Archive for January, 2010

John Edwards and empty suits

Saturday, January 9th, 2010

I have not been very impressed with politicians for years. As a member of the CMA’s Commission on Legislation for nearly ten years, I have had enough exposure to them to cure any illusions. I remember one weekend retreat with Jesse Unruh, who had spent many years as California’s Assembly Speaker and as a candidate for governor. His comment on the corruption of politicians was colorful. “If you can’t drink their whiskey and eat their food and fuck their women, and then vote against them in the morning, you don’t belong here.” Well, that might have been enough for Jesse, but some of us are not so sure.

John Edwards had “phony” written all over him the first time I saw him but he had a good run for a while. This excerpt of a new book completes the picture of a narcissistic phony who wasn’t very smart after all. Obama may not be the best president we could expect from the Democratic party these days, but he is a saint compared to this empty suit. Elizabeth isn’t much better.

Charles Payne

Saturday, January 9th, 2010

There is a radio program on Saturday afternoons by a guy named Charles Payne. It’s a finance and investment show. Until I saw a Glenn Beck show recently, I had no idea Payne was black. He has a great life story and is on the Beck show right now with an audience that is all black. It’s an interesting show. Payne grew up poor in Harlem and, as long as he can remember, he wanted to be a businessman. His great desire as a kid was to have a briefcase. Finally, for Christmas, he got one plus a calculator inside it. He says it was his best Christmas ever. He joined the Air Force so he could go to college on the GI Bill.

What a great life story ! What a contrast with the Reverend Wright church !

He readily admits he voted for Obama and I can certainly see why he would do so. His explanation is that he was hoping the example, of Obama coming up through education, would counteract all the stereotypes of black kids reaching success only as rappers or professional athletes. He’s disappointed but I think he has a good point about Obama being a better example for kids.

I am very impressed with this guy whose investment show is the best I have found on radio. The life story is just a bonus. I am also impressed with Beck. I am not impressed with the ridiculous Harry Reid, who shows once again the racism of the left.

Health reform as rent seeking

Wednesday, January 6th, 2010

I have been suspicious of most of the medical organizations pushing health reform of the Obama type. I have previously proposed that the problem with cost that we have is due to the effort to achieve pre-paid care, and ultimately free care. The medical organizations that have been pushing this type reform usually have an ulterior motive. The AMA gave up its credibility in 1986 with RBRVS. That was sold to the primary care organizations as a way to take money from specialists, especially surgeons, and give it to the primary care docs. I remember being told at the time that they were doing it for that reason. Well, it didn’t work. Everybody got screwed in a typical “prisoners’ dilemma” situation.

Now, here we go again and the usual suspects are pushing the same argument.

The Congressional reform proposals are based on a widespread consensus that the current model of fee-for-service payments undercompensate evaluation and management services as compared with procedures and technical services, do a poor job of providing incentives to clinicians for collaboration, do not improve efficiency, are not focused on quality and outcomes, and do little to encourage wellness and prevention.

It is well known by everyone in health care that “wellness and prevention” do not contribute to reduced costs except as general public health trends. If obesity is responsible for increasing levels of type II diabetes, for example, doctors are going to have little effect on that trend, no matter how they might scold patients. However, pushing “wellness and prevention” is a way of trying for a bigger piece of the reimbursement pie.

In fact, every step in the march toward government medicine has resulted in less, not more, money for primary care. That is why primary care physicians are leaving the Medicare program and selling their services, in a variation of the fee-for-service model, to patients for cash. The command economy types will never understand that because they do not understand private business. In their world, everybody works for the government, or academia which is the same thing.

Worthwhile In The Science Literature

Sunday, January 3rd, 2010

By Bradley J. Fikes

(Crossposted at my newspaper’s sci-tech blog).

A cheaper way to make antisense oligonucleotides From the abstract in PLoS ONE:

“Antisense oligonucleotides targeting microRNAs or their mRNA targets prove to be powerful tools for molecular biology research and may eventually emerge as new therapeutic agents. Synthetic oligonucleotides are often contaminated with highly homologous failure sequences. Synthesis of a certain oligonucleotide is difficult to scale up because it requires expensive equipment, hazardous chemicals and a tedious purification process. Here we report a novel thermocyclic reaction, polymerase-endonuclease amplification reaction (PEAR), for the amplification of oligonucleotides.”

My take: This should be of interest to companies working with RNA-based therapeutics, like Carlsbad’s Isis Pharmaceuticals or Regulus Therapeutics.

Evolution of Primary Hemostasis in Early Vertebrates From the PLoS One abstract:

Hemostasis is a defense mechanism which protects the organism in the event of injury to stop bleeding. Recently, we established that all the known major mammalian hemostatic factors are conserved in early vertebrates. However, since their highly vascularized gills experience high blood pressure and are exposed to the environment, even very small injuries could be fatal to fish. Since trypsins are forerunners for coagulation proteases and are expressed by many extrapancreatic cells such as endothelial cells and epithelial cells, we hypothesized that trypsin or trypsin-like proteases from gill epithelial cells may protect these animals from gill bleeding following injuries. In this paper we identified the release of three different trypsins from fish gills into water under stress or injury, which have tenfold greater serine protease activity compared to bovine trypsin. We found that these trypsins activate the thrombocytes and protect the fish from gill bleeding. . . In conclusion, we believe that the gills are evolutionarily selected to produce trypsin to activate PAR2 on thrombocyte surface and protect the gills from bleeding. We also speculate that trypsin may also protect the fish from bleeding from other body injuries due to quick contact with the thrombocytes. Thus, this finding provides evidence for the role of trypsins in primary hemostasis in early vertebrates.

My take: Evolution is a highly conservative process: Once it finds something that works, it uses it over and over. So here the researchers have found a mechanism that protects fish, using enzymes commonly found in vertebrates. Trypsins are used in digestion among mammals and other vertebrates. The implication is that the last common ancestor of modern fish and mammals — a water-dwelling animal that looked like a present-day fish — had these trypsins, and that they were important in preventing blood loss. On the surface, you wouldn’t expect to see an enzyme used for digestion to have a role in stopping blood loss, but evolution doesn’t care about what humans would expect.

An Ultrasound Assisted Anchoring Technique (BoneWelding Technology) for Fixation of Implants to Bone – A Histological Pilot Study in Sheep From the Open Orthopaedics Journal abstract:

The BoneWelding® Technology offers new opportunities to anchor implants within bone. The technology melted the surface of biodegradable polymer pins by means of ultrasound energy to mould material into the structures of the predrilled bone. Temperature changes were measured at the sites of implantation in an in vitro experiment. In the in vivo part of the study two types of implants were implanted in the limb of sheep to investigate the biocompatibility of the method … Results demonstrated mild and short temperature increase during insertion. New bone formed at the implant without evidence of inflammatory reaction. The amount of adjacent bone was increased compared to normal cancellous bone. It was concluded that the BoneWelding® Technology proved to be a biocompatible technology to anchor biodegradable as well as titanium-PLA implants in bone.

My take: The bone-implant interface is tricky because bone is a living tissue, changing, growing and breaking down, with microscopic pores. Fusing an implant tightly to the bone helps it take hold. BoneWelding was recognized as one of the best spine technologies for 2009 by Orthopedics This Week, a trade publication.

BoneWelding is the product of a Swiss firm, SpineWelding AG. Other Best Spine Technologies winners include San Diego-based NuVasive, for its XLIF (eXtreme Lateral Interbody Fusion) technology. Carlsbad’s Alphatec Spine also won for its GLIF – Guided Lateral Interbody Fusion technology.

Another shoe drops

Friday, January 1st, 2010

I have been writing here about the failure of health reform as it is currently being concocted. Medicare, which began as a boon to doctors and elderly patients, was always cursed with unrealistic expectations. It destroyed the American health insurance system by converting it to pre-paid care. Now, that model is collapsing.

The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

The “pilot project” will quickly become the norm as the Medicare beneficiaries have little option. Other doctors have been dropping Medicare for the past ten years.

Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

The Mayo Clinic charges for the cash services are a bit higher than others I have seen.

A Medicare patient who chooses to stay at Mayo’s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won’t be allowed to switch to a primary care doctor at another Mayo facility.

A few hundred of the clinic’s Medicare patients have decided to pay cash to continue seeing their primary care doctors, Yardley said. Mayo is helping other patients find new physicians who will accept Medicare.

Good luck finding them.