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Commentary on medical news by a practicing physician.



Updated: 2017-04-13T12:45:29.004-04:00

 



4 Comments

2008-12-11T01:15:46.956-05:00

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Year's End, Blog's End: I've been making my annual year end inventory - deciding what to keep and what to toss. It's become obvious in the past several months that this blog is one of the things that it's time to toss. This will be the last post for Medpundit. Truly.

Wishing you all the best in 2008 and the years beyond.

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Pilgrim Medicine

2007-11-22T20:31:07.253-05:00

Thanksgiving Remembrance: Mayflower Medicine.



Genetic Prejudice

2007-11-12T22:16:52.109-05:00

Any Excuse Will Do: Any excuse to justifying prejudice, or to stir up fear mongering of what may come: At the same time, genetic information is slipping out of the laboratory and into everyday life, carrying with it the inescapable message that people of different races have different DNA. Ancestry tests tell customers what percentage of their genes are from Asia, Europe, Africa and the Americas. The heart-disease drug BiDil is marketed exclusively to African-Americans, who seem genetically predisposed to respond to it. Jews are offered prenatal tests for genetic disorders rarely found in other ethnic groups.Such developments are providing some of the first tangible benefits of the genetic revolution. Yet some social critics fear they may also be giving long-discredited racial prejudices a new potency. The notion that race is more than skin deep, they fear, could undermine principles of equal treatment and opportunity that have relied on the presumption that we are all fundamentally equal."We are living through an era of the ascendance of biology, and we have to be very careful," said Henry Louis Gates Jr., director of the W. E. B. Du Bois Institute for African and African American Research at Harvard University. "We will all be walking a fine line between using biology and allowing it to be abused."We have been living in an era of ascendant biology since Darwin. Remember eugenics? Jews have been offered prenatal testing long before the mapping of the human genome, as have African-Americans. But prenatal screening is not quite the same as the eugenics movement heyday. So why the hyperventilating? It turns out that the Times is taking its cue from blogs commenting on studies studies like this. Well, if the blogs say that genetics justifies prejudice, it must be true! I never thought I would see the day that the New York Times took that attitude on its front pages. It must be part of their plan to join the internet age. Here's the part that's gotten the Times convinced that genetics is going to bring back the days of institutionalized prejudice:There exists a publicly available gene database, The HapMap Project, that contains random samples of genetic sequences from people in China, Japan, Nigeria, and people in the United States with European ancestry. It’s now possible to search the HapMap database for genes that have been linked with intelligence in published scientific studies. In this manner, we can determine if high intelligence genes occur with greater or lesser frequency in the various races.Now, here’s an interesting point. If even a single gene correlated with intelligence occurs with different frequencies in the different races, this alone proves that there are racial differences in intelligence. How is that? Well, the egalitarian theory holds that every race has identical intelligence. Therefore, whatever genes there are that affect intelligence, they must be distributed exactly equally in all human races. Once even a small race difference is proven, the egalitarian theory is proven false. At that point, it’s only a matter of determining which race has the higher average intelligence based on the genetic evidence.Oh, please. Here's a take home lesson for everyone on the science of genetics, and one that should never be forgotten - these studies are about associations of genes with traits, not the concrete coding of a trait by a given gene. Just because a locus on a chromosome can be found more often in people with schizophrenia than in the general population doesn't mean that everyone with that genetic code in that spot will have schizophrenia, anymore than it means that every sibling of a schizophrenic will have the disease. Ditto with intelligence. Ditto, too, with cancer risks and most other traits and diseases human genome mapping is linking to genes. The essence of a man is not written into his DNA. Here's another important point to remember - our science is still young and uncertain:These genomewide association studies have been able to examine [...]



Veteran's Day Remembrance

2008-12-11T01:15:47.136-05:00

In Remembrance: (image)
Winged Victory


Veteran's Day movie recommendation - Wooden Crosses.

Veteran's Day medical reading - the influence of World War I on heart surgery.



A Word About MRSA

2007-11-05T18:13:25.474-05:00

A Word About MRSA: I've been fielding a lot of doorknob questions about MRSA lately. (Doorknob questions= questions thrown out just as my hand reaches the doorknob to leave the room.) Little wonder. It's been in the news again and again, and has even prompted the closing of schools and cancelling of football games. Despite what some editorialists say, it is being framed as a threat to our children. Here's an example of the typical coverage: A 16-year-old Springfield High School junior remained in serious condition Friday in the intensive-care unit of Akron Children's Hospital with a drug-resistant staph infection. Michael Forester of Lakemore was hospitalized Oct. 24 and was to undergo surgery Friday, said his mother, Mary Baxter. "The more prayers I can get, the better," Baxter said Friday at the hospital. On Wednesday, Springfield School Superintendent William Stauffer, in a letter sent to parents, acknowledged that a student had become ill and was admitted to the hospital. The superintendent said rumors that the student has a contagious disease that puts other students at risk and that the high school has an ongoing problem with staph infections are not true. Stauffer could not be reached for comment Friday.What is this MRSA? A better question might be "What is SA"? The "SA" in MRSA is Staphylococcus aureus, a bacteria that resides in our nasal passages and skin. That is its habitat. Normally, it causes us no problem, but if conditions are right, it can make us quite ill. It's often the culprit behind boils and styes and cellulitis and urinary tract infections. It can also cause more serious infections such as pneumonia (as in the case of the young man in the linked to article above), meningitis, sepsis, endocartditis, and osteomyelitis. It is one of the most common causes of sepsis. Penicillin conquered Staph infections for a little while, but the bacteria acquired resistance within a few years of the antibiotic's introduction. When penicillin became widely used in the community, the population of Staph aureus living in noses and on skin shifted toward those containing an enzyme that could cut the betalactam ring on penicillin, rendering it ineffective. New antibiotics were developed to get around this. One of those antibiotics was methicillin, which brings us to the "MR" part of "MRSA". We don't use methicillin any longer. We use drugs like Augmentin instead. But, when we say that a Staph aureus infection is "methicillin resistant" we mean that it's resistant to all penicillins, even those that were developed to get around the betalactam-eating defenses of the Staph aureus population. This doesn't mean that it's resistant to all antibiotics, however, just the ones that we typically use for a Staph infections. In the hospital, we often use vancomycin for MRSA infections. In the outpatient setting, we use drugs like Bactrim and clindamycin. In most cases, the infections respond nicely to these drugs. There is, however, concern that the bacteria may one day develop resistance to these, too, as we use them more to treat the growing resistant population of Staph. So here are the take home points about MRSA:1) It isn't running amok in our schools like the blob or killer tomatoes. It's living on our skin and nasal passages just as it always has before it developed resistance to penicillin and its cousins.2) One of the reasons bacteria acquire resistance is because we expose them to antibiotics when we don't need to. Don't insist on an antibiotic for every runny nose, even if the snot is yellow. And don't insist on one of the special antibiotics for MRSA for every pimple or pustule or red scratch. If we overuse our remaining effective antibiotics, we'll only end up with a population of Staph aureus that is resistant to those, too.3) Don't freak out if you or your child develops a skin infection. Most staph infections are easily treatable. Even most MRSA infections are easily treatable.4) When you read the news[...]



Trusty Dentist

2007-11-03T18:01:12.716-04:00

Trusty Dentist: Not so trusty with music and a drill.



All Saints Medical

2007-11-01T21:58:15.605-04:00

All Saints' Day: A list of medical saints - albeit an incomplete one.



Lipo-Etching

2007-11-01T21:51:37.747-04:00

Forever Young, Forever Firm: Lipo-etching- maybe not all it's cracked up to be.



Statistics, Politics, and Medicine

2007-11-01T21:43:53.674-04:00

Lies, Damned Lies, and, Well, You Know: The New York Times is parsing Rudy Guiliani's prostate cancer statitistics:"I had prostate cancer five, six years ago," Mr. Giuliani, a Republican presidential candidate, said in a speech that has been turned into the radio commercial. "My chance of surviving prostate cancer — and, thank God, I was cured of it — in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44 percent under socialized medicine.".... The Office for National Statistics in Britain says the five-year survival rate from prostate cancer there is 74.4 percent. And doctors also say it is unfair to compare prostate cancer statistics in Britain with those in the United States because in the United States the cancer is more likely to be diagnosed in its early stages."Certainly, if you intensively screen for prostate cancer, you will find early disease,” said Dr. Ian M. Thompson, chairman of the department of urology at the University of Texas at San Antonio. "And simply because you find it earlier, you will always have longer survival after the disease is diagnosed."One reason that prostate cancer is diagnosed earlier in the United States than in Britain is that they don't screen for it at all in Britain - at least not at the expense of the NHS. (Which is one of the reasons they spend less on healthcare than the United States. They don't indulge in as much screening as we do.) At any rate, his statistics don't appear to be all that far off the mark, at least for men in their 80's. But even the NHS admits that prostate cancer survival is increasing because more people are starting to have their PSA checked - meaning that slow growing early cancers are being added to the mix, just as happens here in the US. As it happens, even back in 2002, the five year survival rate for prostate cancer in the US was 99% - still a much better figure than the UK's 71%. But, as the astute bloggers point out, prostate cancer isn't the best example of the benefits of screening. Prostate cancer is, in most cases, slow growing - and although our screening policies detect many early cancers that would never do harm if left undetected, we also end up spending a lot more money treating these same cancers. When given the choice between watchful waiting and removal, many choose removal. (Another reason why we end up spending more and being less healthy in surveys like this.) But the Astutes take a closer look at cancer in England and cancer in the US:See this report, entitled "Cancer Survival Rates Improving Across Europe, But Still Lagging Behind United States" (and remember that England's rates, not broken out, are among the worst in Europe).Taking recent figures, female five-year cancer survival rates are 62.9 per cent on average in the US and 52.7 per cent in England. To compare America's privately insured with England's NHS patients, you'd need to bump up that American survival rate a bit (the uninsured most likely have lower survival rates--otherwise why worry about universal coverage) and bump down the English one (because some Brits have private insurance, and so buy better care).Nationally, American cancer survival rates are significantly better. Certainly not by the 40-point margin Giuliani implied, but still.Looks like the truth is somewhere between Rudy and the Times.[...]



Eliminating Cold Medicine

2007-10-29T08:10:31.455-04:00

Take Some Tylenol and Call Me in the Morning: What will we do without cough and cold medicine? I can hear it now, that familiar refrain - "Tylenol doesn't do anything." And it doesn't, at least not for runny noses, sneezes, and coughs, despite what the expert says:

Children’s Tylenol and Children’s Motrin, when sold by themselves, were excluded from the discussions because the medicines in those products, acetaminophen and ibuprofen, respectively, are safe and effective in treating fevers and aches even in young infants.

Tylenol and Motrin are sold in syrupy concoctions that help coughs because the syrup coats the back of the throat and calms cough receptors, said Dr. Ian Paul, a pediatrician at Penn State Children’s Hospital in Hershey, Pa., who consults for industry.

The committee skipped any lengthy discussion of antihistamines like Benadryl, because there is little debate that such medicines are effective for allergies. Benadryl, also known as diphenhydramine, also puts some children to sleep. But nearly all the experts said deliberate sedation should be discouraged.

The medicines that earned the most scorn were those commonly sold to treat coughs, runny noses and congestion, including dextromethorphan and phenylephrine.

None of them have any proven effect on children’s cold symptoms. All have risks.


The advisory panel is right, however, about the effectiveness of the medications. They are effective mostly in that they give a parent something to do so they don't feel as if they're standing by while their child suffers. The number of children injured by the drugs, however, has been exceedingly small:

A study by the Centers for Disease Control and Prevention found that at least 1,519 children younger than 2 had serious health problems from 2004 to 2005 after having been treated with common cold medicines. Three children died, the disease control agency found.


But the argument is, that if they don't do any good in the first place, then why tolerate any risk? But, according to this story, the pharmaceutical companies say the issue is accidental overdosage, not inherent risk in properly dosed drugs:

The Consumer Healthcare Products Association (CHPA), which represents manufacturers and distributors of over-the-counter medicines, said in a statement: "The data clearly show that these medicines are very safe when used as directed and that harm to this age group, while very rare, is attributable in most cases to accidental ingestion an issue of safekeeping that is best addressed through education."

So what to do? My recommendation would be not to use them. Runny noses and coughs aren't in the category of intolerable suffering, and these products aren't likely to be much benefit anyway.



Screening for Autism

2007-10-29T07:56:20.083-04:00

I Screen, You Screen: The American Academy of Pediatrics is recommending that all children be screened for autism. They've only press-released their recommendations, however, so it's difficult to assess them. Wouldn't it be nice if professional organizations actually released their recommendations to their members before they did so to the public? It would make it so much easier for doctors to discuss the news stories with their patients. They're releasing them today at their annual conference, and later in the November issue of their journal, which is not yet available online. (Though it may be in AAP member's mailboxes.)

Part of any well child visit is screening for developmental delays, so one has to wonder what's different about these recommendations. Are they setting lower limits for what's abnormal so that those mild cases of autism (which some argue aren't really autism or even disease) can be treated? If that's the case, then don't be surprised when a couple of years from now there's a upward spike in the number of cases of autism. And don't blame it on vaccines.



Magnet-Free Europe

2007-10-28T22:19:16.413-04:00

Magnet-Free Europe: For some reason, the EU was proposing severe restrictions on the use of MRI scans, a proposal which has been halted- for now. Here's the reasoning behind the original restrictions:

The Directive was drafted by DG Employment, with the aim of minimising workers’ exposure to electromagnetic fields (EMF). Currently eight million MRI patient examinations per year are carried out in Europe, said Professor Dag Rune Olsen, who works in experimental radiation therapy at the Norwegian Radiation Hospital, Oslo, Norway, and is chairman of the physics committee of the European Society for Therapeutic Radiology and Oncology (ESTRO). “But these are likely to have to stop, since the Directive sets limits to occupational radiation exposure which will mean that anyone working or moving near MRI equipment will breach them, thus making it possible for them to sue their employers. Even those maintaining or servicing the equipment may be affected,” he said.

Radiation exposure? MRI's don't emit radiation, they detect the magnetic spin of atoms. The EU is worried that workers will be mesmerized by the MRI's. Sally Szwarc has more.



Spooky Skulls

2007-10-28T21:58:50.735-04:00

Spooky Skulls:Spooky brain pictures. Background here.



Preventing Alzheimer's

2007-10-28T21:48:23.572-04:00

Of Mice and Mazes: Do high blood pressure medications prevent Alzheimer's? They do in mouse brains - in test tubes and in mazes:

The researchers then tested Diovan in mice that were genetically at risk for Alzheimer's disease.

Some of the mice drank water laced with Diovan. Their Diovan dose was lower than that used for people with high blood pressure.

For comparison, other mice got ordinary water without Diovan.

After drinking their assigned water for 11 months, the mice took a memory test in which they had to learn and remember the path through a watery maze.

The mice that drank the Diovan water fared best in the maze test.

But when the researchers tested mice without the dementia gene glitch, Diovan treatment didn't help or hurt the mice navigate the watery maze.


We'll have to wait a while to see how this pans out. What works on mice in mazes doesn't necessarily work on men in mazes.



In Error

2007-10-28T21:35:50.908-04:00

Errors, Errors: The sad story of a medical error and learning to deal with errors.



Inspiring Lives

2007-10-28T18:08:15.084-04:00

Inspiring Lives: Speaking of the supreme champion of eugenics, here's an inspiring story from the days of his reign.



Medical Sci-Fi Contest: Please Meet the Winner! - Medgadget - www.medgadget.com

2007-10-28T21:04:43.344-04:00

Medical Science Fiction: Late to the party, but here are the winners of Medgadget's Medical Sci-Fi Contest. Enjoy.



Eugenics Past and Present

2007-10-28T08:52:14.517-04:00

Eugenics Past and Present: I've been reading an essay from 1907 by David Starr Jordan, a great mind of his time - scientist, peace activist, president of Standford, and eugenicist. The essay is the The Human Harvest, an anti-war argument grounded in eugenics. From a eugenics perspective, wars are bad because they kill the best men, leaving behind the weakest to perpetuate the race- and weaken the human harvest. Even in the service of a profound good the the callousness and cruelty of eugenics:Startling results may follow from the selective breeding and preservation of paupers. In the valley of Aosta in northern Italy, and in other Alpine regions, is found the form of idiocy known as cretinism. What is the primitive cause of the cretin, and what is the causal connection of cretinism with goiter, a disease of the thyroid glands which always accompanies it, I do not know.It suffices for our purpose to notice that the severe military selection which ruled in Switzerland, Savoy, and Lombardy for many generations took the strongest and healthiest peasants to the wars, and left the idiot and goitrous to carry on the affairs of life at home. To bear a goiter was to be exempt from military service. Thusin some regions the disease has been a local badge of honor. It is said that when iodine lozenges were given to the children of Savoy in the hope of preventing the enlargement and degeneration of the thyroid gland, mother would take this remedy away from the boys, preferring the goiter to military service.In the city of Aosta the goitrous cretin has been for centuries an object of charity. There is a special hospice or asylum devoted to his care and propagation. The idiot has received generous support, while the poor farmer or laborer with brains and no goiter has had the severest of struggles. In the competition of life a premium has thus been placed on imbecility and disease. The cretin has mated with the cretin, the goiter with the goiter, and charity and religion have presided over the union. The result is that idiocy is multiplied and intensified. The cretin of Aosta has been developed as a new type of man. In fair weather the roads about the city a re lined with these awful paupers - human beings with less intelligence than the goose, with less decency than the pig.No acknowledgment that those cretins might have even a glimmer of a soul. The disabled are genetically impure. Eugenics caught up with the goitrous of Aosta. They were forbidden to marry and ceased to be a pollute the public streets. They also became a celebrated example of the power of eugenics to improve the human harvest public health. Many an American eugenicist cited the success of Aosta in ridding itself of goitrous cretins when advocating state eugenic boards.David Jordan Starr must have been horrified by World War I and it's toll on the best and brightest. he died in 1931, before the supreme triumph of eugenics in Europe. No doubt, he would have argued that eugenics was misused in Europe precisely because the best men had all perished on the battlefields of World War I. But the problem with eugenics is its denial of the humanity of those it deems unworthy - whether they be cretins or those with seizure disorders (they were sterlized, too, under the compulsory sterilization laws) or Jews.Science (and society) has pretty much given up on the old fashioned eugenics that relied on controlling reproduction the same way one would in plants or livestock. But we still flirt with eugenics using modern methods of RichardDawkins.net>genetic selection. It might not seem like eugenics because it isn't imposed by[...]



Micropractice vs. Reality

2007-10-27T23:06:57.707-04:00

My Long Absence: I have been away too long from the internets and blogosphere. These forced, long absences always leave me a little depressed. But just as I was leaving for a conference in Chicago about a month ago, events forced me into an ideal micropractice. What does that mean? It means I'm short staffed and doing a lot of extra work myself.

There are two schools of thought when it comes to the business of running a medical practice. The conventional wisdom is that it's a waste of a doctor's productivity to do the small things - rooming a patient, getting the vital signs, giving shots, performing EKG's. It's a better use of resources to have someone else do those things while the doctor concentrates on treating the patient. Some physicians take it even farther - they have ancillary staff take the history and they just concern themselves with the exam and plan. (Not being someone who practices this way, I give them the benefit of the doubt and assume that they confirm that history before acting on it.) In theory, this allows them to see more patients. This is basically my style of practice. Except for this short staffed month.

This month, I've been almost practicing the ideal micropractice way. In the ideal micropractice the doctor does everything himself to reduce overhead. At least, that's the original intent, but even the micropractice guru has hired a nurse to help him out. One of my friends has a micropractice, and she keeps telling me that I do, too, but I don't believe I do. Once you start hiring staff, are you really a micropractice or just a solo practice?

The truth of the matter is that micropractices work only for micropopulations. Most people who practice that way limit themselves to 200-500 patients, whereas traditional practices handle 1500-2000. So which is better for the public good? A practice that can treat more patients and provide jobs or one that sees few patients and has no employees?



Talladega Germs

2007-10-14T12:13:53.710-04:00

Talladega Germs: This was some overly cautious and politically foolish advice:NASCAR fans might seem rabid, but are they actually contagious?Getting a hepatitis shot is standard procedure for travelers to parts of Africa and Asia, but some congressional aides were instructed to get immunized before going to Lowe's Motor Speedway in Concord and the racetrack in Talladega, Ala.....Staff who organized the trips advised the NASCAR-bound aides to get a range of vaccines before attending -- hepatitis A, hepatitis B, tetanus, diphtheria and influenza.Some thoughts: 1) It isn't influenza season, so getting a flu shot now to protect you in Alabama for the weekend is useless. (But not a bad idea if you're thinking forward to January or February 2008.) 2) The hepatitis B vaccine is a series of three shots given over six months. They won't be getting much protection from one shot given just before the trip. Unless the staff is travelling to Alabama with the expectation of one night stands and IV drug needle sharing, the hepatitis B vaccine seems a bit superfluous. (Even for international travel, it's only recommended if a person is expected to have contact with blood or the sex industry.) 3) If there's been an outbreak of hepatitis A among food vendors at the race track, then that makes sense, but evidently that isn't the case. 4) Tetanus is everywhere. Always keep your tetanus booster (which comes included with diphtheria) up to date.In defense of Congress, the organizers say that their staffers were going to be visiting hospitals and police stations where they had the potential to be exposed to hepatitis. Maybe. But unless they were planning to subdue the criminal elements and nurse the ill themselves, they didn't really need the shots. As it turns out, what they really needed was carpal tunnel splints:Walker said he hadn't recommended the immunizations, nor were they necessary. He suggested a possible health risk to them was the voluminous notes they took."I'm sure they needed to soak their wrists, they wrote so much," he said.UPDATE: More on the thinking behind the advice:Homeland Security Chairman Bennie Thompson of Mississippi said he never meant to offend or scare anyone about health risks at the races. The measure was advised to provide congressional staff with the same disease protection first responders get, especially as they head out on a series of fact-finding missions around the country."It's not about whether the people have shots. ... Our staffs as they go forward will be going into sterile areas, they will be working in public health facilities, they will be talking to many holding facilities where criminals are being held...."The NASCAR event is just one date, but after that they will be doing a number of things," said Thompson, adding that the World Series and Super Bowl are two other mass gatherings that are going to be researched for readiness.During the trip to North Carolina, staffers were to visit a medical facility with patients at the Lowe's Motor Speedway. They were also set to inspect an empty mobile hospital. After the House physician told Republican staffers that shots were not necessary to go to North Carolina, they didn't get them. Democratic staffers reportedly did.That explains the influenza shots, anyway.[...]



Alzheimer's and duty

2007-10-02T07:30:26.711-04:00

Blessed are the Dutiful: Being a conscientious person prevents Alzheimer's dementia:

The Rush University Medical Center in Chicago examined nearly 1,000 Catholic nuns, priests and brothers.

Those who rated themselves highly conscientious had an 89% lower risk of Alzheimer's than those who thought they were the least self-disciplined.


What do you suppose the term "conscientious" means to a person in holy orders? Does it mean the same to those of us who are non-religious or living in the secular world? To me, conscientious means trying hard not to overlook any detail in a history, physical, lab, or x-ray result. To a nun or brother, it's more likely to mean praying a lot. Not quite the same sort of brain activity.

The full text isn't available without a fee, but here's the abstract. The BBC report provides some details, though:

None of the participants had dementia when the study started in 1994, but 176 went on to develop the disease.

The researchers asked the volunteers to rank themselves on a five-point scale to determine just how conscientious they were. They also carried out medical and neurological tests each year until 2006.

The average score on the conscientious test was 34. Those who scored 40 or higher were found to be much less likely to develop Alzheimer's, and had a slower general rate of mental decline than those who scored 28 or lower.

When the researchers took into account a combination of risk factors, including smoking, inactivity and limited social connections, they still found that the dutiful people had a 54% lower risk of Alzheimer's compared to people with the lowest scores for conscientiousness.


We don't know how significant that "54% lower risk" is, however. It could be the difference between 2 and 1, or between 100 and 50. Take this one with a grain of salt.



The Wife Factor

2007-10-02T07:18:23.651-04:00

Intrusive Homelife: Does it matter if a candidate is glued to his wife?The fact is that people inside the Giuliani campaign are appalled at the number of times their candidate has felt compelled to interrupt public appearances to take calls from his wife. The estimate from those in a position to know is that he has taken such calls more than 40 times in the middle of speeches, conferences and presentations to large donors. "If it's a stunt, it's not one coming from him," says one Giuliani staffer. "It's an ongoing problem that he won't take advice on."And in trying to explain his odd behavior, Mr. Giuliani has only dug himself in deeper. On Friday he told David Brody of CBN News that since 9/11, when he and Mrs. Giuliani get on a plane, "most of the time . . . we talk to each other and just reaffirm the fact that we love each other." He admitted he had taken calls from his wife "before in engagements, and I didn't realize it would create any kind of controversy." That's hardly possible. Giuliani staffers say he has been warned over and over again that the phone calls are rude and inappropriate and have alienated everyone from local officials to top donors to close friends.Consider a spring incident in Oklahoma City. Mr. Giuliani spoke twice at the Oklahoma History Center, first at a small private roundtable for $2,300 donors and then to 150 people who donated $500 apiece. Ten minutes into the roundtable, Mr. Giuliani's phone rang. He left the room to take the call, apparently from Mrs. Giuliani, and never returned. The snubbed donors received no explanation. "The people there viewed it as disrespectful and cheesy," says Pat McGuigan, a local newspaper editor who was asked by the Giuliani campaign to moderate the roundtable.An hour or so later, Mr. Giuliani was speaking to the bigger group of donors when his phone rang again. While he spoke with his wife, he invited her to say hello to the assembled crowd. "It was remarkable, and was not viewed by the audience in a positive way," public relations executive Brenda Jones told me.I've been told of many other incidents, from a California fund-raiser to a Florida speech to a gathering with top donors at Bear Stearns in New York. At the Bear Stearns meeting, Mr. Giuliani took a call from his wife and then noting the strained faces of his supporters, he sheepishly tried a joke. "I've been married three times," he explained. "I can't afford to lose another one. I'm sure you understand." (Mr. Giuliani's media office didn't return a call I made to them on Friday afternoon.)This brought back memories of people I've known. There was the doctor who was always a half hour late coming back from lunch (spent daily with his wife) who used the same excuse about multiple marraiges. There was another who was perpetually behind because his wife paged him several times a day. He always dutifully left the exam room to answer his page, as if every one were an emergency. Judging from the office end of the conversations, they never were - "Yes. Yes. I love you, too." There was always a general disdain in the workplace for these men. For one thing, it's irritating to the staff who are trying to get a job done only to be constantly delayed by the out of skew priorities of their boss. For another, it sends a loud and strong signal that nothing is as important to these men as their wives. And they are always men, never women, as the inelegant phrase that so aptly describes their emotional servitude proves. There's probably no hope for Gui[...]



Power of the Gods

2007-09-26T08:20:51.388-04:00

The Power of the Gods: Medical infallibility.



Universal Pander

2007-09-26T08:21:29.788-04:00

The Universal Pander: There's nothing like a presidential election to bring out the healthcare crisis. And, since the presidential primary process is stretching into a two year long spectacle, there's been no shortage of proposals on how to fix our current system. Recently, Dennis Kucinich pointed out that his ideas are the closest thing to what the American people want:In a CNN poll this spring, 64 percent of respondents said the government should "provide a national insurance program for all Americans, even if this would require higher taxes," and 73 percent approve of higher taxes to insure children under 18. Those results track New York Times and Gallup polls last year, in which about two-thirds of respondents said it is the federal government's responsibility to guarantee health coverage to all Americans.Such polls allow Kucinich to joke that, far from being in the loony left, "I'm in the center. Everyone else is to the right of me." Ask the American public a different question about the healthcare system, and you'll get a different answer:For the fifth time in six years, Harris Interactive has asked the insured public to rate their own insurance plans. Two thirds of them continue to give their plans an A or a B, with only 10% giving them a D or an F. Substantial but not overwhelming majorities continue to say that they would recommend their own health plans to family members who are basically healthy (76%) or who have a serious or chronic illness (68%).Health insurance companies are like politicians. We dislike all but our own. We should be careful what we wish for, however, for it won't just be our own politicians designing a nationalized health insurance plan; it will be all the others that we dislike, including politicians who believe hospital pork is a public service, that healthcare and personal autonomy are mutually exclusive, and that the right to earn a living takes second place to health insurance.What are people really wishing for when they say they wish for a single nationalized health insurance program? Security. Our current employer-provided system means that most of us are just a pink slip away from losing our insurance coverage. It also means that, deprived of the bargaining power of large corporations and unions, the self-employed are left with fewer choices and higher premiums. Handing over the whole kit and kaboodle to the government is a seductively simple solution. But it would also be a very expensive solution. The British are often held up as the standard to which we should aspire. But we don't live under a British style of government. We live under a government that's truly government of the people, by the people, for the people. And what the people want, the people get. Witness the influence of disease activism even now on disease specific government funding and treatment mandates. In England, the government only pays for colonoscopies to check for colon cancer if there are symptoms suggestive of cancer or a family history of colon cancer. In the United States, the Medicare pays for a colonoscopy every ten years for everyone over 50, regardless of symptoms or risk. So do many insurance companies., sometimes if not by choice, by mandate. In England, mammograms are only covered for women between the ages of 50 and 70, and then only every three years. In the United States, we pay for mammograms beginning at age 40, yearly, and with no upper age limit. We just don'[...]



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2008-12-11T01:15:48.830-05:00

Zing the Body Electric: (image) Treating high blood pressure, circa 1907 (click images to enlarge and read the text):
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A close-up view of the blood pressure machine:

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- from Scientific American, August 24, 1907.

The report sounds so confident:

The important feature is that the cure - the reduction of arterial pressure to the normal value - is permanent, and that the progress of the arteriosclerosis is arrested by the removal of the excess of blood pressure.

Seems kind of silly today, but look - one hundred years on and we're still flirting with the idea.

Here's what else was going on in 1907, and here's an early twentieth century text on treating diseases with electricity.