World's only flying eye hospital

In this BBC news piece there is  a nice video of the inside of the Flying Eye Hospital , narrated by my friend, Hunter Cherwek, who is the medical director  of the  Flying Eye Hospital.
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On approaching the flying eye hospital, it looks like any of the other passenger jets on the runway waiting to take holidaymakers to exotic destinations.

But this DC-10 jet is exceptional - it houses the only airborne operating theatre for eye treatment in the world.

Its mission is to tackle avoidable sight loss and its charter reaches developing countries where 90% of the world's 45 million blind people live.

Clean Water Laws Are Neglected, at a Cost in Suffering

This is an eye-opening article in the sense of how pervasive the problem is. The article doesn't even touch upon the problems of water contamination by pharmaceuticals, which has been shown to be an issue for Reno (link)..
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The Times obtained hundreds of thousands of water pollution records through Freedom of Information Act requests to every state and the E.P.A., and compiled a national database of water pollution violations that is more comprehensive than those maintained by states or the E.P.A. (For an interactive version, which can show violations in any community, visit www.nytimes.com/toxicwaters.)
In addition, The Times interviewed more than 250 state and federal regulators, water-system managers, environmental advocates and scientists.
That research shows that an estimated one in 10 Americans have been exposed to drinking water that contains dangerous chemicals or fails to meet a federal health benchmark in other ways.

Those exposures include carcinogens in the tap water of major American cities and unsafe chemicals in drinking-water wells. Wells, which are not typically regulated by the Safe Drinking Water Act, are more likely to contain contaminants than municipal water systems.
Because most of today’s water pollution has no scent or taste, many people who consume dangerous chemicals do not realize it, even after they become sick, researchers say.
But an estimated 19.5 million Americans fall ill each year from drinking water contaminated with parasites, bacteria or viruses, according to a study published last year in the scientific journal Reviews of Environmental Contamination and Toxicology. That figure does not include illnesses caused by other chemicals and toxins.
In the nation’s largest dairy states, like Wisconsin and California, farmers have sprayed liquefied animal feces onto fields, where it has seeped into wells, causing severe infections. Tap water in parts of the Farm Belt, including cities in Illinois, Kansas, Missouri and Indiana, has contained pesticides at concentrations that some scientists have linked to birth defects and fertility problems.

In parts of New York, Rhode Island, Ohio, California and other states where sewer systems cannot accommodate heavy rains, untreated human waste has flowed into rivers and washed onto beaches. Drinking water in parts of New Jersey, New York, Arizona and Massachusetts shows some of the highest concentrations of tetrachloroethylene, a dry cleaning solvent that has been linked to kidney damage and cancer. (Specific types of water pollution across the United States will be examined in future Times articles.)
The Times’s research also shows that last year, 40 percent of the nation’s community water systems violated the Safe Drinking Water Act at least once, according to an analysis of E.P.A. data. Those violations ranged from failing to maintain proper paperwork to allowing carcinogens into tap water. More than 23 million people received drinking water from municipal systems that violated a health-based standard.  

Life Hacks For Doctors

Check out this SlideShare Presentation by Joshua Schwimmer of efficient MD:
The ophthalmologists especially will appreciate the 'scleral icterus" example

Life Hacks For Doctors

View more documents from Joshua Schwimmer.

Now this is a workout!!!

Man vs. God

Karen Armstrong says we need God to grasp the wonder of our existence

Richard Dawkins has been right all along, of course—at least in one important respect. Evolution has indeed dealt a blow to the idea of a benign creator, literally conceived. It tells us that there is no Intelligence controlling the cosmos, and that life itself is the result of a blind process of natural selection, in which innumerable species failed to survive. The fossil record reveals a natural history of pain, death and racial extinction, so if there was a divine plan, it was cruel, callously prodigal and wasteful. Human beings were not the pinnacle of a purposeful creation; like everything else, they evolved by trial and error and God had no direct hand in their making. No wonder so many fundamentalist Christians find their faith shaken to the core.

But Darwin may have done religion—and God—a favor by revealing a flaw in modern Western faith. Despite our scientific and technological brilliance, our understanding of God is often remarkably undeveloped—even primitive. In the past, many of the most influential Jewish, Christian and Muslim thinkers understood that what we call "God" is merely a symbol that points beyond itself to an indescribable transcendence, whose existence cannot be proved but is only intuited by means of spiritual exercises and a compassionate lifestyle that enable us to cultivate new capacities of mind and heart.

Obama's Speech

This is an absolutely brilliant, humorous, and insightful post about the U.S. Healthcare system by Doc Gurley....Link here. 

I’ve been watching the healthcare reform debate from a distance, like all doctors. It was a brilliant stroke of genius on the part of both Republicans and Democrats (when they undertook the job of changing all of healthcare) to do so without the input of any practicing physicians. I’m very glad about this – it makes the discussion so much more “out of the box” and “process oriented” and only rarely causes “patient death.”
Besides, I’m waiting for my chance to participate when we overhaul the legal system and exclude all the lawyers. Or maybe I’ll hold out for the Plumbing Reformation Act – I’ve got some deep insights (so to speak) on the whole butt-crack issue.

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So you see, this whole healthcare reform thing doesn’t really affect me. Any more than it does you. Sure, I’ve heard tall tales from the rocking-on-a-porch old-timers, those myths about the prehistoric days when dinosaur doctors ruled the earth – when you could throw your primary care massive weight around and decide for yourself how to treat a patient, who you would see and how long to spend. Hell, I even heard there are Jurassic-Park-like pockets where such a thing still exists. Exotic, tribal locales with primitive, rudimentary, non-capitalistic approaches to healthcare. Places like London and Paris and Stockholm. Shudder. Thank God we don’t have to live in fear like those people must.

Rule out Testing

Another great post from the Happy Hospitalist on rule out testing  here.. 
The post really needs to be read in its entirety at the link.

(As an aside one of the frustrating things about the insurance "game" is that the doctor will not be given approval to do a test for a diagnosis according to current CMS rules if the diagnosis is "rule out..."so in the middle ofspending time and effort with regard to the patient's diagnosis one has to creatively pursue a diagnosis for which the insurance company will agree to pay)

A 17 year old female is seen in the emergency room with a chief complaint of shortness of breath. Thus begins the rule out testing.

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This is where rule out testing feels so good.

Do you send the patient home with a diagnosis of panic attack and follow up with her doctor? Or do you pursue further testing for pulmonary embolism? That is the million dollar question. And let me answer it for you. Our current system is set up to pursue the diagnosis of exclusion without regards to cost. And here's why. Doctors act out of fear. Patients respond out of the comfort of knowing. And in both situations, neither is personally held responsible for for the cost of their desires. We pay for it through higher premiums. We will pay for it through higher taxes. The patient is immune from the immediate cost of feel good medicine. The doctor is immune from the fear of not knowing. A fear that is driven to spend other peoples money to prevent a bad outcome.

Look at my four box theory on Testing vs Outcomes. The physician will always want to stay on the top line. Because that's where the lawyers work for food. (Bold lettering mine...check out the "Testing vs Outcomes link for further elaboration from the Happy Hospitalist). That's where they feel good. And that's where the patients feel good. That's why rule out testing feels so good.

Is Doctors' Income the cause of health care inflation?

Moving Meat dissects the role of physician income in health care inflation in a counterpoint to an article by Ezra Klein of the Washington Post...Please read the whole post here.


Ezra has an interesting post in which he posits that the problem in health care economics is that the rate of inflation of health care persistently exceeds the general rate of inflation.  Fine; I do not think anybody is in disagreement on that point any more.  He goes a bit further, wrongly, I think, in implying that the solution is just to pay doctors less. 


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But that ignores the fact that much of physician's revenue does not go to that physician's income.  Most doctors (ER docs being an exception) have offices to maintain, nurses and assistants to pay, healthcare premiums for this employees, in addition to the malpractice insurance and billing expenses.   Medicine is not a low-overhead game any more!  My gut feeling was that physician income has been stagnant-to-declining over the last decade.

So I went to the Bureau of Labor Statistics and I manually pulled the data on physician income over the 1999-2008 timeframe, and the inflation rate for the same time span and saw that I was more or less right:

Note that for the first six years, physician income was less than inflation, and 2006-7 was only a little bit above the overall inflation rate.  Also note that for two years physician income was actually negative.   2008 was the only year in which physician income increased faster than inflation.

Food Habits More Important In Obesity Than Obesity Gene

You may know that correlation studies have shown that the risk of becoming obese is 2.5 times higher for those who have double copies of the best known risk gene for being overweight or obese, the FTO gene (fat mass and obesity associated).

New discoveries of that sort have led to a resurgence in concern that we may be slaves to our genes, but is that the case?  No, in every study obesity still required high calorie consumption, especially fat.

Kids' Smiles Predict Their Future Marriage Success

Pictures of grinning kids may reveal more than childhood happiness: a study from DePauw University shows that how intensely people smile in childhood photographs, as indicated by crow’s feet around the eyes, predicts their adult marriage success.

Lush Land Dries Up, Withering Kenya’s Hopes

LOKORI, Kenya — The sun somehow feels closer here, more intense, more personal. As Philip Lolua waits under a tree for a scoop of food, heat waves dance up from the desert floor, blurring the dead animal carcasses sprawled in front of him.

So much of his green pasture land has turned to dust. His once mighty herd of goats, sheep and camels have died of thirst. He says his 3-year-old son recently died of hunger. And Mr. Lolua does not look to be far off from death himself.

“If nobody comes to help us, I will die here, right here,” he said, emphatically patting the earth with a cracked, ancient-looking hand.

A devastating drought is sweeping across Kenya, killing livestock, crops and children. It is stirring up tensions in the ramshackle slums where the water taps have run dry, and spawning ethnic conflict in the hinterland as communities fight over the last remaining pieces of fertile grazing land.

Why I Get Angry

Please read this excellent post by one of the best medical bloggers out there, Dr. Rob.
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Something touched a nerve yesterday. I kind of lost my composure when someone tried to defend the insurance industry and responded out of emotion – perhaps putting aside some reason in the process.
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I have health insurance. I do understand why it needs to exist, but I also see how harmful the current state can be to my patients. I get frustrated with Medicare and Medicaid as well, but that is not my point. Just because government run insurance has problems doesn’t do anything to change the problems with private insurance. The fact that you can be killed by firing squad doesn’t make the gallows any better.

My Problems with the Business of Medicine

This post by "Topher" seems to hit the proverbial nail on the head...
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The value of having access to a physician (let’s say you have diabetes) that can take an active role in your care, help you correct some mistakes that are leading to uncontrolled glucose levels, and not only extend your life but help you extend it without the complications of the disease is incredible! But as only one man, the number of people for whom he can do this is limited. His service is not scalable.
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Only he’s trapped. In the interim of dropping his Medicare patients, seeing to it that his billing is changed and that no new claims are filled in the next two years, and educating his patients about the changes, his malpractice insurance premiums continue to consume what’s left and he has no chance for air. Gulliver himself couldn’t escape the net of obligations that are binding him to this system and taking away his freedom. In the time it takes to change, he’ll be bankrupt anyway. He closes the money-sink that was once his shining creation. He locks the door on his practice.

Right now, this is what medicine looks like to me. Terrifying, right? I have hopes on hopes that I am wrong and that there is a way to avoid Dr. A’s fate (maybe I’m awfulizing). And I know that there are plenty of doctors running practices, making money, and living comfortably but unless they are completely free of the forces that took down Dr. A in my example, they’re just the last line before the firing squad. Even if I manage to escape it (as physicians do by having concierge or cash-only practices from the start), I don’t want any other physicians to have to deal with it. It’s unjust.

Beyond the Biopsy: A Tiny Monitor for Cancer

DOCTORS doing a needle biopsy to analyze tissue for cancer may one day add a second step to the procedure: depositing a tiny device at the site to report on growth of a tumor — and even the effects of chemotherapy.

Researchers at the Massachusetts Institute of Technology have created prototypes for cancer monitors the size of a grain of rice, small enough to fit easily into the bore of a biopsy needle. Tiny coated particles inside the devices can bind with molecules linked to cancer at the site, creating minuscule clumps that can be detected by a non-invasive scan like an M.R.I., said Michael J. Cima, a professor of materials science and engineering at M.I.T. and leader of the team that created the devices.

Increase Your Happiness With These Six Scientifically Proven Strategies

In recent years there has been an explosion of research on happiness, optimism, positive emotions and healthy character traits. While psychology has traditionally concerned itself with what ails the human mind--such as anxiety, depression, neurosis, obsessions, paranoia, and delusions--, a new branch of psychology, aptly named “positive psychology”, asks the question: "What are the enabling conditions that make human beings flourish?" That is, the goal of positive psychology is to study what actively makes people feel fulfilled, engaged, and happy.

In addition, neuroscientists are studying how the brain can be rewired in such a way that makes happiness more likely. Below you’ll find six strategies from the fields of positive psychology and neuroscience that will help you increase your current level of happiness.

There Are More Slaves Today Than at Any Time in Human History

One writer spent four years inside the world of modern-day slavery; an industry that produces huge profits and countless wasted lives.

The world suffers global recession, enormous inequity, hunger, deforestation, pollution, climate change, nuclear weapons, terrorism, etc. To those who say we’re not really making progress, many might point to the fact that at least we’ve eliminated slavery.

But sadly that is not the truth.

How Different Groups Spend Their Day

The American Time Use Survey asks thousands of American residents to recall every minute of a day. Here is how people over age 15 spent their time in 2008. Related article

Check out the link for the interactive graphic--quite interesting indeed...

Genocide From the Inside

Tracy Kidder's previous book, "Mountains Beyond Mountains," documenting the life of Dr. Paul Farmer is one of my favorites. This seems that this will be a worthwhile read as well...The description below of the hollow, caved in skills with empty eyeholes staring at you, imploring you....accurately describes my feelings as well when I was at the Holocaust Museum in Rwanda last year around this time..

Tracy Kidder asks how a traumatized African becomes an American.

We have preserved the massacre site. We have preserved the death," the young Rwandan man said to me with a bewildering smile. He was leading me briskly through a school where a decade earlier, hundreds of men, women, and children had been hacked to death. Pools of dried blood made the floor sticky. In one corridor, old bits of skull and bone made it crunchy. And then we came to the bodies.

The dead were covered in some kind of greenish preservative and laid out in long rows on the floor. A child—frozen forever at 4 or 5—had her skull split open in one clear blow. A woman's stomach had been hacked, and the contents must have spilled out somewhere: She was empty now. I would like to be able to say the faces of the hundreds of bodies I marched past had an accusatory stare that asked: How could you let this happen to us? But, in reality, they were glassy-eyed and gone.

What happens when you travel in a single 12-hour flight from the splattered heart of this genocide to the streets of New York City? That's what happened to Deogratias Niyizonkiza, a 24-year-old man who had narrowly survived a genocide in two countries and suddenly in 1994 found himself on a flight to a place he had only heard of—America.
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Deogratias fled across a river already beginning to choke with Tutsi corpses into the forests. After days hiding out in the woods—to echoed screams—he realized he had to get out of Burundi. He thought he had an option for safety—to make his way across the border to Rwanda. He nearly didn't make it. He was stumbling from one catastrophe to another—straight into the heart of the Rwandan genocide. The president there was murdered, too, and the extermination of nearly 1 million people—mostly by machete, wielded at high speed–erupted. It took 100 days. "Before the end of the night, the cockroaches are not going to wake up again," the mobs would sing on their killing frenzies.

And suddenly Deogratias was standing in an American airport, with $200 in his pocket and trauma cluttering his head, claiming he had work to do in New York City. A friend had pointed him toward Burundi's airport and urged him to get as far away as he could. He slept in boarded-up buildings and in Central Park and marvelled: "Almost everyone looked happy. Or at least no one looked alarmed. And no one looked terrified. These were people just going about their business, greeting their friends and their families, as if they didn't know there were places where dogs were trotting about with human heads in their mouths. But how could they not know?"

Kidder's descriptions of Deogratias seeing New York for the first time are some of the best in the book. He was so shocked by people wearing their pants low and strolling oddly that he became convinced America was afflicted by an epidemic of broken hips. When he stumbled into Central Park one day, he exclaimed: "My God, I just discovered a forest!"

Why is the African continent poor?

The desolate, dusty town of Pibor on South Sudan's border with Ethiopia has no running water, no electricity and little but mud huts for the population to live in.

You would be hard put to find a poorer place anywhere on earth.

I went there as part of a journey across Africa to ask the question "Why is Africa poor?" for a BBC radio documentary series.

Pictures of the Day

Many great pictures here...