1.
Featured Article:
A Little "Braine Humour" to Start Your
Tuesday
Looking at the Sun Can Trigger a Sneeze For some
people, bright lights mean big sneezes By Karen Schrock, Scientific American,
January 10, 2008
Have you ever emerged from a matinee
movie, squinted into the sudden burst of sunlight and sneezed uncontrollably?
Up to a third of the population will answer this question with an emphatic
"Yes!" (whereas nearly everyone else scratches their head in
confusion). Sneezing as the result of being exposed to a
bright light - known as the photic sneeze reflex - is a genetic quirk that is still
unexplained by science, even though it has intrigued some of history's greatest
minds. To read more, please go to www.medicaltuesday.net/index.asp.
Aristotle mused about why one sneezes more after
looking at the sun in The Book of Problems: "Why does the heat of
the sun provoke sneezing?" He surmised that the heat of the sun on the
nose was probably responsible.
Some 2 ,000 years later, in the early 17th
century, English philosopher Francis Bacon neatly refuted that idea by stepping into
the sun with his eyes closed - the heat was still there, but the sneeze was not
(a compact demonstration of the fledgling scientific method). Bacon's best
guess was that the sun's light made the eyes water, and then that moisture
("braine humour," literally) seeped into and irritated the nose.
Humours aside, Bacon's moisture hypothesis
seemed quite reasonable until our modern understanding of physiology made it
clear that the sneeze happens too quickly after light exposure to be the result
of the comparatively sluggish tear ducts. So neurology steps in: Most experts
now agree that crossed wires in the brain are probably responsible for the
photic sneeze reflex.
A sneeze is usually triggered by an irritation
in the nose, which is sensed by the trigeminal nerve, a cranial nerve
responsible for facial sensation and motor control. This nerve is in close
proximity to the optic nerve, which senses, for example, a sudden flood of
light entering the retina. As the optic nerve fires to signal the brain to constrict the pupils, the theory
goes, some of the electrical signal is sensed by the trigeminal nerve and
mistaken by the brain as an irritant in the nose. Hence, a sneeze. . .
The genetic culprit remains unidentified,
but scientists are starting to take an interest in trying to find out. "I
think it's worth doing," says Louis Ptαcek, a neurologist at the University of California, San Francisco,
and an investigator at the Howard Hughes Medical Institute. Ptαcek studies
episodic disorders such as epilepsy and migraine headaches, and he believes
that investigating the photic sneeze reflex could shed light on their related
neurology.
Epileptic seizures are sometimes triggered by flashing
lights and migraine headaches are often accompanied by photophobia. "If we
could find a gene that causes photic sneezing, we could study that gene and we
might learn something about the visual pathway and some of these other reflex
phenomena," Ptαcek says. . .
Beyond that blip of gravitas, papers published
about photic sneezing have largely leaned toward the whimsical end of the
spectrum. Consider one 1978 publication that took advantage of the then-raging
acronym fad and suggested an alternate name for the photic sneeze reflex:
Autosomal-dominant Compelling Helio-Ophthalmic Outburst syndrome, or, of
course, ACHOO.
Read the entire article at www.sciam.com/article.cfm?id=looking-at-the-sun-can-trigger-a-sneeze.
* * * * *
2.
In the News:
Progress Against the Common Cold?
Speedy New Medical Test can
Identify Twelve Viruses at the Same Time, By Aaron Rowe WIRD, January 07, 2008
On Thursday, the FDA approved a test that doctors can use to quickly diagnose twelve
different types of viral infection -- including those which cause the common
cold, pneumonia, and several varieties of flu.
With only a cotton swab from their patient's nose or
mouth, the new diagnostic panel will allow physicians to make better decisions about
which medications will be effective. Some drugs, such as Tamiflu (oseltamivir),
only work on certain types of viruses. To read more,
please go to www.medicaltuesday.net/news.asp.
This speeds up the usual process of detecting and
identifying respiratory viruses, which can take up to a week," Daniel G.
Schultz, director of FDA Center for Devices and Radiological Health. "And,
because this multiplex viral panel tests for 12 viruses at once, it uses less
of a patient's test specimen."
Based in Texas, Luminex Corporation has a long history
of building instruments that can check for almost anything -- bacteria,
viruses, antibodies, disease genes. The key to their technology: tiny beads.
The biotech company produces color-coded spheres that
latch onto telltale biological molecules. Each microscopic orb can only attach
to molecules from one particular type of organism. In this case, Luminex
scientists made beads that can grab onto amplified genetic material from
viruses. A special scanner can read which beads have DNA stuck down to them --
and thus identify the virus.
You can see a step-by-step explanation of how the new
test works here: Link
From the Luminex Website: With a non-invasive, painless swab, xTAG RVP tests for:
Influenza A, influenza A-H1, influenza A-H3 and
influenza B,which cause the majority of flu cases in the U.S.;
Adenovirus, which is responsible for approximately 10
percent of respiratory infections and a subtype of which the Centers for
Disease Control (CDC) have recently identified as causing multiple deaths
Respiratory syncytial virus (RSV) A and B, the most
common cause of bronchiolitis and pneumonia in infants and children
Metapneumovirus, a recently-discovered virus that
causes flu-like symptoms and is thought to be the second leading cause of
respiratory infection in children
Parainfluenza 1, 2, and 3, which can cause upper or
lower respiratory infections in adults and children and, are thought to be
responsible for about half of croup cases and 10-15 percent of bronchiolitis
and bronchitis cases; and Rhinovirus, which causes the common cold.
It is the first multiplexed nucleic acid test for
respiratory viruses cleared for in vitro diagnostic use by the FDA. It also is
the first test of any kind cleared to detect human metapneumovirus, the first
test cleared for influenza A subtyping, and the first molecular test cleared
for adenovirus.
http://blog.wired.com/wiredscience/2008/01/speedy-new-medi.html
* * * * *
3. International Medicine: Lancet's Editor Speaks Out on
UK's National Health Service
Gordon
Brown's Ideas Outdated: Commentary By Richard Horton, 11/01/2008
As the NHS reaches its
60th anniversary, Gordon Brown has promised, like Tony Blair before him, to
make Britain's health service a litmus test of his leadership. On Monday he set
out his long-awaited and much-trailed vision. It was a dismal collection of
patronising [sic] homilies, ill-thought out policies, and feeble rhetoric.
We have heard the words so many times before. Change,
choice, and empowerment. What have these ideas achieved? The only significant
transformation in the NHS that truly deserves applause is the steep reduction
in waiting times for patients referred to specialist care. But after a decade
in government, the public is entitled to ask: is that it? To read more,
please go to www.medicaltuesday.net/intlnews.asp.
This is
what we know. A third of hospital trusts now fail to provide value for money.
In last year's Audit Commission review, 27 trusts failed every single test of
good management. Half of maternity units are operating out-of-date practices.
The care of premature babies is inadequate and unsafe. Health inequalities are
widening. Outbreaks of perfectly avoidable hospital infection are killing
patients. According to Brown's own health guru, Derek Wanless, Labour's
spectacular health investments have been largely wasted. Reforms have been
rushed, productivity has not improved, and IT delays have blocked real
progress.
Last
week, the Royal Marsden Hospital burned. It was rightly said that the Marsden
is an international centre of excellence in cancer treatment. But in the UK as
a whole, survival for most cancers is worse than in Germany, France, Italy, and
Spain. We have the distinction of delivering some of the worst cancer survival
figures in Europe.
Prevention
is Labour's big new idea. Except that Brown's concept of prevention is
desperately outdated. It is a hopelessly false dichotomy to divide prevention
from cure. The two are often one and the same. His headline screening programme
for abdominal aortic aneurysms will require 60 specialist units in England
alone, staffed by hundreds of surgeons, technicians, and administrators. It
will take 10 years, screening 7000 men and performing many major operations
annually, to make any dent in deaths from triple A. Brown's promise that his
screening strategy will save 200,000 lives every year simply doesn't add up.
Worse,
his plan to give more power to GPs to control health budgets makes no sense.
Modern health care is delivered by teams. The services available in any given
region should be determined by public-health specialists, hospital consultants,
nurses, and pharmacists, among others, as well as GPs. Brown's thinking about
the organisation of health care is a generation out of date.
A large
part of the problem is the Department of Health. In a little publicised report
last year by the independent think tank, the Nuffield Trust, the department was
diagnosed as ill-equipped to manage Britain's increasingly complex health
needs. Its actions are confused, contradictory, and muddled. Most front-line
NHS staff would agree with this view.
If Gordon
Brown really wants a new vision for the NHS, he needs to dismantle a department
that is, by common consent among experts, unfit for the purpose of protecting
the health of our nation. But that is the one policy he will never announce.
www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/11/nlancet211.xml
Dr
Richard Horton is editor of The Lancet
The NHS does not give timely
access to health care, it only gives access to a waiting list.
Eventually you will enjoy
Europe's worst care.
* * * * *
4. Medicare: What's the Real Reason for Forcing
Government Health Care on Every One?
The Truth about Mandatory Health Insurance, By BETSY MCCAUGHEY, WSJ, January 4, 2008
This week, Hillary Clinton's supporters attacked
Barack Obama for not proposing a federal mandate that every American buy health
insurance. Mr. Obama's health plan, they said, is a "Band-Aid" for
the nation's gaping wound: 47 million people without health insurance. Mrs.
Clinton would require all Americans to get coverage. Presidential candidates
John Edwards and Christopher Dodd say they would, too. Not Mr. Obama.
Imposing a federal mandate is a hot issue on the
campaign trail. It's also a burning issue in Congress, where Democratic Sen.
Ron Wyden and Republican Sen. Bob Bennett are pushing the Healthy Americans
Act, which would require everyone not in Medicaid or another government program
to buy health insurance.
But is mandatory health insurance really a good idea?
Requiring catastrophic coverage (our parents called it major medical) probably
is smart. This would ensure that a person who is hurt in a car accident or
diagnosed with a costly illness can pay his own medical bills, instead of being
a burden on society.
But catastrophic coverage is not what the mandate
advocates want. They would require that everyone have comprehensive health
insurance, covering preventive and routine care. To read more,
please go to www.medicaltuesday.net/medicare.asp.
The rationale for this mandate is not personal
responsibility but "shared responsibility," a polite way of saying
shared costs. Requiring comprehensive coverage, the argument goes, will make it
affordable for the sick, by pulling the young and the healthy -- neither of
whom use these health services very much -- into the insurance pool. Advocates
also argue that requiring this type of coverage will cure overcrowded emergency
rooms and help tame skyrocketing health costs.
These arguments are based on myths, not facts.
The first myth is that it's fair to make everyone pay
the same price for health insurance. It is not: For young people who rarely use
health services, this is a rip-off. If people in their 20s paid attention to
politics and voted, politicians wouldn't dare try this.
According to the latest Census data, 56% of the
uninsured are adults aged 18-34. True enough, forcing them to be a part of a
same-price-for-everyone insurance pool will likely bring down premiums. These
young people generally need minimal health care ($1,500 a year, on average,
according to a Commonwealth Fund study).
In most states, (but not New York and Vermont), young
adults who buy health insurance are charged premiums that reflect their low
medical needs. A 25-year-old man can buy a $1,000 deductible policy for a
quarter to a third of what a 55-year-old man has to pay. (In Manchester, N.H.,
a 25-year-old man pays $156 per month, while a 55-year-old pays $542 for the
same policy, according to ehealthinsurance.com).
Both the Clinton proposal and the bipartisan
congressional proposal prohibit insurers from giving such price breaks to the
young. Their mandates would force the young to subsidize the health tab for the
middle-aged generation. This subsidy would come on top of the payroll tax
younger people already pay to support today's Medicare recipients. This is
contrary to a fundamental American principle. This nation has always believed
in making life better for its children, not exploiting them. . .
The second myth behind federal mandate proposals is
this: Lack of insurance forces people into the emergency room for routine
health care. "It's a hidden tax, the high cost of emergency room visits
that could have been prevented by a much less expensive doctor's
appointment," Mrs. Clinton said recently. The truth is that the uninsured
do not use emergency rooms more than other people.
Federal data (the Medical Expenditure Panel Survey
provided by the Agency for Healthcare Research and Quality) show that the
elderly are most inclined to go to the emergency room, though they are
universally covered by Medicare. . .
The third myth, in the words of Mr. Edwards, is that a
"system that leaves 47 million Americans without health care is a moral
disgrace." The remedy he has in mind is a mandate.
The rise in the number of uninsured people (up from 42
million in 2002) is not due to a sudden moral failure of the country or a
broken health system. Instead, a major cause is immigration and cultural
differences that make recent arrivals especially likely to be uninsured. . .
These facts should point the presidential candidates
and Congress toward a sounder policy on health insurance.
According to the Census Bureau, of the 47 million
uninsured, nearly 10 million have household incomes of at least $75,000. They
probably can afford coverage but have chosen not to buy it. Another 14 million
of the uninsured are already eligible for government programs such as Medicaid
(for low income adults) and the State Children's Health Insurance Program (for
children) and simply need to sign up.
That leaves about 23.7 million people -- some
citizens, others newcomers -- who cannot afford coverage. It's up to the nation
to decide what to do about that. One thing is clear: Mandating that everyone,
including young adults, buy insurance, and then hiding a hefty, cost sharing
tax inside their premium, is an unfair solution.
Ms. McCaughey, a former lieutenant governor of New
York, is an adjunct senior fellow at the Hudson Institute.
To read the entire article, go to http://online.wsj.com/article_print/SB119941501118966929.html.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
A Different Form of Mandate - A Fixed Time for Procedure Screening
Recently I ordered a CT imaging study on a patient.
The front office of the Radiological Service said there needed to be a
creatinine and a BUN performed. My office manager checked the chart and there
was a creatinine of 0.9 done 60 days ago. The x-ray facility said it needed to
be less than 30 days.
A patient who had his annual exam with a full
evaluation including major organ screening would not need to have a repeat test
in two months. What was the dilemma?
I could have easily ordered the duplicate test to
please the radiological mandate and probably added close to a hundred dollars
of unnecessary health care costs. That would be simple but highly unethical.
So, since my office manager could not persuade the radiological service front
office to accept the 60 day test, I decided in the national interest of
conserving health care costs and improving patient care and not unnecessarily
inconveniencing my patient, I would call the radiological facility. It took
about three minutes to wade through the front desk, the second in command, the
facility supervisor, and then the radiologist's personal assistant. When the
assistant returned to the phone, he said the radiologist was in the midst of a
procedure and would call me back. About five minutes later, he returned the
call and I interrupted an evaluation of the patient I was seeing to answer the
call. We were disconnected. What is the dilemma now? Should I go through the
above routine again or should I let him call me back and re-interrupt my care
of the patient I was seeing. To read more,
please go to www.medicaltuesday.net/gluttony.asp.
I decided to call back, and keep my patient waiting
longer now rather than another re-interruption and another wait. The Chief
radiologist came on the line and was very pleasant. I explained the situation
and asked him if he felt it was a necessary health care expenditure to repeat
the kidney tests in a stable patient when the function was so good? When he
heard the patient was stable, he agreed with me, took the patient's name and
said he would have them proceed with the radiological CT with contrast.
He was kind enough to briefly discuss that this was a
"best practice mandate" that was handed down from their national
organization. The local group had simply rubber stamped the recommendation. He
agreed that it was an excessive health care cost, that not repeating the test
would not jeopardize the patient during the procedure, and that repeating it
would not produce any improvement in health outcomes.
The office cost for this entire episode was probably
equal to the $100 that the test would have cost. However, such mandates are
very common. It is not only the hundreds of million folks getting x-ray
procedures but also any type of procedure.
This reminded me of a patient who had a complete
annual evaluation and had an electrocardiogram in anticipation of cataract
surgery. The operation had been delayed and it was now seven months after her
ECG. The surgical center required an ECG not over six months old. So an
unnecessary ECG had to be redone. Cataract surgery is one of the lowest risks
for cardiac complications. The cost? Medicare pays physicians about $20 for an
ECG. For the past 20 years, the usual charge is about $80. It never changed
because the reimbursement kept going down. The hospitals charge $180 for it. No
one seems to have any idea of what hospitals actually receive since most
hospital charges and receipts remain secretive. But cataract surgery is a very
common procedure and tens of millions of seniors require one. The list goes on
and on and on. By the time you add up the hundreds of millions of mandated
procedures done yearly, it adds up to tens of billions. Before long, you're
talking of real health care costs.
There are two significant lessons. As the best
practices mandates are implemented, there will be a huge increase in health
care costs under the illusion that this improves health care. Generally it
doesn't.
Patients have gotten so used to these inconveniences
and personal costs, that they perceive them as necessary for their protection
as if someone out there is watching over them. Maybe the oppressive government
is keeping them from harm. But they don't.
These mandates also further distort the smooth
operation of medical care. Medicare and Medicaid will respond by reducing the
pay for physicians to $15 for an ECG and then further reducing it to $10 and
finally declaring that it is part of an office visit and no re-imbursement is
required. Rectal exam with a stool occult blood test requires some costs of the
reagent and slides but is no longer reimbursed. Urologists respond by no longer
doing a stool occult blood test on prostate exams. Internists generally absorb
the cost, which reduces their incomes. But it causes doctors to lose sight of
quality health care by following what Medicare and Medicaid pay, not what is
best practice. Remember, President Reagan found his cancer of the colon when
his personal physician found a positive stool guaiac blood test on his prostate
exam. He then had a colonoscopy to find where the blood was coming from which
diagnosed his colon cancer. It was then resected and he was cured. Without the
stool occult blood test the cancer could have metastasized before symptoms
occurred.
Every mandate, rule, best practice guidelines,
although well intentioned, whether they come from government, insurance
carriers, or our own professional organizations, have their down side. These
then have various poorly understood mostly undesirable consequences. They all
distort the free exchange of medical information and patient-centered
appropriate practice. It will continue to get worse until we get government and
insurance carriers out of the practice of medicine. Does this country have the
will and ability to do this? Do our own professional organizations have this
desire or will? There are no more new worlds, such as ours or Australia, to
flee to for opportunity. If we can't do it, no one can. Is it really that
hopeless?
Remember, it only takes one person with determination
to change the world. Will it be You or me?
* * * * *
6. Medical Myths: More Government Spending Reduces Health
Care Costs
Health Alert: Advice to Candidates (From the Expert Who Explodes Medical Myths)It's a law of human nature. Whenever people start discussing health policy, their IQs fall by 15 points.Exhibit A: Critics who complain that the US health care system outspends every other country and gets nothing in return and then advocate. . . (can it be?). . . more spending! For Senator Obama, it's $60 billion more every year.
For Senators Clinton and Edwards, it's $120 billion - more than $1,000 per year for every household in
America.Exhibit B: Critics who complain that the error rate in US hospitals is way above anything that is tolerable in any other industry and then advocate more rules and regulations that would . . . (surprise!) . . . make it more difficult for hospitals to operate like other businesses.Exhibit C: Critics who complain that poor people have inadequate access to health care and then advocate enrolling them in health plans where . . . (you guessed it) . . . they will have even less access than they have today. Under ordinary circumstances this would all be laughable, but in health care - hey, they might get away with it.To read more about a health plan to help solve the problem, please go towww.medicaltuesday.net/myths.asp.
Now imagine a health plan that goes a long way toward solving the problems of cost, quality and access by (a) not spending any more money, (b) repealing laws and regulations instead of enacting new ones and (c) dismantling bureaucracies rather than creating and expanding them.Now compare your vision to mine by clicking http://www.ncpa.org/pub/special/pdf/health_plan112007.pdf.
The basis for the NCPA vision, by the way, is the realization that the key to reform lies not in changing patients, doctors and hospitals, but in changing government - systematically removing all of the ways in which bad government policies distort incentives and make our problems worse. See " Applying the Do No Harm Principle to Health Policy Reform" in the Journal of Legal Medicine. Cheers John Goodman, PhD, President, National Center for Policy Analysis
12770 Coit Rd., Suite 800, Dallas, Texas 75251, www.ncpa.org
http://cdhc.ncpa.org/commentaries/applying-the-do-no-harm-principle-to-health-policy
Subscribe to this digest: www.ncpa.org/sub/#cdhc
* * * * *
7.
Overheard in the
Medical Staff Lounge: Hospital Price Transparency
Dr. Rosen: I'm
getting more complaints about hospital charges.
Dr. Ruth: I've
always gotten them. I just brush them off and tell my patients that doctors
have no control over hospital charges.
Dr. Edwards: When
I say something like that, my patients just smile. They say that we're just
being modest. Everyone knows that doctors control the hospitals. To read more, please go to www.medicaltuesday.net/lounge.asp.
Dr. Dave: You
know, I've experienced the same. Patients really blame us for all the health
care costs.
Dr. Sam: I
just tell them my vote to reduce them didn't count. They just outnumbered us.
Dr. Rosen: I've
had a few that brought in their hospital statements. They are very
illuminating. One had a two day stay for a pacemaker implant and a statement
for $78,000 or $39,000 a day. One had a five day ICU bill for $43,000 or about
$8500 a day.
Dr. Milton: The
hospitals all seem to be expanding despite the fact that more and more is done
as outpatient.
Dr. Rosen:
Hospitals are trying to capture more and more of the out patient business. When
their lobbyist get a law passed to allow them to practice medicine, they will
begin to put the doctors on salary.
Dr. Yancy: Once
doctors are on a hospital payroll, the doctors will become total slaves. Who's
going to go against the administrator that signs his pay check?
Dr. Michelle: Do
you really think it will be that bad?
Dr. Ruth: They
may be subtle about it but eventually they will become our enemies.
Dr. Rosen: Not
only will they control us. There will be no break in their spending habits.
Hospital costs will go even higher.
Dr. Yancy: The
patients will be the ultimate losers.
Dr. Rosen: But how can we convince them before it's too late?
* * * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
Bulletin of the California
Society of Anesthesiologists, Summer, 2007
Tales from the
Battlefield: Perspectives from a Navy Anesthesiologist
in Combat
By Patrick K. Boyle, M.D.
Introduction
In March 2004, Naval medical personnel responded to
the anticipated needs of the First Marine Division during Operation Iraqi
Freedom and formed a small 26-person unit using personnel and supplies from two
preexisting surgical companies. The Surgical Shock Trauma Platoon (SSTP) was
based at Camp Taqaddum, Iraq, a former Army Command that offered a troop
medical clinic with minimal trauma surgical support. Staffing initially
included an anesthesiologist, a general surgeon, an orthopedic surgeon, and an
emergency room physician to provide rapid resuscitative surgical care near the
point of injury. The physical layout of the unit included a single tent
stabilization area, a single tent operating room, and a rudimentary ward for
postoperative care and minimal holding. This article details the experiences
and challenges of a Navy anesthesiologist staffing this surgical unit during
its first month of deployment concurrent with military operations in Fallujah
in April 2004. To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.
Preparation
While working at Naval Medical Center, San Diego in
February 2004, I received two weeks notice that I was being deployed to Iraq
with a surgical unit. During my mission in Iraq, I drew on previous Naval
experiences with aviation and Marines to provide the best medical care possible
to service members and civilians under my care. After arriving in Kuwait, our
group flew to Al Taqaddum, a former Iraqi Air Force base. While waiting for
supplies, we planned the physical layout of the unit and conducted trauma
training lectures for nurses and hospital corpsmen. Along with the surgeons, I
assisted the Army troop medical clinic with immediate surgical-related problems
and reacquainted myself with peripheral nerve block techniques. I remembered
Vietnam reports wherein regional anesthesia was used during peak
patient-receiving periods.
As a result, I quickly found the utility of doing a
wrist block when I assisted our surgeon with a hand debridement after a Marine
inadvertently cut himself with a knife. After this experience, I started
preparing for the possibility of using regional anesthesia on or near the
battlefield and found this technique to be useful later in the deployment.
Blast and Combat Injuries
After treating the Marine with the hand injury, the
surgical team had its first introduction to what would become a familiar
scenario: blast injuries among troops. Fortunately, the body armor that
coalition troops wore reduced significantly the numbers of abdominal and chest
injuries. In stark contrast, many suspected insurgent cases involved the chest
and abdomen, owing to the lack of body armor. In one instance, a young Army
officer was brought to the clinic with severe damage to one foot and both legs
after stepping on an improvised explosive device. The surgeon and I assisted
the Army team in stabilizing and debriding the patient's wound prior to
evacuation to the Army's Combat Support Hospital in Baghdad. Luckily, this
patient survived his blast injury and this incident heightened my awareness of
the effects of blast injuries on the population of patients in this setting,
something unfamiliar to most anesthesiologists who don't practice in a trauma
environment.
The unit consisted of tents placed on plywood
platforms. We trained each day by working through a mock trauma case,
concluding with a lecture if we were not engaged in clinical activities. On the
first day our unit became operational, our training was out the window when a
Humvee ambulance arrived unannounced and presented our first patient, a coalition
Iraqi truck driver who sustained AK-47 wounds to his abdomen and hand. This
first surgical case became a five-hour abdominal exploration and bowel repair
performed in an operating room tent without air conditioning where temperatures
exceeded 100 degrees. Shortly thereafter, we received a Marine who sustained a
massive head wound from a bomb and arrived dead, followed by another young
soldier with a penetrating neck wound requiring immediate exploration. Afterwards, I thought it would be a long deployment
if it stayed this busy every day. . .
To read the sections on Combat injuries, Challenges,
treating Iraqi people and a summary of Dr. Boyle's experiences, go to www.csahq.org/pdf/bulletin/issue_17/allhazards072.pdf (670 words)
Patrick K. Boyle,
M.D., is an active-duty Navy anesthesiologist practicing in San Diego,
California. He is currently the Vice Chairman and Chief Medical Officer of the
Department of Anesthesiology at Naval Medical Center, San Diego.
* * * * *
9.
Book Review: From
our archives: PhysicianPatientBookshelf.htm
FORCED EXIT - The Slippery Slope From Assisted Suicide to
Legalized Murder, by Wesley J Smith
Wesley J Smith, author of No Contest: Corporate
Lawyers and the Perversion of Justice in America, opens his prologue of Forced
Exit with the story of a dear friend who spent years planning her suicide
and after inviting friends to the event, none of whom came, exited this life
quietly. Smith, an Oakland attorney, contacted the executrix and obtained her
suicide file wherein he found newsletters and other scurrilous documents from
the Hemlock Society that thoroughly sickened him.
This motivated Smith to research into death, the
inventing of the right to die that is driving people to embrace the death
culture, and euthanasia's betrayal of medicine. He finds that a society that
believes in nothing can offer no argument even against death. Seen in this
light, support for euthanasia is not a cause but rather a symptom of the broad
breakdown of "community" and the ongoing unraveling of our mutual
interconnectedness. The consequences of this moral Balkanization can be seen in
the disintegration of family cohesiveness; in the growing nihilism among young
people that has led to a rise in suicides, drug use, and other destructive
behaviors; in the growing belief that the lives of sick, disabled, and dying
people are so meaningless that helping them kill themselves can be countenanced
and even encouraged. To read more, please go to www.medicaltuesday.net/bookreviews.asp.
Smith calls acceptance of euthanasia "terminal
nonjudgmentalism." He finds a good example in A Chosen Death by
Lonny Shavelson, an emergency physician, who describes "Gene" who has
had strokes and depression but is not terminal. Sarah, from the Hemlock
Society, is given the task of assisting in his death. Sarah found her first
killing experience tremendously satisfying and powerful, "the most
intimate experience you can share with a person... More than sex. More than
birth." Sarah gives Gene the poisonous brew as if she were handing him a
beer. Gene drinks the liquid, falls asleep on Sarah's lap who then places a
plastic bag over his head and croons, "See the light. Go to the
light." But Gene, suddenly faced with the prospect of immediate death,
changes his mind and screams out . . . and tries to rip the bag off his face.
Sarah won't allow it, catches Gene's wrist and holds it. Gene's body thrust
upwards and Sarah lays across Gene's shoulders. . . pinning him down, twisting
the bag to seal it tight. Gene's body stops moving.
Smith says what happened to Gene is murder. He
further feels that the ethical thing for Dr Shavelson to have done was to knock
Sarah off the helpless man and then dial 911 for an ambulance and the police.
Shavelson describes his thoughts on whether to act or observe the death, and
Smith calls this non-decision "terminal nonjudgmentalism," or TNJ. He
feels that what Shavelson and other death fundamentalists miss is that
so-called protective guidelines for the "hopelessly ill" are
meaningless; they provide only a veneer of respectability. Once killing is deemed
an appropriate response to suffering, the threshold dividing
"acceptable" from "unacceptable" killing will be
continually under siege. But the fiction of control, essential to the public's
acceptance of euthanasia, will have to be maintained, so the definition of what
will be seen as "legitimate" killing will be expanded continually. .
. .
To read the entire review, go to http://healthcarecom.net/brmedsent11-1299.htm.
* * * * *
10. Hippocrates & His Kin: The Uninsured Reached Its
Peak of 100 Percent in 1930
One hundred million
Americans lack disability coverage. Sixty-eight million lack life insurance.
Only 45 million lack health insurance for a short while. Only about 10-15
million have no health insurance for a full year. That's only 5 percent of the
population compared to 100 percent 80 years ago. Hasn't free enterprise nearly
solved the problem?
Why don't we pass a simple
law feeding all insurance companies more premiums?
Can the tallest building in most cities get any taller?
Can't we just pass a law forcing everyone to buy
health insurance?
The three of the four democratic candidates want to
force people to purchase health insurance. California has a similar law that is
suppose to force every driver to purchase car insurance. Has it worked?
Why is it that almost everyone I know has been hit by
a California driver without car insurance?
To read more,
please go to www.medicaltuesday.net/hhk.asp.
Where did the SCHIP Money
go?
In Ohio enough went to
CareSource, a highly profitable Medicaid HMO that is erecting a $55 million
building in Dayton.
Now if we could get more
people to buy insurance, we could build even larger palaces for the CEOs.
P4P May be illegal in 37
states.
Paying physicians to meet
performance measures might be construed as kickbacks according to the AMA.
What has ever kept the
government from doing something illegal?
Texas has decreed that 18 percent of physicians are
incompetent.
The Texas legislature has expressed in a bill that 18
percent of physicians should be disciplined rather than the 10 percent
currently disciplined. Texas physicians are worried that the Texas Medical
Board will need to turn trivial and irrelevant complaints into
"results" to comply.
Looks like we'll have even more doctor's offices being
invaded by officers with guns.
Whatever happened to gun control?
To read more vignettes, please go to www.healthcarecom.net/hhk1999.htm.
To read Hippocrates Modern Colleagues, go to www.delmeyer.net/hmc2005.htm.
* * * * *
11. Organizations Restoring Accountability in HealthCare,
Government and Society: