Kennedy's Tumor

A Solution For Health Care Costs

2009-05-13T17:22:00.002-04:00

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

Why don't they take the gambling industry instead?

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

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

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

This would stop the madness immediately.

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

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

Don't see how you could refuse this.

Health Care Reform: What You can Expect

2009-05-12T08:24:00.004-04:00

Pins and Needles, Needles and Pins

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

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

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

Grand Rounds is Posted

2009-04-28T11:24:00.003-04:00

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

Go see.

Kennedy's Tumor SNL Weekend Update

2009-04-25T23:29:00.001-04:00

All the Health News Fit to Stink:

Kennedy's Tumor (KT) Sorts the Trash:

This Week's Health Headlines:

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

Max Baucus :

"Everybody here wants to address quality and reimbursements based on quality," Baucus said.

KT: So let the guys from Harvard and Columbia charge more.

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

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

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

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

Difficulty or inability? Are they nuts--or eating walnuts?

Question: Why do they define this so narrowly?

Answer: To include more people in their statistics which enables them to apply for bigger grants from the government....to waste your money. Sinful stuff.

Walnuts may prevent breast cancer

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

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

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

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

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

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

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

Breastfeeding Cuts Moms' Heart Risk

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

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

Why do they study this stuff?

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

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

If Texas Leaves the Union, I'm Following

2009-04-16T18:08:00.003-04:00

Secede and Conquer

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

I hope they do it.

According to The Examiner:

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

DON'T TAX ME BRO

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

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

Kournikova and the Moscow Tennis Clones

2009-04-16T12:39:00.028-04:00

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

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

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

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

2009-04-15T17:11:00.008-04:00

What are the Chances?

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

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

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

Put it in Perspective

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

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

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

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

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

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

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

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

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

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

2009-04-09T01:16:00.041-04:00

Angel on the Rocks

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

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

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

ANAL CANCER--Time to Talk

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

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

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

HPV

Why is that?

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

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

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

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

At Risk:

1. Unprotected Sex

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

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

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

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

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

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

Mammography Faces A New Foe: NNT

2009-04-07T18:53:00.028-04:00

This Door is Closed

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

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

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

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

Lets not even talk about real estate.

Measuring Out Your Life

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

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

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

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

Who is the system? Whoever pays the bills.

Who make s the rules? Whoever pays the bills.

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

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

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

2009-04-07T10:20:00.026-04:00

The Girls From Russia

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

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

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

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

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

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

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

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

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

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

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

NEXT POST: FURTHER REVELATIONS ABOUT "TENNIS' CLONING ACHIEVEMENT!"

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

British Still Resist Screening Mammography--Why?

2009-04-04T08:10:00.015-04:00

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

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

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

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

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

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

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

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

What about cancer? They don't mention that.

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

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

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

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

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

Keeping Smokers Alive to Take Care of Children

2009-04-02T19:44:00.020-04:00

Night of the Living Smoker

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

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

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

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

Who What When...Teddy Kennedy

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

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

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

Looking for Volunteers

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

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

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

Sounds good to me.

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

2009-04-02T13:26:00.030-04:00

Ugly Fish, Painful Sex and a Bad Bug

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

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

Loves Labor Lost

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

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

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

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

Fish Rabies

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

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

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

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

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

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

Don't Be a Hog (Snapper)

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

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

When Will Obama Force Sanjay Gupta to Resign?

2009-03-31T05:29:00.024-04:00

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

Just Put This Pod in Your Hospital

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

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

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

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

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

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

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

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

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

Going Out of Business

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

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

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

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

Winning Back the Penis--One Piece at a Time

2009-03-26T05:20:00.038-04:00

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

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

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

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

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

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

Why so?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Breast MRI and The Coming War Against Medical Technology

2009-03-23T19:54:00.046-04:00

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

The Rising Tide

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

Kevin, M.D. referenced another blog by a general surgeon, Jeffery Parks, who titled his piece "Breast Cancer and MRI," and used the phrases: "Finally some news on the use (or overuse) or MRI in breast cancer;" and "There are situations where MRI could potentially be useful ..." (italics mine).

Both blogs are good ones, worth reading, and full of useful information (including these entries); the blogs and their authors are not my pursuit here. What does interest me is the PRESS that breast MRI (BMRI) gets not because it is a fantastic technology and head and shoulders above mammography, ultrasound and breast exam combined; rather, its the consistent repetitive criticisms that BMRI is expensive and too sensitive. These nonmedical criticisms overwhelm the real message: BMRI saves lives. It can save your life.

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

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

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

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

Why then all the FLAK?

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

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

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

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

Demand What Ted Gets

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

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

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

Natasha Richardson, Epidural Hemorrhage and No Help in Canada

2009-03-20T12:17:00.011-04:00

Previous Posts on Natash Richardson at Kennedy's Tumor:
What Happened toNatasha Richardson?
Natasha Richardson, Epidural Hemorrhage and Canadian Health Care

The Death of Natasha Richardson

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

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

How Remote?

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

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

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

According to JAMA :

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

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

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

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

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

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

Availability of Neurosurgeons

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

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

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

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

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

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

Natasha Richardson, Epidural Hemorrhage and Canadian Health Care

2009-03-19T07:18:00.012-04:00

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

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

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

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

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

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

Canadian Health Care

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

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

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

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

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

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

What Happened to Natasha Richardson?

2009-03-18T08:31:00.016-04:00

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

What happened?

Three most likely possibilities:

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

2. Subdural hematoma

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

3. Subarachnoid hemorrhage (ruptured aneurysm- blood around and/or into the brain)

- rapid symptoms and time course with potential for devastating spasm of vessels

Epidural or Subdural?

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

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

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

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

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

Subarachnoid Hemorrhage (SAH)

When I first heard the sequence of events, I assumed Richardson had an SAH from an aneurysm rupture because:

1. Her age

2. Minor trauma (assumption because she was on a beginner slope with a pro)

3. Lucent interval (SAH can frequently have a small initial bleed which is followed later by a catastrophic bleed)

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

5. Rapid progression to massive brain injury: SAH can quickly cause diffuse spasm of brain vessels leading to brain infarction -- which is irreversible and catastrophic

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

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

Whatever the mechanism, this concatenation of events is tragic it its absolute unlikeliness and in the devastation that has ensued.

Thanks to Kevin, M.D. for link. Read what he has to say...

Also discussed by an ER Doc at Movin' Meat...

2009-03-17T08:25:00.001-04:00

GRAND ROUNDS

This week at ACP Internist.

Grand Rounds is a weekly compilation of medical blogs around the web.

Go there for hope and change.

Mammography Bailout is Coming

2009-03-16T15:22:00.017-04:00

"A Very Expensive Program"

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 here and here and here.

MQSA 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.

As one analyst described The Act:

"the adoption of the MQSA...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."

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 Kennedy's Tumor:

*The sensitivity and specificity of mammography remain unchanged 1993 vs 2009.

*Mammography today is no better at finding cancer than it was in 1993 ...AND

*STILL...a mammogram is an insensitive test for many women
*STILL...mammography remains the second most dangerous thing a doctor can do in all of medicine
*STILL...jury awards for missed cancers on mammograms represent the largest liability awards in all of medical practice.

And what changes has MSQA actually catalyzed?

*massive closing of women's centers
*physicians fleeing the field
*millions of dollars in costs
*destruction of business initiative
*blunting of technology that might actually produce better methods of finding and diagnosing cancer

The Economy of Failure

MQSA has devastated the practice of mammography. But what are the real dollar costs?
A lot of money. As quoted above, a Harvard law school analysis in 2003 listed the government appropriation for operation of MQSA 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 MQSA implementation.

The Congressional Budget Office has estimated that reauthorization of the MQSA program, in 2003, cost $12,000,000 that year and an additional $77,000,000 over the 2003-2007 period.

Of that amount, $52,000,000 is for program services not covered by user fees.

"User Fees" are the fees/taxes levied each year on the mammogram facilities which, for 2008, were $18,398,000.00. These fees do not reflect the cost each center incurs hiring personnel 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 onerous law.

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.

Zero Gravity Mammography

2009-03-15T14:21:00.014-04:00

When You Gotta Go...

There's a scene in 2001 a Space Odyssey, when Dr. David Bowman, the ship commander, has to use the most simple of devices, the crapper.

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...

Posted below, are the Zero Gravity Toilet Instructions for Mammography-- provided by Congress as the Mammograpthy Quality Standards Act (MQSA)--just in case you thought I was exaggerating in my previous posts here and here, describing the only federal law that regulates a specific medical practice or procedure.

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.

Now, provided for your bathroom perusal, are the MQSA guidelines that every mammography center is compelled to abide by -- through the force of law. Think 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 all the things we do in health care (called nationalized health care or single payor system).

Then even Ted Kennedy might be stymied!

MQSA Regulations Overview

Quality Standards

Personnel. Interpreting physicians, radiologic technologists, and medical physicists must meet initial and continuing requirements. Documentation of these requirements must be available for inspection.
Equipment. Only equipment designed specifically for mammography qualifies for certification.
Medical Records and Mammography Reports. 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.
Quality Assurance. 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
Mammography Medical Outcomes Audit. An interpreting physician must annually review the medical outcomes audit data.
Consumer Complaint Mechanism. Facilities must establish a written and documented system for collecting consumer complaints.

Accreditation
Current Accreditation Bodies. American College of Radiology (ACR), Iowa, Arkansas, and Texas.
Responsibilities of Accreditation Bodies. 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.
Accreditation Body Audit. FDA will evaluate the performance of each accreditation body annually.
Facility Accreditation. Facilities must submit verification that personnel, equipment, and practices conform to established quality standards to be eligible for accreditation.

Certification

Current Certification Bodies. FDA, Iowa, Illinois, and South Carolina.
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.

Facility Certification. Accredited facilities are eligible for certification. Certificates are valid for 3 years, and are renewable.

Inspections

General. Facilities must undergo annual inspections.

Inspectors. 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.

Inspector Audit. Annual assessment of state performance is carried out by FDA auditors.
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.

Compliance and Enforcement

Levels of Noncompliance
Level 1: Failure to meet a key MQSA requirement that may seriously compromise mammography quality. The facility is given 15 days to respond with corrective actions.
Level 2: All critical MQSA requirements met, yet a significant mammography quality item overlooked. The facility is given 30 days to respond,
Level 3: 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,

Enforcement/Sanctions/Other
FDA may impose one or more of the following sanctions:
Directed Plan of Correction, allowing facility to correct violations in a timely manner, while being monitored by FDA.
Patient and Physician Notification, 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. Follow-up Inspection.
Certificate Revocation or Suspension.
Civil Money Penalties 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.

Advisory Committee

Title. The establishment of a National Mammography Quality Assurance Advisory Committee (NMQAAC) was mandated by MQSA.
Members. FDA appoints members from the community of physicians, health professionals, consumer organizations, and industry representatives.
Responsibilities. 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.

SOURCE: Mammography Quality Standards Act, 42 U.S.C. § 263b (2003). 21 C.F.R. § 900.1 (2003).

MQSA, MUSSOLINI, AND MAMMOGRAPHY

2009-03-11T19:52:00.063-04:00

Making the Trains Run on Time

"...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."
-NYTimes: June 27, 2002

As I said in my previous post:

PRIOR TO THE 1992 GOVERNMENT SEIZURE OF MAMMOGRAPHY WITH THE MQSA (FEDERAL MAMMOGRAPHY ACT):

1. Women’s imaging is booming – competition for business is brisk
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
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
4. Diagnostic Imaging residencies open a new subspecialty: Women’s Imaging. Interest among radiology residents is high

What is the Situation Today? What Did We get From Government Regulation?

1. Women's imaging centers are closing at the rate of about 20 per month--
2. The wait for screening mammograms is 6 months in many areas and in lower population areas or areas of high liability--there are no radiologists available to interpret mammograms--the tests are shipped out for remote interpretation
3. No one wants mammography business except large hospitals who are banking on the spin-off money from surgery and therapy for the 1 in 1000 screening patients with cancer-- in other words, the only businesses interested in doing mammography now are businesses hoping women have a cancer ...
4. Medical device manufacturers have fled the field. Stereotactic 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
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.

Did MQSA Improve Quality in Mammography?

In mammography, improvement should = greater number of cancers found in any given 100 mammograms in 2009 vs 1993.

No matter what the unintended consequences, if MQSA resulted in MORE cancers found per 100 screening mammograms, then the price of this"reform" might be worth what it cost.

Not With a Bang

The sensitivity and specificity of mammography remain unchanged 1993 vs 2009. 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.

Despite millions of dollars spent in compliance
Despite hundreds of pages of federal regulation
Despite education and training mandates
Despite licensing requirements, yearly requalifications, and mandated QA

Despite all of this, mammography today is no better at finding cancer than it was in 1993

What MQSA has done is to standardize the procedure of taking a breast x-ray 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!

They threw everything they had at mammography -- anecdotes, laws, regulations, Congressmen, feminists, actresses --everything they want to throw at health care today; but, because they started with bad assumptions and a faulty premise, all the rules and dogma and laws could not repair what they perceived as wrong.

And the main reason is because it was not broken. Just like the medicine and surgery of our health care system today. And after such reform, what knowledge?

STILL...a mammogram is an insensitive test for many women

STILL...mammography remains the second most dangerous thing a doctor can do in all of medicine

STILL...jury awards for missed cancers on mammograms represent the largest liability awards in all of medical practice.

Government takeover of mammography has not improved quality, has not reduced liability, and has not saved one life...
But it HAS

...Caused massive closing of women's centers
...Chased physicians from the field
...Cost hundreds of millions of dollars
...Destroyed business initiative
...Stymied technology that might actually produce better methods of finding and diagnosing cancer

Nowhere Train

Is this what we want in health care reform today? Reform the system, reform the process, address social grievances and perceived injustices while satisfying special interest groups and politicians? Because the system then faces the same fate as mammography.

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.

You want the train to run on time but to be going nowhere?

...this is what the government will bring us.

How The Government Destroyed Mammography

2009-03-08T15:29:00.013-04:00

Want a Glimpse of the U.S. Health Care Future?

Look at Mammography.

Do we have any indication, right here, in the U.S. what would happen if the government “took control” of health care?

Yes.

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.

SCENE I:

PRIOR TO THE 1992 GOVERNMENT SEIZURE OF MAMMOGRAPHY WITH THE MQSA (FEDERAL MAMMOGRAPHY ACT)

1. Women’s imaging is booming – competition for business is brisk
2. Women’s centers being built everywhere with parquet floors and vaulted ceilings, furnished with overstuffed chairs and couches providing a private, comfortable milieu
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
4. Diagnostic Imaging residencies open a new subspecialty: Women’s Imaging. Interest among radiology residents is high

DEUS EX MACHINA:

1992: THE FEDERAL GOVERNMENT SEIZES THE MAMMOGRAPHY INDUSTRY WITH AN ACT OF CONGRESS--MQSA IS SLAMMED THROUGH CONGRESS.

WHY?

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 de facto 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).

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 permanently set the price of mammography too low to pay for any of the unfunded mandates foisted on the industry.

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.

But the facts were never an issue at the hearings and the government sailed this massive legislative ship which has devastated mammography.

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?

Because they claimed WIDESPREAD PROBLEMS that were out of control and needed to be acted upon quickly because the mammography industry was:

IN CRISIS

Next:

What was the government’s response to this CRISIS in mammography?
What was the Mammography Quality Standards Act (MQSA)?
Did government intervention fix the perceived problems that lead to the avowed CRISIS?
What has happened to mammography since the MQSA?

This tale will tell you a lot about where our health care is going…

BULLETIN: DVD'S FROM OBAMA REVEALED

2009-03-06T21:43:00.011-05:00

OBAMA REVEALS TO KENNEDY'S TUMOR, MOVIE TITLES OF DVD'S HE GAVE TO PM BROWN

Brilliant folksy reform president, BHO, 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.

In what some journalists 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 nothing 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.

The British press is probably being too hard on BHO, and they likely underestimate his brilliance; and, with this in mind Kennedy's Tumor requested a list of the Top Ten Videos Obama presented to Brown because surely there is method to his gifting and a meaning to his choice of DVD's. Now that we have the list, everything is clear. In reverse order they were:

#10. Leaving Las Vegas

#9.: Who'll Stop the Rain?

#8. The Empire Strikes Back

#7. The Big Chill

#6. Dirty Rotten Scoundrels

#5. Dumbo

#4. The Great Dictator

#3. (3-way tie): King Lear; The King and I; The King of Comedy

#2. I am Legend

#1. Gone with the Wind

BHO Launches Another Trial Balloon

2009-03-06T14:03:00.020-05:00

All The President's Mien

When Ted Kennedy needed to save his own life he called together all of the world's experts on brain tumors and had them advise him.

He did not ask for anecdote; nor did he consult the common man. He was not concerned with homeotherapy, chiropractic adjustments, laughter therapy, anger management or sodomy. He wanted the facts as science dictates at this time and he wanted no nonsense opinion -- based on science and experience -- on which he could act. No time for rhetoric, or BS. There was something important at stake.

Act, he did. Ted flew to one of the best hospitals in the world (HINT: it's not in Cuba or Canada, it starts with a "D" and is present, in North Carolina, thanks to the money contributed by a cigarette heir).

The White House Holds a Health Care "Summit"

When the folksy economist-in-training commander-in-chief Barrack H. Obama wants something done, he holds a "summit;" which, according to Dictionary.com is:

the highest level of diplomatic or other governmental officials: a meeting at the summit

Ted Kennedy held a"summit" to discuss his personal medical problem. He met witht the highest level people available to get quickly to the core of the issue and devise an intelligent, workable solution; namely, GET ME TO DUKE!

In his summit, however, Presidente Obama brought the lowest level experts --the common people -- to lecture and inform the world about the US health care crisis.

So, as the White House launches another dirigible towards New Jersey (are those thunderclouds ahead?), it does so with the quiet applause of the common man; and so we were subjected to -- at this summit-- not the opinions of the learned, but the anecdotal inconsequential ideations of select tendentious individuals, namely:

1. Travis Ulerick. a fire fighter/EMT from Dublin, Indiana, quoted thus:

"Every day on the job, I meet people who don't have health insurance, people who are left out of the current health system. People in my town can't afford health care costs. They can't afford doctors' visits, and they can't afford ambulance rides."

2. Julia Denton, a military wife and Republican

3. Siyavash Sarladi, a third-year medical student at the University of Wisconsin;

4. Yvonne Ruby, who held a discussion at her church in Brooklyn;

5. James Stouffer, a small-business owner and father of five;

6. Jose Olivia, a veteran who hosted a discussion in El Paso, Texas; and

7. Angela Diggs, who runs a senior wellness center in Washington, D.C.

These people brought their individual attestations to Washington as part of the launching process in which BHO sends off a huge gas-filled health care reform dirigible that, by the time it hits the shores of our health care will, undoubtedly -- like the economy -- come reigning down on us in shards of molten steel.

Scanning For Dollars

2009-03-05T06:02:00.007-05:00

Are Doctors Irradiating You So Their Kids Can Go to Private School?

As I reported yesterday, Reuter's put out a story about a relatively important subject: X-ray exposure during Diagnostic Imaging examinations (mainly CT and Nuclear Medicine).

The Reuter's story was fabricated off of this release from the NCRP (National Council on Radiation Protection & Measurement).

Reuters took a straight-forward statement of the facts, talked to a few doctors who implied that "self referral" was an issue in imaging, and came up with this stew:

"The findings... add to already mounting evidence that doctors are ordering too many diagnostic tests, driving up the cost of health care in the United States and potentially harming patients."

This Reuterian conclusion (Reuterian is from the Greek for "stupid head") is at best a deductive error, but really is just a fabrication meant to draw readers, which they did, with 201 subcategory stories on this topic listed on Google by noon yesterday.

Ordering "sophisticated expensive tests" is a common refrain in the corridors of the health care reform hotel, where we are all staying until Obama can bail us out from this health care crisis by "completely overhauling" our horribly broken health care system (that's the one Kennedy chose for his brain cancer treatment when he had the financial options to go anywhere in the world).

The idea is that when those sophisticated and expensive tests are taken away from you and rationed (as they are in Canada where Kennedy DID NOT fly his jet to for treatment), you will be told it's for your own good, because you cannot trust your greedy doctors to order the tests. It is much better that a nurse sitting at a desk in Roanoke Virginia make that decision over the phone, when she gets back from her lunch break and finishes handing out her Secret Santa gifts and goes through the seven hundred requests before yours that are lying in her desk.

You Want the Truth?

Why are so many CT scans ordered? Yesterday I mentioned that the main reason is that the scans are so good -- we want to see them. When you have a pain in your head do you want someone to flash a light into your eyes and stare at your pupils and say "Hmmm...looks good!" Or, do you want a photograph of what's going on inside your skull obtained by a professional on a fabulous (Nobel-winning) machine and then interpreted by an expert? Tough choice.

Why are CT's so good? Because they are computers, that's why. At the top of this page is my first computer. It was a Kay-Pro. It had no hard drive, about 64K of RAM and two huge floppy disks which held about 16K each. That was 1983.

The "C" in CT scan stands for "Computerized." A CT scanner in the 1980 had no processing power and no memory. However, in the 29 years since 1980, CT scanners have advanced their imaging capabilities in a perfectly parallel course with chip processing and memory power. Make sense?

So today -- as opposed to 1980, or even 1990, or 2000 -- the images generated by CT are spectacular and we now can do 3D fly-throughs of your colon (virtual colonoscopy) and stop your heart for a look at your coronary arteries (64/128 slice CT angiography).

Now lets look back at the first sentence in the Reuters article from yesterday:

Americans are exposed to seven times more radiation from diagnostic scans than in 1980, a report found on Tuesday...

And the next line in my report would have been: because the evolution of imaging technology has made it so accurate and valuable that we cannot live without these tests; but, Reuter's next line was:

"as experts said doctors are overusing the tests for profit and raising health risks for patients."

Sin is behovely.

When All You Have is a Hammer...

2009-03-04T11:07:00.012-05:00

Everything is a Nail

Everyone is starting to pile on. Now every announcement of some health issue or new academic study has, as its point, THE HEALTH CARE CRISIS.

Everything contributes to this "Health Care Crisis" (i.e. the cost and insurance crisis) in the hands of undereducated reporters.

Reuters today took a perfectly legitimate issue -- the importance of understanding the use of radiation in imaging -- and turned it into a manifestation of the health care crisis; specifically, a mechanism for greedy doctors to enrich themselves at the expense of their patent's health. *Sigh*

CHICAGO (Reuters) - Americans are exposed to seven times more radiation from diagnostic scans than in 1980, a report found on Tuesday as experts said doctors are overusing the tests for profit and raising health risks for patients.

The findings, issued by National Council on Radiation Protection and Measurement, add to already mounting evidence that doctors are ordering too many diagnostic tests, driving up the cost of health care in the United Statesand potentially harming patients. (italics mine)

Just so that you know, there is no doubt that radiation used in imaging is a force that needs to be understood, acknowledged and discussed publicly. However, doctors are not purposely exposing patients to radiation inorder to boost their coffers.

Truth is, the primary reason physicians order CT scans is because they are so good! You get such a good look at what is going on! A CT scan gives one an image that depicts the inside of the body. This is much preferable to listening with a stethoscope (to try and hear) or feeling with your hands (to evaluate). It's the difference between interviewing a witness at the scene of an accident and having a photo of the accident in progress.

Oh yea, another place where CT is MOST over-ordered is in the Emergency Room. Why is that? Two reasons. First, a CT hands the answer to a busy ER physician:

Is there pancreatitis? No.
Is there bleeding? No.
Is there appendicitis? No.

OK.

Go home --OR -- Yes--go to surgery.

Second, in the ER the Docs are paralyzed for fear of missing something and then getting a registered letter with a court date from Hawkins, Burnett and Crude. The solution? Whole body CT scan.

Do physicians over-order CT scans? Yes. Do they do this for profit-- not many. Is this a factor in the horrible health care crisis as Reuters hammers home? God no.

Everyone needs to become more educated about radiation and diagnostic imaging. It's a real problem and an issue that needs education and discussion. But to use this topic as an issue to bludgeon the system is dishonest.

Health Care Harbinger?

2009-03-03T22:27:00.054-05:00

The Best Laid Plans...

201 articles were listed on Google News tonight under the topic headline: "Health" and "Health care for All."

The topic headline was a compilation of articles from sundry sources detailing the "push" for health care reform that the Obama administration is going to start hawking tomorrow (you'd think they would slow down a little given the results of all this "change" so far?).

Well, if Obama unveils a plan analogous to his stimulus package or his bailout bill or his budget then we can expect an analogous reaction in the health care market as has happened to the markets affected by his financial roll outs (see Dow chart above thanks to Instapundit).

Anyway, I tried to read as many of these articles as I could, but no matter how far I slogged I couldn't find discussion of MEDICINE and SURGERY, only insurance, cost, and distribution of "health care."

Here, at least was a unique criticism of the United States health care system, thanks to Reuters:

President Barack Obama has laid out a broad framework for reorganizing the U.S. health care system, which currently costs more than any other industrialized country's system and yet leaves patients more dissatisfied

Dissatisfied?

There's a potent measuring stick for the worth and value of our system. What units of measurement are used when evaluating dissatisfaction? A peck of grimaces?

At least ABC News expresses a reasonable amount of incredulity about Barack's timing:

The ambitious plan comes during the worst economic crisis this country has seen in a generation. Health care reform wasn't achievable in even the best of times. Now, it could be that much harder.

The most vacuous award, however goes to the appropriately named site: ireallyshouldstudy. This was actually at the top of the Google Crawl at one point! Here's a sample of what Eliot called the vacant into the vacant:

Spending on health care also continues to rise, a very worrisome problem which needs immediate attention. Undoubtedly, health care reforms are desperately needed today in the United States... In a country considered to be among the most modern and thriving in the world, the state of health care in the United States is incredibly poor....

Obama got you scared yet? Great Cesar's ghost.

GRAND ROUNDS

2009-03-03T10:32:00.001-05:00

Grand Rounds is up at The Health Business Blog. This week David Williams is hosting and you should go and peruse this weeks selections of health care blogs from around the net, including a piece from Kennedy's Tumor.

Also, check out his other previous posts which are insightful...

Invaders From Mars at Your Local Imaging Center

2009-03-03T07:01:00.004-05:00

INVADERS FROM MARS: PART I

Both The New York Times and The Wall Street Journal ran articles recently regarding the cost of Diagnostic Imaging (DI); especially MRI (Magnetic Resonance Imaging) CT (Computerized Tomography) and PET (Positron Emission Tomography), which are big-ticket tests for the government and insurers.

Both periodicals raise legitimate concerns regarding the lack of quality assurance in the system; Namely, how good is the machine being used (the scanner); and how good are the the interpretations?

You --the consumer-- don't really have a handle on these questions because your health care brains are controlled by the little guy at the the top of the page. He, in case you don't recognize him, is the leader of Mars (1953 and 1986) and he has taken over the brains of the world so that decisions are made from a single place (his jar) which makes everything easier for everyone.

If you think your health care brains are not controlled by an alien fish head then see if you can answer these BASIC questions about tests many of you have probably had. Let's go....TRUE OR FALSE. OK?

1. A mammogram is a good test
a.True
b.False

CHEAT SHEET: good = accurate; or sensitive; or specific;
or, correct often enough to get into a good college if it were a high school student

2. A CT scan to evaluate the lungs irradiates the breasts
a. True
b. False

CHEAT SHEET: irradiates = to expose to ionizing radiation -- a known cancer causing process

3. A Radiologist is a doctor who delivers radiation to cancer patients to try to cure or ameliorate the cancer
a.True
b.False

CHEAT SHEET: You're on your own. I'll tell you this much: a radiologist has nothing to do with RADIOS on company time

4. The doctor that you consult in his private office (the internist or gastroenterologist or pulmonologist) can look at your CT / MRI / PET-CT / US (ultrasound) and comfortably discuss with you the findings
a. True
b. False

CHEAT SHEET: Ha Ha

5. The doctor who officially reads (interprets) CT/MRI/PET/US is required to have a medical license, or permit, or some type of official permission/authorization to interpret these exams and has been specifically trained to do so.
a.True
b.False

CHEAT SHEET: I mean, come on, just use your common sense

ANSWERS: b;a;b;b;b

If you got any of these answers wrong, or you don't completely understand why I asked these questions the way I did, or what I'm illustrating, then your health care mind is controlled by the guy in the jar who put a needle in your neck when you weren't looking.

Who's In Charge? Not You

The Wall Street Journal and The New York Times are running these articles because Mr. Obama is setting his sites on Diagnostic Imaging. In case you don't know (ha ha) George Bush and Tom Frist already blew away out-patient imaging centers (that are now folding up like origami art) by slipping a 50% reduction of payment into the 2006 Deficit Reduction Act (you didn't read it on line before it was signed into law?) and Obama et al are about to continue the assault.

Eventually you will be getting all your tests done in hospitals as you wait next to the lady writhing in pain from pancreatic cancer and the funny looking guy with a mask on who is coughing up some strange stuff.

And you'll have to wait a month for this privilege.

Want to know more? Read on, because in coming posts I'm going to discuss the answers to this quiz (I'll even teach you what you need to know); why Quality Assurance in Diagnostic Imaging is important for YOU to understand, and why you need to learn these things and start making your own decisions when it comes to these extremely important tests.

If you choose otherwise, or choose to ignore these issues otherwise that's OK because the green guy in formaldehyde intends to direct you and your children and your children's children to the least expensive, lowest-tech imaging facility while the interpretation of the images is done by his cronies, who I believe are gathering en masse in India and China.

Defending Breast Cancer

2009-03-01T17:14:00.000-05:00

ANCHORS AWAY

Recently, I was investigating a study done at Harvard measuring the cortisol levels of women waiting for the results of their breast biopsies. Cortisol is, roughly, considered a "stress" hormone. Biopsy results can take 2-7 days to process and get back to the patient.

Basically, the idea of this study was to prove that waiting for results causes anxiety and this is bad for women; and, by extension, we should rearrange the "system" so that women don't have to wait for their results.

Reading through this paper, I was captivated by the study's disclaimers (like which researcher is on the board of what conflicting company, etc) when I was thunderstruck by a simple statement: This study was funded by the Department of Defense.

The who?

GUNS AND BUTTER AND BREAST CANCER

Turns out that a disease-specific lobby group, the National Breast Cancer Coalition Program somehow "convinced" the Department of Defense that it had to use its budget to support breast cancer research, for which the DOD has spent $1.9 billion since the early 1990's.

What? Well at least they are spending that money on groundbreaking research, like the Harvard study!

Arm twisting by clever disease-specific lobbies -- especially those representing perceived minority groups -- can blackmail legislators into supporting programs like this in end-around spending programs funnelled through non-traditional (and nonsensical) federal funding avenues.

The institution affected (like the DOD) then ends up funding the program--usually forever-- no matter how silly the research. And they spend tons of money. Money wasted on peripheral research that could be used for MEDICINE AND SURGERY...or, GUNS and BUTTER.

For instance, this "funding program" was originally put in place in the 1993 DOD budget and the price tag was $210 million. But like all government giveaways, once they are put in place they are pretty hard to get rid of -- and this profligacy continues to this very day.

Disease-specific lobbyists and their effects need to be addressed in any "health-care" reform initiative, and their unseen costs to the system should be assessed.

According to Wikipedia:

Through the DOD , NBCC worked vigorously to ensure consumer activist
participation at the peer-review research table

Well, that's just what the system needs--consumer activists (are those like community organizers?) at the peer-review research table (otherwise known as the trough).

END OF AN ERA

As reported recently in The Atlantic, the US risks losing its supreme air power dominance during Obama's tenure as generals face the reality of being unable to replace our aging force of F-15's with the miraculous F-22's -- given the strictures of the Obama's DOD budget.

Hi-tech fighter aircraft, new warships and missile defense projects are all potential targets for big cuts in the US defense budget, as the American military faces a new era of limits under President Barack Obama.

So why are we spending $2 billion of the DOD's budget trying to figure out how anxious women are as they wait up to one week for breast biopsy results (95% of which are NEGATIVE)?

According to its website, the mission of the Department of Defense is:

...to provide the military forces needed to deter war and to protect the security of our country. The department's headquarters is at the Pentagon.

I guess there is a war on cancer...

WHAT'S IN YOUR POCKET?

2009-03-01T16:26:00.003-05:00

IGNORING COSTS

Americans are being bamboozled into health care reform. Why? They don't know the difference between MEDICINE AND SURGERY -- which is what health care really is -- and the social/economic issues that bedevil the delivery and distribution of care in America.

How bamboozled?

This graphic, provided in today's New York Times demonstrates just how detached the American public is from their health care. They are detached because they don't pay for it--they hardly share in the cost of it.

Since 1965 the personal and out-of-pocket spending by the American consumer has remained flat, while total national health care spending has gone up more than 400%.

Without direct involvement in cost decisions and implications, Americans have become as detached as trust fund babies from the realities of just what is being purchased and its relative value.

Americans have also been dumbed down to the point where overhaul of the system can be enacted under the ruse of a crisis.

Americans need a chance to choose for themselves whether they want their PHYSICIANS, their MEDICINE and their SURGERY to get thrown out with the dirty bathwater of cost, insurance provision and service distribution.

Anger Kills Health Care Costs

2009-02-24T18:42:00.002-05:00

The Face of Anger

In the Brave New World of nationalized health care the medical-government complex needs to convince us that most illnesses:

1. Can be avoided by "preventative" health care
2. Are exacerbated or initiated by behavioral characteristics
3. Can be ameliorated or treated with "unconventional" therapies -- the kinds that most doctors are not trained in

The common thread? All the above are low-tech, low-cost solutions to health care problems for the government that is paying the bill.

You will see these points driven home in the media in the next several months and years as we move to national health care where low-cost solutions are the goal. For your own good, you should read the articles in full and ignore the headline. Here's why:

Every day the news carries some story to buttress one of the aforementioned health care fallacies, like this one today:

Anger really can kill you, U.S. study shows

...people who had the highest anger-induced electrical instability were 10
times more likely than everyone else to have an arrhythmia in
follow-up, ... the study suggests that anger can be deadly, at
least for people who are already vulnerable to this type of electrical
disturbance in the heart.

Of the group, 7% developed heart disease in
the first five years; 12% showed signs within the first nine years. They were
also more likely to be in a high social class, smoking a couple packs of
cigarettes a day, and have high cholesterol. (italics mine)

This study gets picked up on line and in the news as "anger kills" as you can see from the leader for the cited article. Yet the study only suggests that dangerous heart rhythms may be induced in people who already have severe disease.

Truth is, in these patients (cigarette smokers with high cholesterol!) there are probably a lot of things that may induce rhythm disturbances including burping, surprises, shovelling snow and the doggy position.

Anger?

Please.

But it works for our brave new world of health care. The low cost solution? Anger management.

Gulfstreaming Your Health Care

2009-02-22T19:54:00.001-05:00

Good for the Goose

Ted Kennedy wants to equalize health care for everyone. This is something he hopes to get done now, before his newly diagnosed brain tumor, glioblastoma multiforme, takes him down from behind.

Equal health care for everyone.

Laudable.

To make health care equal for everyone, we, the people, are going to have to make sacrifices. Our choices will be limited, waiting times for diagnostic tests and procedures will be common, and the overall quality of the system will decline to that of other socialist programs like Canada.

So, what does Kennedy know about the fair and equal health care he wants US to have? Let's take a look.

The Best Care in the World

Ted Kennedy knows nothing about health care for the common man or the type of health care we are destined to receive under a nationalized system That's because he and his ilk -- including everyone in Washington -- get the best health care in the world all the time, and they will continue to get the red carpet treatment after health care reform reduces your care to patch quilt.

In previous posts here and here I discussed how Ted Kennedy had a seizure late one weekend night and the diagnosis was glioblastoma multiforme, an incurable cancer.

Immediately after his seizure, Kennedy was whisked to Harvard where a team of physicians gathered STAT to attend to him. The next day experts at Harvard and from around the world conferred with Kennedy to give him their opinions regarding his diagnosis and options.

In a move that is analogous to GM executives jetting to Washington to beg for bailout money, Kennedy (the health care reform Guru) then jetted to Duke to receive the best possible care by the best possible neurosurgeon, as advised by the best possible group of doctors --all within days of his seizure:

According to several news sources Kennedy consulted with

...his doctors at Mass General Hospital and "experts from around the country," Sen. Ted Kennedy decided to trust his treatment for a cancerous brain tumor to Dr.
Alan Friedman of Duke University Medical Center.

Is this the kind of care YOU will get if Kennedy's ideas about reform are institutionalized?

No. You will be relegated to a local oncology clinic where a dispirited foreign graduate will shuffle your papers, give you the routine by-the-book treatment options and then you will wait for whoever is available whenever he is available to actually get your treatment.

Kennedy -- and every other VIP demanding health care reform -- knows that their care will ever be secured by their money, or celebrity or influence.

You will not have those options.

How to Tell Someone is Lying to You About Health Care Reform: Part I

2009-02-19T06:20:00.001-05:00

KISS ME

You are being deceived if you hear or are told that the United States health care system needs to be reformed because of:

high infant mortality
low life expectancy
we spend 13% of GDP on health care
40 million people are uninsured

I'm guessing you will be hearing a lot about these social problems in the coming months as our lawmakers march forward in goosesteps to nationalize health care.

Today, the Commonwealth Fund (sounds like a bad Greenwich investment firm) somehow made the news with these exact well-worn criticisms of the current HEALTH CARE system:

The Commonwealth Fund, a leading private health policy research group, unveiled a comprehensive plan for changing a U.S. health care system that is the world's most expensive yet lags many other nations in important measures of quality.

Problem is, HEALTH CARE does not equal MEDICINE AND SURGERY which is what you really care about. HEALTH CARE, as far as the Commonwealth Fund and other social scientists are concerned is about INSURANCE, DISTRIBUTION and FAIRNESS, which while all are laudable concepts, are separate from MEDICINE AND SURGERY which is what doctors do.

The social scientists know that they are tagging real science with sociology to achieve sociologically satisfying results. This is a purposeful deception --in some corners known as a lie -- meant to play the public for suckers.

Will the results of sociologically appropriate reform of insurance, cost and delivery issues be good for MEDICINE AND SURGERY -- which is what you need to stay well and to stay alive when you are ill...?

Nope. You will lose there. You'll get cheap health care for everybody but it will be...cheap health care for everybody.

As Al Pacino, as Sonny, said in Dog Day Afternoon:

Sonny: Kiss me.
Det. Sgt. Eugene Moretti: What?
Sonny: Kiss me. When I'm being fucked, I like to get kissed a lot.

Searching for Breast Cancer in California

2009-02-18T15:19:00.002-05:00

An interventional radiologist doctor in California -- a Dr. Bittner -- has made Section B in the Wall Street Journal for doing liposuction and burning the removed fat in his automobile, or some such thing.

A much more interesting part of this article about the entrepreneurial Bittner is a side report of how the government came after him in 2003 for proferring MRI of the breast as a cancer screening tool:

... he operated a chain of radiology-imaging shops in California and other states. He offered magnetic resonance imaging, or MRI, that he claimed was better than mammography for detecting breast cancer. In 2003, the California board claimed this was false advertising in a civil suit it filed against him and the company he founded, HealthScan America Inc. The shops closed at about the same time. In 2004, a California state court ruled against the business

Shops? Why do they call them shops? A place where MRI of the breast is done is an imaging center, no? And why in Good Arnold's name would the State be chasing after doctors who are recommending THE TRUTH... namely, MRI is actually WAY better at finding breast cancer than mammography. And it was that way in 2003, believe me.

So why did the government go after him? I know why. But the truth is too shocking, aparently, for you lay people.

So shocking that when I wrote a book about this very subject, in 2006, I could not get it published. No one wants to hear it. No one wants to know. I was told that...well...maybe I shouldn't say.

I will, though.

Stay tuned; I'll get around to it, I promise.

DON'T LINE UP FOR STEM CELLS YET

2009-02-18T09:16:00.001-05:00

Stemming Pundits and Panderers

You know, for years I've been listening to people attack George Bush et al for not supporting stem cell research. And all the while --although I fully support such RESEARCH -- I've also been disgusted at the techniques used to promote stem cell research; namely, falsely aggrandizing what is known or can be done with stem cells right now

Like the following from By Arthur Caplan, Ph.D. -- who gets his medical expertise by doctoring in the philosophy and history of science (translated: don't go to him with your sore bunions):

An administration that has shown itself over and over again to have trouble telling the truth is now telling Americans in wheelchairs, those with damaged hearts, babies who are diabetic and those left immobile by Parkinsonism not to worry. The president, whose grasp of science left him unable to identify creationism as a fundamentally religious idea, and his trusty sidekick Karl Rove, rarely seen in a white lab coat but who knows something about rats, having been in Washington forsome time now, claim to know best which medical researc Is most likely to benefit diseased Americans in the future. (boldface mine)

There are thousands of examples like the above in the news of that day. And diabetic children -- among other tools --were paraded in front of Congress begging for stem cells to cure themselves. I had friends and mothers of friends -- some quite well educated -- calling me asking if a cure for arthritis or ataxia or retinoblastoma was in the offing, just as soon as that idiot demon Bush and his cronies got their fists out of their noses...

Well here's a story on the AP today about a desperate family who went to Israel to have a desperate thing done -- an injection of stem sells:

Report: Fetal stem cells trigger tumors in ill boy

By LAURAN NEERGAARD – 13 hours ago

WASHINGTON (AP) — A family desperate to save a child from a lethal brain disease sought highly experimental injections of fetal stem cells — injections that triggered tumors in the boy's brain and spinal cord, Israeli scientists reported Tuesday.

Read it all here

Stem cell research offers great promise and should be pursued at all speed; but to make irresponsible claims about the current use or potential of this research, especially while conjuring up hope for those immediately ill as a spectre to beat down, hijack, blackmail, or man-up your political or philosophical hobgoblins is dishonest, ignorant, and...well, I guess we should say now, dangerous. Nay, criminal.

HOLLA AT YOUR BOYS

2009-02-18T04:58:00.001-05:00

YOU GUYS ARE CRAZY!

Top Ten Myths of American Health Care?

How did this get into print? I just ordered it. Not that any of it is a surprise, but no you never see THE TRUTH about health care in the MSM, or in a book, let alone in the MSM REVIEWING a book that contains TRUTH about health care and not just the bald face rote nonsense that the reformers have been using since the 1970's to promote their version of National Health Care.

Sally C. Pipes wrote the book. And this is where she works.

Help A Fetus? O No Obama!

2009-02-17T18:06:00.001-05:00

Over the Rainbow

If you are pregnant right now, the $10 billion Obama is handing over to the NIH in the STIMULUS bill is not likely to help your fetus-- if at all-- if ever --until it is an adult.

Because, as even TIME noted in a typically tendentious piece a couple of years ago

It does take on average more than 13 years and often several hundred million dollars for a company to research and test a major new drug before it's presented to the FDA for approval.

Only about one of every 10,000 chemical compounds that are first tested end up as medicine cleared by the feds.

Converting basic scientific research into effective medicines to treat complex diseases like cancer has also become more difficult the past several years with more expensive and longer drug trials, as well as higher failure rates.
So, although I'm all for research, and the NIH, and even STIMULUS, but I mean wtf?

Giving money to the NIH is not going to stimulate this economy. Not now. Not maybe ever.
Sin is behovely

KILL ALL THE CHIROPRACTORS

2009-02-16T23:57:00.001-05:00

A NICE ADJUSTMENT AT NO COST

The New York Time explained today how $1.1 billion of B. H. Obama's STIMULUS bill is going to be used to study the efficaciousness of medical therapies so we can stimulate the economy by making better health care choices. Obama is interested in finding out which treatments are better -- according to evidence-based medicine.

I guess, if this is a STIMULUS bill, we are hoping these policies will STIMULATE the economy; or, namely, help us get out of our current fiscal morass.

Will these 1.1 billion dollars stimulate our hurting economy? Will they save your 401K? Will they help you pay for that house you couldn't afford or for the equity loan you took out on the overleveraged, overassessed value of that home?

How about those tickets you bought for Disneyworld...and three nights at the GRAND FLORIDIAN?

I'm not sure...but if I were you, I'd look into refinancing instead.

Anyway.... that's not the point. I HAVE A BETTER IDEA.

If you believe in evidence-based medicine and you want to save lots of monies, just FIRE ALL THE CHIROPRACTORS. TOMORROW. Or at least cut them off. Cut them out of the health care pie--the part you pare into the garbage disposal unit.

No federal monies. No insurance repayments. Chiropractors go back to the paraprofessional primordial ooze from which their teleologically retarded pseudo medical science crawled out of (I believe it was inventive by a 19th century salesman).

Case Closed.

One billion saved.

Next item on the stimulus bill?

One Evening on the Cape

2008-11-28T17:51:00.001-05:00

In The Ointment

A funny thing happened to Teddy Kennedy just when --as fate would have it -- the rising sun for National Heal Care Reform was dawning. He had a seizure (a seizure is a convulsion, such as a young woman might have seconds after she succumbed and breathed in the water surrounding her trapped, un-rescued body).

It was last May, one night, at his 6-acre palatial Hyannisport compound in Cape Cod. No doubt it took time for those in the household to discriminate Teddy's behavior from a typical bout of inebriated drooling and lip chewing, but when he refused to sober-up, at some point, Teddy was whisked away to the Harvard Hospital System.

If Kennedy's treatment was similar to how other notables are cared for at top hospitals, then tens of thousands of dollars were spent in assuring security, privacy, and an expeditious round of diagnosis and treatment. No waiting in line. No semi-private room. No mistakes. The best doctors called in at all hours. The best, on call, all the time.

Once when Kennedy was hospitalized at a major institution in New York, they shut down a whole floor for him, at untold cost and inconvenience to many patients. No matter. After all, Ted Kennedy is not just anyone.

But you are just anyone. That will become important.

Kennedy undoubtedly had a STAT MRI or a noncontrast CT followed by an MRI,and was quickly diagnosed -- by the radiologist on duty -- as having a brain tumor. A biopsy the next day revealed a grim diagnosis with an equally grim prognosis: Glioblastoma Multiforme.

So Kennedy's quest for health care reform, just as it is rising to prominence in the current "change" environment may be a kingdom unseen by the long-fallen prince. Because a GBM is a rapidly fatal tumor with few treatment options.

What to do?

Why Is Kennedy's Tumor Important?

2008-11-28T16:37:00.001-05:00

Kennedy's tumor

Why Kennedy's tumor?

Ted Kennedy, after years of plastering a cellphone to his ear, developed a Glioblastoma Multiforme -- the worst possible brain tumor -- deep to his ear in the parietal lobe of his brain.

Everything about Teddy's brain tumor (and perhaps Kennedy's life) is metaphorically relevant to the history, current state, and future of health care in the United States. And, just like Ted Kennedy, that health care is about to go in the wrong direction, much as the result of this man's insistence over the years that America was in the midst of a health care crisis.

Teddy's pre-morbid opinions and actions; his disease presentation; his familial and social history; his diagnosis, treatment, care and follow-up are all alike parables created perfectly for this time and our age and in line with the very subject which purportedly formed the center of his political universe -- a universe now invaded by the most wicked of wicked cancers.

Kennedy's Tumor is an incredibly clever device of destruction that seems to have been created by someone who knew what He was doing. It can't be stopped, can't be cured. Ted's tumor, now that it is established, will grow relentlessly until it finally overwhelms him.

The misapplication of the word crisis to the care of sick human beings -- as opposed to the insurance and distribution issues to which it actually pertains was the same tumor. Planted in the public's conscience it has grown -- despite all logical and moral efforts to stop it -- to where now it is overwhelming public consciousness and drastic measures are being taken to "cure" this disease.

Kennedy's tumor is a parable with many parallels and lessons. It will be a joy to unfold it, like an artichoke, until we get to the bitter hard pit.