Trekking with gorillas

Yesterday, we trekked with the silverbacks. It was literally one of the most awesome, surreal experiences of my life. To be in close proximity with such magnificent and powerful creatures was spell binding. The baby gorillas were very entertaining as well. Whether pounding their chests, climbing vines, or spinning in circles they were surprisingly playful. Unfortunately I don't think the internet is fast enough to let me post pics or videos here. We were within 6 to 10 feet of the gorillas. we were with Dianne Fossey nomenclatured group 13, which consisted of one silverback, 10 females, 8 children, and 6 juveniles. The only heart pounding moment is when the silverback started walking right up to us . We backed up very quickly as this 500 to 600 pound male ambled toward us. We didn't know if he was going to get very aggressive with us or what..We could even see the fear in our guide's eyes. Fortunately he stopped about 6 feet in front of us and pulled this long bamboo shoot down and started eating. Whew....
We escapted the fate of my friend Hunter (Medical Director of Orbis) who had his back slapped by a silverback on a prior trip.
I am still awestruck thinking about our experience.

Doctors and Patients: A Rocky Relationship

After a series of recent blog posts about doctors and patients, I’ve been surprised at the level of animosity many patients seem to have for their doctors.
The simmering distrust of the medical system — and the doctors who work in it — are the topic of my Well column this week, as well as a new Well video, “Do You Trust Doctors?” (see below). For their part, doctors aren’t at all surprised patients are angry.

Rwanda Genocide Museum

Funded by the Aegis foundation of the UK, the museum highlights the history of Rwanda leading to the genocide along the outer walls. Spiraling inwards one finds sculptures depicting the tragedy and pain; a room filled with 3x5 home shot photos of the victims--hanging along the walls ; a room filled with skulls with machete made inuries and arm and leg bones hacked off. There are other rooms with movie snippets of interviews of survivors that are absolutely heart wrenching....
As one beautiful young woman whose family was killed says,"I am destroyed. I cannot forgive. I am human. It is up to God to forgive..."

Rwanda Genocide Museum

A small plaque under a poster size picture of a beautiful young Rwandan child:

Favorite person: his big sister
Favorite song: Rwandan National Anthem
Favorite food: candy
Personality: always laughing
Cause of Death: Smashed against wall

Other causes of death recorded under other photos of children: clubbed to death, hacked with machete, stabbed in eyes and skull

Does Fructose Make You Fatter?

High-fructose corn syrup is a sweetener used in many processed foods ranging from sodas to baked goods. While the ingredient is cheaper and sweeter than regular sugar, new research suggests that it can also make you fatter.

The Impossible Art Of Li Wei

Chinese artist Li Wei from Beijing started off his performance series ‘Mirroring’ and later on took off attention with his ‘Falls’ series which shows the artist with his head and chest embedded into the ground. His work is a mixture of performance art and photography that creates illusions of a sometimes dangerous reality. Li Wei states that these images are not computer montages and works with the help of props such as mirror, metal wires, scaffolding and acrobatics.

Check out 14 more pics of Li Wei’s artwork over the various years after the jump.

Islands of Consciousness

A very cool (and trippy ?meditiative) flickr tool (via Photojojo). In a mysterious way, insights are gained into processing, synthesis, and integration of sensory perceptions."Step outside yourself" and consciously "watch" as your retinas scan the images, your acoustic cilia process the sounds, and your brain somehow fashions a silent narrative...

When Oleg Marakov pointed out the similarities between his piece of randomly arranged music Islands and my random movie creator Flickeur it was immediately clear that a combination of both projects would definitely result in something very interesting.

The result of this fusion - Islands of Consciousness - is not a simple combination of the two concepts but a great advancement. Sound and Images enter a very close relationship in which the randomly arranged musical phrases are taking direct influence on the visual outcome. So when you look at this piece keep in mind that all the visuals are assembled in realtime using photos downloaded from Flickr.com. All the transitions and effects are entirely random and only happening on you screen. Other people will see a movie and hear a soundtrack that is totally different from yours.

Whilst the basic idea of Flickeur - an endless virtual videoloop that is in perpetual metamorphosis - has remained I have altered the visual engine and the image selection algoritm in many aspects.

My Son, the Blogger: An M.D. Trades Medicine for Apple Rumors

For eight years, Arnold Kim has been trading gossip, rumor and facts about Apple, the notoriously secretive computer company, on his Web site, MacRumors.com.

It had been a hobby — albeit a time-consuming one — while Dr. Kim earned his medical degree. He kept at it as he completed his medical training and began diagnosing patients’ kidney problems. Dr. Kim’s Web site now attracts more than 4.4 million people and 40 million page views a month, according to Quantcast, making it one of the most popular technology Web sites.

It is enough to make Dr. Kim hang up his stethoscope. This month he stopped practicing medicine and started blogging full time.

Silverback Gorillas

Blogging may be sparse after next week as I will be in Rwanda and Uganda for a month.
I will be working with the fabulous Orbis Flying Eye Hospital.
Another highlight will include celebrating the birthday of my friend Amelia, with a group of friends, that will include a trek to see the famed Silverback gorillas, as shown in the video below...

How Doctors Get Paid

Kudos to The Happy Hospitalist.This blog post is one of the best posts I have ever read (on any subject). Make sure you read the whole thing.

The back bone of our nation's health care system is in shambles. Primary care, or better named, comprehensive care, is being hunted to extinction by the very system that needs it most. The Medicare National Bank and all its failed policies has destroyed the great value that comprehensive care brings to the table. The world is full of bumbling uneducated morons who make comments like, "screw the rich doctors", or "they're only in it for the money". I am here to present to you the economics of the current situation, so you can understand that the backbone is being destroyed.
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Several statistics are worth noting.

* In a practice expected to be fully supported by Medicare, which for all the single payer, government run fanatics out there is the equivalent scenario, you see that under the current government mandated payment system a comprehensive care physician making $150,000 a year in 1997 would be making $154, 279 a year, with out increasing the volume of services being performed. In other words, without increasing volume, a physician would be making no more now than they did 10 years ago. When you factor in the cost of living increases by the consumer price index (CPI), that physician would have to make $196,382 a year in 2007, just to maintain their lifestyle of 1997. It is no wonder why volume rules in a system that uses top line cost control measures. For comprehensive care physicians, that means double and triple booking clinics and hiring less qualified extenders. For specialists that means hiring extenders for all their low paying cognitive encounters and spending more time in the procedure lab making the much higher relative profit. And adding exponential cost to Medicare without an increase in quality.
* If the 2008 July 1st cuts are allowed to stand, a comprehensive care physician would earn 23% less now than they did in 1997, on an absolute basis. Adjusted for inflation, that is a 59% paycut from 1997.
* The current SGR mandated by Congress is set to make comprehensive care physician income on par with the average take home pay for all Americans in 4 short years. That means a college educated nurse will be making more than the average comprehensive care physician. The unionized laboror with a high school education will be making more than your comprehensive care physician.
* Based on current SGR economics mandated by your Congress, in five short years, your comprehensive care physician will be collecting welfare, earning the approximate equivalent of minimum wage.

This is not an alarm, this is a category 5 hurricane that has already swept through our health care system. Medical students with their $200,000 in debt are speaking with their wallets. According to the uneducated masses with the mentality that doctors make too much money, I should be collecting food stamps. In five short years, your government mandated health care system is set up to do just that.

An Open Letter to Medical Students: Please don't become primary care physicians!!

All the talk about the health care crisis is about the costs. All the solutions proposed to the health care crisis are aimed at making it more affordable.

No one ever talks about access to health care. And with good reason -- because everyone knows, in their heart of hearts, that access to health care means access to physicians, and the only way to even attempt to guarantee access to physicians is to enslave them.

Many doctors are leaving the profession, because the bureaucracy is crushing them, preventing them from spending time practicing, and because they aren't getting paid enough for what they do. It is a senseless and useless argument to claim that doctors are being greedy and should accept whatever low payment we healthcare-needing consumers are willing to pay. It doesn't matter. There is nothing that can be done to stop a doctor from leaving the profession. You wouldn't even want to force a doctor to stay in the profession -- ask yourself if you would be willing to operated on a surgeon who didn't want to do the operation and was only there because he was threatened. Could you possibly trust the advice of a practitioner who hated what he did? Does anyone truly believe a mind can be forced, that good judgment can be elicited at

Countries Make Push to Increase Eye Donors

The non-acceptance of corneal transplantation in the third world continues to be a problem. It is encouraging to see that efforts to increase acceptance are being made in Syria. I should also acknowledge that Dr. David Paton, who started Orbis' Flying Eye Hospital, also started the first eye bank in the Middle East. (The article also quotes my friend, Dr. Hunter Cherwek, the current medical director of Orbis).
Orbis continues to promote corneal transplantation in every country it goes to. In fact, the article reminds me of an interview I and an Orbis colleague of mine, Dr. Ahmed Gomaa, did in conjunction with a local ophthalmologist in Enugu, Nigeria last summer. The interview was nationally televised and accepted calls from listeners. One caller asked, with great concern evident in his voice, whether or not a corneal donor would still be able to see in the after-life. The local ophthalmologist gave a colorful answer replete with Biblical references that convinced the caller that he would have vision in Heaven even if he donated his corneas. The entire exchange was quite charming, yet not one that would typically occur in most nationally televised debates in America.


Eye donation recently got a new public face in Syria, where the Grand Mufti, the highest official of religious law, pledged to donate his corneas upon death to help one of the thousands of people waiting for transplants there. In India, it is Bollywood film stars like Aishwarya Rai Bachchan, the former Miss World, who have pledged their eye tissue for transplant.
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Doctors in Syria perform hundreds of transplants a year, said Dr. Said, director of the National Program for Blindness Control. But the supply of tissue from the United States has been dropping, and the corneas the country does get go only to wealthy people who will pay $1,000 or more per eye. A new eye bank in Syria is part of a regional effort to drum up corneal tissue in the Middle East and parts of northern Africa.
(..)
“As corneal transplants become more and more successful, there are more and more candidates for the procedure,” said Dr. Hunter Cherwek, medical director of the Flying Eye Hospital, a DC-10 airplane run by the nonprofit group Orbis that flies to various countries to train eye surgeons. “It truly becomes a supply and demand issue, where the techniques are expanding the demand.”

Orbis is working with a government agency to increase eye donations in Vietnam, where Dr. Cherwek estimates that “thousands, likely tens of thousands could benefit from corneal transplantation.”
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The shortage of eye tissue in many places means that transplants are available only to the wealthy. Building domestic eye banks, experts say, could reduce the price of corneas and allow more people to get transplants. But the experts also say that such growth, however beneficial, is unlikely to improve a more basic problem: lack of access to eye care for the poor.

Saving Mothers, One at a Time

A good description of a typical health care scenario in Africa...

Sue Makin , the newest contributor to this blog, is an American Presbyterian missionary doctor working at a 190-bed mission hospital in southern Malawi. She has been working in Africa for the past 18 years. According to a 2007 study of global maternal mortality rates, more than two-thirds of deaths among Malawian women of reproductive age are linked to pregnancy or childbirth – a larger proportion than in any of the 171 countries in the study.

In spite of – or maybe, because of – the grim statistics on maternal health here in Malawi, a wonderful part of my job is training younger clinicians who will carry on the work after I have left. The lifesaving skills demonstrated by Sam Matandala, a clinical officer in training at our hospital, were a great encouragement to me last month
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...After she lost consciousness and the midwife grew frightened, the pregnant woman’s relatives loaded her onto a bush-bicycle ambulance and walked with her for about two hours to get to the hospital. She continued to bleed on the journey to the hospital.

As Sam rightly points out, women in Malawi, regardless of age, are not empowered to make decisions about their own health. When they are sick or giving birth, they must wait for their husband or other male relatives to decide when they should be taken to the hospital. This leads to delays – particularly when the decision-making man has gone far away from the village – and many women who come to the hospital at all come late, when complications have already set in.

China, Muslims and the Genocide

As my favorite NY Times columnist, Nicholas Kristof, points out that China not only supports the Bashir regimein Sudan, but also, along with Russia, amazingly vetoed a UN Security Council resolution for an arms embargo on Zimbabwe!!!

The BBC has uncovered evidence of Chinese military support for Sudanese forces in Darfur. Given the arrest warrant sought today by the ICC’s chief prosecutor for Sudan’s president on charges of genocide, that is reckless behavior on the part of China. It always astonishes me that China is so sensitive to its image being hurt by anti-government demonstrations, yet will sully its own image by helping out with genocide in Sudan.

It Takes a School, Not Missiles

Since 9/11, Westerners have tried two approaches to fight terrorism in Pakistan, President Bush’s and Greg Mortenson’s.

Mr. Bush has focused on military force and provided more than $10 billion — an extraordinary sum in the foreign-aid world — to the highly unpopular government of President Pervez Musharraf. This approach has failed: the backlash has radicalized Pakistan’s tribal areas so that they now nurture terrorists in ways that they never did before 9/11.

Mr. Mortenson, a frumpy, genial man from Montana, takes a diametrically opposite approach, and he has spent less than one-ten-thousandth as much as the Bush administration. He builds schools in isolated parts of Pakistan and Afghanistan, working closely with Muslim clerics and even praying with them at times.

The only thing that Mr. Mortenson blows up are boulders that fall onto remote roads and block access to his schools.

Mr. Mortenson has become a legend in the region, his picture sometimes dangling like a talisman from rearview mirrors, and his work has struck a chord in America as well. His superb book about his schools, “Three Cups of Tea,” came out in 2006 and initially wasn’t reviewed by most major newspapers. Yet propelled by word of mouth, the book became a publishing sensation: it has spent the last 74 weeks on the paperback best-seller list, regularly in the No. 1 spot.

Warning: Habits May Be Good for You

This article is definitely worth reading in its entirety...

A FEW years ago, a self-described “militant liberal” named Val Curtis decided that it was time to save millions of children from death and disease. So Dr. Curtis, an anthropologist then living in the African nation of Burkina Faso, contacted some of the largest multinational corporations and asked them, in effect, to teach her how to manipulate consumer habits worldwide.

Dr. Curtis, now the director of the Hygiene Center at the London School of Hygiene & Tropical Medicine, had spent years trying to persuade people in the developing world to wash their hands habitually with soap. Diseases and disorders caused by dirty hands — like diarrhea — kill a child somewhere in the world about every 15 seconds, and about half those deaths could be prevented with the regular use of soap, studies indicate.

But getting people into a soap habit, it turns out, is surprisingly hard.

To overcome this hurdle, Dr. Curtis called on three top consumer goods companies to find out how to sell hand-washing the same way they sell Speed Stick deodorant and Pringles potato chips.
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A few decades ago, many people didn’t drink water outside of a meal. Then beverage companies started bottling the production of far-off springs, and now office workers unthinkingly sip bottled water all day long. Chewing gum, once bought primarily by adolescent boys, is now featured in commercials as a breath freshener and teeth cleanser for use after a meal. Skin moisturizers — which are effective even if applied at high noon — are advertised as part of morning beauty rituals, slipped in between hair brushing and putting on makeup.

“OUR products succeed when they become part of daily or weekly patterns,” said Carol Berning, a consumer psychologist who recently retired from Procter & Gamble, the company that sold $76 billion of Tide, Crest and other products last year. “Creating positive habits is a huge part of improving our consumers’ lives, and it’s essential to making new products commercially viable.”

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Those and other studies revealed that as much as 45 percent of what we do every day is habitual — that is, performed almost without thinking in the same location or at the same time each day, usually because of subtle cues.
For example, the urge to check e-mail or to grab a cookie is likely a habit with a specific prompt. Researchers found that most cues fall into four broad categories: a specific location or time of day, a certain series of actions, particular moods, or the company of specific people. The e-mail urge, for instance, probably occurs after you’ve finished reading a document or completed a certain kind of task. The cookie grab probably occurs when you’re walking out of the cafeteria, or feeling sluggish or blue.
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“We could talk about germs until we were blue in the face, and it didn’t change behaviors,” Dr. Curtis said. So she and her colleagues asked Unilever for advice in designing survey techniques that ultimately studied hundreds of mothers and their children.

They discovered that previous health campaigns had failed because mothers often didn’t see symptoms like diarrhea as abnormal, but instead viewed them as a normal aspect of childhood.

However, the studies also revealed an interesting paradox: Ghanaians used soap when they felt that their hands were dirty — after cooking with grease, for example, or after traveling into the city. This hand-washing habit, studies showed, was prompted by feelings of disgust. And surveys also showed that parents felt deep concerns about exposing their children to anything disgusting.

SO the trick, Dr. Curtis and her colleagues realized, was to create a habit wherein people felt a sense of disgust that was cued by the toilet. That queasiness, in turn, could become a cue for soap.
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Their solution was ads showing mothers and children walking out of bathrooms with a glowing purple pigment on their hands that contaminated everything they touched.

The commercials, which began running in 2003, didn’t really sell soap use. Rather, they sold disgust. Soap was almost an afterthought — in one 55-second television commercial, actual soapy hand washing was shown only for 4 seconds. But the message was clear: The toilet cues worries of contamination, and that disgust, in turn, cues soap.

For Students in Kenya, Medicine Seems to Improve Attention Span

Giving schoolchildren in rural Kenya regular doses of malaria medicine, even if they weren’t obviously sick, seemed to improve their attention span in school as it protected them from anemia, a study has found.

The study, published last week in The Lancet, was conducted by researchers from the London School of Hygiene and Tropical Medicine, Harvard and four Kenyan institutions.
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All the students were poor — 97 percent studied by kerosene lamps or candles at home. Nearly half had malaria parasites but no fever when the study began. In malarial areas, it is common for anyone surviving to age 5 to develop some immunity.

The drugs — sulfadoxine-pyrimethamine and amodiaquine — do not contain artemisinin, the newest malaria drug, but are inexpensive and considered safe.

All the students were also treated for intestinal worms, which can cause anemia — a low red-blood-cell count.

New Saudi Arabian University will have a Western Feel

:Another excellent blog on all things Saudi: xrdarabia.com...brings attention to an interesting article in the LA Times..

The Los Angeles Times runs a story on King Abdullah University of Science & Technology (KAUST and the potential it holds. The piece also notes the obstacles it faces and raises the question of how it will interface with the traditional Saudi society around it. Doubts are raised that a new ‘Western enclave’ will achieve very much, but there’s strong opposition to some of the school’s goals, such as co-ed education. Worth a look.

New Saudi Arabia university will have a Western feel
Jeffrey Fleishman

THUWAL, SAUDI ARABIA — Up the corniche, along a coast where boats carrying pilgrims bound for Mecca sailed for centuries, a thicket of cranes rises over whitewashed mosques along the Red Sea.

Steel flashes and blowtorches glow as 20,000 workers build a $10-billion university ordered up by a king who hopes Western ingenuity will revive the economy of this ultraconservative Muslim nation. When finished next year, King Abdullah University of Science and Technology will offer coed classes, Western professors, a curriculum in English and other touches loathed as dangerous liberalism by Islamic fundamentalists.

Why We Are Happy

Tongue in cheek post from the always interesting Saudi Jeans...

When John Burgess published a recent post on Crossroads Arabia titled “Happy Saudis!” I was like “Huh!” The post links to a chart from a study conducted by the World Values Survey based at the University of Michigan Institute for Social Research which states that Saudi Arabia is the 26th happiest country in the world. “It’s widely believed that it’s almost impossible to raise an entire country’s happiness level,” says Ronald Inglehart, political scientist at U-M and the director of the World Values Surveys.

The “surprising finding” has prompted me to think what possibly could be the reasons behind the overwhelmingly positive attitude of my countrymen…

Your life will be flashed before your eyes

Prototype contact lenses that include LEDs and circuits could become a tiny personal display..

Dance Even if Nobody Is Watching

Count me in as one of Matt's fans--watch as he celebrates all over this great globe...

I am late to the Matt Harding fan club, but like four million other viewers before me, I can’t stop watching this man dance.

Mr. Harding is a 31-year-old YouTube sensation featured in The Times this week for an uplifting video that shows him dancing a sort of a jig, described by my colleague Charles McGrath as “an arm-swinging, knee-pumping step that could charitably be called goofy.” Mr. Harding dances alone, and he dances with lemurs, underwater and with children and crowds at various locations around the world.

Where the Hell is Matt? (2008) from Matthew Harding on Vimeo.

Sudan Leader To Be Charged With Genocide

UNITED NATIONS, July 10 -- The chief prosecutor of the Internationals Criminal Court will seek an arrest warrant Monday for Sudanese President Omar Hassan al-Bashir, charging him with genocide and crimes against humanity in the orchestration of a campaign of violence that led to the deaths of hundreds of thousands of civilians in the nation's Darfur region during the past five years, according to U.N. officials and diplomats.

Not a Moment Too Soon, I Thought of Tim Russert

I am someone who hates to quit. But after the third time the group had to stop and wait for me, I decided I had no choice. I watched them pedal away, then lay down in the grass.

I was angry and scared. For the first time my body had given out on me, and I had no clue what was going on. Besides the nausea, my only symptoms were a persistent cough and an overwhelming feeling that something was not right.

I called my wife and got a ride home.

After showering, I lay down in bed and started thinking. Though I am a 50-year-old guy with a stressful job and a little too much around the middle, I had a clean bill of health. I had good cholesterol numbers and a great doctor, and recently I had passed a cardiac stress test.

That’s when Tim Russert popped into my head. In the last couple of weeks, like almost every middle-age man, I had taken a very personal interest in every detail of his story. Yes, he was overweight. But hadn’t he just passed a stress test?

That’s when the light went on...
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Because at the right moment I thought of Tim Russert, I am one of the lucky ones. I get to hug my wife and my kids, understand how wonderful my friends are and realize exactly how much I love my life. It is a debt I can never repay

Pricey Drugs Put Squeeze on Doctors

SAN FRANCISCO -- Long a burden for patients, hyperexpensive cancer drugs are causing economic havoc for another constituency in U.S. health care: doctors.

American doctors rarely used to let costs factor into their treatment decisions. But rising prices -- some cancer drugs now cost more than $100,000 a year -- are dramatically changing that ethos in the field of oncology. Money issues are now disrupting relationships with patients, causing doctors to go into debt and threatening to interfere with treatment options.
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Driving the problem is a new generation of drugs -- including Avastin from Genentech Inc. and Erbitux from ImClone Systems Inc. -- that are transforming cancer care, providing oncologists with the first new options in decades for desperately ill patients. But several months of treatment on these drugs can equal the down payment on a home or a child's college tuition.
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The average wholesale cost for a course of Avastin to treat one type of lung cancer, for example, is $56,000, according to Genentech. It can take 90 days to be reimbursed by Medicare or private insurance plans and even longer for patients to hand over their co-pays. Assuming insurance does cover a course of Avastin, a 20% co-pay comes to $11,200.

Oncologists say this is forcing them into new and nerve-racking territory: weighing costs alongside a drug's potential effectiveness.
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John P. Whitecar Jr., an oncologist in Columbus, Miss., says 89% of his cancer patients are on government insurance. He has watched his income plunge 75% in the past three years because of rising treatment costs and declining reimbursements. He says he's borrowed money to keep his office afloat, and trimmed staff through attrition. Recently, he began sending patients whose health plans reimburse him less than his costs across the street to the local hospital for their chemotherapy infusions.

For the Brain, Cash Is Good, Status Is Better

New research shows for the first time that we process cash and social values in the same part of our brain (the striatum)—and likely weigh them against one another when making decisions. So what's more important—money or social standing? It might be the latter, according to two new studies published in the journal Neuron.

Doctors Press Senate to Undo Medicare Cuts

Facing cuts in Medicare payments, Dr. David D. Richardson, an ophthalmologist in Los Angeles County, closed his practice last week to all but emergency patients and those needing surgery.


WASHINGTON — Congress returns to work this week with Medicare high on the agenda and Senate Republicans under pressure after a barrage of radio and television advertisements blamed them for a 10.6 percent cut in payments to doctors who care for millions of older Americans.
(..)Democrats need just one more vote to pass the bill, and they hope to win over Republicans who were hit by advertisements over the recess. The advertisements assert that Republicans have been protecting “powerful insurance companies at the expense of Medicare patients’ access to doctors.” The commercials were aimed at 10 Republican senators, including seven up for election this fall.

But President Bush has vowed to veto the bill, so the fight — and the uncertainty — could continue for weeks.

Mr. Bush and many Republicans oppose the bill because it would finance an increase in doctors’ fees by reducing federal payments to insurance companies that offer private Medicare Advantage plans as an alternative to the traditional government-run Medicare program.
(..Dr. David D. Richardson, 40, an ophthalmologist in Los Angeles County, closed his practice last week to all but emergency patients and those needing surgery.

“I love practicing medicine,” Dr. Richardson said, “but I would lose more money by keeping my office open than by pulling it back to a skeleton crew. Just like a physician in the emergency room, I try to reduce the hemorrhaging.”

In Topeka, Kan., Dr. Kent E. Palmberg, senior vice president and chief medical officer of the Stormont-Vail HealthCare system, said its 70 primary care doctors were “no longer accepting new Medicare patients as of July 1 because of the draconian cut in Medicare reimbursement.”

Dr. Gerald E. Harmon, a family doctor in Pawleys Island, S.C., said he decided last week that he would not take new Medicare patients “until further notice.”

“This is not what we enjoy doing,” says a notice in his waiting room. “It is what we must do to maintain financial viability.”
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In an interview, Dr. Barrett said: “I lose money whenever I operate on a Medicare patient. In the last week, a number of doctors have told me they will quit seeing new Medicare patients or will cut back on the amount of Medicare work they do.
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But independent studies have repeatedly found that the private plans cost the government more per person than traditional Medicare.
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On the other side of the issue, military families have joined doctors and AARP, the advocacy group for older Americans, in lobbying for the bill.

Happy Liberation Day, Rwanda

Rwanda is perhaps the only country besides the United States where July 4th is a national holiday. And while it is true that Rwandans have great admiration for the U.S., the Fourth of July is only coincidentally a shared day of celebration.

In 1994, that date marked the end of the Rwandan Genocide, and the birth of the new government that rose from the ashes. This Friday, the nation will be celebrating its 14th year of peace and the growing prosperity that has been the result. This is a virtually unbelievable, unpredictable achievement in light of the forces that aligned to prevent it.

What does peace and development look like in Rwanda? Housing projects are springing up; per capita income is up; and health indicators are dramatically improved, with more than 50,000 people receiving the AIDS drugs they need via some of the best delivery mechanisms in all of Africa. Two international-quality malls have sprouted up in Kigali and are doing a brisk business; international banks are eyeing the market; internet service is still the cheapest per megabyte (and fastest) in all of Africa.

The Luckiest Girl

This year’s college graduates owe their success to many factors, from hectoring parents to cherished remedies for hangovers. But one of the most remarkable of the new graduates, Beatrice Biira, credits something utterly improbable: a goat.
“I am one of the luckiest girls in the world,” Beatrice declared at her graduation party after earning her bachelor’s degree from Connecticut College. Indeed, and it’s appropriate that the goat that changed her life was named Luck.

Beatrice’s story helps address two of the most commonly asked questions about foreign assistance: “Does aid work?” and “What can I do?”

GOP fears fallout from Medicare fight

More on the Medicare reimbursement fight...

(Hat tip to Freeze)

The Bush administration moved Monday to assure doctors that coming cuts in Medicare reimbursements would take a few days to kick in, buying time for Senate Republicans to recover from a vote that has Sen. Arlen Specter scrambling to explain himself and GOP aides wondering why their party’s leadership has risked infuriating a loyal constituency.

The Score: Physicians 355; Insurers 59: Blood on the Senate Floor

Good explanation of recent medicare physician fee cut issue in Congress...

In this case, Senate liberals should have not compromised in the first place. They should have stuck to their guns, and insisted on cutting the corporate welfare that Medicare Advantage insurers are receiving. Medicare cannot afford it. And, as the House vote shows, many independents and conservatives understand that the windfall is unwarranted. Medicare is not getting good value for its dollars.

More insights here

Bono

Tim Adams speaks to Bono about the origins of the Make Poverty History campaign and persuading a reluctant Bush administration to provide over $50 billion in aid to Africa

Combat One Plague, Risk Another?

Scientists have genetically engineered a malaria-resistant breed of mosquito that can out-compete non-modified mosquitoes in nature, the BBC reports.Releasing the mosquitoes into the wild could be a winning and cost-effective strategy to combat a disease that kills 1 million people worldwide each year and has dire financial consequences for countries where it is endemic.

But the risks of unleashing the GM mosquitoes are completely unknown, and researchers say it may be 10 years (and 10 million lives lost) before the insects are set loose in nature. The Overcoming Bias blog wonders if it’s worth the wait.

The question is a classic example of the Ellsberg Paradox, which claims that we prefer measurable risk to immeasurable uncertainty. Dubner and Levitt wrote about it in relation to nuclear energy.

Excursions in Medical History: Cataract Surgery

Not so back in the day, oh, maybe 2500 years ago. As the American Academy of Ophthalmology recounts, the earliest form of cataract surgery was couching, a procedure described in 5th century B.C. Sanskrit manuscripts.

This involved displacing the lens away from the pupil and into the vitreous cavity. Centuries later discission, or needling to break up the cataract into pieces, was practiced. In the mid-1700's Jacques Daviel of France and Samuel Sharp of London began surgically removing the lenses from their patients with "the services of a strong assistant...to hold the patient's head still." Local anesthetic drops would not ease the pain and terror of the procedure until 1884.

Officials Praise New Test for Drug-Resistant TB

Considering that 1/3 of all humanity has been exposed to TB and that MDR-TB (multiple drug resistance TB) is an increasing problem, this is indeed good news...

A new test that can detect multiple-drug-resistant tuberculosis in two days instead of the standard two to three months promises to help significantly improve treatment and prevent the spread of the airborne infection, the World Health Organization said on Monday.

Multiple-drug-resistant TB, or MDR-TB, is a growing public health problem in the world. Five percent of new TB cases are resistant to first-line drugs. That is 450,000 of the nine million new TB cases that are detected each year, the W.H.O. says.