Wednesday, November 30, 2005

Worth Every Penny

Slogging away at administrative duties -- meetings (ugh!; with administrators -- double ugh!!), phone calls, software problems, etc. -- have left me little time between surgeries to do any blogging. In the car, however, I have been able to listen to one of the finest series of lectures I have ever heard. My 20 minute drive to and from work these past several weeks has been enhanced by the fascinating Professor J. Rufus Fears. Prof. Fears is "David Ross Boyd Professor of Classics at the University of Oklahoma, where he holds the G.T. and Libby Blankenship Chair in the History of Liberty." That's all well and good, but for me he is quite simply an outstanding speaker and teacher. I have had the good fortune to have a friend who has purchased several of the "Great Courses" offered by The Teaching Company, and loaned me Prof. Fears' "The History of Freedom." I cannot recommend it highly enough, and plan to purchase my own copy for the surglings to watch before they run off to get their minds polluted at college.

Thursday, November 17, 2005

Birthday Kudos for Bill Buckley

National Review Online has a nice collection of plaudits for William F. Buckley, who will be turning 80 next week. A brilliant mind, coupled with the charm and wit to present the conservative view with ease, made Mr. Buckley instrumental in the development of the modern conservative movement. Take a look at what these NRO contributors have to say.

Way Cool

I just love stuff like this -- when smart people can take a new technology and make it into something really useful:

By coating the surfaces of tiny carbon nanotubes with monoclonal antibodies, biochemists and engineers at Jefferson Medical College and the University of Delaware have teamed up to detect cancer cells in a tiny drop of water. The work is aimed at developing nanotube-based biosensors that can spot cancer cells circulating in the blood from a treated tumor that has returned or from a new cancer......
The group took advantage of a surge in electrical current in nanotube-antibody networks when cancer cells bind to the antibodies. They placed microscopic carbon nanotubes between electrodes, and then covered them with monoclonal antibodies -– so-called guided protein missiles that home in on target protein "antigens" on the surface of cancer cells. The antibodies were specific for insulin-like growth factor 1 receptor (IGF1R), which is commonly found at high levels on cancer cells. They then measured the changes in electrical current through the antibody-nanotube combinations when two different types of breast cancer cells were applied to the devices......
"The breast cancer cells don't give a spike if there is a non-specific antibody on the nanotube," he says, "and cells without that target don't cause a current jump whatever antibody is on the nanotubes.
"This method could be used for detection and it could be used for recurring circulating tumor cells or micrometastases remaining from the originally treated tumor," Dr. Wickstrom explains.

This is only one example of the really great work medical researchers are doing with nanotechnology. The next steps will involve directly targeting tumor cells with "chemotherapy-armed" nanoparticles. Sort of reminds me of Fantastic Voyage, only without Raquel Welch's cleavage.

Tuesday, November 15, 2005

Grand Rounds

Doc Shazam at Mr. Hassle's Long Underpants is hosting Grand Rounds this week (that still has to be the best title for a medical blog). Surf on over and have a look at the best of the medical blogosphere this week.

Sunday, November 13, 2005

Baseballs and Dr. Pepper

I visited a grave yesterday. The sky was clear, blue, untroubled. The wind sent the last remaining leaves scurrying to and fro, forming little eddies around memorials large and small.

I had never met the young man buried there. He died a year ago, and his death, like most involving teenagers, had a profound effect on many in our community. He was the older brother of my middle child's close friend, and he died in a manner so sadly common today, one more blip on the DUI statistics chart.

As we drove through the cemetery, quietly searching for the tombstone, I could not but think about his parents. Good people, easy to talk to, folks I know only enough to share a few words with. Twelve months is scarcely time enough to let the pain slide into only profound sadness. I have many times this past year felt an emptiness in myself, inadequate to the simple task of expressing condolences. Not knowing the young man, I cannot feel his loss; I can't not feel for his family. But how does one tell the most casual of acquaintances that you grieve for them?

We had arrived after the office closed and had no map to guide our way. And yet my daughter somehow spied the marker, one among thousands. The gravesite was bedecked with flowers from those who had come to remember this young man, by all accounts a great kid. There must have been some who knew him well, leaving a few baseballs and bottles of Dr. Pepper at the base of the stone. When my only son asked what those mementos meant, I had no ready answer. They were an expression of love and regret, of the sorrow that only is felt in missing a friend who can never return, that touched me in a way the flowers did not. I could only hold his little 11 year old body close and pray that he would have the chance to grow old enough to understand.

About 18 hours before we took that quiet trip, I cared for a young man who drove his car into an immobile object at about 90 mph. ETOH level was a good 300, no seatbelt, fixed and dilated on arrival. The head CT showed enough swelling that the brain had a uniform flatness, with no discernible contours. After the tornado of activity in the trauma room subsided, it was clear to all, with the simplest of tests confirming it, that he was brain dead. Yet there was no one to call, no family known, no donor card signed. Nada. Zilch.

The next day, I stood in the wind hugging my kids in the cold bright daylight. I could not help wondering who will leave this new statistic flowers, hockey pucks, or bottles of pop in remembrance? And what other set of parents will awaken each day now so much older, with someone missing in their lives?

Buckle up. Teach your kids to buckle up. And take the time to remind them that drunk driving death statistics are made up of real people, including teenagers. If they don't quite get it, or just aren't listening, your friendly neighborhood ED is a good place for them to volunteer on a Friday night.

Tuesday, November 08, 2005

Grand Rounds No. 2, Vol. 7

Grand Rounds with a Star Trek theme is being hosted at the MSSP Nexus Blog -- go where many men have gone before to see the best of the medical blogs this week!

Monday, November 07, 2005

Doctors for Medical Liability Reform

As many physician bloggers will attest, there is a real struggle going on for the hearts and minds of Americans being waged over the issue of medical lawsuits. Up until the past few years, this fight was being engaged publicly primarily by trial lawyers. I certainly do not need to educate readers of this blog about my feelings regarding lawsuit abuse, "CYA" defensive medicine, the inequities involved in the current medical malpractice legal climate, etc. Let's just say that I'm not on the attorney's side here.

So, I was very excited when I received an e-mail about two months ago announcing the "Protect Patients Now" effort:

Protect Patients Now is a project of Doctors for Medical Liability Reform (DMLR), a coalition of 230,000 practicing medical specialists who are committed to protecting patients' access to healthcare by supporting federal legislation that will reform our nation's broken medical liability system.
The e-mail came from Tom Russell, M.D., the executive director of the American College of Surgeons; the chairman of Doctors for Medical Liability Reform is Stuart L. Weinstein, M.D., an orthopedic surgeon at the University of Iowa. I think the DMLR site is worth a visit for those wishing to see an admittedly one-sided view of this issue.

In my mind, this type of organized effort is welcome, albeit a bit tardy. Unfortunately, it also appears to be a little amateurish; the animations, which can be seen with IE but not Firefox, succeed only in demonizing trial lawyers. As much as some might feel that's appropriate, what is really needed is education, so that the public understands the personal costs of our current liability system. Actually, a coordinated effort that extends across multiple types of businesses would be the ultimate solution, with TV and radio ads expressing how children can no longer use certain types of playground equipment, why the ED physician orders a chest CT when his suspicion for a pulmonary embolus is essentially zero, why Starbucks has to have a written warning on each of its cups stating "Warning: the beverage you are about to consume is extremely hot," why there are so few vaccine manufacturers left in the US, why (you fill in the blank).....

Nobody is perfect 100% of the time, whether that person is a physician, policeman, butcher, or even attorney. Americans need to move beyond the "culture of blame," or we will continue to cannibalize our society. So, even with its shortcomings, I give a thumbs up to the DMLR freshman effort.

Sunday, November 06, 2005

The Sights and Sounds of Sausage Making

This item from Wednesday received little fanfare while being thrown out into the great media mixing bowl this week, but it is not without impact. Medicare is planning to reduce fees to physicians by 4.4% in 2006, while increasing payments to hospitals by at least 3.7%. This has been in the works for some time, and reflects a long trend of decreasing pay to physicians caring for Medicare beneficiaries; I have related posts here and here.

I was waiting over the past few days for some sort of response from the American College of Surgeons and from Congress -- I subscribe to both the ACS's weekly "ACS NewsScope" e-mails and Senate Majority leader Bill Frist's "Weekly Health Report." The ACS gave it's standard line:

The College continues to urge Congress to pass legislation before the end of the year to stop the 4.4 percent cut from becoming effective. If Congress does act on this issue, it will most likely be tied to pay for performance. Fellows are strongly urged to contact their Representatives and Senators regarding this issue.
Interestingly, Senator Frist's e-mail missive said absolutely nothing that was not already included in the CMS press release (emphasis mine):
Wednesday, the Centers for Medicare and Medicaid Services announced a final payment rule for physicians and hospital outpatient departments. The final rule specifies that, based on the yearly update formula, payment rates per service for physicians’ services will be reduced by 4.4 percent for 2006 unless Congress acts. A provision to address the cut was included in the Senate Budget Reconciliation Bill. The rule also includes other policies affecting Medicare Part B services such as extending the glaucoma screening benefit and providing supplemental payments to federally qualified health centers (FQHCs) that contract with Medicare Advantage (MA) plans.

“The existing law calls for a decrease in payment rates for physicians in response to continued rapid increases in use of services and spending growth, and Medicare does not have the authority to change this,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “The current system is not sustainable, and the payment reduction offers further proof that we must move to a payment system that ensures adequate payments to physicians, but also supports high quality and efficient health care services. We want to continue to work with Congress toward a payment system that is more sustainable. In this rule, we continue to refine payment rates to reflect current medical practice, while doing all we can under current law to support physicians’ efforts to provide greater quality and efficiency of care for Medicare beneficiaries.”
It appears that the Senate did indeed pass the budget reconciliation bill (S 1932) late Thursday, but given the tortured process involved with getting bills through, I have been unable to determine if the above-mentioned provision was left intact --- a series of proposed amendments were voted down. Most of the attention given to this bill in the press has been centered around its provision to allow drilling in ANWR and its intended $35 billion deficit reduction. We may need to wait for a few days to determine if we will truly see a significant reduction in Medicare payments to physicians. Payment reduction will significantly impact the ability of Medicare recipients in many areas (mine included) to access primary care physicians....driving them to the ED for care....driving up health care costs.

Hopefully, someone with inside knowledge can read the tea leaves and let the rest of us know what is in the final bill.

Tuesday, November 01, 2005

Grand Rounds -- In Session

Grand Rounds is being hosted this week at Kidney Notes -- it's always worth perusing the best of the medical blogs!