MedWorm: Health Medicine and Bioethics Commentators

Cheap canadian drugs?

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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Springer spaniels

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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Nissen auditions for fda commissioner

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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When nissen loved vytorin

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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Knowledge is dour

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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Blowing up the critical path

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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A carpenter's shoddy hit job

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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Pfizer's new cme policy: the sum of all fears

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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Msm on speed dial

drugwonks.com > Blog — Fri, 04 Jul 2008 10:34:10 +0100

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Inside the belly of competitive eating

WSJ.com: Health Blog — Fri, 04 Jul 2008 10:07:29 +0100

Joey Chestnut. Photo: AP The world’s greatest eaters are about to converge on Brooklyn for the annual Fourth of July hot-dog eating contest. As you’ll no doubt recall, Joey Chestnut snatched the title last year from the great Takeru Kobayashi by eating 66 hot dogs and buns in 12 minutes. For the Health Blog, this raises a fundamental question: How can anyone (much less these guys, who aren’t particularly large of belly) choke down that many hot dogs that fast? Fortunately, we aren’t the only ones who wanted to know. “The question was, do they empty their stomach really rapidly or does their stomach blow up like a balloon?” Marc Levine, a radiologist at the University of Pennsylvania, told us in a recent phone conversation. Levine was an author of a study published last year in the Journal of Roentgenology — “Competitive Speed Eating: Truth and Consequences” — that provides something of an answer. (Source: WSJ.com: Health Blog)

Fda panel: test diabetes drugs for heart safety

WSJ.com: Health Blog — Fri, 04 Jul 2008 10:07:29 +0100

A diabetes drug may lower blood sugar but still pose risks for the heart. So a panel of FDA advisers voted 14-2 yesterday that the FDA should require drug makers to show that experimental diabetes drugs don’t increase cardiovascular risks. If the FDA takes the panel’s advice — which it usually does — it could be costly for drug makers because it takes a bigger, longer trial to prove heart safety than to prove blood-sugar control. AstraZeneca and Bristol-Myers Squibb could be on the short list of those affected by any changes; the companies are planning to submit their diabetes drug saxagliptin for FDA approval soon. In the short term, at least, Merck could benefit from the changes — its diabetes drug Januvia has already been approved, and would compete with saxagliptin, which is in the same class. And, of course, the elephant in the room in this discussion is GlaxoSmithKline’s Avandia, which found itself at the center of a storm last year after an analysis suggested the drug raised the risk of heart attacks. The company says the drug is safe, and it remains on the market. (Source: WSJ.com: Health Blog)

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In germany, assisted suicide rather than a nursing home

WSJ.com: Health Blog — Fri, 04 Jul 2008 10:07:29 +0100

Roger Kusch shows a video of Bettina Schardt. Photo: Associated Press A 79-year-old German woman killed herself last weekend because she didn’t want to move into a nursing home. Now the case of Bettina Schardt is the talk of the nation, largely because she was advised by Roger Kusch, described in today’s New York Times as “a prominent German campaigner for assisted suicide.” Suicide is legal in Germany, as is aiding a suicide. But there seems to be a push back this week. “I am absolutely against any form of assisted suicide, in whatever guise it comes,” German Chancellor Angela Merkel said on the news this week, the NYT notes. And five German states plan to push for new laws to ban commercial ventures that help people commit suicide. “We want to make it illegal for people here to offer ’suicide by reservation,’ ” one state’s justice minister told the paper. In recent years, hundreds of Germans have traveled to Switzerland to kill themselves with the help of a group that facilitates suicides. Euthanasia, or mercy killing, is against the law in Germany. But Kusch appears to be on solid legal ground. He counseled Ms. Schardt, but didn’t provide or administer the drugs she used to end her life. He left the room after she after she took the drugs and returned three hours later to find her dead on her bed, the NYT says. Health Blog Question of the Day: What’s your opinion on assisted suicide? (Source: WSJ.com: Health Blog)

Elizabeth edwards & a $40 million push for health coverage

WSJ.com: Health Blog — Fri, 04 Jul 2008 10:07:29 +0100

Elizabeth Edwards. Photo: Associated Press A new group called Health Care for America Now is set to pour $40 million into a campaign-related push for universal health insurance. The group is officially nonpartisan, but its policy slant clearly falls on the Democratic side of the political fence — and its “headliner,” as Politico.com puts it, is Elizabeth Edwards, cancer patient and wife of former presidential candidate John Edwards. The effort is backed by a coalition that includes the big unions Service Employees International Union and the AFL-CIO. A planned $25 million ad campaign is set to launch next week. It is one of several “issue groups” that will be spending lots of money in the coming months. As this morning’s WSJ notes, campaign finance reforms passed in 2002 prompted many political donors to start giving money to groups other than candidates and political parties, because those donations remain largely unregulated. But that doesn’t mean the issue groups don’t get involved in politics. “We’re asking members of Congress and candidates, ‘Whose side are you on?’” the Health Care for America Now’s spokeswoman told the WSJ. (Source: WSJ.com: Health Blog)

Hospital company sued for billing patients when insurance doesn’t pay

WSJ.com: Health Blog — Fri, 04 Jul 2008 10:07:29 +0100

Say you wind up in the hospital. The hospital bills your insurance, but the insurance company thinks the price is inflated and only pays part of what’s billed. So the hospital decides that you owe the portion your insurance won’t pay. This is called “balance billing,” and it’s been debated in health-care circles for decades. It’s bubbling up now in California, where the state is suing a big hospital operator called Prime Healthcare Services over the practice. The LA Times has the story. Prime Healthcare owns nine acute-care hospitals, according to the company’s Web site. The company has been growing rapidly, often canceling many private insurance contracts when it acquires a hospital, according to the LAT. That means the hospital winds up being “out of network” — and more expensive — for many patients. Insurers, including Kaiser Permanente, argue that the charges are inflated and have only been sending partial payments. So thousands of patients have been sent bills for the difference, sometimes as high as $50,000. California is trying to put in place a ban on balance billing, though for the time being state law on the subject is somewhat vague, the article says. The head of the state’s Department of Managed Health Care, which filed the lawsuit, was clear enough: “Patients shouldn’t be brought into the middle of billing disputes,” she told the LAT. In a statement, Prime Healthcare said is is “disappointed” that the state “has resorted to punitive actions against the very providers, physicians and hospitals alike, that are essential to maintaining the health care safety net relied on by thousands of patients every day.” The statement added: “We do not believe the DMHC has the requisite legal or equitable standing to bring this suit forward.” Photo: iStockphoto (Source: WSJ.com: Health Blog)

Strong medicine: doctors who signed the declaration of independence

WSJ.com: Health Blog — Fri, 04 Jul 2008 10:07:29 +0100

Declaration of Independence, by John Trumbull. From the Architect of the Capitol. Who knows better than a doctor — witness to birth, sickness and death — that all men are created equal? So it is fitting to recall, this Fourth of July, that the signatures of five physicians are scattered among the 56 names at the bottom of the Declaration of Independence. Here are the basics on the Founding Doctors. Facts not otherwise attributed come from the book Physician Signers of the Declaration of Independence (Yes, there’s really a book with that title, and we were able to get our hands on a copy.) Benjamin Rush was a Pennsylvania doc who served as a high-ranking surgeon in the Continental Army and was later treasurer of the U.S. Mint in Philadelphia. He is known as the Father of American Psychiatry, and his book Medical Inquiries and Observations upon Diseases of the Mind was the standard psychiatry textbook for much of the 19th century, the NIH says. Matthew Thornton practiced for years in rural New Hampshire. When he went to Philadelphia for the Continental Congress, he had himself innoculated against smallpox and wrote of the ensuing ordeal. His satire described a Dr. Cash (”we saw no more of him, till I paid his bill of 18 dollars”); Dr. Critical Observer (”told me he would critically observe every stage … came once in two or three days, and stayed about a minute”); and Dr. Experience (”a merchant, who had the Small Pox, visited us every day, and gave a much truer account of the Small Pox, than all the doctors.”) (Source: WSJ.com: Health Blog)

Independence day

WSJ.com: Health Blog — Fri, 04 Jul 2008 10:07:29 +0100

In observance of Independence Day, the Health Blog will not publish today. Photo by Bob Jagendorf via Flickr (Source: WSJ.com: Health Blog)

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The spark: thomas jefferson (and john adams) survive

The Spark of Yahoo! — Fri, 04 Jul 2008 07:01:00 +0100

Adams, Jefferson, and others signthe Declaration with John Hancock Of all the Founding Fathers, the two most important may have been John Adams and Thomas Jefferson -- the former being one of the strongest voices for independence, the latter being the primary author of the Declaration of Independence.Jefferson and Adams had much in common. Both were lawyers, both served as American diplomats, and both were (obviously) vice president and president. But perhaps the weirdest thing they have in common is that they both died on this date in 1826, exactly 50 years after the ratification of the Declaration.Now, we've made no secret of how much we love coincidence, but this seems less coincidental and more like the final chapter completing their mythic lives. Adams and Jefferson were allied in Philadelphia, but politics and other circumstances -- such as Adams' prickly personality -- forced them apart, and they became bitter rivals. Despite their personal enmity, fellow Founder Benjamin Rush eventually reconciled them in 1812.The former presidents didn't meet in person during their rekindled friendship, but their letters are intimate and probe deep philosophical questions while touching on world events, literature, and science.By 1826, Adams (aged 90) and Jefferson (83) were in reasonable health for their ages, though Adams suffered from rheumatism, and Jefferson had chronic bowel and back problems. Whether intentionally or not, they both managed to hold on for the 50th anniversary of Independence. Jefferson fell into a coma on July 2, rallied on the 3rd long enough to ask, "is it the Fourth?" and died at 12:50 the next afternoon. Adams lasted a few more hours before succumbing to old age. Before he died, though, his last words were reputed to be "Thomas Jefferson survives." Though it's been more than 180 years since Adams and Jefferson died, their legacy does, indeed, survive.Suggested Sites..."Jefferson Still Survives" - a historian examines whether Adams' alleged last words were indeed spoken.The Adams-Jefferson Letters - introduction to the book, with a good overview of the men's relationship.Early America: Obituary of John Adams - reproductions of period obits.You Tube: Peter Stone on "1776" - the librettist of the musical about the Founding Fathers discusses them.White House: James Monroe - another former President who died on the Fourth.Directory categories: John Adams, Thomas Jefferson, American Presidents, U.S. History, 1776: The Musical Archived under: 4th of July, American History, Anniversaries, Biographies, Coincidence, Death, Government, John Adams, Presidents, Revolutionary War, Thomas Jefferson, United States, Weird Stuff (Source: The Spark of Yahoo!)

Transgender advocates discuss thomas beatie and what his pregnancy delivered

Our Bodies Our Blog — Fri, 04 Jul 2008 04:00:00 +0100

Writing at Salon, Thomas Rogers looks at whether the publicity surrounding Thomas Beatie, aka "the pregnant man," who has willingly appeared on "Oprah" and in many other media outlets, has ultimately helped or hurt the public perception about transgendered men... [This is a content summary only. Click the headline to visit Our Bodies, Our Blog for the full post, links, other content and more!] (Source: Our Bodies Our Blog)

Gm volt battery tech lagging

FuturePundit — Fri, 04 Jul 2008 04:00:00 +0100

Jonathan Rauch has written an article for The Atlantic about the development of GM's Chevy Volt pluggable hybrid entitled Electro-Shock Therapy. In the article he talks to GM electrical engineer... (Source: FuturePundit)

Animal rights activists want hemsley millions

Secondhand Smoke — Fri, 04 Jul 2008 02:13:00 +0100

Leona Helmsley left her hundreds of millions of dollars to care for dogs. And now the animal rights groups want that action. From the article by the industry funded and excellent information source, Center for Consumer Freedom: Helmsley's money, which may amount to as much as $400 million in grants every year, "could make such a difference," People for the Ethical Treatment of Animals (PETA) president Ingrid Newkirk told the Associated Press yesterday. [Newkirk] said at least 3 million dogs are put to death each year for lack of spay and neuter programs. "Many people cannot afford the surgery for their dogs," she said. Last year, PETA raised $30 million. With all of this money, it managed to spay or neuter just 6,341 dogs and cats. (PETA also killed 1,997 pets while finding adoptive homes for just 17.) This is an organization for whom fixing the pet overpopulation problem isn't a top priority. It's more interested in ending AIDS research, demonizing carnivores, and targeting children for vegetarian indoctrination. If the executors of Helmsley's estate were looking for a place to invest pet-protection dollars, they could hardly do worse.Well, impeding AIDS research would be a less hyperbolic way of putting it, but animal liberationists don't believe there should even be domesticated animals, so allowing PETA or other such groups to have some of that lucre would be to work against Hemsley's desires.CCF concludes: Here's a modest proposal for the Helmsley estate: Establish a new national Humane Society, an umbrella group devoted solely to distributing money to local pet shelters. No stealth campaigns aimed at winning legal "rights" for chimps, cows, and elephants. Just a real national Humane Society. We've had a pretend one for years. Maybe it's time for the real thing.Yes there will be litigation. With all of that money to be had to promote the ideology, Helmsley's estate will soon look like a it will soon look like jackals on a carcass. (Source: Secondhand Smoke)

It’s fourth of july weekend: here’s what you should be eating

Healthbolt — Fri, 04 Jul 2008 01:48:13 +0100

Image details: Healthy beets served by picapp.com (Source: Healthbolt)

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Special "independence" day post: australians may need a license to smoke

The Rest of the Story: Tobacco News Analysis and Commentary — Fri, 04 Jul 2008 00:57:00 +0100

Adults in Australia who smoke may soon be required to obtain a "license to smoke," according to an article in the Victoria Herald-Sun.According to the article: "Health Minister Nicola Roxon has warned smokers she is prepared to take radical action to force them to give up. A smoker's permit could be among the "innovative options" employed to get Australians to quit. The permit, which smokers would have to buy annually and display every time they bought cigarettes, has been mooted in Britain. ... Under Britain's permit proposal, smokers would have to renew their permit every year and display it when buying cigarettes."This proposal has been endorsed by a leading tobacco control researcher and advocate - Dr. Simon Chapman of the University of Sydney School of Public Health - who writes in a July 4 column on an Australian news web site: "Why not license smokers? After all, doctors issue tens of thousands of temporary licences every day in the form of prescriptions to allow us to access drugs that can save lives and improve health. Critics scoff at the idea, arguing that there would be too many difficulties in policing it, or that an underground market for cigarettes would develop. Given that obtaining a licence for other activities is so straightforward, these arguments hold little weight. Introducing a smoker-licensing scheme could be readily managed by allowing all current adult smokers over the age of 18 to acquire a permit. To be eligible, smokers would need to have their doctor affirm that they are smokers and then apply for a photo ID swipecard. Any new smokers wanting a licence after the scheme's starting date would be required to take a test, proving they fully understood the many health risks of smoking. ID cards could be swiped at stores to limit the number of cigarette packs that could be bought at a time. Two packs a day maximum, say. This would help to minimise a blackmarket of cigarettes being sold on to unlicensed or under-age smokers. And, just as for a driving licence, smokers would need to renew their commitment to smoking every five years."The Rest of the StoryThis is a wonderful idea, but why restrict it just to smoking? There are all sorts of health-related behaviors for which people should be required to have a permit.First of all, people should have to hold a license to drink. I propose a system of licenses by which you are certified at a certain level of drinks allowed per time period. You have to first take a drinking test to see how well you hold your liquor. Based on your test score, your license then indicates how much you can drink without posing a threat to yourself or others. A doctor would have to certify that you indeed do drink alcohol. Upon entering a bar, the bouncer would check your license and then stamp your hand with the appropriate number of allowed drinks. The bartender would check off your stamps as each drink is served.Second, if you need a license to fish, you definitely should need a license to become a parent (to borrow a motif from the movie "Parenthood"). A quick parenting test could be required. Baby dummies could be used with real sound effects to simulate the conditions you need to be able to recognize. You should be required to demonstrate your ability to change a diaper while talking on a cell phone and with a dummy toddler in a standing position, useful when you are using your drinking license in a bar with bathrooms that are not baby-friendly.Prior to your child becoming an adolescent, you would need to renew your parenting license. You would be tested in a simulation in which you would try to conduct a conversation with a testing official who refuses to listen to anything you have to say and doesn't want to be seen in your presence or acknowledge that you exist, except to ask for money to take when he goes out with his testing buddies.Third, you should need a license to buy red meat. With a doctor's certification, you get a permit that allows you to purchase red meat at the grocery store. However, there is a strict limit of two steaks at a time, to prevent a possible black market for rib eye and rump. Before receiving your license, you would of course be required to pass a test demonstrating knowledge of the harmful effects of eating high amounts of fat.Licenses to purchase tater tots should also be required, but available only through a highly competitive lottery system.Fourth, a permitting system should be established for sunbathing. Licenses would be granted only after completing an educational program about skin cancer and methods to help prevent sun exposure.On a similar note, licenses should also be required to go to a tanning salon. A physician's note as well as successful completion of a course in dermatological oncology would be required.Restaurants which continue to serve trans-fats should require their customers to hold a permit before ordering any food that contains more than 0.5 grams of trans-fat. A swipe card system could be developed which automatically keeps track of your trans-fat intake for the week. Once you reach the weekly maximum, you would be denied any further trans-fat containing menu items.Unsafe sex would still be permitted under this system, but would require a license, for which one would need a doctor's note and successful completion of an exam on sexually transmitted diseases. There would also be a weekly partner maximum.Fat people would need a license to eat out in restaurants, and would have to pass an additional certification exam to eat out at fast food restaurants. A special mark on the license, obtainable only with a doctor's permission, would be necessary to supersize it.A special thrill-seeking license would be required for activities like bungee jumping, skydiving, rock climbing, sky surfing, and freestyle motocross. Skateboarding permits would be on a graded system, with funbox, grind box, quarterpipe, and halfpipe levels.Swimming permits would follow the traditional YMCA levels of: guppy, minnow, tadpole, fish, flying fish, and shark. (Source: The Rest of the Story: Tobacco News Analysis and Commentary)

When the police ‘take the fifth’

Cato-at-liberty — Thu, 03 Jul 2008 20:58:05 +0100

Local incident here in the DC suburb of Prince George’s County: The police are trying to solve a murder, but they can’t get useful information from certain key witnesses–even though those witnesses are themselves law enforcement officers. It sounds quite odd until you hear the additional details. The murder victim was suspected of killing a police officer in the line of duty. Seems like police vigilantism. Marc Fisher has a good column about the death of Ron White here. And the Washington Post has an editorial here. This incident provides me with a rare opportunity to criticize the Supreme Court for carrying a provision of the Bill of Rights too far. To briefly digress, never accept the blithe assertion that “sometimes the courts mistakenly expand the government’s powers and sometimes the courts mistakenly expand the constitutional rights of individuals.” That’s true, but very misleading because it sounds as if it all evens out in the end. Not true. In Garrity v. New Jersey, the Supreme Court said police officers could “take the Fifth” with respect to internal investigations into police misconduct. Now police officers, like anyone else, can “take the Fifth” when threatened with arrest and prosecution. However, they should not be able to take the Fifth when they are threatened with the loss of their job. Or, to be more precise, they can invoke the Fifth if they choose, but the police chief can then respond by demanding that they turn in their badges. The dissenting opinion in Garrity contains this quote from one Judge Jerome Frank: ”‘Duty required them to answer. Privilege permitted them to refuse to answer. They chose to exercise the privilege, but the exercise of such privilege was wholly inconsistent with their duty as police officers. They claim that they had a constitutional right to refuse to answer under the circumstances, but . . . they had no constitutional right to remain police officers in the face of their clear violation of the duty imposed upon them.’ Christal v. Police Commission of San Francisco.“ Oliver Wendell Holmes once said, men may have the right to remain silent, but they do not have the constitutional right to be police officers. Holmes was right and Garrity was wrong. Returning now to the apparent murder of Ron White in his jail cell, the silence of the correctional officers is simply inexcusable. County officials should give these officers an ultimatum: You have 24 hours to come forward and tell us what you know. Anyone who remains silent will be discharged. And, note well, the criminal investigation will continue in any event. The local police union will object, but let it. Garrity was decided by a narrow, 5-4 vote. It was incorrectly decided and ought to be overturned. This case could be the perfect vehicle for accomplishing just that. Under current law, citizens can lose their jobs and risk jail for refusing to cooperate with private investigators. It is perverse for the law to permit a double standard for state employees–especially the police. One would think that the law would hold the police to a higher standard here. (Source: Cato-at-liberty)

Guess who’s had a baby or two…

Healthbolt — Thu, 03 Jul 2008 20:46:59 +0100

If you guessed the Jolie-Pitt clan, you’re wrong. According to her OB, there’s still a few weeks to go. No, the babies I’m talking about are the ones that have been born to ‘a 70 year old grandmother’ and ‘a transgender man’. Talk about pushing the limits. Can you imagine having a baby twins at the age of 70? I’m having a hard time getting my head around the idea. And get this, she is already has two daughters and five grandchildern. I could understand if this was a simple fluke of nature, but the twins were conceived through IVF treatment. Why ? Well, according to news reports, it was so there would be a male heir. This, quote by the 77 year old father, who financed the treatment through a combination of savings, mortgaging his land, and credit card loans, sums it all up: “We kept no stone unturned and God has rewarded us. The treatment cost me a fortune but the birth of a son makes it all worthwhile. I can die a happy man and a proud father.” Meanwhile, the transgender man who made headlines around the world as the “pregnant man” gave birth a couple of days ago to a healthy baby girl. There will, no doubt, be exclusive photos to come. After all, this is history in the making. As for Angelina Jolie, she’s sitting in a hospital in Nice, possibly also shaking her head and saying ‘what next?’ Tags: 70 year old mother, angelina jolie, births, Healthbolt, pregnancy, pregnant man, transgender motherShare This (Source: Healthbolt)

Daily persaud covers the diphtheria vaccine shortage

NHS Blog Doctor — Thu, 03 Jul 2008 19:46:00 +0100

NHS BLOG DOCTOR first reported the shortage of vaccine for routine childhood immunisations on 11th June in "More good news from the Department of Health" and followed up with "How long before a British baby dies of diphtheria" on 1st July. The most recent post was "Death from Diphtheria" earlier today, pointing out that, contrary to my original suggestion, there has in fact already been a death from diphtheria.Over the last day or so, Dr Crippen has been talking to a reputable journalist from a reputable paper who was about the give the story some wide publicity, with acknowledgement of sources. It was not to be. The Daily Persaud has already published without, of course, mentioning the original source of the story.One of the frustrations of blogging. (Source: NHS Blog Doctor)

Judge vaughn walker’s fisa ruling

Cato-at-liberty — Thu, 03 Jul 2008 19:29:04 +0100

Glenn Greenwald is all over yesterday’s ruling on FISA. For related Cato work, go here and here. (Source: Cato-at-liberty)

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State-worship, mccain style

Cato-at-liberty — Thu, 03 Jul 2008 19:18:48 +0100

Here’s a snip from John McCain’s Parade magazine essay on patriotism: Patriotism is deeper than its symbolic expressions, than sentiments about place and kinship that move us to hold our hands over our hearts during the national anthem. It is putting the country first, before party or personal ambition, before anything. (emphasis mine) Before anything? I always thought the Buckley clan had some insights on prioritization of duties. (Source: Cato-at-liberty)

Post editorial on fisa

Cato-at-liberty — Thu, 03 Jul 2008 18:07:30 +0100

Disturbed that a public outcry over retroactive immunity for telecommunications companies might snarl the FISA “compromise” in the Senate, this Washington Post editorial calls the debate: “A particularly disturbing example of the Internet tail wagging the legislative dog.” Others might call it democracy. The editorial goes on: No one can claim with certainty that his or her communications were monitored. The likelihood of prevailing — or even getting very far — with such lawsuits is low. The litigation seems aimed as much at using the tools of discovery to dislodge information about what the administration actually did as it is at redressing unknown injuries. Leaving aside the question of whether uncertainty about whether someone is listening to your calls isn’t itself a harm sufficient for standing, you have to wonder why the Post thinks that dislodging information about an illegal wiretapping programs is nefarious. It goes on to discuss the telecoms: Punishing them by forcing them to endure the cost and hassle of lawsuits would be counterproductive to securing such cooperation in the future, while offering little prospect of a useful outcome. Preventing their cooperation in future illegal activity at the behest the President seems like a useful outcome to me. (Source: Cato-at-liberty)

Interview: sally of aprovechar

Ideas For Women News Blog — Thu, 03 Jul 2008 16:59:54 +0100

(This is the ninth in a series of interviews with the top women fitness bloggers I could find!) Sally Parrott Ashbrook writes at Aprovechar where she’s decided to “take the full measure of my life to live it the best I can”. Sally answered some questions about her blog recently: 1) Why did you decide to start your blog or how did you start it? I had always tried to force myself into habits that I thought would lead me to weight loss and better fitness. A variety of influences converged to flip my way of thinking around in January 2007; I had this epiphany that if I focused on self-care as a whole, the weight could come off naturally and I’d be a happier, more self-actualized person in general. I felt giddy with the idea that I could reach goals I had long struggled with if I just took good care of myself. I started a private blog (one without my name and identifiers attached) to keep myself accountable, to give myself shared space to work through some of my emotional issues concerning weight, and to share my basic philosophy with others. By the summer of 2007, my worldview was pretty revolutionized by living out that concept of self-care. After I was diagnosed with food allergies and then celiac disease, I decided to out myself and write publicly about those issues in addition to fitness, food, and weight loss. Even though it doesn’t seem like a big deal now, for me to publish my full name along with my weight was a big deal for me initially! I talk about the concepts underlying my blog more in my first post on my blog. 2) What do you think is the biggest obstacle that keeps women from engaging in a regular fitness routine and/or from living a more healthy lifestyle in general? I think the biggest obstacle probably varies from woman to woman. For me, there have been a few basic obstacles that I had to surmount. One was that I had a long-held belief that weight loss and fitness were all-or-nothing/success-or-failure activities when that just isn’t true. My usual way of dealing with exercise and weight loss was to jump headfirst into a program, get mad at myself for small failures, and then give up on it eventually. With my self-care, I took what was for me a radically new approach. From a diet perspective, I changed my diet gradually to a focus on fresh, local, organic vegetables, whole grains, and generally lean proteins. I didn’t (and don’t) count anything or specifically restrict anything, and I let myself have indulgences while I was (and am) still getting the maximum pleasure from them (which truly is usually just the first 1-4 bites). Exercise-wise, I started out walking daily after work; then a couple of months later, I started doing Couch to 5k 3-4 days a week. Now I usually work out 4-6 days a week for about an hour at a time—and I usually really enjoy it, but there’s no way I could have sustained that many work-outs at the beginning. Taking a gradual approach and letting my comfort level be my guide—but reminding myself that I was doing it for my own well-being—has kept me motivated and engaged in a way that none of my previous efforts did. On the flip side, another obstacle I had to overcome was the idea that engaging in my own health was always going to be easy and pleasurable. I’ve written a good bit about finding the joy in what life has to offer you, and I do think that’s important. But I also think it’s important to recognize the opportunity cost of whatever you choose to focus on in your life. The fact is that our resources (money, time, energy, etc.) are finite. We really can’t have it all, and we will run ourselves ragged if we try. If we choose to focus on making health—and not just weight loss, which can come at the expense of health, but an overall healthy lifestyle—a priority, it will take time that we then cannot use for other activities. If we take an hour to make a homemade, healthy, tasty meal, that hour can’t be spent on cleaning house or watching tv or whatever else. If we take time to go work out, that means we may have a bit less time for our spouses or friends. I think finding support in that effort is important—for example, someone insisting she’ll make one healthy meal for the family instead of one for herself and one for others. (I heartily believe that if a mom is working on a lifestyle makeover, the family could probably use one, too!) But changing habits requires enormous reserves of energy (if not time as well), and I think it’s important for our overall health to recognize if the time and energy just aren’t there at the moment. I had a reader write to me and ask for advice about how she could eat healthier and exercise while she was coping with raising two kids alone and caring for a parent who had terminal cancer. In that case, while she could certainly work to make some small changes in the right direction, her energy was really already divided up into elements of her life that were very important, and it may just not have been the right time for her to try to divvy up her energy further to put a lot of it into being serious about weight loss. And that brings me to my last primary obstacle, which was a huge one: I had to learn to take care of myself emotionally in order to live a healthier life. I used to mentally abuse myself about my lack of willpower, my lack of natural athletic ability, etc. I also used to eat, blindly, when I had emotional needs that were going unmet for some reason. I’ve discovered that when I treat myself empathetically, my life goes much more smoothly. I’ve cut out the negative self-talk, and if it starts up, I stop myself and remind myself that I’m doing the best I can and that I have much to be proud of—and I mean it. When I get a craving for food at a strange time or place, I stop, close my eyes, and ask myself what it is I really want. If it really is a cupcake I want, I might get one later that day. But more often than not, what I really want is a good night’s sleep, or a hug from my husband, or a friend who will listen while I rant. These days, when I stop and focus on what I need, I then try to figure out ways to fulfill that need. Sometimes that can be hard (like if I am at work and am craving a nap), but I talk to myself about getting what I need and remind myself that I will give myself what I need as soon as possible. (And I have left work a couple of times to go home and sleep when that is what I was desperate for!) When I am making sure my life is more emotionally fulfilled, the craving to overeat largely dissipates. 3) What do you consider to be the most unique or helpful thing about your blog? My blog is an unusual combination of self-care issues, including weight loss, fitness, locavore eating, food allergies, and other things. The undercurrent of it is how to embrace your life to find or create joy, pleasure, comfort, and meaning within it. Readers tell me that they value that I’m willing to express what’s going on in my head and heart openly while also working to keep a focus on the positive. My goal is to be a support system for people in general but specifically for women who are working to take control of their health and their lives to create and maintain good lives for themselves. And, of course, as someone who maintains a gluten-free, egg-free, soy-free, dairy/casein-free diet, I want to be a resource for people who are seeking out how to have healthy, engaged, pleasurable lives as they cope with celiac disease and food allergies. Thanks for interviewing me! Thank you Sally for taking the time to answer my questions! Please take some time and visit Sally’s blog: Aprovechar ! (Source: Ideas For Women News Blog)

Not a last resort, but a “never” resort

Cato-at-liberty — Thu, 03 Jul 2008 16:48:35 +0100

An article at Doublethink Online quotes me as saying the following regarding Medicare reform: Cannon asserts that: “For Medicare, we have to realize we simply cannot provide unlimited amounts of free healthcare to every senior. We only have two options: bring more money in or cut benefits. If we simply increase taxes, they would eventually reach 40 percent of GDP. We shouldn’t arbitrarily cut back, either. We are better off finding an amount of money that we can spend per senior on healthcare, and allow them to choose their own options according to the spending guidelines…Politically, you may need to raise taxes, but it should be a last resort.” Hmm. Doesn’t. Sound. Like. Me. The first (positive) part of that sentence certainly could be true. But the second (normative) part legitimizes something I think is categorically illegitimate. I consider tax increases not a last resort, but a “never” resort. I can hear Josh Patashnik now… (Source: Cato-at-liberty)

Mmmmmh, doughnuts!

Stayin' Alive — Thu, 03 Jul 2008 16:30:00 +0100

The other half of the system that controls our behavior is, of course, pleasure. Life would be a stone drag if we were only guided by aversion, but fortunately there are some things that positively make us feel good. Oddly enough, more than a few people subscribe to ethical systems which tend to condemn them, and if George Carlin were still alive I'd bring him in to discuss that oddity, but I'll have to leave it to another day.The bad news is that, like the aversive system that manifests as pain, the pleasure system evolved in creatures less intelligent than ourselves and hence it operates rather crudely, from our supersmart point of view. We can often figure out that deferring some form of gratification now will make us happier in the long run, but we can't always manage to do it, and that makes us even more unhappy because now we are disgusted with ourselves as well a lacking in whatever that longer-term prize was.The most notorious example nowadays has to do with food, of course. Back in the days when calories were always in short supply, and the only really sweet thing we were likely to encounter was a fruit containing plenty of fiber and vitamins as well as sugar, that wasn't going to last very long before something else got it, the best thing to do was gobble it all up right on the spot. The animals we hunted didn't have much fat on them, but what was they had was fuel for the next day's hunt, and it was going to be rancid by then anyway if the hyenas didn't steal it, so chow down!Sadly for us all today, there's far too much of that sweet and fatty stuff around for own good, but we just can't help ourselves. There's even worse news for many people, which is that we've discovered chemicals that drive that pleasure system directly. It's biology, not sin. Here's a reasonably succinct, if rather aloof, explanation. By the way, although in my view the biological addiction model is a bit strained when it comes to behaviors which are intrinsically rewarding like eating and sex, it works very well when it comes to gambling, which alters brain processes very much in the same way as chemical addictions.Following up on yesterday's post, by the way, opioids are useful for the treatment of pain even they don't actually block pain. They don't make pain go away, they make you not care about it -- just the gift I was asking the intelligent designer to give us. Alas, there is that awful price of addiction. The drug becomes an end in itself, for some people the only end, at least when it's difficult to get.I've talked about the illusion of free will before, but this is the most straightforward attack of all. In the case of addiction and compulsive behavior, we may actually have the conscious experience of acting against our own wishes. But does that make any sense? (Source: Stayin' Alive)

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The nea: america (gulp!) in microcosm

Cato-at-liberty — Thu, 03 Jul 2008 16:09:52 +0100

The National Education Association, the most powerful labor union in the country, wants it both ways. It wants every single nickel it can squeeze out of federal taxpayers, but it doesn’t want anyone in Washington telling public schools what they have to do for the money. So despite advocating an ever-greater federal role in education for nearly a century, and practically ramming the U.S. Department of Education down the nation’s throat in the late 1970s, the NEA has declared in the fact sheet for a new “great public schools” manifesto that “constitutionally, education is reserved to the states.” Of course, in just the next line it declares that “the federal government has a vital role to play in advancing the quality of America’s public schools”—that role primarily being to spend lots of money—so you can see the contradiction. No doubt the NEA’s message would be different were it not for the No Child Left Behind Act, the Bush’s administration’s signature domestic achievement that’s supposed to make schools show some progress for their federal booty. The law, as has been well documented, is at best unproven and at worst a cruel sham that promises high standards but delivers empty promises and deception. But that’s not why the NEA hates it. They hate it because they don’t want anyone telling them what to do with education money. They want to dictate terms, but the Bush administration prefers to do the dictating itself. The root problem—aside from the fact that dictatorships pretty much only work for the dictators—is the utter disregard for the Constitution demonstrated by the NEA, big-government conservatives, and the millions of Americans who for decades have treated the Constitution as a wonderful relic to be admired in the National Archives, trotted out whenever they don’t like something the feds are threatening to do, but ignored when they come up with something they think it would be nice for Washington to give them. You can’t have it both ways. You can’t demand that the federal government fund something it’s not supposed to be involved in and then expect it to leave you alone. You can’t demand that the Constitution protect you from what you don’t like and then cast it aside to get things you do. You can either always respect the document that gives Washington only a few, specifically enumerated powers, or you can forget about having any protection at all. That’s a lesson the NEA needs desperately to learn. Unfortunately, it’s far from alone. Happy 4th of July… (Source: Cato-at-liberty)

Rescue us from the che guevara myth

Cato-at-liberty — Thu, 03 Jul 2008 15:52:22 +0100

The rescue of 15 hostages from the clutches of Colombia’s Marxist rebels yesterday is a riveting story with major repercussions for the region, as my colleague Juan Carlos Hidalgo blogged earlier. But one minor detail of the drama should not go by without comment. The Colombian Army rescuers involved in the ruse were wearing Che Guevara T-shirts as they landed in the guerrilla camp to claim the hostages. Guevara, of course, is the late Argentine communist revolutionary and sidekick to Fidel Castro. Che T-shirts are apparently popular in FARC rebel camps, as they are on U.S. college campuses. In a letter to the Wall Street Journal that was coincidently published on the day of the hostage rescue, Peruvian writer Alvaro Vargas Llosa tells the real story of Che Guevara. Far from being a hero, he presided over mass executions, prison labor camps, bloody and failed insurrections, and economic ruin. Yesterday’s rescue was a welcome blow to everything Che Guevara stood for. (Source: Cato-at-liberty)

An ending fit for a movie

Cato-at-liberty — Thu, 03 Jul 2008 15:30:00 +0100

As the details of the rescue operation of the FARC hostages come to light, it’s clear that yesterday’s liberation of Ingrid Betancourt and 14 others constitutes an ending fit for a movie. I propose Oliver Stone as director. (Source: Cato-at-liberty)

Time to skedaddle?

Cato-at-liberty — Thu, 03 Jul 2008 15:23:45 +0100

ABC News reports that the Bush administration may be on the verge of closing Guantanamo. This is because the recent Boumediene ruling will be bringing judicial scrutiny to the facility. In other words, from the standpoint of Bush administration lawyers, if the law pertaining to habeas corpus is coming to Guantanamo Bay, it may be time to get out of Dodge! Quick, move the prisoners to places where the judiciary can’t find them. This might be called the “executive flight privilege” because when a person (who is not in the employment of the state) tries to evade the course of justice by leaving town to avoid arrest or the institution or continuance of legal proceedings, prosecutors say it is unlawful flight. This turn of events was foreseeable. Too much emphasis on Guantanamo (i.e., who has sovereignty? The U.S. or Cuba?) would perhaps inevitably lead to more cat and mouse games between the executive and the judiciary. If the courts would focus more on the jailor and less on the jail, the cat and mouse stuff might finally stop. (Source: Cato-at-liberty)

Death from diphtheria

NHS Blog Doctor — Thu, 03 Jul 2008 15:11:00 +0100

Princess Alice of HesseIn November of 1878, tragedy struck Alice's home. Her eldest daughter Victoria came down with diphtheria, and the girl's fever was extremely high. Four days later, Alice sent her mother a telegram stating another daughter, Alix, had also contacted the disease, and it appeared the child would die. Not soon after, May also became ill. Eventually all the children with the exception of Ella were infected with diphtheria. As it turned out, all but little May pulled through. The disease had resulted in a painful choking death for the little girl. Alice kept the news of May's death a secret from the others for as long as she could. Eventually the children started to question their mother about May's absence, and she finally confessed that their sister was dead. Ernie, still recovering from the illness, was extremely grieved. In an attempt to comfort him, Alice kissed the boy, and she contacted diphtheria as a result of this action. Weak from sleepless nights of nursing her family through the ordeal, Alice had no strength left to fight her illness. On December 14th, the 17th anniversary of her father's death, she passed away. She was only 35. (source)___________________________Like Dr Crippen, you probably thought this sad story was of historical interest only. I hope that is correct. But the shortage of vaccine is worrying. I must apologise to readers for implying that there has not yet been a death from diphtheria in contemporary England. A reader points out that I was wrong:Death of a child infected with diphtheria in London8 May 2008The Health Protection Agency has been responding to the death of a child in London. The most likely explanation for the child’s death is an infection with diphtheria. The Agency is recommending that people ensure that they are up to date with their routine immunisations. Diphtheria is extremely rare in the UK due to the success of vaccinations children receive as part of the childhood immunisation programme. The few isolated cases that are seen are usually in unvaccinated people who have travelled to countries where the disease is still common. These cases do not usually spread the infection to others in the UK because the population is well protected through immunisation. Professor Peter Borriello, from the Health Protection Agency said, “It is rare for people to die from diphtheria as severe infection is prevented by immunisation and the majority of children are routinely immunised against diphtheria in the UK. This child had not been immunised. (Health Protection Agency)Meanwhile the government dishonesty and doublespeak about the shortage of vaccine continues. My practice is currently cancelling baby immunisation clinics because we cannot get enough of the appropriate vaccines. (Source: NHS Blog Doctor)

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Pfizer to eliminate cme grants to mecc’s

Policy and Medicine — Thu, 03 Jul 2008 14:15:17 +0100

In a move that provides no guarantee of improved excellence and performance in continuing medical education, Pfizer has announced that they will no longer fund CME through medical education companies. Announced via press release Pfizer Changes Its Funding of Continuing Medical Education in the U.S. and in the Wall Street Journal: Pfizer to End Financial Support: For Commercial Doctor Classes and other publications. According to Pfizer: Pfizer will continue to support CME programs at many of the world’s leading academic medical centers and teaching hospitals, as well as programs sponsored by associations, medical societies and community hospitals, in keeping with the shared goal of improving public health. Effective immediately, Pfizer is eliminating all direct funding for physician continuing medical education (CME) programs provided by medical education and communication companies (MECCs). The company will honor existing commitments. “This move by Pfizer, to my knowledge the first among commercial supporters of CME, represents a significant advance in the profession’s ability to address the complex issue of conflict of interest,” said Dave Davis, MD, Vice President, Continuing Education and Improvement, Association of American Medical Colleges. (Um AAMC, aren’t they going to be the beneficiaries of this move) “Continuing medical education, when done right, improves healthcare provider understanding of disease, expands evidence-based treatment, and contributes to patient safety,” said Dr. Joseph M. Feczko, Chief Medical Officer of Pfizer Inc. “We understand that even the appearance of conflicts in CME is damaging and we are determined to take actions that are in the best interests of patients and physicians.” Pfizer’s new approach reflects its goal of meeting the highest standards for medical education, and academic medical centers, hospitals, associations and medical societies best meet these standards. For example, Pfizer will continue to support grants such as one made to the California Academy of Family Physicians in March for a three-year national healthcare professional education campaign to reduce the number of U.S. smokers. This grant was distributed among nine partner organizations, including the University of Wisconsin, a leading institution in the improvement of continuing medical education. "The purpose of continuing medical education is to help physicians and other healthcare professionals enhance clinical care and improve patient outcomes,” said Dr. George Mejicano, Associate Dean for Continuing Professional Development, University of Wisconsin School of Medicine and Public Health. “Today's announcement sends a strong signal that educational funds must be used appropriately and that industry support is intended to fund education to improve health." (Didn’t Pfizer just state the University of Wisconsin got a three year grant, could there be any conflict of interest here? Imagine if the press release was on the elimination of commercial support for university CME and a MECC president like myself was quoted as saying: “Today's announcement sends a strong signal that educational funds must be used appropriately and that industry support is intended to fund education to improve health." Certainly there would be outrage by the Medical Schools including University of Wisconsin pointing out the hypocrisy and self interest of such a statement, I would be run out of the CME community for that statement) The Coalition for Healthcare Communications issued this response: Coalition for Healthcare Communication Position Paper on the importance of commercial providers in the CME enterprise As a major participant in efforts to address public policy questions on conflicts of interest in medicine, the Coalition for Healthcare Communication applauds efforts at self regulation by industry partners, but fears that Pfizer's recent decision to eliminate all direct funding for continuing medical education (CME) by commercial providers is misguided and may be counterproductive. While we agree with other aspects of Pfizer's recent public announcements intended to address much recent public criticism of commercial support, we believe commercial providers spur excellence in patient care by adding innovation, excellence, and entrepreneurship to the CME enterprise. Despite much recent public criticism of industry supported CME, commercial providers have an unequaled record of compliance with conflict of interest rules, and provide much of the best CME available today to the nation's doctors and other healthcare providers. Pfizer's attempt to blunt public criticism feeds the worst of the misperceptions of the industry and does not address the true challenges facing doctors and patients today. The Coalition, industry partners, organized medicine and public policy makers agree that patient care is best served by quality education from multiple providers. Most also agree that conflicts of interests are best managed by full disclosure and robust reporting and transparency programs. Moreover, the Coalition and many others believe that patient care is best served when commercial providers are allowed to compete in the education marketplace because entrepreneurs spur innovations and competition for excellence in education as well as regulatory compliance. Pfizer's recent decision to redirect it education grants may well depress the innovationsbrought to CME by commercial entrepreneurs over the past few decades. Commercial providers have historically been among the first to introduce new and innovative programs to the medical community Indeed, commercial providers have been willing to take the financial and other risks needed to move beyond the boundaries of traditional education in at least four areas: development of interactive and multi-media techniques that actively involve the learners in programs and outcomes support of critical clinical needs assessments and creation of innovative educational programs designed to meet those needs focus on fostering and measurement of clinical outcomes from educational programs, and development of Internet learning platforms and programs designed to address the immediate needs and time constraints facing clinicians. Furthermore, the Pfizer decision does not recognize that commercial providers are the leaders in regulatory compliance. Indeed, these entrepreneurs currently are uniquely qualified, staffed and otherwise equipped to create and implement the developing compliance and reporting functions demanded by policy makers and the public. This is particularly true given extensive and increasingly complicated regulatory oversight, transparency and reporting requirements facing the industry. Indeed, because conflict of interest compliance so far has been largely focused on commercial support from industry and commercial providers, commercial providers lead the industry in compliance. By contrast, the commercial conflicts faced by medical schools, hospitals and similar providers are just beginning to be recognized and addressed, and thus transparency and other compliance programs are in their infancy. Shifting the burden of regulatory compliance to these institutions without mature compliance systems will not serve Pfizer, organized medicine or patient care. We stand proud of the record of commercial providers of CME, and continue to believe that patients are best served when all provider types -- including commercial providers -- are allowed to fully participate in the enterprise and are subject to the same oversight by government and self-regulation institutions, including the FDA, HHS-OIG, and the ACCME. Commercial providers have always abided by, met or exceed the same standards of commercial support from these regulatory bodies. It is interesting to note that an interview published today in Medical Meetings, Mike Saxton the Senior Director and Team Leader of Continuing Medical for Pfizer stated: "We are eliminating support for commercial CME providers, whether they are for profit or nonprofit, and regardless of whether they have firewalls.” In the same interview Saxton states: “MECCs’ role is critical. Patients would clearly lose if MECCs were not part of the equation. They’re innovative, they’re efficient, and they have competencies that other provider groups often lack. The best model for MECCs is to collaborate with hospitals, associations, and academic medical centers." Saxton clarifies that this move is not a blanket condemnation of medical education and communication companies. "Some of the best providers out there are MECCs and some of the worst are MECCs, so it is unfortunate that this action will not allow us to give direct support to quality MECCs.” Contrary to Pfizer’s own press statement stating Pfizer spent about $80 million last year on CME courses offered by companies and nonprofit organizations alike, Ms. Clary said, with less than half going to for-profit companies. Saxton stated that up until this announcement, Pfizer had awarded 17 percent of its CME funding to medical education and communication companies in 2008. So let's do the math, 17% of roughly 6 million, less the $3.4 million block grant is: $442,000 in grants first quater to MECC's. It is also interesting to note that Pfizer spent around $6 million on CME grants in the 1st Quarter, and $3.4 million going to the University of Wisconsin Consortium. This would translate to about $24 million in CME spending for the year, significantly less than the $80 million they reported in 2007, and even that number of $80 million is significantly less than what they spent just three years ago. So why the announcement, why now.... Several questions need to be asked: Many of our programs are focused towards under severed communities, many in community hospitals, how will this move contribute in the dissemination of CME to those communities? How will the concentration of CME funds to smaller number of entities contribute to the elimination of bias? Why does Pfizer think that a non commercial entity with less resources, provide better education than a commercial one? (what about private universities vs public?) What effect does this move have on commercial free speech, does this limit the access to ideas? How is devaluing the contribution of MECC’s and their dedicated employees to providing high quality education, contribute to the cause of improving quality in medical education? This move only serves to de-value the work of thousands of dedicated individuals who work for Medical Education and Communications Companies, who have dedicated their life work to providing high quality medical education. Links to Sources: Pfizer Press Release Wall Street Journal Pfizer Ends Direct Funding of Courses CNN Money Pfizer Ends Direct Funding of Courses Medical Meetings “Pfizer Cuts off Medical Education Companies” Medical Marketing and Media Pfizer sacks commercial support of CME FiercePharma: Pfizer to Stop Funding for Profit CME Pfizer Letter to CME Providers Pfizer Frequently Asked Questions on New Criteria Also as part of their press release Pfizer announced that: To qualify for Pfizer support in the future, CME programs will have to meet revised, stricter criteria. These criteria will: Eliminate all new direct funding commitments for CME programs by medical education and communication companies (MECCs); Initiate a competitive grant review period for grant applicants to encourage more innovative, high-quality grant applications; Support the medical community’s call for balanced funding in CME by establishing financial caps on grant support; and Require all major grant applicants to meet criteria equivalent to ACCME’s highest level of accreditation[1]. In addition, Pfizer will continue to publicly report all CME grants provided in the U.S. at www.pfizer.com. (Source: Policy and Medicine)

Ben bradshaw gets it wrong

NHS Blog Doctor — Thu, 03 Jul 2008 13:44:00 +0100

Ben Bradshaw might be forgiven for hating GPs. He fought his first general election in Exeter against the appalling, self-promoting, god-bothering, pole-dancer hating, homophobic GP Dr Adrian Rogers.Dr Adrian RogersPrior to the 1997 general election Ben Bradshaw, the openly-gay Labour candidate in Exeter, faced a sustained campaign to ‘Stop the Pink Flag flying over Exeter’. Opposing candidate Dr Adrian Rogers distributed leaflets at schoolgates and Exeter FC deriding homosexuality as: “sterile, disease-ridden and God-forsaken”. Bradshaw secured a higher than average 11.91 per cent swing to Labour on polling day. (Stonewall) The victory in Exeter was welcome but there is little else to recommend about Ben Bradshaw. He has now risen to his level of incompetence and survives only because he is an oleaginously compliant prime ministerial acolyte.GPs have been attacked by a minister for operating "gentlemen's agreements" whereby they promise not to accept other doctors' patients. In a BBC News website interview, Ben Bradshaw accused family doctors in some areas of blocking patient choice. Mr Bradshaw said the lump sum "dampened the incentive" to attract new patients and meant some doctors were able to survive with very few patients. He said government research had found one practice in the south of England with just two patients, but he refused to say exactly where that was. Nor could he say how widespread the issues were. He added the introduction of choice in GP care could drive up standards in the same way it had for hospital care. (BBC)Patients have always had the right to register with the GP of their choice. Nothing new there, Ben. The MPIG is designed to support doctors with small lists. If you abolish it, Ben, the GPs working in rural areas with large practice areas and small lists will go out of business. So what will happen in the Orkneys, in the Shetlands, the Lake District, Bodmin and the North Yorkshire moors? The patients will be left without a local doctor and will have to commute fifty miles to the nearest “competitive” nurse-run polyclinic. That will save the government a lot of money, but is that what we really want?Mr Bradshaw made the comments ahead of publication of the government's primary and community care strategy on Thursday. The strategy, which builds on the Darzi review published on Monday, is expected to set out a vision for a more personalised GP service. It will call for more use of e-mail and telephone GP consultations - these only happen in rare cases currently. (BBC)Oh dear God! Telephone consultations? Email consultations? We all do a few of these and it is not unreasonable for the “I have run out of hayfever medication” sort of problem. But doctors are not clever enough to make diagnoses over the telephone. Only nurse-specialists can do that, and it is the nurse-speciaist you are going to be seeing at the new “competitive” polyclinics.And what of the allegation that GPs do not compete for each others’ patients? That we have a gentleman’s agreement not to “poach” each others’ patients?Laurence Buckman, chairman of the BMA's GPs committee, said he was not opposed to phasing out the lump sum and putting more weight on the size of GP lists. But he added: "It is absolute nonsense to suggest there are gentlemen's agreements - it just doesn't happen."Nor are we going to compete for patients, that is not the way general practice works." (BBC) Laurence is only half right. We are certainly not going to start “competing” for each others’ patients. We are doctors, not soap powder salesman. Doctors who tout for patients risk being struck off. It is right and reasonable and proper to make clear what services one’s practice offers. A practice booklet and a website is acceptable. But offering inducements – for example free gym membership – is unethical. It is part of the “pile ‘em high and treat ‘em cheap” big business ethic. It is not what reputable doctors do.But – and I speak for my practice area now, I cannot generalise on the whole county – we certainly do have a “gentleman’s agreement” not to take on patients from other local practices. We are a big group practice. There are three single handed GPs within the area as well. We don’t routinely take their patients and they don’t routinely take ours. This is not to try to strangle competition. Far from it. It is because the patients who try to change practices are usually heart-sink, difficult people who are trying to move because their doctor will not do as they want."I want to change because Dr Smith never gives me antibiotics and my neighbour who is with you says you always do.”So, when we are approached by such patients, one of us always sees them personally to ask why they want to change. If it is because there has been one of those occasional breakdowns in the doctor-patient relationship (it happens to all of us) then we probably take them. It is a difficult area, and difficult to predict what we will do in any individual case. We may not get it right on every occasion.But let us put the problem in proportion. We get one or two such request a month. Never more. Usually less. Ben Bradshaw gives the impression that nationwide this is a huge problem. It is not. There is and always has been complete freedom of choice of doctors and, once they have signed on with a practice, very few patients wish to change. (Source: NHS Blog Doctor)

A home fit for a president

Cato-at-liberty — Thu, 03 Jul 2008 13:37:29 +0100

According to the Washington Post, Barack and Michelle Obama wanted to step up from their $415,000 condo. They chose a house with six bedrooms, four fireplaces, a four-car garage and 5 1/2 baths, including a double steam shower and a marble powder room. It had a wine cellar, a music room, a library, a solarium, beveled glass doors and a granite-floored kitchen. It sounds — and looks – like a home fit for a Roosevelt. Of course, the old-money Roosevelts had their homes, so they didn’t have to go through the costly and distasteful process of taking out a mortgage to buy them. Fortunately for the Obamas, the Chicago-based Northern Trust made the process a lot less costly than it might have been for other people. (See also a comment here from Clio1, who claims to know that the deal was even better than the Post suggested.) (Source: Cato-at-liberty)

New meta-analysis of effect of smoking bans on heart attacks shows bias in tobacco control research

The Rest of the Story: Tobacco News Analysis and Commentary — Thu, 03 Jul 2008 13:01:00 +0100

A new meta-analysis that is in press at Preventive Medicine purports to show that smoking bans result in a 19% immediate decline in heart attack admissions. The meta-analysis pools data from 8 published studies which have examined changes in heart attack admissions following implementation of smoking bans. The study, funded by the National Cancer Institute, concludes that smoking bans result in an immediate reduction in heart attacks, estimating the drop to be 19%, with a 95% confidence interval of 14% to 24% (see: Glantz SA. Meta-analysis of the effects of smokefree laws on acute myocardial infarction: an update. Preventive Medicine 2008 [in press]).The Rest of the StoryUnfortunately, a meta-analysis is only as good as the studies that go into it. Since the studies used in this meta-analysis have each been discredited, the meta-analysis is not of particular value. A meta-analysis cannot legitimately show that smoking bans dramatically and immediately reduce heart attacks if the individual studies have no validity in drawing such conclusions because they are based on shoddy science.So it troubles me that tobacco control researchers would even think of conducting a meta-analysis at this early point in time, when we don't even have a single convincing study to suggest that there is a causal relationship between smoking bans and immediate, dramatic reductions in heart attacks.But more troubling to me is the fact that researchers would include in a meta-analysis (of the effects of smoking bans on heart attacks) studies in which there is no control or comparison group to determine whether observed changes in heart attacks are merely mirroring trends that are occurring everywhere, despite the smoking ban.If smoking ban opponents produced economic impact studies using the same methodology (showing that there was a decline in restaurant sales or a decrease in the number of restaurants in a particular location, but not employing a control or comparison location), we in tobacco control would trash those studies, pointing out that without a comparison group, one cannot legitimately demonstrate that the smoking ban was what caused the change in restaurant business.Professor Glantz certainly understands the importance of a comparison group because in his own study (the Helena study), he used a comparison group of non-Helena residents to make sure that the observed changes in heart attacks that occurred in Helena did not also occur outside Helena.The authors of the studies in Pueblo and Bowling Green also understood the importance of a comparison group because their conclusions were largely based on the finding of a reduction in heart attacks in those cities which did not occur in the comparison areas (El Paso County and Kent, respectively).Unfortunately, only 3 of the 8 studies used in the meta-analysis employed a comparison group (Helena, Pueblo, and Bowling Green). The other 5 studies did not have a comparison group (Italy x2, Ireland, Saskatoon, and New York State).There is simply no way that the studies without any comparison group should have been included in this meta-analysis. I don't believe that an objective scientific approach would allow one to use such studies. How can one possibly know that the observed changes in heart attacks were simply a reflection of changes that were taking place everywhere, or at least in similar, neighboring areas?You can't possibly know that unless you specifically check for it. And 5 of these studies failed to do that.The more I examine these smoking ban and heart attack studies, the more I am realizing that tobacco control science has become a very highly biased field right now. The bias is so apparent in these studies that it is practically dripping off the pages. Why peer reviewers of the journals do not pick this up is a mystery to me. One possibility, however, is that it is the same set of also-biased tobacco control researchers who are reviewing these articles.I would be very interested to see how a statistician or econometrician - someone not associated with the tobacco control movement in any way - would review these studies.Another major problem with the meta-analysis is that it fails to address the very strong possibility of publication bias. It is very likely that tobacco control researchers have only written manuscripts about this issue when they have found or suspected a decline in heart attacks. There has so far been no systematic study of changes in heart attacks in a number of locations to see objectively whether or not this hypothesis is correct. All the studies have been single-site studies.I myself have examined the heart attack data throughout the U.S. in a systematic way, and based on my review of these data, I was not able to find any evidence that statewide smoking bans led to a dramatic, immediate decline in heart attack admissions. I suspect that if a systematic study were conducted, it would not find any dramatic effect. I think that publication bias is a severe problem in this situation.The bottom line is that I think it is far too premature to be conducting a meta-analysis in the first place. But if you are going to conduct one, at least have some decent criteria for inclusion of studies.The rest of this story is not so much about whether smoking bans affect heart attacks or not. It is more about how investigator bias is creeping into tobacco control research these days. And I'm not sure what can be done to stop it. (Source: The Rest of the Story: Tobacco News Analysis and Commentary)

Overcoming underearning: book review part 9

Ideas For Women News Blog — Thu, 03 Jul 2008 13:00:08 +0100

This week I’ve read Chapter 8 of ‘Overcoming UnderEarning’ by Barbara Stanny. In this chapter Barbara goes through step 5 of the 5 steps to make you a ‘doer’. Step 5: Respect and Appreciate Money The name of this step pretty much describes what this chapter is about. Now, personally, I don’t have a problem with taking care of the money I have, my problem is figuring out how to make more of it. But given the rate of savings in the U.S. and how much the average person is in debt, this chapter is probably pretty valuable to a lot of people out there. “If you want it to last, you’ve got to take care of it.” Barbara says that she met many people while researching this book and that “the ones with the highest net worth were not necessarily the ones who made the most money“. Next she lists the Four Rules of Money: 1) Spend less 2) Save more 3) Invest wisely 4) Give generously She also discusses how you need to shift your mindset from whatever it is now to that of a wealth builder. From my own experience I can say that, yes, at times it was difficult to go without something I wanted - but I keep a close eye on my savings account. And it felt really, really, good to see that number get bigger and bigger over time. Sure, it takes a while. You have to be patient. If you can only save a little bit each month it takes a while, but it does all add up. And once I had a decent amount saved I was able to think about actually investing some in mutual funds. I ended up buying the ‘Mutual Funds for Dummies’ book and that really helped me a lot to understand what I needed to do. Anyway, back to the book: This chapter includes a 2 part exercise also: Part 1: Track your Spending Part 2: Spending Review These are really important. I used to keep a notebook where I would write down everything I bought, all my expenses, etc. And see where I could cut back so I could save as much as possible. Barbara is really giving some good advice in this chapter - do what she says and in a few years you will be very happy that you did! Next time - Chapter 9. Time for my favorite quote from this chapter: “My advice to you is if you can’t afford it, don’t buy it.” – Warren Buffett (See whole ‘Overcoming UnderEarning’ review series here) (Source: Ideas For Women News Blog)

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Nails in the coffin - the 4 hour rule

DB's Medical Rants — Thu, 03 Jul 2008 12:55:09 +0100

Dr. RW provided a link to Dr. Wachter’s excellent article reviewing the 4 hour rule and why it failed. For those who do not have access to the Annals of Internal Medicine, here is the abstract: The administration of antibiotics within 4 hours to patients with community-acquired pneumonia has been criticized as a quality standard because it pressures clinicians to rapidly administer antibiotics despite diagnostic uncertainty at the time of patients’ initial presentations. The measure was recently revised (to 6 hours) in response to this criticism. On the basis of the experience with the 4-hour rule, the authors make 5 recommendations for the development of future publicly reported quality measures. First, results from samples with known diagnoses should be extrapolated cautiously, if at all, to patients without a diagnosis. Second, for some measures, "bands" of performance may make more sense than "all-or-nothing" expectations. Third, representative end users of quality measures should participate in measure development. Fourth, quality measurement and reporting programs should build in mechanisms to reassess measures over time. Finally, biases, both financial and intellectual, that may influence quality measure development should be minimized. These steps will increase the probability that future quality measures will improve care without creating negative unintended consequences. Actually, what Bob and his colleagues are recommending is that quality measures should pass the common sense test! Readers of the blog know that I have railed against the 4 hour rule for many years. This rule did not pass the "sniff" test. Any experienced clinician could have predicated the unintended consequences that this rule created. I have an additional suggestion (to the excellent suggestions of Wachter and colleagues.) We should never adopt a performance measure until we have a prospective trial of that measure. We should do research on measures prior to using them. We "require" research on new drugs or devices. Why did the quality gurus think they could bypass this necessary step? I suspect that the "quality gurus" are suffering from religious passion. They worship at the altar of measurement. They rarely continue to practice medicine (if they ever did) and thus have lost the context necessary in understanding the complexities of practice. They worship their databases and their sophisticated mathematical tools They believe that what works for airline pilots will work for medical care. They forget that patients do not come in standard sizes, with standard diseases. Patients do not come to the ER with a diagnosis tatooed on their chest. Patients have multiple diseases. We deal with too much complexity to simplify our quality to simple quality measures. But as I have written previously, the "quality gurus" will persist because our society is infatuated with measurement. I once again recall the wonderful quote from Onora O’Neill (famed British philosopher): Bogus numbers can be more than an expensive irrelevance. They can create perverse incentives, especially when numbers are published in league tables for the public without the complex information needed to set them in context. (Source: DB's Medical Rants)

Az petition seeks to reverse e-verify mandate

Cato-at-liberty — Thu, 03 Jul 2008 12:34:00 +0100

A petition has been filed in Arizona to qualify a ballot initiative that would reverse the E-Verify mandate that went into effect there in January. My recent paper on E-Verify is here, and I’ve posted about E-Verify in Arizona a few times. (Source: Cato-at-liberty)

Repeat after me: fisa doesn’t expire

Cato-at-liberty — Thu, 03 Jul 2008 12:32:19 +0100

One of the hazards of running a grassroots campaign is that sometimes those grassroots supporters raise a ruckus if you don’t live up to your primary campaign promises. The New York Times reports that 7000 of Obama’s supporters (the number is up to 13,000 as I write this) have created a group on Obama’s own campaign website to pressure him to reject the “compromise” FISA legislation that the House passed last month. Obama declared his opposition to any FISA legislation that included retroactive immunity back in February, and many of Obama’s liberal supporters feel betrayed that while he is still nominally against the immunity provision, he has signaled a willingness to support the overall legislation whether or not the immunity provision is stripped out. Not surprisingly, the Obama campaign’s response is both lame and misleading: Greg Craig, a Washington lawyer who advises the Obama campaign, said Tuesday in an interview that Mr. Obama had decided to support the compromise FISA legislation only after concluding it was the best deal possible. “This was a deliberative process, and not something that was shooting from the hip,” Mr. Craig said. “Obviously, there was an element of what’s possible here. But he concluded that with FISA expiring, that it was better to get a compromise than letting the law expire.” I feel like a broken record, but FISA, which was enacted in 1978 and updated in 2001, doesn’t expire. It will remain the law of the land indefinitely, whether or not Congress passes new legislation this month. The Protect America Act, which was passed last August, has already expired — back in March. As I pointed out at the time, the expiration of the PAA simply returned us to the permissive surveillance regime that Congress enacted with the Patriot Act in 2001. That regime isn’t perfect, to be sure, but it leaves our intelligence community with plenty of tools to spy on terrorists. What Mr. Craig is most likely referring to is the fact that the first surveillance “authorizations” under the PAA will begin expiring in August. These “authorizations” are good for a year, so any authorizations approved in August 2007 will expire in August 2008. But that simply means that intelligence officials will have to apply for a FISA order under the still fairly permissive Patriot Act rules. Those rules include a lower legal threshold than exists under ordinary criminal wiretaps, and an “emergency” provision allowing wiretapping to begin immediately and authorization to be sought after the fact. The net result will be a modest increase in the NSA’s paperwork burden, but there’s no reason to think any reasonable surveillance activities will cease. (Some indiscriminate vacuum-cleaner surveillance may have to be stopped, but that wouldn’t be a bad thing) Indeed, Pres. Bush himself praised the changes Congress made to FISA in the wake of the September 11 attacks, noting that the Patriot Act’s FISA amendments “will allow surveillance of all communications used by terrorists, including e-mails, the Internet, and cell phones” and makes the intelligences community “able to better meet the technological challenges posed by this proliferation of communications technology.” That’s the legal regime that will apply if Congress declines to enact a FISA bill this year. There hasn’t been a major terrorist attack on American soil in the six and a half years that legal regime has been in place. Surely it will serve us well enough for another six and a half month until Obama himself is likely to be sitting in the Oval Office and can negotiate a FISA reform more consistent with his supposed liberal principles. (Source: Cato-at-liberty)

Unitedhealth settles with calpers for $895 million

WSJ.com: Health Blog — Thu, 03 Jul 2008 10:33:17 +0100

It’s been years since the world figured out that UnitedHealth was backdating stock options for its executives, but the company is still dealing with the fallout. In an SEC document filed this morning, the insurer said it will pay $895 million to settle a federal securities class action lawsuit led by Calpers, the big California pension fund. “No parties admit any wrongdoing as part of the proposed settlement,” the document notes. Last month, the Calpers suit led to the emergence of some pretty juicy documents regarding the company’s backdating practices. Also last month, Bill McGuire, the former CEO whose stock options at one time may have been worth more than $1 billion, said he didn’t know backdating was wrong. Back to the present: The company also said this morning that it expects full-year earnings, excluding items, of $2.95 to $3.05 a share, down from its reduced April forecast of $3.55 to $3.60 a share, Dow Jones Newswires notes. Photo: iStockphoto (Source: WSJ.com: Health Blog)

J&j: not just another pretty face

WSJ.com: Health Blog — Thu, 03 Jul 2008 10:33:17 +0100

Johnson & Johnson is getting into the dermal-filler business. The company’s Evolence, an injectable collagen for treating facial wrinkles, has just been approved by the FDA. The Web site for the product carries the tag line “a naturally younger-looking you.” The company says Evolence is made from “naturally sourced collagen”; translated from marketing language, that means it’s made from tendons harvested from pigs — in this case, from the U.S. and Australia — the WSJ notes. J&J is the first of the old-line big pharma players to get into the dermal-filler business in the U.S.; the big sellers here are Restylane, made by Medicis Pharmaceuticals, and Juvederm, made by Allergan. “The most salient feature of this is that it’s the first time one of the ‘bigs’ has gotten into the sandbox,” a dermatologist and J&J consultant told the WSJ. Evolence was developed by ColBar LifeScience, an Israeli company J&J bought two years ago. It’s been available in other countries since 2004. Photo: Getty Images (Source: WSJ.com: Health Blog)

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Roche ceo won’t shy away from primary-care drugs

WSJ.com: Health Blog — Thu, 03 Jul 2008 10:33:17 +0100

The big move in pharma these days is away from primary-care drugs for chronic maladies such as high blood pressure and diabetes, and toward high-priced specialty medicines for diseases such as cancer. But Roche, which has tended to focus more on specialty medicines, may be moving in the other direction. In an interview with the Financial Times, the company’s new CEO Severin Schwan said: “I believe less in this question of hospital versus primary care. Our strategy is true medical differentiation.” Historically, pharma companies have hired legions of salespeople to push primary-care drugs — and lately, many companies have been shrinking the size of those expensive armies. Schwan said Roche could wind up licensing marketing to someone else. One other thing: Roche isn’t likely to build its own generics or consumer-health business (in the model of, say, its cross-town rival Novartis). “I dont see a need to diversify into other businesses,” Schwan said. (Source: WSJ.com: Health Blog)

Seroquel and nexium: astrazeneca’s two for two in generic fight

WSJ.com: Health Blog — Thu, 03 Jul 2008 10:33:17 +0100

The war against generics is going well for AstraZeneca these days. A federal judge in New Jersey just granted the company summary judgment in a case where Teva and Sandoz (Novartis’s generics arm) were seeking to sell generic copies of AstraZeneca’s Seroquel. The ruling means the company isn’t likely to face generic competition for the antipsychotic until 2011, the WSJ reports. Seroquel’s global sales last year were about $4 billion — second for the company only to Nexium, a heartburn drug that had sales of more than $5 billion last year. And AstraZeneca’s outlook for Nexium got a lot brighter just a few months ago, when it cut a deal with Ranbaxy giving the generics shop the exclusive right to sell a copy of the drug — in 2014, six months before the AstraZeneca patent expires. Other companies are still fighting to bring generic Nexium to market, but Ranbaxy was seen as a key threat that could have brought a generic to market as soon as this year. AstraZeneca’s stock was up more than 5% today in London, and it was up about 3% in U.S. trading this morning. Photo via Wikimedia Commons (Source: WSJ.com: Health Blog)

Pfizer stops funding some classes for doctors

WSJ.com: Health Blog — Thu, 03 Jul 2008 10:33:17 +0100

Doctors and pharmaceutical companies have been getting beat up lately for their intimate ties (see here, here and here). Now Pfizer is backing off a bit from one of its connections to medical practice: funding for physicians’ continuing medical education, or CME, courses. The drug maker has decided to end payments for CME are provided by for-profit, third-party companies. It will continue funding courses offered by academic medical centers, teaching hospitals and medical societies. “The reason were not going to directly support them has to do with mitigating the perception of a conflict of interest, if a direct payment is going from a company like Pfizer to them,” Cathryn Clary, VP of US external medical affairs, told Dow Jones Newswires. Pfizer told DJ wires it spent $80 million funding CME courses last year; less than half went to for-profit companies. The drug industry as a whole spent over $1 billion in 2006 funding these courses, which doctors must attend in order to keep their medical licenses. As the WSJ reported a few years back, the companies’ funding of CME intensified after the industry agreed it should spend money educating physicians, rather than simply entertaining them. But there’s been (Source: WSJ.com: Health Blog)

Kennedy lays groundwork for expanding health coverage

WSJ.com: Health Blog — Thu, 03 Jul 2008 10:33:17 +0100

Even as Sen. Ted Kennedy continues treatment for brain cancer, he has instructed his staff to begin planning for a major health-care overhaul that could begin when a new president takes office next January — especially if that president is Barack Obama. The story is in this morning’s Boston Globe. Kennedy’s aides have started a series of meetings that include staffers from Obama’s Senate office, as well as aides to other Democratic and Republican senators. One recent meeting was with doctor’s groups; another was with health-care coalitions. The idea is to avoid some of the suqabbling that has sunk previous health-reform efforts and be able to move quickly when a new administration comes in. “The senator is trying to learn from health-reform attempts in the past and to build a fair amount of consensus,” Jay Himmelstein, a health-policy specialist at University of Massachusetts Medical School and a former Kennedy staff member who has been involved in the talks, told the Globe. Kennedy has long been a central player in national health-care policy, and he was key in getting federal money to help his home state implement its big push toward universal health insurance. Now his aides are tapping people involved with the Massachusetts health plan to try to figure out whether some of the state’s initiatives can work on the national level. At one recent meeting, they discussed whether the Massachusetts Health Connector, the quasi-public entity that helps uninsured people obtain coverage in the state, could be adopted nationwide, the Globe says. (Source: WSJ.com: Health Blog)