Sunday, March 30, 2008

Can the MFR Experts Save Us From the Doom of a Black Hole

I read this article Asking a Judge to Save the World, and Maybe a Whole Lot More in the NY Times today and one of my immediate rather Freudian Stream of Consciousness thoughts was that perhaps we should send in a few of the John F. Barnes Myofascial Release experts in as a safety measure since apparently they have developed an ability to manipulate the quantum properties of matter.  Just a tongue in cheek thought.

The Should've Been Once and Future President? Gore 2008?

Within the continuing and contentious debate between the Clinton and Obama campaigns on their respective candidate's path to the White House in 2008 there lies a path to the White House for Al Gore who won the popular vote but lost the White House due to the idiosyncrasies of the Electoral College and the meddling of the Supreme Court.

Should the two leading Democratic contenders continue in their current tactics and ultimately damage either of their chances in defeating the presumptive Republican nominee Senator John McCain it is possible that Al Gore could be the inevitable nominee of the Democratic Party. 

This is possible only if the uncommitted Super Delegates to the Democratic Convention recognize they have either the unenviable position of playing the role of the 2000 Supreme Court and deciding between Clinton or Obama and thereby risk disenfranchising the sizable contingent of strong supporters for one or the other or they simply sit out the balloting until all delegates are no longer committed.  At that point it is conceivable that Al Gore could be cast in the role of the White (Green?) Knight to save the party.  Should either Clinton or Obama fail to win and then in an open convention ballot be nominated and be the resultant Democratic nominee.  This could also potentially alleviate the Michigan and Florida problem if the convention rules committee were to allow for the seating of these delegations should the possibility of an open ballot arise.

Of course this scenario would become moot if the two members of what would constitute the Democratic Dream Ticket would simply resolve among themselves which of the two were to head the ticket and which would settle for being the Vice Presidential nominee.

Friday, March 28, 2008

The Purveyors of "Woo" and the Wellness Space

We should all find it unsettling that the purveyors of Woo and pseudoscience seem intent on taking over the "Wellness" space.  This story Do Gooders on the Internet Intent to Focus on Wellness from Techcrunch should cause us all a little discomfort.  As the experts in movement and function this should be the space that Physical Therapists dominate.

Thursday, March 27, 2008

BBC Eliminates Complimentary Medicine Pages from Health Website

Well score one for the rational world. The BBC has removed the Complimentary Alternative Medicine (CAM) pages from their Health Website. Some of the ludicrous claims of the CAM community outlined in this blog post from DC's Improbable Science Blog probably point as to why this decision was made. Hopefully this is a trend that will continue.

Monday, March 24, 2008

Potential Tools to Combat the Fringe Element

David Gorski, MD, PhD, has written an outstandingly insightful piece on the Science Based Medicine Blog titled "When impressive science fails to impress patients"  He touches on salient points as to why some patients may ignore scientifically supported recommendations regarding treatment which I believe also has relevance to those who will accept the pseudoscientific treatment methods of certain fringe elements. 

This article should provide sufficient insight on how best to arm ourselves to approach patients who may be considering certain unreasoned approaches of Complimentary Alternative Medicine (CAM) as opposed to the effective and scientifically based approaches that may be recommended.

I look forward to further discussion in how the principles outlined in Dr. Gorski's article may be utilized.

Sunday, March 23, 2008

The Ignorance of Fundamentalist Belief - A World Going Mad

File this post under the "Etcetera" nature of this blog. 

This weekend while watching the ABC World News Tonight my sense of reason was rudely assaulted by this piece on yet another Creationist Museum or as they term it "Biblically Correct".  The children who are being so wrongly misled in this news item remind me of the children who find themselves in the radical Islamic Madrassahs.  They are being indoctrinated with fundamentalist archaic beliefs that no longer have relevance in a reasoned scientifically enlightened world.  I find it ironic that these same fundamentalist Christians are probably the same people who rail so incessantly against the Muslim radical fundamentalists.  It seems to me they are the opposite side of the same wrongful coin content to live in ignorance and conflict with all that is reasonable.  Conflicts of culture and nationalism will only be resolved when relativistic and dogmatic belief is replaced by reason.

Sunday, March 16, 2008

Where Have All Flowers Gone? A New Verse?

As I commented to a friend the other day, unless something changes soon with respect to the current medical practice environment, in the not too distant future people are going to wake up and wonder where have all the medical people gone.  I guess it could be a new verse to the old Pete Seeger tune.

Perhaps this story below is a presage of what might be.

Doctor shortage takes a toll in Japan from
Japan might boast universal health cover and some of the world's best medical technology, but an acute shortage of doctors is leaving some hospitals unable to treat even car crash victims. [...]

Observations From the Precipice

This week I was disturbed by some continued trends in the downward spiral of our health care system and this is a bit of just rambling tid bits but I find it all somewhat disturbing as an illustration of what is amounting to healthcare these days.

First, I had the privilege of seeing a gentleman this week following a fracture of the proximal humerus and radius. While these are not atypical conditions seen everyday in Physical Therapy clinics across the country what was disturbing was his difficult navigation of the health care system prior to arriving in my clinic. This gentleman was unfortunate enough to have been talked into being a subscriber of one of the various Medicare Advantage managed (mangled?) health care programs.

After this gentleman fell fracturing his proximal humerus and radius in is driveway as a result of impaired balance and gait as a result of his battle with Multiple Sclerosis and lying undiscovered in his driveway for approximately 2 hours in the early morning hours he was transported to the local Emergency
Room where he was assessed, diagnosed with the proximal humerus and radius fractures and then sent home in a splint with instructions to see an orthopedist for further treatment (casting). First, this caught me by some surprise but apparently Emergency Room physicians in this region no longer cast fractures and instead patients are referred to a local orthopedist for this procedure in their offices. Now this is where the complications become more apparent since there is apparently a very limited number of orthopedists who are participating in this Medicare Advantage program. So, it was not until four days after an exhaustive search by the patient and his wife later that this patient was finally casted.

A second story I was told this week was by one of my support staff. Apparently her sister had taken her three young children to a local pediatrician as they were all suffering from a respiratory infection. Well after having been seen by the physician the mother went to the reception check out desk and wrote her check for the three $40 dollar copays and then started for the exit. It was at this point that the story took an odd turn. As she headed for the door she was headed off by the front desk person who informed her that she owed an additional $120 dollars for the three office visits. After a shocked "Excuse me?" she was informed that there was a $40 per visit surcharge for being seen "after hours". I guess my question is exactly how does it qualify as "after hours" if the office is open and waiting room is full? It wasn't exactly like the pediatrician was dragged out of his bed in the middle of the night? It seems more like a gaming of the system more than anything else. Not that I'm not sympathetic to the plights of the pediatrician with respect to reimbursement but this once again smacks of the continued capitulation mentality and allowing reimbursement to drive practice.

A third disturbing story also came to light this week when a friend of mine informed me that his primary care physician now charges a $15 surcharge for a referral to a specialist if there is no office visit.

Things are bad and are seemingly only getting worse.

Tuesday, March 04, 2008

Anodyne Light Therapy Doesn't Ease Sensory Neuropathy in Diabetics

This article Anodyne Light Therapy Doesn't Ease Sensory Neuropathy in Diabetics appearing today on Medscape sheds doubt on the purported benefits of Monochromatic Infrared Energy (MIRE) therapy using the probably best known MIRE device on the market.

This double blind study utilized a number of measures which point to a strong placebo effect but refute the claimed benefits of the device itself.

Hopefully I will be able to find the original research article for a more critical review.  But in the meantime for those considering the purchase of this device I guess the phrase "Buyer Beware" should hold special meaning in this case.