Tag: medical

Trump Went to Hospital Today

Trump made an unscheduled trip to Walter Reed Hospital today.

The claim is that he was getting a jump on his annual physical, but I kind of doubt it.

President Trump underwent a two-hour doctor’s examination on Saturday at Walter Reed National Military Medical Center, which the White House said was part of a routine annual physical and included lab work.

The appointment was not on the president’s schedule, in contrast to a previous physical that Mr. Trump had in February, also at Walter Reed outside Washington.

In a statement, Stephanie Grisham, the White House press secretary, said Mr. Trump, 73, was taking advantage of a free weekend to begin portions of his annual physical, and was anticipating a busy schedule in 2020. She did not specify what types of tests Mr. Trump had.

Yeah, sure.

This is what happened, because the White House is always completely honest about health issues with Presidents.

Aggressive Enforcement of Metrics Lead to Cheating

Ayn Rand style completion works about as well in the healthcare industry as it did at Sears:

On a Thursday morning this past April, 61-year-old Darryl Young was lying unconscious in the eighth-floor intensive care unit of Newark Beth Israel Medical Center. After suffering from congestive heart failure for years, Young, a Navy veteran and former truck driver with three children, had received a heart transplant on Sept. 21, 2018. He didn’t wake up after the operation and had been in a vegetative state ever since.

Machines whirred in his room, pumping air into his lungs. Nutrients and fluids dripped from a tube into his stomach. Young had always been fastidious, but now his hair and toenails had grown long. A nurse suctioned mucus from his throat several times a day to keep him from choking, according to employees familiar with his care. His medical record would note: “He follows no commands. He looks very encephalopathic” — brain damaged.

That day, in another wing of the hospital, where a group of surgeons, cardiologists, transplant coordinators, nurses and social workers gathered for their weekly meeting in a second-floor conference room, his name came up.

“Anything on Darryl Young?” asked cardiologist Dr. Darko Vucicevic, according to a recording of the meeting obtained by ProPublica.


The recordings show that the transplant team was fixated on keeping him alive, rather than his quality of life or his family’s wishes, because of worries about the transplant program’s survival rate, the proportion of people undergoing transplants who are still alive a year after their operations. Federal regulators rely on this statistic to evaluate — and sometimes penalize — transplant programs, giving hospitals across the country a reputational and financial incentive to game it. Newark Beth Israel’s one-year survival rate for heart transplants had dipped, and if Young were to die too soon, the program’s standing and even its own survival might be in jeopardy.

June 30, Zucker explained at the meeting, was the date of the next report by a federally funded organization that tracks transplant survival rates. “If he’s not dead in this report, even if he’s dead in the next report, it becomes an issue that moves out six more months,” he said in the recording.


In the ensuing months, the doctors continued to leave Young’s family in the dark, according to his sister Andrea and employees familiar with Young’s care. They didn’t want to run any risk that the people who loved him would interfere with their agenda: boosting the program’s numbers. “I’m not sure that this is ethical, moral or right,” Zucker told the team at the April meeting, but it’s “for the global good of the future transplant recipients.”


Arthur Caplan, head of the Division of Medical Ethics at NYU School of Medicine, reviewed transcripts of the recordings, including discussions about Young. “The management of this patient is egregiously unethical,” he said. “Prolonging ‘dying’ to preserve a flawed transplant program makes a mockery of transplant medicine and is an assault on both ethics and compassion.”

This is unalloyed evil, and everyone who knew of it, and refused to report it, should be banned from the practice of medicine forever.

I Heard an Ad from Doctor Patient Unity on the Radio, and Did Some Digging

Congress is getting close to advancing one of the few significant bipartisan reforms to the health care system still on the docket: legislation to curb the practice of “surprise medical billing.”

Naturally, that progress has sparked a last-ditch, dark money blitz bent on sinking these relatively modest bills, which aim to make it harder for unsuspecting patients to get hit with exorbitant bills if they see the wrong doctor in an emergency situation.

A group called “Doctor Patient Unity,” formed in June, has bankrolled a sweeping campaign of radio and television ads to pressure senators up for re-election in 2020 to oppose proposals to reform surprise medical billing.

Now, the dark money group is going after key lawmakers with direct appeals to their constituents. A mailer paid for by Doctor Patient Unity, obtained by The Daily Beast, urges Rep. Tim Walberg’s (R-MI) constituents to call his office and tell him to “say no to rate-setting” and “to put patients first.”


“They’re throwing the full kitchen sink at our efforts here and seeing what will stick,” said a congressional aide, who requested anonymity to discuss the matter candidly. “It’s unclear whether or not members are seeing a huge influx of constituent calls, but it’s obvious what they’re trying to do here, which is to back members off this proposal.”


Those hospitals and doctors have led the charge in publicly opposing the changes Congress is mulling. But as for who exactly is pouring money into the mailers and TV ads, Doctor Patient Unity appears to have taken pains to conceal the identities of the individuals or organizations running and financing the effort. Public records provide some clues, however. Incorporation documents on file in Virginia list an address in the town of Warrenton that is shared by the prominent Republican law firm Holtzman Vogel Josefiak Torchinsky.

The group’s treasurer, according to filings with the FCC, is a woman named Janna Rutland. She serves as treasurer for a handful of other political and policy organizations, and appears to be an employee of the GOP consulting firm Crosby Ottenhoff, which counts a number of high-profile Republican candidates and party organs among its clients.

Emergency, anesthesiology, and neonatal intensive care practices are prime targets for private equity buys because the are typically involve people who are too desperate to do the deep digging required to avoid outrageous charging, which gives them almost unlimited pricing power.

Once again, there is nothing that Wall Street finance cannot get worse.

A Medical Myth Busted

A study in the BMJ shows that capping interns hours at 80 per week does not adversely effect quality of care later in their careers.

Seeing as how working interns 100+ hours a week is killing patients today, and does not produce better outcomes tomorrow, it’s a good thing that accreditation authority has banned this:

When new rules by the Accreditation Council for Graduate Medical Education capped medical residents’ training hours at 80 hours per week in 2003, critics worried that the change would leave physicians-in-training unprepared for the challenges of independent practice.

Now, new research published July 11 in the journal BMJ and led by scientists in the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School (HMS) says that their warnings appear largely unjustified. The team’s analysis found no evidence that reduced training hours had any impact on the quality of care delivered by new physicians.

The push to scale back residents’ hours and change other aspects of training was sparked by a series of high-profile patient injuries and deaths believed to stem from clinical errors caused by fatigue.

The researchers found no significant differences in 30-day mortality, 30-day readmissions, or inpatient spending between physicians who completed their residencies before and after the hour reforms.


The study analyzed 485,685 hospitalizations of Medicare patients before and after the reform.

The training-hour reforms were not associated with statistically significant differences in patient outcomes after the physicians left training.

I always figured that the brutal hours of medical residency were primarily about ritual scarring as a coming of age ritual, and it appears that I was right.

Correlation? Causation? ¯_(ツ)_/¯

Scientists have identified what they claim is a biomarker for chronic fatigue syndrome.

I am not so sure.

What they are describing is a marker for a stressed immune system, and there are any number of conditions that stress the immune system.

What they need to do is look at how this test works for people with other related conditions: Depression, mitochondrial disorders, McArdle’s disorder, etc.

Then again, I’m an engineer, not a doctor, dammit!*

People suffering from a debilitating and often discounted disease known as chronic fatigue syndrome may soon have something they’ve been seeking for decades: scientific proof of their ailment.

Researchers at the Stanford University School of Medicine have created a blood test that can flag the disease, which currently lacks a standard, reliable diagnostic test.

“Too often, this disease is categorized as imaginary,” said Ron Davis, PhD, professor of biochemistry and of genetics. When individuals with chronic fatigue syndrome seek help from a doctor, they may undergo a series of tests that check liver, kidney and heart function, as well as blood and immune cell counts, Davis said. “All these different tests would normally guide the doctor toward one illness or another, but for chronic fatigue syndrome patients, the results all come back normal,” he said.

The problem, he said, is that they’re not looking deep enough. Now, Davis; Rahim Esfandyarpour, PhD, a former Stanford research associate; and their colleagues have devised a blood-based test that successfully identified participants in a study with chronic fatigue syndrome. The test, which is still in a pilot phase, is based on how a person’s immune cells respond to stress. With blood samples from 40 people — 20 with chronic fatigue syndrome and 20 without — the test yielded precise results, accurately flagging all chronic fatigue syndrome patients and none of the healthy individuals.

The diagnostic platform could even help identify possible drugs to treat chronic fatigue syndrome. By exposing the participants’ blood samples to drug candidates and rerunning the diagnostic test, the scientists could potentially see whether the drug improved the immune cells’ response. Already, the team is using the platform to screen for potential drugs they hope can help people with chronic fatigue syndrome down the line.

They have shown a test for immune response to various stressors, but this does not make it a reliable test for CFS, nor for that matter, does it prove the existence of CFS.

Absent a mechanism, or a more extensive study and comparison to other conditions that resemble, it’s very preliminary to claim proof of anything.

*I love it when I get to go all Dr. McCoy!

Any Californians Want to File a Report to the Medical Board?

A single San Diego doctor wrote nearly a third of the area’s medical vaccination exemptions since 2015, according to an investigation by the local nonprofit news organization Voice of San Diego. The revelation follows growing concern that anti-vaccine parents are flocking to doctors willing to write dubious medical exemptions to circumvent the state’s vaccination requirements. Since California banned exemptions based on personal beliefs in 2015, medical exemptions have tripled in the state. The rise has led some areas to have vaccination rates below the levels necessary to curb the spread of vaccine-preventable illnesses. Moreover, it signals a worrying trend for other states working to crack down on exemptions and thwart outbreaks of vaccine-preventable diseases. There are currently six outbreaks of measles across the country.

Medical vaccination exemptions are intended for the relatively few people who have medical conditions that prevent them from receiving vaccines safely. That includes people who are on long-term immunosuppressive therapy or those who are immunocompromised, such as those with HIV or those who have had severe, life-threatening allergic reactions (e.g. anaphylaxis) to previous immunizations. Such patients typically receive medical exemptions incidentally during their medical care. But some doctors are providing evaluations specifically to determine if a patient qualifies for an exemption and granting exemptions using criteria not based on medical evidence. Some doctors are even charging fees for these questionable exemption evaluations—including the doctor in San Diego, Tara Zandvliet.

Zandvliet’s practice website specifically lists “Evaluation for Medical Exemption to Vaccination” as a service provided. The website also lays out the conditions and diseases she considers as qualifying for a medical exemption. The list reaches far beyond what medical experts say are acceptable reasons for exempting someone from life-saving immunizations. The list includes having a family history of bee-sting allergies, type I diabetes, or simply hives. After a reporter with the Voice of San Diego questioned some of the conditions listed, Zandvliet removed three from the list: asthma, eczema, and psoriasis.

“I have found that a few of the diseases on my list seem to invite misinterpretation more than others, and so I have deleted them,” she told the outlet in an email.

Zandvliet charges $180 for the evaluation, and her practice does not accept insurance.

Since 2015, Zandvliet has issued 141 of the 486 total medical exemptions granted in the San Diego Unified School District. After Zandvliet, the second highest number of medical exemptions granted by a single doctor was 26. The Voice of San Diego noted that Zandvliet’s practice is listed on several websites as being friendly to anti-vaccine parents.

She is renting her medical license to antivaxxers.

The solutions is to pull her medical license.

Dutch Triffids

The overuse of antibiotics by agriculture are a public health threat.

A story out of Holland shows that the aggressive use of of anti-fungals for the tulip crop has resulted in the introduction of massively resistant fungi into the environment.

We really need to be a lot more proactive in keeping human trugs out of farmer’s fields in the first place.

The consequences are simply too dire.

Never Stop Your Enemy from Stepping on His Own Dick

VIDEO: Rep. Chris Collins speaking on his phone at last summer’s White House Congressional Picnic. The photo was taken at approximately 7:17 p.m. According to the indictment, Collins called his son Cameron at 7:16 p.m. (VIDEO: CBS) pic.twitter.com/EvSzrHTkY4

— News 4, WIVB-TV (@news4buffalo) August 8, 2018

Your honor, we find the defendants incredibly guilty

Representative Chris Collins (R-NY) has been charged with insider trading.

What’s more, he was caught on video calling his son about failed drug trials ……… At the White House:

Federal prosecutors charged Rep. Chris Collins (R-N.Y.), President Trump’s first congressional supporter, with insider trading on Wednesday, alleging the New York Republican schemed with his son to avoid significant losses on a biotechnology investment.

Collins was at a congressional picnic at the White House last year when he learned that Innate Immunotherapeutics, an Australian biotechnology company, had received bad news about an important drug trial. Collins frantically attempted to reach his son, Cameron Collins, whom he tipped off to the confidential corporate information days before it would be made public, according to prosecutors. Cameron Collins and several others used the information to avoid more than $700,000 in losses, they said.

Collins “helps write the laws of this country,” said Geoffrey S. Berman, the U.S. attorney for the Southern District of New York. But Collins “acted as if the law did not apply to him.”

Collins turned himself in to the FBI at 7 a.m. Wednesday morning and then appeared in a Manhattan federal court in the afternoon wearing a dark suit and white button-down shirt open at the collar. He spoke only briefly during the nearly 20-minute hearing, telling the judge: “I plead not guilty.”


The charges could turn into a headache for several House Republicans who invested in Innate Immunotherapeutics at Collins’s encouragement. Prosecutors did not allege in the indictment that Collins tipped off any of his colleagues in Congress about the failed drug trial before it was made public, but Democrats pounced on the charges and said those lawmakers would have to answer tough questions about their investments in Innate.


According to the indictment, while at the June 2017 congressional picnic at the White House, Collins received an email from Innate Immunotherapeutics’ chief executive alerting the company’s board that an eagerly anticipated drug trial had been a failure. Minutes later, Collins responded to the email: “Wow. Makes no sense. How are these results even possible???”

Almost immediately, Collins tried to get in contact with his son, who owned millions of shares of the company’s stock, according to the indictment. Within a few minutes, Collins and his son called each other six times before connecting and talking for six minutes. During that last call, Collins told Cameron Collins, his son, about the failed drug trial, according to the indictment, which cites phone and bank records as well as texts.

It gets even better: It looks like a number of other Republican Congressmen are implicated in this:


Collins, worth $66 million, apparently urged Republican colleagues in Congress to invest.

“If you get in early, you’ll make a big profit,” Collins reportedly told House Republicans last summer.

At least six Republicans appear to have been convinced by Collins’ pitch (though at various times they claimed to have arrived at the stock purchase through media reports).

They were:

1. Tom Price, who served as Secretary of Health and Human Services. During his confirmation hearings, Price was accused of taking advantage of a special deal on Innate stock only available to a select number of lawmakers at a discount offered by Collins.

2. Rep. John Culberson (R-TX): The Texas Republican claimed he heard about Innate from media reports, but as the Houston Chronicle noted, it’s not clear which. At the time of his purchase, Innate was described as “a tiny pharmaceutical company from Australia that has no approved drugs and no backing from flashy venture capital firms.” The Chronicle pointed out that Culberson’s past investment history does not square with his purchase of biotech stocks and his opponent, a research physician, has wondered what led Culberson to invest, “since at the time he bought it in January there had been no published research articles or significant clinical trial updates on the drug, known as MIS416.”

3. Rep. Mike Conaway (R-TX) is another Texas lawmaker who bought large shares in Innate. He does not appear to have purchased Innate stock at a discount.

4. Rep. Doug Lamborn (R-CO) sat Health Subcommittee of the Committee on Energy and Commerce at the time of his stock purchase, raising a possible conflict of interest, reports the Daily Beast.

5. Rep. Markwayne Mullin (R-OK) sat on the subcommittee as well.

6. Rep. Billy Long (R-MO) reportedly became far more active in the stock market in 2015. Long sat on the House Energy and Commerce Committee, which addresses health policy.

Republicans, particularly Trump Republicans are not having a good time right now.

In 2006, it was Mark Foley, and now it seems that there a whole passel of Mark Foleys.

H/t Crooks and Liars.

I Have a Weird Metabolism

I am not referring to my inclination toward stoutness, that is pretty ordinary.

About a week ago, I hurt my shoulder, and after about a week progress was slow despite my loading up on Naproxen Sodium and Ibuprofen, , so I went and got some aspirin.

Within 12 hours I was essentially pain free.

I’m not sure why, but it appears that willow leaf juice is particularly effective on yours truly.

I think that it may have something to do with aspirin’s ability to chelate calcium.

Adventures in the Annals of Quackery

In the annals of quack medicine, there is patent medicine, there is quackery, and then there is treating someone with the saliva of a rabid dog:

“Hair of the dog” remedies may do the trick for some hangover sufferers. But health experts say that a Canadian homeopath took the idea too far—way, way too far.

Homeopath and naturopath Anke Zimmermann used diluted saliva from a rabid dog to “treat” a four-year-old boy, according to a blog post she published earlier this year. Zimmermann claims that the potentially infectious and deadly concoction successfully resolved the boy’s aggressive behavior, which she described as a “slightly rabid-dog state.”

The tale fits with the scientifically implausible principles of homeopathy. These roughly state that substances that produce similar symptoms of a particular ailment can cure said ailment (“like cures like”) and that diluting a substance increases its potency (“law of infinitesimals”).

Health experts say Zimmermann’s claims aren’t just farfetched, but, rather, they’re barking mad.


Zimmermann quickly sniffed out the source of the problem: when Jonah was younger, a dog bit him. That is, Jonah’s mother said that one time a dog accidentally “broke the skin slightly” on Jonah’s hand while it was reaching to get food Jonah was holding.

Zimmermann pounced on the tidbit, claiming:

A bite from an animal, with or without rabies vaccination, has the potential to imprint an altered state in the person who was bitten, in some ways similar to a rabies infection. This can include over-excitability, difficulties sleeping, aggression, and various fears, especially of dogs or wolves. This child presented a perfect picture of this type of rabies state. Most homeopaths would have easily recognized the remedy required in this case.

The “remedy” to this “state” was clearly the saliva of a rabid dog, Zimmermann concluded. Months later, the mother reported that Jonah’s issues had improved—although they had not resolved entirely.

You can read the whole article for innumerable dog puns, but this is truly horrifying, and Zimmerman needs to be locked up to protect the rest of society.

Ban Agricultural Use of Antibiotics

In a frighteningly short time, an antibiotic resistant gene, MCR-1, has spread around the world.
Investigations have revealed that it originated in the antibiotics inundated world of agriculture:

The mcr-1 gene, which helps bacteria resist colistin – one of the few remaining antibiotic drugs of last resort that still work – has now reached hospitals all across the world.

And thanks to new research, we now have more evidence of where it came from – pig farms in China.

While experts had previously thought the gene developed on Chinese pig farms, due to their extensive use of colistin on the animals, the latest study offers more evidence to back this idea up.

It pinpoints the start of the spread to sometime in 2005.


The speed at which mcr-1 spread globally is indeed shocking,” says lead researcher Francois Balloux, from University College London (UCL) in the UK.

By sequencing the genomes of 110 bacterial strains and comparing them to existing genomic data, the team identified a large dataset of 457 mcr-1 positive genome sequences, taken from humans and farm animals spread across five continents.

That enabled them to show exactly where mcr-1 had emerged from, and how it spread globally – attaching itself to various bacterial pathogens by “hitchhiking” on different mobile genetic elements.

The supporters of antibiotic use on livestock have always said that no one ever showed that antibiotic resistance has originated from their use on live stock.

Not any more.

This needs to be banned world wide.

Silly Rabbit, Jail Is Not for White Folks

This is one Very white person

And corporate criminals don’t come any whiter than Elizabeth Holmes:

Elizabeth Holmes, the founder of blood testing startup Theranos, has been charged with engaging in a “massive fraud” by the Securities and Exchange Commission. The SEC says she and the company’s president raised more than $700 million using an “elaborate, years-long fraud in which they exaggerated or made false statements about the company’s technology, business, and financial performance.”

No, she won’t be going to jail over this. In fact, even though she faces some serious penalties over the charge — she’s losing control of the company and won’t profit if it is sold — she also doesn’t have to admit wrongdoing as part of a settlement with regulators.

To recap, Theranos was once a Silicon Valley favorite because of its promise that its technology could allow for a wide variety of blood tests with just a droplet of blood. That all began to fall apart when the Wall Street Journal raised serious questions about the accuracy of the tests, prompting a government agency to shut down one of its labs.


Here’s are some of the things Holmes has agreed to do to settle with the SEC.

She’ll give up financial and voting control of the company.

  • Holmes has to pay a $500,000 fine.
  • She cannot be a director or officer of a publicly traded company for 10 years. Theranos is a privately-held company, which means she can continue to be CEO.
  • She has to return 18.9 million shares of Theranos stock.
  • She will give up her majority voting control of the company by converting her shares to Class A Common shares from Class B Common share

She should be in jail, and she should be banned from managing publicly traded companies for life, but she does not even have to admit liability.

Well, I suppose she’s commiserating with David Petraeus about how unfair this all is.

No Blogging Tonight

Between my cold in generally running around, I was so out of it today but I left the restaurant where I had lunch without paying my tab.
I realized this when I left work and looked at my take out. ( Pancakes, I had breakfast for lunch.)
So, I went back to the restaurants, paid my tab, and tipped generously.
In any case, I have concluded that I cannot maintain my usual levels of coherence.  (That sentence positively buggers the mind, doesn’t it?)
So, I am taking a not particularly well deserves evening off.

Posted via mobile

Cheer the IT Revolution

It turns out that the increasing use of electronic health records saves neither time nor money, but this hasn’t stopped a rush by the government and the private healthcare industry from

I thought of working words like “debacle,” “scam,” or “bezzle” into the headline, but today is my day to be kind (and the entire topic really demands that I pull on my yellow waders and write another “Credentialism and Corruption” post, which I might do at a later time). However, the headlines give a sense of what a bombshell this study should be for the EHR industry. On the spectrum from reluctant admissions all the way through to The Bezzle:

  1. Electronic health records don’t cut administrative costs Harvard Gazette (February 20, 2018).
  2. Electronic Health Records Don’t Reduce Administrative Costs Harvard Business School (February 20, 2018).
  3. EHRs fall short in reducing administrative costs Health Data Management (February 21, 2018).
  4. Why health IT experts think Apple will succeed where Google failed with medical records Health IT and CIO Review
  5. An Introduction to Medicalchain: Blockchain for Electronic Health Records CryptoSlate. (This is from February 8, but I couldn’t resist.)

The complete study (an “Original Investigation”) is here at the Journal of the American Medical Association. Unfortunately, the study is paywalled, and the study material that JAMA exposes muffles the bombshell. From the abtract, the methodology:

IT is going to change the world making unachievable claims based on bad/non-existent evidence, and all we have to do throw money at them.

Brazil Shows Us What We Need for Good Healthcare

It appears that all you need is a community minded hyper-violent drug lord:

Thomaz Vieira Gomes, also known as 2N, is considered one of the most dangerous criminals in Rio de Janeiro, but recently he actually did something decent, albeit still illegal, for once.

He and his gang kidnapped two male nurses and made them vaccinate the poor people of his favela against yellow fever.

For months, Brazil has been dealing with a yellow fever epidemic that has already left dozens dead. Despite the Health Ministry’s plans to vaccinate millions of people in the hopes of containing the outbreak, immunisation centres struggle to keep up with the high number of patients, and, as always, the poorest communities are usually ignored.


On January 27th, the young gang leader and a few of his cronies descended on a local state-run clinic in two black cars, took as many syringes and vaccine doses as they could find, and kidnapped two of the male nurses on duty that night.

They then drove to the Amarelinho bar in Salgueiro where the two nurses spent hours administering yellow fever vaccines to members of the local community.


After doing their job, the two victims were reportedly taken back to their workplace.


Even the country’s former Minister of Environment took to Twitter to comment on this bizarre story, saying that while 2N is still an “a-hole” his actions were a “public service”.

I’m not entirely sure WHAT the lesson to be learned here, but I am sure that there IS a lesson to be learned here.