Final Four: The Presidential Candidates & How their Health Care Plans Differ

Republican candidates:
McCain vs. Huckabee: Seems to come down to the abortion issue with former Arkansas Governor Huckabee stating he is staying in the race to promote a constitutional ban on abortion. Senator John McCain opposes abortions but believes it is a state, not a federal issue. Huckabee endorses defining a fertilized embryo as a person and granting it with constitutional rights.

Clinton vs. Obama: Clinton is now attacking Obama on his health care plan. She is accusing him of only insuring children and not adults.
Fact: Clinton's plan requires mandated insurance for all, punishing those who are uninsured.
Obama's plan requires mandated insurance for children only.
Both are advocating universal health insurance.

Honestly, these are the only major differences I can find...if you have uncovered more, "hit me up".


Thank you idiomusic2 for use of Candidate Finder '08 "cootie catcher".

Labels: election 2008, healthcare policy

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Betadine, Dr. Roozrokh?

Two years ago in San Luis Opisbo, California, the paths of Dr. Hootan Roozrokh (transplant surgeon from Stanford University) and 25 year old Ruben Navarro (disabled patient with adrenoleukodystrophy [ALD]) crossed in Sierra Vista Regional Medical Center. Today, Mr. Navarro is dead and Dr. Roozrokh faces three felony counts relating to his care and a civil suit filed by Mr. Navarro's mother. Dr. Roozrokh was not working for the medical center and was not in any way involved in the care of Mr. Navarro, who had been transferred from an assisted living center to the medical center following a cardiac and respiratory arrest. Mr. Navarro had been placed on life-support. Dr. Roozrokh was working for a regional organ procurement group, the California Transplant Donor Network.

Facts:

• It is against California state law for transplant doctors to direct treatment of patients until they are declared dead
• This restriction is in place to protect vulnerable patients and families so that organ retrieval does not take precedence over patient care.
  
• Dr. Roozrokh was not authorized by Sierra Vista Medical Center to care for patients or order medications
  
• Dr. Arturo Martinez and Dr. Roozrokh are both under investigation by the California State Medical Board
• Both of these transplant surgeons were involved in the now discredited Kaiser Permanente San Francisco kidney transplant program.
• KP announced closure of the program May 12, 2006
  
• Dr. Martinez was director of the program. In August 2006, KP was ordered to pay a $5 million penalty for mismanagement of the program
• $2 million fine
• $3 million to promote organ donations
• The United Network for Organ Sharing, which oversees organ allocation, reprimanded the California Transplant Donor Network for breaking protocol in the case of Mr. Navarro.
• Mr. Navarro was taken from ICU to the OR by the transplant team. It was then that Dr. Roozrokh began directing "end-of-life care", according to federal investigators. At 11:10 PM 100 mg of morphine and 40 mg of Ativan were administered and his breathing tube was removed. Navarro's heart kept beating, so he was given another 100 mg of morphine and 40 mg of Ativan by the ICU nurse who accompanied them to the OR.
  
• Morphine causes respiratory depression
• the dosages given of both of the medications are about 10 x the usual therapuetic dosage
• Mr. Navarro weighed 80 lbs.
• 140 mg. of Morphine is the recommended dosage for anesthetizing a 1200 lb. horse.
  
• After 30 minutes, the organs are no longer viable. Mr. Navarro's heart kept beating. He was wheeled back to the ICU. He died the next morning. His organs were never harvested.

Betadine? The New York Times is reporting today that Dr. Roozrokh administered Betadine to Mr. Navarro. You know that brown liquid stuff that health care staff use to clean and disinfect the skin? That is betadine or povidone iodine...I have never seen it administered internally. What? Blogger Cilla Slugga reports that:

• It is routine to administer Betadine via nasogastric tube into the stomach of an organ donor - after the donor is dead
• Dr. Roozrokh did the procedure while Mr. Navarro was still alive resulting in iodine poisoning
• symptoms are abdominal pain, diarrhea, pulmonary edema..."there may be esophageal stricture should the patient survive the acute stage..."

Dr. Roozrokh was not alone in the room with Mr. Navarro that night. Five other health care professionals were present, plus a pharmacist released the massive doses of medications. Is the American Society of Transplant Surgeons alarmed by this breach of ethics and alleged criminal activity? Donate Life America reports 18 people per day die waiting for an organ. Honestly, people seem more alarmed that organ donations might drop than in stepping back and taking a look at this horrifying picture.

A disabled man entered a hospital for care. He died. A multidisciplinary health care team may have hastened his death...that's sick. That's predatory. That's appalling. It's against the law. And it's wrong.

Thank you djfiander for use of photo Human organ for transplant.

Labels: Dr. Martinez, Dr. Roozrokh, organ transplants

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Thank You Science Roll for Grand Rounds 4.22: The Future of Medicine

Bertalan Mesko is a Hungarian 5th year medical student specializing in clinical genetics. He is all about personalized genetics and genomics and just recently presented at the Medicine Meets Virtual Reality conference in Long Beach, CA. He hosted this week's Grand Rounds and kindly included my post Something We Can all agree on - New Stem Cell Source along with a wealth of knowledge from a rich range of other voices.

Thanks, Berci, and we shall see who wins the hot chocolate! (We have a bet going on the outcome of the US Presidential election).

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Wii-hab Therapy for patients in England

Queen Victoria Hospital in England is part of the National Health Service and is a regional care center for 4.5 million people. Specializing in burns and plastic and reconstructive surgery, physical therapy is an important part of the rehabilitation process. Serco Group plc donated two Nintendo Wii games consoles to the therapy department and patients have been making great strides ever since.

When playing on a Wii console, the player acts out the normal physical movements in games like golf, tennis or boxing. They have so much fun, they forget about their discomfort and are motivated to move more, speeding recovery. It is being used for patients recovering from spinal cord injuries and other traumatic injuries at Walter Reed Army Hospital as part of occupational therapy.

Wii therapy/exercise is being used in schools to help teenagers who were skipping Physical Education classes (PE). And you may want to ask your surgeon to play a few rounds of Marble Mania before she dons her gloves for your next operation. Fine motor movements and manual dexterity are the name of the game - both in Wii and surgery. The applications are endless - diabetics, obesity, stroke patients...

Wii!

Thank you John Kannenberg for use of awesome picture of Parents playing Wii Boxing...

Labels: boxing, PE, therapy, wii

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Thank You Daily Interview for Grand Rounds 4.22

I am an interview junkie so I love the blog Daily Interview, who hosted Grand Rounds this week. Thanks for including my interview with US Surgeon General Richard Carmona in a fascinating round up of excellent writing!

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Pain Got You Down? Watch CBS Evening News with Katie Couric 6:30 PM February 19-21

Chronic pain is a serious public health problem plaguing millions of sufferers. The estimated costs to society are $100 billion in terms of lost productivity, medications, and other treatments. Pain affects 1 in 4 people and causes more disability than heart disease and cancer combined.

CBS Evening News addresses the pain issue in a 3 part series this week. Last night, Dr. Jon LaPook reported on some fascinating alternatives to medications. A TDCS (Transcranial Direct Current Stimulation) device is part of a clinical trial using a small amount of electrical current to interfere with the brain's perception of pain. The technique dates back 2,000 years ago when a Roman doctor used electric eels to relieve pain from headache and gout. Today TDCS may offer hope for people with fibromyalgia, spinal cord injury, migraine and other forms of chronic pain.

Tonight, Dr. LaPook will explain "Abuse Deterrent Opiates" - medications that don't work if crushed or taken improperly. Sounds great to me because I am overdosing on stories of unscrupulous doctors and pharmacists doing harm to people with chronic pain and other problems.

Tomorrow night on CBS Evening News, look for CNN's Dr. Sanjay Gupta to talk about video imaging that is being used to measure pain in little ones who can't tell us how they feel - babies. Facial recognition technology is part of another clinical trial to measure pain in infants and Dr. Gupta tells us all about it.

Understanding pain and new ways to cope with it is good news - Watch CBS News to learn more.

Labels: Alternative therapy, CBS, chronic pain

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In the Global Fight Against Malaria WHO turns on Gates Foundation?

The deadliest animal on the planet is the irritating little mosquito, responsible for over 1 million deaths annually. Dr. Regina Rabinovich has dedicated her life to solving the problem of malaria, haunted by the specter of 3 deaths of children per minute or 3,000 deaths daily due to the disease.

I guess that's why the Gates Foundation hired her as Director of Infectious Disease in 2003, making malaria and the search for a vaccine of this complex virus a priority. Dr. Rabinovich is a pediatrician and epidemiologist and the recipient of a 1993 NIH merit award for her outstanding contribution to the NIH vaccine research program. In 2002, she argued that Africa was made poor by malaria and that infectious diseases were costing the continent billions of dollars per year. Research from the Wellcome Trust supported her assertions that more money must be spent on the search for a vaccine against malaria, not just treatment of the disease.

The Gates Foundation launched the Malaria Vaccine Initiative in 1999 with a $50 million grant. Today, Dr. Rabinovich commands a budget of $1 billion. The Gates Foundation has put $1.2 billion into malaria interventions since 2000, ramping up the attention the disease had been receiving. Enter Dr. Arata Kochi, Japanese physician and public health specialist, appointed Director of the WHO Global Malaria Programme in 2006. Forced out of his previous position as head of WHO's Stop TB Programme because he alienated donors and partners,
Dr. Kochi is complaining that Dr. Rabinovich and the Gates Foundation have created a malaria "cartel". Health policy expert Professor Amir Attaran of University of Ottawa has weighed in, calling Dr. Regina Rabinovich "autocratic".

For some reason this reminds me that one of the things that bothered the Royal Family about Princess Diana was that she worked with HIV/AIDS and leprosy patients. The Queen admonished her to "do something more pleasant". Back in the '80's, when the disease was new and people still thought it could be contracted by casual contact, the Princess sat with AIDS victims and held their hands. That simple act helped change perceptions about AIDS, but it cost Diana personally.

I am grateful to the Gates Foundation and the work they do for global health. If it takes an "autocratic" (translation - strong) person of whatever gender to get the issue of malaria solved, then so be it. Let's support her. Let's thank her. Let's respect her for the years of her life she has dedicated to trying to save lives. As Senator Obama said last night, "...if it was easy, it would already have been done...".

Thanks Pandiyan, for use of photo The Most Dangerous Killer in the World.

Labels: Attaran, global health, Kochi, malaria, Princess Diana, Rabinovich

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CJD deaths in France due to contaminated HG hormones

Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease. I have only seen one case of it in my career - and it was an forgettable. A young South African physician was reduced to a writhing, wilted mass of humanity, unresponsive and unaware of the world around her, confined to a bed in our ICU. CJD causes rapidly progressing dementia which is fatal within a matter of months after diagnosis. As a student I watched the occasional autopsy and noticed the pathologists harvesting the pituitary glands of the cadavers. I recall asking why but did not receive an answer.

Today, doctors, pharmacists and other medical officials are on trial in France, accused of treating children with tainted growth hormones in the 1980's, resulting in over 100 deaths from CJD. Over 800 more people may be at risk for this terrifying disease. While the US and Britain stopped using growth hormones manufactured from human pituitary glands in 1985 due to concerns about contamination, France continued the practice. Despite warnings in 1980 from scientist Luc Montagnier, the scientist who discovered the AIDS virus. Luminaries from the scientific world, including 1997 Nobel Prize Winner for Medicine, Stanlely Prusiner, who identified prions, are testifying in the trial.

Seventeen years ago, family members brought suit against the medics. They are accused of not disclosing the dangers of treatment to parents and of violating safety practices. Investigators have uncovered evidence that harvested pituitary glands were purchased from Eastern Europe neurological and infectious disease units. A pharmacology professor is accused of taking bribes. If convicted he faces 10 years in prison. CFD symptoms can take 30 years to manifest.

Thank you Goldtoe for use of photo.

Labels: CFD, France lawsuit

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How Sweet it Is? Valentine's Day Grand Rounds Thanks to HealthBlawg

Thank you David C. Harlow at HealthBlawg, the Health Care Law Blog, for including my post Preventable Tragedies: Pimp C & Heath Ledger in his Grand Rounds 4.21. With a nod to both Chaucer and Shakespeare, he makes this week's wrap-up of medical maladies palatable.

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Hug a Tree? It's Trails Advocacy Week February 11-14

Forget chocolates and (blood) diamonds. Take a hike with your loved ones for Valentine's Day. The American Hiking Society celebrates Trails Advocacy Week and if you don't have a favorite trail, this week is good time to discover one. Click on the map to find your new special spot. The season doesn't matter - as long as you dress appropriately and take along the right gear - and a friend.

Why hiking? Well, at least you are moving. You are out in nature, you aren't alone and you are aware of something bigger than yourself. Hikers support clean air and a safe, clean environment for health and safety of all people.

Get kids involved, too. Youth Outreach involves kids in trail maintenance and public works. Take a hike and have a picnic - it's something the whole family can enjoy.

Thank you svanes for use of photo of LA hiking trail, Paseo Miramar.

Labels: hiking, nature, outdoors

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Something we can all agree on - New Stem Cell Source

The Institute for Regenerative Medicine at Wake Forest University has discovered a new source for stem cells - amniotic fluid obtained from amniocentesis. Broad potential stem cells isolated in amniotic fluid have been used to create muscle, bone, liver, nerve and other important cells. The hope is this will be an important option for tissue repair or growing engineered organs (see my post on organ harvesting from live donors and the potential for exploitation).

Multiple progenitor cell types from the developing embryo are found in amniotic fluid. These would be similar to embryonic stem cells, in that they are not yet differentiated, but without the ethical/political issues that have created roadblocks to treatment for many. Scientists at Wake Forest think these amniotic fluid-derived stem cells (AFS) may be an intermediate step between adult stem cells and embryonic stem cells. Similar stem cells were harvested from placenta and other tissues after childbirth delivery. These cells grow quickly - doubling in 36 hours, and they do not produce tumors, a problem with some other types of stem cells.

With more than 4 million live births in the US each year, scientists are excited that this new potential resource could provide a bank of 100,00 specimens giving 99% of the population a perfect genetic match. In a previous post about Tiantan Puhua Stem Cell Center in Beijing, I reported that doctors in China were already using stem cell transplant therapy to treat Batten Disease. They are also treating Parkinson's, brain injury, cerebral palsy, stroke, mutiple sclerosis, ALS and other neurological conditions. Regenerative medicine - the potential to implant new cell that stimulate our bodies to grow new healthy cells where others have been damaged by disease or trauma - offers new hope and that's exciting.

Thank you Sam Blackman for use of photo.

Labels: Stem cell therapy

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Historic Breakthrough Treatment at China's Stem Cell Center

Tired of waiting for the US to figure out the moral ambiguities of stem cell research? Apparently, the family of 6 year old California boy Blake Dell'Aringa, diagnosed with Late Infantile NCL or Batten Disease, were - so they took their son to China. Tiantan Puhau Stem Cell Treatment Center in Beijing is the destination for seekers of the most advanced stem cell procedures and treatment. Dr. Wu Li Ke and Dr. Wang Xiao Juan lead the stem cell treatment program.

Late Infantile NCL is a fatal genetic disease resulting in rapid deterioration of neurological function. Most kids with the disease don't live beyond age 12. At age 6, Blake was rejected by a federally authorized stem cell trial in Oregon. His father took him to China for stem cell transplant therapy in October, 2007. In a matter of months, he progressed from being spastic, barely responsive and unable to sit, to being able to participate in a therapeutic horseback riding program. On January 15, 2008 he returned to school.

Treating a patient with Late Infantile NCL is a historic first for Tiantan Puhua Stem Cell Treatment Center. Congratulations to Blake, his family and the medical team for this miracle of biotechnology. It is hard to argue the morality of seeing a young child receiving the gift of life and health.

Thank you Abraxas3D for use of photo of stemcells.

Labels: batten disease, China, medical tourism, Stem cell therapy

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Preventable Tragedies: Pimp C & Heath Ledger

Codeine + promethazine + clorazepate + sleep apnea + obesity (BMI 39.2) = DEATH. For Houston rapper Pimp C (Chad Butler), found dead in his hotel room December 4, 2007 , it proved a lethal mix of prescription medications and medical diagnoses.

Oxycodone + hydrocodone + diazepam + temazepam + alprazolam+ doxylamine + insomnia + depression(?) = DEATH. For Australian actor Health Ledger, found dead in his apartment January 22, 2008, it was a deadly cocktail of prescription medications and medical diagnoses.

Suddenly, it's not street drugs we have to worry about kids, friends and loved ones abusing. Abuse of prescription medications is the fastest growing drug abuse problem in the US. The number of teens abusing prescription drugs has tripled in the past decade, and it has doubled in the population at large. How does everyone get these drugs? Obviously, they know how to work the system, and work around all of the checks and balances put in by the legal, health care, insurance and pharmaceutical systems. Anyone who has gone to a doctor's office recently to get a prescription for anything, trudged to the pharmacy and had to produce proof of insurance, ID and a credit card knows what I am talking about.

Prescription medications are available over the internet, sold and traded on campuses and the street. But there has to be more to it than that. Somewhere a doctor or two is writing prescriptions and a pharmacy is dispensing the medications. A National Drug Intelligence Center (NDIC) report published June, 2007 noted that Houston has become a hub for pharmaceutical drugs diverted outside the Houston area by "unscrupulous doctors and pharmacists". In the City of Syrup, a Houston doctor and three pharmacists conspired to distribute the same syrup found in Pimp C's hotel room. A Byzantine case - Dr. Hall-Herpin and her employees, three street level drug dealers, and 7 pharmacists were convicted for selling prescriptions for cash, distributing 1.7 million tabs of hydrocodone, 2,500 gallons of "the syrup". Dr. Hall-Herpin would sell stacks of prescriptions, prescriptions to friends of patients and to fictitious persons. She claims she learned the system from another doctor. These are the few who got caught. Open your eyes. Look around you. There are plenty more - in your neighborhood.

If you have any concerns about Prescription Drug Abuse, call 1-866-523-5613.

Thank you Runs with Scissors for use of photo.

Labels: overdose, prescription drug abuse

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Thank you Diabetes Mine for Grand Rounds 4.20 The Health 2.0 Explosion

Diabetic Amy Tenderich is a journalist/patient blogging from San Francisco who put together a stellar Grand Rounds this week. She included my post, Calling Dr. Kumar: Real Life "Dirty, Pretty Things". Thanks Amy, for an informative round up and for including me in it!

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Global Healthbeat: Kenya - What happened?

Kenya, to most North Americans, has long been one of those African nations that seemed safe and stable. We know that it is on the east coast, on the equator, it may be the birthplace of our species, and with exotic wildlife in a gorgeous setting, a place to take the family on safari. We know there is high employment and extreme poverty but we knew that up until late December 2007, Kenya was politically stable. Elections were held in December 2007 for a new President. Incumbent President Mwai Kibaki (Party of National Unity - PNU) was running against Raila Odinga (Orange Democratic Movement and while Kibaki has been sworn into power again, many claim the results are suspect. Kenya has descended into violence and mayhem since then, and many lives have been lost, many more are internally displaced.

Had we been paying attention, we would have noticed some unsettling facts: it is a nation of 37 million people but the GNI per capita is about $540 and the life expectancy; 46 years for women. It is ranked one of the 20 most corrupt countries in the world. The US gives $1 billion annually in aid for health care, education, and HIV/AIDS prevention.

Lucas Sang and Wesley Ngetichc, track and field stars, were killed in the violence. Sang competed in the Seoul Olympics in 1988. Mugabe Were, a member of parliament and a peacemaker, was killed. U.S. presidential candidate Obama has family members in Kenya who are affected by the violence. Gender based violence - especially rapes of girls under age 18 - including brutal gang rapes - has escalated. Women and children, forced to flee their homes and seeking shelter in camps with little or no security, are in double jeopardy. UNICEF has launched an appeal for an emergency $3 million to assist women and children displaced by the violence in Kenya.

Thank you ActionPix Maruko for use of photo 2007 Post election violence Kenya.

Labels: Kenya, rape, violence

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Improving Health Literacy: Healthline Launches Drug Search

People searching online for health information are increasingly looking for information about medications, supplements and herbals. Some research indicates as much as 40% of online health related search by consumers is done to learn more about medications.

The shifting sands of medicine, pharmaceuticals and insurance are forcing consumers to be savvy, informed drivers of their own health care services. Understanding and complying with prescription medications is one point of care that consumers, physicians and pharmacists struggle with. Despite labeling, patient education in the provider's office and at the pharmacy - when it comes to drug usage - people still aren't getting it. Otherwise medication errors would not be such a huge problem resulting in hospital admissions and deaths. No matter what the literacy level or education level - understanding prescription medications and how and when to take them - is something we all struggle with.

Healthline Networks has launched a beautiful suite of products to address this gap in health literacy - Drug Search. Developed by a pharmacist, physician and other smart, caring people dedicated to consumer health, Healthline's Drug Search features an exclusive blend of expert pharmaceutical content with information on medicinal herbs, supplements and all possible interactions - including with foods.

• Try out our Interaction Checker.
• Pill Finder helps you identify medications via an image gallery
  
• FDA Patient Safety Alerts provides up-to-date information about consumer alerts
• Drug Notebook is one of my favorites. Everything you could want to know about your medications are answered on each drug page. Licensed from the American Hospital Formulary System (AHFS), the authoritative reference for pharmacists, the tabs at the top provide: Basic Info, Top Questions, Clinical Information and Interactions.
  
• FDA Alerts are available on each drug page
• As is a Media Gallery with images of the medication
• Drug Notebook includes content from Natural Standard, one of the world's premier sources of evidence-based complementary and alternative therapies. Check out Drug Notebook for Basic information, Top Questions and Interactions for herbs and supplements.

Take some time this weekend to explore Drug Search for the medications, supplements and herbals you and your loved ones are taking. It is our sincere hope that you learn a lot. Here's to your health and improving YOUR health literacy.

Thank you Cerner Multum for use of image of Dilacor.

Labels: drug search, health literacy, herbs, medications, supplements

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