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    Saturday, April 27, 2002

    A Fifth a Day Keeps the Doctor Away: The Onion has this report on heart attacks.
     

    posted by Sydney on 4/27/2002 05:21:00 PM 0 comments

    Carry Me Back to Old Virginity: Spanish legislatures are introducing legislation to make virginity certificates illegal. Evidently, the growing Muslim population in Andalusia is raising the specter of doctors being asked to guarantee the virginity of young girls:

    " 'Certifying that a woman has an intact or ruptured hymen isn’t a doctor’s work and has nothing to do with medical practice, both in public and private sectors," Dr Padrós said.

    He added that the college’s ethical commission would soon release an "official position report" so that Catalan doctors were aware of how to act. He said that the college had been asked twice recently by Catalan gynaecologists what they should do when faced with a request for a virginity certificate.

    These cases, which involved Muslim parents who wanted a certificate so that their daughters could get married without problems, prompted the college to draft its guidelines. Although the phenomenon may be new in Spain, it is a common practice in Muslim countries such as Turkey and Morocco.

    A study published three years ago in JAMA (1999;282:485-90) on virginity examinations in Turkey showed that, although the Turkish Medical Association condemned the practice except in cases of alleged sexual assault, nearly half of Turkish forensic doctors conducted "virginity examinations for social reasons despite beliefs that such examinations are inappropriate, traumatic to the patient, and often performed against the patient’s will.' " (italics are mine)

    Even subjugated women can be enterprising enough to find ways around this, though, as Dutch gynecologists have found:

    " 'Many immigrant groups hold strongly with the tradition that girls must be virgins when they marry. If the bride cannot show her bloody sheet after the wedding night, her family are shamed. Her new husband's family may exact revenge in the form of violent reprisals and banishment of the bride. Because of these far reaching consequences, many gynaecologists in the Netherlands are willing to reconstruct the hymens of adolescent girls who are no longer virgins but wish to appear so.' "

    In the Netherlands they can do this without parental consent. The women can also have all references to the procedure removed from their medical records and away from the prying eyes of their owners, er, I mean families.
     
    posted by Sydney on 4/27/2002 07:19:00 AM 0 comments

    Celebrity Medical Watch: Jesse Helms' heart surgery
     
    posted by Sydney on 4/27/2002 07:16:00 AM 0 comments

    Serving at Their Peril: A firsthand account of the terrorist campaign against doctors in Pakistan.
     
    posted by Sydney on 4/27/2002 07:16:00 AM 0 comments

    Location, Location, Location: Here's a study that shows that location is a bigger factor than race in choosing a physician. The authors conclude:

    " 'Our results suggest there is another avenue for increasing the quality of care--create incentives for high-quality doctors, whatever their race, to locate where many minority patients reside," said Thurston in the statement.

    "Programs that create financial or other incentives for doctors to locate in underserved areas would likely be equally, if not more, effective as simply creating a system that encourages more minority physicians," he added."

    Makes more sense than having a "Take a Loved One to the Doctor Day." Tommy Thompson, are you listening?
     
    posted by Sydney on 4/27/2002 07:12:00 AM 0 comments

    Oompa Loompa Strike: Chocolate workers strike over health insurance coverage. At least they aren’t paid in cocoa beans like the workers at Willy Wonka's factory.
     
    posted by Sydney on 4/27/2002 07:08:00 AM 0 comments

    Friday, April 26, 2002

    Chips, Fries, and Bagels Vindicated: Steve Milloy's FoxNews column debunks the fried and baked potato scare.
     

    posted by Sydney on 4/26/2002 09:45:00 PM 0 comments

    Greek Mystery Virus: Just in time for the Greek Orthodox Holy Week, an unidentified virus is spreading through Greece. Thirty-six people have contracted it, and three of them have died. The story doesn’t say if the three who died were already in poor health before getting the virus. The Greek media have been suggesting that people avoid holy communion lest they catch the bug, which of course upset the Church:

    "The Church of Greece angrily objected to suggestions in the Greek media that taking holy communion could spread the virus.

    "It should be considered blasphemous, to say the least, to consider it possible that epidemic ailments could be transferred through holy communion and endanger human life," the Athens diocese said in a statement."

    Now, I happen to believe in the sacrament of the holy eucharist, but I draw the line at saying the communion cup is free of earthly taint. The health officials think the virus is a member of the enterovirus familiy. These viruses are the second most common infectious viruses in the world, and they are most definitely transmitted by saliva and respiratory droplets. It's more than a little obtuse of the Greek Church hierarchy to suggest otherwise.
     
    posted by Sydney on 4/26/2002 07:06:00 AM 0 comments

    Celebrity Medical Watch: Dr. Atkins' Cardiac Arrest

    Dr. Atkins is the author of the "Atkins Diet" a popular high protein, low carbohydrate weight loss diet. He claims that his diet gives you a healthy heart. He's also quick to point out that his heart condition has nothing to do with his diet. I wonder how he can be so sure. According to the story, the doctor suffers from cardiomyopathy, which means the muscle cells of his heart are diseased. He thinks it was caused by a virus. This is a supposition on his part. There is no way to confirm that with any medical certainty. However, this posting, by a nutritionist, on the physiologic effects of the the Atkins diet says it causes a depletion of glycogen in muscle cells. Glycogen is required by cells to keep themselves healthy and working properly. It’s not much of a stretch to surmise that his diet, if he follows it, may have something to do with his disease.
     
    posted by Sydney on 4/26/2002 07:00:00 AM 0 comments

    Boil, Don't Bake: Swedish researchers claim that baking and frying starchy foods is hazardous to your health. They say that they have found high levels of the chemical acrylamide in bread and potatoes that have been baked and fried. Acrylamide is a carcinogen in lab rats. They were so alarmed by their findings that they rushed to publicize them, avoiding the usual peer review process:

    "The Swedish officials said they were so surprised by the information that they decided to make it public immediately, rather than wait for publication in a scientific journal."

    Thankfully, the researchers realize that bread is the staff of life:

    "We found the substance at levels that, if it was just one product, we would ask that it be immediately taken off the market," said Leif Busk, head of the Research and Development Department of the Swedish National Food Administration. "But it is in foods that we cannot live without, so there is no question of prohibiting it."

    That’s good. I couldn’t face a world without bagels, chips, and fries. If we believed all of these studies on dangerous contaminants we wouldn’t be able to eat anything or breathe the air around us. Luckily, our bodies aren’t as fragile as these researchers would have us believe, and the human race just keeps on trucking along.

    I’m not the only one who’s skeptical. Junkscience has a post that quotes the American Council on Science and Health’s response to the Swedes:

    “’There is no compelling evidence which supports today's claim by Swedish researchers that fried or baked foods high in starch introduces chemicals which increase the risk of human cancer," according to the American Council on Science and Health (ACSH), a nonprofit, consumer education consortium of physicians and scientists based in New York City.

    "We are deeply concerned that Americans will unnecessarily worry about safe, nutritious foods after hearing today's news," said Dr. Elizabeth M. Whelan, President of ACSH.

    "The claim that acrylamide, found in common foods such as potatoes and bread, after cooking, poses a human cancer risk is based exclusively on high dose studies in laboratory animals. There is no evidence whatever that humans who eat the observed levels of acrylamide are exposed to any risk of any type of cancer," noted Dr. Whelan.”

    Let’s face it, the world is not a risk-free place. If the acrylamide doesn’t get you, something else will.
     
    posted by Sydney on 4/26/2002 06:50:00 AM 0 comments

    Sudden Infant Death: Researchers now think that a subtle but deadly infection may be responsible for SIDS deaths. From the details of the article, it sounds plausible. I suspect, however, that not all SIDS deaths have the same cause, and that much like sudden adult death, there are many possible etiologies.
     
    posted by Sydney on 4/26/2002 06:48:00 AM 0 comments

    Convoluted Acronym Award: The HEALTH Act (Help Efficient Accessible, Low-cost, Timely Health Care Act) was introduced in the US House yesterday, to attempt to cap malpractice awards. It's an awkward title, but a worthy cause:

    "The bill would cap non-economic damage awards in malpractice suits at $250,000; limit punitive damages to the greater of $250,000 or twice the amount of economic damages; allow damage awards to be paid over time rather than in one lump sum; limit attorney fees; requires in most cases that suits be filed within 3 years; and alter rules under which plaintiffs who are only partially responsible can be held accountable for full damages."

    The malpractice crisis isn't just a lot of whining on the part of doctors. Malpractice premiums are skyrocketing across the country, in some cases making it impossible to cover the cost of overhead. Tort reform would be a welcome step forward, but even the sponsors of this act aren't optimistic it will pass. My home state, Ohio, tried something like this a few years ago, but it was struck down by the Ohio Supreme Court as unconstitutional. I don't know enough about law to know how this sort of thing would fare nationally, but it deserves some serious consideration.
     
    posted by Sydney on 4/26/2002 06:43:00 AM 0 comments

    Meanwhile... Physicians take matters in their own hands and sue the insurance companies for failing to pay them. The Tennessee Medical Association is suing the state's four largest insurers for failing to pay their bills on time and properly. The idea is catching on:

    "Physicians' groups in New York and South Carolina filed similar lawsuits this year. A federal lawsuit against major health care companies is pending in Florida by 600,000 doctors who claim they are routinely shortchanged on their reimbursement claims under a system that institutionalized underpayments."

    I think we will see more and more suits like this. Many of the insurance companies are beginning to reimburse physicians at below 50% of their usual charges, and it's just not possible to run an office with those sorts of discounts.
     
    posted by Sydney on 4/26/2002 06:41:00 AM 0 comments

    Thursday, April 25, 2002

    Pap Smear Revisions: The Right Way to Make Medical Decisions: This week, new guidelines were issued both for the interpretation of pap smears by pathologists, and for the treatment of abnormal pap smears by physicians. Pap smears are a random sampling of cells from the cervix, a button of tissue at the end of the vagina that serves as the gateway to the uterus. The cells are examined under a microscope by a pathologist (or a technician) to screen for cancer of the cervix. The pathologist sends the physician a report that describes the cells in terms of degrees of abnormality, from normal to clearly cancerous. It’s the slightly abnormal cells that are difficult to categorize, both for the pathologist and for the treating physician. It’s these cells that the new guidelines address.

    Cells can be slightly abnormal because of irritation, inflammation or infection. If the infection happens to be caused by the human papilloma virus (HPV) then those slightly abnormal cells have a higher risk of going on to become cancerous. We now have the technology to test for human papilloma virus infection with the same sample of cells that are used for the pap. It is this ability that has made the new guidelines possible.

    In the past, when a pap was mildly abnormal, the pathologist would make a judgement on whether or not it was likely to be a benign cause or to be a precursor to cancer. Now, he no longer has to make that difficult distinction. In addition, the same cell sample can now be tested for the presence of HPV, and that HPV can be further tested to see if it is the type of HPV that is associated with increased cancer risks or if it is the benign version that has no risk. If the HPV test is positive for the high risk type, then the patient warrants a closer look. If not, the patient can be screened routinely as if she had a normal pap. This will reduce significantly the number of women who have to undergo biopsies and repeat testing. As this quote from an American Cancer Society spokeswoman points out:

    "Right now, there's a lot of overdiagnosis, a lot of extra unneeded follow-up tests that are being done, which are a tremendous health care cost but also a tremendous cost to the women in terms of anxiety, time and discomfort," said the cancer society's Debbie Saslow. If many women with inconclusive results can be reassured, "that will be a big benefit for society."

    The new guidelines were adopted with no controversy at all, in contrast to attempts to modify the guidelines for screening mammography. The American Cancer Society still insists that mammograms save lives by detecting cancer early despite much evidence to the contrary. For some reason they have turned a deaf ear and a blind eye to the realities of breast cancer screening. The difference, of course, is that pap smears and cervical cancer have not been politicized as has breast cancer. No one wears pink ribbons on behalf of cervical cancer victims, Congress doesn’t hold hearings on pap smears, and pathologists and gynecologists don't try to bully guideline authors into accepting the validity of one approach, as radiology groups have done with mammograms. In fact, the published guidelines are careful to reveal the financial interests of one of the authors. (The disclosure is at the bottom of the abstract.) The approach to the pap smear guidelines should be used as a model for all medical guidelines. The data on effectiveness should be made by a panel of physicians who are not influenced by politics; senators and congressmen should stay out of the process completely; and all financial interests of those involved should be fully disclosed.
     

    posted by Sydney on 4/25/2002 08:27:00 AM 0 comments

    Physician Uses Children in Smallpox Experiments (in 1767): This essay describes a series of experiments in smallpox inoculation at London's Foundling Hospital in the mid-eighteenth century. The first smallpox inoculation was done in 1722, and by 1765 the practice had reduced mortality from smallpox from 1 in 6 to 1 in 500. This particular experiment wasn't so much about whether or not the inoculation was effective (they already knew it was),as it was about the best method of inoculation. They obviously had no qualms about using the poor foundlings as experimental subjects. Although, to be fair, all of the children in such an institutional setting would surely have been inoculated anyway to prevent an epidemic.
     
    posted by Sydney on 4/25/2002 07:47:00 AM 0 comments

    More Smallpox History: Here's an article on the last smallpox epidemic in Boston in the early twentieth century and the city's struggle with compulsory vaccination. At the beginning of the outbreak, they tried voluntary vaccination, but smallpox cases continued to turn up. They then turned to compulsory vaccination, fining people who refused to be vaccinated $5 or sentencing them to 15 days in jail. In some cases, they used force, as in this description of a "virus squad" inoculating the homeless:

    "A reporter for the Boston Globe accompanied a squad one night and described the scene: "Every imaginable threat from civil suits to cold-blooded murder when they got an opportunity to commit it, was made by the writhing, cursing, struggling tramps who were operated upon, and a lot of them had to be held down in their cots, one big policeman sitting on their legs, and another on their heads, while the third held the arms, bared for the doctors." One "fighting tramp," who "went down in a heap on the floor" from the blow of a policeman's club, received both vaccination and suturing of his scalp."

    Of course, such tactics were controversial, even at the turn of the twentieth century, and vaccine opponents were very vocal. One opponent went so far as to expose himself to the disease to prove it wasn't dangerous to healthy people:

    "The 60-year-old Pfeiffer had not been vaccinated since infancy. In an unprecedented move, Durgin lifted the strict requirement of recent, successful vaccination for all health workers entering the Gallop's Island smallpox hospital. Pfeiffer visited the hospital on January 23, 1902, and was escorted among more than 100 patients with smallpox by the physician in charge, Dr. Paul Carson, who reportedly suggested that he smell the odor of a patient's breath. Health officers surreptitiously observed Pfeiffer after the visit, and on February 8, 1902, he was found to be critically ill in his home in Bedford. The following day, the headlines read, "Pfeiffer Has Smallpox. Anti-vaccinationist May Not Live."

    He lived, but needless to say his case against vaccination was severely weakened.

     
    posted by Sydney on 4/25/2002 07:37:00 AM 0 comments

    Healthcare Inflation: The American Association of Health Plans (that's the lobbying group for insurance companies) commissioned a study to determine the chief causes of rising health care costs. The findings:

    "Prescription drugs, medical devices and other advances in health care were the biggest contributors to a 13.7% rise in US health care costs last year."

    It also noted other important contributing factors:

    "The aging of the population, greater media coverage of new treatments, increased attention to prevention and diagnostics, and the move away from less-expensive managed care is generating greater consumer demand for medical services, the report said.

    At the same time, expenses for class action lawsuits, malpractice premiums and other legal costs as well as government-mandated benefits are on the rise."


    It's those last few factors that are particularly nettlesome. They push up the cost of health care for all of us, even those of us who don't demand all that much from the system. Our legislatures, if they really wanted to do something about rising healthcare costs, could make a huge leap forward by enacting tort reform and minding their own business when it comes to what insurance companies should and shouldn't cover.
     
    posted by Sydney on 4/25/2002 07:35:00 AM 0 comments

    Role Reversal is Deadly: An epidemiologist has found a higher rate of heart disease in women executives compared to other women and in stay-at-home dads compared to other men. The study has the two cardinal hallmarks of a study of questionable worth: it was released at a conference instead of published in a journal, and its results are expressed only in percentages and not in real numbers. Both of those characteristics make me question its validity.

    The author, however, can't be accused of bias. She's obviously distressed by the results:

    "It is upsetting," Eaker conceded. "These men and women were on the cutting edge of social conditions. The hope is that we're through that transition. I think rather than being judgmental, we have to value people in the roles they're in and not put social judgments on people."

    Well, I don't believe social judgments or stress are the root causes of the study's findings. I suspect it's just another case of misleading statistics.
     
    posted by Sydney on 4/25/2002 07:32:00 AM 0 comments

    Wednesday, April 24, 2002

    An FDA advisory panel has recommended that Lotrenex, a drug for irritable bowel (also known as spastic colon) be allowed back on the market.

    I have mixed feelings about this. On the one hand, it can help people who have severe symptoms that are not controlled by other medication. On the other hand, serious complications have happened with it's use - including death. I commend the panel for recommending that stringent guidelines for its use be implemented. That ,at least, will encourage the company to promote it responsibly. When it was on the market before, patients would ask for it because they had read about it as being the "best treatment" for irritable bowel. The assumption being that if it works when other drugs fail, it's the best. Now, at least both doctors and patients will be aware of the severity of the potential complications and exercise caution in its use.
     

    posted by Sydney on 4/24/2002 07:19:00 AM 0 comments

    Vulcan Neck Grip Prototype? A one hundred year old Javanese anesthetic method bears a remarkable resemblance to Spock’s neck pinch.
     
    posted by Sydney on 4/24/2002 07:04:00 AM 0 comments

    28 Gallon Donor: This man has given 28 gallons of blood in his life time. Wow.

    I have only one small quibble with the story. It says that Howard Drew has O positive blood, making him a universal donor. It's O negative blood that makes a universal donor.
     
    posted by Sydney on 4/24/2002 06:58:00 AM 0 comments

    Tuesday, April 23, 2002

    Weekly Art History Lesson
     

    posted by Sydney on 4/23/2002 08:42:00 PM 0 comments

    AIDS Treatment Globalilzation: The World Health Organization has issued a set of guidelines to help doctors in developing countries treat AIDS effectively. This is good news. Treatment of AIDS can be very confusing, and a set of guidelines would be extremely helpful for physicians practicing in rural, underdeveloped areas. As one official said:

    ''This is a major step,'' said Paul R. DeLay, acting director of the Office of HIV/AIDS at the US Agency for International Development. ''The way HIV infection is treated in the developed world is what we call the `French chef approach,' or treatment tailored for the individual. But that can only happen if you have a team of skilled AIDS physicians and lab support. If we really are going to roll out antiretrovirals in the developing world, we are going to need ... a standardized regimen.'

    Now, all they have to do is get their hands on the drugs.
     
    posted by Sydney on 4/23/2002 08:45:00 AM 0 comments

    Calritin/Clarinex: Looks like Schering-Plough is using the indoor-outdoor allergy lie (pioneered by the makers of Zyrtec) to hype it's new antihistamine, Clarinex, which is essentially the same as Claritin. Claritin, you will recall, will soon be available over the counter. Of course, all antihistamines work on both indoor and outdoor allergies. If you don't believe me, listen to this pharmacologist:

    "All these allergy claims are pretty hocus-pocus," says pharmacologist Raymond Woosley, dean of the University of Arizona College of Medicine. "Indoor allergy vs. outdoor allergy? Come on." And anyone who has taken Claritin has taken Clarinex. He explains: "Clarinex is just a breakdown product of Claritin. When you take Claritin, there's a lot of Clarinex in your blood."

    Yup.
     
    posted by Sydney on 4/23/2002 08:26:00 AM 0 comments

    The Grass is Always Greener: There's been a slew of reports lately about the the dangers of putting off motherhood. The latest is from a group of fertility nurses in England . The nurses seem to be jumping on the media bandwagon that was set in motion by a recent book that purports to document the unhappiness of successful career women who have delayed motherhood or forsaken it altogether. I don’t dispute the notion that conception and pregnancy are more difficult in older women, but I do dispute the notion that women must have children to be happy. It’s a myth that needs to be exploded.

    No doubt if you had polled women fifty years ago when they saw themselves as having no other options but marriage and motherhood, they would have placed less value on having children than on having a life to call their own. Now, women have that life, but wish they could live the domestic bliss fantasy. The grass is always greener on the other side of the fence.
     
    posted by Sydney on 4/23/2002 08:08:00 AM 0 comments

    Angry Young Men: A recent study shows that bad-tempered doctors are more likely to have heart attacks than good-natured ones:

    “The study volunteers, who graduated from medical school between 1948 and 1964, received an initial medical exam and answered questions about their medical history, health behaviors and reactions to stress. Every 5 years, the group completed a questionnaire in which they provided information about their health and checked a box next to phrases that described how they respond under pressure.

    In 1995, when the average age of the group was nearly 65 years, about 8% had been diagnosed with premature heart disease. Men who reported that they became irritable, expressed their anger, felt angry but concealed the emotion, and participated in gripe sessions had a higher risk of premature heart disease and heart attack, compared with men who were less angry, regardless of cholesterol levels, body mass index (BMI) and blood pressure.”

    The article suggests that angry men get “counseling” to make them nicer. I have my doubts about the ability of counseling to change someone’s personality. Maybe they should just get some punching bags.
     
    posted by Sydney on 4/23/2002 08:06:00 AM 0 comments

    Angry-Looking Young Men: This article about the original Botox doctor, reveals a unique use for the drug by a San Francisco psychologist:

    "He's been using Botox for five years. He's got some lines above his eyebrows that make him look stern or angry, and he wants to look more empathetic to his patients," he said.
     
    posted by Sydney on 4/23/2002 08:04:00 AM 0 comments

    Or maybe they just wear tighter pants: A study claims that men in Southern California (read Los Angeles) have lower sperm counts than men in Northern California. The researchers argue that since Los Angeles has more smog than Northern California, the sperm count difference must be due to ozone exposure, as if there were no other differences between the two geographic locations. (Climate and culture are two big ones that come easily to mind). It just goes to show you, put a word like “sperm” in your research title and it will be sure to grab media attention.
     
    posted by Sydney on 4/23/2002 07:50:00 AM 0 comments

    Monday, April 22, 2002

    Charles Krauthammer has another good argument against human cloning in The New Republic. Check it out.
     

    posted by Sydney on 4/22/2002 06:17:00 PM 0 comments

    Another Republican decides an issue with his heart and not his head: One of the items mentioned in this article on Medicare changes is this:

    "One key change is that Medicare will begin paying for major, sophisticated diagnostic tools for the detection of breast cancer, which strikes 90,000 Medicare beneficiaries a year. The program will cover Positron Emission Tomography, or PET, a scanning system that shows cross-sectional images of biological activity in tumors or lesions. It can detect the disease when X-rays appear to be normal. The technology gives patients and doctors "potentially lifesaving information not provided by traditional imaging," said Health and Human Services Secretary Tommy G. Thompson."

    PET scans are very expensive, and finding breast cancer early doesn't increase survival except in very rare cases. It makes no sense to have Medicare cover such a procedure for screening purposes. But, then again, as Secretary Thompson has told us before, his wife is a breast cancer survivor, so throwing money at the disease uncritically is a good thing to do.
     
    posted by Sydney on 4/22/2002 08:11:00 AM 0 comments

    Vaccine Shortage: Finally the mainstream media picks up on the story of childhood vaccine shortages . This truly is a public health issue, unlike Congressman Burton's autism "epidemic". You can learn more about the shortages and the illnesses the vaccines prevent in my previous posts (scroll down to the last post on Saturday, March 23 and also see the posts for Friday, March 22).
     
    posted by Sydney on 4/22/2002 08:00:00 AM 0 comments

    Our Genes Are Not Our Destinies: Researchers have identified a mutant gene that may play a role in breast cancer. Now, the only question is, what do we do with it? Evidently not much, it only increases the risk of getting cancer, it doesn't predestine anyone to get cancer. It's just one more risk factor in a long line of risks.
     
    posted by Sydney on 4/22/2002 07:58:00 AM 0 comments

    America to the Rescue: An American health care firm is being hired by Britain's National Health Service to provide care for English cancer patients.

    "America's largest healthcare provider is planning to take over a large slice of National Health Service work by supplying cancer treatment worth 50 million pounds to 10,000 patients a year.

    Instead of patients having to wait up to six months for operations, radiotherapy and chemotherapy at NHS hospitals, GPs will be able to refer them directly to the American firm's private clinics in Britain. The scheme will be launched this summer by HCA International , which runs more than 200 hospitals in America."

    HCA thinks it can do this more cheaply than the NHS, and more efficiently. It will certainly do it with less paperwork. Let's see, first they announce they're giving their physicians more autonomy, then they hand over a portion of their business to a capitalist health system. I guess the British are serious about revamping their National Health Service.
     
    posted by Sydney on 4/22/2002 07:55:00 AM 0 comments

    No More Free Lunches: The pharmaceutical industry has adopted new, more stringent guidelines for pitching their products to doctors. No more expensive trips, expensive meals, or sporting event tickets. Only pizza and pop. They probably figure they don't have that much to lose by cutting out these things anyways. Afterall, their direct to consumer advertising is bringing in big bucks in sales for them. All they have to do is sell the public on their drug and the doctors will be pressured to prescribe them.

    I stopped seeing drug reps in my office several years ago. I never trusted their information, and I finally decided that the free samples they gave me weren't of any substantial value to my patients. They only gave samples of the newest and most expensive drugs, and my patients are probably better served by getting more reliable and less expensive ones. Also, as my practice has gotten busier, and I've gotten older, I've found it harder and harder to remember where I learned something about a drug. Did I read it in a respected journal, or did I hear it from some detail man? It just wasn't worth it anymore. So, I said good-bye to the drug reps forever.

    This hasn't stopped them from trying, though. In many cases, their salaries are based on the number of prescriptions filled for their products in their sales area. They even know how much of their product and how much of their competitors' products are prescribed by each doctor in the area. They are constantly stopping by the office trying to catch me between patients and leaving invitations to plays, dinners, and the like. I've never yet gone to any of these, although I do use their pens and magnets. (One of the more annoying things my mother does when she visits our house is to survey our refrigerator magnets and shake her head disapprovingly, murmuring, "Payola.")

    To tell you the truth, I think this is a step in the right direction. For too long the medical profession as been more than willing to take the drug companies' cash, and although doctors always claim they aren't influenced by the sales pitches, they are. It may be a subtle influence, but it's real. It reflects badly on us that it is the drug industry that is reigning these practices in and not the medical profession.
     
    posted by Sydney on 4/22/2002 07:50:00 AM 0 comments

    Sunday, April 21, 2002

    Thought for the Day: "One of the most widespread diseases is diagnosis."
    -Karl Kraus
     

    posted by Sydney on 4/21/2002 11:17:00 AM 0 comments

    Political definition of “epidemic”: When a politician or one of his family members has the disease.

    Representative Dan Burton from Indiana thinks we are in the midst of an autism epidemic.

    "We have an epidemic on our hands and we in Congress need to make sure the NIH (National Institutes of Health) and CDC (Centers for Disease Control and Prevention) treat this condition like an epidemic," Burton said.

    How is it that Representative Burton alone among a nation is aware of this raging epidemic? His grandson is autistic. No doubt the autism of his grandson has affected his family in very grave and tragic ways, but that doesn’t mean our nation should spend the $500 million dollars a year on the disease that he wants. It’s not as if the CDC and NIH have been ignoring the disease. The CDC website is a font of information on programs and research available in the area.

    Burton is aided and abetted in his hysterics by (what else?) a political lobbying group for autism, The Autism Society of America. The Autism Society claims that the number of autism cases is on the rise in the United States:

    The organization estimates that the disorder is increasing at a rate of 10 percent to 17 percent a year, "faster than any other disability or disease," said Lee Grossman, the society's president.

    Autism and its related disorders affect 1 to 2 out of every 1,0000 people. Ten years ago, that number was 1 in 10,000, but ten years ago the label of autism was used only for those whose behavior was profoundly abnormal, the children who sat in a corner rocking back and forth and never spoke or interacted with anyone. Now the disease label has been expanded to include people who are still able to live a very productive life, but who are not adept at social interactions, like this artist. The interviewer, who views his syndrome as the over-riding definer of who the man is, describes him thus:

    “At the age of 44 he’s thinning on top, baggy-faced, soft in the belly and long in the tooth, yet there’s something childlike about him. I don’t mean this sentimentally: a clever child, the sort who can lie undetectably while looking you in the eye, but an easy person to be around. Anything can be said. Forget the normal etiquette between strangers, the need to pick your way through the minefield of another’s sensibilities. Howson has his touchy spots, but until he tells you where they are there is no way of knowing. To spend time in his company is to understand how strange communication is without non-verbal cues, how weightless words become. For a couple of hours, autism is a two-way street.

    Insights and commonplaces turn up in the same sentence. He talks about Madonna, Kylie Minogue and Britney Spears in the same voice as he discusses Ingres, Delacroix and Velazquez. And yet it’s not like sitting opposite a Martian. He laughs, makes jokes which are funny, nods in eager assent before I’ve finished speaking. Then mistrusts his own intuition and has to ask me to finish the sentence anyway.”


    He’s a little boorish, but certainly not mad.

    So, Representative Burton wants us to divert money from other causes to find ways to make people like Mr. Hawson more sociable and more capable of following etiquette. Hardly a cause worthy of 500 million tax payer dollars.
     
    posted by Sydney on 4/21/2002 11:06:00 AM 0 comments

    The Fantastic Voyage: Now doctors can use a video camera pill to look inside your intestines.

    In this case, it was used to get a good look into a patient's small intestine, where it is very difficult to reach with other methods. We don't have an endoscope that's capable of snaking it's way through the long tangled web of the small intestine, and barium x-rays have a hard time imaging it, too, because the loops of small bowel overlap each other so much. I don't think that this will replace the scopes we use to examine the lower colon and the stomach and esophagus, however. With the scopes the doctor can visualize the entirety of the bowel wall, stomach wall, or esophageal wall. This isn't possible with the video pill. There are bound to be some areas of the bowel wall that are out of camera range as it passes through the body.

    An Afterthought: The video camera pill really bears more resemblance to the Shusaku Endo story "Incredible Voyage" (found in the collection of short stories, Stained Glass Elegies), in which doctors journey through a patient's bowels in a shrunken ship, than to the Fantastic Voyage, the Jane Fonda movie where they travel through the patient’s blood stream.
     
    posted by Sydney on 4/21/2002 10:26:00 AM 0 comments

    "Into as many houses as I may enter, I will go for the benefit of the ill, while being far from all voluntary and destructive injustice: -from the oath of Hippocrates

    The Israeli's seem to be upholding this basic tenet. They are providing care for the Palestinians, and have even offered to help Palestinian doctors:

    "Sever said Israeli health experts have been and are willing to help Palestinian health professional regarding pharmaceuticals, infectious disease, and other public health matters, but they were turned down by Za'anoun. The PA regards Israel as an enemy, so they refuse to accept direct Israeli assistance, Sever said.

    ....But she said great efforts are being made to ensure that patients who cannot be treated in the territories are quickly taken to Israeli hospitals, even though there is no guarantee of payment.

    There have been dozens of such cases, including a 13-year-old Ramallah boy who was rushed to Hadassah-University Hospital in Jerusalem to donate bone marrow for his six-year-old brother who suffers from a serious metabolic disease.

    An 18-month-old baby who fell from the roof of his Tulkarm home was flown at Israel's expensive to Haifa's Rambam Hospital, where he is being treated for skull fractures and contusions.

    A Palestinian boy suspected of having rabies was conclusively diagnosed, and Israeli experts saw to it that relatives and others in contact with him were vaccinated against the disease. Hadassah and Shaare Zedek Hospitals, both in Jerusalem, among others, regularly call Bassa to arrange for ambulance transportation so Palestinian patients can get anti-cancer treatment."

    That's quite a contrast to the Palestinians who use their ambulances as bomb conveyances and teach their children to value only Palestinian lives(scroll down to the New Republic link.
     
    posted by Sydney on 4/21/2002 09:34:00 AM 0 comments

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