Kevin, M.D. - Medical Weblog: October 2005

KidneyNotes hosts this week's Grand Rounds. Come get the weekly best of the medical blogosphere.

Some conservative groups think the cervical cancer vaccine will promote teenage sex. "What the Bush administration has done has taken this coterie of people and put them into very influential positions in Washington. And it's having an effect in debates like this." (via FARK.com)

Posted by Kevin | link | Comments (6) |

The more things change, the more they stay the same:

Drug makers have come under fire for "ask your doctor" style advertising and have vowed to change their ways, but research data shows they are spending more on direct-to-consumer (DTC) prescription drug advertising in 2005 than they did last year.

Posted by Kevin | link | Comments (1) |

A doctor wants to drug test all high school students for marijuana. "Perth doctor George O'Neil suggests that high schools should test students for marijuana use as part of an annual health check and if they fail, they would be forced to undergo monthly tests." (via FARK.com)

Posted by Kevin | link | Comments (1) |

Doctors offices in Florida still have no power - emergency rooms are swamped. "Six days after Hurricane Wilma, more than 1 million people are still without power and many doctors offices have been closed for a week. That leaves hospitals - now the only source of medical care in some communities - swamped with routine medical problems."

Posted by Kevin | link | Comments (0) |

Skewed priority: Grocery stores are receiving flu vaccines before doctor's offices. "The patients are asking why don't we have it if Stop & Shop is saying they have vaccine available."

I'm asking that same question too. (via Medpundit)

Posted by Kevin | link | Comments (7) |

Immigrant populations are practicing some dangerous health practices. "Teresa Muñoz of San Bernardino died last year following an injection of an antibiotic she'd purchased from an unlicensed practitioner at a Rialto swap meet.

Rialto police said Muñoz bought the antibiotic and a syringe in September 2004, and the merchant showed her how to inject herself at home.

But the 42-year-old Mexican immigrant, who was seeking relief from a cough perhaps the flu had a severe allergic reaction following the injection. Days later, she was dead."

Posted by Kevin | link | Comments (2) |

The FDA is taking a look at celebrity endorsements of drugs. "It's hard to imagine a setting in which a celebrity endorsement of a drug conveys any meaningful information to patients in terms of either efficacy or side effects."

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News flash: Ordering more tests increases health care spending. "Dr. Brenda Sirovich, assistant professor of medicine at Dartmouth Medical School, published a report last week in which she and her research team concluded that higher health care spending is driven in large part by physicians ordering more tests, referrals and treatments."

Posted by Kevin | link | Comments (23) |

Quicken Medical Expense Manager

I would like to welcome Quicken Medical Expense Manager as the newest partner to this blog.

The NY Times recently wrote about the bewildering array of paperwork that accompanies the patient anytime they use the medical system:

Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out - known as E.O.B.'s - are filled with unintelligible codes.

With the shift towards consumer-directed health plans, the burden of cost responsibility will increasingly shift towards the patient. Which means the paperwork will only increase.

Enter the Quicken Medical Expense Manager. Created by an Intuit employee to track out-of-control medical bills, this is an elegant program to sort through the barrage of medical paperwork one encounters as a patient. I use it to track my own family's medical expenses.

Features include a medical log, to keep a simple, ongoing record of each family member's medical appointments and prescriptions, for quick answers about past expenses, as well as tools to track medical history.

Of course, a key feature is the ability to track flexible spending accounts (FSA) health expenditures.

More sample screenshots can be found here.

You can also view a product demo.

Highly recommended.

Posted by Kevin | link | Comments (0) |

New Jersey keeps feeding the plaintiff lawyers. "And of course whenever this topic comes up here, someone always trots out the red-herring study showing that plaintiff-bar parasitism only increases the cost of health insurance by one or two percent. The real costs are indirect, as providers overprescribe diagnostics and procedures designed more to insulate themselves from malpractice awards than from improving outcomes for patients, and decline to provide certain services at all."

Posted by Kevin | link | Comments (14) |

A home health company was giving out fake flu shots. "As many as 1,000 Exxon Mobil employees and 14 residents of a senior citizens home were injected with fake flu vaccine, authorities said Friday, and the owner of a home health care company was arrested.

Preliminary tests indicated the syringes were filled with purified water, U.S. Attorney Chuck Rosenberg said. And no ill effects from the shots were reported."

Posted by Kevin | link | Comments (3) |

GruntDoc links to the best emergency nurse rap video I've seen.

Posted by Kevin | link | Comments (3) |

Someone knitted a digestive system.

(via Boing Boing)

Posted by Kevin | link | Comments (2) |

Not a misprint: Doctors and lawyers are working together in Tennessee. "Doctors and lawyers _ often natural-born enemies in the courtroom _ are joining forces in Chattanooga in an experimental effort to keep junk science and dubious malpractice cases out of court.

Under the program, judges presiding over malpractice cases will select an independent doctor from out of state to evaluate the testimony of potential expert witnesses and help decide well before trial whether those witnesses should be allowed to take the stand."

Posted by Kevin | link | Comments (4) |

Supporters of Dr. Bennett picket at a pretrial hearing.

"We have to stick up for Dr. Bennett. If he retires, I’ll have to take up witchcraft. He speaks his mind, and if you listen to him, he’ll add a lot of years to your life." (image via Portsmouth Herald)

Update:
Said by one of Dr. Bennett's black patients: "Dr. Bennett is no racist. I’m living proof of that. In fact he’s been a solid rock of support for me and my family.

Me personally, and I know most of my black friends . . . they admire a woman with (a) curvaceous figure and that’s known by everybody. At least I thought it was. People wrote songs about it."

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A doctor was arrested for spanking his son in public - he claims racism. "Claiming he was targeted because he is black, a doctor who was arrested for spanking his 2-year-old son at the Quaker Bridge Mall has sued Lawrence and Plainsboro townships."

Posted by Kevin | link | Comments (1) |

"The clitoris needs more respect." "She undertook in the 1990s to dissect a series of female cadavers and document, layer by layer, the anatomy of the clitoris. Then, with magnetic resonance imaging, she was able to document live anatomy in healthy volunteers. This research has led to better education of medical students about the clitoris, better sexual health for women undergoing pelvic surgery and some brand-new observations."

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They're making a Jack Kevorkian movie. "A film adaptation is being made of the book 'You Don't Know Jack,' the story of Michigan suicide doctor, Jack Kevorkian."

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Doctors misdiagnosed avian flu in tourists in Bangkok.

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No HIPAA in Canada: Patient records are being photocopied at the Business Depot. "I don't like the thought of my private medical records being at Business Depot."

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Most of the flu vaccine is going to grocery stores and drug stores. "The N.C. Academy of Family Physicians conducted a survey in which 85 percent of the 240 doctors interviewed said they hadn't gotten vaccine despite placing orders in the spring.

Dr. Christopher Snyder III of Cabarrus Family Medicine said doctors are frustrated that they have to tell patients to go to large grocery and drug stores to get flu shots. His practice has 70,000 patients at seven offices. "

The same thing is happening in New Hampshire. Physicians' orders were cut, but the shopping malls seem to have plenty of vaccine.

Posted by Kevin | link | Comments (5) |

More woes of telephone medicine. "A night call from a patient who complained of back pain. The doctor quickly established the pain was an old problem and asked the patient if he could leave the consultation until the next morning. The patient agreed but later had a mild myocardial infarction. He had not had time to report his chest pain. The researchers urge doctors to consider the possibility of a hidden concern, especially during a late night call and to give patients time to explain their chief complaint. Asking: 'Is there anything else you want me to know about?' can be used to uncover potentially important information."

Is the best way to prevent such sue-worthy scenarios is just to send everyone to the ER after hours?

Posted by Kevin | link | Comments (28) |

An orthodontist is buying back candy from kids after Halloween. "Every year on that day he gets phone calls from parents whose children have damaged their braces by eating chewy Halloween candy.

So Lawrence came up with a plan to cut down on those calls. He offers the trick-or-treaters $1 a pound for their goodies.

He started this five years ago and says it has been very successful."

Posted by Kevin | link | Comments (2) |

Subpoenas are being issued in the wake of alleged mercy killings in New Orleans.

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Mammograms are validated to have an association with a decrease in breast cancer deaths. "The study, being published today in The New England Journal of Medicine, concludes that 28 to 65 percent of the sharp decrease in breast cancer deaths from 1990 to 2000 was due to mammograms. The rest was attributed to powerful new drugs to treat breast cancer."

We'll have the data next for PSA and prostate cancer screening. As it stands, only mammograms and fecal occult blood tests for colon cancer screening are associated with a mortality benefit.

Posted by Kevin | link | Comments (1) |

Tamiflu shipments to the US have been suspended. Blame hoarding.

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Vioxx jurors are cashing in as trial advisors. "The practice of paying discharged jurors for their insights, unheard of until recently, shows a growing sophistication and coordination among mass tort lawyers as they pursue big quarry such as Merck. In addition, legal experts say, it could carry risks for the jury process as payments become more commonplace." (via PointofLaw.com)

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A patient awoke from anesthesia to discover her head ablaze. She's suing the hospital.

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Washington medical malpractice: Vote yes on I-330. "Earlier this year I found myself staring at my computer screen reading and re-reading an e-mail I did not want to send. I knew that once I clicked 'submit' I would be locked into a path that I didn't want to go down, because at the end of it I would no longer be a doctor. After seven years of helping families bring their babies into the world, of working with women before, during and after pregnancies to keep them (and their children) healthy, I would no longer be able to be there for my patients."

Posted by Kevin | link | Comments (36) |

Doctors gone wild: A physician is suspended after a drucken brawl during his engagement party "Thomas, who currently works as a Clinical Fellow in ENT at Southmead Hospital in North Bristol NHS Trust, was arrested and put in a cell - but paramedics were called when he slumped unconscious to the floor."

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A doctor wants to ban visitors to the hospital wards during the flu season.

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A mother spent two hours waiting with her sick baby while the doctor they were due to see was passing in front of them on a unicycle. "Miss Dadswell, 33, had taken her six-month-old son James to South Tyneside District Hospital, South Shields, after he fell ill.

As they waited to be seen, she watched the young doctor practising his one-wheel feats up and down the corridors of Ward 12 as nurses looked on.

He eventually put down the unicycle, picked up his notes and walked over to assess James's condition."

Posted by Kevin | link | Comments (4) |

"It's not about the money." The family of a man stricken with Legionnaires' disease in Toronto is suing for $600 million.

Posted by Kevin | link | Comments (8) |

"Shatner marveled at the purity of the pain." Yes, kidney stones hurt.

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Linking Tamiflu, the avian flu, and intelligent design. "Finally, Americans and their leaders will have to get over their love affair with intelligent design . Polls show that most don't believe in evolution. But it is actually impossible to talk logically about bird flu, or any other rapidly evolving and constantly changing virus, without using the language of evolution -- specific words such as 'mutant,' 'recombination,' 'genome' and 'selection.' Without that language, a sensible popular or political discussion, let alone a scientific discussion, is impossible: We're stuck talking about the virus 'jumping' from birds to humans, as if it were a magic bug with a mind of its own. We're stuck thinking that a virus is a hex that can be lifted with a single lucky charm, not something that will change over time."

Posted by Kevin | link | Comments (8) |

The Krafty Librarian wonders why UptoDate is so indispensable. "Why do doctors love UpToDate so much? Is the content that much different than FirstConsult and eMedicine? All three products cover approximately the same medical topics, with a few exceptions: example: UpToDate's Neurology section is in development and they do not have Urology nor Surgery section however, FirstConsult and eMedicine do."

As many of you know, I am an avid user of UptoDate, and use eMedicine occasionally. I have not used FirstConsult, so I can't speak for that product.

One has to note that UptoDate is geared towards the internist, and eMedicine geared towards emergency medicine. One resource simply cannot replace another.

UptoDate has more emphasis on the evidence, with relevant studies peppering its narrative. This fact alone gives UptoDate an advantage in depth.

eMedicine was originally conceived for use in the emergency room, and subsequently their monographs are more bottom-line, with their links to studies buried at the end under a bibliography. eMedicine does hold the advantage of containing more topics, due to its emergency medicine roots.

However, one cannot force internists to use a resource meant for ER docs.

Update:
Dr. RW comments.

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The story of Polio, told as a comic.

(via Boing Boing)

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George Clooney considered killing himself while dealing with the pain arising from a tear of the spinal dura. "Clooney’s complaints were dismissed until spinal fluid started leaking from his nose. He has since had numerous operations." (via FARK.com)

Posted by Kevin | link | Comments (33) |

DB talks about the lack of outpatient internists. "The concept of our reimbursement system is bankrupt. If you pay me for a unit of care, regardless of how much time I spend, I will look for ways to decrease the time of that unit of care. If I can see 7 patients in 2 hours rather than 6, I have increased my gross income by 17%, without significantly changing my overhead! But I also had to decrease each patient visit by approximately 3 minutes."

I'm an outpatient internist. These words ring true.

Posted by Kevin | link | Comments (2) |

Air pollution and smog is a problem in China.

"More than 400,000 people in China die prematurely annually from air pollution, according to an unpublished study by the research arm of the government's environmental protection agency, AFP learned." (image via Yahoo! News)

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David Williams talks about "benefit-based co-pays" being an increasing trend. "As if 3-tier drug formularies weren't confusing enough, there is a new movement toward 'benefit-based co-pays,' or BBCs. Under a BBC, the patient's co-pay is determined by the drug's clinical benefit. The more beneficial the drug, the lower the co-pay. In certain cases, the patient can even be paid to take the medicine."

Posted by Kevin | link | Comments (3) |

Guns blazing: Dr. Bennett's supporters are forcing the NH Board to investigate one of their own. "Reached by phone, Bennett said he found it hypocritical to have someone with a paper trail indicating multiple patient complaints and several firings for patient abuse sitting on the board of anything, if the allegations are true . . .

. . . Bennett said he is furious, and is not going peacefully. Bennett said he questions Assistant Attorney General Catherine Bernhard’s motivation. She is the official who handles the board’s cases.

'She is a fanatic, and there are many complaints against her,' said Bennett. 'She is hiding behind the cloak of state government. She can’t be sued individually, only fired. We devoutly hope that happens as a warning to others who abuse power.'"

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The Ontario government is posting medical wait times on the web. The average wait is 202 days for a knee replacement, and 28 days for a CT scan.

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Setting an example: Some doctors in Canada are admitting to hoarding Tamiflu. "Some physicians -- who expect to be on the front line treating patients with the disease -- have amassed pills to be taken as a prophylaxis, to prevent the disease.

One of them is Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital, who will be at the forefront of an avian flu pandemic.

Dr. Low, who is also the medical director of the Ontario Public Health Lab, said he paid for 100 pills out of his own pocket, even though the capsules are covered under most private health plans.

'I thought about this a couple of years ago and I kept saying, 'I'm going to do this,' . . . and finally I did it,' Dr. Low said yesterday."

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The confusion over prescription labels.

"For example, common misinterpretations of a yellow label bearing an icon of the sun with a slash through it were, 'Don't take medicine if you've been in the sunlight too long,' 'Don't leave medicine in the sun,' and 'Don't leave medicine in the sun, but in a cool place.' The extremely fine print of that label actually read, in all capital letters: 'YOU SHOULD AVOID PROLONGED OR EXCESSIVE EXPOSURE TO DIRECT AND/OR ARTIFICIAL SUNLIGHT WHILE TAKING THIS DRUG.'

The 'FOR EXTERNAL USE ONLY'' sticker stumped 25 percent of even those who could read every word, and misled 90 percent of the adults in the lowest literacy group."

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Grand rounds is up. Come get the weekly best of the medical blogosphere.

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A picture of necrotizing fasciitis, where this patient's eyes and nose were removed. "Doctors gave him the option of having his nose and eyes removed or dying."

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Derek Lowe on the Pargluva fiasco. "What on Earth were they thinking, submitting data in a way that makes it look like they were trying to pull a fast one with the cardiovascular risk factors? Now, of all times?"

Posted by Kevin | link | Comments (0) |

Smelling blood: Mark Lanier is banding lawyers together to fight Merck. "We've got the best courtroom lawyers, we've got the best mass tort lawyers … and we've got the best negotiators that America has to offer working together on a dream team that is Merck's biggest nightmare. We call it kind of the 'Legal Godfathers.'"

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A patient wants to give his doctor a share of his lawsuit settlement. "I have a patient who was struck by a car, suffering multiple severe injuries requiring numerous operations. He is pleased with the outcome ("You saved my legs, Doc") and expects a large settlement from a lawsuit he filed against the driver. He says he will give me a portion of that money."

Posted by Kevin | link | Comments (2) |

When having health insurance isn't enough. "He said one of his hardest moments was telling his father about the bankruptcy. His father had worked two or three jobs during hard times, but always managed to pay his debts. Arnold Dorsett made more money than his father ever had, he said, but what good did it do him?"

Posted by Kevin | link | Comments (3) |

Sue the Lancet for the MMR/autism fiasco? "The editor of the Lancet is a more tempting target. Wakefield's original research was based on a sample of just 12 children, which was too small to be meaningful, as the Lancet ought to have known. Medical journals are not the richest of institutions, however, and it would probably take only a couple of thousand single jab bills to close the Lancet down." (via Black Triangle)

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Fixing what wasn't broken - what a mistake Wisconsin made by lifting their malpractice caps. "The effect of the caps is, to some extent, a matter of quantifiable public record because Wisconsin has set a variety of limitations on medical malpractice lawsuits over the last three decades. A Journal Sentinel examination of jury verdicts statewide, Milwaukee County case filings, and national and state government databases found that the caps, though rarely directly applied, appear to have contributed to a dramatic decline in the rate of malpractice lawsuits."

Posted by Kevin | link | Comments (5) |

Lethal translations: California wants to ban child interpreters. "'She tells me where it hurts and then we go to the doctor together. But I don't really know what a uterus is,' said Jue, whose English is peppered with words from his sixth-grade textbooks and terms from the football field. 'She tells me things I don't know how to say. Sometimes I tell the doctor something else.'"

This is definitely a good idea. But of course, hospitals and clinics will have the pony up the costs of expanded translator services. Is the government willing to back up these bills with appropriate funding?

Posted by Kevin | link | Comments (3) |

Fight over the pink ribbon. A Canadian anti-abortion group is using the pink ribbon to advertise claims that abortion is linked to breast cancer. The Canadian Cancer Society is not amused:

The pink ribbon is an official trademark of the Canadian Breast Cancer Foundation, and as such the foundation has the exclusive rights to use the mark in Canada and authorize its use by others. We haven't authorized the use by this coalition who's doing this campaign and it's something we're concerned about and we are investigating.

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Pregnancy as a "personal injury". "Now comes a story from New Zealand about a woman who’s suing after her tubal ligation failed. The woman has won a huge legal battle by having her pregnancy declared a “personal injury”, which means her lawsuit against the country’s Accident Compensation Corporation can proceed."

Posted by Kevin | link | Comments (2) |

Generic Tamiflu: Should developing countries ignore intellectual patents from developed nations? "First India said it would ignore Roche's patents to make a generic form of Tamiflu and now Taiwan is saying the same thing. In both cases, they make the claim that saving the lives of their citizens is a lot more important than protecting the intellectual property of a foreign company."

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Toxic or hysteria? "Behind the label" of common personal hygeine products. Here's what they say about Colgate Total toothpaste:

Conventional toothpastes often contain irritating detergents like sodium lauryl sulphate, which can cause sore gums and mouth ulcers, and abrasives like hydrated silica, which can erode tooth enamel. Total contains a glue-like substance, PVM/MA copolymer, that sticks the active ingredients to teeth. Saccharin, a known carcinogen in animals, is also found. The colouring CI 42090 (banned in Austria, Belgium, France, Germany, Norway, Switzerland and Sweden) causes cancer in animals. Total contains Triclosan, an antibacterial agent that can in certain circumstances combine with chlorine in tap water to produce chloroform gas, which is easily absorbed into the skin or inhaled and can cause depression, liver problems and cancer.

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"Complaining with confidence": Patients are urged to speak up against dirty hospital wards to fight MRSA in the UK. "Visitors are also being told to confront staff if they believe they have not washed their hands and to tell a matron if they spot any dirt or dust on the ward."

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The Alaska Board of Medicine admits a mistake and apologizes to a physician. "Shaking with emotion, Murphy said the board established a 'scary precedent' by jumping in during an incomplete hospital review of a doctor and suspending that doctor before due process could be completed.

Murphy was referring to the board's decision to suspend her license based on reports the board received about the Alaska Regional Hospital review."

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The bizarrely tragic story of one pediatric ophthalmologist accused of murdering another. Fascinating reading. This is the cover story of the current issue of Medical Economics.

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Kevin, M.D. - Medical Weblog

Commentary and opinion on current medical issues by a practicing primary-care physician.

Monday, October 31, 2005

Saturday, October 29, 2005

Quicken Medical Expense Manager

Friday, October 28, 2005

Thursday, October 27, 2005

Wednesday, October 26, 2005

Tuesday, October 25, 2005

Monday, October 24, 2005

Saturday, October 22, 2005