Sunday, January 29, 2006

Drugmakers to Cut Off Some Free Prescriptions

From The Washington Post:
Several of the nation's largest drug manufacturers say they will no longer provide free or discounted medications to low-income elderly and disabled patients because they should be covered by the new Medicare drug benefit. But for about 1 million Americans with serious illnesses such as AIDS and cancer -- patients who last year relied on the pharmaceutical industry's giveaways -- that means Medicare coverage could cost them more than $3,600 this year.
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Flickr: Top of Tokyo 2

From Flickr. Uploaded by MikeT on 23 Jan '06, 2.06pm PST.

Hilarious Journal Articles #40: Longitudinal Study of Disappearing Teaspoons

The BMJ is the Monty Python's Flying Circus of journals.

The case of the disappearing teaspoons: longitudinal cohort study of the displacement of teaspoons in an Australian research institute -- Lim et al. 331 (7531): 1498 -- BMJ:
Objectives To determine the overall rate of loss of workplace teaspoons and whether attrition and displacement are correlated with the relative value of the teaspoons or type of tearoom.

Design Longitudinal cohort study.

Setting Research institute employing about 140 people.

Subjects 70 discreetly numbered teaspoons placed in tearooms around the institute and observed weekly over five months.

Main outcome measures Incidence of teaspoon loss per 100 teaspoon years and teaspoon half life.

Results 56 (80%) of the 70 teaspoons disappeared during the study. The half life of the teaspoons was 81 days. The half life of teaspoons in communal tearooms (42 days) was significantly shorter than for those in rooms associated with particular research groups (77 days). The rate of loss was not influenced by the teaspoons' value. The incidence of teaspoon loss over the period of observation was 360.62 per 100 teaspoon years. At this rate, an estimated 250 teaspoons would need to be purchased annually to maintain a practical institute-wide population of 70 teaspoons.

Conclusions The loss of workplace teaspoons was rapid, showing that their availability, and hence office culture in general, is constantly threatened.
Technorati Tags: , ,

Friday, January 27, 2006

Pfizer Wins F.D.A. Approval for Inhaled Form of Insulin

From The New York Times:
An inhaled form of insulin won federal approval today, offering the first alternative to injections for millions of people with diabetes since the drug was introduced in the 1920's.
Technorati Tags: Diabetes, Insulin, Inhaled Insulin

Most US Healthcare Workers Not Vaccinated Against Influenza

From Reuters:
Just 38 percent of healthcare workers in the United States received an influenza vaccine in 2000, despite strong evidence showing that vaccination can reduce the rate of hospital-acquired infections in patients and employee absenteeism, according to a new report.
Technorati Tags: Influenza, Influenza Vaccine

The Strange Story of the Drug Aprotinin (Trasylol): from "This Drug is Safe, Why Do We Need to Study This Further?" to "This Drug Kills People."

The drug Aprotinin, used during bypass surgery to reduce bleeding, is in the news lately because a new study in the New England Journal of Medicine suggests that it actually increases heart attacks, strokes, and kidney failure. This is particularly bizarre because less than a month ago Aprotinin was in the news as an example of a drug that is so safe that is should no longer be studied. From The Washington Post (January 2, 2006):
One article examined 18 years of research on aprotinin, a drug used to reduce bleeding during heart surgery. [The study] concluded that research on these subjects went on long after the answers were known -- namely, that aprotinin worked... Patients who received aprotinin during surgery bled less. They had only one-third the chance of needing a blood transfusion of patients who did not get the drug.

What was surprising was that this advantage was clear by June 1992, after the 12th of the 64 studies. If researchers after that time had familiarized themselves with previous studies -- and especially if they had analyzed summaries of those studies, called "meta-analyses" -- they might not have considered it necessary to run their own.
From The New York Times (January 26, 2006):
A drug used worldwide to reduce bleeding during heart surgery can increase the risk of kidney failure, heart attacks and strokes, and should be abandoned, doctors are reporting today. They say other medicines are safer and cheaper, and should be used instead.

The drug, aprotinin, is sold under the brand name Trasylol and made by Bayer...
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Husband-And-Wife 'Botox' Docs Get Prison

Via Salon:
Husband-and-wife doctors were sent to prison Thursday for selling a dangerous bootleg form of Botox to hundreds of physicians...

On Wednesday, a Fort Lauderdale physician, Dr. Bach McComb, was sentenced to three years behind bars for injecting himself and three others with knockoff Botox that had not been properly diluted, causing botulism and nearly killing all four of them.
Technorati Tags: Botox

Hilarious Journal Articles #39: Sex Reduces Stress from Public Speaking

From Biological Psychology:
Penile–vaginal intercourse (PVI) but not other sexual behavior is associated with better psychological and physiological function. I examined the relationship of sexual behavior patterns to blood pressure (BP) and its reactivity to stress (public speaking and verbal arithmetic). For a fortnight, 24 women and 22 men used daily diaries to record PVI, masturbation, and partnered sexual behavior in the absence of PVI. Persons who reported PVI (but no other sexual activities) had better stress response (less reactivity and/or lower baseline levels) than persons reporting other or no sexual behaviors. Persons who only masturbated or had partnered sex without PVI had 14 mmHg more systolic BP reactivity than those who had PVI but not the other behaviors. Many variables were examined but failed to confound the observed relationships. The magnitude of the sexual behavior effect on BP reactivity is greater than of other factors in the literature. These findings add to the research corpus on the benefits of PVI (differentiated from other sexual activities).
Technorati Tags: Sex, Public Speaking, Hilarious Journal Articles

Thursday, January 26, 2006

Flickr: Leif the Lucky in Fog

From Flickr. Uploaded by Sigurrós on 21 Jan '06, 12.18am PST.

Wednesday, January 25, 2006

Article in JAMA Argues that New Conflict of Interest Policies Needed for Doctors and Drug Industry

From The Washington Post:
Declaring that the pervasive influence of drug industry money is distorting doctors' treatment decisions and scientific findings, a prestigious panel of medical experts called on their colleagues yesterday to adopt far-reaching new conflict-of-interest policies.

In an article in the Journal of the American Medical Association, the group said that voluntary efforts to limit corporate inducements have failed, resulting in the overprescribing of some medications and the withholding of negative discoveries about others.
From JAMA:
Conflicts of interest between physicians' commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism. These conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised. Although physician groups, the manufacturers, and the federal government have instituted self-regulation of marketing, research in the psychology and social science of gift receipt and giving indicates that current controls will not satisfactorily protect the interests of patients. More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts. We propose a policy under which academic medical centers would take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry.
Technorati Tags: JAMA, Washington Post, Pharmaceutical Industry

Tuesday, January 24, 2006

Hilarious Journal Articles #38: This Is Your Brain on Schadenfreude

From The New York Times:
Now that schadenfreude, which I always thought meant "shades of Freud" but actually means taking pleasure in someone else's misfortune, has been located in the brain, I am awaiting news on the location of ennui, angst, misery, malaise and "feeling pretty..."

I think my expectations are reasonable. After all, brain scans - which were used in the detection of schadenfreude - have clearly reached the level of sophistication required to identify states of mind described by complicated German words. Soon they will advance to states of mind truly expressible only in French, and ultimately to the kind of internal experience until now captured only in our best musical comedies.
From "Empathic neural responses are modulated by the perceived fairness of others" in Nature:
The neural processes underlying empathy are a subject of intense interest within the social neurosciences1, 2, 3. However, very little is known about how brain empathic responses are modulated by the affective link between individuals. We show here that empathic responses are modulated by learned preferences, a result consistent with economic models of social preferences4, 5, 6, 7. We engaged male and female volunteers in an economic game, in which two confederates played fairly or unfairly, and then measured brain activity with functional magnetic resonance imaging while these same volunteers observed the confederates receiving pain. Both sexes exhibited empathy-related activation in pain-related brain areas (fronto-insular and anterior cingulate cortices) towards fair players. However, these empathy-related responses were significantly reduced in males when observing an unfair person receiving pain. This effect was accompanied by increased activation in reward-related areas, correlated with an expressed desire for revenge. We conclude that in men (at least) empathic responses are shaped by valuation of other people's social behaviour, such that they empathize with fair opponents while favouring the physical punishment of unfair opponents, a finding that echoes recent evidence for altruistic punishment.
Technorati Tags: Schadenfreude, Neurology, Functional MRI, Hilarious Journal Articles

Monday, January 23, 2006

Grand Rounds 2.18

Grand Rounds 2.18, this week's best posts of the medical blogosphere, is up at Kevin, M.D.

Technorati Tags: Medicine, Medical Blogosphere

FDA Panel Recommends Weight-Loss Pill Orlistat (Xenical) for Over the Counter Sale

Federal health advisers voted Monday to recommend over-the-counter sales of a weight-loss pill now sold only with a prescription.

GlaxoSmithKline Consumer Healthcare still needs final Food and Drug Administration approval before it can sell a nonprescription version of orlistat, a diet pill already marketed in prescription form as Xenical. The FDA approved the prescription version of the fat-blocking pill made by Roche in 1999.
Technorati Tags: Orlistat, Xenical, FDA, Weight Loss

Sunday, January 22, 2006

Reducing Coronary Artery Disease at the Google Blog

Via Dr. Taraneh Razavi at the Google Blog:
How many of you resolved that in the New Year you'd start a cholesterol- or blood pressure-reducing medication, or perhaps plan to spend a few days in the coronary care unit? My guess is that not too many of you -- but you might end up needing this sort of help rather than staying resolute to intended lifestyle changes that reduce the risk of heart disease, stroke, and diabetes. Let's face it, it's tough to get motivated. It's so much easier to take the pills or have the tests done -- later.

So to help motivate you now, here's a short review of the findings of a recent study by J. A. Iestra that appears in a 2005 issue of the journal Circulation. It's called "Effect Size Estimates of Lifestyle and Dietary Changes on All Cause Mortality in Coronary Artery Disease Patients." Iestra's data showed notable reductions in coronary artery disease -- and mortality -- when patients make these changes...
Technorati Tags: Coronary Artery Disease, Google Blog, Google

KidneyNotes Podcast and Medical Podcasts in eWeek

As an experiment, I'm offering a podcast of KidneyNotes (read throgh Talkr) at Via eWeek:
Not surprisingly, topics like yoga, fitness, sex and pilates dominate the list of health-related podcasts on Apple iTunes. But in the last few months, major health care institutions and scientific journals have all hurried to issue their own, much more sober, podcast offerings.

This could mean that consumers, as well as doctors, scientists and other industry professionals, will have more accessible updates on the most recent heath care research developments.

Technorati Tags: Podcasts, Medical Podcasts

Saturday, January 21, 2006

Hilarious Journal Articles #37: Food buying habits of people who buy wine or beer: a cross sectional study

From the British Medical Journal:
Objective To investigate whether people who buy wine buy
healthier food items than those who buy beer.
Design Cross sectional study.
Setting Supermarkets in Denmark.
Data Information on number, type of item, and total charge
from 3.5 million transactions over a period of six months.
Results Wine buyers bought more olives, fruit and vegetables,
poultry, cooking oil, and low fat cheese, milk, and meat than
beer buyers. Beer buyers bought more ready cooked dishes,
sugar, cold cuts, chips, pork, butter or margarine, sausages,
lamb, and soft drinks than wine buyers.
Conclusions Wine buyers made more purchases of healthy
food items than people who buy beer.
Technorati Tags: Beer, Wine, Hilarious Journal Articles

Friday, January 20, 2006

The Bin Laden Book Club

Via Salon:
On Wednesday, the 72-year-old Washington author William Blum existed only on the fringes of the publishing industry. His 2000 foreign-policy diatribe, "Rogue State: A Guide to the World's Only Superpower," ranked No. 205,763 on Amazon's bestseller list. His byline rarely appeared in print, he says, because even left-leaning journals like the Nation often found his views too radical.

But then the world's No. 1 newsmaker, bin Laden, showed up Thursday on the Al-Jazeera network to promise another terrorist attack on America, ask President Bush to withdraw American troops -- and plug Blum's book. "If Bush decides to carry on with his lies and oppression," the reclusive terrorist announced, in a video message bounced to a potential audience of billions, "it would be useful for you to read the book 'Rogue State'."

By Friday morning, "Rogue State" was ranked No. 35 on Amazon, just behind Harry Potter and just ahead of Strunk & White. At home, in his small Connecticut Avenue apartment, Blum was delighted to learn from a reporter news about his newfound profitability. "Oh my God," the author exclaimed, wearing his morning slippers as he scribbled the Amazon statistics on a pad of paper. "I must tell my publisher."
Technorati Tags: Osama Bin Laden, Rogue State

Basic Blogging: An Introduction to Medical Blogs

Originally published on and reprinted with the permission of iKidney.


The population of blogs on the Internet has recently exploded. In case the term is unfamiliar, "blog" is short for "weblog," a sequential collection of text and pictures posted on a website.

According to Technorati, a blog-monitoring service, in July 2005, there were 14 million blogs in existence and this number is doubling every 5.5 months. Put another way, approximately one new blog is created every second.

"Anyone Can Create One"

This unexpected and rapid growth is related to the most important feature of blogs: anyone can create one. Free services like Google's Blogger make this new form of publishing accessible to anyone with an Internet connection and the desire to share their writing. On Blogger and other services, step-by-step instructions are provided, and it is assumed that most users have no prior experience in creating websites.

A search of blogs can uncover discussions on almost any topic imaginable. Blogs on politics, entertainment, and technology as well as others that are personal journals are common. Most blogs also allow readers to comment on each entry, encouraging discussion and feedback.

Medical Blogs

A growing number of patients, physicians, and other healthcare professionals have also created blogs. Busy people take the time to write blogs for many reasons. For some patients, they may provide a place to anonymously discuss medical issues, record their experiences, and interact with others with similar problems. In this way, a blog can simultaneously function as a journal, a support group, and a forum for questions and answers.

For physicians and other healthcare professionals, blogs provide a place for writings rarely found in medical journals. Providers may use blogs to write about personal experiences, editorialize on problems encountered in practice, voice opinions, ask for advice, and tell important stories. Blogs may also serve as forums for debates on policies, politics, ethics, and other issues related to practice.

Many variations in content are possible. For example, some professionals choose to use blogs to comment on recent health news or scientific advances, and others may use them to help publicize their practice, consulting services, or publications.

Blogs also allow patients and healthcare providers to easily read the other's writings on medical issues. Potentially, each may benefit from the other's unique perspectives and insights.

Accuracy and Patient Confidentiality

For health care professionals who are bloggers, accuracy and patient confidentiality are very important. Medical bloggers should maintain the same standards of professionalism in online communication as they would with other forms of public expression. Ideally, all information on medical topics should be accurate, authoritative, and sources should be cited when appropriate.

Often, medical bloggers may write about cases and common situations encountered in practice. While case presentations are a vital part of medical communication, care should be taken to maintain patient confidentiality. Protected health identifiers, as defined by the HIPAA privacy law, should always be removed from presentations. Further information on patient confidentiality may be found on the HIPAA blog and the Clinical Cases and Images Blog .

Some medical professionals may also choose to have their blogs formally certified by the Health on the Net Foundation, which provides accreditation to websites which maintain high standards of accuracy and confidentiality. More information may be found on the Health on the Net Foundation website.


The best way to learn about blogs is to read them. There are many excellent blogs out there. If you're interested in exploring the world of blogs (also known as the blogosphere), the following websites are good places to start.

Finding Blogs:Blogs by Healthcare Professionals:Blogs by Patients:Services for Creating Blogs:

FDA Unveils New Prescription Drug Labels

From the Washington Post:
Package inserts that accompany every prescription drug are getting a major makeover that will provide doctors and patients with the clear and concise information they need while cutting down on the small-print warnings that only lawyers seem to understand.
Technorati Tags: Drug Labels, FDA, Drugs

Wednesday, January 18, 2006

Flickr: Frankfurt Barge

From Flickr. Uploaded by raforrest on 13 Jan '06, 3.09am PST.

Technorati Charts and Grand Rounds

Technorati has implemented automatically updating charts of keywords that can be posted to blogs. For example, the following is a chart for "Grand Rounds." The spikes are Tuesdays, when new Grand Rounds are posted and medical bloggers link to them.

Posts that contain "Grand Rounds" per day for the last 90 days:
Technorati Chart

Technorati Tags: , ,

Tuesday, January 17, 2006

William Shatner sells kidney stone for charity

Actor William Shatner has sold his kidney stone for $25,000, with the money going to a housing charity [Habitat for Humanity], it was announced Tuesday.
Technorati Tags: Kidney Stones, William Shatner

Female Kidney Transplant Turns Lumberjack Into Housewife

Via Ananova:
A Croatia lumberjack claims he started 'enjoying housework and knitting' after he was given a female kidney..

Stjepan Lizacic, 56, from Osijek, is suing his local health authority because he says he's become a laughing stock.

He says his life changed from enjoying heavy drinking sessions with pals to prefering housework after the operation.

He told a local newspaper: "The kidney transplant saved my life, but they never warned me about the side effects..."
Technorati Tags: Kidney Transplantation

Grand Rounds 2.17

Grand Rounds 2.17, this week's best posts of the medical blogosphere, is up at GruntDoc.

Technorati Tags: ,

Monday, January 16, 2006

Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency

Treatment with ACE inhibitors slows the progression of proteinuric kidney disease, but physicians are often worried about using these medications in patients with reduced kidney function -- the group of patients who might benefit the most -- because of the potential risks of hyperkalemia and acute renal failure.

Once, after starting a patient with a creatinine of 3 on an ACE inhibitor, I was asked for evidence that the benefits of ACE inhibitors in these patients outweigh the risks. It's a reasonable question that was only recently answered. An article in this month's NEJM, Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency, provides evidence that ACE inhibitors should be used in patients with proteinuric renal disease, even if the creatinine is 3 - 5. However, while this study showed a substantial benefit in slowing the decline of renal function, the danger for misuse of ACE inhibitors without sufficient monitoring exists. This might lead to an increase in hyperkalemia and other side effects, similar to the increase in serious hyperkalemia related to spironolactone after the RALES study was published.

From The New England Journal of Medicine:
Background Angiotensin-converting–enzyme inhibitors provide renal protection in patients with mild-to-moderate renal insufficiency (serum creatinine level, 3.0 mg per deciliter or less). We assessed the efficacy and safety of benazepril in patients without diabetes who had advanced renal insufficiency.

Methods We enrolled 422 patients in a randomized, double-blind study. After an eight-week run-in period, 104 patients with serum creatinine levels of 1.5 to 3.0 mg per deciliter (group 1) received 20 mg of benazepril per day, whereas 224 patients with serum creatinine levels of 3.1 to 5.0 mg per deciliter (group 2) were randomly assigned to receive 20 mg of benazepril per day (112 patients) or placebo (112 patients) and then followed for a mean of 3.4 years. All patients received conventional antihypertensive therapy. The primary outcome was the composite of a doubling of the serum creatinine level, end-stage renal disease, or death. Secondary end points included changes in the level of proteinuria and the rate of progression of renal disease.

Results Of 102 patients in group 1, 22 (22 percent) reached the primary end point, as compared with 44 of 108 patients given benazepril in group 2 (41 percent) and 65 of 107 patients given placebo in group 2 (60 percent). As compared with placebo, benazepril was associated with a 43 percent reduction in the risk of the primary end point in group 2 (P=0.005). This benefit did not appear to be attributable to blood-pressure control. Benazepril therapy was associated with a 52 percent reduction in the level of proteinuria and a reduction of 23 percent in the rate of decline in renal function. The overall incidence of major adverse events in the benazepril and placebo subgroups of group 2 was similar.

Conclusions Benazepril conferred substantial renal benefits in patients without diabetes who had advanced renal insufficiency.
Technorati Tags: Benazepril, Kidney Disease, Chronic Kidney Disease, New England Journal of Medicine

Gene (CEL VNTR) Increases Diabetes Risk, Scientists Find

From The New York Times:
Scientists have discovered a variant gene that leads to a sizable extra risk of Type 2 diabetes and is carried by more than a third of the American population.

The finding is being reported today in the journal Nature Genetics by researchers at Decode Genetics, a company in Reykjavik, Iceland, that specializes in finding the genetic roots of human diseases. Decode Genetics first found the variant gene - one of many different versions that exist in the human population - in Icelanders and has now confirmed the finding in a Danish and an American population.

An immediate practical consequence of the discovery, said Decode's chief executive, Kari Stefansson, would be to develop a diagnostic test to identify people who carry the variant gene. If people knew of their extra risk, they would have an incentive to stay thin and exercise, he said.
The paper is "Mutations in the CEL VNTR cause a syndrome of diabetes and pancreatic exocrine dysfunction."

Technorati Tags: Diabetes, New York Times, Genetics

Saturday, January 14, 2006

Hilarious Journal Articles #36: A Novel Method for the Removal of Ear Wax

From CMAJ:
D.K. (a family and emergency physician) assessed the utility of the Super Soaker Max-D 5000. He was surprised to note that it was able to deliver a superbly pressured narrow stream of water equivalent to, or perhaps exceeding, the quality of that achieved with standard ear-syringing instruments. The owner of the Super Soaker Max-D 5000 was sought out; after hearing an explanation of its intended application, he granted permission for its use.

Verbal consent (covering risks and benefits) was obtained from the patient. He then changed into swimming shorts, located himself on an ideal location on the deck and held a Tupperware container (product number 1611-16) to the side of his neck, in lieu of a kidney basin. The Super Soaker Max-D 5000 was filled with body-temperature water and then mildly pressurized using the blue hand-pump. The trigger was depressed, releasing a gentle, narrow jet of water, which was then aimed along the posterior wall of the ear canal (Fig. 1). After approximately 15 seconds, the jet was aimed along the anterior wall. This cycle was repeated (with occasional repressurizing) until the Super Soaker was empty.
Technorati Tags: Hilarious Journal Articles, Cerumen, Super Soaker

Waking Up Is Like Being Drunk

Via CNN:
If it takes a while to clear the cobwebs after waking up, that's understandable -- "sleep inertia" leaves some people so groggy they might as well be drunk, researchers said on Tuesday.

"For a short period, at least, the effects of sleep inertia may be as bad as or worse than being legally drunk," said researcher Kenneth Wright of the University of Colorado at Boulder.

That befuddled feeling usually lasts for at least a few minutes but may be detectable for up to two hours, Wright wrote in a report published in this week's issue of the Journal of the American Medical Association.
Technorati Tags: Sleep, Waking Up, JAMA

Friday, January 13, 2006

New Jersey Threatens to Block Killer Nurse's Kidney Donation

From FOX News:
If killer nurse Charles Cullen stops cooperating with a probe into his crimes, New Jersey authorities say, they'll withhold the one thing they have that he really wants: permission to donate a kidney to an ailing acquaintance...

Cullen has pleaded guilty to 29 murders and six attempted murders in New Jersey and Pennsylvania, and has told investigators he might have killed as many as 40 people. In most cases, he gave patients an overdose of heart medication, usually digoxin.
Technorati Tags: Charles Cullen, Kidney Transplantation

Pregnancy Tests Indirectly Responsible for Extinction of Species

Via Slate:
A fungus that grows on the backs of frogs may be responsible for the extinction of dozens of species, say the authors of a study published in Thursday's issue of Nature. Amphibian chytrid fungus seems to have spread around the world astride the South African clawed frog, Xenopus laevis, which was exported for use as a pregnancy test...
Technorati Tags: Frogs, Pregnancy, Pregnancy Test

Wednesday, January 11, 2006

Flickr: sunrise over bagan

From Flickr. Uploaded by David Haberlah on 11 Jan '06, 9.45am PST.

Stricter Nanotechnology Laws Are Urged

From the Washington Post:
An independent report being released this morning concludes that current U.S. laws and regulations cannot adequately protect the public against the risks of nanotechnology -- the rapidly growing science of making invisibly small particles and molecular devices.

Unless existing laws are modified or a new one is crafted, the report warns, the immense promise of the field -- predicted to be a trillion-dollar industry by 2015 -- may be short-circuited by either a disaster or an economically damaging crisis of public confidence.
Technorati Tags: Nanotechnology

New York City Starts To Monitor Diabetics

First reported in The New York Times.

From The Washington Post:
New York City is starting to monitor the blood sugar levels of its diabetic residents, marking the first time any government in the United States has begun tracking people with a chronic disease.

Under the program, the city is requiring laboratories to report the results of blood sugar tests directly to the health department, which will use the data to study the disease and to prod doctors and patients when levels run too high.
Technorati Tags: New York City, Diabetes, Privacy

Tuesday, January 10, 2006

"My Brain Is a Walnut" - Inside a functional MRI machine

When I was a resident, I also participated in a study in a functional MRI. I still have the images. Via Slate:
"If we find any gross abnormalities in your brain, would you like a radiologist to tell you about it?" Tobias Egner asks me. He is about to wheel me into the dark gullet of an fMRI machine at the Functional MRI Research Center at Columbia University, a leading neuroscience lab where he is a research fellow. I say yes to his question and ask if anyone ever says no. "If you answer no, we cannot do the test," Egner says. He speaks with a soft certainty and a German accent; if this were a movie, he'd be played by Willem Dafoe, a la The Life Aquatic With Steve Zissou. "Ready to roll?"
Technorati Tags: Function MRI, MRI, Columbia University

The National Report Card on the State of Emergency Medicine

From the American College of Emergency Physicians:
The National Report Card on the State of Emergency Medicine assesses the support that each state and the District of Columbia provides for their emergency care systems. A wake-up call for policymakers, the report underscores the challenges facing patients who need emergency care and recognizes efforts to address these needs. This report should motivate state and national policy support for improving emergency care systems.
The national grade: C-.

Technorati Tags: Emergency Medicine

Coffee Notes #6: "It's not for me..."

Via Overheard in New York:
Woman: One grande caramel frappuccino with extra whipped cream, please.
Man: You know there's six or seven hundred calories in that, right?
Woman: It's not for me, it's for my hamster. I swear.

--Starbucks, Bay Ridge
Technorati Tags: Coffee, Coffee Notes

Grand Rounds 2.16

Grand Rounds 2.16, this week's best posts of the medical blogosphere, is up at Clinical Cases and Images.

Technorati Tags: , , ,

Monday, January 9, 2006

"Surviving Miner Develops Slight Fever" - How much detail can doctors give the press?

Slate on HIPAA:
The only trapped miner to survive last week's explosion in West Virginia developed a slight fever on Monday, according to his doctors. Randal McCloy Jr. remains in critical condition, and he's still connected to a ventilator even though he is now breathing on his own. Is there any private information the hospital can't give to the press?

Yes. Under federal privacy rules, doctors can give the press (and the public at large) only the most general information about a patient, called "directory information." They can confirm that a specific patient has been admitted to the hospital, and they can give a short assessment of his overall condition. (Most assessments are just one word—good, fair, serious, or critical.) If a patient is conscious and alert when he comes into the hospital, he's given the option to keep even this general information under wraps.
Technorati Tags: HIPAA, Slate, Randal McCloy

Osama bin Laden banned from orbit

From The Register:
The US Federal Aviation Authority has responded to the possible threat of terrorist exploitation of the burgeoning space tourism business by drafting some proposed regs to ensure Ossie bin Laden and his mates don't book themselves aboard Virgin Galactic.

In effect, the FAA says space tourists should be treated the same as airline passengers, with the usual security checks and a quick shufti of the global "no-fly" list to see if the wannabe astronaut has previously been barred from airlines worldwide for attempting to open the door mid-flight in order to have a quick ciggie.
Technorati Tags: Space, FAA

Flickr: Top 20 Favourites for 2005 chosen by your good selves

From Flickr. Uploaded by Hey Jack Kerouac on 4 Jan '06, 9.52pm PST.

What's an Induced Coma?

Via Slate:
Doctors can try to reduce swelling by putting the patient in a coma. (Among the other available options: opening a hole in the side of the head to let out fluid, cutting out portions of the inflamed brain, or inducing hypothermia.) Inducing a coma is beneficial because a comatose brain uses less energy—and oxygen—than an awake and alert one. A brain that's been shut down in a coma can survive longer with a limited supply of oxygen. The coma also further reduces blood flow to the brain, which eases pressure in the cranium. Reduced blood flow does mean less oxygen gets to the brain, but since comatose brains don't need much oxygen this isn't a problem.
Technorati Tags: Coma, Ariel Sharon, Medicine

Sharon Case May Raise Theological Issues

Via Redorbit:
Like nearly everything in Israel, Ariel Sharon's condition touches both the hard-edged logic of the secular world and the vagaries of faith.

For doctors, the next medical challenge could come Monday when they start bringing Sharon out of his drug-induced coma. After that - should he need life support or fail to awaken - his case could become drawn into the thorny disagreements among Jewish scholars about the boundaries of life and what measures should be taken to sustain it.
Technorati Tags: Ariel Sharon, Israel, Medicine

Diabetes and Its Awful Toll Quietly Emerge as a Crisis

From The New York Times:
Begin on the sixth floor, third room from the end, swathed in fluorescence: a 60-year-old woman was having two toes sawed off. One floor up, corner room: a middle-aged man sprawled, recuperating from a kidney transplant. Next door: nerve damage. Eighth floor, first room to the left: stroke. Two doors down: more toes being removed. Next room: a flawed heart.
Technorati Tags: Diabetes, New York Times, Montefiore Medical Center, New York City

Sunday, January 8, 2006

Treating Hyperkalemia (High Blood Potassium) According to the New 2005 CPR Guidelines

Hyperkalemia is a common problem that can range in severity from inconsequential to life-threatening. The treatments for hyperkalemia also vary widely and can include simply restricting dietary potassium; administering oral, intravenous or inhaled medications; and providing emergent dialysis for more extreme elevations.

Given a lack of standardization, it's not surprising that different doctors treat hyperkalemia in different ways. The new 2005 CPR guidelines from the American Heart Association provide recommendations for the treatment of hyperkalemia. Unfortunately, while these new guidelines are easy to follow, there are many potential problems, and I offer some criticisms.

For mild elevations (5 - 6 mEq/L), in addition to dietary and medication changes, the guidelines recommend removal of potassium from the body with
  1. Furosemide 40 - 80 mg IV. In my opinion, especially for slight elevations, in most cases intravenous diuretics are unnecessary, and oral furosemide could be just as easily substituted.
  2. Kayexalate 15 to 30 g orally in sorbitol (or by enema). While kayexalate is an important treatment for hyperkalemia, in my opinion, giving kayexalate routinely for any potassium elevation over 5 is a bad practice. It is often unnecessary and physicians frequently overlook the cramping, diarrhea, and discomfort it causes patients. Rarely, kayexalate in powdered form (which doesn't cause diarrhea) or occasionally florinef can be given to outpatients.
For moderate elevations (6 to 7 mEq/L), the guidelines recommend shifting potassium intracellularly. Previously, many algorithms suggested first obtaining an ECG to look for changes due to hyperkalemia -- "peaked" t-waves and new QRS widening -- and if either of these were present, the old algorithms recommended particularly aggressive treatment. The problem is, there is no good definition for what constitutes a peaked t-wave. (Various definitions have included "greater than 10 mm in the anterior leads" and "anything that looks like it would hurt you if you sat on it.") Another problem is that potentially, arrythmias may develop in patients without ECG changes. The new CPR guidelines do not recommend obtaining an ECG before treatment for moderate elevation. They recommend treatment with
  1. Glucose plus insulin (10 units of regular insulin and an amp of D50).
  2. Sodium bicarbonate 50 mEq IV over 5 minutes. In my opinion, for patients without metabolic acidosis, this is unlikely to be effective.
  3. Nebulized albuterol (10 to 20 mg) over 15 minutes. In my opinion, while this is an effective and rapid treatment for hyperkalemia, there are many patients with tachycardia or coronary artery disease who should not be given albuterol.
  4. The guidelines do not explicitly suggest treating moderate potassium elevations with kayexalate or furosemide, but these should also be routine treatments in my opinion.
For severe elevations (> 7 mEq/L with "toxic ECG changes"), the guidelines recommend shifting potassium into the cells, eliminating potassium from the body, and stabilizing the myocardial cell membrane. (Presumably, although not stated explicitly, severe potassium elevations without ECG changes should also be treated aggressively.)
  1. Calcium chloride 10%, 500 to 1000 mg (5 to 10 ml) IV over 2 to 5 minutes. Previously, many guidelines recommended 1 amp of calcium gluconate, which has about 1/3 the elemental calcium of calcium chloride. The common wisdom was that giving calcium chloride this rapidly had the potential to provoke arrythmias which outweighed the benefit of preventing arrythmias. Therefore, I found the recommendation to use calcium chloride (rather than gluconate) puzzling.
  2. Sodium bicarbonate 50 mEq IV over 5 minutes. See the above caveat.
  3. Glucose plus insulin (10 units of regular insulin and an amp of D50). In my opinion, this should be administered before sodium bicarbonate.
  4. Nebulized albuterol (10 to 20 mg over 15 minutes). See the caution about albuterol above.
  5. Furosemide 40 to 80 mg IV.
  6. Kayexalate 15 to 50 g in sorbitol orally or by enema. Kayexalate generally takes hours to work, so in my opinion, kayexalate should never be given to patients with severe hyperkalemia unless suggested by a nephrologist. Many patients with severe hyperkalemia require dialysis, which usually works faster than kayexalate. Being on dialysis with severe diarrhea from a medication you never needed is an unhappy experience for a patient.
  7. Dialysis is the ultimate treatment for hyperkalemia. Patients with end stage renal disease are routinely emergently dialyzed with severe hyperkalemia. For other patients with severe hyperkalemia due to acute renal failure (or other causes) the decision to dialyze is sometimes complicated and depends largely on the reversibility of the condition. Sometimes, patients with mild and moderate elevations of potassium are also treated with dialysis, depending on the situation.
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Coffee Notes #5: Solving the mystery of the elusive "short" cappuccino

Via Slate:
Here's a little secret that Starbucks doesn't want you to know: They will serve you a better, stronger cappuccino if you want one, and they will charge you less for it. Ask for it in any Starbucks and the barista will comply without batting an eye. The puzzle is to work out why.

The drink in question is the elusive "short cappuccino"—at 8 ounces, a third smaller than the smallest size on the official menu, the "tall," and dwarfed by what Starbucks calls the "customer-preferred" size, the "Venti," which weighs in at 20 ounces and more than 200 calories before you add the sugar.
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Hilarious Journal Articles #35: Does Her Ass Look Fat In This?

Via Yahoo News:
The School of Textiles and Design at Heriot-Watt University in Edinburgh have begun what is believed to be the world's first-ever study on how women's clothing affects the bottom.

Models with variously sized posteriors will wear different types of clothing as part of the research, which will examine how designs, colours, patterns and fabric types affect perception.

Others will be asked to assess how big or small each model's backside appears to look in the outfits.
(Thanks, Shrinkette!)

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A woman who couldn't pay her bills is unplugged from her ventilator and dies. Is this wrong?

From Slate:
Tirhas Habtegiris, a 27-year-old terminal cancer patient at Baylor Regional Medical Center in Plano, Texas, was removed from her ventilator last month because she couldn't pay her medical bills. The hospital gave Ms. Habtegiris' family 10 days' notice, and then, with the bills still unpaid, withdrew her life support on the 11th day. It took Ms. Habtegiris about 15 minutes to die.
Technorati Tags: Slate, Mechanical Ventilation, Tirhas Habtegiris

Flickr: IMG_2471

From Flickr. Uploaded by Fishtail@Taipei on 26 Dec '05, 2.50pm PST.

Flickr: Stadshuset

From Flickr. Uploaded by Dave Gorman on 7 Jan '06, 9.49am PST.

Saturday, January 7, 2006

Nine new lawsuits filed in UCI liver transplant scandal

Via The Mercury News:
Former patients and family members of patients who waited for liver transplants at a University of California hospital for months or years filed nine lawsuits against the state university system Friday.
Technorati Tags: University of California at Irvine Medical Center, Liver Transplantation

The Top Ten Health Absurdities

From the National Review Online:
Kevin Trudeau's book on Natural Cures which argues that "medical science has absolutely, 100 percent failed in the curing and prevention of disease," and says that tap water can kill you and that organic food is our only hope — is one of 2005's best-selling advice books.
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Thursday, January 5, 2006

Vaprisol (Conivaptan), a Vasopressin Antagonist, Approved for Hyponatremia

Via PRNewswire:
Astellas Pharma US, Inc. today announced that the U.S. Food and Drug Administration (FDA) has approved VAPRISOL(R) (investigational name: YM087, generic name: conivaptan hydrochloride injection), an arginine vasopressin (AVP) antagonist for the intravenous treatment of euvolemic hyponatremia in hospitalized patients. VAPRISOL, discovered and developed by Astellas, is the first drug specifically indicated for the treatment of euvolemic hyponatremia, a potentially life- threatening condition that occurs when the body's blood sodium level falls significantly below normal. The FDA also issued an approvable letter for VAPRISOL as a treatment for hypervolemic hyponatremia. Astellas plans on working closely with the FDA to obtain an approval for VAPRISOL's use in patients with hypervolemic hyponatremia.
Technorati Tags: Vaprisol, Conivaptan, Hyponatremia, FDA

Tuesday, January 3, 2006

2005 Medical Weblog Awards: Polls Are Open!

Every year, Medgadget hosts the Medical Weblog Awards.

KidneyNotes is one of the 36 blogs (!) nominated for the category of Best New Medical Weblog. The nominations are outstanding and I read many of them regularly. If you enjoy this blog, please consider voting for KidneyNotes.

Thank you.

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Hilarious Journal Articles #34: Harry Potter Decreases Emergency Room Visits

Building upon the work of researchers who noted that emergency room visits decrease during the world series, researchers in the British Medical Journal have discovered that visits for injuries to pediatric emergency rooms decrease when new Harry Potter books are released.
To date no research has addressed the option of "distraction therapy" to prevent traumatic injuries. Alternative strategies such as "restraint therapy" and "pharmacological modification'" have been considered and abandoned on ethical grounds. Distraction therapy has been used successfully in settings such as painful clinical procedures with good effect.

We observed a significant fall in the numbers of attendees to the emergency department on the weekends that of the two most recent Harry Potter books were released. Both these weekends were in mid-summer with good weather. It may therefore be hypothesised that there is a place for a committee of safety conscious, talented writers who could produce high quality books for the purpose of injury prevention.
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Patient Quote of the Day #8: Vacation

Health Care Provider: Your blood pressure is 159/96. Did you take your meds today?

Patient: I'm on vacation!

Grand Rounds 2.15

Grand Rounds 2.15, this week's best posts of the medical blogosphere, is up at Random Acts of Reality.

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Monday, January 2, 2006

Superfluous Medical Studies Called Into Question

The Washington Post asks "Do we really need to be studying that again?"
A finding has to be reproducible to be believable. Only if different scientists in different places do the same study and get the same outcomes can physicians have confidence the finding is actually true. Only then is it ready to be put into clinical practice.

Nevertheless, one of medicine's most overlooked problems is the fact that some questions keep being asked over and over. Repeated tests of the same diagnostic study or treatment are a waste -- of time and money, and of volunteers' trust and self-sacrifice. Unnecessary clinical trials may also cost lives.

All this is leading some experts to ask a new question: "What part of 'yes' don't doctors understand?"
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Nephrology Cases #10: Hypertension and Neurofibromatosis

A 35 year old woman with neurofibromatosis presents with severe hypertension. What two forms of secondary hypertension should be considered?

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Sunday, January 1, 2006

Flickr: Happy New Year @ Hong Kong

From Flickr. Uploaded by Littopillo on 31 Dec '05, 8.56pm PST.

Flickr: times square lit up

From Flickr. Uploaded by nj dodge on 31 Dec '05, 12.36pm PST.

Flickr: New Year 2006 London

From Flickr. Uploaded by paolo999 on 1 Jan '06, 12.22am PST.

Widespread Flu Outbreaks in Western U.S.

From CNN:
Four western states are the nation's hotspots for flu, and an epidemiologist predicts infections will grow after the holidays as children return to school and adults go back to work.

Arizona, Utah, California and New Mexico report widespread flu infections, according to the Centers for Disease Control and Prevention's weekly flu report. "Widespread" is the CDC's highest designation for flu activity.
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