antibiotics would come to an end during my practice. Antibiotics simply aren't, at the time, profitable drugs for companies to develop.

The discovery of platensimycin is exceedingly good news. Its good news for the pharm company working on it as well, Merck (they needed it). It works by a mechanism previously untargeted by antibiotics; it blocks the production of fatty acids unique to bacteria. This is all fine and dandy; potential very powerful antibiotics spring up every once and a while, but the main news around this one is the experiments it has been put through so far which show an incredible effectiveness against MRSA and VRE in mice. You can read about platensimycin here and here.

p.s. I found this without visiting Slashdot.

It Was All Made Up?

BellSouth is calling for USA Today to retract its "NSA is mining your phone calls" story.
USA Today has not yet responded to the letter. It said earlier this week it stands by its story, but that it would investigate the denials issued by BellSouth and Verizon.
Shows me the consequences of trusting USA Today. I don't know what to believe now or how mad to be.

Robbed in Texas

This is my opinion of Steve Javie and the rest of the officials who worked Game 2 & Game 3 of the Spurs - Mavericks NBA Playoff series.

Game 3 shouldn't have even come down to the wire. The Spurs were the best team on the court, the Mavericks won that game at the free throw line and anyone who thinks that Refs don't decide games or that the Spurs should've "risen above" the poor officiating is a fool. In a playoff series this close, with two nearly evenly matched teams, they make all the difference.

If your team manages to lose this series with the calls falling their way, then they suck Mark.

At least there's some good news seeing as the Mavs are all class acts (makes you wonder how the hell the Spurs have more technical fouls in this series. Thank God for quality NBA officials).

The Basic Science Years

Dr. Centor throws his rant into the discussion of the basic science years. Other discussions can be found throughout the medblog world here, here, and here.

From DB,
We should revamp how we teach basic sciences. We should emphasize the word basic, and minimize exercusions into the personal hobby of the professors.
And then my none too articulate opinion,
Perhaps the basic science curriculum needs to be weened down to more basics, that emphas[ize] what is truly clinically important.

More From APPROVe

I wish Reuters and NPR wouldn't print this as fact.
A 107-page report provided to the Food and Drug Administration by Merck last week included data from a four-year study suggesting the risk started much earlier, NPR said.

"Experts who have reviewed (the data) for NPR say it shows that patients were at higher risk of heart problems and strokes almost as soon as they started taking Vioxx," NPR said.

Merck, which is facing thousands of lawsuits alleging harm from Vioxx, disagreed with NPR's description of the report.

The Reuters headline states matter of factly that, "Vioxx risk seen with short-term use". In reality, the risk is statistically insignificant and while that doesn't play well in court rooms the best way to think about it in lay terms is like the +/- 3 percentage points on a political poll. The poll isn't completely accurate, and neither is the statistical analysis of this data. The increased risk of cardiovascular events with short term Vioxx consumption in this data falls within that range of "error".

Still, In the Pipeline is concerned about it.

Which is fine, as far as it goes. A more objective look at the data, though, show that they didn't miss statistical significance by all that much. The numbers seem to be all against Vioxx, which is enough to make you wonder if the lights would have truly flashed red in a more statistically appropriate study. As it is, Merck is in the position of saying that a study which wasn't expected to show a statistical difference between Vioxx and placebo heart safety didn't show a difference - and that that's good news.

Wednesday, May 17, 2006

I Feel Safer Already

The TSA's old guidelines: ??? The TSA's new guidlines: watch for suspicious things.
Select TSA employees will be trained to identify suspicious individuals who raise red flags by exhibiting unusual or anxious behavior, which can be as simple as changes in mannerisms, excessive sweating on a cool day, or changes in the pitch of a person's voice.
Still, after very recently watching the training of a TSA employee on an X-Ray machine, which wasn't going too smoothly, I'm not so sure we're dealing with the type of people who can be turned into master poker players (i.e. able to read people).

Chromosome 1

Is the largest chromosome, contains 3,141 genes, and has now been sequenced.

H/T Slashdot

Spread The Blame

In The Pipeline goes over a Wall Street Journal article on NEJM's response and denouncement of Merck. Basically, you come away with the sense that the Journal's overzealous condemnation of Merck, an apparent attempt to turn focus from itself, is right at the line of being malicious and dishonest.

Every Vioxx plantiff jury verdict is looking better every day. Thank God twelve random people are so smart.

From the WSJ article,

Perhaps the most sensational allegation in the journal's expression of concern was that the authors of the November 2000 article deleted heart-related safety data from a draft just two days before submitting it to the journal for publication. The journal said it was able to detect this by examining a computer disk submitted with the manuscript.

The statement was ambiguous about what data the authors deleted, hinting that serious scientific misconduct was involved. "Taken together, these inaccuracies and deletions call into question the integrity of the data," the editors wrote.

In reality, the last-minute changes to the manuscript were less significant. One of the "deleted" items was a blank table that never had any data in it in article manuscripts. Also deleted was the number of heart attacks suffered by Vioxx users in the trial -- 17. However, in place of the number the authors inserted the percentage of patients who suffered heart attacks. Using that percentage (0.4 percent) and the total number of Vioxx users given in the article (4,047), any reader could roughly calculate the heart-attack number.

Striking Residents & Medical Students

Here's the Times of India, although this story picks up the situation in the middle and is clearly a little confusing. A brief summary: the strikes center on medical education; specifically the government's plan to place quotas on state run medical schools to enroll a certain number of disadvantaged students.
[T]he Centre on Wednesday threatened action against the striking resident doctors.
Notices to individual doctors have already been served asking them to resume duties or else face action as per the service rules, according to the Health Ministry officials.
The AIIMS' RDA is spearheading the doctors agitation against the proposed quota for other backward classes in the institutes of higher learning, crippling health services.
RDA said that doctors would not end their strike unless government withdraws the controversial proposal.
Higher medical education in India is exceedingly competitive and based on merit which must be built up from the very early years in school and on standardized tests which haunt a student for his entire life. This affirmative action proposal is meeting with much resistance and severely hindering public state run hospitals in the country.

Medicine and Man has a perspective (via Kevin, MD)

Pan American Medical Errors Conference

Patients from across North and South America come together in San Francisco to work against preventable mistakes.
In the United States alone, medical errors cause more deaths each year than breast cancer, car accidents or AIDS, according to a 1999 study by the Institute of Medicine.
Well, maybe. Here is the IOM study, To Err Is Human and the Agency for Healthcare Research & Quality on the issue.

As prestigious as the Institute of Medicine is, peer reviewed work, including the JAMA article cited below, has found a potential overestimation in their figures.

Hayward RA. Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 286(4):415-20, 2001 Jul 25.
Conclusions: Medical errors are a major concern regardless of patients' life expectancies, but our study suggests that previous interpretations of medical error statistics are probably misleading. Our data place the estimates of preventable deaths in context, pointing out the limitations of this means of identifying medical errors and assessing their potential implications for patient outcomes.

[...]

As predicted on theoretical grounds, many deaths reportedly due to medical errors occur at the end of life or in critically ill patients in whom death was the most likely outcome, either during that hospitalization or in the coming months, regardless of the care received. However, this was not the only, —or even the largest, source of potential overestimation. Previously, most have framed ratings of preventable deaths as a phenomenon in which a small but palpable number of deaths have clear errors that are being reliably rated as causing death. Our results suggest that this view is incorrect; —that if many reviewers evaluate charts for preventable deaths, in most cases some reviewers will strongly believe that death could have been avoided by different care; however, most of the "errors" identified in implicit chart review appear to represent outlier opinions in cases in which the median reviewer believed either that an error did not occur or that it had little or no effect on the outcome.
As Hayward and Hofer say, this is in no way to undercut the importance of efforts to limit medical errors which are a serious problem the world over.

I Don't Want To Be...

A Yale study says people are willing to make sacrifices to not be overweight.
"We were surprised by the sheer number of people who reported they would be willing to make major sacrifices to avoid being obese. It drives home the message that weight bias is powerful and pervasive," said Marlene Schwartz, associate director of the Rudd Center and lead author of the study in Obesity, which was issued this month.
I don't care about the personal choices that lead to people being overweight, and in some cases there are legitimately genetics behind extreme obesity. But, this is the fattest country in the world, so somehow I can't help but think these willing "sacrifices" are lip service.

The Humanity of Funding

Why Type I Diabetes gets so much more federal research funding, than Type II Diabetes.

Their chief advocates are parents of children with Type 1, a group that includes skilled, upper-income professionals devoted to finding a long-sought cure, which many think is approaching.

People with Type 2, on the other hand, are far more likely to be old and poor, overweight and not white, although this disease also stems, in part, from genetic factors. The risk increases with age. Because their disease is associated with eating and inactivity, they routinely encounter less sympathy. Often they are stigmatized as undisciplined.

Tuesday, May 16, 2006

An Opinion on the Duke Case

Crime & Federalism on the Duke lacrosse rape case.
The prosecutor held some 70-or-so press conferences, essentially attempting to try to the case to the media. When it seemed that he had no physical evidence, and an unreliable complaining witness, he clammed up. Once the first round of DNA tests were conducted, the prosecutor claimed that he had more cards - but that he would be keeping those close to the vest.
H/T Point of Law (They've also reprinted Mr. John Calfee's piece on the Vioxx litigation)

Who? Us?

Verizon and Bell South deny giving phone records to the NSA as a USA Today story claimed.
"One of the most glaring and repeated falsehoods in the media reporting is the assertion that, in the aftermath of the 9/11 attacks, Verizon was approached by NSA and entered into an arrangement to provide the NSA with data from its customers' domestic calls," the company said in a statement issued Tuesday.

Verizon said it was not asked by the government agency to provide, nor did Verizon give out, customer phone records from any of its businesses, or any customer call data.

Last week USA Today reported that the National Security Agency was secretly collecting phone records from the country's three biggest phone companies -- Verizon, Bell South, and AT&T-- in an effort to detect terrorist plots.

BellSouth Corp., the No. 3 U.S. local telephone carrier, spoke out against the USA Today story on Monday, denying that it handed over customer phone records.

Can't fault me for being upset over the USA Today story at the time, but hopefully it turns out to be blown a little out of proportion.

Optimistic on Bird Flu

"Much like the millennium bug fear, everyone waited apprehensively, and nothing happened"
Scientists say the H5N1 strain will eventually mutate so that it can spread from human-to-human. When it manages to do so we could be facing a global flu pandemic. How serious the flu pandemic may be depends on the virulence of the mutated virus.
H5N1 will mutate?

A Solution To Waiting Times

A British court rules that British citizens who have to wait for treament and seek it outside of the country are entitled to a refund for the cost of the treatment by the NHS.
UK patients forced to wait longer than they should for NHS treatment are entitled to reclaim the cost of being treated in Europe, a court has ruled.

The European Court of Justice said the NHS must refund costs if patients waited longer than clinicians advised, even if waiting time targets were met.

The case, which centres on the definition of "undue delay", could have a significant impact on the NHS.

It will allow any patient facing an unacceptable delay who has the funds to pay for an operation upfront to seek treatment abroad and recoup the costs from the NHS.

Monday, May 15, 2006

Third Duke Lacrosse Player Charged

The DNA evidence "could not affirmatively exclude" him. Okay.
David F. Evans, 23, of Bethesda, Md., a team captain who lived in the house where a black woman says she was sexually assaulted by three white players during a party, was charged with rape, first-degree sexual offense and kidnapping.

Mr. Evans said that he and his roommates had voluntarily helped the police when officers executed a search warrant at their house, and that he willingly provided DNA, spoke to investigators without a lawyer present and offered to take a polygraph test, which officials declined.

She also picked out Mr. Evans but was not totally certain of the identification, Mr. Cheshire said. He said that according to a transcript of her remarks during the lineup, the woman believed that Mr. Evans had been wearing a mustache at the time of the attack. His client had never had a mustache, the lawyer said.

Mr. Evans's indictment came three days after defense lawyers received the results of a second round of DNA tests that they said failed to link any lacrosse players to the alleged crime. Tests on a fake fingernail found at the scene showed DNA from multiple sources and could not affirmatively exclude Mr. Evans, the lawyers said.

"That, according to our expert, is about as weak a DNA analysis as you could ever have," Mr. Cheshire said. He said the nail had been found in a trash can and could have been contaminated by used tissues or other items carrying the players' DNA.

She also picked out Mr. Evans but was not totally certain of the identification, Mr. Cheshire said. He said that according to a transcript of her remarks during the lineup, the woman believed that Mr. Evans had been wearing a mustache at the time of the attack. His client had never had a mustache, the lawyer said.

She thought he had a mustache? And yet earlier reports said she was 90% sure it was him? Uh...

Saturday, May 13, 2006

Texas Rabies Case Ends

Unfortunatley.
Zachary Jones, 16, died on Friday, a week after he became ill from the bat bite he received about a month before.

According to U.S. Centers for Disease Control statistics, only 10 other people have died of rabies in the United States since 1998.

"Rabies, which causes devastating neurological damage, is almost always fatal once symptoms appear, as was the case with this child," Texas Children's Hospital said in a statement.

A 15-year-old girl from Wisconsin who contracted rabies in 2004 survived after the onset of symptoms, which can take weeks to develop.

False Hope

The Defense spins the DNA evidence. Remember the DNA is not a full 13 point match (which means there is a good chance it is inadmissible in court), it came from a fingernail found in a trashcan (not exactly the purest site) and it even the partial match does not implicate either of the players currently indicted. As well, vaginal DNA testing implies that someone other than a lacrosse player had had recent sex with the accuser. Although, this is often a major hurdle in some rape prosecutions, as prosecutors must overcome the victim's sexual personality and history.

Still, I'm not really sure where the evidence is in this case. It seems like it boils down to the accuser's word versus a whole host of others (cab drivers, outcry witnesses, other lacrosse players) who seem to be backing the defense. As always of course, I should wait until the trial.

"There is no conclusive match of DNA," attorney Joe Cheshire said.

However, the attorney said, semen obtained from vaginal swabs of the accuser indicated that she had sex with a man who is not a Duke student. Cheshire would not identify that man, saying it would not be fair to him.

Cheshire said DNA was found on a plastic press-on fingernail, but the genetic material did not belong to either of the players who have been indicted. He emphasized that the fingernail was taken from the trash can by two Duke players who rented the house where the rape is alleged to have occurred.

The players volunteered the fingernail to the Durham, North Carolina, police department after the players learned of the rape allegations, which Cheshire said was not behavior consistent with that of rapists.

Also, he said, the trash can from which the fingernail was taken contained toilet paper and cotton swabs that were full of DNA, so it would be more surprising not to find DNA on the fingernail.

"It would be a real story if there was no DNA that could show some genetic strain of some of the Duke lacrosse players who used that bathroom," Cheshire said. "What a stunner that would be."

Friday, May 12, 2006

Academic Freedom

Outside the Beltway and Human Events Online look at standards of academic freedom. OTB claims that Dr. Blaine has violated the Statement of Principle on Academic Freedom.

School's Out for Summer

Right here

Eight weeks until I begin again.

Poll Shows Support for NSA

I don't agree. Here's the actual poll. I'm also troubled by the military patroling the border. Tsk tsk.
Thursday's House vote allowed Defense Secretary Donald Rumsfeld to assign military personnel under certain circumstances to help the Homeland Security Department with border security. The vote was 252-171, and the provision was added to a larger military measure.

Thursday, May 11, 2006

Faster Than Light...

...and heading backwards.
To understand how light's speed can be manipulated, think of a funhouse mirror that makes you look fatter. As you first walk by the mirror, you look normal, but as you pass the curved portion in the center, your reflection stretches, with the far edge seeming to leap ahead of you (the reference walker) for a moment. In the same way, a pulse of light fired through special materials moves at normal speed until it hits the substance, where it is stretched out to reach and exit the material's other side [See "fast light" animation].

Conversely, if the funhouse mirror were the kind that made you look skinny, your reflection would appear to suddenly squish together, with the leading edge of your reflection slowing as you passed the curved section. Similarly, a light pulse can be made to contract and slow inside a material, exiting the other side much later than it naturally would [See "slow light" animation].

To visualize Boyd's reverse-traveling light pulse, replace the mirror with a big-screen TV and video camera. As you may have noticed when passing such a display in an electronics store window, as you walk past the camera, your on-screen image appears on the far side of the TV. It walks toward you, passes you in the middle, and continues moving in the opposite direction until it exits the other side of the screen.

A negative-speed pulse of light acts much the same way. As the pulse enters the material, a second pulse appears on the far end of the fiber and flows backward. The reversed pulse not only propagates backward, but it releases a forward pulse out the far end of the fiber. In this way, the pulse that enters the front of the fiber appears out the end almost instantly, apparently traveling faster than the regular speed of light.
Unfortunately it does not prove the insurmountable speed of light possible. The conclusion of Einstein's work that nothing may travel faster than the speed of light still stands.

H/T Slashdot

Silicosis

Silicosis at Point of Law. God bless Texas & Mississippi.

Bird Flu Not Spreading

Well, as quickly as some feared. Actually, I don't really know how valuable this study from Wetlands International is. Basically, it says that someone's fear, somewhere about how fast bird flu was going to spread might have been unfounded. Well, glad we got that settled.

Kind've sounds like the guys at Wetland International don't want any governments going around exterminating wetland birds in an avian flu panic.

Anyway, here's the Houston Chronicle story or info from Wetlands International themselves.
Experts from Wetlands International tested some 5,000 wild birds in countries including Tunisia, Egypt, Burkina Faso, Sudan, Senegal, Malawi and Kenya but didn't find the highly pathogenic H5N1 virus, which can be fatal in humans, said Ward Hagemeijer, who studies the disease for the organization.

Scientists had feared that the spread of the virus would pick up speed with the birds' winter migration to Africa and the Middle East, and their spring return to Europe.

Scientists say they do not know why bird flu does not appear to be spreading in the wild as widely and quickly as feared.

Hwang Wook Suk Update

Hwang Woo Suk has been indicted in South Korea stemming from his fraud.

If you don't remember over 2004 - 2005 the doctor and his team claimed to have derived stem cells from a cloning process. The entire results published in Science turned out to be false.

USA Today Plagerizes The NY Times?

A Drudge headline raises such a question about this story, printed months ago, about the NSA pooling info on domestic phone calls.

Dr. Blaine on Cardinal Martini

Cardinal Martini has some more coverage of the ongoing saga of feminist USC instructor Dr. Blaine. There are plenty of others, but here are some good summary posts:

Post #1: The 10 Commandments of Dr. Blaine

Post #2: The argument against Dr. Blaine's continued employment

This really is of a larger issue. How do you balance academic freedom (which I truly do highly value) with extremist personal beliefs? I don't know the full answer but I do know it must involve the right to discussion in her taught courses and the ability of her to not discriminate against students who disagree with her. I don't buy that part of opening students to new ideas and experiences is in forcing them to accept such views.

Maybe she does that, I have no reason to believe otherwise. Many of her collective comments posted by Cardinal Martini seem to imply at least lip service to allowing students to engage in her class even with differing opinions.

TrojanWire also gets in on the act
concerning Dr. Blaine's comments on Mark Sanchez's recent sexual assault arrest.

Finally, I want to look at the way Dr. Blaine goes around defending herself:
So I hadn't been on your blog in a while, as finals have been currently ruining my life, but I was shocked to see how many people have made it their life's work to respond with such hate. While they try to sound quite philosophical with their responses, they come out sounding ignorant.
This is from a student email in support of her which she quotes. I just don't think she does a very good job defending her beliefs. I think she does at least as poorly as those who disagree with her, despite the letter above. I understand that much of what she comments on concerning feminism are standard feminist ideas in some circles - such as holding men as a sex responsible for rapes but some of her discussions seem to draw conclusions based on naked evidence and at times she makes seemingly opposed comments.

For instance look at this anecdote as"proof".
I had been teaching at Claremont McKenna, where there's not one [a Gender Studies Department], and I had become disheartened by the misogyny flourishing at that school. Prove it? O.K. One evening the Take Back the Night march came through CMC's campus and some of the students enacted a mock-rape in silhouette as the protestors walked by.
Singular events, simple stories don't establish evidence of broad claims. The vocabulary implies a condemnation of more than just those who carried out the fake rape. I'm not saying that the culture at Claremont McKenna isn't misogynist...I have no idea about that, this is merely commentary on Dr. Blaine's apparent thought process. The reasoning behind her claims, her debate points just seems lacking (and no matter how much she claims she doesn't care about the opinion of her detractors every post seems to be a thinly veiled response to such).

Maybe medical school is just getting to me; who cares about standards of evidence?
I'm still struggling with what I think of this situation at my alma matter. The real debate is twofold when does academic freedom cross the line and when should one's personal life have consequence in one's professional life; I guess that should've been the real focus of this post (but it wasn't). There are lines that can be crossed for both these issues. Academic freedom isn't limitless and notoriety so as to bring disrepute to your job is also a real issue.

We might certainly be closer to those lines than Dr. Blaine seems to want to admit. I certainly don't expect USC to take action, but this is a real debate.

Finally (really this time) I bring up the idea of personal responsibility for others which I trashed previously. I want to give the idea of the sin of omission a fair shake, even as a Libertarian I don't buy it. You can read a short, famous theological debate of the issue or you can read how our responsibilities to others only extend to not opposing them, all else is a personal belief/choice.

Basic Science In Medical School

A few days ago I got fifty dollars to trash "pseudoscience," to use Dr. RW's term. My school is one of a few to receive a grant from the American Medical Student Association to develop a Complimentary and Alternative Medicine curriculum.

I'll never see it because it is still being developed, and God willing with the answers I gave on that survey neither will any future basic science year students at my school. I felt kind've bad for basically cursing any attempt to introduce this into our curriculum, seeing as taking the survey entered you into a raffle to win a $50 Barnes and Noble gift card (which bought me Dan Harrington's first volume on tournament hold'em and a history of the Knights Templar). At the least I should've spent the gift card on this.

It is an odd trend we're experiencing. On the one hand more and more basic science is being crammed into the first two years. It is remarkable what I'm taught compared to my parents 20 years ago. The growth of the volume of information presented has forced students to decide earlier and earlier that they are called to medicine. The schools want to build off what you should have already studied in college. Next year for the college seniors applying to my medical school they will have had to have taken 2 semesters of physics, 2 semesters of general chemistry, 2 semesters of organic chemistry, 4 semesters of biology/zoology, 1 semester of calculus or statistics, 1 semester of biochemistry.

That is nearly two full years, half or you college education, dedicated to science. Imagine wanting to be well rounded, being an English major (or in my case a Screenwriting major) and trying to accomplish this. All I can say is thank God for summer school (and I didn't even have to have biochemistry).

At the same time material like medical ethics and alternative medicine are trying to be worked into the first two years of medical school.

Stories like this one from Australia are a little concerning and have prompted Orac and Dr. RW to comment on the story's focus, that touchy feely subjects are crowding out time for basic sciences. Dr. Rangel got the debate started with his opinion that medical students actually don't need so much basic science.

I'm not really sure where I really stand. A lot of this is important stuff, and God forbid it be replaced by CAM but is there too much basic science? Dr. RW has already put it best,
Memorizing all the steps in the glycolytic sequence and the Krebs cycle won’t make you a better doctor but it could be important to understand how those reactions yield energy, why a molecule of glucose yields only a couple of ATPs in the glycolytic sequence, but an additional 30 some odd in the Krebs cycle, a fact that explains the difference between aerobic and anaerobic metabolism and why folks have to breathe. It’s all about the how and why of health and disease.
I've never witnessed medical students misidentifying the heart but if there is a glut of basic science ignorance on the wards then the problem stems from time constraints. Sure, these fluff classes can certainly be part of the problem. Although my school doesn't have required art appreciation courses (from Orac), I get the sense that such courses aren't the major factor that is driving basic science ignorance. Basic science itself is driving the ignorance.

I hear it when I go home for a free meal with my two doctor parents, I hear it from physicians who interact with 1st and 2nd years regularly, the amount of basic science information presented in medical schools is growing year to year. There is so much information nowadays that your goal is to study it only long enough to remember it for a three hour test. You hope that when you start studying fo the Step 1 it somehow all comes back.

I suppose I'm a poor one to be making this claim considering the time I've spent posting over the past few days. Clearly not like I'm buried in books all day.

A very closely associated contributing problem is the lack of relevance of the basic science material. No doubt, some schools do better than others at integrating 1st and 2nd year material with clinical experience. My school is probably somewhere in the middle, not poor by any stretch of the imagination. But with so much information (and the classes after me will only have more) even when you shadow a physician every once and a while or when a surgeon comes into an anatomy lecture and shows you video, the basic science information doesn't mean anything to you, in terms of the actual practice of medicine. By the time they're trying to show you info's relevance you're already off cramming for the next exam.

Basically, you can't decipher what is important and what isn't to the actual practice of medicine as a first year. At least I can't all the time. It is all a mush.

Let me make it clear, this is not a complaint. It is not like I've forgotten all of first year already (we'll see how many brain cells I kill drinking after my last exam) or that there is so much information that students can't even manage their first two years, but if there is a lack of basic science knowledge as presented by that story from Australia then this is the culprit. Perhaps medical school should be five years (and not the five year pathway innitiated by student performance) or perhaps the basic science curriculum needs to be weened down to more basics, that emphasis what is truly clinically important. Like Dr. RW says himself, do I really need to be forced to memorize the Krebs Cycle?

Such changes however would take a considerable national effort involving the NBME. You have to teach to the USMLE Step 1.

Duke Defense Takes A Blow

The Durham Herald-Sun is reporting a partial DNA match. The private lab is using some pretty weird terminology to describe it,
Analyzing the tissue, scientists concluded it came from the same genetic pool and was "consistent" with the bodily makeup of one of 46 lacrosse players who gave DNA samples for testing, the sources said.

At the same time, scientists ruled out a possible match with any of the other 45 students, according to the sources.

This is good news for the Durham DA, but it is also kind've fishy. Nifong has a State Crime Lab at his disposal, which did the initial round of testing, but then he went out and hired a private lab to do additional testing (?!). Maybe there's an explanation in the complexity of the testing. Now they have DNA evidence "consistent" with the DNA of one of the 46 lacrosse players.

An uncited "DNA expert" provides his analysis,

A DNA expert said Wednesday that one way a DNA report sometimes says DNA is "consistent" with a particular person is when there's a partial DNA profile of fewer than all 13 genetic markers commonly used in testing kits.

In that case, the number of markers available determines the reliability of the match, said Theodore D. Kessis, owner of Applied DNA Resources in Columbus, Ohio.

"It really depends then upon how partial is that profile," he said in a telephone interview. "A lot of people are of the opinion, including myself, that if it's supposed to test for 13, it should get 13, and something less than 13 is starting to hinge on the reliability of the result."

Nifong said earlier he was pursuing the possibility of another indictment, although reports indicated the dancer was able to identify a third person with only 90 percent certainty. WRAL-TV, citing a transcript of the photo identification session the dancer had with police, reported Wednesday that she indicated a fourth player also may have been involved in assaulting her.

Tissue found under the dancer's fingernails was consistent with the third man's DNA pattern, sources told The Herald-Sun on Wednesday.

As well, in a convenient move, the cab driver who provided an alibi for one of the accused is picked up on a 2 1/2 year old shoplifting warrant. He goes 2 1/2 years without the warrant being enforced and its not like this happens at a traffic stop, they go out and arrest him. While he's in custody they question him extensively about the Duke lacrosse case (according to him).

Taxi driver Moezeldin Elmostafa said Investigator R.D. Clayton and another officer asked whether he had anything new to tell them about the rape case before driving him to the Durham County jail. He said no and was held for five hours, until a friend posted his bail on a shoplifting charge.

Ernest Conner, a Greenville lawyer who represents defendant Reade Seligmann, said the cabbie's arrest amounted to intimidation. "It appears to me they are trying to pressure a witness who supports our defendant's rock-solid alibi," Conner said.

I'm not trying to make it sound like I believe these guys are innocent (although I know I'm doing a good job of that), but com'n, the prosecution's advancement of this case has been well outside the realm of "normal". Their tactics and behavior has been bizarre, and this incident with the cab driver only highlights that.

The Last of Privacy

I don't care how much history it has behind it, I don't care that they don't know the content of the calls, this NSA program, if this is accurate, is outrageous.
"It's the largest database ever assembled in the world," said one person, who, like the others who agreed to talk about the NSA's activities, declined to be identified by name or affiliation. The agency's goal is "to create a database of every call ever made" within the nation's borders, this person added.

The government is collecting "external" data on domestic phone calls but is not intercepting "internals," a term for the actual content of the communication, according to a U.S. intelligence official familiar with the program. This kind of data collection from phone companies is not uncommon; it's been done before, though never on this large a scale, the official said. The data are used for "social network analysis," the official said, meaning to study how terrorist networks contact each other and how they are tied together.
It is outrageous that there is a database out there with info on how many 1-900 calls I've made! (j/k) Also, USA Today actually broke a story? Isn't this the newspaper written at the 7th grade level so everyone can read it?

*UPDATE* At least moderate Republican chairman Arlen Specter is on it.

*UPDATE* Sen. Trent Lott does what President Bush won't; confirms NSA program.
The U.S. National Security Agency has obtained the phone records of millions of Americans in an effort to stop terrorists, a Senate Intelligence Committee member confirmed.

Senator Trent Lott, a Mississippi Republican, told reporters he was briefed on the program and said the U.S. needs ``to use modern technological tools'' to defeat terrorists.

*UPDATE* A lack of denial is a confirmation but Bush says any domestic spying he's authorized is lawful.

Bush did not confrim the report that AT&T Corp., Verizon Communications Inc., and BellSouth Corp. began turning over records to the NSA shortly after the Sept. 11, 2001, terrorist attacks, as USA Today reported based on anonymous sources it said had direct knowledge of the arrangement.

"Our intelligence activities strictly target al-Qaida and their known affiliates," Bush said. "We are not mining or trolling through the personal lives of innocent Americans."

Wednesday, May 10, 2006

Terrible Trial

The terrible course of rabies.

A Houston area teenager wakes up a few weeks ago from a nap to find a bat in his room, doesn't realize while he slept the bat bit him and then weeks later develops rabies.
The boy began feeling ill last week, was taken to the hospital and diagnosed with rabies. He was being treated, but Palacio said the chance of survival was poor. Ten people in the United States have died of rabies since 1998, according to the Centers for Disease Control and Prevention, or CDC.
There is only slight hope.

New Malpractice Study

A new Harvard study looks at how many medical malpractice claims are frivolous. Other studies have looked at this same thing, but their data is at least 10 years old. The two older notable studies certainly found more non-negligent malpractice claims (75%) but those studies involved all claims, even those not settled.

However, a 40% frivolous rate is nothing to laugh at. 85% of plantiffs who recieve payment actually deserved it according to the study. I guess I'll let you decide if the fact that 15% of all successful plantiffs are full of it, is too high.

What is notable is that the other highly cited malpractice studies looked at both those who filed claims and those who didn't. They show upwards of 90% of those who suffer negligence don't file claims. That in and of itself may be a more notable number when calling for reform.

H/T Kevin, MD

Tuesday, May 09, 2006

Children Most At Risk

H5N1, should it ever mutate to easily infect humans, will hit school age children the hardest.
One of Canada's top microbiologists warned on Tuesday that school-age children would be most at risk in a bird flu pandemic, echoing a 1918 pandemic that killed millions of people.

"Most cases in humans have been young, reminiscent of 1918," Donald Low, microbiologist-in-chief at Toronto's Mount Sinai Hospital, said in a speech in Toronto.

The Moral Authority...

...to question the United States on the issue of torture no longer belongs to the U.N. Not if they allow Swiss politician Jean Ziegler to take his seat on the newly formed Subcommission on the Promotion and Protection of Human Rights.

For all intents and purposes this is an investigative body, but such is difficult when the investigators are of singular focus and preformed opinion.
Ziegler's main idea was anti-Americanism. He was a founding editor of the journal L'Empire, and you don't need many guesses to know which "empire" was the subject. The United States, according to Ziegler, is an "imperialist dictatorship" that is guilty, among other atrocities, of "genocide" against the people of Cuba by means of its trade embargo.

In 1989, Ziegler was one of a group of self-described "intellectuals and progressive militants" who gathered in Tripoli to announce the launching of the annual "Muammar Qaddafi Human Rights Prize," awarded by the government of Libya. Ziegler explained that the purpose of the Qaddafi prize was to counterbalance the Nobel prize, which, he said, constituted a "perpetual humiliation to the Third World."

I've already made an off kelter post about the U.N.'s waste in questioning the U.S. on its human rights violations at Guantanamo. This episode is just another example of the U.N.'s futility and lack of appropriate focus.

It is embarrassing that the U.N. is used as a soap box for anti-American sentiment. That is what this international body has been reduced to, a tool of diplomats and governments in the world of diplomacy, not an independent force for good. Not to say there aren't reasons for many to be upset with America but is it really appropriate for the U.N. questioning of the U.S. on torture to be grabbing international headlines when the U.N.'s response to Darfur has been so dramatically inadequate up to this point? To be taking U.N. committee time while much more severe human rights abuses continue the world over?

The U.N. is a joke. Ziegler taking his seat will merely contribute to that.

Cancer Resistant Mice

From Wake Forest University.

A single injection of cancer-resistant macrophages offered long-term protection for the entire lifespan of the recipient mouse, something very unexpected...

Sounding Stupid While Trying To Sound Smart

I've been using the word rhetoric a lot in a couple of recent posts. I get in funks like this, where I think a word sounds intelligent...as if I've ever actually been enrolled in an Intro to Logic class.

HIV Testing For All

Well, not forced, but make it part of general workup tests. Make the consent for it part of the standardized form and not special. At least that is what the CDC is recommending, and I think its a good plan.

Wherein Our Infant Mortality Figures Get Trashed

Well, the press release from Save the Children has certainly sparked ridiculous news articles.

American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the U.S. than in Finland, Iceland or Norway, Save the Children researchers found.

This is ridiculous for several reasons. Its greatest fault is that it implies this is new information. They're reusing bogus figures.

The study relies heavily WHO figures which I've already chastised as comparing apples and oranges. These are almost universally self reported figures that use surprisingly different standards for what constitutes a newborn death.

The actual study looks at key factors for infant and maternal health and then seperately rates developed and developing countries based on them. The United States rates #10 of all countries in both the categories. Obviously the main focus of the study isn't the United States, but where the real problem is, the developing world.

Pregnant women, all of Americans, live a relatively unhealthy lifestyle, and we wonder why we have premature infants born at a higher rate. Complications of prematurity are the #1 cause of death the world over, and the percentage is even larger in the United States. As I've already mentioned this is a public health issue. This isn't a failure of healthcare will, and while its true that disparities in healthcare access lead to higher rates of infant mortality for lower socioeconomic classes the greatest thing we can due to improve infant mortality in this country is improve the life choices all Americans and pregnant women in particular make.

Monday, May 08, 2006

The X-Prize Comes Into The Mainstream

Remember the X-Prize? Well, now NASA is getting in on the publicly developed space technology gig.
NASA plans to award $2 million to a team that can design, build and fly a mission that simulates a lunar takeoff and landing.

Patterned after the successful $10-million Ansari X Prize, which was awarded in 2004 for the first private manned spaceflight, NASA is underwriting the Lunar Lander Analog Challenge in hopes of spurring new ideas and low-cost technologies to support its moon exploration initiative.

Even if I had to make a landing in a vehicle built in someone's garage if I had a chance to go to the moon or Mars, I'd jump at it. There's virtually no risk that would disuade me, as long as there was some chance of returning.

North Dakota university students have also recently completed a relatively cheap NASA grant to develop a space suit.

Engineers and university students are putting their North Dakota Experimental Planetary Space Suit through a series of challenges, including mock-Martian hikes, sample collections and – this Saturday – a simulated sandstorm.

The Mars spacesuit is the culmination of 14 months of work by faculty and students with the North Dakota Space Grant Consortium, which received $100,000 from NASA to develop the prototype.

David Blaine Blackout

It is still a pretty amazing attempt. He was trying to break the 8 min 58 sec record for holding one's breath as he was submerged underwater. He lasted 7 min and 8 sec before he blacked out and had to be rescued.

Murat Gunel, Blaine's doctor, said he advised the modern-day Houdini against performing the escape, which he said could cause a blackout, a heart attack, a stroke, or nerve damage in the fingers.

Federal Tort Reform On Life Support

Nothing new here, its like a cycle.
Senate Democrats on Monday blocked the latest Republican attempts to limit damages for pain and suffering in medical malpractice lawsuits.

Republicans offered two versions of the bill, one applying to all malpractice cases and the other limited to obstetrics and gynecology, an area with high malpractice insurance costs.

Both bills failed to garner the 60 votes necessary in the 100-member Senate to advance to a full debate. The vote was 48-42 on the broader bill and 49-44 on the obstetrics and gynecology bill, largely along party lines.

Legislation with a $250,000 cap has passed the House of Representatives repeatedly but has been blocked in the Senate.

Minority Leader Sen. Henry Reid has no idea what he's talking about. He's reading off a talking points sheet from trial lawyers,

"These two bills are put here as a result of the insurance industry," said Senate Democratic leader Harry Reid of Nevada during the debate. "These measures before the Senate don't represent a serious attempt to improve health care or the civil justice system in our country."

I'll take Dr. Frist's word,

"Medical malpractice liability premiums have skyrocketed and they are poisoning the practice of medicine," said Senate Majority Leader Bill Frist, a Tennessee Republican who is also a physician.

Why We Need Basic Science

I can fall asleep in microbiology lecture but I still agree with Dr. RW as he defines why medical students need basic science.

He has a said a lot from a position much more informed than myself (still stuck in the middle of the basic science years) but I hope to explain my own beliefs on why basic science education is good for physicians tomorrow. Right now however, I'm going to go study neuroscience and go to bed.

'Fatal Contact' Review

The New York Times looks at ABC's upcoming MOW about bird flu.
France is the first country to develop a vaccine, but its leaders refuse to share the patent; finally, after the international community threatens sanctions, the French surrender. However gratifying, that fantasy is one of the sillier conjectures in the film. France would have no reason to prevent other countries from reproducing the vaccine, and even if it did, nearly all countries have laws that allow them to violate patents in emergencies.

Its worst-case scenario led flu experts to express concern that the film was sensationalist and could needlessly panic viewers.

"Fatal Contact" is a May sweeps movie, not a public service message, so it is hardly surprising that it errs on the side of Armageddon, but that does not mean it is irresponsible. It is a soberly and compellingly told tall tale, and quite alarming.
I'm not upset the movie was made, I just think the advertising is inappropriate. It indeed makes it feel like a public service announcement, crying out watch this movie to see the future.

Still, I'm not saying ABC should be prohibited from advertising anyway they see fit, I'm just of the feeling they should have the desire to be more responsible.

Take one final quote from the New York Times,
In real life, scientists have said publicly what one movie epidemiologist says to another after the first human case is diagnosed: "It's not a question of if, but when.
Its a matter of when the next flu pandemic will happen. The same thing can be said about an asteroid hitting the earth. I know that is a ridiculous comparison considering the relative risks aren't even close to each other. Still, H5N1 against the future field of influenza viruses...well the odds are decidedly against it being H5N1 or it starting tomorrow.

Quite Teamsters Need Their Sleep

Physicians go blue collar in New York. (Subscription Required)
Frustrated over recently announced cuts in reimbursement rates and existing restrictions on medical care imposed by Excellus BlueCross BlueShield, the doctors joined the approximately 1-million member Teamsters Local 1149 in Baldwinsville, N.Y., hopeful that the organization will help increase their leverage to negotiate with such large insurers.

Yowzer, Talk About Empowerment

No one who stumbles across this site comes here for the talk of USC. Still, this professor at USC stirring up debate with her near virulent feminism got my attention.
So if a few bad eggs don't respect women's right to decide if to have sex with them, why should I hold the whole football team accountable? Because I do. Because I hold every single male on this campus responsible. Because every single male on this campus has the responsibility for stopping rape. Every fraternity brother, every science major, every professor, every one of them. Because they all rape? Of course not. But because only men rape and only men can stop other men from raping.
Well, there are always examples like this.

Beyond the technical accuracy of the claims it is obvious how I, and the great majority of men and women feel about this (we don't need to pay a polling service). I don't want to give the idea too much credit by breaking down the different reasons why it could be stirring up a little resentment on the USC campus. Basically, we need only to realize it as faulty logic. It is this kind've fuzzy almost emotional feminist rhetoric. It doesn't need to stand up to critical dissection, only to tug at a sense of guilt by mysteriously balancing victimhood with a commanding call for others to act.

There should be more feminist trial lawyers. It is a complete rhetoric they present. What I mean is that it is one of persuasion, not of debate or compromise. This isn't philosophy in the traditional sense of the search for the truth. Not only can extreme feminism not claim to be preaching the truth, but they can't even claim to be searching for it for their lack of use critical reasoning. They are playing with the psychology of persuasion, not with any Socratic skills.

Really, the argument above hasn't been thought through logically. To be fair for its intention, as I laid out above, it didn't need to be. However, for the same we can't take this kind've composition as more than an advertisement.

The implications of Dr. Blaine's idea are unreasonable. A sin of omission is not a sin of commission. That is what this idea of this kind've responsibility for one's sex proports. If every man is jointly responsible for every rape because he doesn't act to stop the violence in a general sense, then every dollar that Dr. Blaine spends on a latte while children starve in Africa is comparable to taking food from their mouth.

Even if proponents of omission/commission equality are willing to admit to such an interpretation it leaves them with no moral base on which to judge others as almost everyone, except perhaps aid workers living on the bare necessities and working towards equality for all, become identical sinners. Either way Dr. Blaine's quote above doesn't hold up.

On a lighter note, despite giving her such respect so far, I am a little offset by her prominent title. Its true, she's earned it with her PhD, but go around telling people in public you're a "Doctor" and see how many ask you, "Of what?"

She just seems like the type of person with "Dr." printed on her personal checks. Just kidding (who uses personal checks these days?)


I know how egotistical that sounds, reserving the everyday use of the title to healers, and I know how absolutely stunning it is to find a (future) physician with an ego. Ah, just a pet peeve.

Man, it is late, there are more typos and grammatical errors in this post than when President Bush fired all his speech writers.