Just a week after the FDA issued a report warning against the overdose of radiation, hospitals left and right have been revisiting their use of  radiation machines after Cedars-Sinai hospital admitted to 206 overdose cases.

"The hospital’s radiology manager at the time, Bruce Fleck, called the overdose a “rogue act of insanity.” Robert Schlag, chief of the state’s division of Food, Drug and Radiation Safety, said it was “one of the more egregious, extreme cases that I have ever seen.”

The Arcata case is considered particularly disturbing because children are more vulnerable to the long-term effects of radiation, including cancer.

For reasons not yet fully understood, the X-ray technologist, Raven Knickerbocker, activated the CT scan 151 times on the same area, state investigators concluded. A normal test involves some 25 images, Mr. Schlag said. The test was terminated only after the victim’s father, who had been holding his son still, began to worry that it was taking too long."

Cedars-Sinai is now facing major lawsuit possibilies, all because of its refusal to check its dosage charts and treatment plans. This is a lesson for doctors and hospitals to stay in a state of awareness all the time.

To read the full article, please click here: http://www.nytimes.com/2009/10/16/us/16radiation.html?sq=October 16 2009&st=nyt&adxnnl=1&scp=4&adxnnlx=1255957210-J78dzKcFohq5+Uk5U/06vg

From the front page of the New York Times:

"Anti-vaccinators, as they are often referred to by scientists and doctors, have toiled for years on the margins of medicine. But an assemblage of factors around the swine flu vaccine — including confusion over how it was made, widespread speculation about whether it might be more dangerous than the virus itself, and complaints among some health care workers in New York about a requirement that they be vaccinated — is giving the anti-vaccine movement a fresh airing, according to health experts."

"Barbara Loe Fisher, president of the National Vaccine Information Center, an advocacy group that questions the safety of vaccines, said the swine flu has “breathed new life” into the cause. “People who have never asked questions before about vaccines are looking at this one,” Ms. Fisher said.

The increased interest is frustrating to health officials, who are struggling to persuade an already wary public to line up for shots and prevent the spread of the pandemic. According to a CBS News poll conducted last week, only 46 percent said they were likely to get the vaccine. The nationwide poll, which has a margin of sampling error of plus or minus three percentage points, found that while 6 in 10 parents were likely to have their children vaccinated, less than half said they were “very likely to.”

To read the full article, please click here: http://www.nytimes.com/2009/10/16/health/16vaccine.html?scp=1&sq=October+16+2009&st=nyt

Dr. Pauline Chen writes in her New York Times column another lesson in doctor and patient relationship care. This time she writes about the importance of mindfulness in a doctor.

Instead of falling deep into "the zone," Dr. Chen warns doctors to always stay alert and mindful of their surroundings. Awareness, she writes is vital in staying on top of one's game, especially when it comes to patient care.

Patients are often afraid and nervous to be in the hospital and the last thing they need is an automatron for a doctor.

Writes Dr. Chen, "The time pressures and demands that drive this endless multitasking and loss of focus on patients have contributed to high rates of burnout among physicians. Depending on the study, anywhere from one out of every three to more than half of all doctors is suffering from burnout, with potentially devastating clinical implications. Doctors who are burned out are more likely to depersonalize their patients and treat them as objects rather than as individuals suffering from disease. They are less professional, exhibit less empathy and are more prone to making errors. And these physicians are also more likely to become depressed, commit suicide and leave a profession that is already facing severe shortages in specialties like primary care. "

To read the full article, including many of Dr. Chen's anecdotal stories, please click here: http://www.nytimes.com/2009/10/15/health/15chen.html?scp=12&sq=October+15+2009&st=nyt

As reported in the New York Times:

"As the White House and Congressional leaders turned in earnest on Wednesday to working out big differences in the five health care bills, perhaps no issue loomed as a greater obstacle than whether to establish a government-run competitor to the insurance industry."

"Of the many difficult decisions remaining — including how to pay for an overhaul and how many people will be left uninsured — few carry as much political weight for the president as the public option. The plan, which would be for people who do not get health care through their employers, has become a proxy for a larger debate over where Mr. Obama is taking the country."

To read the full article, please click here: http://www.nytimes.com/2009/10/15/health/policy/15public.html?scp=1&sq=October+15+2009&st=nyt

While 1918 is far off, tucked away in our history books, a new study came out today that suggested that aspirin could have been a factor in the 1918 flu pandemic that killed 50 million Americans nationwide.

"Dr. Karen M. Starko, author of one of the earliest papers connecting aspirin use with Reye’s syndrome, has published an article suggesting that overdoses of the relatively new “wonder drug” could have been deadly.

What raised Dr. Starko’s suspicions is that high doses of aspirin, amounts considered unsafe today, were commonly used to treat the illness, and the symptoms of aspirin overdose may have been difficult to distinguish from those of the flu, especially among those who died soon after they became ill."

While we know better today about aspirin, the lesson is still important to take into consideration: We musn't rely on so-called wonder drugs for everything. While using what works is vital, we must always keep in mind that not everyone will react to certain treatment plans the same way and that our job as doctors is to cater to each patient.

To read the full article, please click here: http://www.nytimes.com/2009/10/13/health/13aspirin.html?scp=15&sq=October+13+2009&st=nyt

Scientists and researchers are now asking whether a virus is the cause of the mysterious chronic fatigue syndrome that besets doctors and patients alike with frustration, costly medications and an unknown diagnosis and treatment plan.

As reported in the New York Times, "

A study published last week in the journal Science suggested that might be the case, reporting that many patients who had the syndrome were infected with a recently discovered virus.

Chronic fatigue syndrome has long been a medical mystery and the subject of debate, sometimes bitter, among doctors, researchers and patients. It affects at least one million Americans, causing extreme fatigue, muscle and joint pain, sleep problems, difficulty concentrating and other symptoms. Its cause is unknown, symptoms can last for years and there is no effective treatment. Researchers disagree about whether it is one disease or a collection of symptoms that may have different causes in different patients. It has sometimes been stigmatized as more mental than physical, with patients labeled neurotic, depressed or hypochondriacal. Many patients find even the name of the disorder offensive, a not-so-subtle hint that it is not a real disease."

To have the syndrome caused by a virus, doctors and patients can really finally achieve a sanctified treatment plan.

To read the full article, please click here: http://www.nytimes.com/2009/10/13/health/13fatigue.html?scp=5&sq=October+13+2009&st=nyt

California public health officials are investigating medical errors at Cedars-Sinai Medical Center in Los Angeles in which 206 patients were exposed to high doses of radiation during CT brain scans after an FDA report issued an alert to hospitals nationwide, warning them to review their safety procedures for CT scans. But the alert did not specifically name Cedars-Sinai.

The FDA stated that: “The magnitude of these overdoses and their impact on the affected patients were significant“ and put "patients at increased risk for long-term radiation effects.”

To read the full article and to link to the FDA report, please click here: http://www.nytimes.com/2009/10/11/health/11radiation.html?scp=3&sq=October+11+2009&st=nyt

In her latest column for the New York Times, Dr. Pauline Chen writes about the need for thinking outside of the typical medical box in order to achieve arriving at a diagnosis.

Dr. Chen writes about a book by Dr. Lisa Sanders, who pushes further into the rare and sometimes absurd depths of medical mysteries in making diagnoses...all for the comfort of the patient.

Dr. Chen writes, "But, as Dr. Lisa Sanders shows in her thought-provoking new book, “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis” (Broadway Books, 2009), my fascination, our fascination, with diagnoses may have more to do with the importance of having a diagnosis than with the robustness of the process itself."

To read more about the book and Dr. Sanders, click here: http://www.nytimes.com/2009/10/08/health/08chen.html?scp=8&sq=October+8+2009&st=nyt

As reported in the New York Times:

"The Senate Finance Committee legislation to revamp the health care system would provide coverage to 29 million uninsured Americans but would still pare future federal deficits by slowing the growth of spending on medical care, the nonpartisan Congressional Budget Office said Wednesday.

The much-anticipated cost analysis showed the bill meeting President Obama's main requirements, including his demand that health legislation not add ''one dime to the deficit.'' Indeed, the budget office said, the bill would reduce deficits by a total of $81 billion in the decade starting next year.

Despite the expansion of coverage at a cost of $829 billion over 10 years, the budget office said 25 million people -- about one-third of them illegal immigrants -- would still be uninsured in 2019. In all, it said, the proportion of nonelderly Americans with insurance would rise over the 10 years to 94 percent, from 83 percent today."

To read the full article, click here: http://query.nytimes.com/gst/fullpage.html?res=9802E1DF163CF93BA35753C1A96F9C8B63&scp=1&sq=October+8+2009&st=nyt

From the New York Times:

The Senate Finance Committee still intends to vote this week on its health care bill, possibly as soon as Thursday. But the panel's 10 Republicans want to have some budget and tax experts weigh in first.

In a letter on Tuesday to the committee's chairman, Max Baucus, Democrat of Montana, the Republicans demanded that officials from the Congressional Budget Office and the Joint Committee on Taxation be brought before the panel to answer any questions ahead of any changes or a final vote on the health care bill.

''Before the Committee votes to report the legislation out of committee,'' the letter said, ''it is important that all members have a thorough understanding of the cost of the legislation and how individuals, families and businesses will be affected.''

To read the full article, and to link to the transcripts of the panel hearing, click here: http://query.nytimes.com/gst/fullpage.html?res=9E06E2D91E3BF934A35753C1A96F9C8B63&scp=1&sq=October+7+2009&st=nyt

"Utah is only the second state to develop its own insurance exchange, and it is distinctly different from its better-known counterpart in Massachusetts. It is also unlike anything currently envisioned in Congress.

Aimed initially at small businesses, the exchange offers a way for companies to pay a fixed amount toward their employees’ medical coverage, instead of buying the coverage directly for them. The workers then can select from various plans on the exchange. If they cost more than the employer’s contribution, the employee pays the difference."

Excerpts from a New York Times article offers insight into the dilemma Congress is going through in its plight to establish a universal healthcare for our nation. There are so many options and ideas out there that narrowing them down into one that will fit an entire nation is difficult. Utah's example works for that state but would fall to pieces in larger states like Texas or California.

To read the full article, click here: http://www.nytimes.com/2009/10/06/business/06exchangeside.html?scp=9&sq=October+6+2009&st=nyt

The New York Times reported today that a cocaine vaccine is now available that prevents addicts from getting high. However, researchers state that the vaccine does not prevent addicts from craving the narcotic.

Researchers also report that despite the limited success of the vaccine, cocaine abusers who used the vaccine in the trial reduced their use of the drug by nearly half.

''This is the first study that has ever been done with an illicit drug to show that a vaccine can be effective in humans,'' said Dr. Thomas R. Kosten, professor of psychiatry and neuroscience at Baylor College of Medicine in Houston and principal investigator of the study, published in Tuesday's Archives of General Psychiatry. An earlier, separate pilot study found similar results." (All reported in the New York Times).

Spending money on vaccines for illicit drugs might seem like a waste of resources, especially since drugs could be compared to elective procedures; why spend the money on helping addicts? For the same reason we help those with obesity; both drain society of resources so preventing the spread of both is key to a healthier society.

To read the full article, click here: http://query.nytimes.com/gst/fullpage.html?res=9E06EFDB1E39F935A35753C1A96F9C8B63&scp=4&sq=October+6+2009&st=nyt

The debate over universal healthcare continues today as Democrats try to balance individual cost with individual coverage.

The New York Times reported that, "As Democrats prepare to take up health care legislation on the floor of the Senate and the House, they are facing tough choices about two competing priorities. They want people to pay affordable prices for health insurance policies, but they want those policies to offer comprehensive health benefits."

To read the full article, click here:

http://www.nytimes.com/2009/10/06/health/policy/06health.html?_r=1&scp=3&sq=October+6+2009&st=nyt

Medicare is putting a new policy in place regarding the use and coverage of Avastin that will sharply curtail the use of the drug used for the treatment of eye diseases.

While Avastin costs thousands of dollars a month as a cancer treatment, when used in tiny portions, such as for the treatment of eye diseases, the medicine is just $30 to $40 an injection. But Medicare has now introduced a special reimbursement code just for the smaller doses of Avastin. And starting Thursday, the reimbursement of Avastin dropped to about $7.20 for the dose typically used in the eye.

Doctors who administer the drug will now be losing money on the drug. Medicare apparently calculated the reimbursement rate for the tiny eye doses based on the average sales price of Avastin for cancer. But it did not take into account the markup charged to eye doctors by compounding pharmacies — the chemists that divide up the Avastin into tiny doses under sterile conditions.

Now payers and insurance companies are going to be footing the bill which could potentially cost patients and subscribers more money.

To read the full article, click here: http://www.nytimes.com/2009/10/02/business/02avastin.html?scp=6&sq=October+2+2009&st=nyt

Two alternatives to heart surgery, the Edwards and the CoreValve heart valves, offer a less invasive alternative to surgery but do so is very different ways.

The Edwards unit is bigger and is deployed when a heart specialist blows up a balloon to position it. The Corevalve heart valve expands into its original shape, giving structure to the the valve.

Specialists claim that the Edwards unit is more durable yet the Corvevalve unit is easier to use. The ease of use can costly though; many patients have had to recieve pace makers to restore the heart's rhythm. Concerns about the durability of the Corvevalve, which is made of a nickel and titanium alloy -- in contrast to the steel Edwards unit -- are also on the surface.

"For its part, the Edwards device also encountered problems during its development. In 2005, the company stopped an early study after several patients died. The company then revised the implant procedure."

To read the full article, including a nunmber of comments from doctors and physicians worldwide, click here: http://www.nytimes.com/2009/10/01/business/01valveside.html?scp=9&sq=October+1+2009&st=nyt

The much-anticipated flu vaccine is on its way into the States, the New York Times reported.

Some injectable swine flu shots will become available earlier than expected, a pharmaceutical executive said, because his company has been able to finish making its vaccine nearly two weeks ahead of schedule. “The first truck left Pennsylvania today,” said Christopher A. Viehbacher, chief executive of Sanofi-Aventis, the pharmaceutical company based in Europe, which has a flu vaccine plant in Swiftwater, Pa. Until recently, nearly all the first vaccine batches were expected to be of the nasal spray form, a live virus that is not recommended for pregnant women, children under 2, adults over 50 and people with health problems.

The number of diagnosed cases of melanoma has been on the rise over the years but a recent British study reports that the "the epidemic may be due to diagnostic drift."

The report defines diagnostic drift as "the growing tendency to identify and treat benign lesions as malignant cancers," the New York Times reports.

"The study, published in the September issue of The British Journal of Dermatology, examined a cancer registry with 3,971 cases of melanoma and found that incidence increased 48 percent from 1991 to 2004, similar to the 44 percent increase reported by the Centers for Disease Control and Prevention over the same period for American whites. The disease is almost 20 times as common in whites as in blacks."

However, the research group found that almost all of the increase in diagnoses was in the earliest stage of the disease.

 “A lot of dermatologists will argue that they’re getting better at diagnosing melanoma, but I don’t think that’s very likely,” Dr. Marianne Berwick, a professor at the University of New Mexico said in the New York Times. “They’re taking a lesion that would not be diagnosed as melanoma 20 years ago and calling it melanoma.”

To read the full article and the implications of "diagnostic drift," click here: http://www.nytimes.com/2009/09/29/health/29mela.html?scp=20&sq=September+29+2009&st=nyt

In a step toward reducing mistakes and standardizing medical practices, North Shore-Long Island Jewish Health System, a major hospital group in New York, has announced the most sizeable effort to adopting digital health records.

The group's investment is a $400 million commitment that would put digital health records in 13 of its hospitals. The plan offers "its 7,000 affiliated doctors subsidies of up to $40,000 each over five years to adopt digital patient records. That would be in addition to federal support for computerizing patient records, which can total $44,000 per doctor over five years."

Stated the New York Times, "The federal program includes $19 billion in incentive payments to computerize patient records, as a way to improve care and curb costs. And the government initiative has been getting reinforcement from hospitals. Many are reaching out to their affiliated physicians — doctors with admitting privileges, though not employed by the hospital — offering technical help and some financial assistance to move from paper to electronic health records. "

Digital health records can improve the health outcome for patients and reduce costly administrative fees and costs for hospitals. "Indeed, the rationale for investing in digital records is that the technology can be used to help monitor and measure the results of care, providing the evidence needed to shift remuneration away from the current fee-for-service system, which encourages more tests, more procedures and more pills prescribed."

To read the full article, click here: http://www.nytimes.com/2009/09/28/technology/28records.html?scp=1&sq=September+28+2009&st=nyt

Dr. Conrad Murray, the physician who treated the late Michael Jackson and allegedly overdosed the music pop star that resulted in his death, is under major legal heat for malpractice, the New York Times reports today.

Dr. Murray claims that he made no errors with Jackson. However, the Los Angeles County medical examiner has determined Jackson died of an overdose of propofol, a powerful sedative used during surgery, and another sedative, lorazepam; the police are trying to determine if Dr. Murray made mistakes, either through negligence or by consciously disregarding risks of the drugs, that would warrant a manslaughter or murder charge.

The key question facing prosecutors and the grand jury is whether Dr. Murray was negligent, and if so, to what degree, legal experts said. For an involuntary manslaughter conviction, prosecutors would have to show only that Dr. Murray took a reckless action — one a reasonable doctor would not take — that created a risk of death or bodily injury. For second-degree murder, however, they would have to prove he knew the cocktail of medicines could cause death and ignored the risk, legal experts said.

To read the full article, click here: http://www.nytimes.com/2009/09/27/us/27murray.html?scp=1&sq=September+27+2009&st=nyt

For the second time in two years, the popular contraceptives Yaz and Yasmin are under fire for health concerns, largely due to marketing ploys that describe the pills as much more than for the use of pregnancy prevention.

Yaz, the second generation birth control from Bayer Health Care, is under particular questioning. The New York Times reported that, "the top-selling birth control pill in the United States, owes much of its popularity to multimillion-dollar ad campaigns that have promoted the drug as a quality-of-life treatment to combat acne and severe premenstrual depression."

However, patients using Yaz have been reporting blood clots, strokes and other health concerns more often than competing birth control options.

"But regulators are finding other faults with the Yaz franchise. The Food and Drug Administration early this year asked Bayer to correct misleading television commercials. Last month, the agency cited the company for not following proper quality control procedures at a plant that makes hormone ingredients."

It's no surprise then that has been served with 74 lawsuits brought by women who charge that they developed health problems after taking Yaz or Yasmin. The company says it intends to defend itself vigorously against the suits. 

To read the full article, click here: http://www.nytimes.com/2009/09/26/health/26contracept.html?scp=5&sq=September+26+2009&st=nyt