PRACTICAL POLITICS CONSISTS IN IGNORING FACTS.

The outrageous planners (the Bush budget) who have scheduled a 10% reduction in Medicare physician reimbursement should hide their collective heads in shame. The reduction was to take place on January 1, 2008, but a special senate finance committee deal arranged for a six month delay. Democratic chairman Max Baucus (Montana) and ranking Republican Charles Grassley (Iowa) wanted to schedule a one or two year delay, but they were unable to get agreement. Without exception every medical organization petitioned Congress not to allow the action to take place. Many doctors and medical facilities are already squeezed to the point of discontinuing to care for Medicare patients. All expenses of operating overhead are increasing so it is understandable when doctors tell Medicare they aren’t going to take it any more.

WE HAVE MET THE ENEMY AND HE IS US! Walt Kelly (Pogo)

Malpractice events in medicine can occur from simply overlooking a lab slip, or not carefully reading a previous history, or more commonly failure to document instructions or a conversation, but how does one explain operating on the wrong side of a patient’s skull? It occurred at a hospital in Rhode Island, and then it happened again! Yes, at the same institution a second patient was craniotomized on the wrong side. Unexplainable, right? And then it happened a third time, all in the same year, despite a carefully detailed pre-operative surgical protocol with checks and double checks designed specifically to avoid cutting on the wrong side. In the first case the nurse warned the doctor, but he refused to listen and stated that he knew what he was doing. (An arrogant doctor? I"m shocked!) In the second operation a physician-in-training failed to read the chart before proceeding, and in the third case the nurse saw the error but failed to warn the surgeon. This occurred at the state’s most prestigious medical facility which is a teaching hospital for Brown University. How far can you stretch Murphy’s Law? Go figure.

FACULTY: THE PEOPLE WHO GET WHAT’S LEFT AFTER THE FOOTBALL COACHES SALARY.

A recent study published in the journal Ophthalmology attempted to determine the incidence of burnout in academic chairs of departments of ophthalmology. Data were returned from 101 department chairs, a satisfying 77% response rate. Seventy percent said they are currently satisfied with their positions, down from 79% in a study done five years ago. Nine percent were deemed to have burnout based on Masiach Burnout Inventory-Human Services Survey (MBI-HSS) and 56% had scores consistent with low personal achievement, the major risk factor for burnout. MBI-HSS data showed high levels of emotional exhaustion, and moderate levels of depersonalization and personal accomplishment. Major stress producers are retention/ recruitment of qualified staff, residency and medical education and compliance issues, and of course, hospital and department budget matters. Since it is known that 8 to 12% of physicians are drug-addicted at some point in their professional lives, that the physician suicide rate is 40% higher than other Americans, frequently in a burnout setting, and the cost of replacement of a department chair is probably around half a million dollars, the hospital powers-that-be should strive to keep the department chairs fat and happy.

PERHAPS CONGRESSMEN SHOULD GET PMS. HEY, I THINK THEY DO!

In recent years, college coeds have been able to buy birth control pills at a big discount afforded to college and university health facilities by federal statute. Not any more! Since January 1, 2007, the price has risen four or five fold. Fewer college women are taking the pill now because they cannot afford it. What happened? Congress passed the deficit reduction act in 2005 and apparently failed to include college and university health centers on a list of providers for the large discount which they can pass on to the students. Now according to the American College Health Association more students are seeking emergency contraception and pregnancy tests. Two senators, Obama and McKaskill, are trying to get Congress to add the college health centers to the list of dispensers who are qualified for the discount. It would be easy to do and would not cost taxpayers a nickel.

FACTS DO NOT MATTER. LET’S FIND THAT DEEP POCKET.

A four year old boy attending a licensed day care center in Virginia was tragically killed in a lawnmower accident which was clearly the fault of the center. The attorney for the plaintiffs (no doubt a supporter of Democrat attorney John Edwards) found that the day care center had a mere $100,000 in liability insurance, so the suit against them was dropped and instead the complaint was addressed to the manufacturer of the lawnmower. The suit cited the lack of a safety device on the sixteen-year-old lawnmower, a device which had not been invented at that time, nor had anyone even recommended it. The jury found in favor of the plaintiffs for two million dollars.

THE SERUM CHOLESTEROL IS NORMAL SO YOU NEED TO BE TAKING LIPITOR.

Pfizer Inc. which previously pled guilty to fraud and paid a penalty of $430 million for illegal promotion of their drug Neurontin is being sued by a former employee, Jesse Polansky. Dr. Polansky was Pfizer’s director of outcomes management from 2001 to 2003. He was fired for complaining about improper marketing. His lawsuit claims that Pfizer’s educational campaign "led thousands of physicians to prescribe Lipitor for millions of patients who did not need medication" and could be harmed by overly aggressive treatment. Dr. Polansky is now working as a senior medical officer for a Medicare fraud and abuse unit. The suit has special significance because Lipitor is the world’s number one selling drug with 2006 revenue of $13.6 billion, even though the number needed to treat (nnt) for the drug is a remote 83 according to the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).

THINK POSITIVE. DEATH IS ONE OF THE FEW THINGS THAT CAN BE DONE LYING DOWN.

That slippery slope the "sanctity of life" people worry about has not appeared after ten years of the Oregon "death with dignity" law. According to a report in the Journal of Medical Ethics a total of 292 people have chosen physician assisted suicide (PAS) to end their lives, but 248 of them were in hospice care. This number represents 0.15% of all Oregon deaths for this period. In Holland, which has a more flexible euthanasia policy, about 2% of deaths annually result from physician or self-administered lethal drugs.

A ROTARIAN, ELK, LION – ONE OF THOSE CLUB GUYS.

In Anchorage, Alaska, a bull moose wandered into town and became intoxicated on fermented crab apples. He ran his immense rack of antlers through a decorated Christmas tree and entangled a string of lights which he was dragging through town. He stopped in the courtyard of Berny’s Bungalow Lounge and gave glass-eyed stares at customers until a fish and game biologist arrived to apply a tranquilizer dart. Nicknamed "buzzwinkle" the moose was wearing a tag indicating he had been previously sedated, so perhaps he was hooked on tranquilizers and just needed a fix.

HERE YOU GO, BOWSER. IT TASTES A LOT LIKE CHICKEN.

The gullible American public has accepted the absurdity of re-filtered tap water pumped into plastic bottles for consumption in the car, at the seashore, in the theater, in church, and on the plane, train or bus, to the tune of $9 billion annually. Now this nonsense has gone a step further with flavored bottled water of Beef Tenderloin, Bacon Delight, and Roasted Turkey all for phideaux to enjoy with his Kibbles. Those creative polluters, Coca Cola and Pepsi, are well aware of how devoid of common sense pet lovers can be, so they are enjoying a new population for marketing.

ADDENDA ----

----- Statistical data collected by the Consumer Product Safety Commission found that 1300 eye injuries were reported in 2006 as a result of fireworks.

----- Worldwide each New Year’s Eve 354 million bottles of champagne are consumed, and in the USA 250 eye injuries are caused by flying champagne corks.

----- According to Finnish scientists, human urine collected from one person over the course of a year could fertilize a 90-square-meter plot and grow more than 160 cabbages, a notable increase over standard fertilizer. Okay, but what will it do to the corned beef flavor?

----- If you ignite a synthetic Christmas tree it will burn up in 32 seconds. No fiery data available on a dry douglas fir.

----- There are 24 flowers on each Oreo cookie.

----- Remember, first you pillage then you burn..

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