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Friday, October 29, 2010

Halloween on the Health Train


My friend and buddy for Halloween night.


If it doesn’t work out, there is always this,


Happy Goblins !!

A Haunting I will go

Thursday, October 28, 2010

Lines in The Sand


Stanford University

The San Jose Mercury News Reports,


Stanford University opens
new stem cell building,
bucking federal

Across the nation, embryonic stem cells live in legal
limbo, their fate uncertain with a lawsuit challenging
public funding for research.
But they are cherished celebrities at Stanford
University's School of Medicine, which on
Wednesday inaugurated a new home for them at the



Lorry I. Lokey Stem Cell Research Building, now the
largest stem cell facility in the nation.
"The stem cell revolution has been launched in


Bob Klein of the California Institute for
Regenerative Medicine
declared at the afternoon
ceremony. After his son was diagnosed with
diabetes and his mother with Alzheimer's, Klein w
rote the language for Proposition 71, which
cleared the way for such research in California.

"In this fine facility, research is insulated from federal influence. Science is served by patients, not politics."


The cells, which will contribute to pioneering
research, remained upstairs in a high-security lab
during the afternoon pageantry. They live in flat

plastic dishes, within warm incubators where they
eat nutrient-rich broth -- and multiply by the
"They are very, very, very precious," said research
manager Vittorio Sebastiano, who is responsible for
the well-being of the 10 million to 100 million cells,
a diverse collection of both innocents and killers.
Many are derived from donated embryos; others
come from tissues of sick or dying patients.
He handles each dish carefully, and only briefly,
wearing plastic gloves to
avoid contamination. He monitors their health by
the color of the pH-sensitive broth, which shifts
from pink to purple or yellow with any change in the
cells' conditions.
Until recently, these cells were scattered in
individual labs, some off campus.
To keep them undisturbed and centrally located
during the chaos of construction and lab relocation,
Stanford collected the cells and put them together in
one small room, which was completed early, at the
new site. The dozens of dishes were loaded into
Styrofoam boxes -- kept warm by bottles of heated
water -- then quickly driven across campus and
moved to the new incubators.
Meanwhile, lab equipment -- ranging from pipettes
to centrifuges -- has been shipped to the new site.
The Lokey Building's 200,000 square feet of lab
space will serve 500 people and 33 different
research projects.
Bringing all the researchers under one roof will
make it easier for them to collaborate while sharing
expensive equipment and technical support.
Located so close to Stanford Hospital, doctors can
treat patients and then walk to their labs within

minutes. The new building also offers 60 temporary
"hotel" rooms for researchers from as far away as
Germany and Singapore, contributing valuable
cross-pollination of ideas.
"All the real experts in California in stem cell
biology are right here, together, in this building,"
said Sebastiano, a developmental biologist.
Meanwhile, scientists outside California endure a
legal roller coaster, as a lawsuit challenging federal
funding of this research wends its way through the
judicial system. At stake are an estimated 1,300
jobs, as well as more than $200 million in grants
from the National Institutes of Health that support
more than 200 projects.
The study of embryonic stem cells has been subject
to religious objections and was limited for years by
the Bush administration. The Obama administration
lifted the limits, but a lawsuit has left the field more
restricted than ever. In August, Chief Judge Royce C.
Lamberth, of Federal District Court for the District of
Columbia, issued an injunction blocking research.
The ruling is now being appealed.
The Stanford effort, in contrast, is supported by $44
million in state funding from the California Institute
for Regenerative Medicine, created by voter approval
of Proposition 71 in 2004. An additional $75
million was donated by Stanford alumnus Lorry I.
Lokey, founder of Business Wire. The remainder of
the $200 million budget was raised through private
donations and university resources.
Scientists there also teach. Already 100 students,
postdoctoral fellows, physicians and researchers --
from campuses including San Jose State, UC Santa
Cruz and UCLA -- have learned how to derive and
care for stem cells.
The new facility will expand this training program

-- and perhaps offer the first Ph.D. program in cell
biology in the country.
"It's brilliant," said Sebastiano. "It's not a matter of
research. It's a matter of how to pass the knowledge
of this research to a new generation of scientists."
Throughout the turmoil, the cells continue to grow.
Some of the embryo-derived cells have matured into
tiny heart cells, and beat in unison. Scientists hope
to build tissue to patch up damaged hearts, create
insulin-producing cells for diabetics or heal the
damaged spinal columns of quadriplegics.
Other cells do not come from embryos -- they are
mature cells donated by patients.


Ravi Dasgupta became the first person ever to receive a stem cell transplant.


Some cause cystic fibrosis; others, sickle cell
disease. One dish holds skin cells from patients
with epidermolysis bullosa, a rare and life-
threatening blistering disease of the skin.
In the future, as the Lokey building fills, they will be
joined by legions of others, causing diseases as
diverse as cancer to Parkinson's disease -- a virtual
Noah's Ark of cell samples.
Lokey, a jovial 83-year-old, said he was excited by
the potential of stem cells to improve health and
extend longevity.
"This life," he told the crowd, "is too rewarding, and
good, to leave early."

There are many dedicated to advancing hope for cures. We should not despair about the present political morass . We shall overcome.

Wednesday, October 27, 2010

Health Train Express The Book


is now available for the cost of an email to me requesting it. This edition covers January 2010 through October 26, 2010.  It is in a pdf format.


Get one quickly…THEY WILL GO FAST. The first 100 will also get a free picture of the author.


Wait too long, and this may happen. Tags: ,

Tuesday, October 26, 2010

A Short and Useful Life


It’s nice to honor someone before they pass away and that is the subject of this mornings’ blog.

I first met her in 2003 or 2004. I don’t really remember the exact year. It was in a time when I did not know someone like her even existed. 

For me it was an invigorating change in semi-retirement. She would fill many hours of each day.

She was a breath of fresh air in my life, however at times I did not know how to communicate with her, and she often misunderstood my intentions.

She was a ‘new age being’, one who many others also discovered. However when ever I knocked on her door, I would only have to whisper secret words and she would invite me in once again. She rarely tired of my visits, she primped for my visits, and at times would not let me visit as she dressed in some new attire for my pleasure.  During my days I would check on her ,often unbelieving when I found her wanting my attention, even though she was occupied with others.

Our relationship was passionate as I awoke each morning to sample her offerings.  I admit gradually she became my connection with the world.

Over the course of the last several years,  I admit I became fickle, seeking to satisfy my needs with others who had adopted her fresh and seductive ways Others took her best features and adopted her ‘fashion into new garments and like with an older woman,  her admirers and courtiers were attracted to their new muses.

I also sadly developed new relationships with the come-latlies and found it more difficult to be with her.  I was an admitted adulter who found time short at I wooed others throughout my day, however she remained my morning sunrise as I awoke each day.

Last week I heard the news that she only had several more weeks to live.  I rushed to her and she had left me a message that what I had heard was true.  She  would be gone by the end of the month. In her own amicable way (as she had done all her)  life she offered to help me make the transition to new friends.   I had loved how she gathered the rest of my friends.  She was a  social butterfly. I followed her lead and made many new friends, forming a close group who will go on in her absence. We all contributed to her passing with our fickle nature.

I don’t know what our group plans to do when she passes. She was unique, and insular, even while very sociable, choosing to stand alone, not attaching herself to another form of entertainment. Some of us have found other lovers. For me,although she showed her age, she is still my morning cup of tea. Will there be a ‘celebration for her beginning’ or will she pass quietly into the night?   The younger generation in a short time will not remember her or the important role she played in our lives.

Perhaps some of you will know of whom I speak.  You can still visit her here.  If you have been with her she always recognized you with the right words.

Be still, old friend knowing that you changed all our lives.



Monday, October 25, 2010

Accountable Care Organizations


This is the new buzz word sweeping through the MBA, MHA, and HHS.

So, who is accountable to whom, and what?

You may watch a webinar or attend a conference in Los Angeles, California on October 25-27 2010 focused on Accountable Care Organizations.

There are the usual number of talking heads including CEOs of large medical groups, the head of the California Association of Physician Groups.  Notably absent is the California Medical Association, which represents physicians. It makes me wonder if CMA was even invited…

image             image

If you or your group wish to present at the next National Meeting You can apply here:

Know your ‘enemy’ make them your friends, be aware and make yourselves heard !!



Saturday, October 23, 2010

Health Train Express Schedule & Health 2.0


Stamford-New Canaan Railroad


Health Train will be stopping twice a day to publish an article in the morning and then in the evening. Don’t forget to check twice each day. The AM edition will cover scientific breakthroughs both in basic science and clinical science as well as HIT which will impact how medicine will be practiced in the 21st century. The PM edition will continue to cover HIT and policy reform as well as appropriate humorous subjects.

This morning the train stops briefly to review the messages at Health 2.0, just held the past week in San Francisco.

The street is big on all the flurry and buzz about medicine and HIT. Although I have never attended a Health 2.0 shout out,


I have managed to follow them on the web. Without judging the merits of each presentation, or idea there are substantial numbers of entrepreneurs betting their wallets and time on these developments. We as physicians will gain much from these presentations, if we advise our patients to consider these options. Most of them are “consumer-centric”  and their success will largely depend upon patient acceptance.  Recent market surveys indicate wider acceptance and use of the resources. Videos have been published from the recent gathering of minds.

I enjoyed this one in particular.  Regina Holiday attended the meeting and created a wonderful summary in paint of the conference and what it represented.  Have a look !

Friday, October 22, 2010

I Work So Hard !!


Sorry I had to interrupt my regular programming to bring you this hysterical video. 

We docs work so hard !!  That’s what you think.


Workin so hard !


THIS IS NOT A POLITICAL MESSAGE ! It is a politically correct message . 

Thursday, October 21, 2010

Heather Gold is Allowed to Suck


Maybe you think Health Train has gone off his rails.

The relevance here is about malpractice.  This video should inject some ‘humor’ about a not so humorous part of our lives.

At times the “law” attempts to  make impossible contracts work. Perhaps the liability is a two way street. Why does it always land on the physicians’ plate?

Heather Gold Sucks !!


Health train has been addressing IT, health reform, and Health 2.0, with it’s rapid paradigm shift effecting medical care. The latest acronym  ACO, Medical Home, and others I want to forget

So, for the next several days Health Train Express will be aggregating feeds to what I think are the revolutionary and newsworthy events in clinical research, science, and basic science. Some of these have no apparent value to medical care, unless you are smart enough to extrapolate.

For many of us who are now ‘brain dead’ from CMS, EMR, HIT, ACO, HMO, PPO, and planning for SGR, HITECH, PPA overload it will be a leap. Here are a few openers.


Breakthrough Medical News Digest

Making Progress, Does clinical science lead to breakthroughs in Basic Science?

Science Presentations

Science Magazine Breakthrough (An organized presentation of the roles of different basic sciences)

Tuesday, October 19, 2010

CMS Statistics Meaningless according to study published in the Archives of Surgery


If a surgical procedure is in your future, the Centers for Medicare and Medicaid Services would like to make your life a little easier by helping you choose a hospital with a good safety record. Its Hospital Compare website allows you to search hospitals in your area and see whether they do a good job of some seemingly important things, like giving patients antibiotics when they’re supposed to and heading off dangerous blood clots.
But don’t put too much stock in the Hospital Compare ratings. According to a study being published in Tuesday’s edition of Archives of Surgery, patients who went under the knife in the lowest-scoring hospitals did just as well as patients who were treated in the best hospitals.
“Currently available information on the Hospital Compare website will not help patients identify hospitals with better outcomes for high-risk surgery,” wrote the researchers, who were from the University of Michigan and the Michigan Surgical Collaborative for Outcomes Research and Evaluation in Ann Arbor. “Patients who choose their hospital based on high rates of process compliance will not improve their chance of survival or complications.”

Get breaking news alerts delivered to your mobile phone. Text BREAKING to 52669.

In coming to this conclusion, the researchers examined data on nearly 230,000 Medicare patients who had one of six surgical procedures (abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair or pancreatic resection) in 2,038 hospitals in 2005 or 2006. They ranked those hospitals according to their compliance with various safety measures. Then they compared the experiences of patients treated in the best hospitals with those treated in the worst.
It turned out that patients were just as likely to die within 30 days of their surgeries in the “safe” hospitals as in the “unsafe” ones. There was one exception – patients who had an aortic valve replacement were less likely to die in hospitals that had the best compliance with the safety measures. Overall, degree of compliance accounted for only 3.3% of the variation in mortality rates observed at different hospitals.
What’s more, patients experienced fewer complications in hospitals that did the worst job complying with the safety measures, and more complications in hospitals with the best compliance records.
The researchers didn’t seem to be terribly surprised by their findings. As they pointed out, blood clots (due to deep venous thrombosis or pulmonary embolism) are rare, and there may not be enough cases to distinguish “good” hospitals from “bad” ones. Other things the government keeps track of, like surgical site infections, are important but don’t have a huge impact on mortality.
The researchers concluded that more research is needed to determine whether it’s worthwhile for hospitals to spend so much time in tracking and reporting this “safety” information. Perhaps the government – and patients – would be better off with other kinds of safety data, they wrote.
-- Karen Kaplan / Los Angeles Times

Friday, October 15, 2010

Resistance is NOT FUTILE


Unlike the Borg of Star Trek humanity (at least in the United States) is resisting becoming total automatons by following our governmental policy proclaiming it knows what is best for us.

Things are not as bad as they seem.  Yesterday a Florida judge proclaimed:  Thursday that a legal challenge to the new health care law by officials from 20 states could move forward ...," The New York Times reports

"The White House downplayed the ruling Thursday." Stephanie Cutter, an assistant to the president for special projects, wrote on the White House blog: "This is nothing new. We saw this with the Social Security Act, the Civil Rights Act, and the Voting Rights Act – constitutional challenges were brought to all three of these monumental pieces of legislation, and all of those challenges failed. So too will the challenge to health reform".

Just last week a Michigan judge struck down a similar challenge to the health reform law, arguing the congress was well within its constitutional authority when it crafted the law.


Reforming the Reform


How to Reform Obama Care Starting Now

Scott Gottlieb and Tom Miller, American Enterprise Institute
The Wall Street Journal, 10/14/10

After November, more than 30 Republican governors (many newly elected) will have the opportunity to resist the health overhaul legislation at the state level. They should perform as much radical surgery as possible on the mandated health insurance exchanges until a new Congress working with a different president can do something better. By offering their own market-friendly versions of the exchanges, they will establish an alternative to Obama Care and its one-size-fits-all health plans. For example, any willing insurers already licensed to operate in a state should be able to offer plans. Once inside the exchange, consumers would be guaranteed the ability to renew their coverage without regard to changes in their health status, so long as they remain continuously insured. Some states, particularly Utah, are moving in this direction with their own version of market-based exchanges before Obama Care's regulations can catch up. The Utah Health Exchange is an Internet-based information portal that connects consumers to the information they need to make informed choices. In many cases, it allows them to buy insurance electronically. Several other states are interested in establishing similar plans and daring the Obama administration to stop them. Replacing the command-and-control features of Obama Care with a plan offering consumers a real marketplace is a change many people can start to believe in. And one Mr. Obama would be imprudent to oppose.
Read More »

Saturday, October 9, 2010

Laughter is the best Medicine


This weekend deserves some special humor.  Several of my blogger colleagues have pointed me to some pretty funny people riding on the Health Train Express.

So saddle up, get a brew, or or whatever loosens you limbic system, and have some hearty laughs.  Laughter is the best medicine, after all !

For the back window.


Top of the TV


Bedroom Armoire


For The Garage




Guest Bedroom


Friday, October 8, 2010

THIS JUST IN….Another blow to the Constitution


Just kidding

This just in: A federal judge in Detroit Thursday afternoon rejected a request for a preliminary injunction to halt the health-care overhaul signed into law by President Obama back in March.

In his 20-page opinion, Judge George Caram Steeh upheld the constitutionality of the law, finding that Congress possesses the authority under the Constitution’s Commerce Clause to require that every American purchase health insurance. Click here for the Bloomberg report; here for the opinion; here for other LB coverage of challenges to the health-care law.

Steeh’s analysis under the Commerce Clause was broken into two parts. First, he found that the economic decisions that the Act regulates as to how to pay for health care services affect the interstate health care market. He wrote:

decisions to forego insurance coverage in preference to attempting to pay for health care out of pocket drive up the cost of insurance. The costs of caring for the uninsured who prove unable to pay are shifted to health care providers, to the insured population in the form of higher premiums, to governments, and to taxpayers. . . . These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers, and the insured population who ultimately pay for the care provided to those who go without insurance.

Next Steeh found that the individual mandate, the provision that requires everyone to have health coverage, was essential to the act’s larger goal of regulating “the interstate business of health insurance.


This decision is only the first shot across the bow of Obamacare. There are numerous actions in several state and district courts, see here,  and here, and here.   A word from the Supreme Court


Justice Steven Breyer Tags: ,,

Wednesday, October 6, 2010

Pomegranate Juice, What is ??

The Wall Street Journal reports an impending battle between the marketers of Pomegranate Juice and the Food and Drug Administration.  In their report which contains this video clip

POM  vs.. The FTC


The FTC official who has accused the company (which Resnick runs with her husband Stewart) of making false health claims about the beverage has gone “crazy” on this issue and is a “zealot,” as she says in the WSJ today. She says unlike other major food producers, the company won’t back down from the spat — let’s call it a battle, at this point — in part because her husband hates “bullies.”

Now would it not be wonderful if we “impotent physicians took a lesson from this company.  They have done the research, and it is going to be up to the FTC and perhaps the FDA to disprove their ‘preventive nutritional product”.   I see lots of federal dollars being appropriated to perform an official trial. More wasted taxpayer dollars !

At a time when CMS and all the insurers are beating their chests about outcomes and prevention it once again points out the schizophrenia of HHS.

To the Resnicks I say thank you ….All of us should. This will be a landmark case.  It took awhile for ‘allopathic medicine to catch on to the benefit of omega 3 fatty acids and it’s role in immunology.

Discrimination in Play for Health Reform in California


Discrimination in Play for Health Reform in California


CALHIPSO, or California Health Information Partnership & Services Organization has issued a brief regarding it’s services which will only be available to primary care physicians.

The California Health Information Partnership and Services Organization (CalHIPSO) is an organization founded by clinical providers, for clinical providers, to help them successfully navigate through the complicated world of electronic health records (EHR) implementation. Our founding organizations are the California Medical Association (CMA), the California Primary Care Association (CPCA) and the California Association of Public Hospitals & Health Systems (CAPH).


CalHIPSO is primarily supported through stimulus funding made available from the federal Office of the National Coordinator for Health Information Technology to support the ability of 100,000 clinical providers nationwide to adopt EHR by the year 2014. Beginning in 2011, Medicare and Medi-Cal will make payments between $44,000 and $63,750 per provider to those who can demonstrate that they are “meaningfully using” EHRs. The sooner you can demonstrate “meaningful use,” the more funding you will receive since EHR incentive payments will end in 2014.

It is apparent that although federally funded by all our tax dollars these funds are unavailable to specialists.

It seems to me that communication between primary care and specialty practices is not a meaningful use for EMRs according to CMS & HHS. It is also blatantly apparent the guise of EMR is to extract data from EMRs and not to improve quality of care. Without a tight integration between primary care and specialty care there is a breakdown and further decrease in efficiency. How are outcomes going to be truly assessed without input from specialty care, (aren’t most surgeries performed by surgeons?) many of whom do primary care medicine.

Apparently the California Medical Association also does not support specialty care. Regardless of whether one supports the implementation of EMR and HIE it behooves all physicians to notify CMA of our displeasure at being de-selected from their representation.

Also, because the number of specialty care physicians outweigh the number of primary care physicians our combined membership in CMA would carry significant weight. (or perhaps specialty physicians have already quit CMA and AMA realizing they do not represent us.

This message is personal opinion only and does not represent the opinions of Docs4PatientCare. 


Gary M. Levin M.D.

Monday, October 4, 2010

How Statistics Lie

The New England Journal of Medicine in an article written by Thomas Bodenheimer M.D., Ph.D., And David West M.D analyze  Medicare statistics from the beloved Dartmouth Study. The Dartmouth Atlas of Health Care study reveals a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.

The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida.  The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The study has previously criticized for a number of flaws.

One factor which may  explain the disparity regarding numbers of cardiac cases is Golden Colorado’s proximity to a major heart center in Denver, Colorado.  A quick google map search will reveal that is is a short 15  minute ride to the outskirts of Denver, and a 25 minute ride to downtown Denver and the University of Colorado.

This is a very important factor in the numbers differences.

“Centers of Excellence”  became a buzzword about ten years ago for cardiac, orthopedic, and other specialties.

The typical scenario for a patient with cardiac problems would be to travel and  seek out the best experts in a region for a cardiac problem.

Would you seek out a surgeon or cardiologist in Golden if you could drive down the road for fifteen or twenty minutes to have a cardiac surgery at a university center? 

The article attempts to justify the differences in cost as a result of managed care organizations with primary care as the ‘gatekeepers’. They attribute risk management coupled with witholds of physician payments, rewarding groups that manage costs well with a financial reward and a form of rebates.

In my opinion there were some very good observations that might be transferrrable to other communities, regardless of reimbursement algorithms.

1.Rocky and Grand Junction’s family physicians made another unusual decision: to pay physicians Medicaid fees equal to those for other patients. As a result, Medicaid patients gained access to private primary and specialty care — and became less likely to utilize expensive care in emergency departments. This policy is probably responsible for the low per-enrollee cost for Medicaid acute care

2.The most important event in Grand Junction’s health care history was the assumption of leadership by family physicians.4 In the early 1970s, a group of primary care physicians and specialists founded the physician-run Rocky Mountain Health Plans (“Rocky”) and the Mesa County Physicians Independent Practice Association (MCPIPA). Family physicians gained substantial control of these organizations and fostered a culture of incentives for cost control and cost transparency. In 2006, Grand Junction had 85% more family doctors per capita than the national average.

3.Many medical communities have two or more hospitals with cardiac-surgery units and other expensive services. To compete for cardiologists and cardiac surgeons, such hospitals create more cardiac-catheterization facilities and perform more coronary angiography and revascularization procedures. In Grand Junction and its surrounding hospital referral region, there is only one tertiary care hospital, St. Mary’s, providing interventional cardiac care, neurosurgery, and other subspecialized services. St. Mary’s is fed by smaller secondary care hospitals that do not offer expensive interventional services. Moreover, thanks in part to the control of the primary care community over Rocky, St. Mary’s has kept its number of beds and amount of expensive equipment at reasonable levels. Because only one hospital can offer interventional cardiac procedures, there isn’t room for many cardiologists in Grand Junction; with such limits on facilities and workforce, the rates of such procedures remain low.

4.Finally, with the encouragement of family physicians, low-cost end-of-life care became a prominent part of the region’s health care system. Thanks to the area’s single nonprofit hospice, which also offers palliative care, physicians are educated about initiating discussions with elderly patients about advance directives, and the public is informed about end-of-life choices. As a result, Grand Junction’s population spends 40% fewer days in the hospital during the last 6 months of life and 74% more days in hospice than the national averages, and 50% fewer deaths than average occur in the hospital.