What is NOT true of giant cell arteritis?

A. Associated with acute headache
B. Often found in patients >55 years old
C. Elevated ESR
D. Should be managed by observation

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Portugal was the third European Union member to seek a bailout. As with Ireland, Portugal’s woes are considerably less than those of Greece and yet its austerity measures it had to implement to achieve its bailout, and avoid bankruptcy, are no less painful. And the austerity measures’ effect on the publicly financed health system is interesting. In an admittedly poorly written piece The Guardian newspaper attempts to attribute a rise in mortality figures for the early part of this year to cuts in the health system’s budget.

[O]pposition politicians blame budget cuts for a thousand extra deaths in February, 20% more than usual.

“They hiked the fees in January…Now a visit to the emergency room costs €20 instead of €9. A consultant costs €7.50. People are angry.”

[...]

In the meantime, the government blames flu and cold weather for February’s surprise jump in the mortality rate, but newspapers have begun to publish scare stories about people who claim to have been priced out of the public health service.

Not knowing the specifics it would be difficult to attribute recent cuts to a 20% increase in the monthly mortality rate. That said it isn’t difficult to imagine austerity and cuts in services significantly influencing people’s access to healthcare in countries like Portugal and Greece and Italy and Spain.

What antibody against targets in the cerebellum is sometimes associated with ovarian cancer?

A. Anti CBIR1
B. Anti Yo
C. Anti Hu
D. Anti MGCR

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What C2 screw technique avoids risk to the vertebral artery?

A. Laminar screws
B. Pedicle screws
C. C1/2 Transarticular Screws
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What area of the brain harbors the highest concentration of HIV?

A. Basal Ganglia
B. Thalamus

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What is the first line pharmalogic treatment for GH secreting tumors?

A. Ketonconazole
B. Bromocriptine
C. Octreotide
D. Cabergoline
E. Pegrisomant

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The New York Times has an interesting history of the potent malarial drugs derived from artemisinin.

In the 1960s, [Mao] got an appeal from North Vietnam: Its fighters were dying because local malaria had become resistant to all known drugs. He ordered his top scientists to help.

But it wasn’t easy. The Cultural Revolution was reeling out of control, and intellectuals, including scientists, were being publicly humiliated, forced to labor on collective farms or even driven to suicide. However, because the order came from Mao himself and he put the army in charge, the project was sheltered. Over the next 14 years, 500 scientists from 60 military and civilian institutes flocked to it.

[...]

China’s effort formally began at a meeting on May 23, 1967, and was code-named Project 523, for the date.

Researchers pursued two paths. One group screened 40,000 known chemicals. The second searched the traditional medicine literature and sent envoys into rural villages to ask herbal healers for their secret fever cures.

One herb, qinghao, was mentioned on tomb carvings as far back as 168 B.C. and praised on medical scrolls through the centuries, up to the 1798 Book of Seasonal Fevers. Rural healers identified qinghao as what the West calls Artemisia annua, or sweet wormwood, a spiky-leafed weed with yellow flowers.

Worth a read without a doubt. Interesting stories like this make the New York Times the best newspaper in the world.

What anesthetic agents should be avoided during neuromonitoring?

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A two month old survey by Deloitte [PDF] of physicians opinions on health care reform has drawn some very differing conclusions from partisan commentators.

The 501 physicians answered a number of questions, the most notable of which included a dichotomous question on whether the Affordable Care Act was “A good start” or “A step in the wrong direction”. The question was split 44% to 44%. All respect for Mr. Pollack and Dr. Murthy writing for The New Republic who find the sum of survey data to date equivocal, including the recent small Deloitte survey, but, it seems to me, despite that single question, that physicians, at least as much as the general public, have a distaste for the ACA which is not improving.

In that same Deloitte report 69% of physicians responded “Yes: I think the best and the brightest who might have considered medicine as a career will think otherwise” when posed to rate the “Impact of health reform on the future of the medical profession.” Previous surveys as the debate over health care reform raged last year found similar dissatisfaction amongst physicians with the Affordable Care Act. The act remains very unpopular, with a plurality of Americans opposing it and a large majority continuing to oppose an individual mandate. Despite implementation of more than a few parts of the law, that opposition amongst the public has barely budged. And neither, seemingly, has the opinion of physicians moved.

Attempts to paint widespread support for the act amongst physicians is misplaced.

A better way to gauge these issues is to examine how physicians and the organizations which represent them actually behaved during last year’s health reform. One wouldn’t know from Pipes’ article that the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, the American College of Surgeons, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American Osteopathic Association, the American Psychiatric Association, and the American College of Cardiology all endorsed last year’s health reform. These groups represent hundreds of thousands of physicians across a wide range of medical sub-specialties.

Its true that, like physicians as individuals, organized medicine’s reasons for supporting the Affordable Care Act were disparate, but at the highest levels of the largest organizations I promise you, pledges by the Obama administration to work towards a full Sustained Growth Rate formula fix and a feeling that physicians would be left out of the table served as the reasons to support reform far more than any true love for the provisions of the Affordable Care Act.

It’s wishful thinking that the public at large or physicians will come around to the Affordable Care Act, even once the most powerful provisions come online in 2014.

We believe that physicians will embrace the Affordable Care Act because the new law helps to address many critical issues that have long concerned physicians and patients—abuses and market failures in the provisions of health coverage, rising numbers of uninsured patients, variable quality, poor coordination of care, the erosion of primary care, and the lack of focus on prevention and public health. As the law’s main provisions kick in, physicians will see that it is, indeed, a big step in the right direction. We are sure that the new law will attract serious criticism. Real on-the-ground progress will provide the best rebuttal.

Here is how I imagine the next few years as it comes to physician and public opinion on the Affordable Care Act. The Supreme Court hears and decides the challenges to the individual mandate this term and strikes it down but allows the rest of the act to stand. Now you’re left, for the physician, with the bureaucracy of ACOs, CMS pushing pay for performance and best practice trials and independent of the ACA, but tainting the opinion of government’s role in health care in general, no SGR fix.

I can’t imagine a majority of physicians having a truly positive opinion of the ACA anytime soon.

Describe Turcot Syndrome.

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