Medskool

NEW HOME!

2006-08-07T23:00:00.000-05:00

NEW HOME

WWW.FROMMEDSKOOL.COM

Hit The Breaks, Online Poker

2006-08-05T19:11:00.000-05:00

Wired discusses the legailty of online poker. This is my favorite opinion,

[M]any argue poker tournaments online technically are not gambling.
"You get a prize for a competition," said Howard Krent, dean of the Chicago-Kent College of Law at the Illinois Institute of Technology.

A Sign of the Times...

2006-08-05T12:25:00.000-05:00

...more like of the mystery surrounding Castro and his health. Several gambling sites are taking bets on whether Castro is dead, will die, or in slightly more taste, whether he will make a public appearance before his 80th birthday.

TGN1412

2006-08-05T11:51:00.000-05:00

I'm late to the ball here. Even so, as it was all over the news when I was in England in March, I thought I'd provide a summary post.

In case you don't know what I'm talking about, this is one of the worst modern Phase I trial disasters of all time. Six test subjects injected with an immunomodulatory drug called TGN1412, suffered severe excessive immune reactions reactions, swelled up like "elephant" men from inflammation associated with excessive cytokines, suffered gangrene, and possibly face severe long term consequences.

NRI student Nav Modi, one of the "Elephant Men" who nearly died in March during a botched drugs trial in a London hospital, fears he may have only two more years to live.

"It's a really bizarre feeling when you discover you might be dead in a couple of years or even in a couple of months," 24-year-old Modi who has just graduated from university and was looking forward to a career in his family's electrical business told The Sunday Times.

The botched drug test has been one of Health Care Renewal's category coverage issues. From their first post to the most recent, it's a good resource.

The broad idea was for the drug to work as an immunosupressant for B Cell leukemia patients by activating regulatory T Cells. An odd idea to say the least, seeing as the drug worked as a superantigen, activating T Cells independent of the T Cells specificity or of the antigen being presented by an antigen presenting cell. The Telegraph provides a description of what might have gone wrong.

The drug, called TGN1412, is an antibody treatment designed for some forms of leukemia and rheumatoid arthritis. It stimulates the production of T-cells with the aim of improving control of a malfunctioning immune system.
"This is a different sort of antibody and I don't know of another antibody that is on the market that works in the same way," Sir Gregory said. "It is a different and very potent process and very difficult to predict in advance how mild or severe the clinical response might be."

Not all explanations of what went wrong have been so kind as to claim that this effect was impossible to predict or judge. In New Scientist,

An immunologist contacted by New Scientist, but who asked not to be named, says: "You don't need to be a rocket scientist to work out what will happen if you non-specifically activate every T cell in the body."

Even so, the company that carried out the testing was found to have followed all procedures, and cleared of wrong doing in both an interim report and final report by the Medical and Helathcare products Regulatory Agency of the UK.

The manufacturer (not the same company as the one who carried out the test), TeGenero, filed for bankruptcy limiting the financial compensation available to the six victims. They did have these kind words.

Meanwhile, the future of drug testing and the future health of the TNG1412 victims remains in the air.

More on Doping

2006-08-05T10:27:00.000-05:00

ESPN Cycling has an interview with a World Anti Doping Agency doctor who talks about testing and testosterone. It is about a week old but answers some questions.

[Testosterone is] certainly not one of the first-line drugs one thinks of for racing. Steroids can increase strength and improve recovery time and prevent the breakdown of muscle, maybe make him more assertive and aggressive. All of those could have some positive attribute. But most steroids are given in cycles [6-12 weeks] and in context of working out in a gym with weights. It makes no sense to me why an athlete would take testosterone the day of a race when it doesn't work that way. It doesn't make sense in terms of the pharmacology of the drug, and it really doesn't have the attributes that would be attractive to a cyclist -- particularly one running the risk of violating anti-doping regulations.

Still Here, But No One Is Talking

2006-08-05T10:09:00.000-05:00

Remember when avian flu was rearing to be the next great pandemic? Well, it still may be, but as I contended, as it stands right now it has gone the way of the other public health media freakouts. At least as far as the media coverage is concerned.

B Sample Is Positive

2006-08-05T09:56:00.000-05:00

Landis' B sample has completed the testing regimine and came back confirming the elevated levels of testosterone that Landis showed in the A sample.

The official decision to strip Landis of the victory rests with the International Cycling Union (UCI), but Tour de France director Christian Prudhomme said: "It goes without saying that for us Floyd Landis is no longer the winner of the 2006 Tour de France."

Disappointing.

Attempts At Photography In Europe 2

2006-08-04T22:48:00.000-05:00

Responsibility In HIV

2006-08-04T22:37:00.000-05:00

A man loses an appeal against Iowa's HIV spreading law.

Court documents indicate Musser, 25, of Iowa City, learned in July 2000 that he carried HIV after being tested at a free health clinic. Although he knew he carried the virus and was taking medication for it, he had unprotected sex on several occasions with different partners.

The high court rejected several constitutional arguments in Musser's appeal, including that the state law requiring a carrier of HIV to notify a partner violates the First Amendment protection against forcing speech against one's will. The court ruled that the state law promotes a compelling state interest and is narrow enough in scope to be constitutional.

What are the arguments for and against such laws? What are the rights at stake here? What about he stigmatization of HIV+ individuals? UCSF has a nice article on the criminalization subject.

Attempts At Photography In Europe

2006-08-04T22:13:00.000-05:00

We're Listening

2006-08-04T21:24:00.000-05:00

The EFF's suit against AT & T is taking a brief hiatus. Still better than the ACLU's attempt. Thank God for civil liberty friendly judges,

The ACLU argued that the practice was no longer secret, because numerous news reports had made it clear that phone records had been given to the agency.
But the judge said the news reports amounted to speculation and in no way constituted official confirmation that phone records had been turned over.

Yeah, those newspaper reports were just speculation but if it came out during a court case then I'd believe it. Without the AT&T documents the plantiffs couldn't prove they had personally been spied on, and without that proof they had no standing.

Just How Sick Is Castro?

2006-08-04T20:59:00.000-05:00

With no sign of him or his brother for days, it is making everyone wonder. If you don't know, Castro turned over power to his brother for a brief period in order to go under the knife for an intestinal bleeding condition. Speculation on his health is nothing new.

Talk of Castro‘s mortality was taboo until June 23, 2001, when he fainted during a speech in the sun. Although Castro quickly recovered, many Cubans understood for the first time that their leader would eventually die.

Castro shattered a kneecap and broke an arm when he fell after a speech on Oct. 20, 2004, but laughed off rumors about his health, most recently a 2005 report he had Parkinson‘s disease.

You have to suspect that they wouldn't be leading their populace to dissappointment, by claiming he's recovering nicely, if he was already dead or on his way too it. Still, not everyone is convinced that he's okay.

Anne Louise Bardach, author of the best-selling book Cuba Confidential, is one who believes Castro's condition is more serious than the official line indicates. She says the timing of the announcement - how it was handled in Havana post-surgery as opposed to pre-surgery - says a lot. She also believes that when Castro dies, the world won't know about it until days later, when the succession has been put in place.

Other theories arise in the same article.

But Maria Werlau, executive director of the Cuba Archive project that documents human rights abuses in Cuba, is convinced the exercise is an elaborate ruse.

"Castro has a long record of turning weakness into strength and I think he's doing it again," says Werlau, the daughter of a Cuban exile killed in the Bay of Pigs fiasco. "Castro knew his 80th birthday was going to attract a lot of negative publicity, but in handing over to Raul and ordering his birthday celebrations delayed to December, he's diverted all the negative attention. It's very clever: he's managed to use his mortality as a weapon." Werlau also believes it's a strategy that will allow Castro to determine who in Cuba remains loyal to him, a way "to gauge his control internally and then come back stronger than ever".

Ah, Good To Be Back...

2006-08-04T20:29:00.000-05:00

...okay, it isn't at all. I finished my first Pharm exam today.

I'm one of those jerks who listens to the same song over and over and over for days straight and then gets bored with it and doesn't listen to it for months or years. In that spirit, I found at the end of last year (and apparently it has carried over into this year) that I pick a theme song or two during chrunch time, right before exams.

I'm not sure Dexy's Midnight Runners and Pharmacology are the best mix.

Can Democrats Fix Healthcare?

2006-08-04T19:59:00.000-05:00

Over at the Decision '08, they're preparing for the worst. Republicans should be, well the one's who haven't jumped ship.

I've more than alluded to my personal political views and I, like many physicians (medical students other than myself tend to be a little more liberal. But that is before they have to start paying back their student loans) am a little conservative when it comes to medical matters. Organized medicine has found allies on the state level in Republicans when it comes to medical liability reform, residency training funding, battling expanded procedures for non-physician practitioners, and a host of other issues.

However, is a Democratic controlled House really such a blow to the political goals of the nation's physicians? Well, maybe; a split Congress, with an unpopular President isn't exactly going to put out groundbreaking reforms. And we remember this debacle.

Its interesting that the flop of the last major Democratic health initiative was instrumental in bringing in a Republican majority in 1994. Of course, more substantial matters are likely to fell the ruling party this time around.

But, back to my point, what have Republicans really accomplished on health care in Washington? Frist can't even appropriately schedule a vote or throw his support behind national tort reform. We can't get substantial reform on the SGR, and so battle year to year on Medicare cuts. We've seen the implosion of the extreme disappointment that is Part D.

Some of the most discouraging signs have been the lack of substantiated effort by the Republican majority.

In anycase, I'm sure we can't expect more from a split government, but we probably can't expect less either. I find myself not particularly mourning a Republican absolute shelacking in November, and that is exactly what it is shaping up to be.

More Steroid Use

2006-08-04T19:39:00.000-05:00

A backup USC safety (and his identical twin) quit the USC football team after testing positive for steroids.

Just last week, Brandon and his identical twin, Ryan, also a defensive back, announced they were quitting football to concentrate on preparing for medical school. Neither could be reached Wednesday for comment.

[...]

USC Athletic Director Mike Garrett said the drug test that Brandon Ting failed was administered by the NCAA. If still on the team, he would have faced a one-year suspension.

It remained unclear how this situation might affect his stated ambition to study medicine, preferably at USC. In a prepared statement, the university's Keck School of Medicine declined to "engage in a discussion of hypothetical situations concerning applicant qualifications."

An NCAA official said that if USC provides drug education - and school officials say they have - teams are not held accountable for use of banned substances by players.

"A positive drug test is basically an individual sanction," said Mary Wilfert, an NCAA associate director of health and safety.

Here's an interview with the twins, after they had announced they were leaving the team, but before it came out one of them had tested positive for steroids.

This of course is just another dent in USC's very recent horrific set of off field problems. USC has turned into the new Miami.

In the final week of April, Bush and All-American receiver Dwayne Jarrett came under scrutiny for potential violation of NCAA rules. News cameras showed quarterback Mark Sanchez arrested - he was not subsequently charged - on suspicion of sexual assault.

In June, the Los Angeles City Attorney's office charged former defensive lineman Frostee Rucker with two misdemeanor counts of spousal battery and two counts of vandalism in connection with an alleged August 2005 altercation.

Pete Carrol keeps insisting our All-American reciever, in Dwayne Jarrett, will not face any suspension for his faults of NCAA rules. As for the very serious matter of Bush's family's housing arrangement, that could take some more time, but the longer it drags on, the less likely I think it is that USC will face major future penalties (losses in scholarships, etc.) It would be scary though if USC had to forfeit games Bush played while his parents were living in the house.

At least we're not the only team facing these problems.

College Football Is Back

2006-08-04T19:28:00.000-05:00

USC, despite losing two Heisman Trophy winners, has come out ranked #3 in the preseason Coaches' poll.

1. Ohio St.
2. Texas
T-3. USC
T-3. Notre Dame
5. Oklahoma
(Missing Starting QB)
6. Auburn
7. West Virginia
8. Florida
9. LSU
10. Florida St.

It's a shame USC only got one first place vote (I wonder who that was?) It is also a crime that Texas is ranked so high and W. Virginia and LSU ranked so low.

Grossberg v. Merck

2006-08-04T19:16:00.000-05:00

Merck won its second Vioxx case in a month. This is Forbes with prelim reporting, as well as more extensive quotes from Merck counsel in another piece, and here is Point of Law's archive on its coverage of the ongoing situation.

Here's some history on the Grossberg case at Drug Injury Watch (nice name for a blog). Unlike some other cases I can't find mention of any of the extreme MI risk factors in Mr. Grossberg that have appeared in other plaintiffs (both victors and losers) - extremely high cholesterol, disjointed lipid profiles, hypertension, diabetes.

Home Based Surgery

2006-07-31T22:31:00.000-05:00

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

2006-07-31T20:23:00.000-05:00

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

2006-07-31T19:59:00.000-05:00

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?

2006-07-31T00:30:00.000-05:00

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.

I Love Local News

2006-07-27T16:56:00.000-05:00

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

2006-07-27T16:54:00.000-05:00

Wired dreams up home uses for medical equiptment.

I Always Thought This Was Wierd

2006-07-27T16:43:00.000-05:00

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?!

2006-07-27T16:02:00.000-05:00

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.

Something to Look Forward To...

2006-07-26T21:36:00.000-05:00

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...

Quackery As A Substitute

2006-07-25T20:12:00.000-05:00

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.

The Best Homeopathic Marketing Campaign

2006-07-24T21:33:00.000-05:00

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

2006-07-24T17:55:00.000-05:00

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."

Back to the Moon

2006-07-21T22:43:00.000-05:00

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...

2006-07-21T22:27:00.000-05:00

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

2006-07-21T18:06:00.000-05:00

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.

Federal Funding Stem Cell Bill Passed

2006-07-18T17:28:00.000-05:00

...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...

2006-07-18T16:08:00.000-05:00

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

2006-07-18T07:58:00.000-05:00

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

2006-07-18T07:45:00.000-05:00

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."

Immigrant Health

2006-07-17T23:38:00.000-05:00

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

2006-07-17T21:49:00.000-05:00

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

2006-07-17T19:54:00.000-05:00

"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

2006-07-17T16:24:00.000-05:00

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...

2006-07-17T16:08:00.000-05:00

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...?

Point of Law on Slate

2006-07-13T13:44:00.000-05:00

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

2006-07-13T06:50:00.000-05:00

A Webcast: Hearings of the House Committee on Energy and Commerce, Subcommittee on Health (10:00 am EST, Thursday, July 13, 2006)

H/T Kevin, MD

The Question of Free Will In Law

2006-07-12T21:40:00.000-05:00

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

2006-07-12T18:40:00.000-05:00

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?"

Lab-made Sperm

2006-07-11T13:54:00.000-05:00

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

2006-07-11T08:20:00.000-05:00

"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

2006-07-11T06:06:00.000-05:00

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.

I'm Back

2006-07-09T21:17:00.000-05:00

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.

The Debate Over Global Warming

2006-06-05T13:02:00.000-05:00

Is it a surprise that Dr. Bill Gray, doesn't think global warming is as sure fire as the media makes it out to be?

It might be difficult to tell that is his opinion from this snippet from The Frederick News-Post,

Meteorologist William Gray, a professor of atmospheric science at Colorado State University, pioneered hurricane forecasting. Each year, Mr. Gray and his team issue predictions on the number of major tropical storms and hurricanes that will form in the Atlantic Ocean.
For 2006, Mr. Gray has predicted 17 named storms with nine becoming hurricanes, five of those with winds greater than 110 mph.

Warmer ocean water combined with lower trade winds favors the development of hurricanes in greater numbers and with greater intensity, he said.

"When the surface of the Atlantic is 1 degree higher in temperature, which it is, there is potential for a more severe season," Mr. Markey said.

Yeah, "global warming" isn't used once in this article, but this "garbage," as Dr. Gray calls it is so embedded, so prevalent in the media that it is understood what the quote above is implying. Or maybe it is just me.

"Let's just say a crowd of baby boomers and yuppies have hijacked this thing," Gray says. "It's about politics. Very few people have experience with some real data. I think that there is so much general lack of knowledge on this. I've been at this over 50 years down in the trenches working, thinking and teaching."

One thing is for sure, a lot of misinformation is out there. I love it how climate change and global warming are virtually synonymous in that AP wire piece.

This is the most over-politicized environmental issue in my lifetime and it is skewing the debate, or lack thereof. This has become scripture for some people who have never even glanced at the evidence beyond snippets from the New York Times mentioning by what size a certain glacier has shrunk. I mean, neither have I, but at least I'm sitting here arguing for some actual discussion on the topic.

Health Savings Accounts

2006-06-05T12:15:00.000-05:00

Health Care Blog takes on the Cato Institute's, defense of Health Savings Accounts.

According to Mathew Holt,

[Canon] suggests that basically the healthy members of the group are better off moving into higher and higher deductible plans. Eventually no one will be left able to afford the "sicker" plan, so the effect will have been the movement of everyone to a high-deductible from a low deductible plan.

This ignores two HUGE issues. The first is the loss of the money from the pool to pay for the care of the sick people in it. Unless miraculously in Year 1 overall health care costs collapse, the movement of all the healthy people into a lower premium insurance product will mean that there won't be enough money in the pool to pay all the health care expenses of its members. Why not? Because it's the premiums from those healthy "students" that's paying for the care for the sick "professors". If you stop collecting premiums from the 80% of healthy people and allow them to keep them in cash, there is not enough money left in the pool to cover the care of those who get sick. The math just doesn't work, as I showed here (and I'm by no means the only one who's pointed this out). Someone has to make up the difference in year one. (This is BTW why social security privitization is a political non-starter because it demands more money in the first years).

You can read a brief summary of HSAs at Wikipedia, or the CRS report on HSAs, or look at nationalized health coverage proponent Jill Quadango trashing HSAs.

I really could care less about, nor am I capable of grappling with the, economic implications of HSAs. I think they're the right thing to do whatever disparity they do (or do not) create. I take this quote from Rep. Jim McDermott, from an editorial against HSAs. Where he finds fault I find beauty:

A bedrock principle of this nation is to pool our resources and share the risk, because it benefits all. That's why we collectively support police and fire departments, national defense and a host of other essential services. The alternative would turn back the clock to the early 20th century...

A bedrock principle which Mr. McDermott admits is itself merely a hundred years old? Less I would argue when applied to health. Quite fundamental, been around forever as you can see. Moving on though, healthcare falls something short of the police or fire department not only in terms of the comparison (which I don't think is apt) but in terms of the fundamental role of government.

Worst Case of Mistaken Identity Ever

2006-06-05T12:07:00.000-05:00

A women in a coma is mistaken for a dead girl by doctors and her family.

For more than a month, Laura VanRyn's friends and relatives thought she had survived a van crash that killed five people, and they celebrated the young woman's milestones as she recovered.
Then came the stunning news last week of a tragic mix-up: It was not VanRyn, but a college classmate who had survived in a coma-like state. On Sunday, friends and relatives gathered to remember VanRyn, a 22-year-old senior who was just weeks shy of graduation.

Cerak, 19, who bore a strong resemblance to VanRyn, was in a coma after the van she and other students from Taylor University were riding in was hit by a tractor-trailer April 26. Her face was swollen, and she had broken bones, cuts and bruises.

VanRyn's parents did not begin to question whether she was actually their daughter until, as she regained consciousness, she started saying things that did not make sense to them, including referring to VanRyn's father by a pet name he did not recognize.

HIPAA Improves Patient Care?

2006-06-05T11:24:00.000-05:00

My God, I've spent enough time working as office staff in multiple physician's offices to know this is a bogus claim.

Goldman and other privacy advocates point to numerous reports of health information being made public without patients' consent -- the recent theft of millions of veterans' records that included some medical information, a California health plan that left personal information about patients posted on a public Web site for years, and a Florida hospice that sold software containing personal patient information to other hospices.
In the meantime, Goldman said, surveys continue to show that for fear that their medical information will be used against them, people avoid seeking treatment when they are sick, pay for care out of pocket, or withhold important details about their health from their doctors.

"The law came about because there was a real problem with people having their privacy violated -- they lost jobs, they were embarrassed, they were stigmatized. People are afraid. The law was put in place so people wouldn't have to choose between their privacy and getting a job or going to the doctor," said Goldman, who also heads the Health Privacy Project, a Washington-based advocacy group. "That's still a huge problem."

I am for government regulated formalized patient privacy protections. But the argument for such is purely one of the importance of the right of privacy. This argument that HIPAA improves patient care, is in my mind, complete numbskullery. If this was really the idea behind this man's passion when he helped construct the HIPAA law then he's a fool.

Any benefit gained by patients seeking care for sensitive issues is easily outweighed by the costs of the bueacracy, slow down and lapses in the ability to communicate patient data between healthcare entities (don't pretend that doesn't happen just because HIPAA makes provisions for it), and other issues.

In any case the entire Washington Post article is a little baloney. They chastise the Department of Health & Human Services for not imposing fines in 70% of complaints. What percentage of those cases that they didn't hand out fines went something like this --

Patient notices record sitting on unattended computer screen where everyone can see.

Low level medical record clerk with high school degree sends out patient's records even though the release, while filled out by the patient, was accidentally not signed.

Patient complains that physician office is slow in amending his medical record, per his request, that he was treated for syphilis in 1997 NOT 1999!

The physician office's EMR system doesn't quite meet government security standards. Hackers are lurking, watch out!

It has been two and a half weeks since I asked to see my own records! I filled out a little form, and left it on in someone's 'in box' shaped like a waste basket, I don't know the person's name I left it for, and I haven't checked in since but my God someone should've handled my request by now.

80%? 90%? Maybe more? This isn't people's records being posted negligently on the web. This isn't records being sold. This isn't, for the large part, records being sent to employers, to entities with authority over patients. I'm not sure heavy fines can lower the rate of such examples of complaints as listed above.

There are over 5,000 cases open, some likely involving major neglect or even malice. What the hell is this article complaining about? My God, we have to come down on that office, that clerk faxed my medical records to the wrong doctor's office! Now anyone could have them! If we fine them now, that clerk will never hit 5 instead of 6 on the fax machine ever again!

For any casual reader this article is alarmist and paints a completely single sided picture of the situation.

H/T Slashdot

Go Heat Go

2006-06-03T23:06:00.000-05:00

Suddeny The Big Guy and D Wade are my heroes.

Costs Like Clear Glass

2006-06-02T23:04:00.000-05:00

Medicare is publishing the average prices it pays hospital for 30 elective procedures, so that the patients it covers can make more informed decisions. It is a move in the right direction.

The U.S. Centers for Medicare and Medicaid Services, which runs the Medicare health program for over 43 million elderly and disabled people, is posting the average price Medicare pays for 30 common elective procedures broken down by U.S. county.
Health care costs are generally opaque in the United State, in part because intermediaries like health insurers and employers finance much of the system for patients. Experts have said Americans know more about the quality and pricing of their cars than their health care.

Duke Lacrosse To Play Next Year

2006-06-02T22:54:00.000-05:00

Although Duke has denied a newsconference scheduled for Monday is to anounce such. One of the assistances is to start the next season as interim head coach.

A news conference is expected Monday.
On Friday night, Duke spokesman John Burness denied that the school planned to announce the team would play next season.

Former three-time Duke All-American Kevin Cassese, 25, who served as an assistant Blue Devils coach last season, will run the program pending a national search for a head coach, Newsday reported.

Duke University President Richard H. Brodhead announced on March 28 that the university was suspending future games of the men's lacrosse team until there was a clearer resolution of the legal situation involving team members.

On May 1, a Duke University committee recommended that the lacrosse program be reinstated.

USC QB Mark Sanchez

2006-06-02T22:52:00.000-05:00

Has been cleared by the Los Angeles County DA of rape allegations leveled by a fellow USC student.

End of FP?

2006-05-31T20:48:00.000-05:00

Duke closes it's Family Medicine residency. Kind've sad.

H/T Kevin, MD

Don't Ask, Don't Tell

2006-05-31T16:21:00.000-05:00

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.

AIDS Growth Slowing

2006-05-30T22:31:00.000-05:00

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

2006-05-30T22:23:00.000-05:00

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.

A Year

2006-05-28T16:02:00.000-05:00

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

HIV From A Stab Wound

2006-05-28T15:57:00.000-05:00

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.

Why Does Healthcare Cost So Much?

2006-05-26T13:45:00.000-05:00

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.

Can Greg Garber Write Anything But Fluff?

2006-05-25T17:19:00.000-05:00

The social perception of lacrosse.

Cloaking

2006-05-25T15:41:00.000-05:00

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

2006-05-25T15:37:00.000-05:00

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.

Cancer & Marijuana

2006-05-24T20:24:00.000-05:00

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

2006-05-24T18:09:00.000-05:00

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

2006-05-24T11:24:00.000-05:00

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.

National Organization of Women

2006-05-23T17:57:00.000-05:00

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...

2006-05-23T15:55:00.000-05:00

...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"

2006-05-23T15:43:00.000-05:00

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

2006-05-23T13:14:00.000-05:00

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.

Thus Ends

2006-05-22T22:54:00.000-05:00

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

2006-05-22T14:30:00.000-05:00

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

2006-05-22T11:12:00.000-05:00

This man,

says that even San Antonians know they have no sense of humor.

The Opacity of Cost

2006-05-22T10:55:00.000-05:00

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

2006-05-22T09:17:00.000-05:00

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.

Signature Try

2006-05-21T16:50:00.000-05:00

Mark Cuban Sucks

2006-05-20T22:20:00.000-05:00

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"

2006-05-20T09:45:00.000-05:00

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...

2006-05-20T00:35:00.000-05:00

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.

Wow...

2006-05-19T23:55:00.000-05:00

...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

2006-05-19T22:09:00.000-05:00

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

2006-05-19T00:12:00.000-05:00

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 World s, 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

A New Antibiotic

2006-05-18T23:51:00.000-05:00

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?

2006-05-18T18:10:00.000-05:00

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

2006-05-18T17:55:00.000-05:00

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

2006-05-18T10:21:00.000-05:00

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

2006-05-18T00:10:00.000-05:00

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.

I Feel Safer Already

2006-05-17T23:45:00.000-05:00

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

2006-05-17T22:12:00.000-05:00

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

H/T Slashdot

Spread The Blame

2006-05-17T19:21:00.000-05:00

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

2006-05-17T15:42:00.000-05:00

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

2006-05-17T13:07:00.000-05:00

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...

2006-05-17T13:00:00.000-05:00

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

2006-05-17T08:27:00.000-05:00

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.

An Opinion on the Duke Case

2006-05-16T21:16:00.000-05:00

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?

2006-05-16T21:10:00.000-05:00

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.