Archives for July 2008

Personal Political Power For Physicians and Medical Group Managers

Personal Political Power For Physicians and Medical Group Managers

Interesting new blog from a (?former?) medical lobbyist.

amanzimtoti: Third world aid

amanzimtoti: Third world aid
Third world aid
We recently had an American delegation from PEPFAR (the United States President’s emergency plan for AIDS relieve) visit our clinic. I didn’t stick around for the circus because preceding the visit a list of demands was given to the clinical manager. Now PEPFAR isn’t even one of our major sponsors – from what I understand the money they’ve given us was just enough to put up some shelves in our pharmacy. Don’t get me wrong, we’re grateful for any donations, but if you’re going to give money for a worthy cause, you should do it out of the goodness of your heart, not so you can make them jump through hoops for you.

Ugly Americans.

MedBlog Grand Rounds Here 7-22-08

Ladies and Gents,

I’m the proud host on 7-22-08 for MedBlogs Grand Rounds.  It’s either my 5th or 6th time hosting, depending on how you score the April Fools’ Edition.  (I’ll let you vote in the comments if this is #5 or 6).

Please send your submission to, or use the contact form at the top of the blog.  Submissions accepted until Noon your time 7-21.

No theme.  I’m not that creative.

Google News screws up (a little)

I have a Google News Alert set for Emergency Medicine, and delete 99% of them.  I noticed this one, as it’s about the MedGadget interview I just linked to.

Here’s what caught my attention:

The text, for those who have trouble with the screen cap:

Google News Alert for: Emergency Medicine

Medgadget Interviews Dr. J. James Rohack, President-elect of the AMA – San Francisco,CA,USA
He’s a resident of emergency medicine at Mount Sinai in New York. Many pundits and experts believe that the US government will improve access to primary
See all stories on this topic

Heh.  That’sn accurate description of Dr. Nick Genes, who’s a contributor to MedGadget, but the interviewer was Dr. Michael Ostrovsky, an anesthesiologist (on the West Coast somewhere).

Ah, well.  It’s nice they’re talking about you fellows!

Medgadget Interviews Dr. J. James Rohack, President-elect of the AMA – Medgadget –

Medgadget Interviews Dr. J. James Rohack, President-elect of the AMA – Medgadget –
Medgadget rarely ventures into politics. However, after one of our editors contacted the American Medical Association (AMA) public relations department to check out how the AMA is doing, we were offered a chance to talk to senior leadership in the organization. We, of course, couldn’t have missed such an opportunity! The result is an interview with J. James Rohack, MD, a cardiologist from Bryan, Texas, in the Texas A&M Health Science Center College of Medicine, and recently announced president-elect of the American Medical Association. Dr. Rohack will assume the AMA presidency in about a year from now, in June 2009.

Looks to be a good interview.  I’ll read it when I get home tonight.  Way to go Dr. Ostrovsky!

Musings of a Highly Trained Monkey: The great internet embargo of 2008

Musings of a Highly Trained Monkey: The great internet embargo of 2008

…So I’m putting the keyboard away for a while.

The life cycle of most bloggers is short, but we all get something from the experience.  I hope she comes back, but only time will tell.

ER "super users" and New Jersey

Repeat ‘super users’ are swamping the ER

by Carol Ann Campbell/The Star-Ledger Sunday July 13, 2008, 8:45 AM

Bean-thin and sallow, George tugged on a cigarette in the blistering parking lot of a Camden men’s shelter. Standing on the pavement, his foot on a picnic bench, he recalled how he took his first drink at 13.

George, here talking to a social worker in Camden, is an emergency room ”super user,” having been admitted to ERs in the small city between 30 and 40 times in the past year.

The hard living shows in the lines of George’s face — and in his medical history. When he gets sick, which is often, the 55-year-old has no place to go except one of the city’s emergency rooms.

George is a “super user,” a new name coined to describe people who turn to the ER with astonishing frequency and at an astonishing cost to a health system under siege on all fronts.

This is a very well written article, and I’d bet every ED in America has the same group of ‘super users’, patients who are in the ED a lot, not because they want to be but because for a variety of reasons they don’t have other choices.  It’s unfortunate that their only choice is horribly expensive and fragmentary care.

Nobody has an answer to the problem, but I applaud New Jersey for trying to do something about it.

Epilepsy Drugs May Avoid Black Box –

There may be hope for the FDA on black boxes just yet…

Epilepsy Drugs May Avoid Black Box –
Epilepsy Drugs May Avoid Black Box
July 11, 2008; Page B6

BELTSVILLE, Md. — A Food and Drug Administration panel has recommended against adding the agency’s toughest warnings to labels of epilepsy drugs, saying studies didn’t show a high-enough risk for suicidal behavior to warrant such warnings.

So, the full FDA panel realizes hitting medications with a Black Box makes doctors not want to prescribe them, and said the very small increase in suicides among people taking epilepsy drugs didn’t warrant the warning.

So, if an increase in suicidality isn’t boxable, what about tendons and tendon ruptures?

Michael DeBakey, pioneer of heart procedures, dead at 99 –

Michael DeBakey, pioneer of heart procedures, dead at 99 –
HOUSTON, Texas (AP) — Dr. Michael DeBakey, the world-famous cardiovascular surgeon who pioneered such now-common procedures as bypass surgery and invented a host of devices to help heart patients, died Friday night at The Methodist Hospital in Houston, Texas, officials announced. He was 99.


Toyota’s Prius Becomes a Southern Belle | Autopia from

Toyota’s Prius Becomes a Southern Belle | Autopia from
The SUV is dead and Toyota can’t build Prius hybrids fast enough, so it’s suspending production of big trucks and will build the Prius in Mississippi at a plant that was slated to produce SUVs.

Not until 2010, but it looks like Toyota is betting fuel isn’t going down, and they’re going to give up on the Big Truck market, or at least give up their push to displace one of the Big Three.

Movin’ Meat: Clout

Movin’ Meat: Clout

Shadowfax is correct here: Organized Medicine has no clout.  The ablilty to ride the coat-tails of politically popular programs, yes, but no actual clout.

Read Movin’ Meat should you disagree.

Change of Shift: Volume Three, No. 1 // Emergiblog

Change of Shift: Volume Three, No. 1 // Emergiblog
This edition of Change of Shift marks the beginning of its third year.

In celebration, I asked nurse bloggers to send in their first posts and tell us a bit about why they started blogging.

I was surprised at how long some of my colleagues have been writing about their nursing adventures, sharing their lives and opinions.

Many thanks to all the bloggers, nursing and otherwise, who have supported CoS over the last two years and to all who have hosted the carnival.

Let’s get started!

And many happy returns!


Doctors worried by Supreme Court gun ruling | U.S. | Reuters

WASHINGTON (Reuters) – Last month’s Supreme Court ruling striking down a strict gun control law in the U.S. capital will lead to more deaths and accidental injuries, the editors of the New England Journal of Medicine said on Wednesday.

They joined a growing clamor from medical doctors, especially emergency room physicians, who fear a surge of accidental deaths, murders and suicides if handguns become more easily available than they already are.

Huh?  I’m on the email lists for the two major EM organizations, and none of them have said a word about it.  Oh, there’s one quote from one EM doc at the end of their article (and the NEJM, which has always been for gun control is quoted, again shockingly still for gun control) but there’s been no “increasing clamor” from EM docs about this.

Another reporter writing what they want, despite the facts.

DB’s Medical Rants » I love the Wal-mart program

DB’s Medical Rants » I love the Wal-mart program

Dead on.

Black Box Warnings now Officially Useless

FDA to Add Warning to Antibiotics –
July 9, 2008; Page B7

WASHINGTON — The U.S. Food and Drug Administration will seek to add strong warnings about the risks of tendon rupture associated with a class of antibiotics used to treat bacterial infections.

The FDA wants to add black-box warnings, the strongest warning the agency issues, to a handful of drugs, including Bayer AG’s Cipro and Johnson & Johnson’s Levaquin. The move comes six months after the consumer group Public Citizen sued the FDA to require the agency to add black-box warnings to the drugs.

Serious reports of tendonitis and tendon rupture continue to increase with use of the drugs, prompting the FDA to ask companies to add the stronger warnings, the FDA said in a posting on its Web site Tuesday. Such ruptures most frequently involves the Achilles tendon, but also include ruptures of the shoulder, hand, biceps, and thumbs.
(emphasis mine)

Black box warnings used to be for very serious, life-threatening problems in drugs.  Now tendonitis and tendon rupture are life threats, or are so serious they warrant a Black Box?  The elevation of known, well-documented drug side effects to Black Box status dilutes its meaning, and will ultimately require the formation of a new class of warnings.

Tendon ruptures aren’t benign.  Neither are infections.  Name me an antibiotic that wouldn’t rate a black box under the criteria used on the flouroquinolones, then wonder at what’s happened to the FDA.