Monday, October 31, 2005


The population of blogs on the internet has exploded. At last count, Technorati estimates there are at least 19 million blogs in existence, and this number is doubling every 5 months. While some blogs are automated producers of spam (with their own unusual physiology), the majority of blogs are written regularly by real people with real things to say.

The subset of medical blogs, the "medical blogosphere," has been created by a growing number of physicians, nurses, students, patients, scientists, social workers, administrators, engineers, IT professionals, consultants, and many other people involved in health care. One way of seeing at a glance what people are talking about is the Medical Blogosphere Tag Cloud, an abstraction of the most common keywords from medical blogs.

Grand Rounds, which is hosted each week by a rotating group of bloggers, is the easiest way to stay up to date with the best writing in medical blogs. Grand Rounds shares the same purpose as the annotated table of contents in printed medical journals like the NEJM and the Annals of Internal Medicine: it introduces noteworthy writing and encourages further reading.

I have the pleasure of hosting Grand Rounds this week. Here are the blogs:

Doctor Stories
As a psychiatrist, how do you terminate a relationship with someone who is dying, and you can't help them, and your shift in the hospital is over?
(See Intueri.)

Caring for a patient who is over 800 pounds presents challenges.
(See Chronicles of a Medical Mad House.)

Colonoscopies make people say unusual things.
(See Doc Around the Clock.)

What is Web 2.0?
The term Web 2.0 refers to a constantly evolving series of tools designed to put more of your information on the web under your own control, rather then on your own personal computer. Examples of these tools include web based mail (Gmail), photo sharing (Flickr), social bookmarking systems (, Wikipedia, feeds, and blogs. The Clinical Cases and Images Blog has an introduction to Web 2.0 in Medicine and creating medical presentations for the web and PDAs using free tools. Also see this web based tutorial on subscribing to medical feeds using bloglines.

Images in Clinical Medicine

(See the Pulmonary Roundtable.)

The Department of Halloween
Some hospitals have policies against staff members dressing up for Halloween. In this neonatal intensive care unit, the nurses dress up the babies.
(See Code Blog: Tales of a Nurse.)

An internal medicine resident investigates the historical and medical foundations of zombies and vampires.
(See Antifaust.)

New Vaccine Recommendations
New vaccine recommendations have been released for hepatitis A and pertussis.
(See Aetiology.)

A Case of Mistaken DNA
What happens when your brother, to whom you gave a bone marrow transplant, commits a crime, but your DNA is discovered?
(See the Genetics and Public Health Blog.)

Surgical Treatments for Gastroesophageal Reflux
There are at least two major endoscopic treatments for GERD. Kits for performing one of them, the ENTERYX procedure, were recently recalled by the FDA due to complications.
(See Aggravated DocSurg.)

Medical Education and Clinical Practice
Dr. Kent Bottles speaks to medical students and practicing physicians and offers thoughts on blogging.
(See Sound Practice.)

A few simple rules may improve hospital rounds.
(See Ad Libitum.)

Diabetes Mellitus
The prevalence of diabetes differs by racial group. Diabetes is particularly common among Filipino-Americans.
(See Parallel Universes.)

A large number of pets have diabetes, and their owners care for them.
(See Diabetes Mine.)

Hurricane Relief
Enoch Choi, who previously travelled to Louisiana, is deploying as part of the Department of Health and Human Services Hurricane Relief Program.
(See Medmusings.)

Images in Knitting

(See Kevin, MD and Craftster.)

Health Insurance
Should in vitro fertilization be covered by health insurance? Perhaps not, argues Insureblog. Healthy Concerns provides another view.

Wal-Mart has recently been pressured to offer its employees improved health care benefits.
(See the Health Business Blog.)

Code Blue for Code Blue
The author argues that the overhead "Code Blue" page for hospital emergencies is archaic and should be stopped.
(See GruntDoc.)

Information Technology
Just in time for Halloween, an IT specialist talks about the theft of medical data.
(See the Healthcare IT Guy.)

Healthcare IT remains prominently in the headlines.
(See Hospital Impact.)

The Department of Skepticism
A new machine adds electrons to water. Orac responds.
(See Respectful Insolence.)

Patient Stories
Stephanie Wukovitz, a blogger, composer, and type 1 diabetic on hemodialysis, just received a simultaneous kidney and pancreas transplant.
(See Fearful Symmetry.)

Letter from the Editor
Dr. George Lundberg, the editor of Medscape General Medicine, in a video blog editorial asks "Is there a place for medical blogs in a medical media company?" (The text is here.) Dr. Lundberg argues that the content of blogs has historically existed in many other forms, and he worries about issues of privacy and accuracy. Respectful disagreement is offered by Clinical Cases and Images, DB's Medical Rants, and Steve Hoffman (who worked with Dr. Lundberg at Medscape).

Scientific Advances
A new method for distinguishing between bacterial and viral meningitis has been published.
(See California Medicine Man.)

A novel anti-freeze protein from snow fleas may have a role in preserving organs for transplant.
(See the Biotech Weblog.)

The Cancer Battle
Warfare is an analogy for the practice of oncology.
(See the Cheerful Oncologist.)

Women's Health
Emergency contraception is post-coital birth control. The FDA recently considered making Plan B (levonorgestrel) over the counter. The basics of emergency contraception are reviewed.
(See the Well-Timed Period.)

Obstetricians report being pressured to perform more caesarian sections rather than vaginal births.
(See Milliner's Dream.)

The relationship between electronic fetal monitoring, cerebral palsy, caesarian sections, and obstetric lawsuits is complex. Neither fetal monitoring nor caesarian sections have decreased the rate of cerebral palsy.
(See Red State Moron.)

Flupocalypse (term by Warren Ellis)
Avian influenza is a real threat. Topics of recent posts have included the possibility of an avian flu pandemic, the flu vaccine, hoarding of Tamiflu, patent issues, potential flu scenarios, the responsibility of health professionals to treat patients with avian flu, and unwarranted flu hysteria.
(See Shrinkette, the Bioethics Blog, KidneyNotes and H591.)

The Emergency Department
Tension often exists between the Emergency Department, which wants patients admitted quickly to the hospital, and the admitting service, which wants patients worked up prior to admission.
(See Dr. Tony.)

Quite possibly, this is the best emergency room nurses' music video ever.
(See GruntDoc.)

That concludes this week's Grand Rounds. Thank you for your submissions.

Next week's Grand Rounds will be hosted at the MSSP Nexus Blog.

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Sunday, October 30, 2005

Will the New Cervical Cancer (HPV) Vaccine Encourage Sexual Activity?

...because fear of cervical cancer is a major reason why teenagers avoid sex.

From the Washington Post:
A new vaccine that protects against cervical cancer has set up a clash between health advocates who want to use the shots aggressively to prevent thousands of malignancies and social conservatives who say immunizing teenagers could encourage sexual activity.

Although the vaccine will not become available until next year at the earliest, activists on both sides have begun maneuvering to influence how widely the immunizations will be employed...
Technorati Tags: HPV, Cervical Cancer, HPV Vaccine, Cervical Cancer Vaccine

Kidney Thieves in Pakistan Earthquake Zone

From the Times Online:
Police in Pakistan have arrested a gang of Afghans who were caught removing kidneys from the bodies of Kashmiri earthquake victims. The four men were discovered carrying a freezer box containing 15 organs from corpses trapped in rubble...

It was unlikely that the organs were in a fit state for any successful transplantation, but the men had planned to sell them to hospitals in Lahore and Rawalpindi. They had been working as jobbing butchers in Peshawar and were said to have believed that the kidneys would make their fortunes...
Technorati Tags: Pakistan Earthquake, Earthquake, Kidney Thieves, Organ Transplantation

Weekend Photos: Puerto Rico

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Saturday, October 29, 2005

Update on the Unknown Smell in New York City

First commented on here. From the NYT, "Good Smell Vanishes But It Leaves Air of Mystery":
The night air all over Manhattan was brisk, with a hint of winter and a dash of something sweetly out of the ordinary. Some thought it smelled like maple syrup. Some said caramel, or a freshly baked pie, or Bit-O-Honey candy bars.

From downtown Manhattan to the Upper East Side, Prospect Heights in Brooklyn and parts of Staten Island, the question was the same on Thursday night and into early yesterday: What was that smell?

The aroma not only revived memories of childhood, but in a city scared by terrorism, it raised vague worries about an attack deviously cloaked in the smell of grandma's kitchen.

It was so seductive that many New Yorkers found themselves behaving strangely, succumbing to urges usually kept under wraps...

The chase led the city's environmental bloodhounds to some interesting places. Investigators working on a tip checked the Jacques Torres Chocolate Haven in SoHo, but the owner insisted he had not been the culprit. His staff had spent the afternoon roasting almonds, he said. And anyway, chocolate, for those who really know, smells bitter, not sweet...

Experts say that no human sense is more directly connected to the emotions than the sense of smell. "Before we know we are even in contact with a smell we have already received it and reacted to it," a professional perfumer, Mandy Aftel, said. "Smells come in without language and go directly to the emotional center of the brain. That's why they are so connected to memory..."
More updates at the New York Daily News and the Washington Post.

Technorati Tags: New York City Smell, New York City, Smell

Hilarious Journal Articles #20: Scanning the Brains of Anxious People with Headaches May Save Money

From the Journal of Neurology, Neurosurgery, and Psychiatry:
Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache.

Journal of Neurology, Neurosurgery, and Psychiatry. 2005;76:1558-1564.

Objectives: Aims were to investigate (a) whether neuroimaging in patients with chronic daily headache reassures patients or fails to reassure them and/or worsens outcome, impacting on service use, costs, health anxieties, and symptoms, and (b) whether this reassurance process occurs differentially in patients with different levels of psychological morbidity.

Methods: Design: randomised controlled trial; setting: headache clinic in secondary care, South London; participants: 150 patients fulfilling criteria for chronic daily headache, stratified using the Hospital Anxiety and Depression Scale (HADS); intervention: treatment as usual or the offer of an MRI brain scan; main outcome measures: use of services, costs, and health anxiety.

Results: Seventy six patients were randomised to the offer of a brain scan and 74 patients to treatment as usual. One hundred and thirty seven (91%) primary care case notes were examined at 1 year, 103 (69%) patients completed questionnaires at 3 months and 96 (64%) at 1 year. Sixty six (44%) patients were HADS positive (scored >11 on either subscale). Patients offered a scan were less worried about a serious cause of the headaches at 3 months (p = 0.004), but this was not maintained at 1 year; other health anxiety measures did not differ by scan status. However, at 1 year HADS positive patients offered a scan cost significantly less, by £465 (95% confidence interval (CI): –£1028 to –£104), than such patients not offered a scan, due to lower utilisation of medical resources.

Conclusions: Neuroimaging significantly reduces costs for patients with high levels of psychiatric morbidity, possibly by changing subsequent referral patterns of the general practitioner.
Via Medscape.

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Weekend Photos: Thailand

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Friday, October 28, 2005

News from New York #13: Unexplained Good Smell Perplexes New Yorkers

I smelled this yesterday and wondered what it was. Apparently, I wasn't alone. From the NYT:
An unseen, sweet-smelling cloud drifted through parts of Manhattan last night. Arturo Padilla walked through it and declared that it was awesome.

"It's like maple syrup. With Eggos. Or pancakes," he said. "It's pleasant..."

By 11 p. m., the search had turned up nothing harmful, according to tests of the air. Reports continued to come in from as far north as 112th Street shortly before midnight. In Lower Manhattan, where the smell had begun to fade, it was back, stronger than before, by 1 a.m.

"We are continuing to sample the air throughout the affected area to make sure there's nothing hazardous," said Jarrod Bernstein, an emergency management spokesman. "What the actual cause of the smell is, we really don't know..."
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I will be hosting Grand Rounds next week. Please email your submissions by Monday, October 31st at 6PM EST to kidneynotes [at] gmail [dot] com.

Thursday, October 27, 2005

Medical Blogosphere Tag Cloud Weekly Update

The following are the top 100 keywords from the Medical Blogosphere Tag Cloud, a way of seeing at a glance what people are talking about online. The full cloud with links to individual posts is here.
access ... air ... american ... antibiotics ... avian flu ... battle ... benefit ... bird flu ... blog ... blogosphere ... bottles ... bush ... california ... canada ... caps ... carnival ... case ... clinic ... community ... computer ... death ... diagnosis ... doctors ... driven ... drugs ... email ... emergency room ... england ... family ... feed ... flu ... flu pandemic ... furthermore ... georgia ... google ... grand rounds ... guess ... health care ... heart ... hope ... hospitals ... hurricane katrina ... idea ... intelligent design ... internal medicine ... job ... kent ... lawyers ... love ... mail ... malpractice ... marketing ... massachusetts ... medical practice management ... medical records ... medical school ... medications ... medicine ... mental health ... merck ... money ... nejm ... new england journal ... new orleans ... new york ... nurses ... nyt ... palo alto ... pandemic ... parents ... pediatrician ... pfizer ... pharmaceutical companies ... photo ... physicians ... podcast ... primary care ... quality ... reading ... scientists ... search ... service ... state ... story ... suffering ... target ... texas ... therapy ... tort reform ... united states ... vaccines ... vioxx ... wall ... wall street ... wall street journal ... war ... ward ... washington ... white ... wsj
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Nephrology Cases #6: Clinical Outcomes of Chronic Kidney Disease (In Order Of Preference)

Chronic kidney disease sometimes follows a progressive course that ends in transplantation, dialysis, or death. Many outcomes are possible, and nephrologists try to ensure the best ones for their patients. In decreasing order of preference, the range of outcomes for patients with chronic kidney disease may include:
  1. Stable kidney function, usually through blood pressure control and the use of medications. Dialysis or transplantation is never needed.
  2. Kidney transplantation.
  3. Hemodialysis with a native arteriovenous fistula, which should be created and allowed to mature months before dialysis is needed. Some patients choose (and prefer) peritoneal dialysis instead.
  4. Hemodialysis with a synthetic graft, which is easier to place then a fistula, can be used sooner, but has a higher rate of complications.
  5. Hemodialysis with a tunneled dialysis catheter, which is not desirable for long term access because it has a high rate of complications, particularly infections.
  6. Urgent hemodialysis with a temporary (nontunneled) catheter.
  7. Unanticipated death due to untreated kidney failure.
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Medical School Professors Endorse Anti-Drug Ad Statement

Via Adrants:
Showing their opposition to prescription drug advertising, 211 professors from U.S. medical schools endorsed a statement that "direct-to-consumer marketing of prescription drugs should be prohibited." The statement's endorsers include prominent medical school professors from Harvard, Johns Hopkins, University of Pennsylvania, Columbia, Stanford, Yale, Duke, University of California, San Francisco and other top medical schools, along with two former editors-in-chief of the New England Journal of Medicine. Commercial Alert wrote and organized the statement, and released it today...
The full text of the statement is at Commercial Alert.

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Wednesday, October 26, 2005

Panel Recommends Whooping Cough Vaccine for Adults

Via The Washington Post:
The Advisory Committee on Immunization Practices, which helps set federal vaccination guidelines, voted unanimously to recommend that all non-elderly adults get a pertussis booster...
Technorati Tags: Pertussis, Whooping Cough, Vaccination

Sex Selection Clinical Trial is Launched

From UPI:
U.S. physicians have reportedly started a clinical trial to assess the effects of allowing couples to choose the gender of unborn children.

The journal Nature said doctors can use a technology called preimplantation genetic diagnosis to examine the sex of embryos that they create by assisted reproduction. Couples then select male or female embryos to implant in the mother's uterus.
Technorati Tags: Pregnancy, Sex Selection, Preimplantation Genetic Diagnosis

New England Journal of Medicine Audio Interview: The Metrics of the Physician Brain Drain

The latest NEJM interview is with Dr. Fitzhugh Mullan and Sreekanth Chaguturu on the health care brain drain.

The NEJM podcast feed is here.

The free full text article is Metrics of the Physician Brain Drain.
Background There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians.

Methods Data on the countries of origin, based on countries of medical education, of international medical graduates practicing in the United States, the United Kingdom, Canada, and Australia were obtained from sources in the respective countries and analyzed separately and in aggregate. With the use of World Health Organization data, I computed an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration.

Results International medical graduates constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia, and lower-income countries supply between 40 and 75 percent of these international medical graduates. India, the Philippines, and Pakistan are the leading sources of international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines. Nine of the 20 countries with the highest emigration factors are in sub-Saharan Africa or the Caribbean.

Conclusions Reliance on international medical graduates in the United States, the United Kingdom, Canada, and Australia is reducing the supply of physicians in many lower-income countries.
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What Do You Get When You Design A Condom Men Want To Use? Sued.

Via Salon, which often entertains:
In a courtroom in New Jersey, lawyers are arguing about condom size.

The case is a patent-infringement suit. In the normal run of events, such cases are mind-numbingly boring. But when the product in question is a condom, and the patents at issue refer to design modifications that are supposed to increase male pleasure during the sexual act, you're not dealing with a normal legal situation...

We'll get back to condom size in a moment. (Suffice it to say, size matters.) For now, the basics are this: A company called Portfolio Technologies (PTI) is suing the conglomerate that owns the makers of Trojan condoms, who recently brought to market a popular condom called the Twisted Pleasure...

This isn't PTI's first attempt to defend its patents. Five years ago, it failed in a similar effort to prevent another condom, the Inspiral, from being distributed in the United States. And here is where a kinky story starts to get a little bizarre. All three condoms -- the Pleasure Plus, the Inspiral and the Trojan Twisted Pleasure -- were designed by the same man, one Dr. Alla Venkata Krishna Reddy...
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Legionnaires' Disease Class Action Suit Seeks $600M

A class action lawsuit seeking $600 million in damages has been launched on behalf of a man who became ill following the deadly outbreak of legionnaires' disease in an East Toronto nursing home.

Gerald Glover, 58, was infected with legionnaires' disease earlier this month during the outbreak at the Seven Oaks Home for the Aged in Scarborough.

His family is baffled because Glover lives in a building across the parking lot from the home, and they say he hasn't even been in Seven Oaks...
More on Legionnaires' Disease here.

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McDonald's to Add Nutrition Facts to Packaging

From The New York Times:
That Double Quarter Pounder With Cheese? It has 730 calories. A Sausage Biscuit With Egg? It will use up 49 percent of an adult's daily recommended fat intake.

That information and more will be on the packaging of most McDonald's food items starting next year, the company announced at a news conference in a Chicago restaurant Tuesday. The nutrition labeling, which is intended to be even easier to read than the labels on packaged foods, will tell customers how many calories, grams of fat, protein, carbohydrates and sodium are in each product and will include a chart showing the percentage of the government's recommended daily intakes.
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Doctor Stories #6: My Back is Killing Me

My Back is Killing Me, from Chronicles of a Medical Mad House.

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Hemolytic Uremic Syndrome in New York City

From the NY Bureau of Communicable Disease:
Recently three cases of E. coli O157:H7 were reported in children who attend separate daycares throughout New York City. The cases are not related to one another and no outbreaks have occurred. DNA typing has not connected these cases to a known statewide outbreak, and DOHMH wishes to remind physicians, particularly those caring for children, to include E. coli O157:H7 in the differential diagnosis of patients presenting with gastrointestinal illness (particularly bloody diarrhea or diarrhea with fever), HUS, hemolytic anemia or thrombocytopenic purpura (TTP). Note that the absence of high fever, presence of grossly bloody stools, and severity of abdominal findings in HUS can lead to the mistaken diagnosis of intussusception in children, and inflammatory bowel disease or ischemic colitis in the elderly.

We receive an average of 20 case reports per year, 29% are in children under 5. The number of case reports received in August and September has not been unusual. The ill children are 9-22 months old with illness onset between September 13th and September 29th. Two of the children have been diagnosed with HUS and were hospitalized.

Illness with E. coli O157:H7 typically begins 3 to 4 days after exposure and patients develop watery diarrhea; the diarrhea resolves without progression and the illness is mild in 25-75% of patients. In those in whom the illness progresses, bloody diarrhea usually begins on the second or third day, with the amount of blood ranging from streaks to stools that consist of gross blood. Studies have shown that treating with antibiotics may increase the risk of developing HUS. Antibiotic treatment is not recommended except in those patients who are septic...

To identify additional suspected cases of E. coli 0157:H7 or HUS and to help us determine whether there is a common source of exposure, we request that all patients, especially children, with bloody diarrhea and/or diarrhea with fever be tested for E. coli O157:H7 by culture. It is important to request a stool culture regardless of whether shiga toxin testing is also performed. Isolates should be forwarded to the DOHMH Public Health Laboratory for confirmation and molecular typing. Please report all suspected or confirmed cases of E. coli 0157:H7 or HUS to the Bureau of Communicable Disease: During business hours: 212-788-9830; After hours, contact the Poison Control Center: 212-764-7667 or 1-800-222-1222
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Tuesday, October 25, 2005

Searching, the social bookmarking site, now allows searching.

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Seeding Dictionaries With False Entries to Spot Copyright Violations

The New Yorker discusses the common practice of seeding dictionaries with false entries to pick up copyright violations:
Turn to page 1,850 of the 1975 edition of the New Columbia Encyclopedia and you’ll find an entry for Lillian Virginia Mountweazel, a fountain designer turned photographer who was celebrated for a collection of photographs of rural American mailboxes titled “Flags Up!” Mountweazel, the encyclopedia indicates, was born in Bangs, Ohio, in 1942, only to die “at 31 in an explosion while on assignment for Combustibles magazine.”

If Mountweazel is not a household name, even in fountain-designing or mailbox-photography circles, that is because she never existed. “It was an old tradition in encyclopedias to put in a fake entry to protect your copyright,” Richard Steins, who was one of the volume’s editors, said the other day. “If someone copied Lillian, then we’d know they’d stolen from us...”
Technorati Tags: Dictionary, Copyright

Grand Rounds Vol. 2 #5

Grand Rounds Vol. 2 #5, this week's best posts of the medical blogosphere, is up at Hospital Impact.

I will be hosting Grand Rounds next week. Please email your submissions to kidneynotes [at] gmail [dot] com.

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Monday, October 24, 2005

Red Blood Cell Skeletons Are Geodesic Domes

From Science Daily:
A human red blood cell is a dimpled ballerina, ceaselessly spinning, tumbling, bending, and squeezing through openings narrower than its width to dispense life-giving oxygen to every corner of the body. In a paper published in the October issue of Annals of Biomedical Engineering, which was made available online on Oct. 21, a team of UCSD researchers describe a mathematical model that explains how a mesh-like protein skeleton gives a healthy human red blood cell both its rubbery ability to stretch without breaking, and a potential mechanism to facilitate diffusion of oxygen across its membrane...
Technorati Tags: Red Cells, Blood, Red Blood Cells, Buckminster Fuller

Fearing the Remote, Ignoring Real Dangers

From an article by Abigail Zuger in the New York Times:
Just in time for Halloween, the usual yearly ritual of terror by headline is now playing itself out in medical offices everywhere. Last year it revolved around flu shots; a few years ago it was anthrax and smallpox; a few years before that it was the "flesh-eating bacteria"; and before that it was Ebola virus, and Lyme disease and so on back into the distant past. This year it's the avian flu.

"I was crossing Third Avenue yesterday and I was coughing so hard I had to stop and barely made it across," a patient told me last week. "I'm really scared I'm getting the avian flu."

I just looked at him. What could I say? He has smoked two packs of cigarettes a day for the last 50 years. He has coughed and wheezed and gasped his way across Third Avenue now for the last 10 years. His emphysema is not going to get any better, but it might stop getting worse if he were to stop smoking...
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Hilarious Journal Articles #19: Viagra Helps the Heart Respond to Stress

Apparently Viagra, a phosphodiesterase inhibitor, was originally designed as a medication for the heart, but it failed in initial trials. It was shelved until someone realized that Viagra's unusual side effect of improving erections might be potentially useful.

Now, an article in Circulation has resurrected interest in the cardiovascular benefits of Viagra. From Forbes:
Viagra, famous for improving men's sexual function, also appears to reduce the effects of hormonal stress on the heart by 50 percent, claims a report by researchers at Johns Hopkins University...

"Unlike what was previously thought, drugs like Viagra can in fact alter heart function," said lead researcher Dr. David Kass, a professor of medicine at Johns Hopkins. "It alters it particularly when the heart is stimulated by hormones..."

Kass noted that his group is starting a clinical trial to see if Viagra can be effective in patients with heart failure. "If you gave a drug like Viagra not just acutely, but chronically, you might be able to improve heart function and reduce the chronic stress response in patients with hypertrophy..."
From the article in Circulation, "Sildenafil Inhibits ß-Adrenergic–Stimulated Cardiac Contractility in Humans":
Background— Sildenafil inhibits phosphodiesterase 5 (PDE5A) to elevate intracellular cGMP and to induce vasodilation. This effect has led to its use for treating erectile dysfunction. Although its influence on rest heart function has appeared minimal, recent animal studies suggest that sildenafil can have potent effects on hearts stimulated by ß-adrenergic or pressure overloads. We therefore tested whether sildenafil blunts dobutamine-stimulated cardiac function in humans.

Methods and Results— Thirty-five healthy volunteers underwent a randomized, double-blind, placebo-controlled study in which cardiac function was assessed in response to dobutamine before and after oral sildenafil (100 mg, n=19) or placebo (n=16). Echo Doppler and noninvasive blood pressure data yielded load-independent contractility indexes (maximal power index and end-systolic elastance), ejection fraction, and measures of diastolic function. In the initial dobutamine test, systolic and diastolic function improved similarly in both treatment groups (eg, peak power index rose 80±28% in the placebo group and 82±31% in the sildenafil group; P=NS). However, in subjects who then received sildenafil, their second dobutamine response was significantly blunted, with peak power, ejection fraction, and end-systolic elastance changes reduced by 32±34%, 66±64%, and 56±63%, respectively (each P<0.001 versus the initial response). This contrasted to the placebo group, which displayed similar functional responses with both dobutamine tests. Sildenafil treatment did not significantly alter diastolic changes induced by dobutamine compared with results with placebo.

Conclusions— PDE5A inhibition by sildenafil blunts systolic responses to ß-adrenergic stimulation. This finding supports activity of PDE5A in the human heart and its role in modifying stimulated cardiac function.
(According to another article, Viagra also helps save endangered species.)

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The Fight Over Citywide Wireless Internet

From Slate:
This wireless fantasy land, where wireless is as much a public utility as water and electricity, has become irresistible to hundreds of cities. Earlier this month, Philadelphia chose EarthLink to build and manage a wireless network spanning the entire city. Cost to taxpayers? $0. The deal requires EarthLink to put together the network on its own dime—an estimated $10 million to $15 million—and share future revenues with the city. To recoup its investment, EarthLink will charge users $20 a month (half that to low-income households). Chicago; Miami Beach; Milwaukee, Wisc.; and Portland, Ore., are also exploring muni wireless. Recently, Google offered to make all of San Francisco wireless for free, reaping revenue by targeting ads to users...
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"Ten Super Foods For Better Health"

The Center for Science in the Public Interest has released a list of "Ten Super Foods For Better Health." They aren't yet in violation of the Food, Drug, & Cosmetic Act, but if anyone steps over the line, the FDA will be there. (See the previous post.)
  1. Sweet Potatoes
  2. Grape Tomatoes
  3. Skim Milk
  4. Blueberries
  5. Wild Salmon
  6. CrispBread
  7. Instant Brown Rice
  8. Watermelon
  9. Diced Butternut Squash
  10. Ready-to-Eat Bagged Greens
Via Health-Hack.

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FDA Targeting Makers of Cherry Products

The FDA has sent warning letters to makers of various cherry products advising them they are in serious violation of the Federal Food, Drug, and Cosmetic Act ("The Act") by advertising that cherries can cure arthritis, cancer, and gout. The makers of Tart Cherry Juice Concentrate, for example, received this sternly worded letter.

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Tetanus and the Pakistan Earthquake

From The Daily Times:
Five people have died from tetanus and 42 other cases are being treated in the aftermath of Pakistan’s devastating earthquake, the Health Ministry has said.

Pakistani and international aid workers have launched a massive campaign to vaccinate millions of people who survived the disaster but whose wounds could become infected...
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The Physiology of Spam Blogs (Part 2)

If you've ever wondered why your post now appears on a blog about Vioxx, Niall Kennedy has an introduction. Also see Google Blogoscoped.

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Sunday, October 23, 2005

News from New York #12: World Sumo Wrestling Challenge

Matt Fraction via Warren Ellis:
Two dozen gigantic fat men in diapers and sandals shuffled across 7th avenue yesterday morning from the Hotel Pennsylvania into the tubby, tubby destiny awaiting them at Madison Square Garden.

Literally, tens of tens of Sumonisatas will almost fill the more modestly-priced seating sections of parts of the Garden for the World Sumo Challenge tonight at 8 PM, where prize purse of $13,000 dollars promises to keep these ginormous gladiators Super-Sized for weeks to come.

While more discerning Sumo snobs might scoff at a fight-card with but three native Japanese combatants surrounded by the pudgiest pugilists the Former Soviet Bloc Countries have to offer, the mood on the street crackles with electricity scented more of crispy, crispy bacon than of the usual ozone and urine.

All of New York's ironic obscuro-sports aficionados will testify that tensions outside the Garden feel more taut than a wrapped thong diaper as Torsten "Der Todespringer" Scheibler, Gold Medal winner in last week's Osaka Sumo Tourney and 418-pound flab of fettesau fury and Deszo Libor, the Hugongous Hungarian and Osaka silver-taker, prepare kick the sacred sand and slap the sacred man-teets, twin towers of power not even the ladyboys of the Taliban can knock down.

Unfounded and debunked rumors claiming that Levan Altunashvili, Jondo Dabrundashvili, and Levan Ebanoidze do not hail from the Republic of Georgia but rather from the suburbs of Atlanta, Georgia, spread like wildfire this afternoon before the truth shone through.

While Mr. and Mrs. America might cozy up in the warm safety of their living rooms for Game One of the White Sox-Astros World Series (Sox in 6), the real action in the sporting world this piss-drizzly October night happens here in New York City with this pandemic outbreak of fighting fat men and the arena that loves them.
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New LED Lights: White Light, No Heat

Via Worldchanging, which wins points for the title:
An accidental discovery at Vanderbilt University may well be the key to making light-emitting diodes the dominant lighting technology of the century. Up until very recently, the only way to make "white" light was to add yellow phosphors to bright blue LEDs. It wasn't quite right, though, as even the best "white" LED retained a blue tint. This week, we got the news that a chemistry grad student at Vanderbilt has stumbled on a way to make broad-spectrum white LEDs using quantum dots -- and in doing so, he may well have kicked off a revolution.

Michael Bowers was making quantum dots, tiny nanocrystals just a few dozen atoms across. Crystals at that scale often have unusual properties, and the ones that Bowers created were no exception. When he illuminated his batch with a laser, rather than the blue glow he expected, out came a rich white light, similar in spectrum to sunlight.

Bowers then took a polyurethane sealing liquid, mixed in some of his dots, and coated a blue LED. Although the resulting bulb -- pictured above -- is crude, it puts out white light. Its visible spectrum is similar to a typical incandescent bulb, but it puts out fifty times the light-per-watt, and lasts sixty times longer. One key reason for its efficiency is that it doesn't put out the infrared light typical of a regular light bulb; despite being much brighter, it's still far cooler to the touch. Completely by accident, Bowers had come up with a technology that possessed the quality of incandescent light, but none of its drawbacks...
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Wall Street Journal Avian Flu News Tracker

The Wall Street Journal, as they did for Hurricane Katrina, has an Avian Flu News Tracker.

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Weekend Photos: Thailand

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Bariatric Surgery Risks Higher Than Were Believed

From The Washington Post:
Stomach surgery to treat obesity is much riskier than had been thought, with patients facing a far greater chance of being hospitalized and dying following the increasingly popular operations, according to two large new studies.

One analysis of more than 60,000 California patients found they were twice as likely to require hospitalization after the operations than before, while the second study of federal data from more than 16,000 patients nationwide found the chance of dying after being released from the hospital was significantly higher than earlier studies indicated.
From the article in JAMA:
Results A total of 16 155 patients underwent bariatric procedures (mean age, 47.7 years [SD, 11.3 years]; 75.8% women). The rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs 1.5%, 4.8% vs 2.1%, and 7.5% vs 3.7% at 30 days, 90 days, and 1 year, respectively; P<.001). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1% vs 3.9% at 1 year; P<.001). After adjustment for sex and comorbidity index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged ≥75 years; n = 136) than for those aged 65 to 74 years (n = 1381; odds ratio, 5.0; 95% confidence interval, 3.1-8.0). The odds of death at 90 days were 1.6 times higher (95% confidence interval, 1.3-2.0) for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and comorbidity index.

Conclusions Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested and associated with advancing age, male sex, and lower surgeon volume of bariatric procedures. Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients.
Technorati Tags: Bariatric Surgery, Stomach Surgery, Washington Post, JAMA

"The Dog Flu" Is Canine Influenza

"Influenza Virus Infection in Racing Greyhounds" from Emerging Infectious Diseases (CDC):
The influenza virus in canine lungs was unexpected since no influenza virus infection in dogs had been reported...

In conclusion, recent outbreaks of hemorrhagic pneumonia and associated deaths in Iowa racing greyhounds were primarily due to infection by an H3N8 influenza virus genetically and antigenically similar to equine influenza viruses. This conclusion can be supported by a previous report of fatal hemorrhagic pneumonia by H3N8 virus infection in racing greyhounds in Florida. The fact that greyhounds in 2 different racetracks, which are in geographically remote sites in Iowa, simultaneously died of the disease without the involvement of sick horses suggests that the influenza virus isolate is likely a canine-adapted strain and able to perpetuate and spread among dogs...
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Saturday, October 22, 2005

Taiwan To Ignore Tamiflu Patent And Manufacture Their Own

From The BBC:
Taiwan has responded to bird flu fears by starting work on its own version of the anti-viral drug, Tamiflu, without waiting for the manufacturer's consent.

Taiwan officials said they had applied for the right to copy the drug - but the priority was to protect the public...
Technorati Tags: Tamiflu, Taiwan, Avian Flu, Avian Influenza

Doctor Stories #5: Punk Rock Angel

Punk Rock Angel, on Push Fluids.

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Email Turns 34 Years Old: Post From Gmail's Paul Buchheit on the Google Blog

From Paul Buchheit, Gmail's first engineer, on the Google Blog:
It's difficult to pin down the exact origin of email, but in October 1971, an engineer named Ray Tomlinson chose the '@' symbol for email addresses and wrote software to send the first network email.

At the time, it must not have seemed very important – nobody bothered to save that first message or even record the exact date. I've always thought that it would be fun to witness a little bit of history like that – to be there when something important happened. That's part of what drove me to join a little no-name startup named Google, and it's why I was excited when I was given a chance to create a new email product, now called Gmail.

Of course that wasn't the only reason why I wanted to build Gmail. I rely on email, a lot, but it just wasn't working for me. My email was a mess. Important messages were hopelessly buried, and conversations were a jumble; sometimes four different people would all reply to the same message with the same answer because they didn't notice the earlier replies. I couldn't always get to my email because it was stuck on one computer, and web interfaces were unbearably clunky. And I had spam. A lot of it. With Gmail I got the opportunity to change email – to build something that would work for me, not against me.

We had a lot of ideas, but first we spent a lot of time talking to all kinds of people about their email. They let us watch over their shoulders and helped us really understand how they use email and what they need from it. We didn't want to simply bolt new features onto old interfaces. We needed to rethink email, but at the same time we needed to respect that email already had over 30 years of history, thousands of existing programs, and nearly a billion users. So we started by learning which features were most important, and which problems were most aggravating. We also realized that solving everyone's problems was too big of a challenge for the first release. It would be better to build a product that a lot of people love, than one that everyone tolerates, and so that was our goal...
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Best Science Photographs of 2005

Via Slashdot. The photographs may be found on the official website, the BBC, and National Geographic.

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Experts Refute Anti-bacterial Soap Claims

From The Washington Post:
Antibacterial soaps and washes aren't any better than plain, old soap and water for fighting illness in the household, says a panel of federal health advisers.

They warned manufacturers they will have to prove their products' benefits or they may be restricted from marketing them...
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Nature's Bioterrorist: Avian Flu Article from The New Yorker

From The New Yorker:
Early last September, an eleven-year-old girl from Kamphaeng Phet, a remote village in Thailand, developed a high fever, a severe cough, and a sore throat. She lived with her aunt and uncle in a one-room wooden house—not much more than a hut on stilts. The family had fifteen chickens, which wandered freely beneath the plank floor, where the young girl often played and slept. Then, at the end of August, the chickens died. Within days, the girl was sick, too. Her aunt took her to the hospital, but the fever kept rising. The girl’s mother, who lived near Bangkok, where she worked at a factory, rushed to her bedside; sixteen hours later, her daughter was dead. In keeping with Thai custom, she was cremated immediately.

Avian influenza is nothing new in Thailand, or anywhere else where poultry are raised. Veterinarians often refer to it as the fowl plague, because in one form or another the disease has killed millions of chickens, turkeys, and other birds over the years. In 1983, the virus raced so rapidly through the Pennsylvania poultry population that health officials there were forced to slaughter nearly every chicken in the state. Until recently, however, humans rarely became infected with this type of virus. It had happened fewer than a dozen times since 1959, and in each case the illness was mild. But the strain that killed the girl from Kamphaeng Phet is different; in the past two years, it has caused the deaths of hundreds of millions of animals in nearly a dozen Asian countries. No such virus has ever spread so quickly over such a wide geographical area. Most viruses stick to a single species. This one has already affected a more diverse group than any other type of flu, and it has killed many animals previously thought to be resistant: blue pheasants, black swans, turtledoves, clouded leopards, mice, pigs, domestic cats, and tigers. Early in February, nearly five hundred open-billed storks were found dead in Thailand’s largest freshwater swamp, the Boraphet Reservoir. And the disease is no longer limited to Asia. In October, customs officers at the Brussels airport seized two infected eagles that had been smuggled from Thailand and destroyed them, along with the other animals held in quarantine at the airport...
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Some Vaginal Lubricants May Damage Sperm, Interfere With Fertility Treatments

From WebMD:
Some brands of vaginal lubricants commonly recommended to couples undergoing fertility treatments may actually damage sperm and reduce the chance of conception.

A new study shows three brands of vaginal lubricants, FemGlide, Replens, and Astroglide, damaged sperm integrity and activity (motility) in laboratory tests. But a fourth brand of vaginal lubricant, Pre-Seed, did not appear to cause significant damage to sperm...
Technorati Tags: Pregnancy, Fertility, Pre-Seed, PreSeed

Weekend Photos: Thailand

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Friday, October 21, 2005

Do Health Care Professionals Have A Duty To Treat Bird Flu Patients?

From the International Herald Tribune:
In A.D. 166, a smallpox epidemic struck Rome. Galen, who had already acquired a reputation for his dissections, fled the city. In 1382, Venice passed a law forbidding physicians to flee in times of plague, and other European cities followed suit. When the plague hit London in 1665, many of the city's physicians - the great Thomas Sydenham included - abandoned their patients to escape the outbreak. In 2003, there were nurses and physicians who refused to care for SARS-infected patients.

Whether wise or cowardly, all these health care workers were aware of a simple fact: Those treating patients are often among the first victims of virulent epidemics. In 2005, with the impending arrival of bird flu on our shores, the question arises: Do health care professionals have a duty to treat bird flu patients?
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"Medical Beer"

MedGadget has an excellent discussion of "medical beer," prohibition, and why many hospitals still have beer on their formularies.

Also see "Beer Plus: Beer with Additives."

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Deep Brain Stimulation Regulates Blood Pressure

From the Engineer:
The possibility of a patient lowering their blood pressure at the flick of a switch has been raised by research led by Oxford University, which shows that stimulating parts of the brain with electrodes can change a patient’s blood pressure...

Deep brain stimulation – placing very thin electrodes onto exact locations in the brain – is already used to relieve pain or to help Parkinsons’ sufferers to move better. Fifteen patients having the operation to implant electrodes for pain control agreed to take part in a study to see whether stimulating another location in the brain could alter blood pressure...

It was found that blood pressure could indeed be changed, and that it could be raised or lowered very precisely by stimulating different, very specific parts of the brain...
Abstract from the NeuroReport:
Deep brain stimulation can regulate arterial blood pressure in awake humans. Neuroreport. 16(16):1741-1745, November 7, 2005.

The periaqueductal grey matter is known to play a role in cardiovascular control in animals. Cardiovascular responses to electrical stimulation of the periventricular/periaqueductal grey matter were measured in 15 awake human study participants following implantation of deep brain stimulating electrodes for treatment of chronic pain. We found that stimulation of the ventral periventricular/periaqueductal grey matter caused a mean reduction in systolic blood pressure of 14.2+/-3.6 mmHg in seven patients and stimulation of the dorsal periventricular/periaqueductal grey matter caused a mean increase of 16.7+/-5.9 mmHg in six patients. A comparison between ventral and dorsal electrodes demonstrated significant differences (P<0.05). These changes were accompanied by analogous changes in diastolic blood pressure, pulse pressure, maximum dP / dt but not in the time interval between each R wave on the electrocardiogram.
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Thursday, October 20, 2005

The Splog Flu

The Blogger's Blog has details:
There are many names being created for the offensive, growing mass of spam blogs like spamnami, splogicane, splogsplosion, splogquake, splogstorm and the splog flu. But no matter what you call them spam blogs have quickly become the blogging industry's biggest problem. Perhaps calling it The Splog Flu might work best since splogs (spam blogs) seem to be growing at an ever increasing rate and infecting more and more services. Google's Blogger service has been blamed for the majority of the splogs and over the weekend they were attacked by a splognami of over 10,000 splogs. ZDNet reports that this past weekend there was a huge splog assault...
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New CDC Adult Immunization Recommendations

The new CDC adult immunization recommendations, including the Palm-based "Shots 2005" program, are here.

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How to Impersonate a Doctor

Two recent articles discuss impersonating doctors. In one, a Florida con man impersonates a pediatric heart surgeon to pick up women (courtesy of Kevin, M.D.). In another, the Weekly World News advises on how to impersonate a doctor to meet women.

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OpenOffice 2.0 Has Been Released

From 2.0 is the productivity suite that individuals, governments, and corporations around the world have been expecting for the last two years. Easy to use and fluidly interoperable with every major office suite, 2.0 realizes the potential of open source...
(Thanks to Corpus Collosum.)

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From the MMWR: Rate of Triplet and Other Higher-Order Multiple Births --- United States, 1980--2003

From the MMWR:
The rate of triplet and other higher-order multiple births increased substantially, from 37 per 100,000 live births in 1980 to 194 in 1998, a trend largely attributable to increased usage of fertility therapies. During 1999--2003, the rate of triplet and higher-order multiple births has remained stable. Older mothers and non-Hispanic white mothers are the most likely to have a triplet or higher-order multiple birth.
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The Point of Google Print ("Books of Revelation")

From The Wall Street Journal, via the Google Blog:
Imagine sitting at your computer and, in less than a second, searching the full text of every book ever written. Imagine an historian being able to instantly find every book that mentions the Battle of Algiers. Imagine a high school student in Bangladesh discovering an out-of-print author held only in a library in Ann Arbor. Imagine one giant electronic card catalog that makes all the world's books discoverable with just a few keystrokes by anyone, anywhere, anytime.

That's the vision behind Google Print, a program we introduced last fall to help users search through the oceans of information contained in the world's books. Recently, some members of the publishing industry who believe this program violates copyright law have been fighting to stop it. We respectfully disagree with their conclusions, on both the meaning of the law and the spirit of a program which, in fact, will enhance the value of each copyright. Here's why...
Technorati Tags: Google Print, Wall Street Journal, Copyright

U.S. Warnings Against Fish In Pregnancy May Be Harmful

From the American Journal of Preventive Medicine. Via Bloomberg:
U.S. government warnings against eating mercury-contaminated fish may cause more harm than good because fish oils boost health and mental development more than mercury harms fetuses, Harvard University researchers reported.

Pregnant women who cut their fish intake by one-sixth following a 2001 government advisory about avoiding mercury in fish experienced an 80 percent decline in the intelligence benefit that their developing children otherwise would have gained from maternal fish consumption, according to studies led by Harvard researcher Joshua Cohen.
Technorati Tags: Fish, Mercury, Pregnancy

Why Roche Released Tamiflu

From TIME:
A day after Roche reversed course under pressure and announced it is willing to enter discussions with countries and companies interested in licensing rights to produce its flu drug Tamiflu came the reminder of why the Swiss pharmaceutical giant had for so long been so reluctant to make the move. Roche announced Wednesday that its revenues climbed 17% in the third quarter, boosted in large part by world-wide demand for Tamiflu. Sales of the drug more than doubled, to $215 million in the quarter. Roche expects to rake in as much as $925 million from Tamiflu sales this year, up from $266 million in 2004. And as governments keep building their stockpiles, it will continue to generate billion-dollar revenues for the next couple of years, according to Keith Redpath, head of Wood Mackenzie Life Sciences Research.

Why the sudden about-face? Roche probably had no choice. Most countries, including the U.S., have in their laws a provision that permits their governments to overturn patents in exceptional circumstances. "If Roche plays hardball," says Redpath, "governments could just say, 'we're going to overturn the patent. This is a national emergency.'" Such moves would not be unprecedented. After anthrax mailings following the Sept. 11 terrorist attacks stoked biosecurity concerns, the Canadian and the U.S. government told the German drug firm Bayer that if it did not ramp up production and sell its anti-infective Cipro at a reasonable cost, they would do so themselves. Bayer wound up cutting its prices by 55% and boosted production...
Technorati Tags: Tamiflu, Roche, Avian Flu, Avian Influenza

Value Of Bed Rest For Pregnant Women With High Blood Pressure Questioned By Cochrane Review

A recent Cochrane review questions the value of bed rest in pregnant women with high blood pressure:
Background Bed rest or restriction of activity, with or without hospitalisation, have been advocated for women with hypertension during pregnancy to improve pregnancy outcome. However, benefits need to be demonstrated before such interventions can be recommended since restricted activity may be disruptive to women's lives, expensive, and increase the risk of thromboembolism.

Objectives To assess the effects on the mother and the baby of different degrees of bed rest, compared with each other, and with routine activity, in hospital or at home, for primary treatment of hypertension during pregnancy.

Search strategy We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005), and EMBASE (January 2002 to December 2004).


Main results Four small trials (449 women) were included. Three were of good quality. Two trials (145 women) compared strict bed rest with some rest, in hospital, for women with proteinuric hypertension. There was insufficient evidence to demonstrate any differences between the groups for reported outcomes. Two trials (304 women) compared some bed rest in hospital with routine activity at home for non-proteinuric hypertension. There was reduced risk of severe hypertension (1 trial, 218 women; RR 0.58, 95% CI 0.38 to 0.89) and a borderline reduction in risk of preterm birth (1 trial, 218 women; RR 0.53, CI 0.29 to 0.99) with some rest compared to normal activity. More women in the bed rest group opted not to have the same management in future pregnancies, if the choice were given (1 trial, 86 women; RR 3.00, 95% CI 1.43 to 6.31). There were no significant differences for any other outcomes.

Authors' conclusions Few randomised trials have evaluated rest for women with hypertension during pregnancy, and important information on side-effects and cost implication is missing from available trials. Although one small trial suggests that some bed rest may be associated with reduced risk of severe hypertension and preterm birth, these findings need to be confirmed in larger trials. At present, there is insufficient evidence to provide clear guidance for clinical practice. Therefore, bed rest should not be recommended routinely for hypertension in pregnancy, especially since more women appear to prefer unrestricted activity, if the choice were given.
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Doctor Stories #4: Supersize It

From Chronicles of a Medical Mad House:
At first I was sure it was a mistake. Must’ve been someone who was trying to enter 80 and simply, mistakenly, pressed the zero an extra time. Could this be real? Can any human being really be bigger than 800 pounds?
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Wednesday, October 19, 2005

New England Journal of Medicine Audio Interview: Dr. Susan Wood on the FDA and Plan B

Dr. Wood was the assistant commissioner for women's health and director of the Office of Women's Health at the Food and Drug Administration from November 2000 until August 2005, when she resigned. An interview in the NEJM is here.

The podcast feed is here.

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Hilarious Journal Articles #18: Using Viagra Saves Endangered Species

Via Worldchanging. From the Times of India:
The spread of Viagra, the wonder drug that promises to cure erectile dysfunction, is saving endangered species as many men switch from using animal parts to treat the malady, claims a new survey.

William von Hippel, a psychologist from the University of New South Wales in Sydney, Australia, and his brother Frank von Hippel, a biologist from the University of Alaska in Anchorage, showed that the Western treatment for the sexual problem seems to be replacing traditional medicines, including potions made from seal penises and reindeer antler velvet...
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Technorati's State of the Blogosphere, October 2005

From David Sifry's Blog:
Technorati is now tracking 19.6 Million weblogs, and the total number of weblogs tracked continues to double about every 5 months. This trend has been consistent for at least the last 36 months. In other words, the blogosphere has doubled at least 5 times in the last 3 years. Another way of looking at it is that the blogosphere is now over 30 times as big as it was 3 years ago...
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Recent NYT & WP Articles On B.K.S Iyengar, Yoga Teacher

Recent articles on B.K.S. Iyengar have appeared in the New York Times and the Washington Post. From the Times article:
Mr. Iyengar, 86, the author of 14 books, including the groundbreaking 1966 manual "Light on Yoga," is widely regarded as the greatest living yoga teacher...
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Wednesday Recommendations: Light on Yoga

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"Beta Blockers Should Not Remain The First Choice Treatment For High Blood Pressure"

A meta-analysis published today in The Lancet (registration required) argues that beta blockers are associated with worse outcomes than other classes of anti-hypertensive medications. The researchers found that the risk of stroke was 16% higher with beta blockers than with other drugs, while all-cause mortality was 3% higher. MedPage Today has more details.

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Tuesday, October 18, 2005

New Version of AvantGo Supports RSS Feeds

For those of you who use AvantGo on your PDA, there's a new version which supports feeds here. If you'd like to try it out, I've added this button to the sidebar:

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"Email Makes Office Workers Lazy"

From BBC News:
The explosion in e-mail use risks creating a generation of unfit, overweight office workers, say experts.

Whereas white collar workers were once forced to walk to colleagues' desks to pass on information, now all it takes is the click of a button.

As a result, many people are missing out on the little exercise available to them during the working day...

Dr. Dorian Dugmore, an international heart expert, said: "We are losing millions of hours of exercise through the explosion of e-mail..."
Technorati Tags: Email, BBC

Are the Contraindications of Glucophage (Metformin) Contraindicated?

Glucophage (metformin) is a frequently used and effective medication for type 2 diabetes. Unfortunately, it is often stopped in patients with kidney disease because of concerns about lactic acidosis, a feared complication. (Currently, the guidelines are to stop metformin when the creatinine is greater than 1.4 - 1.5.)

However, lactic acidosis is rare, and doctors may be stopping metformin in many diabetic patients with kidney disease even though the risk of this complication is very low.

The Canadian Medical Association Journal has an excellent review of the debate for and against relaxing the guidelines for the use of metformin in patients with kidney disease.

(Thanks to Dr. RW.)

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Grand Rounds Vol. 2 #4

Grand Rounds Vol. 2 #4, this week's best posts of the medical blogosphere, is up at Diabetes Mine.

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Monday, October 17, 2005

The Blog of a Patient with a New Kidney and Pancreas Transplant

Stephanie Wukovitz, a type 1 diabetic and composer on hemodialysis, just received a simultaneous kidney and pancreas transplant. (The donor was a 21 year old who fell off a roof.) Her blog is Fearful Symmetry.

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TIME's List of the 100 Best Novels

TIME Magazine has released their list of the 100 best novels from 1923 to the present. There are some obvious choices (1984, Gravity's Rainbow, Slaughterhouse Five, Lolita) and some surprising ones (Infinite Jest, Neuromancer, Snow Crash, Watchmen, White Noise).

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Essays About Hurricane Katrina In This Month's New England Journal of Medicine (Free Full Text)

This week's NEJM has eight essays on Hurricane Katrina written by physicians. The text is free online. Many of the doctors are from New Orleans. In Finding Supplies, Gregory S. Henderson, M.D., Ph.D. writes the following:
So with hotel security at the watch, the pharmacist, the police officers, the family practice physician, and I waded across Canal Street in thigh-deep water to the drugstore. With their weapons drawn, officers Jeff Jacob and Tommy Redmann kept the looters out. The door had already been smashed. We went in with several other police officers. It was dark and full of water, it stank, and there were items floating everywhere. The pharmacy was locked, but our pharmacist figured out how to smash through a plastic window divider and climb in. Then he figured out how the shelves were organized and found a refrigerator containing some insulin. I tried to stuff things into my pockets but soon realized that it was futile. Someone found trash bags, and we were in business...
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Sunday, October 16, 2005

Weekend Photos: Silkworms, Thailand

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...this is why I keep Google Ads.

After all I've posted recently, the current ad is for the Hank Williams Museum in Montgomery, Alabama. Really.

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An Avian Influenza Pandemic Scenario and Other Resources

From the New York Times:

The New York Times obtained a draft of the [Bush administration's] plan, dated Sept. 30. No one would confuse the 381-page document with a screenplay, but pages 45 through 47, the section titled "Pandemic Scenario - Origin and Initial Spread," are gripping. They describe a flu epidemic moving from a village in Asia to the United States, where it causes panic and as many as 1.9 million deaths...

In April of the current year, an outbreak of severe respiratory illness is identified in a small village in a country known to have experienced recent avian influenza disease. At least 25 cases have occurred, affecting all age groups. Several household clusters with infection of multiple family members are identified. Twenty patients have required hospitalization at the local provincial hospital, five of whom have died...

In July, small focal outbreaks begin to be reported throughout the United States. The first doses of a new pandemic vaccine become available in September. Despite full-scale production by manufacturers, supply remains very limited... Community-wide outbreaks begin to occur more frequently as children return to school, and by late August, outbreaks are occurring simultaneously throughout the country...

Overall, about 2 percent of Americans with influenza illness die. In communities during the peak weeks of ... outbreaks, about a quarter of workers are absent because of illness, the need to care for ill relatives and fear of becoming infected.

Hospitals are overwhelmed and staff shortages limit capacity. Intensive care units at local hospitals are unable to provide care for all who need it, and there are shortages of mechanical ventilators for treatment of patients with severe pneumonia. Makeshift hospitals established in schools and armories care for those who are unable to be treated in regular hospitals...

And it gets worse.

Like many people, avian influenza is a topic that I've been interested in and alarmed about. See the "avian flu" link in the sidebar for more. Also see the Avian Flu Blog and H5N1.

Dr. Taraneh Razavi, a Google staff doctor, continues to use the Google blog to educate people in this post about avian influenza. (He previously wrote about deep venous thromboses in travelers.)

And here's a summary of recent news from Warren Ellis:
"In other news, at least 1000 people are dead from the Kashmir earthquake, hundreds are missing after hurricane Stan rampaged through Mexico and central America, the avian flu vaccine doesn't work, the 1918 Spanish Flu was probably avian, the arctic ice cap is melting and we're all going to fucking die."
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