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Archive for January, 2006

Tuesday, January 17th 2006

Infection Weapon

A robber took $1000 from a liquor store by threatening the owner with a needle he said had HIV infected blood on it.

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Tuesday, January 17th 2006

Relying On The Super Rich

I don’t like the idea that the super rich owe something more than others. I don’t even understand how the proposition is defensible.

But off my ideological thought block for a moment, there are other reasons why taxing the super rich too much is a bad idea.

Here however is a novel pragmatic argument being made that relying on the rich for too much of your tax revenue provides inadequate diversity and opens yourself up for disaster. Just take the state of California where the top 5% of earners represented almost 60% of tax revenues.

The personal income tax represented $33.7B of the $73.6B in revenues in the 03 budget, high income filers represented 58.8% of 45.8% of the budget, or 26.9% of the annual budget.

Since this represents 680,000 returns of the 13.6 million filed, it’s fair to say that half a million households provide about a quarter of the revenue to the state.

I think this is an amazingly bad idea. I don’t think that this is a bad idea because it’s unfair to the half-million rich households. I think it’s a bad idea because it builds insane levels of volatility into the state revenue stream.

There’s numbers on the site to prove it.

On the federal level the top 5% account for 38.4% of all federal tax revenue (not just income tax). Personal taxes account for almost exactly 80% of all federal revenue! 80%!

The United States government borrows and overspends obviously. But of the revenue they do bring in, around 2.2 trillion dollars, personal payments from the top 5% account for about 31%. This doesn’t even include corporate taxes, many of which the top 5% of earners are likely to have vested interests in.

Nearly a third of revenue comes directly from the earnings of the super wealthy. The question is, do recessions, in terms of percentage change in income, not absolute dollars, hurt these individuals more than other classes?

Are the income sources of these individuals diverse enough for this reliance on them by the federal government not to be an unnecessary risk?

Monday, January 16th 2006

Anatomy

I went in and scrubbed in for a cardiac surgery today. Apparently the left ventricle is not the most anterior chamber of the heart, as I claimed. Thank the Lord it was after the surgery and to another doctor, not the surgeon(s), but it’s not like it was a slip of the tongue. I was watching them cut into the left side of the patient’s heart and thinking, during the surgery, ‘this is really weird,’ they’re cutting into the LV. Why would you go in to close a VSD through the more muscular ventricle?

This despite the fact that I just went through this in anatomy lab a little over two months ago. It’s not like I misidentified a CA branch…I thought I was looking at the LV because it was on the left side of the patient.

Good job me.

Sunday, January 15th 2006

Academic Medicine = Depression

This study involved a set of self reporting surveys that got less than 55% response. It found a number of complaints amongst academic physicians and that a significant percentage of them were clinically depressed.

While you have to have respect for the authors who are all notable academians, obviously those who feel there is something that needs to be reported, basically those who are depressed or are likely to report negatives about academic medicine are more likely to complete the survey.

Not to go into my history but I probably have as good a perspective about the condition of academic medicine as any undergraduate medical student. It has certainly been a part of my life since early childhood.

Is life as a physician really just as atrocious as this survey makes it out to be?

The term “crisis” has been used to describe the state of American medical care for a number of years.

There is stress everywhere in medicine and it goes beyond the financial situation and threat of litigation (although these are concerning) to the nature of the job. Certainly, such stress is unavoidable in academic medicine as well along with concerns that attractors for joining academic medicine – research and teaching – are being diminished. But there’s a “crisis” going on?

My perspective is limited to specific academic institutions but…these numbers seem bloated. Still, it’s not like depression manifests itself on the faces of those you pass in the hallway and it is hard to judge the situation without living it. This study could just as well be an accurate representation of the state of academic medicine.

H/T to HCRenewal.

Sunday, January 15th 2006

Is America's Health Growing?

The United Health Foundation, American Public Health Association, and Partnership for Prevention have released their annual report on how fast America’s health is improving. Apparently compared to the past 5 years the growth of America’s health has slowed down and this is an issue of grave concern. I took this from NewsRX.

Of specific concern in the report and if you visit UHF’s website is the fact that America is getting fatter. This despite the fact that plenty of reports document the fact that the health risks, in terms of absolute life expectancy, associated with being obese have been greatly overstated. Being mildly overweight appears to have no effect on life expectancy in this country. Read my previous post on this issue of reworking the numbers on obesity.

It should be noted that I’m nearly underweight, so I’m not defending myself here, I just think that America’s prevention efforts are probably misplaced in spending so much time in slowing down America’s “growth”.

America does finish 27th in life expectancy, which is of note, and apparently how quickly our life expectancy is rising compared to other leading countries is concerning. Here is a list of world life expectancies.

The argument has long been, by those I typically disagree with, that America leads the world in health spending, both on services and research, and yet if we lag behind other countries in health then there is something wrong with the model. This report certainly adds to their argument.

Saturday, January 14th 2006

How Competitive Are You?

Would you step in front of Shaq to take a charge?

Just kidding. This program tries to tell you which medical schools you’re most competitive at based on your state of residence, GPA, and MCAT score.

I don’t know what the cutoff is but it arranges schools by extremely competitive, competitive, and less competitive (read: not competitive). I’m not going to post where I was “extremely competitive” and I wouldn’t put TOO MUCH weight in this thing, but if you’re applying to medical school, not too squemish or if you have a 4.0 and a 40 MCAT then it is kind of fun and maybe a guide.

Saturday, January 14th 2006

Caribbean Medical Education

The Medical Board of California has documented 20 new for profit Caribbean medical schools, which cater to U.S. college graduates, since 2000.

Is there a reason for concern? I don’t know. One one hand as this article from the AMA’s site (password required) points out, these kids do much worse on the USMLE board steps.

But then there is some questionable logic from a member of the Federation of State Medical Boards,

“Boards are increasingly concerned about IMGs from these schools, their caliber and the rigor of their basic medical education,” Austin said. “We have no good means of assessing that.”

Why am I taking the Step 1 and 2 then?

“This is becoming a huge issue on a national level and in California,” said Joyce Hadnot, chief of licensing at the Medical Board of California. “You may find someone … sharp enough to pass a test [USMLE Steps 1 and 2] but not have the skills to practice medicine independently.”

You have to put a lot of weight on their ability to complete these tests. Especially those that can do it on the first try. In that category there is some concern. 70% of graduates of Foriegn Medical School graduates who are not citizens of the U.S. but come here for residency training pass the USMLE Step 1 on their first try. Only, 53% of U.S. citizens who go to medical school outside the United States and then try to return for residency training pass the USMLE Step 1 on the first try. These are largely Caribbean school graduates.

That probably says more about the quality of the students at these out of country schools geared for Americans, than about the curriculum and quality of education. 99% of the Americans there failed to get into a stateside school despite the effort.

Saturday, January 14th 2006

From The Lecture Halls To The Front Page

H5? N1?

Its semantic but thanks to actually opening my microbiology syllabus and going to lecture I now know what they’re describing when they talk of Avian Flu as H5N1.

Orthomyxoviruses have two really important surface proteins involved with the viruses ability to enter and exit the cell: Hemagglutinin (H) and Neuraminidase (N).

The 5 and the 1 describe the specific proteins that appear on the Avian Flu. But these protein types are not specific to a strain, for instance the flu vaccine put out every year inoculates for three flu strains but, even though the specific viruses you’re vaccinated against change year to year, it remains constant that one of the strains in the vaccine is always H1N1 and one is always H3N2.

Tamiflu is actually a neuraminidase inhibitor
. There are other antivirals that target influenza proteins, including hemagglutinin, and another protein which helps the virus exit the endosome once it is inside the cell. I’m not in pharmacology, and even if I was I might not be able to say, so I’m unsure why the neuraminidase inhibitor is the only one that seems to have any legitimate effect on H5N1.

Thursday, January 12th 2006

Real ID

After 9/11 the federal government set down guidelines for state driver’s licenses. Like all “requirements” of states by Washington the federal government prohibited from “dictating” what the states should do. That would violate the entire principle of federalism.

But, Washington holds the purse strings and so states’ rights is a farce. Those who don’t adopt standardized requirements for issuing a license and link their driver history databases and driver’s license application databases to a national collection will be prone to decreasing federal highway funds and,

State licenses that fail to meet Real ID’s standards will not be able to be used to board an airplane or enter a federal building.

The law requiring airlines to require ID (and of a certain kind) is bogus. I remember my horror at the images of September 11th so well but is my “pre-emptive” security worth so much? I really, really believe that people underestimate what they’re giving up with this sort of law.

I mean, who cares if I have to show an ID to get on a plane, right? It is one thing for this to be a dictated policy of the airline. Let market values drive security and if they don’t then it isn’t important. I understand it gets dangerous when I start shouting down all pre-emptive protection measures. Should I really be allowed to buy a rocket launcher? When does community safety outweight my freedom? When can I not shout “fire”?

Unlike a lot of people, I just think if you’re going to err it shouldn’t be on the side of safety. You start making that argument and it can be used to excuse all protective acts. You have to err on the side of liberty, although if I was a 9/11 victim’s family I’d probably be thinking differently.

Thursday, January 12th 2006

Kind of Stupid

These are physicians and scientists. Yet, they’ve basically made up a grading system of emergency healthcare. There is no apparent baseline and it certainly is not comparative with other systems.

I mean, there’s really a difference between the model in California and Arkansas? Why didn’t they compare the United States with other countries before giving the U.S. a grade? All we can take from this study is that you’re better off being a victim of trauma in California than Arkansas.

Emergency care in the United States is comparatively fine (and that is all it is worth judging it on). There I’ve said it.