Todays’ post is a potpourri of health related blogs.
Medical care and Art by Ted Bacharach MD (retired)
3D CT scan of a 300-year-old pocket watch
by Vijay
HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Friday, November 5, 2010
Wednesday, November 3, 2010
Election day Aftermath
del.icio.us Tags: election,hmo,healthcare reform,obama care,constitution,redistribution,health train express
Here we are one day post election. It was reported that 1.6 billion dollars was spent for the benefit of politicians and free spending businesses, lobbyists, and some well meaning citizens who buy into their lies, promises and grandiose ideology and plans for the republic. No doubt many of these companies, and individuals had some self serving sinister motives. Campaign financing laws are easily thwarted, to attain these levels of spending a mid-term election. There is a great deal of American Wealth at stake, your wealth as our politicians fight to obtain your money for their purposes, without regard as to whom elected them or pay their salaries. Media companies flourish from our largesse, disseminating half trues, and opinion, competing for advertising dollars and ratings.
“Take back our country” should be re-stated as “Take back our Money”
I have always been a moderate, paid taxes, contributing as much as I could when I was relatively well off, employing ten people, accountants, attorneys, insurance companies, not only for malpractice, but liability, disability, health insurance and more. I fueled several medical technology companies for diagnostic and surgical equipment as equipment became obsolete every five years, or less. I created a ten year business plan investing a significant amount in equipment with a depreciation plan.
All of my planning and budgeting were sabotaged by the ‘threat of inflation’ and the projected insolvency of Medicare. During the late 1980s and early 1990s a plan was developed by some ‘hidden magical gurus of health care planning’ located within the D.C. Beltway. HMOs, IPAs, Managed Care, PPOs and other eponyms were launched with the objective and promise of ‘cost containment’.
It is difficult to prove a negative but one naturally questions what would have occurred if these changes did not occur. Medical care and the quality of care suffered greatly, administrative expenses soared with the multiple tiers of billing, review and organizational expense. New positions were created for ‘executive directors’, added administrative expense and consultants in management. Most patients and physicians despised the system.
We were paid less, buying into the concept of ‘withholds’ which would be paid back if doctors managed well and thereby receive a rebate. I witnessed one of our organizations hi-jacked by our board, using our funds to capitalize the organization to sell it to Aetna’ managed care plan. This company and many others like it removed much of our income which formerly covered operating expenses and allowed for charity care for the uninsured, both in our private offices and hospitals. Whether there were cost savings remains very much open to question. Many of these organizations merged, failed or became insolvent.
The true definition of insanity is to repeatedly do the same thing, resulting in a bad outcome and then repeat it expecting a different outcome.
Our entire medical system has been manipulated and re-organized with devastating outcomes, the number of uninsured has soared, as government has become more involved in the process. Rest assured our elected officials will fail to control their mandates for ‘Obama Care’. That is evident from the law they passed without reading or understanding the full implication of the law. They certainly did not plan the secondary or tertiary effects of the law and how insurers, employers and patients would “gain the system.”
Think about this…40 million citizens (and perhaps a fair number of undocumented aliens receive food stamps to survive. Some of them drive gas guzzling SUVs which have become less expensive to buy because others cannot afford these vehicles to drive to and from work any longer. (Another unintended consequence of a well meaning mandate for fuel economy and “green”. So the poor non working and some disabled can afford better things that hard working employed who have significant other cost of living expenses from their ‘declining spendable income.”
Not mentioned is the tremendous increase in cost of regulating and enforcement of these new laws.
While you and I have little time to devote to being a ‘watchdog’ over administrators , politicians, we are paying their salaries to got to meetings to plan our destruction, not only of the earners but the people’s freedoms who receive the ‘rearrangement’ and re-distribution of your property and wealth.
The election illustrates that physicians themselves are still trusted by the people. Several physicians, one of whom is Rand Paul, MD (an ophthalmologist) were elected to the U.S. Senate. And despite being ridiculed by other candidates, and even some physicians his message rang true for the people of Kentucky.
The forgers of our constitution were very brilliant in codifying our country’s foundational concepts. Those concepts brought us through many crises, and it should not be decimated by “ convenience to businesses, decision makers, nor Presidents. It has already been significantly degraded and is in danger of being destroyed.
Our republic was formed with the ability to reform itself through legal process codified in the US. Constitution. Our peaceful transition of ruling and power is peaceful despite significant and deeply entrenched diverse values of our peoples.
As long as these values of our legal citizens are respected as we move forward things should continue to flourish despite our current
difficulties. The Constitution was created for our present contingencies as an eternal document to be built upon ,just as the Magna Carta, and the Bill of Rights have served as part of our republic.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
restrictions”
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
California,"
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
minute.
"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.
del.icio.us Tags: health train,train wreck
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.
GML
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?
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…
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
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.
Call Me Senator from RightChange on Vimeo.
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 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
Bathroom
Guest Bedroom
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