Archives for October 2007

Erectile Dysfunction meds can make you hard…of hearing

From Medscape today:

Erectile Dysfunction Drugs Linked to Risk for Hearing Loss

Publication LogoYael Waknine

October 19, 2007 — Sudden loss of hearing has been reported in patients taking phosphodiesterase 5 (PDE-5) inhibitors, the US Food and Drug Administration warned healthcare professionals yesterday.

In some cases, the sudden loss or decrease in hearing was accompanied by vestibular symptoms such as tinnitus, vertigo, and dizziness, according to an alert sent from MedWatch, the FDA’s safety information and adverse event reporting program.

The warning was based on 29 postmarketing cases that occurred in a strong temporal relationship to dosing with sildenafil (Viagra, Pfizer, Inc), tadalafil (Cialis, Lilly ICOS, LLC), and vardenafil (Levitra, Bayer Pharmaceuticals Corp), which were taken for the treatment of erectile dysfunction. Other cases were also reported during clinical trials…

Ladies, if your whispered sweet nothings are being ignored, speak up a bit.

Change of Shift: Volume Two, No. 10 // Emergiblog

Change of Shift: Volume Two, No. 10 // Emergiblog

Ready, set, go!

Google chases Microsoft over online personal health records

Google unveils plans for online personal health

October 17, 2007 (Computerworld) — Less than two weeks after Microsoft Corp. announced plans to support online personal health information records, Google unveiled plans to follow suit.

Marissa Mayer, Google’s vice president of search products and user experience, said Wednesday here at the Web 2.0 Summit that Google plans to support the “storage and movement” of people’s health records.

Although she provided only scant details on the effort, she noted that Google became interested in the personal health record market as it watched Hurricane Katrina take aim at the Gulf Coast and all the paper-based records stored in various medical offices and hospitals in the region.

“In that moment it was too late for us to mobilize,” Mayer said. “It doesn’t make sense to generate this volume of information on paper. It should be something that is digital. People should have control over their own records.”

Wow, Google does vaporware? This is a lame attempt, and invoking Katrina a) is a cheap rhetorical gambit and b) points out that even if it were true they’ve had over 2 years to come up with their answer, and it’s not even at a Beta stage?

Weak response from Google. Embarrassing, really.

Marginal Revolution: How to debate health care policy

Marginal Revolution: How to debate health care policy
How to debate health care policyHealth care policy should be debated through micro-facts. Let’s consider a few:

1. American health care outcomes look much better once we adjust for race and other demographic factors, including violence and car crashes. Some groups — such as Asian-American women — have remarkably good health care outcomes.

2. Some of the health care savings of other systems occur through price effects (e.g., doctors are paid an average of $60,000 in France) and do not involve real resource savings.

There’s more, and a common-sense set of ground rules at the end. Looks good to me!

via InstaPundit

MedBlogs Grand Rounds 4.04

NY Emergency Medicine: Come one, come all…
Welcome to NY Emergency Medicine and to this week’s edition of Grand Rounds!

It’s by an ER Doc, so what’s not to like?

Baby Jessica 20 Year Anniversary

20 years (and 3 days, I missed it a bit) ago Jessica McClure was brought back to the surface in Midland, Texas after having spent 2 1/2 days in a well. If you don’t remember it you were too young or didn’t have access to a TV.

From the Dallas Morning News:

Jessica McClure Morales says it doesn’t bother her that people still call her “Baby Jessica.” Or that she still has a diagonal scar on her forehead: “It shows who I am, and the fact that I am here and that I could not have been here,” she told NBC’s Today show host Matt Lauer on Monday…

I linked to an article about her graduation from High School in 2004, but didn’t say any more. I personally knew three of the big names in the rescue, Steve Forbes from Paramedic class way, way back (1982-83), Robert O’Donnell from a months’ employment at the Midland Fire Department (1986) and Andy Glasscock, friend of a friend before and after. This isn’t meant to be a name-dropping exercise, more to illuminate that fame can be a curse.

That two of the three have had lives-turned-wrong afterward is well documented (O’Donnell committed suicide and Glasscock is doing time in the pen for sexual assault), and cause is always attributed to their reaction to the fleeting nature of fame. Read the linked articles for details (especially O’Donnells’, it’s exceptional), and take away what you can that keeps you alive and mentally healthy.

There’s a book, The Rainbow’s Shadow: True Stories of Baby Jessica’s Rescue & the Tragedies That Followed by D. Lance Lunsford, available from I’ve ordered one.

Cautionary tales for us all. And, congrats to Jessica!

Update 10/18/07: CNN is reading!

Texas Tort Reform: One View from the Legal Side

Of course, when docs and insurance companies say this it’s just people with a financial incentive lining their pockets at the expense of patients.  Now lawyers are pointing out the same thing:

Once suffering from a doctor shortage, the Lone Star State can now brag it has longest wait list of wanna-be MDs in the country.  [GruntDoc: actually, they’re real doctors, just not licensed in Texas yet.]
Medical specialists are flocking to Texas from places like New York and Florida, attracted by new laws curbing frivolous lawsuits and the low malpractice insurance rates they’ve begotten. Austin’s biggest health care crisis today: figuring out how to process the deluge of Texas Medical Board applications to set up shop in our state.

Medical malpractice reform, we now know, is working for Texas.

We mean for the patients. It isn’t working for the trial lawyers, to be sure. But then again, it wasn’t intended to.
Alas, it comes as no surprise that, in light of all this good news, Texas’ lawsuit industry is still angling behind the scenes to bring back our state’s jackpot justice-happy past.

Unsurprisingly plaintiff’s attorneys aren’t taking this lying down, and are back to the courts to try to overturn Texas’ medmal reform.  Read the article for details.


via the Kevin, MD news clipping service.

Musings of a Dinosaur: How to Really Piss Me Off

Musings of a Dinosaur: How to Really Piss Me Off

Aah, those dang stupid, stupid ER docs.  If only everyone were as smart or as clever as office docs, the world would be such a better place.

Where’s the cheese?  Seriously, if we’re going to start a series of whines about inappropriate calls and silly treatments I’ve got a box full of “‘just go to the ER’s” that I’d be glad to trot out.

Nurse Ratched’s Place: It’s Military Week at Grand Rounds

Nurse Ratched’s Place: It’s Military Week at Grand Rounds

This week at Grand Rounds we are honoring health care professionals who serve their country by serving others. I want to thank Dr. Nick Genes for letting me host Grand Rounds this week, and I also want to thank everyone for all of their great submissions. The number of submissions that I received overwhelmed me, and apologize that I didn’t have room for every post. The artwork found in this week’s edition of Grand Rounds illustrates the history of military medicine, and the dedication of the men and women who care for patients in military medical facilities and outposts around the world. In the 1944 painting above by Jack McMillen, the artist depicts life at the Forest Glen annex of the Walter Reed Army Medical Center. The annex served as a holding and rehabilitation unit for medical patients, including psychiatric patients during World War II and in subsequent wars.

I’m embarrassed I couldn’t write a suitable post. I appreciate the hard-charging, dedicated and self-sacrificing Navy Corpsmen and Docs (I’m sure the lesser services have good people, too, but I didn’t live and work with them) and they deserve the respect of all, in and out of the service. It’s hard in a weird way to be the one whose role is to be ‘the soft one’, the one who cares for the warriors. It’s a job sometimes unappreciated by the warriors themselves, but that doesn’t make it any less important; in fact, that magnifies its importance.  19 year old males believe they’re bulletproof, and it’s our job to be there when reality strikes.  My service was blessedly between wars, and nobody wanted to hear that Things Happen.

I genuinely liked my corpsmen, and hope they’re doing well, now 9-13 years since I was their leader. I hope they have the pride of a job well done, and understand the thanks of at least one ex-Navy Doc.

Why the heck couldn’t I write THAT before the deadline?

richard[WINTERS]md: Facebook for Medical Conferences

richard[WINTERS]md: Facebook for Medical Conferences

A good idea for Facebook to expand into a new niche.

Emergency Physicians Monthly is blogging ACEP’s Scientific Assembly

Here’s their first blog entry from ACEP:

ACEP Blog: From the floor
Monday, 08 October 2007

Nothing says ACEP Scientific Assembly like a line of 50 docs waiting for a mug a free coffee. That’s right, it’s Monday morning, the first day of the ACEP convention, and activities got started early. ..

Opening lectures began at 7:30, if you can believe it. I hope the speaker was from the East Coast and still jet-lagged. The minute the docs start surging into the exhibit hall, the stories start flying. Here are just a few highlights from the morning:

I wish I’d thought of that.  It would have given me a reason to actually attend (besides all the wonderful talks).

And this from Logan Plaster at EP Monthly:

If [your / our] readers have any questions about the convention, we aim to seek out answers and post them in real time.

There’s a ‘contact’ form at the blog link, so ask questions for them there, not here.

How to make coffee 102

Coffee 101: put coffee in filter, add water to reservoir, and turn on the heat. You’ve got that, this is 102.

This is very-modestly advanced coffee making, but the payoffs are:

  • better tasting coffee (I don’t know why)
  • no coffee grounds in the pot
  • much easier to clean the basket after brewing
  • elevation in the coffee making ranks

Begin with standard hospital coffee reagents: low-bid coffee, two filters, and a budget drip coffeemaker:
Coffee making reagents needed

Add your normal amount of coffee to filter 1:

Coffee added to filter 1

Gather the edges of filter 1, to enclose all the coffee in one filter:

Coffee filter 1 gathered for next step

Place filter one gathered-edge down into filter 2:

Filter 1 in 2

Add filters 1 & 2 to the basket, and make your coffee.

Both filters in basket, ready to brew

Be prepared to do it over and over when people tell you your coffee is good!

Hallway Four and ‘customer service’

In the ‘why didn’t I say that’ category goes Hallway Four: The customer is always right when… « Hallway Four

The picture of The Customer is Always Right poster is dead-on.

Change of Shift is up

here: madness: tales of an emergency room nurse: to bob barker…thanks for the memories

Microsoft and the EMR

To swipe a lead-in from the WSJ Healthcare Blog, “Microsoft finally beat Google at something”.

From the straight reporting:

The Wall Street Journal Home PageA new Microsoft Web site announced Thursday, called HealthVault, includes a secure way to upload data such as blood-pressure readings so consumers can keep record of their health information. The “personal health center,” as Microsoft calls it, is designed to allow consumers to share such information with physicians and other medical professionals. The site also offers Internet search and a Web page for viewing and organizing articles and other information on health.

HealthVault is the latest step in a two-year effort by Microsoft to build software and services in the health field, targeting both consumers and health-care organizations. The company has quietly built a group of programmers and professionals with related expertise, and purchased several companies to help speed its move into healthcare.

I think this could be a very important development toward a more-universal EHR.  The current focus on internet-connectible BP monitors is weird, and what I’d like to see it used for are things like your latest EKG, etc.  I would guess major clinics and hospitals will partner with MS as a ‘value-added’ feature to entice patients to use their health system (“we’ll make your results available to all your doctors 24/7” sound more reassuring and less like a threat to privacy).

We’ll see how this plays out, and I think it’s got a lot of promise (and some talented deep-pockets behind it), so here’s to MS for getting out in front on internet storage of health care information.