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.
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.
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.
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.
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.
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.
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’.
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.
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.
Norton & McAfee Are Pending Release of a ‘Warning’
Implantable medical devices are often programed by radio frequency from outside the body. We’re talking about things like pacemakers, internal defibrillators, spinal cord simulators amongst other devices.
The example devices I cited above send little electrical shocks to various parts of your body (the heart in the case of the first two and the cord in the case of the latter). The generators that send the electricity can be programed to send various energy levels or to send at various frequencies or to send to various electrodes. There are a whole host of ‘options’ which can be customized. When you need to customize those options you don’t want to have to open up the patient and physically fiddle with the implanted generator.
Instead, these devices come with little (often wand shaped) computers, which you can put over the site of the generator on the external skin. The computer sends radio signals to reprogram (or even turn on or off) the generator.
Turns out that communication between the computer and the generator for the pacemaker or defibrillator or SCS is in no way encrypted.
Hopefully you see where this is leading. A team of computer scientists from the University of Massachusetts - Amherst and the University of Washington built their own little computer to talk to a commercial pacemaker and successfully reprogrammed it (including turning it on and off) inside a simulated human body. They hacked a pacemaker.
Fu and Halperin said they used a cheap $1,000 system to mimic the control mechanism. It included a software radio, GNU radio software, and other electronics. They could use that to eavesdrop on private data such as the identity of the patient, the doctor, the diagnosis, and the pacemaker instructions. They figured out how to control the pacemaker with their device.
“You can induce the test mode, drain the device battery, and turn off therapies,” Halperin said.
This type of disclosure of ’security holes’ by computer scientists on the good side of the aisle is common practice. The idea being they want to discover it, disclose it, force someone to fix it before someone malicious discovers the hack and does something bad with it.
Although they disclose the details of their endeavor entirely in their published paper and make their feat reproducible, it isn’t time to freak out. The hack is a complex and limited thing. It isn’t like someone on a NYC subway is going to have their pacemaker turned off tomorrow from across the car. Still, it is something serious which poses a small but real risk for patients and a liability for device makers.
So I recently upgraded to Wordpress 2.6 from some stoneage version of the blogging software. It wasn’t without it’s difficulties and I’m thinking my current 3 year old blog theme might need a little overhaul to make it more WP 2.6 compatible. We might just change the whole art design of From Medskool.
One of the reasons I finally upgraded my blog software is so that I could use the new iPhone Word Press application. This is my first post from my iPhone.
We’ll see how long I stay interested in mobile blogging. For now if you see any glitches since I upgraded to WP 2.6 let me know (I can promise you there are some glitches behind the scene).m
During the third and fourth years of U.S. allopathic medical education, the medical students are in clinics and hospitals getting hands on experience with patients. The affiliation between the medical student’s school and the hospitals in which students rotate is typically not a financial one but often involves health care facilities with a mandate and mission for education on top of their primary one to provide care.
In New York City that is about to change. A for profit Caribbean medical school, St. George’s University, has essentially bought spots for its medical students to rotate in New York City public hospitals. Those public hospitals are run by the New York City Health and Hospital Corporation who recently signed a potentially $100 million dollar deal with the Caribbean medical school, which plays host largely to U.S. citizens who did not get into American allopathic medical schools.
New York City’s Health and Hospitals Corporation has signed a 10-year, $100 million contract with a profit-making medical school in the Caribbean to provide clinical training for hundreds of students at the city’s 11 public hospitals.
The unusual deal, proposed by a member of the corporation’s board who has long worked for the Caribbean school, has been met by an outcry from New York medical schools fearing that clerkship slots will grow scarcer and that they might have to increase tuitions to compete.
Under the contract, which was signed last year but never publicly announced, St. George’s pays the hospitals $400 to $425 per student per week — St. George’s charges students about $1,000 a week in tuition — on top of an annual fee of $50,000 for hospitals that take 24 or more St. George’s students.
“If that $400 per week per student algorithm were applied to the New York schools, I think it’s not affordable and it would certainly be a problem,” said Dr. Brotman, estimating that it would cost N.Y.U. $2.8 million per year. “I don’t come at this from a quality point of view. I come at this from a volume and logistics point of view.”
[...]
“This changes the whole dynamic from an academic relationship to a dollar-based relationship,” said Dr. Michael J. Reichgott, associate dean for clinical affairs and graduate medical education at Albert Einstein College of Medicine in the Bronx.
As above, one of the major concerns is the implications of this for allopathic medical students in New York City. Many public hospitals are primary teaching affiliates of medical schools within the city. Those schools include Albert Einstein, Mount Sinai, New Your University, Cornell, and Columbia.
On top of that, the deal is a major grab for St. George’s in the highly competitive world of for profit medical education. U.S. clinical rotations are a near necessity for these Caribbean medical schools, as most students there are Americans and aspire to come back and do a residency in the U.S. Caribbean medical schools have affiliations with hospitals all over the U.S. but having such a large number of rotator positions in one city and at such diverse and well experienced hospitals as Bellevue and others means that St. George’s has really staged a bit of a coup. And they intend to keep it that way,
The contract also bans the hospitals from providing clerkships to other Caribbean medical schools — a critical provision to St. George’s, which has faced heightened competition in recent years, particularly from Ross University on the island of Dominica, part of DeVry Inc., a publicly traded educational company, since 2003.
The member of the Board of the NYC Health and Hospital Corporation who brought the deal forward to be considered was a graduate of St. George’s and serving in the school’s Dean’s Office. Although he recused himself from discussion on the deal, he has since resigned from the Board of the Health and Hospital Corporation.
The board member, Dr. Daniel D. Ricciardi, submitted a brief letter of resignation to the president of the corporation, Alan D. Aviles.
Dr. Ricciardi had come under fire from officials of New York-based medical schools for his role in securing the contract for the city’s 11 public hospitals to provide clinical training to students from St. George’s University School of Medicine in Grenada.
[...]
He was promoted to dean of clinical studies at St. George’s, overseeing the clinical clerkships, just before the contract was signed a year ago.
Okay, my tone might’ve implied differently above, but I actually don’t have a problem with this. Why shouldn’t these rotation spots be up for bidding? Especially considering this is an infusion of revenue into a financially troubled public hospital system. It can do nothing but improve the health of the populace of New York City. The more prestigious schools within the city limit should be eager and willing to face the challenges of competition, even from ‘for-profit’ medical schools. As if the title ‘for-profit’ somehow diminishes the medical schools goals or the education they give their students.
As for Dr. Ricciardi, we can’t know his influence in the matter sitting on the other end of a NYT story. However, it appears, per everyone’s word, that he recused himself and did not participate in the debate. He seems a very….outspoken gentleman…and his comments and actions after the accusations started flying towards him might have as much to do with his resignation as any impropriety in the whole deal between SGU and the NYC HHC. Still, just based on what is at stake an investigation is probably in order. Hopefully the HHC won’t cow to the weight of the medical schools in the city, unless they actually find something wrong in the methodology of the deal they reached with St. George’s.
But that’s just another two cents into this whole debate.
Because I’ve recently taken the day-to-day running of Grand Rounds over, From Medskool was blogrolled by the LA Times. And because they listed the medical blogs alphabetically this blog is actually at the top. Pretty cool. There’s a lot of really good blogs listed; everything from big guys like Kevin to small guys like myself. You should go check out as many of them as you can.
I did my undergrad work in USC's School of Cinematic Arts. I have a Bachelors of Fine Arts in Writing for Screen & Television. I loved it, but a future of waiting tables and taking meetings with B-List producers was not for me.
This blog is ostensibly to discuss healthcare policy and maybe educate a few of my fellow medical students. But it will stray into current events, politics, and other science topics when they draw my interest
Other odd notes about me:
I've skied half the resorts on this list (Squaw Valley/Lake Tahoe, Snowbird/Park City, Whistler, Taos, Vail)
I "played" lacrosse in high school and through a club level team in college
Nothing on this website is to be taken as medical advice. I am not a physician. Please consult a physician concerning any health related questions.
This blog is entirely self funded. It accepts no advertising or other supporting revenue. The author has no relevant financial relationships to disclose.
Unless otherwise noted the media on this blog is under the copyright of the blog author, used under a Creative Common or free use license with appropriate accreditation or is in the public domain. If you believe images or video posted on this blog are copyrighted works used inappropriately please contact me.
Endorsements
"Please be more precise in your practice of medicine than you are in your blogging!"
- Mark Lanier
