GIF89a̙fffff33333!,I8ͻ`(dihlp,tmx|pH,Ȥrl:ШtJZجvzxL.zn|N~@8V8 a%(T@  bĆJhȱcGnXH20dĉDTp2Lqi@I,*D$̣.Qit!|*4QB^TP@.jD FIBLmĺUHBک8jv&ֹC[C[v* $5zG[kpc<[W{.)HWњ> Jmםi!L/ V5&s mjdO ʓh(л˅"ݥ!Ye% QS 2xĀ{,4aUb$$'Ԅh\t C}enpc!z%g"E,=!IE% 85 gSS9VtS7UDԌSquImyC ȇ{]6g 1*l\3tfYۭPCXxOB=>RcP0Xפ^'9t]*\]O ,$1ex}{m9` :s[kfMhfL/'mmsQ){ PV@GQ.Ap[ws,:% oq^ f8!!|AE&Ƒx:ǿd)0 <]g:٭!PD۔z䁾du% FXv HDE%^xaULkF䈧 ix#c22L#ǶaF??T! :#{A!MPcJ>*rk$b١~:" ƞy/dF(HPNJ,SDK\eiL&ʯ ⢣0uD fy@i:N>#!xKeS@Y4,shyl6g&IRT,S πiAFz0ldP2iQxdk֣aw}O dW&}`GO̯ڔDYD {G"פW&)~w_T3A|_ΰv>Vmo{Q^{~|I:cFDa~Ok+D(y<ͨU/D m-,ؗi5"'vb#noҀ  &#7a(6؁ "8$X&x(*,؂.0284X6x8:<؃>@B8DXFxHJp6p00P(pSx^(U\(^XaQ؆ 0rZx`^hH=pȇ}Xp pH"`؈0i8px(`((؈g(Xx[؋V8~NxxxhfHH`xfHhx8X#؍"pe(Ũ ؈0˘XxqobvX昏:Hن)YI!iH&*#و'yh647lXؑs3)6)hF ؆<[M%ЈM\Kۚ ّ=f ]Cz9:0vXݜ <x+Aܾ,-? ڵ-:ߺm>=-]^Pι=ކKiн=a|}%omͬ\}MdMވ͝؋X|۬>n 1ۼߝ:C=xIĽ2( KN]D-Q-T>\l3,:ʪ ͈zm7+iI@ʚ=ms]\F N$톍౎ A^*$>W~(~n,ݞN|띭'!Rm>{=6@~X؍ˎ@ڶ՜ +©̎ŽH" pWmΉN ϑ=5(m︭⯞㘻Nϔu@~_=n>ۍo\OI~亮D-kI4 `ޮ'|+Т`-+9_1);ɲ.\Mi_}/,+)b1|Ժ:M}WH|_?*ƋǍ>m隖/yw?nv* SӦ_'UȌ-Wyc{ޏ# /Sdž*˯/U f&_5@ INYR}:6qԺ".q``shP>: {N? 0 *Ԣ 78KQ0ACVk 1;"Bh"1̏(A(r4Dɯ[rdQ̚oBb)ѡ(o''2qчNLL(۠.\Ql,Ϝ <(O<LgEHb*4\Q`)DosV0U^etawTbZH6ZijsRtjlUT;-JaD#hs=3ZST^>Mw= |?WWlZ}V Wށ8a?9dG&dOF9eWfe_9fgfo9gwg:h&hF:ifi:jj:kk;l&lF;mfm߆;n离n;oox'xG>ygy矇>z駧z>{{?|'|G?}g}߇?~秿~?`8@ЀD`@6Ё`%8A VЂ`5Av(0 $"$@@(B@ @ &< BЃP@81ЁbBD"BD* 07V;TA*E,cи hшM<D3N'v3:t#S%‐Cǒ)RrDr1͑!XI@VQȣK"҉A$!p3~MDDv24m#YfRԘ8g8w~-.QMRG)Ѕ ?SCbPhyKG5XcP I.$pAI7B&3Ae$,EVke!L+6-3@Z-}0+TA8i(3ظ46e+c!63Pb@%ZZlD;ϴ"(%#)Y.+)8gdyT"#QEj 1߸MҀ$EyY $f9UG/nLmiMs=x}d _R%;̡u7[qKevmkdʒ:fiΙOΖh`m5=4yl2(@>$$%kbav~,=JчEu[m2oWߑerOg|Nh7S;us[5x q-j|3tі)r~y}[d#%Qƣ6v?>9ͩzm^<.Δ:ͫtO9oAӛX~ziF}~ܙ޷:7;s.y1v:vz$Gi'z3oUu y'Qݸ j?>ͯg}y_COϙ⛞_~@oG ZjOlyk'Ĩӿ3Y-c@#k:;{@D#[=Ż@_A2A?18C>9R83LӴփ7+)ۺKKq#B=J"@9$%\t!/8BBк/$@8A1-ϻ71ԂC l:,@@6t>k>*8,ړ맢BBH۩LӲJC0 $yK695 C#@Ck6B;I~*3N0F~:*,HBԵ#d/L;4EL*$lt9>$dEm>AD>WdU26ƛk<|GRܤbBo$@I@ GLJ%FC|ES0)):/iCoy\0CI|=w,I:s5W򥉫!lVşܙ2cJ& pJ*X9Yȧ<Z jİc8 G QT_;&k%Bh$BKCdozsCAƍ!qDǿ4\DADBry!ċGDȫ R˛K:2̉Qj0Œ~J4*Z&RIpL̏ 0͌۲dNB2̽5T-M@A#ܜ@HrMT<C#:[-+ν:NKW#ALLl&+PMDTPL̻9:$OF,DzO&-JS O 8ǤIѾf#>J# , 'M;"e3'<p*όPSZ/EC\UD*}EP[P8mQnPěBtS[m2XiVGq ˬM!L$@V]%H 'vC]ҖDЀeTA=Y#3T#Wye0(}-P|6.mS'MXdY&eMZ:0|%,yRZE"*Z#dNZژų$mIXE@Dm(8;YBK[O3S*uCGY`F&`ۼہfIdm#luB[l[T+\@QR$\[|ۇ5Eř)/Sݱ]Rr%U5b݈֕U%]kN]U\*YE:1K8%^٥ŞFpMQ$SPp]WAU_ *_z0BE_&6FVfv `‚_`C`=,EY!J{ݶ\LC ̚]¥PKX9VdŋeRJٱS1ӫIf ε+Ël LDmE#;؄j!$cݤUUM`7<6c,cqx$*3?K3^KO@. / I~G#E~hp t deLJݨv1K1h&GiR,vឭ\)3r,.⠤VUSbB";ElCc4FӰ:m&nE4ޮWmc>Lǫi T{Y0Qdv\L:BX.B=Xf\,*Eh/E\lo~, dTZ.FqjL..BDŽLklmײiMXiudR'SrRvXKaoŇk";e WUk˽r*vJQo*K޺>j-Jԋ%beFDM@(T̝b8Ϟqad$Q1n ĝї>"&n*\'\[eO#[VyNcH^y}<0/vzNfvUg=T ^R) NrVgbS%8C;_^sOUl%ORiK?TxaGuM&)-Z ˾V'zXtumO(> [HO*s&K2fWe+oVtBrIoovPz.VTOV5[ˣfs"~rfog3#mz{s->,p_%/VĔMj-u{2 婗ժOgeXI[dYJKaΨ++,@^B[F_@[`B^O% 'hhJ# Mœ ٭$ WT,)-Ei*ȳ١0ͩ`$qq`rr/H+pyh=z*\fB$R< 4җ"A(7x&#L^ `@Z E0lo&q@Р4zqG"ǒóL,KkPcTb^(KZW;Lx5MTyԔW3+~~MDYvIk5%bM-m ,͏%j\IM&\8퉊ZO^JVc":L@tn:Hc3 0 pF: Tkn08̱r̫(Kh"`A4h.+:4gyWC4 g_ШUĠ#[_}$a~<_HA]gbK{!WhWPgݍEb4rߎFj,JatɜW#{0E;\D$j t%Ywya -0\Xdz/963N>9qډ(7]Y7dYmhMlyjt*pW|#%諆nmXX!;Ԓ֧)~AhyİjaxrDh8Ydm**!81j)L##ZçWnhH,jZ[(*`)+畳{q5AO 8DEK ;,ԹA !&l*{šq O$|A ",BpO紤\hHDK9Iclء>]c1joq6mfku ν$M6yҦ"Gi'5;N"ۏK>9[~9kNy{9衋>:饋ҹ驫:뭻:(>;~;˞;;<<<;<1o[=={0?>>髿>>?????(< 2| #( R 3 r C(&!(!F<"%P2N|"()RV"-r^"(1f<#Ө5n|#(9ұv#=~# )A/;

Archive for June, 2008

Sunday, June 22nd 2008

Why I Support Barack Obama For President


Seriously, John McCain Has Never Even Heard of A Health Savings Account

Everyone likes feeling like they ‘know‘ their leaders. No matter how cynical they are about politics in general. I’m not different; I’m star struck of Barack. I’ll say with a smile (despite it’s true inconsequence) that I met the future President once. I attended the AMSA Legislative Affairs Leadership Institute in 2006 with about 40 other medical students and had the joy of having Senator Obama speak to us and indeed getting to chat one on one with him. Granted that makes me far from a political mover and shaker but that is one of the joys of Senator Obama, his ability to create rock star-esque moments as I now realize I had.

I remember thinking, at the time, how I could never find myself agreeing with the man’s health care policy but how intelligent he was. Senator Obama was direct and critical of physicians’ role in maintaining the current health care system and highly knowledgeable about the workings of health care policy. Granted, he had an RWJF fellow on his staff at the time but I remember appreciating his fund of knowledge and his willingness to criticize those medical students before him and challenge them to do more than physicians currently were to help fix the American health care system. That even if I didn’t agree with the charge.

Now, over the course of a brutal primary, he has proven his charisma and leadership as well as that intelligence and integrity I saw that day on Capitol Hill.

I went out and gave my winter break to campaign for Ron Paul in four degree weather in the Iowa Republican primary. I am a libertarian (with a small ‘l’). But one of the privileges of staking out that territory of political ideology is that no mainstream candidate will ever satisfy all of my positions on the issues. Largely I am socially liberal and fiscally conservative. Because of such I am, for all intents and purposes, an independent.

I will never agree with Obama’s effort for universal health care or likely with his tax policy or any number of his fiscal policies. That said, as much as I have trouble stomaching liberal health care proposals, Mr. Obama having David Cutler as his chief health economics adviser is about as good as could be hoped for from a Democrat. Dr. Cutler has long refuted the claim that America’s spending on health care is somehow dramatically misappropriated. And, where Dr. Cutler has spent the considerable bulk of his work I actually agree with his conclusions – pay for performance. Granted, such is a delicate matter which we may argue over the specifics of, but certainly tying provider pay to outcome measures is where I stray from organized medicine and more conservative commentators in general.

Even if I find much fault with his proposals on health care, on a whole host of issues I will agree with Barack Obama. Namely, something every American should cherish, his promise to protect our civil liberties.

My greatest fear remains that Senator Obama will get so caught up in securing the middle, in toeing the line that he will forgo his promises (I do feel shameful linking to the Huffington Post) to defend our civil liberties.

But until that plays out Obama remains everything we need right now. His charisma and intelligence are things desperately needed on the world stage. This coming from an author who generally, initially supported the war in Iraq – so far as America had the will and stomach for it – and who doesn’t give a whole lot of credence to multilateral action or for how the world thinks of us.

I don’t believe that America is in it’s darkest hour as some crazy ass liberals will shout but what more could America hope for after the blunders of the Bush administration than a charismatic intellectual as President? John McCain that certainly would not be.

Pending surprises on the campaign trail I imagine that down here in Texas my vote may not count for much but, even if Ron Paul throws in his hat as an independent and even with the Libertarian candidate on the ticket, I will be casting my ballot for Barack Obama.

Share/Bookmark
Sunday, June 22nd 2008

TSA Now To Require ID To Travel


Despite The Signs You See, Until Now You Did Not Have To Show ID

You’re about to have to pull out that driver’s license to board a private airplane.

Despite attempts by the Transportation Security Administration to convince you otherwise, you were not required to show government identification to board a plane as long as you were willing to undergone secondary security screening. Such was affirmed by a lower court and the 9th Circuit Court of Appeals in Gilmore v. Gonzales (here’s the opinion in full). Largely, the court said that because Gilmore, or anyone else, could choose between showing identification OR undergoing more thorough security screening that the TSA rules did not violate his right to privacy.

But you can throw that reasoning out the window now. CNET’s Survelliance State blog has good coverage of what is going on, but essentially starting Saturday, June 21st you will no longer be able to refuse to show government identification in order to board a plane.

Beginning Saturday, June 21, 2008 passengers that willfully refuse to provide identification at security checkpoint will be denied access to the secure area of airports. This change will apply exclusively to individuals that simply refuse to provide any identification or assist transportation security officers in ascertaining their identity.

This new procedure will not affect passengers that may have misplaced, lost or otherwise do not have ID but are cooperative with officers. Cooperative passengers without ID may be subjected to additional screening protocols, including enhanced physical screening, enhanced carry-on and/or checked baggage screening, interviews with behavior detection or law enforcement officers and other measures.

Excuse my French but this is fucking bullshit. The idea that only when it is a passenger engaging in a little act of civil disobedience and ‘willfully’ refusing to show ID is it unsafe to let them on a plane without an ID is obviously ludicrous.

It is no longer outlandish to start making tangential analogies to the internal passport systems of repressive regimes the world over (for example here and here).

Read More »

Thursday, June 19th 2008

Our Prayers Are With You Dr. Davis

The immediate past president of the American Medical Association has pancreatic cancer. At the annual meeting I just rolled back from his address at the opening session of the House of Delegates was…very touching. The second hand accounts online don’t really do it justice but here is the WSJ Health Blog on it and the AP piece.

In an upbeat, sometimes funny and at moments poignant, emotional 45-minute speech, Davis talked about his life and how it has changed, both good and bad since his diagnosis. He spoke of his hopes for the future, his own and that of his fellow doctors and their patients. And he talked about legacy — his and that of everyone listening to him.

“So, whether we are ill or well, we should not waste any of that time before figuring out how to leave our mark on this planet,” he said.

My prayers are with Dr. Davis and his family.

p.s.
The above quote represents fair use despite this interpretation of the rule.

Tuesday, June 17th 2008

The AMA On Industry Funding of Education

I just got back from Chicago and part of the American Medical Association’s Annual Meeting.

I’ve been very involved with organized medicine over my medical school career.I think I fairly readily admit the faults of organized medicine (and forgive them) and I also realize that my involvement has been mostly, nearly fatuous. Many of my positions exist largely to draw medical students in to organized medicine and not as conduits for the medical student voice in shaping policy. That’s okay, I’ve learned a lot about both policy and the functioning and innards of organized medicine.

I truly believe that organizing physicians and other health care providers and speaking with a semi-cohesive voice is important. Politicians in Washington and the public don’t understand the nuances of fractured physician opinion. Nothing gets done on your behalf up in Washington without a concerted, concentrated effort. Criticisms of the AMA and organized medicine in general are not inappropriate, but if you want change it won’t be by backing out of the system altogether. If you disagree with policy you need to work to change it from within has always been my perspective. Because even as involvement in organized medicine by practicing physicians dwindles, it remains the voice for medicine in all of the places that matter.

I lay all the above out because such is the light I want to look at the topic of industry funding of medical education. When I left Chicago the docs still up there were facing a report (word doc) from the AMA’s Council on Ethical and Judicial Affairs. In dramatic flair, already championed by several academic institutions (see here for example), the report calls for physicians and medical institutions to forgo industry funding of all educational activities except for certain technical training (such as learning how to use a new device in the operating room).

The American Medical Association wasn’t ready for such. They’ve referred it for further study, while also, in an obvious rebuke, passing a resolution (word doc) in support of industry funding for continued medical education.


Baby Steps To Ethics

The result is a mixed bag. I would hope the AMA would take a leading step towards ethics. As always, I respect the right of physicians and academic institutions to take as much pharma and other industry money as they like. Legislation to dampen such would be appalling. But if the refusal of such money is by personal choice that is an obviously different matter altogether.

Being innovative and adventurous is difficult for any large and diverse policy body admittedly and so I remain hopeful. It is likely inevitable, eventually that it becomes the ethical standard for industry not to fund medical education. We’ll ease into it and the catastrophe of the death of free or cheap continued medical education or that catered pasta dish at grand rounds won’t look quite so disastrous from the other side. Or so I predict.

——-
Photo: Mike Licht / CC License

Tuesday, June 10th 2008

Vegans Face Prosecution


I Spit My Green Beans Out As A Twelve Year Old And Ate A Whole Lot Of Meat

A little girl in Britain is sick, suffering from, amongst other things, rickets and several pathological fractures at the age of twelve years old. Such is the case because her parents have raised her on a strict vegan diet.

A 12-year-old girl in Scotland brought up by her parents on a strict vegan diet has been admitted to hospital with a degenerative bone condition said to have left her with the spine of an 80-year-old woman.

Doctors are under pressure to report the couple to police and social workers amid concerns that her health and welfare may have been neglected in pursuit of their dietary beliefs.

This wouldn’t be the first time that vegan parents were prosecuted for neglect. An infamous case in Georgia last year involved parents whose attempt at weaning their newborn along on a strict vegan diet led to his death and their life sentences. I’ll stay away from passing judgment on a specific case based on some blurb article in The Times. That said, it really is unacceptable to neglect children like this based on parental beliefs.

I’m drawing a line here admittedly. In the past I’ve been sympathetic to parents circumcising their children, I’ve supported the decisions of children young adults, who have reached a level of comprehension, to forgo medical treatment even when it appears clear their parents were influencing such a decision. Serving your child a strict vegan diet goes beyond that though. We’re discussing risk versus reward here and while you’d hate to have the government and society weighing every parental decision on such a scale in hindsight, there are things that clearly cannot be accepted.

What makes cases like this difficult is that we (or I at least) like to imagine negligence as something of lack of caring and lack of action. True, in vegan cases there is usually some of that. For instance, it is hard to imagine many of these children getting to the point they do if they had gone to recommended pediatrician visits. But, these aren’t parents trying to starve their children. They often come across as…well, moronic but not malicious.

That makes it tough, but it shouldn’t excuse it. We should expect parents to either know that such diets are bound to harm their children or, if uninformed about infant and children nutrition, to seek out information from reputable sources. Anything less has to amount to negligence, doesn’t it? Shouldn’t the state strive to protect its most hapless charges by reprimanding parents who harm their children by essentially starving them even if such isn’t through malice?

I think the answer has to be ‘yes’.

Tuesday, June 10th 2008

Presidential Candidates' Health Care Plans

Health care, something I was sure would be the primary domestic issue this election is slowly fading away as it usually does. Not into oblivion obviously but taking a decidedly back seat to the more pressing economic issues facing the country. But it is important and people should take the time to distinguish Obama’s and McCain’s plans for health care in this country.

Like many professional/specialty organizations the AMA polled the presidential candidates (before Hillary’s bail) about their health care plans. It is little more than a venue for the campaigns to harangue to those who like to pretend they’ll actually cast their vote based on the nuances of the issues. I wonder what intern got to drum up the answers, considering I doubt Senator McCain even knows what HIT is,

HIT is essential to the success of my proposal. It amazes me a health economy of over two trillion dollars that epitomizes advanced technology has an underdeveloped HIT infrastructure.

I’m afraid we’ll have to give the old gent a pass on all health care issues considering his confused opinion on autism and vaccines.

Back to the point at hand, the AMA’s little fluff publication does at least summarize some of the differences between McCain and Obama and you should go read it for that reason. I’ll spare you an analysis now, although I’d like to put individual ones for both candidates up once I am done with psych (and third year in general). Such analysis will be a little redundant as there are already great resources out on the web. If you’re pressing to read more, right now on the two candidates health care plans I encourage you to check out The Health Care Blog’s look at both Obama’s and McCain’s plans.

Monday, June 2nd 2008

Kennedy Has 'Successful' Tumor Debulking

Senator Ted Kennedy went down to Durham today for the first step in treating his high grade glioma. He had part of his tumor removed by Dr. Allan Friedman.

“I am pleased to report that Sen. Kennedy’s surgery was successful and accomplished our goals,” Dr. Allan Friedman said in a written statement issued after the procedure.

“Sen. Kennedy was awake during the resection, and should therefore experience no permanent neurological effects from the surgery.”

That is, I imagine, kind’ve the key for these types of operations. First do no harm. Get out as much of the tumor as is feasible and leave as little neurological deficit as possible. Such is why patients are woken up for the actual part of the surgery where the tumor is debulked, so that the surrounding area can be ‘mapped’ and sensitive brain matter can be spared.

Kennedy scheduled to undergo radiation and chemotherapy back up in Massachusetts once he gets out of the hospital in Durham. He’s probably got six weeks of radiation therapy, which they might do first or while also starting the chemo at the same time. Then he’s probably got chemotherapy for months after that.

Good luck Senator Kennedy.

Sunday, June 1st 2008

Panda Bear, MD Is Leaving The Blogosphere


A Big Part of the Medical Blogosphere Is Moving On

My excuse for being two weeks late to it is that I’ve been pretty busy moving. In anycase, if you spend any time paying attention to the medical blogosphere you probably already know that Panda Bear, MD is dropping out to focus more on life activities. He will obviously be missed.

I’ve decide to stop blogging. Although I have enjoyed writing this blog and mightily appreciate all of you who have taken the time to read and comment upon my many articles, keeping the blog going has taken an appreciable toll on my sleep, studying, and even on my family time. As I am about to enter my last year of residency I will have many new responsibilities to my program competing for my time. Additionally, I have signed a contract for my first job and, as I need to devote my last year of training to ensure that I am completely ready to take care of you, your family, and your friends if you ever end up in a gurney in my trauma bay, I won’t have time to update this thing and I’d rather just end it than let it fade out.

He is “pulling the plug” on the blog itself soon, so if you’re interested in the interesting things he has had to say over his stent on the internet then you should hurry over and read.

Sunday, June 1st 2008

Physicians Saying I'm Sorry

Their is a (perhaps) growing trend of physicians being very candid when they make mistakes when caring for patients and saying I’m sorry.

For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.

But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.

By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.

[...]

Despite some projections that disclosure would prompt a flood of lawsuits, hospitals are reporting decreases in their caseloads and savings in legal costs.

This ‘trend’ has been discussed in detail elsewhere. I’ll say though that for all the time I give to the current medical malpractice environment from the physician perspective, the environment is just as bleak from the patient side. The work of the godfather of medical malpractice research has consistently implied that the vast majority of patients who actually suffer harm due to negligence never even seek compensation. I’d like to know what these physician disclosure practices do to that rate.

Granted, we wouldn’t want physicians themselves to be the sole arbitrator of negligence, disclosure and compensation. However, under the current flawed medical tort system this (perhaps) growing system of apologizing and offering some form of compensation is a nice addendum. The ideal system, here very non-specifically described, is a no-fault system headed by expert healthcare courts/arbitrators which should hope to have a much better track record than the current system. Both in terms of actually compensating patients suffering negligence and holding physicians accountable when they actually commit gross negligence.

I suppose I can dream.

Sunday, June 1st 2008

Urban Exploring Hospitals

This account by an urban explorer of touring the abandoned Charles Camsell Hospital in Edmonton reminds me of touring Charity Hospital after Katrina. I wish I could find some of the pictures I took. It was creepy. Dark with everything still in the hospital. And no one could go in and start cleaning it up or pull things out yet, because all the office and hospital equipment was government property. Nevermind most of it was ruined, it had to be accounted for before it could be hauled off and the building gutted.


Charity Looked A Lot Like Charles Camsell