"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Some bankruptcies are caused by crushing medical debt. But they aren't half of all bankruptcies, and the only way to create the impression they are is to jimmy the figures. For example, the study classifies "uncontrolled gambling," "drug addiction," "alcohol addiction," and the birth or adoption of a child as "a medical cause," regardless of whether medical bills are involved. Yes, there may be situations in which a researcher might legitimately want to classify those conditions as "medical," but a study that is being used to prove that Americans are going bankrupt as a result of crushing medical bills is not one of them. A father who has gambled away his family's mortgage payment is not likely the victim of crushing medical bills. Similarly, new parents who find they can no longer afford their previous lifestyle now that one of them has to stay home with the baby will usually find the obstetrician's bill the least of their problems. Babies are a financial hardship even when hospitals give them away free.
Maybe that's why only 28.3 percent of the surveyed debtors themselves agreed with the authors that their bankruptcy was substantially caused by "illness or injury." The rest put the blame elsewhere, even when the study labeled their problems as at least in part "medical."
Wonder if they counted compulsive shopping and mania-induced spending sprees, too?
The popular herbal remedy, St John's wort, is as effective at treating moderate to severe depression, as a commonly prescribed anti-depressant, the results of a new study indicate.
.....The study involved 301 patients, both male and female, all of whom had some form of depression. The participants, aged between 18 and 70, took either the drug or herbal extract over a six-week period.
At the end of the trial, 50% of those who had taken the herbal extract found their symptoms in decline, compared to just 35% of those taking paroxetine.
Furthermore those taking the herbal extract suffered less side-effects. Altogether there were 269 adverse effects reported among the group taking paroxetine, compared to 172 in the herbal group.
The study was a short one, only 6 weeks, so it's far from the last word on side effects. The major drawback to St. John's Wort is that chemically, it's similar to the very old anti-depressants called monoamine-oxidase inhibitors, which have the potential for deadly interactions with other medications and even certain foods. Take this one with a grain of salt and a large dose of caution.
Love and Politics: Have we really become so politically divided that same-party couples are the wave of the future?
'There may be a few cute examples of successful marriages like Arnold Schwarzenegger and Maria Shriver,' says Sal Prano, president of Liberal Hearts. 'However, I believe if they met for the first time in today's political climate the relationship would never get to first base.' Christopher Cook, president of Conservadate.com, seems to agree: 'The truth is that our political alignment carries with it an underlying set of values, and having values in common is very important in creating a successful relationship.'
Only politicians, journalists, and pundits would think this true. In the real world, couples of mixed political ideology are common, at least if my friends and patients are any indication. Most people aren't political idealogues. You can agree about a lot of important things in life without agreeing on who to vote for. You can agree on how to raise your children and still disagree on the need or wisdom for intervention in Iraq, or federal fiscal policy,
It's kind of sad, really, to see people limiting themselves to socializing only with those who think like them. It's so stifling. So provencial. posted by Sydney on
2/11/2005 07:58:00 AM
0 comments
Traditional Power: Never ignore the dunning letters from a traditional healer, at least if one Zimbabwe athlete is to be believed:
According to the newspaper, Mr. Sithole told the court that he had been born with both male and female genitals, and that his parents consulted a traditional healer for help. The healer, he said, prescribed a mix of herbs that caused his male organs to disappear entirely.
Unfortunately, he said, his parents paid only half the healer's fee. And when the healer recently tired of waiting for the balance, Mr. Sithole said, he caused the male genitals to spontaneously grow back as punishment. Mr. Sithole said that he had made arrangements to pay the debt, and that he had been scheduled to turn over the money - and revert to exclusively female status - on the day he appeared in court. posted by Sydney on
2/11/2005 07:38:00 AM
0 comments
Character Record: One problem with electronic medical records is that they have no character:
While appreciating the greater accessibility of information in a computerised record, many GPs still miss the feeling that, just by holding a records envelope in their hand, all sorts of knowledge will seep into their brains. Thickness, weight, state of repair, handwriting, and wee diagrams all contribute. Why can't electronic records carry more of this context?
It's true. When I hold a paper chart in my hand, it's almost as if the chart has something of the patient's character about it. I get a better and quicker sense of the patient (at least established patients) holding a paper chart than I do looking at an electronic record. No two paper charts look exactly alike. Some will have corner turned here, a scratched out line there. And there's something about a handwritten page that brings back clearer memories of the previous visit than the typewritten one. (I found this true for transcribed dictation, too.) posted by Sydney on
2/11/2005 01:40:00 AM
0 comments
Broken Hearts Club: This past weekend, I was consulted on a patient admitted to psychiatry after a suicide attempt. As I was examining her, I explained I was going to listen to her heart, and she very softly said, "It's broken." The medical consult may have been appropriate:
Researchers at Johns Hopkins University in Baltimore examined 19 individuals with no prior medical problems who showed symptoms of stress cardiomyopathy — chest pain, difficulty breathing or low blood pressure — following a stressful event.
A series of exams, including blood tests and angiograms, revealed that all of the subjects had a severe dysfunction of the left side of the heart. The same tests performed two to four weeks later, however, indicated that these defects had completely resolved.
The investigators noticed that these individuals had abnormally high levels of stress hormones, which can be toxic to the heart muscle. They hypothesized that this temporary weakening of the heart muscle may be triggered by the stress hormones.
The good news is the broken hearts bounce back. the abstract is here, as well as the curious observation that the syndrome is much more prevalent in post-menopausal women:
The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. posted by Sydney on
2/10/2005 09:13:00 AM
0 comments
Great Expectations: A very good - and accurate - personal account of knee replacement surgery by the New York Time's Jane Brody. Her experience of waking up to find the pain more than she expected and of longer duration is a common one. I'm often surprised at how many people think they'll feel better right after a joint replacement. Recovery is a process, not an event. It takes several months before the benefits of the surgery are realized. posted by Sydney on
2/10/2005 09:02:00 AM
0 comments
Enforcing the Law: Glenn Reynolds writes about bot-generated lawsuits and brings up a point that can also be applied to the current malpractice crisis:
Lawyers who file complaints without taking care to verify them are subject to sanctions. Courts don't impose those very often, but based on the press accounts this seems like it might be a prime candidate for that sort of supervision. Organizations who file bogus or frivolous lawsuits based on the results of obviously flawed computer programs ought to be sanctioned. They should have to compensate the people they falsely charge for their costs, lost time, aggravation, and damage to reputation. And the lawyers involved should be subject to professional discipline.
This happens in malpractice cases all the time, although the lawyers don't use computer bots to get the names of their targets - yet. For now they do it the old fashioned way, by getting the paper charts and paying someone to comb through it for every single name to sue, without ever checking to see if they've had anything to do with the alleged injury. And they do it with impunity. In the future world of universally accessible computerized records, there's no reason to think they won't be using bots, too.
War Medicine: The battlefield has always been fertile ground for medical advancements, traditionally at the hands of surgeons. In Iraq, the anesthesiologists take their place in the march of progress:
Six months after the first wounded started coming home from Iraq, Buckenmaier flew to Baghdad with a laptop, a digital camera, a satellite phone, a leatherbound journal, a 9-mm Beretta, and his bag of pain pumps.
And here's what he does with his travel kit:
...When Buckenmaier asked him to estimate his pain on a scale of 0 to 10, he said 10, "the worst pain imaginable." Wilhelm had been carried into the OR for debridement, the harrowing process of removing dirt and dead tissue from a wound. Buckenmaier got out his bag and went to work.
First he used a millivolt stimulator to probe for leg nerves that were still functioning. The soldier's ankle flexed - a sign that the stimulator had found the nerves serving the injured area. Then Buckenmaier placed two blocks by inserting ultrafine catheters into Wilhelm's back and thigh to bathe his sciatic and lumbar nerves in a drug called mepivacaine.
Throughout the 85-minute operation, Wilhelm remained awake and talking. At one point, a technician lifted his wounded leg to clean it, and the weakened tibia fractured with a sharp crack that sent shudders through the surgical staff. But the blocks were so effective, Wilhelm didn't even feel it.
The typical scene in the recovery tent is a somber one: friends touching the sides of the bed around an unconscious soldier in a silent show of support. By contrast, when Wilhelm's operation was over, 15 of his buddies crowded around, laughing and joking with him.
Later, Wilhelm's catheters were connected to pumps, each about the size of a TV remote control and weighing only about 6 ounces, with tiny LCD screens. Hooked up to a supply of ropivacaine, they would provide continuous anesthesia for 48 hours on two AA batteries. The entire apparatus fit in a fanny pack.
The advantage of delivering anesthesia locally to the damaged nerves rather than to the brain (which is where morphine and general anesthesia work their magic) is that it seems to reduce the incidence of chronic pain once the injury has healed. It also keeps the patient awake and alert and better able to participate in his own medical care.
Read the whole article. It's a fascinating account.
U.S. regulators have given conditional approval to Cyberonics Inc.'s bid to sell an implanted device to treat chronic depression, the company said Wednesday, sending its shares up over 30 percent.
Houston-based Cyberonics (Research) said it expects full U.S. Food and Administration approval by May.
The VNS Therapy System is a pacemaker-like device implanted in the chest that delivers electrical impulses to the brain through an electrode attached to a nerve in the neck. Cyberonics already sells the implant for reducing seizures from epilepsy.
It costs about $20,000, including surgical and hospital expenses, said Cyberonics Chief Executive Skip Cummins.
How Little We Know: What goes on inside the minds of the brain injured?
Thousands of brain-damaged people who are treated as if they are almost completely unaware may in fact hear and register what is going on around them but be unable to respond, a new brain-imaging study suggests.
The findings, if repeated in follow-up experiments, could have sweeping implications for how to care best for these patients. Some experts said the study, which appeared yesterday in the journal Neurology, could also have consequences for legal cases in which parties dispute the mental state of an unresponsive patient.
.....In the study, a team of neuroscientists in New York, New Jersey and Washington, D.C., used imaging technology to compare brain activity in two young men determined to be minimally conscious with that of seven healthy men and women. In a measure of overall brain activity, the two groups were vastly different: the two minimally conscious men showed less than half the activity of the others.
But the researchers also recorded an audiotape for each of the nine subjects in which a relative or loved one reminisced, telling familiar stories and recalling shared experiences. In each of the brain-damaged patients, the sound of the voice prompted a pattern of brain activity similar to that of the healthy participants.
"We assumed we would get some minimal response in these patients, but nothing like this," said Dr. Nicholas Schiff, an assistant professor of neurology and neuroscience at Weill Cornell Medical College in Manhattan and the study's lead author. The two men showed near-normal patterns in the language-processing areas of their brains, Dr. Schiff said, suggesting that some neural networks "could be perfectly preserved under some conditions."
One of the researchers is quoted as saying that the brain injured are "more human" than we thought they were. Of course.
Liars, Liars:8 Things Your Doctor Wont Tell You - Men's Health. It's a rather cynical piece. Most doctors actually do tell their patients these things. Except the nutritional counseling. That takes a lot of time. Trust me. I spent some precious several minutes last week listening to the rants of a butter connoisseur when I tried to counsel him on a low cholesterol diet. Better to outsource the nutritional counseling to a nutritionist. posted by Sydney on
2/08/2005 09:03:00 PM
0 comments
Tony's Place: Dr. Tony is another family physician blogger - from Tennessee, who has loads of interesting posts, including this about the TennCare struggle:
Whenever there is an article, like this, about TennCare, they always describe some poor soul that nobody could justify removing from the roles. However, I never see any articles listing all the healthy 20-somethings I see in the ER who are on TennCare. These are potentially insurable people who simply elect not to buy insurance and get on TennCare during an acute illness, usually requiring hospitalization, and then just stay on the roles. Then they ask for a prescription for Tylenol because they have no money. Then they spill their beeper and cigarettes out of their purse as they reach for that cell phone that's ringing.
Grand Rounds: I was absent from Grand Rounds again this week, but Enoch Choi has done an excellent job, even though he's relaxing in Singapore. posted by Sydney on
2/08/2005 07:46:00 PM
0 comments
Cutting Budgets: The Administration is cutting back on veteran's benefits, which has some people upset:
Veterans groups attacked the proposals. Richard B. Fuller, legislative director of the Paralyzed Veterans of America, said: 'The proposed increase in health spending is not sufficient at a time when the number of patients is increasing and there has been a huge increase in health care costs. It will not cover the need. The enrollment fee is a health care tax, designed to raise revenue and to discourage people from enrolling.'
Mr. Fuller added that the budget would force veterans hospitals and clinics to limit services. 'We are already seeing an increase in waiting lists, even for some Iraq veterans,' he said.
In Michigan, for example, thousands of veterans are on waiting lists for medical services, and some reservists returning from Iraq say they have been unable to obtain the care they were promised. A veterans clinic in Pontiac, Mich., put a limit on new enrollment. Cutbacks at a veterans hospital in Altoona, Pa., are forcing some veterans to seek treatment elsewhere.
One reason there are long waiting lists at some VA centers is that they're being inundated with affluent older veterans who use them as a source of cheap drugs and free healthcare - even though they have generous medical coverage through their employers and Medicare. Going to the VA allows this group of veterans to drive a nicer class of car, take better vacations, and spend more on their kids and grandkids than they could if they relied only on their Medicare and their secondary insurance. In fact, their use of the VA system as a sort of Sam's Club pharmacy is pretty transparent. Most of them go through perfunctory doctor's visits at VA clinics and promptly ignore their advice. They go to their local primary care doctors for their regular check-ups and to their local hospitals when they need hospital care. And most of them were never injured in the line of duty. At least, that's been my experience.
And it's that group who are, rightly, the targets of the budget cuts, which are rather modest:
The president would increase the co-payment for a month's supply of a prescription drug to $15, from the current $7. The administration says the co-payment and the $250 "user fee" would apply mainly to veterans in lower-priority categories, who have higher incomes and do not have service-related disabilities.
Note the Paralyzed Veteran's of America shouldn't be affected, at least if they became paralyzed in the service and not as a civilian on their Harley. posted by Sydney on
2/08/2005 07:24:00 AM
0 comments
ABC Television, which has captured big audiences in recent years with reality programs chronicling alterations to people's physical appearance and to their homes, will apply that formula this year to people's health.
The network agreed late last week to place an initial order of six episodes for a program with the working title "Miracle Workers," according to two people who were briefed on the deal but who said being identified by name might scuttle the project. In the program, a team of physicians will scour the country seeking people who urgently need medical care but do not have the wherewithal to obtain it.
.... One person apprised of the deal said that 'Miracle Worker' would involve no games or other competition, but would instead seek to improve the lot of at least one family each episode. For example, the program's 'dream team' of physicians, who will serve as recurring characters, might arrange a heart procedure for one critically ill family member, while also securing psychological care for the person's spouse and children.
Because families will be filmed over the course of several weeks, each episode could include some follow-up scenes.
Because the program's producers intend to bring medical care to the sick, their efforts raise questions about who will be responsible for paying for a procedure and who will be held liable should it fail. Such details, including the contents of waivers that participants may be asked to sign, have yet to be resolved, those close to the program said.
But one person said that the program, while seeking to showcase 'breakthrough medical procedures that people might not know about,' would seek to steer clear of 'life-threatening surgeries.' posted by Sydney on
2/08/2005 07:14:00 AM
0 comments
Bloggered: Tried to post yesterday, but Blogger wouldn't let me for some reason. I haven't fallen off the face of the earth, although it feels like it sometimes.
The EMR saga continues. I'm beginning to think the reader who emailed saying that adopting electronic records slows down a busy practice was right. Despite one good day last week, so far it's mostly meant more work for me. The medical assistant, who also happens to be the one employee least comfortable with computers, is constantly running behind and can't seem to keep up with her other work, such as stocking rooms, answering phone messages, and calling in refills. I remain optimistic and think that once we are completely switched to electronic records and don't have any of the work of paper records, it will get better. I just hope no one quits out of frustration in the meantime. posted by Sydney on
2/08/2005 07:05:00 AM
0 comments
Monday, February 07, 2005
IBM Medicine: Maybe the day isn't so far away when different medical record software can communicate with one another:
IBM on Monday will unveil software it developed in coordination with U.S. health agencies and private hospitals that makes it easier for health care workers to exchange clinical data in a medical crisis.
The software, developed as a response to the anthrax attacks in Washington and other U.S. cities in 2002, is designed to vacuum up data from a range of conflicting databases while ensuring patient privacy in the event of a flu outbreak or the spread of tainted food. It can also track long-term health problems such as diabetes or detect adverse drug interactions in patients.
IBM will also announce on Monday, that Canada's government has purchased the software to conduct a pilot on an early warning and response system for biological threats in Winnipeg.
The new software, known as Health care Collaborative Network (HCN), is designed for use by local or regional medical communities, IBM said.
It helps public and private health organizations to tap into national electronic networks that can alert them to unusual medical patterns; identify the origin or spread of any problems, and target solutions. posted by Sydney on
2/07/2005 06:58:00 AM
0 comments
ABC Television, which has captured big audiences in recent years with reality programs chronicling alterations to people's physical appearance and to their homes, will apply that formula this year to people's health.
The network agreed late last week to place an initial order of six episodes for a program with the working title "Miracle Workers," according to two people who were briefed on the deal but who said being identified by name might scuttle the project. In the program, a team of physicians will scour the country seeking people who urgently need medical care but do not have the wherewithal to obtain it.
.... One person apprised of the deal said that 'Miracle Worker' would involve no games or other competition, but would instead seek to improve the lot of at least one family each episode. For example, the program's 'dream team' of physicians, who will serve as recurring characters, might arrange a heart procedure for one critically ill family member, while also securing psychological care for the person's spouse and children.
Because families will be filmed over the course of several weeks, each episode could include some follow-up scenes.
Because the program's producers intend to bring medical care to the sick, their efforts raise questions about who will be responsible for paying for a procedure and who will be held liable should it fail. Such details, including the contents of waivers that participants may be asked to sign, have yet to be resolved, those close to the program said.
But one person said that the program, while seeking to showcase 'breakthrough medical procedures that people might not know about,' would seek to steer clear of 'life-threatening surgeries.'
Cutting Budgets: The Administration is cutting back on veteran's benefits, which has some people upset:
Veterans groups attacked the proposals. Richard B. Fuller, legislative director of the Paralyzed Veterans of America, said: 'The proposed increase in health spending is not sufficient at a time when the number of patients is increasing and there has been a huge increase in health care costs. It will not cover the need. The enrollment fee is a health care tax, designed to raise revenue and to discourage people from enrolling.'
Mr. Fuller added that the budget would force veterans hospitals and clinics to limit services. 'We are already seeing an increase in waiting lists, even for some Iraq veterans,' he said.
In Michigan, for example, thousands of veterans are on waiting lists for medical services, and some reservists returning from Iraq say they have been unable to obtain the care they were promised. A veterans clinic in Pontiac, Mich., put a limit on new enrollment. Cutbacks at a veterans hospital in Altoona, Pa., are forcing some veterans to seek treatment elsewhere.
One reason there are long waiting lists at some VA centers is that they're being inundated with affluent older veterans who use them as a source of cheap drugs and free healthcare - even though they have generous medical coverage through their employers and Medicare. Going to the VA allows this group of veterans to drive a nicer class of car, take better vacations, and spend more on their kids and grandkids than they could if they relied only on their Medicare and their secondary insurance. In fact, their use of the VA system as a sort of Sam's Club pharmacy is pretty transparent. Most of them go through perfunctory doctor's visits at VA clinics and promptly ignore their advice. They go to their local primary care doctors for their regular check-ups and to their local hospitals when they need hospital care. And most of them were never injured in the line of duty. At least, that's been my experience.
And it's that group who are, rightly, the targets of the budget cuts, which are rather modest:
The president would increase the co-payment for a month's supply of a prescription drug to $15, from the current $7. The administration says the co-payment and the $250 "user fee" would apply mainly to veterans in lower-priority categories, who have higher incomes and do not have service-related disabilities.
Note the Paralyzed Veteran's of America shouldn't be affected, at least if they became paralyzed in the service and not as a civilian on their Harley. posted by Sydney on
2/07/2005 06:21:00 AM
0 comments
