tag:blogger.com,1999:blog-43491430085249771292024-03-08T11:38:08.814-05:00Kennedy's TumorThe Final Parable for Health CareDr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.comBlogger43125tag:blogger.com,1999:blog-4349143008524977129.post-45555985893528317062009-05-13T17:22:00.002-04:002009-05-13T17:38:50.181-04:00A Solution For Health Care Costs<a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sgs94LfLNGI/AAAAAAAAAT0/cwoh-JtGL20/s1600-h/casino_mainphoto082407.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 278px;" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sgs94LfLNGI/AAAAAAAAAT0/cwoh-JtGL20/s320/casino_mainphoto082407.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5335426218916000866" /></a><br />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).<br /><br />Why don't they take the gambling industry instead?<br /><br />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?<br /><br />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 because....it's fun? Or entertaining?<br /><br />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?<br /><br />This would stop the madness immediately.<br /><br />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.<br /><br />And we'd never have to see Trumps poorly-dyed combover ever again.<br /><br />Don't see how you could refuse this.Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com1tag:blogger.com,1999:blog-4349143008524977129.post-4750833730852469632009-05-12T08:24:00.004-04:002009-05-12T08:36:11.218-04:00Health Care Reform: What You can Expect<div><strong><u>Pins and Needles, Needles and Pins</u></strong></div><br /><div><strong><u></u></strong></div><div>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.</div><br /><div></div><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sglsn79qOEI/AAAAAAAAATs/kNu3tACFpwo/s1600-h/acupuncture_back_pain.jpg"><img id="BLOGGER_PHOTO_ID_5334914666964072514" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 300px; CURSOR: hand; HEIGHT: 210px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sglsn79qOEI/AAAAAAAAATs/kNu3tACFpwo/s320/acupuncture_back_pain.jpg" border="0" /></a><div>You will see more and more promulgation of <a href="http://www.dbtechno.com/health/2009/05/12/study-shows-acupuncture-real-or-fake-is-best-for-back-pain/">these low-cost solutions</a> 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 <a href="http://en.wikipedia.org/wiki/Placebo">placebo effect</a>; however, there is no placebo effect possible for your traumatic neck injury, ruptured cruciate ligament or placenta previa.</div><br /><div></div><div>Remember, when health care "reform" takes place, technolgy advancement freezed in place, like a wooly mammoth in a berg.</div>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-12626381005321376022009-04-28T11:24:00.003-04:002009-04-28T11:28:52.200-04:00Grand Rounds is Posted<a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SfcgINGXZ-I/AAAAAAAAATk/cQg094FbXWQ/s1600-h/bomed.jpg"><img id="BLOGGER_PHOTO_ID_5329764009343674338" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 248px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SfcgINGXZ-I/AAAAAAAAATk/cQg094FbXWQ/s320/bomed.jpg" border="0" /></a> <a href="http://sixuntilme.com/blog2/2009/04/grand_rounds.html">Six until me </a>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,<br /><br />Go see.<br /><div></div>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-35869770553976904272009-04-25T23:29:00.001-04:002009-04-26T17:55:13.046-04:00Kennedy's Tumor SNL Weekend Update<strong><u>All the Health News Fit to Stink:</u></strong><br /><br /><a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/Se6Ws2loXMI/AAAAAAAAAS8/tQPvBOR5ClA/s1600-h/snl.jpg"><img id="BLOGGER_PHOTO_ID_5327361106537635010" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 265px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/Se6Ws2loXMI/AAAAAAAAAS8/tQPvBOR5ClA/s400/snl.jpg" border="0" /></a><br /><br /><div><strong><u>Kennedy's Tumor (KT) Sorts the Trash:</u></strong></div><br /><br /><div>This Week's Health Headlines:</div><br /><br /><div></div><span style="font-family:courier new;"><strong>Reuters: <u>U.S. lawmakers eye Medicare in Health Reform Drive</u></strong></span><br /><br /><div></div><div>Max Baucus :<br /></div><div>"Everybody here wants to address quality and reimbursements based on quality," Baucus said.<br /></div><div></div><div><em>KT: So let the guys from Harvard and Columbia charge more.</em></div><br /><div>If you are interested in quality educate the people, give them choices, and let them choose with their pocketbooks<br /><br /></div><div><span style="font-family:courier new;"><span style="font-family:times new roman;"><strong>WebMD</strong> (shame on u guys):</span><u><strong> About 2% of U.S. Population Is Paralyzed, New Survey Shows</strong></u></span></div><br /><div>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:</div><br /><div>The survey defines paralysis as having "<strong><em>difficulty or inability"</em></strong> in moving the upper and lower extremities because of a condition affecting the central nervous system </div><br /><div>Difficulty or inability? Are they nuts--or eating walnuts? </div><div>Question: Why do they define this so narrowly?<strong> </strong></div><div>Answer: To include more people in their statistics which enables them to apply for bigger grants from the government....to waste your money. Sinful stuff.</div><br /><div><span style="font-family:courier new;"><strong><u>Walnuts may prevent breast cancer</u></strong></span> </div><br /><div>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:</div><br /><div><em>Mice fed the human equivalent of two ounces (56.7g) of walnuts per day developed fewer and smaller tumours.</em> </div><br /><div>So eat walnuts. Or be a mouse. Or live in the land of postmodern medicine.<br /><br />USA TODAY: <span style="font-family:courier new;"><strong>Study:<u> Video-game-playing kids showing addiction symptoms</u></strong></span></div><br /><div><em>Nearly</em> one in 10 children and teens who play video games <em>show behavioral signs</em> that <em>may indicate</em> addiction, a new study reports (the stoopid parts of this article are italicized by me).</div><br /><div></div><div>OK they <em>may</em> show behavioral signs (a red octagon or a yellow triangle?) that <em>may</em> 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.</div><br /><div></div><div>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.</div><br /><div></div><div><strong><u>Breastfeeding Cuts Moms' Heart Risk</u></strong></div><br /><div></div><div><br />Breastfeeding cuts a woman's risk of heart disease and diabetes long after her infant has grown up, new data strongly suggest.</div><div></div><div><br />Soooo...what's the point? I mean, how important could this be</div><div></div><div></div><div><br /><em>Why do they study this stuff?</em></div><div><em></em></div><div><br />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.</div><div></div><div><br />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 agenda...like <em>video games are bad</em> or <em>we need to have more people qualify as disabled</em>...and every penny we save on these circuitous nonprogressive counterproductive pseudoscientific wankfests will go towards....health care! That would be radical, eh?</div>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-30310191882518827352009-04-16T18:08:00.003-04:002009-04-16T18:17:29.380-04:00If Texas Leaves the Union, I'm Following<a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SeeuXt1C0BI/AAAAAAAAAS0/I4BpJ36UDaM/s1600-h/secede.jpg"><img id="BLOGGER_PHOTO_ID_5325416806851203090" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 135px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SeeuXt1C0BI/AAAAAAAAAS0/I4BpJ36UDaM/s400/secede.jpg" border="0" /></a><br /><div><br /><div><strong><u>Secede and Conquer</u></strong><a href="http://3.bp.blogspot.com/_LH3hqfBtmVE/SeetyqPv3GI/AAAAAAAAASs/wk-D3sW06Rw/s1600-h/secede.jpg"></a> </div><br /><div>Texas Governor Rick Perry is saying he wants his state to secede from the Union.<br />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.<br /><br />I hope they do it.<br /><br />According to <a href="http://www.examiner.com/x-4107-SF-Gay--Lesbian-Examiner~y2009m4d16-Texas-to-secede--Good-riddance">The Examiner</a>:<br /><br />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.<br /><br /><strong><u>DON'T TAX ME BRO</u></strong></div><br /><div></div><div>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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">then</span> 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.<br /><br />I hope it's Texas, because that's so less far to travel then China. </div></div>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com2tag:blogger.com,1999:blog-4349143008524977129.post-34590401296796199132009-04-16T12:39:00.028-04:002009-04-26T17:43:58.859-04:00Kournikova and the Moscow Tennis Clones<strong><u>NAME THAT TUNE</u></strong><br />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?<br /><br />Oh....and you can only spin the thirteen million number wheel twice in any given year...<br /><br /><br /><p><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SedkGe4mWWI/AAAAAAAAASc/xPYAb_UBYQE/s1600-h/anna_kournikova.jpg"><img id="BLOGGER_PHOTO_ID_5325335146921351522" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 224px; CURSOR: hand; HEIGHT: 320px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SedkGe4mWWI/AAAAAAAAASc/xPYAb_UBYQE/s320/anna_kournikova.jpg" border="0" /></a><br /><a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SedjppNuQVI/AAAAAAAAASM/HvNvZG87C88/s1600-h/dementieva.jpg"><img id="BLOGGER_PHOTO_ID_5325334651478098258" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 243px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SedjppNuQVI/AAAAAAAAASM/HvNvZG87C88/s320/dementieva.jpg" border="0" /></a><br /><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SedjipgdHoI/AAAAAAAAASE/SNS6VcPMDNo/s1600-h/petrova.jpg"><img id="BLOGGER_PHOTO_ID_5325334531297582722" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 240px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SedjipgdHoI/AAAAAAAAASE/SNS6VcPMDNo/s320/petrova.jpg" border="0" /></a><br /><a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/SedjbB_eQFI/AAAAAAAAAR8/0rcyYVGU7sA/s1600-h/kleybanova2.jpg"><img id="BLOGGER_PHOTO_ID_5325334400431177810" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 249px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/SedjbB_eQFI/AAAAAAAAAR8/0rcyYVGU7sA/s320/kleybanova2.jpg" border="0" /></a><br /><a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SedjSymdUsI/AAAAAAAAAR0/6pPu6GJhBDo/s1600-h/chakvetadze02.jpg"><img id="BLOGGER_PHOTO_ID_5325334258860774082" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 179px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SedjSymdUsI/AAAAAAAAAR0/6pPu6GJhBDo/s320/chakvetadze02.jpg" border="0" /></a><br /><a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SedjMj5OFaI/AAAAAAAAARs/zqjixiUG2f4/s1600-h/kirilenko2.jpg"><img id="BLOGGER_PHOTO_ID_5325334151833720226" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 213px; CURSOR: hand; HEIGHT: 320px; TEXT-ALIGN: center" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SedjMj5OFaI/AAAAAAAAARs/zqjixiUG2f4/s320/kirilenko2.jpg" border="0" /></a><br /><a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SedjFAUIGRI/AAAAAAAAARk/Is39zOzGgtI/s1600-h/Vera+Dushevina.jpg"><img id="BLOGGER_PHOTO_ID_5325334022023813394" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 214px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SedjFAUIGRI/AAAAAAAAARk/Is39zOzGgtI/s320/Vera+Dushevina.jpg" border="0" /></a><br /><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SedgqBrPslI/AAAAAAAAARU/nmdBsHHIGQU/s1600-h/Ekaterina-Makarova460.jpg"><img id="BLOGGER_PHOTO_ID_5325331359509492306" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 192px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SedgqBrPslI/AAAAAAAAARU/nmdBsHHIGQU/s320/Ekaterina-Makarova460.jpg" border="0" /></a><br /><br /><br /><br /><br /><br /><p><em><strong>Also see:</strong></em><br /><a href="http://tedstumor.blogspot.com/2009/04/clone-wars-impossible-reality-of.html">Clone Wars: The Impossible Reality of Moscow's Female Russian TennisPlayers </a><br /><a href="http://tedstumor.blogspot.com/2009/04/maria-shapapova-anna-kournikova-and.html">Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal</a></p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-3628661112686900962009-04-15T17:11:00.008-04:002009-04-26T17:47:58.002-04:00Clone Wars: The Impossible Reality of Moscow's Female Russian Tennis Players<strong><u>What are the Chances?</u></strong><br /><br />Over at the <a href="http://www.womenstennisblog.com/2009/01/09/all-russian-final-at-the-asb-classic-elena-dementieva-vs-elena-vesnina/">Women's Tennis Blog</a> I found this feature that describes <em>17 all-Russian women tennis finals</em>. The most recent of these match-ups was this past January, in Aukland where these two players met:<br /><a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/SduLSLIywmI/AAAAAAAAAP0/_IwrxpUxiLY/s1600-h/elena-dementieva-photo.jpg"><img id="BLOGGER_PHOTO_ID_5322000529011950178" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 134px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/SduLSLIywmI/AAAAAAAAAP0/_IwrxpUxiLY/s200/elena-dementieva-photo.jpg" border="0" /></a><a href="http://3.bp.blogspot.com/_LH3hqfBtmVE/SduLMZYoiOI/AAAAAAAAAPs/UJ6FQN_sTxU/s1600-h/elena+vesnina.jpg"><img id="BLOGGER_PHOTO_ID_5322000429757270242" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 133px" alt="" src="http://3.bp.blogspot.com/_LH3hqfBtmVE/SduLMZYoiOI/AAAAAAAAAPs/UJ6FQN_sTxU/s200/elena+vesnina.jpg" border="0" /></a> That's Elena Dementieva on the left and Elena Versina on the right. In the finals. Both were born...in Russia.<br /><br /><p></p><p></p><a href="http://3.bp.blogspot.com/_LH3hqfBtmVE/SduOo4qeqnI/AAAAAAAAAP8/Fg7_U9TTvEk/s1600-h/zvonareva-84441708.jpg"><img id="BLOGGER_PHOTO_ID_5322004217724840562" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 126px; CURSOR: hand; HEIGHT: 170px" alt="" src="http://3.bp.blogspot.com/_LH3hqfBtmVE/SduOo4qeqnI/AAAAAAAAAP8/Fg7_U9TTvEk/s200/zvonareva-84441708.jpg" border="0" /></a><a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SduOuK6YPTI/AAAAAAAAAQE/ev-ZTi436dY/s1600-h/petrova.jpg"><img id="BLOGGER_PHOTO_ID_5322004308522712370" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 133px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SduOuK6YPTI/AAAAAAAAAQE/ev-ZTi436dY/s200/petrova.jpg" border="0" /></a> <strong><u>This Can Only Be Genetic Meddling</u></strong><br />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, <strong><em>eleven women born in Moscow </em></strong>-- 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?<br /><br />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.<br />Approximately 1 in 13 million <em>tennis players</em> 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 <em>in a generation</em>. So are 11 possible? 11 blonds with the same game? No way.<br /><br /><strong><u>Put it in Perspective<br /></u></strong><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br /><br /><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SeZMjTrHrUI/AAAAAAAAARM/QAL_IbTSphc/s1600-h/dolly2.jpg"><img id="BLOGGER_PHOTO_ID_5325027778872454466" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 318px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SeZMjTrHrUI/AAAAAAAAARM/QAL_IbTSphc/s320/dolly2.jpg" border="0" /></a><br /><br /><strong><u>Messing With the Eggs</u></strong><br />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.<br /><br />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.<br /><br />So let's ask Russia for their rationale. Let's ask them a <em><strong>whattssup wit dat!</strong></em><br /><br /><p>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.</p><p><em><strong>Also See:</strong></em><br /><a href="http://tedstumor.blogspot.com/2009/04/maria-shapapova-anna-kournikova-and.html">Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal</a><br /><a href="http://tedstumor.blogspot.com/2009/04/kournikova-and-moscow-tennis-clones.html">Kournikova and the Moscow Tennis Clones </a></p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com16tag:blogger.com,1999:blog-4349143008524977129.post-71313000009636080692009-04-09T01:16:00.041-04:002009-04-09T19:05:16.913-04:00Farrah Fawcett's Anal Cancer--Can You Prevent Yours?<a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sd2MK7S2O_I/AAAAAAAAAQs/EqjF7asbjvc/s1600-h/farrah2.jpg"><img id="BLOGGER_PHOTO_ID_5322564453965118450" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 150px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sd2MK7S2O_I/AAAAAAAAAQs/EqjF7asbjvc/s200/farrah2.jpg" border="0" /></a> <strong><u>Angel on the Rocks</u></strong><br /><br />This isn't a topic on the top of every one's blog list but <em>WHY NOT?</em> 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.<br /><br />Last September, <a href="http://gawker.com/5056620/pj-orourke-will-probably-survive-anal-cancer">P.J. O'Rourke was diagnosed</a> with anal cancer. According to <a href="http://www.cnn.com/2009/HEALTH/04/09/anal.cancer.fawcett/">CNN</a>:<br /><br />"The numbers of anal cancer cases are rising, although experts haven't been able to pinpoint why."<br /><br /><strong><u>ANAL CANCER--Time to Talk</u></strong><br /><br />OK, thankfully it's rare -- 1 in 100,000 people -- but with over 6 billion people in the world...do the math. It's significant, and growing in incidence, <em>especially</em> since the advent of the acceptance of anal sex--a fact that needs addressing.<br /><br />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 <em>be aware</em>! 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 <em>35 times higher risk.<br /></em><br />In addition, MSM who are HIV positive are <em>twice </em>as likely to get anal cancer than MSM who are HIV negative. Likewise then, WOMEN with HIV+ partners need to be EQUALLY VIGILANT.<br /><br /><strong><u>HPV</u></strong><br /><br />Why is that?<br /><br />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.<br /><br /><em>Genital warts</em> 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:<br /><p><a href="http://3.bp.blogspot.com/_LH3hqfBtmVE/Sd5vDFM6HRI/AAAAAAAAAQ8/eribLVikCYY/s1600-h/warts.jpg"><img id="BLOGGER_PHOTO_ID_5322813908325113106" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 82px; CURSOR: hand; HEIGHT: 86px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_LH3hqfBtmVE/Sd5vDFM6HRI/AAAAAAAAAQ8/eribLVikCYY/s200/warts.jpg" border="0" /></a><br />These are anal warts. Bumpy, cauliflower-like appearance. Probably due to the association between HPV and anal cancer, <em>women with history of cervical cancer are at increased risk of developing anal cancer</em>. This is what you want to look for and act on. People with these are at an increased risk for cancer. </p><p>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 <em>at risk</em> group. </p><p>At Risk: <p>1. Unprotected Sex <p>2. Anal sex -- protected or not, male or female <p>3. Male-female vaginal sex if the male is uncircumcised <p>4. Many sex partners over the course of a lifetime, vaginal or anal or oral sex <p>5. History of genital warts--exposed to genital warts</p><p>Why worry about <em>many</em> 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.<br /><br />And let's not forget the legend as she was:<br /><br /><a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sd2MREo8v-I/AAAAAAAAAQ0/pjKd-K6mXCw/s1600-h/farrah-fawcett.jpg"><img id="BLOGGER_PHOTO_ID_5322564559552954338" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 144px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sd2MREo8v-I/AAAAAAAAAQ0/pjKd-K6mXCw/s200/farrah-fawcett.jpg" border="0" /></a> </p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com3tag:blogger.com,1999:blog-4349143008524977129.post-91677599506800179732009-04-07T18:53:00.028-04:002009-04-07T20:42:06.625-04:00Mammography Faces A New Foe: NNT<a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SdvwfG0wtpI/AAAAAAAAAQU/to9qNZnTzmw/s1600-h/adviceClosedDoors.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 200px; height: 153px;" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SdvwfG0wtpI/AAAAAAAAAQU/to9qNZnTzmw/s200/adviceClosedDoors.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5322111801866892946" /></a><br /><strong><u>This Door is Closed</u></strong><br /><blockquote>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</blockquote><br /><blockquote><strong>CONCLUSION:</strong> "Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up"<br />--<a href="http://jama.ama-assn.org/cgi/content/abstract/273/2/149?ijkey=14fbc7c289ae4652b339e079156e0168bfec5504&keytype2=tf_ipsecsha">JAMA Vol. 273 No. 2, January 11, 1995</a></blockquote><br />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: "<a href="http://www.kevinmd.com/blog/2009/04/how-much-do-we-really-need-mammograms.html">How Much Do We Really Need Mammograms</a>." 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.<br /><br /><strong><u>Market Tops</u></strong><br />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 <em>price to earnings</em> ratio , was no longer valid. Instead we would look at a new valuation method: <em>price to sales</em> 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.<br /><br />Lets not even <em>talk</em> about real estate.<br /><br /><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SdvvgXICVjI/AAAAAAAAAQM/MP-YfsRyn5I/s1600-h/coffee+spoons.jpg"><img id="BLOGGER_PHOTO_ID_5322110723910948402" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SdvvgXICVjI/AAAAAAAAAQM/MP-YfsRyn5I/s200/coffee+spoons.jpg" border="0" /></a><br /><div><strong><u>Measuring Out Your Life</u></strong></div><br /><div></div><br /><div>The <em>Number Needed to Treat</em> 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:<br /></div><br /><blockquote>... 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).</blockquote><br /><p>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, <em>not how many fewer people die</em>. 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 <a href="http://tedstumor.blogspot.com/2009/04/british-still-resist-screening.html">here</a>.</p><br /><p>So, theoretically, even if screening mammography reduces deaths from breast cancer, if you have to do too many mammograms to prevent one death, then...it isn't worth it to the system</p><br /><p>Who is the system? Whoever pays the bills. </p><br /><p>Who make s the rules? Whoever pays the bills.</p><br /><p>Who's paying the bills in the future of your heath care? The government. </p><br /><p>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 system...as Arnold Swartzeneger says in almost every movie he makes: "GET DOWN!"</p><br /><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SdvxllzVz8I/AAAAAAAAAQc/IKiY-HwJaf0/s1600-h/Arnold_Schwartzenegger.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 156px; height: 200px;" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SdvxllzVz8I/AAAAAAAAAQc/IKiY-HwJaf0/s200/Arnold_Schwartzenegger.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5322113012773277634" /></a>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com3tag:blogger.com,1999:blog-4349143008524977129.post-69087183934002788372009-04-07T10:20:00.026-04:002009-04-26T17:52:15.532-04:00Maria Shapapova, Anna Kournikova, and the Russian Tennis Cloning Scandal<a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sdt5Slz9e9I/AAAAAAAAAPM/cMpZ6K859cs/s1600-h/maria-sharapova-camel-toe.jpg"><img id="BLOGGER_PHOTO_ID_5321980744963029970" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 107px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sdt5Slz9e9I/AAAAAAAAAPM/cMpZ6K859cs/s200/maria-sharapova-camel-toe.jpg" border="0" /></a><br /><br /><strong><u>The Girls From Russia<br /></u></strong><br />This past weekend, in Key Biscayne Florida, another young tall, blond, pig-tailed Russian girl with devastating ground strokes won a major tennis tournament.<br /><br />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!<br /><br />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: <strong>Victoria Azarenko:</strong><br /><br /><br /><p><a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/SdlVtbnXnKI/AAAAAAAAALE/b6VqKaZ_uBg/s1600-h/aza.jpg"><img id="BLOGGER_PHOTO_ID_5321378673710308514" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 237px; CURSOR: pointer; HEIGHT: 178px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/SdlVtbnXnKI/AAAAAAAAALE/b6VqKaZ_uBg/s320/aza.jpg" border="0" /></a><br /><br /><strong><u>Just the Facts, Ma'am</u></strong><br />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...<br /><br />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:<br /><br /><a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/Sdt5johGOoI/AAAAAAAAAPU/B8qwkriPgvw/s1600-h/daniela-hantuchova-5.jpg"><img id="BLOGGER_PHOTO_ID_5321981037746993794" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 171px" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/Sdt5johGOoI/AAAAAAAAAPU/B8qwkriPgvw/s200/daniela-hantuchova-5.jpg" border="0" /></a><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sdt5qp5p3iI/AAAAAAAAAPc/ba82Fs4gQRQ/s1600-h/cibulkova.jpg"><img id="BLOGGER_PHOTO_ID_5321981158377512482" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 133px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sdt5qp5p3iI/AAAAAAAAAPc/ba82Fs4gQRQ/s200/cibulkova.jpg" border="0" /></a><strong><u>Say It IS So<br /></u></strong>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 <strong><em>THE FORMER USSR </em></strong></p><p>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!</p><br />Here are the Russians in the TOP 100 with their birthplaces and dates:<br /><br />Sharapova former #1--: Nyagan, Siberia, Russia 1987<br />Dinara Safina #2--Moscow Russia 1986<br />Elena Dementiava #4 --Moscow Russia 1981<br />Svetlana Kuznetsova #8-- St. Petersburg, Russia 1985<br />Nadia Petrova #9--Moscow 1982<br />Victoria Azaranka #10--Minsk, Belarus 1989<br />Dominika Cibulkova #16-- Bratislava, Slovak 1989<br />Alisa Kleybanova #17 -- Moscow, Russia, 1989<br />Anna Chakvetadze #23-- Moscow, Russia. 1987<br />Anastasia Pavlyuchenkova #27--Samara Russia 1991<br />Alona Bondarenko #38 --Krivyi Rig (Ukraine),1984<br />Maria Kirilenko #39-- Moscow Russia 1987<br />Maria Daniela Hantuchova #43 --Poprad, Slovakia 1983<br /><br />And don't forget the queen bee. The original. The model from whom the others seem to have begotten:<br /><br />It all started with Anna Kournikova, born in 1981; where else? Moscow Russia.<br /><br /><a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sdt70pgti7I/AAAAAAAAAPk/pXAWGJeK7GQ/s1600-h/kournikova.jpg"><img id="BLOGGER_PHOTO_ID_5321983529094843314" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 159px; CURSOR: hand; HEIGHT: 200px" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/Sdt70pgti7I/AAAAAAAAAPk/pXAWGJeK7GQ/s200/kournikova.jpg" border="0" /></a><br /><br />NEXT POST: FURTHER REVELATIONS ABOUT "TENNIS' CLONING ACHIEVEMENT!"<br /><br /><strong><em></em></strong><br /><strong><em></em></strong><br /><strong><em></em></strong><br /><strong><em></em></strong><br /><strong><em></em></strong><br /><strong><em></em></strong><br /><strong><em></em></strong><br /><strong><em>Also See:</em></strong><br /><a href="http://tedstumor.blogspot.com/2009/04/clone-wars-impossible-reality-of.html">Clone Wars: The Impossible Reality of Moscow's Female Russian Tennis Players</a><br /><a href="http://tedstumor.blogspot.com/2009/04/kournikova-and-moscow-tennis-clones.html">Kournikova and the Moscow Tennis Clones</a>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com5tag:blogger.com,1999:blog-4349143008524977129.post-58801974839929746842009-04-04T08:10:00.015-04:002009-04-04T10:06:49.521-04:00British Still Resist Screening Mammography--Why?<a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SddOkOybQrI/AAAAAAAAAJ8/ovdPrGP08QQ/s1600-h/british.jpg"><img id="BLOGGER_PHOTO_ID_5320807869113385650" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SddOkOybQrI/AAAAAAAAAJ8/ovdPrGP08QQ/s320/british.jpg" border="0" /></a><u><strong>The Empire Strikes Back</strong></u><br />The British always want to do less than the Americans (just ask <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Barak</span> Obama), especially as regards breast cancer screening. Once again I picked up the the <a href="http://www.nytimes.com/2009/03/31/health/31mamm.html?em">New York Times</a> to read another article in which the Brits question the value of mammography. I guess since they <a href="http://ije.oxfordjournals.org/cgi/content/full/33/1/43#B29">lost the statistical and factual debate</a> 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?<br /><br /><u><strong>The Hundred Years War</strong></u><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_1">mammographic</span> screening policy was: one view of each breast every three years! When the data finally <a href="http://ije.oxfordjournals.org/cgi/content/full/33/1/43#B29">settled the case</a> 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: <em>Why?</em><br /><br />The title of the most recent handmaid tale from Britain in the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">NYT</span>: <em>Benefits of Mammogram Under Debate in Britain</em>. 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.<br /><br />"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."<br /><br />This woman turned out to have a low-grade <span class="blsp-spelling-error" id="SPELLING_ERROR_3">tumnor</span> (<span class="blsp-spelling-error" id="SPELLING_ERROR_4">DCIS</span> -- which is not always low-grade)and basically, hers and the the British complaint is that we (Americans) <em>find too many women with breast cancer</em> 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).<br /><br />To ameliorate this "problem" a British mammogram expert,Dr. Peter C. <span class="blsp-spelling-error" id="SPELLING_ERROR_5">Gotzsche</span>,rewrote a "letter" provided to British women regarding mammography screening:<br /><br />“It may be reasonable to attend breast cancer screening with mammography, but it may also be reasonable not to attend.”<br /><br /><a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sddhb8zHAwI/AAAAAAAAAKE/qujxAXlZzfY/s1600-h/Cemetery%2520photo%25202.jpg"><img id="BLOGGER_PHOTO_ID_5320828617566388994" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 250px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sddhb8zHAwI/AAAAAAAAAKE/qujxAXlZzfY/s320/Cemetery%2520photo%25202.jpg" border="0" /></a><u><strong>The Objective of Mammography</strong></u><br />The British doctors worry about <em>too many biopsies</em> which result in <em>extra cost</em>, <em>stress</em> to the women, and <em>extra radiation</em> during repeat <span class="blsp-spelling-error" id="SPELLING_ERROR_6">mammographic</span> imaging. Don't they sound like nannies?<br /><br />What about cancer? They don't mention that.<br /><br />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 <em>infinity</em>. Or ask any breast cancer advocate.<br /><br /><strong><u>Socialist Mind Set</u></strong><br />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.<br /><br /><span class="blsp-spelling-corrected" id="SPELLING_ERROR_7">Are</span> we ready to change mindsets? Are we ready to understand <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">that you</span> can't <em>try</em> to save everyone all the time? <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">That</span> i<span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">t</span> may <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">not</span> be worthwhile to save one person if the cost incurred is deemed to be asymmetrical to the system?<br /><br />And if we are, then are we ready to abandon the Tort system that penalizes the failures to each individual--<span class="blsp-spelling-corrected" id="SPELLING_ERROR_12">because</span> some individuals are going to the graveyard (or worse)-- because the system cannot afford to respond individually.<br /><br />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.Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com1tag:blogger.com,1999:blog-4349143008524977129.post-67495445650333037642009-04-02T19:44:00.020-04:002009-04-03T10:27:47.221-04:00Keeping Smokers Alive to Take Care of Children<a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/SdVQ9thKmgI/AAAAAAAAAJs/xgSKVLUldZ0/s1600-h/romero.jpg"><img id="BLOGGER_PHOTO_ID_5320247555929053698" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 213px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/SdVQ9thKmgI/AAAAAAAAAJs/xgSKVLUldZ0/s320/romero.jpg" border="0" /></a> <strong><u>Night of the Living Smoker </u></strong><br /><br />The government has finally declared its intentions to the cigarette smoker: KEEP SMOKING BRO!<br /><br /><p><span class="blsp-spelling-error" id="SPELLING_ERROR_0">BHO</span> 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!</p><p>This represents the largest federal tobacco tax increase <em>ever</em>. In some cases, smokers will be coughing up $9-$10 for a pack...</p><p>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 <em>cigarette tax money</em>, which nowadays is viewed as a way to raise funds for federal programs.</p><p><u><strong>Who What When...Teddy Kennedy</strong></u></p><p><strong><u></u></strong><br /><a href="http://3.bp.blogspot.com/_LH3hqfBtmVE/SdYWj21Da-I/AAAAAAAAAJ0/YnAj0bqKmkM/s1600-h/chapp.jpg"><img id="BLOGGER_PHOTO_ID_5320464815054089186" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 231px" alt="" src="http://3.bp.blogspot.com/_LH3hqfBtmVE/SdYWj21Da-I/AAAAAAAAAJ0/YnAj0bqKmkM/s320/chapp.jpg" border="0" /></a> </p><p>In 1997 Teddy Kennedy sponsored an expansion of Medicaid (<span class="blsp-spelling-error" id="SPELLING_ERROR_1">SCHIP</span>) in order to provide insurance for families that <em>were not poor enough</em> to qualify for Medicaid. An expensive proposition. This February, one of <span class="blsp-spelling-error" id="SPELLING_ERROR_2">BHO's</span> first acts as president was to expand this program (stimulus <span class="blsp-spelling-error" id="SPELLING_ERROR_3">shmimulus</span>) to include <em>millions</em> more people, even those who are not traditional families, including immigrants.</p><p>When pressed for a funding solution to support this new expansion of the government program, <span class="blsp-spelling-error" id="SPELLING_ERROR_4">BHO</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_5">SCHIP</span>. So now cigarette smokers are taking care of kids, at the cost of their lives.</p><p>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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">government</span> 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.</p><strong><u>Looking for Volunteers<br /></u></strong><p>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.</p><p>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 <span class="blsp-spelling-error" id="SPELLING_ERROR_7">AmeriCorps</span>.</p><p>Or maybe the government could keep people alive, on smoking farms--<span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">which</span> 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_9">BHO</span> funds his support of future smokers by maintaining their health as children. </p><p>Sounds good to me.</p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com1tag:blogger.com,1999:blog-4349143008524977129.post-41298128274970805402009-04-02T13:26:00.030-04:002009-04-04T08:08:50.406-04:00Why Worry About Pistachio Recall When Poison Fish Can Ruin Your Sex Life?<a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SdT6pW2REuI/AAAAAAAAAJM/fQyH3WBiDu8/s1600-h/crjack.jpg"><img id="BLOGGER_PHOTO_ID_5320152648246170338" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 213px" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SdT6pW2REuI/AAAAAAAAAJM/fQyH3WBiDu8/s320/crjack.jpg" border="0" /></a> <u><strong>Ugly Fish, Painful Sex and a Bad Bug</strong></u><br /><br />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...<br /><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_0">amberjack</span>: a rough and tumble little guy hanging with his <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">posse</span> -- groupers, red snappers, eel, sea bass, barracuda, and Spanish mackerel -- who together sicken as many as <em>50,000 people</em> every year. Take that pistachios!<br /><br /><u><strong>Loves Labor Lost</strong></u><br /><u><strong><br /></strong></u><a href="http://www.msnbc.msn.com/id/29898937/">In a new report</a>, public health investigators describe a cluster of cases of <em>painful intercourse</em> 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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">algae</span> contaminated with a bad bug, a protozoan -- <span class="blsp-spelling-error" id="SPELLING_ERROR_3">dinoflagellida</span> to be exact -- from the class <span class="blsp-spelling-error" id="SPELLING_ERROR_4">PHYTOMASTIGOPHORA</span>.<br /><br />The bugs make a poison, <span class="blsp-spelling-error" id="SPELLING_ERROR_5"><strong><em>ciguatera</em></strong></span>, which, when ingested, can cause some pretty weird and alarming symptoms like:<br /><br />Paradoxical temperature reversal (cold objects feel hot and hot objects feel cold)<br />A feeling of loose teeth<br />Painful intercourse (for both the man and the woman)<br /><span class="blsp-spelling-error" id="SPELLING_ERROR_6">Arthralgias</span><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_7">Myalgias</span><br />Weakness<br />Ataxia, vertigo<br />Respiratory paralysis<br />Coma<br /><br />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.<br /><br /><a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/SdUbG2-dl0I/AAAAAAAAAJk/NATqyU_DQNs/s1600-h/Great-Barracuda.jpg"><img id="BLOGGER_PHOTO_ID_5320188339458774850" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 240px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/SdUbG2-dl0I/AAAAAAAAAJk/NATqyU_DQNs/s320/Great-Barracuda.jpg" border="0" /></a><u><strong>Fish Rabies</strong></u> <p></p><p>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 <span class="blsp-spelling-error" id="SPELLING_ERROR_8"><strong>ciguartera</strong></span> <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">poisoning</span> by living in Iowa or Uzbekistan. This illness strikes everywhere. And <span class="blsp-spelling-error" id="SPELLING_ERROR_10"><strong>ciguatera</strong></span> poisoning is the most common <span class="blsp-spelling-error" id="SPELLING_ERROR_11">nonbacterial</span>, fish-borne poisoning in the United States.<br /><br />So how will you know if you've been poisoned?<br /><br />First, you will have eaten fish. Maybe a fish sandwich or the daily special which was grouper <em>provencale</em>...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?</p><p>The room starts to spin right before you begin panting to catch each breath. You feel <span class="blsp-spelling-corrected" id="SPELLING_ERROR_12">exhausted,</span> yet your heart is beating faster and has a jumpy feeling. </p><p>That's when you go to grab the ice-cold can of Coke...AND IT'S BURNING HOT!<br /><br />That's the classic finding: <em>temperature reversal</em>. If this happens to you send yourself straight to the local ER and demand several hours of a <span class="blsp-spelling-error" id="SPELLING_ERROR_13">Mannitol</span> 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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_14">treat</span> you symptomatically.<br /><br /><u><strong>Don't Be a Hog (Snapper)<br /></strong></u><br />If you want to <span class="blsp-spelling-corrected" id="SPELLING_ERROR_15">avoid</span> <strong>c<span class="blsp-spelling-error" id="SPELLING_ERROR_16">iguatera</span></strong>, 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 <span class="blsp-spelling-error" id="SPELLING_ERROR_17"><strong>ciguatera</strong></span> poison are proportional to its size and if the fish was greater than 2 kg--have the lasagna.<br /><br />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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_18">accidentally</span> roll over the shells.<br /></p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-88073592278171350482009-03-31T05:29:00.024-04:002009-03-31T20:09:35.562-04:00When Will Obama Force Sanjay Gupta to Resign?<a href="http://1.bp.blogspot.com/_LH3hqfBtmVE/SdHnkdVQ8gI/AAAAAAAAAIs/IkuPHv_F3qQ/s1600-h/pod.jpg"><img id="BLOGGER_PHOTO_ID_5319287248436392450" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 179px; CURSOR: hand; HEIGHT: 241px; TEXT-ALIGN: center" alt="" src="http://1.bp.blogspot.com/_LH3hqfBtmVE/SdHnkdVQ8gI/AAAAAAAAAIs/IkuPHv_F3qQ/s320/pod.jpg" border="0" /></a><br /><em></em><div align="center">"I never knew fear until I kissed Becky"<br />--Dr. Miles J. Bennell, from <em>Invasion of the Body Snatchers</em> </div><div><br /><strong><u>Just Put This Pod in Your Hospital</u></strong></div><div></div><div>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?<br /><br />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.<br /><br /><a href="http://www.examiner.com/x-4285-Salt-Lake-Nonpartisan-Examiner~y2009m3d29-Obama-knows-best-as-GM-Exec-Wagoner-resigns">Monday, Mr. Wagoner resigned</a> from his job of 19 years as CEO of the storied automaker. He resigned because President Barak Obama told him to.<br /><br />There was a time when this sequence of events would have rocked the news. <em>The president of the United States told a CEO of a major American company to step down.</em> But today, as the government moves in on our private institutions in a bad remake of <em>Invasion of the Body Snatchers</em>, we applaud the decision.<br /><br />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.<br /><br />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).<br /><br />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. </div><br />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."<br /><br />Can Sanjay Gupta be far behind Wagoner? Watch the door Dr. Gupta.<br /><br /><u><strong>Going Out of Business</strong><br /></u><br /><a href="http://3.bp.blogspot.com/_LH3hqfBtmVE/SdHpM0McBWI/AAAAAAAAAI0/rnNeIAhhQ4k/s1600-h/gupta.jpg"><img id="BLOGGER_PHOTO_ID_5319289041279780194" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 219px; TEXT-ALIGN: center" alt="" src="http://3.bp.blogspot.com/_LH3hqfBtmVE/SdHpM0McBWI/AAAAAAAAAI0/rnNeIAhhQ4k/s320/gupta.jpg" border="0" /></a><br />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.<br /><br />Those strings were pulled this past weekend as Barak Obama told Rick Wagoner to resign. And now?Now Obama says that the government may <a href="http://online.wsj.com/article/SB123845591244871499.html">force GM into bankruptcy!</a><br /><br />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."<br /><br />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.Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-77429934777362375812009-03-26T05:20:00.038-04:002009-03-26T09:51:23.513-04:00Winning Back the Penis--One Piece at a Time<a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/SctnoG2Kg3I/AAAAAAAAAIU/dsusQKoOEHI/s1600-h/motherings.jpg"><img id="BLOGGER_PHOTO_ID_5317457723771224946" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 151px; CURSOR: hand; HEIGHT: 117px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/SctnoG2Kg3I/AAAAAAAAAIU/dsusQKoOEHI/s320/motherings.jpg" border="0" /></a>The first time I ever saw a man who was <em>status post</em> penectomy I decided that circumcision was the right thing to do.<br /><br /><div>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). </div><br />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.<br /><br />Today we have <a href="http://www.abcnews.go.com/Health/Sex/story?id=7172989&page=1">news about circumcision.</a> Namely, it seems that the procedure is extremely effective in reducing STD's. In fact:<br /><br /><span style="font-size:85%;">"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."<br /></span><br />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.<br /><br />Why so?<a href="http://www.medicinenet.com/penis_cancer/article.htm"></a><br /><br /><strong><u>Don't Touch That Penis!</u></strong><br />Around the same time that I decided circumcision was a <em>good</em> 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 (<a href="http://www.doctorsopposingcircumcision.org/">DOC</a>)." 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"<br /><br />If you read the entire position statement, however, the AAP admits <em>quite a few risks</em> associated with the uncircumcised state, including:<br /><br /><span style="font-size:85%;">"the risk of developing penile cancer in an uncircumcised man compared with a circumcised man is increased more than three fold"</span><br /><br />In the end the AAP conclude in their position statement that <em>parents should evaluate the data and make an informed decision.</em><br /><em></em><br /><strong><u>Along Came Mary</u></strong><br />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.<br /><br />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.<br /><br />So they came to a new cause, circumcision. And they came like hungry birds: Activists, rights groups and newly formed coalitions like <a href="http://www.mothersagainstcirc.org/">MAC </a>(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 <a href="http://www.foxnews.com/story/0,2933,59639,00.html">this </a>Fox report.<br /><br />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.<br /><br />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 <em>ashamed to admit they circumcised their child</em>, as recounted in a serious but humorous article on this topic in <a href="http://www.salon.com/mwt/feature/2007/01/09/pollack_circumcision/">Salon </a>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:<br /><br />"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."<br /><br />Individuals get slammed, but they are only pawns of bad doctors...and, of course, <em>the American health care system,</em> as demonstrated nicely by the words of Tim Hammond, a leading opponent of circumcision and founder of <a href="http://www.noharmm.org/home.htm">NOHARMM</a>, the U.S. National Organization to Halt the Abuse and Routine Mutilation of Males:<br /><br /><span style="font-size:85%;">Tim Hammond, believes that circumcision in the U.S. is perpetuated by arrogance and the radical American health environment.</span><br /><br /><strong><u>Radical, Dude</u></strong><br />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.<br /><br />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.<br /><br />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.Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-63635295274184790612009-03-23T19:54:00.046-04:002009-03-24T21:48:43.708-04:00Breast MRI and The Coming War Against Medical Technology<a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sckg32LBE_I/AAAAAAAAAIM/KCZmXHtpM8U/s1600-h/flak3.jpg"><img id="BLOGGER_PHOTO_ID_5316816978894197746" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 248px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sckg32LBE_I/AAAAAAAAAIM/KCZmXHtpM8U/s320/flak3.jpg" border="0" /></a><strong>Flak</strong>: noun<br />1. antiaircraft fire, esp. as experienced by the crews of combat airplanes at which the fire is directed.<br />2. criticism; hostile reaction; abuse: <em>Such an unpopular decision is bound to draw a lot of flak from the press. </em><br /><br /><strong><u>The Rising Tide<br /></u></strong><div></div><div>I came <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">across</span> <a href="http://www.kevinmd.com/blog/2009/03/does-breast-mri-have-any-benefit-for.html">this </a>headline on the website of Kevin, M.D.: <em>"Does Breast MRI have any benefits for patients with breast cancer?"</em> Being a big fan of breast MRI (and the lives of the women I've seen it save), this headline took me aback somewhat.</div><div><br />Kevin, M.D. referenced another blog by a general surgeon, <a href="http://ohiosurgery.blogspot.com/2009/03/breast-cancer-and-mri.html">Jeffery Parks</a>, who titled his piece "<em>Breast Cancer and MRI,</em>" and used the phrases: "Finally some news on the use (or overuse) or MRI in breast cancer;" and "There are situations where MRI <em>could potentially</em> be useful ..." (italics mine).</div><div></div><div>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 (<span class="blsp-spelling-error" id="SPELLING_ERROR_1">BMRI</span>) gets <em>not</em> because it is a fantastic technology and head and shoulders above mammography, ultrasound and breast exam <em>combined</em>; rather, its the consistent repetitive <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">criticisms</span> that <span class="blsp-spelling-error" id="SPELLING_ERROR_3">BMRI</span> is expensive and too sensitive. These <span class="blsp-spelling-error" id="SPELLING_ERROR_4">nonmedical</span> criticisms <em>overwhelm</em> the real message: <span class="blsp-spelling-error" id="SPELLING_ERROR_5">BMRI</span> saves lives. It can save <em>your</em> life.</div><div></div><br /><u><strong>That's a Fact Jack</strong></u><br />Let's start with <em><strong>two</strong></em> facts as demonstrated by multiple studies over the past 15 years:<br /><br />1.<em>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.</em><br /><br />2. <em>The sensitivity of mammography in dense breasts can be as low as 45%</em> ...................(otherwise known as a coin flip); and <em>when a cancer is identified on a mammogram it can frequently be found on <strong>last</strong> year's mammogram, as often as 70% of the time</em><br /><em></em><br />There are LOTS of studies that document the power of MRI in making the diagnosis of breast cancer.<br /><br /><p>Why then all the FLAK?</p><p><strong><u>Share it fairly but <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">don't</span> take a slice of my pie</u></strong></p><p>It seems to me that there is a lot of hostility out there as regards <span class="blsp-spelling-error" id="SPELLING_ERROR_7">BMRI</span> 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.</p><p>MRI gets a lot of flak because of 2 reasons:<br />1. It's expensive<br />2. It finds a lot of things that aren't cancer resulting in more biopsies and follow-ups that...<em>cost more money</em></p><p>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 <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">biopsies</span> and follow-ups also usually complain that this creates COSTS. Some authors now applaud President <span class="blsp-spelling-error" id="SPELLING_ERROR_9">Obama's</span> search for cost effectiveness via the stimulus package as a welcome effort aimed at optimizing care while reducing costs.<br /></p><p><strong><u>Demand What Ted Gets</u></strong></p><p>In systems where the government is in charge of distributing <span class="blsp-spelling-error" id="SPELLING_ERROR_10">limited tax</span> dollars between different budgetary <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">demands</span>--one of which is health care--<span class="blsp-spelling-corrected" id="SPELLING_ERROR_12">bureaucrats</span> 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, <span class="blsp-spelling-error" id="SPELLING_ERROR_13">homeotherapy</span>, adjustments, zinc tablets, and laughter therapy.</p><p>The other 5% -- the people in the <span class="blsp-spelling-error" id="SPELLING_ERROR_14">ICU's</span> 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."</p><p>These are the patients who will be left behind in the future of Ted Kennedy's <em>Health Care America.</em></p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-23582534209208589492009-03-20T12:17:00.011-04:002009-03-20T12:40:03.177-04:00Natasha Richardson, Epidural Hemorrhage and No Help in Canada<a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/ScPFcQuVHLI/AAAAAAAAAIE/Wr5RRkev4yk/s1600-h/grey-395x298-photo5_0.jpg"><img id="BLOGGER_PHOTO_ID_5315309074543615154" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 241px; TEXT-ALIGN: center" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/ScPFcQuVHLI/AAAAAAAAAIE/Wr5RRkev4yk/s320/grey-395x298-photo5_0.jpg" border="0" /></a><br /><div>Previous Posts on Natash Richardson at Kennedy's Tumor:<br /><a href="http://tedstumor.blogspot.com/2009/03/what-happened-to-natasha-richardson.html">What Happened toNatasha Richardson?</a><br /><a href="http://tedstumor.blogspot.com/2009/03/natasha-richardson-epidural-hemorrhage.html">Natasha Richardson, Epidural Hemorrhage and Canadian Health Care</a></div><br /><div><strong><u>The Death of Natasha Richardson</u></strong><br /></div><br /><div><a href="http://www.kevinmd.com/blog/2009/03/did-canadian-health-system-fail-natasha.html">Kevin, M.D.</a> 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:<br /><br /><span style="font-size:85%;">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.<br /></span><br /><strong><u>How Remote?<br /></u></strong><br />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.<br /><br />As of 2005, Mont Tremblant had been recognized by Ski Magazine as the #1 ski resort in Eastern North America for 8 consecutive years.<br /><br />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.<br /><br />According to <a href="http://jama.ama-assn.org/cgi/content/abstract/295/8/919">JAMA </a>: </div><br /><div><span style="font-size:85%;">...head injuries are common in alpine skiers and snowboarders.</span><a name="RREF-JOC60015-2"></a><a name="RREF-JOC60015-4"></a><span style="font-size:85%;"> Head injury is the most frequent reason for hospital admission</span><a name="RREF-JOC60015-5"></a><a name="RREF-JOC60015-8"></a><span style="font-size:85%;"> and the most common cause of death among skiers and snowboarders with an 8% fatality rate among those admitted to hospital with head injuries.</span><a name="RREF-JOC60015-9"></a><span style="font-size:85%;"> 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.</span><br /><br />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 <em>in Colorado</em> from accidents on the ski slopes, and among the fatally injured in one study, head injury was the cause of death in 87.5%;<br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/11350656?dopt=Citation">Another report</a> lists the incidence of ski head injury incidence at 0.77 per 100 000 ski visits<br /><br />And a <a href="http://www.ncbi.nlm.nih.gov/pubmed/3370085?dopt=Citation">mega-study</a> estimated rate of one death per 1.5 million skier-days.<br /><br />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.</div><br /><div></div><div>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.<br /><br /><strong><u>Availability of Neurosurgeons<br /></u></strong><br />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.</div><br /><div>Neurosurgeons are not so easy to find in Canada where subspecialization is not rewarded, and <em>50-60% of boarded neurosurgeons leave the country to practice somewhere else within 2 years of their certification.<br /></em><br />The last good data I could find listed only <em>174 neurosurgeons in the entire country</em>. 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 <em>604</em>.<br /><br />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.</div><br /><div></div><div>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.</div><div> <br /><br />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.</div>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com12tag:blogger.com,1999:blog-4349143008524977129.post-45390656197138896852009-03-19T07:18:00.012-04:002009-03-19T14:29:35.237-04:00Natasha Richardson, Epidural Hemorrhage and Canadian Health Care<a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/ScJdUZ5yFVI/AAAAAAAAAH0/6X11JLM8Opk/s1600-h/art-ms461662_fig2.jpg"><img id="BLOGGER_PHOTO_ID_5314913115382617426" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 229px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/ScJdUZ5yFVI/AAAAAAAAAH0/6X11JLM8Opk/s320/art-ms461662_fig2.jpg" border="0" /></a><br /><br />This CT scan (LEFT) shows 4 TYPES of <span class="blsp-spelling-error" id="SPELLING_ERROR_0">intracerebral</span> hemorrhage:<br /><br />1. EPIDURAL short white arrow;<br />2. <span class="blsp-spelling-error" id="SPELLING_ERROR_1">SUBDURAL</span> short black arrow<br />3. <span class="blsp-spelling-error" id="SPELLING_ERROR_2">SUBARACHNOID</span> long black arrow<br />4.<span class="blsp-spelling-error" id="SPELLING_ERROR_3">INTRAPARECNCHYMAL</span> ( = in the brain matter itself)<br />long white arrow<br /><br />Yesterday it was my conclusion that Natasha Richardson suffered from a <span class="blsp-spelling-error" id="SPELLING_ERROR_4">subarachnoid</span> hemorrhage (from a ruptured aneurysm)rather than an epidural or <span class="blsp-spelling-error" id="SPELLING_ERROR_5">subdural</span> hemorrhage because, as I said:<br /><br /><br /><span style="font-size:85%;">"Both epidural and <span class="blsp-spelling-error" id="SPELLING_ERROR_6">subdural</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_7">hematomas</span> should have / would have been rapidly diagnosed and she would have had an emergency procedure to release the pressure."</span><br /><br /><br />In other words, it was my <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">assumption</span> that if she had an epidural or <span class="blsp-spelling-error" id="SPELLING_ERROR_9">subdural</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_10">hematoma</span> it would have been rapidly treated when she was taken to a local hospital --Centre <span class="blsp-spelling-error" id="SPELLING_ERROR_11">Hospitalier</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_12">Laurentien</span>--after falling ill with a recent history of head trauma.<br /><br />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?<br /><br /><strong><u>Canadian Health Care</u></strong><br /><br />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.<br /><br />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.<br /><br />In Canada, there are only 10.3 CT scanners per million people whereas the U.S. has 29.5 per million...so it is reasonable to ask if Centre <span class="blsp-spelling-error" id="SPELLING_ERROR_13">Hospitalier</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_14">Laurentien</span> has a CT scanner, and did Richardson get a CT of the brain STAT?<br /><br />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 <span class="blsp-spelling-error" id="SPELLING_ERROR_15">neurosurgical</span> attention.<br /><br />Can you bet that Natasha Richardson got that care? I hope so. I do have some doubts because shortly after being admitted to Centre <span class="blsp-spelling-error" id="SPELLING_ERROR_16">Hospitalier</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_17">Laurentien</span>, she was shipped out to a larger hospital in Montreal; and, of course, later that day she was pronounced brain dead.<br /><br />I hope Natasha Richardson got the appropriate health care and that this was all a tragic and improbable <span class="blsp-spelling-corrected" id="SPELLING_ERROR_18">occurrence</span>. But if not, it would be an important thing to know.Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com11tag:blogger.com,1999:blog-4349143008524977129.post-78352120138241448582009-03-18T08:31:00.016-04:002009-03-18T14:58:38.031-04:00What Happened to Natasha Richardson?<a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/ScDyil1LXBI/AAAAAAAAAHs/Zam5Qi4WTPM/s1600-h/epidural02.jpg"><img id="BLOGGER_PHOTO_ID_5314514236381813778" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 274px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/ScDyil1LXBI/AAAAAAAAAHs/Zam5Qi4WTPM/s320/epidural02.jpg" border="0" /></a><br /><div>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."</div><br /><div></div><div>What happened?</div><br /><div></div><div>Three most likely possibilities:</div><br /><div>1. <strong>Epidural hematoma</strong> (see CT scan on the left)<br />-arterial bleed between skull and brain with rapid and devastating pressure developing on brain; short time course, usually over hours</div><br /><div>2. <strong>Subdural hematoma</strong> </div><div>-venous bleed between skull and brain, slower time course but reaches a point when pressure can create catastrophic pressure effects</div><br /><div>3. <strong>Subarachnoid hemorrhage</strong> (ruptured aneurysm- blood around and/or into the brain)</div><div>- rapid symptoms and time course with potential for devastating spasm of vessels</div><br /><div></div><div><strong><u>Epidural or Subdural?</u></strong></div><div></div><div>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 <em>focused</em> blow to the skull:</div><br /><div></div><div><span style="font-size:85%;">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. </span></div><br /><div></div><div>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:</div><br /><div></div><div><span style="font-size:85%;">Acute SDH is commonly associated with extensive primary brain injury. In one study, 82% of comatose patients with acute SDH had parenchymal contusions</span></div><br /><div><span style="font-size:85%;"></span></div><div>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.</div><br /><div></div><div><strong><u>Subarachnoid Hemorrhage (SAH)</u></strong></div><br /><div><strong><u></u></strong></div><div>When I first heard the sequence of events, I assumed Richardson had an SAH from an aneurysm rupture because:<br /></div><div></div><div>1. Her age</div><div>2. Minor trauma (assumption because she was on a beginner slope with a pro)</div><div>3. Lucent interval (SAH can frequently have a small initial bleed which is followed later by a catastrophic bleed)</div><div>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</div><div>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</div><br /><div></div><div>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.</div><br /><div></div><div>Also, the time course is very bizarre, I mean, to go from a minor fall to brain dead in 24 hours?? </div><br /><div></div><div>Whatever the mechanism, this concatenation of events is tragic it its absolute unlikeliness and in the devastation that has ensued.</div><div></div><div></div><div></div><div>Thanks to <a href="http://www.kevinmd.com/blog/2009/03/is-natasha-richardson-brain-dead-was.html">Kevin, M.D.</a> for link. Read what he has to say...</div><div>Also discussed by an ER Doc at <a href="http://allbleedingstops.blogspot.com/2009/03/talk-and-die.html#links">Movin' Meat</a>...</div>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com4tag:blogger.com,1999:blog-4349143008524977129.post-13396821742735215282009-03-17T08:25:00.001-04:002009-03-17T08:29:07.545-04:00<a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/Sb-XFVB76QI/AAAAAAAAAHk/k8ksBMUfD5Q/s1600-h/V0015175.jpg"><img id="BLOGGER_PHOTO_ID_5314132203120879874" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 257px" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/Sb-XFVB76QI/AAAAAAAAAHk/k8ksBMUfD5Q/s320/V0015175.jpg" border="0" /></a><br /><div></div><br /><p>GRAND ROUNDS</p><p> </p><p>This week at <a href="http://www.acpinternist.org/">ACP Internist</a>.</p><p>Grand Rounds is a weekly compilation of medical blogs around the web.</p><p>Go there for hope and change.</p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-69279837895528986082009-03-16T15:22:00.017-04:002009-03-16T18:13:52.737-04:00Mammography Bailout is Coming<img id="BLOGGER_PHOTO_ID_5313876509084094114" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 240px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sb6uh-hADqI/AAAAAAAAAHc/jZwoPQz0nk0/s320/elephant.jpg" border="0" /><strong><u> "A Very Expensive Program"</u></strong><br /><br />In 1993 the United States government seized control of the mammography "industry" with the Mammography Quality Standards Act. Over the past week I have blogged about this catastrophic government takeover <a href="http://tedstumor.blogspot.com/2009/03/how-government-destroyed-mammography.html">here </a>and <a href="http://tedstumor.blogspot.com/2009/03/mqsa-mussolini-and-mammography.html">here </a>and <a href="http://tedstumor.blogspot.com/2009/03/zero-gravity-mammography.html">here</a>.<br /><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_0">MQSA</span> was purportedly designed to "improve" quality in mammography; however, as we have seen, the people involved in enacting the law really did not have a good grasp on the medical issues involved; rather, they were fixated on a political and social agenda that would send a bigger message to the United States health care system, and the world.<br /><br />As one analyst described The Act:<br /><br /><span style="font-size:85%;">"the adoption of the <span class="blsp-spelling-error" id="SPELLING_ERROR_1">MQSA</span>...was a highly political decision that reflected the efforts of numerous advocates and legislators to remedy the historical failure of the medical establishment and regulatory structure to pay the proper amount of attention to issues affecting the health of the nation’s women."<br /></span><br />Because the aim of the act was social and political, the unintended consequences included the possibility of actually harming the practice of mammography -- something which has come to pass. As previously noted by <em>Kennedy's Tumor</em>:<br /><br />*The sensitivity and specificity of mammography remain unchanged 1993 vs 2009.<br /><br />*Mammography today is no better at finding cancer than it was in 1993 ...AND<br /><br />*STILL...a mammogram is an insensitive test for many women<br />*STILL...mammography remains the second most dangerous thing a doctor can do in all of medicine<br />*STILL...jury awards for missed cancers on mammograms represent the largest liability awards in all of medical practice.<br /><br />And what changes has <span class="blsp-spelling-error" id="SPELLING_ERROR_2">MSQA</span> actually catalyzed?<br /><br />*massive closing of women's centers<br />*physicians fleeing the field<br />*millions of dollars in costs<br />*destruction of business initiative<br />*blunting of technology that might actually produce better methods of finding and diagnosing cancer<br /><br /><strong><u>The Economy of Failure</u></strong><br /><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_3">MQSA</span> has devastated the practice of mammography. But what are the real dollar costs?<br />A lot of money. As quoted above, a Harvard law school analysis in 2003 listed the government appropriation for operation of <span class="blsp-spelling-error" id="SPELLING_ERROR_4">MQSA</span> its first year of full operation, 1994, at $10,000,000 followed by an additional $1,000,000 that were transferred from the Center for Disease Control for <span class="blsp-spelling-error" id="SPELLING_ERROR_5">MQSA</span> implementation.<br /><br />The Congressional Budget Office has estimated that <span class="blsp-spelling-error" id="SPELLING_ERROR_6">reauthorization</span> of the <span class="blsp-spelling-error" id="SPELLING_ERROR_7">MQSA</span> program, in 2003, cost $12,000,000 that year and an additional<strong> $77,000,000</strong> over the 2003-2007 period.<br /><br />Of that amount, <strong>$52,000,000</strong> is for program services not covered by user fees.<br /><br />"User Fees" are the fees/taxes levied each year <em>on the mammogram facilities</em> which, for 2008, were <strong>$18,398,000.00.</strong> These fees <em>do not</em> reflect the cost each center incurs hiring <span class="blsp-spelling-corrected" id="SPELLING_ERROR_8">personnel</span> to assist with compliance; buying software to track, publish and compile the data requested; and pursuing ongoing continued medical education training courses as required by this <span class="blsp-spelling-corrected" id="SPELLING_ERROR_9">onerous</span> law.<br /><br />And those user fees are plummeting (think credit default swaps), as centers close at the rate of 20 per month; meaning more government bailout money will be needed, only this time to support the continued depreciation of the practice of screening women for breast cancer-- caused directly by government intervention in health care.<br /><br /><p></p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-87256502284151597502009-03-15T14:21:00.014-04:002009-03-15T17:32:14.567-04:00Zero Gravity Mammography<a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sb1NXMQU2pI/AAAAAAAAAHU/I-CFn0Moygo/s1600-h/g.bmp"><img id="BLOGGER_PHOTO_ID_5313488196189084306" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 217px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/Sb1NXMQU2pI/AAAAAAAAAHU/I-CFn0Moygo/s320/g.bmp" border="0" /></a><br /><div><a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/Sb1J_yqjuWI/AAAAAAAAAHM/XmmTO5JNNHM/s1600-h/untitled.bmp"><img id="BLOGGER_PHOTO_ID_5313484495647914338" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 221px" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/Sb1J_yqjuWI/AAAAAAAAAHM/XmmTO5JNNHM/s320/untitled.bmp" border="0" /></a> <strong><u>When You Gotta Go...</u></strong></div><div><strong><u></u></div></strong><div>There's a scene in <em>2001 a Space Odyssey</em>, when Dr. David Bowman, the ship commander, has to use the most simple of devices, <em>the crapper</em>.</div><div></div><div>Unfortunately, poor Dr. Bowman is going to have to wait until he reads and deciphers the instructions for the Zero Gravity Toilet before he gets to go...</div><div> </div><div></div><div>Posted below, are the <em>Zero Gravity Toilet Instructions for Mammography--</em> provided by Congress as the Mammograpthy Quality Standards Act (MQSA)--just in case you thought I was exaggerating in my previous posts <a href="http://tedstumor.blogspot.com/2009/03/how-government-destroyed-mammography.html">here </a>and <a href="http://tedstumor.blogspot.com/2009/03/mqsa-mussolini-and-mammography.html">here</a>, describing <em><strong>the only federal law that regulates a specific medical practice or procedure.</strong></em></div><div> </div><div></div><div>There are no such guidelines for brain surgery or giving chemotherapy to children or even pulling bullets out of mafia hit men in the ER; only mammography -- the most basic of all basic radiological exams -- warrants its own set of rules, assessments and penalties, provided by its own law.</div><br /><div></div><div></div><div>Now, provided for your bathroom perusal, are the MQSA guidelines that every mammography center is compelled to abide by -- through the force of law. <em>Think</em> of what it costs to do this (and you'll begin to understand why women's centers are shutting down at the rate of 20 per month!)...then think about what the situation will be when we have laws for <em>all the things we do in health care (</em>called nationalized health care or single payor system<em>)</em>. </div><div> </div><div>Then even Ted Kennedy might be stymied! </div><div><br /></div><div><strong><u>MQSA Regulations Overview</u></strong></div><div><br /><strong>Quality Standards</strong></div><div><u>Personnel</u>. <span style="font-size:85%;">Interpreting physicians, radiologic technologists, and medical physicists must meet initial and continuing requirements. Documentation of these requirements must be available for inspection.</span><span style="font-size:85%;"><br /></span><u>Equipment</u>. <span style="font-size:85%;">Only equipment designed specifically for mammography qualifies for certification.</span><span style="font-size:85%;"><br /><u>Medical Records and Mammography Reports</u>. Summary data written in lay terms must be sent directly to all patients as soon as possible. Mammography films and reports must be retained for at least 5 years and up to 10 years, and labeled according to Food and Drug Administration (FDA) regulation.<br /></span><u>Quality Assurance</u>. <span style="font-size:85%;">Quality control testing protocols must be used and maintained by each facility, including mammography equipment evaluations and an annual physics survey. Documentation of daily, weekly, quarterly, semiannual, and annual quality control tests must be retained for FDA inspections</span><span style="font-size:85%;"><br /></span><u>Mammography Medical Outcomes Audit</u>. <span style="font-size:85%;">An interpreting physician must annually review the medical outcomes audit data.</span><span style="font-size:85%;"><br /></span><u>Consumer Complaint Mechanism.</u> <span style="font-size:85%;">Facilities must establish a written and documented system for collecting consumer complaints.</span></div><br /><div><strong><u>Accreditation</u></strong><br /><u>Current Accreditation Bodies.</u> <span style="font-size:85%;">American College of Radiology (ACR), Iowa, Arkansas, and Texas.</span><br /><u>Responsibilities of Accreditation Bodies</u>. <span style="font-size:85%;">Accreditation bodies must monitor facility compliance with quality standards, review clinical and phantom images from each facility at least once every 3 years, conduct annual onsite visits of at least 5 percent of the facilities it accredits, and maintain a consumer complaint system.</span><br /><u>Accreditation Body Audit</u>. <span style="font-size:85%;">FDA will evaluate the performance of each accreditation body annually.</span><br /><u>Facility Accreditation.</u> <span style="font-size:85%;">Facilities must submit verification that personnel, equipment, and practices conform to established quality standards to be eligible for accreditation.</span></div><span style="font-size:85%;"><br /><div><span style="font-size:100%;"><strong>Certification</strong></span></div><div></span></div><u>Current Certification Bodies.</u> <span style="font-size:85%;">FDA, Iowa, Illinois, and South Carolina.<br />Responsibilities of Certification Bodies. Certification bodies must issue Mammography Quality Standards Act (MQSA) certificates allowing accredited facilities to operate lawfully, and must perform annual inspections of each certified facility.</span> <div><u>Facility Certification.</u> <span style="font-size:85%;">Accredited facilities are eligible for certification. Certificates are valid for 3 years, and are renewable.</span></div><span style="font-size:85%;"><br /><div></span></div><strong>Inspections</strong> <div><u>General</u>. <span style="font-size:85%;">Facilities must undergo annual inspections.</span></div><div><u>Inspectors</u>. <span style="font-size:85%;">Facilities may be inspected by FDA inspectors, state or local agency inspectors under FDA contract, or inspectors from states that are certifying agencies. Federal facilities can be inspected only by FDA inspectors.</span></div><div><u>Inspector Audit.</u> <span style="font-size:85%;">Annual assessment of state performance is carried out by FDA auditors.<br />Fees. The facility undergoing inspection is responsible for all inspection fees. As of October 1, 2003, a fee of $1,749 is charged for the first mammography unit inspected, and $204 for every unit thereafter. Follow-up inspection fees are $991.</span></div><br /><div><strong></strong></div><div><strong>Compliance and Enforcement</strong><br /></div><div><strong>Levels of Noncompliance</strong><br /><u>Level 1:</u> <span style="font-size:85%;">Failure to meet a key MQSA requirement that may seriously compromise mammography quality. The facility is given 15 days to respond with corrective actions.<br /></span><u>Level 2:</u> <span style="font-size:85%;">All critical MQSA requirements met, yet a significant mammography quality item overlooked. The facility is given 30 days to respond,<br /></span><u>Level 3:</u> <span style="font-size:85%;">A minor deviation from MQSA standards. The facility is given until next annual inspection to address the problem, although it is advised to correct it as soon as possible,</span></div><br /><div><strong>Enforcement/Sanctions/Other</strong><br />FDA may impose one or more of the following sanctions:<br /><u>Directed Plan of Correction</u>, <span style="font-size:85%;">allowing facility to correct violations in a timely manner, while being monitored by FDA.<br /></span><u>Patient and Physician Notification</u>, <span style="font-size:85%;">requiring facilities to inform those that may be at risk due to unacceptable image quality or other conditions that could cause significant negative impact on patient health. </span><u>Follow-up Inspection.<br />Certificate Revocation or Suspension.</u><br /><u>Civil Money Penalties</u> <span style="font-size:85%;">of up to $10,000 per examination or per violation per day may be applied to facilities performing mammography services without proper certification or for other significant violations.</span></div><br /><div><strong>Advisory Committee</strong></div><div><u>Title</u>. <span style="font-size:85%;">The establishment of a National Mammography Quality Assurance Advisory Committee (NMQAAC) was mandated by MQSA.<br /></span><u>Members</u>. <span style="font-size:85%;">FDA appoints members from the community of physicians, health professionals, consumer organizations, and industry representatives.<br /></span><u>Responsibilities</u>. <span style="font-size:85%;">The NMQAAC advises FDA on appropriate quality standards, assists in the development of sanctions, designs a method to investigate consumer complaints, reports on new developments in breast imaging, determines whether a shortage of health professionals exists, and measures the costs and benefits of MQSA compliance. </span><br /></div><br /><div>SOURCE: Mammography Quality Standards Act, 42 U.S.C. § 263b (2003). 21 C.F.R. § 900.1 (2003).</div>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com2tag:blogger.com,1999:blog-4349143008524977129.post-45221178909060514712009-03-11T19:52:00.063-04:002009-03-15T19:11:08.223-04:00MQSA, MUSSOLINI, AND MAMMOGRAPHY<a href="http://4.bp.blogspot.com/_LH3hqfBtmVE/SbhvMBZNIiI/AAAAAAAAAHE/R1BCp9Y5B_8/s1600-h/unintendedf.jpg"><img id="BLOGGER_PHOTO_ID_5312118012806767138" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 212px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://4.bp.blogspot.com/_LH3hqfBtmVE/SbhvMBZNIiI/AAAAAAAAAHE/R1BCp9Y5B_8/s320/unintendedf.jpg" border="0" /></a><br /><strong><u>Making the Trains Run on Time</u></strong><br /><br />"...the Mammography Quality Standards Act... had little if any precedent in the history of medicine. Never before had the federal government claimed a role in the regulation of medical practice."<br />-<span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">NYTimes</span></span>: June 27, 2002<br /><br />As I said in my <a href="http://tedstumor.blogspot.com/2009/03/how-government-destroyed-mammography.html">previous </a>post:<br /><br />PRIOR TO THE 1992 GOVERNMENT SEIZURE OF MAMMOGRAPHY WITH THE <span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">MQSA</span></span> (FEDERAL MAMMOGRAPHY ACT):<br /><br />1. Women’s imaging is booming – competition for business is brisk<br />2. Women’s centers are being built everywhere with parquet floors and vaulted ceilings, furnished with overstuffed chairs and couches providing a private, comfortable milieu<br />3. Medical device manufacturers are eagerly in the game, developing <span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">stereotactic</span></span> minimally invasive biopsy machines; MRI of the breast and digital mammography are both rapidly being developed to advance sensitivity and specificity of diagnosis<br />4. Diagnostic Imaging residencies open a new <span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">subspecialty</span></span>: Women’s Imaging. Interest among radiology residents is high<br /><br /><strong><u>What is the Situation Today? What Did We get From Government Regulation?</u></strong><br /><br />1. Women's imaging centers are <em>closing at the rate of about 20 per month</em>--<br />2. The wait for screening mammograms is 6 months in many areas and in lower population areas or areas of high liability--there are <em>no</em> radiologists available to interpret mammograms--the tests are <em>shipped out</em> for remote interpretation<br />3. <em>No one</em> wants mammography business except large hospitals who are <em>banking on the spin-off money</em> from surgery and therapy for the 1 in 1000 screening patients with cancer-- in other words, <em><strong>the only businesses interested in doing mammography now are businesses hoping women have a cancer ...</strong></em><br />4<em>.</em> Medical device manufacturers have fled the field. <span class="blsp-spelling-error" id="SPELLING_ERROR_4"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">Stereotactic</span></span> biopsy devices, MRI of the breast and Digital mammography are all dead in their first or second iterations--without profits, no one is buying new technology, which therefore remains fallow<br />5. Radiology residents eschew women's imaging and most fellowships go unfilled and without applicants--despite the fact that at least 30 million mammograms will be done each year in the U.S.<br /><br /><strong><u>Did MQSA Improve Quality in Mammography?</u></strong><br /><br />In mammography, improvement should = greater number of cancers found in any given 100 mammograms in 2009 vs 1993.<br /><br />No matter what the unintended consequences, if <span class="blsp-spelling-error" id="SPELLING_ERROR_6"><span class="blsp-spelling-error" id="SPELLING_ERROR_6">MQSA</span></span> resulted in MORE cancers found per 100 screening mammograms, then the price of this"reform" might be worth what it cost.<br /><br /><strong><u>Not With a Bang</u></strong><br /><br />The sensitivity and specificity of mammography <em>remain unchanged 1993 vs 2009</em>. This means that for every 100 mammograms the same number of cancers would be found today as would be found in 1992--before the government seized mammography with MQSA.<br /><br /><p><em>Despite millions of dollars spent in compliance </em><br /><em>Despite hundreds of pages of federal regulation</em><br /><em>Despite education and training mandates</em><br /><em>Despite licensing requirements, yearly <span class="blsp-spelling-error" id="SPELLING_ERROR_7"><span class="blsp-spelling-error" id="SPELLING_ERROR_7">requalifications</span></span>, and mandated <span class="blsp-spelling-error" id="SPELLING_ERROR_8"><span class="blsp-spelling-error" id="SPELLING_ERROR_8">QA</span></span></em><br /></p><p>Despite all of this, mammography today is no better at finding cancer than it was in 1993 </p><p><br />What <span class="blsp-spelling-error" id="SPELLING_ERROR_9"><span class="blsp-spelling-error" id="SPELLING_ERROR_9">MQSA</span></span> has done is to standardize the procedure of taking a breast <span class="blsp-spelling-error" id="SPELLING_ERROR_10">x-ray</span> and the machinations of the women's mammography facility--akin to Mussolini making the trains run on time in Italy in the 1940's --without ever addressing or even understanding why mammograms cannot do any better after reforms than before! </p><p>They threw everything they had at mammography -- anecdotes, laws, regulations, Congressmen, feminists, actresses --everything they want to throw at health care today; but, because <em>they started with bad assumptions and a faulty premise</em>, all the rules and dogma and laws could not repair what they perceived as <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">wrong</span>.</p><p>And the main reason is because it was not broken. Just like the medicine and surgery of our health care system today<strong>. </strong>And after such reform, what knowledge?</p><p><em><strong>STILL</strong></em>...a mammogram is an insensitive test for many women</p><p><em><strong>STILL</strong></em>...mammography remains the second most dangerous thing a doctor can do in all of medicine<br /><br /><em><strong>STILL</strong></em>...jury awards for missed cancers on mammograms represent the largest liability awards in all of medical practice.<br /><br />Government takeover of mammography has not improved quality, has not reduced liability, and <em>has not saved one life...</em><br />But it HAS </p><p></p><p>...Caused massive closing of women's centers<br />...Chased physicians from the field<br />...Cost hundreds of millions of dollars<br />...Destroyed business initiative<br />...Stymied technology that might actually produce better methods of finding and diagnosing cancer<br /><br /><strong><u>Nowhere Train</u></strong></p><p>Is this what we want in health care reform today? Reform the system, reform the process, address social <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">grievances</span> and perceived injustices while satisfying special interest groups and politicians? Because the system then faces the same fate as mammography. </p><p>You will reform insurance. You will reform distribution. You will address costs, but in the process, you will vitiate the services, chase away the best practitioners, and create a great a void where once the world's best health care resided.</p><p>You want the train to run on time but to be going nowhere?</p><p><br />...this is what the government will bring us. </p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com1tag:blogger.com,1999:blog-4349143008524977129.post-84114229325140602532009-03-08T15:29:00.013-04:002009-03-11T08:16:13.882-04:00How The Government Destroyed Mammography<a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SbQdFp6RGkI/AAAAAAAAAG8/nNHzHafLuSA/s1600-h/capitoldr.jpg"><img id="BLOGGER_PHOTO_ID_5310901843563452994" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 234px" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SbQdFp6RGkI/AAAAAAAAAG8/nNHzHafLuSA/s320/capitoldr.jpg" border="0" /></a><br /><strong><u>Want a Glimpse of the U.S. Health Care Future?<br /></u></strong><br /><strong><u>Look at Mammography.</u></strong><br /><br /><div align="left">Do we have any indication, right here, in the U.S. what would happen if the government “took control” of health care?<br /><br />Yes.<br /><br />All you need to do is look at the story of mammography and the Mammography Quality and Standards Act of 1992. Want to see what you are in for? Here’s a synopsis. In the coming days I’ll give you the whole juicy story.<br /><br />SCENE I:<br /><br />PRIOR TO THE 1992 GOVERNMENT SEIZURE OF MAMMOGRAPHY WITH THE MQSA (FEDERAL MAMMOGRAPHY ACT)<br /> <br />1. Women’s imaging is booming – competition for business is brisk<br />2. Women’s centers being built everywhere with parquet floors and vaulted ceilings, furnished with overstuffed chairs and couches providing a private, comfortable milieu<br />3. Medical device manufacturers are eagerly in the game, developing stereotactic minimally invasive biopsy machines; MRI of the breast and digital mammography are both rapidly being developed to advance sensitivity and specificity of diagnosis<br />4. Diagnostic Imaging residencies open a new subspecialty: Women’s Imaging. Interest among radiology residents is high<br /><br /> <em><strong>DEUS EX MACHINA:</strong></em><br /><br />1992: THE FEDERAL GOVERNMENT SEIZES THE MAMMOGRAPHY INDUSTRY WITH AN ACT OF CONGRESS--MQSA IS SLAMMED THROUGH CONGRESS. </div><div align="left"> </div><div align="left"> </div><div align="left">WHY?<br /><br />Perceived quality issues are championed by television “investigative” reporters, and then picked-up by nonmedical women’s activists and disease-specific lobbyists as a political, social and moral cause. Mammography is assumed to be tainted by the male-dominated health care industry and it becomes <em>de facto</em> evident to all that because of the second class social status given to women, this most valuable diagnostic examination is poorly supervised, and, as a result, cancers are being missed and women are being harmed (by the health care system).</div><p align="left">Popular female political figures like Olympia Snowe team up with grass roots organizations like The National Breast Cancer Coalition and The National Black Women's Health Project to take up the cause with Congress. Congressional hearings ensued and the lack of formal studies and empirical data to support the notion that mammography was seriously and significantly amiss were ignored in the rush to right the wrongs done by Western civilization on women in America. A gargantuan wish-list of regulations, oversights, and QA controls were compiled and thrown at mammography practitioners along with serious and disabling price controls which <em>permanently</em> <em>set the price of mammography too low</em> to pay for any of the unfunded mandates foisted on the industry.</p><p align="left">Why price controls in the face of new massive regulation? The proposal was that too many women were not getting mammography, despite the fact that out-of-pocket expenses for health care had not changed in 30 years and have not changed yet, to this very day.</p><p align="left">But the facts were never an issue at the hearings and the government sailed this massive legislative ship which has devastated mammography.</p><p align="left"><br />In summary: The media fanned the anecdotal flames and activists seized their opportunity to effect CHANGE, despite the facts, and Congress marched in lockstep behind the forces of political and social activism against which they are incapable of fighting and, in a worst-case-scenario, massive legislation was enacted without appropriate data collection and consideration -- and why did they act so quickly?</p><p align="left">Because they claimed WIDESPREAD PROBLEMS that were out of control and needed to be acted upon quickly because the mammography industry was:<br /><br />IN <strong><em>CRISIS</em></strong><br /><br />Next:<br /><br /><em>What was the government’s response to this <strong>CRISIS</strong> in mammography?<br />What was the Mammography Quality Standards Act (MQSA)?<br />Did government intervention fix the perceived problems that lead to the avowed <strong>CRISIS</strong>?<br />What has happened to mammography since the MQSA?<br /></em><br />This tale will tell you a lot about where our health care is going…</p>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com0tag:blogger.com,1999:blog-4349143008524977129.post-74602017017568417122009-03-06T21:43:00.011-05:002009-03-07T08:39:19.709-05:00BULLETIN: DVD'S FROM OBAMA REVEALED<a href="http://2.bp.blogspot.com/_LH3hqfBtmVE/SbID1V1UZNI/AAAAAAAAAGs/4s8RuVZ24mQ/s1600-h/untitled.bmp"><img id="BLOGGER_PHOTO_ID_5310311125551965394" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 228px; CURSOR: hand; HEIGHT: 320px" alt="" src="http://2.bp.blogspot.com/_LH3hqfBtmVE/SbID1V1UZNI/AAAAAAAAAGs/4s8RuVZ24mQ/s320/untitled.bmp" border="0" /></a> <strong><u>OBAMA REVEALS TO KENNEDY'S TUMOR, MOVIE TITLES OF <span class="blsp-spelling-error" id="SPELLING_ERROR_0">DVD'S</span> HE GAVE TO PM BROWN</u></strong><br /><div></div><div> </div><div>Brilliant folksy reform president, <span class="blsp-spelling-error" id="SPELLING_ERROR_1">BHO</span>, came under criticism for a gift of 25 DVDs to Gordon Brown the British PM who is the first European leader to visit Obama since his inauguration.</div><br /><div></div><div>In what some <a href="http://www.swamppolitics.com/news/politics/blog/2009/03/obama_notsospecial_gift_to_top.html">journalists </a>described a lapse in taste, or protocol, or maybe even upbringing, Obama presented the British leader with a pile of mass-produced plastic discs which mainly celebrate American pop-culture (which understandably may mean <em>nothing</em> the Brown); whereas Brown gave to Obama gifts that were unique, well-thought out, and tasteful, including a pen holder sculpted from the timber of an anti-slave ship and a Churchill first edition.</div><div> </div><div>The British press is probably being too hard on <span class="blsp-spelling-error" id="SPELLING_ERROR_2">BHO</span>, and they likely underestimate his brilliance; and, with this in mind Kennedy's Tumor requested a list of the Top Ten <span class="blsp-spelling-error" id="SPELLING_ERROR_3">Videos Obama</span> presented to Brown because surely there is method to his gifting and a meaning to his choice of <span class="blsp-spelling-error" id="SPELLING_ERROR_4">DVD's</span>. Now that we have the list, everything is clear. In reverse order they were:</div><br /><div>#10. Leaving <span class="blsp-spelling-error" id="SPELLING_ERROR_5">Las</span> Vegas</div><br /><br /><div>#9.: Who'll Stop the Rain? </div><br /><br /><div>#8. The Empire Strikes Back</div><br /><br /><div>#7. The Big Chill</div><br /><br /><div>#6. Dirty Rotten Scoundrels</div><br /><br /><div>#5. Dumbo</div><br /><br /><div>#4. The Great Dictator</div><br /><br /><div>#3. (3-way tie): King Lear; The King and I; The King of Comedy</div><br /><br /><div>#2. I am Legend</div><br /><br /><div>#1. Gone with the Wind</div>Dr.Thttp://www.blogger.com/profile/16720781758479209563noreply@blogger.com2