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.