Wednesday, May 13, 2009

A Solution For Health Care Costs

The government is willing to take over health care -- 17% of our GDP. They have no problem with the idea of usurping this large, complex, successful industry in the name of "the greater good" (no matter how much bad they do).

Why don't they take the gambling industry instead?

Why are the Bonnano heirs, Osceola heirs, and Trump heirs given state and federal permission (actually MY permission and YOUR permission)to TAKE money away from people at games that are UNWINNABLE,in what amounts to an absolute brain-dead free ride to zillions of dollars; and yet those who actually have succeeded and achieved and do provable good for people in the health care industry are to come under the thumb of tyranny?

Gambling will generate $92 billion in revenue this year in the United States. This money is generated by US citizens who insist on handing it over to casino owners's fun? Or entertaining?

Well, in the new era of Obama consciousness raising, and responsibility towards our fellow man and uninsured citizens...why don't we throw out the Trumps, Mafia, and Indians and take over the casino industry, have the government run that (better that than health care) and use the 92 billion dollars to pay for health insurance for everyone who's out there gambling with their Social Security checks? Eh?

This would stop the madness immediately.

We could keep the best health care system in the world and people would be whistling while they fueled the engine that pays for health care.

And we'd never have to see Trumps poorly-dyed combover ever again.

Don't see how you could refuse this.

Tuesday, May 12, 2009

Health Care Reform: What You can Expect

Pins and Needles, Needles and Pins

As money for real research, advanced care, and high-tech solutions to complex medical problems gets sucked up by a national bureacracy that will devour 60% of funds, you can expect that the medical establishment and the government will suddenly begin finding low cost alternative medicines, homeotherapy and "natural" remedies to your real problems.

You will see more and more promulgation of these low-cost solutions that can be delivered by some deficient 9-5 paraprofessional staffer at your local broken-down health care clinic. These therapies rely mostly on the placebo effect; however, there is no placebo effect possible for your traumatic neck injury, ruptured cruciate ligament or placenta previa.

Remember, when health care "reform" takes place, technolgy advancement freezed in place, like a wooly mammoth in a berg.

Tuesday, April 28, 2009

Grand Rounds is Posted

Six until me is a cool blog by a cool person who you should check back with after today. She puts A LOT of effort into the site, and I'm definitely a reader,

Go see.

Saturday, April 25, 2009

Kennedy's Tumor SNL Weekend Update

All the Health News Fit to Stink:

Kennedy's Tumor (KT) Sorts the Trash:

This Week's Health Headlines:

Reuters: U.S. lawmakers eye Medicare in Health Reform Drive

Max Baucus :
"Everybody here wants to address quality and reimbursements based on quality," Baucus said.
KT: So let the guys from Harvard and Columbia charge more.

If you are interested in quality educate the people, give them choices, and let them choose with their pocketbooks

WebMD (shame on u guys): About 2% of U.S. Population Is Paralyzed, New Survey Shows

Look around you. Are 2 out of every 100 people in wheel chairs? No. Why are they trying to redefine paralysis? Think about what "paralyzed" means; now read what they say in this article:

The survey defines paralysis as having "difficulty or inability" in moving the upper and lower extremities because of a condition affecting the central nervous system

Difficulty or inability? Are they nuts--or eating walnuts?
Question: Why do they define this so narrowly?
Answer: To include more people in their statistics which enables them to apply for bigger grants from the waste your money. Sinful stuff.

Walnuts may prevent breast cancer

Speaking of eating walnuts, THIS is from Britain...a social health care system. They don't want to do MRI's to find your breast cancer and they don't want to pay for monoclonal antibodies to treat it. What's easier? Chiropractic adjustment. Eating walnuts: OFF YOU GO THEN:

Mice fed the human equivalent of two ounces (56.7g) of walnuts per day developed fewer and smaller tumours.

So eat walnuts. Or be a mouse. Or live in the land of postmodern medicine.

USA TODAY: Study: Video-game-playing kids showing addiction symptoms

Nearly one in 10 children and teens who play video games show behavioral signs that may indicate addiction, a new study reports (the stoopid parts of this article are italicized by me).

OK they may show behavioral signs (a red octagon or a yellow triangle?) that may indicate addictive behavior -- I'll give you that totally vague and poorly defined slop of suppositions-- to this activity which is fun, exciting, improves motor skills and is infinitely better than sexting, sniffing glue or running with scissors.

What do video gamers need? Proper parents with proper supervision (oops)...not nannies and housekeepers. You need a good mom and dad who know how to balance things.

Breastfeeding Cuts Moms' Heart Risk

Breastfeeding cuts a woman's risk of heart disease and diabetes long after her infant has grown up, new data strongly suggest.

Soooo...what's the point? I mean, how important could this be

Why do they study this stuff?

The Obama administration is sharpening its scalpel, about to vivisect and put at risk the best health care system in history because it is too expensive to give away for free.

I have a better idea...why don't we just stop funding these studies? Why don't we establish a national board of research approval and evaluation. You get no money for feeding walnuts to rats and no money trying to further or establish a social video games are bad or we need to have more people qualify as disabled...and every penny we save on these circuitous nonprogressive counterproductive pseudoscientific wankfests will go care! That would be radical, eh?

Thursday, April 16, 2009

If Texas Leaves the Union, I'm Following

Secede and Conquer

Texas Governor Rick Perry is saying he wants his state to secede from the Union.
I have personally filed for a license in Texas; and, God bless them, if they secede, I'm going to take my considerable talents there, with glee.

I hope they do it.

According to The Examiner:

Speaking at a Republican "tea party" event yesterday, Perry said Washington has abandoned the country's founding principles of limited government and is strangling Americans with taxation, spending and debt.


As America's leadership continues to punish the successful by taking more of their profits I firmly believe that eventually someone somewhere will open a tax-free zone for the smart and creative. The SAC (Smart and Creative) will then move to that area in order to do WHAT THEY DO without punitive taxation to support the listless and effete...and THAT'S WHERE I'M GOING.

I hope it's Texas, because that's so less far to travel then China.

Kournikova and the Moscow Tennis Clones

Here are 8 female tennis players -- all in the top 100 women (except for Anna at this moment) -- born in MOSCOW in the 1980's. Coincidence? Would you bet on the number "1" to come up on a thirteen million number roulette wheel 8 times in 10 years?

Oh....and you can only spin the thirteen million number wheel twice in any given year...

Also see:
Clone Wars: The Impossible Reality of Moscow's Female Russian TennisPlayers
Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal

Wednesday, April 15, 2009

Clone Wars: The Impossible Reality of Moscow's Female Russian Tennis Players

What are the Chances?

Over at the Women's Tennis Blog I found this feature that describes 17 all-Russian women tennis finals. The most recent of these match-ups was this past January, in Aukland where these two players met:
That's Elena Dementieva on the left and Elena Versina on the right. In the finals. Both were Russia.

This Can Only Be Genetic Meddling
So who are these next two? Want to take a crack at it? Two more female Russian players in the top 100. Blond. Same ground stroke game. Right now, eleven women born in Moscow -- a city of 6 million -- are in the top 100 of the WTA tennis tour; and, twenty of the top 100 women come from a small geographic area including Moscow, all of which are former members of the USSR... And they are almost all blond, skinny, around the same age, and have identical ground strokes. Does that bother you? Why not? Is it a statistical possibility or probability?

What if there were 11 women born in New York City in the top 100? What if most of them looked alike? Would anyone say: "Whoa--that's not statistically possible?" Because it's not.
Approximately 1 in 13 million tennis players can expect to make the top 100 in professional tennis. So if there are 6 million people in Moscow and one out of fifty play tennis, you might expect less than 1/2 of one tennis player to make the top hundred in a generation. So are 11 possible? 11 blonds with the same game? No way.

Put it in Perspective

There has been no time in history when so many people from so constricted a geographic area have numbered so heavily in the top of their sport.

In all of women's professional sporting history, can you name two or three women from the same country who have achieved the top of their sport who look alike, have the same "game" and are around the same age? No. It is simply unprecedented.

Tennis is an international sport whose competitors come from everywhere; competition is year-round, and the chances of "making" it on the professional tour are infinitesimal. The Chinese, Japanese, Koreans, Europeans, Australians, and Americans produce tens of thousands of tennis pros every year all of whom receive the top training, instruction and support, yet only a very small percentage of whom make it to the top 100. So could 11 girls born in Moscow between 1981 and 1992 be in the top 11 just by good luck or even with superior training (most Russian girls train overseas anyway)? NO.

And don't forget who we are talking about--the former USSR. These are the same people who championed the secretive use of professionals when the Olympics were an amateur event; and the same people who created hoarse-voiced female champion weightlifters by pumping them full of steroids. Now they have messed with the genetics of these girls, because mathematically there is no explanation. It can't be nurture so it has to be nature.

Messing With the Eggs
These women are genetically similar. Either they've been cloned or are related to the same sperm donor or egg recipient...or whatever the explanation; it is not up to me to explain how they did it but there is no doubt that we are looking at DNA evidence of a deception...or a crime.

And just like in court, if the DNA evidence is positive (= overwhelming statistical evidence) then you are GUILTY AS CHARGED....unless you can tell us why not, convincingly.

So let's ask Russia for their rationale. Let's ask them a whattssup wit dat!

Because now that the Russians know the game, who knows where they will use the knowledge next; I assure you it will be something less benign than in professional tennis.

Also See:
Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal
Kournikova and the Moscow Tennis Clones

Thursday, April 9, 2009

Farrah Fawcett's Anal Cancer--Can You Prevent Yours?

Angel on the Rocks

This isn't a topic on the top of every one's blog list but WHY NOT? Cancer is cancer, whether it occurs in the jaw, breast, kidney, or anus. Former "Charlie's Angels" actress Farrah Fawcett, 62, is back in the hospital this week reportedly with metastases from her anal carcinoma, diagnosed in 2006.

Last September, P.J. O'Rourke was diagnosed with anal cancer. According to CNN:

"The numbers of anal cancer cases are rising, although experts haven't been able to pinpoint why."

ANAL CANCER--Time to Talk

OK, thankfully it's rare -- 1 in 100,000 people -- but with over 6 billion people in the the math. It's significant, and growing in incidence, especially since the advent of the acceptance of anal sex--a fact that needs addressing.

According to statistics, the odds of anal cancer are 35 TIMES HIGHER in men who have sex with men (MSM). MSM is the current euphemism for anal sex, and I don't have any problem with the acronym, except it isn't just MSM but also WHASM (women who have anal sex with men) who need to be aware! BE AWARE that condoms are essential. So men or women who are having unprotected (or even protected) anal sex need to understand--you are at 35 times higher risk.

In addition, MSM who are HIV positive are twice as likely to get anal cancer than MSM who are HIV negative. Likewise then, WOMEN with HIV+ partners need to be EQUALLY VIGILANT.


Why is that?

The most common manifestation of this disease may very well be propagated by the Human Papilloma Virus. At least that is the leading theory. So just like women can get cervical cancer from HPV and we believe that uncircumcised men can get penile cancer from HPV; probably, both sexes can get anal cancer from HPV. Who gets HPV? Who gets these? Individuals with a history of multiple sexual partners, anal receptive (read anal) intercourse, and genital warts are at an increased risk for infection.

Genital warts are one of the few visible manifestations of HPV. Anal warts are, basically, a sexually transmitted disease, mostly transmitted through anal sex. I'm gonna show you a picture of them right now, so gird your loins:

These are anal warts. Bumpy, cauliflower-like appearance. Probably due to the association between HPV and anal cancer, women with history of cervical cancer are at increased risk of developing anal cancer. This is what you want to look for and act on. People with these are at an increased risk for cancer.

Take Home Lessons: Wear condoms. Avoid people with warts in the genital area. Avoid sex with HIV+ individuals unless you are REALLY well informed and quite well protected. And a far as I am concerned, you should get the HPV vaccine if you are in an at risk group.

At Risk:

1. Unprotected Sex

2. Anal sex -- protected or not, male or female

3. Male-female vaginal sex if the male is uncircumcised

4. Many sex partners over the course of a lifetime, vaginal or anal or oral sex

5. History of genital warts--exposed to genital warts

Why worry about many partners? Because HPV is transmitted with increasing likelihood with an increasing number of partners; in addition, the virus will often cause no symptoms. It's frequently silent, and you'll never know you got it. As for women, given the frequency of cervical cancer and the implication of HPV in the origin of that disease, unless you intend to have very few partners --get the vaccine.

And let's not forget the legend as she was:

Tuesday, April 7, 2009

Mammography Faces A New Foe: NNT

This Door is Closed
DATA IDENTIFICATION AND ANALYSIS: Literature search of English-language studies reported from January 1966 to October 31, 1993, using MEDLINE, manual literature review, and consultation with experts. A total of 13 studies were selected, and their results were combined using meta-analytic techniques based on the assumption of fixed effects

CONCLUSION: "Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up"
--JAMA Vol. 273 No. 2, January 11, 1995

The efficacy of screening mammography in reducing breast cancer mortality is not really any longer statistically debatable; unless you have a new meta-analysis or multi-center trial with tens of thousands of patients to refute what has been a done deal for quite a while. So why would Kevin, M.D., a notable and widely-read blogger title a post: "How Much Do We Really Need Mammograms." And why would he attempt to validate this proposition by adducing the "Number to Treat" statistical evaluation, saying that NNT is "a statistic that is gaining increasing relevance in mainstream health reporting." ?? Sheesh.

Market Tops
A wizened investor analyst once told me that at market tops, when people no longer have a rationale for explaining the market distortions that lead to overvalued assets, they invent new definitions for value. So when Internet stocks rose to the heavens on vapor profits, analysts began to tout the theory that the standard of value measurement, the price to earnings ratio , was no longer valid. Instead we would look at a new valuation method: price to sales ratio. Of course, sales were an estimate (as opposed to earnings); and, when sales failed to materialize as predicted by overzealous and greedy stock analysts (duh), millions of people lost billions of dollars as the Internet stock bubble exploded.

Lets not even talk about real estate.

Measuring Out Your Life

The Number Needed to Treat is the "price to sales" ratio of this debate. It's how we are going to redefine your life in the era of nationalized health care and how the coming regime intends to measure out your care with coffee spoons. According to Wikipedia, the NNT:

... is an epidemiological measure used in assessing the effectiveness of a health-care intervention... The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome (i.e. to reduce the expected number of cases of a defined endpoint by one).

The importance of "the number of patients who need to be treated" translates to COST. This is what all you Obamaphiles should get through your heads. We intend to make the measure of health care what it costs to get it done, not how many fewer people die. What does it COST to save a life? It is not a measure that is used in our courts where the Tort system projects the value of life into millions; obviously. See my previous post here.

So, theoretically, even if screening mammography reduces deaths from breast cancer, if you have to do too many mammograms to prevent one death, isn't worth it to the system

Who is the system? Whoever pays the bills.

Who make s the rules? Whoever pays the bills.

Who's paying the bills in the future of your heath care? The government.

So, if they want to question the value of mammography not in relation to death reduction but rather on how much it costs to actuate as compared to the eventual cost to the Arnold Swartzeneger says in almost every movie he makes: "GET DOWN!"

Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal

The Girls From Russia

This past weekend, in Key Biscayne Florida, another young tall, blond, pig-tailed Russian girl with devastating ground strokes won a major tennis tournament.

Was it Anna Kournikova? No. Maria Sharapova? No. Elena Dementyava? No. Vera Zvonareva? Daniela Hantuchova? Dinara Safina? Nadia Petrova? Anastasia Pavlyuchenkova? Maria Kirilenko? Dominika Cibulkova? Anna Chakvetadze?? No, no, no, no, no, NO!

Those would all be good guesses, though, because those are all top female tennis players with remarkably similar appearances and games. And they are all Russian, or very close to it. It was none of these top players. It was yet another eerily similar female seemingly popped out of a mold: Victoria Azarenko:

Just the Facts, Ma'am
What is going on here? Has not anyone stopped to take note that an impossibly large number of young, blond Russian teenagers are now within the top 100 female tennis player? And they are, for the most part, tall, skinny and sport pulverizing forehands -- all manufactured with a severe Western forehand grip--and two-handed backhands that rip through the court like steam through a samovar...

Has anyone not said: "What are the chances?" No? Well let me ask you this: can you think of any 3 female tennis players in the history of United States tennis that were look alikes? Tracy Austin, Pam Shriver, Chris Everet, Mary Carillo, Lindsay Davenport, Mary Joe Fernandez...? No. Not even close. Even the Williams sisters -- who are indeed sisters -- look less alike than say, Maria Sharapova and Viktoria Azarenko; or Hantuchova and Cibulkova:

Say It IS So
It really cannot be. It really is impossible. There is simply no way, statistically, that so many similar appearing women with nearly identical tennis games could all come from Russia, or very close to Russia--basically all from that part of THE FORMER USSR

Remember the USSR? Remember them? The original sports cheaters. The first country to use professional athletes disguised as amateurs. The first country to use performance-enhancing drugs on their athletes--the ones who must have put together the genetic material for this cloning experiment in the 1980's!

Here are the Russians in the TOP 100 with their birthplaces and dates:

Sharapova former #1--: Nyagan, Siberia, Russia 1987
Dinara Safina #2--Moscow Russia 1986
Elena Dementiava #4 --Moscow Russia 1981
Svetlana Kuznetsova #8-- St. Petersburg, Russia 1985
Nadia Petrova #9--Moscow 1982
Victoria Azaranka #10--Minsk, Belarus 1989
Dominika Cibulkova #16-- Bratislava, Slovak 1989
Alisa Kleybanova #17 -- Moscow, Russia, 1989
Anna Chakvetadze #23-- Moscow, Russia. 1987
Anastasia Pavlyuchenkova #27--Samara Russia 1991
Alona Bondarenko #38 --Krivyi Rig (Ukraine),1984
Maria Kirilenko #39-- Moscow Russia 1987
Maria Daniela Hantuchova #43 --Poprad, Slovakia 1983

And don't forget the queen bee. The original. The model from whom the others seem to have begotten:

It all started with Anna Kournikova, born in 1981; where else? Moscow Russia.


Also See:
Clone Wars: The Impossible Reality of Moscow's Female Russian Tennis Players
Kournikova and the Moscow Tennis Clones

Saturday, April 4, 2009

British Still Resist Screening Mammography--Why?

The Empire Strikes Back
The British always want to do less than the Americans (just ask Barak Obama), especially as regards breast cancer screening. Once again I picked up the the New York Times to read another article in which the Brits question the value of mammography. I guess since they lost the statistical and factual debate that mammography actually does save lives (which they resisted for years), they will now draw their limp straws and swing away with anecdote and opinion. The American press continues to support these ruminations as if they have validity which seems odd, doesn't it?

The Hundred Years War
In case you don't know, this argument used to go on constantly. The British have been kicking and screaming and resisting mammography for the better part of thirty years. As late as the 1990's their mammographic screening policy was: one view of each breast every three years! When the data finally settled the case that mammography saves lives they begrudgingly capitulated and now recommend two views of the breast every two-three years. But they still resist. You have to ask your self: Why?

The title of the most recent handmaid tale from Britain in the NYT: Benefits of Mammogram Under Debate in Britain. I'm won't bore you with all the details, but you can trust me on this summation of today's controversy: A woman (let's call her Anecdotal Lady Agatha) underwent a screening mammogram which was positive for cancer.

"She had a lumpectomy but was offered such a confusing array of treatment options that she realized doctors knew little about how aggressively to treat this kind of cancer."

This woman turned out to have a low-grade tumnor (DCIS -- which is not always low-grade)and basically, hers and the the British complaint is that we (Americans) find too many women with breast cancer and some of these women (they admit there is no way to tell which ones before a biopsy) do not need full-on breast cancer therapy, and it is difficult to know how aggressively to treat this particular subset of breast cancer. The British solution? Don't look so hard, and you won't find so many low-grade cancers (nor high-grade cancers I might add).

To ameliorate this "problem" a British mammogram expert,Dr. Peter C. Gotzsche,rewrote a "letter" provided to British women regarding mammography screening:

“It may be reasonable to attend breast cancer screening with mammography, but it may also be reasonable not to attend.”

The Objective of Mammography
The British doctors worry about too many biopsies which result in extra cost, stress to the women, and extra radiation during repeat mammographic imaging. Don't they sound like nannies?

What about cancer? They don't mention that.

The object of mammography is to find cancer. That's the prime directive: FIND CANCER. If a mammogram finds a cancer, it's done its job. If the surgeons and pathologists and oncologists have yet to sort out which cancers need treating, that's just the state of their art; however, to look less hard for cancer clearly in inimical to what we, in the U.S. want. We want to find all the cancer possible -- and if you don't believe me consult the Tort system which has the accuracy rates sighted on infinity. Or ask any breast cancer advocate.

Socialist Mind Set
In the British health care system, the individual is less well regarded than the group, which is the state. This is the system we are moving toward. It therefore makes sense that the British want to do less when doing more is costly. In the United States our health care system has always done everything it can all the time despite the cost. It's a mindset.

Are we ready to change mindsets? Are we ready to understand that you can't try to save everyone all the time? That it may not be worthwhile to save one person if the cost incurred is deemed to be asymmetrical to the system?

And if we are, then are we ready to abandon the Tort system that penalizes the failures to each individual--because some individuals are going to the graveyard (or worse)-- because the system cannot afford to respond individually.

One thing the reformers of our health care system are not accounting for is the American mind set. If people wake up and understand that "health care reform" means the government has to make funding choices that pit the individual against society, then maybe even all the false hue of crisis will not cover the fundamental changes being proposed out of Washington in the name of hope.

Thursday, April 2, 2009

Keeping Smokers Alive to Take Care of Children

Night of the Living Smoker

The government has finally declared its intentions to the cigarette smoker: KEEP SMOKING BRO!

BHO just engineered an increase in the federal excise tax on cigarettes so that yesterday, the tax on every pack jumped from 39 cents to $1.01!

This represents the largest federal tobacco tax increase ever. In some cases, smokers will be coughing up $9-$10 for a pack...

For years health officials have claimed they hope that tax-price increases will motivate smokers to quit, and perhaps at one time that sentiment was real. But now the government--like the desperate smoker-- is also addicted, but addicted to cigarette tax money, which nowadays is viewed as a way to raise funds for federal programs.

Who What When...Teddy Kennedy

In 1997 Teddy Kennedy sponsored an expansion of Medicaid (SCHIP) in order to provide insurance for families that were not poor enough to qualify for Medicaid. An expensive proposition. This February, one of BHO's first acts as president was to expand this program (stimulus shmimulus) to include millions more people, even those who are not traditional families, including immigrants.

When pressed for a funding solution to support this new expansion of the government program, BHO and someone really clever (maybe Robert Reich?) came up with the idea that they could add another tax on cigarettes (who can argue against that?) and use that money to fund SCHIP. So now cigarette smokers are taking care of kids, at the cost of their lives.

The federal government has come to rely on cigarette taxes -- as states rely on lottery income-- to fund their social programs, so if people stop smoking...that would be bad. This approach is obviously contradictory. If the government discourages tobacco use with taxes then people will stop smoking. However, if the government uses the tax money to fund its pet projects then if people stop smoking, pet projects will suffer.

Looking for Volunteers

One could foresee a day when people quitting smoking may seriously jeopardize something important, like climate change research or digital TV converter coupons, and this administration in its inestimable cleverness would be looking for new solutions. For change.

One idea is to have young people, when they turn 21, to volunteer as smokers for 1-3 years. This would be seen as public service, a Marlboro AmeriCorps.

Or maybe the government could keep people alive, on smoking farms--which could be erected adjacent to windmill farms-- and let their breathless bodies shift from foot to foot in search of oxygen, but addicted to cigarettes while BHO funds his support of future smokers by maintaining their health as children.

Sounds good to me.

Why Worry About Pistachio Recall When Poison Fish Can Ruin Your Sex Life?

Ugly Fish, Painful Sex and a Bad Bug

Possibly, two people are sick from contaminated pistachios. Nonetheless, the whole country is on red alert with grocers busy pulling bags of nuts off shelves while housewives search their cupboards for the wandering lost shell...

Meantime, an actual threat with an ugly mug is swimming offshore in your local subtropical coral reef zone. There he is, on your left. The amberjack: a rough and tumble little guy hanging with his posse -- groupers, red snappers, eel, sea bass, barracuda, and Spanish mackerel -- who together sicken as many as 50,000 people every year. Take that pistachios!

Loves Labor Lost

In a new report, public health investigators describe a cluster of cases of painful intercourse associated with eating one of these fish. You heard me right. It makes one wonder what questions our public health professionals are asking their subjects during investigations...but as it turns out these fish ingest algae contaminated with a bad bug, a protozoan -- dinoflagellida to be exact -- from the class PHYTOMASTIGOPHORA.

The bugs make a poison, ciguatera, which, when ingested, can cause some pretty weird and alarming symptoms like:

Paradoxical temperature reversal (cold objects feel hot and hot objects feel cold)
A feeling of loose teeth
Painful intercourse (for both the man and the woman)
Ataxia, vertigo
Respiratory paralysis

In the group reported with painful intercourse the men had painful ejaculations and the women complained of burning, and some of these problems persisted for a month.

Fish Rabies

Since fresh fish--like the baracuda you see here-- gets flown all around the world nowadays, don't think for one minute that you are safe from ciguartera poisoning by living in Iowa or Uzbekistan. This illness strikes everywhere. And ciguatera poisoning is the most common nonbacterial, fish-borne poisoning in the United States.

So how will you know if you've been poisoned?

First, you will have eaten fish. Maybe a fish sandwich or the daily special which was grouper provencale...Well, after about 6 hours your mouth and lips will feel numb and you'll start to vomit and get a bad case of the runs. Then your hands and feet will start to tingle...makes you wonder how anyone actually got to the point where they might experienced painful sex, doesn't it?

The room starts to spin right before you begin panting to catch each breath. You feel exhausted, yet your heart is beating faster and has a jumpy feeling.

That's when you go to grab the ice-cold can of Coke...AND IT'S BURNING HOT!

That's the classic finding: temperature reversal. If this happens to you send yourself straight to the local ER and demand several hours of a Mannitol infusion -- an IV with heavy molecules in it which serves to "flush" out the toxin. This seems to reverse the neurological problems and from that point on have your doctor treat you symptomatically.

Don't Be a Hog (Snapper)

If you want to avoid ciguatera, make sure you identify any fish you eat anywhere. No mystery fish allowed. Next, if the fish is from a tropical or subtropical zone, ask how big it was. Really. Because the chances of a fish accumulating significant ciguatera poison are proportional to its size and if the fish was greater than 2 kg--have the lasagna.

Now can anyone remember why the hell we are rushing to throw away 700 thousand tons of pistachios? The only painful intercourse resulting from eating nuts is when you accidentally roll over the shells.

Tuesday, March 31, 2009

When Will Obama Force Sanjay Gupta to Resign?

"I never knew fear until I kissed Becky"
--Dr. Miles J. Bennell, from Invasion of the Body Snatchers

Just Put This Pod in Your Hospital
Is any one in the health care reform cabal talking to former GM chairman Rick Wagoner? Any of the physicians, insurers or hospitals who are right now working with the White House to decide just what form of government-directed-and-funded national health care is best?

I'm talking about the American College of Physicians and the American Medical Association; the national hospital groups and insurance companies who, either out of self-interest or fear or for what they believe is inevitable have decided to make the government the essential and most powerful part of our health care system.

Monday, Mr. Wagoner resigned from his job of 19 years as CEO of the storied automaker. He resigned because President Barak Obama told him to.

There was a time when this sequence of events would have rocked the news. The president of the United States told a CEO of a major American company to step down. But today, as the government moves in on our private institutions in a bad remake of Invasion of the Body Snatchers, we applaud the decision.

I turned on CNN to hear talking heads and politicians list all the business reasons why GM is a bad company, has made bad decisions and why Rick Wagoner needs to go. They were spouting opinions with perfect assuredness and authority as if they knew what they were talking about. As if they were part of the twenty years Rick Wagoner has spent making deals, managing contracts, overseeing a gargantuan international company, and as if they could sit in judgment and say: Wagoner has to go.

Maybe indeed, Wagoner had to go. I wouldn't know. That is far from the point here. The point is: when will the president, the White House and the media knock on Sanjay Gupta's door and tell him he needs to step down as a neurosurgeon (we have too many of those); or to leave his academic position at Grady Hospital (we need neurosurgeons in Michigan's Northern penisula--get going); or to get the hell off of television (it's not the right image for health care).

And when Dr. Gupta is yanked and remanded to Siberia, will we similarly sit at home, watch the news and say nothing? I guess there will be nothing to say.

The public will be numb to Sanjay's fate because they are inured by the neverending crisis talk that rains night and day from Washington through the media. "They had to do it," "Too big to fail," "Crisis, crisis, crisis."

Can Sanjay Gupta be far behind Wagoner? Watch the door Dr. Gupta.

Going Out of Business

Crisis drove (or actually flew) Wagoner and the other automaker CEO's to Washington in Novemebr where they asked for and got government intervention. Money. Strings attached.

Those strings were pulled this past weekend as Barak Obama told Rick Wagoner to resign. And now?Now Obama says that the government may force GM into bankruptcy!

So the power we invest in the government when they fund us is...control. We have to remember this. Since Obama takes his authority from taxpayers and dispenses it in the form of "aid" or "bailout" or "control" they are free to act, even if that act destroys or fundamentally changes the institution they are steping in to "help."

So Sanjay Gupta, if he doesn't watch out -- and by analogy our health care institutions and practices -- he may one day face the absolute and final solution directed from some bureaucrat and promulgated by a media frenzy: Out of Business.

Thursday, March 26, 2009

Winning Back the Penis--One Piece at a Time

The first time I ever saw a man who was status post penectomy I decided that circumcision was the right thing to do.

He was a young man, in his thirties, and when I explored his medical history it contained reports of chronic low-grade infection involving the internal foreskin (he was then uncircumcised); multiple sexual partners, and phimosis (a condition where the foreskin is too tight).

This anecdotal experience lead me to the "stacks" (the magazine and journal library where we went for information before GOOGLE) where I reviewed the literature on penile cancer and circumcision. Although penile cancer was rare, it was significantly and seriously more common in uncircumcised men, who also had more frequent infections and complications than uncircumcised males. That was my take and I was OK with it.

Today we have news about circumcision. Namely, it seems that the procedure is extremely effective in reducing STD's. In fact:

"Over two years, the men who were circumcised had a 28 percent reduced risk of infection with the herpes virus and a 35 percent reduction in HPV infection."

Of course, HPV virus is an etiologic factor in cervical cancer, so these data have serious implications not only for the health of men, but for women also. Yet rates of circumcision have been falling dramatically all over the world in the past two decades, especially in the United States.

Why so?

Don't Touch That Penis!
Around the same time that I decided circumcision was a good thing, people had begun talking about the downsides of circumcision and a movement took hold which has since exploded, propelled by activists, disease-specific lobbyists and not a few doctors, who even formed an activist group of their own, "Doctors Opposing Circumcision (DOC)." Many of these groups cited the American Academy of Pediatrics (AAP) 1999 position statement which was selectively cited as saying that "the procedure is not essential to the child's current well-being"

If you read the entire position statement, however, the AAP admits quite a few risks associated with the uncircumcised state, including:

"the risk of developing penile cancer in an uncircumcised man compared with a circumcised man is increased more than three fold"

In the end the AAP conclude in their position statement that parents should evaluate the data and make an informed decision.

Along Came Mary
People who need work frequently look for injustices to remedy then they try to find publicity. This usually requires trumping up an issue with fiddled data, acquiring a celebrity, gaining publicity and eventually twisting the arm of a legislator to create a law to support the position, create a new class of "victims" and criminalize the opposition. Unfortunately, this happens in "health care" all the time.

Eventually, these groups rise in power and prestige and their pet legislators funnel pork back to the activist cause, creating a little industry funded by eternal government grants...and all this creates a nice little living, or avocational supplementation, for the activists and their socially and politically aligned warrior friends.

So they came to a new cause, circumcision. And they came like hungry birds: Activists, rights groups and newly formed coalitions like MAC (mothers against circumcision). A mini-movement overwhelmed the scientific data concerning circumcision, which rose in the socio-political ranks until it reached full-blown status as "child abuse" as detailed in this Fox report.

Soon enough, the government in multiple states was disallowing Medicaid reimbursement for circumcision (no matter what the parents decided was best for their male child) and the MAP (movement against the Penis) continued to pick up steam so that feminists were analogizing it to female mutilation and began trying to push circumcision to the level of a criminal act, which is the Holy Grail of activists.

If health activists cannot criminalize you they will demonize you. Public reprobation is another tactic of these oh-so-righteous activists. Soon enough people were ashamed to admit they circumcised their child, as recounted in a serious but humorous article on this topic in Salon which tracks the guilt and public shame heaped upon two Jewish parents who were torn between circumcision and the public disgust it seemed to incur:

"On one family visit, they'd been teasing me, saying that Elijah would probably end up being a Republican engineer, whatever that was. I said that I'd love him no matter what he became."

Individuals get slammed, but they are only pawns of bad doctors...and, of course, the American health care system, as demonstrated nicely by the words of Tim Hammond, a leading opponent of circumcision and founder of NOHARMM, the U.S. National Organization to Halt the Abuse and Routine Mutilation of Males:

Tim Hammond, believes that circumcision in the U.S. is perpetuated by arrogance and the radical American health environment.

Radical, Dude
No one can deny that grass roots movements often inform the public and help individuals make decisions regarding their own health. This can be powerful and good as demonstrated by the public awareness surrounding drunk driving and smoking. However, it is my contention that this process has been usurped by radicals, publicity seekers and those who need to make a living off of federal grants and monies.

Too often the tactics of bullying and public recrimination are used to blackmail legislators and voters, and the end result is wasted funds, wasted research, wasted health.

If we are going to reform health care (whatever that is), I think it is unwise not to look at this phenomenon and address it...unless you want these people deciding the fate of your penis.

Monday, March 23, 2009

Breast MRI and The Coming War Against Medical Technology

Flak: noun
1. antiaircraft fire, esp. as experienced by the crews of combat airplanes at which the fire is directed.
2. criticism; hostile reaction; abuse: Such an unpopular decision is bound to draw a lot of flak from the press.

The Rising Tide
I came across this headline on the website of Kevin, M.D.: "Does Breast MRI have any benefits for patients with breast cancer?" Being a big fan of breast MRI (and the lives of the women I've seen it save), this headline took me aback somewhat.

Kevin, M.D. referenced another blog by a general surgeon, Jeffery Parks, who titled his piece "Breast Cancer and MRI," and used the phrases: "Finally some news on the use (or overuse) or MRI in breast cancer;" and "There are situations where MRI could potentially be useful ..." (italics mine).
Both blogs are good ones, worth reading, and full of useful information (including these entries); the blogs and their authors are not my pursuit here. What does interest me is the PRESS that breast MRI (BMRI) gets not because it is a fantastic technology and head and shoulders above mammography, ultrasound and breast exam combined; rather, its the consistent repetitive criticisms that BMRI is expensive and too sensitive. These nonmedical criticisms overwhelm the real message: BMRI saves lives. It can save your life.

That's a Fact Jack
Let's start with two facts as demonstrated by multiple studies over the past 15 years:

1.The sensitivity of MRI of the breast is very high -- as high as 95-97% -- in detecting invasive cancer, no matter the size of the lesion.

2. The sensitivity of mammography in dense breasts can be as low as 45% ...................(otherwise known as a coin flip); and when a cancer is identified on a mammogram it can frequently be found on last year's mammogram, as often as 70% of the time

There are LOTS of studies that document the power of MRI in making the diagnosis of breast cancer.

Why then all the FLAK?

Share it fairly but don't take a slice of my pie

It seems to me that there is a lot of hostility out there as regards BMRI and this is symptomatic of the overarching strategy of the health care reform movement, magnified in this burgeoning era of limiting costs for health care. Since we seem to spend too much then we need to cut back. Where to cut back? Expensive treatments, diagnostics, drugs, and therapies.

MRI gets a lot of flak because of 2 reasons:
1. It's expensive
2. It finds a lot of things that aren't cancer resulting in more biopsies and follow-ups that...cost more money

A lot of people lobby against routine breast MRI because they feel it is an elitist form of care that most people cannot afford or for which most people are not insured. The case against extra biopsies and follow-ups also usually complain that this creates COSTS. Some authors now applaud President Obama's search for cost effectiveness via the stimulus package as a welcome effort aimed at optimizing care while reducing costs.

Demand What Ted Gets

In systems where the government is in charge of distributing limited tax dollars between different budgetary demands--one of which is health care--bureaucrats and their medical claque need to decide how to make maximum use of minimum dollars. As Canada and England and others have discovered, it is ideal to placate the 95% of people who never need more than simple remedies, homeotherapy, adjustments, zinc tablets, and laughter therapy.

The other 5% -- the people in the ICU's and in the trauma ward; the severely burned, the patients with rare chronic diseases and those who would benefit from high-end diagnostics -- those 5% don't make a potent voting block and don't seem significant in surveys that affirm "satisfaction with the health care system."

These are the patients who will be left behind in the future of Ted Kennedy's Health Care America.

Friday, March 20, 2009

Natasha Richardson, Epidural Hemorrhage and No Help in Canada

The Death of Natasha Richardson

Kevin, M.D. today adduces that Natasha Richardson indeed had a CT of the brain at Centre Hospitalier Laurentien--after falling ill with a recent history of head trauma, but there was no neurosurgeon available to do a STAT craniotomy which would have saved her life; however, this is not a fault of the Canadian system:

in remote resort areas in the United States, small community hospitals would likely lack neurosurgical coverage. In fact, because of the huge malpractice risk associated with the field, even if there was a neurosurgeon available, whether he or she would take emergency call at a community hospital would be in question.

How Remote?

Mont Tremblant is one of the most recognized and popular ski resorts in the world. It is famous for celebrity sitings, and the rich and famous frequently take up seasonal residence there.

As of 2005, Mont Tremblant had been recognized by Ski Magazine as the #1 ski resort in Eastern North America for 8 consecutive years.

Given the popularity of the area and the nature of skiing and snowboarding, Natasha Richardson may be the most famous person that’s ever come down from Tremblant’s slopes needing emergency neurosurgery, but I doubt that she is the first.

According to JAMA :

...head injuries are common in alpine skiers and snowboarders. Head injury is the most frequent reason for hospital admission and the most common cause of death among skiers and snowboarders with an 8% fatality rate among those admitted to hospital with head injuries. Of the 3277 patients with injuries recorded, 578 patients (17.6%) had head injuries. Head injuries accounted for 288 (17.9%) of 1607 alpine skiing injuries, 248 (17.8%) of 1391 snowboard injuries, and 32 (17.9%) of 179 of Telemark skiing injuries.

Head injuries constitute only 5% to 15% of all injuries from ski and snowboard accidents, yet are the primary cause of serious disabling injuries and death. There are approximately 10 fatalities per year in Colorado from accidents on the ski slopes, and among the fatally injured in one study, head injury was the cause of death in 87.5%;

Another report lists the incidence of ski head injury incidence at 0.77 per 100 000 ski visits

And a mega-study estimated rate of one death per 1.5 million skier-days.

Comparable ski areas in the U.S. – say Vail and Park City – both list neurosurgeons in their cities. Vail, Colorado has a population of 4,589 and is home to 1 practicing neurosurgeon. Park City, Utah population 7,371 also lists 1 practising neurosurgeon.

So, ski resorts should probably think hard about neurosurgical availability, is my impression, but all of the above begs the real issue, which is the differences between the Canadian model for health care and ours -- and where ours is going.

Availability of Neurosurgeons

Kevin, M.D. rightly states that a neurosurgeon is probably just as unlikely to be available in a U.S. ski town, as in Canada, and that may be so but the reasons are diametrically the opposite.

Neurosurgeons are not so easy to find in Canada where subspecialization is not rewarded, and 50-60% of boarded neurosurgeons leave the country to practice somewhere else within 2 years of their certification.

The last good data I could find listed only 174 neurosurgeons in the entire country. In the U.S. we have 3,500. A study on the need of neurosurgeons listed the density of neurosurgeons in the U.S. to be about 1/55,000 people which means that an analogous number of neurosurgeons needed in Canada would be about 604.

It is true that neurosurgeons eschew emergency room coverage in the United States, but it is for completely different reasons than in Canada. Here, our ED’s don’t want to pay what it takes to hire a neurosurgeon for coverage; in Canada, no one wants to even be a neurosurgeon.

So, in a sense, the Candian model for health care failed Natasha Richardson because of an artificially created shortage of subspecialists, which is a purposeful design meant to keep costs low in a taxpayer-funded-system. The U.S. would very much like to go in this direction and the plan is to broaden non subspecialized care options while reducing higher-tech procedures, diagnostics and physicians.

But as we go towards a single-payer system, we can all expect that when we need it most, the system will not be there for us, as it was not there for Natasha Richardson.

Thursday, March 19, 2009

Natasha Richardson, Epidural Hemorrhage and Canadian Health Care

This CT scan (LEFT) shows 4 TYPES of intracerebral hemorrhage:

1. EPIDURAL short white arrow;
2. SUBDURAL short black arrow
3. SUBARACHNOID long black arrow
4.INTRAPARECNCHYMAL ( = in the brain matter itself)
long white arrow

Yesterday it was my conclusion that Natasha Richardson suffered from a subarachnoid hemorrhage (from a ruptured aneurysm)rather than an epidural or subdural hemorrhage because, as I said:

"Both epidural and subdural hematomas should have / would have been rapidly diagnosed and she would have had an emergency procedure to release the pressure."

In other words, it was my assumption that if she had an epidural or subdural hematoma it would have been rapidly treated when she was taken to a local hospital --Centre Hospitalier Laurentien--after falling ill with a recent history of head trauma.

So if Natasha Richardson had an epidural hemorrhage, the question becomes: did she get a STAT CT scan and was there a neurosurgeon at the hospital, or nearby on call who would be able to do the emergency procedure needed to save Natasha Richardson's life?

Canadian Health Care

It's important to ask this question, because this is precisely the situation where the Canadian-type health care system -- much touted by reform advocates -- tends to fail Canadians.

In the United States, we pay a lot for health care, but that care is widely dispersed, into communities, with high-level diagnostic and therapeutic options available in fairly wide-flung areas.

In Canada, there are only 10.3 CT scanners per million people whereas the U.S. has 29.5 per it is reasonable to ask if Centre Hospitalier Laurentien has a CT scanner, and did Richardson get a CT of the brain STAT?

In the United States if someone falls and hits her head and then an hour later is rushed to the emergency room you can bet she will get a STAT CT scan and immediate neurosurgical attention.

Can you bet that Natasha Richardson got that care? I hope so. I do have some doubts because shortly after being admitted to Centre Hospitalier Laurentien, she was shipped out to a larger hospital in Montreal; and, of course, later that day she was pronounced brain dead.

I hope Natasha Richardson got the appropriate health care and that this was all a tragic and improbable occurrence. But if not, it would be an important thing to know.

Wednesday, March 18, 2009

What Happened to Natasha Richardson?

Monday, Natasha Richardson was skiing on a beginner slope and suffered a fall. She seemed to recuperate, but later became symptomatic and was rushed to a hospital in Canada. Tuesday night she was reported as "brain dead."

What happened?

Three most likely possibilities:

1. Epidural hematoma (see CT scan on the left)
-arterial bleed between skull and brain with rapid and devastating pressure developing on brain; short time course, usually over hours

2. Subdural hematoma
-venous bleed between skull and brain, slower time course but reaches a point when pressure can create catastrophic pressure effects

3. Subarachnoid hemorrhage (ruptured aneurysm- blood around and/or into the brain)
- rapid symptoms and time course with potential for devastating spasm of vessels

Epidural or Subdural?
Both epidural and subdural hematomas suggest a significant blow to the skull. Dr. Michael Baden suggested an epidural hematoma lat night on Fox news, mainly because of Richardson's rapid decompensation and the "lucent" period (she was normal for a short time after the injury), which, clinically, is the time it takes for the blood collection to get large enough. However, most epidural bleeds require a significant focused blow to the skull:

The inciting event often is a focused blow to the head, such as that produced by a hammer or baseball bat. In 85-95% of patients, this type of trauma results in an overlying fracture of the skull.

A subdural hemorrhage that is bad enough to render you brain dead in a day, also usually involves a significant blow to the skull and an associated brain injury:

Acute SDH is commonly associated with extensive primary brain injury. In one study, 82% of comatose patients with acute SDH had parenchymal contusions

Both of these lesions can be rapidly and simply diagnosed with a noncontrast CT scan of the brain and both of these lesions can be rapidly treated --with reversal of the outcome-- in a modern, competent, well-equipped emergency room.

Subarachnoid Hemorrhage (SAH)

When I first heard the sequence of events, I assumed Richardson had an SAH from an aneurysm rupture because:
1. Her age
2. Minor trauma (assumption because she was on a beginner slope with a pro)
3. Lucent interval (SAH can frequently have a small initial bleed which is followed later by a catastrophic bleed)
4. Both epidural and subdural hematomas should have / would have been rapidly diagnosed and she would have had an emergency procedure to release the pressure
5. Rapid progression to massive brain injury: SAH can quickly cause diffuse spasm of brain vessels leading to brain infarction -- which is irreversible and catastrophic

The problem I have with SAH is that they would not have put her in a plane and flown her to NY the next day...aneurysm patients are at a high risk for rebleed and need to be treated quickly, if at all possible in a nearby geographic location; unless the course of events was so rapid and tragic that it didn't matter.

Also, the time course is very bizarre, I mean, to go from a minor fall to brain dead in 24 hours??

Whatever the mechanism, this concatenation of events is tragic it its absolute unlikeliness and in the devastation that has ensued.
Thanks to Kevin, M.D. for link. Read what he has to say...
Also discussed by an ER Doc at Movin' Meat...

Tuesday, March 17, 2009


This week at ACP Internist.

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Go there for hope and change.