One World One Dream - Olympics 2008 Ready to Launch

The 2008 Olympics kick off on August 8, 2008 in Beijing, China. This year's theme One World One Dream is meant to express the ideal of humankind sharing a dream for peace. 600,000 foreign visitors and athletes are expected to convene in Beijing and health concerns have been raised due to poor air quality. Anyone with asthma or other respiratory problems should be prepared for flare ups due to smog and indoor air pollution.

3.3 million cars have been ordered off roads and construction has been halted throughout the city, according to the International Herald Tribune. Factories have shut down, but the smoggy skies persist due to a long stretch of humid weather trapping the polluted air. Ethiopian marathon runner Haile Gebrselassie, who is a world record holder and has a history of asthma, has already dropped out of the games due to health concerns.

Other health risks are dog bites and rabies. Beijing has the second highest rabies rate in the world. Visitors are advised to avoid petting stray dogs and monkeys. Motor vehicle accidents, especially vehicle vs. pedestrian accidents are common. Visitors are advised to wash hands often and watch their step.

Thank you rytc for use of image Birds Nest in Smog, Olympic Village Beijing 2008.

Labels: 2008 smog, Beijing Olympics, health concerns

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Death by Taser: The Medicine Behind the Headlines

Baron Pikes of Louisiana, USA, died in January 2008 in police custody after being Tasered 9 times while handcuffed. Winn Parish Coroner Dr. Randolph Williams ruled Pikes death a homicide at the hands of arresting police officer, Scott Nugent, who has since been fired. A Grand Jury convenes this month in Louisiana to determine if Nugent should face criminal charges in Pikes death.

The Taser is a conducted electrical weapon developed and manufactured by Taser International, Inc. (Scottsdale, AZ) since the 1970's. Conducted electrical weapons are less than lethal weapons used by thousands of law enforcement agencies in the US. More than 120,000 private US citizens carry a Taser for personal protection. The Taser delivers an electrical pulse, resulting in tetanus like muscle contractions, and sudden death has been associated with its use.

How does it work? The Taser is a weapon powered by 8 AA nickel metal hydride batteries. When the operator fires the device from a distance of as much as 7 meters (21 feet), 2 9-mm barbs (#8 fishhook), attached to the Taser gun by copper wires are discharged. The barbs may hook the skin, but more often the clothing and the electrical impulse can be delivered through 2 inches of clothing. Once contact is made, an electrical pulse (up to 50,000 volts) is discharged for 5 seconds which incapacitates the subject. More electricity is released as the trigger is pulled again.
Voltage is energy potential - I am no expert on electricity, but apparently it isn't voltage that poses danger - it is electrical current expressed in amps (amperes). The average current of the Taser is 2 amps (maximum US household current is 240 amps and the threshold for ventricular arrythmias is 50-100 amps).

Estimates of 170 deaths since 1999 have been attributed to Taser use, and while intuitively the thinking may be that the cause is cardiac arrythmias, that does not pan out. While Tasers have been tested on volunteer subjects, those subjects are "healthy workers" and are subjected to one 5 second electrical pulse. The population being subdued by the police may be intoxicated or in a stated of excited delirium - i.e. violent and aggressive.

The American College of Physicians (ACEP) recommends that agitated subjects be brought to the ED for medical evaluation and supportive care. As a former ED nurse, trust me, ED staff are used to working with cops and agitated patients. If subjects are intoxicated (alcohol, cocaine, PCP, methamphetamine) or agitated due to psychosis or other unknown reasons, they may be hyperthermic, tachycardic and dehydrated. Supportive medical care - with sedation and intravenous fluids -may prevent death in police custody in these cases. Laboratory studies for drug and alcohol levels and other abnormalities can be done and treated.

The barbs themselves can cause injury and can be treated in the ED as would any other fishhook injury. The ACEP recommends that everyone who has been TASERed be given a head-to-toe examination in the ED to rule out any injuries.

Thank you JamesProvost for use of image Taser Effects.

Labels: Baron Pikes, homicide, TASER

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Doctors and Nurses Who Participate in Torture

Will Moore of Florida State University's Department of Political Science reports that 78% of governments around the world use torture against persons under their control, and the US is one of them. While politicians, reporters and the general public decry torture as abhorrent, the use of torture techniques is widespread and ever more sophisticated.

In 2004 the New England Journal of Medicine (NEJM) reported on the complicity of US doctors, nurses and medics in torture in Guantanamo Bay, Iraq and Afghanistan. The International Red Cross complained about prisoners medical records being turned over to interrogators. But it went beyond that - there is evidence that medical personnel have become part of the prison environment and involved in the actual planning and orchestration of torture.

These practices are in direct conflict with the World Medical Association Resolution on the Responsibility of Physicians in the Documentation and Denunciation of Torture 0f 2002. It is a gross violation of medical ethics for medical personnel to participate in torture. Doctors in Nazi Germany orchestrated the death camps and so-called medical experiments. In Chile and elsewhere in the Americas, South Africa and the Soviet Union and the Middle East, medical personnel and especially psychiatrists have been participants in government sponsored torture.

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Thank You Grunt Doc for Hosting Your 6th Grand Rounds!

GruntDoc, a blog writing, Grand Rounds hosting ER physician in Texas hosted the 200th edition of Grand Rounds this week. Hey Doc - thanks for including my Happy 90th Birthday Nelson Mandela post...Check out Grand Rounds, always some interesting stories...from around the globe in medicine.

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Medical Doctors and Genocide - Dr. Karadzic Captured

First Do No Harm - it's the time honored Hippocratic Oath of all medical doctors. But there is more:

Labels: Bosnia, doctors, genocide, Karadzic, war crimes

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Murder on My Mind

No matter how great the strides we make in health care and science, the news of homicides is relentless. At least 5 homicides of males were reported in the Bay Area this weekend. Murder is the 10th leading cause of death of men in the US. But the US isn't even close to the top 10 countries in homicide rates worldwide. It is difficult to get accurate numbers and it depends on the reporting methods and sources, but as of this writing, Columbia appears to hold the dubious distinction for being the country with the highest homicide rate (although other sources claim El Salvador).

The list of the top 25 on Wikipedia reads like a Travel Zoo Top 20 - many of the same destinations we flock to as tourists are listed. Mexico, Jamaica, Trinidad and Tobago, Belize, Brazil, Panama, South Africa. The US comes in at number 40. Washington, DC is one of the most dangerous cities in the US. Honolulu and San Francisco are considered safe cities. Even though Finland as a country has a low homicide rate, the murder rate in Helsinki is high. Louisiana is the most dangerous state and Puerto Rico has a high murder rate, too. Maine has the lowest homicide rate of the 50 US states.

Most murders are due to men arguing with men, usually about money or property. Most murders (in the US) are white on white males under age 25 years, under the influence of alcohol. Homicide and violence are global public health problems. The World Health Organization defines violence as: The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm,
maldevelopment or deprivation. Over half a million people are murdered every year. A public health problem demands a comprehensive public health prevention program.

Thank you AJC1 for use of photo Chalk Outline.

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Happy 90th Birthday Nelson Mandela!

July 18,2008 is the 90th birthday of Nobel Peace Prize winner and South Africa's first black president, Nelson Mandela. He spent 30 years in prison for his fight against apartheid and is now a world statesman, fighting for the rights of the poor and oppressed. Today he campaigns for funding for HIV/AIDS victims and is speaking out for redistribution of wealth.

President Mandela reminds us that the poor don't live as long as the wealthy and wealthy nations have obligations to poor nations. Communicable diseases like measles, HIV, respiratory illness, malaria, TB and diarrhea account for half of the global disease burden, shouldered by the poor. Child mortality in poor countries is primarily due to malnutrition and preventable diseases.


Thank you commonswikipedia for use of image Nelson Mandela 1989.

Labels: distribution of wealth, Nelson Mandela

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Congress Overrides Bush Veto of Medicare Bill (HR 6331)

Both the Senate and House of Representatives passed HR 6331 which President Bush vetoed on July 15, 2008 but the House voted to override him. Interestingly, neither presidential candidate for the Democratic or Republican party this issue. HR 6331 now becomes law. What's at stake? Cuts to Medicare payments (10.6%) to providers as a way to fund private Medicare Advantage (MA) Plans. Doctors threatened to stop seeing Medicare patients if the cuts were made law.

HR 6331 is a victory for those with mental illness, and may represent the beginning of a shift in policy changes. Parity for mental illness with physical illness shifts cost sharing from 50% to 20%. Part D will now offer broad coverage of antidepressants, antipsychotics, and anticonvulsants and the ban on coverage of benzodiazepines, used for treatment of mania and anxiety disorders. There are also changes to the Low Income Subsidy (LIS) eligibility requirements which lowers premiums, drug cost sharing and eliminates the nasty donut hole coverage gap for beneficiaries.

What's all the fuss about? Most (80%) of the 44 million elderly and disabled opt for Medicare's traditional fee-for-service payment plan. The other twenty percent (about 10 million people) are enrolled in a Medicare Advantage Plan which include HMOs, PPOs, MSAs and even private fee-for-service PFFS plans. The Medicare Advantage Plans offer Medicare Part A, B and sometimes D through coordinated network services. MA payments are higher than traditional Medicare payments, which raises questions about equity of distribution of benefits for the Medicare population. Apparently the government has subsidized these plans with billions of dollars to finance low premiums and extra benefits for the privileged few who enroll - who are generally in good health. Now $14 billion will be cut from these programs over the next five years and the majority of Medicare beneficiaries will continue to receive care.




Thank you eliz.avery for use of hilarious image My Doctor Often Walks Me to the Door and Waves Goodbye
...in my dreams.

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Medicare in the News - Payments to Dead Doctors & other Issues

The Washington Post reported that Medicare has paid millions of dollars for durable medical equipment (DME) prescribed by doctors who were dead at the time of billing. The government established the Medicare Fraud Task Force to try to prevent such abuses, but fraud continues to costs us billions of dollars each year. No wonder health care is so expensive. Senator Norm Coleman - R (MN) said, "...scam artists have treated Medicare like an ATM machine...".

Durable medical equipment (DME) is medically necessary, prescribed by a doctor and is not useful to a person in the absence of an illness or injury, and is appropriate for use in the home.
Look in the phone book or the internet to see all of the suppliers - there is a huge potential for quick profit and unscrupulous suppliers have no problem obtaining beneficiaries’ Medicare health insurance claim numbers. Most DME providers only need a business license and supplier number. Then they need to fill out claim forms verifying medical necessity to Medicare.

• The DME supplier is required to fill out Certificates of Medical Necessity (CMNs) describing products and equipment to be used by the patient. There is a medical information section on the form which must be completed by a physician. This is where fraudulent suppliers can forge the information of deceased physicians.
• When medical necessity has been documented by the beneficiary’s doctor, the Durable Medical Equipment Regional Carrier (DMERC) may purchase or make monthly payments to suppliers for rented DME. Once the equipment is no longer needed the supplier is not entitled to payments and beneficiaries notify the supplier to pick up unused equipment.

Unscrupulous suppliers may obtain Medicare claim numbers fraudulently as a path to pursuing Medicare dollars:

• Beneficiaries are paid for their Medicare number or goods and services are exchanged for the number
• The elderly are preyed on. Be wary of phone calls offering health surveys or health screenings.
• "What is your Medicare number?" - guard and protect this number just as you do your social security number
• Lists of Medicare beneficiaries are obtained from long term care facilities

Recruiters or “cappers” offer money to beneficiaries to visit a clinic for medical screening tests. The beneficiary receives a cursory examination and prescription for DME equipment that is not medically necessary. Medicare is billed for supplies the claimant does not receive and the claimants receive other household goods at a profit for the DME provider. Numerous cases of power wheelchair fraud have made headlines. Medicare is billed for a power wheelchair and a less expensive scooter is provided to the claimant. Medicare and Medicaid beneficiaries are actively solicited (we have all seen the TV commercials) for motorized scooters. Federal health care programs and private insurers are billed for motorized wheelchairs, which cost about twice as much as scooters that were provided.

Discharge planners used to be a nurse or social worker employed by hospitals and medical care centers to help patients transition smoothly from the hospital facility to the home or long term care facility. Today, some erstwhile "discharge planners" in medical centers are actually employees of DME suppliers. Conflict of interest, anyone? Unneeded equipment and supplies are ordered. Federal and private insurers pay the bill. I have personally witnessed this little trick: The beneficiary calls the provider to pick up rental equipment that is no longer needed. The provider doesn't pick it up for months because they can continue to bill for it until they do. Or they can send the wrong equipment and bill for the wrong and right equipment because it was contaminated just by virtue of the fact that it was delivered.

It is illegal and fraudulent to:

• misuse a Medicare claim number to receive medical care, supplies, or equipment
• To bill federal programs for services not provided

• to bill for a more expensive or Medicare covered item when a less expensive, non-covered item was provided (upcoding)
• Submit duplicate claims for the same service
• provide kickbacks (payments) to doctors for patient referrals
• obtain Medicare numbers through false pretenses (telemarketing, health screenings, medical surveys, or offers of goods and services)
  

These are but some examples of the flagrant abuses of Medicare. Type in "medicare fraud" in our Search Box to learn more.


Thank you taurusaficionado for use of photo Scooter Lady.

Labels: medicare fraud

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Step Up For 9.4 Million Uninsured Children in the US

The Children's Defense Fund (CDF) wants us all to step up on behalf of the almost 10 million uninsured children in our nation.

Step up and join these children and CDF's Healthy Child Campaign today by sending an email to your Members of Congress telling them to ensure that every child has access to affordable and comprehensive health coverage.

One in eight children in America is uninsured and another is born uninsured every 41 seconds. Millions of kids have health insurance, but can’t get the care they need because the services they require aren't covered or require high co-payments. According to CDF : " Although improving the federal health programs currently in place—Medicaid and the State Children's Health Insurance Program (SCHIP)—is a step in the right direction, it's not enough. Increased funding and incremental expansions would still leave many children without the comprehensive, affordable coverage they urgently need.

This crisis threatens the health and prosperity of our nation. Consider this:

• When children lose health coverage, state and local costs rise due to more frequent use of emergency rooms and longer hospital stays, while children suffer needlessly.
• Uninsured children are almost nine times as likely to have a medical need that goes unmet as a child with health coverage.
• Uninsured children are more likely than insured children to perform poorly in school; in contrast, enrolling children in health coverage has been associated with greatly improved school performance.
• Children are the least expensive to cover and a smart investment in our future.

We can solve this problem if we all do our part. And there is a solution: The All Healthy Children Act would provide affordable, comprehensive, and seamless health coverage for all children and pregnant women in America—something every child needs today!

Thousands of children across America are stepping up and taking action today to help solve this crisis. Show your support today by sending an email to your Members of Congress asking them to do their part by passing the All Healthy Children Act that would ensure every child has access to health coverage."

Please speak out and step up on behalf of our children today.

Thank you Tanitta for use of photo Happy Children.

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Evolence Approved for Facial Wrinkles

OrthoNeutrogena's Evolence, a dermal filler, was approved by the FDA for correction of deep facial wrinkles, including nasolabial folds. Evolence is collagen structure developed from pigs, injected by a trained physician. Results can be seen after one treatment and last for 6 months.

Collagen breaks down with age. Evolence is a 3-dimensional collagen matrix that builds up the structures beneath the skin. A skilled physician can use Evolence to restore structure and volume to depleted areas. Results can be seen immediately. The only reported side effects are mild swelling, redness and pain at the injection site.



Thank you University of Bath for use of image Collagen.

Labels: EVOLENCE®

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Nobel Laureate Sir John Sulston Decries Profits over Patients

British scientist Sir John Sulston won the 2002 Nobel Prize in Medicine for his work in genetics. He has long advocated that knowledge derived from the Human Genome Project be kept free and open for use by scientists. He opposes privatization of scientific information and patenting genes and genetic information.

Speaking at the inauguration of the Institute of Science, Ethics and Innovation (iSEI) at the University of Manchester, Sulston called for an international biomedical treaty to develop policies about the use of intellectual property and patents. Sulston asks us to consider, Who Owns Science? The mission of iSEI is to examine the social and ethical consequences of advances in technology and science, and how they can be managed in a way that improves the lives of people. Some of the ethical questions iSEI will be exploring are:

• genetic manipulation of species to create hybrids
• genetic selection of human embryos
• disparity in funding in research of healthcare issues in the developing world vs. the developed world
• ethics of healthcare delivery models (from the US based distribution of services by wealth to free access to care)
• climate change
• global trade

Sulston hopes to ensure that global justice and a better future for humanity are ensured along with strides in technology and science.

Labels: ethics, science, Sir John Sulston, technology

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New for Clinicians - Helping Patients with Obesity

According to the World Health Organization (WHO), 1 billion people are overweight and more than 300 million of those people are obese. The cause of the obesity epidemic is decreased physical activity with an increase in consumption of energy rich foods high in saturated fats and simple sugars. Obesity puts the worlds population at increased risk for chronic diseases such as type 2 diabetes, heart disease, cancers and stroke. A BMI greater than 25 is overweight and over 30 is considered obese.

Clinicians are struggling to help patients who are overweight and obese. The Handbook of Obesity, Third Edition has just been published by Informa Healthcare. Edited by Drs. George Bray and Claude Bouchard, the Handbook provides in-depth information about aspects of treating and preventing obesity. Both doctors are professors at the Pennington Biomedical Research Center in Baton Rouge, Louisiana.

Seventeen of the book's forty chapters are dedicated to medical management of obesity. Reviewers are calling it a "...must have resource for endocrinologists, cardiologists, internal medicine clinicians and others working in the field..."












Thank you Malingering for use of photo Cupholder/Beer Belly.

Labels: obesity, overweight

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Thank You Dr. Rich for a Very Patriotic Grand Rounds!

DrRich is a cool guy who writes books and blogs about our crazy health care system. (Are you listening, presidential candidates?) He hosted Grand Rounds for the 4th of July and put together a very patriotic round-up to honor the 232nd birthday of dear old US of A at The Covert Rationing Blog (Healthcare Rationing: Where even Angels Fear to Tread). I am honored that he included my post, Record Numbers of Suicides in US Troops, in this venerable company under the heading Service and Sacrifice. Thank You Dr. Rich and Thank You to our troops who continue to serve and serve again. Our thoughts our with you...

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