A TICK SKIT. A TASK KIT. A LYME AND QUANDARY BASKET.

In 2006 the Infectious Diseases Society of America (IDSA) developed a set of guidelines for Lyme Disease which characterize the condition as an acute infection, and recommend treatment with a few weeks of antibiotics. The guidelines are essentially in agreement with the Centers for Diseases Control and Prevention (CDC). The problem is that a sizable number of patients believe that Lyme disease can become chronic or produce a post-Lyme syndrome, frequently even with no tick bite history. There are complaints of persistent and severe joint pain and fever, and that the syndrome requires long term treatment with medication. The Connecticut Attorney General has been pursuing an antitrust investigation and claims his office has uncovered "serious flaws in the IDSA process,"and "undisclosed financial interests held by several of the most powerful IDSA panelists." The panelists have denied that they received any financial benefit from the guidelines, and no complaint has been filed. Still, the investigation has cast a poisonous shadow over therapy for Lyme disease, and some doctors don’t want to see Lyme patients. In an attempt to clear the air, IDSA will convene a new eight to twelve member independent review panel made up solely of physicians and scientists to determine the medical and scientific validity of the 2006 guidelines. To date no Lyme ticks have been found in Hawaii.

A BRIGHT EYE INDICATES CURIOSITY; A BLACK EYE TOO MUCH.

A multi-center clinical trial is underway in the United States to study the benefits of a revolutionary treatment for keratoconus called collagen cross-linking or CXL. The potential is huge for the refractive surgery market, and there are other possible applications including treating infectious corneal ulcers, corneal melts and corneal edema. In 2003, German investigators found that they could stop the progression of the cone-shaped thinning of the cornea through the interaction of riboflavin and ultraviolet light (UVA). The treatment is now in use in every major nation except the U.S., and it is anticipated that the Food and Drug Administration will soon get on board. The process involves removing the corneal epithelium, applying 0.1% riboflavin and illumination with UVA for 30 minutes. The outcome is cross-linking with corneal collagen which stiffens the cornea and stops the progression of keratoconus and corneal ectasia after refractive surgery.

A FINE IS A TAX FOR DOING WRONG. A TAX IS A FINE FOR DOING WELL.

Anti-sin taxes (alcohol, tobacco, gambling) have always been popular with politicians, but a proposal in the Oregon legislature goes far beyond the predictable. House bill 2641 would increase the tax on beer by 1,900% moving the tax per barrel from $2.60 to an outrageous $52.21. Oregon is the second largest micro-brewery producer in the United States, and its 96 breweries already provide over 5,000 jobs and $2.25 billion to the Oregon gross domestic product. Proponents of the measure point out that Oregon is 49th in the nation in malt beverage tax, and the law has not changed in 32 years although attempts have been made biennially and have always been defeated. Stephanie Pump (not related to the Town Pump) of the Governor’s Council on Alcohol and Drug Abuse states that the measure is one of the most logical steps to be taken to stabilize addiction and recovery services. If passed the law will also drive brewers out of Oregon, cost the loss of many jobs, and encourage beer drinkers to cross the Columbia river and do their shopping in Washington.

HEY, FTC! I CAN TELL YOU WHERE TO PUT YOUR RED FLAG.

The American corpus medicinensis is already buried under commissions, agencies, regulations, investigators, accountants, lawyers, bureaucrats of all colors, et cetera – ad nauseam, not to mention the screw-you-over insurance carriers. The latest planned abuse is making practicing physicians policemen for the Federal Trade Commission. By May 1, 2009, practicing physicians must implement a formal identity theft program under the FTC’s "red flag" policy. These flags are meant to be for financial and banking institutions for preventing identity theft and not for doctors struggling to survive in a whirlpool of crapola. Apparently lawyers for the megalith can interpret rules and regulations any way they wish. Failure to comply could mean administrative penalties or up to $2,500 in fines per violation. It is time for the American Medical Association to say NO, NO, NO! To apply this red flag baloney to physicians’ practices is stupid, unenforceable and abusive.

NOTHING IS EVER AS SIMPLE AS IT FIRST SEEMS TO BE.

When the going gets tough, the tough – give up their ova. A healthy young woman with high college SATs may be able to sell her eggs for up to $50,000, although the American Society of Reproductive Medicine states compensation above $10,000 is not appropriate. Some agencies advertise that certain specific characteristics may provide a much greater financial reward. A history of hepatitis, diabetes, cancer, or sexually transmitted disease are automatic eliminators, and a comprehensive test of psychological and genetic factors must be included. Moreover, several weeks of hormone injections to synchronize the donor menstrual cycle with the recipient is part of the routine before the vaginal wall approach to harvest the cell(s). Donors must also refrain from smoking, drinking and sex. Once informed, many opt out. Still, college loans, credit card and mortgage debt, savings exhaustion, and other economic pressures have applicants lining up, and in some instances husbands are offering their wives. Take my wife, please!

TOO MUCH WINE INJURES A MAN INTERNALLY, EXTERNALLY AND ETERNALLY.

Unlike other countries France has two drinking ages. Wine and beer can be purchased at age 16 and hard liquor at age 18. No matter what the customers age, bartenders and shopkeepers rarely ask for ID when they sell, uncork or pour. The government of President Nicolas Sarkozy wants to reduce the damage of addiction among young people, and has proposed to raise the age for wine consumption to 18 years. While the powerful winemakers lobby does not intend to obstruct the law, they believe the government is making a mistake They believe that the new law will encourage binge drinking, a habit imported from the U.S. where the legal age is 21. The French have an age-old custom of teaching their children to taste and appreciate wine with family meals and that is unlikely to change irrespective of a legal change in age limit.

A SCHOOL BOARD CAN MAKE A DECISION THAT IS DUMBER THAN ANY OF ITS MEMBERS

Six years ago in Arizona a 13 year old girl, an honor student with no history of disciplinary problems, was accused by a classmate of providing prescription-strength ibuprofen pills. She denied the allegation, but was taken to the principals office. The school, which has a no-tolerance policy for both prescription and over the counter drug use without permission, subjected the girl to a strip search down to panties and bra conducted by a nurse and assistant, both females. No drugs were found. The student was humiliated and traumatized by the experience. The American Civil Liberties Union representing the student, claims that older students deserve the same constitutional rights as adults, but the educators argue that a ruling against them would jeopardize campus safety. The initial ruling by a federal magistrate and three person panel supported the school policy, but the U.S. Circuit Court of Appeals overruled that body, and now the issue has percolated to the United States Supreme Court. Zero tolerance doesn’t mean zero common sense.

MOST MODERN TOYS ARE EDUCATIONAL, SOMETIMES MORE THAN SEEMS NECESSARY.

Toy retailers reported that one of the biggest sellers of 2008 was an animatronic "Baby Alive Learns to Potty." The doll comes complete with special "green beans" and "bananas" packets that when fed to the doll come out the other end as simulated feces. The doll then says, "Oh, I made a stinky." Geez! One can’t help but wonder where Hasbro will go next with their true-to-life biologic representation.

ADDENDA –

• A federal arbitrator ruled in March that an employer had for years willfully violated the Fair Labor Standards Act exploiting its employees by failing to pay overtime. The guilty employer: The U.S. Equal Employment Opportunity Commission.
• A "Stop the Violence" concert was held at Silver Springs, Maryland. A brawl broke out and sixteen people were arrested.
• In Ft. Pierce, Florida a woman called 911 three times to report that her local McDonald’s was out of chicken McNuggets.
• In Vilas County, Wisconsin the district attorney’s office is looking for a woman about 5 foot 8 inches, 140 lbs who is willing to stick her head into a toilet to validate a homicide theory.
• Half of the large bowel is a semi-colon.

Aloha, and keep the faith. ----------rts

Contents of this Newsletter do not necessarily reflect the opinion, policy or position of the Hawaii Ophthalmology Society or the Hawaii Medical Association. Editorial comment is strictly that of the writer