Halloween Grand Rounds

Head on over to Dr. Hebert's Halloween poetry themed Grand Rounds - this week's best of the health blogosphere, the carnival of the caregivers. It's quite creative in presentation!

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Grow A Face Rather Than Transplant It

Stanford University researchers propose to regenerate skin cells from stem cells to replace damaged facial skin rather than the approach French surgeons have attempted recently, partial reconstruction for extensive facial disfigurement.

I'm excited about this for sentimental reasons. A lot of why I got into Brown's Program in Liberal Medical Education was due to my parent's foresight at age 16 to ship me from Peoria, IL to take a summer in a lab in U of I, Champaign-Urbana, where I practiced cell culture technique and recombinant DNA research. One of the dreams I had was that in the future they'd grow cells for organ replacement, and now, more than double that age, we're starting to have the inkling that it could come true.

The reason this is exciting is that embryonic stem cells have the potential to heal and form skin that neither scars during healing, nor has the problem of rejection of transplanted tissue. Current approaches to reconstruction by using cadaveric tissue, requires the patient to be on lifelong immunosuppressive medications. By using cells that aren't seen as foreign, the patient could potentially forego that lifelong risk of contracting illness, since they don't want their body to reject their new face.

It's exciting times we're living in, and recent legislation points to loosening of restrictions on use of stem cells. I just hope it's not due to the lobbying of the cell banks that would love to sell these unused embryos.

via Wired.

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Elizabeth Edwards: Saving Graces: Finding Solace and Strength from Friends and Strangers

I'm live blogging from a meeting with Elizabeth Edwards on her recent book, "Saving Graces: Finding Solace and Strength from Friends and Strangers." Here are quotes from our interview with the Silicon Valley Moms Blog who Elizabeth reached out to as likeminded friends:

On health: "Women haven't been able to integrate it into our lives, I can't make an appointment for a mammogram 5 months from now, we need it:
- in public places where you visit
- in elementary schools
- make it more convenient for us. I don't know my schedule so far in advance."

The book was timed to release during Breast Cancer Awareness month, as the last chapters chronicle her battle with breast cancer. I was inspired at how she found joy after the initial devastation. Although she hardly emailed and participated online during her treatment because of the nausea and side effects, she found online community to be very supportive previously during the time of grieving when she lost her son. She's taken down all of her public emails in her communities to protect her husband's campaign, but saved printouts of almost all of her active participation.

On Politics: "I wouldn't be interested in running for office, even though my background is similar to Hillary's. John committed enormously to politics, so I made a decision to change and be the mom that does the soccer practices and brings my kids around. I wasn't going to be a partner in a big firm, and I made that choice gladly. Hillary chose power. I chose giggles and mud, I'm happy with my choices"

How do you stay grounded? "I never bought into the 'I'm on TV, I'm somebody special.' We went into this so that folks that go to Friday night football could be a part of the political process."

How did your world change? "In Washington, I'm a little bit the odd man out. They're younger, they have younger friends, they do things that I'm too old and tired to do."

You've been in the public eye, how has the media changed over the years? "We haven't been in the public eye that long. I'm very glad that citizen journalists are out there. It's not conventional wisdom, there's no filter or lens, it's not filling out the blanks for a story."

Elizabeth was so down to earth, we didn't just focus on her book. She came across as heartfelt, meeting with likeminded mothers, a few of whom similarly worked as lawyers as well as mothering. What does this have to do with technology in medicine, you ask? Well, two themes: the frustration at the overloaded health care system and inability to get prompt care, and the richness of her participation in online community and how I would hope that would grow to support patients searching for opinions about physicians they're interested getting care from.

I pointed out to Elizabeth that as more mothers blog and demand that their healthcare providers give them same day visits and prompt care, physicians will respond to the market demands. I provide Urgent Care, and see patients who come and wait to see me without an appointment, similar to an ER (emergency room). My group provides this kind of same day appointments under the moniker of "Advanced Access" where a patient calls, and gets an appointment that day at Palo Alto Medical Foundation. The idea is to do today's work today, and reduce the number of patients that fail to show up, such that in traditional practices, they double and triple book their physicians due to no-shows.

What I intend to email Elizabeth about, which I didn't have a chance to ask her in person, is around page 300 in her book, she recounts how Mrs. Heinz Kerry told her "There are plenty of good doctors out there, but don't go to XXX" who happened to be a physician who was on her team. Elizabeth shared that it knocked her off of her "razor blade balancing act" and plunged her into depression. John tried to support her and say that many people have bad experiences with physicians and don't take one person's opinion, take many. What I intend to ask is whether or not she would trust online comments in the communities she participated in, as trustworthy opinions. Many people express opinions on their physicians in online forums and email lists such as ones she participated in. I believe that as their participation grows, more and more stories, good and bad, will be posted about patient's experiences with their physician. It would be wonderful if Elizabeth had the chance to be reassured by the opinions of online friends she already trusted. I felt terribly about this particular incident.

What a wonderful afternoon to share with the potential next First Lady. It was amazing she'd reached out to our local mothers and were interested in our concerns and wanted to dialogue with us. It was more than I'd seen in any politician, and perhaps that's why she said she chose mothering rather than a political career. She connected to these women, as a likeminded mother who wanted to be friends. I'm honored to be her friend. I'm honored to be a friend of the bloggers at Silicon Valley Moms Blog. It doesn't mean I share their political views, but I'm interested in their opinions.

One husband of our group pointed out that by meeting Elizabeth, it branded the group as all Democrat. I disagree. I want to hear multiple opinions, a wealth of discourse, and find good ideas regardless of the political party it comes from. We need solutions, and those don't belong to one party, they belong to those who care about solving them.

www.flickr.com enochchoi's Elizabeth Edwards SVMB photoset

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Grand Rounds Volume 3 Number 5 is available

Bob Coffield hosts this week's Grand Rounds, the best posts of the health blogosphere from this past week, also known as the carnival of the caregivers.

Thanks for Bob for posting from the hills of West Virginia, and for being the first lawyer to participate in Grand Rounds. Cheers!

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Sanofi-Aventis Flu Vaccine Not Suspected in Deaths of 4 Israelis, Israel Resumes Vaccinations

Israel briefly halted flu vaccinations after up to 4 recipients died following administration. They have since resumed vaccination since they don't believe the vaccinations themselves to be involved. Sanofi-Aventis dispatched investigators. I'm sure more will come.

Further Update:
Taiwan lifts ban, 24 hours after instituting it.

Update: Taiwan halts vaccination pending investigation:

Deputy Director-General of the Center for Disease Control (CDC) Chou Chih-hao (周志浩) said yesterday that no more flu vaccines from the French firm Sanofi-Aventis would be administered until the CDC feels confident that the vaccines are not connected to four recent deaths in Israel.

Get the latest via Google News.

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HEALTHmap Maps Epidemic Text Alerts to a Graphical Map of the World

HEALTHmap provides a jumping-off point for real-time information on emerging infectious diseases and has particular interest for public health officials and international travelers.

It "brings together disparate data sources to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. This freely available Web site integrates outbreak data of varying reliability, ranging from news sources (such as Google News) to curated personal accounts (such as ProMED) to validated official alerts (such as World Health Organization). Through an automated text processing system, the data is aggregated by disease and displayed by location for user-friendly access to the original alert."

Sure, you can scan through this information in the freely available sources, but by displaying it on a graphical map, it allows one to pick a particular geographical location with all of the alerts aggregated about that place. In Web2.0 parlance, it's called a mashup, re-displaying information in a more usable way. Moreover, it's wonderful that you have the chance to pick specific resources that you believe in, and exclude the ones you don't.

This started as a research project, and I hope it finds funding to continue and become independent. Add Google ads and I'll bet it will be sustainable. At least I'm hoping so!

Others commenting: MedGadget, Wired News, Alex Soojung-Kim Pang of IFTF.

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My Picks for This Week's Best of Healthline Blogs

You know, I'm one of a bunch of great bloggers here at Healthline, and I wanted to point you to my highlights of this last week:

Paul Auerbach reports on the latest stingray attack in "Another Stingray Attack". Attacks are so rare, it's strangely so close in timing to Steve Irwin's deadly injury.

Dr. Bob Norris advises you to call 911 for chest pain of the sort he describes in "Chest Pain? Don't Wait!". So many folks come to my PAMF Urgent Care with heart attacks, and we send 'em right over to the ER. Then again, plenty of folks don't have a heart attack, and I have the pleasure of reassuring them in Urgent Care.

There are plenty more great posts over at the other bloggers, so scroll down and read all about them below.

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Neurometrix NC-stat, a New Nerve Conduction Test, a Moneymaker, Divides Doctors

Neurometrix's new nerve-testing system, called the NC-stat, is used to diagnose peripheral neuropathy in cases such as CTS carpal tunnel syndrome, and came under fire today with a New York Times expose on the marketing schemes promoted to the family physicians who make a tidy $250 from this 15 minute test.

Although their marketing practices do sound shady, I'm more interested in knowing if their test performs as well as the gold standard for diagnosing peripheral neuropathy - sensory nerve conduction study (NCS). It's not clear to me from reviewing the evidence posted at their website, how well it performs in this regard. From the NYT article, a surgeon receiving referrals for CTS was wary of the diagnoses and referred the patients to neurologists. This is only one physician's opinion, and I find it curious that he'd refer to a neurologist rather than simply ordering the EMG himself. It's probably because surgeons like to operate, focusing on that rather than the diagnostic process.

If it acutally works, the device sounds like a painless alternative to the sometimes uncomfortable sensory nerve conduction study (NCS) gold standard. For not, I'd trust sensory nerve conduction study (NCS) for my diagnoses of peripheral neuropathy until larger studies show validity to the company's claims. I'll forgo the potential income, as most physicians would, until the evidence shows it's accurate.

Others reporting: TailRank, KevinMD, Mcarthur Web.

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Roche Diagnostics CoaguChek PT Test Strips Nationwide Recall

Roche Diagnostics CoaguChek PT test strips have been recalled due to the potential of reporting falsely elevated protime (INR) test results, which indicate a patient's blood is thinner than it actually is. If actions were taken to decrease the dose of anticoagulant taken, a patient's blood could become prone to clot, resulting in unanticipated complications for the patient.

Generally speaking, anticoagulation is achieved via taking the oral medication warfarin, which goes by the trade name of Coumadin. Anticoagulation is necessary in many varied situations: to prevent blood from clotting on mechanical heart valves, or after developing a blood clots in a leg (DVT deep vein thrombosis) or lung (PE pulmonary embolism) and is even used to prevent blood from clotting in patients with a genetic predisposition to having more easily clotting blood, such as with lupus anticoagulant.

Home based testing has revolutionized the ease of monitoring one's INR, because previously one had to go to a lab for a blood draw and wait for the physician to call them back with instructions on how to alter the dose of coumadin. With home based testing, one can easily check their INR then call their doc for immediate advice.

I hope this recall doesn't shake patient's trust in this technology, as it has been available for many years. It's not the simplest of devices, for example some test strips need refridgeration. But it's helped many, including my own grandmother, after multiple strokes. It's so wonderful not to have to go to a lab for a blood draw.

MedWatch - The FDA Safety Information and Adverse Event Reporting Program

Roche Diagnostics and FDA informed consumers and healthcare
professionals of the recall of CoaguChek PT test strips used to
determine blood clotting time of patients taking anti-coagulant
medication to prevent blood clots. The recall was due to the potential
for a test strip defect that may cause falsely elevated test results,
resulting in an incorrect dose of anti-coagulant medication or
unnecessary corrective measures being taken to reduce the effect of
circulating anti-coagulants. Healthcare professionals who use CoaguChek
PT test strips should institute 'duplicate testing', or use two strips
with different lot numbers, on each patient to reduce the risk of bias.
Home users of CoaguChek PT test strip should immediately discontinue use
of the product and contact their healthcare provider.

Read the complete MedWatch 2006 safety summary, including a link to the
FDA press release

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Play is Important in Children's Development

Children's play is a 'technology' specifically needed in children's development, according to the AAP American Academy of Pediatrics, in it's recent report, "The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds." I wholeheartedly agree, and have my children in play-based preschool co-ops in order to capitalize on their development, as well as my own parent education.

Some suggestions included:

* Emphasizing the benefits of "true toys", such as blocks and dolls, in which children use their imagination fully over passive toys that require limited imagination;
* Supporting an appropriately challenging academic schedule for each child with a balance of extracurricular activities. This should be based on each child's unique needs and not on competitive community standards or need to gain college admissions;
* Helping parents evaluate claims by marketers and advertisers about products or interventions designed to produce "super-children;"
* Encouraging parents to understand that each young person does not need to excel in multiple areas to be considered successful or prepared to compete in the real world;
* Suggesting families choose childcare and early education programs that meet children's social and emotional developmental needs as well as academic preparedness.

Take a look at the report, there are great suggestions on developmentally appropriate and fun activities for our kids.

Others reporting on this: AAP, Vincent Iannelli.

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Pediatric Flu Vaccine Supply Delayed, Not A Shortage

Sanofi pasteur, the manufacturer of FluZone states that there will be a delay in shipping their injectable flu vaccine, the only one FDA approved for children aged 6 months to 3 years old. The AAP (American Association of Pediatrics) advises parents to get their children immunized, and the earlier the better for children receiving the vaccine for the first time since a booster dose is needed 1 month after the initial dose.

In California, a state law became effective July 1, 2006 which makes it illegal to give flu vaccine that contains zero to trace amounts of thimerisol to children under 36 months of age or pregnant women. So even though there is no scientific evidence of any harmful effects of thimerisol, it's a crime in California to administer this. This is an example of politics trumping good medical science, with activists successfully pushing their agenda, harming the greater public. As less people are immunized, we lose the benefit of herd immunity which I recently blogged about. Since the standard flu shot vaccine contains thimerisol, pregnant women must wait for thimerasol-free flu vaccine to be shipped. Children under 3 will have to wait for FluZone to be shipped.

AAP stresses that the shot is effective even when administered into January and later, when the flu season really picks up. It takes 2 weeks for the body to ramp up antibody production to fight flu, so keep that in mind when getting your kids immunized.

Others covering this: Vincent Iannelli, NEJM JournalWatch, AP, WebMD, PA Weekly, USAToday, Taraneh Razavi and Rob Lamberts.

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First Case of Polio in Kenya in Twenty Years

The most potent technology fighting infectious disease is our own immune system, and vaccination remains as the most effective way to protect an entire population. It pains me to read that polio has stricken a Somali refugee in Kenya for the first time in twenty years. Just days after the WHO announced that they're focusing on 4 remaining countries to try and eradicate polio via vaccination, new concerns arise that Kenya could be an upcoming area of concern.

The power of vaccination to prevent disease is rooted in the fact that if you immunize enough of a population, the people who remain unimmunized won't come in contact with another person with the disease since so few of them remain unimmunized and at risk of getting the disease. Herd immunity is the term physicians use to describe this pattern of protection. Herd, because if you immunize enough people, few people will be left without antibodies that protect them from disease, and the disease can't spread because there aren't enough unimmunized people in a population.

I'm worried that many of my local friends and parents here in the United States are finding the risks of immunization too high, and deferring or refusing immunization. They're right, there are very rare and serious side effects from some immunizations, but they're very rare. Part of participating as a citizen in a democracy is accepting that level of risk for the good of the entire citizenry. Ok, time to get off my pulpit and back to technology.

The risk is that in Somalia, religious leaders there accused western health agencies of attempting to sterilize their muslim population through vaccination. A large percentage of that population heeded their warnings, and an outbreak of polio occured. I'm praying that the near-religious level of conviction of local U.S. parents doesn't spread and allow a similar outbreak to occur here.
Many voted during the BMJ's (British Medical Journal) call for nominations last month of the top medical technology since 1940 as immunization, and I'd agree.

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Come Grab a Cuppa Joe with Kim of Emergiblog at Grand Rounds

Once a week, health bloggers from around the world contribute to Grand Rounds, a roundup of the best that the blogosphere has to offer in regards to health and medicine. This week, Kim from Emergiblog has continued on her tear (recently hosting 2 other blog carnivals), and welcomes us to join her in grabbing a cuppa joe at her site, Emergiblog. She's a blog veteran, and local here in the SF Bay. Read about how she finds time at her Medscape Pre-Rounds interview with Nick, the founder of Grand Rounds.

Tailrank links to many of those contributors...

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Grand Rounds Volume 3 Number 3 is available

Thanks to JonMikel, MD for hosting this week's Grand Rounds, Volume 3 Number 3, and including my post on E Coli contamination of lettuce & ground beef, and Paul Auerbach's post on minor head injury.

Go read more on JonMikel over at Medscape where he's interviewed for Pre-Rounds, the weekly interview of the Grand Rounds host by the founder, Nicholas Genes.

TailRank lists those commenting...

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Doctors Report Feast and Famine For Flu Vaccine

NPR covers physicians' frustration that they haven't received their flu vaccine supply yet, and patients are clamoring for it. They quote a large supplier, Mark Mlotek of Henry Schein, Inc. as stating, "Will there be Wal-Marts that have it and doctors' offices that don't? Yes, I believe that will happen again this year."

If so, I'd expect that the CDC would retool their advice on who gets immunized. They haven't, and publicly state that there should be enough vaccine, although supplies may not be delivered until later. This is perfectly ok in terms of considering how soon you need to be immunized: it takes 2 weeks to become immune. The flu season doesn't start being more of a problem until January-Febuary, and although in rare years it does start to be a problem in October, that doesn't seem to be happening this year. In many years the largest part of the nation's flu vaccine supply isn't delivered until November, which is ok. This still gives patients plenty of time to develop immunity before the flu season really kicks in.

To be safest, of course you should get your flu shot sooner than later. But for now there's no need to fear a shortage as Henry Schein's statement may lead you to believe. As long as you believe the CDC...

Update: Vincent Iannelli, MD found a reason for the delay: "The likely reason for the delay in shipment of flu shots relates to the fact one of the strains of the flu that was included in this year's flu shot was 'hard to grow,' as was reported by a flu expert from the Public Health Agency of Canada."

Update: Dr. Anonymous has a 2 dozen commenters chattering away on how they feel when patients come knocking for flu vaccine too early, with one of the commenters, Tim, saying that a significant portion of the population needs to be immunized in order for herd immunity to take place, and posting on his own blog about why flu vaccine shortages take place: we don't pay manufacturers enough and there's no economic benefit from putting more effort into ensuring adequate production. This is why I love reading blogs, they link to each other's great posts about the same topic and start a discussion. He links to PBS and NY Times coverage on flu vaccine production. Tim also links to Greg Mankiw at Harvard who points to the WSJ coverage of the PLoS study I covered a few posts ago about who to immunize in order to get the most effect in lowering flu illness.

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Intel Mobile PC Platform To Help Healthcare Providers Only If It Fits Our Workflow

Intel recently announced a partnership with Mobile Computing detailing their mobile computing platform, which it claims will improve patient safety and healthcare provider efficiency. It will do so by providing a toteable tablet sized portable computer that wirelessly communicates with an electronic medical record (which I've blogged about the benefits ad naseum). This platform can improve the safety of administering your medications by allowing the nurse to first check your identity via RFID. RFID technology comes as a chip that you probably didn't realize is placed in the packaging of many household disposables such as razors, to monitor their progress from the warehouse to your corner drugstore. Some hospitals are using it to identify patients, as well as your healthcare providers to allow them access to computers and identify them.

Technology is only as useful as it's actually used, and this technology is no different. The plastic wrist bracelet with your name printed on it could identify you to your nurse, if she looked at it. That's how RFID is proposed to help, by not allowing the medication to be dispensed without being in the presence of the right patient. For many years, we've had dispensing machines that were located at the nursing station that monitors a whole wing of patients. Now, manufacturers are trying to make this machines more portable, and be able to move from one room to another, and get next to the actual patient.

I love it when other blogs give me the dirt on devices, and of the many who wrote about it, Tim Gee, lists the details on what makes a successful portable medical computing device according to Intel. The one requirement that stands out is durability, e.g. getting dropped.

HIStalk is my favorite blog for reprints of opinions about healthcare technology and today's post inspired me to comment:

From HIS Boy Elroy: "Re: Intel's new gadget. Intel may have consulted with El Camino Hospital about their new slate PC monstrosity, but I know a nurse from there who said Intel just about got laughed out of the place when they showed them the final product. Some PhD nurse from Intel loaded it up with every possible gizmo known to man regardless of whether users need it, obviously not consulting anyone about workflow. Plus, ECH is known for shilling for vendors with inferior solutions. This is a perfect example of outsiders who come into healthcare with guns blazing, criticizing an industry which only they can save because the rest of us fell off turnip trucks. Does every RN need a camera? How do you crawl across a patient's bed to their wrist lugging a tablet PC to scan their barcode? Craig Barrett might want to keep his healthcare solutions to himself until he learns something about it other than his reluctance to give up his Intel millions to pay for it."

If this quote is correct, it doesn't sound like Intel's listening to their own "ethnographic research among [these] nurses at El Camino Hospital in Mountain View, Calif." HIS Boy Elroy may have not used RFID cards to sign into a computer before since you can be several feet away and be identified, although I suspect that distance would be decreased to differentiate different patients in adjoining beds. He also might be overstating the millions that he suspects Intel is pouring into this attempt since I'll bet that their partner Mobile Computing is contributing heavily. Even with these caveats, I'm concerned with the allegation that Intel didn't listen to their research. The device has to fit within the workflow of healthcare providers or it won't be used.

I can share an example from my own experience. Many Emergency Rooms use tablet PCs to look up and document patient information. I think they're too heavy to lug around, whereas this Motion Computing model looks to be lighter and thinner. Many of the devices that are small enough to put in a pocket, such as UMPCs or UMPC-pro, don't display enough pixels on their screens (less than 1024x768) Epic. A tablet is no use if I can't click on buttons I need since they're off the screen.

Another problem I've had is with battery life. I can't get through a shift of work, 4 hours, which is almost double the 2 hour battery life from many of these UMPCs. Swapping batteries is a pain.

A final problem is with data entry. I'm able to quickly enter my patient chart information when I sit down at a keyboard by using macros, but there aren't any usable keyboards on these tablets or UMPCs. I've yet to find voice recognition that works (even 99% accuracy is too low for me, to have to go back and correct text). Handwriting recognition is getting a lot better, and even more so with the medical dictionaries Motion Computing offers. I tried this at a recent conference HIMSS, and was impressed.

Overall, it's really concerning that Intel is ignoring its own research. If these devices don't fit in our workflow and make our work more efficient, we won't use them.

Disclosures: I have consulted for UMPC-pro manufacturer OQO in the past, but no longer do. I used to blog for Medgadget, but no longer do, but they remain good friends.

Others who've commented: Intel, Dan Farber, Medgadget, Engadget, eWeek, Geekzone, and many at Google

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Green Leaf Lettuce and Ground Beef Recall Due to E Coli

Hot on the tail of the recent spinach contamination comes a fresh batch of reports of bacterial E Coli contamination of lettuce and ground beef, which could cause a serious diarrheal illness.

Definite contamination of ground beef has occured, whereas E Coli has only been found in the water used to wash lettuce. The strain of E Coli found in the ground beef is the same strain found in the recent spinach outbreak, a potentially deadly strain. That strain causes more illness than the other strains of E Coli, which were found in the wash water of lettuce grown in Salinas, CA where the recent spinach outbreak occured.

These outbreaks underscore the importance of keeping cattle and other animals away from the irrigation and wash water of our nation's food supply. Bacterial contamination occurs when animal feces contaminates this water that is used, either to irrigate or wash the produce or the machinery used to harvest the produce.

Here are details gleaned from the companies' and AP news reports, which I haven't confirmed from CDC reports since they haven't published them yet.

Nunes' Foxy lettuce:

a voluntary recall of green leaf lettuce designated by the code 6SL0024 sold October 3, 2006 through October 6, 2006 under the Foxy® brand.

The items recalled by The Nunes Company, Inc. are:

* Green Leaf 24 Count, waxed carton
* Green Leaf 18 Count, cellophane sleeve, returnable carto

...distributed in Arizona, California, Nevada, Washington, Oregon, Idaho, and Montana, and sold to retail stores, and distributors who may have further sold it to restaurants. The product can be identified as Foxy® green leaf lettuce sold under lot code 6SL0024, and purchased on or after October 3, 2006 through October 6, 2006.

No illnesses have been reported to date.

Jim's Market and Locker Inc. of Harlan, Iowa:

...ground beef patties and packages August and September 1, and sent it to distributors in Georgia, Iowa, Massachusetts, Nebraska, New York, Texas and Wisconsin, and to one retail establishment in Iowa, said the U.S. Food Safety and Inspection Service.

Each package in the latest recall bears the establishment number "Est. 2424" inside the USDA mark of inspection.
Product details

These products are recalled:

# 10-pound boxes of "PACKED FOR: DAVIS MOUNTAIN ORGANIC BEEF, 100% CERTIFIED ORGANIC 3-1 BEEF PATTIES," with lot code G6-540 or G6-544.

# Five-pound packages of "DAVIS MOUNTAINS 100% ORGANIC BEEF, LEAN GROUND BEEF 90/10," with lot code G6-544.

# One-pound packages of "MASTER CHOICE 100% ORGANIC ANGUS BEEF, 90/10 GROUND BEEF," with lot code G6-544.

# One-pound packages of "DAVIS MOUNTAINS 100% CERTIFIED ORGANIC GROUND BEEF," with lot code G6-544.

# 10.5-pound boxes of "NEBRASKA, BEEF GROUND BEEF PATTY 6 OZ," with lot code G6-541.

# 60-pound boxes of "SPECIALLY SELECTED FOR: FARNER-BOCKEN FOOD SERVICE BEEF PATTIE MIX 6/10," with lot code G6-542.

# One-pound packages of "PACKED FOR: IRWIN COUNTRY STORE, BEEF GROUND BEEF 16 OZ," with lot code G6-541.

# One-pound blocks of "PACKED FOR: IRWIN COUNTRY STORE, BEEF GROUND BEEF PATTIES 4-1," with code G6-541.

# 10-pound boxes of "DISTRIBUTED BY: STUBE RANCH, WAGYU BEEF, BEEF GROUND BEEF PATTIES, 8 OZ. PATTIES," with lot code G6-546.

The federal service said people could get more information by calling the company at 712-755-5158

Image courtesy of Mr. E.

Others commenting: FoodMusings, Taraneh Razavi, SJ Merc (AP), NPR.

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4 Patients Can't Breathe Due To Botulism Contamination

More on this when I'm not so beat: 4 patients are paralyzed and dependent on a ventilator to make them breathe after suffering from the toxic effects of Botulism toxin traced back to unrefrigerated Bolthouse Farms carrot juice:

The carrot juice consumed by these four patients was manufactured by Bolthouse Farms, Inc., and distributed in all 50 states, Mexico, Canada, and Hong Kong with the labels "Bolthouse Farms 100% Carrot Juice," "Earthbound Farm Organic Carrot Juice," and "President's Choice Organics 100% Pure Carrot Juice." Investigations of these cases by state and local health departments and investigations of the manufacturer by FDA are ongoing. On September 29, GDPH and the Georgia Department of Agriculture recommended that Georgia residents not purchase or consume Bolthouse Farms carrot juice. The same day, the FDA warned consumers not to drink Bolthouse Farms carrot juice with "best if used by" dates of November 11, 2006 or earlier (i.e., all bottles produced before the date the warning was issued), and Bolthouse Farms issued a voluntary recall of these products. Additional information regarding the recall is available from the Bolthouse Farms website (pdf) or from FDA (telephone, 888-723-3366).

Suspected botulism cases should be reported immediately to local or state public health officials, who then should call the 24-hour CDC Emergency Operations Center at 770-488-7100; the center will immediately connect them with an on-call botulism specialist. Health-care providers and public health officials are encouraged to inquire specifically about consumption of carrot juice as part of the food history of suspect botulism cases. Additional information on botulism is available at the CDC.

via Dr. Nancy Reyes, Taraneh Razavi.

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Immunize School Aged Children for Flu and Protect Us All

What ages to immunize to reduce the spread of infectious disease is an important public health topic of research. Recent evidence from a study published in PLoS and covered by the WSJ, suggests that for influenza the answer changes with the varying transmissibility of that particular strain. Currently, we immunize the young and old since they are at the highest risk for dying from flu and it's complications. The recent studies suggest that with a moderately transmissible influenza strain, immunizing the young will provide the most protection for the entire population.

This reminds me of how the Japanese were able to drastically reduce their rate of overall deaths when they immunized all school aged children. Unfortunately, the political will to continue this evaporated, and with the decrease in immunization rates of children, all-cause mortality returned to their previous levels. This suggests that immunizing the children protected the rest of the population including the elderly.

This is all the more sad as NEJM JournalWatch covers CDC reports that toddlers aren't getting immunized. "At least half of children between ages 6 months and 5 years aren't receiving influenza vaccine." The AP reports it as well.

It will be interesting to see how this evidence plays out in discussions at the NCIP who decides our national immunization policies. Here are their current policies. Will we "drain the swamp" as Dr. Reyes so richly illustrates, or continue to preferentially immunize the elderly as well. In a year with ample vaccine, we can immunize all - but what in a year with less supply?

via PLoS, CDC, Instapundit, WSJ, Kevin, MD, NYT, Connotea, FierceBiotech, Taraneh Razavi and Dr. Nancy Reyes.

Tailrank lists other commenters... as does the comments over at economist Greg Mankiw's blog.

Image via AndyInSouthAmerica

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This Weeks' Best of Health Matters

The Health Matters HealthBlog Network consists of a dozen independent and unfiltered medical professionals blogging about the topics that matter to you. Each week, Healthline's Editors select the three top posts from the network to share with all of our readers in one convenient post. We hope you'll enjoy them!

Infertility Stress Reduction Tips
If you, or someone you know, has struggled with infertility you know what a stressful time that can be. Visit The ART of Conception where expert Carl “Rusty” Herbert MD offers some tips for getting through these rough patches … read more

What Should Cancer Patients and Family Do About the Flu Vaccine?
Vaccinations can be a lifesaver. Most vaccines contain inactive viruses, but others contain a small amount of a live virus. Tune into Cyndy King’s Cancer Treatment and Survivorship blog to learn what people undergoing cancer treatment that can compromise their immunity should do…read more.

Throw a Stronger Punch (or Push a Car or Stroller)
People don’t always realize how many times a day they are hurting their backs. Read on to learn more about what Dr. Jolie Bookspan of the Fitness Fixer blog says is one of the most common misconceptions in fitness….read more.

Additionally, we're pleased to announce the launch of two new blogs this week! Freedom from Smoking with expert Lowell Kleinman, MD and Straight Talk from the ER with expert Robert L. Norris, MD.

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New cure for hiccups via the oldest medical technology: digital rectal exam

One of the first medical technologies physicians-in-training are tasked with perfecting is our physical exam. For male physicians, one of the most dreaded parts is the digital rectal exam, since we know that we ourselves will need to be subjected to this someday. Every man gets prostate cancer if he lives long enough.

Who would know that it's also a documented cure for intractable hiccups? At least in this New Zealander and Israeli patient. I think my patients would prefer the traditional medications I use for intractable hiccups such as benzodiazepines.

One note to intrepid souls dying to try this at home: don't! I've seen enough folks faint from the vagal stimulation of rectal examination. I'd hate for you to have a bump on your head to accompany your hiccups. Hmmm... That's possibly the way this works after all!

This case report was so strange, I'll tell you how I found this: via Kevin MD who saw it at BoingBoing via JWZ who found out from the IgNobel Awards, covered by AP , Wikipedia, and My Alter Ego.

Tailrank lists many commenting on this...

Picture courtesy of Denn

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Dyson Airblade Is Not Better Than Alcohol Hand Rubs

Although Dyson’s done good with vacuums, if making it into MoMa is what vacuuming is all about, I’m not so sure with their newest invention. Or shall we say, reinvention? The Dyson Airblade is your daddy’s hand dryer on steroids - a 400 mph blast of air to dry your hands in 10 seconds. But does it dry them any better? No! Just quicker. Well, one thing it does remind me of is in med school we did experiments in biochemistry class, placing damp hands and dry hands on culture plates, and guess which ones grew more bacteria? The damp hand ones of course.


Instead of getting this Dyson dohickey or a similar Mitsubishi unit, grab a bottle of Purell, and keep it handy. A research study in the Sept 2005 Pediatrics details exactly how much better alcohol based hand rubs are than soap and water - you’ll get less stomach flu if you have wee little ones in daycare. You may not reduce the frequency of your colds & flus, but at least you know you can avoid getting Montezuma's revenge from your kids.

An unpublished study here in my urgent care clinic by Dr. Charles Weiss shows drastically increased usage of alcohol-based rubs if you place the bottles in easy to access areas. So get a ton of these bottles and scatter them around your home. We have them strategically placed on our dining table, by each sink, in each of our kid’s bedrooms, and by diaper changing stations. The more the better!

Update: here's a link to a video of 400 mph in action...

via CrunchGear, Engadget who claims it a copycat, The Sun, Arbroath, ArsGeek, Gizmodo.

Thanks to TailRank for listing more commenting on this device.

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The Best of the Medical Blogosphere

Thanks to those of you who came and read Grand Rounds here last week. It was great to have so many visitors and bloggers who were inspired to post at their own sites.

I wanted to holler out thanks to the host of this week's Grand Rounds for including my post discussing taking daily heart-protecting aspirin at a different time from NSAIDS (advil, motrin, alleve) in his review of the best of the medical blogosphere this past week. To read this weeks’ Carnival of the Caregivers posts click here.

Feel free to read more about Grand Rounds, look at the full schedule of all Grand Rounds, and look forward to another great round at next week's host.

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