Down at the Union Gospel Mission on 1st street there's a little clinic that's been there about 13 years. A mess of health care workers have volunteered to run a clinic by appointment from 9-3 tomorrow Christmas Eve. It's pretty sweet little clinic with dental chairs and dental xrays in a couple rooms and 2 small medical exam rooms. There's not a lot of medical supplies like injectables and lab testing supplies and stuff but we'll get supplies as we go.
Itsa free clinic and we're starting out with just seeing folks living at the mission and working/volunteering at the mission. Plus I'm allowed to schedule my own home-visit/email patients in there too.
We'll be doing a walk in clinic for the mission folks on Christmas from 1-5 if anyone wants to stop by and bring us food :)
Email me if you want to make an appointment for tomorrow
doctorcrafts@yahoo.com
Here's their website https://www.yugm.org/ministry.asp?ministryID=16 ; it'll get updated eventually with the more recent developments
right now it's got stuff about the med student clinic that's been running every other saturday run totally by the DO med students
there's a long story to this , of course
heath care workers who want to volunteer contact yugmvolunteers@gmail.com
Everyone who has wanted to donate money to me over the last 14 odd months, please donate to the UGM and the UGMC once we get a donate button.
Cheers!
Thursday, December 23, 2010
Monday, September 20, 2010
Same old song, different year
In the news today there's a flood of articles about flu shots reducing heart attacks. I've yet to find the original study but the news indicated British researchers reviewed charts and found a 21% decrease in the rate of heart attacks in people over 40 if they got the flu shot between september and mid november and a 12% decrease if they got the shot later in the year.
This isn't new. Last September stories like this were published
Before that there have been studies showing a 50% to 90% decrease in mortality in elderly people who received the flu shot.
All of these studies suffer from what's called "selection bias". People who choose to get the vaccine, especially elderly people, are more likely to seek medical care for their chronic conditions like high blood pressure or heart disease. Influenza doesn't account for more than 5% of deaths in the elderly and yet the shot somehow lowers mortality 50% or more? Additionally some of these studies found the "benefits" growing the following summer after the shot and flu season were long gone.
The theory that reducing the stress of the viral infection, influenza, will prevent heart attacks makes sense to me but it is equally reasonable that the myriad other viral infections that replace it (in the minority of vaccination recipients who do benefit) will stress the system just as much if not more. Influenza unlike a few other respiratory viruses isn't known to directly infect the heart muscle for example.
It's flu season and the stories touting benefits to vaccination are coming out of the woodwork again.
Here's a good summary of what we know about influenza from vaccinations to antiviral drugs.
This one specifically talks about the misleading results on mortality
gotta hit play on that one
So when you hear the flu shot prevents heart attacks say "that's selection bias bubba".
Thursday, September 16, 2010
Blame Manichanh
My PA friend sent me this article from one of them PA magazines
http://www.jaapa.com/pneumococcal-disease-swinging-away-at-a-dangerous-killer/article/177825/?DCMP=EMC-JAAPA_Perspectives
It got me all riled up and my comment ended up being a pretty good overview of several vaccines so I gotta save it here. You can stop reading now if you're not ready to spend like an hour thinking about this mess.
Are you serious? How about instead of reading CDC reports and recommendations and parroting them to PAs, we look at the actual clinical trials and quantify the benefits and risk of the vaccines you covered?
PCV-7: The 2 prelicensure trials show a decrease in IPD which becomes less pronounced over the short 3 year span of the studies. There is a marked serotype replacement phenomenon that continues to be studied to this day. PCV-7 was just mentioned in a JAMA article which reported a RCT showing serotype replacement with 19A nearly twice as often compared to unvaccinated controls. Additionally there is zero mortality benefit demonstrated in any PCV7 clinical trial and the pneumonia benefits don't reach statistical significance unless the trial was outside of the US where attack rates are much higher.
PCV7 isn't even recommended at this point with the new PCV13 taking its place. There were no clinical trials used in the approval of PCV13 except for immunology studies which showed borderline responses for 3 of the 13 serotypes by the by.
http://tinyurl.com/ybnc3xp
http://www.ncbi.nlm.nih.gov/pubmed/17456820
http://www.news-medical.net/news/20100224/FDA-approves-Wyeth-Pharmaceuticals-Prevnar-13-pneumococcal-disease-vaccine.aspx
http://jama.ama-assn.org/cgi/content/abstract/304/10/1099?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=pneumococcal&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Routine influenza vaccination was summarized so well by Cochrane that I've nothing to add:
http://www2.cochrane.org/reviews/en/ab004876.html (in the eldery)
http://www2.cochrane.org/reviews/en/ab005187.html (health care workers)
http://www2.cochrane.org/reviews/en/ab000364.html ( patients with asthma)
http://www.digitaljournal.com/article/288946 (swine flu and routine influenza vaccination)
Why would you recommend routine influenza vaccine? Is it because the CDC recommends it? That is NOT evidenced based medicine. It's expert opinion based medicine.
As for adult vaccination with PPV23: The results are underwhelming
http://www2.cochrane.org/reviews/en/ab000422.html
I do like the baseball analogy. PAs are like the designated hitter in the majors. They're paid less but reap huge rewards for the team. I agree it's time for the PAs to "step up to the plate" but only metaphorically speaking. It is time for PAs to join their brothers and sisters watching the GAME from the stands. It is they who pay your salary and it is they who you are duty bound to advocate for. Stop playing the GAME and start examining the men behind the curtain.
http://www.jaapa.com/pneumococcal-disease-swinging-away-at-a-dangerous-killer/article/177825/?DCMP=EMC-JAAPA_Perspectives
It got me all riled up and my comment ended up being a pretty good overview of several vaccines so I gotta save it here. You can stop reading now if you're not ready to spend like an hour thinking about this mess.
Are you serious? How about instead of reading CDC reports and recommendations and parroting them to PAs, we look at the actual clinical trials and quantify the benefits and risk of the vaccines you covered?
PCV-7: The 2 prelicensure trials show a decrease in IPD which becomes less pronounced over the short 3 year span of the studies. There is a marked serotype replacement phenomenon that continues to be studied to this day. PCV-7 was just mentioned in a JAMA article which reported a RCT showing serotype replacement with 19A nearly twice as often compared to unvaccinated controls. Additionally there is zero mortality benefit demonstrated in any PCV7 clinical trial and the pneumonia benefits don't reach statistical significance unless the trial was outside of the US where attack rates are much higher.
PCV7 isn't even recommended at this point with the new PCV13 taking its place. There were no clinical trials used in the approval of PCV13 except for immunology studies which showed borderline responses for 3 of the 13 serotypes by the by.
http://tinyurl.com/ybnc3xp
http://www.ncbi.nlm.nih.gov/pubmed/17456820
http://www.news-medical.net/news/20100224/FDA-approves-Wyeth-Pharmaceuticals-Prevnar-13-pneumococcal-disease-vaccine.aspx
http://jama.ama-assn.org/cgi/content/abstract/304/10/1099?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=pneumococcal&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Routine influenza vaccination was summarized so well by Cochrane that I've nothing to add:
http://www2.cochrane.org/reviews/en/ab004876.html (in the eldery)
http://www2.cochrane.org/reviews/en/ab005187.html (health care workers)
http://www2.cochrane.org/reviews/en/ab000364.html ( patients with asthma)
http://www.digitaljournal.com/article/288946 (swine flu and routine influenza vaccination)
Why would you recommend routine influenza vaccine? Is it because the CDC recommends it? That is NOT evidenced based medicine. It's expert opinion based medicine.
As for adult vaccination with PPV23: The results are underwhelming
http://www2.cochrane.org/reviews/en/ab000422.html
I do like the baseball analogy. PAs are like the designated hitter in the majors. They're paid less but reap huge rewards for the team. I agree it's time for the PAs to "step up to the plate" but only metaphorically speaking. It is time for PAs to join their brothers and sisters watching the GAME from the stands. It is they who pay your salary and it is they who you are duty bound to advocate for. Stop playing the GAME and start examining the men behind the curtain.
Monday, August 30, 2010
Good News, Cancer Rates and Health Care Costs Decreasing
http://www.kaiserhealthnews.org/Daily-Reports/2010/August/30/Medical-Imaging.aspx
http://www.kaiserhealthnews.org/Stories/2010/August/23/imaging-tests-health-risks-sidebar.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+khn%2Ffulltext+%28All+Kaiser+Health+News+%28Full+Text%29%29
-------------------
To have something in the journal Radiology that calls for evidence-based guidelines for when to order a CT....... Leaves me speechless.
This combined with the decreases in screening mammograms will decrease cancer rates noticeably and cut a major source of revenue for hospitals and specialists. Health care expenditures are going to decrease because of this. That's not good news for the larger institutions' bottom line.
So let's summarize:
Less cancer + less expensive health care = financial hardship for radiologists, oncologists and hospitals
That's a recipe for disaster, having the incentives between patients and institutions clash so completely.
Let's see if I find a copy of the journal articles themselves.
"Part of the explosion in medical imaging over the past two decades may be attributable to overuse, and steps need to be taken to cut back," according to a study in the journal Radiology, MedPage Today/ABC News reports.
"Initiatives include rewriting the fee-for-service system, curbing physician self-referral practices, and creating appropriateness criteria for imaging, according to William R. Hendee of the Medical College of Wisconsin in Milwaukee and colleagues. … Imaging services and their costs have grown at about twice the rate of other technologies in healthcare including lab procedures and pharmaceuticals, Hendee and colleagues wrote." Overuse of imaging "also exposes the public to unnecessary radiation." The authors "called for a national effort to develop evidence-based appropriateness criteria for imaging, so that physicians can make greater use of practice guidelines in requesting and conducting imaging studies" (Fiore, 8/29).
This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.
http://www.kaiserhealthnews.org/Stories/2010/August/23/imaging-tests-health-risks-sidebar.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+khn%2Ffulltext+%28All+Kaiser+Health+News+%28Full+Text%29%29
Several recent studies show the risk of cancer associated with CT scans appears to be greater than previously believed.
A study published last year in the Archives of Internal Medicine projected that 29,000 future cancers will be directly attributable to the 57 million CT scans performed in the United States in 2007.
Another study last year by the National Council on Radiation Protection and Measurements found medical imaging was responsible for about half the total radiation exposure to the typical U.S. resident, up from just 20 percent in the 1980s. The council was chartered by Congress to recommend ways to limit radiation exposure.
A 2007 study published in The New England Journal of Medicine estimated that 0.4 percent of all cancers in the country may be attributable to the radiation from CT studies. By adjusting this estimate for current CT use, this estimate might now be as high as 2 percent.
"By definition, an unnecessary exam that uses radiation, such as a CT scan, is an unnecessary exposure to radiation and, in self-referring facilities, perhaps an inordinately high radiation dose since many of them are not properly accredited," said John Patti, chairman of the American College of Radiology’s board of chancellors.
-------------------
To have something in the journal Radiology that calls for evidence-based guidelines for when to order a CT....... Leaves me speechless.
This combined with the decreases in screening mammograms will decrease cancer rates noticeably and cut a major source of revenue for hospitals and specialists. Health care expenditures are going to decrease because of this. That's not good news for the larger institutions' bottom line.
So let's summarize:
Less cancer + less expensive health care = financial hardship for radiologists, oncologists and hospitals
That's a recipe for disaster, having the incentives between patients and institutions clash so completely.
Let's see if I find a copy of the journal articles themselves.
Wednesday, July 7, 2010
Happy Birthday to Me
So way back on May 8th I got this cake in the mail. My artist friend from Bellingham makes treats and sends them through the mail.
She actually designed her own little business around it on flickr.
She also takes incredible pictures which end up in the northwest newspapers.
So if you want custom made confectioneries just let Juline know.
http://www.flickr.com/photos/julescakewalk
And her pictures are here http://www.flickr.com/photos/julineb/
But most importantly, those of you with flickr accounts (and you automatically have one if you have aYahoo mail account) please favorite this picture of the cake and/or comment on it.
http://www.flickr.com/photos/julineb/4580632440/in/set-72157622526233311/
It's for a good cause.
Friday, June 11, 2010
Just in time for summer
http://www.cnn.com/2010/TECH/innovation/06/09/technology.prize.window/index.html?hpt=Sbin
A professor who invented low-cost solar cells that may be incorporated into energy-producing windows has been awarded the Millennium Technology Prize.
A professor who invented low-cost solar cells that may be incorporated into energy-producing windows has been awarded the Millennium Technology Prize.
Monday, June 7, 2010
Overtreatment in the news
http://news.yahoo.com/s/ap/20100607/ap_on_bi_ge/us_med_overtreated
Overtreatment means someone could have fared as well or better with a lesser test or therapy, or maybe even none at all. Avoiding it is less about knowing when to say no, than knowing when to say, "Wait, doc, I need more information!"
It's great this is in the news but again the way overtreatment is framed leaves people without a clear picture of the harms. They do mention a risk of cancer with excessive CT scans but they refer only to the "limitations" of PSA screening. They don't mention the harms of screening mammograms at all. They don't mention the blockbuster (expensive) vaccines gardasil and prevnar which have more evidence of harm than benefit.
They mention a couple medications which are overprescribed such as Nexium and antibiotics but they again leave the magnitude of harm vague.
It's interesting to watch the system attempt to retreat slightly and reduce the overtreatment burden slightly with guidelines and payment incentives for physicians to counsel more and test/over treat less.
Amend and reform, amend and reform.
But what if the core of the system is rotten?
What if the fundamentals of health care incentivize overtreatment? How are some guidelines going to counteract the massive marketing power of pharmaceutical companies?
See it's times like these that "lip stick on a pig" would be appropriate but our friend Sarah P ruined that gem for us all.
Oh well.
But this article does sample a pretty large chunk of the super-sized american health care experience. It's a superficial view of the harms from all this over testing, over treating. It doesn't make the connection between overtreatment and marketing. It doesn't make the connection between over everything and lack of coverage via high costs.
It doesn't talk about how overtreatment and over testing are the same things as economic growth in the so called health care industry.
IF
IF we somehow reverse this trend toward more and more unnecessary/harmful health care, then what will it do to the economy? I mean other than the military and other government spending, health care has been one of the few consistent sources of economic growth. Do we really have a system that punishes society with yet another bursting bubble (dot com followed by housing followed now by health care) because society finally figures out that more is less?
Because as we break this mindless cycle of excessive treatment and testing and reduce the harms that go with it all, some mighty powerful industries will be forced to shrink and good, hardworking people will be out of a job.
The stuff about low back pain in the article reminds me of a local phenomenon. Here in Yakima one of the few highly lucrative health care institutions is the pain clinic. The pain clinic functions as a kind of deep injection factory. Nerve blocks, epidurals, spinals. These deep injections often under xray guidance pay very well. The benefits are almost always short-lived and the potential harms remain vague in most minds but the financial incentives to do more tests and more procedures are painfully evident at the pain clinic.
And now that the ER has a fancy new MRI scanner, there's even more opportunity to find common disc abnormalities that can be harvested at the pain clinic.
But almost all of their business at the pain clinic is discretionary spending. Most of the patients walking in their doors will either get better on their own and/or not benefit from the procedures preformed.
It's not that we don't need specialists who can do nerve blocks well. It's just that the incentive to do more procedures, advertise and repeat runs counter to the best interests of the average patient in pain.
Put another way: If most people with low back pain will get better just as rapidly with certain treatments as without, then most people are harmed in some fashion by said treatments.
It's pretty grotesque but almost every popular AKA lucrative treatment and test in medicine is over applied. It just makes sense, if you limit interventions to just the people who need them, you are missing out on a larger market. The goal, financially, of any medical intervention is to apply something studied in a limited population of patients to the general population.
Like with acid blockers like Nexium. If it works well in people with ulcers then focus on the symptoms that are most common in the general population and get people used to treating the symptoms. There are thousands of times more potential customers who have occasional heartburn versus the rare individual with stomach ulcers.
Interesting times
Overtreatment means someone could have fared as well or better with a lesser test or therapy, or maybe even none at all. Avoiding it is less about knowing when to say no, than knowing when to say, "Wait, doc, I need more information!"
It's great this is in the news but again the way overtreatment is framed leaves people without a clear picture of the harms. They do mention a risk of cancer with excessive CT scans but they refer only to the "limitations" of PSA screening. They don't mention the harms of screening mammograms at all. They don't mention the blockbuster (expensive) vaccines gardasil and prevnar which have more evidence of harm than benefit.
They mention a couple medications which are overprescribed such as Nexium and antibiotics but they again leave the magnitude of harm vague.
It's interesting to watch the system attempt to retreat slightly and reduce the overtreatment burden slightly with guidelines and payment incentives for physicians to counsel more and test/over treat less.
Amend and reform, amend and reform.
But what if the core of the system is rotten?
What if the fundamentals of health care incentivize overtreatment? How are some guidelines going to counteract the massive marketing power of pharmaceutical companies?
See it's times like these that "lip stick on a pig" would be appropriate but our friend Sarah P ruined that gem for us all.
Oh well.
But this article does sample a pretty large chunk of the super-sized american health care experience. It's a superficial view of the harms from all this over testing, over treating. It doesn't make the connection between overtreatment and marketing. It doesn't make the connection between over everything and lack of coverage via high costs.
It doesn't talk about how overtreatment and over testing are the same things as economic growth in the so called health care industry.
IF
IF we somehow reverse this trend toward more and more unnecessary/harmful health care, then what will it do to the economy? I mean other than the military and other government spending, health care has been one of the few consistent sources of economic growth. Do we really have a system that punishes society with yet another bursting bubble (dot com followed by housing followed now by health care) because society finally figures out that more is less?
Because as we break this mindless cycle of excessive treatment and testing and reduce the harms that go with it all, some mighty powerful industries will be forced to shrink and good, hardworking people will be out of a job.
The stuff about low back pain in the article reminds me of a local phenomenon. Here in Yakima one of the few highly lucrative health care institutions is the pain clinic. The pain clinic functions as a kind of deep injection factory. Nerve blocks, epidurals, spinals. These deep injections often under xray guidance pay very well. The benefits are almost always short-lived and the potential harms remain vague in most minds but the financial incentives to do more tests and more procedures are painfully evident at the pain clinic.
And now that the ER has a fancy new MRI scanner, there's even more opportunity to find common disc abnormalities that can be harvested at the pain clinic.
But almost all of their business at the pain clinic is discretionary spending. Most of the patients walking in their doors will either get better on their own and/or not benefit from the procedures preformed.
It's not that we don't need specialists who can do nerve blocks well. It's just that the incentive to do more procedures, advertise and repeat runs counter to the best interests of the average patient in pain.
Put another way: If most people with low back pain will get better just as rapidly with certain treatments as without, then most people are harmed in some fashion by said treatments.
It's pretty grotesque but almost every popular AKA lucrative treatment and test in medicine is over applied. It just makes sense, if you limit interventions to just the people who need them, you are missing out on a larger market. The goal, financially, of any medical intervention is to apply something studied in a limited population of patients to the general population.
Like with acid blockers like Nexium. If it works well in people with ulcers then focus on the symptoms that are most common in the general population and get people used to treating the symptoms. There are thousands of times more potential customers who have occasional heartburn versus the rare individual with stomach ulcers.
Interesting times
Saturday, June 5, 2010
Stress
http://www.yesmagazine.org/happiness/want-the-good-life-your-neighbors-need-it-too
....It's not the inferior housing that gives you heart disease, it's the stress, the hopelessness, the anxiety, the depression you feel around that. The psychosocial effects of inequality affect the quality of human relationships. Because we are social beings, it's the social environment and social relationships that are the most important stressors. For individuals, of course, if you're going to lose your home, or if you're terribly in debt, those can be more powerful stressors. But amongst the population as a whole, it looks as if these social factors are the biggest stressors because so many people are exposed to them.
...
If you grow up in an unequal society, your actual experience of human relationships is different. Your idea of human nature changes. If you grow up in a consumerist society, you think of human beings as self-interested. In fact, consumerism is so powerful because we're so highly social. It's not that we actually have an overwhelming desire to accumulate property, it's that we're concerned with how we're seen all the time. So actually, we're misunderstanding consumerism. It's not material self-interest, it's that we're so sensitive. We experience ourselves through each other's eyes—and that's the reason for the labels and the clothes and the cars.
.....
....It's not the inferior housing that gives you heart disease, it's the stress, the hopelessness, the anxiety, the depression you feel around that. The psychosocial effects of inequality affect the quality of human relationships. Because we are social beings, it's the social environment and social relationships that are the most important stressors. For individuals, of course, if you're going to lose your home, or if you're terribly in debt, those can be more powerful stressors. But amongst the population as a whole, it looks as if these social factors are the biggest stressors because so many people are exposed to them.
...
If you grow up in an unequal society, your actual experience of human relationships is different. Your idea of human nature changes. If you grow up in a consumerist society, you think of human beings as self-interested. In fact, consumerism is so powerful because we're so highly social. It's not that we actually have an overwhelming desire to accumulate property, it's that we're concerned with how we're seen all the time. So actually, we're misunderstanding consumerism. It's not material self-interest, it's that we're so sensitive. We experience ourselves through each other's eyes—and that's the reason for the labels and the clothes and the cars.
.....
The gift in a sense is a symbol that you and I don't compete for the necessities of life. We don't need to fight each other for them. You feel a sense of indebtedness and you reciprocate the gift, which anthropologists have suggested is a sort of basic social contract. That symbolism is still really important: You invite your friends over, sit around the same table, and share food, the basic necessity of life. The symbolism is also there in religious services and communion—these things are very fundamental, very deep.
Inequality is a reflection of how strong hierarchies are, how much we share or how much we don't. It shows us which part of our potential we're developing. What game do I play? Have I got to fend for myself? Or have I got to get people to trust me and cooperate with me? Is my survival dependent on good relationships? Are you my rival? Are you going to steal from me? Have I got to keep what I've got, defend it? Or can we share? Human beings can do both. We've lived in the most egalitarian and the most awful, hierarchical, tyrannical societies. It's very interesting that we can measure how unequal societies are and how that can elicit more of certain kinds of behavior.
Friday, June 4, 2010
Blow Back
http://www.yesmagazine.org/issues/water-solutions/real-people-v.-corporate-people-the-fight-is-on
Real People v. Corporate “People”: The Fight Is On
The Supreme Court says corporations can spend as much money as they want on political advertising. Millions of Americans say they've had it.
Hard to add anything to that so I won't.
Saturday, May 29, 2010
Jama Article about shenanigans and a loose tangent on a new vaccine
http://jama.ama-assn.org/cgi/content/short/303/20/2058
So of the articles reporting on clinical trials that didn't reach statistical significance 40% contained some "spin". Spin being a fancy way to say lie. Distract, trick, deceive .... Whatever
They say in the comment section of the article (which isn't free online):
Our results are consistent with those of other related studies showing a positive relation between financial ties and favorable conclusions stated in trial reports. Other studies assessed discrepancies between results and their interpretations in the Conclusions sections.....
The publication process in biomedical research tends to favor statistically significant results and to be responsible for "optimism bias" (ie, unwarranted belief in the efficacy of a new therapy). Reports of RTCs with statistically significant results for outcomes are published more often and more rapidly than are those of trials with statistically nonsignificant results. Good evidence exists of selective reporting of statistically significant results for outcomes in published articles.
So, not only are clinical trials showing a positive effect from a new med or treatment more likely to be published and published faster than those showing negative effects or lack of benefit but also trials get published spinning a lack of effect into benefit?
It's not really a surprise then when medications proven to increase suicidal thinking in teens and children get marketed as safe and effective depression treatments.
Of course the same JAMA has an entire section called "from the centers for disease control and prevention". This issue has basically an Ad for Prevnar 13. The CDC editorial note points out that "Overall, rates of IPD have remained stable at 22-25 cases per 100,000 since 2002."
IPD is invasive pneumococcal disease. It means the bacteria pneumococcus got in the ear fluid, blood, lungs, spinal fluid. Prevnar came out in 2000 and wasn't widely available because of production problems for at least 2 years. If Prevnar made a big impact, then why didn't the rates drop more?
Oh but the CDC looks at a subgroup for us, children less than 5 years old, it shows that in 2007 black children had a rate of 35.8 per 100,000 while other races was 30.7 and white children 18.4
Prevnar was famous for how it was going to eliminate the racial disparity of the infectious diseases caused by pneumococcus.
This new vaccine, Prevnar 13, covers approximately 64% of the serotypes that cause IPD in 2007. The previous prevnar covered about 80%. There's no worry about testing the effectiveness of the new vaccine. They just did some antibody studies and then backpedaled on how they measured success of that when 3 serotype-specific antibodies didn't reach target levels after 3 shots. After 4 shots one serotype (6) still wasn't reaching the target antibody levels.
Who knows how this will translate to clinical cases of IPD. MAYBE we will get lucky and drive the rate down further from 22-25 per 100,000. And maybe we'll get lucky and not cause another serotype like 19A which currently tends to be multidrug resistant and difficult to cure. And maybe the MRSA spike in children wasn't related to the effects the 1st Prevnar had on the normal nasal flora of children.
I guess we're going to find out as the experiment rolls on.
Unless the 24% uptake of the swine flu shot is any indication of the state of trust in organizations like the CDC.
So of the articles reporting on clinical trials that didn't reach statistical significance 40% contained some "spin". Spin being a fancy way to say lie. Distract, trick, deceive .... Whatever
They say in the comment section of the article (which isn't free online):
Our results are consistent with those of other related studies showing a positive relation between financial ties and favorable conclusions stated in trial reports. Other studies assessed discrepancies between results and their interpretations in the Conclusions sections.....
The publication process in biomedical research tends to favor statistically significant results and to be responsible for "optimism bias" (ie, unwarranted belief in the efficacy of a new therapy). Reports of RTCs with statistically significant results for outcomes are published more often and more rapidly than are those of trials with statistically nonsignificant results. Good evidence exists of selective reporting of statistically significant results for outcomes in published articles.
So, not only are clinical trials showing a positive effect from a new med or treatment more likely to be published and published faster than those showing negative effects or lack of benefit but also trials get published spinning a lack of effect into benefit?
It's not really a surprise then when medications proven to increase suicidal thinking in teens and children get marketed as safe and effective depression treatments.
Of course the same JAMA has an entire section called "from the centers for disease control and prevention". This issue has basically an Ad for Prevnar 13. The CDC editorial note points out that "Overall, rates of IPD have remained stable at 22-25 cases per 100,000 since 2002."
IPD is invasive pneumococcal disease. It means the bacteria pneumococcus got in the ear fluid, blood, lungs, spinal fluid. Prevnar came out in 2000 and wasn't widely available because of production problems for at least 2 years. If Prevnar made a big impact, then why didn't the rates drop more?
Oh but the CDC looks at a subgroup for us, children less than 5 years old, it shows that in 2007 black children had a rate of 35.8 per 100,000 while other races was 30.7 and white children 18.4
Prevnar was famous for how it was going to eliminate the racial disparity of the infectious diseases caused by pneumococcus.
This new vaccine, Prevnar 13, covers approximately 64% of the serotypes that cause IPD in 2007. The previous prevnar covered about 80%. There's no worry about testing the effectiveness of the new vaccine. They just did some antibody studies and then backpedaled on how they measured success of that when 3 serotype-specific antibodies didn't reach target levels after 3 shots. After 4 shots one serotype (6) still wasn't reaching the target antibody levels.
Who knows how this will translate to clinical cases of IPD. MAYBE we will get lucky and drive the rate down further from 22-25 per 100,000. And maybe we'll get lucky and not cause another serotype like 19A which currently tends to be multidrug resistant and difficult to cure. And maybe the MRSA spike in children wasn't related to the effects the 1st Prevnar had on the normal nasal flora of children.
I guess we're going to find out as the experiment rolls on.
Unless the 24% uptake of the swine flu shot is any indication of the state of trust in organizations like the CDC.
Friday, May 28, 2010
Now THIS is punishment
http://money.cnn.com/2010/05/26/news/companies/boycott_BP/index.htm
The truth is it's not as easy to boycott BP as activists might think because BP is one of the biggest companies on the planet with many different businesses. So, even if you're not buying BP gas you're likely a consumer. Your mechanic may be putting Castrol motor oil into your car, the soda you're drinking today may be in a can produced from Arco Aluminum and the next aircraft you board may using BP fuel and BP hydraulic fluid.
Oh really? Well a .2 second google search alerted me to the group of 118,000 declaring their intention to boycott BP.
http://www.facebook.com/pages/Boycott-BP/119101198107726
And right there on the front page it says
Boycott BP stations. BP brands to boycott include Castrol, Arco, Aral, am/pm, Amoco, and Wild Bean Cafe, Safeway gas. laissez le bon temps rouler pas chez Bp.http://twitter.com/bayoule
It's not that hard to find out which products BP profits from and punish them at a time when they are the most vulnerable.
It's a shame that good people who work for BP and are insured by BP are going to be harmed by the fall out. But just like with pharmaceuticals that do us more harm than good and/or are overhyped/marketed, we have to be selfish with our health.
Powering civilization with ancient carbon is poisoning our air and water. Even without this spill we have to change our power source to survive.
"There's not enough money"
Absurd. Money isn't real. It's just one old concept in a medieval method of organizing society. We wave a congressional magic wand and make 2 trillion appear to bail out financial institutions who somehow managed to lose at a rigged game.
I'm all for punishing BP just to remind everyone how powerful a weapon the masses hold. Especially in a consumer driven economy, our mundane choices prop up the wealthy. But I wish the boycott were more of an ultimatum....
Something like "we will boycott BP until they begin applying their drilling expertise to geothermal heat mining"
Google that and look at the estimates from the US government about the potential zetajules of energy waiting to be mined in the US alone.
NEW YORK (CNN) -- An online movement to boycott BP for its role in the Gulf of Mexico oil spill is growing at a rate of better than 25,000 names a day.
"I won't buy their gas any more. I won't patronize a company that's destroying our planet," New Jersey resident Patricia Jarozynski told CNN, one of 118,000 fans of the "Boycott BP" Facebook page as of this writing.
The truth is it's not as easy to boycott BP as activists might think because BP is one of the biggest companies on the planet with many different businesses. So, even if you're not buying BP gas you're likely a consumer. Your mechanic may be putting Castrol motor oil into your car, the soda you're drinking today may be in a can produced from Arco Aluminum and the next aircraft you board may using BP fuel and BP hydraulic fluid.
Oh really? Well a .2 second google search alerted me to the group of 118,000 declaring their intention to boycott BP.
http://www.facebook.com/pages/Boycott-BP/119101198107726
And right there on the front page it says
Boycott BP stations. BP brands to boycott include Castrol, Arco, Aral, am/pm, Amoco, and Wild Bean Cafe, Safeway gas. laissez le bon temps rouler pas chez Bp.http://twitter.com/bayoule
It's not that hard to find out which products BP profits from and punish them at a time when they are the most vulnerable.
It's a shame that good people who work for BP and are insured by BP are going to be harmed by the fall out. But just like with pharmaceuticals that do us more harm than good and/or are overhyped/marketed, we have to be selfish with our health.
Powering civilization with ancient carbon is poisoning our air and water. Even without this spill we have to change our power source to survive.
"There's not enough money"
Absurd. Money isn't real. It's just one old concept in a medieval method of organizing society. We wave a congressional magic wand and make 2 trillion appear to bail out financial institutions who somehow managed to lose at a rigged game.
I'm all for punishing BP just to remind everyone how powerful a weapon the masses hold. Especially in a consumer driven economy, our mundane choices prop up the wealthy. But I wish the boycott were more of an ultimatum....
Something like "we will boycott BP until they begin applying their drilling expertise to geothermal heat mining"
Google that and look at the estimates from the US government about the potential zetajules of energy waiting to be mined in the US alone.
In the words of Bill Murray, "which is nice"
http://www.nytimes.com/2010/05/25/opinion/25gyatso.html
WHEN I was a boy in Tibet, I felt that my own Buddhist religion must be the best — and that other faiths were somehow inferior. Now I see how naïve I was, and how dangerous the extremes of religious intolerance can be today.
Such tensions are likely to increase as the world becomes more interconnected and cultures, peoples and religions become ever more entwined. The pressure this creates tests more than our tolerance — it demands that we promote peaceful coexistence and understanding across boundaries.
Granted, every religion has a sense of exclusivity as part of its core identity. Even so, I believe there is genuine potential for mutual understanding. While preserving faith toward one’s own tradition, one can respect, admire and appreciate other traditions.
An early eye-opener for me was my meeting with the Trappist monk Thomas Merton in India shortly before his untimely death in 1968. Merton told me he could be perfectly faithful to Christianity, yet learn in depth from other religions like Buddhism. The same is true for me as an ardent Buddhist learning from the world’s other great religions.
A main point in my discussion with Merton was how central compassion was to the message of both Christianity and Buddhism. In my readings of the New Testament, I find myself inspired by Jesus’ acts of compassion. His miracle of the loaves and fishes, his healing and his teaching are all motivated by the desire to relieve suffering.
I’m a firm believer in the power of personal contact to bridge differences, so I’ve long been drawn to dialogues with people of other religious outlooks. The focus on compassion that Merton and I observed in our two religions strikes me as a strong unifying thread among all the major faiths. And these days we need to highlight what unifies us.
Take Judaism, for instance. I first visited a synagogue in Cochin, India, in 1965, and have met with many rabbis over the years. I remember vividly the rabbi in the Netherlands who told me about the Holocaust with such intensity that we were both in tears. And I’ve learned how the Talmud and the Bible repeat the theme of compassion, as in the passage in Leviticus that admonishes, “Love your neighbor as yourself.”
In my many encounters with Hindu scholars in India, I’ve come to see the centrality of selfless compassion in Hinduism too — as expressed, for instance, in the Bhagavad Gita, which praises those who “delight in the welfare of all beings.” I’m moved by the ways this value has been expressed in the life of great beings like Mahatma Gandhi, or the lesser-known Baba Amte, who founded a leper colony not far from a Tibetan settlement in Maharashtra State in India. There he fed and sheltered lepers who were otherwise shunned. When I received my Nobel Peace Prize, I made a donation to his colony.
Compassion is equally important in Islam — and recognizing that has become crucial in the years since Sept. 11, especially in answering those who paint Islam as a militant faith. On the first anniversary of 9/11, I spoke at the National Cathedral in Washington, pleading that we not blindly follow the lead of some in the news media and let the violent acts of a few individuals define an entire religion.
Let me tell you about the Islam I know. Tibet has had an Islamic community for around 400 years, although my richest contacts with Islam have been in India, which has the world’s second-largest Muslim population. An imam in Ladakh once told me that a true Muslim should love and respect all of Allah’s creatures. And in my understanding, Islam enshrines compassion as a core spiritual principle, reflected in the very name of God, the “Compassionate and Merciful,” that appears at the beginning of virtually each chapter of the Koran.
Finding common ground among faiths can help us bridge needless divides at a time when unified action is more crucial than ever. As a species, we must embrace the oneness of humanity as we face global issues like pandemics, economic crises and ecological disaster. At that scale, our response must be as one.
Harmony among the major faiths has become an essential ingredient of peaceful coexistence in our world. From this perspective, mutual understanding among these traditions is not merely the business of religious believers — it matters for the welfare of humanity as a whole.
Friday, May 21, 2010
Chris Rock's Movie Good Hair
On a recent trip cut short by my dog getting another major abdominal surgery I saw the movie Good Hair.
That's one hell of an opening sentence eh?
Yeah I went to Canada too. What's up with the pre-check point check point when you go over the bridge before meeting the Canadian border guards? I think it was a group of american border guards who were bored. But they slowed down the process more than the actual border crossing into Canada.
Any-who, the movie is a documentary/satire of sorts. I learned a lot watching it. Like the chemical in hair straightener is sodium hydroxide, more commonly known as lye.
http://en.wikipedia.org/wiki/Sodium_hydroxide
Wiki says most over the counter products switched to less caustic bases but that "professionals" still use the older, stronger sodium hydroxide preparations.
http://en.wikipedia.org/wiki/Relaxer
"Manufacturers vary the sodium hydroxide content of the solution from 5% to 10% and the pH factor between 10 and 14"
This looks like the same % found in stuff like liquid drano http://en.wikipedia.org/wiki/Drano
Women and children put this stuff in their hair and on their scalp regularly to break down the chemical bonds that make the hair curl.
But the big money is made in hair weaves. Which I was surprised to learn are mostly made of human hair from India.
http://en.wikipedia.org/wiki/Tirumala_Venkateswara_Temple
Many devotees also have their head tonsured as an offer. The daily amount of hair collected is over a ton.[15] The hair thus gathered is sold by the temple organization a few times a year by public auction to international buyers for use as hair extensions and in cosmetics,[16] bringing over $6 million to the temple's treasury
On the other side of the world, Americans pay around 1000 dollars for a good hair weave. There's all this maintenance that has to be done on the hair as well and plenty of women spend 10k dollars or more on hair a year.
Chris Rock interviewed a bunch of celebrities including the Reverend Al Sharpton who said something to the effect that black people should make money off the sale of weaves purchased by black people. It's interesting that women spending 1000 dollars at a time for other people's hair so they may look more "natural" is a fine business opportunity. I guess it's ok to exploit a people if you're the same color.
And don't think these themes are isolated to black women and curly hair modification. Cosmetics are in general chocked full of toxic metals and petroleum chemicals. You can't even check the ingredient list on a lot of these products because it's "proprietary". You have to protect the patent rights of corporations before you disclose the potentially harmful toxins going on a woman's FACE.
Which reminds me of the Walmart cadmium jewelry story.
Anyone see this ?
http://www.thaindian.com/newsportal/health1/warning-walmart-issues-recall-on-ge-coffee-maker_100367643.html
Oh snap, I put "walmart cadmium" into google and that popped up 1st in the news feed.
Cadmium in the children's jewelry and now GE is selling coffee makers that burn down houses? I wonder what the story is behind that? I'm going to guess it has something to do with using cheap materials and slave labor, but I'm too lazy to dig into it right now.
But speaking of GE, word around the campfire locally is that the mammogram center has seen a steep drop off in screening mammography the past 6 months. Wonder how that combination of ever increasing health care costs and the recent press over the substantial harms of screening mammograms is affecting the bottom line of our mighty health care institutions. It's stuff like that that makes it difficult to afford underground parking garage construction.
/just sayin
For those of you wondering what happened to the hound dog; he's recovering from a false alarm surgery. He went into the vet for vomiting and they felt a big spleen and his xray looked funny. After cutting him open, everything looked normal and they left him with his spleen. He's mighty sore but no longer vomiting.
That's one hell of an opening sentence eh?
Yeah I went to Canada too. What's up with the pre-check point check point when you go over the bridge before meeting the Canadian border guards? I think it was a group of american border guards who were bored. But they slowed down the process more than the actual border crossing into Canada.
Any-who, the movie is a documentary/satire of sorts. I learned a lot watching it. Like the chemical in hair straightener is sodium hydroxide, more commonly known as lye.
http://en.wikipedia.org/wiki/Sodium_hydroxide
Wiki says most over the counter products switched to less caustic bases but that "professionals" still use the older, stronger sodium hydroxide preparations.
http://en.wikipedia.org/wiki/Relaxer
"Manufacturers vary the sodium hydroxide content of the solution from 5% to 10% and the pH factor between 10 and 14"
This looks like the same % found in stuff like liquid drano http://en.wikipedia.org/wiki/Drano
Women and children put this stuff in their hair and on their scalp regularly to break down the chemical bonds that make the hair curl.
But the big money is made in hair weaves. Which I was surprised to learn are mostly made of human hair from India.
http://en.wikipedia.org/wiki/Tirumala_Venkateswara_Temple
Many devotees also have their head tonsured as an offer. The daily amount of hair collected is over a ton.[15] The hair thus gathered is sold by the temple organization a few times a year by public auction to international buyers for use as hair extensions and in cosmetics,[16] bringing over $6 million to the temple's treasury
On the other side of the world, Americans pay around 1000 dollars for a good hair weave. There's all this maintenance that has to be done on the hair as well and plenty of women spend 10k dollars or more on hair a year.
Chris Rock interviewed a bunch of celebrities including the Reverend Al Sharpton who said something to the effect that black people should make money off the sale of weaves purchased by black people. It's interesting that women spending 1000 dollars at a time for other people's hair so they may look more "natural" is a fine business opportunity. I guess it's ok to exploit a people if you're the same color.
And don't think these themes are isolated to black women and curly hair modification. Cosmetics are in general chocked full of toxic metals and petroleum chemicals. You can't even check the ingredient list on a lot of these products because it's "proprietary". You have to protect the patent rights of corporations before you disclose the potentially harmful toxins going on a woman's FACE.
Which reminds me of the Walmart cadmium jewelry story.
Anyone see this ?
http://www.thaindian.com/newsportal/health1/warning-walmart-issues-recall-on-ge-coffee-maker_100367643.html
Oh snap, I put "walmart cadmium" into google and that popped up 1st in the news feed.
Just yesterday it was announced that Walmart, the huge department store chain, has finally recalled their Miley Cyrus line of jewelry after finding out that it contained dangerous levels of cadmium back in February. Although they claimed that the jewelry was not made for children, since many young girls do seek out the ‘Miley Cyrus’ name, the products were posing a danger to them which Walmart was aware of for 3 months prior to the recall. And now, as announced by the CSPC, Walmart has issued a recall on their GE coffeemakers.
The US Consumer Product Safety Commission has announced on their website that Walmart is voluntarily recalling several of their GE coffeemakers. To find out if your product is on this list check the CSPC website here. The huge headline for the site states, “Walmart Recalls General Electric® Coffee Makers Due to Fire Hazard”. It estimates that about 900,000 coffee makers are included in this recall. Also stated on this site is the following:
“Hazard: The coffee maker can overheat, posing fire and burn hazards to consumers.
Incidents/Injuries: Walmart has received 83 reports of overheating, smoking, melting, burning and fire, including three reports of minor burn injuries to consumer’s hands, feet and torso. Reports of property damage include a significant kitchen fire and damage to countertops, cabinets and a wall.”
Incidents/Injuries: Walmart has received 83 reports of overheating, smoking, melting, burning and fire, including three reports of minor burn injuries to consumer’s hands, feet and torso. Reports of property damage include a significant kitchen fire and damage to countertops, cabinets and a wall.”
Cadmium in the children's jewelry and now GE is selling coffee makers that burn down houses? I wonder what the story is behind that? I'm going to guess it has something to do with using cheap materials and slave labor, but I'm too lazy to dig into it right now.
But speaking of GE, word around the campfire locally is that the mammogram center has seen a steep drop off in screening mammography the past 6 months. Wonder how that combination of ever increasing health care costs and the recent press over the substantial harms of screening mammograms is affecting the bottom line of our mighty health care institutions. It's stuff like that that makes it difficult to afford underground parking garage construction.
/just sayin
For those of you wondering what happened to the hound dog; he's recovering from a false alarm surgery. He went into the vet for vomiting and they felt a big spleen and his xray looked funny. After cutting him open, everything looked normal and they left him with his spleen. He's mighty sore but no longer vomiting.
Monday, May 17, 2010
Richest Country on Earth
Read this is a news story today:
The United States has the highest incarceration rate on the planet - five times the world's average. A total of 2,380,000 people are now in prison. The U.S. has five percent of the world's population, but 25 percent of the world's prison population.
Minorities make up a disproportionately large share of inmates. Black males have a 32 percent chance of serving time in prison at some point in their lives
When we combine this number with the % of young people unemployed (anywhere from 30-50% currently with the recession) and the % of young people in the military, you end up with the vast majority of youth in this country.
Unemployed, serving in the military or in prison....
Is this really the best we can do? This is the apex of progress?
And don't tell me military service isn't so bad. We've been at war for damn near a decade with no end in sight. Soldiers are killing themselves at ever increasing rates. Hell we haven't demobilized the military since world war 2.
Most of our youth enter adulthood unemployed, as soldiers or as prisoners.
What does that do to a society?
The wealth distribution gap continues to grow. Prisons, the military and the entitlement systems are our most consistent growth industries.
In such a land, it matters not who is elected president.
Our root systems are corrupting.
We will find a way of living differently because to continue as we are is suicide.
We will find a way of living differently.
The United States has the highest incarceration rate on the planet - five times the world's average. A total of 2,380,000 people are now in prison. The U.S. has five percent of the world's population, but 25 percent of the world's prison population.
Minorities make up a disproportionately large share of inmates. Black males have a 32 percent chance of serving time in prison at some point in their lives
When we combine this number with the % of young people unemployed (anywhere from 30-50% currently with the recession) and the % of young people in the military, you end up with the vast majority of youth in this country.
Unemployed, serving in the military or in prison....
Is this really the best we can do? This is the apex of progress?
And don't tell me military service isn't so bad. We've been at war for damn near a decade with no end in sight. Soldiers are killing themselves at ever increasing rates. Hell we haven't demobilized the military since world war 2.
Most of our youth enter adulthood unemployed, as soldiers or as prisoners.
What does that do to a society?
The wealth distribution gap continues to grow. Prisons, the military and the entitlement systems are our most consistent growth industries.
In such a land, it matters not who is elected president.
Our root systems are corrupting.
We will find a way of living differently because to continue as we are is suicide.
We will find a way of living differently.
Friday, May 14, 2010
Friday, May 7, 2010
Cardiologist Stirs the Pot
http://www.msnbc.msn.com/id/35895682/ns/health-heart_health/
Doctor says heart groups too cozy with industry
‘It's time to draw the line’ on corporate funding, says prominent cardiologist
The news article spends the 1st half of the story talking about how he got it wrong with the whole coke a cola funding some heart awareness campaign. Let's see if we can find a copy of his speech somewhere....
Putting his name into google:
He helped put the smack down on a diabetes drug that raises heart attack risk. Wonder if that drug is related to Avandia?
I don't know, but Dr Nissen has also been in Avandia's business it seems http://spotlight.vitals.com/2010/02/dr-steven-nissen-on-diabetic-drug-avandia-shown-to-damage-the-heart/
Oh man and Vytorin too http://blog.cleveland.com/medical/2008/01/clinics_dr_steven_nissen_stirs.html
And the FDA user fees too!
Ok, I have a new hero.
Still haven't found a copy of his speech!
Friday, April 9, 2010
Prostate
Sometimes referred to as the prostrate which is fine since the prostrate position protects the prostate. Anyway, there's a new twist in the marketing for this much maligned little organ.
Cancer prevention through a pill! Woohoo! What can possibly go wrong?
This is the craziest headline ever.
Heart failure risk linked to prostate drug
FDA recently approved Avodart as a cancer preventive medication for men
I have a copy of the study they're referring to in the article. They took men with elevated PSA tests and a set of negative prostate biopsies and labelled them high risk. These men were then placed on a prostate shrinking drug called Avodart or a placebo. They had another set of biopsies at 2 years and at 4 years.
There were more men with a positive biopsy for cancer at both 2 and 4 years in the placebo group.
Turns out that 70% of the benefit was in slow growing cancers. You can try and predict which cancers are slow growing and unlikely to spread and those which are fast growing based on how abnormal the cells look under the microscope, it's called a Gleason's score. Most of the benefit was in preventing or delaying or masking the more benign cancers. When men are diagnosed with the slow growing prostate cancers there's a lot of treatment options including "watchful waiting". Where you can tell a man that his cancer is so slow growing that we can't make you any healthier treating it with radiation or surgery only harm you.
Well what about the cancers that have already spread did Avodart prevent them? No sir, there weren't any like that found in this study.
What about the more aggressive looking ones on the biopsy, with a high Gleason's score?
Well the highest scores the last 2 years of the study were found more often in the Avodart group. And of the most aggressive looking cancers found on biopsy those last 2 years of the study, 14 were in the Avodart group and 1 in the placebo group.
So what will happen is this "prevention" will be applied to all men with a high PSA or with a family history or certain races. Sure looks like it might be causing aggressive prostate cancers and why are we trying to use a "prevention" when the PSA test has been proven to harm about 48 men for every 1 it saves?
Don't get me started on the rate of side effects
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