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Monday, July 31, 2006

Home Based Surgery

A couple are charged after a woman they were doing liposuction on, in their basement, died. Neither of them are physicians.

"Honey! Turn down the washing machine, I can't concentrate!"

The district attorney's office said authorities believe that Ribeiro and his wife administered illegally obtained drugs and performed the surgical procedure on the woman. Neither Ribeiro nor his wife are licensed to practice medicine in Massachusetts.

Police charged Ribeiro with unauthorized practice of medicine, drug possession and distribution, and illegal possession of a hypodermic needle. His wife was charged with unauthorized practice of medicine and drug distribution.

Synthetic Testosterone

A French newspaper is reporting that some of the testosterone in Landis' sample could not be simply of his incredible masculinity, as it is a synthetic variety.

A New Symptom

I no longer simply go blank and quite when I walk into a standardized patient's room. No, I've gotten passed my nervousness and I'm actually fairly competent with the physical exam. However, I have developedaprettysloppyhabitwhere
Italkreallyfastandexplainstuffintoomuchdetail.
ThisiscalledaPronatorDrifttestandmigh
thelpidentifyspecificdeficitsinsomeone's
corticalspinaltract!*Whew*

AIDS Caused By HIV?

I suppose for anyone who keeps up with conspiracy theories this is nothing new. Indeed, the documentary is kind've old. It argues that HIV is not the causes of AIDS. I guess this fact sheet didn't exist when this video was published.

Here's another documentary which looks at the theory that HIV was first introduced through contaminated Polio Vaccines in Africa, which is advocated by Edward Hooper.

Thursday, July 27, 2006

I Love Local News

At least they don't show a picture of a bad staph infection. I'll spare you as well.
It looks like a spider bite, but doctors say it's really much worse than that.

It could be MRSA, a type of staph infection that looks much like a spider bite or a boil. Right now, doctors all over the city are seeing cases of MRSA.

Home Use

I Always Thought This Was Wierd

Why did earlier med mal studies (including at least one in which Studdert was involved) find such higher rates of frivolous lawsuits than the recent Harvard School of Public Health study? Well, we don't actually get an answer to that question (I'm sure an excuse is around somewhere) but Specialty Insurance Blog discusses how the study was spinned to look like a victory for the current method of reimbursing people. I always thought the title of that HSPH press release was a little more than just announcing the findings.

What Does It All Mean?!

Doping in professional cycling. Everyone let out a *gasp*.

Okay, so we don't know anything officially yet. It could all be a big mistake. But, how exactly does testosterone help professional athletes? And just how plausible are Landis' potential excuses?
Landis told SI.com that elevated levels of testosterone are a common problem among cyclists and that he is retaining the services of Spanish doctor Luis Hernandez to help prove his innocence. "In hundreds of cases, no one's ever lost one," Landis told the Web site.

Landis also told SI.com that he has been taking an oral dose of thyroid hormone to help a thyroid condition he's been treating. He also suggested cortisone shots he's been given for his hip might have contributed to the test result.

Testosterone and other androgens promote muscle growth and hematopoietic stem cell maturation (we all remember when Lance was accused of giving himself EPO, a drug specifically used to raise one's red blood cell count and thus increase your oxygen delivering capacity).

As for Landis' claims, they sound semi-plausible. I have no idea how one identifies testosterone in the lab, but increased levels of thyroid hormone could raise one's testosterone levels. From what I understand increased levels of thyroid hormone increase the overall level of testosterone in your body, but also increases the levels of SHBG. Since most of your testosterone is bound to that, the level of free testosterone isn't greatly affected by increases in thyroid hormone. If they're measuring levels of free testosterone, I'm not sure how strong Landis' argument is, but if the lab is deducing the levels from SHBG, then Landis might have somewhat of an argument.

Wednesday, July 26, 2006

Something to Look Forward To...

Why 3rd year is so much better than the 1st two over at MedRants.

I was stressed first year, I'm getting stressed second year, but I will say I'm a lot less of a nervous wreck than some of my classmates. I mean, I think I'm pretty friendly, even in the midst of exam weeks. To be honest with you I don't know if that's a good thing or a bad thing.

All of that might change the closer I get to Step 1, I will say...

Tuesday, July 25, 2006

Quackery As A Substitute

A Virginia judge has lifted the order for a 16 year old boy to restart chemotherapy until his appeals have been exhausted.
A lawyer for Abraham and his parents argued that if the lower court order was allowed to stand, any further legal appeals would be moot.

"Once those doctors take control of Abraham, then the game is over in terms of their appeal that they're entitled to by statute," said John Stepanovich, lawyer for Jay and Rose Cherrix.

Of course, the evidence for this homeopathic treatment isn't looking good,

The type of cancer Abraham has is highly treatable in early stages. Abraham had court-ordered X-rays at CHKD in June. He also had a follow-up exam with his doctors at the Biomedical Center in Mexico, where he'’s receiving the Hoxsey treatment. Both exams showed that his tumors - one in his neck and one near his windpipe - had grown since February [when he started the herb treatment].

At least the center in Mexico admits his tumors have grown. I'm not really sure what that says though.

Monday, July 24, 2006

The Best Homeopathic Marketing Campaign

If you haven't seen it, which would be hard if you've watched almost any cable TV in the past several weeks, well take a look at this commercial.

Then, and only then, go find out exactly what it is.

HCA

HCA is the largest for profit hospital operator in the country. Well, actually its the largest irregard of profit seeking status. In anycase, it has agreed to the 2nd largest leveraged buy out ever.

What the heck is leveraged buy out? Well, I asked that question at least. Turns out it'll no longer be a publicly traded company. The entire company will be, as it was founded, privately owned.

This is not just business news, but as Slate points out it's a little bit of political irony. It's sad as well for all those wishing for some market based solutions to our healthcare problems...seeing as those most likely to advocate for such, are basically betting against it.
Big business deals usually aren't ironic, but this one surely is. HCA, a firm founded by the family of the Republican Senate majority leader, Bain, a firm whose founders include Massachusetts governor and GOP presidential aspirant Mitt Romney, and KKR, a firm run by Henry Kravis, a major Republican donor, are betting on the continued expansion of government. HCA's sale is essentially a $33 billion investment in the idea that government will take an even bigger role in health care. As Les Funtleyder, health-care strategist at Wall Street firm Miller Tabak + Co., put it this morning, "[T]he buyout firms are making a leveraged bet on an improving economy and the prospect of universal health care."

Friday, July 21, 2006

Back to the Moon

A Libertarian-esque individual excited about public sector space exploration. Hypocrisy!

Thirty-seven years ago today, Project Apollo put the first humans on the surface of the Moon. The next time the U.S. launches its astronauts to Earth's natural satellite, they will do so as part of Project Orion, collectSPACE.com has learned.

NASA intends to use the moniker Orion as both the title for its next generation manned craft, the Crew Exploration Vehicle (CEV), and as the project’s name. This approach is modeled after the 1960's program when Apollo Command Modules launched astronauts under Project Apollo.

Under Project Orion, NASA would launch crews of four astronauts aboard Orion capsules, first to Earth orbit and the International Space Station and then later to the Moon.

I would quit medical school and work cleaning out donkey stalls the rest of my life if I could be on one of this missions to the moon...or even better.

H/T Slashdot

Your Right To Choose Your Care...

I didn't hear the case, I've never heard this boy's pleas for self determination, and so I can't speak to his maturity or eloquence. Even if I had it might be hard to determine just how sound and fit he was; if he was along enough in his development to truly make reasoned sound decisions for himself.

That's probably why so many states, for the majority of self determination decisions, have set an arbitrary age of eighteen.

Having said all that, I think this sixteen year old teenager should be able to choose how he wants to live his life and fight this cancer...I can even understand his choice a little bit, although I would never make. Some chemo regimens sound like terrible things (not that I have any idea what he was on).

Matt Leinart Predicts A National Championship

Matt Leinart told ESPN that USC will win a BCS national title this year.
"I think that SC is going to win the national championship."
Read it as TrojanWire.

Tuesday, July 18, 2006

Federal Funding Stem Cell Bill Passed

...but not by veto proof margains in either house. Which of course means this veto is going to hold up.

Wow, This Is So Me...

The WSJ has an article profiling the multitude of Netflix customers who let rented movies sit on their shelves. I still have three movies from May.
"It's a paradox of abundance," said Siva Vaidhyanathan, a professor of culture and communication at New York University. If people aren't pressured to see a movie in a specific time frame, he said, viewers tend to put it lower on their priority list. "When you have every choice in front of you, you have less urgency about any particular choice," he added.

Stem Cell Cheat Sheet

Just what it says, Wired's Stem Cell Cheat Sheet:

What are embryonic stem cells?

Embryonic stem cells make up the inner cell mass of the blastocyst, a body of cells that forms in the first few days immediately following fertilization. Blastocysts are about the size of a grain of sand and typically consist of about 150 cells.

What's so special about these cells?

Most cells can only produce limited copies of the same kind. Embryonic stem cells, by contrast, can develop into many different cell types in the body, and have a limitless ability to divide and replenish. As a result, embryonic stem cells are an ideal research material. Scientists hope they can manipulate these cells to one day produce therapies targeting specific diseases, and even regrow damaged or destroyed tissues for any part of the body.

Have doctors cured anyone using human embryonic stem cells?

The jury is still out. Some researchers, mostly in developing countries, have claimed success. But no one has yet published successful results in a peer-reviewed medical journal -- a step required for scientific acceptance and confirmation.

Why are some people opposed to embryonic stem-cell research?

Extracting embryonic stem cells from the blastocyst destroys the embryo. Some religious and other groups believe human life begins at conception, and therefore are ethically opposed to embryonic stem-cell research.

Is it currently illegal to conduct embryonic stem-cell research in the United States?

No. Existing regulations only restrict the funding activities of the National Institutes of Health, or NIH, the organization that allocates federal funds for medical research. Under the current rules, the NIH can't fund embryonic stem-cell research except with stem-cell lines approved by the president. But scientists can use private funding to perform embryonic stem-cell research.

What happens Tuesday?

The Senate will vote on three stem-cell bills, all of which are expected to pass. Two of those bills are in line with the Bush administration's embryonic stem-cell policy. The third is expected to force a showdown and face an almost-certain veto.

The Stem Cell Research Enhancement Act (SB471) is the Senate version of HR810, a bill approved by the House of Representatives last year that would allow researchers to use surplus embryos produced at fertility clinics that would otherwise be discarded. The bill was amended to bar federal funding for research that results in the destruction of embryos; but it would supersede a 2001 executive order from Bush that restricts NIH funding of embryonic stem-cell research to embryonic stem-cell lines that were already created by that date.

Are embryos the only source of stem cells?

No. Stem cells can be found in many mature tissues, including bone marrow, blood, the brain, hair follicles, fat, the pancreas and umbilical cords. These stem cells are called "adult" stem cells. Researchers have also derived stem cells from fetal tissue taken from embryos older than eight weeks, usually following abortion or spontaneous miscarriage.

Does anyone object to using adult stem cells?

No. Objections to date have been focused on harvesting embryonic stem cells.

So why don't scientists just use adult stem cells instead?

Doctors have been using adult stem cells, such as the blood-forming type in bone marrow (called hematopoietic stem cells), to perform bone-marrow transplants for more than 40 years. Similar techniques have since been developed for treating leukemia, lymphoma and several inherited blood disorders. But scientists believe adult stem cells are not as flexible as embryonic stem cells, and hold far less promise for extreme therapies, such as rebuilding nerves severed in a spinal cord injury.

Are there any other options?

Maybe. Scientists and ethicists have been working on alternatives for obtaining stem cells as powerful as those that come from embryos without actually creating or destroying an embryo. Scientists presented several proposals to the President's Council on Bioethics in May 2005. One of the bills up for vote this week asks the NIH to focus on making these alternative methods viable.

Katrina Euthanasia Case

A doctor and two nurses were charged Monday with killing an unknown number patients that the hospital couldn't evacuate during Katrina.
Late Monday, Dr. Anna Pou, Lori L. Budo and Cheri Landry were arrested in connection with the alleged deliberate deaths of some patients at New Orleans Memorial Medical Center after Hurricane Katrina hit, a source close to the investigation told CNN.

In October, CNN reported exclusively that after deteriorating conditions -- with food running low and no electricity -- some medical staff openly discussed whether patients should be euthanized.

Dr. Bryant King, a contract physician for Memorial who was working before and after the hurricane, said another doctor came to him and recounted a conversation the doctor claimed she had earlier with a hospital administrator.

According to King, the doctor said that the administrator suggested patients be put "out of their misery."

Monday, July 17, 2006

Immigrant Health

The New York Times profiles hospitals in North Texas and how they deal with illegal immigrants. Parkland Hospital (one of UTSW's primary teaching hospitals) has chosen the kind've military with homosexuality deal.

What the hospital staff did not know, because they did not ask, was whether Ms. Domi­nguez was an illegal immigrant.

"I don'’t want my doctors and nurses to be immigration agents,"” said Dr. Ron J. Anderson, the president of Parkland.

Patients like Ms. Domi­nguez,— uninsured Hispanic immigrants with uncertain immigration status, have flocked in recent years to public hospital emergency rooms and maternity wards in Texas, California and other border states. Their care has swelled costs for struggling hospitals and increased the health care bills that fall to states and counties, giving ammunition to opponents of illegal immigration who complain of undue burdens on local taxpayers.

It is a major problem, as Parkland's website itself says it cannot only be a hospital for the poor. Read it below,

Parkland's greatest challenge is a constant - bearing the brunt of responsibility to care for the rising number of uninsured in Dallas County.

While our obligation to serve those who cannot otherwise afford medical care remains, if we are a system of care only for the poor we could become a poor system of care.
That is the ordeal. No one cares of the illegal immigrant who comes in and pays his hospital bill. He is far from a burden on the healthcare system. But the question becomes, in these times of rising healthcare costs and limited budgets, if we must ratio healthcare is it proper to do it by favoring residents over people in this country illegally?

Stem Cells

The Senate is about to pass a bill (already cleared the House in a form) that would open up federal research dollars to be used on new embryonic stem cell lines.

That summary was in case you've been living in a cave for the past week or so.

Where I stand isn't so important but reading some of the LOUDER (that's the adjective I'm going to use) debate, the type that makes you wonder if Socrates is rolling over in his grave, I thought I'd write a brief post on it.

There's no doubt that stem cells hold great hope. But the debate needs to be viewed on level respectable terms. Here, despite what bloggers like this say, it comes down to how you define life. It is an impossible task to move someone off of their life at (blank) stance. You oppose stem cell research, understanding their huge promise, if life begins at conception. You support stem cell research if it doesn't.

I can't imagine who some of these bloggers are writing to - that unknown individual who really believes the life of a few embryos is worth all those who could potentially be saved by stem cells. The most faithful utilitarian of all time.

In anycase, I understand the passion, it is literally for some a life and death issue and, probably as important, it is an issue up for debate right now. Just know what's actually up for debate.

The End of Whoops

"New" technologies to keep track of surgical insturments.

Doctors at Stanford University School of Medicine who tested sponges embedded with radio frequency identification tags said the system accurately alerted surgeons when they deliberately left a sponge inside a temporarily closed surgical site and waved a detector wand over it.

But they said the size of the chips used -- 20 millimeters or about 0.8 of an inch -- was too large and would need to be reduced to be practical on sponges and surgical instruments.

What with costs and the concerns of the article I wouldn't expect this to be common place anytime soon. Still, it is an interesting step in the right direction.

Alzheimer's & Diabetes

Now there is a correlation.
Swedish researchers looked at 1173 people over 75 and concluded that people with borderline type 2 diabetes — that is, chronically elevated blood sugar — were some 70% likelier to develop Alzheimer's than those with normal sugar levels. Another study, based in the U.S., looked at the medical records of 22,852 type 2 diabetics, none of whom had any sort of dementia at the outset, and found that the more elevated their blood sugar tended to be, the bigger the risk they'd develop Alzheimer's.

And You Thought It Had Gone Away...

The Duke case since I last commented.
A woman who accused three Duke University lacrosse players of rape initially told police she was attacked by five men at a team party and at one point denied she had been raped, according to a police report released Friday by a defense attorney.
If you don't remember, this is a "hole"-y case against three Duke lacrosse players accused of raping an exotic dancer who came to a lacrosse team party. We have a victim with a history of accusing men of rape and then dropping the charges, alibis (including time stamped ATM receipts and testimony of a cab driven) for two of the accused, a complete lack of DNA evidence, the accuser being discovered passed out drunk in a car in a grocery store parking lot hours after the alleged rape and then repeatedly changing her story, and the other exotic dancer who was there that night calling the victim's story "crock."

Still, the fact the case is going forward with nothing but what appears to be a he said/she said case, might not bode well for the defense.
"You kind of find it hard to believe that this case in this condition can find its way to trial unless the prosecution has something going for it that we just don't know," said Stan Goldman, a Loyola Law School professor and former Los Angeles County public defender. "That's the 64-dollar question. What does he have?"
In anycase, Mr. Nifong has taken another turn into a sticky situation. He wants access to records of every lacrosse player's school ID card, which are used to access buildings on campus. Even the ones who claim to have not been at the party. His reasoning is that he needs to know if they're telling the truth about that night (where they where, etc.) Their reasoning is, it is a violation of their privacy. A broad sweeping net intended to track the movements of everyone even tangentially involved in this case without respect for probable cause or actual necessity.

He seriously can't nail down the player's who are actually important to his case before he files for access to their ID card records? Seriously are the Durham police or DA investigators even working? He needs access to all their records because I'm sure they'll all be on his witness list...?

Thursday, July 13, 2006

Point of Law on Slate

Point of Law has an excellent "review" of the Slate article on Med Mal I previous linked to.
Klein attacks the "Republican" approach--damage caps--by tackling that straw man argument, namely that caps have to do with medical malpractice lawsuits being frivolous. To argue his case, Klein regurgitates arguments made by Tom Baker and points to a few studies, including the comprehensive Harvard Medical Practice Group study of 15 years ago, the recent Studdert-Mello Harvard study, and a RAND study. He makes a mess of it.
Also, at this moment, CNN is reporting breaking news that Merck has been found not liable in the 7th Vioxx case.

Innovative Solutions to Medical Liability

Wednesday, July 12, 2006

The Question of Free Will In Law

From The Times of London (via Reddit), comes the story of a Virginia man who became a pedophile because of a benign brain tumor. In an odd coincidence, I literally read this piece five minutes after turning off Law & Order: SVU.
[T]otally out of character, he began visiting paedophiliac websites. Next he was making sexual advances to his young stepdaughter, so his wife had him arrested for child molestation. On the point of going to jail, he complained of severe headaches, and a benign tumour the size of an egg was discovered in the “prefrontal” area of his brain. After the op his paedophiliac urges vanished, and he returned to normal.



Doctors theorised that the tumour had restricted blood supply to the area of the brain associated with impulse control. Last year the tumour came back, and so did the paedophiliac urges. He has had a second operation and, for the time being, appears to be his old decent self.

This rears, once again, the debate over incarceration versus treatment. What is the point of the criminal justice system? Vengeance andeterrencece or rehabilitation?

And of course, the much broader question, when is someone responsible and how do you define free will?

Then again, there's nothing illegal about having such desires (indeed, no one would dispute that having such desires constitutes a mental disease), it is only acting on them, the loss of self control, that is punished. Some studies put pedophilia (the attraction to prepubescentnt children not actual engagement in sexual activity with them) at 7 - 10% of the adult population, pretty creepy, but clearly not that many adults commit actual child molestation...I don't think (I don't actually know the statistics).

HIV Screening for Everyone

As the title says. A good idea.
[T]he national Centers for Disease Control and Prevention is expected to release similar guidelines this summer that would expand HIV screening to all adults in the United States

If this happens, it means that just about anybody over the age of 13 could be asked by their doctor, "Would you like an HIV test?"

Tuesday, July 11, 2006

Lab-made Sperm

In Germany, they've grown sperm from stem cells and then used it to successfully impregnate mice. (via Slashdot)
Using a specialised sorting instrument they were able to isolate some stem cells that had begun to develop as sperm.

They encouraged these early-stage sperm cells, known as spermatogonial stem cells, to grow into adult sperm cells and then injected some of these into female mouse eggs.

The fertilised eggs grew and were successfully transplanted into female mice and produced seven babies.

However, the mice showed abnormal patterns of growth, and other problems, such as difficulty breathing.

Idiots On Slate

"The Medical Malpractice Myth" is a review and praise of Tom Baker's book on Slate. I guess you can judge what they say for themselves:
The most impressive and comprehensive study is by the Harvard Medical Practice released in 1990. The Harvard researchers took a huge sample of 31,000 medical records, dating from the mid-1980s, and had them evaluated by practicing doctors and nurses, the professionals most likely to be sympathetic to the demands of the doctor's office and operating room. The records went through multiple rounds of evaluation, and a finding of negligence was made only if two doctors, working independently, separately reached that conclusion. Even with this conservative methodology, the study found that doctors were injuring one out of every 25 patients—and that only 4 percent of these injured patients sued.

[...]

But a new study, released in May, demolishes that possibility. Dr. David Studdert led a team of eight researchers from Harvard Medical School and Brigham Young University who examined 1,452 medical malpractice lawsuits. They found that more than 90 percent of the claims showed evidence of medical injury, which means they weren't frivolous. In 60 percent of these cases, the injury resulted from physician wrongdoing. In a quarter of the claims, the patient died.

Peripheral Defendants

Point of Law has some quotes and citations on the discussion of naming virtually every physician in a med mal plantiff's chart and then sorting the "guilty" from the non-negligent later.

Sunday, July 09, 2006

I'm Back

A month away?! Say it ain't so.

I've been backpacking through Europe (London, Paris, Bayeux, Brussels, Brugess, Amsterdam, Munich, Vienna, Florence, Venice, Rome, Naples). I got back tonight and start my second year of medical school at 9 am tomorrow. Holy moly!

In anycase, I spent a lot of my time on trains and planes learning about the history of how healthcare is paid for. Pretty interesting and I'll have some comments, next week.