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    Saturday, June 26, 2004

    Garden Medicine: A run-down on the adverse reactions of some of the more popular herbal medications.
     

    posted by sydney on 6/26/2004 06:36:00 PM 1 comments

    Pity Me Not: The British Medical Journal has some good advice for this guy.
     
    posted by sydney on 6/26/2004 08:55:00 AM 0 comments

    Friday, June 25, 2004

    There Ain't No Disputin' Sir Isaac Newton: Singing Science Records.
     

    posted by sydney on 6/25/2004 09:36:00 PM 0 comments

    Matters of the Heart: Researchers are reporting that diabetics with erectile dysfunction may also have undiagnosed heart disease:

    Men with diabetes who also have trouble getting an erection may have heart disease and not realise it, Italian doctors say.

    The study is among the first to document what some experts had predicted with the advent of new drugs to treat erectile dysfunction - that they would help flush out men with heart disease but no serious symptoms apart from erectile problems.

    "If our findings are confirmed, erectile dysfunction may become a potential marker to identify diabetic patients to screen for silent coronary artery disease," said Dr Carmine Gazzaruso of Maugeri Foundation Hospital in Pavia, Italy, who led the study.

    Writing in the journal Circulation, Dr Gazzaruso and colleagues said theirs was the first study to evaluate how common erectile dysfunction was among men with type 2 diabetes and silent heart disease.


    It may be the first study, but it's long been conventional medical wisdom that when there's disease in the small blood vessels of one part of the body (penis, legs, kidneys, eyes) there's a high likelihood of disease in the blood vessels of the heart.
     
    posted by sydney on 6/25/2004 09:30:00 PM 0 comments

    Warning, Warning, Danger, Danger: The FDA has put out a warning. It seems that a food producer neglected to put ingredient labels on their containers:

    The Food and Drug Administration warned Friday that a line of food products sold nationwide contains no ingredient labels.

    ...To date no injuries have been reported, FDA said.


    Whew. That's good. Better recall them quick. Before it's too late.
     
    posted by sydney on 6/25/2004 09:25:00 PM 2 comments

    Gotta Get Rhythm: New research suggests that stroke damage can be overcome, even years later, by active rhythmic motion:

    In their study, Luft's team had 20 long-term stroke survivors engage in six weeks of either standard physiotherapy -- in which physiotherapists passively move the patient's trunk, shoulder, arms and hand -- or BATRAC. In BATRAC, patients push or pull a T-bar in rhythmic time with a metronome for four, 5-minute periods per day.

    All of the study participants had suffered a stroke between 10 months and 39 years prior to the therapy, for an overall average of 9 years.

    According to the researchers, six of the eight patients in the BATRAC group gained improvements in arm function, while no such improvement was seen in the 12 patients taking regular physiotherapy.

    Using sophisticated MRI techniques, the researchers also detected what they called 'reorganization of central motor networks' in the brains of those patients whose arms improved after BATRAC, according to Luft. This type of brain reorganization was not seen in patients taking normal physiotherapy, they added.


    That sounds promising. There is, as always, a caveat. The research was presented at a conference, so it's impossible to tell how significant the improvement in function was. Or if the patients thought it was worth the work.
     
    posted by sydney on 6/25/2004 09:20:00 PM 0 comments

    Managing Women: There's a discussion thread in my family practice management list-serve about how difficult it is to manage women employees. And, this may come as a surprise, all of the discussants so far have been women. They all agree unanimously - managing women employees means a lot of handholding, a lot of tiptoeing around feelings, and a lot of refereeing of interoffice spats. In short, it's like managing children. Small children.

    That sounds sexist and offensive, I know. Which is probably why only the women on the list-serve have felt comfortable discussing it. Significantly, no one has argued the opposite.

    I hate to admit it, but this has been my experience, too. Even when I was in an employed position, the problems with an all-woman workforce were far too apparent. In all of my jobs there have been problems with back-biting, too easily hurt feelings, the tendency to turn a small problem into an insurmountable one. And I've got it now in my own office. I hired a third person to take some of the pressure off the front desk, but two of them aren't getting along. And it only seems to be on Mondays. One says something grumpy and the other one comes to me immediately tattling on her. Ugh. If they were my children I would bark at both of them, "Knock it off." And they would. They would knock it off. But I can't do that. And I shouldn't have to. I shouldn't even have to do a polite version of it.

    I've never seen this sort of behavior among men. Not that they're perfect, or that they always get along with one another. They just seem to be able to deal with differences and disagreements in ways that don't interfere with getting the job done. Which is why I always sneer at that feminist trope about how much better the world would be if women were in charge. If my job experience, and the experience of those on my list-serve are any indication, it would be one large cess-pool of dysfunction.
     
    posted by sydney on 6/25/2004 08:50:00 PM 0 comments

    And the Strike Played On: The strike is getting ugly. Although it isn't AFL-CIO ugly, it is getting uncivil. Or maybe it started out that way. The nurses have revealed that the hospital's negotiator pulled a Cheney:

    Hey, we know you shut the cell phone off. You guys got to quit these *#$&@^! games.

    What's that about? Well, it turns out that with fifteen minutes left before their contract expired, when they were still negotiationg the terms of a cooling off period, the nurse's union told the hospital they were shutting off their phones and not taking any more calls. (They were tired.)

    Now they're shocked, shocked, that the hospital refused to sit down with them the next day to resume negotiations. I've absolutely no experience with negotiations and labor disputes, but the union doesn't appear to be handling this well. Not at all. Telling someone you will no longer be taking their calls is the same as saying you're through talking.

    Granted, the hospital respresentative did not distinguish himself with his response, but neither did the nurses. Reading their version of events, one can't help but come away with the feeling that this battle is more about personalities than it is about healthcare insurance or wages or pensions. And that's sad, because the strike is not only hurting the hospital. It's hurting the community.

    And Another Thing: The nurses' seem to think that they've got an edge here when it comes to public sympathy. But letters like the one below (not from Akron) suggest that they shouldn't over-estimate the coinage of their image as angels of mercy. That image is becoming sadly tarnished, everywhere:

    Unfortunately, we have experienced first hand the difference in today's hospitals and nurses from those of the past. My dad (age 77, diabetic, double amputee, strokes, heart attacks, etc.) was taken to the ER of one of the "best" hospitals in the city yesterday afternoon, because he is suffering from fluid in his lungs due to congestive heart failure.

    When I went to see him at 7:30, I expected to find him settled in a room. Instead, he was still in the ER. Not only was he in an uncomfortable position (it is very difficult for him to move himself around), but he had not had anything to eat or drink since noon. Nor had anyone checked his blood sugar or given him insulin. The ER doctor had given a cursory look at his chart, and seeing that he had had trouble swallowing in the past, assumed that he was aspirating his food and wanted to put in a feeding tube. My dad refused it, and it made the doctor angry. Fortunately, another doctor correctly diagnosed the problem and put my dad on IV lasix (sp?), antibiotics, and breathing treatments.

    No one bothered to make him comfortable or even shown him where the TV controls were. He was just left there in a room by himself staring at the walls. I turned on the TV for him, but when I left at 9:15, he still had not had anything to eat or drink and was still in the ER.

    Visiting him in his room tonight, I found that the bathroom in his room wasn't clean (it certainly wasn't used by my dad). Also, he told me he hadn't drunk his milk at dinner, because no one brought him a straw or opened it for him. When the nurse brought him his snack, she just left a package of string cheese, crackers, and unopened milk on his tray and breezed out. If I hadn't been there, he wouldn't have been able to open or consume any of that either. Then when the respiratory tech came in and put the mask on my dad for his breathing treatment, he put it over my dad's glasses, which pushed his galssed into his face. Again, if I hadn't been there, it would have stayed that way.

    Some of these may seem trivial, but overall it shows either laziness or a lack of compassion and concern that is really sad. My poor dad is about as helpless as a person can be, and yet, nobody seems to care enough to see that he is at least somewhat comfortable. They do the absolute minimum and leave.

    My dad has no idea what the doctor thinks or has planned. He saw the doctor for about 5 minutes this morning. Either he didn't understand what the doctor said, or the doctor really didn't tell him much. I think my dad feels like he's being treated like a piece of meat. It's the first time in all his illnesses that I've seen him so discouraged and ready to give up. Right now, I think I'd rather be desperately ill at home than be hospitalized.


    UPDATE: Another reader makes a valid point:

    I read your post that starts like this: "The nurses' seem to think that they've got an edge here when it comes to public sympathy. But letters like the one below (not from Akron) suggest that they shouldn't over-estimate the coinage of their image as angels of mercy. That image is becoming sadly tarnished, everywhere"

    However, the majority of the letter dealt with the ER doctor that got mad, the bathroom that wasn't sufficiently cleaned by the housekeepers, the RT that mis-placed the treatment mask, and the doctor that barely spent 5 minutes with him the next day.

    I agree that the lack of comfortable position and the fact that someone (could have been the nurse, could have been the CNA) just plopped down the dinner tray/snack without inquiring as to whether the patient needed things opened for him is not very nice, but was the nurse assigned to that patient running around like the proverbial chicken, or was he/she out at the desk doing a crossword?

    Overall, I think you unfairly pointed out nurses with that letter, when it's clear that other disciplines also participated in this patient's lack of care.


    That's true. We're all responsible for the decline in modern hospital care. Too busy, too rushed.


    UPDATE II: Another reader disagrees and makes the connection between managing women and the strike:

    You missed a major point in your own article. [see the post above this one - ed.] Most of the nurses are female and you have problems with female employees, soooo it is not a big leap to understand some of the problems in settling the strike. Ego. Add to this my outside view of hospital administration being made up mostly of women and you have a very difficult situation.

    I have a problem with a group making above average wages, in an area with a declining economy, complaining about working conditions. When you go to the hospital they could care less about the patients, only about their next break, it is hard to feel sympathy.


    Well, I didn't entirely miss the point. I posted the two in close proximity because I thought they were somewhat related. Although, I think the union's concerns (the loss of benefits) are ones that are widespread among all unions - the way they're negotiating and the tenor of their website does smack of the same problems that a lot of people have complained of in managing an all-woman staff. That is, a preponderance of the emotional at the expense of the rational. And at this hospital, by the way, the administration is overwhelmingly male.

    And I agree. I have trouble sympathizing with a group who is making above average wages in a region with a declining economy, too.

    UPDATE III: And another reader also thinks that the reputation of nursing as a profession is declining:

    I'm emailing about the update that said you unfairly pointed out nurses when it's clear that other disciplines also participated in this patient's lack of care.

    Background: My father has been in hospitals about every 2-3 years, for the last 14 years, due to complications related to his heart stopping 6 times in one day. He is now having the same water in the lung problems mentioned in the original email.

    In regards to nursing, we‚ve found the ICU staffs have always been top notch. The regular floor and EM treatment have been a mixed bag. He had a hunting accident and one pupil is always dilated. It‚s obvious when a nurse comes in, if they haven‚t read the chart. On some floors, there‚s an annoying tendency of the staff to gossip for hours at a time and do the minimum required.

    The good, professional nurses stand out because they are the exception instead of the norm. The opposite of how it used to be. I realize nursing is a tough job, and all the paperwork doesn‚t make it any easier, but nurses are the backbone of care that is received. If they are just putting in their time, it shows.


    This is true. I know a lot of top-notch nurses who have switched from the medical floors to the ICU precisely because they wanted to be able to actually care for patients rather than be a documentor, medication handler and supervisor of nursing aides. Once upon a time, the standard of the ICU was the same for the regular medical floors. Patients were cared for by nurses, not by aides.


     
    posted by sydney on 6/25/2004 07:14:00 PM 0 comments

    Thursday, June 24, 2004

    Miracle Milk: One of the hardest common conditions to treat is the common wart. You can freeze them, treat them with acid, duct tape them, laser them, and still they just keep coming back for more. That's because they're caused by a tenacious virus. To cure the wart, you have to kill almost every last infected skin cell in it. But a group of Danes say they've found an antiviral compound in human breast milk that attacks the virus. They call it HAMLET:

    Svanborg's team was testing ways to fight what is called bacterial superinfection - bacteria infecting cells already infected by a virus. They applied a protein in mother's milk called alpha-lactalbumin to double-infected lung cancer cells.

    To the researchers' surprise, the cancer cells as well as the bacteria inside them were killed. That was because the milk protein had changed its configuration, bound to another milk component called oleic acid, and created the more powerful HAMLET compound.

    The research team then tested the compound against warts on patients' hands and painful ones on their feet, called plantar warts. The warts shrank by at least 75 percent over the first three weeks the compound was applied to the skin. And at least three-quarters of the warts disappeared after a second treatment.

    The researchers dubbed the compound HAMLET, an acronym for human alpha-lactalbumin made lethal to tumor cells, partly because of their proximity to the scene of the Shakespeare play, which took place in Denmark.


    Seventy-five percent cured after two applications. That's a fairly impressive result, but a very twisted linguistic to get a catchy acronym.
     

    posted by sydney on 6/24/2004 11:22:00 PM 0 comments

    Preparedness: The CDC says that there will be plenty of flu vaccine out there this fall:

    Determined to avoid a repeat of last year's flu-shot shortage, the government announced that vaccine makers will have 100 million doses ready for this winter.

    That figure does not include the estimated 4.5 million doses of flu shots the Centers for Disease Control and Prevention is planning to keep in reserve for children in its first-ever stockpiling of the vaccine.

    For the 2003-04 season, there were 86.9 million doses available, compared with 95 million in 2002.


    I've ordered mine. But I'm still waiting for the Prevnar I ordered three months ago. And that shortage is supposed to be letting up, too.
     
    posted by sydney on 6/24/2004 11:13:00 PM 0 comments

    Little Old Men: Researchers say stroke is common in children:

    In fact, according to new Canadian research, about six in every 100,000 children will have a stroke. At least one-third of those cases are in newborns. While the incidence rate is far lower than among seniors, it is much higher than anyone had ever imagined.

    Six per 100,000 isn't exactly common, but it more frequent than one would suspect. The research was presented at a conference, so it's impossible to critique. But, given the traumatic process that is birth, it probably shouldn't be too surprising that infants suffer strokes. The wonder is that so many make it through delivery intact.
     
    posted by sydney on 6/24/2004 11:06:00 PM 0 comments

    The Forgotten: Kill or Cure a BBC series that examines the all too common and too much neglected diseases of the Third World. (Hint: It isn't about AIDS)
     
    posted by sydney on 6/24/2004 10:57:00 PM 0 comments

    Expensive Bug Spray: The widely used Alzheimer's drug, Aricept, is about as effective as placebo:

    Pfizer Inc.'s Aricept drug for Alzheimer's disease didn't prevent worsening of disability caused by the brain malady and isn't a cost-effective treatment, a study of 565 patients published in the U.K. journal the Lancet found.

    After three years, 58 percent of those taking donepezil, marketed as Aricept, had a worsening of their disability, compared with 59 percent of those on placebo, researchers at the University of Birmingham in the U.K. found. It didn't reduce the likelihood of patients needing extended care, the authors said.


    No news there. From the time of its introduction it was known to be ineffective. The best claim drugs like this can make is a one year delay in mental decline in 20% of patients taking it. Not exactly effective, but family's will grab the slightest chance for the slightest improvement, such is the burden of the disease. And at $130 a month, that slight hope comes at a hefty price.

    Aricept is an acetylcholinesterase inhibitor, the same kind of stuff found in bug spray. It's about as effective as bug spray, too.
     
    posted by sydney on 6/24/2004 10:20:00 PM 0 comments

    MedMal Myths: I never read Bob Herbert. The sight of his by-line sends my eyes skipping across the newspaper page to find something, anything, else to read. He's too uncritical. But Point of Law has a dissection of his typically atrocious medical malpractice piece.
     
    posted by sydney on 6/24/2004 12:02:00 AM 0 comments

    Wednesday, June 23, 2004

    Superboy: There's a fascinating article in this week's New England Journal of Medicine about a super strong toddler who has a genetic defect in a muscle-controlling gene called myostatin. When the gene is inhibited, or not expressed, the muscles develop disproportionately large. Interestingly, the same mutation slows the development of fat cells. Go figure.

    There's a picture of the little boy's muscular legs on the main page of the New England Journal. An accompanying perspective article notes that cattle producers have long been aware of this gene. The Belgian Blue breed in particular is known for it. Baby Belgian Blues are so big that their mother's risk death delivering them, and are often delivered by C-section. Poor things.

    But I digress. The article is interesting for what it says about the role of genetics in our body morphology. The little boy is unusually strong for a toddler. His mother was a professional athlete, and her family has many members who are unusually strong. Some of us really can work a lot less and have less fat than others. Genetics and basic metabolism do matter.

    (One odd thing, the genogram the article provides leaves out the child's father completely. It looks as if he sprang de novo from his mother. Is he a clone? Or is there just no way to represent two ships that passed in the night so lightly that one knows absolutely nothing about the other?)


     

    posted by sydney on 6/23/2004 11:34:00 PM 0 comments

    Strike: (Warning: Boring local stuff.) The nursing strike at the hospital has been going on for one week now, and shows no signs of ending soon. It's made things slower for me on the hospital side. Call is quieter because there are fewer patients in the hospital, and because the emergency room was closed. They re-opened yesterday, so it's likely to get busier, but they're still diverting major traumas and some emergency squad runs to other hospitals. The surgical suites and labor and delivery are half-running, and cardiology is completely up to speed.

    Both sides are operating a PR campaign. So far the hospital is winning. At least they come across as more gracious and reasonable than the union. Every day they send an email update out to let us know the staffing situation on each floor. They never say a disparaging word about the nurses or their union representatives. If only the same could be said of the nurse's union. They sent out a letter to the community today that accuses the hospital of bad faith negotiations, of "squandering" negotiation time and that ends with a reference to "corporate managers with expense accounts triple a nurse's salary and who live in million dollar home neighborhoods."

    That last bit just doesn't ring true. The hospital is an extremely frugal one when it comes to spending. Hard to imagine anyone there with an expense account "triple a nurse's salary." The top salary for a nurse there is $28/hour. That would be an expense account of $240,000. No one would get away with spending that sort of money there. And although the CEO lives in a very nice house in a very nice neighborhood, it's also highly doubtful that it's worth a million dollars.

    And what if it were? And what if the CEO gave up his salary and his home, joined the Franciscans and ran the hospital gratis? Would that provide the money the hospital would need to meet the nurses' demands? Of course not. They want higher wages, and, most unreasonable, they want their spouses to be covered on their healthcare insurance, even if said spouses have insurance already through their own jobs. That in itself is a multi-million dollar benefit when spread over the six-hundred some nurses.

    And one final thought about this strike. What do you do in this strike situation if you're the sole bread-winner of your family, and yet you're a member of a union which is made up mostly of people who work for supplemental income? Seems like the sole bread-winners end up carrying a disproportionate amount of the strike burden, even if they voted against it. Guess you'd have no other recourse but to quit and find another job somewhere else if things went on too long.
     
    posted by sydney on 6/23/2004 10:54:00 PM 0 comments

    Devils Known and Unknown: Are elderly Americans taking Celebrex and its relatives needlessly?

    Findings reported in a study published today in the Archives of Internal Medicine found that over half of patients within a predominantly retiree population taking COX-2 anti-inflammatory drugs on a long-term basis were also taking aspirin therapy for its cardio-protective benefit.

    Previously published clinical research has shown that using aspirin along with COX-2 therapies can negate the gastrointestinal (GI) benefit of using COX-2's, one of the primary reasons for using these more costly medications.

    ...Researchers at pharmacy benefit manager Express Scripts examined aspirin and other over-the-counter pain reliever use among COX-2 users from a large employer group. In addition to the high rate of aspirin use, half of the aspirin users were taking daily doses of 325mg or more, which is considered higher than necessary for the primary prevention of cardiovascular disease and stroke. Aspirin use has been shown to significantly increase the risk of bleeding in the GI tract, even at low doses, and guidelines state that patients who require aspirin therapy for cardio-protection should use the lowest dose possible.

    "These findings have important implications for patient safety and cost," said Emily Cox, PhD, lead author of the study. "For patients needing both cardio-protective and anti-inflammatory therapy, the GI protective effects of a COX-2 agent are lost by taking aspirin and don't justify their higher expense. Patients should ask their physician about changing to another equally effective lower cost non-steroidal anti-inflammatory drug (NSAID) instead of a COX-2 agent."


    But the question is, which is more dangerous? Taking aspirin and a lower-cost, older non-GI protective NSAID or taking aspirin and a COX-2? We don't necessarily know the answer to that. Most assume that taking aspirin and a COX-2 is the safer route.
     
    posted by sydney on 6/23/2004 10:43:00 PM 0 comments

    On Beyond Precaution: A reader on mercury and precaution:

    Enjoyed the column on Tech Central concerning risk. Having managed an endangered species program and a toxic metals program, it is obvious that the present use of the "precautionary principle" has become a hazardous to our health, pocket books and personal liberty.

    I will not delve into the endangered species issues and misuse other than to say as a trained scientist I get very angry with the misuse of data, the lack of formal "scientific methods" in so called scientific studies and deliberately fighting the collection of appropriate data all the while demanding extreme regulation to restrict rather benign human activity.

    Mercury is a good example of how the focused use of the precautionary principle to prevent harm for mercury "pollution" can actually cause harm, in this case physical harm. Almost all the epidemiological studies indicate that humans that eat a high level of marine finned fish protein are healthier both in mind and body. Even in studies where entire populations feed almost exclusively on fish that are considered higher than the action levels set by the US FDA and US EPA the risks from mercury are almost non-existent and the overall benefits from eating marine finned fish are very high.  

    Biological life on earth, including humans, has been exposed to natural levels of mercury for most of our evolutionary history. A large portion of mercury pollution is from natural cause like volcanoes. Eliminating all human uses of mercury, direct and indirect, will not dramatically lower the overall burden of mercury in the earth's environment.

    Yet, our government, regardless of which party runs the show, continues to stated that eating any marine fish is hazardous to one's health due to mercury contamination. And, indeed, in the time of pending energy crisis, burning of coal would be regulated almost out of business, in spite of the fact that we are down wind from China which has ever intention of burning their coal reserves.  

    So the cost to business, the taxpayer and public health due to the mis-application of the precautionary principle relative mercury will be significant while the decrease in health risk minimal and probably unmeasureable.


     
    posted by sydney on 6/23/2004 10:09:00 PM 0 comments

    Technical Difficulties: Blogging is on the fly today because my laptop is dying. Its power converter is on the fritz and I'm waiting for a replacement to come in the mail. Blogging, I'm afraid will be brief and intermittent until then. (And just when there are so many things to talk about. That's always the way.)
     
    posted by sydney on 6/23/2004 07:00:00 PM 0 comments

    Epidemic! Michael Fumento debunks the cancer epidemic:

    Yes, cancer is still our second-greatest killer, but only because we in the West live long enough to get it. Cancer CAN strike at any age, but is overwhelming a disease of the old. And a cancer diagnosis at age 75 seems rather preferable to contracting malaria at age five.

     
    posted by sydney on 6/23/2004 11:38:00 AM 0 comments

    Epidemic! Michael Fumento debunks the cancer epidemic:

    Yes, cancer is still our second-greatest killer, but only because we in the West live long enough to get it. Cancer CAN strike at any age, but is overwhelming a disease of the old. And a cancer diagnosis at age 75 seems rather preferable to contracting malaria at age five.

     
    posted by sydney on 6/23/2004 11:38:00 AM 0 comments

    Needless Paps: New research from the VA says that millions of women are getting needless pap smears:

    Nearly 10 million U.S. women who have had hysterectomies are needlessly getting routine Pap tests, researchers say.

    ...."I actually was quite surprised because, in this case, women are being screened for cancer in an organ they don't have," said Dr. Brenda Sirovich of the VA Medical Center in White River Junction, Vt., and Dartmouth College.

    ...Pap tests involve scraping cells from the cervix and examining them for abnormalities under a microscope. In women without a cervix, vaginal cells are evaluated, but vaginal cancer is extremely rare and Pap tests were not designed to detect it, Sirovich said.

    While the tests are relatively inexpensive, these women are undergoing uncomfortable exams, doctors are being distracted from more important matters, and lab specialists are spending needless time analyzing specimens, Sirovich said.


    In the study, the researchers wonder about the reasons for this:

    The US Preventive Services Task Force recommendations either have not been heard or have been ignored.

    They've been ignored. While it's true that the Pap smear may not be the greatest test for finding early vaginal cancer, if you tell someone they no longer need Pap smears, they stop having vaginal examinations, too. And the risk of a missed vaginal cancer, though small, is too great a risk to take. Esepcially in today's malpractice environment. Vaginal cancer is rare, but I've had two cases in the past seven years. One of those was a woman who stopped having pap smears and pelvic exams because she had a hysterectomy. And a colleague of mine was sued for missing the diagnosis in a woman who had a hysterectomy.

    When the guidelines first came out, I would tell patients with hysterectomies that they didn't need Pap smears, but they did need to have their vaginas visually checked every year or two. The problem was, they'd never schedule for those kinds of check-ups, so I stopped trying to make a distinction between "pelvic exams" and "Pap smears." The two are so hopelessly intertwined in the public consciousness that I couldn't un-entwine them. (The Pap is a laboratory test that's taken during a pelvic exam. The pelvic exam involves looking in the vagina and checking manually for pelvic masses. Just to clarify.)

    And there's another reason doctors continue to do pap smears on women who have had hysterectomies. Hysterectomies used to be much more common up until about thirty years ago. They were done for everything from painful periods to cervical cancer. A lot of patients from that era have absolutely no idea why they had their hysterectomies. An astounding number say, "I just didn't need it anymore." What's a doctor to do? If someone had a hysterectomy because they had cervical cancer or pre-cancerous lesions of the cervix, they're still supposed to get Pap smears after the uterus is removed. If there's the slightest doubt, most of us will err on the side of "needless" testing.

    So, we're not as dense as the press reports of the study make us seem. And we're not in cahoots with the labs to boost their profits. We're just a cautious bunch.
     
    posted by sydney on 6/23/2004 07:10:00 AM 0 comments

    Tuesday, June 22, 2004

    Stem Cells and Me: John Kerry and stem cell research.
     

    posted by sydney on 6/22/2004 08:37:00 AM 0 comments

    Beyond Precaution: The confusion of risk and harm. (My Tech Central Station column.)
     
    posted by sydney on 6/22/2004 08:32:00 AM 0 comments

    Insurance and Entitlements: The Supreme Court ruled that insurance companies can't be sued for denying coverage. At least they can't be sued in state courts, where the damage awards have no limits:

    The court said HMOs are shielded from lawsuits in state courts, where juries are more apt to side with victims and recommend multimillion-dollar judgments from insurance companies.

    Justice Clarence Thomas, who wrote Monday's ruling, relied on a federal pension benefit law that predates the rise of managed care and said patients may pursue claims only in federal courts, where awards are capped at only the cost of medical services the HMO would not cover.


    Maybe some day doctors will get this sort of protection, too.
     
    posted by sydney on 6/22/2004 08:24:00 AM 0 comments

    Honesty: Recent research from Alberta says that dogs can sense people's seizures before they happen. But the doctor who did the research says that might not be the case:

    Dr. Adam Kirton of Alberta Children's Hospital in Calgary, said that the study was a small one and advised people not to get too excited by his findings. He said that his findings should be regarded as preliminary ones. He said parents with epileptic children should not go out and buy a dog just because they heard about his small study.

    If only all medical researchers were so unassuming.
     
    posted by sydney on 6/22/2004 07:59:00 AM 0 comments

    Monday, June 21, 2004

    Southampton Medicine: This is just wrong:

    The 95-year-old financially ailing Southampton Hospital - the only serious medical emergency center on the South Fork - is offering a plan aimed at wealthy summer visitors whose primary doctors are back in Manhattan and out of reach, presumably along with the hospital's sense of propriety. For $6,000 per family, or $3,800 for individuals, not including doctors' fees, cardholders in the Southampton PLUS plan are entitled to 'priority access' to medical care at the hospital from May 28 to Sept. 26. A brochure about the plan was mailed to several thousand summer homeowners from a mailing list the hospital purchased from a source it declined to identify.

    Southampton Hospital lets you know that it understands what a drag all this messy medical stuff can be when you're on a busy summer weekend, careening from tennis lesson to benefit to cocktail party with nary a moment to waste sitting around a hospital emergency room. Since 'a visit to the emergency department is gut-wrenching enough without the added frustration of filing out multiple forms,' the brochure commiserates, PLUS members are pre-registered, which includes being met at the door of the hospital 'by a member of the hospital's senior staff.' The brochure confides, 'You shouldn't have to wait around where your health is concerned,'' and adds, 'While we can't guarantee you'll be seen first, we'll do everything possible to get you in and out fast.' The plan covers not only family members, but also weekend house guests and 'hired help,' as the brochure so quaintly describes what must be the au pair.


    True illness is egalitarian, and its treatment should be, too.

    UPDATE: A reader wonders what's wrong with this if the hospital isn't providing priority access? I suspect they really are providing priority access for subscribers. They probably wouldn't give a minor illness priority over a critical illness, but they would treat two equally minor illneses differently. The subscribers would get treatment first, regardless of how long non-subscribers may have been waiting before them. Would they do the same with two equally critical illnesses? One would hope not.

    This may not seem like such a big deal, and maybe I still retain too much of my youthful idealism, but access to a physician for an urgent illness should not be predicated on the ability to pay in advance. Illness and death don't discriminate based on the ability to pay, and neither should we.

     

    posted by sydney on 6/21/2004 08:44:00 AM 0 comments

    Jarring: Knocking the eyeballs.
     
    posted by sydney on 6/21/2004 08:33:00 AM 0 comments

    Preparedness: The CDC keeps saying that they'll be able to give everyone immunizations after a bioterrorist attack with smallpox - no problem. Here's what happened last week when one waitress in Massachussettes came down with hepatitis A:

    According to the local Board of Health, the company estimated that in the last two weeks, 3,800 people may have been exposed to hepatitis A, which is a contagious viral disease that causes the liver to swell and is spread through fecal contamination.

    Yesterday, at the Symmes Hospital site, health officials administered immune globulin, which can prevent illness or reduce the severity of symptoms if given within two weeks of exposure.

    ..."It's very rare that a situation like this happens," added Connolly. She arranged to have 2,300 doses of immune globulin on hand at Symmes, but the crowd was estimated to exceed that supply.

    "They expected several thousand people, but it looks like half of Arlington is here," said Wayne Springer, the deputy fire chief.

    The queue snaked across a parking lot, up and down stairs. When people were finally admitted into the building, they waited in yet more lines. One elderly woman fainted in line and was taken to a hospital after emergency medical technicians examined her. A fire official had no further information on her condition.

    ....I'm at the point where I'm going to ask people in line if they're willing to help after they get the shot,' an overwhelmed Connolly said. She commended various departments in Arlington and neighboring towns for their help.


    And that's for a disease that's not nearly as fatal or contagious as smallpox.
     
    posted by sydney on 6/21/2004 08:31:00 AM 0 comments

    Crying Game: The SARS virus has been found in tears:

    Doctors in Singapore swabbed the tear ducts of 36 patients with suspected Sars in April 2003. Eight of these were later diagnosed with probable SARS.

    The doctors have now revealed that they found signs of SARS in the tears of three of these patients.

    Writing in the British Journal of Ophthalmology, they said the findings suggest the virus could be transmitted through tears.


    That might help explain why conventional infection-control methods so often failed during the SARS outbreak. Tears aren't usually thought of as sources of infection, even though they are body fluids. Maybe because they're the only body fluid that it's socially acceptable to spill in public.
     
    posted by sydney on 6/21/2004 08:15:00 AM 0 comments

    Promotions: CBS news discovers Amazon links.
     
    posted by sydney on 6/21/2004 08:07:00 AM 0 comments

    Nursing Education: A reader sends these observations on why registered nurses are no longer the masters of the bedside they once were:

    Old fashioned nurses were working class girls who went to 3 years schools. They studied one year, then worked for two years on the wards part time while studying. Then they got an RN degree. By the end of three years, they could bedside nurse.

    Then the ANA, about the time women's lib started, decided nurses should be "professionals" and would be better nurses with a B.S. --they would study Literature and be more refined and well rounded. But the BS degree was too expensive for working class girls like myself (I went to Medical school under a Great Society scholarship which was one of the few scholarship programs that did not discriminate according to sex, but without a scholarship could never have afforded college--and the local nursing BS colleges gave few scholarships back then). As a result, working class girls ended up either nurses aides or with a two year associate degree. The two year nurses were useless in bedside nursing until they worked a year or two.

    So, nurses, now "professionals", usually "supervised" nurses aides rather than bedside nurse (Except in ICU etc). I had surgery in one of the best Boston hospitals ten years ago. For the first day, I was cared for ok, but after that, I saw a nurse (?) when I got pain pills. I was given two every six hours, when what I needed was one every four hours. So I was oversedated for three hours and in pain two hours. After several requests, I started hiding my pain pills so I could take them when I wanted to take them. No one noticed. They didn't supervise me, so when I was told I wouldn't go home until I moved my bowels, I lied, so I could go home. No nurse asked why I had no visitors, nor checked post discharge planning, so I was sent home in a taxi to my waiting teenaged adopted sons who barely spoke English, couldn't drive, and who of course couldn't pick up my pain medications (luckily I still had my stash from ones I didn't take).

    But what was worse, is that when I walked myself (no help) down the hall, the nurses were busy typing medical information on their shiny new computers....And as soon as the other patients found I was an MD, I was grilled about their medical problems. (nurses used to teach, but the computers came first. As for doctor visits, that was five mintues a day).


    Nurses are also responsible for all the documentation that has to go into the chart. And suffice it to say that in today's litiginious environment, documenting care has become more important than actually giving care.

     
    posted by sydney on 6/21/2004 07:51:00 AM 0 comments

    Quit, Bob, Quit: One man's long good-bye to cigarettes.
     
    posted by sydney on 6/21/2004 07:15:00 AM 0 comments

    Sunday, June 20, 2004

    Suffer the Fathers: Why is it that so many father's are given the task of bringing their newborn babies in for their first set of immunizations? It's a surprisingly common practice. Usually the father either gets sent by himself, or he's brought along so the mother can make a quick exit when it's time to give the shots, usually exclaiming as she leaves, "I just can't stand to watch!" As if fathers' hearts are hardened against the suffering of their children, while mothers' hearts are only full of tender love.

    Here's wishing a Happy Father's Day to all you misunderstood, suffering fathers who sacrifice so much for the good of the family.
     

    posted by sydney on 6/20/2004 03:34:00 PM 0 comments

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