Internet Exile

For my crimes against the internet, I’m going to exile myself from the digital wold for a week.

Also, I’m getting on a boat.

Please play well together, and have all the problems solved when I come back.

Xigris Pulled from Market

The irony here is that Eli Lilly has advanced sepsis care (as a prelude to using their drug), and while Xigris hasn’t panned out, aggressive sepsis resuscitation has.

Eli Lilly is withdrawing drotrecogin alfa (Xigris) from all markets worldwide after a major study failed to show a survival benefit for patients taking the drug.

Xigris should be discontinued immediately in patients currently receiving it and should not be started in new patients, the company said.

The trial with the bad news on Xigris was called PROWESS-SHOCK, a placebo-controlled study with 28-day mortality as the primary outcome and planned enrollment of nearly 1,700 patients.

via Medical News: Sepsis Drug Pulled from Market – in Product Alert, Prescriptions from MedPage Today.

At ACEP the reviewers of this study said it favored placebo over Xigris. Tough to market a very very expensive drug when not using it is better…

Guest Column: Better Care, Thanks to Tort Reform — Health Reform and Texas | The Texas Tribune

Wait, I was told this would Never Work.

Thanks to the passage of lawsuit reforms, medical care is now more readily available in many Texas communities. For many patients, this change has been life-altering; for some, life-saving.

via Guest Column: Better Care, Thanks to Tort Reform — Health Reform and Texas | The Texas Tribune.

Libertarians, Medical Malpractice and Contract | Cato @ Liberty

Interesting think piece on pre-arranged medmal arrangements, and why they won’t currently work…


The one signal fact about the American court system is that, paternalistically, it generally refuses to enforce contractual arrangements of this sort. No matter how well spelled out in advance, courts will not enforce the disclaimer of liability or apply the agreed-on damage limit. You will instead get the malpractice coverage that courts and lawmakers deign to prescribe for you, not the coverage you and your medical provider might have chosen yourselves.

via Libertarians, Medical Malpractice and Contract | Cato @ Liberty.

Best of my ACEP 2011 Twitter feed

If you don’t follow me on twitter, you missed my play by play of the recent ACEP 2011 Scientific Assembly from San Francisco. Several of us attending twittered (and it was terrifically entertaining to meet them and socialize)!

These are trimmed from my tweets ( http://twitter.com/#!/gruntdoc ) and should you be interested, all the Scientific Assembly tweeters were using the hashtag #sa11.

My rough count for the ones I included here is 95. Some are more interesting than others. Enjoy.

Asplin says its harder to collect from high deductible/HSA pts than from self pay. Seems odd. Asplin

1% of population accounts for 30% of all spending in a given year, 5% account for HALF. 20% spend nothing. There’s your problem.Asplin

Understatement: there’s a gap between the vision and the reality of the Medical Home. Asplin

ER docs make the most expensive routine decision in healthcare: admit or home? We have little to no control over readmissions. Asplin

[Read more...]

Army seeking troops bitten by stray animals following rabies death – Army – Stripes

Wow, that is awful beyond belief.

Army seeking troops bitten by stray animals following rabies death – Army – Stripes.

SEOUL – The Army is redoubling its search for anyone who might have been bitten by a wild animal in Iraq or Afghanistan following the Aug. 31 death of a soldier from rabies, the service’s public health command stated Wednesday.

“The death of this soldier is very tragic, and we are taking actions to ensure something like this does not happen again,” Lt. Col. Steven Cersovsky, director of epidemiology and disease surveillance at the Army’s Public Health Command, said in the release.

Spc. Kevin Shumaker, 24, became the first soldier to die from rabies since 1967 after he was bitten by a stray dog in Afghanistan.

Shumaker told his parents that he received three of six necessary rabies shots in Afghanistan, but did not receive the final shots because they were expired, according to a Contra Costa Times report. Shumaker, a 10th Mountain Division soldier, died at Fort Drum, N.Y., eight months after the bite.

“I would not be without my son if the proper treatment was given to Kevin,” his mother, Elaine Taylor, told the newspaper in September.

Prayers for his family.

World’s first malaria vaccine works in major trial | Reuters

Okay, like all of us I want an effective and safe malaria vaccine, and the tone of the article is hopeful. But…

The trial is still going on, but researchers who analyzed data from the first 6,000 children found that after 12 months of follow-up, three doses of RTS,S reduced the risk of children experiencing clinical malaria and severe malaria by 56 percent and 47 percent, respectively.

Loucq said widespread use of insecticide-treated bednets in the trial — by 75 percent of people taking part — showed that RTS,S can provide significant protection on top of other existing malaria control methods.

via World’s first malaria vaccine works in major trial | Reuters.

We’ll have to read the study, but if you’re mixing a change in bednet use AND a new vaccine, well, let’s hope they were measuring what they thought they were.

Alternate Spelling?

I was recently at ACEP’s Scientific Assembly in San Francisco, and once again ACEP did a very good job of getting the whole shebang organized. I think I saw that there were about 5,800 attendees, which isn’t many compared with some meetings, but for Emergency Medicine docs it was the second-most attended (after last years’ in Las Vegas).

There are exhibitors there, and while the theme of the year was ‘win an iPad’, EMR’s and Scribes, it was a good turnout and I enjoyed talking to the vendors.

I bring this up to point out an anomalous spelling that snuck through (and it’s not ACEP’s miss, I don’t think). Right inside the main doors there’s a very cool, touch screen gadget to find a particular exhibitor by name, type, etc with an interactive map. Really Cool.

And, it had this:

Aah, well.

Meeting of the Minds

@movinmeat and myself meet with ACEP Immediate Past President Angela Gardner ( @ACEPHeadliner ).

ACEP Scientific Assembly 2011

It’s in San Francisco this year, and starts in the morning. While I’m NOT a morning person I’m going to make as much of it as I can, as the lectures are good, and worth the time.

I plan to live-tweet my conferences tomorrow, so if you’re interested follow along on Twitter @gruntdoc. Last year I had more than 200, and some people liked them. We shall see, some lectures, and lecturers, are more quotable than others.

Yes, people watching here.

ACEP Scientific Assembly 2011

Update: Seems I’m not alone, I got this today (October 4th):

VERIFY YOUR PACKET CONTENTS!
Due to a printer error, some course tickets do not match course schedules in the mailed packets. Corrections have been made by the printer and were mailed on October 4. Please bring both packets with you to San Francisco. If you do not receive your corrected tickets before you leave for San Francisco, a set will be waiting for you at ACEP Registration, Moscone Center South.

Well, good. Here’s hoping the correct ones arrive on time.

Original post: I have a problem. I didn’t get what I needed from the pre-registration for this years’ SA.

When I look online, I have a full schedule, Sat-Tuesday, and while this makes me an extra-special dork, it makes me sad.

Sad, as yesterday I got my SA materials (kudos for the effort!) which have me with 2 classes on Saturday, 3 on Sunday, a full boat on Monday and none on Tuesday. Bonus, you say, but you’re wrong (again).

I just checked the ACEP SA site, and I have all the classes I signed up for online, which makes me think there’s a big disconnect between the SA site and what ACEP sent me. This matters, as ACEP gives us ‘tickets’ for every class, which are checked at the door, and in the immortal words of Indiana Jones, “No Ticket!”.




Wish me luck in about 9 days doing battle with the nice people at the registration desk…

Mark Kelly, husband of Rep. Giffords, retires from Navy – CNN.com

Thank you for your service, Sir. Does anyone know his rank at retirement? I read 5 articles about this and none said. Per @petulantskeptic on Twitter, he retired a Captain (O-6).

CNN — Mark Kelly, the astronaut and husband of U.S. Rep. Gabrielle Giffords, formally retired from the Navy on Saturday.Kelly, 47, is a former Navy combat and test pilot who went on to command Space Shuttle flights in 2008 and again in May, several months after his wife, U.S. Rep. Gabrielle Giffords, was wounded in a shooting at a constituent event in Tucson, Arizona. He also flew as part of Shuttle crews in 2001 and 2006.

via Mark Kelly, husband of Rep. Giffords, retires from Navy – CNN.com.