Room at the Bottom

Nanomedicine’s Promise Is Anything but Tiny | WP | 1.31.05

It was a small wedding. Very small. But big changes are coming from the marriage of medicine and nanotechnology, the new branch of science that deals with things a few millionths of an inch in size.

Think “tiny medicine,” and you probably think “Fantastic Voyage,” the 1966 movie (and Isaac Asimov book) about a minuscule medical crew submarining through a patient’s circulatory system. In fact, some nanomedicine experts foresee a day when invisibly small robots will cruise through the body looking for signs of disease…

Quantum Dot Diagnostics…

Nursing Neurons With Nanogels…

Blood Test in a Nanotube…

Frying Tumors…

With nearly $10 billion slated for investment in nanotech research this year, nanomedicine is sure to get hotter as well.

Wikipedia

A mite examines a gear chain produced using nanotechnology

Nanomedicine is here—not quite the fictionalized nanonics, more in keeping with Feynman’s “…room at the bottom.”

Who’s New at the Trough

Employers Can Get Medicare Subsidies for Lower Benefits | NYT | 1.31.05

WASHINGTON, Jan. 30 - The Bush administration has touched off a furious debate with new rules allowing employers to collect billions of dollars in federal subsidies for prescription drug benefits less generous than what many retirees were expecting under the new Medicare law. …

The Congressional Budget Office estimates that Medicare will spend $71 billion on employer subsidies from 2006 to 2013. The maximum subsidy in 2006 will be $1,330 per retiree. Medicare officials say the average subsidy payment will be $668 per retiree. …

Under the new law, the federal government will pay a tax-free subsidy to employers who provide retirees with drug benefits that meet federal standards. The subsidy payable to an employer will be 28 percent of a retiree’s drug costs from $250 to $5,000 in 2006.

To qualify for the subsidy, an employer must meet two criteria: the overall value of its retiree drug coverage - the expected amount of claims paid - must be at least equal to that of the standard Medicare drug coverage. In addition, the net value of retiree drug coverage, after subtracting premiums, must equal or exceed the net value of the standard Medicare drug benefit.

In making these calculations, the government said, many employers can “disregard the value of catastrophic coverage” that will be provided by Medicare.

The catastrophic coverage kicks in after beneficiaries have spent $3,600 of their own money. Costs covered by a former employer do not count toward that limit. Under the rules, many employers can assume that retirees have supplemental coverage. Such coverage lowers out-of-pocket costs, reducing the retirees’ reliance on Medicare. …

I’ll bet $71B is just the start of the subsidies…

Going for the Guppies

Tax-Exempt Hospitals’ Practices Challenged | WP | 1.29.05

TUPELO, Miss. — When Tim Gardner was born at the hospital here 53 years ago, it was just “one little building on the hill” in a town best known as Elvis Presley’s birthplace.

From those humble beginnings, North Mississippi Medical Center has grown into the largest non-metropolitan hospital in the country, a booming enterprise with a complex of glass and marble buildings and 40 satellite clinics stretching into Alabama and Tennessee. The company, incorporated in Delaware, has nearly $300 million in the bank and “exceptional profitability,” according to one Wall Street rating agency.

And it pays no taxes. As one of 4,800 nonprofit U.S. hospitals, North Mississippi Medical Center is exempt from federal, state and local taxes in return for providing care to “charity patients.”

But when Gardner, who is uninsured and suffers from heart trouble, asked for more time to pay off a $4,500 bill, the response came in the form of a summons. The hospital sued him for the balance plus $1,100 in legal fees. …

“Their goal is to discourage these uninsured patients from returning,” said Richard F. Scruggs, the lead attorney. “If they paid taxes, I couldn’t complain. But these hospitals are given freedom from taxation for doing something.” …

“Mr. Scruggs is seeking to use the courts to reform the health care system,” said AHA executive vice president Rick Pollack. “We don’t think lawsuits are the answer to the problem of the uninsured.” …

Gardner, the cook who is a plaintiff in the North Mississippi suit, was surprised to learn that the hospital where he was born pays no taxes, charges uninsured patients higher rates and then picks on people such as him, “a guppy in the overall picture,” as he put it.

“Why do they take somebody who is visibly not having an easy time paying but is trying, and kick them when they’re down?” he asked. “It’s just wrong.”

Chronology is here

Micturating Rescue

Man peed way out of avalanche | Ananova | 1.28.05

A Slovak man trapped in his car under an avalanche freed himself by drinking 60 bottles of beer and urinating on the snow to melt it.

Rescue teams found Richard Kral drunk and staggering along a mountain path four days after his Audi car was buried in the Slovak Tatra mountains. …

He had 60 half-litre bottles of beer in his car as he was going on holiday, and after cracking one open to think about the problem he realised he could urinate on the snow to melt it, local media reported.

He said: “I was scooping the snow from above me and packing it down below the window, and then I peed on it to melt it. It was hard and now my kidneys and liver hurt. But I’m glad the beer I took on holiday turned out to be useful and I managed to get out of there.” …

Hat tip P²

Not to mention the large micturated volume, in addition to the thermal impact, had a lowering of the freezing-point impact (ethanol, in this case, was a desperate man’s ethylene glycol). Surely with such large volumes there was insufficient urea to affect the freezing point…

I’m somewhat skeptical on this one—I wouldn’t be surprised if this turns out to be an urban legend. Thirty liters (six times the blood volume of the 70 Kg adult male) of cold beer consumed would leave this guy incredibily hypothermic, and not to mention just a tad ketotic.

Dismissive Fraud

Alvarado Attorneys Seek Case Dismissal | San Diego Tribune | 1.27.05

Attorneys for Alvarado Hospital Medical Center, its parent company and a former executive accused of involvement in a kickback scheme rested their case without calling any witnesses yesterday and asked the court to dismiss the case.

The defense said federal prosecutors had failed to prove the government’s case and said there was “no need to delay the case any longer,” according to a court filing. The trial in U.S. District Court in San Diego started in October.

The prosecution accuses Alvarado, Tenet Healthcare Corp. and former hospital executive Barry Weinbaum of using physician relocation agreements as a means to bribe doctors with more than $10 million in exchange for patients. …

“At most, there was some evidence suggesting that a few relocation agreements may have violated internal policy, or may have been poor business decisions,” Tenet said in a statement. “But there was no evidence presented to suggest that any defendant knowingly entered into a relocation agreement as part of a willful attempt to influence any doctor’s medical judgment.”

Federal prosecutors said in court that they will oppose the request. …

Unless the judge dismisses the case, closing statements are likely to begin next week.

Involuntary Dismissal | FRCP 41(b)

For failure of the plaintiff to prosecute or to comply with these rules or any order of court, a defendant may move for dismissal of an action or of any claim against the defendant. Unless the court in its order for dismissal otherwise specifies, a dismissal under this subdivision and any dismissal not provided for in this rule, other than a dismissal for lack of jurisdiction, for improper venue, or for failure to join a party under Rule 19, operates as an adjudication upon the merits.

It seems Alvarado/Tenet are pretty confident on the lack of merits—or are they folding their cards or making a motion for appeals? What about the poor pleaded felon Nazaryan—did she fold too early and needlessly?

See here, here and here.

Stiff Justice

Penis-Pumping Judge Faces Three Felony Counts | The Legal Reader | 1.21.05

JANUARY 21–The Oklahoma judge who was forced from the bench last year for using a penis pump in court (among other really gross acts) was charged yesterday with indecent exposure for his judicial indiscretions. Donald Thompson, 58, entered a not guilty plea yesterday to three felony counts during an appearance in Creek County District Court, where he worked until resigning last August. According to the below yucky probable cause affidavit, Thompson exposed himself during three separate 2003 cases (two of which were murder trials). For example, on May 13, while he was presiding over State v. Kurt Arnold Vomberg (who was accused of killing his girlfriend’s 21-month-old daughter), Thompson loudly pumped himself up.

…I posted about the allegations against former judge Thompson earlier here.

“Pump” Judge Gets Popped | The Smoking Gun | 1.21.05

…Two court employees told investigators that they saw Thompson (pictured in the mug shot…) attach the suction device to his penis, while five jurors reported hearing whooshing sounds, which they thought were coming from either a bicycle pump, blood pressure cuff, or an air cushion on the judge’s chair.

…If convicted of the indecent exposure counts, Thompson could face a maximum of 10 years in prison on each charge.

See here.

The charges do not seem over-inflated…

Vapors

Harvard Hysterics | WP | 1.27.05

…

Someone like MIT biology professor Nancy Hopkins, the hysteric (see above) who, hearing Summers, “felt I was going to be sick. My heart was pounding and my breath was shallow.” And, “I just couldn’t breathe because this kind of bias makes me physically ill.” She said that if she had not bolted from the room, “I would’ve either blacked out or thrown up.”

Is this the fruit of feminism? A woman at the peak of the academic pyramid becomes theatrically flurried by an unwelcome idea and, like a Victorian maiden exposed to male coarseness, suffers the vapors and collapses on the drawing room carpet in a heap of crinolines until revived by smelling salts and the offending brute’s contrition?

…

George Will is so good—got to love the expression “suffers the vapors,” that is something that we see in the ER quite often sans the hooped skirt…

$802

Suit alleges county violated rules on indigent health care | San Diego Tribune | 1.25.05

Five local residents sued San Diego County yesterday in Superior Court, alleging officials violated state law by denying them medical care.

The residents, whose incomes just exceed the county limit for indigent care, say their applications for aid should not have been considered on monthly income alone, but also on their limited ability to pay for care.

Attorney Juanita Brooks, who represents the residents, said state law requires counties to create other options for those who exceed income limits, which for indigent care in San Diego County is $802 a month for an individual. …

County Counsel John Sansone disagreed, saying Brooks’ interpretation of the law would have the county “providing universal health care to anybody who simply cannot afford it, and that is not what state law requires. …

County Medical Services, the name of the program for indigent patients, covers emergency expenses for uninsured residents with low incomes who fail to qualify for other aid.

It serves 22,000 people a year, at a cost of more than $60 million, said Vicki Mizel, an assistant deputy director in the county’s Health and Human Services Agency.

Welfare & Institutions Code § 17000

Every county and every city and county shall relieve and support all incompetent, poor, indigent persons, and those
incapacitated by age, disease, or accident, lawfully resident therein, when such persons are not supported and relieved by their
relatives or friends, by their own means, or by state hospitals or other state or private institutions.

For the sake of local governments in California, hopefully this class action will get tossed. Local governments are too strapped to be saddled with what is in essence a carte blanche.

Science for Art

Are Treatment Guidelines Reliable? | WSJ | 1.26.05

With studies that show Americans get only half of recommended medical care, health plans are increasingly using best-practice guidelines drawn from “evidence-based medicine” to make coverage decisions about drugs and treatments and reward doctors who follow the rules. …

Health officials and medical experts are now calling for better evidence-gathering to identify adverse effects and new risks, including the use of patient registries to track drug side effects once drugs or treatments are approved, and new information technology systems to synthesize data from clinical trials. …

Gathering Evidence

Where to find the latest data on evidence-based guidelines:

Source	Website	Comment
National Guidelines Clearinghouse	Guidelines.gov	Government-sponsored site allows users to gain access to more than 1,400 guidelines and register for e-mail updates on new evidence.
Institute for Clinical System Improvement	ICSI	Guidelines cover 59 diseases and conditions; sponsored by Minnesota health plans; links to new and recently revised guidelines.
The Cochrane Library	Informed Health Online	Australian site provides information from Cochrane Collaboration, developer of evidence-based guidelines from research world-wide.
Vanderbilt Center for Evidence-Based Medicine	Vanderbilt EBM	Site has links to information about evidence-based medicine and guidelines issued by specialty medical groups and international organizations.

Amen, lets get some science for our art…

Economies of Size

60 Companies Plan to Sponsor Health Coverage for Uninsured | NYT | 1.27.05

In a novel attempt to extend health coverage to uninsured workers, 60 large employers are joining together to sponsor an array of low-cost health insurance options. The program, to begin in the fall, will be offered for at least two years and is intended to cover uninsured part-time and temporary workers, contractors, consultants and early retirees, who typically are not eligible for employer health plans.

The sponsors, which include General Electric, I.B.M., McDonald’s and Sears, Roebuck, will begin promoting the low-cost plans in April and May to 3 million eligible workers, about 7 percent of the 45 million uninsured Americans. They hope that several hundred thousand people will sign up at the start.

The employers will not subsidize the coverage, but their participation created a pool of potential participants sufficiently large to justify lower insurance rates than individuals would have to pay on their own.…

Only with very large and broad economies of size and scope will there be a solution for the 45 million uninsured…harbinger of a national health plan? By proxy?

Next Page »