Wednesday, April 30, 2014

Should Doctors Care About Cost?

Excellent perspectives here: Link
Dr. Shapiro in the third letter  down points out that Congress has allowed Drug Companies exorbitant pricing on their products. While Medicare and Ins. companies try to "nickel and dime" doctors, who are operating at very low profit margins as it is, drug companies can charge 2000$ a month for medications injected into patient's eyes, and medicare wants to totally eliminate paying ophthalmologists for exams when pt's get injections. If medicare decides to cut out doctor payments for 12 exams a year per patient, it still will not equal what medicare pays for one dose of an injected medicine per month, such as Lucentis. If a patient is getting one of these expensive drugs in both eyes monthly, it costs medicare 48, 000$/year. The payment to the physician is a small fraction of that amount.

In an excellent segment on 60 minutes (link here), which one congressman pointed out was the "ugliest night he had ever seen (in Congress),  it is pointed out that pharmaceutical companies paid 100 million dollars a year to lobbyists (and that was in 2007). Their lobby is bigger than defense and oil according to a recent meeting I attended last week. It is the biggest lobby in the world. 

The whole video is a definite must watch, but at ~5:20 into the video it clearly states that the Bill prohibited the Government, with its massive purchasing power, from negotiating the price of drugs with pharmaceutical companie!. It is thus  no surprise that this bill was written by the pharmaceutical industry

It is no surprise that Tom Scully, Medicare's lead negotiator on the drug bill told the chief actuary to withhold  at the congressional hearings,his revised estimates that it would cost you the tax payer, 500 billion dollars for the first ten years. At the same time he prohibited this revised estimate from being announced, he was negotiating to be a lobbyist for the pharmaceutical companies. It is no surprise that 15 of the key congressman who got the drug bill based shortly thereafter got lucrative jobs working for pharmaceutical companies, either.

Want to Be More Creative? Take a Walk

If you are unable to think of a catchy, creative way to present sales data or begin a newspaper column, take a walk. A brief stroll, even around your office, can significantly increase creativity, according to a handy new study.

The focus on patient satisfaction is enough to make you sick

All patients should be treated with professionalism and respect.  We all want our patients leaving our care happy, healthy and satisfied, if at all possible.  However, sometimes patients don’t leave an emergency department very happy or satisfied.  Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the treating physician did, or didn’t, do.
The reasons for a patient being dissatisfied with a particular healthcare encounter can be very complex.  It’s not so simple as to just include a line in a survey such as, “Were you satisfied with your doctor?”
Who should be held responsible for the results of these surveys, is where the crux of this debate lies.
So why are hospitals obsessed with patient satisfaction?
It’s the same reason Walmart puts greeters at the front door (the ED), not the back door (inpatient floors), and the same reason the government collects taxes and not sea shells: money.  The question we really need to be asking is: Why is the obsession with patient satisfaction in the ED so soul-crushing to those that work there?
Sometimes a patient voices frustration in a survey despite your best efforts to be nice, helpful, professional and clinically astute.  This may be due to factors out of your control regarding ER wait times, a large hospital bill, dirt on the waiting room floor, or a rude staffer that wasn’t you.  If the results are used against you, it is very difficult to smile and say, “It’ll never happen again.  I’ll do better next time.”
You didn’t make it happen, and you have little if any ability to make it better next time.  You’re already nice to your patients, do your best to help them and treat them with respect.  There’s tremendous cognitive and emotional dissonance there.  Things like this can end careers and fuel burnout in a big way.  Such things are the undercurrents that cause doctors to go work for insurance companies, as non-clinical consultants, or just plain move on.

Monday, April 28, 2014

Hearing quality restored with bionic ear technology used for gene therapy

Researchers at UNSW Australia have for the first time used electrical pulses delivered from a cochlear implant to deliver gene therapy, thereby successfully regrowing auditory nerves. The research also heralds a possible new way of treating a range of neurological disorders, including Parkinson's disease, and psychiatric conditions such as depression through this novel way of delivering gene therapy..
Professor Housley and his team at UNSW developed a way of using electrical pulses delivered from the cochlear implant to deliver the DNA to the cells close to the array of implanted electrodes. These cells then produce neurotrophins.
"No-one had tried to use the cochlear implant itself for gene therapy," says Professor Housley. "With our technique, the cochlear implant can be very effective for this."
While the neurotrophin production dropped away after a couple of months, Professor Housley says ultimately the changes in the hearing nerve may be maintained by the ongoing neural activity generated by the cochlear implant.
"We think it's possible that in the future this gene delivery would only add a few minutes to the implant procedure," says the paper's first author, Jeremy Pinyon, whose PhD is based on this work. "The surgeon who installs the device would inject the DNA solution into the cochlea and then fire electrical impulses to trigger the DNA transfer once the implant is inserted."


Sunday, April 27, 2014

Answering an Emergency Call: Yes, There Is a Doctor on Board

WHEN I travel, I try to remember a quotation often attributed to William Butler Yeats that there are no strangers, only friends you have not yet met.
I’m a retinal surgeon at University Hospitals Case Medical Center in Cleveland. When I travel in that capacity, I’m either speaking at a meeting or going someplace to help train other surgeons. I enjoy every place I go. I’m not needy when I travel. I don’t get jet-lagged. I try to just take things in stride.
But no doctor wants to hear, “Is there a doctor on board?”

For Drugs That Save Lives, a Steep Cost

We approve drugs and devices without considering cost-effectiveness, or even having a clue about price. We don’t ask for estimates and then are surprised when the nation is stuck with a $2.7 trillion annual health care bill.

In the case of the naloxone device, the question is germane because the drug itself is very old, and long off patent. A simple syringe filled with a dose of naloxone should cost about $3, said Dan Bigg, director of the Chicago Recovery Alliance, which has long deployed the drug in communities to reverse overdoses. He says giving the shot is “no more complicated than basting a turkey. It’s a no-brainer: You pull up this liquid and inject it into the muscle.”
But experts expect that Evzio could well be priced close to $500.
For many years, drug manufacturers have justified the high price of new drugs by citing their investments in research and development. But it has become harder to claim that it takes, say, $1 billion to bring a new drug to market, since many medicines originate with government-funded research, 

Wednesday, April 23, 2014

An Apple a Day, and Other Myths

SAN DIEGO — A trip to almost any bookstore or a cruise around the Internet might leave the impression that avoiding cancer is mostly a matter of watching what you eat. One source after another promotes the protective powers of “superfoods,” rich in antioxidants and other phytochemicals, or advises readers to emulate the diets of Chinese peasants or Paleolithic cave dwellers.
But there is a yawning divide between this nutritional folklore and science. During the last two decades the connection between the foods we eat and the cellular anarchy called cancer has been unraveling string by string.
This month at the annual meeting of the American Association for Cancer Research, a mammoth event that drew more than 18,500 researchers and other professionals here, the latest results about diet and cancer were relegated to a single poster session and a few scattered presentations. There were new hints that coffee may lower the risk of some cancers and more about the possible benefits of vitamin D. Beyond that there wasn’t much to say.

Monday, April 21, 2014

Why You Shouldn't Put Your Money Where Your Mouth Is

Talk about dirty money: Scientists are discovering a surprising number of microbes living on cash.
In the first comprehensive study of the DNA on dollar bills, researchers at New York University's Dirty Money Project found that currency is a medium of exchange for hundreds of different kinds of bacteria as bank notes pass from hand to hand.
By analyzing genetic material on $1 bills, the NYU researchers identified 3,000 types of bacteria in all—many times more than in previous studies that examined samples under a microscope. Even so, they could identify only about 20% of the non-human DNA they found because so many microorganisms haven't yet been cataloged in genetic data banks.
Easily the most abundant species they found is one that causes acne. Others were linked to gastric ulcers, pneumonia, food poisoning and staph infections, the scientists said. Some carried genes responsible for antibiotic resistance.
"It was quite amazing to us," said Jane Carlton, director of genome sequencing at NYU's Center for Genomics and Systems Biology where the university-funded work was performed. "We actually found that microbes grow on money."

Sunday, April 20, 2014

Grandmother Uses Oculus Rift as Therapy

Spokane doctor brings first retina laser to Angola

It took two years of fundraising and a mountain of paperwork for Dr. Eric Guilielmo of Spokane Eye Clinic to install a retina laser at a hospital in Angola, a country located on the southwest shore of Africa. Many of the patients there suffer from retinal eye conditions and up until Dr. Guilielmo brought the disassembled laser to the country there was nothing available to save them from blindness.

Angola gained independence from Portugal in 1975, and then spent the next 27 years engaged in a blood diamond funded civil war. President Jose Eduardo dos Santos has  been in power since 1975 and has been accused of corruption and of plundering the country’s oil wealth. According to Forbes, the people of Angola live off of $2 a day while President dos Santos has secured a $3 billion fortune for his daughter through questionable government funded business deals.

Thursday, April 17, 2014

Younger Skin Through Exercise

Exercise not only appears to keep skin younger, it may also even reverse skin aging in people who start exercising late in life, according to surprising new research.

Monday, April 14, 2014


Deciding if a sick, elderly patient should have surgery should be a team effort, with input from the patient, family members, the surgeon, primary care physician, nurses, and non-clinicians, such as social workers or advocates.

Sunday, April 13, 2014

How Much Does Your Doctor Really Make?

The U.S. government released payment data for 880,000 physicians this week—to widespread misinterpretation. What the numbers can actually tell us.

These approaches to looking at the new payment records suffer three major flaws.


The purpose of Lunar Tabs is to give a person who is blind the ability to more easily access electronic guitar tablature (tabs) by converting electronic tabs to a format that a screen reader can process.

Saturday, April 12, 2014



Friday, April 11, 2014

Breakthrough in Quest to Grow Body Parts

Lab-Made Vaginas Transplanted Into Patients Whose Own Were Absent Due to Rare Disease

Scientists have successfully transplanted laboratory-made vaginas into four teenage girls whose own were absent because of a rare disease, marking a milestone in the quest to grow structurally complex body parts.
The experiment was published Thursday in the journal Lancet along with another study, in which a separate group of researchers transplanted lab-made nostrils into patients whose noses were damaged by cancer.
The vaginas were created from the patients' own cells and implanted between 2005 and 2008. Today, the women report normal sexual function.
Dr. Atala began the effort to make a lab-grown vagina in the late 1990s to address disorders that cause some girls to be born without normal vaginas. Cancer and trauma can also lead to vaginal damage or loss. Currently, doctors reconstruct the vagina using a patient's own skin or part of the intestine, but both cause other physical problems.
The effort immediately hit a roadblock: "We couldn't even get the vaginal mucosal cells to grow outside the body," Dr. Atala recalled. After solving that problem, the team needed to find something to serve as a scaffold—or skeleton—on which the cells would sit. They rejected various options, including the material used to make surgical sutures, before settling on one they liked: tissue from a pig's intestine.
The pig tissue was first bathed in detergent, which removed the original cells and left behind a scaffold-like structure made from collagen. This was coated on one side with epithelial cells, which line the body's cavities, and which had been obtained via a biopsy of the patient's external genitals. The other side was coated with smooth muscle cells, also from the patient. When the scaffold was placed in an incubator and nourished with chemicals and oxygen, the cells began to grow.
The scaffold was hand-sewn into a vagina-like shape and tailored to fit the patient. Surgeons created a cavity in the patient's pelvis and sutured the cell-populated scaffold to reproductive structures, including the uterus.

Tuesday, April 08, 2014

Play It Again And Again, Sam

A couple of years ago, music psychologist Elizabeth Margulis decided to make some alterations to the music of Luciano Berio. Berio was one of the most famous classical composers of the 20th century, a man internationally recognized for the dramatic power of his compositions. But Margulis didn't worry much about disrupting Berio's finely crafted music. After loading his most famous piece into a computer editing program, she just randomly started cutting.
"I just went in and whenever there was a little pause on either side of something, I grabbed that out and then I'd stick it back in — truly without regard to aesthetic intent," she says. "I wasn't trying to craft anything compelling."
The idea behind this vandalism was simple: Margulis wanted to see if she could make people like Berio's music more by making it more repetitive.

They reported enjoying the excerpts that had repetition more," Margulis says. "They reported finding them more interesting, and — most surprising to me — they reported them as more likely to have been crafted by a human artist, rather than randomly generated by a computer."
What's So Seductive About Repeats?
We are drawn to repetition. It surrounds us, not just in modern American pop music, Margulis says, but everywhere.
So mere exposure is one of the reasons we respond so well to repetition — both of music and in music — but Margulis clearly doesn't think it's the whole story. She says repetition also allows us to shift our attention around, from the surface aspects of the music to other aspects.
And in that way, she says, it allows us to shift our experience of the reality around us

Sunday, April 06, 2014

Samsung Releasing Smartphone-Paired Technologies for Blind People

Today’s smartphones have a surprising amount of technology built into them to help people do all sorts of things that were otherwise impossible not so long ago. Their brilliant screens are one of their greatest draws, but somewhat surprisingly at first, the technology within can be harnessed and expanded to help blind people navigate, “see” their environment in a new way, andcommunicate with others. Now Samsung is pushing the boundaries of what smartphones can do for blind people by releasing three new assistive devices that work with their Galaxy Core Advance phones.
The most exciting is perhaps the Ultrasonic Cover that works like a virtual white cane to spot objects ahead of the user. It will vibrate or use text-to-speech (TTS) to notify the user when something is within a couple meters of the cover. 

Saturday, April 05, 2014

Science More: Happiness Happify Psychology Success Five Quick Ways To Make Yourself Happier Read more:

Happiness isn't about winning the lottery according to Happify, a website and app that uses games and tasks based in positive psychology to make you happier.
Happiness is a combination of three things: your circumstances (10%), your genetics (about 50%), and your thoughts and actions (40%).
Happify works on the latter. The app trains your brain to think and act in ways that will make you happier. For example, reaching out to old friends, being thankful for the good things in life, and being nice to others.
Here are five specific things you can do you make yourself happier.

Friday, April 04, 2014

Advice for a Happy Life by Charles Murray

Consider marrying young. Be wary of grand passions. Watch 'Groundhog Day' (again). Advice on how to live to the fullest

The transition from college to adult life is treacherous, and this is nowhere more visible than among new college graduates in their first real jobs. A few years ago, I took it upon myself to start writing tips for the young staff where I work about how to avoid doing things that would make their supervisors write them off. It began as a lark as I wrote tips with titles such as, "Excise the word 'like' from your spoken English."
But eventually, I found myself getting into the deeper waters of how to go about living a good life. At that point, I had to deal with a reality: When it comes to a life filled with deep and lasting satisfactions, most of the clich├ęs are true. How could I make them sound fresh to a new generation? Here's how I tried.

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