MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'informed,'. Wed, 21 Jul 2010 11:02:09 +0100 http://www.medworm.com/index.php?rid=3740559&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F07%2Fhospitals-star-crossed-financial.html And speaking of the costs of financial maneuvering by hospitals, the Wall Street Journal just reported on "Hospitals' Wall Street Wounds,"Hospitals nationwide are tangling with Wall Street to get out of disastrous wagers that have complicated their financial problems.Some hospitals are paying millions of dollars in penalties to get out of derivatives contracts, after betting incorrectly that interest rates would rise. Other hospitals are paying higher interest rates. At many, these ill-fated financial bets have contributed to layoffs and scuttled projects. More than 500 nonprofit hospitals—at least one in six—bought interest-rate "swaps" in a bid to lower their borrowing costs, estimates Municipal Market Advisors, a Concord, Mass., consulting firm. The swaps allowed hospitals to act mu... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3740559 Fri, 09 Jul 2010 20:48:00 +0100 3740559 http://www.medworm.com/index.php?rid=3746683&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F07%2Ffailure-of-success-healthcare-when.html In the last few years, it seems that the whole world got tangled up in a web of complex financial dealings that mostly benefited those moving the money and paper, but often harmed everyone else.  So it should be no surprise that health care was similarly affected.  A story from the St. Louis Post-Dispatch provided an illustrative case.  The news article began discussing the current difficulties of two local St Louis hospitals, then provided an explanation in what amounted to a series of flashbacks. Let me re sequence it a bit, starting with the background of two local hospitals that got caught up in web.BackgroundFor several decades, Forest Park Hospital — founded in 1889 as Deaconess Central Hospital — was one of the city’s leading community hospitals, serving a ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3746683 Thu, 08 Jul 2010 14:31:00 +0100 3746683 http://www.medworm.com/index.php?rid=3737008&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F07%2Ffailure-of-success-healthcare-when.html In the last few years, it seems that the whole world got tangled up in a web of complex financial dealings that mostly benefited those moving the money and paper, but often harmed everyone else.  So it should be no surprise that health care was similarly affected.  A story from the St. Louis Post-Dispatch provided an illustrative case.  The news article began discussing the current difficulties of two local St Louis hospitals, then provided an explanation in what amounted to a series of flashbacks. Let me re sequence it a bit, starting with the background of two local hospitals that got caught up in web.BackgroundFor several decades, Forest Park Hospital — founded in 1889 as Deaconess Central Hospital — was one of the city’s leading community hospitals, serving a ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3737008 Thu, 08 Jul 2010 14:31:00 +0100 3737008 http://www.medworm.com/index.php?rid=3724490&cid=t_358665_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Finformed-consent-how-technology-can.html Image by thinkpanama via FlickrThis is a guest post from Mr Parag Vora, CEO, Infoseek, in which I am an angel investor. Infoseek makes patient educational videos in India.Getting Informed consent from the patient remains a very tricky area in medical practice today . Failure to obtain valid consent is one the commonest reasons patients go to court when they are unhappy with their doctor.Unfortunately, no standardised guidelines have ever been published by the Medical Council of India, Indian Medical Association, or any other ‘reputed’ medical body. This is a huge lacuna, and the importance of taking consent has never been taught to most doctors properly, even though there has been a huge rise in medico-legal and malpractice claims in the past decade or so. All over India there is a lot... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3724490 Sun, 04 Jul 2010 15:10:00 +0100 3724490 http://www.medworm.com/index.php?rid=3652370&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F06%2Ffinding-out-about-health-care.html A persistent theme for Health Care Renewal has been how concentration and abuse of power in health care trap patients and heath care professionals in a maze of bureaucracy, perverse incentives, deception, and conflicts of interest.  To anyone who has to make the transition from person to patient, some of these problems become immediately obvious.  Consider, for example, this account of "going into a hospital for a minor procedure":The very idea of being a patient is anathema. To people of my generation -- the 'me' generation -- who like to be in control, the experience begins with loss of control. First the paperwork -- three or four times paperwork has to filled out and given to a succession of strangers. Then they take all of your belongings, they tell you to take your clothes ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3652370 Thu, 10 Jun 2010 21:04:00 +0100 3652370 http://www.medworm.com/index.php?rid=3632382&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2010%2F06%2Fdtc-genomics-adjusts-for-regulations.html In a blatantly obvious, why the hell werent they doing that in the first place? move.23andSerge acknolwedges, finally, that they ARE Providing clinically important work. Duh, Since the website won't let me copy the presser, I will quote, with my own translation through business BS speak."23andMe customers now have the option to speak with a board certified genetic counselor" -Translation, we realized that by testing BRCA mutations we put people at risk and needed some back up from someone who knows what the FCUK they are doing opposed to a VC billionaire babe and ruby on rails programmer kids.-Because, frankly, we don't want to get sued or go to jail......Like Liz Dragon...... "We chose Informed because they were the leading independent genetic counseling provider"-Translation, we alienate... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=3632382 Fri, 04 Jun 2010 22:26:00 +0100 3632382 http://www.medworm.com/index.php?rid=3595541&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F05%2Freading-between-lines-scrappy-wellpoint.html Giant US for-profit insurance company/ managed care organization WellPoint has provided numerous examples of problems with the current way health care organizations are lead.  Here we discussed charges that recent rate increases by its Anthem subsidiary may have violated previous agreements not to directly fund from premiums the golden parachutes of executives who left after the merger of Anthem and WellPoint; that WellPoint used magical accounting to make administrative costs appear to be from patient care; and that WellPoint investigated patients who developed cancer to find minor errors in their policy applications, and  used these as excuses for post-hoc cancellations (rescissions) of their policies.  And here we discussed a long list of WellPoin... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3595541 Mon, 17 May 2010 16:26:00 +0100 3595541 http://www.medworm.com/index.php?rid=3573643&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F05%2Freading-between-lines-scrappy-wellpoint.html Giant US for-profit insurance company/ managed care organization WellPoint has provided numerous examples of problems with the current way health care organizations are lead.  Here we discussed charges that recent rate increases by its Anthem subsidiary may have violated previous agreements not to directly fund from premiums the golden parachutes of executives who left after the merger of Anthem and WellPoint; that WellPoint used magical accounting to make administrative costs appear to be from patient care; and that WellPoint investigated patients who developed cancer to find minor errors in their policy applications, and  used these as excuses for post-hoc cancellations (rescissions) of their policies.  And here we discussed a long list of WellPoin... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3573643 Mon, 17 May 2010 16:26:00 +0100 3573643 http://www.medworm.com/index.php?rid=3549275&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F05%2Fwhy-pretend-advertising-executive-and.html Obesity as a public health problem has been the subject of considerable discussion.  So that luminaries from the prestigious Partners Healthcare system and Massachusetts Blue Cross Blue Shield would weigh in on the issue at a public meeting should surprise no one.  But see this report by the Boston Herald:When asked about rising health-care costs, Jack Connors - chairman of the Partners chain, which includes Mass. General and Brigham and Women’s hospitals - said yesterday, 'Taking care of yourself starts at home.''What happened to individual responsibility?' Connors said at a Greater Boston Chamber of Commerce breakfast at the Westin Boston Waterfront. 'Why is obesity such an epidemic (when) we all know that a big part of being healthy is exercising and eating the right fo... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3549275 Mon, 10 May 2010 16:07:00 +0100 3549275 http://www.medworm.com/index.php?rid=3542553&cid=t_358665_87_f&fid=35052&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FWomensBioethicsBlog%2F%7E3%2FgyvOUPaQPBI%2Fbioethical-perspective-on-oklahomas-new.html The percentage of college educated Americans who support legal abortion seems to have reached a new low among women under thirty and among the population as a whole,  so it should be no surprise that states are passing laws to restrict safe abortions. Before performing any abortion Oklahoma’s new 2010 law requires that the doctor do an ultrasound and describe to the woman the dimensions and gestational age of the embryo, cardiac activity if any, and appearance of external and internal structures.  A vaginal transducer must be used when doing so will display the embryo more clearly than an abdominal transducer.  Oklahoma’s law thus requires doctors to perform an ultrasound that is not medically indicated and likely to be invasive. In this era of skyrocketing medical costs... Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=3542553 Thu, 06 May 2010 16:26:43 +0100 3542553 http://www.medworm.com/index.php?rid=3460207&cid=t_358665_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2010%2F04%2Fmy-three-shrinks-podcast-51-vegan.html For this podcast I brought some homemade vegan gingerbread cookies that I baked using a recipe from the Steph Davis blog. I'm also looking for a good sugar cookie recipe that doesn't use refined sugar or all-purpose flour. If you've got one, send it along.We discuss my post Is it malpractice to lie? which involves a surgeon sued for malpractice for allegedly lying to a patient regarding his professional background. We wonder how much, if any, information physicians may some day be obliged to disclose to their patients prior to treatment. There is a new type of research being done, called "in silica" research, in which people write computer programs to model behavior. We talked about computer models of suicide and how this can replicate suicide epidemics in real life. Roy is inspired to tal... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=3460207 Mon, 12 Apr 2010 09:00:00 +0100 3460207 http://www.medworm.com/index.php?rid=3436245&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F04%2Fconcern-about-medical-records-is-not.html A Wall Street Journal letter to the editor I authored entitled "Concern About Medical Records Is Not Misplaced" was published today, April 3, 2010.On Mar. 23, 2010 the WSJ had carried an Op-Ed entitled "Your Medical Records Aren't Secure" by patient privacy rights advocate Deborah Peel, MD, a psychiatrist and founder-leader of the organization Patient Privacy Rights. Dr. Peel's Op Ed can be read here.My letter to the editor is in response to criticism of Dr. Peel's concerns. The criticism occured in a WSJ letter "Industry Rep Calls Patient Privacy 'Overblown' Worry" on Mar. 30, 2010 by Mary R. Grealy, president of the Healthcare Leadership Council, a "coalition" of chief executives from major healthcare companies and organizations. Ms. Grealy's letter can be read here.In her letter, Ms. ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3436245 Sat, 03 Apr 2010 16:04:00 +0100 3436245 http://www.medworm.com/index.php?rid=3415986&cid=t_358665_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F03%2F29%2Fjournal-of-medical-ethics-2009-vol-36-no-1%2F content page Fade Fave: Rights, respect for dignity and end-of-life care: time for a change in the concept of informed consent Fade Skinny: The current concepts of autonomy, surrogate autonomy and informed consent often lead to futile and expensive care at the ends of life. They may impinge on the dignity of the patient as well as subject society to unwarranted expense. In order to provide affordable healthcare for all, these concepts are in need of modification (NHS Athens is required to access this article online) Filed under: Athens Password, Current Awareness, E-Journals, Journals Tagged: Athens Password, Current Awareness, E-Journals, End of Life Care, Informed Consent (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3415986 Mon, 29 Mar 2010 11:20:25 +0100 3415986 http://www.medworm.com/index.php?rid=3374174&cid=t_358665_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2010%2F03%2Fis-it-malpractice-to-lie.html I came across this interesting malpractice case via the HealthLaw Twitter feed which I've been following for a while now. The case is Willis v Bender, a 10th Circuit Court of Appeals case out of Wisconsin.In this case a surgeon was sued by his patient following complications from a laparoscopic cholecystectomy (gall bladder removal). Before the procedure he explained the risks of the surgery to her, and she also asked him questions about his experience and success rate with the procedure. She asked additional questions about whether he had ever been sued for malpractice or had any action taken against his medical license. He answered no to both questions and added that he had an almost perfect success rate with the surgery. Well, bad things happened. The patient suffered a perforated intes... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=3374174 Wed, 17 Mar 2010 13:00:00 +0100 3374174 http://www.medworm.com/index.php?rid=3258953&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F02%2Fgreen-ketchup-for-novartis.html We recently commented on the challenges facing the large, Swiss based multinational pharmaceutical company Novartis.  From Business Week came an interview with the new CEO of Novartis, in which he revealed why he thinks he is especially qualified for the job:Joe Jimenez says that more than 20 years selling Clorox (CLX) bleach and Heinz ketchup taught him to make decisions quickly. Now, as CEO of Novartis (NVS), Europe's second-largest drugmaker, he'll try to prove that speed can also make a difference in the pharmaceutical business. Jimenez, an American with degrees from Stanford and the University of California at Berkeley, believes his consumer-products background will help. He started his career at Clorox, the world's largest maker of bleach, ran two divisions of ConAgra Foods (CAG... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3258953 Tue, 09 Feb 2010 22:42:00 +0100 3258953 http://www.medworm.com/index.php?rid=3216842&cid=t_358665_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F3RHWBeMHIwE%2F Will the third time be the charm? Once again, the New Jersey legislature is being urged to pass a bill requiring a doctor or nurse to obtain informed consent from a minor’s parent before writing a prescription for any psychotropic that already carries a Black Box warning. The issue first emerged in the wake of the controversy over links between antidepressants and suicidal behavior in teens. As with two previous efforts, the initiative is being pushed by several parents who believe that FDA-mandated Med Guides for antidepressants are insufficient. Their earlier attempts were thwarted by a state senator who repeatedly blocked introduction (see here and here), but the Senate health committee now has a new chair. The bill was recently introduced in the assembly and Senate support is bei... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3216842 Thu, 28 Jan 2010 12:57:20 +0100 3216842 http://www.medworm.com/index.php?rid=3212283&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F01%2Fdrowning-our-sorrows-in-ketchup.html Here's the latest corporate health care marcher in the legal settlement parade, as reported in the Wall Street Journal.Swiss drug giant Novartis AG said its U.S. subsidiary struck a plea agreement with U.S. investigators to resolve criminal allegations regarding the company's promotion of the epilepsy drug Trileptal, and agreed to pay a $185 million fine.Federal investigators have been carrying out civil and criminal investigations of Novartis' marketing of the drug, including allegations that it promoted the drug for uses for which it is not approved by the Food and Drug Administration, an illegal practice known as 'off-label' marketing, Novartis said in a statement Tuesday as it announced fourth-quarter results. To resolve criminal allegations, Novartis said it agreed to plead guilty to ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3212283 Tue, 26 Jan 2010 22:16:00 +0100 3212283 http://www.medworm.com/index.php?rid=3126633&cid=t_358665_105_f&fid=36987&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FIvorKovicMd%2F%7E3%2FMcez8peU6jI%2F I discovered Informed Pocket Guides almost two years ago and have been a huge fan ever since. The first product I got was the Emergency & Critical Care Pocket Guide. I believe the fact that I take extra care this little/big guide is always in my bag when I go to work, says it all. It is small, light and compact, yet it has all the necessary reference information you might need in medical emergencies. It is especially useful if you work in the field. Emergency & Critical Care Pocket Guide has almost 200 pages and covers the following topics: Current ACLS Algorithms, Lab Values, Metrics, Notes Emergency, ACLS Drugs & Top Prescription Drugs IV Drips, Drug Infusions, Dosages Poisons & Overdose / ‘Rave’ Drug 12-Lead ECG Section & Acute MI Medical Emergenci... Ivor Kovic, M.D. blogs http://www.medworm.com/rss/comments.php?id=3126633 Tue, 29 Dec 2009 02:01:37 +0100 3126633 http://www.medworm.com/index.php?rid=3126568&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F12%2Fon-automobile-and-health-care-companies.html The New Republic published "Upper Mismanagement" about what happens when businesses are run by people who do not understand their companies' businesses.  Although the article was focused on the decline of manufacturing in the US, its applicability to health care is obvious:Harvard business professor Rakesh Khurana, with whom I discussed these questions at length, observes that most of GM’s top executives in recent decades hailed from a finance rather than an operations background. (Outgoing GM CEO Fritz Henderson and his failed predecessor, Rick Wagoner, both worked their way up from the company’s vaunted Treasurer’s office.) But these executives were frequently numb to the sorts of innovations that enable high-quality production at low cost. As Khurana quips, “That�... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3126568 Mon, 28 Dec 2009 22:54:00 +0100 3126568 http://www.medworm.com/index.php?rid=3118839&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F12%2Fonc-defines-taxonomy-of-health-it.html As in my post "More On Healthcare Management By Domain Neutral Generalists", Roy Poses' post "Health Care Leaders: Don't Know Much About Health Care" and many others on the topic of ill informed healthcare management (query link) at Healthcare Renewal, a common theme is lack of appropriate education and background in many of today's healthcare leaders.ONC, the Office of the National Coordinator of health IT at HHS, has apparently now defined a taxonomy of health IT leadership in their funding opportunity announcements (FOA's).Note the formal educational recommendations I've highlighted. Seems they’ve heard the message about the importance of cross-disciplinary -- and formal -- education for health IT leaders and even lower level workers: From the Founding Opportunity Announcement "Progr... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3118839 Thu, 24 Dec 2009 14:43:00 +0100 3118839 http://www.medworm.com/index.php?rid=3100748&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F12%2Fwith-leaders-like-these.html My current favorite book about the global financial meltdown, aka great recession, The Sellout, by Charles Gasparino, featured vivid portraits of the bad leadership that lead to the collapse.  For example:Richard S Fuld, Jr, former CEO of Lehman Brothers (now bankrupt) - Fuld had become more isolated and arrogant. (p.208)As the firm's leverage increased, Fuld's grip on his management and board grew. He was revered by so many people in his circle of senior advisers that almost no one dared to speak out about the firm's risk and leverate, and almost never to Fuld himself. Everyone else was so scared to be cursed at in public or even fired that they simply kept their mouths shut.Fuld's leadership was more like that of a cult leader than even that of an imperial CEO. (p. 20... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3100748 Thu, 17 Dec 2009 22:04:00 +0100 3100748 http://www.medworm.com/index.php?rid=3100749&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F12%2Fteaching-would-be-health-care-leaders.html The Wall Street Journal just published a story on a big innovation in the business school curriculum:David Song was in the middle of a two-year executive M.B.A. program at University of Chicago's Booth School of Business in February when he got the idea to create a course to help business people better understand the inner workings of medicine.Dr. Song, chief of plastic surgery at the University of Chicago Medical Center, believes the course may help close the gap between such industries as pharmaceutical and biotech, and the medical community they serve.'Why not help reveal how things run and how we make decisions, particularly in this time of immense overhaul to the system?' says Dr. Song, who began collaborating with one of his marketing professors, Sanjay Dhar, to put together the cour... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3100749 Thu, 17 Dec 2009 20:57:00 +0100 3100749 http://www.medworm.com/index.php?rid=2916162&cid=t_358665_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2009%2F10%2Fgoogling-and-oogling.html We've been talking about Psychiatrists and Facebook here on Shrink Rap and it got me thinking about psychiatry and technology. I always think of the internet as kind of public turf. Can it be "wrong" to Google someone? It's not illegal, it's not hard, and the stuff is all in the public domain. People will sometimes mention they've Googled me to find my phone number. I don't often Google patients, but once in a while. Someone once told me about their brother's murder in an international scandal and it sounded a bit weird, so I Googled (--the brother had been murdered and there was some mention of the international issue). But is "wrong?" I'm perplexed.In a Psychiatric News story from July, Jun Yan writes in Psychiatrist Must Beware the Perils of Cyberspace: Recently, APA's Ethics Committee ... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=2916162 Wed, 21 Oct 2009 21:01:00 +0100 2916162 http://www.medworm.com/index.php?rid=2883054&cid=t_358665_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2009%2F10%2Fyou-may-go-now.html I've learned something important from....reading the comments posted to our blog, listening to people talk, being a person who talks....No one likes to feel their concerns are being dismissed (myself included).It's a recurrent theme in the comments that are sent to us, especially with regard to medications: a reader has a concern about a medication, feels it isn't working or that the side effects are too severe, and either their doctor does not address their concerns in a way that feels validating or the reader perceives that the doctor does not understand....since I'm not there, I can't say which is happening, but the feeling on the part of our readers is clear.And just so you know, I've been on both ends of the discussion. I once lowered the dose of a medication, found it to be just as e... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=2883054 Mon, 12 Oct 2009 02:05:00 +0100 2883054 http://www.medworm.com/index.php?rid=2862445&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F10%2Ftrustee-of-what-caliber-for-hospital.html The Hospital for Special Surgery in New York, a prestigious institution focused on orthopedics and rheumatology, closely affiliated with Weill Cornell Medical College, just announced its newest trustee, whose qualifications for the position turn out to be just a wee bit curious. Here they are as described by the press release:He is a former CEO of WachoviaHospital for Special Surgery announced today that Robert K. Steel, former President and Chief Executive Officer of Wachovia Corporation, has been named a member of the hospital's Board of Trustees.Steel facilitated Wachovia's merger with Wells Fargo to create the second-largest retail brokerage in the country.Before then, he served in the Treasury DepartmentPrior to running Wachovia, Steel served in the U.S. Treasury Department as Under S... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2862445 Mon, 05 Oct 2009 17:00:00 +0100 2862445 http://www.medworm.com/index.php?rid=2836162&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F09%2Foutstanding-job-of-educating-themselves.html At numerous posts at Healthcare Renewal, we have pointed out what we feel to be a serious gap in the credentials of many in biomedical leadership roles.The gaps are in the form of a near complete lack of any scientific or biomedical education and experience, except perhaps a high school chemistry and biology class or two.We often receive comments back, usually from "anonymous" posters such as here to our opinions that this expertise gap impairs the judgment of such leaders on medical matters:... No. I've met individuals with management training who do an outstanding job of educating themselves about clinical issues. And I've met individuals with clinical training who do an outstanding job of educating themselves about management and business issues.I feel this "anyone can be an expert" sen... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2836162 Sun, 27 Sep 2009 15:57:00 +0100 2836162 http://www.medworm.com/index.php?rid=2788493&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F09%2Fmore-on-healthcare-management-by-domain.html Both Roy Poses and I have written on a plague of healthcare mismanagement and perhaps malfeasance in part due to leadership by domain amateurs, i.e., healthcare leadership profoundly lacking in biomedical education and experience.Examples of recent posts about the risks posed by domain neutral biomedical leadership are:"NY Times Proclaims Anyone Can Run a Health Care Organization with a Little Studying Up" (Poses)"Health Care Leaders: Don't Know Much About Health Care" (Poses)"On Optimal Expertise for Leadership in Biomedicine" (me)"Informatics, or Infomagic? Health IT Cannot Flourish When Everybody is an Expert" (me)and "Pfizer/Wyeth Merger And Sacrificing The Future: Laying Off Scientific Staff All Over The Place" (me).I have also written of a cross-occupational invasion of healthcare by... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2788493 Fri, 11 Sep 2009 23:38:00 +0100 2788493 http://www.medworm.com/index.php?rid=2752047&cid=t_358665_125_f&fid=34820&url=http%3A%2F%2Fwww.dentalblogs.com%2Farchives%2Fadministrator%2Finformed-consent-greater-risk-for-practitioners%2F In two recent cases, in Maryland and Wisconsin, proof of medical negligence was not required for the plaintiffs to bring an informed-consent claim. So what does that mean to the average dental practitioner? A lot! We are responsible for providing the appropriate technical information by which our patients make choices, i.e. a root canal or extraction, medicate first or extract the hopeless infected tooth or even an implant or a three unit bridge? These two decisions basically stated that our informing the patient of “appropriate” technical information is not enough and that all alternate, viable medical modes of treatment, including diagnosis, as well as the benefits and risks of such treatments, must be explained. A simple example of this is: do we use lidocaine, mepivacaine or artica... dental blog for dentists about dentistry blogs http://www.medworm.com/rss/comments.php?id=2752047 Mon, 31 Aug 2009 14:27:02 +0100 2752047 http://www.medworm.com/index.php?rid=2741374&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Fon-optimal-expertise-for-leadership-in.html There has recently been debate on these pages regarding optimal expertise for biomedical leadership, precipitated by Roy Poses' posts "Health Care Leaders: Don't Know Much About Health Care" and "NY Times Proclaims Anyone Can Run a Health Care Organization with a Little Studying Up".I am resurfacing a post I wrote in Jan. 2009 entitled "Pfizer/Wyeth Merger And Sacrificing The Future: Laying Off Scientific Staff All Over The Place" that I believe succinctly states the problems with 'management by amateur.'Read the entire post, but here are the highlights:... Those in charge [and who lack domain credentials -ed.] cannot see that which the domain specialist sees.They cannot see because they lack the training, experience, and what is described as 'meta-competence' (in this brilliant article on... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2741374 Fri, 28 Aug 2009 13:28:00 +0100 2741374 http://www.medworm.com/index.php?rid=2737727&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Fhealth-care-leaders-dont-know-much.html Our recent post about health care organizations recruiting executives with no experience in or knowledge about giving health care or biomedical science has attracted some attention. Some people suggested that letting some people from the "outside" into health care leadership might lead to fresh thinking and new ideas. My concern was not about that. However, I do believe that to be succesful, the leadership of health care organizations ought to collectively be knowledgeable about health care, and understand its context, culture, science base, and values. My concern was not about a few "fresh thinkers," but that the preponderance of health care leaders today know little about what it's like to actually take care of patients, have little understanding of biomedical science and health care res... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2737727 Wed, 26 Aug 2009 17:06:00 +0100 2737727 http://www.medworm.com/index.php?rid=2730067&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Fny-times-proclaims-anyone-can-run.html Last week, the NY Times published a somewhat breathless article on the wonderful opportunities available in health care management. Health care management seems to be the one area that is growing during the "great recession."Health care may be a costly drag on the economy, but it’s still a great place to find a job.Midcareer managers and other workers have been migrating to health care jobs for years, of course. Now, with the recession, the lure is even stronger. The article suggested managing health care organizations does not require knowing much about health care.'The demand for talented leaders in health care is only going to go up,' predicted Jane Groves, a senior vice president at Integrated Healthcare Strategies, an executive search and consulting firm in Kansas City, Mo. 'All tha... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2730067 Mon, 24 Aug 2009 19:41:00 +0100 2730067 http://www.medworm.com/index.php?rid=2727338&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2009%2F08%2Fphg-foundation-and-my-point.html A long time ago I had a post entitled "Beware Doctors Bearing Genetic Tests" back in April of 2007. It was an interesting post where I point out that this wonderful GI doctor who was IVY league trained completely hashed genetic testing for HNPCC.I went on to explain the shortcomings with Internists in interpreting APC testing for familial adenomatoid polyposis coli. 1 in 3 misinterpret tests.....Wait till you see the DTC interpretation!Everyone who gets all in a huff when I say that these DTC genetic tests should be regulated. But I am here to say there is a good reason for it, and it has nothing to do with the people getting the tests.......There is now threat of public harm.....But first let me explain my frustration. Saturday I was on Twitter and Daniel MacArthur and I had a conversatio... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=2727338 Mon, 24 Aug 2009 11:49:00 +0100 2727338 http://www.medworm.com/index.php?rid=2719693&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Fwhy-siemens-healthcare-fails.html I have written numerous times on this blog about the blind-man ignorance displayed by many healthcare IT and biomedical companies regarding Medical Informatics expertise.As a graduate level Medical Informatics educator with considerable applied expertise, as well as talent management experience, I teach students of a variety of healthcare backgrounds that the only way to overcome the sociotechnical complexities (i.e., issues at the intersection of people and their interaction with technology) of HIT is via education and considerable experience.Once students become aware of the nuances and complexities of HIT in real-world clinical settings (if not already enmeshed in such environments), they find the lessons learned from substantial and rigorous immersion into a wide corpus of literature, ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2719693 Thu, 20 Aug 2009 23:46:00 +0100 2719693 http://www.medworm.com/index.php?rid=2517362&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2009%2F06%2F23andmx-looking-to-cook-books-in-ca.html Daniel MacArthur and I have been noticing something and he decided to cover it today, which is why I have decided to provide a counterpoint here....Also GenomeWeb published on this. SB 482 is a bill I glossed over in a post in the past and was recently interviewed for in the San Jose Mercury News....... Daniel leads this as 23andMx leading the regulatory push.....but this is more insidious than that. This is 23andMx trying to cook the books and create laws which exempt them from the stringent regulation which they should receive...... I told this to the newsies over at San Jose on Sunday, so I am going to post this today...... It turns out that this bill SB 482 essentially exempts DTC companies from facing the harshest regulations that medical providers/labs have to face From Daniel"In oth... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=2517362 Thu, 25 Jun 2009 15:56:00 +0100 2517362 http://www.medworm.com/index.php?rid=2510430&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F06%2Foriginal-excuse.html The Associated Press just published a story about another company which apparently failed to report adverse events associated with its product:Complaints about a contact lens solution linked to a 2007 outbreak of eye infections that blinded several people went unreported by the manufacturer for more than a year, government documents show.The documents show Advanced Medical Optics received complaints about the solution more than a year before it was recalled, and failed to promptly report nine complaints as required by law.The company pulled its Complete MoisturePlus off the market in May 2007 after the Centers for Disease Control and Prevention linked the fluid to dozens of cases of a serious infection called Acanthamoeba keratitis.Lawyers for customers suing AMO obtained the documents, wh... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2510430 Mon, 22 Jun 2009 21:26:00 +0100 2510430 http://www.medworm.com/index.php?rid=2510434&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F06%2Fsynthes-indicted.html Last month, we posted about a legal settlement in which device manufacturer Synthes agreed to stop creating conflicts of interests by paying physicians who performed its trials with company stock. Synthes is back in the news, and not in favorable terms. As reported by the Philadelphia Inquirer,A Swiss company with major operations in West Chester illegally tested its bone cement on about 200 people, three of whom died, according to a 52-count indictment issued yesterday by the U.S. attorney in Philadelphia.Synthes Inc., a producer of orthopedic products that employs about 1,400 in Chester County, did not tell any of the patients that they were participating in experimental surgeries, the indictment said.Federal prosecutors also accused Synthes executives of lying to the U.S. Food and Drug ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2510434 Fri, 19 Jun 2009 19:45:00 +0100 2510434 http://www.medworm.com/index.php?rid=2452969&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2009%2F06%2Fgappnet-hacked-records-and-icob.html Happy Donut Day Everyone!"Wha?"That's what I said as I walked into my Dunkin Donuts across the street from our new HQ. The guy saw me coming in, prepped my coffee, Large Blueberry, Milk and Sugar......As I went to pay, he said, "Happy Donut Day" I barely understood what he said when the manager said "Pick your donut, FREE"OMG, as if I wasn't fat enough. How many other of my readers took the free Donut today. I looked around in my DD and it seemed everyone took the donut.People certainly are game for free......... Speaking of FREE, the Coriell Personalized Medicine Collaborative is in essence a Navi/23andM- scan for FREE. I just got some more results this week. I don't have Hemochromatosis HFE type, Hooray! This can be yours as well.....That is if you are willing to participate in the study... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=2452969 Fri, 05 Jun 2009 12:44:00 +0100 2452969 http://www.medworm.com/index.php?rid=2349210&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2009%2F04%2Fdeath-knell-to-cancer-genetic.html ACOG has finally come around. They are now beginning to realize that it IS the responsibility of the OB/GYN to evaluate cancer risks. In this case BRCA1/2. Soon I imagine they will learn to appreciate the risk of Lynch Syndrome with their Endometrial cases.All of this could spell trouble for the cancer genetic counselors in this country. OR it could mean a bunch of referrals. It all depends........ACOG practice bulletin 103 recently published says "Women may wish to discuss their personal and family history of breast and ovarian cancer with their physician in order to determine whether any further genetic assessment is warranted."Well, with Myriad in your office saying, "Doc, you can do this test. And SHOULD do this test" It is going to be hard not too. Especially with ACOG now saying that... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=2349210 Tue, 14 Apr 2009 12:07:00 +0100 2349210 http://www.medworm.com/index.php?rid=2323361&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2009%2F04%2Ffamily-history-beats-fancy-genetic-test.html I was talking to the president elect of the ACMG the other day about something that could be pretty useful. I told him that even though we disagree about the role of DTC, I laud his efforts towards education.Our teaching point should be plain and simple. The family history is the best addition to the geneticist's history and physical. It separates them from other specialities. It is a help towards clinical judgement and use of testing. This is precisely the thing that will keep geneticists from being replaced by eager self-testers and Online "web apps" to teach patients about their 6 billion base pair report.In genetics we all know of benign variants in genes and hell, even chromosomes. Changes which in the grand scheme of things may never make a difference......that's because clinical alw... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=2323361 Mon, 06 Apr 2009 11:35:00 +0100 2323361 http://www.medworm.com/index.php?rid=2323370&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2009%2F03%2Fanother-bs-pr-move-congrats-public.html Ok,To Quote Diane Sawyer "Is there any way that they could just report the diseases you can prevent?"That was on Good Morning America today. I swear 23andME's PR firm has a plant in ABC.So let me explain the clinical scenario. A woman walks into the OB's office carrying 30 pages of information on 90 different diseases. The super swamped OB has 15 minutes for the patient. In that time they need to go over sexual history, health history, anticipatory guidance regarding possible pregnancy, maybe perform a pap smear.....and suddenly, the OB gets ambushed with a 30 page hand out......The Patient "Umm I was wondering, if I have a 1.37 Odds Ratio of having a heart attack, could I prevent my baby from having this?"That is the story with 23andMe's new push for samples to sell to third parties......... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=2323370 Tue, 31 Mar 2009 14:01:00 +0100 2323370 http://www.medworm.com/index.php?rid=2306978&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F03%2Fretirement-of-generic-manager.html A frequent theme on Health Care Renewal has been the adverse effects of health care leadership by generic managers with no background or experience in health care, and no intuitive understanding of its values. This type of leadership arose after some health care economists called for abolishing the supposed physicians' "guild," and transferring power over health care to managers as a way to control health care costs. This has not lead to control of health care costs.The recent coverage by the New York Times of the sudden retirement of the CEO of General Motors suggests that the notion that organizations should be run by generic managers is one whose time ought to be past. Wagoner presided over a dramatic decline in the fortunes of GM.Mr. Wagoner presided over some of the biggest losses in ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2306978 Mon, 30 Mar 2009 20:09:00 +0100 2306978 http://www.medworm.com/index.php?rid=2233847&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2009%2F03%2Fover-200-studies-what-is-bs-what-is.html With the advance of genome wide associations we need to collate them and evaluate them. A research physician associate of mine told me that on average 9 out of 10 association studies will eventually be proven incorrect. His research, not mine.That is a pretty huge number. But it is with that mindset in which I review GWAS. What do I look for? How do I evaluate them? There have been some good articles recently in JAMA which illustrate some of the key concepts.In genetic studies, one potential cause of spurious associations is differences between cases and controls in ethnicity, a situation termed population stratification. Was measurement of the genetic variants unbiased and accurate? Methods for determining DNA sequence variation are not perfect and may have some measurement error. Do the ... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=2233847 Tue, 03 Mar 2009 13:42:00 +0100 2233847 http://www.medworm.com/index.php?rid=2206715&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F02%2Finformatics-or-infomagic-health-it.html I recently saw a hospital ad for a surgeon in my local newspaper:Professor of SurgeryMust have 5 year post fellowship exp as Thoracic Surgeon, fellowship in advanced minimally invasive surgery of lung & esophagus, & fellowship/post-fellowship exp in thoracic oncology, radio frequency ablation, & airway, esophageal & endoluminal techniques. Board Eligible/Board Certified in General & Thoracic Surgery. Fax resume to James Diehl, MD, Director, Thomas Jefferson University, 215-955-6010.There is nothing at all unusual about this ad. It calls for someone who has completed premed (4 years), medical school (4 years), internship and residency training (4 years), one or two postdoctoral fellowships (~2 years each) in highly complex subspecialties, and at least five years of exper... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2206715 Sun, 22 Feb 2009 18:22:00 +0100 2206715 http://www.medworm.com/index.php?rid=2182522&cid=t_358665_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2009%2F02%2Fsilent-psychiatrist.html This morning, I woke up and got ready for work. Time to go and I called to the kid to come. Only nothing came out. Nothing. I felt fine, but I'd lost my voice. Completely, barely a whisper emerged.It was just before 8. Kid announced she felt sick and went back to bed. I fetched the carpool kids (--the issues of what to do about carpoolers when one's own child is sick could be its own entire blog). My first patient was for 9:00 and it seemed like too short notice to cancel. I did croak out cancellation calls to the next couple of patients with the thought that they might have a hard time conducting the session without my input; some people don't come in and just talk spontaneously, they look to me for direction, a little more than I sometime wish and a lot more than my voice could tolerate ... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=2182522 Fri, 13 Feb 2009 02:05:00 +0100 2182522 http://www.medworm.com/index.php?rid=2167992&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2009%2F02%2Frecessionary-discretionhotcoupons4u.html Yes, I am a big fan of the race to the bottom. At least in the case of SNP scanning. We have seen Navigenics drop their price, deCode drops off the earth and 23andMe???? Well, in a discretionary move they show use the true value of SNP scans.....I give you HotCoupons4U.....The 23andMe special, pay close attention...From the website.....Featured Savings & Discount DealsWin $5000 A Week For Life (Expires 2/26/2009)Win $25,000 Room A Day (Expires 3/6/2009)Dicks Sporting Goods Coupon: $10 OFF (Expires 4/30/2009)Win a Smart Fortwo Car or $14,000 Cash (Expires 10/31/2009)Get Free Nutrish Dog Food Sample (On Going)Honey Baked Big or Small Ham Feast (On Going)$3 Off Disney DVD in The Store (On Going)ToysRUs Free Shipping on Select Toys (On Going)Victoria's Secret December $10 off Any Purchase ... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=2167992 Fri, 06 Feb 2009 12:22:00 +0100 2167992 http://www.medworm.com/index.php?rid=2107718&cid=t_358665_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2009%2F01%2Fhuman-experiment.html There are things to do about symptomatic distress in addition to medications and therapy. I often encourage people to make themselves their own human experiments. There are a few things we can change easily: we alter our diets, sleep, exercise, and the assorted "substances" we ingest. I sometimes suggest to people that they do 2 week trials and see if something helps. Is your life better if you stop drinking for a couple of weeks, exercise mor or less, give up food additives, decrease the carbs in your diet, cut out or add caffeine? Pick a variable, change it for a time, and see if you feel better.That being said, I've been having some trouble sleeping. I decided I'd take my own advice and change some things. Oh, but you know, I'm an inpatient sort of soul, and I decided to change a few th... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=2107718 Fri, 16 Jan 2009 01:13:00 +0100 2107718 http://www.medworm.com/index.php?rid=2086900&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Fin-joint-commission-sentinel-events.html In "Joint Commission Sentinel Event Alert On Healthcare IT" I applauded the Joint Commission (the organization that accredits U.S. healthcare organizations such as hospitals) for releasing a Sentinel Event Alert in December 2008 on the risks of improperly implemented health IT. At "A 21st Century Plague? The Syndrome of Inappropriate Over-Confidence in Computing" I pointed out that prior to this Alert, those who have written on the issue of HIT risk when improperly designed and implemented have taken reputational hits as alarmists.Finally, at "The Health IT Clueless, Or, Mr. Obama Gets Wrong Cautions on HIT" I wrote that resistance to, or lack of acknowledgement of the findings in this Alert were leading to bad advice on Health IT challenges to the incoming administration. The administrati... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2086900 Wed, 07 Jan 2009 16:01:00 +0100 2086900 http://www.medworm.com/index.php?rid=2086901&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Fis-medtronic-ceo-abrogating.html It would appear so. If this is the case, this CEO and his board of directors should be dismissed as a danger to the public. The CEO, William A. Hawkins III, being a biomedical engineer, would take special blame for this distorted attitude.In "Pre-emption' Cited as Major Case Is Tossed", Wall Street Journal, Jan. 7, 2009 we learn that a federal judge, U.S. District Judge Richard H. Kyle in Minneapolis, threw out lawsuits on behalf of thousands of patients with heart-defibrillator wires that have been shown to fracture and fail to function or dispatch potentially lethal shocks, concluding that a recent Supreme Court opinion made the dismissals inevitable.Judge Kyle did allow that "the Court recognizes that at least some plaintiffs have suffered injuries from using Sprint Fidelis leads, and t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2086901 Wed, 07 Jan 2009 14:44:00 +0100 2086901 http://www.medworm.com/index.php?rid=2074422&cid=t_358665_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2008%2F12%2Foddity-of-physicians-insistence-that.html By the fourth sentence of the preface to The Silent World of Doctor and Patient, Jay Katz has quietly issued a startling challenge to a fundamental principle of the doctor-patient relationship. He writes: It took time before I appreciated fully the oddity of physicians’ insistence that patients follow doctors’ orders. During my socialization as a physician I had been taught to accept the idea of doctors’ Aesculapian authority over patients. When I began to doubt this authority, that was the moment when the book began to take shape in my mind. “The oddity of physicians’ insistence that patients follow doctors’ orders” – the phrase brings you to an abrupt halt. Jay Katz, who wrote those words in his landmark book published nearly a quarter of a century ago, died in late Novem... Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=2074422 Mon, 29 Dec 2008 04:43:00 +0100 2074422 http://www.medworm.com/index.php?rid=1974998&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F11%2Flook-whos-in-operating-room.html At an article today entitled "Medtronic Says Device for Spine Faces Probe" (Wall St. Journal, Nov. 19, 2008, subscription required) the WSJ reports another major medical device manufacturer, Medtronic, faces a probe for promoting unapproved uses of its technologies, which is improper:Doctors can deploy FDA-approved drugs and products any way they see fit, but companies aren't permitted to promote off-label applications or to pay doctors inducements to do so."While the law establishes that doctors can prescribe any approved treatment, but off-label promotion by manufacturers is not allowed, there's growing concern that the line is being crossed, and a Justice Department review is the right kind of response to those questions," said Sen. Charles Grassley (R., Iowa) who has been looking into ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1974998 Thu, 20 Nov 2008 00:19:00 +0100 1974998 http://www.medworm.com/index.php?rid=1951815&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F11%2Fwhat-is-not-taught-about-leadership-in.html One of our scouts forwarded me a link to the curriculum from an MBA program from the distinguished Yale School of Management designed especially for would-be health care leaders. The program is entitled "MBA for Executives: Leadership in Healthcare."Here are the required courses, in alphabetical order:- Competitive Strategies- Corporate Finance of Biotechnology- Economic Analysis- Enhancing Negotiation Skills- Entrepreneurial Business Planning- Field Studies in Healthcare Management- Financial Accounting- Financial Management- Financial Reporting- Healthcare Policy, Finance & Economics- Hypothesis Testing and Regression- Independent Study- Integrated Leadership Perspective- Law & Management- Leadership- Managerial Controls- Marketing Management- Operations Management- Policy Modeli... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1951815 Tue, 11 Nov 2008 20:15:00 +0100 1951815 http://www.medworm.com/index.php?rid=1943401&cid=t_358665_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2FQo5i_lhxjCc%2F   Now that accessing your genetic information is cheaper than buying a Google Smartphone, now what? What can you get from it? How can you use it? Just as important, but less asked - how do you protect it? The journal "Nature" joins the debate with a full online issue devoted to the personal genome revolution and its implications. For a fee or for free, you can squeeze more information out of the SNP data or full sequence you got from the commercial genome services you paid for initially. For example, you can get an idea of your risk for a certain disease. With so much information at your fingertips, is everything believable? Should you change your lifestyle because you have one variant for some disease risk? How many "risky" variants does one need anyway? Should y... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=1943401 Fri, 07 Nov 2008 13:44:23 +0100 1943401 http://www.medworm.com/index.php?rid=1921188&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F10%2Fin-new-england-journal-again-crp.html Trick or Treat..... That's Russ Altman, Disguised as a Wolf-Man!!!First the Treat!Ok, so I hate to say it, but I am firmly convinced that the New England Journal of Medicine has been taken over by geneticists!!! I jump for glee as I open a new edition and see genetics plastered all over it.....just like the week before......and the week before that! It is true....medicine will soon be a small sub specialty of genetics!!!!!! At least if the NEJM has their way with it!Now for the TrickBut then I stop....pinch myself and ask "Now which company will rush to market with these findings???"""The biggest danger to Personalized Medicine is not the lack of physician understanding. Nor is it the lack of good reimbursement systems. Nor is it the lack of education in medical school. Nor is it the lack ... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1921188 Fri, 31 Oct 2008 11:25:00 +0100 1921188 http://www.medworm.com/index.php?rid=1901415&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F10%2Fif-this-is-how-wellpoint-has-managed.html Among other news outlets, the Indianapolis Star reported that giant health care insurance company/ for-profit managed care organization WellPoint has had trouble with its investment portfolio:WellPoint is like many other investors these days: Its portfolio took a sizable hit from the financial crisis.The Indianapolis-based health insurance giant saw its quarterly profit fall 5.4 percent, dragged down by investment losses.The company Wednesday reported a profit of $820.7 million for the third quarter ending Sept. 30. That's down from a profit of $868 million a year earlier. WellPoint's quarterly revenue of about $15 billion also was down slightly from a year ago.WellPoint said that those results included pre-tax investment losses of $562.6 million, or 71 cents a share. Of those losses, $229... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1901415 Thu, 23 Oct 2008 15:30:00 +0100 1901415 http://www.medworm.com/index.php?rid=1883570&cid=t_358665_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F421456941%2F Three years ago, the FDA required makers of antidepressants to supply Med Guides along with their pills. That wasn’t good enough for a couple of New Jersey moms, who have been pushing their state legislature to go further - a bill requiring a doctor or nurse to obtain informed consent from a minor’s parent before writing a prescription for any psychotropic that already carries a Black Box warning. In fact, thanks to their urgings, a bill has been kicking around the state legislature for nearly two years and passed the assembly. However, the state senator who heads the Senate health committee, Joe Vitale, has repeatedly failed to schedule the bill for a vote (here’s the bill and the assembly version). Last fall, he told us the bill would move forward, but it never did. And Vitale ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1883570 Wed, 15 Oct 2008 10:49:50 +0100 1883570 http://www.medworm.com/index.php?rid=1856401&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F10%2Fsherpas-plan-criminal-acts-for-200.html There is a storm coming. The way clinical genetics services are delivered in academic centers needs to change. Trying to make money through incident services could costs counselors and genetics departments everywhere. Billing through an extender leverages the already busy clinician and helps us see many patients.When a physician needs to bill for an extender they pick an NP or a PA. If they pick a CGC and never see the patient, bill for a clinical consult, and have someone forge their name, then they could be in a little bit of trouble. Especially with Medicare.....Yet that is precisely what is happening in a majority of medical centers in the country. In my unscientific poll, 15 of the top 30 institutions who host cancer genetics clinics are doing this exact thing. I won't point fingers a... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1856401 Tue, 07 Oct 2008 10:15:00 +0100 1856401 http://www.medworm.com/index.php?rid=1829472&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F09%2Fsherpas-plan-lack-of-qualified.html I have received great response to our HelixGene Foundation. We are quickly building our community. It is so heartening to see everyone support this effort. It is frankly, breath taking!Today I will be headed to a wonderful company. They are called Cine-Med. They are joining forces with the Sherpa to create Genomic CMEs. We have some great ones that are fast approaching launch. My mentor told me that I am doing to much. But I have to tell you, I am not doing enough. I need your help. Help empower physicians to learn and practice Genomic Medicine!Remember what I said about NCHPEG.....only 6 of 100 primary care physicians had ever heard of them. Instead they would rely on the Sunday NY Times. There has to be a better way! Either we launch a multi-million dollar awareness campaign for NCHPEG o... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1829472 Fri, 26 Sep 2008 10:33:00 +0100 1829472 http://www.medworm.com/index.php?rid=1785856&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F09%2Ftossing-legionella-samples-case-from.html Sometimes you just cannot make this stuff up. Here are extracts of a story in the Pittsburgh Tribune-Review:U.S. House members on Tuesday admonished Veterans Affairs officials from Pittsburgh for ordering the destruction of thousands of Legionella samples even as a researcher was attempting to save the 'irreplaceable' collection.The destroyed samples represented nearly 30 years of medical research by Dr. Victor Yu, former chief of the VA's Infectious Disease Section, and Dr. Janet Stout, former director of the Special Pathogens Laboratory in Oakland and one of the nation's leading researchers in Legionnaires' disease.During a congressional hearing held in Washington and carried live on the Internet, VA officials said they destroyed the samples because Yu and Stout did not provide a catalog... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1785856 Thu, 11 Sep 2008 19:19:00 +0100 1785856 http://www.medworm.com/index.php?rid=1668386&cid=t_358665_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2008%2F07%2Flove-me-love-my-tats.html Recently one of our readers wondered what I thought of a study that was recently reported in Scientific American Mind. It was a study that was done in a forensic psychiatric hospital, looking at the correlation between tattoos and a diagnosis of antisocial personality disorder. Briefly, they examined 36 inpatients for the presence or abscence of tattos and then did semi-structured interviews to assess them for antisocial personality disorder. Unsurprisingly, they found that people with tattos were more likely to be diagnosed with antisocial personality disorder and to have histories of substance abuse and suicide attempts.My first thought when I read this report was: "This was a forensic fellows' research project."Psychiatrists in training to be forensic psychiatrists are encouraged to do ... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=1668386 Wed, 30 Jul 2008 18:30:00 +0100 1668386 http://www.medworm.com/index.php?rid=2513554&cid=t_358665_177_f&fid=38133&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTubalReversalBlog%2F%7E3%2FxI6LJK6EAuM%2Fchapel-hill-tubal-reversal-center-mission-statement.html Chapel Hill Tubal Reversal Center is the only medical facility specifically for tubal ligation reversal surgery. We provide the most detailed and accurate information about tubal reversal available from any doctor, hospital, or medical institution. Providing facts rather than offering misleading or speculative statements about tubal reversal success is one mission of our practice. (Source: Tubal Reversal Blog) Tubal Reversal Blog blogs http://www.medworm.com/rss/comments.php?id=2513554 Sun, 29 Jun 2008 15:10:43 +0100 2513554 http://www.medworm.com/index.php?rid=1543906&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F06%2Fburrill-reportdecoded.html Consumers are worried about developing genetic based diseases, but remain reluctant to use genetic tests that will provide early warning signs.That is the lead statement in the executive summary from the Burrill and Company Personalized Medicine and Wellness report issued last week. Many may ask "What's this report have to do with me?" many have even doubted the validity of the report in favor of the blogosphere......In the arena of Genomic Medicine, I would say the blogosphere is pretty one sided.....IN fact, that is why the Sherpa is popular. Until I started blogging, this place was pretty much a mutual admiration society. Further proven by the backlash I received when I said that governmental regulation was coming and then came.So let's go back to the poll.....Second LineCompanies need ... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1543906 Tue, 24 Jun 2008 09:00:00 +0100 1543906 http://www.medworm.com/index.php?rid=1535926&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F06%2Fdaniel-is-great-guy.html I wanted to post quickly today on a this whole turf topic again. I thank Daniel over at Genetic-Future (Pound for pound the best new blog in this arena). It took some discourse to figure it out.What happens normally with genetic testing?Traditionally a lab scientist, being PhD or MD runs the lab and when results are in writes a report that is to be delivered to......Guess who? A physician. That physician or genetic counselor working with the physician interprets the report clinically at the interface of the patient.......presenting the patient the results and the clinical implications. (This is the part that laboratory scientists often never see)Eureka! I have finally figured out this whole play!!!! Why is the state cracking down? When these DTC companies, Genetic, SNP, or not deliver resu... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1535926 Sat, 21 Jun 2008 18:39:00 +0100 1535926 http://www.medworm.com/index.php?rid=1502734&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F06%2Fnewborn-screening-for-alzheimers.html Don't Forget that Gene Genie is up at Neurophilosophy so check it out!I want to thank the Connecticut Geriatric Socitey for inviting me to speak at their wonderful group's Annual Meeting. It was a lively time and the Salmon was excellent. At the end of the lecture we had a lively debate with several clinicians. Family history is king when it comes to Alzheimer's Disease. APOE e4 testing is not super worthwhile, unless you identify ApoE e4 in an affected and then work the family up that way. But the 3 gene panel for Early Onset Alzhemier's is definitely a must. Provided the 3 tenets of Informed Consent are met.What are those 3?1. A plan of action for results. "What would you do if you had a positive or negative or uncertain test result?2. Are you Psychologically prepared to handle the resul... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1502734 Mon, 09 Jun 2008 11:30:00 +0100 1502734 http://www.medworm.com/index.php?rid=1472689&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F05%2Fgenetic-susceptibility-to-cancer.html I love the pen. It has the ability to befuddle, convince, coerce, and give false or true hope. This is the case with journal articles. I am always amazed by what is reported and what is real. You see, the Buddhists will tell you that all reality is merely false. Why? Because perception is what we view to be reality. Since reality needs to be constant, yet perception not only changes but is viewer dependant....it is not constant. Hence, there is no spoon.This is the case with a recent article published in JAMA's clinician's corner. The article entitled "Genetic Susceptibility to Cancer" did something wonderful. It took 161 meta and pooled analyses encompassing 18 cancer sites and 99 genes/344 variants (Trust me, this took some heavy lifting) and evaluated for Odds Ratios and evaluated stati... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1472689 Wed, 28 May 2008 14:10:00 +0100 1472689 http://www.medworm.com/index.php?rid=1458472&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F05%2Fpass-ketchup-to-novartis.html The Wall Street Journal just reported on the "makeover" of Novartis. Part of that makeover was the appointment of a new leader for the company's pharmaceuticals division.Joe Jimenez was running Novartis's consumer health-care business and had spent most of his career at packaged-goods companies, including H.J. Heinz Co., before Dr. Vasella tapped him to revamp Novartis's pharmaceuticals as the division's new chief. On Mr Jiminez's accomplishments,Mr. Jimenez, the pharmaceuticals chief, started four pilot projects in tough markets to try to improve Novartis's relations with payers. In the Pacific Northwest, Novartis is trying to develop closer relations with an HMO by paying to train its nurses in some aspects of heart disease.Mr. Jimenez calls this 'key account management,' similar to a pa... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1458472 Tue, 20 May 2008 21:18:00 +0100 1458472 http://www.medworm.com/index.php?rid=1439998&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F05%2Fepi-genomic-canary.html So many people talk about guniea pigs as the research subject. I think this is a disservice for the pigs. Personally I think the Shaft Canary is a much better analogy. You see, the subtle changes from the human guinea pigs may not make big headlines or get the public to listen....But, the canary in the shaft always makes big press.If you don't know what I am talking about, let me explain. One of coal miners earliest and continuous problems was carbon monoxide. It can kill fairly quickly. But way back when, there were no gas detectors.....we had a vey limited ability to identify the dangerous gas. So what did they do? They carried a surrogate into the mine...The canary was a pretty easy to read detector. If the bird died, then you should leave the mine shaft. With our ever expanding set of ... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1439998 Tue, 13 May 2008 13:51:00 +0100 1439998 http://www.medworm.com/index.php?rid=1432784&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F05%2F276-pages-of-pure-reality.html Have you read it? Come on.....You didn't. Well, you are missing out. Back in 2004 I started watching the Secretary's Advisory Committee on Health, Genetics and Society. But even more importantly I began watching back meetings that were webcast, including the SACGT. I studied the players in the field, the advisors, the government. I began to notice trends and agendas. This is why I saw all of the regulations coming. I began emailing members, speaking with advisors, and learning how and when all of the issues would arise and then be solved. Then in 2005 I began to develop the business plan for Helix Health. The safest climb to the summit is with trained genetics professionals like the ones we have. The riskiest is D-I-Y. The SACGHS is against D-I-Y...notably this 276 page report goes into th... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1432784 Thu, 08 May 2008 19:19:00 +0100 1432784 http://www.medworm.com/index.php?rid=1426504&cid=t_358665_131_f&fid=34989&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FGeneticsHealth%2F%7E3%2F285259938%2F Following my recent article on ethical guidelines for informed consent in genomic studies, a group of scientists met at the Translating ESLI conference in Cleveland to debate this whole ethical argument. This issue is particularly critical for genome-wide association studies and in establishing and using large biobanks. It was universally acknowledged that consent forms are difficult to read for participants who do not have reading skills beyond middle school or high school, for example. As a result, these paticipants may be unaware of what exactly the research could mean to them. Laura Beskow, a researcher at Duke University’s Institute for Genome Sciences and Policy worked with the Association of American Medical Colleges to start a working group on informed consent issues and what ... Genetics and Health blogs http://www.medworm.com/rss/comments.php?id=1426504 Wed, 07 May 2008 09:57:34 +0100 1426504 http://www.medworm.com/index.php?rid=1404192&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F04%2Foprah-oprah-oprah.html In a gut wrenching episode of Oprah the other day Randy Pausch spoke about pancreatic cancer. It is a scary disease as almost everyone dies from this cancer AND it is so difficult to detect. He is correct, we know so little about pancreatic cancer. We know so little about its pathoetiology(Cause of). We are learning a little about pancreatic cancer genetics. But what scares the hell out of me is when a well respected pulmonologist and critical care specialist comes up to me today and says "My wife's father had pancreatic cancer. She's scared to death about getting it. She saw on Oprah a genetic test and something called 23andMe. Can you help me get these tests?"Woah......Big fella!!!! I spent 30 minutes going over familial pancreatic cancer, doing a quick family history and coming up with ... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1404192 Mon, 28 Apr 2008 14:06:00 +0100 1404192 http://www.medworm.com/index.php?rid=1378045&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F04%2Ftoo-good-to-miss.html Ok....so I have been reading Hsien's discussions about DTC testing good or evil?This spirited debate is very important. Everyone has concerns about regulations. It is the reason why 23andMe jumped the non-clia certified lab ship (And probably Why Andrew's results were delayed) But it is also why LabCorp has now locked out all other corporate genomic companies for now....This debate is going to boil down simply to this...I posted yesterday and maintain this position"Predisposition is Pre-Disease". This is the case with BRCA testing, it is the case with some robust SNPs. The ICD10 codes will catch up with this....If it is not the case (i.e. for entertainment purposes only, NO HEALTH IMPLICATIONS) then they don't need medical regulation.So I ask, are the SNPs which are being tested for and re... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1378045 Thu, 17 Apr 2008 00:34:00 +0100 1378045 http://www.medworm.com/index.php?rid=1363845&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F04%2Fback-to-basics.html I used to play football and had a coach who said "If you block and tackle better than anyone, then you will win championships"I thought he was crazy. I thought you had to have super talent to win. But year after year it is clear in the NFL that teams who block and tackle better...win. You know this to be true in all sports.So here at the Gene Sherpa, I am going back to the basics. I have been getting away from that and being a little preachy and in fact turning into a tabloid...While it does generate alot of blog hits.....Searches for Navigenics has sent my hit rate rocketing on FeedBurner....I think we need to report on how we are doing in our progression to Genomic Medicine.So when I open this month's edition of Internal Medicine News "The Leading Independant Newspaper for the Internist-... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1363845 Thu, 10 Apr 2008 13:22:00 +0100 1363845 http://www.medworm.com/index.php?rid=1361139&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F04%2Fnew-hope.html I just got out of a meeting with a Very Nice Angel Investor. He had some really interesting ideas that I am dying to tell you about....but I just can't.....for now.But what I can do is now tell you about how sad I am that I missed "Navigenics 2008 Opening Day" I don't know who was pitching...but from what I heard it was a success. Speaking of success, I just had another patient come to me with the magic 84 page printout. It will be interesting to see how the Mayo study comes out regarding all of these lab reports and patient comprehension. A few days ago a patient was seen by us for Pharmacogenomic analysis and he was puzzled by the laboratory reports and data. He actually thought that the boiler plate information on the bottom of the report was actually personalized. He asked "If I only h... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1361139 Wed, 09 Apr 2008 18:12:00 +0100 1361139 http://www.medworm.com/index.php?rid=1356361&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F04%2Ft-minus-21-hours.html Till Navigenics Launch.......Stay Tuned!-Stevep.s. Congrats to Amy over at....oh wait...she hasn't started a blog yet ;) But in all seriousness, congratulations. Thanks to Jonathan at Tree of Life for leaking this...... (Source: Gene Sherpas: Personalized Medicine and You) Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1356361 Tue, 08 Apr 2008 01:11:00 +0100 1356361 http://www.medworm.com/index.php?rid=1353084&cid=t_358665_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2008%2F04%2Fthirty-six-million-dollar-rectal-exam.html In 2004, while working at a construction site, Brian Persaud was hit in the head by a large wooden plank, lost consciousness, and was taken to the emergency room at New York Presbyterian Hospital. There he received what he says was an unjustified digital rectal exam. Persaud brought suit against the hospital, and soon, four years later, the case will come to trial in the New York State Supreme Court. The arguments in the case are legal, but the underlying issues are also medical and ethical.More at Clinical Correlations, the NYU Internal Medicine blog. (Thanks to D.M. Esq. for a quick legal education.) (Source: Zackary Sholem Berger) Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=1353084 Sun, 06 Apr 2008 02:30:00 +0100 1353084 http://www.medworm.com/index.php?rid=1344601&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F04%2F4-days-too-long.html As I sit here in the Sheraton New Orleans before our presentation I am re-living my days here in New Orleans....When we arrived I immediately had to go get Jambalaya.....and then diarrhea..........The next day I went to the "World Famous" Cafe DuMonde....I was filled with excitement about this exotic sounding place.....If I only would have google'd it first. When I approached the cafe from Jackson Square I saw what seemed to be perhaps a beach side cafe with a starving artist out in front of it.....I must admit when I got in the Green and White Awning open air cafe I saw a neat business model and tasted what I deem "smooshed funnel cake". It turns out at the Cafe Du Monde, the waiters take your order, pay the cashier...almost as if they are reselling the goods........meaning the Beignet! T... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1344601 Wed, 02 Apr 2008 12:42:00 +0100 1344601 http://www.medworm.com/index.php?rid=1327599&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F03%2F500-hospitals-want-to-know.html Lots of stuff happening online today. I just left a conference call where I was the invited guest panelist along with Robert Resta CGC. The Advisory Board Company and The Innovations Center presented an Issue Brief entitled-The Genetic Testing Frontier: Impact on Clinical Care, Market Opportunities. Hundreds of hospitals were online wondering how they too can get a piece of the action.....Also....did anyone read the Washington Post today? Genetic Testing Gets Personal again another article on this "revolution" non subscription link here"We call it consumer-enabled research," said Linda Avey, co-founder of 23andMe, based in Mountain View, Calif. "It's about changing the paradigm of how research is done."Well Said.......You could also call it uninformed cohort analysis...."Free Kits?" Come-O... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1327599 Tue, 25 Mar 2008 19:11:00 +0100 1327599 http://www.medworm.com/index.php?rid=1909210&cid=t_358665_177_f&fid=38133&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FTubalReversalBlog%2F%7E3%2F286469501%2Ftubal-reversal-specialist-start.html After my first meeting with Dr. Berger, I drove home and was ecstatic our conversation went so well. I did not know what to expect when I first visited the center but my visit was everything I could have hoped for. Immediately when I got home I told my wife about my experience. I had never told [...] (Source: Tubal Reversal Blog) Tubal Reversal Blog blogs http://www.medworm.com/rss/comments.php?id=1909210 Tue, 18 Mar 2008 23:32:29 +0100 1909210 http://www.medworm.com/index.php?rid=1304936&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F03%2Fhacking-icd-ham-radio-opinion.html Roy Poses wrote at "Hacking an ICD" that:An ICD is a device whose correct operation is critical for the health and safety of patients in whom it is implanted. One would think that the managers responsible for the design of such devices would have pushed to make sure that the operation of such devices could not be hacked or accidentally altered in ways that could put patients' health and lives at risk.Indeed.It is probably not well known that in addition to being a Medical Informaticist, I am also a ham radio enthusiast, licensed at the Extra class. I know more about electronics than most physicians - and most IT people in hospitals to boot, although that often didn't matter in the dysfunctional world of hospitals and health IT.As a medical informaticist and ham radio operator, I am concern... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1304936 Fri, 14 Mar 2008 21:28:00 +0100 1304936 http://www.medworm.com/index.php?rid=1303453&cid=t_358665_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F251477919%2F A controversial New Jersey bill to require informed consent from a minor’s parent before a doc can write a prescription for any psychotropic that already carries a Black Box warning was approved overwhelmingly by the state assembly yesterday in a 72-to-3 vote. You can read the bill here. Now, an identical Senate version heads for what may be a fractious debate in the Senate health committee. This a big leap from just three months ago, when the bill appeared to be dead after a year-long fight by a pair of New Jersey moms and their allies, who argue that informed consent is the only way to make sure info is passed from docs to patients. In particular, they’re concerned that side effects, such as suicidal behavior and thoughts, that are linked to antidepressants can be misconstrued as par... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1303453 Fri, 14 Mar 2008 16:11:49 +0100 1303453 http://www.medworm.com/index.php?rid=1303215&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F03%2Fhacking-icd.html Implantable cardiac defibrillators (ICDs) are battery-powered, computerized electronic devices implanted in the body. They are designed to detect dangerous heart rhythms and administer a shock to the heart to stop these them. We have discussed these devices before, including a story about how one manufacturer suppressed data that suggested some of their ICDs were less reliable than heretofore thought. It appears that a new, and potentially worrisome adverse effect of these devices has just been discovered.An article to be published in the IEEE Symposium on Security and Privacy [Halperin D, Heydt-Benjamin TS, Ransford B et al. Pacemakers and implantable cardiac defibrillators: software radio attacks and zero-power defenses. IEEE Symposium Security Privacy 2008; in press. Link here.] demons... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1303215 Fri, 14 Mar 2008 14:35:00 +0100 1303215 http://www.medworm.com/index.php?rid=1278312&cid=t_358665_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F245595792%2F A controversial New Jersey bill to require informed consent from a minor’s parent before a doc can write a prescription for any psychotropic that already carries a Black Box warning is picking up steam. An assembly committee yesterday passed the bill - which you can read here - unanimously and now a state senator is poised to introduce a companion version. A spokeswoman for Shirley Turner says the senator plans to ‘drop the bill’ this week. This a turnabout from just three months ago, when the bill appeared to be dead after a year-long fight by a pair of New Jersey moms and their allies, who argue that informed consent is the only way to make sure info is passed from docs to patients. In particular, they’re concerned that side effects, such as suicidal behavior and thou... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1278312 Tue, 04 Mar 2008 17:17:13 +0100 1278312 http://www.medworm.com/index.php?rid=1271599&cid=t_358665_131_f&fid=35743&url=http%3A%2F%2Fthegenesherpa.blogspot.com%2F2008%2F03%2Fcf-success-story.html Today I am writing about something I call truly Personalized Medicine. This topic hits near and dear to my heart and I am going to talk about this because it is an ethical dilemma. The recommendations for genetic screening by the American College of Medical Genetics, the American College of Obstetricians and Gynecologists, and the National Institutes of Health were issued in 2001. According to recent letter in the NEJM it turns out that the birth rate of children with Cystic Fibrosis has dropped. The number of infants born with cystic fibrosis in Massachusetts decreased by 50% from one four-year period to the next according to this letter in the NEJM. They attribute this to the Newborn screening available in Massachusetts since 1999. In addition they also report a drop in those patients bo... Gene Sherpas: Personalized Medicine and You blogs http://www.medworm.com/rss/comments.php?id=1271599 Sat, 01 Mar 2008 15:51:00 +0100 1271599 http://www.medworm.com/index.php?rid=1268595&cid=t_358665_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F243395476%2F Three years ago, the FDA required makers of antidepressants to supply Med Guides along with their pills. That wasn’t good enough for a couple of New Jersey moms, who have been pushing their state legislature to go even further - a bill requiring a doctor or nurse to obtain informed consent from a minor’s parent before writing a prescription for any psychotropic that already carries a Black Box warning. Last November, however, it looked like the bill, which had been kicking around a year, was dead after making it to the New Jersey assembly and senate. The state senator who heads the health committee, Joe Vitale, failed to schedule the bill for a vote, citing procedural issues and the need for further study. At the time, he told us the bill would still move forward, but it never did. He ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1268595 Fri, 29 Feb 2008 16:22:22 +0100 1268595 http://www.medworm.com/index.php?rid=1250109&cid=t_358665_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2008%2F02%2F22%2Fguidance-on-nominating-a-consultee-for-research-involving-adults-who-lack-capacity-to-consent%2F   establishes how to identify an appropriate consultee for the purposes of section 32 of the Mental Capacity Act 2005.  Researchers are required by the Act to take reasonable steps to identify a person who, as a result of an existing relationship with the person who lacks capacity, can advise the researcher about that person’s participation in the project. Where no such person can be identified, the Act requires another person who can provide this advice to be appointed in accordance with guidance. (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=1250109 Fri, 22 Feb 2008 13:05:34 +0100 1250109 http://www.medworm.com/index.php?rid=1221295&cid=t_358665_87_f&fid=35052&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FWomensBioethicsBlog%2F%7E3%2F232770073%2Falways-excellent-kaiser-foundations.html The always excellent Kaiser Foundation's Daily Health Report http://www.kaisernetwork.org/daily_reports/rep_index.cfm calls attention to a startling new research finding--apparently "most patients... [[ This is a content summary only. Visit my website for full links, other content, and more! ]] (Source: Women's Bioethics Blog) Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1221295 Mon, 11 Feb 2008 04:11:43 +0100 1221295 http://www.medworm.com/index.php?rid=1213275&cid=t_358665_87_f&fid=35052&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FWomensBioethicsBlog%2F%7E3%2F230550370%2Fsues-post-for-wednesday-im-on-vacation.html According to BBC news, the UK may allow researchers to clone cells from human tissues donated for research purposes ... without the express consent of the donor. Supporters assert that being able to... [[ This is a content summary only. Visit my website for full links, other content, and more! ]] (Source: Women's Bioethics Blog) Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1213275 Thu, 07 Feb 2008 03:31:25 +0100 1213275 http://www.medworm.com/index.php?rid=1204683&cid=t_358665_87_f&fid=35052&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FWomensBioethicsBlog%2F%7E3%2F229235581%2Fbiobanking-part-3-returning-research.html So: you've agreed to participate in a genetic study for health purposes, and (with or without your consent--see post #2 on biobanking) the data you've provided has been made available to the broader... [[ This is a content summary only. Visit my website for full links, other content, and more! ]] (Source: Women's Bioethics Blog) Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1204683 Tue, 05 Feb 2008 02:21:14 +0100 1204683 http://www.medworm.com/index.php?rid=1187179&cid=t_358665_87_f&fid=35052&url=http%3A%2F%2Fwomensbioethics.blogspot.com%2F2008%2F01%2Fwhen-is-painkiller-not-painkiller.html (Source: Women's Bioethics Blog) Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1187179 Wed, 30 Jan 2008 01:42:00 +0100 1187179 http://www.medworm.com/index.php?rid=1185819&cid=t_358665_87_f&fid=35052&url=http%3A%2F%2Fwomensbioethics.blogspot.com%2F2008%2F01%2Freligion-of-father.html (Source: Women's Bioethics Blog) Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1185819 Tue, 29 Jan 2008 16:14:00 +0100 1185819 http://www.medworm.com/index.php?rid=1160975&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F01%2Fbusiness-think-rationale-for-in-store.html An urban legend that has haunted health care in the last 20 years, to its great detriment, is that the application of business-like thinking, business-think for short, to health care (not just financing health care), will yield enormous improvements.One of the latest health care fads generated by business-think appears to be in-store clinics. We have blogged several times, (most recently here, here, here, and here) about these clinics. Such clinics are situated in retail stores, such as drug stores, staffed by nurse practitioners, but usually not doctors, and claim to treat a limited number of ailments quickly for reasonable prices. They have been touted as the latest business-like solution to the decline of primary care.My biggest concern is that these clinics may fail to provide good car... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1160975 Fri, 18 Jan 2008 19:41:00 +0100 1160975 http://www.medworm.com/index.php?rid=1158243&cid=t_358665_87_f&fid=35052&url=http%3A%2F%2Fwomensbioethics.blogspot.com%2F2008%2F01%2Fnys-supreme-court-case-stirs-ethical.html (Source: Women's Bioethics Blog) Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1158243 Thu, 17 Jan 2008 09:46:00 +0100 1158243 http://www.medworm.com/index.php?rid=1909219&cid=t_358665_177_f&fid=38133&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FTubalReversalBlog%2F%7E3%2F286469510%2Ftubal-ligation-informed-consent.html I received an email message today from a patient that prompted me to write about informed consent for tubal ligation. (See my previous blog about informed consent for tubal reversal.) Here is the message that was sent to me. Hello, Dr. Berger, You performed tubal reversal surgery on me on 10/29/07, and I just found out [...] (Source: Tubal Reversal Blog) Tubal Reversal Blog blogs http://www.medworm.com/rss/comments.php?id=1909219 Tue, 15 Jan 2008 19:37:16 +0100 1909219 http://www.medworm.com/index.php?rid=1142371&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F01%2Fwill-minuteclinics-be-wash.html This article implies that CVS Caremark MinuteClinics will not have any plumbing within the clinics proper. They will not have sinks and soap dispensers, and they certainly will not have toilet facilities. How adjacent such facilities would be is unclear.Why is this a big problem? Take a look at the list of conditions which MinuteClinics claim to be able to treat. They include "bladder infections," "pink eye and styes," and a variety of skin infections.Diagnosis of bladder infections requires a urinalysis, and usually a urine culture. How will MinuteClinic patients provide urine samples? If patients are required to go out into the CVS store to find a bathroom, produce their sample, and go back to the clinic, how many would refuse out of embarrassment? If patients with bacterial urinary trac... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1142371 Thu, 10 Jan 2008 18:29:00 +0100 1142371 http://www.medworm.com/index.php?rid=1909238&cid=t_358665_177_f&fid=38133&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FTubalReversalBlog%2F%7E3%2F380926449%2Ftubal-reversal-informed-consent.html What Is Informed Consent? Informed consent means that a person has access to and understands all relevant information about a medical or surgical treatment necessary to make an informed decision about it. In the case of tubal ligation reversal, informed consent means that a person understands how it the surgery is performed, the alternative treatment of [...] (Source: Tubal Reversal Blog) Tubal Reversal Blog blogs http://www.medworm.com/rss/comments.php?id=1909238 Sun, 09 Dec 2007 23:36:57 +0100 1909238 http://www.medworm.com/index.php?rid=1054977&cid=t_358665_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F191383896%2F Nearly three years ago, the FDA required makers of antidepressants to supply Med Guides along with their pills. That wasn’t good enough for a couple of New Jersey moms, who have been pushing their state legislature to go even further - a bill requiring a doctor or nurse to obtain informed consent from a minor’s parent before writing a prescription for any psychotropic that already carries a Black Box warning. (Here it is) The bill, which has been kicking around for about a year, made it to the state assembly and senate - until last week, when it died a quiet death. The senate health committee failed to list the bill on its schedule this week and for procedural reasons, this means the legislation would have to be re-introduced in another session or it fades from view. The state sen... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1054977 Tue, 27 Nov 2007 17:18:32 +0100 1054977 http://www.medworm.com/index.php?rid=1014866&cid=t_358665_90_f&fid=34499&url=http%3A%2F%2Fcalifmedicineman.blogspot.com%2F2007%2F11%2Fherpes-test-in-doctors-office-near-you.html (Source: California Medicine Man) California Medicine Man blogs http://www.medworm.com/rss/comments.php?id=1014866 Thu, 08 Nov 2007 15:57:00 +0100 1014866 http://www.medworm.com/index.php?rid=994947&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F10%2Fmandatory-treatment-of-university-of.html This case is already all over the web [starting here], but it has an unusual health care slant which has heretofore not been covered, so....The University of Delaware, a large, state-supported US university, which includes a College of Health Sciences, recently instituted a new "treatment"program for university students, described in the draft of a detailed report. [Following page references are from that report.] (References to the program, also described as a curriculum, as a "treatment" are on page 8, 10, and 14) Subjects will be exposed to educational and behavioral interventions, the latter described in one document as that which will "leave a mental footprint on their consciousness." An example of one behavioral intervention requires subjects to line up, then step forward or backwa... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=994947 Wed, 31 Oct 2007 19:24:00 +0100 994947 http://www.medworm.com/index.php?rid=845903&cid=t_358665_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F152969671%2F A few weeks ago, a long-awaited study known as the Victor trial was published in The New England Journal of Medicine about Vioxx and colorectal cancer. The findings were contentious, however, because they suggested the painkiller may have caused heart attacks far sooner than Merck indicated. And buried in the methodology section was something else of interest. The authors, led by Oxford University’s David Kerr, wrote that paperwork given trial participants was “amended twice to reflect evolving data on the possible adverse cardiovascular effects” associated with Vioxx. The statement apparently refers to the ongoing debate over Vioxx and heart risks, which took place while the trial was conducted between 2002 and September 2004, when Vioxx was withdrawn. However, the patie... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=845903 Thu, 06 Sep 2007 13:32:18 +0100 845903 http://www.medworm.com/index.php?rid=827976&cid=t_358665_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F08%2Fblogscan-dilbert-in-medicine.html On Retired Docs Thoughts, this post takes off with a commentary on the recent New England Journal of Medicine article on the rush to do "quality improvement" without evidence that it works to address the rise of the business culture in health care. The best part was:Twenty years ago when I began to do some consultative work with the corporate world,I felt rather smug that my field (medicine) was immune to the Dilbert like silliness that seemed to pervade the corporate culture. However,medicine has become more and more corporate and the business school belief that one does not need know a business to run it is increasingly applied to medical practice . The business-speak jargon now echoes through the hospitals and clinics and we talk about vision statements and leveraging this and that and ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=827976 Tue, 28 Aug 2007 14:52:00 +0100 827976 http://www.medworm.com/index.php?rid=505071&cid=t_358665_99_f&fid=35344&url=http%3A%2F%2Fzackarysholemberger.blogspot.com%2F2007%2F03%2Finformed-consent-notes-for-talk-mr.html Informed consentNotes for a talkMr. C. is a 55-year-old Spanish speaking man with abdominal pain that has migrated from the epigastrium to the right lower quadrant of the abdomen. You are asked to “consent” him for a CT scan of the abdomen. Your Spanish is good enough to talk to him, but Mr. C. does not ask any questions, even when you repeatedly press him on the matter. He keeps saying, “Whatever you say, doctor.”More here. (Source: Zackary Sholem Berger) Zackary Sholem Berger blogs http://www.medworm.com/rss/comments.php?id=505071 Thu, 01 Mar 2007 05:00:00 +0100 505071 http://www.medworm.com/index.php?rid=464812&cid=t_358665_111_f&fid=34711&url=http%3A%2F%2Fmillinersdream.blogspot.com%2F2007%2F02%2Fdear-shamhat.html In response to Shamhat's comment, on this post:Dear Shamhat,Since in this context I am teaching in a hospital, where the women have already usually chosen hospital birth--and often, with an OB--I am referring to their choice between medicated and unmedicated labor.I insist on teaching all their options--and am fortunate at this hospital that I am "allowed." Many hospitals, including another local one, teach: "This is our facility, and this is how you give birth..." If the day came when I was told I could not teach all options in that hospital setting, I would resign. And, by teaching all options, I believe in some cases I am able to present some in my classes with the options and tools to go unmedicated. It's a seemingly forgone conlclusion that most want/will have/plan epidurals now. By s... Milliner's Dream blogs http://www.medworm.com/rss/comments.php?id=464812 Thu, 15 Feb 2007 21:30:00 +0100 464812 http://www.medworm.com/index.php?rid=470310&cid=t_358665_109_f&fid=34730&url=http%3A%2F%2Fpsychiatrist-blog.blogspot.com%2F2007%2F01%2Fmy-three-shrinks-podcast-4-gifts_01.html Today's podcast was recorded at the same time as #3 (Wii Three Bobo Dolls), and is much more rambling than usual (though we actually did have a list of topics, many of which were related to other bloggers' recent posts). I edited out Dinah's recording of the Red Sox' 2004 victory, but I'll put it in the next one if folks want to hear it (it's on her keychain). December 31, 2006: Gifts Topics include: Informed consent and emergencies: New Jersey Supreme Court may require consent before providing emergency procedures (American Medical News) Doctor Anonymous' 6-month anniversary: Dr A celebrated 6 months of blogging on Dec 18. (That's twice as long as the average blog lasts.) Congrats! Fat Doctor on gift-giving grief (or, Why she kinda hates Christmas) What to get your psychiatrist Bad gifts... Shrink Rap blogs http://www.medworm.com/rss/comments.php?id=470310 Mon, 01 Jan 2007 05:12:00 +0100 470310