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  • Archive for the 'Medicine' Category

    Robot of the Week

    Posted by David Foster on 30th July 2017 (All posts by )

     

    Automated suturing

     

    Posted in Medicine, Tech | 1 Comment »

    Triage vs Surge pricing

    Posted by TM Lutas on 27th July 2017 (All posts by )

    Sarah Hoyt’s site has an interesting article entitled The Free Market versus Death Panels. I recommend it in general but it misses one point that I think deserves some examination. There is one exception to the market rule that is so embedded in our social mores that both market and non-market advocates alike pass over it. They shouldn’t. It’s called triage.

    I have never met a free market advocate of medicine who does not recognize and accept non-market allocation in terms of emergency care, specifically when medical treatment systems and personnel are overloaded. When you have 10 operating theaters and 50 people who need surgery, who gets in first and who gets in last? The market would institute surge pricing and let the ill or their care circles sort out how much they can wait. Triage orders it so that the fewest number of people die.

    It’s an important footnote to recognize triage and to explain *why* that limited exception is ok, properly fenced off with limiting principles so the exception doesn’t swallow the rule, and what is the reason we’re all generally ok with triage causing more suffering and against surge pricing.

    First is to note that triage causes excess suffering because it is designed, and functions well at minimizing loss of life at the cost of extending suffering for those condemned to delays in treatment by the triage system. We’ve all made a moral decision that some non-fatal suffering is an acceptable payoff for a reduced fatality count when medical systems are overwhelmed and resources have to be quickly, efficiently deployed to reduce fatalities.

    It’s important to cover these things because they take away all the central planner’s best arguments away from them when you reconcile the free market with triage. Solidarity, the common good, human decency, these are the heartstring appeals of the statists who falsely claim that free market medicine will cause wicked outcomes because the market has no sense of solidarity, the common good, or human decency.

    These statists are wrong. But they have to be shown wrong. Examining triage is a very good way to do it.

    Posted in Markets and Trading, Medicine | 46 Comments »

    Worthwhile Reading – Science and Technology Edition

    Posted by David Foster on 15th May 2017 (All posts by )

    It seems that octopuses have the ability to edit their RNA dynamically.

    An interesting piece on FDA regulation and medical device innovation.

    Zymergen has automated part of the drug discovery process via a combination of robotics and machine learning.

    Was big data analytics (more specifically, excess faith in same) a major cause of Hillary Clinton’s electoral loss?

    Is there an artificial intelligence misinformation epidemic?

    Cotton spinning – a quintessential technology of the Industrial Revolution – returns to England.

    But to what degree will spinning, as well as weaving, cutting, and sewing, be replaced by 3d printing of clothing?

    James L Taylor Manufacturing, a 106-year-old company making clamps and other woodworking tools sold to producers of furniture, flooring, and cabinets, recently introduced a robotic nester…it replaces the work of a human nester who “snatches boards coming off a conveyer belt in random lengths, hastily rearranges them so that each row of one to five pieces is so long, and bundles the rows into a stack.” One mill in Mississippi placed an urgent order for 3 of these (at $115K each) with the explanation: “I have eight nesters and four of them just called in sick.”

    What is especially interesting about this is that the robotics system was not developed by hiring consultants from MIT or Silicon Valley; the company’s chief engineer (also part-owner of the company) designed the machine himself and wrote the 7000 lines of C++ code to run it.  Reminds me of the cucumber sorting machine developed by a Japanese guy to help out on his parents’ cucumber farm..although that system was developed for the family’s own use rather than as a saleable product as with the robotic nester.

    Posted in Business, Entrepreneurship, Health Care, Medicine, Tech | 6 Comments »

    Worthwhile Reading

    Posted by David Foster on 4th March 2017 (All posts by )

    Simulating a microprocessor with techniques similar to those used in neuroscience raises some cautionary thoughts about conclusions being drawn in the later work.

    Don Sensing links his 2014 post:  America is adopting the Middle East model, and he’s not talking about Islam but rather about the   fact that “At an increasing pace, politics in the West, especially in America, is the surest way to wealth, a 180-out from the West’s history”…but consistent with the way things have worked for millennia in the Middle East.

    Anthony Esolen:  We are a people now illiterate in a way that is unprecedented for the human race. We can decipher linguistic signs on a page, but we have no songs and immemorial stories in our hearts.

    Wendy McElroy on “social justice warriors” and the persecution of heretics.

    Despite about all the automation innovations and the concerns about robots taking all the jobs, manufacturing productivity may really not be showing much in the way of an upward trend.

    Management and meaningful work, studied via Legos

    Posted in Civil Society, Deep Thoughts, Economics & Finance, Human Behavior, Leftism, Management, Medicine, Middle East, Science, Tech | 1 Comment »

    “Underground DSM-IV – Full Version”

    Posted by Jonathan on 31st October 2016 (All posts by )

    An interesting and entertaining post from AVI:

    Related: “No one is listening to me,” means “no one is agreeing with me.” This has been remarkably durable over my career. The idea seems to be “If you were really listening to me you couldn’t possibly disagree.” Countering with the statement “I hear what you are saying, but i don’t agree with it” can actually provoke assaultive rage. It must come near the core of problem.
     
    Pts. referring to length of time they have been in hospital as an argument for privileges or discharge means they still don’t get it.
     
    Gazing intently slightly upward — choosing among several things to say (Lots of people do this.)
    The further up the gaze, the more possible responses – usually not a healthy sign.
    Gazing at ceiling: = Choosing among a multitude of things to say, i.e. lying.
    Turning back to interviewer, spinning in chair: = Antisocial PD

    Worth reading in full.

    Posted in Deep Thoughts, Human Behavior, Medicine | Comments Off on “Underground DSM-IV – Full Version”

    Does Hillary Clinton Have Parkinson’s Disease?

    Posted by Michael Kennedy on 18th September 2016 (All posts by )

    The Hillary collpase last Sunday has prompted a lot of speculation on her condition. Early on I was inclined to blame her neurological condition on her history of concussion and cerebral vein thrombosis.

    That seemed logical, given her history. However, it does not explain her quick recovery. It also has nothing to do with pneumonia.

    This video has now convinced me that she has Parkinson’s Disease, and it is fairly advanced. In the video, the physician mentions Apomorphine, which is not morphine but an alpha adrenergic drug used in Parkinson’s Disease.

    Currently, apomorphine is used in the treatment of Parkinson’s disease.

    What use does it have in Parkinson’s? It is used for “Non-motor symptoms.”

    What does that mean ? Parkinson’s Disease is characterized by a serious of motor disabilities.

    The cardinal symptoms of Parkinson’s disease are resting tremor, slowness of movement (bradykinesia) and rigidity. Many people also experience balance problems (postural instability). These symptoms, which often appear gradually and with increasing severity over time, are usually what first bring patients to a neurologist for help. Typically, symptoms begin on one side of the body and migrate over time to the other side.

    These symptoms are typically controlled with Dopamine like drugs, such as L-Dopa. There are other symptoms less easily controlled.

    For example, in advanced cases, difficulty swallowing can cause Parkinson’s patients to aspirate food into the lungs, leading to pneumonia or other pulmonary conditions. Loss of balance can cause falls that result in serious injuries or death. The seriousness of these incidents depends greatly on the patient’s age, overall health and disease stage.

    Hmmmm.

    There are also side effects of L Dopa.

    L-DOPA therapy is further complicated by the development of movement disorders called dyskinesias after 5 – 10 years of use in most cases.

    Dyskinesias are movement disorders in which neurological discoordination results in uncontrollable, involuntary movements. This discoordination can also affect the autonomic nervous system, resulting in, for example, respiratory irregularities (Rice 2002). Dyskinesia is the result of L-DOPA-induced synaptic dysfunction and inappropriate signaling between areas of the brain that normally coordinate movement, namely the motor cortex and the striatum (Jenner 2008).

    Read the rest of this entry »

    Posted in Elections, Medicine | 18 Comments »

    Hillary Clinton and Cerebral Venous Sinus Thrombosis.

    Posted by Michael Kennedy on 13th September 2016 (All posts by )

    The episode of Hillary Clinton’s collapse at the 9/11 Memorial Sunday has raised some interesting questions. Several years ago, she had a series of neurological events.

    Getting a true picture of the events requires that we go to British newspaper sites, as the US media has shielded her for ten years.

    1998 Blood Clot
    Clinton’s first known blood clot occurred in 1998, while she was still first lady.
    Clinton experienced symptoms while attending a fundraiser for Sen. Charles Schumer of New York, who would soon become her Senate home-state colleague. Her right foot swelled up to the point where she couldn’t put on her shoe.
    Clinton got quietly taken to the National Naval Medical Center in Bethesda for treatment at the time. She was found to have ‘a big clot’ blood clot behind her knee, Clinton wrote in her memoir, ‘Living History.’
    She called it ‘the most significant health scare I’ve ever had,’ the Washington Post noted.
    According to her physician, Mt. Kisco physician, Lisa Bardack, Clinton was advised at the time to take Lovenox, described as a short-acting blood thinner, when she took flights. The meds were discontinued when she went on Coumadin.

    That history has not been discussed, to my knowledge in light of her recent problems.

    Read the rest of this entry »

    Posted in Current Events, Elections, Medicine | 49 Comments »

    Monitoring Air Quality – Speck Sensor

    Posted by Carl from Chicago on 14th August 2016 (All posts by )

    Due to the fact that computing power continues to increase exponentially, devices that once were out of reach for the general population are now becoming mainstream. I wrote about Netatmo, a device that measures temperature, humidity and sound (indoor and outdoor) here. Due to the internet, these devices can also be connected together in order to see a real-time version of the country, without having to look at a weather forecast.

    Recently I saw an article in an MIT journal about indoor air quality which described how cooking eggs aggravated the authors’ asthma and they were able to take specific actions because they were able to pinpoint the source of the spike in unclear air. The name of the company that created the monitor is called Speck and it was sold for approximately $200 so I thought that was a decent price point for me to join the air quality monitoring revolution. I am specifically most interested in INDOOR air quality but I will explain the broader context and then come back to the specific items I am reviewing (basically you can get official measurements of air quality in the US from public sources).

    Read the rest of this entry »

    Posted in Environment, Medicine, Tech | 3 Comments »

    Supermarket Parable

    Posted by Jonathan on 5th August 2016 (All posts by )

    At the store they offer plain, vanilla and chocolate soy milk. Chocolate is the only flavor that’s any good IMO. Other customers seem to agree as chocolate is always in short supply and sometimes sold out by the time I get to the store. It seems obvious they should stock more chocolate but they never do.

    I complained a couple of times to guys in the dairy department and once to a manager. They didn’t understand what the problem was so I stopped complaining. When they have chocolate on the shelf I load up.

    Today I took two cartons of chocolate and couldn’t reach a third. One of the stock guys climbed up on the shelf and got it for me. He good-naturedly said that it’s great stuff, it flies off the shelves. I thanked him and mildly suggested the store should stock more chocolate because it’s the most popular flavor. He said that, on the contrary, people who like chocolate should be more considerate and leave some for the other customers. He added that there is a God upstairs and He is watching. I believe this man missed his calling. He could have been a successful bioethicist.

    Posted in Bioethics, Business, Customer Service, Deep Thoughts, Economics & Finance, Medicine, Personal Narrative | 31 Comments »

    Why Importing Foreign Doctors May Not Solve the Shortage.

    Posted by Michael Kennedy on 17th April 2016 (All posts by )

    MoS2 Template Master

    The coming doctor shortage that I have previously written about might be dealt with as Canada did with theirs some years ago, by importing foreign medical graduates. Britain has adopted a similar plan as thousands of younger doctors plan to leave Britain.

    How is the plan to import foreign doctors working out ?

    Not very well.

    Nearly three-quarters of doctors struck off the medical register in Britain are foreign, according to shocking figures uncovered in a Mail on Sunday investigation.
    Medics who trained overseas have been banned from practising for a series of shocking blunders and misdemeanours.
    Cases include an Indian GP who ran an immigration scam from his surgery, a Ghanaian neurosurgeon who pretended he had removed a patient’s brain tumour, and a Malaysian doctor who used 007-style watches to secretly film intimate examinations with his female patients.

    First of all, foreign medical schools are often limited in real experience and students often graduate with nothing beyond classroom lectures.

    Read the rest of this entry »

    Posted in Big Government, Education, Health Care, Immigration, Medicine | 15 Comments »

    The Doctor Shortage revisited.

    Posted by Michael Kennedy on 1st April 2016 (All posts by )

    33 - Lister

    I have previously written posts about a coming doctor shortage.

    They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

    The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

    This is all well and good. What happens when a patient comes in with a serious condition ?

    The health policy “experts” have been concerned to train “lesser licensed practitioners” and have pretty much ignored primary care MDs except to burden them with clumsy electronic medical record systems that take up time and make life miserable.

    I repeatedly ask medical students if they would choose a career in primary care if it would completely erase their student loan debt. A few hands go up, but not many. In fact, for a while now, the federal government has dedicated millions of dollars to repaying loans for students who choose primary care. Yet residency match numbers show that the percentage of students choosing primary care is not increasing. Though loan forgiveness is a step in the right direction, medical students realize that by choosing a more lucrative specialty, they can pay off their loans just fine.

    I proposed years ago, a health reform that resembled that of France where medical school is free. It could be arranged that service in primary care, low income clinics would give credit against student loans. Nothing happened. Except physician income has declined. And tuition has increased.

    Read the rest of this entry »

    Posted in Big Government, Education, Entrepreneurship, Health Care, Medicine | 19 Comments »

    It’s All About Control

    Posted by Michael Hiteshew on 18th December 2015 (All posts by )

    The Manhattan Contrarian writes on Consensus Science And Orthodoxy Enforcement

    This is an old problem with the left, where everything – and I mean everything – is politicized and put into service to the Agenda of The Party. For those on the ground, they are almost unaware that there are serious alternatives to The Party Line. Every question or criticism is dismissed out of hand as propaganda from entrenched interests or misinformation or so obviously and laughably wrong only an idiot could believe it because everybody knows that’s not true! For those in the middle of The Party hierarchy, there are big payoffs to being a loyal Party Apparatchik. Marcia McNutt is advancing nicely along that road. She will be well rewarded for her willingness to crush all dissent while presenting her smiling and attractive to face to the public. For those at the top, the only purpose of anything is to advance the power and control of The Party with themselves at the helm. And everything can be sacrificed to that end. And will be.

    Posted in Academia, Environment, Medicine | 9 Comments »

    More evidence that Obamacare is just expanded Medicaid.

    Posted by Michael Kennedy on 2nd November 2015 (All posts by )

    I have been saying that Obama care is just Medicaid for all. As time goes by, here is more and more evidence that this is the case.

    The latest evidence is in The Wall Street Journal and behind a pay wall but I will quote some of it.

    But a new paper from the Heritage Foundation, however, suggests that nearly all of the increase came from adding nearly nine million people to the Medicaid rolls.

    In other words, ObamaCare expanded coverage in 2014 to the extent that it gave people free or nearly free insurance. That goal could have been accomplished without the Affordable Care Act. To justify its existence, ObamaCare must make affordable private insurance available to a broad cross-section of uninsured Americans who are ineligible for Medicaid.

    But with fewer people buying insurance through the exchanges, the economics aren’t holding up. Ten of the 23 innovative health-insurance plans known as co-ops—established with $2.4 billion in ObamaCare loans—will be out of business by the end of 2015 because of weak balance sheets.

    And while rates vary widely by state, the cost for private insurance through the exchanges is also increasing dramatically. An analysis by consulting firm Avalere Health released on Friday shows that some of the most popular insurance plans in the ObamaCare exchanges will experience double-digit premium hikes in 2016.

    My earlier objections to Obamacare were that it promises too much and pays too little.

    As it turns out, Medicaid patients can’t get appointments with physicians.

    “America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

    Read the rest of this entry »

    Posted in Big Government, Health Care, Medicine | 6 Comments »

    Medicine: The Public-Health Model is Wrong

    Posted by Jonathan on 30th October 2015 (All posts by )

    This Theodore Dalrymple post is a variation on a conventional argument whose unstated main premise is that medical cost decisions should be evaluated from a public-health perspective.

    The annual medical is a kind of ceremonial or ritual which, according to its critics, is without rational foundation despite the fact that so many patients, and perhaps a majority of doctors, believe in it. This proves that superstition is not dead: but perhaps that is no fatal criticism of the annual medical after all, because superstition will never be dead. If it does not attach to one thing, it will attach to another.
     
    [. . .]
     
    In fact, most medicals are bureaucratic procedures rather than exercises in getting-to-know-you (as The King and I put it). The doctor asks a few questions, ticks some boxes on a computer screen, performs a perfunctory physical examination equivalent to examining a cubic inch of haystack to find a pin, and does a few selected blood tests, the interpretation of whose abnormal results (if any) will be far from straightforward. In fact, what has been done and measured in annual medicals over the years has changed, without any change in their ineffectiveness.

    Ineffective for whom?

    The answer depends on who is paying the bill. If it’s third parties such as govts or insurance companies then the conventional argument has merit: maximizing system utility is an important goal. However, if patients control their own medical spending then the main goals should be whatever the individual customers want them to be.

    Dalrymple’s analyses are usually much better than this one. Perhaps his frame blindness in this case is a function of his background with the NHS.

    Posted in Health Care, Medicine, Systems Analysis | 14 Comments »

    Celiac Disease and the “Worried Well”

    Posted by Dan from Madison on 23rd October 2015 (All posts by )

    My oldest daughter just got diagnosed with Celiac Disease. Maybe it really isn’t called that, but she had a strong reaction on the test. She was feeling sore in her joints and they decided to give her the test. We will be having her re-tested to be sure, but are already taking appropriate steps with her diet.

    I have had a discussion over the years with my better half that the whole celiac thing is overblown and that most of it is b.s. So this is a funny diagnosis in a goofy sort of way. My wife and I pretty much eat anything and everything and had passed that along to our kids. There are literally only four or five things I don’t like to eat and my wife is the same way. Protein, starch, vegetables, fruit, all in moderation. A balanced diet. Seems to work for us.

    A friend of mine on Facebook posted something interesting about some research that is proving that most people when they are lied to about what they are eating and given placebos, feel “better” or “worse” depending on what they THINK they are eating. I completely believe this. One doctor (or so he said he was one) provided this comment, that to me, became the quote of the day:

    In my practice I frequently see people who have NOTHING WRONG WITH THEM but who have a strong need to assume the role of a patient with some kind of diagnosis. I encourage them to go see “alternative medicine” practitioners. Indeed, the great benefit of alternative medicine is to provide the “worried well” with a pantomime theater of treatment.

    While my daughter’s diagnosis could be true, I still believe that the vast majority of people who are going “gluten free” are doing so out of misinformation or wanting to be part of a fad. Just for kicks, my wife and I are getting tested as well. We hear that it is hereditary. But we both feel fine. Maybe we need to get our chakras in order and everything will be OK.

    Posted in Medicine, Personal Narrative | 19 Comments »

    The Doctor Shortage Update.

    Posted by Michael Kennedy on 5th October 2015 (All posts by )

    There is an interesting piece today in the Daily Mail about young NHS GPs quitting and going to Australia.

    In the past five years, the number of GP appointments made by Britons has risen from 300 million to 370 million a year, an increase of more than 20 per cent.
    The number of GPs employed to meet that demand has risen by around 1,600, or just over five per cent.
    All of which has led to the second major factor behind their exodus — in the UK, they often feel terribly overworked; after moving they find themselves having to spend far less time at the coalface.
    ‘More and more British GPs talk about the pressure they’re under,’ says Guy Hazel. ‘I’m not sure the general public understand how mentally draining it is to see 35 to 40 patients a day. All the British GPs I know are exhausted.’
    An Australian GP, by contrast, will see 20-25 patients per day.

    This concerns the young, newly trained doctors. I posted some concerns about the issue of primary care in the US.

    Primary care here is referred to as “General Practice” in Britain and they seem to be having a loss at both ends of the doctor career.

    Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.

    According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.

    Read the rest of this entry »

    Posted in Big Government, Britain, Health Care, Medicine | 9 Comments »

    Melanoma and Pregnancy.

    Posted by Michael Kennedy on 26th September 2015 (All posts by )

    This is just a brief post to mention that that today’s Daily Mail has an article about a pregnant women with a spreading melanoma. In my book, linked on this site, I have a chapter on melanoma and several stories of patients whose melanoma went wild during a pregnancy. There is no report in the medical literature that supports this connection. Most reports deny any connection, although a few mention some negative prognosis.

    The literature continues to be split on the role of pregnancy in melanoma; however, most recent series show no difference in survival. Multiple studies have failed to show significant effects of female hormones on melanoma cells or on the incidence or progression of melanoma.

    In my book, I describe several cases where pregnancy would “awaken” melanomas that had been removed years earlier or would stimulate worrisome growth in moles. Two of my patients had extensive metastatic melanoma during pregnancy that disappeared after the baby was delivered, in one case with my help. Both women were disease free many years later and neither had another pregnancy.

    How interesting that this young woman has developed metastatic melanoma during pregnancy. I wonder how it will turn out.

    Posted in Health Care, Medicine | 4 Comments »

    “The Medical History of the American Civil War”

    Posted by Jonathan on 8th September 2015 (All posts by )

    Michael Kennedy’s blog series in six parts:

    The Medical History of the American Civil War

    The Medical History of the American Civil War II

    The Medical History of the American Civil War III

    The Medical History of the American Civil War IV

    The Medical History of the American Civil War V

    The Medical History of the American Civil War VI

    Posted in History, Medicine, Military Affairs, USA, War and Peace | 2 Comments »

    The Coming Shortage of Doctors.

    Posted by Michael Kennedy on 3rd August 2015 (All posts by )

    33 - Lister

    I’m sure everyone is tired of my pessimism about politics so I thought I would try something new. Here is a piece on pessimism about health care.

    This Brietbart article discusses the looming doctor shortage.

    Lieb notes, that the U.S. is only seeing 350 new general surgeons a year. That is not even a replacement rate, she observed.

    A few years ago, I was talking to a woman general surgeon in San Francisco who told me that she did not know a general surgeon under 50 years old. The “reformers” who designed Obamacare and the other new developments in medicine are, if they are MDs, not in practice and they are almost all in primary care specialties in academic settings. They know nothing about surgical specialties.

    They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

    The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

    This is all well and good. What happens when a patient comes in with a serious condition ?

    Read the rest of this entry »

    Posted in Health Care, Medicine, Politics | 22 Comments »

    Still Too Early – But Perry Makes Some Points

    Posted by Ginny on 6th July 2015 (All posts by )

    Most here haven’t commented on the darting and illusory fortunes of the huge Republican field; I’d mentioned earlier that Perry would have trouble – double or triple BDS syndrome, a bit too much of an Aggie for Texas, God knows for the rest of the country. But that great t-sipper, Kevin Williamson, discusses the case for Perry after a strong speech. That’s worth reading and both Williamson & Perry are worth while.

    Perry’s fighting, turning arguments around to free market principles, to the human: he did this earlier on the relatively friendly Fox’s Chris Wallace. Wallace pressed him on the number of uninsured Texans. Perry didn’t fight him on those grounds but on the far more important, far more serious, and far more consequential grounds of “access.” Access in Texas to health care has risen sharply with Perry’s policies. And, let’s face it, if there is enough access, all the assurances of insurance are pretty useless. Or, as Venzueleans found out, Chavez had promised to meet their every need – government promises of toilet paper and oil were there, access was not.
    Read the rest of this entry »

    Posted in Entrepreneurship, Health Care, Medicine, Politics | 17 Comments »

    Obamacare Lives !

    Posted by Michael Kennedy on 25th June 2015 (All posts by )

    obamacare

    UPDATE: The decision is analyzed at Powerline today with quotes from the decision.

    The Affordable Care Act contains more than a few examples of inartful drafting. (To cite just one, the Act creates three separate Section 1563s. See 124 Stat. 270, 911, 912.) Several features of the Act’s passage contributed to that unfortunate reality. Congress wrote key parts of the Act behind closed doors, rather than through “the traditional legislative process.” Cannan, A Legislative History of the Affordable Care Act: How Legislative Procedure Shapes Legislative History, 105 L. Lib. J. 131, 163 (2013). And Congress passed much of the Act using a complicated budgetary procedure known as “reconciliation,” which limited opportunities for debate and amendment, and bypassed the Senate’s normal 60-vote filibuster requirement. Id., at 159–167.

    Therefore, Roberts rewrote it. Nice !

    Today, the Supreme Court upheld the Obamacare state exchange subsidies.

    The Supreme Court has justified the contempt held for the American people by Jonathan Gruber. He was widely quoted as saying that the “stupidity of the American people “ was a feature of the Obamacare debate. This does not bother the left one whit.

    Like my counterparts, I have relied heavily on Gruber’s expertise over the years and have come to know him very well. He’s served as an explainer of basic economic concepts, he’s delivered data at my request, and he’s even published articles here at the New Republic. My feelings about Gruber, in other words, are not that of a distant observer. They are, for better or worse, the views of somebody who holds him and his work in high esteem.

    The New Republic is fine with him and his concepts.

    It’s possible that Gruber offered informal advice along the way, particularly when it came to positions he held strongly—like his well-known and sometimes controversial preference for a strong individual mandate. Paul Starr, the Princeton sociologist and highly regarded policy expert, once called the mandate Gruber’s “baby.” He didn’t mean it charitably.

    Read the rest of this entry »

    Posted in Big Government, Civil Society, Conservatism, Current Events, Economics & Finance, Health Care, Leftism, Medicine, Obama, Politics | 30 Comments »

    A Bleg.

    Posted by Michael Kennedy on 16th June 2015 (All posts by )

    cover.

    I have a new book out on Kindle that is now published. It is called “War Stories: 50 Years in Medicine.”

    I’ve been working on this for 20 years and kept having to revise it as I would put it down and then go back to it after ten years. I finally decided to rework it and publish it two years ago. My students were reading the draft on my laptop while I was editing so maybe it will be interesting.

    It is a memoir of patients. They are all patients’ stories that I have tried to describe accurately and to describe what we did then. Sometimes I screwed up and I tell those, too. Sometimes we did the best we could and we now know better. Some of these cases are still hard to explain.

    Two of them, in the chapter on Melanoma, are about young women who developed major melanoma metastases years after the primary was excised but when they had become pregnant. The melanoma went wild in pregnancy, in one case ten years later. In the other, three years after I had removed the primary, she developed extensive metastases while pregnant. She refused abortion and I thought it would cost her her life. In both cases the melanoma vanished after pregnancy ended. In one case, the woman, last I heard, was free of melanoma 25 years later. The other was free ten years later. The medical literature says pregnancy has no effect on melanoma. Neither ever became pregnant again.

    Another case is an example of the only supernatural near-death experience I have ever heard.

    The book starts when I began medical school in 1961 and describes experiences with patients, including my summer working with schizophrenic men in 1962. I have a series of stories about patients I saw as a student and sometimes intersperse stories from later that are about similar cases and events. One that is amusing, I guess, is about my very first pelvic exam, on a 40 year old prostitute who had just gotten out of prison and enjoyed it thoroughly. I had a dozen student nurses as witnesses. I do have some biography in it but try to keep it to minimum.

    After the first eight chapters, I go on to residency and then finally to private practice. I continued to teach and there are a few of those stories. There is a chapter on ethics including my thoughts on euthanasia and “benign neglect.” Toward the end of my career, I started and ran a trauma center in our community hospital. I also did a fair amount of testifying in court in both trauma cases and some civil cases where I testified for plaintiffs and for defense. I consider it a compliment that Kaiser Permanente had me testify for their defense even though I had also testified against them.

    Anyway, the book is on Kindle and I hope somebody is interested. It has some similarity to my medical history book, which I plan to do a Kindle version of once this one is launched. In this one, I spend some time explaining the diseases in a way that I used to explain to patients and I still do to students. Without some basic understanding, most of these stories would not make sense and I hope the explanations are not too dull. If so, all comments are welcome. If anyone likes it, feel free to post a review on Amazon. Two reviewers from the first book in 2004 told me to let them know if I did another one and I have contacted them.

    If anyone wants to discuss the book here, feel free to add comments.

    Posted in Biography, Blegs, Book Notes, Health Care, Medicine, Personal Narrative | 16 Comments »

    Why Doctors Quit.

    Posted by Michael Kennedy on 29th May 2015 (All posts by )

    Today, Charles Krauthammer has an excellent column on the electronic medical record. He has not been in practice for many years but he is obviously talking to other physicians. It is a subject much discussed in medical circles these days.

    It’s one thing to say we need to improve quality. But what does that really mean? Defining healthcare quality can be a challenging task, but there are frameworks out there that help us better understand the concept of healthcare quality. One of these was put forth by the Institute of Medicine in their landmark report, Crossing the Quality Chasm. The report describes six domains that encompass quality. According to them, high-quality care is:

    1) Safe: Avoids injuries to patients from care intended to help them
    2) Equitable: Doesn’t vary because of personal characteristics
    3) Patient-centered: Is respectful of and responsive to individual patient preferences, needs and values
    4) Timely: Reduces waits and potentially harmful delays
    5) Efficient: Avoids waste of equipment, supplies, ideas and energy
    6) Effective: Services are based on scientific knowledge to all who could benefit, and it accomplishes what it sets out to accomplish

    In 1994, I moved to New Hampshire and obtained a Master’s Degree in “Evaluative Clinical Sciences” to learn how to measure, and hopefully improve, medical quality. I had been working around this for years, serving on the Medicare Peer Review Organization for California and serving in several positions in organized medicine.

    I spent a few years trying to work with the system, with a medical school for example, and finally gave up. A friend of mine had set up a medical group for managed care called CAPPCare, which was to be a Preferred Provider Organization when California set up “managed care.” It is now a meaningless hospital adjunct. In 1995, he told me, “Mike you are two years too early. Nobody cares about quality.” Two years later, we had lunch again and he laughed and said “You are still too years too early.”

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    Posted in Big Government, Health Care, Medicine, Politics, Science | 17 Comments »

    Obamacare = Medicaid

    Posted by Michael Kennedy on 8th May 2015 (All posts by )

    emergency

    I have been interested in health care reform for some time and have proposed a plan for reform. It is now too late for such a reform as Obamacare has engaged the political apparatus and sides have been taken. The Obamacare rollout was worse than anticipated and it was hoped that the Supreme Court would have mercy on the country, but that didn’t happen and it has been the law for two years.

    What has it accomplished ? Well, the forecast drop in ER visits hasn’t happened. It also didn’t happen in Massachusetts when that plan took effect.

    Wasn’t Obamacare supposed to solve the problem of people going to the ER for routine medical problems? We were told that if everyone had “healthcare” — either through the ACA exchanges or through Medicaid expansion — people would be able to go to their family doctors for routine care and emergency rooms would no longer be overrun by individuals who aren’t actually experiencing emergencies.

    As it turns out, Medicaid patients can’t get appointments with physicians.

    “America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.

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    Posted in Business, Health Care, Law Enforcement, Leftism, Medicine, Obama, Politics | 7 Comments »

    Myopia and why it is increasing.

    Posted by Michael Kennedy on 25th April 2015 (All posts by )

    myopia

    A couple of interesting articles about the increasing incidence of myopia in children.

    Myopia isn’t an infectious disease, but it has reached nearly epidemic proportions in parts of Asia. In Taiwan, for example, the percentage of 7-year-old children suffering from nearsightedness increased from 5.8 percent in 1983 to 21 percent in 2000. An incredible 81 percent of Taiwanese 15-year-olds are myopic.

    The first thought is that this is an Asian genetic thing. It isn’t.

    In 2008 orthoptics professor Kathryn Rose found that only 3.3 percent of 6- and 7-year-olds of Chinese descent living in Sydney, Australia, suffered myopia, compared with 29.1 percent of those living in Singapore. The usual suspects, reading and time in front of an electronic screen, couldn’t account for the discrepancy. The Australian cohort read a few more books and spent slightly more time in front of the computer, but the Singaporean children watched a little more television. On the whole, the differences were small and probably canceled each other out. The most glaring difference between the groups was that the Australian kids spent 13.75 hours per week outdoors compared with a rather sad 3.05 hours for the children in Singapore.

    This week the Wall Street Journal had more. There are some attempts to deal with the natural light effect.

    Children in this small southern Chinese city sit and recite their vocabulary words in an experimental cube of a classroom built with translucent walls and ceilings. Sunlight lights up the room from all directions.

    The goal of this unusual learning space: to test whether natural, bright light can help prevent nearsightedness, a problem for growing numbers of children, especially in Asia.

    The schools have tried to get Chinese parents to send the kids outdoors more but it doesn’t seem to work.

    And it isn’t limited to Asians.

    In the U.S., the rate of nearsightedness in people 12 to 54 years old increased by nearly two-thirds between studies nearly three decades apart ending in 2004, to an estimated 41.6%, according to a National Eye Institute study.

    But Asians with their focus on education are the most effected.

    A full 80% of 4,798 Beijing teenagers tested as nearsighted in a study published in the journal PLOS One in March. Similar numbers plague teens in Singapore and Taiwan. In one 2012 survey in Seoul, nearly all of the 24,000 teenage males surveyed were nearsighted.

    So, what to do ?

    Though glasses can correct vision in most myopic children, many aren’t getting them. Sometimes this is because parents don’t know their children need glasses or don’t understand how important they are for education. Other times, cultural beliefs lead parents to discourage their children from wearing them, according to Nathan Congdon, professor at Queen’s University Belfast and senior adviser to Orbis International, a nonprofit focused on preventing blindness. Many parents believe glasses weaken the eyes—they don’t.

    Getting kids to spend even small amounts of time outdoors makes a difference.

    Why myopia rates have soared isn’t entirely clear, but one factor that keeps cropping up in research is how much time children spend outdoors. The longer they’re outside, the less likely they are to become nearsighted, according to more than a dozen studies in various countries world-wide.

    One preliminary study of 2,000 children under review for publication showed a 23% reduction in myopia in the group of Chinese children who spent an additional 40 minutes more outside each day, according to Ian Morgan, one of the researchers involved in the study and a retired professor at Australian National University in Canberra. (He still conducts research with Sun Yat-sen University in the Chinese city of Guangzhou.)

    That is a very significant effect of small changes in behavior. Now the researchers are trying something new.

    Dr. Morgan, Dr. Congdon and a team from Sun Yat-sen are now testing, as reported recently in the science magazine Nature, a so-called bright-light classroom made of translucent plastic walls in Yangjiang to see if the children can focus and sit comfortably in the classroom. So far it appears the answer is yes.

    In 2007, Donald Mutti and his colleagues at the Ohio State University College of Optometry in Columbus reported the results of a study that tracked more than 500 eight- and nine-year-olds in California who started out with healthy vision6. The team examined how the children spent their days, and “sort of as an afterthought at the time, we asked about sports and outdoorsy stuff”, says Mutti.

    It was a good thing they did. After five years, one in five of the children had developed myopia, and the only environmental factor that was strongly associated with risk was time spent outdoors6. “We thought it was an odd finding,” recalls Mutti, “but it just kept coming up as we did the analyses.” A year later, Rose and her colleagues arrived at much the same conclusion in Australia7. After studying more than 4,000 children at Sydney primary and secondary schools for three years, they found that children who spent less time outside were at greater risk of developing myopia.

    What is the mechanism ? Maybe it is this.

    The leading hypothesis is that light stimulates the release of dopamine in the retina, and this neurotransmitter in turn blocks the elongation of the eye during development. The best evidence for the ‘light–dopamine’ hypothesis comes — again — from chicks. In 2010, Ashby and Schaeffel showed that injecting a dopamine-inhibiting drug called spiperone into chicks’ eyes could abolish the protective effect of bright light11.

    Retinal dopamine is normally produced on a diurnal cycle — ramping up during the day — and it tells the eye to switch from rod-based, nighttime vision to cone-based, daytime vision. Researchers now suspect that under dim (typically indoor) lighting, the cycle is disrupted, with consequences for eye growth. “If our system does not get a strong enough diurnal rhythm, things go out of control,” says Ashby, who is now at the University of Canberra. “The system starts to get a bit noisy and noisy means that it just grows in its own irregular fashion.”

    Another possible treatment is the use of atropine drops in the eye.

    Atropine, a drug used for decades to dilate the pupils, appears to slow the progression of myopia once it has started, according to several randomized, controlled trials. But used daily at the typical concentration of 1%, there are side effects, most notably sensitivity to light, as well as difficulty focusing on up-close images.

    In recent years, studies in Singapore and Taiwan found that a lower dose of atropine reduces myopia progression by 50% to 60% in children without those side effects, says Donald Tan, professor of ophthalmology at the Singapore National Eye Centre. He has spearheaded many of the studies. Large-scale trials on low-dose atropine are expected to start soon in Japan and in Europe, he says.

    More than a century ago, Henry Edward Juler, a renowned British eye surgeon, offered similar advice. In 1904, he wrote in A Handbook of Ophthalmic Science and Practice that when “the myopia had become stationary, change of air — a sea voyage if possible — should be prescribed”.

    Posted in China, Education, Health Care, Medicine, Science | 5 Comments »