Archive for the ‘Medical’ Category

making the rounds

Thursday, August 26th, 2010

tales of healthcare pre-reform

Monday, August 23rd, 2010
the emergency room series, cc by-nc-nd image from Jillian Corinne on Flickr

the emergency room series, cc by-nc-nd image from Jillian Corinne on Flickr

What follows is a deidentified and slightly dramatized (but only slightly) version of a recent encounter I was privy to:

Setting – The emergency room of a large hospital somewhere on the east coast of the United States, 4:30am.

An employee of said hospital has just brought his wife in from home after she developed excruciating abdominal pain that medications didn’t help. In an examination room, she lies on a gurney, writhing in pain and unable to get comfortable. He looks on, tense with worry; he knows enough to be concerned about several possible things that might be wrong, but is unable to do more than wait for test results to return and pain medication to arrive. He’s also exhausted, both from the stress of the moment and the suddenly truncated sleep.

A slim man, bearing a clipboard, enters the room. He is pleasant, but slightly awkward.

Warren: “Hello, my name is Warren. Are you Anne Turner?”

The woman nods assent before twisting to a new position.

Warren: “And so that makes you Jack Turner?”

The man blinks bleary eyes, and straightens up in his seat.

Jack: “Yeah, that’s me.”

Warren: “Alright, I just need to deal with one small thing about your insurance.”

Jack: “Okay… I work here, and you already know that I have my insurance through this hospital.”

Warren: “Yes! We just need to resolve the matter of the $25 copay. Would you like a payroll deduction, to pay it out of pocket, or be sent a bill?”

The man and the woman exchange a beleaguered look.

Jack: “So, I work at this hospital, I have my medical insurance through this hospital… and I have to pay a copay for this ER visit?”

Warren: “Yes, sir.”

Jack: “And I can do this through a PAYROLL DEDUCTION?! Is that supposed to be a perk?”

Warren: “Um… yes, sir.”

The man and the woman gaze at each other with incredulity.

Jack: “Fine, I’ll just pay it now, then.”

He pulls two $20 bills from his wallet and hands them to the slim man, who quickly exits. The slim man returns about ten minutes later, money still in hand.

Warren: “I’m sorry, Mr. Turner, but do you have change?”

Jack: “Change? Change? The hospital… doesn’t have change?”

Warren: “No, sir.”

The man and the woman share yet another bemused glace. He checks his wallet again.

Jack: “Since I work for this hospital, neither do I, it seems.”

Warren: “Well, would you like me to do a payroll deduction?”

Jack: “You know what? Just send me the bill.”

pandemic over, man

Tuesday, August 17th, 2010
cough medicine... I think I love you!, cc by-nc-nd image from Happy Squid on Flickr

cough medicine... I think I love you!, cc by-nc-nd image from Happy Squid on Flickr

The world is no longer in phase 6 of influenza pandemic alert. We are now moving into the post-pandemic period. The new H1N1 virus has largely run its course.

With those words, the Director-General of the World Health Organization finally deescalated the 2009 H1N1 influenza situation out of pandemic mode last week. If it feels like this is a bit late – after all, there has been little reported influenza activity by the CDC for many months now – then it’s good to recall that the world does, in fact, extend beyond the borders of the good old United States. By any assessment, the WHO’s retaining the pandemic designation for this long has been conservative, but not unjustified.

Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic. Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics.

During the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics.

The 2009 H1N1 influenza virus has had the potential (and still does) to mutate into something far more lethal than it has to date. While the overall mortality rates have been low, especially considering that 20-40% of the population was infected over the last year, this is a virus that has a taste for preferentially killing the young and the healthy. As this virus “fades” more deeply into the typical seasonal influenza ecology over the coming year, continued vaccination, prevention and monitoring are of critical importance.

Based on available evidence and experience from past pandemics, it is likely that the virus will continue to cause serious disease in younger age groups, at least in the immediate post-pandemic period. Groups identified during the pandemic as at higher risk of severe or fatal illness will probably remain at heightened risk, though hopefully the number of such cases will diminish.

Unsurprisingly, the influenza vaccine for the coming season is going to include the 2009 H1N1 as one of it’s components. In a couple of months, you’ll be inundated with the following basic advice, but I’ll take the liberty of getting a head start: Wash your damn hands frequently. If you’re coming down with a respiratory infection, limit your contact with others, and don’t hesitate to reach out to your doctor to help with a work note, if need be. And, for fuck’s sake, get your influenza vaccine once they become available in a few weeks – there’s no rational, real reason not to.

All that said, soon influenza won’t be our biggest infectious worry – dengue hemorrhagic fever is making it’s way north from Florida and Mexico. For those who felt that this just-ended pandemic wasn’t painful enough, well… you’ll be getting yours soon.

making the rounds

Tuesday, August 10th, 2010
  • ReConStruction was a damn fun time, but notable for having rather desolate overall attendance and some interesting fan dynamics. Autopsy notes will be forthcoming.
  • I did not attend Otakon, having little direct investment in things otaku at the present time, but passively got a taste of event while out with friends in Baltimore’s Inner Harbor two weekends past. Costume watching proved to be rather brilliant, and I had not been aware that the con is nearly as big as Dragon*Con in terms of overall attendance. Given that the masquerade is likely to be insanely over the top, and is held in the First Mariner Arena, that may be worth checking out next year for the spectacle alone.

patient protection and affordable care and let freedom ring

Friday, July 2nd, 2010
Burn Fireworks, Burn, cc by image by Orin Zebest on Flickr

Burn Fireworks, Burn, cc by image by Orin Zebest on Flickr

I was reminded today, while inadvertently seeing a horrible “interview news” segment on television as I passed through the physician’s lounge for a bagel, that I had meant to link to the now several-months-passed healthcare reform legislation. Even this far after its passage, I continue to be amazed at how many people use this law as a prop to argue for and against various medical and economic issues without, you know, having actually read it.

Although the full text is a legalese-swollen 906 pages, I still recommend it as a must-read for every US citizen, whatever your political bent is. At the very least, there are some excellent (and far more easily digestible) summaries of the key points on the site.

To all Americans, I wish you a happy 4th of July weekend! It’s a time to reflect on the good of the freedoms we enjoy in this country… and note the bad that becoming complacent in said freedoms can result in, as typified by the content of, and the “democratic” process that resulted in, this legislation.

Also, be careful with the fireworks and the adult beverages this weekend, lest you find yourself acutely needing the health care system this is attempting to reform… Enjoy!

bacterial fatality, in clay

Friday, June 11th, 2010

A bit of infectious diseases whimsical warfare for your Friday…

I recently stumbled across this playful short video on the Improbable Research blog, showing a bacterium being infected by a bacteriophage. Bacteriophages are viruses that specifically infect bacteria, but not the cells of humans or other animals. Although they have seen little use in the United States in terms of medical and biotechnology applications, they have been more widely used in other countries. With the continued concern over antibiotic-resistant bacteria and a lack of new drugs to treat them with, bacteriophages may be more extensively researched for clinical uses in the future. (This was a subject I had the pleasure of discussing at last year’s Dragon*Con.)

And really, who wouldn’t want to, when they look this cute?

on holism

Thursday, March 11th, 2010
image by virtualreality on Flickr

image by virtualreality on Flickr

“If holistic-health advocates were content with encouraging sensible preventive medicine or with criticizing the economic organization of American medicine, we might be enthusiastic, but they are not. If the movement were without influence on American life, we would be indifferent, but it is not. Holistic medicine is a pablum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity toward reason.

Too many people seem willing to swallow the rhetoric—even too many medical doctors—and the results will not be benign. At times, physicians may find themselves in sympathy with the holistic movement, because some fragment of the rhetoric rings true, because of certain practices and attitudes they encounter in their daily work with colleagues and patients, or because of dissatisfaction with the economic and social organization of medicine. One hopes they will speak bluntly, but it does no good to join forces with cranks and quacks, magicians and madmen.”

-C. Glymour and D. Stalker from “Engineers, cranks, physicians, magicians”; N Engl J Med. 1983 Apr 21;308(16):960-4

weekly rounds

Monday, March 1st, 2010
  • That noted, my interview on KXDJ with Chris was great. His questions were keen, and getting a chance to give a more meaningful answer to the not-so-simple question of “is the H1N1 pandemic overhyped?” is always refreshing. (Easy response – “yes” from a lay media public fear angle, and “no” from a vaccine and preparedness standpoint. That discussion is worth a post or 10… or a few convention talks, as the case may be. :) )

radio reminder

Wednesday, February 24th, 2010

KXDJ Radio, 98.3 FM

I’ll be on with Chris Samples tomorrow morning on 98.3 KXDA radio out of Perryton, Texas, talking about the current state of the influenza season, and the 2009 H1N1 virus in particular. I’ve had the pleasure of being on Chris’s show twice last year, and our conversations have been both fun and insightful – I’m looking forward to it.

My segment will go on at 10:20 EST (09:20 CST). You can listen to the live stream here.

Cmar-con schedule for 2010

Wednesday, February 10th, 2010
Cmar at Dragon*Con 2009, photo by Bruce Press

Cmar at Dragon*Con 2009, photo by Bruce Press

Although mired in what the local atmosphere contends is “deep winter,” the con(-vention? -ference? You decide!) season is already upon me, what with the Maryland ACP Scientific Meeting last week, and Farpoint ahead this weekend. The roundup of how my year is looking at this point is as follows:

  • Farpoint – February 12-14, Timonium, MD – Yikes! This weekend! Must prepare, and dig out, and stuff! I’ll be working the science track, and generally enjoying myself at this smaller, more low-key gathering.
  • Ravencon – April 9-11, Richmond, VA – Although relatively new as cons go, 5-year-old Ravencon continues to grow as a great regional weekend. The move this year to a better hotel (fare thee well, horrifying board-room meeting places) can only help matters. I’ll be doing the science track thing.
  • Johncon – April 16-18, Baltimore, MD – It’s named after me. How could I not go? Well, sure, it’s primarily a gaming convention put on by the Johns Hopkins University sci-fi and anime clubs, and they asked me to be a science guest, but really, it’s named after me. ’nuff said.
  • Balticon 44 – May 28-31, Baltimore, MD – If you’ve been paying any attention to me over the last few years and don’t know Balticon, then for shame. The science and new media tracks will see my hand, and the awesome will be brought.
  • ReConStruction (NASFic 2010) – August 5-8, Raleigh, NC – When Worldcon takes place outside of North America, that year a North American Science Fiction convention is birthed to sate the Worldcon-need for those unable to travel. It looks like I’ll be involved in the science guest here, in addition to the other festivities.
  • Aussiecon 4 (Worldcon 2010) – September 2-6, Melbourne, Australia – The World Science Fiction Convention migrates to another continent this year, and Laura and I shall follow, both to attend and for an extended first trip to Australia. At this point, I won’t have any track involvement, which suits me just fine – it’s vacation, dammit.
  • APDIM Fall Conference – October 14-17, San Antonio, TX – More of the same as the APDIM Spring Conference, except in an arguably more exciting locale than Baltimore.
  • Philcon – November 19-21, Cherry Hill, NJ – This was a blast last year, and I intend to return again this time around, spouting off my physicianly wit in an official capacity if I can.

That’s… quite a full year, but there’s more that either haven’t made the cut or are only on “maybe” status. Due to saving up both rupees and leave time for Australia, I will sadly not be making the return trek to Origins. Both Dragon*Con and Con On The Cob (which I have long wanted to check out, but never have) are out due to direct conflicts, and my attendance at the big two Infectious Diseases conferences of the year, the ICAAC and IDSA meetings, is going to be dictated by energy and leave reserves as the time gets closer.

All that noted, it’s shaping up to be brilliantly fun and educational year on the con front. Won’t you join me?