Kevin, M.D. - Medical Weblog

A lawyer uses his background as a doctor to recruit Vioxx plaintiffs. However, Overlawyered looks deeper at this shady marketing:

The newspaper asks medical ethicist Arthur Caplan about Goldstein's "selective use of parts of his medical background to recruit legal clients". Caplan's response: "I think it's sleazy".

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More are searching for a doctor by affinity group:

Several Web sites can help consumers find doctors and other health care providers with specified characteristics, including race, religion and sensitivity to sexual orientation.

The sites -- which list physicians who are African American, Christian or "gay- or lesbian-friendly" -- are putting a new spin on affinity-group marketing, a tactic usually associated with insurance or real estate sales.

"We feel that, with so many pressing medical issues for blacks, that we need to make sure that our medical issues are attended to," said Salli Purnell, marketing director for BlackDoctorFinder.com, a Web site based in Norfolk.

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Via Grand Rounds, Dr. Charles talks about being sued:

But instead of hearing his words I only saw them twisted and misrepresented by a phantom lawyer pouring over my notes, even as I presently jotted them down in the chart. The lawyer was fat, sweaty, and angry as he sat his corpulence upon my shoulder to see what I was writing. I recognized him from daytime television commercials on channel 7. I couldn’t stop myself from ordering CT scans of the brain, chest, abdomen and pelvis, in addition to MRI’s of the hip and back, plus a complete metabolic panel, complete blood cell count, thyroid function tests, folate and B-12 levels, and a goddamned magnesium level. The man nodded okay, and limped out of the examining room.

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The Boston Globe reports on the "flying ICU", which evacuated the wounded ABC newscasters from Iraq:

"What you saw is why these two guys are alive, and why so many of our soldiers are still alive," said Dr. Laurence Ronan, a Massachusetts General Hospital internist who was on the flight that carried Vogt and Woodruff out of Iraq. "It is amazing, cutting edge medicine."

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A nursing home employee raping a 92-year old demented resident is not medical malpractice.

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A physician on futile end-of-life care: ". . . the health care equivalent of Hail Mary passes."

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I often wonder what medical malpractice is like overseas. Here's a story of medical malpractice in Japan:

"We are at war with hierarchical, old-fashioned Japanese society," says Doctor A. "But we are doctors so it is our responsibility to put the dignity of patients first."

Mr. Cummings was operated on by doctors using a relatively new neurosurgery procedure called endovascular coiling, which involves threading a catheter from a vein in the groin to the aneurysm and using aluminum coils to block the flow of blood and stop it rupturing.

It is a complicated operation, beyond the competence of the two surgeons who performed it, says Dr. Matsuoka. "They broke hospital procedures for this kind of treatment." The procedures state that a four-doctor team was supposed to be present, but the two less-experienced doctors went ahead without notifying their colleagues.

The surgeons made a number of critical errors, including failing to inject medicine to stop bleeding in Mr. Cummings' brain, claim hospital staff. During the seven-hour operation, his blood pressure fell disastrously and he went into a coma from which he never recovered.

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Are children of scientists more prone to autism? "The recent rise in autism may have been driven by the tendency of like-minded engineers, physicists, mathematicians and other 'systemizers' to marry each other, according to a Cambridge University professor."

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NY Times: "The homeless die at twice the rate of other New Yorkers, and AIDS and substance abuse account for a third of all their deaths but fewer than 5 percent of deaths in the general population, according to the study released yesterday."

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Feds drop fraud case after physician dies. How thoughtful of them.

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

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E-mails from a military doctor in Iraq:

"These guys don't complain," the doctor wrote. "They only ask over and over, 'How is Sgt. Smith doing?' or 'When can I go back to work?' These guys are true heroes. I am so lucky to be a part of taking care of them."

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Below, we had the lawyer's view. Now we have the reality:

Rashelle Perryman's first two babies were born at Crittenden County Hospital in Marion, Ky., about 10 minutes from home.

But her third child, due in June, is to be born in Madisonville, 40 miles away in Hopkins County, because rising malpractice-insurance rates caused doctors at Crittenden County Hospital to stop delivering babies last year.

That forced the hospital to drop obstetrical services and Perryman to find a new doctor.

"I don't like it at all," she said about having to give birth in another county. She is a nurse at Crittenden County Hospital and its former obstetrics supervisor.

With Perryman's first two deliveries, "I knew everybody here in the hospital, and I was comfortable," she said. "And now I'm going somewhere where I don't know anybody or how anything's done."

Perryman's experience makes her a supporter of Senate Bill 1, aimed at lowering medical malpractice rates to keep doctors from leaving Kentucky or from dropping risky specialties.

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"Blaming the lawyers is just killing the messenger." Medical malpractice as viewed by the trial lawyers.

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Changing his story: Frist tries to defend his tele-diagnosis of Terri Schiavo.

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The American Academy of Dermatologists doesn't agree with the black box warning on Elidel:

"The AAD is very disappointed with this ruling by the FDA," AAD spokeswoman Abby Van Voorhees, MD, tells WebMD. "We don't think the science supports this harsh labeling. The link to cancer was not proven, and the data shows these medications to be quite safe."

Eczema patients -- and their doctors -- are going to be frightened by the warning, says Van Voorhees, assistant professor and director of the psoriasis and phototherapy treatment center at the University of Pennsylvania.

"Eczema patients have a lot of pain and suffering, and we worry they might not get these medicines due to unwarranted fear," she says. "This is a medication that can be very helpful for patients. We would hate to see them be inadequately treated as a consequence."

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A physician turns his practice into a brothel. "Neil Benson, who shut his Coopers Beach practice in April last year, plans to call the new business venture Whalers.

He said he would hire 'professional girls' from outside the region and cater for locals and visiting tourists.

He admitted his plan was contentious, but said there had been 'a lot of support from the men in the community'.

Dr Benson closed the medical centre in Coopers Beach, 350km (220 miles) north of Auckland, after a dispute with his local health authority over after-hours care."

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RIP primary care? Regular readers of this blog already know this:

Primary care -- the basic medical care that people get when they visit their doctors for routine physicals and minor problems -- could fall apart in the United States without immediate reforms, the American College of Physicians said on Monday.

"Primary care is on the verge of collapse," said the organization, a professional group which certifies internists, in a statement. "Very few young physicians are going into primary care and those already in practice are under such stress that they are looking for an exit strategy."

Dropping incomes coupled with difficulties in juggling patients, soaring bills and policies from insurers that encourage rushed office visits all mean that more primary care doctors are retiring than are graduating from medical school, the ACP said in its report.

The group has proposed a solution -- calling on federal policymakers to approve new ways of paying doctors that would put primary care doctors in charge of organizing a patient's care and giving patients more responsibility for monitoring their own health and scheduling regular visits.

U.S. doctors have long complained that reimbursement policies of both Medicare and private insurers reward a "just-in-time" approach, instead of preventive care that would save money and keep patients healthier.

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Banning cell phones in hospitals may do more harm than good. "The prohibition against mobile phones in hospitals may do more harm than good, a new report reveals.

Medical facilities prohibit cell phone use, but some doctors already use them. And it turns out they reduce medical errors because communication is more timely, a new study finds.

Mobile phones rarely cause electronic magnetic interference, Yale School of Medicine researchers reported today."

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Happy Chinese New Year

The Year of the Dog:

Dogs are born under the sign of idealism and no matter what size or shape they come in, a Dog's honesty and loyalty is there for all to see. Whether a stray down on his luck or a Cruft's champion of champions, the eternally touching expression in a Dog's eyes is invariably one of unconditional devotion. Few animal signs have such a wide range of influences as Man's Best Friend and a Dog's many faceted outlook is perfectly described by the 16th century vicar and natural historian, the Rev. Edward Topsell. He wrote: "There be some Dogs which bark and do not bite, Dogs which bark and bite, and some which bite bitterly before they bark."

Champion of the underdog, the Chinese see Dogs as men and women of the left strong advocates for change and social reform. Indeed, most Dog people will seek out injustice and fight it with every means possible. Once a Dog has been given a task worthy of his or her trust, no other animal sign can equal their stubborn determination to see it through at all costs. Equality, freedom and justice are what Dogs fight for, and they demand that their open and sometimes blunt voice is heard.

It is always worth remembering that once you have earned a Dog's trust something that will seldom be given lightly, you may count on them for anything. A Dog will move mountains to carry out a task, or prove their worth. It must stressed that for all their warmth and devotion, Dogs will not easily forgive or forget an act of cruelty. Mistreat a Dog and you will find yourself no longer the object of their devotion. In cases where Dogs have been badly abused the advice is to take great care when building up a relationship. It may be the case that the Dog in question might never fully overcome their grievances. Dogs feel hurt very deeply and they have little or no technique for dealing with long term emotional pain.

Stubborn, watchful and often defensive, Dogs are quick to criticise our lack of concern for the world's injustices. Fear of not being thought to do their best frequently causes a Dog to become anxious. A Dog will often speak out of turn and appear cynical at times, often unaware that those around are doing their best. The Dog's main ambition is to please. Failure to be thought well of might swiftly lead a Dog into a state of anxiety, which they find almost impossible to escape from. This in turn leads a Dog to respond to life's setbacks with more pessimism than is normally thought to be healthy. Faced with uncertainty or lack of purpose, Dogs will never fully distinguish the wood for the trees. Although Dogs might easily make money, often huge sums, it will never bring the comforts of security it does for many others. In fact, Dogs care virtually nothing for wealth and place their only high premium on personal relationships.

The three phases of a Dog's life will all be affected by the undercurrent of anxiety. Dog children will act dutifully and stay close to home and to parents. The middle period often calls for flexibility, a quality which Dogs find difficult unless there is a true purpose to it, and may be a bit uphill. Old age offers no respite, adding a sad but true reflection on the old expression it's a Dog's life. Dogs may console themselves with the fact that of all the signs, they are noble beyond compare.

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A pedicatrician is sued for "behavior modification therapy":

The malpractice suit, filed Thursday in King County Superior Court by an unnamed plaintiff, accuses Schnall of improperly prescribing psychiatric medication and conducting "behavior modification therapy" in an attempt to groom the patient, now 16, for sexual contact.

I've never heard of psychiatric treatment to "groom" a teenager for sexual contact. Perhaps the psychiatrists who read this blog can educate me.

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The Cheerful Oncologist talks about the inaccuracy of mainstream health reporting:

One of the frustrations of educating the public about new developments in cancer care is that most people get their information from the mainstream media, which in my opinion often fails to report these stories clearly and accurately. This leads folks to make broad assumptions about cancer and its treatment that can lead to disappointment and disillusion when they are eventually proven to be false.

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Washington Post on the latest Vioxx trial:

Another trial is in progress in South Texas in the case of Leonel Garza Sr., a retired auditor who died in 2001. The facts in the case make it relatively defensible for Merck -- Garza was 71, had a history of heart trouble and took samples of Vioxx for less than three weeks before his death, far less than the 18 months flagged by the study. But the proceeding is in the Rio Grande Valley, which has a history of awarding plaintiffs huge verdicts in product liability cases.

They also comment on the "NEJM effect":

Two key developments have changed the landscape since the first three trials, lawyers agreed. First, the New England Journal of Medicine published an editorial that accused the drug company of withholding heart attack data from a 2000 article about Vioxx's safety. "It's just not going to play well with a jury," said Charles Rhodes, a law professor at the South Texas College of Law in Houston. "If the jury's not happy with you because they think you're an irresponsible company" they are more likely to find for even a relatively weak plaintiff's case, he said.

Though Merck's lawyers played down the importance of the editorial, they are clearly taking it seriously -- they got Fallon to grant permission to depose two of the journal's editors before the next federal trial.

(via PointofLaw.com)

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PLoS Medicine on using search engines to find medical information:

Google will not point to the answer to every question, and often the articles it finds in response to your question are not freely available. But for many clinical scenarios, Google and other search engines can provide, quickly enough, an answer that is good enough. This article aims to provide tips that will help with these clinical scenarios, saving time that can be used with a medical librarian to answer more difficult problems.

(via Notes from Dr. RW)

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Washington Post: "Hundreds of very live Americans are walking around with pieces of the wrong dead people inside of them.

A macabre scandal has spread from a body-harvesting lab in New Jersey to hospitals as far away as Florida, Nebraska and Texas as hundreds of people discover that they have received tissue and bone carved from looted corpses."

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Yummy - some natural food dyes come from beetles:

"Beetlejuice" is more than just a movie name — foodmakers regularly use crushed female cochineal beetles to dye food, particularly certain yogurts, juices and candy, The Wall Street Journal reported today.

While shocking, it's perfectly legal, the paper reports. Foodmakers don't have to list the bug-based ingredient, because beetles are part of nature. Only man-made dyes, like FD&C Red No. 40, have to be listed.

But that may change soon. The Food and Drug Administration may recommend that companies list beetle additives as "carmine" or "cochineal."

Why? Using beetles in food proves problematic for vegetarians, people who keep kosher and for those with certain food allergies.

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Is nitro less effective in Asians? "New research indicates that up to 50 percent of Asians carry a genetic variant or 'polymorphism' that makes nitroglycerin less effective, or even ineffective, for the treatment of angina."

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The FDA approves inhaled insulin. "Deutsche Bank analyst Barbara Ryan said she expects a daily supply of Exubera will cost about $4 to $5. Treatment with injected insulin costs $1 to $1.50, she said."

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It's all fun and games until . . . "Joshua Philip Martin was in his fourth day on the job as a rescue-squad worker in Russell County when, in a playful mood, he decided to reach into the front seat of the ambulance and zap one of his co-workers with the defibrillator paddles. The rookie's mistake was fatal." (via Random Acts of Reality)

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Sometimes, you just can't find forceps when you really need them.

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Surprisingly, some countries are looking at the US for health-care guidance. Color some skeptical:

American scholars and policy analysts had expressed skepticism at Friday's conference that there was much the widely admired German health system could learn from the U.S. mode, which costs far more, leaves more than 40 million people uninsured and delivers worse results in life expectancy and infant mortality.

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PointofLaw.com on how the liability system costs lives - in this case, talking about a drug for HIV prophylaxis:

"In part because the prospect of harming a healthy person raises formidable liability issues for Gilead Sciences, tenofovir's manufacturer, the company says it has no interest in marketing the drug as a prophylaxis, even if trials prove that it works."

Peter Huber in Liability long ago argued that our liability system can cost more lives than it saves. As The New York Times Magazine article notes, the human cost imposed by our liability system can be profound indeed: "Optimistic mathematical models [that do not account for behavioral changes stemming from the presence of a prophylaxis] show that if tenofovir PrEP is effective 90 percent of the time and is used by 90 percent of the people who are at highest risk of becoming infected, it could cut new H.I.V. infections in a community by more than 80 percent in a few years."

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Some say that lawyers being unfairly demonized:

“We’ve been hit by a very expensive, well-financed public-relations offensive by special interests bent on changing the subject from accountability and responsibility for their actions to creating a new bogeyman,” says Richard Taylor, chief executive of the North Carolina Academy of Trial Lawyers, which has more than 4,000 members. “We’re it.”

Most of his group’s members represent individuals who claim injury by faulty products, negligence, accidents or malpractice, but the taint is spreading even to members of firms that represent business and industry. “There’s no doubt the profession is under assault,” says Willis Whichard, a former state Supreme Court justice and ex-legislator who is dean of Campbell University’s law school. “The level of respect has declined to the point, you hear over and over, that lawyers rank just ahead of used-car salesmen in public esteem.”

(via a reader tip by CJD)

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It's the advertising:

As attorneys, we've shot ourselves in the foot with tacky advertising. And that leads to an increased perception that we're all greedy, rich, ambulance chasers.

Of course it is.

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Not enough money, is the reason why Maryland can't keep up with the investigation of complaints against physicians:

Pinder said the board employs 10 investigators to review complaints, but five similar positions remain vacant, largely because the annual starting salary of about $33,000 is too low to attract applicants.

Del. Peter A. Hammen, a Baltimore Democrat and the health committee chairman, said he would meet with state officials to find ways to help the board boost its pay scale.

"If you don't raise salaries, you're not going to get qualified individuals," Hammen said.

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A pending bill in West Virginia will allow doctors to refuse CPR in futile situations, even against a patient's advanced directives:

Under the bill, if a patient has a living will or medical power of attorney requesting CPR be used to extend life, doctors could refuse to perform it if the attending physician and another doctor agree it would be "medically ineffective."

Medically ineffective CPR is defined in the bill (HB4022, SB161) as CPR that would be unsuccessful in restoring pulmonary function or that would restore it for only minutes or hours, even if repeated.

Under those circumstances, doctors who refuse to perform CPR could not be subject to criminal or civil liability.

Doctors would have to inform the patient and the patient's authorized decision-maker about the plan to withhold CPR and give them an opportunity to change doctors. If the patient cannot be transferred to another doctor's care, the doctor and health care facility would still not be required to provide medically ineffective CPR, the bill says.

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Want to attract more male patients to your practice? Buy a truck:

The last thing Howard Chipman thought he'd be noticed for is having the biggest truck in town.

The 1970 Army truck parked in the shopping plaza off Tampa Road and Forest Lakes Boulevard attracts attention for his walk-in clinic.

He bought the truck for $5,500 off the Internet and found that it especially catches the eye of male patients, who typically don't like going to the doctor.

"They think the doctor might be cool," said Chipman, 43.

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The BMJ says that prostitution should be legalized.

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A second surgery to remove a facial mass in a Haitian teen.

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A Marble Desk analyzes whether a "fat tax" is a good idea:

I have to be honest, I personally am not in favor of such a tax, and think that this line of reasoning is defective. So I figured, it's time for a little research. The question "should there be a fat tax?" actually boils down to 4 separate questions here:

1. Has taxation been ever shown to reduce consumption of any other unhealthy consumables?
2. Are those other unhealthy consumables comparable to "junk food" in significant ways?
3. If implemented, will the tax have the effect intended?
4. Should, as a matter of public policy, a tax therefore be implemented?

I will examine each of these questions in turn.

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A whistle-blower fired? "A doctor has filed a lawsuit against a Beaverton pediatric clinic and its managers, claiming he was fired in retaliation for pushing the clinic to revaccinate children after the clinic stored vaccines at the wrong temperature."

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An academic conceirge practice. "The University of Miami's medical school -- best known for treating the poor at Jackson Memorial and in clinics -- has gone into the upscale concierge business, opening a practice in Key Biscayne in which patients must shell out a $1,500 annual fee."

This is the first one I've seen that is affiliated with a university.

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The Vioxx trials exposes serious shortcomings in America's products liability system. ". . . those aspects of Merck’s behavior that do appear to have been precipitated by the products liability system – their decision to pull the drug off the market for everyone – are troubling in the other direction. It may be that there are patients and physicians who would reasonably select Vioxx, even when fully informed, because their constellation of health problems and risk factors is such that the increased risks of cardiovascular disease does not undermine the reasonableness of taking the drug, all considered.

Third, the compensation of victims and the liability for Merck are rough justice in only the very roughest way. Mrs. Ernst, the only successful plaintiff so far, had just over $450,000 in actual lost income but managed to receive $24 million in non-pecuniary damages. Texas, unlike most jurisdictions, permits a surviving family member to ask the jury for two separate sums of money relating to non-pecuniary loss – one that supposedly represents the value of loss of companionship, and one that supposedly represents compensation for grief. The jury conveniently awarded $12 million for each. Mrs. Ernst had been married to her husband for less than one year. There is nothing reasonable about this compensation, which will make Mrs. Ernst an extremely rich woman." (via In the Pipeline)

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A gynecologist is told to stop treating women. I think that will severely limit his patient base.

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"We don't need physicals." So says the Boston Red Sox yesterday, in defending their off-season trades. Dr. William Morgan, the former Red Sox team physician, begs to differ:

"When I heard it yesterday, that these guys didn't have physicals, I thought, 'What is going on !? This didn't happen on my watch, did it?'" said Dr. William Morgan, the Red Sox's team physician from 1987 to 2004.

"That's unacceptable. Let me put it this way, the only way to really understand what is really going on with a player or a pitcher is to put your hands on them, talk to them and physically examine them. I lend much less credence to studies than to physical examinations. This was a point of discussion between myself and the administration in regards to Pedro Martinez, for example. We had a questionable MRI, but the physical examination was perfect and the performance was perfect.

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What stops men from seeking mental health help? Their ego:

Experts said more women suffer from depression than men. It could have something to do with human biology, but fewer men seek treatment because of their principals about being a man.

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Two strikes against HSAs. "But in many cases, people have evidently signed up not because they are eager to direct their own medical spending but because the plan looked cheap or they had no other insurance option. And at least half of those enrolled have not put money in their health savings accounts. So there will be no money building up for next year's out-of-pocket expenses — a big selling point for these health plans.

In addition, many employers have been slow to offer the plans. And companies that do so have been reluctant to encourage worker participation by contributing money to the savings accounts. The employers figure that 'portability' means that their money will go out the door with workers who leave."

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The French could be as fat as Americans by 2020.



(image via the NY Times)

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A doctor is put on probation for borrowing $177,000 from an elderly patient. "Doctors are ethically barred from borrowing money from patients under rules set by the American Medical Association because the transaction could cause tension in the doctor-patient relationship and compromise the patient's care."

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A study suggests that Dads in the delivery room do more harm than good:

But nowadays he is expected to be in the delivery room witnessing every stage of baby's arrival - even if it is a caesarean.

While his job is to help his partner through her ordeal, however, he could be making things worse for her and the child, it is claimed.

Instead of reassuring her, he tends to pass on his fears that something might go wrong - affecting not only her levels of pain but also her chances of breastfeeding and bonding, says a report.

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Fake braces are being banned in Thailand.



"The fake braces, which are glued onto the teeth, can also cause sores on the gums and inside the mouth and some of the wires have been found to contain lead, she said.

Rasamee said the board will sign an order later today punishing sellers, importers and producers of fake braces, which will take effect immediately.

Under the new order, selling fake braces will be punishable by six months in prison or a 50,000 baht ($A1,700) fine.

Importers and producers could face up to one year behind bars and a 100,000 baht ($A3,500) fine."

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What the hell is going on at UC Irvine? First their transplant programs come under attack. Now this:

The University of California, Irvine Medical Center accepted a young doctor into a residency position in radiology after the man's father pledged $250,000 to the radiology department, according to a published report.

UCI did not choose Alfred Sein during the regular selection process that determines where most medical school graduates do their residency to become a specialist, the Los Angeles Times reported on Thursday.

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What's causing deficits in the UK Health System? Is it the rising cost of medication, or the increasing expensive technology of modern treatment and diagnostic tests? No, it's blamed on physician pay raises. Laughable.

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A 100% diagnosis rate via mammogram and/or pathology is an oxymoron. The NHS Blog Doctor sheds more light:

If you work in hospital medicine as either a Consultant Radiologist or a Consultant Hispto-pathologist you make a hundred decisions a day. And each and every decision is recorded and stored away for ever. Five hundred decisions a week or more. Twenty five thousand decisions a year. That is probably a million decisions in a working life time.

Make a one in a million mistake and some one may die. Make a one in thousand mistake and, over your career, a thousand people may die. Ask yourself, could you live to that standard? Could you honestly say that for every thousand decisions you make at work, not even one is wrong? And if you did have to live to that standard, how much pressure would it put you under.

Radiologist and histo-pathologists look at X-Rays and mammograms and slides of tissue biopsies and they make a few mistakes. Less than one in a thousand, less even than one in ten thousand. But they do make mistakes. Even doctors are not perfect.

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A dermatologist is running the 10th annual Skinnies Awards. "For the 10th year running, skinema.com features the annual roundup of notable movie and celebrity skin conditions. This year features Brangelina, Katie Holmes, Johnny Depp, Joaquin Phoenix, Reese Witherspoon, and Harry Potter. Can you match those winners with the following skin issues: Scars, acne, tattoos, cold sores, frown lines, and syphilis? If not, the Awards are waiting for you at skinema.com..."

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Bang on - this is what's wrong with our healthcare system. You can't have everything:

Americans want more health care for less money, and when they don't get it, they indict drug companies, insurers, trial lawyers and bureaucrats. Although these familiar scapegoats may not be blameless, the real problem is us. We demand the impossible.

The changes we truly need are political. We need to reconnect people with the public consequences of their private acts. We should curb the subsidization of private insurance. Medicare recipients should pay more of their bills.

But these changes won't happen because people don't want to see the costs. We don't have the health-care system we need, but we do have the one we deserve.

(via Medpundit)

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A family doctor in Canada is burned out:

"You think you can save the world and so you take everyone on," she said. "That was a mistake."

She described a typical day. She might get called out at 2 a.m. to deliver a baby. Then, about six hours later, she'd be at her office, seeing maybe 50 patients until about 5:30 p.m. Then she'd stay in the office until 9 or 10 p.m., finishing up paperwork.

In addition to that, she made house calls, worked once a week at a centre for young unwed mothers and, every six weeks, toiled at a local mental health facility.

It all added up, she said, to between 80 and 100 hours of work each week.

"It's non-stop," she said. "I have my pager on 24/7."

But what got lost along the way, she said, was her husband, her three kids and any semblance of sanity.

"There has to be a point where you say, 'OK, I can't save the world,'" she said. "And I've come to that point personally, because I never see my kids and I realize this is not how I want to spend the next 20 years of my life.

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"By the time you read this, I will be dead."

A retired physician urged the Government yesterday to make assisted suicide legal as she took her life with the help of doctors at a controversial clinic in Switzerland.

Anne Turner, 66, who was suffering from the incurable brain disease progressive supranuclear palsy (PSP), had seen her husband, Jack, die from a closely related d