OUT WITH THE OLD. IN WITH THE INCOMPETENT.

In a monumental backward step in health care, Oklahoma passed a law permitting optometrists to perform laser surgery. Veterans Administration policy allows health care professionals to function within the full scope of their state license anywhere in the VA system. So, when a Kansas VA facility was ready to allow an Oklahoma licensed optometrist to do laser work, organized medicine reacted, and got the VA to add the requirement that such optometrists must be supervised by an ophthalmologist. No laser surgeries were ever performed. A group of ophthalmologists and optometrists was empaneled by the VA to work out a mechanism for supervision. A stalemate resulted and the optometrists gave up the surgery issue. "We don’t want any part of our work to be under others, so we would rather not do this in the VA." Small wonder. Supervision would reveal gross ignorance in optometrist knowledge and skills.

 

AGAINST STUPIDITY THE GODS THEMSELVES FIGHT IN VAIN.

The Miami Herald carried a story verifying P.T. Barnum’s law of childbirth. In Miami, a law professor with three doctoral degrees and teaching at the University of Miami, fell for the notorious Nigerian scam and sent $1.68 million to a "government official" based solely on the e-mail contact. The official claimed to need some legal advice and offered the professor $200,000 for his services in a legal matter with a truck leasing company. A check from Penske Truck Leasing to pay for equipment ordered from Freightliner in Atlanta, somehow got to the professor who volleyed it off to Nigeria. The U.S. Secret Service is investigating, Penske has filed a complaint with their bank, and the professor is still waiting for his "fee."

 

AN EFFICIENT BUREAUCRACY IS THE GREATEST THREAT TO LIBERTY.

Beginning May 23, 2005, physicians can apply to Centers for Medicare and Medicaid Services (CMS), for the latest in identification. This ten digit number, the National Provider Identifier or NPI, is destined to be the number for each and every provider (once called doctor) in the country. Ultimately, the Medicaid billing number, and the drug enforcement agency (DEA) number may or may not disappear, CMS isn’t sure yet. The plan is to have each and every one of us properly numeralized and entered in the giant data bank within two years after May 23, 2005. The various payers, HMOs, Blues, et alii, will have to work out their own details on how to deal with this latest in government mandated confusion. No doubt, we are headed for a body part tattoo or implanted identifier for both patient and doctor to coordinate, record and file whatever comes about. Hello, George Orwell.

 

HELLO, THIS IS MEDICARE. HOW MAY I MISDIRECT YOUR CALL?

The Government Accountability Office (GAO) set out to audit the 24 hour Medicare information line. In response to 300 test calls, the GAO found that 30% of the calls were not accurate and 10% of the calls did not get any response. 60% of the calls were answered accurately. In response, officials claimed that the number 1-800-Medicare, brought a heavy deluge of calls (16.5 million through September 30, 2004), and that representatives need more training. Worse yet was the separate audit of a special line for physicians’ calls which found that only 4% got complete and accurate information while 60 % were inaccurate, and 36% were incomplete. On the other end of the phone, if the physician screws up his/her billing numbers, the result may be a public accusation of fraud or theft, which the media loves to report.

 

THE TROUBLE WITH CHILDREN IS THEY ARE NOT RETURNABLE.

Child health experts have convinced just about everybody that "breast milk is best milk" for human infants. Yet some mothers cannot breast feed, so in an effort to comply with the pediatric dictum, they go to the dairy. There are milk banks where parents can buy donated milk that has been screened and pasteurized, but supplies are limited and used primarily for very sick infants, and they require a doctor’s prescription. What to do? Simple! Go to the internet where human milk may be offered on e-bay for as little as 25cents an ounce, while milk from a certified bank may cost $3 an ounce (plus shipping). Two bits an ounce sounds like a good deal, but unregulated milk has no control, no guarantee of age of the milk, nor of storage at proper temperature. Moreover, breast milk can carry diseases such as HIV, syphilis, hepatitis, and might contain illegal drugs, alcohol, heavy metals, and who knows what other contaminants. The American Academy of Pediatrics and La Leche League International are against unregulated breast milk, and it is illegal in some states to share body fluids or tissue except through a licensed facility. But hey, the internet doesn’t pay much attention to such details as veracity and legality. Once again it’s buyer beware, or stick with formula.

 

A FLASH OF LIGHT, A CLOUD OF DUST AND ----WHAT WAS THE QUESTION?

A rather frightening report came out of the recent annual meeting of the American Society of Anesthesiology in Las Vegas. A study at Duke University found that many elderly patients having non-cardiac surgery, usually joint repair or replacement, sustained significant declines in cognitive abilities after surgery. Patients sixty years and older were given a battery of cognitive tests pre and post op, three months later and again two years later. Of the 354 patients, 34% were found to have significant declines at three months, and 42% showed losses at two years. The control group of oldsters who had no surgery showed no measurable change in mental ability. Postulated cause is the anesthetic event or stress of the procedure or perhaps both, but in any case, more study is indicated, and I think that my BPH can be tolerated for the nonce..

 

ALL’S FAIR IN LOVE AND WAR, OR IS IT?

In Kansas City, Missouri, an 18 year old man had consensual sex with a 14 year old classmate in a residential school for developmentally disabled children. Missouri state law considers sex between teens who are close in age a less serious crime than sex between a teen and older adult. However, the law only applies for heterosexuals, and in this event, the partner was another male. The judge gave the perpetrator 17 years in prison, but if the partner had been female, the sentence would have been 15 months. The appeals court said the sentence was justified because homosexual behavior is not part of "traditional sexual mores."

 

CHILDREN SHOULD BE SEEN AND NOT HAD.

About 16 million American women take birth-control pills and hundreds of millions have used the medication since "The Pill" was introduced in 1960. Now in a huge federal study involving 162,000 women taking the hormones, results were presented at the American Society of Reproductive Medicine conference. While previous research suggested that The Pill increased chances of heart disease, the study found the opposite. The women showed lower risk of heart attacks, strokes, high cholesterol, high blood pressure and other heart related problems. In summary, there’s an 8% risk reduction of ever having cardiovascular disease. Moreover, women using the pill had a 7% lower risk of developing any form of cancer, especially ovarian and uterine cancer. The effect appeared to be most evident among those women who took contraceptives early on in reproductive years. And also, not mentioned is that there is a greatly reduced risk of that dreaded disease, pregnancy.

 

"DO YOU WANT THIS TO COME OR TO GO?"

In Nassau County, New York, two women, ages 34 and 38, were running a hot dog wagon. However, rumors were that they were offering unusual side dishes besides the usual mustard and relish. When Rick Capece, commander of the county vice squad heard the gossip, he had an undercover officer investigate, and the two women were charged with prostitution. "It was a legitimate business, the most unusual thing I’ve ever seen," said Capece. The actual number of clients is unknown, nor what they usually ordered on their wieners.

 

ADDENDA -----

----- Americans consume 6 million pounds of squeeze cheese per year. (Ugh)

----- According to one survey, three out of four Americans believe in vigilante justice.

----- Blood comes in three colors: yellow, insects: blue, lobsters (and a handful of Bostonians): and red.

----- The praying mantis is the only animal on earth with just one ear.

----- Worldwide, an average of 300 million Coca Colas are consumed every day.

----- Money, to be worthy anything, must have blood and perspiration on it – preferably someone else’s.

 

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

THE WEATHERVANE

HAWAII OPHTHALMOLOGY SOCIETY NEWSLETTER

Volume XX, Chapter 12 December 2005 Editor R. T.Stodd, M.D.

WHAT DO YOU MEAN BOGUS VACCINE? I MADE IT MYSELF THIS AFTERNOON.

The event could have been taken from a Law and Order television script. In Houston, Texas, as many as 1,000 people have been injected with a make-believe flu vaccine. The owner and manager of Comfort and Caring Home Health in Houston, Texas, provided fake flu vaccine for over 1,000 Exxon employees at a health fair, as well as 14 patients at his home care facility. A contract nurse became suspicious when she heard employees complaining about having to stay up all night filling syringes. She noted that the employees had no knowledge of lot numbers used to track vaccines, so she notified authorities. The FBI seized 32 syringes for analysis which were found to contain "some form of purified water" according to the FDA. If found guilty, the man could face ten years in federal prison and a fine of $250,000.

IF THINGS SEEM TO BE GOING WELL, YOU HAVE OVERLOOKED SOMETHING.

A six year old boy with a benign brain tumor had successful cranial surgery and was recovering well. During a follow-up MRI, an attendant brought an unsecured oxygen tank into the room. The tank, about the size of a fire extinguisher, was caught in the powerful magnetic field, flew rapidly into the chamber, struck the child in the head and caused his death. According to the FDA’s Manufacturer and User Facility Device Experience (MAUDE) only 389 MRI incidents of deaths and injuries have been reported in the last ten years. Most of the deaths were failure of pacemakers or insulin pumps, and injuries were burns, projectiles, and implant problems. This number (389) is considered very small since 10 million patients are scanned annually, but experts doubt these numbers since MAUDE only requires reporting "serious" incidents. When Pennsylvania required mandatory reporting of all incidents, data were gathered over 16 months and 88 MR events occurred, which fortunately were "near misses" with no patient injuries (flying chairs, stools, etc). Emanuel Kanal, MD, director of MR services and professor of neuro-radiology at University of Pittsburgh Medical Center, estimates that the FDA data base records less than 10% of MR incidents and less than half of all deaths.

IF AT FIRST YOU DO SUCCEED , WHAT ARE YOU USING?

Every competitive athlete is looking for a legitimate way to get an edge, and testimonials from prominent athletes have endorsed lasik surgery. To determine real or imagined improvement, Daniel Laby, MD, associate clinical professor at Harvard and David Kirschen, O.D. PhD at UCLA evaluated a dozen baseball players who had undergone lasik surgery. As might be predicted, performance at bat was not improved following the operation. The investigators recommended that due to the possibility of career ending complications, athletes should wait until retirement from competitive sports before considering a surgical procedure. Despite technical magic, the best route to the hall of fame at Cooperstown or Canton, Carnegie Hall or Nashville is practice, practice, practice.

IT’S NOT SPEED, HORSE, POT, ACID OR HASH. IT’S JUST GREAT MUSIC.

And on the subject of getting an edge, baseball purists clamor for steroid-using Barry Bonds, Mark McGuire, Rafael Palmeiro, Jason Giambi et al., to give back their awards. But what about concert musicians! Thirty years ago in the 1970s a tuba-playing vascular surgeon tried prescribing a beta blocker to calm down nervous musicians with stage fright. It worked, and in a very short time nervous musicians became users. Normally prescribed for vascular disease, the drug slows the pulse and lowers blood pressure. According to a 1987 study of 51 major concert orchestras, every fourth musician was using a beta blocker. Seventy percent get the drug illicitly. Does the artistic world care? Not even a little bit. Beta-blockers are banned by the World Anti-Doping Agency from everything from curling to bobsledding (and even chess), but the musical world apparently could not care less. Whatever complaints exist stop outside concert hall, and how do you measure a concert musician’s performance anyway?. Ladeda and tralala.

WHY IS THE CAPTAIN CARRYING A WHITE CANE?

Researchers at the University of Iceland in Reykjavik studied 445 men age fifty and beyond regarding the incidence of lens opacities. Surprisingly, 71 of the 79 with cataracts were pilots. The interpretation is that exposure to cosmic rays while high in the sky, increases the risk of developing cataracts. They also found an association with smoking and sunbathing. Previously it has been reported that astronauts have a higher risk of premature lens opacities. So, fly low, refrain from lounging at the pool or seaside, eschew tobacco, wear good sunglasses, stay away from steroids, and carefully select your genes. You might be boring, but you will see better.

IF YOU THINK THERE IS GOOD IN EVERYBODY, YOU HAVEN’T MET EVERYBODY!

In Minnesota, Blue Cross/Blue Shield elected to financially penalize physicians who choose to hospitalize their patients at hospitals the Blues consider too costly. Doctors who refused to sign an agreement to refer to cheaper hospitals would automatically be placed on a "least desirable" list and their patients obligated for higher out of pocket costs. The Minnesota Medical Society jumped in with the argument that ranking physicians and hospitals on the basis of cost should not be considered without also evaluating quality of medical care. The Blues backed off, which probably only means they will seek another mechanism to twist physicians’ arms. Ranking hospitals according to cost is not rare on the mainland, but unheard of in Hawaii. Incidentally, a recent investigation of overall physician reimbursement in Hawaii found the Aloha state physicians 5th from last in the US of A.

AGAINST LOGIC THERE IS NO ARMOR LIKE IGNORANCE.

The ubiquitous human papilloma virus which causes genital warts can be controlled. Both Merck and Glaxo-Smith Kline are ready to market a vaccine which they claim will give 100% protection. It is extremely important because the virus infection is linked to cervical cancer which kills 3,700 American women each year, and many thousands more world wide. It is a very subtle infection spread by sexual contact, and there may be no signs or symptoms. Both sexes can unknowingly carry the virus. Should the vaccine be given to grade school children along with standard childhood immunizations to produce 100% immunity? One might think this is a no-brainer, but not to conservative religious parties in the Bush camp. They argue that a vaccine designed to prevent a sexually transmitted disease will sabotage their abstinence message, and encourage young people to have pre-marital sex. Nonsense, say vaccine advocates. "Does wearing a seat belt mean you intend to have a crash?" How the vaccine will be used will be determined largely by the Advisory Committee on Immunization Practices, a panel of experts assembled by the Centers for Disease Control and Prevention (CDC).

WHO IS THAT, GERONIMO OR ROBIN HOOD?

In Montclair, California, a freight train was stopped to let another train pass. A man jumped on the train with a bow and arrow and threatened the two man crew. The crew immediately bailed out and ran, but the alert engineer closed the throttle as he left, essentially stranding the train. Police were called and shot the man (no serious injury) when he pointed his weapon at an officer. Zounds! What to charge him with besides threatening with a deadly weapon? The DA decided on car-jacking since the train has a diesel engine and was towing 70 cars.

MACABRE, SPECTRAL, WEIRD, EERIE -- IT’S JUST HALLOWEEN! OR IS IT?

It was October 31st in Frederica, Delaware. When police received a call about a body hanging from a tree fifteen feet over a road, they rolled their eyes. Assuming it was a Halloween trick they took their time arriving on the scene. Surprise! It was not a dummy at all, but a real woman who had been hanging for hours. Passing motorists and pedestrians thought some pranksters were at play and failed to call until someone punched in nine one one.

ADDENDA -----

----- 2,000 teenage smokers become newly addicted to tobacco every day. Thank you Philip Morris, et al.

----- San Francisco cable cars are the only rolling National Monuments.

----- Coca Cola was originally green.

----- Don’t suffer from stress. Be a carrier!


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.

THE WEATHERVANE

HAWAII OPHTHALMOLOGY SOCIETY NEWSLETTER

TWO WRONGS DON’T MAKE A WRITER.

How often do eye surgeons see patients complaining of sudden onset of spots and floating strands in the field of vision? Every day? Twice a week? In the following case, a 54 year-old man consulted with his eye surgeon. The doctor dilated the eyes, saw "4+ cells" in the vitreous, diagnosed pars planitis and prescribed oral steroids. A week later the patient returned, and his symptoms had not improved. Two weeks later he returned with a retinal detachment. A retinal surgeon operated promptly but the retina failed to reattach, and a second attempt failed also. The patient developed headache, double vision, cataracts, and eye strain with reading and writing. The patient sued the initial ophthalmologist stating that he should have seen and treated retinal tears which could have prevented the detachment. He won a $7.5 million award, primarily due to a lack of documentation. The surgeon described the second office visit as "no change to retina," Jurors told the defendant’s attorney that his chart failed to state "complete retinal exam performed." The trial attorney’s mantra, if you didn’t write it down, it didn’t happen, and one could add, "You lose!"

WHEN SOMEONE SAYS HE IS COMING TO DO GOOD, RUN FOR YOUR LIFE!

In Virginia a sixteen year boy is suffering with Hodgkin’s Disease. He went through three months of chemotherapy which left him weak and nauseous. When his doctors recommended further chemo-therapy he refused, and stated that he did not want any more of that kind of treatment. Responding to an interview, the lad sounds intelligent and quite capable of making such a decision. His parents support him, and say they want to pursue alternate forms of therapy. Subsequently, the matter came to Judge Jesse Demps who ordered that the parents must share the decisions for his medical treatment with the Accomack County Department of Social Services, and the lad must report to the hospital and accept treatment recommended by his doctors. Wow! Compare that kind of reasoning with the 1914 ruling of Judge Nathan Cardozo, Justice, New York Supreme Court, "Every human being of adult years and sound mind has a right to determine what shall be done to his own body". What kind of big brother social agency and judge feel empowered to override the rights of an intelligent 16 year old supported by his parents?

WE’RE NUMBER ONE! WE’RE NUMBER ONE! OH WAIT, WE’RE NUMBER 37!

The World Health Organization (WHO) ranks the United States number one of 191 countries surveyed in responsiveness to patient’s needs, choice of physician, autonomy, dignity, timely care, and confidentiality. Alas however, the US is ranked 37th among developed nations in failing to require mandatory health insurance thereby failing to meet WHO’s fairness and distribution goals. Additionally, 56% of US health care dollars are privately managed while most countries rely on federal financing. Another problem (?) is medical savings accounts (MSAs) which encourage fee-for-service payments, making it difficult to regulate and control treatment practices and prevent central pooling of dollars. Yes, how crazy these Americans who want to control their own pocketbooks, select their own physicians, and decide what medical care they want, if any!

EVERY DECENT MAN IS ASHAMED OF HIS GOVERNMENT.

In an effort to scrap the senseless and unfair Medicare reimbursement formula (sustainable growth rate) promulgated during the Clinton years, Representative Michael Burgess, M.D. of Texas has introduced a bill tied to the Medicare Economic Index (MEI). The present mechanism is a built-in negative feedback loop that constantly creates a deficit in health care funding. By using his formula, physicians would receive annual updates equal to the MEI percentage minus 1%. The current plan would be changed from a projected cut of 4.7% in January 2007 to an estimated 1.5% increase. That’s a swing of 6.2% for the coming year, and reimbursement would continue to be directly related to medical expenditures. Access to care is already threatened, and without a new formula more doctors will refuse to provide care to the elderly.

A HANGOVER IS THE WRATH OF GRAPES.

Using a Center for Communicable Disease and Prevention (CDC) "Behavioral Risk Factor Survey of 2004" as a data base, Forbes magazine rated America’s drunkest cities. The five parameters were state laws, numbers of drinkers, heavy drinkers, binge drinkers and alcoholics. Milwaukee, Wisconsin, was the dubious winner, followed in order by Minnesota’s Twin Cities, Columbus, Ohio, Boston, Massachusetts, and Austin, Texas. Milwaukee citizens were upset claiming that it was just an unfair stereotype because of beer production there, and Chicago barkeeps were upset because the Windy City rated too low at number six. Surprisingly, party cities like New York, Las Vegas and New Orleans were on down the list. San Francisco-Oakland was way down at number 20, party-town Miami was 33rd, and Honolulu didn’t even make it into the top 35.

INSTANT HUMAN. JUST ADD COFFEE.

In Scotland a seven year study of 11,000 men and women ages 40 to 59, revealed that heavy coffee drinkers were less likely to have heart disease than tea drinkers. Labeled the Scottish Heart Health Study, the data showed that the heavy coffee drinkers were less likely to die of other conditions as well while the opposite was true for tea lovers. Meanwhile, a study of 125,000 people done by Kaiser Permanente Division of Research in Oakland, California, turned up a protective effect of coffee in cutting the risk of liver cirrhosis. Their numbers indicated that one cup of coffee a day reduced the threat of cirrhosis by 20%, and four cups a day cut cirrhosis frequency by an astounding 80%. The figures held true for various ethnic and racial groups. Added to this plus for coffee, is the American Medical Association study demonstrating that coffee drinkers are 30% less likely to develop Parkinson’s Disease, and Italian research found an even steeper drop to 80% for Parkinson’s.

IF YOU CAN’T LAUGH OFF AN INSULT, YOU PROBABLY EARNED IT.

Officials at Waterfront Development Park in Louisville, Kentucky, found that their public fountains had dangerously high bacteria counts, presumably due to homeless people using them for bathing, as well as diapered toddlers wading in the pools. Signs warning of dangerous contamination had little or no effect. Park Director, David Karem, decided to post new signs, "DANGER! Water contains high levels of hydrogen KEEP OUT!" The bacteria count plummeted, and the local newspaper (Louisville Courier-Journal) complained that Karem was treating Louisville citizens like fools. If the shoe fits .....

SOME PUSH THE ENVELOPE. OTHERS JUST LICK IT. SOME CAN’T EVEN FIND THE FLAP.

In Chicago, Illinois, a 29 year old man had a strange looking object in his carry-on bag while going through airport security. When asked by the officer what it was (actually part of a penis pump) he said it was "a bomb." After his arrest he stated that he said that because his mother was nearby, and he did not want her to know about the device. He is charged with felony disorderly conduct and could face up to three years in prison. How deflating! And now his mother knows!

ADDENDA –

----- Flu was first described by Hippocrates in 412 B.C.

----- Jesus saves sinners – and redeems them for cash and valuable prizes.

----- A smoking section in a restaurant is like a peeing section in a swimming pool.

----- All true wisdom is found on bumper stickers and tee shirts.

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.
 

ONE KIND OF MEDICINE MAKES ANOTHER KIND NECESSARY.

The recent ugly reports of fungal disease related to eye solution use have caused a widening worry among contact lens wearers. Fully one-third of the patients with fusarium keratitis related to use of Bausch & Lomb Inc. solutions are scheduled for corneal transplants. The people who make contact lens solutions, namely Bausch & Lomb, Inc., Alcon, Inc., Ciba Vision, and AMO, Inc. and eye care professionals (ophthalmologists and optometrists) have to clean up their acts. Doctors and their staffs and patients need to emphasize simple chores like washing hands, timely discarding of disposable contacts, and regular sterilizing or replacing contact lens cases. Moistening agents like tap water and saliva are no-nos. Of course, there is another way out, it is called lasik.

IS HE CONAN THE BARBARIAN, KINDERGARTEN COP OR MISTER UNIVERSE?

No one has ever suggested Arnold Schwarzenegger is not a smart fellow. Now the California Governor has moved ahead of the White House by signing a law which will reduce greenhouse gas emissions (principally carbon dioxide) to 1990 levels by the year 2020. The law calls for a decrease by a factor of 25% and easily passed the California Legislature, although it was opposed by Arnold’s own party. While signing the bill he accused President Bush of failing to provide leadership in environmental matters which makes one wonder about Arnold’s ultimate goals. Is he thinking perhaps of a Constitutional Amendment to allow a foreign-born American to become President? Ach du lieber!

DIETING IS JUST WISHFUL SHRINKING.

The American Diabetic Association (ADA) held its 2006 Food & Nutrition Conference and Exposition in Honolulu September 16-19 attended by almost 10,000 dietitians, researchers and nutrition professionals. More than half of Hawaii’s adults are overweight or obese. In addition, the prevalence of diabetes in our fair state is above the national average. Native Hawaiians have one of the highest rates of diabetes of any racial group in the country, and also have the highest mortality rate from diabetes. Every eye surgeon has a stable of diabetics he monitors for retinopathy. But in seeking a dietary advisor, there is a problem. Anyone can call him/herself a dietitian whether or not they have any education or qualifications! Hawaii Legislature passed a law in 2000 requiring licensure of registered dietitians, but to date Hawaii is yet to have its first such person.

FOOLISH FASHIONS ARE AS CONTAGIOUS AS THE PLAGUE.

In Madrid, Spain, the regional government has placed a ban on overly thin models at the top-rated fashion show in September. Using the body mass index (BMI), a height/weight ratio, 30% of models who were at a previous show were turned away. The medical point is that the show sponsors want to show healthy young women, and do not want to portray a waif-like "heroin chic" look. Their fear is that teen-age girls want to mimic the super-thin svelte model’s appearance and develop eating disorders. A spokesperson for the New York model agency Elite said "This is outrageous. What about discrimination against models or freedom of designers?" Too bad, I say. Anything that can be done to curb this potentially devastating psychosomatic disease is good preventative medicine. Ask any pediatrician who cares for teen age children.

AL GORE IS WALTER MONDALE WITHOUT THE PIZZAZZ.

Al Gore (you remember him) wants us all to know An Inconvenient Truth and sends a global warming warning. He helped make a frightening motion picture of the future for the world if we cannot change our behavior about greenhouse gases. He could have also looked more at the hopeful creative side of environmental challenges. With the passage of strong regulations, acid rain in the northeast has decreased by more than 30% since 1990 and Appalachian forests are not dying. Chlorofluorocarbons have all but disappeared and the ozone hole shows signs of reducing in size. Air pollution from automobiles is down by one-third to one-half from 1970, and smog and acid rain have continued to decline with the current Bush administration.. New cars today emit less than 2% of air polluting gases compared with 1970 vehicles, and autos have not been priced out of sight. Hydrogen powered vehicles are still in genesis, and they do not pollute at all. So, get panicky if you must, but go in the way of directed research not around in doom and gloom chicken-little circles.

EQUAL OPPORTUNITY MEANS EVERYONE HAS A RIGHT TO BE INCOMPETENT.

With the overcrowding in emergency departments and the shortage of skilled personnel, deaths such as the 49 year-old woman in Waukegan, Illinois, are going to occur. According to the news report, the patient complained of chest pain, shortness of breath and nausea and was listed as "semi-emergent." After two hours when her name was called, the patient had expired. The coroner’s jury called it a "gross deviation from the standard of care." Okay, that appears to be true, but the fascinating part of this episode is that the coroner’s jury decided to call the case a homicide! There may be a certain rationale for that kind of thought, but who can be named as the perpetrator – the hospital? the triage nurse? the emergency department supervisor? the ER doc who never saw the patient? or perhaps even a whining non-emergency patient who caused the delay? This is vaguely reminiscent of the California district attorney’s failing attempt to prosecute physicians for a nursing home death that occurred about ten years ago. Like the bumper sticker says, stuff happens!

THERE ARE TWO WAYS TO ARGUE WITH CMS. NEITHER ONE WORKS.

To make their books look better Centers for Medicare and Medicaid Services (CMS) did not pay you for your services for nine days from September 22 to September 30. This $1.3 billion delay roll-over from FY 2006 to FY 2007, permitted by Congress, is done without penalty and without any interest being paid, and doctors and hospitals just have to eat it. You might even think that FY meant something other than fiscal year. Physicians who think that they would be better off with a single payer system must understand just what CMS can do. These people are not your friends. Doctors should recognize that the federal bureaucracy retains an ongoing animosity toward physicians.

THE GAS STATION – WHERE YOU FUEL THE CAR AND DRAIN THE DRIVER.

If you think the motorists of Hawaii are being victimized with the price of gasoline, consider the local add-ons. The average tax on a gallon of gasoline in America is 42 cents. The lowest per gallon tax is Alaska with 26.4 cents; the highest (of course) is Hawaii at 53 cents. Then we have the additional county gasoline tax on Maui 18 cents, Honolulu 16.5 cents, Kauai 13 cents and the big island 8.8 cents. Lucky you live Hawaii, right? Well, most of the time.

IN THE TWIN CITIES PEOPLE CAN SLEEP IN SAFETY, MAYBE.

In Columbia Heights, Minnesota, police had to struggle to get a couple under control after a motor vehicle crash at one A.M. The driver, a 28 year old woman had crashed into a truck and then a car. Her 33 year old boy friend fought with officers and had to be hit with a taser gun to be subdued. The driver was cited for driving under the influence (BAC 0.213) and they both were placed in jail, a rather familiar place since they are both police officers in nearby Minneapolis.

ADDENDA ----

----- Please don’t eat today’s spinach because E. coli is lurking there according to the USDA. Ironically, according to the Associated Press the evil farm is called Natural Selection. Apparently, it is Darwinian spinach. If you survive you will be stronger.

----- Never try to use ear hair as a comb-over.

----- If life gives you lemons make lemonade. If life gives you tomatoes, make bloody marys.

----- If your voting could really change things, it would be illegal.

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.
 

BEAUTY COMES FROM WITHIN – JARS, TUBES, SYRINGES.

Historically, Allergan Inc., of Irvine, California, has been known for its ophthalmic products. Not any longer! Ocular medications now seem to be relegated to a sideline. Along came Botox for paralyzing facial muscles and smoothing wrinkles, and now with the introduction of Juvederm, an injectable cosmetic product recently approved by the Food and Drug Administration, Allergan is deeply into facial aesthetics. Juvederm, a hyaluronic acid dermal filler, is used to treat the deep skin folds that run lateral to the nose and down to the corners of the mouth. The effect is to plump up the creases by adding subcutaneous volume, but like Botox, Juvederm will wear off in approximately six months. For baby boomers, there is no need to fear geezerhood. Facial remodeling can keep the AARP population looking youthful indefinitely, but like as with dental appointments, patients will have to see their cosmetic surgeon twice a year otherwise one morning they may look in the mirror and see the portrait of Dorian Gray. Allergan’s TV consumer advertising budget jumped from zero three years ago to $120 million per year.

ON BRITISH AIRWAYS IT’S LIFE-RISK VS. COST BENEFIT ANALYSIS.

Just seconds after take off from Los Angeles, California, last July the number two jet engine of a a British Airways Boeing 747 with 351 souls aboard burst into flame and had to be shut down. The air traffic controllers immediately prepared to bring the huge jet back to the airport, but instead the flight crew contacted headquarters in Britain for advice. To the shock of the tower controllers, the captain was advised that the aircraft was certified to fly on three engines and to continue on its regular flight plan! The airplane continued across the United States, the Atlantic Ocean and eventually landed in Manchester, England, short of its destination because of worries about fuel consumption. Wow, is that legal? Not according to Federal Aviation Administration rules, but apparently okay by British air regulations. British Airways denied that the cost involved was a consideration, but admitted that $30,000 of fuel would have had to be dumped, and about $250,000 in passenger penalties and reroutes could have ensued. And if another engine had burst into flame over the Atlantic what would that cost? This is a disgraceful example of money trumping the safety of human cargo.

THE CLOSEST THING TO IMMORTALITY ON EARTH IS A GOVERNMENT BUREAU.

Nice work if you can get it, and you can get it if you happen to be in the right place with the right spouse. Mrs. Barack Obama, wife of the charismatic Illinois senator, suddenly found herself promoted to Vice President in the University of Chicago Hospitals system, and her salary jumped from $121,910 to $316,962 in her role as liaison with the south side community. President Michael Riordan who scheduled the promotion stated that he had planned for the role to expand to VP level to demonstrate greater outreach in south Chicago. Michelle Obama earned a bachelors degree from Princeton and law degree from Harvard and is surely worth the money. However, one wonders about the other sixteen veeps who are all paid between $291,000 to $364,000 in the not-for-profit system.

PACK MY BAGS, SWEETIE. I’M GOING TO BERMUDA AND GET A NEW LIVER

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began accepting applications from overseas hospitals early in the 1990s. Now more than 100 hospitals in twenty countries on five continents have received JCAHO approval including fourteen new hospitals this year. Cities as diverse as Hyderabad, India, Milan, Italy, and Izmir, Turkey, provide services where satisfied patients claim the quality of care is superior to what they received here. Medical tourism is now a commonplace event as patients (and third party payers) seek huge discounts for various operations. Procedures such as vascular bypass and shunt will cost you USA $62,000, overseas $8,750; CABG USA $63,000, overseas $15,000; kidney transplant USA $73,000, overseas $28,000. As the saying goes, "follow the money." Obviously, there are risks in traveling abroad for major surgery, such as not understanding medical standards, surgical training, credentialing, and post-operative care. Moreover, what happens with complicated follow-up; does the patient return to India or Singapore or Brazil? And if a procedure is botched what is the recourse and venue for the unfortunate injured patient?

I CHANNEL SURFED FROM C-SPAN TO HOME SHOPPING NETWORK AND ACCIDENTALLY BOUGHT A CONGRESSMAN.

It requires some sort of blinders to be a politician. House Speaker Dennis Hastert was told by aides and members of his own party more than two years ago that Florida Representative Mark Foley was engaging in e-mail conversations of a sexual nature with under age Capitol pages. With Foley it was like when Hastert read ex-Senator Packwood’s diary – he couldn’t wait to get to the bottom of the page. Apparently, when Hastert was informed, he is quoted as saying "It’s been taken care of." Now he claims he only knew of the problem on Friday, September 30, 2006. Come on, Mr. Speaker. Surely Ted Kennedy and Bill Clinton would advise you to get on with honest damage control immediately. Denial or delay hoping the sin will disappear is ineffective, stupid and exposes one as a liar. Motive in this case could be that Hastert was fearful of losing a vital seat in the House of Representatives. Now he is more likely to lose several seats along with his job as Speaker and his self respect.

HONESTY IS THE BEST POLICY, UNLESS YOU ARE A VERY GOOD LIAR.

South Carolina revised its medical practice act last June, and the new law requires that an out-of-state physician must obtain a license before being able to offer testimony as an expert witness. Also, it is policy of the American Medical Association that providing expert testimony is considered the practice of medicine. The intention is to get medical-legal prostitutes off the street. It is no surprise that no such law has ever been suggested in Hawaii. Now three attorneys have filed a lawsuit against the South Carolina Board of Medical Examiners claiming that the license requirement violates state and federal constitutional guarantees of equal protection, due process and free speech. And professional integrity, how about protecting that, counselor?

ONE TEQUILA, TWO TEQUILA, THREE TEQUILA, FLOOR.

A story in the South Florida Sun Sentinel stated that a 47 year old off duty police officer was arrested for driving 90 MPH on the Florida turnpike when she swerved and almost collided with a police cruiser. She had a large open bottle of Southern Comfort on the seat and was naked from the waist down. When asked where her pants were, she replied, "I don’t know." She refused to take a breath test, but failed the roadside sobriety test after donning a pair of sweat pants. Her job with the police department: DUI training for police recruits!

WHERE ARE YOU CALLING FROM? CAN YOU HEAR ME NOW?

The Washington Post reported that four men held in a maximum security prison in El Salvador had inserted cell phones, including chargers and chips, into their rectums in order to communicate while in prison. Suspicious police officers ordered X-rays which revealed the presence of foreign objects "in the body cavity."

ADDENDA –

----- 36% of Americans between the ages of 18 to 29 have at least one tattoo.

----- It is not too late. You can still join the 728 people who are members of the I Hate Cilantro club.

----- We are born wet, naked and hungry. After that things get worse.

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.
 

WHAT A GREAT VICTORY! FOR ONCE WE DIDN'T LOSE GROUND!

After considerable turmoil, sweat and some tears, both houses of Congress have agreed not to reduce Medicare physician reimbursement for 2006. By law, CMS had already imposed a 4.4% reduction, but that was eliminated and reimbursement was rolled back to 2005 levels. This time Congress was obviously impacted by the AMA's report that 38% of their members would reduce the number of Medicare patients they would care for if the reduction was not eliminated. This is good news for physicians, but really only for this year. To look at the larger picture, it's obvious that the flawed formula which is at the root of the reimbursement mayhem, remains in place. So far all attempts to replace the absurd "sustainable growth rate" (SGR) schedule with a formula based upon actual practice costs have failed.

IED - INJURED EYE DISASTERS.

A compilation of American military ocular injuries in the Iraq war after the end of the ground offensive was published in the January 2006 issue of Ophthalmology, with reports limited to injuries in the first eight months of 2004. During this period, over 500 soldiers were killed and 4,000 were injured. The ocular injuries were all prospectively examined and treated at the 31 st Combat Support Hospital in Baghdad. Two hundred seven severe ocular and ocular adnexal injuries, including 132 open globes were cared for. While conventional weapons such as mortars, rockets, sniper rifles and automatic rifles were used effectively by the insurgents, the majority of the ugly injuries (51%) were from improvised explosive devices (IED). Of 41 eye removals, 24 resulted from IEDs. Many, but not all of these injuries would have been prevented with consistent use of ballistic protective lenses. This is one ugly war!

COME ON, BABY, LIGHT MY FIRE ...

At Swedish Hospital in Seattle, a 54-year-old woman was under sedation while undergoing a lymph node biopsy. She awoke with her hair and neck in flames, and suffered burns to her face and neck with significant scarring. How the ignition occurred is still a mystery, but the fire was largely due to an alcohol-based hair style product which had been recently applied. A law suit seeking unspecified damages has been filed citing the hospital as negligent. The hospital is altering its pre-surgical procedures to include screening for hair care products.

SPEED KILLS! SLOW INFURIATES.

Everybody wants to avoid the airport congestion of long security lines. Now a program of "Registered Traveler" is being designed to permit those who have submitted personal data, been fingerprinted and issued a "smart card," to bypass the crowd through a special checkpoint. You can participate for a mere $80 per year. Sounds wonderful, right? Maybe not. The Federal Transportation Security Administration (TSA) has said participants would still be subject to random secondary screening, would not be exempt from removing shoes and coats, or sending laptops through X-ray machines. Because the program will be run by a private company, the personal information must be submitted to the TSA for security clearance. TSA will verify identity, conduct background checks, criminal records, and terrorism watch lists. Initially in support, the airlines are now against the program since they would have to build a special gate and add kiosks for scanning cards. Another worthwhile idea crashing on the rocks and shoals of bureaucracy!!

AGE DOESN'T ALWAYS BRING WISDOM. SOMETIMES AGE COMES ALONE..

Marilyn Albert, PhD, is director of the division of cognitive neuroscience at Johns Hopkins University School of Medicine. She has collected studies from the MacArthur Foundation Studies of Successful Aging, the Chicago Health and Aging Project, the Northern Manhattan Study, the Canadian Study of Health and Aging, and the Berlin Aging Study. The compilation of work identified a limited set of factors that appear to predict who will remain mentally sharp into their 70's and beyond. To summarize, these elements are physical activity, mental activity, social engagement and good cardiovascular health. Gender and genetics were not deemed to be as important.




YOU NEED A CIGARETTE TO STEADY YOUR NERVES AFTER READING ABOUT THE DANGERS OF TOBACCO.

It has long been known that a large and disproportionate number of individuals with mental disorders are smokers. While the national average of smoking Americans is about 22%, those with schizophrenia, attention-deficit/hyperactivity disorder (ADHD) or other mental afflictions is almost double the national average at 41%. Reporting in the Archives of General Psychiatry, Kollins et al., theorize that these individuals get some benefits from tobacco that others do not. Using magnetic resonance imaging on the brains of rats, nicotine use increased activity in the reward centers in both controls and ADHD rodents, but those with ADHD-like symptoms also enjoyed temporal and auditory stimulation. In theory, the additional activation might help alleviate symptoms of ADHD. What is known is that anti-smoking campaigns have been effective in cutting the rate of tobacco use in the broad population, but have had no effect on the mentally ill.

WHAT DO YOU MEAN HEADACHE? THIS IS FOR YOUR HEALTH CARE!

At the University of Florida, employees can now get health insurance to cover their domestic partners. The underwriters added one proviso: the applicant must swear that there was sexual contact with the partner for a minimum of one year in order to be covered. Kyle Cavanaugh, University vice president for human resources, stated that such "non-platonic" requirements are now commonplace in such significant other policies. No mention is made of married couples, who apparently don't need to swear to an active sexual relationship in the prior year (good thing .. perjury is a serious crime).

HOPE IS GOOD COMPANY ALONG THE WAY, BUT GENERALLY A WRONG GUIDE.

Trading on hope, "alternative" medical clinics have attracted terminally ill North Americans across the border to Baja California in search of miracle cures. The practice gained notoriety in the l970s when actor Steve McQueen went there where he was treated with coffee enemas and laetrile. Needless to say, he expired. Now (at last) authorities have closed the Santa Monica Health Institute where Coretta Scott King, widow of Dr. Martin Luther King, Jr. died. Citing improper and irregular treatment, unauthorized surgery, unsanitary conditions, and improperly trained personnel, Mexican health officials locked the door. The clinic director has a criminal history and was known for providing dubious medical care.

THE EXCEPTION PROVES THE RULE, ESPECIALLY THE GOLDEN RULE.

In western New York state, a 10-year-old bat boy for a little league team was accidentally struck in the chest

by a baseball bat. His heart stopped, he collapsed and became unconscious. Penny Brown, a nurse trained in CPR, was nearby and her prompt action revived the child. Now, seven years later, Ms. Brown was dining at a restaurant when a bolus of food lodged in her throat and she was unable to breathe. When patrons screamed for someone to help, a 17-year-old eagle scout and volunteer firefighter, Kevin Stephan, came to help. He performed an effective Heimlich maneuver and cleared the obstruction. Right! He was the boy she had saved at the ball park seven years before. And that's the rest of the story!

WHATEVER HITS THE FAN WILL NOT BE DISTRIBUTED EVENLY.

In Paderborn, Germany, zookeeper Friedrich Riesfeldt wanted to help his constipated elephant. He fed the ailing animal 22 doses of cathartic and added a bushel of berries, figs and prunes. With still no action he was using an olive oil enema when the impaction suddenly broke. The zookeeper was struck by a huge dump of 200 pounds of pachyderm feces, fell to the ground, was knocked unconscious when he struck his head on a stone, and was buried as the elephant continued to empty its bowels. Undiscovered by other attendants for about an hour, he died by suffocation under the 'mountain do.' Which goes to prove what the bumper sticker has been telling us, "SHIT happens."

ADDENDA -

----- Due to rising (usually sagging) obesity, standard hypodermic needles are increasingly unable to penetrate fat and reach buttock muscle.

----- The first canned beer in the United States was introduced in January 1935 by Pabst Brewing Company.

----- Hillary Clinton is inscrutable, but I can't vouch for the rest of her.

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.
 

WOMEN SHOULD WEAR COFFEE AS A PERFUME.

Having failed repeatedly to incriminate coffee in everything except insomnia, researchers have finally come up with an obscure reason to avoid caffeine. In the Blue Mountains Eye Study out of Sydney, Australia, researchers claim they found a relationship of coffee and caffeine intake to intra-ocular pressure (IOP). 3,654 participants completed a detailed questionnaire including average daily intake of coffee and tea, and were followed with Goldmann tonometry and automated perimetry. With the usual adjustments for age, sex and systolic blood pressure, it was found that those patients with open-angle glaucoma who consume more than 200 mg. of caffeine per day (one 8 oz. cup) had a higher mean IOP (19.47) than those with less than 200 mg. daily (17.11). But on the plus side, caffeine will reduce your chances of getting Parkinson’s Disease, colon cancer, and type two diabetes, and will elevate your mood and often clear up your headache. Pour me a second cup, please.

HEY WAL-MART! COME OUT FROM UNDER THAT ROCK SO WE CAN TALK.

Five years ago, Debbie Shank was a shelf stocker at Wal-mart. She was involved in a terrible vehicle crash with a tractor-trailer and was left seriously brain damaged. She is confined to a wheel chair in a nursing home with severe memory loss and brain stem damage. The trucking company settled a lawsuit for $900,000, but after the attorney’s bill and other charges, the remaining share was $417, 477 which the court placed in a trust to pay for her long term care. Her husband received $119,000 for loss of consortium. This would all be ugly enough, but there is more. Because she was awarded damages in a settlement, Wal-mart is suing her to recover their insurance claim costs of $469,216. If Wal-mart prevails, the Shanks will not just lose all the trust money, they will owe Wal-mart $52,000 plus court costs. A spokesman for Wal-mart stated the suit was a way to preserve options (Like what, taking their house and car?), and that the health plan may decide not to pursue the law suit. Experts say this is not an uncommon case, and insurers often have policy clauses which require that they be reimbursed from lawsuit proceeds. So remember, the large print giveth, the small print taketh away!

BUMMER, DUDE! SURFERS RUN OVER BY THE GREEN MACHINE.

In a brief letter, and without warning, Gordon "Grubby" Clark, said it’s all over. With an action that is certain to have major repercussions in Hawaii, Clark Foam of Laguna Niguel, California, suddenly shut down operations. For more than 40 years Clark has supplied foam blocks for designing and shaping surf boards. With a virtual monopoly, Clark provides blocks for about 90% of all custom made surf boards world wide, so the surfboard market is in a panic mode. What happened? Clark said his company has been repeatedly hit with local and state regulations about use of non-standard production equipment, most of which he designed himself, and the use of aromatic hydrocarbons such as toluene diisocyanate. He stated he paid $500,000 in fire code fixes and $400,000 in defending a law suit. Moreover, he was faced with buying a multimillion dollar "scrubber’ to comply with EPA pollution issues. "They simply grind away until you either quit or they find methods of bringing serious charges or fines that force you to close." So, if you are in the market for a new board, shop now while supplies last. Prices are already on a major upswing.

AND RALPH NADER ASKS WHY DOCTORS DON’T SELF- POLICE MORE VIGOROUSLY.

In Minnesota, a creative attorney is trying to rewrite the rules in malpractice cases. The complaint centers around a patient who had gastric bypass surgery, and suffered post-operative complications. The plaintiff’s attorney discovered that the surgeon was not board certified and had previous malpractice actions brought against him. The law suit was then modified to include the hospital and medical staff for alleged negligent credentialing, and that the doctor should not have been granted privileges. The issue was altered from meeting the standard of care, as is the rule in malpractice cases, and instead involves the peer review process. However, the Minnesota peer review statute "absolutely prohibits the hospital from disclosing the deliberative processes by which the credentialing decision was made ..." rendering the hospital unable to defend itself.. The District Court judge ruled that the state did not grant immunity to hospitals or other review organizations in negligent credentialing claims, and he pushed the issue to the Minnesota Court of Appeals. For certain, if peer review deliberations become discoverable, no doctor will agree to serve in that capacity.

TWENTY-THREE MILLION MEN CAN’T BE WRONG.

A report in the American Journal of Ophthalmology from the Casey Eye Institute at the Oregon Health Sciences Center presented data on 892 cases of reported side effects from the use of erectile dysfunction drugs. Ocular side effects were found to be transitory and fully reversible. According to World Health Organization classification, ischemic optic neuropathy is "possible" due to ED drugs, but no conclusive evidence exists to establish a link. As all older eye surgeons know, anterior ischemic optic neuropathy was around long before the arrival of ED medication.

LIFE IS NOT A SPECTACLE OR A FEAST. IT IS A PREDICAMENT.

The majority of malpractice insurance policies offered by physician-owned carriers contain a clause allowing the policy holder to accept or reject a settlement offer. The primary purpose is to discourage nuisance suits, which is good, but the choice has a double edge. In Baton Rouge, Louisiana, an obstetrician was sued by the parents of a child who suffered brain damage during delivery. The family claimed that the doctor was negligent, and they offered to settle for $100,000 in damages. The insurer recommended that the offer be accepted, fearing that the child’s condition could cause a sympathetic jury to award a much greater amount. The doctor refused to settle, thejury found him negligent, and awarded $1.5 million to the plaintiff. Moreover, because the award was far beyond the settlement offer, the defendant was held personally responsible for the plaintiff’s legal expenses which the judge reduced to $10,000. The moral is that insurers and their legal staffs often recognize which cases can and should be defended and which should not. Listen to them.

SCOPES TRIAL - TAKE 2

In what should have come as no surprise, Judge John Jones III struck down the Pennsylvania school board plan to introduce "intelligent design" to high school biology students. He agreed with scientists who testified that intelligent design is little more than biblical creationism in a new suit. "The breathtaking inanity of the board’s decision is evident when considered against the factual backdrop which has now been fully revealed through this trial." Interesting to note that Judge Jones is a Dubya appointee with a strong conservative background, who obviously feels that Constitutional amendment article one regarding prohibition of state sponsored religion must be protected. The President thinks intelligent design should be taught in public schools and appears to disagree with the first amendment, but then he apparently disagrees with the fourth also (illegal search and seizure).

TALK IS NOT SO CHEAP WHEN YOU SAY IT WITH THESE FLOWERS.

Why send a predictable dozen roses when you can give a bouquet of "glow in the dark" chrysanthemums or roses? "The market needs new ideas and innovation," said the spokesman for a Dutch company, FloraHolland BV which is offering flowers that glow in the dark. The costs are about 50% more than regular prices. Rumors that their potting soil came from Chernobyl and Three Mile Island have not been verified.

ILLINOIS - LAND OF THE VOTING DEAD.

In Joliet, Illinois, Harrahs Hotel and Casino sent out 11,000 coupons to favorite customers. Some of them were for $525, but the printer made an error and all of the coupons were for $525. The manager refused to honor the coupons, referring to a disclaimer on the back which stated that Harrahs had the option to change the rules at will. The Illinois gaming commission disagreed and ordered Harrahs to recognize the stated value. Harrahs immediately changed their tune and said they were always glad to provide tops in customer service. Right! What nice guys those casino operators are (when whipped).

ADDENDA –

----- 42,636 people were killed in traffic accidents in 2004, a decrease of 0.6% . Bicycle deaths increased 15%, and motorcycle deaths jumped 7.9%. Wear a helmet!

----- A mere 13% of Americans know what a molecule is.

-----The average mall Santa weighs 218 lbs.

----- Television is a medium - so called because it is neither rare nor well done.

----- Learn from your parents’ mistakes. Use birth control.

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
 

MOMMA, DON’T LET YOUR BABIES GROW UP TO BE CHEER LEADERS.....

Some startling statistics regarding injuries to cheer leaders and pom-pon girls were reported in the journal Pediatrics. Using data collected from hospital ERs, investigators found that 208,000 cheer leaders injuries in children ages five to eighteen, were recorded in the twelve years from 1990 to 2002. Moreover, in that time period, the frequency jumped 110% as 10,900 visits occurred in 1990 and 22,900 in 2002. Strains and sprains made up 70% of the damage, but fractures and dislocations were 16%, and closed head injuries were 3.5%. These numbers are believed to be far below reality since many injuries are treated by school trainers and family physicians, and never see the ER. A good portion of the problem is that cheer leading is not considered a sport, so the participants and their coaches have no training in gymnastics, often lack adequate practice facilities, and are not taught how to avoid injuries when falling. Be careful out there.

VAGINOPLASTY? HYMEN-RECONSTRUCT?

In this over-populated world gone more than slightly nuts, the current practice of a few surgeons is vaginal plastic surgery. "Revirgination" or hymenoplasty can be obtained for around $1800, and one woman called it the ultimate gift for the man who has everything. She plans to give her husband a "virgin" to celebrate their 17th wedding anniversary. The operation has been known for some time in the Middle East and Latin America where an intact hymen has exaggerated significance. This absurdity is further magnified since the membrane frequently ruptures with non-sexual activity such as athletics. No data is available, but now the procedure is becoming more popular north of the border. One New Jersey gynecologist has been performing hymenoplasty since 1975 when he had one or two patients a year, but now he markets the operation and does ten a month. This ought to be enough, but more of the plastic surgery vogue is vaginal cosmetic surgery where some women want to redesign their private parts to make themselves more attractive.

DON’T HAVE YOUR HEART ATTACK IN THE BIG APPLE.

In New York, statistics show that people are more likely to die from heart attacks than any other state. It is not diet, life style, or stress, but in fact it is public score cards! In 1989, New York became the first state to make public reports on mortality for two procedures, coronary bypass and angioplasty. Almost from day one, surgeons began gaming the system. Five studies published in reputable journals have been recorded, all suggesting that New York heart surgeons are refusing to operate on patients perceived as a greater risk for death or complication. Why jeopardize your good rank? The any question of doubt was buried when an anonymous survey sent to every doctor who does angioplasty in New York, found that an overwhelming majority (79%) admit that the public mortality numbers have discouraged them from caring for risky patients. So, the hospital statistics look great as the mortality for bypass surgery dropped from 3.52% to 1.6%. Of course, technology and surgical techniques have improved, but risk adjustments make the data meaningless. Michigan does not have surgeons’ score cards, and data taken directly from hospitals and compared with New York, found an astonishing fact. If a patient came to the hospital in shock having a heart attack, that person was four times as likely to have surgical care in Michigan than New York. Why does it surprise anyone that doctors would alter behavior to protect their careers? Medicare will soon implement "pay for performance" so let the games begin.

JUST SIGN HERE, THEN I CAN TAKE MORE OF YOUR MONEY!

The Florida Bar rules allow attorneys to collect as much as one-third of any damages in a malpractice case up to $1 million, 20% between $1 and 2$ million, and 15% exceeding $2 million, but those are the old numbers. In the fall of 2004, the people of Florida overwhelmingly (70%) approved an amendment limiting contingency fees in medical liability cases to 30% of the first $250,000, and 10% of all damages beyond that figure. Michael Feiler, president of the Dade County Trial Lawyers Assn, stated that with these changes attorneys would likely ask clients to sign a waiver to increase the contingency fees to make it financially feasible to take a case. Mr. Feiler is asking the client to waive his constitutional right in order to enrich the man who is advising him to do so. But wait! Could that be a conflict of interest?

BEND OVER, AMERICA! HERE COME THE PHARMACY PEOPLE.

Personal account - A good friend has radiation proctitis due to overdose by the radiation therapist. The patient was given a prescription for Canasa, an Axcan Pharma, Inc. anti-inflammatory suppository. Checking with five pharmacies in the area, the patient found that prices for a 30 day supply ran from $284.09 to $343.69. A phone call to a reputable Canadian pharmacy found that the same medication, 30 day supply was $54.10, a saving of 80 to 85%. Is there any doubt that the pharmaceutical industry is virtually extorting money from the American people, especially when the direct to consumer advertising budget is greater than the R&D expenditure? Congress and the President should be ashamed for allowing this financial abuse of sick Americans.

GENEVA CONVENTION? WHAT’S THAT?

The John McCain amendment to the Department of Defense Appropriations bill states, "No individual in the custody or under the physical control of the United States government regardless of nationality or physical location shall be subject to cruel, inhuman or degrading treatment or punishment." Remarkably, President Bush originally said he would veto the DOD bill if the McCain language was adopted, but after both houses gave the amendment broad support, he backed down. The American Medical Association sent a strong letter to the leadership of the Senate Committee on Appropriations urging prompt adoption of the McCain amendment stating that torture is fundamentally incompatible with physicians’ duties to prevent harm and exercise their role as healers.

THE BEST MAN FOR THE JOB IS OFTEN A WOMAN.

Looking for a new employee? Here are some questions you should not ask: (1) Anything related to ethnicity, including place of birth, country of origin, nationality of applicant or spouse or parents, (2) Anything related to disability must be carefully phrased such as asking if the applicant can fulfill a job description (ignore crutches, walkers, canes, wheelchairs, seeing-eye dogs, absent extremities, etc.), (3) Do not ask any question even suggesting religion, such as observing religious holidays, (4) Avoid curiosity about marital status, pregnancy, children, need for child care, and (5) Pose no questions about disease, past or present illness, state of health, or health history. (6) Avoid remarks about hardware in the tongue, lip, eyelid, nasal or ear cartilage, bare midriffs, or malodorousness. You may contact references and ask the applicant to explain any negative responses, and you can do a criminal background check.

EVERY MOON HAS A DARK SIDE.

In Rockville, Maryland, a 44 year old man got into an argument with his neighbor. As the neighbor left her home with her eight year old daughter, the man dropped his trousers to more or less punctuate his argument by mooning her. He was convicted of indecent exposure, but the case was later dismissed. The appeals court judge stated that the law refers to exposure of genital parts and not the buttocks, and if exposure of buttocks is a crime, half the plumbers and most of the bikini clad women at the beach would be arrested.

GREAT LINES WORTHY OF FORGETTING --

* I am the future! (Dan Quayle)

* It’s a law of nature. Republicans are more boring than Democrats. (Stewart Alsop)

* I am a loyal Republican. I support President Bush when he’s right. I just try to keep quiet the other 95% of the time. (Russ Stodd)

* I don’t know about politics, but I know a good party when I see one. (Mae West)

ADDENDA -----

----- Average daily rate for a nursing home private room in 2005 was $203.00, which computes to $74,095 per annum.

----- The French work 23.5% fewer hours than they did in 1970. Americans work 20% more.

----- The most consumed fruit in the United States is the coffee bean.

----- $18,000 is the sum of money paid for a bar of soap allegedly made from fat liposuctioned from the Italian Prime Minister Silvio Berlusconi. It might make one sing better in the shower.


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
 

A LUXURY IS SOMETHING YOU DON’T NEED BUT HAVE TO HAVE.

How do you sell an expensive intra-ocular lens implant to the Medicare cataract population? Thanks to direct to consumer advertising (DTC) multiple avenues are available. ReZoom the multi-focal implant made by Advanced Medical Optics, Inc. (AMO) decided on a well known senior golfer, Gary Player. The screen shows him putting out with a birdie on the first hole, and attributing his skill largely to his sharp vision with the implanted lens. Now he is the paid spokesman for AMO, and the campaign includes a package of television, radio and print ads. ReStor, the competing lens from Alcon Laboratories Inc., features a handsome white-haired grandmother type with a young lad beside her on safari. She is wearing no glasses of course, as she reads from her guidebook and spots gazelles, elephants, and other game. The marketers have learned from lasik that it is best to get the manufacturer out of the loop, and have local ophthalmologists tie their personal footage to the mini-drama. So far, sales are lagging. The hard part is explaining to elderly patients why they need to buy a $4000 implant instead of a pair of drug store reading glasses.

SIGN ON THE EMERGENCY DEPARTMENT DOOR "CLOSED TODAY. BACK TOMORROW MAYBE."

In our Aloha state, new doctors are not coming, some established docs are leaving, older physicians are retiring, and if we didn’t have the John Burns School of Medicine, access to care would be folklore. It doesn’t have to be this way. In 2003 Texas passed tort reform by way of public referendum and the malpractice climate has changed. Doctors are more likely to accept patients with high-risk problems and physician recruiting is now much easier. According to Medical Economics the Texas state medical board expects to receive 4,500 new physician license applications this year, an increase of 40% over 2005. The board executive director attributes tort reform as the "only viable hypothesis" to explain the huge increase.

TO MINIMIZE LOSS DUE TO EARTHQUAKES TRY NOT TO OWN THINGS.

The October 15, 2006, earthquake that shook the Hawaiian Islands should serve as a wake-up call for all of us, because defects in preparedness showed up in multiple areas. Certainly the most difficult to comprehend was the near total loss of electric power which lasted all day on Oahu. Hawaiian Electric failed to offer a satisfactory explanation. More significantly, why was there no Civil Defense emergency radio broadcast? KSSK, a Honolulu commercial outlet, fired up emergency generators to provide the only information obtainable. The Hawaii Health Systems Corporation management got egg on its face because the structural defects which resulted in damage at Kona Hospital had been previously reported by Civil Defense. That report was either not read or was ignored. The absence of injury to patients and staff was just good luck, because if the Richter reading had been slightly higher Kona Community Hospital might have been a pile of rubble and a state government scandal could have ensued.

HURRAH! IT’S A GIANT STEP ..... sideways.

Hawaii has mandated that at least 85% of gasoline sold after April 2006 contain 10% ethanol. The green people cheer because it is cleaner, less pollution, a great step ahead! But is it really? What it also means is that your miles per gallon will drop by 20 to 25%. Consumer Reports tested a Chevrolet Tahoe and found that highway mpg dropped from 21 to 15, and city mileage went from 9 to 7. Who really benefits from this great leap forward? The highly subsidized and tax supported corn and grain growers of middle America, principally Archer Daniels Midland (recently fined $100 million for anti-trust violations) are delighted, and so are the oil companies since fewer miles per gallon means increased fuel sales. Our generous Hawaii legislature passed a law which gives investors $2 tax credit for every $l spent on building an ethanol plant, plus five additional tax breaks. The Alaska Science Forum as far back as 1980 found that the cost of producing and harvesting the biomass (irrigation, fertilizer, etc), plus plant construction, and the energy required for production totals out to a negative. In summary, gasohol may be cleaner, but it looks like a loser. And guess who has to pay the bill for reduced gas mileage, agribusiness subsidies, and tax credits?

IN AN AIRCRAFT THERE IS NO SUCH THING AS A LITTLE PROBLEM.

As passengers were exiting an Air France flight from Manchester, England, a large and hairy spider fell from the overhead baggage compartment, delaying the Airbus’s return to Paris by five hours. The spider was never found. A Swissair Airbus bound for Vienna was grounded for two days as personnel searched and eventually trapped a rat. In Zurich, Switzerland, a flight to Moscow was delayed for almost two hours because an eight inch snake was spotted. The serpent had escaped from the pocket of a young man who had slipped it by U.S. Security agents. It was a harmless snake, but still represented a major concern for both passengers and crew. Many such events happen every year as aircraft are held up by mice, rats, snakes, spiders and in one case by a pit bull terrier. It had escaped from the cargo hold and chewed up parts of the plane and gnawed on electrical cables as big around as a garden hose. To date, there has been no recorded crash caused by stowaway critters, and certainly the delays don’t amount to much dollar loss compared with the cost jet fuel, still it is a genuine issue for passenger angst and air transport carriers.

ALWAYS SAY NO TO DRUGS. THAT WILL DRIVE THE PRICES DOWN.

To the dismay of the American pharmaceutical industry, U.S. Customs and Border Protection officials have been told to stop ceasing prescription drugs imported through the mail from Canada. For over a year, the practice was depriving tens of thousands of American seniors of their medicine and protecting the outrageous prices of American drug companies. Although it is illegal under U.S. law, Canadian and U.S. Customs had turned a blind eye to these puny orders, but the Pharmaceutical Research and Manufacturers of America had argued about the "dangers of unsafe imported drugs." What a crock! Everyone (even the Dubya administration spokesperson) admits that the bulk of profits for drug manufacturers comes right out of the pockets of America’s seniors.

SO THAT’S WHAT GRANNY WAS DOING BACK THERE IN THE STACKS.

In Levy County, Florida, public libraries have seen a 97% reduction in their volunteer help. New County regulations require that all employees and volunteers be tested for drugs. They are told to "pee in the cup" within earshot of a supervisor. Because most of the volunteers are retired people who help stock and arrange the bookshelves, they have refused to oblige and given up this generous task. "Why are we spending tax money to test 75 year old grandmothers for marijuana?" said one silver-haired lady.


ADDENDA -----

----- According to government statistics flu kills 3% of patients age 65 to 84, and 8% of those 85 and beyond.

----- If you are average, your lacrimal glands put out about four quarts of tears per year.

----- Coca Cola can be used to clean your toilet bowl.

----- If a human sperm were the size of a salmon it could swim at 500 miles per hour.

----- Wilma Flintstone’s maiden name is Slaghoople.


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.
 

MYSTICISM IS A RELIGIOUS DISEASE.

In Atlanta, Georgia, ophthalmologists expressed extreme concern when it was found that an estimated fifty followers of Hira Ratan Manek were following his instructions and staring directly at the sun. He defended this practice by stating that he preaches staring only 10 seconds at first and gradually building up to 45 minutes! He claimed his advocates should stare while the sun is close to the horizon. Similar cultist was loose on Maui about 15 years ago and brought about macular burns in her true believers before being reported to authorities.

THE REALITY CHECK BOUNCED.

Surgical teams in both the United States and Europe have announced to the media that they have the ability to transplant a new face on patients who have survived with severe scarring from burns, extensive oral or facial cancer surgery, or tissue destruction from IEDs (improvised explosive devices). Often the patient is so deformed that he/she fears being seen in public and feels unable to maintain a meaningful life. The prospect of a new face sounds great, but the consequences of facial transplant are nearly insurmountable. The patient must be maintained on life-long expensive immunosuppressant drugs with the potential for kidney failure or cancer, and to discontinue the medication often results in death. Moreover, the psychological factors of wearing someone else’s face (from a cadaver), and lacking expression due to inadequate muscle and nerve control, is another ethical problem to overcome. The factors of drug cost, concomitant complications of immunosuppressant therapy, and psychological burdens, means that such patients must be carefully selected. It’s yet another case of doctors leaping ahead into the field of "Okay, we can do it, but should we?" Of course, it does sound wonderful on the six o’clock news.

IF AT FIRST YOU DON’T RECEDE, COME GET INJECTED.

In the ever-so-popular field of exploiting fat Americans, a number of medical cosmetic spas are now promoting Lipodissolve, touted as a non-surgical alternative to lipo-suction. They are offering Botox for your brow spasm, Restylane for your facial creases and now PCDC for your porky bottom. Fatty areas of the buttocks or abdomen are injected with a series of tiny shots meant to melt fat. There are no fat-lysing injectables approved by the FDA, so practitioners use a custom mix from a local pharmacy or one made in a doctor’s office. A concoction used by many is called PCDC, a combination of phosphatidylcholine and sodium deoxycholate. A retrospective study published in the Aesthetic Surgery Journal collected data from 75 physicians in 17 countries on 17,376 patients, and found that 12% were unhappy with the result, and some had complications of hyper-pigmentation, pain and allergic reactions. The pathetic truth is that an increasing number of doctors are concentrating on lucrative cosmetic procedures, and reducing standard areas of care.

SHIFT THE RESPONSIBILITY; THE TRIAL LAWYER’S GAME.

In Sacramento, California, a 51 year-old truck driver went to his doctor for a routine physical exam. Laboratory tests were done, including CBC and urinalysis which revealed some abnormalities. The patient was scheduled to return in two weeks for a colonoscopy, but he failed to keep that appointment and did not see the doctor again. Two years later, after passing blood from his rectum, he saw a different physician who found that the patient had colon cancer. The patient brought a law suit against the original physician for failing to follow up when he did not return. The facts were not in dispute, but the patient (and his trial attorney) claimed the doctor should have contacted the patient when he missed his second appointment. Fortunately, the physician was supported in this case, but the question remains, who is responsible for not keeping an appointment, the patient or the doctor? Are we accountable for our own actions or inactions?

FOR A GIFT ONE IS ALWAYS BEHOLDEN.

The New England Journal of Medicine recently published results of a study of gifts to physicians from pharmaceutical manufacturers. Collecting data from 1,662 physicians in 2003 and 2004, it was found that 94% acknowledged that they had accepted some form of gifts or money from drug companies or medical-device manufacturers. Specifically, 83% reported being treated to meals; 78% took free drug samples and 35% accepted reimbursements for the cost of attending educational conferences hosted by drug companies. Almost 7% admitted they were treated to food, lodging, travel, plus cultural and sporting events. Moreover, 28% were paid for speaking engagements and enrolling patients in clinical trials. "We all know that gifts and gratuities create a subconscious sense of indebtedness," according to lead investigator Professor David Blumenthal, M.D., of Harvard Medical School. The American Medical Association strongly urges doctors to accept no gifts worth more than $100. Some physicians challenge the broad conclusions coming from such surveys, and ask "Does having pizza with a drug rep compel me to prescribe his company’s latest compound?"

SHE RARELY HAS A HEADACHE!

According to Reuters the Orient Industry Co. of Tokyo, Japan, turns out 80 finely designed and anatomically correct "love dolls" each month which sell for $850 to $5500. The more elaborate models are made of silicon, are remarkably life-like, and have up to 35 movable parts. They are purchased by men who prefer synthetic girls to flesh and blood. Says one satisfied buyer who has two dozen dolls which all have names, "I prefer live women, but dating is such a bother."

OUR SAFETY NET HAS SOME LARGE DEFECTS.

The Institute of Medicine (IOM) wants us to know that the nation’s emergency-care system is breaking down. The IOM found that in some cities emergency teams save half of victims of cardiac arrest, but in other places they save only 5%. The crisis is already apparent in day-to-day emergencies which means that in any bus or plane crash or other catastrophic event, the emergency system would be unable to provide equipment, beds and personnel. The IOM report recommends that state agencies, health organizations, and hospitals set up regionally coordinated emergency systems to direct ambulances and patient flow. Considering the unique geography of Hawai’i, the potential for breakdown is even more serious. This is a challenge the DOH and Civil Defense must undertake.

TO BE OR NOT TO BE.............. "HEY, WHATEVER"

In Great Britain educators have endorsed rewriting the works of Shakespeare as comic books using simpler language for "bored" students. The examples given were lines from Henry V, "Stiffen the sinews, summon up the blood. Disguise fair nature with hard-favour’d rage; then lend the eye a terrible aspect." Comic book version, "Get a fierce look in your eyes."

ADDENDA -

----- According to Price Waterhouse Coopers 10% of every dollar spent on health care is attributable to medical liability and defensive medicine.
----- Officials in Saudi Arabia announced that the country is 80 be-headings ahead of last year’s pace, and is on track to break the record of 191 set in 2005.
----- In Belgium, the newly elected prime minister, Yves Leterme, was asked to lead in singing the national anthem on National Day, so he stepped to the microphone and sang the Marseillaise.
----- A Finnish man won the International Mobile Phone Throwing contest with a toss of 89.62 meters.
----- Headline in the El Paso Times, "Man stabbed outside Hiney’s seeks help at Hooters.
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.
 

 
TECHNOLOGY IS RAPIDLY FILLING OUR LIVES WITH DEVICES SMARTER THAN WE ARE.
While the concept of a "bionic eye" has been around for decades, a device to help a blind person actually see is approaching reality. At Stanford University, physicist Daniel Palanker, Ph.D., and associates have developed a three millimeter chip which can be implanted behind the failing retina to theoretically produce a ten degree field with visual acuity of 20/80. The patient would wear a pair of goggles mounted with a mini-video camera. The camera transmits a wireless message to a wallet-size computer which relays the message back to an infra-red screen on the goggles, which is then transmitted to the retinal implant. Voila! The patient can read the headlines, enjoy Saturday Night Live, and live independently. Please don’t step on the goggles.

RESULTS OF THE TEXAS CHAIN SAW MASCARA.
Dry eye disease afflicts millions of Americans, especially women over age forty. It is estimated that 25% of eye-doctor visits are for dry eye complaints. Multiple factors can be a cause such as hormone imbalance, contact lens wear, after eyelid or lasik surgery, or environmental conditions such as air conditioning, wind, dust, and allergies. For some the problem can be serious and debilitating, but typically these patients receive perfunctory treatment. The doctor is likely to recommend increased blinking, or lacrimal punctum plugs, or over the counter moistening agents. These may yield transient relief, but are only temporarily effective. Allergan’s prescription eye drop, Restasis, works for some, but fails for others. Moreover, many solutions are expensive. Pharmaceutical people now recognize that the market for a successful product can reach annual sales of $1.5 billion. Now there are about 20 products in various stages of research, such as Alcon’s low-dose steroid eye drop which should hit the FDA in 2009. AMO also has a dry-eye development program underway. Show me the money!! gets action every time.

PLEASE NO MORE CHEESE! I JUST WANT OUT OF THE TRAP.
So what is next? Doctors with badges and issuing subpoenas? Six states, California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania, now require physicians to report people who may be unfit to drive, such as elderly patients with significant disease. Moreover, the feds even want doctors to document immigrants who come for help. Obviously it is necessary to report child abuse or elder abuse, but what about the pregnant sixteen year old girl who had consensual sex with an adult male? Failing to report is risky and may make the physician vulnerable to serious penalties, such as fines or even imprisonment. And is it wise to report female abuse when the police fail to lock up the abuser, and the woman has to return to the same home? Will patients seek help if they think the physician cannot be trusted to keep medical care confidential? It is the physician’s role to always do what he feels is medically best for the patient within the parameters of ethics and logic. Please get the politicians and various government agencies out of the house of medicine.

MAUI BUMPER STICKER - YOU WOULD DRIVE BETTER WITH THAT CELL PHONE UP YOUR A***.
A survey released by Nationwide Mutual Insurance showed that DWD, "driving while distracted," is very prevalent. Of those who responded, 59% do not consider themselves distracted drivers, but 80% admit to multi-tasking on the road. As might be expected 73% confess to talking on cell phones, and 37% of young adults admit to text-messaging! Almost half of respondents (48%) said they eat a full meal while motoring. Less common DWD events were reading a book, putting on contact lenses, watching a movie, nursing a baby, and even changing seats with a passenger. OMG (oh my god) be careful out there!
WOW! THIS LOOKS REALLY WEIRD. MOVE THE CAMERA OVER THIS WAY.
In Massachusetts, state representative Martin Walsh, a Democrat, has introduced a bill that would require licensed hospitals to make video and audio recordings of all surgeries. His expectation is that this would protect patients and possibly expose medical errors. Just what is needed in the OR; putting doctors and patients in adversarial positions! Both doctors and plaintiff attorneys do not like the bill and state that it would do more harm than good. The Massachusetts Medical Society is against the bill and President Kenneth Peelle, M.D., stated that the measure implies that the surgeon is not to be trusted. Also, it is one more distraction to impair the surgeon’s judgement.

IF A WOMAN’S PLACE IS IN THE HOME, WHAT WAS SHE DOING IN THAT PICKUP?
In Arlington, Texas, a 38 year old man arrived home earlier than expected. He found his wife having sex in the back of a pick-up parked in the driveway. When the woman saw her husband she screamed rape, so the man shot and killed the "rapist." Subsequent investigation revealed that the sex was not rape, and that the woman had a relationship with the victim. The husband was not prosecuted and the police accepted that he was trying to defend his wife. The grand jury indicted the wife for "reckless behavior which caused the death" and she faces from two to thirty years in prison if convicted.

THERE’S A SNAKE IN THE GARDEN OF WAL-MART!
In central Florida a man shopping in the garden section of a Wal-Mart store was bitten by a pygmy rattlesnake. The man tried to shake off the snake which was clinging to his finger, stepped backward into his shopping cart and fell injuring his back. The snake’s venom is poisonous and the man was hospitalized when his hand was paralyzed. Subsequent research revealed that at least seven other cases of snake bite have occurred at Wal-Mart garden centers. Of course, no need to worry at Hawaii’s Wal-Mart stores since snakes are banned in our state, but do the snakes know that?

THE OTHER SENSES BELIEVE THEMSELVES. THE EARS BELIEVE OTHER PEOPLE.
In recent years media moguls Larry King, Paul Harvey and others have been extolling the benefits of garlic with the claim that it lowers low density (bad) cholesterol (LDL). Oops! According to a study done at Stanford University and published in the Archives of Internal Medicine, it just ain’t so. Researchers studied 192 adults with moderately high cholesterol for six months, and each was given either raw garlic or a garlic supplement while a control group received a placebo. The effect on LDLs was zero. It was noted that the placebo did not cause as many people to back away.

EDUCATED INTELLIGENCE IS NO MATCH FOR NATURAL STUPIDITY.
A book on sale at the Grand Canyon National Park describes how this natural wonder was actually formed about five thousand years ago by Noah’s biblical flood. Apparently, in order to avoid offending religious fundamentalists, the National Park Service was directed to suspend its belief in geology. Most geologists agree that the Grand Canyon was formed by the Colorado River about six or seven million years ago. The American Geological Institute and seven geo-science organizations sent letters to the Park Service asking that the book be removed. Because many park employees were enraged, the book was moved from the natural science section of the bookstore to the inspirational rack. The book completely sold out, presumably to non-scientific park visitors for something to read while waiting for the "rapture."

ADDENDUM ---
Memo to Al Gore: There’s global warming on Mars. According to the U.S. Geological Survey in Flagstaff, Arizona, Mars southern ice cap is shrinking and has lost billions of tons of carbon dioxide over the last four Martian years, and air temperatures may have increased as much as four deg. Celsius. Something should be done. More hybrid cars, perhaps?

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.
 

MY DOG IS HALF PIT-BULL HALF POODLE. NOT MUCH OF A GUARD DOG, BUT A VICIOUS GOSSIP.

Because of results of research in dogs, it was thought that statins, drugs which are extensively used for hypolipidemic effect, were likely to cause an early appearance of cataracts in humans. Subsequent studies have shown that exactly the opposite is true. The typical nuclear cataract so commonly found in aging patients, occurs at lower frequency in patients who are taking statins. Other types of cataract formation, such as posterior sub-capsular opacity, are not effected. The drug people are so relieved..
 

THE EVIL EMPIRE STRIKES AGAIN!

In those halcyon days of yesteryear here in America patients and doctors made choices and medical decisions. Now United Health Groups Inc. has informed doctors that they may be fined $50, and receive lower reimbursement, and/or perhaps excluded from the plan, if their patients have tests performed outside the network. If the patient, for whatever reason, decides to select a facility for lab tests which is not part of United’s tentacles, then the physician can be penalized! The American Medical Association leadership is shouting that corporations should not be allowed to penalize the doctor for patients’ choices. Just another example of corporate America shafting patients and doctors to enrich the bottom line. If medicine is to survive as a profession, physicians must recognize that their only hope is to discontinue being servants of third party payers.

THE MACHINE WORKED GREAT UNTIL WE TURNED IT ON.

In the constantly emerging technical world of health care, some doctors’ offices and public clinics are offering quickie cholesterol screening. Unlike the typical clinical lab where blood is drawn and results forwarded in four or five days, the results of the office screening tell the patient cholesterol levels in four or five minutes. A finger prick produces a drop of blood which is placed in a machine about the size of a business desk phone. In two to five minutes the result is available. The Cholesterol Reference Method Laboratory Network, established by the CDC offers certification of testing devices and holds them to the same standards as large lab equipment. Companies that sell the devices claim their results are comparable to laboratory blood tests. Some experts disagree, and state that a drop of peripheral blood will never be as good as a lab test of circulating venous blood. Whether true or not, a prompt in-office report has great appeal for both patient and physician.

HEY, DOC, TEACH ME; DON’T PREACH TO ME.

What is it with these moralizing physicians? A study conducted by ethics researchers at the University of Chicago and published in the New England Journal of Medicine surveyed 1144 doctors that were selected by an AMA database designed to include all U.S. physicians. Twenty-nine percent would have difficulty referring patients to another doctor for procedures that are legal but controversial, especially birth control for minors, abortion and sedation of a dying patient. Fifteen percent saw no duty to even present such choices! "That approach doesn’t even give a patient the option to access other physicians," said R. Alta Charo, professor of law and bio-ethics at the University of Wisconsin-Madison (he was not involved in the study). Interestingly, even after considering religious characteristics, women physicians were substantially more likely to state that doctors must give all the information and refer patients for controversial procedures.

THE SPONGE WENT MISSING.

Studies have shown that surgeons leave a foreign object inside a patient’s body, usually a sponge, once in every 10,000 operations which could produce complications and perhaps even death. In a small study done at Stanford University and published in the Archives of Surgery, surgeons deliberately left a sponge tagged with a computer chip inside eight patients and temporarily closed the wound. By waving a detector wand over the area, the chip alerted the doctors and identified the presence of a retained foreign body. The present chip is still too large to incorporate into operating room material, but as the technology is refined it may be possible to reduce the frequency of such events to zero by using markers such as those already in use for commercial products.

HAWAII’S LEGAL SYSTEM GETS A D-MINUS; NOT EXCELLENT, NOT EVEN GOOD, JUST BARELY THERE.

The US Chamber of Commerce Institute for Legal Reform commissioned Harris Polls to evaluate states for legal fairness. A survey of 1,400 practicing corporate attorneys and general counsels judging a variety of elements, including venue requirements, treatment of class action suits, size of punitive damages, judges’ competence and impartiality and juries’ fairness and predictability. It should come as no surprise that Hawai’i is near the bottom (again) at number 46, with only West Virginia, Mississippi, Alabama, and Louisiana rated somewhat worse than the Aloha state.

HE IS TRYING TO PRESERVE HIS OLD FOOTBALL IMAGE; NOW HE LOOKS LIKE ONE.

In America’s number one fattest city, Chicago Alderman Edward Burke wants to ban restaurant chains from using trans- fat oils in their cooking. The current logic (?) is that trans-fats raise the body’s level of "evil" LDL cholesterol which increases the risk of heart disease. Why not ban butter also? After all, it contains saturated fat and cholesterol. In January 2007, the Food and Drug Administration made the jump and required trans-fats to be listed on nutritional labels. This goofy planned prohibition ignores the real issue. The problem generates from that delicious fried chicken, succulent Double Whopper, juicy Big Mac, and the 3500 calorie restaurant evening. Instead of worrying about what kind of fat the doughnut was fried in, we must convince our patients to avoid the high calorie diet which brings on obesity, hypertension, cardiovascular disease, and diabetes.

MEN WITH GOATEES LIKE TO STROKE THEIR CHINS. IT’S LIKE HAVING A PET STUCK ON YOUR FACE.

In the United Kingdom at the University of Bristol researchers studied a group of men aged 45 to 59 for shaving habits. They controlled such factors as occupation, marital status, smoking and other risk and lifestyle factors. They found that men who don’t shave regularly are 24% more likely to die, and 68% more likely to suffer a stroke than men who shave daily. Therefore, it appears that the five day growth, popularized by movie stars and professional athletes, can lead you to an early grave. As Gillette used to say, "look sharp, feel sharp, be sharp."

IF, AS THEY SAY, YOU ARE WHAT YOU EAT, I PREFER BEEF TO TOFU.

Gourmets world-wide have already come to enjoy beef from Waygu cattle in western Australia. Now to enhance the flavor, the cattle are being fed a diet of choice grains soaked in a 2004 cabernet-merlot wine. Beef cows will consume about a daily liter of wine during feeding for their final sixty days. The manager for Margaret River Premium Meat Exports anticipates that the major difficulty will be in keeping up with demand. Choice steaks will probably go for about $90 per serving. Be careful driving home.

ADDENDA -----

• About 20% of professional rodeo bull riders now wear helmets with a face mask instead of cowboy hats because of the frequency of serious head and face injuries.
• Approximately 20% of people who received gift cards in 2005 didn’t use them.
• Pay your taxes. Twenty-one million illegal aliens are depending on you.
• Beauty is in the eye of the beerholder.
• Condoms should be used on every conceivable occasion.

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.
 

 

BEING GOOD DOES NOT ALWAYS PAY OFF, AND THERE IS NO COMPENSATION FOR MISFORTUNE.
Bausch and Lomb is a Rochester, New York, medical company first organized in 1853 by two German immigrants, John Bausch and Henry Lomb. They opened a business dealing in optical equipment. Today the company has grown into a major ophthalmic supplier employing 13,000 people. In recent years the company has been heavily into contact lenses and various solutions as well as fixed implements. The company stock traded at more than $80/share in 2005, but then was shocked by the disclosure of fungus infections implicating B&L solutions. Sales dropped 21% in 2006, and share prices dropped to $41.20 but have partially rebounded. Now this solid old company is stumbling badly and the directors have agreed to sell to a private equity firm Warburg Pincus. Pretty sad to see an ancient stalwart forced out of the business by mold.

CATCH 22, OR DAMNED EITHER DIRECTION.
In Boise, Idaho, a mother brought her five week old daughter to the hospital emergency department with a temperature of 101.3 F. The ER doc feared a bacterial infection of meningitis and planned a spinal tap, consistent with the hospital’s standard of care. The mother refused the procedure believing that it was too risky. The doctor called the hospital social worker, who called the police, who took possession of the baby, and the spinal tap was accomplished (it was negative). Now the parents are suing the doctor, the hospital, the social workers and the police for depriving them of the their constitutional right to make a medical decision for their child. I smell a lawyer in the background looking for an easy settlement.

HAVE SOME VICODIN! IT’S NO MORE ADDICTIVE THAN ASPIRIN. NOT!
It was the largest drug-company criminal settlement in history when Purdue Frederick Co. and three executives agreed to pay $634.5 million for misbranding OxyContin with the intent to defraud and mislead the public. According to U.S. Attorney John Brownlee, the drug was promoted as less addictive and less likely to be abused than it really is. Moreover, the sales force was trained to inform physicians and pharmacists that it was difficult to extract oxycodone, the active ingredient, for purposes of abuse. Naturally, these three drug pushing executives, CEO Michael Friedman, General Counsel Howard Udell and former Chief Medical Officer Paul Goldenheim will simply pay fines and none will do jail time; never mind the lives and careers disrupted by the addiction these three overpaid hot shots promoted. Only small time distributors do jail time.

ANOTHER ATTACK OF POLLSTERGEIST.
A survey conducted by PNC Financial Services Group determined that almost one-third of health care dollars are spent on the bloated error-prone claims processing system in this country. Twenty percent of claims are denied or delayed, and a massive 96% must be submitted more than once, according to the 200 hospital executives and 1,000 consumers who participated in the study. Twenty-five percent of consumers claimed that their health plan denied coverage of a legitimate claim, and one in five of that group ultimately paid the bill out of pocket. Is this system screwed up, or what? And how long are physicians going to continue working in this swamp of paper?

THE SEARCH FOR SOMEONE TO BLAME IS ALWAYS SUCCESSFUL.
A physician in Massachusetts allegedly discharged a diabetic patient from the hospital without warning him about the dangers of hypoglycemia. About 45 minutes after leaving the hospital he became unconscious as a result of low blood sugar, lost control of his car and struck a man riding a motorcycle. The injured man is suing the physician for negligence. The physician asked the court to dismiss the lawsuit because he did not have a physician/patient relationship with the motorcyclist and did not owe him a duty of care. The judge denied the motion and ruled that there was a "special relationship" and the lawsuit should go to trial. To date, five states, Missouri, Texas, Iowa, Kansas and Florida have refused to impose a "special relationship" while three states, California, Michigan and Delaware ruled that the physician has such a duty. The issue could be analogous for eye surgeons – what is the doctor’s duty in insuring highway safety when a patient has failing eyesight? And most importantly, carefully document any warnings or special instructions.

CHOOSING A POLITICIAN IS DECIDING BETWEEN THE DISASTROUS AND THE UNPALATABLE.
In sorting out the two major parties’ potential nominees, it is hard to exaggerate the hypocritical "man-of-the-people" factor – Mitt Romney, net worth $250 million with a different political jacket for every gathering, or Rudy Giuliani who is averaging a million per month on the speaking circuit, or John Edwards who invests in Cayman Islands assets which he attacks from the podium, or the Billary ticket where she was advanced $8 million on her next book and Bill was advanced $10 million for his. Oh, the suffering of poor Barack Obama whose estate is a mere one million. John Edwards, the tort lawyer probably takes the blue ribbon four-flusher award. He has now been enriched to an estimated $40 million, built a $5 million 102 acre estate, was paid almost ½ million as a consultant (and investor) with a Cayman Islands hedge fund of sub prime mortgage lenders while he runs his campaign on helping the down trodden working man. What a guy!

NOW YOU CAN BE ALL YOU ARE CRACKED UP TO BE!
The Roxbury Spa in Beverly Hills is now offering the "Butt Facial." Yes, you can call for an appointment and have your neglected heinie polished, de-blemished, massaged, toned-up and glamorized. It begins with a vigorous scrub followed by action with the cellulite-reducing machine, then a bottom-bra is applied. In some cases a little tissue extraction may help to leave customers with firm, mobile and gorgeous cheeks. Cost: $650 to $800. I couldn’t make this up.

TALK IS CHEAP BECAUSE THE SUPPLY EXCEEDS THE DEMAND.
The relative peace and tranquility of air travel with a welcome hiatus from ground-bound business is likely to end within twelve months. U.S. airlines will soon offer in-flight internet connections with text-messaging and e-mail. Moreover, airborne cell phone chatter will likely come along as well despite the Federal Communications Commission (FCC) claim that it will keep a ban in place. The FCC has already auctioned off radio spectrum for cell phone use on aircraft.

THESE STUDENTS ARE NOT COMPLETE IDIOTS. SOME PARTS ARE MISSING.
The University of Minnesota campus newspaper reported that some students who donated blood to the local blood bank, promptly headed for the nearest bar after the needle was removed. Supposedly, the relative anemia made the blood alcohol concentration (BAC) considerably more potent. "The rest of the night is a real turn on."

ADDENDA –
----- The department of Veterans Affairs sends a monthly check to 124,000 veterans to care for their hemorrhoids.
----- In Singapore an increasingly popular cosmetic procedure is plucking the eyebrows and tattooing a new artistically curved brow.
----- The average desk top has more bacteria than any surface in the bathroom. Toilet seats and photocopier surfaces were the least contaminated sites in all offices tested..
----- A fanny fetish is perilously close to assfixiation.

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.
 

WHY GRANDMA! WHAT RED EYES YOU HAVE.
ALL SOLUTIONS BREED NEW PROBLEMS.

It’s used to be rare and it is ugly. The Centers for Disease Control and Prevention (CDC) is currently investigating 138 cases of corneal infection with Acanthamoeba. In some soft contact lenses wearers this parasite has invaded the cornea with devastating result. It produces redness and severe pain, but little discharge. Specifically, the recent infections seem to be related to use of Advanced Medical Optics Inc., (AMO) contact lens solution Complete Moisture Plus Multi-purpose Solution. The company immediately invoked a voluntarily recall of the solution and instructed patients to discard any remaining solutions, affected contact lenses, and cases. Even when the diagnosis is made promptly, treatment is difficult and ongoing for months, frequently resulting in corneal transplant surgery, or even blindness. This ubiquitous amoeba can be found in tap water and is innocent normally, but can turn mean given the right corneal environment. There are always some bad bugs out there lurking and looming. The question is why have they suddenly reappeared.

WE ARE FROM THE GOVERNMENT AND WE ARE HERE TO PROTECT YOU.

The subject of why Acanthamoeba is now turning up in AMO contact lens solutions and why fungus has crept into Bausch and Lomb solutions, may be related to an approach not previously suspected. The culprit may well be the Environmental Protection Agency (EPA) which in 2002 restricted the levels of byproducts of chlorine and other cleaning agents in drinking water in an effort to reduce chemical contamination. In the last five years microbial corneal infections have tripled, according to Reza Dana, M.D., director of the corneal service at Massachusetts Eye and Ear Infirmary. Both fungal and acanthamoeba infections were exceedingly rare until recent years. Now a Chicago team, Doctors Charlotte Joslin and Elmer Tu, has produced a soon to be published paper linking the EPA action with these nasty eye disorders. The EPA needs to remember that it is impossible to change just one thing.

IT IS IMPORTANT NOT TO RUN SHORT OF SCAPEGOATS.

Michael Moore, the rotund "documentary" film maker who has become extremely rich by attacking the vulnerable, has turned his sights onto the American health care system. His latest effort called "Sicko" will appear in theaters in the USA at the end of June, and apparently will feature insurance and health care. Hey, any physician in active practice could write an expose on the shabby methods and money-grubbing third parties who are milking big bucks out of the system. The issue is not whether health care in America is sick, but rather what to do about it. Congress generated most of our problems by initiating Medicare, irrespective of ability to pay, and then embarked on a deliberate plan to destroy the independent family physician by rewarding "health plans." Medical expenditures would decrease and doctors and patients would be much happier if third parties were limited to catastrophic coverage only, and first dollar coverage would be eliminated.

TURN LEFT, SWEETIE; I WANT A PROFILE VIEW.

Seventy years after superman showed us the way with x-ray vision, the imaging industry has developed high energy "backscatter" x-ray which allows examiners to visualize the human body through wearing apparel. We are told that the exposure is harmless and the Transportation Security Administration (TSA) has announced that it will conduct a trial run with the device in Sky Harbor Airport in Phoenix, Arizona. The machines are very expensive, and probably do represent an invasion of privacy. Will the traveling public put up with this additional demand? There could be a major groundswell of resistance to security officers arbitrarily selecting passengers for a radiographic strip search.

ALL I WANT FROM THIS LAWYER IS AWAY.

It almost reads like a script from the archives of the Keystone Kops or a reprise for a W. C. Fields film. After an x-ray for a chest injury, Andrew Speaker, a 31 year old personal injury lawyer, was found to have tuberculosis, not just a common mycobacterium, but one called XDR TB, a highly resistant bug. According to Julie Gerberding, M.D. director of Center for Disease Control and Prevention (CDC), Mr. Speaker was advised not to travel, but he had plans to honeymoon in Italy with his bride, so who worries about spreading a little harmful bacteria? When the CDC determined the virulence of his infection, officials attempted to contact the patient and found that he was in Europe contaminating Italy. He was advised to seek help promptly from Italian health authorities, which he did not to do. Instead, Mr. Speaker flew to Canada and chose to return to the USA through the backdoor at Champlain, New York. The Homeland Security Administration (HSA) border guard screened his passport and found specific instructions to hold the man, but "the guy didn’t look sick" so he just let him go! Apparently, if you don’t hack, cough, sneeze, faint or vomit, you’re not sick. So, smile for the HSA people while removing your shoes, your jacket, your wrist watch, your newspaper, and whatever else. Somehow I don’t feel safer.

HE IS GOING WHERE TO DO WHAT?

At New York’s Presbyterian/Columbia Medical Center a 66 year old woman had her gall bladder removed with an "extremely experimental" approach through the vagina. According to her surgeon, Dr. Marc Bessler, the standard laparoscopic gall bladder removal entering through the abdominal wall, results in muscle damage and post-operative pain. He claimed that entering through the body’s natural orifices causes less tissue injury and less post-operative pain. "Going through a natural orifice, the mouth, rectum or vagina, to get into the abdomen and do an operation is being worked on by a lot of people." Well maybe, but when he can do a laparoscopic C-section through the ear canal, then I’ll be a believer.

WHEN IGNORANCE GETS ROLLING THERE ARE NO LIMITS.

Mike Lake, a member of Canadian Parliament, has agreed to introduce a petition to place Sasquatch (Bigfoot) on the Canadian version of the endangered species act. This is very reassuring because it affirms the fact that not all the nut cases are south of the 49th parallel. How can a species that has never been counted nor even seen be considered "endangered?"
FOR THE BOROUGH CHIEF NIMBY SUCCESS IS NOT ENOUGH.
For decades until 2001, Staten Island was the dump for New York City, but now has the motto "greenest, cleanest and safest." A local ice cream company is marketing a delicious dessert concoction of fudge, chocolate crunchies, and other additives which it calls "Staten Island Landfill." Borough President James Molinaro is not amused and wants to boycott the treat claiming it is an ugly stereotype. Hey, loosen up, Dude! It’s ice cream not a housing project.

SHE MIGHT WANT TO CONSIDER A CAREER CHANGE.

At the Marshalltown, Iowa, court house it was noted that toilet paper consumption was excessive. Careful employee oversight revealed that Suzanne Marie Butts (of course) was carrying rolls of two ply out of the court house under her skirt. Was she marketing these rolls for dough, or was this a thrill crime for excitement? In any case, the crapper napper paper caper has been wiped off the books.

ADDENDA ----

----- At any given hour the average number of people airborne over the US is 61,000.
----- Seventy seven million baby boomers are expected to retire in the next 10 to 15 years and 75% of them will face unanticipated financial difficulties. Most will keep right on working.
---- San Francisco cable cars are the only mobile National Monuments.
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.
 

SHE SLEPT WITH AN OPHTHALMOLOGIST WHO KEPT ASKING, "IS IT BETTER LIKE THIS, OR LIKE THIS?"

The eye surgeon went home after a busy day in the operating room where all the surgeries were smooth and uneventful. The following day the post-op patients were all suffering with corneal edema, diffuse anterior inflammation, and perhaps even fibrin or hypopyon in the anterior chamber. The condition is called toxic anterior segment syndrome (TASS), and the cause can be any of a number of operative problems, most commonly one of the solutions used to irrigate during the surgery. Over 100 cases were reported in the first half of 2006 alone. It can be wrong pH in the balanced salt solution, or epinephrine with preservative used to keep the pupil dilated rather than preservative-free, or gas residue when hand instruments are sterilized with ethylene oxide, or an anti-biotic with wrong concentration injected beneath the conjunctiva at the end of surgery leaking into the eye. It can be catastrophic for both patient and doctor, and determining the exact cause can be complicated and difficult. Stuff happens!

NEVER LET THE DOCTOR TAKE YOUR TEMPERATURE WITH HIS FINGER.

For many years we have had "doc in the box" medical care with clinics usually set up in tourist areas which provide walk-in physician care. They are often frustrating competition for local practitioners, but usually do a fair job for emergency problems. Now we have RBCs, retail based clinics at Wal-Mart and Target stores, caring for patients at the mall or shopping center. The nice part for patients is the ease of seeing a medical person, and the nice part for the clinics is that it is all cash, no insurance forms, no detailed coding baloney, and regular hours. Recently, the American Academy of Pediatrics and the American Medical Association spoke out against RBCs, claiming that medical care is fragmented with poor follow-up and loss of continuity. This is true, of course, but the problem really generates from crowded doctors’ schedules, prolonged waiting in reception areas and delays in getting appointments. So, get used to it, people. It is free enterprise at work at the mall.

"IF WE WANT OUR COMPANY TO SURVIVE AND PROSPER OVER THE LONG TERM, WE MUST GET OUR SHARE OF THE YOUTH MARKET." R. J. Reynolds Inc. 1974

The tobacco people do not sleep. "Snus" is a smokeless tobacco product popular in Scandinavia for decades, but banned in most of Europe as an oral carcinogen. Now R .J. Reynolds is test marketing "Camel Snus" in Portland, Oregon, and Austin, Texas, two communities viewed as "hipster havens." The product is put up in small neat pouches of 20 per tin. They smell of mint tea, taste like gum and come in three flavors, regular, spice and frost, packets that fit inside the mouth. Supposedly, they are spit-free as well as smoke-free. Of course, they are not designed to appeal to youth. Right!! The snuscamel.com website says you can use it at a concert, in a jet plane, even at a crowded up-scale restaurant. How about a teenager in a classroom?

MAN IS THE ONLY MACHINE THAT NEEDS TO BE LUBRICATED WITH ALCOHOL.

The national average for alcohol-related traffic deaths is 39%. Ugly! What is even more ugly is that right here in our Aloha state the figure is actually 51%, twelve full percentage points above the national average, and that places us right at the top (really the bottom) of all 50 states. Only Washington D.C. is ahead of Hawai’i at 54%. Look at the celebrities arrested for DUI, starting with Mel Gibson, comedic actors Rip Torn and Tracey Morgan, and Michelle Rodriguez, who was jailed here for five hours (that’s all) of a sixty-day sentence for repeat DUI, to mention just a few. The sport star arrests would fill up a phone book, including Sacramento Kings head coach Eric Musselman. These are supposed to be responsible citizens. And as a responsible physician, what action do you take (if any) when you detect alcohol on your patient’s breath? Obviously, if the DUI highway slaughter is to be stemmed, the offenders must be jailed, and their drivers’ licenses and auto licenses impounded. A modest fine, a suspended jail sentence and probation are fruitless.

IT’S NOT ENOUGH TO HAVE NEED. FOR MEDICAL CARE IN HAWAI’I, YOU HAVE TO EARN A CERTIFICATE!

The Hawai’i comprehensive health planning law which provides for "certificate of need" (CON) for certain medical expenditures is under severe attack by many citizens on the island of Maui. Ronald Kwon, M.D., Hawai’i born, Harvard educated, and a long-time infectious disease specialist on the island, in partnership with Triad Hospitals (ranked number four by Fortune magazine among America’s most admired health care companies) applied for a CON to build a second hospital in south Maui. The plan has the vigorous support of the Mayor of Maui County, Governor Linda Lingle, many Maui physicians and a large and varied group of people. After a complicated and prolonged application, followed by a stair-step collection of hearings and one re-hearing, the application was denied. Wow!! The passion and animosity toward the director of SHPDA (State Health Planning and Development Agency), people on the panels, and Hawai’i Health Systems Corporation, which is perceived as the primary obstructionist, was palpably frightening. What next? Apparently further steps are in the works, but the underlying cause of the mess is the absurd health planning law which does not exist in many states. In Ohio and Illinois similar statutes have resulted in bribery with criminal prosecutions. For valid reasons, both the AMA and HMA have policy opposing state health planning laws, but don’t expect it to disappear. It is far easier to eradicate Mt. Rushmore than a government bureau. SHPDA lives on!

YOUTH IS LIKE SPRING; TRANSIENT, EXAGGERATED, AND WITH THE ATTENTION SPAN OF LINT.

We all knew it was coming, and now the hearing loss in young adults has arrived. At the University of California Irvine Medical Center, the effects of the MP3 player which comes with stock "ear buds" has apparently caused damaged hearing in several students. Normally this type of loss would not be seen until 50 or 60 years of age. The sound is digital and kids can crank up the volume without the distortion of previous technologies. Unlike the previous portable headset music players, the MP3 has buds which close off the ear canal and do not allow sound to escape.

HEY! HAS ANYBODY SEEN MY BAYONET?

In the realm of unbelievable medical errors, a Seattle man had abdominal surgery for a tumor. For two months after surgery he complained of pain, but apparently no further studies were performed. When he failed to clear an airport metal detector, x-ray revealed a thirteen (!) inch blade in his abdomen. He won $105,000 in a court settlement; a fair payday for intermittent pain. His attorney said, "It was like missing a truck parked in your front yard."

MONEY CAN BE LOST IN MORE WAYS THAN WON.

According to the Super Bowl Predictor of investments, 2007 is expected to see a rise in stocks. Yes, this completely unscientific indicator has been accurate in 80% (32 of 40) bowls. The factor is whenever an "original" National Football League team wins the big game, e.g. San Francisco, Chicago, Green Bay, the Dow Jones Industrial Average goes up for that year. The market falls when the team is a later addition to the league, e.g New England, Denver. Since both teams, Indianapolis (nee Baltimore) Colts and Chicago Bears are original franchises, your blue chip investments are given a four out of five prediction to rise. Sleep well on your blue chips.

ADDENDA –

----- Fish ‘n Flush is a toilet which doubles as an aquarium. (I did not make this up!)
----- Headline in the Salt Lake Tribune, "Utah risks loosing its best teachers." I think this warning is a bit tardy.
----- Wine is mentioned in every book of the bible except Jonah.
----- What’s medically good for you depends on who sponsors the study.

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.
 

PATCHES? WE DON’T NEED NO STINKING PATCHES!

At Nottingham University in the United Kingdom, scientists are researching the problem of amblyopia. Typically, therapy involves patching the better eye to stimulate the neural connections in the amblyopic eye, and to encourage the eyes to work together. At Nottingham, experimental treatment revolves around using virtual reality (VR) computer games to create a three dimensional environment. In a VR driving experiment the computer sends images of one’s own car to the bad eye, and images of other cars to the fellow eye. Obstacles on the track are sent alternately to both eyes so that the viewer must combine the images to get through the game. According to the research team the game produced in one hour the same visual level obtained with 400 hours of patching. The technique has not been proven with rigorous peer-reviewed trials, but initial results show remarkable progress.
AT B&L THE LIGHT AT THE END OF THE TUNNEL IS A BOTTLE OF CHAMPAGNE.
Who would have thought just a few months ago when Bausch and Lomb Inc.(B&L) was mired in the frightening findings of contaminated eye solutions that the company would be the sweetheart in a competitive auction? Just a month ago B&L had settled on a deal to sell out to Warburg Pincus, a private investment firm, for $3.67 billion. The deal included a 50 day option period and before the door closed, Advanced Medical Optics Inc (AMO) jumped in with a considerably better number of $4.23 billion. This is a weird picture for two reasons. First, both B&L and AMO have had some serious contamination and infection problems with significant legal vulnerability. And second, in the world of big-time private equity, gentlemen simply do not jump on one another’s signed deals. So, at this time B&L stock which had dropped to $41/share has moved back up, and the Warburg Pincus offer is at $65/share and the AMO ticket is $75/share. For B&L shareholders some contaminated eye drops aren’t really such a bad thing.

TO SEE A MAN AT HIS WORST, WATCH WHAT HE DOES IN THE NAME OF GOD.

In Bakersfield, California, a woman brought her little girl with an ear infection to a pediatrician. The doctor, Gary Merrill, M.D., refused to care for the child because the mother has tattoos. He based his behavior on the teachings of Christ (?) and has a sign on the office wall, "This a private office. Appearance and behavior standards apply." That means no tattoos, body piercings, and a host of other requirements, all standards according to Merrill, based upon his Christian faith. The child had to wait until the following day to before another physician was found. The American Medical Association backed up the doctor (sort of) stating that the doctor has a private office and has the right to refuse any patient he wants. It doesn’t take an authority on Christianity to know that this doctor has his head up you-know-where. If a doctor chooses to be a bigoted jackass, don’t blame Jesus.

TECHNOLOGY IS MAKING OUR CARS SMARTER THAN WE ARE.

Mobileye Advanced Warning System - 4000 is a windshield mounted camera using cutting edge automotive safety technology. It can give the driver night vision, provide alerts when drifting out of the proper lane and/or when moving too close to other objects. It can even make the steering wheel vibrate if it senses a dangerous situation. Moreover, it will nag the driver for failing to use turn indicators. The downside is it cannot function in dense fog or snow (it will notify and deactivate), and with all the bells, beeps and chirps the motorist may become so annoyed, he/she might turn it off. BMW, Cadillac, Infiniti and Buick offer the options at somewhere between $1100 and $2000, depending on variables. Technocrats have still not solved the difficulty with the loose nut at the end of the steering column.

IF SOMETIMES YOU FEEL LIKE A NUT, HEY, GO FOR IT!

Typically, dieticians and some gastro-enterologists have advised patients with diverticular disease to avoid seeds, nuts, popcorn and other indigestible fiber. It was suspected that these elements would lodge in diverticula and set up inflammation and infection. A study done at the University of Washington in Seattle combined with data from a number of Boston hospitals found the exact opposite to be true. Researchers studied a cohort of 47,228 men ranging in age from 40 and 75 years who participated in the study, and were free of disease in 1986. With follow up every two years for 18 years, the occurrence of inflammatory bowel disease was not increased, but actually decreased by 28% in those men who ate popcorn at least twice a week, and 20% in men who regularly consumed nuts.

STATISTICS THAT MAKE SENSE - EVEN TO THE DOCTOR.

In the world of medical therapy there is a new number called the NNT which translates to number needed to treat to prevent one adverse outcome. Many people derive little or no benefit from their medication, but they are never told that. For example, if 67 men take cholesterol-lowering statins for 5 years, one will benefit and the other 66 will not. The NNT is 67, and will have cost about $5,000, so if patients understood that risk, they might decide to refuse to take the drug. For patients with a bladder infection where three days of antibiotics will cure one out of two the NNT is 2; no question, take the medication. And on the opposite side of the therapy issue is the NNH, which is the number needed to harm, which should be introduced in various surgical or other interventions. With the NNH a small number is frightening, a large one reassuring. The point of the NNT and the NNH is to help patients (and the doctor) recognize what is the possible benefit, what is the ball-park cost figure, and what are the risks or side effects.

AGAINST STUPIDITY THE GODS THEMSELVES FIGHT IN VAIN.

In Palm Springs, California, a 65 year-old-man was angry because the Desert Sun newspaper did not have the coupons he wanted. He phoned the paper to complain, and was told that the coupons would be sent the next day. The coupons were delivered, but he was still not satisfied and phoned the paper again and said "What do I have to do? Come down there and blow up the building?" The newspaper management phoned the police. A search was conducted at the newspaper with dogs sniffing for explosives (negative), and the man was jailed for issuing a terrorist threat. Bail was set at $25,000. Only idiots joke about bombs these days.

A NEW DIRECTION FOR MAKE LOVE, NOT WAR!

Study done under the sunshine project in the Freedom of Information Act, revealed that in 1994 the U.S. Air Force was considering a plan to develop a "gay bomb." The proposal would include a powerful aphrodisiac hormone that would make enemy troops irresistible to one another. The "love bomb" would cause widespread "disgusting but non-lethal" homosexual activity disrupting morale and discipline. This $7.5 million absurdity was not pursued. I couldn’t make this up!

ADDENDA —

----- The world’s oldest intact condom, made from pig intestine, was found in Lund, Sweden. Dating from 1640, the condom came with an instruction manual written in Latin, and is presently on exhibit in an Austrian museum.
----- If pro is the opposite of con, is progress the opposite of Congress?
----- Why doesn’t Michael Moore do a documentary on obesity?
----- Volkswagen and Energizer have merged to make a battery operated car, the Bugs Bunny.

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.