Should "older" women get pregnant? Fertility and ethics

I don't plan to define "older." However, we know that older women can conceive (especially if they go through in vitro fertilization or IVF), but should they? What are the ethical issues involved? Modern medical technology has advanced infertility treatment, but when do we start crossing ethical boundaries? CNN's Diana Magnay explores some of these issues in this little video.

Hostile audiences at health care forum

I'm afraid that things are really going to get out of control soon. All these debates and civil discussions about healthcare reform may eventually turn into violent crime scenes. I really hope that doesn't happen, but it's hard to think otherwise when you see a story on CNN that says: "Specter faces hostile audience at health care forum"

A hostile crowd shouted questions and made angry statements Tuesday at a town hall meeting on health care in Pennsylvania led by Democratic Sen. Arlen Specter... The shoving incident occurred early in the 90-minute session when a man started shouting that he had been told by Specter's staff that he could speak, but he didn't get one of the 30 cards distributed to people allowing them to ask questions. Another man stood up and shoved the protester, and Specter approached the men shouting for calm.

Watch this video to see all the shouting, shoving, and big security officers standing by:


To read the CNN story, click here.

Another potential way to reduce breast cancer risk: breast feeding

"Breast-feeding may protect at-risk women from breast cancer"

CNN STORY HIGHLIGHTS:

• Study: Nursing cut the risk of breast cancer in half for high-risk women
• Researchers followed 60,075 women for more than nine years
• Breast-feeding's effect was similar to taking tamoxifen for five years
• Breast-feeding didn't affect risk for women who didn't have breast cancer in family

We all probably know someone who has been affected by breast cancer. Fortunately, treatment is quite effective if the cancer is diagnosed and treated.

This new research sounds quite promising, but we probably still don't have enough evidence to make any claims about causality. We know that there is an association, but that's about it because this was a prospective cohort study. I don't think we're ever going to see any randomized controlled trials evaluating this clinical question, so this may be the best type of evidence we get.

Click here for the story on CNN.
Click here for the abstract from the Archives of Internal Medicine.

Man injured at health care town hall meeting

Healthcare debates are turning into physical danger zones. According to this story on the Kansas City Star, a man was injured during fighting that erupted last week when audience members at a St. Louis-area aging forum began yelling about health care reform. Healthcare reform debates are just getting crazy, aren't they? Kenneth Gladney, 38, was injured and is currently accepting donations toward his medical expenses. Gladney was laid off recently and has no health insurance.

Fox News had an interview with Kenneth Gladney. Here's an interesting video:

Healthcare debates are turning into shouting matches

Wow, healthcare reform debates aren't just debates anymore. They're turning into shouting matches that are including death threats. According to this story on CNN:

Senators this week joined their colleagues from the House at town hall meetings as they spent their August recess in their home districts. But disruptive protests are turning town hall meetings into shouting matches and drowning out discussion over what is and isn't in health care plans in the House and Senate.

Now this is scary:

Democratic Rep. Brad Miller of North Carolina even had a death threat phoned into his office. A caller said that if Miller supported Obama's plan, it could cost him his life, Miller told CNN.

Here's another interesting snippet:

Former Alaska Gov. Sarah Palin fueled the charge on her Facebook page Friday, writing that "the sick, the elderly, and the disabled" would suffer as doctors have to "ration care."

The bottom line can be summarized here:

As the emotion has intensified, misinformation has spread about what is and isn't in current health care proposals.

I have found that so many people truly are misinformed about the healthcare reform proposals that are currently floating out there. It's so easy to spread viral e-mails or short little tweets on Twitter that are not accurate. Let's hope that consumers and healthcare professionals can be properly educated so that misinformation doesn't lead to more serious problems in this country.

Miami drug wholesaler convicted of conspiring to divert growth hormones

Here's the latest press release:

MIAMI PRESCRIPTION DRUG WHOLESALER CONVICTED

Jeffrey H. Sloman, Acting United States Attorney for the Southern District of Florida, and David W. Bourne, Special Agent in Charge, U.S. Food and Drug Administration (FDA), Office of Criminal Investigations, Miami Field Office, announced that after a two week trial before U.S. District Judge Alan S. Gold, a jury convicted Arnesto Segredo, 43, of Miami, of conspiring to divert the prescription drugs Serostim and Nutropin AQ, both human growth hormones, and one count of causing the diversion of these human growth hormones, in interstate commerce. Sentencing is scheduled for October 23, 2009 at 4:00 p.m.

According to the evidence presented at trial, Segredo caused California-based human growth hormone suppliers, all of which were unlicensed to engage in the wholesale distribution of prescription drugs in California, to regularly ship to him in Miami hundreds of boxes of Serostim, and some Nutropin AQ, from 2000 through the end of 2002. Serostim is an injectable drug approved by the FDA for the treatment of AIDS-wasting syndrome in HIV-infected patients, and Nutropin AQ is an injectable drug approved by the FDA for the treatment of growth hormone deficiency, including children with short stature.

From 2000 through 2001, Segredo operated Life Extension Institute, a Miami-based prescription drug wholesaler, which was also not licensed to engage in the distribution of prescription drugs in Florida. He later operated through Genendo Purchasing Organization, a Miami-based prescription drug wholesaler that became licensed in Florida in July 2001. A significant portion of the Serostim that Segredo distributed through these two companies originated from California-based AIDS patients who sold their Serostim supplies secured from the Medi-Cal Medicaid program.

Mr. Sloman commended the investigative efforts of the FDA’s Office of Criminal Investigations. The case was prosecuted by Assistant U.S. Attorney Jose A. Bonau of the Economic and Environmental Crimes Section, and Special Assistant U.S. Attorney Michael Varrone, a Trial Attorney with the FDA’s Office of Chief Counsel.

A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

Co-pay support program for patients taking Enbrel (Etanercept)

Amgen and Wyeth Pharmaceuticals have announced the ENBREL Support™ Co-pay Card Program for all eligible patients who take Enbrel (Etanercept). Who's eligible? Well, maybe we should start with those who are not eligible:

This program is not open to uninsured patients or patients receiving prescription reimbursement from federal, state, or government-funded insurance programs (for example, Medicare, Medicaid, etc.) or patients who live in Massachusetts (or where prohibited by law). Restrictions, including monthly maximums, may apply. Offer subject to change or discontinuation without notice.

This co-pay support program may offer:

• 6 months at no co-pay cost, and
• A co-pay of $10 or less per month thereafter (Patients will receive 50% off their co-pay or pay no more than $10 per month—whichever helps more)

The ENBREL Support™ Co-pay Card Program provides patients with up to $750 of assistance per month for months 1-12. For patients with moderate to severe plaque psoriasis who are first starting ENBREL, the program provides up to $1,500 per patient per month for months 1-3. Patient is responsible for costs above these amounts. Participation in the program can be renewed every year.

More than 45,000 people have already used a co-pay card for their ENBREL treatment.
The program is simple for you to share with patients. Direct patients to call 1-888-4ENBREL to enroll today.

Patients who lose their jobs but are covered by private insurance, including COBRA, may receive up to an additional 6 months of ENBREL at no co-pay cost. Potential help for patients who are uninsured or in need of other financial help is also available.

Here are the FDA-approved indications for ENBREL:

• ENBREL is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis. ENBREL can be initiated in combination with methotrexate (MTX) or used alone.
• ENBREL is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients ages 2 and older.
• ENBREL is indicated for reducing signs and symptoms, inhibiting the progression of structural damage of active arthritis, and improving physical function in patients with psoriatic arthritis. ENBREL can be used in combination with methotrexate in patients who do not respond adequately to methotrexate alone.
• ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.
• ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

Click here for additional details of the co-pay support program.

Since Enbrel is a TNF blocker, make sure you read this:

• FDA: Cancer Warnings Required for TNF Blockers

The NEJM on healthcare reform

I've seen so many articles on the New England Journal of Medicine (NEJM) on the topic of healthcare reform. This week, the article that caught my eye is titled, "Why Paying for Health Care Reform Is Difficult and Essential — Numbers and Rules."

This perspective by Henry J. Aaron, Ph.D. concludes with the following paragraph:

The challenge of finding acceptable ways of paying for near-universal coverage is formidable and may prove insurmountable. For reasons that President Obama has forcefully stated, health care system reform is vital. But the full reform agenda may be beyond immediate political reach. It is therefore essential to identify elements of the full plan that would set the stage for later reforms and that can be financed at a politically digestible price — and find a way to ensure their passage.

So my question is: what's a politically digestible price? How many billions of dollars can we afford during these difficult economic times? If we were reforming healthcare and our country wasn't in the middle of a recession, then we'd be faced with an entirely different situation. However, with more people getting unemployed, the prevalence of uninsured will only increase. I agree that there's an urgency to reform healthcare. Are we rushing through this process?

Generic drugs for BPH from Walmart

I was having a discussion with someone about generic drugs used to treat BPH or Benign Prostatic Hyperplasia. Since you can get $4 drugs Walmart, I decided to write a blog post evaluating generic drugs that are currently available at Walmart. I don't know how much the Walmart generic drug formulary varies from state to state, so this may not be entirely accurate. Plus, I imagine that these formularies are constantly changing.

Alpha-1-adrenergic antagonists

Here are the generic drugs on the Walmart $4 list:

• terazosin (on the $4 Walmart generic drug list) - generic form of Hytrin (made by Abbott)
  
• doxazosin (also on the $4 Walmart generic drug list) - generic form of Carduara (made by Pfizer)
  

Not currently available as generic drugs:

• tamsulosin or Flomax (marketed by Boehringer Ingelheim and Astellas)
  
• alfuzosin or Uroxatral (made by sanofi-aventis)
• silodosin or Rapaflo (made by Watson)
  

5-Alpha-reductase inhibitors


Here is a generic drug, but it is not on the $4 Walmart list:

• finasteride (not on the $4 Walmart list) - generic form of Proscar (made by Merck)
  

Not available as generic drugs:

• dutasteride or Avodart (made by GSK)
  

So, you can't get a 5-alpha-reductase inhibitors for $4 at Walmart, but you can find the alpha-1-adrenergic antagonists (and they are listed under "Heart Health & Blood Pressure").

Are healthcare protests being orchestrated?

Health care protests 'clearly being orchestrated,' senator says
So, here are the story highlights from CNN:

• Democrat decries disruptions over health care reform at town-hall meetings
• Sen. Durbin: It's not right "when these people come in just to disrupt the meetings"
• Sen. McConnell slams complaints about citizens organizing
• "They need to deal with it. Americans are concerned," McConnell says

This CNN story starts with:

The Senate's second-ranking Democrat slammed recent town-hall protests over health care on Sunday, insisting they violate "the democratic process," while the Senate's top Republican accused Democrats of "attacking citizens" with such complaints.

So are healthcare reform protests getting out of control? Physicians don't like what's being proposed about healthcare reform. Politicians seem to be quite mixed. Are we rushing through these changes? I wonder if we'll see certain aspects backfire and cause problems that we didn't anticipate (for instance, what if physicians choose not to accept public insurance plans?). President Obama calls reforming health care the centerpiece of his current domestic platform. We will definitely see new jobs in health information technology (health IT) and we see new hospitals and medical schools being built. So will healthcare reform save our struggling economy? To read the story on CNN, click here.

Integrating PACS with EHR

PACS = picture archiving and communications system (used in radiology)
EHR = electronic health record

So, it should be simple to integrate digital radiology images into an existing EHR, right? Well, it can be more complex than that because you have different PACS and EHR systems out there. The systems may not "talk to each other" very effectively.

One recent project demonstrates a successful link between Merge’s Fusion PACS with an EHR system from Epic. Where did this occur? Minneapolis-based HealthPartners and Merge Healthcare. Epic is widely used in many hospital systems. This Epic/Merge integration certainly won't be the last. However, I wonder which PACS solution will emerge as the leading option for hospitals running EHRs such as Epic.

Here are some interesting tidbits about PACS according to Wikipedia:

Most PACSs handle images from various medical imaging instruments, including ultrasound (US), magnetic resonance (MR), positron emission tomography (PET), computed tomography (CT), endoscopy (ENDO), mammograms (MG), digital radiography (DR), computed radiography (CR) etc.

In August of 2004, DR Systems was the first to announce that it had received FDA clearance for diagnostic reading of digital mammography images on a PACS. Since that time, other PACS vendors including CareStream Health, GE Healthcare, Cedara, FUJIFILM, Philips Healthcare, Sectra, Emageon, and Siemens Medical Solutions have also obtained FDA clearance for full field digital mammography (FFDM).

Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and transmitting information in medical imaging. There are several Digital Imaging and Communications in Medicine (DICOM) Viewers available both free and proprietary. Some of the DICOM Viewers include: Medstrat, eFilm, K-Pacs, DICOM Works, OsiriX, SureVistaVision , UniPACS, Syngo Imaging, VRRender, ImageJ and MicroDicom. Various viewers can connect directly to a PACS server or retrieve images from local storage. Of note, OsiriX is an open-source DICOM viewer.

So, did you catch all those acronyms? Welcome to the world of Health IT!

Comparing Canada's healthcare system with the U.S.

I've written about this topic in the past, but here's a CNN video that actually look at the two healthcare systems. CNN's Kitty Pilgrim looks to see how the Canadian health system fares compared to the U.S. Is this a fair example?

Top 5 posts for last week on MedicineandTechnology.com

Here are the top 5 posts from last week here on MedicineandTechnology.com

1. 419 Scam on Facebook

2. Free medical school in Florida!

3. CNBC debate between Gov Dean and Sermo

4. Grand Rounds July 14, 2009: Technology and Healthcare

5. Jobs for Physicians with No Residency Experience

Will Medical Technology Reduce Healthcare Costs?

This is a guest post by Adrienne Carlson. If you're interested in submitting a guest post, please contact me.

Will Medical Technology Reduce Healthcare Costs?

While the debate over the pros and cons of President Obama’s healthcare plans and reforms rage on, other measures are being taken to decrease the overall cost of providing healthcare to people in the long run. Companies that manufacture medical technology are jumping on this bandwagon with their inventions and innovations, with claims that their products will help reduce healthcare costs in the long run.

Medical technology businesses are already testing out digestible chips that check if you’re taking your prescribed medication correctly. The chips will be attached to your medication, and using a sensing device worn on your skin, will be able to tell doctors if you are getting the right dose of medicine and also read them your vital signs. The whole system works using wireless technology, taking advantage of the vast infrastructure that is already being used by mobile phones and notebook computers. The technology is supposed to allow doctors to monitor you even though you are at a distant location and to provide medical attention if your signs seem to show some anomaly.

The entire premise of this concept is based on the fact that hospital visits and hospital stays because of unnoticed and hence untreated symptoms contribute to a large percentage of healthcare costs. So if this cost can be reduced using this technology, it augurs well for the people who really need healthcare to be affordable. But, even though there may be some truth in this supposition, the fact remains that:

• The initial cost of the technology is going to be pretty high, especially when it is in its infancy and still in the post experimental stage.
• Only those who can afford it are going to buy it, given that they believe it will work.
• Insurers may not be willing to back this technology on the grounds that it is unproven and expensive, just as they refuse to cover other experimental treatments like bone marrow transplants.
• If the treatment is not covered by insurance, how does it help bring down the cost of healthcare?
• Most hospitals and doctors would not want to invest their time and effort in technology for which they are not reimbursed by insurance companies.

While it is true that such technology does help improve the quality and effectiveness of healthcare for those who can afford it, it is arguable if it will help bring down healthcare costs, even in the long run.

This guest article was written by Adrienne Carlson, who regularly writes on the topic of radiography technician salary. Adrienne welcomes your comments and questions at her email address: adrienne.carlson1@gmail.com

China: exercise in a gym or outside?

It looks like indoor gym memberships are really becoming popular in China. These gym memberships aren't free, but it's free to exercise outside. Watch this CNN video that talks about current exercise trends in China. How often do you see people practicing Tai Chi in the parks?

Avoiding medical errors in the hospital: practical tips

CNN has a nice article titled, "Nurses offer tips for surviving a hospital stay."

People don't seem to realize how dangerous the hospital can be for a patient. As many as 98,000 people die in U.S. hospitals each year as a result of medical errors, according to an Institute of Medicine report. Some 99,000 people die each year from infections acquired in the hospital, according to data from the Centers for Disease Control and Prevention (CDC).

Here are the 5 tips mentioned in the article:

1. Bring in a list of the medications you're taking
2. Make sure the hospital gets your name right
3. Ask about every medication they give you
4. Make sure everyone washes hands
5. If you think something's wrong, don't back down

Let me add my own hospital safety tips:

• If you have a drug allergy, mention that fact each time you receive a medication.
  
• Request a current list of medications that you are receiving in the hospital each day (keep that medical student busy).
• If you're not receiving a medication that you normally take at home, ask them about that! (how will you know this unless you have a list from home and you can compare that to your list in the hospital?)
  
• If you're having surgery on an arm/leg, make sure they mark the correct limb with a marker. You don't want to wake up with the wrong limb missing!

To read the CNN story, click here.

Dr. Nancy: Should doctors be on salary? Survey results are in!

Should doctors be on salary? Today, MSNBC featured survey results from a Sermo posting about physicians being on salary. The data got presented on the Dr. Nancy Show, hosted by Dr. Nancy Snyderman. Also appearing on the show was Sermo Founder, Dr. Daniel Palestrant who debuted the Sermo survey results on the issue of healthcare reform and physician salaries and Dr. William F. Streck, President and CEO of Bassett Healthcare.

Visit msnbc.com for Breaking News, World News, and News about the Economy

419 Scam on Facebook

If you're on Facebook, make sure to never give (or send) money to anyone who solicits money from you. Last month, my Facebook account got compromised and someone logged into my account and started soliciting money from my list of friends. Most of my contacts were aware of the "419 scam" so they quickly disconnected. Allow me summarize by quoting CBS5 news:

Facebook has a name for the latest scam, it's called the "419" scam and works like this: A hacker takes over a users' identity and sends messages to the users' friends. The messages claim that the user is stuck in London or another foreign city, after being mugged of their cash, credit cards and phone and requests friends to wire money so the user can get back home.

You may think that people are familiar with the 419 scam on Facebook, but I'm sure you'll find people who have no idea what you're talking about. Therefore, I hope you'll join me in raising public awareness about these types of dangerous scams on Facebook.

Related posts:

• My Facebook account got hacked!

• Reflections on a compromised Facebook account

• Tips on managing online passwords

New Frontiers in Schizophrenia and Bipolar Disorder Research

Here's a video from the Department of Brain and Cognitive Sciences at MIT. The title of this video is: "New Frontiers in Schizophrenia and Bipolar Disorder Research" and the presenter is Dr. Edward Scolnick, Director, Psychiatric Disease Program and the Stanley Center for Psychiatric Research at the Broad Institute. At the Broad Institute, Edward Scolnick, MD works to identify risk genes for bipolar disorder and schizophrenia.

Plasmapheresis leading to more kidney transplants

There is an inspiring story on CNN where seven kidney transplants were performed over four days at Georgetown University Hospital and Washington Hospital Center. The transplant teams were led by Dr. Keith Melancon, director of the kidney and pancreas transplant program at Georgetown University Hospital, and Dr. Jimmy Light, director of transplantation services at Washington Hospital Center.

The recipients had been on dialysis. Six of the seven kidney recipients and five of the seven donors were African-American. Minority groups are at higher risk for kidney problems, but they also receive fewer kidneys because of the lack of suitable matched organs. According to CNN, the use plasmapheresis, or plasma exchange, allowed all seven patients to match closely enough with their donors to allow the transplants. In plasmapheresis, a machine removes antibodies from a patient's blood that can cause organ rejection.

The use of plasmapheresis is significant, Melancon said, because it increases the chances of African-Americans to receive life-saving organs.

I know several people who have donated a kidney. Would you be willing to donate a kidney for a loved one? Probably. Would you be willing to donate a kidney for a complete stranger? Perhaps you may be motivated if someone else was willing to donate a kidney for someone you loved. This type of "kidney swap" has been known to happen. If you don't match for your loved one but someone else does, then perhaps you can donate for another individual and have someone else donate for your loved one. Seems confusing, doesn't it?

The Medical Fusion conference

Are you a physician interested in career change or opportunities in non-clinical careers? Are you frustrated with your medical career and interested in learning about career options for medical professionals? Do you wonder what else you could be doing with your medical training?

The Medical Fusion conference (www.MedFusionConf.org) is a new event that is focused on physician career change. Experts from around the country have been recruited to teach on non-clinical jobs, physician entrepreneurship, venture capital, medical journalism, medical informatics, and opportunities for physicians in the pharmaceutical industry, law, and television.

This life-changing event will take place November 13-15, 2009 at the Wynn Las Vegas. Participants will receive a special room rate at the Wynn for $199 per night and tuition is only $599 for twenty hours of lecture, much lower than many CME events. Register online as a reader of this blog and enter the code "JKBLOG" to receive a $25 discount.

Why continue the frustration? Learn how to use your talents and training in new and interesting ways. Be taught by physicians who have successfully bridged the gap between clinical and non-clinical careers such as:

• Dr. Michael VanRooyen, Co-Director of the Harvard Humanitarian Initiative and co-founder of four start-up companies
• Dr. Mike Woo-Ming, former Family Physician who retired from clinical medicine at age 35 and now runs many successful internet marketing companies
• Dr. Julie Silver, Chief Editor of Books at Harvard Health Publications and author of 14 books
• Dr. Ken Kamler, surgeon and best-selling author who is a consultant for the Discovery Channel and columnist for National Geographic Adventure
• Dr. Joe Smith, Vice President of Emerging Technology at Johnson & Johnson
• Dr. Mark Crockett, expert in medical informatics and President of the Emergency Care Division of Picis
• Dr. Mark Kroll, medical device inventor and expert in medical technology

Come to Vegas in November and learn from the best. Visit the Medical Fusion conference website at www.MedFusionConf.org and see why so many physicians are turning to Medical Fusion to begin their new careers. Make this event your first step to a new and exciting career change. Register online as a reader of this blog and enter the code "JKBLOG" to receive a $25 discount.

The early registration tuition rate for Medical Fusion ends on September 15th. After September 15th the tuition goes up to $799 for physicians and $649 for non-physicians.

FDA: Cancer Warnings Required for TNF Blockers

Here is the latest news from the FDA regarding TNF blockers and the risk of cancer:

FDA: Cancer Warnings Required for TNF Blockers

The U.S. Food and Drug Administration is requiring stronger warnings in the prescribing information for a class of drugs known as TNF blockers. The warnings, which include an updated boxed warning, highlight the increased risk of cancer in children and adolescents who receive these drugs to treat juvenile rheumatoid arthritis, the inflammatory bowel disorder, Crohn’s disease, and other inflammatory diseases.

In addition, the FDA is working with manufacturers to explore new ways to further define the risk of cancer in children and adolescents who use these drugs.

TNF blockers target and neutralize tumor necrosis factor-alpha (TNF-α), a protein that, when overproduced in the body due to chronic inflammatory diseases, can cause inflammation and damage to bones, cartilage and tissue. The drugs in this class include

• Remicade (infliximab),
  
• Enbrel (etancercept),
  
• Humira (adalimumab),
  
• Cimzia (certolizumab pegol) and
  
• Simponi (golimumab).

Today’s action is based on the completion of an investigation first announced by the FDA in June 2008. An analysis of U.S. reports of cancer in children and adolescents treated with TNF-blockers showed an increased risk of cancer, occurring after 30 months of treatment on average. About half of the cancers were lymphomas, a type of cancer involving cells of the immune system. Some of the reported cancers were fatal.

Additional required updates to the prescribing information include incorporation of reports of psoriasis associated with the use of TNF blockers.

Can you list who manufacturers the medications listed above? Eventually, I think we're going to realize that there's an increased risk of cancer with many of the biologic agents that are out there. The irony is that many biologic agents (different classes of drugs with varying mechanisms of actions) are also used to treat cancer. As we learn more about biologic agents, we may eventually complete the cancer circle. The more we understand about what causes cancer, the better we may be able to treat cancer.

DNA testing in children, talents, and privacy in China

In China, scientists (probably along with some government officials) are performing genetic tests in young kids to identify skills and talents by analyzing their DNA. That's right, no personal privacy issues here. Submit a DNA sample to see what talents your parents should cultivate. Is this ethical? This is a fascinating video.

Swine flu deaths around the world exceeding 1,100

According to this CNN story, the World Health Organization is reporting that global swine flu deaths are exceeding 1,100. We know that H1N1 is an unstoppable pandemic. This virus has spread in six weeks like how the common flu virus spreads in six months! We're waiting for effective vaccines and I'm sure we'll see them. The question in my mind is: will we have enough vaccines?

So who should get the vaccine?

The priority groups include pregnant women, health care and emergency services personnel, children, adolescents and young adults from six months to 24 years of age, household and caregiver contacts of children younger than six months and healthy adults with certain medical conditions.

Even though there are strong public health campaigns to get people vaccinated, we know that some simply won't receive the vaccine. Either they will refuse it, or they won't have access to medical care. Some won't make it a priority and they won't get the swine flu vaccine in time. Will we have enough anti-viral therapies for all those who don't receive a vaccine?

FDA Approves Livalo (pitavastatin)

Here's a recent FDA new drug alert: FDA Approves New Cholesterol-Lowering Drug

The U.S. Food and Drug Administration today approved the 4 milligram maximum dose of Livalo (pitavastatin), a drug intended to improve blood cholesterol levels in persons with elevated or abnormal blood cholesterol levels.

Like other statins, Livalo is intended for patients when diet and exercise fail to lower their cholesterol levels. Statins improve elevated blood cholesterol levels primarily by inhibiting a liver enzyme called HMG Co-A reductase, thus reducing the liver's ability to make cholesterol.

"Elevated or abnormal cholesterol levels are associated with an increased risk for heart disease and stroke," said Eric C. Colman, M.D., deputy director, Division of Metabolism and Endocrinology Products, in the FDA’s Center for Drug Evaluation and Research. “Today’s approval offers patients and their health care professionals another alternative way to treat high cholesterol.”

Livalo was approved on the basis of five clinical trials comparing its efficacy and safety to that of three currently marketed statins.

The most frequently reported adverse reactions from taking Livalo were muscle pain, back pain, joint pain and constipation.

Livalo is manufactured by Kowa Pharmaceuticals America Inc. of Montgomery, Ala.

So, can you name all the statins that are currently out there? We have: lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor), and rosuvastatin (Crestor). Now, we can add to that mix: pitavastatin (Livalo).

Blame the chimps for malaria?

If malaria came from the chimps, then what does that tell us about the origins of malaria? Understanding the origins may someday lead to a cure. However, a cure for malaria could result in a problem with population control since malaria acts as a "natural" way to control the world's population. Worldwide, malaria infects 500 million people every year and kills between 1 million and 3 million. Undoubtedly, it's a huge public health problem. However, if a cure for malaria reaches developing nations, then we may start seeing more countries enforcing birth-controlling policies such as China's one-child policy.

A story on CNN highlights the research that traces the roots of malaria to chimps. Here's an interesting snippet:

According to Nathan Wolfe and his team, malaria jumped to humans from our closest ancestors: chimpanzees. This finding, he says, unlocks one of the biggest medical mysteries confronting humans.

"We can actually understand, we can actually re-create the story that explains a fundamental and important part of our history," Wolfe said. "For me, this is the microbiological equivalent of discovering the origins of HIV."

Understanding the origin -- and the genetic behavior -- of a pathogen is the holy grail in the world of infectious disease.

So, we know that many viral infections jump from animals to humans. We've seen this happen with SARS, bird flu, swine flu, and even HIV. It's definitely interesting to see that malaria (which is not a viral infection) may have also jumped from animals to humans.

What do you know about mesothelioma?

How many people do you know who have mesothelioma? The annual incidence of mesothelioma in the U.S. is approximately 3300 new cases per year. Fortunately, the incidence is declining because we've done a better job to control for asbestos exposure. However, many people live with a long history of asbestos exposure because of certain types of occupations.

From a public health standpoint, mesothelioma is a significant health burden because mesothelioma prognosis is often quite poor. The median survival of patients with mesothelioma is between 6 and 18 months. Considering that advances in modern medicine have not significantly improved survival, we're faced with an illness that we still can't treat very effectively. Mesothelioma is often classified into three broad histologic subtypes:

1. epithelioid,
   
2. sarcomatoid, and
   
3. biphasic (mixed)

Mesothelioma doesn't just occur in the chest. There are other forms, such as peritoneal mesothelioma that occurs in the abdominal space. This type often rapidly spreads within the abdomen and is causes problems as the disease affects abdominal organs. So what types of treatments are currently available? You have surgery, radiation, chemotherapy, and a variety of combinations. Recently, investigators have also been exploring the role of gene therapy. That's the area that I find most fascinating because we may potentially see some novel treatment approaches that combine gene expression profiling and prognostication. By engineering viruses to carry certain genes. For instance, the administration of AdHSVtk could transduce the tumor cells, enabling them to express viral thymidine kinase, and thus make them sensitive to the normally nontoxic antiviral drug ganciclovir. This type of bioengineering research sounds very interesting to me.

EHRs leading to fewer medical errors

Since we're all human, we (as healthcare professionals) can make medical errors. Thanks to advances in electronic health records (EHRs), hospitals and clinicians are making fewer errors by leveraging automated alerts, alarms, and other features that prevent medical errors. Watch this CNN video that highlights "a close-up look at how one system is using electronic medical records to deliver better care and make fewer mistakes."

How should doctors receive education about new drugs?

We have seen so many new drugs and even new classes of drugs emerge over the last ten years. How do most physicians learn about new drugs? Many (certainly not all) community practitioners would say they learn what they need to know from the drug reps. Others indicate continuing medical education or CME activities as their main source of information regarding new drugs. Back in the "old days," docs would also attend many promotional/marketing dinners and social functions to learn about new medications. Those days are ending as PhRMA code regulations get stricter.

So what is the most effective way for physicians to learn about new drugs? They are so busy and easily overwhelmed by their workload that many have a difficult time keeping up with the latest science, the latest medical news, or even urgent FDA alerts and warnings.

Most of the clinical studies evaluating new drugs are performed by the drug manufacturer. Most of the CME activities that include any information related to new drugs are often underwritten by pharmaceutical companies, but the educational content is developed independently to be fair-balanced and is not influenced by industry. You won't see certified-CME activities that focus only on a single drug (maybe the only exception is when that's the only drug that's out there for a specific condition).

If a new drug comes out, do doctors really know how to use it safely and effectively? How can they accomplish this unless they receive fair-balanced education that highlights the clinical utility of such new agents? This becomes especially important when we're talking about brand new classes of drugs that have entirely new mechanisms of actions and pharmacological profiles.

There has been a lot of talk recently about industry-supported CME (certified continuing medical education). Some think that it's a bad idea for industry to support CME. Others feel that the lack of industry support may have a significant negative impact on physician continuing education. Why? Because the availability of fair-balanced educational programs may shrink considerably. What would happen if physicians only get exposed to marketing/promotional messages about new drugs and they don't get exposed to fair-balanced continuing education about those same products?

Public Insurance Plan

CNN Money.com has another article on healthcare reform. This one is titled, "Health reform follies: How to keep up" and it's a special report in the "Fixing Healthcare" section of CNN Money.com.

I'd like to focus on the section that discusses a public option. Let's begin with a small snippet:

Those who want a public insurance plan want it fiercely, saying it's the only thing that can force private insurers to reduce costs and be more competitive. Those who oppose it are equally fierce, saying it would result in a government takeover of the heath care system.

Where do you stand on this issue? Do you want to see a public insurance plan that's available for everyone and anyone? Is that really the right answer?

Two major bills that lawmakers will consider -- the tricommittee bill from the House and the bill put out by the Senate Health committee -- propose a public health insurance option. That public plan would compete with private insurers on a health insurance exchange -- or insurance supermarket -- that the bills also propose.

If we see a public plan emerge, will physicians choose to accept this plan? Already, we see many healthcare professionals who choose to only accept cash. They no longer wish to deal with the headaches of chasing reimbursement from insurance companies. As a result, they state that they no longer accept any forms of insurance and they use a fee-for-service model. If this trend continues, then the presence of a public insurance plan will yield no benefit for consumers who need outpatient medical care.

At the end of the day, will such public insurance plans mainly be for hospital admissions and major catastrophes? Maybe the government will take over all the hospitals. Sometimes I wake up in the middle of the night wondering if all of this is a dream.

Free medical school in Florida!

Wow, the University of Central Florida (UCF) is a brand new medical school and it has arranged to offer its entire inaugural class full scholarships totaling $7 million. This isn't just a publicity stunt. It's the real deal! 40 fortunate medical students will graduate without being burdened by school loans for tuition. Here's a snippet:

All 40 students of this charter class that begins Monday have received full scholarships totaling $7 million, donated entirely by members of the community -- including individuals, hospitals, banks and law firms.

Why can't I be so lucky? Would you turn down acceptance at Harvard to attend UCF if you could get a free ride? Read the CNN Money.com story here. Things like this don't happen every day.

Top posts in July 2009 on Medicine and Technology

July was a really busy month on MedicineandTechnology.com and I saw some serious peaks in traffic because I hosted Grand Rounds and because my Facebook account got hacked. Never give anyone money on Facebook.

The top referring websites for this month were 1) Medscape (thanks to Colin for the article), 2) Twitter (thanks to my 17,000+ followers), 3) Pajamas Media (thanks to Glenn Reynolds AKA Instapundit for telling people about Grand Rounds), and 4) CNN (thanks to Sphere, my blog posts often appear at the bottom of health-related CNN articles).

Here were the top posts for July:

1. Grand Rounds July 14, 2009: Technology and Healthcare

2. Is Canada's health system better?

3. Jobs for Physicians with No Residency Experience

4. Things are getting ugly between Sermo and the AMA

5. Non-Clinical Medical Opportunities for Physicians and Other Clinicians

6. Medical treatment based on the color of your skin

7. CNBC debate between Gov Dean and Sermo

8. Fake NASA moon landings?

9. After Obama's speech last night, will more physicians look for non-clinical careers?

10. My Facebook account got hacked!

In July, so much traffic came from referring sites so search engines only represented 13% of my site traffic.

Dr. Gupta’s ‘Four Months to Fitness’ initiative

I love how CNN's Dr. Sanjay Gupta is leveraging social media like Twitter. He's creative, innovative, and I believe he can make a significant public health impact through his "Four Months to Fitness" initiative. He says that his upcoming birthday (Twitter hashtag #1023) motivated him to launch the fitness forum with viewers. He wants himself, and America, to get in the best shape of their lives. To read more about this program, make sure you have a Twitter account and read the story here.

ARRA, Healthcare Reform, and National Health IT Week

I attended a HIMSS (Healthcare Information and Management Systems Society) webinar today titled, "A Mix of all the Right Ingredients: ARRA, Healthcare Reform, National Health IT Week and YOU!"

The webinar provided an overview of National Health IT Week 2009 and the HIMSS 8th Annual Policy Summit. The presenter was State Sen. Richard Moore from Massachusetts, who serves as Vice President of the National Conference of State Legislatures (NCSL). Senator Moore (D-MA) is poised to lead this important association’s 7,328 state legislators and legislative staff in the next two years. Sen. Moore discussed his perspective on the current health IT policy landscape.

Here were some of the key points from Sen. Moore:

• We must consider the impact of health IT on healthcare costs
• Look at examples of quality improvement
  
• By 2015 - every physician (or every prescriber) must have competency in using health IT resources
• Simplification and administrative streamlining

Julia Zarb, PhD (Zarb Consulting) jumped in to provide some information about National Health IT Week.

• This is the fourth year of National Health IT Week
• The event will be September 21-25 in Washington D.C.
• Find out more here: http://www.healthitweek.org

HIMSS 8th Annual Policy Summit

• September 22-23, 2009
• Washington D.C.

Fred Hannett spoke about the HIMSS "Asks" Task Force.

• The "Asks" Task Force has a funny name and you may see some funny faces if people don't hear the "k" as you're saying "Asks"
  
• The goal is to develop 3 "Asks" (key message points) for Capitol Hill that will impact health IT policy
  

Harry Greenspun, MD (@HarryGreenspun) delivered the closing comments.

• $50 to attend the Policy Summit
• How can organizations receive financial assistance?
• Stipends will be available (count me in!)

So, do you plan to be in Washington in September? It's too bad it's not a Health IT weekend. That makes it a bit difficult for us in the working world, doesn't it?

FDA approves Onglyza (saxagliptin)

FDA approved Onglyza (saxagliptin) for type 2 diabetes. This is the 2nd DPP-IV inhibitor to be approved. The first DPP-IV was Januvia (sitagliptin).

Here's the FDA press release:

The U.S. Food and Drug Administration today approved Onglyza (saxagliptin), a once-daily tablet to treat Type 2 diabetes in adults. The medication is intended to be used with diet and exercise to control high blood sugar levels.

The hormone insulin keeps blood sugar (glucose) levels within a narrow range in people who don’t have diabetes. People with Type 2 diabetes are either resistant to insulin or do not produce enough insulin to maintain normal blood sugar levels.

Onglyza is in a class of drugs known as dipeptidyl peptidase-4 (DPP-4) inhibitors which stimulate the pancreas to make more insulin after eating a meal.

“Keeping blood sugar levels in adequate control is essential to the good health of the 24 million people in the United States with Type 2 diabetes,” said Mary Parks, M.D., director of the Division of Metabolism and Endocrinology Products in the FDA’s Center for Drug Evaluation and Research. “High blood sugar levels can cause blurry vision and excessive urination and eventually result in such serious conditions as kidney and eye disease.”

The most common side effects observed with Onglyza are upper respiratory tract infection, urinary tract infection, and headache. Other side effects include allergic-like reactions such as rash and hives.

Approval of Onglyza was primarily based on the results of eight clinical trials. The application seeking FDA approval was submitted before December 2008 when the agency recommended that manufacturers of new diabetes drugs carefully design and evaluate their clinical trials for cardiovascular safety. Although Onglyza was not associated with an increased risk for cardiovascular events in patients who were mainly at low risk for these events, the FDA is requiring a postmarket study that will specifically evaluate cardiovascular safety in a higher risk population.

Onglyza is manufactured by Bristol-Myers Squibb Co. of Princeton, N.J., and marketed by Bristol-Myers and AstraZeneca Pharmaceuticals LP, of Wilmington, Del.

Colchicine receives FDA approval? It's about time!

This may sound a bit odd, but "FDA Approves Colchicine for Acute Gout, Mediterranean Fever." Wait a minute, isn't colchicine a really old drug? Yes, but I guess it's technically been used off-label for all these years. According to the FDA:

Oral colchicine has been used for many years as an unapproved drug with no FDA-approved prescribing information, dosage recommendations, or drug interaction warnings.

So, if that little piece of trivia tickles your brain, then read this full FDA press release about the recent approval of colchicine:

The U.S. Food and Drug Administration has approved Colcrys to treat acute flairs in patients with gout, a recurrent and painful form of arthritis, and patients with familial Mediterranean fever (FMF), an inherited inflammatory disorder. The medication’s active ingredient is colchicine, a complex compound derived from the dried seeds of a plant known as the autumn crocus or meadow saffron (Colchicum autumnale).

Colchicine has been used by healthcare practitioners for many years to treat gout but had not been approved by the FDA. The FDA has an initiative underway to bring unapproved, marketed products like colchicine under its regulatory framework. This initiative promotes the goal of assuring that all marketed drugs meet modern standards for safety, effectiveness, quality and labeling.

Physicians historically have given colchicine hourly for acute gout flares until the flare subsided or they had to stop treatment because the patient began experiencing gastrointestinal problems. A dosing study required as part of FDA approval demonstrated that one dose initially and a single additional dose after one hour was just as effective as continued hourly dosing for acute gout flares, but much less toxic. As a result, the drug is being approved for acute gout flares with the lower recommended dosing regimen.

The FDA is alerting healthcare professionals to this new dosing regimen and also warning about the potential for severe drug interactions when patients take colchicine.

The medicinal value of using colchicum was first identified in the first century A.D. and its use for treating acute gout dates back to 1810. Physicians have prescribed the medication since then. Although single-ingredient colchicine has not been approved by the FDA until now, a combination product containing colchicine and an agent that increased the excretion of uric acid in the urine was approved by the FDA in 1939.

FMF is the most common of the hereditary periodic fever syndromes and is characterized by recurrent episodes of fever, arthritis and painful inflammation of the lining layers of the lungs and abdomen. Though rare in the United States, it is more common in Mediterranean countries. Physicians have prescribed colchicine for FMF for many years based on studies showing that it reduced the frequency of attacks but use of colchicine for FMF had never been approved. With this approval, Colcrys becomes the first drug approved to treat FMF.

Colcrys is manufactured by Mutual Pharmaceutical Company, Inc., Philadelphia.

How's that for an interesting mix of fascinating trivia coupled with some FDA news?

Do your children need ADHD medications?

Kids are hyper, aren't they? They also have really short attention spans, don't they? Did you catch the CNN story titled, "Does your child need ADHD drugs?" If you're not a healthcare professional, can you evaluate whether your children (who have ADHD) should be taking medications for their ADHD? What do we (as healthcare professionals) really understand about ADHD? We certainly know a lot more than we did 10 or 20 years ago. However, we probably also have a lot more to learn about the brain.

My concern with this CNN story is that parents (or children) may read this and decide that they may want to perform a little experiment and stop taking their ADHD medications. In this example, the girl eventually told (or confessed) to her parents that she had intentionally stopped taking her meds. But what if your child does the same thing and never tells you? Physicians don't generally recommend that children with ADHD should be making decisions about stopping medications. Who likes taking medications? I don't.

The CNN story also points to the dangers associated with free drug samples. You're not going to find free drug samples of cheap, generic drugs. Instead, you get samples of the latest and greatest. What happens when the samples run out? You end up paying for the latest and greatest instead of paying for cheap generics. For some families, that may not be a big deal. For others, that could become a significant financial strain. So do your children need ADHD medications? If so, which drugs are the best options?

Did you know that Consumer Reports has a list of ADHD drug recommendations? I love Consumer Reports, but should they be making such medical recommendations when ADHD therapy really needs to be tailored for each individual? These types of reports could mislead parents and children, so although they may be helpful for some, they could also confuse or mislead others. At the end of the day, I hope you're working with a really good healthcare professional who can explain why you (or your child) may need ADHD medications.

Dr. Joseph Kim in the news

My name is so common that you may think that it appears in the news all the time. The truth is that I don't see my name appearing too often. Without the "Dr." or "M.D." the name "Joe Kim" or "Joseph Kim" is ubiquitous. When I was in college, I knew 3 other people in my social network who shared my name.

Let's talk about "Joseph Kim" in the news (and yes, this will be medically relevant):

• There's a young golfer named Joseph Kim (age 21) who may end up becoming really popular someday. He's not a doctor yet, but maybe he'll aspire to become one someday.
  
• Then there's J. Joseph Kim, PhD (CEO of Inovio Biomedical Corporation) who's working on a swine flu (H1N1) vaccine and you'll be seeing his name all over the Internet. Like me, he's an MIT alum.
  
• S. Joseph Kim, MD (Division of Nephrology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario) recently published an article in the Journal of the American Society of Nephrology titled, "H-Y Incompatibility Predicts Short-Term Outcomes for Kidney Transplant Recipients."
• Finally, Joseph Kim, MD (a cancer specialist and surgeon at the City of Hope medical center) has been in the news for treating Steve Jobs (pancreatic cancer).

That's quite a list of some very accomplished people!

Senate Hearing on Medical Research and Education

Yesterday, Chairman Herb Kohl (D-WI) chaired a hearing titled "Medical Research and Education: Higher Learning or Higher Earning?" The entire meeting was about the Continuing Medical Education or CME industry. You can watch the video by clicking here (This is from the Senate Special Committee on Aging). This is a long video, but make sure you view the entire clip. Otherwise, you will only hear one side of the story.

What do you think? Will industry-supported CME be a thing of the past? What's going to happen to the medical research and continuing medical education industries? Industry-supported CME has evolved dramatically over the past 10 years and I've seen some significant changes in the way industry-supported CME is developed and delivered. Without free CME, physicians may need to pay thousands of dollars each year for their CME credit. I think most physicians are able to detect potential bias when they listen to a speaker. If they can't, then they should be shielded from journal ads, television ads, and other types of drug promotion. Perhaps marketing and promotional activities need to reduce so that more focus can be spent on evidence-based education.

Should all physicians be on salary?

This is the Sermo "poll du jour." Former governor of Vermont and DNC Chairman, Howard Dean closed the recent debate with Dr. Daniel Palestrant on CNBC by saying: “All physicians should be on salary.” If you are a physician, do you agree?

• What impact will making physicians salaried employees have on patient care?
• What action would you most likely take in the event that the Federal Government attempts to make all physicians salaried employees?
• Would you accept more federal involvement in your healthcare practice, on behalf of your patients care?
• Would this involvement improve overall efficiency in your practice? For you? For your patients?
• What if doctors are forced to negotiate payment rates with the US Secretary of Health and Human Services?

So far, we have over 700 responses on this Sermo poll. Let's see what gets published in a few weeks. If you missed the CNBC debate on TV, you can catch it here: CNBC debate between Gov Dean and Sermo

Tips on managing online passwords

My wife and I have had had several discussions about Internet security and online passwords. Why? Because my Facebook account got hacked over the weekend. We probably all know that accounts can get hacked, but can you imagine the headache if your accounts shared the same passwords? What if you couldn't get into your e-mail account anymore? What if you couldn't access your online banking accounts? (that wasn't the case in my situation, so I didn't lose control of my e-mail, blogging, Twitter, LinkedIn, eBay, PayPal, or any of my bank accounts. I was able to send a Tweet to all my followers to warn them about my Facebook situation).

If you have a common password that protects your personal health record (PHR), then you could be exposing yourself to potential hackers. Do you consider your health record more important than your banking accounts?

Many of us have a variety of online accounts. Do you use the same password on several accounts? You're putting yourself at grave risk if you do that. I admit that there was a time when I used a few passwords among different accounts. However, I now have unique passwords for every account and I use a systematic approach so that I can easily remember every one.

Allow me to share a few Internet security tips:

• Never use the same password on multiple accounts. This may lead to someone hacking your Facebook account and then eventually getting access into other things (like your bank account, PayPal, credit card accounts, etc.)
• Never use a dictionary word as your password. Using "wojljsdflkwe" is better than that any word that would appear in a dictionary.
  
• Never use numbers that reflect your personal profile. Don't use numbers that may reflect your birthday, your address, your phone #, etc.

How can you systematically create a unique password for each website so that you can remember your password easily?

Suppose you really like the word "Amazon" as your password. It's 6 characters, so it works as a password on many websites. Let's see how we can use this word to create unique passwords for 3 different websites. We'll use the unique letter(s), common number(s), common word technique. This is a very basic technique that works quite well if you're a newbie at this.

1. The unique letter(s) is based on the name of the website. Choose the 3rd and last letters of the website title as your unique letters and this becomes the first few letters of your password.
2. Choose a common number. Let's choose 16 (legal driving age). This is the second component of your password.
   
3. Choose a common word. Let's choose "zamazon" (I love to shop on Amazon, but we don't want to use a word that can be found in the dictionary, so we'll add a "z" to amazon). This becomes the end of your password.
   

When you combine these elements, we end up with 3 unique passwords for the following 3 websites:

1. Paypal: the password would be "yl16zamazon" (y = 3rd letter; l = last letter)
   
2. Chase: the password would be "ae16zamazon" (a = 3rd letter; e = last letter)
   
3. Google: the password would be "oe16zamazon" (o = 3rd letter; e = last letter)
   

You can get really creative using this technique and you can develop unique password patterns for every website that you visit. You could end with your unique letters. You could flank your common numbers/letters around your unique letters. You could also choose different patterns for different types of websites. For instance, for banking sites, you may choose to start with the common number and end with the unique letters. For social networking sites, you may want to use the method in reverse (or change your common # or letter). You may want to have one common word for websites that start with a vowel and a different common word for websites that start in a consonant. Once you have a series of consistent patterns, you only need to remember your common number(s) and common word(s). This can reduce your risk for password theft which could lead to identity theft and a series of other major headaches. If you're married, you don't have to share your actual passwords with your spouse. You simply have to explain your method and share your common words/numbers. Let your spouse go through the exercise of coming up with a method. Sounds like fun, doesn't it?

Are we rushing through healthcare reform?

It seems like some people really love all the healthcare reform proposals and others really hate them. Many people are worried that we might be rushing through this process and the end result might be a disaster. Our country is going through a serious economic recession and there are too many people out there who need health insurance. Unemployment is still rampant and many people are struggling to survive during these difficult times. Are we making decisions based on the current state of the economy or are we planning for the future?

President Obama has outlined eight basic consumer protections:

• No discrimination for pre-existing conditions
• No exorbitant out-of-pocket expenses, deductibles or co-pays
• No cost-sharing for preventive care
• No dropping of coverage if you become seriously ill
• No gender discrimination
• No annual or lifetime caps on coverage
• Extended coverage for young adults
• Guaranteed insurance renewal so long as premiums are paid

All of this sounds great, but how will we get there? I've been speaking with many physicians who are deeply concerned about some of the healthcare reform proposals that are out there. Will these reforms create such a change in the healthcare system that it undermines the quality of care that people end up receiving?

FTC to delay "Red Flags" enforcement until Nov. 1

I just received this Breaking News alert from Modern Physician:

Moving an Aug. 1 deadline, the Federal Trade Commission will wait until Nov. 1 to enforce a provision of the “red flags” rule that requires physicians and hospitals to adopt written plans for tracking and responding to indicators of identity theft in their billing operations.

FTC Announces Expanded Business Education Campaign on 'Red Flags' Rule

Here are a few relevant snippets:

To assist small businesses and other entities, the Federal Trade Commission staff will redouble its efforts to educate them about compliance with the "Red Flags" Rule and ease compliance by providing additional resources and guidance to clarify whether businesses are covered by the Rule and what they must do to comply. To give creditors and financial institutions more time to review this guidance and develop and implement written Identity Theft Prevention Programs, the FTC will further delay enforcement of the Rule until November 1, 2009.

To assist small businesses and other entities, the Federal Trade Commission staff will redouble its efforts to educate them about compliance with the "Red Flags" Rule and ease compliance by providing additional resources and guidance to clarify whether businesses are covered by the Rule and what they must do to comply. To give creditors and financial institutions more time to review this guidance and develop and implement written Identity Theft Prevention Programs, the FTC will further delay enforcement of the Rule until November 1, 2009.

The FTC’s Red Flags Web site, www.ftc.gov/redflagsrule, offers resources to help entities determine if they are covered and, if they are, how to comply with the Rule.

Why the delay? Read more at the FTC site here.

A pregnant woman in Mass was killed and her baby is missing

This is really a disturbing story, but perhaps there is an opportunity to leverage social media (like Twitter and Blogs) to help with this medically-related criminal case. According to this story on CNN, a pregnant woman (Darlene Haynes) living in Worcester was killed and her 8-month-old fetus was taken out of her body. Police say the missing infant could survive, but would need immediate medical attention. Anyone with information on the case or the whereabouts of the baby is urged to call Worcester detectives at 508-799-8651. More details can be found on Boston.com

101.5 Degrees: The 2009 MGH Surgery Intern Music Video

These people are talented! How do surgical interns find so much free time? Watch this classic video:

The 2009 MGH Surgery Change Show Intern Music Video that rocked a nation. Shot live on the helipad, in the ether dome, in the burn unit, and in the real-life operating rooms of Massachusetts General Hospital.

MayoClinic.com partners with Everyday Health

Wow, this is big. No, this is huge! MayoClinic.com (owned by Mayo Clinic) has partnered with Everyday Health (operated by Waterfront Media). Will this form the ultimate consumer healthcare portal?

You may be wondering, "why this partnership?" I think the answer is rooted in advertising revenues. Consumers are drawn to healthcare ads and many companies are willing to pay quite a bit to target consumers. Sometimes I wonder if people will eventually learn to completely ignore ads. The truth is that certain ads can be very difficult to ignore. What does this do to WebMD? Maybe they should partner with Google.

Here's a snippet from the press release:

Everyday Health, operated by Waterfront Media, will support Mayo Clinic's online advertising efforts through a multi-year relationship. Waterfront Media will represent MayoClinic.com in the following business categories: CPG (consumer packaged goods), OTC (over the counter drugs), retail consumer goods and services, cosmetics, food and beverage, auto, finance, entertainment, technology and media MayoClinic.com will continue to work directly with pharmaceutical advertisers.

Note of clarification from Ginger Plumbo, the publicist for MayoClinic.com:

MayoClinic.com is still owned and operated by Mayo Clinic. We are only working with Everyday Health for advertising representation in certain categories of advertising, but will continue to represent ourselves in the pharmaceutical category. Mayo Clinic will continue to manage MayoClinic.com's content, navigation, and overall management of the site.

More free medical care

Watch this CNN video of people receiving free medical care in Virginia.

AstraZeneca Expands AZ&Me Prescription Savings Program

During these difficult economic times, any type of savings program is appreciated. AstraZeneca is expanding its prescription savings program by extending assistance to qualifying patients who have recently lost their jobs, had their incomes reduced, or experienced a change in marital status or family size.

"AstraZeneca is committed to helping patients get the medicines they need," said Rich Fante, US President, AstraZeneca Pharmaceuticals LP. "Our responsibility goes beyond developing medicines to also making them available to those who cannot afford them."

Here are the details of the AZ&Me(TM) Prescription Savings programs:

• AZ&Me(TM) Prescription Savings program for people without insurance: AstraZeneca provides AstraZeneca medicines at no cost to qualifying individuals without prescription drug coverage who make up to $30,000 per year and families of four who make up to $60,000 per year.
• AZ&Me(TM) Prescription Savings program for people with Medicare Part D: AstraZeneca provides low-cost AstraZeneca medicines for qualifying Medicare Part D patients who make up to $30,000 per year or couples who make up to $40,000 per year.
• AZ&Me(TM) Prescription Savings program for healthcare facilities: AstraZeneca provides AstraZeneca medicines at no cost to qualifying non-profit healthcare facilities, such as disproportionate share hospitals, community health centers and community free clinics. This program connects patients to the AstraZeneca medicines they need at the same time and place they receive their treatment.

Patients can learn more about the AZ&Me(TM) Prescription Savings program at www.azandme.com or by calling 1-800-AZandMe.

CNBC debate between Gov Dean and Sermo

Here's the video (embedded in this blog post) of the CNBC debate between Gov Dean and Sermo physicians:

Healthcare reform must be tailored

Where are we going with healthcare reform? Do decision makers really understand all the issues at stake? With so many doctors no longer accepting Medicaid or Medicare, what's going to happen if doctors choose not to accept other forms of government insurance?

Reflections on a compromised Facebook account

My personal encounter with a compromised Facebook account has taught me several (OK, maybe more than several) things:

• Too many people use common passwords on the Internet. As a result, it can make it easy for people to "hack" into one account and then gain access to many others.
• I used to get annoyed at banking accounts that asked you to answer a security question whenever I tried to log in using a different computer. Now, I'm grateful for that level of security and I hope that more sites (like Facebook) will adopt a higher level of Internet security.
• You don't have to click on any phishing links to become a victim.
• I used to have several common passwords for various websites. I didn't use a single password on more than a few sites and some were considered "low security" passwords while others were more complex and for those "higher security" sites like bank accounts. Now, thanks to my brilliant wife, I have a unique password for every website and I'm using a logical system that helps me remember each one so that I don't have to write them down anywhere. Don't worry, I'm no longer using the same password on my Facebook account.
  
• There are still many people out there who are unaware of scams on Facebook (like the common story of being stranded in London or needing money for some other reason). Hence, there is a need to tell others about potential scams on Facebook.
  

Well, that's about it for now. I'm back on Facebook. I only lost control of the account for a few hours and I'm grateful for all my friends who reached out to me during that crazy period. I'm just glad that I wasn't on vacation when all this happened.

Camp Twitch and Shout

I love summer camps. However, "Camp Twitch and Shout" is not your typical summer camp. This is a camp for people who have Tourette syndrome (according to Wikipedia is also called Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourette's or TS). It's a neurological disorder characterized by motor and voice tics.

According to the Centers for Disease Control and Prevention, three out of every 1,000 school-age children are believed to have Tourette syndrome. The cause is unknown, but genetics appear to play a role. Most children develop the condition between 7 and 10, and if their tics are mild to moderate, they usually require no medicine to control them. Symptoms usually peak during the late teens or early 20s.

What goes on at Camp Twitch and Shout? Children with Tourette's get to have fun. It's so great to see social support groups like these camps. We have CaringBridge and other online social support sites for people who are struggling with various health conditions. When you get to meet at a camp, interact, and have fun, then I'm sure some unique friendships develop. Click here for the CNN story.