Fraud In NJ

The University of Medicine and Dentistry of New Jersey agreed today to reimburse the state and federal governments $4.9 million for double-billing the Medicaid program, and to allow a federal monitor to oversee its finances.

The agreement will allow the 35-year-old state-run college, New Jersey's only medical school, to avoid criminal prosecution for health-care fraud, U.S. Attorney Christopher Christie said in a statement.

Federal investigators for much of 2005 have been looking into the university's billing for Medicaid and Medicare patients as well as the alleged awarding of no-bid contracts to consultants with political ties and the alleged theft of documents that might be related to the prosecutor's case.

The school's board of trustees voted unanimously in favor of the agreement at a meeting today in Newark which was attended by Acting Governor Richard Codey. The university in the agreement acknowledged that it double-billed Medicaid, the government health-insurance program for the poor.

Now, I wonder who actually got the money from the fraud, and where it is now. It's a real shame that a medical school, with a good reputation, would get involved with type of activity.

No Incentive For HIV Vaccine

In an unusually candid admission, the federal chief of AIDS research says he believes drug companies don't have an incentive to create a vaccine for the HIV and are likely to wait to profit from it after the government develops one.

And that means the government has had to spend more time focusing on the processes that drug companies ordinarily follow in developing medicines and bringing them to market.

"We had to spend some time and energy paying attention to those aspects of development because the private side isn't picking it up," Dr. Edmund Tramont testified in a deposition in a recent employment lawsuit obtained by The Associated Press.

Tramont is head of the AIDS research division of the National Institutes of Health, and he predicted in his testimony that the government will eventually create a vaccine. He testified in July in the whistleblower case of Dr. Jonathan Fishbein.

"If we look at the vaccine, HIV vaccine, we're going to have an HIV vaccine. It's not going to be made by a company," Tramont said. "They're dropping out like flies because there's no real incentive for them to do it. We have to do it."

I must say that this is utterly disappointing, but probably true. It's all about the money in the end. Why would a drug manufacturer wish to make a vaccine that can prevent the disease, when they can keep selling their pricey cocktail of drugs and reap in the profits? They barely make the influenza vaccine, but they all want to make another hypertension of cholesterol medication.

Overthinning The Blood

More than 40% patients with non-ST-segment elevation acute coronary syndromes were given the wrong dose of antiplatelet or antithrombin medications, according to results of a large observational study.


Most of the errors involved doses above the recommended range, reported Karen Alexander, M.D., of the Duke Clinical Research Institute, and colleagues, in the Dec. 28 issue of the Journal of the American Medical Association.


The drugs were unfractionated heparin, low-molecular weight heparin, and glycoprotein IIb/IIIa inhibitors, wrote Dr. Alexander and colleagues.


In the prospective observational analysis in 387 U.S. academic and non-academic hospitals, 42% of patients had at least one initial dose outside recommended ranges. Moreover, excess dosing errors were more likely in vulnerable subgroups, including women, the elderly, and those with renal insufficiency, Dr. Alexander and colleagues found.


These were patients already at increased risk for bleeding. Such patients were in "double jeopardy" for bleeding complications, the researchers wrote.

The study goes on to say that almost 1/3rd of patients on heparin, and over 1/4 of patients on glycoprotein IIb/IIIa inhibitors were on too much. Of note, the low molecular weight heparins were overdosed about 13% of the time, implying a greater margin of safety compared to traditional heparin.

The full study is in today's JAMA.

Depression Device Gains Acceptance

A tiny implantable device that aims to treat depression patients has started gaining some acceptance months after the federal government approved its used, the manufacturer said.

The Vagus Nerve Stimulator delivers mild electrical pulses every 5 minutes to the vagus nerve, which carries information to parts of the brain that control mood, sleep and other functions.


An increasing number of psychiatrists and surgeons were receiving training to use the stimulator devised by Houston-based Cyberonics. More than 2,000 psychiatrists and 250 surgeons were trained for the therapy during the quarter that ended Oct. 28, said chief executive and president Robert "Skip" Cummins.

"I think it has started out a bit slowly. But the average psychiatrist, I think, is excited to have something that is a new possible treatment," said Dr. Thomas Schwartz, assistant professor of psychiatry at SUNY Upstate Medical University in Syracuse, N.Y, one of 20 sites that participated in study of the device.

More insurance companies were agreeing to reimburse patients for the cost of the device. By early December, 62 insurance providers had agreed to pay for costs associated with the therapy.

This is a novel approach to the treatment of depression. It uses an implantable device to stimulate the vagus nerve, similar to what is occasionally done in epilepsy patients. You can visit the manufacturer's website for further information.

Special Sponge

A HUMBLE kitchen sponge could hold the key to wiping out the deadly superbug MRSA, Scots scientists have discovered.

Rife in modern hospitals, MRSA has claimed the lives of thousands of patients, but is resistant to most antibiotics.

Now biologists working on a powerful new antibiotic have found the best way to cultivate the cure is on the surface of an ordinary kitchen scouring pad - and strangely, one brand alone.

The experts at Heriot-Watt University in Edinburgh have spent the past five years developing the antibiotic from bacteria found on seaweed from North Berwick, East Lothian.

But bizarrely, the antibiotic can only be grown on a kitchen sponge sold in Morrisons supermarkets, at a bargain 89p for a packet of eight (11p each).

We all know that a dirty, old sponge can harbor bacteria. Who knew that we could use this to our advantage against bacteria?

Doc Loses Medical License For Administering Weedkillers

The licence of a 70-year old Indian American doctor has been suspended by the Medical Board of Georgia state for allegedly using insecticides to treat cancer patients and prescribing unauthorised drugs.

The Board took the decision unanimously at a 30-minute meeting on Thursday and the notice was served on the doctor, Totada R. Shanthaveerappa a little later.

The nine-member Board’s unanimous action came after a federal grand jury had earlier in the week accused the doctor, who practices in Stockbridge, of using weed killer and insecticide to treat patients.

The jury had returned an 87-count indictment which, among other things, accuses him of falsely billing insurance companies by indicating that he was using approved drugs.

The prosecutors alleged that Shanthaveerappa, also known as T. R. Shantha, was using dinitrophenol, or DNP, a weed killer and insecticide Chemail Ukrain and hyperbaric oxygen therapy to treat patients.

His lawyer Dan Conaway told media that the doctor, who calls himself an alternative healer, would stop treating the patients but his clinic would remain open with other doctors continuing to attend on the patients.

I think the "take home message" is weed-b-gon = doc-b-gon for this physician. Hopefully, this is rather an unusual case.

Season's Greetings

Happy Holidays, from the staff at Doc To Doc.

Pour Carefully

The US researchers from Cornell University asked 198 students and 86 bartenders to pour a shot of alcohol.

They found students poured 30% more into the short glasses, while bar workers faired only slightly better at 20%, the British Medical Journal said.

The groups poured more than a standard shot measure into both types of glasses.

Students also said they thought the tall glasses held more, suggesting they were trying to compensate for size when pouring into the short, wide glasses.

Perhaps a graduated cylinder would be an appropriate gift so we know how much alcohol to put into our glasses!

Doses Of Tamiflu In Avian Flu

BIGGER doses of the anti-viral drug Tamiflu may be needed to treat avian flu, the drug group Roche said yesterday after evidence emerged of resistance to the drug.

It may also be necessary to combine the drug with other antiviral agents to treat the H5N1 avian virus, the company said in a statement.

“Roche agrees that other treatment regimens for the H5N1 virus need to be explored, including higher dose and/or longer duration of treatment with Tamiflu, or a combination of antiviral agents,” the company said. Safety data supported the use of higher doses.

A study published in the New England Journal of Medicine, highlighted the deaths of two Vietnamese girls who had become resistant to Tamiflu despite getting the current full dose of treatment. Two more deaths from bird flu in Indonesia were confirmed yesterday, taking the known total to 73. The number of cases, including survivors is 141. All the deaths so far have been in Asia.

The immediate relevance of the finding to a potential world pandemic of flu was not clear. Any pandemic strain will be easier to catch but less virulent than H5N1, and trials of Tamiflu against seasonal flu have shown that in a small proportion of cases, resistance does develop. For adults, the rate of resistance is about 0.4 per cent, and for children under 12, about 4 per cent. The resistant virus is less virulent than the unaltered type, so if Tamiflu is ineffective in these cases it may not matter much.

The implication, if we need to be using larger doses, is that we may have even a greater shortage of the drug.

Mr. Clean, The British Way

THE National Health Service has ignored a British technique for eliminating dangerous infections such as MRSA and Clostridium difficile from hospital wards.

A six-month trial — conducted in the US with the co-operation of the Atlanta-based Centres for Disease Control — has just finished and has provided solid evidence that bugs can be killed using a technique developed by Bioquell, of Andover, Hampshire.

The method was successful at Stoke Mandeville Hospital in Buckinghamshire after it suffered 300 cases of C. difficile infection and a dozen deaths. “We have been trying to set up a trial for the last year in the UK and got nowhere,” said Nick Adams, Bioquell’s chief executive, yesterday. “In the US it took three months to launch the trial and the results were so good we were asked to stay on.”

Bioquell’s technique is to empty wards of patients, seal doors and windows and install Dalek-like machines that pump out a mist of hydrogen peroxide, a powerful oxidising agent. When the mist passes the dew point, a near-invisible film is deposited on all surfaces. It kills bacteria without damaging materials. The agent degrades into water and oxygen, so requires no cleaning up. In a few hours the ward is clean and ready for patients to move back in.

This sounds like a very promising technique. If your hospital is anything like mine, there are plenty of patients on contact isolation, and it's a real chore for everyone to take care of them observing the proper precautions. If we could cut down on the infections there could be a lot of cost savings. I'm just not sure where we put the patients while we're "cleaning house."

SuperSize Surgery

The number of gastric bypass and other bariatric surgeries conducted in the United States more than quadrupled between 1998 to 2002, from 12,775 procedures to 70,256, researchers report.

And experts at the American Society for Bariatric Surgey estimate that that number may have doubled again since then, to more than 140,000 bariatric procedures performed in 2004.

"The observed increase in bariatric surgery rates is related in part to an increase in the utilization of the laparoscopic technique by surgeons and greater acceptance by patients of the minimally invasive option," the study authors conclude in the December issue of Archives of Surgery.

Bariatric surgery is the only effective sustained method of weight loss for people who are morbidly obese, according to the University of California, Irvine researchers who conducted the study.

They believe the dramatic increase in bariatric surgery in recent years is linked to the increasing use of minimally invasive laparoscopic techniques.

The California group pored over data from the Nationwide Inpatient Sample for the years covered by the study.

With the rise of obesity, and better, less invasive procedures, this shouldn't shock anyone.

Benefits of Chocolate

Just in time for the candy-clogged holidays, a new Swiss study finds a little dark chocolate each day could slow hardening of the arteries in smokers.

Chocolate is still no substitute for quitting smoking, of course, and the researchers add that the findings are not an excuse to binge on fattening sweets.

However, the results do "provide new important information about the potential beneficial effects of cocoa," said study author Dr. Roberto Corti, from the University Hospital in Zurich.

His team assigned 20 male smokers to either eat about 1.5 ounces of white chocolate or dark, then evaluated the effects of each on blood flow and other parameters. Before the men ate the chocolate, they were instructed to abstain for a full day from other foods that are rich in the same antioxidants found in cocoa. Those foods include apples, other cocoa products and onions.

Then researchers then subjected the smokers to ultrasound scans and blood tests.

Two hours after the men finished eating the dark chocolate, the scans showed improved smoothness of the blood flow through the arteries -- an effect that lasted eight hours, according to the report published in the January issue of Heart.

The dark chocolate also halved blood platelet activity, which in turn decreased the risk of blood clots. Antioxidant levels in the blood also rose among those who ate dark chocolate.

White chocolate did not have those effects, however.

New Colorectal Cancer Test

Biotech company Exact Sciences confirmed Monday an improved version of its colorectal cancer test that would lead to earlier identification of patients at risk for the disease is expected to hit the market in the next six months.



The announcement came after the Marlborough, Massachusetts-based company’s stock rose 11 percent or $0.18 to $1.79 on Friday. Shares closed up $0.01 to $1.80 on Monday.



“A future test would also pick up all stages [of colorectal cancer] and adenomas, a pre-cancerous condition,” Harry W. Wilcox, Exact Sciences chief executive, told RedHerring.com.



The company, which said it’s the only developer of DNA cancer testing kits for stool samples, is hoping that its current test, marketed by Laboratory Corporation of America Holdings (LabCorp), will be included in the guidelines of the American Cancer Society.

More info here.

Earbuds Cause Hearing Loss Faster Than Headphones

Back in the early days of portable audio players, headphones were quite commonly used for private listening, however as time went on, ear-buds gradually replaced the bulkier headphones due to their very small compact size and how cheap they have become. As these ear-buds can easily output in excess of 110 decibels with some MP3 players, there have been a lot of warnings about prolonged listening causing permanent hearing-loss with listeners as young as children.

Recently, a North-western University audiologist has issued a warning about using iPods with their included ear-buds, since a study has found that due to how close the ear-buds are present to the eardrum, they effectively magnify the sound by between 6 and 9 decibels compared with traditional over-ear headphones. Also, as these players have the ability to play up to 20 hours of continuous music depending on the player, users also tend to listen to a lot more music than with cassette tapes and CDs.

One friend of an audiologist at the university has carried out random tests on students he encounters listening to music and found some listening to music as loud as 120 dB; loud enough to potentially cause hearing loss in just 1 hour 15 minutes of continuous exposure. While over-ear headphones are less likely to cause harm due to their lower intensity, he recommends choosing noise-cancelling headphones, since these also block out most external noise, thus making the user much less likely to turn up the volume as loud. Alternatively, as consumers prefer ear-buds, he recommends adopting a 60% : 60min rule, where the listener should keep the volume below 60% maximum volume and only listen up to an hour’s worth per day.

I can't say I'm surprised by this one. How can Apple make a device that's so loud? No common sense there. If I were a headphone maker, I would put this on each package!

From CD Freaks.

Milk: Overstated Intolerance

Milk and other lactose-rich products may be getting a bum rap for food-related gastrointestinal symptoms, researchers here say.

The real culprit could well be an as-yet uncharacterized intestinal immune-mediated disorder, reported Laura Paajanen, M.D., of the Foundation for Nutrition Research here in the December issue of the American Journal of Clinical Nutrition.

In a blinded challenge of 23 individuals with food-related gastrointestinal symptoms, milk caused significant symptoms in only two, Dr. Paajanen and colleagues found.

They surveyed 827 individuals, ages 16 to 21, about food-related gastrointestinal symptoms. They then gave a clinical exam and a battery of tests, including a lactose-intolerance test and the blinded milk challenge, to 47 participants who reported such symptoms and agreed to the various tests.

The 47 participants reported food-related GI symptoms including abdominal pain, regurgitation, chronic nonspecific diarrhea, non-ulcer dyspepsia, dyschezia, and constipation. Only 14 of the 47 consumed milk or diary products without restriction. Most limited their intake of diary products to some extent, believing these to be at least partially responsible for their symptoms.

A control group of 29 symptom-free individuals also underwent the tests.

See, it's true- "milk, it does a body good!" After this study, folks will have to blame something else for a while.

From CNN.

Your Vote Is Needed

I know we're quite new, but if you like what you see, then vote for us in the Medical Weblog competition over at MedGadget. Please vote for us (by writing into the comments section on the link provided in the title) in the "Best New Medical Weblog" category. Thanks for your support.

Vote here.

Diarrhea Vaccine

An experimental vaccine provided some protection against that scourge of tourism, traveler's diarrhea, when put to a rigorous test among U.S. students in Mexico and Guatemala, scientists reported Friday.

The research provides important evidence that a vaccine is possible against the hard-to-avoid germs, instead of merely urging travelers to guard against risky food and water. Now the challenge is to strengthen that protection.

"This is a very encouraging first step," said microbiologist A. Louis Bourgeois of Johns Hopkins University's Bloomberg School of Public Health, who led the study of the Swedish-developed vaccine.

Traveler's diarrhea is the leading cause of illness among visitors to developing countries, striking an estimated 20 million international travelers a year. While there are numerous causes, the chief culprit is bacteria called enterotoxigenic E. coli, or ETEC. It is spread through contaminated food and water, and while rarely life threatening to the otherwise healthy traveler, it can cause up to a week of misery.

ETEC is becoming more resistant to antibiotics, making it harder to treat the seriously ill and increasing the need for a vaccine, said Dr. David Hooper of Massachusetts General Hospital, who helped organize the American Society for Microbiology meeting where the data was unveiled.

Scientists are hunting a variety of ways to make an anti-ETEC vaccine. This one came about almost accidentally: During tests of a cholera vaccine in Bangladesh, some recipients also seemed temporarily protected from ETEC-caused diarrhea. So researchers at the University of Goteborg in Sweden and that country's SBL Vaccines created a vaccine especially for traveler's diarrhea.

They used part of that cholera vaccine, because a toxin produced by cholera is very similar to an ETEC-produced toxin. The new vaccine also contains killed E. coli cells -- designed to stimulate the immune system to attack the germs before they dock in the intestine and start making toxin.

Some 1,406 U.S. students swallowed the vaccine or a placebo before spending up to a month studying Spanish in Guatemala or Mexico. (The vaccine is considered so safe that students received it by mail, swallowing it at home as researchers supervised by telephone. )

At first, the vaccine appeared only to lessen disease severity, Bourgeois said. Then researchers used blood tests to determine if the vaccine in fact stimulated an immune response. It didn't "take" in everybody.

But among responders, it was 84 percent effective at blocking severe diarrhea, and 63 percent effective at blocking even mild cases, too. Vaccine responders who did get sick had half as many days of illness as placebo recipients.

A vaccine is always preferable to antibiotics!

From Wired.

Web Site To Notify Partners of STD's

Los Angeles County health officials have opened an internet website on which users can anonymously notify their sex partner of having been infected with a sexually transmitted disease.

The site, www.InSPOTLA.org," which opened on Wednesday, offers different types of electronic postcards to simultaneously e-mail up to six sexual partners of being infected with an STD.

"You're too hot to be out of action," reads one card, featuring the back of a handsome man covering his behind with a towel. "I got diagnosed with an STD since we played. You might want to get checked too."

The site gives information about several of the most common STDs and how to prevent them.

Another card reads: "It's not what you brought to the party, it's what you left with. I left with an STD. You might have too. Get checked soon."

The site was developed by a non-profit group called the Internet Sexuality Information Services, and co-sponsored by the Aids Healthcare Foundation, with funding from the Los Angeles County.

"Face-to-face communication is really the way to go, but some people can't do that," said Karen Mall, Aids Healthcare Foundation's director of prevention and testing.

Leave it to those crazy Californians to come up with this one. You just never know what you'll find in your email inbox now!

Just charge it...

WellChoice (New York; $3.4 million in assets) and American Express (New York) will offer American Express HealthPay Plus Card, a healthcare payment solution for participants in Empire Total Blue's consumer-directed health plan. The card, provided by American Express Bank, provides two payment options. It is tied to both a Health Savings Account (HSA) and a line of credit to help cover costs that may exceed the balance of the HSA. The HSA also allow consumers to contribute pre-tax dollars to their medical expenses.

The card provides WellChoice's 40,000 members in the Empire Total Blue consumer-directed health plan with a single payment option at a healthcare provider, physician, pharmacy or hospital.

The card allows consumers, providers and insurers a secure and easy way to manage healthcare costs and payments, asserts Jason Gorevic, senior vice president chief sales and marketing officer of WellChoice. "A lot of innovations in consumer-directed healthcare have been adding features, but this solution solves real problems and delivers real value to both consumer and healthcare providers because of the integrated claim processing," he says.

According to Gorevic, WellChoice identified the need for the HealthPay Plus Card to engage consumers further into the financial decision-making process. The health insurer also set up the card because of consumer concerns over the administrative complexity of consumer-directed health plans. "Matching up an explanation of benefits with a bill from a provider, accessing the funds and deciding where the funds are going to come from concerned the consumer," explains Gorevic. Furthermore, providers, who are used to receiving co-pays, expressed concern about collection. "We identified that a single-source solution addressed these barriers to consumer-directed healthcare," notes Gorevic.

FDA Curbs Fake Flu Remedies

The U.S. Food and Drug Administration said on Tuesday it had warned nine companies to stop marketing "bogus" flu products.

The products, including capsules that allegedly contain bacteria from dirt and other assorted immune system "boosters," all claim or claimed to help prevent or treat avian flu.

"FDA is not aware of any scientific evidence that demonstrates the safety or effectiveness of these products for treating or preventing avian flu and the agency is concerned that the use of these products could harm consumers or interfere with conventional treatments," the agency said in a statement.

"The use of unproven flu cures and treatments increases the risk of catching and spreading the flu rather than lessening it because people assume they are protected and safe and they aren't," said Dr. Andrew von Eschenbach, acting FDA commissioner.

"I consider it a public health hazard when people are lured into using bogus treatments based on deceptive or fraudulent medical claims."

All of the companies sell via Internet Web sites and the FDA complained about several claims, including "prevents avian flu," "a natural virus shield," "kills the virus," and "treats the avian flu."

Most are promoted as being "natural" or "safer" treatments that can be used in place of approved drugs.

"In the Warning Letters, FDA advises the firms that it considers their products to be drugs because they claim to treat or prevent disease," the FDA said.

This type of thing makes you wonder how far we've come from the snake oil salesman of the Wild West in the late 1800's. Perhaps not as far as we think we have. What was their phrase? "Good for whatever ails ya!" This resonates today as well.

Technology Being Developed To Aid The Elderly

In a sprawling exhibit at the conference in a Washington hotel Monday, the group displayed 50 prototypes and early-stage products -- from a robotic assistant called ``Nursebot'' to an interactive, Web-enabled medicine cabinet.

Some of the technology is expensive. It costs about $4,500 to outfit a home with wireless sensors in one Intel project: A personal computer and the Internet are used to allow doctors and relatives to check on a range of activities by a senior living alone. It tracks such things as whether medications have been taken to how many steps the person has walked since waking up, said Eric Dishman, chair of the Center for Aging Services Technology.

Prices should come down significantly in the future, he said, and those costs would be weighed against the sky-high price of medical care.

``If you look at a condition like Alzheimer's, keeping somebody in their own home for one to three days could pay for the cost of the technology,'' said Dishman, who also heads Intel's Health Research and Innovation Group.

Barrett has made health research a priority at the company, saying it fits with Intel's strategy of identifying new ways to use technology.

Barrett is a senior citizen himself, moving from chief executive officer to board chairman earlier this year because of a company policy requiring CEOs to give up their post at 65. But he said his own age has nothing to do with his recent work on technology for the aging, although he joked to the conference's opening session that he was the oldest of the six keynote speakers. Barrett said he was motivated by experience dealing with the medical needs of an older family member.

As the elderly demographic continues to increase, there will be manpower, and financial pressures to care through these patients through technology. I'm not sure if the nursebot concept will take off though.

High Fiber Diet May Not Prevent Colon Cancer

EATING lots of fibre may do little to protect against colon cancer, the latest analysis of evidence has found.

While people who eat the most fibre — in the form of cereals, vegetables and fruit — are slightly less likely to get colon cancer, the association is weak and disappears altogether when other factors are taken into account, according to an international team in the Journal of the American Medical Association. The research undermines one of the greatest of dietary shibboleths, first enunciated by the British physician Denis Burkitt in the 1960s. Working in Africa, he noticed that rates of colon cancer were low, and put it down to the fibre-rich diet of local people.

Ever since, people have been urged to eat their fibre. The latest analysis pools the results of 13 studies of about 750,000 men and women followed for between 6 and 20 years, in which more than 8,000 colon cancers were detected.

At first sight, the results suggest a link. People in the top fifth for the fibre content of their diet were 16 per cent less likely to get colon cancer than those in the lowest fifth. But on further analysis, the link disappears. If other dietary factors such as red meat, milk and alcohol are included, the link between fibre and cancer becomes insignificant.

Well, we have to eat something. Every week another study comes out and the pendulum swings some other way.

Exercise & CHF

A little exercise can go a long way for congestive heart failure patients.

A study in rats that were predisposed to heart failure found the rats that exercised moderately had a 15% extension in life span.

Researchers say humans and rat hearts are very similar, and a simple walk every day may prolong lifespan and delay heart failure symptoms in humans.

Heart failure happens when the heart progressively weakens until it can't pump very hard and fluid backs up into the lungs.

The rats were predisposed to heart failure and had hypertension. Of the rats that didn't exercise 9/10 developed terminal heart failure. 10 out of 10 exercising rats didn't die = 15% extension in life span (could have been longer had study gone longer). The study lasted 22 months.

Based on research from other labs, it appears that low intensity exercise is probably safe for people with developing heart failure, in fact it may be beneficial and may prolong life span or delay the development of heart failure.

In this study, researchers intervened at the beginning of heart failure (not when there were still no signs of the condition) and the rats showed this positive benefit.

This is encouraging news for cardiac rehab programs.

Primum Non Docere...

U.S. regulators alerted the public on Friday to a study showing a higher death rate among heart disease patients a year after taking an Abbott Laboratories Inc. antibiotic, as part of an effort to release early information about potential safety concerns.

The drug is biaxin. Why would an antibiotic cause deaths years later? This needs a lot more study.

Helping Seniors To Choose Medicare Prescription Coverage

This holiday, baby boomers can give their parents a gift they really may need: help choosing a Medicare prescription drug plan.

The new drug coverage kicks in next year, presenting those 65 and older dozens of options, each with its own premium structure, list of covered drugs and participating pharmacies. One of the best tools for cutting through the maze is Medicare's drug plan comparison program at www.medicare.gov.

That's the problem. About three-quarters of older Americans have never been on the Internet, according to a recent Kaiser Family Foundation survey. Baby boomers and younger generations can provide assistance by putting their keystroke skills to work.

Alan Dorenfeld of Pikesville recently went through the Medicare online program to select prescription drug plans for his 85-year-old father and 82-year-old mother.

"It's well done, but not well done for seniors," said Dorenfeld, 60. "You have to be comfortable with the computer -- kind of like trial and error. Put data in; take data out. Let's be honest, what percentage of 85-year-olds are computer-literate enough to be able to do that?"

The enrollment period runs from Nov. 15 through May 15. Sign up before the end of the year and coverage begins Jan. 1. Enroll after the May deadline, and you'll pay a penalty in the form of an escalating premium for each month you delay.

Personally, I'm hoping the government simplifies the plans over the next year into something everyone can understand. Do we really need so many plans except to confuse everybody?

US Life Expectancy

U.S. life expectancy has hit another all-time high — 77.6 years — and deaths from heart disease, cancer and stroke continue to drop, the government reported Thursday.

Who says we're not doing a good job?

From MSNBC.

2nd Cancer Risk In Breast Cancer Patients

Researchers led by Lene Mellemkjær of the Danish Cancer Society in Copenhagen, Denmark conducted a huge study involving 525,527 patients with breast cancer in 13 cancer registries in Europe, Canada, Australia and Singapore. Records were analyzed for second primary cancers during the period 1943 to 2000, with 133,414 women followed for more than 10 years after the initial diagnosis of breast cancer. The increased risk of a second cancer was seen in many different sites, as shown in earlier studies. "The excess of cancer after a breast cancer diagnosis is likely to be explained by treatment for breast cancer and by shared genetic or environmental risk factors although the general excess of cancer suggests that there may be additional explanations such as increased surveillance and general cancer susceptibility," the authors note.

The study found an almost 6-fold increase in the risk of cancer in connective tissue of the thorax and upper limbs, which suggests that radiation therapy, which has been used to treat breast cancer since the beginning of the 20th century, may play a role in developing a second cancer in organs close to the breast. An increased risk of myeloid leukemia was also shown, possibly as a result of chemotherapy. In addition, while previous studies had shown an increased risk of endometrial cancer with the use of tamoxifen, the current study suggests that this may not be entirely due to the drug, since the increased risk was already shown within one year of breast cancer diagnosis, it was shown before 1975 when tamoxifen was rarely used, and an increased risk of breast cancer was also seen after endometrial cancer. Colorectal, kidney and postmenopausal breast cancer appear to share obesity as a risk factor, while ovarian cancer and breast cancer seem to have a genetic predisposition in common. The study found an excess of ovarian cancer already within one year of breast cancer diagnosis, along with an increased risk of breast cancer after ovarian cancer.

From Science Daily.

Oxytocin & The Fear Hub

Scans of the hormone oxytocin's effect on human brain function reveal that it quells the brain's fear hub, the amygdala, and its brainstem relay stations in response to fearful stimuli. The work at NIMH and a collaborating site in Germany suggests new approaches to treating diseases thought to involve amygdala dysfunction and social fear, such as social phobia, autism, and possibly schizophrenia, report Andreas Meyer-Lindenberg, M.D., Ph.D., NIMH Genes Cognition and Psychosis Program, and colleagues, in the December 7, 2005 issue of the Journal of Neuroscience.

"Studies in animals, pioneered by now NIMH director Dr. Thomas Insel, have shown that oxytocin plays a key role in complex emotional and social behaviors, such as attachment, social recognition and aggression," noted NIH Director Elias Zerhouni, M.D.. "Now, for the first time, we can literally see these same mechanisms at work in the human brain."

"The observed changes in the amygdala are exciting as they suggest that a long-acting analogue of oxytocin could have therapeutic value in disorders characterized by social avoidance," added Insel.

Inspired by Swiss scientists who last summer reported [1] that oxytocin increased trust in humans, Meyer-Lindenberg and colleagues quickly mounted a brain imaging study that would explore how this works at the level of brain circuitry. British researchers had earlier linked increased amygdala activity to decreased trustworthiness. [2] Having just discovered decreased amygdala activity in response to social stimuli in people with a rare genetic brain disorder that rendered them overly trusting of others, Meyer-Lindenberg hypothesized that oxytocin boosts trust by suppressing the amygdala and its fear-processing networks

It's neat to see new information about the good ol' hormones. Who would have thought it had something to do with fear as well?
From Science Daily.

Technology To Help The Elderly & Disabled

Fernie, 56, has transformed an interest in gadgets into a lifelong professional quest to find ways for people to overcome the ravages of disease or age and let them live as independently as possible.

"For old people and people with disabilities, winter is an enormous problem," said Fernie, vice-president of research at the Toronto Rehabilitation Institute. "We know people who just don't go out in winter, because by the time they've got their coats and boots on, they're exhausted."

So some of Fernie's colleagues are designing new forms of winter coats and boots that are easier to use.

"Weather is actually a big interest of ours," Fernie said, "if only because most of the assistive devices that currently exist don't work very well except when conditions are just right.

Fernie is not just content to do research -- his goal is to create products that people can buy and use.

For instance, he designed and brought to market the SturdyGrip pole -- a movable handgrip that makes it easy for people to get out of chairs and beds. A product called Staxi -- a stackable transport chair -- enables people to get around in hospitals without having to wait for a volunteer.

This is great work to help these folks function more independently.
From CNN.

Colon Cancer PostOp Chemo Underused

More than a decade after new treatment guidelines for the disease were issued, many patients with advanced colon cancer are not getting chemotherapy after surgery, despite clear-cut evidence it boosts survival, a study found.

Blacks, women and elderly patients were found to be less likely to get chemo, even though such treatment was shown to improve survival in all groups.

About two-thirds of the patients who received chemotherapy in addition to surgery were alive after five years, compared with about half of those who had surgery alone, according to the study in Wednesday’s Journal of the American Medical Association. On average, chemotherapy improved the five-year survival rate by about 16 percent.

From MSNBC.

We're unprepared...

Federal health officials have made little if any progress in disaster preparedness since 9/11 and state health departments are not faring much better, says a watchdog group that has given mostly low grades to public health agencies nationwide.

Pandemic flu, a natural disaster or an act of bioterrorism would strain health agencies' capacity to respond, and thus amplify the effects of a mass emergency, especially if one were to strike now, said experts from Trust for America's Health, a nonprofit and nonpartisan organization in Washington.

The group produced an unflattering critique of the nation's disaster readiness and a long list of low grades in its report: "Ready or Not? Protecting the Public's Health from Disease, Disasters and Bioterrorism." The report serves as a wake-up call to the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, and state health departments. It is the group's third such report.

"I think the report is even more critical this year in the wake of Hurricane Katrina," said former three-time U.S. Sen. Lowell Weicker, who is president of Trust for America's board. "The response to the hurricane was a sharp indictment of the nation's emergency response capabilities. "Overall, the federal government received a D+ grade," for all post-9/11 disaster preparedness, Weicker said.

Let's not get caught with our pants down...again.

From Newsday.

For a stress free recovery...

Even if spouses usually get along well, the stress caused by a half-hour argument can slow healing of a surgical wound by as much as a day, researchers here reported.


If they are generally hostile, the delay in wound healing can be doubled, according to Ronald Glaser, Ph.D., and Janice Kiecolt-Glaser, Ph.D., both of Ohio State here.


One implication of the finding, reported in the December issue of the Archives of General Psychiatry, is that marital stress plays an important role in recovery from surgery, Dr. Kiecolt-Glaser said.


"This shows why it is so important that people be psychologically prepared for their surgeries," she added.


Dr. Kiecolt-Glaser said the study, combined with previous work, suggests that "hospitals need to modify existing practices in ways that will reduce stress prior to surgery."


Reducing pre-surgical stress, both researchers said, would lead to shorter hospital stays, lower medical bills, and a reduced risk of nosocomial infection.

Well, this may be a good reason for the family to not visit a postop patient!

From Med Page Today.

Could they make this more confusing?

The good news for California's 4.3 million Medicare beneficiaries is that there are more than 60 prescription drug plans to choose from.

The bad news? There are more than 60 plans to choose from.

Additional bad news: Making the choice is time-consuming, confusing and often stressful.

"We've been inundated with calls. Our lines are jammed. We're seeing a lot of people with a lot of questions, and it can be very frustrating for them," says Deanne Beebe of the Medicare Rights Center, an independent nonprofit organization that helps educate seniors about Medicare.

Enrollment began Nov. 15 for Medicare's new prescription drug plan, also known as Medicare Part D. It will allow elderly and disabled Americans who are covered by the Medicare program to get subsidized drug coverage through private-insurance companies. Each region has its own set of drug plans, each with different benefits, costs and stipulations.

So let me get this straight. In typical government bureacracy, we've decided to confuse the elderly with so many choices that they don't ever get the drugs.

From Sign On San Diego.

Robo-Patients Allow Students To Practice In Canada

A simulator lab training centre set up by the anesthesia department allows students to experience the challenges of working in a hospital operating room in a setting that looks and functions as close as possible to the real thing. An official opening of the lab was held on Wednesday.

In a room on the first floor of the McMaster University Health Sciences Centre, the new training lab features computer-operated medical equipment hooked up to what appears to be a real patient on an operating room table. In fact, the patient is a $100,000 computerized, human-like robot that mimics bodily functions such as breathing, heartbeat, swelling and other changes in human conditions that might be experienced by an actual patient.

Medical students learn how to properly administer anesthesia and monitor the patient and medical equipment. A control room in the lab allows the instructor to watch the students and manipulate the mannequin's responses to mimic what might occur in a real-life situation. The patient's heart rate or breathing can change, and the throat or tongue can swell, requiring the students to think on their feet and make the necessary adjustments.

The use of simulation technology at McMaster will expand significantly in coming months, as the School of Nursing uses government funding to establish another simulation lab, complete with a family of robo-patients. The lab will provide a virtual hospital experience in which nursing students can practise assessment and treatment, and apply their critical, problem-solving skills using anatomically-correct, computerized mannequins that can speak and simulate different medical conditions. It will be utilized by students of the joint McMaster-Mohawk-Conestoga nursing program, and eventually expand to offer interprofessional training for students in a variety of health care training programs.

I remember when practicing on the patients was "on the job training;" ah, the good 'ol days. I think we're going to see a lot more simulators to learn procedures in the years ahead. If we can teach a pilot to land a jet on an aircraft carrier in a simulator, I'm sure we can figure out how to teach a doctor to remove a gallbladder.

From TechNudge.

Up your nose...

A new nasal vaccine against influenza, which helps patients avoid the needle, has caused no unexpected side-effects, U.S. government researchers reported Tuesday.

A study of the 2.5 million people who got the vaccine over the past two flu seasons showed no unexpected serious risks, according to the report in the Journal of the American Medical Association.

FluMist has been approved since 2003 for use against the seasonal flu, which kills 36,000 Americans every year and as many as 500,000 globally in an average flu season. But people have been slow to use it, despite efforts by U.S. health officials to promote its use

This is a great alternative for healthy, younger patients, especially those that are adverse to needles, such as children over 8 years old. It can set off asthmatic episodes in the series in a small percentage of patients with known asthma.

Anti-Perspirants & Breast Cancer

If you've checked out the back of your antiperspirant lately, you might have noticed something different: new labels required by the Food and Drug Administration. They point out that antiperspirants are "drugs" containing "aluminum" ingredients — that's what stops the sweat.

The aluminum is also what concerns some people, including Dr. Kris McGrath.

"I personally feel there is a very strong correlation between the underarm hygiene habits and breast cancer," McGrath tells CBS News correspondent Sharyl Attkisson.

McGrath, an immunologist and instructor at Northwestern University, has been intrigued by a potential breast cancer link since medical school.

It got personal when his wife — a frequent shaver and antiperspirant user — got breast cancer.

I thought this was some bit of urban legend, but apparently some are loking into a possible connection.

"Breast cancer has existed since Hippocrates. But when you plot the sales of antiperspirant deodorants with the incidence of breast cancer in the United States, they both have grown in almost a parallel fashion."

From CBS.

Virtual Medicine May Lead To Real Lawsuits

Peter Beasley is a busy man who currently has no health insurance. He's also a customer of TelaDoc Medical Services, a setup that allows him to call an unknown doctor and get medicine prescribed sight unseen.

Within an hour or so of his call to an 800 number, he gets a call from a doctor who discusses his symptoms and will often write a prescription.

TelaDoc provides its members -- which the company estimates at 30,000 -- with access to a doctor 24 hours a day, seven days a week.

While members like Beasley praise the service as a convenient way to address nagging medical needs at odd hours, others in the health care industry say treating patients without seeing them in person is worrisome, perhaps dangerous. California's medical board is investigating TelaDoc's activities in that state.

TelaDoc chief executive Michael Gorton said the Dallas-based company is merely providing a needed service and is not meant to replace the family physician. The company began offering its services nationwide this year after an earlier test run.

However, all is not ideal. Several physician groups, as well as state medical boards are looking into this brave new frontier of medicine. In their view, this is stretching the doctor patient relationship to a very thin limit- too thin for some.

But doctors' groups and medical ethics experts question the notion of putting convenience first.

"Practicing medicine without seeing the patient is still a dangerous thing," said Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania. "From the doctor's point of view, it's not standard of care."

Dr. Larry S. Fields, president of the American Academy of Family Physicians, said he doesn't see the benefit of TelaDoc.

"As much as I'd like to put a positive spin on it, most patients can get to their family physicians just as quick by telephone," he said. Establishing a doctor-patient relationship should involve an office visit with a general exam and an ongoing plan for the patient's long-term health, Fields said.

While the American Medical Association doesn't have a specific policy on such services, there are some concerns for the patient, said AMA president Dr. Edward Hill. "Nothing we think can replace the face-to-face with a doctor."

From TechNudge.

Robo Suit

We developed the exo-skeleton type power assist system to realize the walking aid for the gait disorder person.
At the present time, HAL-3 is state of the art power assist system in the world.
Some sensors such as angle sensors, myoelectrical sensors, floor sensors etc. are adopted in order to obtain the condition of the HAL and the operator.
All of the motordrivers, measurement system, computer, wireless LAN, and power supply are built in the backpack.
Using the battery attached on the waist, HAL works as the complete wearable system.

Yes, this guy is serious. There is a lot of potential here, even though he looks like something out of a comic book.

Some more here, including the price tag. I'm not sure insurance will reimbuse for this; they'll claim it's experimental.

Tylenol...The Drug That Hospitals Trust Most

SEATTLE, Nov. 30 - Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported.


Users of the popular painkiller who are most at risk include those with depression, chronic pain, alcohol/narcotic use, and those who take several acetaminophen-containing products at the same time, they added.


"Education of patients, physicians, and pharmacists to limit high-risk [acetaminophen] use settings is recommended," wrote Anne M. Larson, M.D., of the University of Washington, and colleagues at 21 other U.S. centers, in the December issue of Hepatology.


Acetaminophen (Tylenol and generics) is widely available in over-the-counter preparations for headaches, colds, allergies, osteoarthritis, and other conditions.


The data suggest that consistent use of as little as 7.5 g/day of acetaminophen could lead to severe hepatic injury, Dr. Larson and colleagues wrote.

As some of us have seen, innocuous Tylenol can be a real nasty medication in larger quanities. Some suggestions to avoid a problem for our patients are:

*Inform patients that acetaminophen dosing greater than 7.5 g/day could be hazardous. Reassure them, however, that acetaminophen-related liver toxicity is an uncommon occurrence, and that the drug itself is not toxic.


*Instruct patients who use over-the-counter medications to read labels carefully and look for the ingredient acetaminophen in analgesics, cold and allergy medications, sleep aids, and other products.


*Inform patients who have alcoholic liver disease that smaller amounts of acetaminophen (4-5 g/day) have been reported to cause acute liver failure.

From Med Page Today.

Implantable Accucheck

Developed by Craig A. Grimes, professor of electrical engineering and materials science and engineering at Penn State, the glucose biosensor, when placed under the skin, could provide glucose levels for diabetics without a finger prick. Diabetics must monitor the levels of glucose in their blood and adjust insulin injections to maintain normal levels and avoid the complications of the disease. The device, which measures about a centimeter by half a centimeter and is about the depth of a thin hair, is composed of an I-shaped backbone crossed by a series of 10 slightly decreasing bars. The shape vaguely resembles a miniature harp.

The backbone and crossbars are made of a magnetorestrictive metallic glass – a material that changes shape with application of a magnetic field and generates a magnetic field when it changes shape – coated with a polymer that reacts to changes in acidity. This coating is then topped with glucose oxidase, the enzyme that reacts with glucose. The acid sensitive coating makes the device swell or shrink, changing mass depending on the surrounding acidity. The acid that causes the changes comes from the reaction of glucose with glucose oxidase, which produces gluconic acid.

When a magnetic field from the outside is placed near the sensor, the sensor vibrates at a frequency dependent on the mass of the sensor. A magnetic coil can read the magnetic flux of the sensor and determine the amount of glucose in the blood.

This could be a great boon so diabetics who don't check their glucose enough. Imagine continuous monitoring capabilities. Now, this could be real tight control. Unfortunately, it's not currently available.
Some more info here.

I'll let the robot do it....

Hansen Medical, a developer of robotic medical technology, raised $30 million through a third round of funding led by Vanguard Ventures, an early-stage venture capital firm focused on financing technology and life-sciences ventures. Existing Hansen investors also participating in the round included Prospect Venture Partners, Skyline Venture Partners, Thomas Weisel Healthcare Venture Partners, De Novo Ventures and Sapient Capital.

This brings Hansen's total equity fundraising to more than $58 million.

The Mountain View company has developed a robotic catheter control system for precise catheter navigation and control within the chambers of the heart.

The technology -- which requires regulatory clearance and is not yet commercially available -- includes a robotic catheter manipulator that is designed to respond instinctively to physicians' commands entered into a workstation, allowing doctors to place ablation catheters in hard-to-reach anatomical locations within the heart.

The technology is also designed to allow physicians to maintain stability during treatment of complex cardiac arrhythmias, such as atrial fibrillation, a major cause of stroke and severe long-term disability.

So the robot can be more prcise than us. I'm not sure if we should feel threatened or not. What do you think?

Where is the flu?

A flash utility to see the latest influenza activity by each state.

C Diff- In The News

"Hospitals need to be conducting surveillance and implementing control measures. And all of us need to realize the risk of antibiotic use may be increasing" as the bacteria continue to mutate, McDonald said.

The bacterium is Clostridium difficile, also known as C-diff. The germ is becoming a regular menace in hospitals and nursing homes, and last year it was blamed for 100 deaths over 18 months at a hospital in Quebec, Canada.

"What exactly has made C-diff act up right now, we don't know," McDonald said.

The article published in the CDC's Morbidity and Mortality Weekly Report focused on cases involving 33 otherwise healthy people that were reported since 2003 in Pennsylvania, Ohio, New Jersey and New Hampshire.

Most of the 33 hadn't been in a hospital within three months of getting sick, and eight said they hadn't taken any antibiotics in that span

New Disease....Addicted to The Internet

THE waiting room for Hilarie Cash's practice has the look and feel of many a therapist's office, with soothing classical music, paintings of gentle swans and colorful flowers and on the bookshelves stacks of brochures on how to get help.

But along with her patients, Dr. Cash, who runs Internet/Computer Addiction Services here in the city that is home to Microsoft, is a pioneer in a growing niche in mental health care and addiction recovery.

The patients, including Mike, 34, are what Dr. Cash and other mental health professionals call onlineaholics. They even have a diagnosis: Internet addiction disorder.

These specialists estimate that 6 percent to 10 percent of the approximately 189 million Internet users in this country have a dependency that can be as destructive as alcoholism and drug addiction, and they are rushing to treat it. Yet some in the field remain skeptical that heavy use of the Internet qualifies as a legitimate addiction, and one academic expert called it a fad illness.

Skeptics argue that even obsessive Internet use does not exact the same toll on health or family life as conventionally recognized addictions. But, mental health professionals who support the diagnosis of Internet addiction say, a majority of obsessive users are online to further addictions to gambling or pornography or have become much more dependent on those vices because of their prevalence on the Internet.

But other users have a broader dependency and spend hours online each day, surfing the Web, trading stocks, instant messaging or blogging, and a fast-rising number are becoming addicted to Internet video games.

Dr. Cash and other professionals say that people who abuse the Internet are typically struggling with other problems, like depression and anxiety. But, they say, the Internet's omnipresent offer of escape from reality, affordability, accessibility and opportunity for anonymity can also lure otherwise healthy people into an addiction.

I'm not sure if I would really categorize it as a disease. The best part is these therapists are getting paid cash to "treat" these patients. Is Donald Trump addicted to making money? I don't see anyone treating him for it.