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Archive for August, 2008

Sunday, August 31st 2008

I Am Happy To Be Here

It Is Sad Part Of My Personal Philosophy Is Summed Up In A Commercial

I truly believe we live, as a society, in a State of Fear. Politicians, media, religious groups and others all play off of it. It is a pessimistic, depressing view of the world. The theme is: everything is to be feared; tomorrow is going to be terrible unless you do what I say.

What bullshit.

Now, I have my personal religious faith. But even if there was nothing else, existence is amazing. There is something incredible to even being part of the universe. Even if your personal time is fleeting there is something tiny, nearly unmeasurable, but tangible in you having been. Think of how huge the universe is and yet, to have witnessed what I have in this tiny, tiny part of it that I can behold is amazing. The fact you are even here reading this is a wonderment. It is incredible.

Not to get all morbid or stoic or eastern. How could just a single day of consciousness not be worth death even if there was nothing else to follow? To witness even the mediocrities of life, even the hard parts and the suffering, is a gift and nothing less.

We really have to stop taking the world around us for granted. There should be so much optimism rather than fear. Oh well, I guess our predilection for pessimism is and of itself a pretty interesting and cool thing to ponder and wonder over.

Friday, August 22nd 2008

Civil Jury Trials: Restoring Our Faith in Humanity

A young woman in Iowa has had a jury of her peers find in favor of her for $1.5 million in a case against her ex-boyfriend. As you might expect, if it is to be posted on this blog, the nature of the verdict and award are…stunning.

The plaintiff claimed the defendant gave her human papillomavirus. HPV comes in many flavors (serologies). Two of those serologies (6 and 11) cause more than 90% of all “common” genital warts, which despite cosmetic and comfort concerns are not a serious threat to your health. There are many forms of the virus which are associated with cervical cancer but serologies 16 and 18 account as the etiology for approximately 70% of cervical cancers.

In this case in Iowa this woman claims she contracted at least on HPV virus associated with the warts and at least one associated with cervical cancer. Here is the story over at On Point,

Karly Rossiter, 25, has been diagnosed with both strains of the human papillomavirus (HPV), one of which causes genital warts and the other cell abnormalities that can lead to cervical cancer. In a petition filed in March 2007, she alleged that Dr. Alan Evans, a Muscatine, Iowa, dentist, infected her during their 18-month relationship and failed to warn her to take appropriate steps to protect herself from infection.

So there are several weird things about this case.

First, the defendant was not tested for HPV and his status is unknown. The claim that the plaintiff contracted the infection from Dr. Evans was based solely on her announcement that she had only been with two men in her life and Dr. Evans was the most recent.

Second, and in line with the first point, the plaintiff claims a strange time table for the development of symptoms.

In April 2005, she learned that she could have the virus and about a year after the New Year’s Day encounter with Evans she developed genital warts.

The average time to the development of warts from infection is 2-3 months. 1 year is not too far astray. Also not too far astray is that at least 30% of low-risk HPV infections don’t clear and the women get reoccurences of genital warts from the same infection. Maybe she was infected before. And a lay jury was burdened with making that determination? Give me a break.

Third, the notion that this infection is worth $1.5 million is beyond belief. And that is if there was some proof this infection was due to the defendants actions (or lack thereof).

This woman is likely to clear her low-risk HPV infection (which caused her genital warts) and if she doesn’t, this remains a largely cosmetic issue. And this woman is very, very, very unlikely to get cervical cancer from her HPV infection.

For all of the media surrounding the HPV vaccine attention cervical cancer is not an epidemiological emergency. In fact one of the questions surrounding the vaccine is if it is really needed, if it is really cost effective considering the low incidence of cervical cancer in the U.S.

Here are the numbers: 30% of the women in the plaintiff’s age range (20 – 25) are infected [PPT] with at least one high risk form of HPV. 30%! Yet there will be only 11,000 (and that really is a small number when you think about the number of women in this country) new cases of cervical cancer in this country.

Yes there is an increased risk she has been burdened with but life is full environmental factors which increase our risk for cancer – such as when she was sitting out on her porch and a diesel pick up came through billowing exhaust. I would feel comfortable betting that, with regular health maintenance, the plaintiff will not suffer from invasive cervical cancer as a result of this infection.

Jury decisions like this make me cringe. But this case is nothing new.

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Monday, August 18th 2008

Concierge Medicine 2.0

Concierge medicine will never be mainstream in my lifetime. Neither will functional patient-physician encounters online. The fact is that health care consumption is too concentrated in an older generation. It is concentrated in those of lower socioeconomic means. But that doesn’t mean it doesn’t have a future or a place in the delivery of health care for certain savvy, affluent, generally healthy populations.

Such appears to be the case with the very new practice, getting lots of attention online, Hello Health. This is the partial brainchild of Dr. Jay Parkinson, already an internet ‘hipster’.

An Introduction to Hello Health

This is an incredible idea and practice model which I am terribly envious of. If I lived in the Williamsburg area (and actually made use of medical care with any frequency) I would be all over this.

Those Darn, Creative Vandals

The only blip in the launch of the new practice is that their subway ads had to be pulled because the empty dialogue and thought bubbles were too enticing for vandals.

Photo via Barbarian Blog

Sunday, August 17th 2008

McCain Calls Majority of Americans Stupid

This Would’ve Been An Interesting Scene To Be At

In some non-healthcare related news, there is a report going around the blogosphere that John McCain, during a private fundraiser on Friday, August 8th, essentially called the vast majority of Americans morons. The original reporting seems to be from the OSI Gazette blog.

When joking about lopsided tax breaks at dinner, he purportedly justified it by saying, “People who make under $80,000 are too stupid to understand taxes anyway.”

If the report is real, joke or not you have to ask if this guy can keep his mouth shut.

I Like The Beach Boys As Well But Yikes…

Sunday, August 17th 2008

Most Children Oppose More Healthcare for Children

The Onion Reports On An Important Study

via Peter Rost

Saturday, August 16th 2008

How Much Is Wasted In U.S. Healthcare?

Talk About Being Wasteful…

A PriceWaterhouseCoopers report estimates that the American healthcare system wastes $1,200,000,000,000 a year.

That is a huge estimate, much larger than any I’ve ever seen but you’ve read it right…1.2 trillion dollars a year is wasted according to PriceWaterhouseCooper. Now granted, their estimate is based solely on accounting of existing figures which previous, more independent, researchers have used to come to different figures on U.S. healthcare waste. As the WSJ Health Blog says,

PricewaterhouseCoopers also boosts the number by adding a category called “behavioral” waste, which includes the $200 billion costs of obesity and overweight and $100 billion for “non-adherence” to medical regimens generally. (Click on image at left to read PwC report.)

In anycase, no matter the number it highlights that the American system remains the least efficient in the world.

Friday, August 15th 2008

I Used To Be A Doctor For Pretend

If NPH Likes It, You Should Go Buy It

Wednesday, August 13th 2008

News Says Russia Invaded Georgia But I Don't See Anything From My Trailer…

President Bush & Supreme Ruler Prime Minister Putin In Beijing

Wednesday, August 13th 2008

Where Does All The Money Go?

AHRQ staffers have published a new piece in Health Affairs looking at who gets government health care dollars. The actual study is subscription only but the Health Affairs blog breaks down what Selden and Sing found. You should go read it. Mostly because it re-enforces the fact that the government is holding most of the cards, if they could act cohesively, when it comes to provider reimbursement.

Using the most recent data available in sufficient detail, economists Thomas Selden and Merrile Sing of the Agency for Healthcare Research and Quality (AHRQ) report that public outlays and tax expenditures constituted 56.1 percent of all health care spending in 2002.

Granted that figure includes tax subsidies. But 56% is still stunning. And that is 2002. The pace with which the government is increasing its piece of the health care expenditure pie is a really ignored story. That pace is alarming. No doubt today, in 2008, the percentage of health care spending made by the government is something more than 56% by the accounting used by Selden and Sing.

The large part of that government spending is Medicare. As MedPAC recently pointed out Medicare reimbursement made up nearly 1/4th of all personal health care spending in 2006. More today.

And, as long as Medicare reimbursement covers at least something nominally above cost, doctors are going to abandon Medicare en masse? Anecdotes and forward looking self reported physician surveys aside the real question is, abandon those Medicare patients and replace them with what? This is nearly a fourth of reimbursement controlled by a single payer. That is insane.

God bless the efforts of organized medicine in selling our politicians medicine’s side, because it is clear that on everything from P4P to the SGR the physicians aren’t the ones actually holding the strings on reimbursement issues.

In anycase, go read the Health Affairs piece, it has some other interesting comments about to whom government health care spending goes.

Tuesday, August 12th 2008

Olympic Opening Ceremony Faked

The opening ceremony for the XXIXth Olympiad in Beijing was heralded as remarkable. It was an introduction for most of the world to the rise of China.

It should also serve as an introduction to China’s desperate personality disordeesque need to demonstrate its progress. I say that as more and more comes out that, at least some of, the spectacularness of the opening ceremony was was a work of ‘forgery’.

Don’t Believe Your Eyes

For example the Chinese pulled a Milli Vanilli. Here is a translated interview with the Musical Director for the opening ceremony,

Chen Qigang: The first condition was that the director wants the image to be very cute. We selected about ten children… Then we had to choose one from those who had a good image who can sing well…

We chose one ten-year-old child, whose voice was really good. All the rehearsals were using her singing… In the end the director thought her image was not the most appropriate, she was a little too old… so regrettably, we had to let her go.

Then, as we chose another singer, the standard was that she needs to be seven years old. Lin Miaoke was one of them, another was Yang Peiyi, and there were others.

Then we went to the Central People’s Radio Station to do the recording…

Except of those children auditioning, they decided to use one of their voices but put a different one out for the audience to see. Here is how he goes on to defend the decision to use the ‘voiceover’,

Chen Qigang: The reason was for the national interest. The child on camera should be flawless in image, internal feelings, and expression.

Lin Miaoke is excellent in those aspects. But in the aspect of voice, Yang Peiyi is flawless, in each member of our team’s view.

TV Hostess: … So the one in front of camera is Lin Miaoke, but the voice [we heard] is from Yang Peiyi?

Chen Qigang: Yes.

As he says it, the decision was forced on the Olympic game organizers by some high ranking members of China’s national government.

The transcription of the original interview in Chinese, along with video of the interview can be found here.

Those footsteps which started the fireworks display of the opening ceremony were also faked. As Sky News reports,

Stunned viewers thought they were watching the string of fireworks filmed from above by a helicopter.

But in reality they were watching a 3D graphics sequence that took almost a year to produce.

It even included a ‘camera shake’ to mimic the effect of filming from a helicopter.

The dupe was revealed by China’s Beijing Times

Other questions about the technical aspects of the opening ceremony also raise the possibility of further ‘forgery’. For example, what were seemingly hidden projection screens in the roof of The Bird’s Nest stadium used for? One of them projected the Windows Blue Screen of Death during the lighting of the torch, thus revealing its presence.

There is a lot at stake, in terms of national pride, for China in these games. This ‘forgery’ during the opening ceremony is just a demonstration of the continued antagonistic, us versus them, thought process amongst the political elite in the Politburo. There is a drive from the top of Chinese society to present the rosiest picture for the outside world and amongst their own people. The Chinese continue to feel they can demonstrate no weakness and that they must cultivate this myth of incredible growth and China’s newfound relevance.

Yes, China has done incredible things considering where it started from. But, for a nation centered on the ideal of collectivism, it remains a nation with trouble in the distribution of its new found affluence. Despite China’s official (bogus) claims, poverty amongst the rural population may mean that 20% or more of Chinese continue to live on less than a dollar a day.

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