ALL GREAT SUCCESS IS A WORK OF ART!

Now there truly is a therapeutic tool for treating macular degeneration (AMD). At a medical meeting in Montreal in July 2005, Genentech Inc. reported the results of a big phase III study which showed that Lucentis when injected into the eye was found to halt blindness in 90% of patients with AMD and improved vision in 30%. This is not just great; it is miraculous! However the cost is $2000 per injection and a two year program would reach nearly $50,000. But wait! Almost simultaneously, additional off-line trials with the anti-cancer compound Avastin, the molecule Lucentis was derived from, has been used by some bold doctors. They found it to be just as effective and it costs a mere $40 per injection. For the first time, the National Institutes of Health (NIH) has received federal funds to conduct a head to head study to compare the two biotechnology drugs. Both compounds are marketed by Genentech, but (needless to say) company executives are hoping Avastin will fail. This test sounds simple enough, but pharmaceutical industry moguls are terrified. They see the study as the first step in the government comparing cost vs. effectiveness and refusing to pay for drugs that fail to make the grade. That is exactly what has happened in the United Kingdom.

MAYBE THEY SHOULD BRING BACK CANING.

In a fourteen year study published in the New England Journal of Medicine, medical students who exhibited unprofessional behavior during training were three times more likely than their colleagues to be disciplined by state medical boards. For those whose behavior included poor attendance and irresponsible patient care, the risk was eight times greater than their colleagues. Principal reasons for discipline were alcohol or other drug abuse, appropriating drugs or mis-prescribing, conviction of a crime, negligence, and unprofessional conduct. Spot the troublemakers while in training and maybe they can be made into professionals.

JUST BECAUSE YOU CAN DO IT, DOESN’T MEAN YOU SHOULD.

Whoa! A team of New York doctors claim they are ready to perform the first uterine transplant for the purpose of helping a woman bear a child. The article in the January Obstetrics and Gynecology outlined how the team would transplant a donor uterus, wait three months to insure proper function, then transfer a frozen embryo, and at term expect to deliver a child by cesarean section and remove the uterus. The spokesdoc claims to have successfully performed the procedure on rats, pigs, rabbits and a rhesus monkey. The procedure has produced a major ethical and technical controversy regarding organ transplant and artificial reproduction, as well as rights of the mother, the embryo donor, and the child. There are so many pitfalls, the concept is almost beyond serious contemplation.

THE NURSING BOARD LACKS SEX REPEAL!

The specialty of the house at the Heart Attack Grill in Tempe, Arizona, is a Quadruple Bypass Burger piled high with four ½ pound beef patties, cheddar cheese, lettuce, tomato and special sauce. But the obvious gastronomic insult is not what has the Arizona State Board of Nursing upset. They are angry because the waitresses wear stethoscopes around their necks, white hats with a cross, brief little skirts, fishnet stockings and tight cleavage-baring tops. The nursing Board even got the attorney general’s office to write a letter stating that the wait staff called themselves "nurses" and were misleading the public. The proprietor, "Dr. Jon," has laughed it off, been very grateful for the publicity, and stated that it is a matter of free speech. He says that the waitress title of nurse is a parody and his clientele is well aware that their skills are limited to food service. Moreover, he is no more a doctor than Julius Irving (Dr. J) the retired basketball star. He offered free french fries to the Arizona State Board of Nursing.

THE THOUGHT OF SUICIDE IS A POWERFUL COMFORT TO THE AFFLICTED.

The issue of physician-assisted suicide was regenerated in the current session of the Hawaii Legislature. In 2005 a similar bill was killed after intense testimony. This time the measure was wisely 86ed after one committee hearing. One difference in the current measure is that physicians would be required to provide the patient’s death wish or refer the patient to a doctor who is willing to help him/her die. Repeated polls have shown that about 60% of Americans believe that people suffering with incurable medical conditions have a right to end their own lives. Yes, that is an important social issue. However, the American Medical Association and the Hawaii Medical Association have consistently held that physicians are in the business of preserving life not ending it, and if society decides to help people die, do not make doctors the hammer.

HIS CAPACITY FOR MENDACITY EXCEEDED HIS VERACITY.

In Florida, a cardio-vascular surgeon testifying on behalf of a plaintiff claimed that he was the lead surgeon in an average of 10 to 12 coronary bypass graft procedures per year in the six years leading up to the case. In fact, hospital records revealed that he hadn’t done any! Now the doctor is facing criminal prosecution for lying under oath about his qualifications and leading the judicial process astray. The case brings to light legislation previously proposed by the Florida Medical Association(and other states) to define the provision of expert witness testimony as the practice of medicine and subject to peer review, but that was defeated by the trial lawyers association. They claim that the judicial system is a good gatekeeper. Ralph Nader and associates often disparage medical societies and state boards for failure to weed out bad docs, but those attempts are inevitably hamstrung by Ralphie’s colleagues.

IS MEDICINE BECOMING A PROFESSION OF QUITTERS?

According to an alarming survey conducted by the American College of Physician Executives, the practice of medicine has become so stressful that 60% of physicians have considered leaving the field. More than one-third have actually sought jobs outside of healthcare. The single largest cause of dissatisfaction was low reimbursement at 22%, followed by loss of autonomy 21%, red tape 17%, job overload and loss of respect 12%, and malpractice environment 11%.

NICE WORK IF YOU CAN GET IT, AND YOU CAN GET IT IF YOU’RE IN THE BIG APPLE AND RICH.

The Transportation Security Administration (TSA) will spend over a half million of your dollars to install a security screening point at a Wall Street location heli-pad. For $139, corporate travelers can fly by a private chopper shuttle service direct to JFK airport, skip security and go undisturbed to the gate. Try to appear appropriately humble.

EITHER WAY, THIS ADDITION BECOMES A DEDUCTION.

In Germany a new statute provides incentive for child-bearing with bonuses up to $33,000. The new year saw a birth boom in January as mothers struggled to hold off delivering in December until the new law kicked in January 1st. Meanwhile, in the United States an estimated 6% of January deliveries were scheduled for labor induction in late December to obtain the $4,000 dependent tax deduction. Either way you get some pay.

ADDENDA –

----- 32% of people carry their Social Security card in their wallet or purse.
----- The eye of the right whale is about the size of an orange.
----- In Atlanta, state officials canceled a severe weather drill because of bad weather.
----- Omphaloskepsis is a form of meditation by means of contemplating one’s navel.
------Flabbergasted is being appalled at how much weight you have gained..

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.