Friday, December 28, 2012

a bit like where's Wally...

but with wildlife pictures...

http://uk.news.yahoo.com/photos/can-you-see-what-it-is-yet-amazing-camouflaged-animals-slideshow/

try to find the animals! answers at the end!

a couple below to wet your appetite...





A Great Gray Owl positions …

Wednesday, December 26, 2012

oregano oil


http://www.nytimes.com/2012/12/26/science/chicken-farms-try-oregano-as-antibiotic-substitute.html?src=me&ref=general

In Hopes of Healthier Chickens, Farms Turn to Oregano

Jessica Kourkounis for The New York Times
Chickens raised for Bell & Evans, like these in Pennsylvania, eat feed laced with oregano oil.
FREDERICKSBURG, Pa. — The smell of oregano wafting from Scott Sechler’s office is so strong that anyone visiting Bell & Evans these days could be forgiven for wondering whether Mr. Sechler has forsaken the production of chicken and gone into pizza.

Jessica Kourkounis for The New York Times
The experience of Scott Sechler, Bell & Evans’s owner, with using oregano oil led to a test at Country View Family Farms.
Oregano lies loose in trays and tied into bunches on tabletops and counters, and a big, blue drum that held oregano oil stands in the corner. “Have you ever tried oregano tea?” Mr. Sechler asked, mashing leaves between his broad fingers.
Off and on over the last three years or so, his chickens have been eating a specially milled diet laced with oregano oil and a touch of cinnamon. Mr. Sechler swears by the concoction as a way to fight off bacterial diseases that plague meat and poultry producers without resorting to antibiotics, which some experts say can be detrimental to the humans who eat the meat. Products at Bell & Evans, based in this town about 30 miles east of Harrisburg, have long been free of antibiotics, contributing to the company’s financial success as consumers have demanded purer foods.
But Mr. Sechler said that nothing he had used as a substitute in the past worked as well as oregano oil.
“I have worried a bit about how I’m going to sound talking about this,” he said. “But I really do think we’re on to something here.”
Skeptics of herbal medicines abound, as any quick Internet search demonstrates. “Oil of oregano is a perennial one, advertised as a cure for just about everything,” said Scott Gavura, a pharmacist in Toronto who writes for the Web site Science-Based Medicine. “But there isn’t any evidence, there are too many unanswered questions and the only proponents for it are the ones producing it.”
Nonetheless, Mr. Gavura said he would welcome a reduction in the use of antibiotics in animals.
At the same time, consumers are growing increasingly sophisticated about the content of the foods that they eat.
Data on sales of antibiotic-free meat is hard to come by, but the sales are a tiny fraction of the overall meat market. Sales in the United States of organic meat, poultry and fish, which by law must be raised without antibiotics, totaled $538 million in 2011, according to the Organic Trade Association. By comparison, sales of all beef that year were $79 billion.
Still, retailers like Costco, Whole Foods and Trader Joe’s, as well as some restaurant chains, complain that they cannot get enough antibiotic-free meat.
Noodles & Company, a fast-growing chain of more than 300 restaurants, recently added antibiotic-free pork to the choices of ingredients that customers can add to their made-to-order pastas. It ensured its supply by ordering cuts of meat that were not in relatively high demand and by committing in advance to buy a year’s worth, said Dan Fogarty, its executive vice president for marketing.
“We’re deliberately voting with our pocketbooks,” he said.
In a nationwide telephone survey of 1,000 adults in March, more than 60 percent told the Consumer Reports National Research Center that they would be willing to pay at least 5 cents a pound more for meat raised without antibiotics.
“Before, it was kind of a nice little business, and while it’s still microscopic in the grand scheme of things, we’re seeing acceptance from retailers across the country, not just in California and on the East Coast,” said Stephen McDonnell, founder and chief executive of Applegate, an organic and natural meats company.
Mr. McDonnell said a confluence of trends, from heightened interest in whole and natural foods to growing concerns about medical problems like diabetes, obesity and gluten allergies, were contributing to the demand for antibiotic-free meat.
There is growing concern among health care experts and policy makers about antibiotic resistance and the rise of “superbugs,” bacteria that are impervious to one or more antibiotics. Those bacteria can be passed on to consumers, who eat meat infected with them and then cannot be treated.
In November, the Centers for Disease Control and Prevention and 25 national health organizations and advocacy groups issued a statement on antibiotics that, among other things, called for “limiting the use of medically important human antibiotics in food animals” and “supporting the use of such antibiotics in animals only for those uses that are considered necessary for assuring animal health.”
In 2011, there were several prominent recalls involving bacterial strains that are resistant to antibiotics, including more than 60 million pounds of ground beef contaminated with salmonella Typhimurium and about 36 million pounds of ground turkey spoiled with salmonella Heidelberg.
Consumer Reports released a study last month that found the bacteria Yersinia enterocolitica in 69 percent of 198 pork chop and ground pork samples bought at stores around the country. Some of the bacteria were resistant to one or more antibiotics.
Analysis of Food and Drug Administration data by the Center for Science in the Public Interest found that 80 percent of all antibiotics sold in the United States are used in animals. The majority of those antibiotics are used to spur growth or prevent infections from spreading in the crowded conditions in which most animal production takes place today.
The European Union has banned the use of antibiotics to accelerate growth, and the European Parliament is pushing to end their use as tools to prevent disease as well.
The oregano oil product Mr. Sechler uses, By-O-Reg Plus, is made by a Dutch company, Ropapharm International. In the late 1990s, Bayer conducted trials on the product, known as Ropadiar in Europe, comparing its ability to control diarrhea in piglets caused by E. coli with that of four of the company’s products.        


 In all four test groups, Ropadiar outperformed the Bayer products. “Strange but true!” Dr. Lucio Nisoli, the Bayer product manager, wrote in his report on the trial. “Compared to the various anti-infectives, with Ropadiar I have obtained much more effective and quicker results. Furthermore, piglets treated with Ropadiar look much more healthy and were not so dehydrated and wasted.”
Jessica Kourkounis for The New York Times
Over the last six months, about 5,000 pigs at Country View Family Farms have eaten feed laced with By-O-Reg after being weaned from their mothers.
Astrid Köhler, a spokeswoman in Monheim, Germany, for Bayer Healthcare’s animal health business, confirmed that the company had done the trial but said that “in further evaluations the results of the first study could not be replicated with the same species, nor with other species.”
Other testing is rare. A test of oregano oil on four small farms in Maine, which was financed by a $9,914 grant from the Agriculture Department, found it was effective in controlling the parasites and worms that afflict goats and sheep.
Dr. Harry G. Preuss, a professor of physiology and biology at the Georgetown University Medical Center, studied the effectiveness of oregano oil on 18 mice infected with staph bacteria. Six mice were given oregano oil, and half survived for the full 30 days of the treatment. Six received carvacrol, regarded by many experts to be the antibacterial component in oregano, in olive oil, and none of them survived longer than 21 days. Six other mice received only olive oil and died within three days.
The study, which was underwritten by a company, North American Herb and Spice, and presented at a meeting of the American College of Nutrition in 2001, was repeated and all those findings were corroborated, Dr. Preuss said.
Dr. Preuss said he had applied to the National Institutes of Health for financing of a larger study, with no luck so far. “This is really promising, particularly when you consider that we are facing a crisis in our hospitals and health systems with the increasing resistance to antibiotics,” he said.
After hearing about Bell & Evans’s use of oregano oil, Bob Ruth, the president of Country View Family Farms, a Pennsylvania-based company, decided to test it on some of his pigs. Over the last six months, about 5,000 pigs have eaten feed laced with By-O-Reg after being weaned from their mothers.
“The preliminary results are encouraging, but we need to be sure it’s giving us the results we need to give us the confidence to start using it more broadly,” Mr. Ruth said.
Mr. Ruth and Mr. Sechler warned that using oregano oil to control bacterial infection also requires maintaining high standards of sanitation in barns where animals are sheltered, as well as good ventilation and light, and a good nutrition program.
After a chicken flock leaves a barn at Bell & Evans for slaughter, for instance, the facility is hosed down, its water lines are cleaned out and everything is disinfected. It sits empty for two to three weeks to allow bacteria to die off and to ensure that the rodents that carry salmonella and campylobacter are eliminated.
“You can’t just replace antibiotics with oregano oil and expect it to work,” Mr. Sechler said.        

Monday, November 26, 2012

Follow your nose...

http://blogs.scientificamerican.com/the-curious-wavefunction/2012/11/26/the-perils-of-translational-research/


Musings on chemistry and the history and philosophy of science
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The perils of translational research



This is an updated and revised version of an article I wrote for the Lindau Meeting of Nobel laureates and Current Science magazine.
In 1969, one of the more memorable incidents in the public advocacy of science took place. The American physicist Robert Wilson was asked to testify before Congress in support of the construction of the Fermi National Accelerator Laboratory, known as Fermilab. For Wilson, building this huge machine had been a labor of love and nobody had a better background for it. He had worked on the Manhattan Project where he was the youngest group leader in the experimental division, and after the war he had become a professor at Cornell University.
Wilson was a first-rate amateur architect who saw accelerators as works of art. He lovingly designed Fermilab with his own hands and, in order to add to the aesthetic appeal of the place, turned the surrounding acres into a wilderness housing bison and geese. His efforts paid off; Fermilab would become the largest accelerator in the United States and CERN’s primary competitor. In 1969 Wilson was asked to justify the expenditure for the multi-million dollar laboratory in front of Congress. The Cold War was raging, most research and especially physics research was being viewed in the context of national security, and Wilson was specifically asked what contribution the new laboratory would make to national defense. He replied in words that should be etched on the foundation stone of every center of basic research. The research, he said, had no direct bearing on national defense. Instead,
“It has only to do with the respect with which we regard one another, the dignity of men, our love of culture. It has to do with: Are we good painters, good sculptors, great poets? I mean all the things we really venerate in our country and are patriotic about. It has nothing to do directly with defending our country except to make it worth defending”.
It has nothing to do directly with defending our country except to make it worth defending. In saying these words, Wilson was appealing to the heart of what makes any country great. It is not the fancy cars, the shiny malls, the great financial houses and the cornucopia of industrial food that truly contribute to a country’s progress. At one point or another in history, Athens, Florence, Takshashila, Baghdad, Oxford, Gottingen, Copenhagen and Philadelphia were primarily known not for their wealth and the splendor of their monuments but for the unmatched wealth of ideas about science, art, economics, politics, freedom and human dignity that their citizens generated. These ideas are now the bedrock of much of modern civilization. Many of these ideas were solutions to practical problems, but most only sought to explore and push the boundaries of human creativity, curiosity, passion and tolerance. The creators and dreamers of these ideas were less concerned about their practical application and more concerned about their ability to answer questions about human origins and nature, our place in the cosmos and our relationship to other human beings.
Why am I retelling the story of Robert Wilson? Because I believe it strikes at the heart of what these days is fashionably called “translational research”. Just like physics research was being viewed through the lens of national defense in the 60s, basic biomedical studies run the risk of being viewed through the lens of translational research in the 2010s. The approach is clearly not popular among leading researchers. In 2009, Nobel Laureate Martin Chalfie gave a talk at the Lindau Meeting in which he described the great satisfaction he had gotten from doing non-translational research. Chalfie is not alone; last year I attended a lecture by another Nobel Laureate, Thomas Steitz. Steitz who won the prize for cracking open the structure of the ribosome proudly announced at the beginning of the talk that “the only kind of translation I have worked on is that orchestrated by the ribosome”. And this week in Sciencemagazine, Nobel Laureates Joseph Goldstein and Michael Brown lament the passing of the golden age of basic research at the NIH – an era which produced nine Nobel Prize winners during a single decade. As Goldstein and Brown put it, “translational research relegates basic science to a back burner…individual curiosity-driven science has been replaced by large consortia dedicated to the proposition that gathering vast amounts of correlative data will somehow provide an answer to life’s fundamental questions”.
So what is translational research? Many definitions seem to abound and Wikipedia seems to be as good a guide as any: “Translational research is a way of thinking about and conducting scientific research to make the results of research applicable to the population under study and is practised in the natural and biological, behavioural, and social sciences”. The goal of translational research especially in medicine seems to transform basic biomedical research discoveries from “bench to bedside”.
In the last few years this kind of thinking has has swamped the public discourse on science. New centers are being founded and funded whose mandate is to translate basic research into products directly benefiting humanity. The NIH, the largest biomedical research agency in the world, has also embraced a new National Center for Advancing Translational Research. The director of the NIH, Francis Collins, has not tired of pointing out the exciting advances in discovering new drugs which would be made possible by harnessing data from the human genome project. Not surprisingly, the press has eagerly jumped on the bandwagon, with reports pitching translational research and personalized medicine regularly appearing in the nation’s leading papers. Echoing leading scientists, the press seems to be telling us that we should all look forward to supporting translational research in its various guises.
All this makes the idea of translational research sound promising. And yet there must be a good reason why distinguished Nobel Prize winners like Chalfie, Steitz, Goldstein and Brown bristle at the mention of translational research. The reason is actually not too hard to discern. The problem is not with applied research per se. Nobody can doubt that applied research especially done by the pharmaceutical and biotechnology industries has saved innumerable lives in the last one hundred years. As Pasteur said, “there is science and the applications of science”, and he saw them lying on a continuum. No, there is nothing wrong with trying to turn basic ideas into applied products.
What is wrong is that translational research is being seen as a panacea that will address the flagging rate of new biomedical advances. The thinking seems to declare that if only more people were given more money and deliberately focused on direct application, we would suddenly see a windfall of new therapies against disease. This thinking suffers from two major problems.
The first problem is that history is not really on the side of translational research. Most inventions and practical applications of science and technology which we take for granted have come not from people sitting in a room trying to invent new things but as fortuitous offshoots of curiosity-driven research. Penicillin was discovered through serendipity by a most alert Alexander Fleming who was trying to plate bacterial cultures, not one trying to actually discover the next breakthrough antibiotic. Nuclear Magnetic Resonance (which in turn led to MRI) was discovered by physicists who were interrogating the properties of atoms using magnetic fields, not ones who were trying to find a method for determining the structures of organic and biological molecules. The discovery of most drugs built upon basic discoveries about human physiology and anatomy made by physicians and researchers who were simply trying to find more about how the body works. As Goldstein and Brown describe in theirScience opinion piece, NIH scientists in the 60s focused on basic questions involving receptors and cancer cells, but this work had an immense impact on drug discovery; for instance, heart disease-preventing statins which are the world’s best-selling drugs derive directly from Goldstein and Brown’s pioneering work on cholesterol metabolism. Examples also proliferate other disciplines; the Charged-Coupled Device (CCD), lasers, microwaves, computers and the World Wide Web are all fruits of basic and not targeted research.
If the history of science teaches us anything, it is that curiosity-driven basic research has paid the highest dividends in terms of practical inventions and advances. Tinkering, somewhat aimless but enthusiastic exploration of biological and physical systems and following one’s nose have been the ingredients for some of the key inventions that have transformed our lives. Radar, computers, drugs, detergents, plastics and microwave ovens were all made possible not because someone sat down and tried to discover them but because they arose as fortuitous consequences of elemental, pure research. The hype of translational research not only deflects attention from curiosity-driven basic research but also creates the illusion – and dangerously so especially in the minds of young scientists – that asking people to discover new things is the best way to generate new ideas. In fact, trying to discover new things by forcing people to discover them will only siphon off funds from those who have the actual capability of discovering these things. This is especially damning for bright young researchers who are trying to survive in an increasingly straitjacketed research milieu.
The second more practical but equally important problem with translational research is that it puts the cart before the horse. First come the ideas; then come the applications. There is nothing fundamentally wrong with trying to build a focused institute to discover a drug, say, for schizophrenia. But doing this when most of the basic neuropharmacology, biochemistry and genetics of schizophrenia are unknown is a great diversion of focus and funds. Before we can apply basic knowledge, let’s first make sure that the knowledge exists. Efforts based on incomplete knowledge would only result in a great squandering of manpower, intellectual and financial resources. Such misapplication of resources seems to be the major problem for instance with anew center for drug discovery that the NIH plans to establish. The NIH seeks to channel the newfound data on the human genome to discover new drugs for personalized medicine. This is a laudable goal, but the problem is that we still have miles to go before we truly understand the basic implications of genomic data. It is only recently that we have started to become aware of the “post-genomic” universe of epigenetics and signal transduction. We have barely started to scratch the surface of the myriad ways in which genomic sequences are massaged and manipulated to produce the complex set of physiological events involved in disease and health.
And all this does not even consider the actual workings of proteins and small molecules in mediating key biological events, something which is underlined by genetics but which constitutes a whole new level of emergent complexity. In the absence of all this basic knowledge which is just emerging, how pertinent is it to launch a concerted effort to discover new drugs based on this vastly incomplete knowledge? It would be like trying to construct a skyscraper without fully understanding the properties of bricks and cement.
Chalfie, Steitz and others like them are also right to criticize the frenzy that translational research generates in the popular press. We live in an age when buzzwords are eagerly generated and assimilated by the media. These buzzwords usually run roughshod over subtleties and ambiguities and the press seldom has a taste for indulging these in the first place. Needless to say, committing national resources and public attention to translational research when most of the basics are still to be understood is an endeavor fraught with great risk and uncertainty. It would be far wiser to bolster basic research that can bring us to the brink of real application. There are places where such research is conducted. They are called universities.
Ultimately, the importance of basic research goes back to what Robert Wilson said to Congress. It has to do with the same reasons that we created the Mona Lisa, painted the Sistine Chapel, built Chartres Cathedral, wrote The Love Song of J. Alfred Prufrock and composed the Goldberg Variations. Da Vinci, Michelangelo, T. S. Eliot and Bach were all trying to find the essence of man’s soul and his relationship with the universe and with his fellow men. So were Einstein, Newton, Faraday and Darwin. They were not trying to invent a better mousetrap, but the world did beat a path to their door. Similarly, once our basic understanding of biological systems is firmly in place, translation will willingly follow. The next researcher, when asked to comment on the relevance of his or her basic studies in cell biology to translational research, should echo Wilson: “It has nothing to do directly with translational research, except to enable it”.
Ashutosh JogalekarAbout the Author: Ashutosh (Ash) Jogalekar is a chemist interested in the history and philosophy of science. He considers science to be a seamless and all-encompassing part of the human experience. Follow on Twitter @curiouswavefn.

Friday, November 23, 2012

'Cancer Survivor or Victim of Overdiagnosis?'

From the New York Times

http://www.nytimes.com/2012/11/22/opinion/cancer-survivor-or-victim-of-overdiagnosis.html?src=me&ref=general


FOR decades women have been told that one of the most important things they can do to protect their health is to have regular mammograms. But over the past few years, it’s become increasingly clear that these screenings are not all they’re cracked up to be. The latest piece of evidence appears in a study in Wednesday’s New England Journal of Medicine, conducted by the oncologist Archie Bleyer and me.
The study looks at the big picture, the effect of three decades of mammography screening in the United States. After correcting for underlying trends and the use of hormone replacement therapy, we found that the introduction of screening has been associated with about 1.5 million additional women receiving a diagnosis of early stage breast cancer.
That would be a good thing if it meant that 1.5 million fewer women had gotten a diagnosis of late-stage breast cancer. Then we could say that screening had advanced the time of diagnosis and provided the opportunity of reduced mortality for 1.5 million women.
But instead, we found that there were only around 0.1 million fewer women with a diagnosis of late-stage breast cancer. This discrepancy means there was a lot of overdiagnosis: more than a million women who were told they had early stage cancer — most of whom underwent surgery, chemotherapy or radiation — for a “cancer” that was never going to make them sick. Although it’s impossible to know which women these are, that’s some pretty serious harm.
But even more damaging is what these data suggest about the benefit of screening. If it does not advance the time of diagnosis of late-stage cancer, it won’t reduce mortality. In fact, we found no change in the number of women with life-threatening metastatic breast cancer.
The harm of overdiagnosis shouldn’t come as a surprise. Six years ago, a long-term follow-up of a randomized trial showed that about one-quarter of cancers detected by screening were overdiagnosed. And this study reflected mammograms as used in the 1980s. Newer digital mammograms detect a lot more abnormalities, and the estimates of overdiagnosis have risen commensurately: now somewhere between a third and half of screen-detected cancers.
The news on the benefits of screening isn’t any better. Some of the original trials from back in the ’80s suggested that mammography reduced breast cancer mortality by as much as 25 percent. This figure became the conventional wisdom. In the last two years, however, three investigations in Europe came to a radically different conclusion: mammography has either a limited impact on breast cancer mortality (reducing it by less than 10 percent) or none at all.
Feeling depressed? Don’t be. There’s good news here, too: breast cancer mortality has fallen substantially in the United States and Europe. But it’s not about screening. It’s about treatment. Our therapies for breast cancer are simply better than they were 30 years ago.
As treatment improves, the benefit of screening diminishes. Think about it: because we can treat most patients who develop pneumonia, there’s little benefit to trying to detect pneumonia early. That’s why we don’t screen for pneumonia.
So here is what we now know: the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than has been previously recognized.
But to be honest, that general message has been around for more than a decade. Why isn’t it getting more traction?
The reason is that no other medical test has been as aggressively promoted as mammograms — efforts that have gone beyond persuasion to guilt and even coercion (“I can’t be your doctor if you don’t get one”). And proponents have used the most misleading screening statistic there is: survival rates. A recent Komen foundation campaign typifies the approach: “Early detection saves lives. The five-year survival rate for breast cancer when caught early is 98 percent. When it’s not? It decreases to 23 percent.”
Survival rates always go up with early diagnosis: people who get a diagnosis earlier in life will live longer with their diagnosis, even if it doesn’t change their time of death by one iota. And diagnosing cancer in people whose “cancer” was never destined to kill them will inflate survival rates — even if the number of deaths stays exactly the same. In short, tell everyone they have cancer, and survival will skyrocket.
Screening proponents have also encouraged the public to believe two things that are patently untrue. First, that every woman who has a cancer diagnosed by mammography has had her life saved (consider those “Mammograms save lives. I’m the proof” T-shirts for breast cancer survivors). The truth is, those survivors are much more likely to have been victims of overdiagnosis. Second, that a woman who died from breast cancer “could have been saved” had her cancer been detected early. The truth is, a few breast cancers are destined to kill no matter what we do.
What motivates proponents to use these tactics? Largely, it’s sincere faith in the virtue of early diagnosis, the belief that screening must be good for women. And 30 years ago, when we started down this road, they may have been right. In light of what we know now, it is wrong to continue down it. Let’s offer the proponents amnesty and move forward.
What should be done? First and foremost, tell the truth: woman really do have a choice. While no one can dismiss the possibility that screening may help a tiny number of women, there’s no doubt that it leads many, many more to be treated for breast cancer unnecessarily. Women have to decide for themselves about the benefit and harms.
But health care providers can also do better. They can look less hard for tiny cancers and precancers and put more effort into differentiating between consequential and inconsequential cancers. We must redesign screening protocols to reduce overdiagnosis or stop population-wide screening completely. Screening could be targeted instead to those at the highest risk of dying from breast cancer — women with strong family histories or genetic predispositions to the disease. These are the women who are most likely to benefit and least likely to be overdiagnosed.
One final plea: Can we please stop using screening mammography as measure of how well our health care system is performing? That’s beginning to look like a cruel joke: cruel because it leads doctors to harass women into compliance; a joke because no one can argue this is either a public health imperative or a valid measure of the quality of care.
Breast cancer is arguably the most important cancer for a nonsmoking woman to care about. Diagnostic mammography — when a woman with a breast lump gets a mammogram to learn if it’s something to worry about — is an important tool. No one argues about this. Pre-emptive mammography screening, on the other hand, is, at best, is a very mixed bag — it most likely causes more health problems than it solves.

'A Shortcut to Wasted Time'

From the New York Times

http://www.nytimes.com/2012/11/23/opinion/shortcuts-in-medical-documentation.html


A FEW years ago, we doctors kept handwritten charts about patients. Back then, it sometimes seemed like we spent half our time walking around looking for misplaced charts, and the other half trying to decipher the handwriting when we found them. The upside was that if I did have the chart in front of me, and I saw that someone had taken the trouble to write something down, I believed it.
Unfortunately, this is no longer the case. The advent of electronic medical records has been a boon to patient safety and physician efficiency in many ways. But it has also brought with it a slew of “timesaving” tricks that have had some unintended consequences. These tricks make it so easy for doctors to document the results of standard exams and conversations with patients that it appears more and more of them are being documented without ever having happened in the first place.
For instance, doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation.
Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.
Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click. Medicare thinks so too. This fall, the attorney general and secretary of health and human services warned the five major hospital associations that this kind of abuse would not be tolerated.
And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes.
In short, reading the electronic chart has become a game of looking for a small needle of new information in a haystack of falsely comprehensive documentation and outdated, copied text. Why do we doctors do this to ourselves? Largely, it turns out, for the same reason most people do most things: money.
Doctors are paid not by how much time they spend with patients, how well they listen or how hard they think about what could be wrong, but by how much they write down. And the rules for what we have to write are Byzantine: Medicare’s explanation takes 87 pages. To receive the highest level of payment for an office visit, I have to document several aspects of the main problem, screening questions about at least 10 organ systems, something about the patient’s family and/or social history, and/or a lengthy physical exam. In addition, I have to demonstrate that my medical decision making was very complicated, considering the number of possible diagnoses and treatments, the complexity of the data and/or the patient’s risk of serious complications. That type of visit is supposed to take about 40 minutes.
Last week, I spent 40 minutes with a patient who had just placed her mother into hospice care. My patient was distraught, not sleeping, not eating. I gave her some advice, but mostly I just listened. By the end of our visit, she was feeling much better. But I wouldn’t be able to bill much for that visit based on my documentation: I didn’t review her medical or family history, conduct a review of organ systems or perform a physical exam.
What the payment system tells me to do is to cut her off after 10 minutes, listen to her heart and lungs and give her a sleeping pill. Which doctor visit would you prefer?
Of course, I would never go back to the bad old days of lost charts, illegible writing, manual prescription refills and forgotten information. Electronic medical records help us avoid dangerous drug interactions and medical ordering errors, remind us to provide preventive care and allow us to view data as trends over time. Even copy and paste have legitimate uses.
But physicians need to be better stewards of our records so they remain useful, regardless of skewed incentives and new technology. And as a nation, we should question whether paying physicians by documentation — instead of by time spent on quality patient care — is such a great idea after all.

Monday, November 19, 2012

Bullying

Another thoughtful and heartening episodes from the Fine brothers and teens of Teens React.

Saturday, November 17, 2012

Respect to good people

http://www.salon.com/2012/11/15/pam_geller_accuses_jewish_group_of_nazi_sympathies/


Pam Geller compares Jewish group to Nazi sympathizers

A Jewish group opposes the Islamophobic activist-blogger's new bus ads and gets labeled "judenrat" in return


Topics: Chicago, Islamophobia, Pam Geller, Sharia,
Pam Geller compares Jewish group to Nazi sympathizers (Credit: flickr/WarzauWynn)
For some people, stoking fears about Islam and Shariah  is an election year issue (ahem, Rep. Michele Bachmann), but for others, like influential Islamophic blogger Pam Geller, it’s a life’s mission. Geller led the campaign against the so-called Ground Zero Mosque in lower Manhattan and is one of a handful of activists at the core of the anti-Shariah movement; a few months ago, she paid for controversial ads on New York City buses and subways defaming Islam as “savage.” The campaign provoked a backlash, including vandalism and lawsuits, but the law sided with Geller’s right to free speech in both cases, with a court ordering New York’s transit authority to display the ads and arrests for some who defaced her ads.
Now she’s taking her act to Chicago, where her ad went up on 10 buses yesterday afternoon. “In any war between the civilized man and the savage, support the civilized man. Support Copts. Defeat Jihad,” the ads read. Copts are Egyptian Christians who have been persecuted by the Muslim majority in the country.
But this time, activists, led by the Chicago-based Jewish Council on Urban Affairs, were prepared. They launched a campaign against the ads before they even appeared. “These ads are meant to create false divisions among our communities, generating suspicion and animosity,” Judy Levey, the executive director of the group, said in a statment. “It is very important to say in a clear voice, ‘not in our city.’ We’re better than that.” The JCUA held a rally Tuesday night against the ads and set up an online campaign to coordinate action and to collect voices of Jews in the area upset with the ads.
While Geller’s actions have been met with resistance from multi-faith groups in the past, opposition has usually been led by Muslim groups like CAIR, the Council on American Islamic Relations. How did she react to the novelty of a Jewish-spearheaded opposition? By comparing them to Nazi sympathizers, naturally.
“As if on cue, dhimmi Jews in Obama’s old stomping ground did the step ‘n fetchit for Islamic supremacism. Taking their cue from the Jewish councils of Germany and the judenrat that sold out their own people, they immediately denounced from ads,” she wrote on her blog.
There’s a lot to unpack there. “Dhimmi” refers to non-Muslims who live under Islamic states and connotes inferior status. “Judenrat,” in case it’s not obvious from the context, were Jewish councils who collaborated with the S.S. in Nazi-occupied lands to coordinate the affairs of the ghetto and “were responsible for organizing the orderly deportation to the death camps.” And finally, lest any group be left unoffended, “step ‘n fetchit” refers to Stepin Fetchit, the stage name of one of Hollywood’s first African-American actors, Lincoln Perry, who has since become controversial for playing racist or stereotypical roles, not unlike black minstrels of an earlier era.
Geller continued: “I expect Hamas-CAIR to denounce our ads … [But] These Jewish ‘leaders’ are failing not just the Jews in Israel, but all persecuted and oppressed people. Did we not learn our lesson from World War II? Did we not have to make amends for our gross negligence while millions were slaughtered?” She even went after Manya Brachear, who wrote a news item about the ad in the Chicago Tribune, saying she’s “only too happy to subjugate herself in the cause of Islam.”
“CTA understands that this ad may be offensive to our customers,” he added. “While the courts have ruled this ad is a form of protected speech under the First Amendment, we object to its divisive message,” a spokesperson for the Chicago Transit Authority told Brachear.
At least we know the CTA is not a tool of al-Qaida.
UPDATE: Levey, the Executive Director of the JCUA sent over the following response to Geller:
“The whole point of JCUA’s response to Geller’s ads is that hate speech is destructive. As Jews and as Americans, we can’t stand idly by as people fan the flames of divisiveness by using hateful words and outrageous characterizations.
JCUA doesn’t think Americans should be talking to each other like this. When hate and inflammatory language is injected into the discourse, nothing good comes of it.
That’s not a Jewish value and it certainly isn’t an American value.”
Close
Alex Seitz-Wald is Salon's political reporter. Email him at aseitz-wald@salon.com, and follow him on Twitter @aseitzwald.

digital footprints

http://blogs.reuters.com/great-debate/2012/11/15/collatoral-damage-of-our-surveillance-state/

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Collateral damage of our surveillance state

As the surreal sex scandal that forced CIA Director David Petraeus’ resignation reveals another prominent general’s “flirtatious” emails, the serious scandal here may well be the breadth of the FBI’s power to launch fishing expeditions through Americans’ most intimate communications.
This investigation began in May, as we now know from copious FBI leaks, with a series of rude anonymous emails to Tampa socialite Jill Kelley. The messages criticized her cozy relationships with military officers at a local base, where she volunteers as a social planner. Although the e-mails have been described as “cat-fight stuff” rather than threats, a friend of Kelley’s at the FBI, Frederick W. Humphries IIwho had sent Kelley shirtless photos and was ultimately barred from the case by superiors worried he had become “obsessed” ‑ urged the bureau to investigate.
The FBI obliged ‑ apparently obtaining subpoenas for Internet Protocol logs, which allowed them to connect the sender’s anonymous Google Mail account to others accessed from the same computers, accounts that belonged to Petraeus biographer Paula Broadwell. The bureau could then subpoena guest records from hotels, tracking the WiFi networks, and confirm that they matched Broadwell’s travel history. None of this would have required judicial approval ‑ let alone a Fourth Amendment search warrant based on probable cause.
While we don’t know the investigators’ other methods, the FBI has an impressive arsenal of tools to track Broadwell’s digital footprints — all without a warrant. On a mere showing of “relevance,” they can obtain a court order for cell phone location records, providing a detailed history of her movements, as well as all people she called. Little wonder that law enforcement requests to cell providers have exploded — with a staggering 1.3 million demands for user data just last year, according to major carriers.
An order under this same weak standard could reveal all her e-mail correspondents and Web surfing activity. With the rapid decline of data storage costs, an ever larger treasure trove is routinely retained for ever longer time periods by phone and Internet companies.
Had the FBI chosen to pursue this investigation as a counterintelligence inquiry rather than a cyberstalking case, much of that data could have been obtained without even a subpoena. National Security Letters, secret tools for obtaining sensitive financial and telecommunications records, require only the say-so of an FBI field office chief.
Though President Barack Obama once pledged to end the use of these letters to siphon up sensitive information about innocent Americans without judicial oversight, they have been issued in unprecedented numbers during his administration. More than 14,000 Americans were affected just during his first year in office. Internal audits have revealed “widespread and serious misuse” of this authority, yet Congress has not acted to restrict it.
Unlike conventional wiretaps or physical searches, many of these methods can be used without the targets ever being told ‑ regardless of whether evidence of a crime is found. Americans remain largely in the dark about how widely or frequently they are used.
While federal courts must report on the number of wiretap orders issued each year, there’s no similar requirement for most other forms of digital surveillance. Where reporting requirements exist, they are routinely flouted by the Justice Department, which sometimes waits years to provide Congress with mandatory reports.

With Broadwell identified as the anonymous emailer ‑ explaining her surprising knowledge of Petraeus’ social calendar ‑ one might have expected the investigation to be closed. Yet, though Justice Department attorneys seem to have ultimately determined that Broadwell committed no crime, the bureau didn’t stop.
Rather than questioning Broadwell or Petraeus at this point, the FBI sought access to the contents of her email accounts and uncovered thousands of intimate messages, largely irrelevant to the purpose of this inquiry, that revealed an illicit affair between the married CIA director and his Boswell.
Humphries—whose “worldview,” according to FBI sources, led him to fear a pre-election coverup to protect Obama — then re-emerged as a “whistleblower” and leaked the sordid investigation details to House Majority Leader Eric Cantor (R-Va.).
At some point—it’s still unclear how— the FBI also obtained “flirtatious” e-mails between Kelley and General John Allen, which were later disclosed to the military. These, too, appear to have been non-criminal, however allegedly “inappropriate.”
Petraeus seems to have behaved stupidly on every possible level. But this chain of events should still be profoundly disturbing to anyone familiar with the FBI’s long and ugly history of using targeted leaks from electronic surveillance in an attempt to destroy political adversaries. Perhaps the most notorious example remains J. Edgar Hoover’s attempt to drive Martin Luther King Jr. to suicide, using tapes of his extramarital liaisons, so that he could be replaced by what the bureau euphemistically called “the right kind of Negro leader.”
This incredible record of abuse was uncovered only years ‑ and in some cases decades ‑ after the fact, following an intensive Senate investigation.
Concerns about the bureau’s power should only be more pressing in an age where cheap data storage and a fear-fueled blank check for intelligence agencies combine to give the government a detailed portrait of our virtual lives that would have staggered even Hoover. The demand for access to Broadwell’s emails was just one of 6,321 requests for user data—covering 16,281 user accounts—fielded by Google alone in the past six months. Those requests may expose not just current correspondence but years’ worth of e-mails and chats, as they did with Broadwell.
Though technology continues to advance at a breathtaking pace, the federal digital privacy rules were written in 1986 ‑ when Atari was king. Investigators often don’t even need a Fourth Amendment search warrant to go fishing through your emails. For messages on a server longer than six months, a prosecutor’s subpoena or a court order based on that same weak showing of “relevance” to an investigation can do the trick.
Even if you don’t use Google and aren’t currently under suspicion, there’s no guarantee that some of your communications aren’t sitting in a database awaiting a curious agent’s query. Under the 2008 amendments to the Federal Intelligence Security Act (FISA), the National Security Agency now has broad power to vacuum up international communications without the need for individual warrants ‑ power that has predictably resulted in “over-collection” of even domestic emails on a massive scale.
The Senate Intelligence Committee has robust oversight powers under the FISA ruling, but the NSA has repeatedly refused to give even a rough estimate of how many American citizens’ communications are now stored in their vast database.
You don’t have to sympathize with Petraeus to wonder whether any prominent national figure who runs afoul of the FBI—or another influential official, for that matter—could survive the kind of humiliating exposure our modern surveillance state makes commonplace. If everyone has a skeleton or two in the closet, information is the power to decide whose careers will survive.
We have unwittingly constructed a legal and technological architecture that brings point-and-click simplicity to the politics of personal destruction. The Petraeus affair has, for a moment, exposed that invisible scaffolding ‑ and provided a rare opportunity to revisit outdated laws and reconsider the expanded surveillance powers doled out over the past panicked decade.
Congress should seize the opportunity to re-examine and revise these myriad surveillance techniques and update the oversight process. At a bare minimum, lawmakers should drag the 1986 Electronic Communications Privacy Act into the 21st century ‑ requiring a warrant for all law-enforcement access to communications contents and tightening the rules for access to sensitive information, such as cellphone location data. They should also demand more answers about the use of programmatic surveillance under the FISA Amendments Act—and refuse to reauthorize the law until they get them.
If we don’t take steps to rein in the burgeoning surveillance state now, there’s no guarantee we’ll even be aware of the ways in which control is exercised through this information architecture. We will all remain exposed ‑ but the extent of our exposure, and the potential damage done to democracy, is likely to remain invisible.'

http://www.salon.com/2012/11/16/paula_broadwells_big_mistake/

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1004675

Sunday, November 11, 2012

ISM

http://www.ism-london.org.uk/3705/

A letter from Gordon Bennett, Ellie Clayton and Aimee McGovern — currently under house arrest in Tel Aviv.

Kufr QaddumAs many of you may already know, we are currently volunteering in the occupied Palestinian Territories with the International Solidarity Movement (ISM) – a non-violent Palestinian-led solidarity organization. Much of the work that we do is documenting human rights abuses, taking pictures and videos, writing reports and carrying out direct action, such as attending demonstrations. Hence our presence in the village of Kufr Qaddoum on Friday the 21st of September.
As Friday’s demonstration progressed, it became clear that the army were targeting international observers for arrest – a tactic regularly used by the Israeli authorities to prevent human rights abuses being reported in international media. The three of us were eventually beaten and arrested after taking pictures of the demonstration.
What followed was a 48 hour ordeal of detention – being split up, strip-searched, shackled hand and foot, denied access to prescription medication and imprisoned in cockroach-infested cells with no idea of what was going on.
We were eventually brought to court, where we were charged with fabricated offences – throwing stones at soldiers and knowingly being in a ‘closed military zone’. No evidence was brought against us, because there was none. After 48 hours, we were released to 24/7 house arrest in this flat in Tel Aviv, where we await a decision as to whether we’re to be deported at the end of the week. We’ve been told by the British consulate in Jerusalem that this is not a punishment they have heard of being used before for British nationals, so for this reason we are unsure of our status.
Thankfully for us, during this ordeal ISM and Israeli activists from Anarchists Against the Wall (AATW) have provided us with legal assistance, a translator, transport, accommodation and support in Tel Aviv. They’ve also acted as guarantor for our conditions of house arrest – if we were to take even one step outside of this building, our friend would be charged 3500 pounds. Without their help, we would likely have been held for seven days in prison and then deported immediately.
Both ISM and AATW are working on tiny budgets and regularly have to face these kind of crippling financial costs to maintain their work against the occupation in Palestine. Donations are desperately needed to allow both organisations to continue. The three of us would like to appeal to our friends and families to make a donation to support their ongoing work.
As international citizens, we are provided with some legal protection under Israeli law. Palestinians, on the other hand, are not. Two Palestinian men were arrested at the same time as us, facing the same charges. They are still awaiting trial, but there’s no way they’re going to get the chance of moving to house arrest after just two days inside – Israel’s ‘administrative detention’ regime for Palestinians can mean being held indefinitely without charge for months or years. It’s a regime that has been criticized time and again by human rights organisations.
Please write to the Israeli government: the Minister of Public Security, Yitzhak Aharonovitch, at sar@mops.gov.il, and the Military Advocate General, Brigadier General Danny Efroni at avimn@idf.gov.il, calling for:
  • The immediate release of Majd Obeid (23) and Abdelateef Obeid (25), or for them to be promptly tried in a hearing which meets internationally recognized fair trial standards;
  • An end to the policy of administrative detention for Palestinians;
  • An end to the arrest and trial of Palestinian minors as adults;
  • An end to ill-treatment of Palestinians in detention;
  • An end to the harassment and arrest of international and local human rights defenders.
You can make a donation here which will be used to help cover our legal fees, and to support ongoing work by ISM and AATW. This link is for the ISM donation site, so PLEASE write a note on the Paypal page for all or part of the donation to go to AATW. Alternatively, if you would prefer not to use Paypal, email us to make a pledge to either organization and we can provide you with bank details to make a transfer and we will pay it directly to AATW or ISM.
Also, please share this letter as widely as you can!
Shukran! (Thank you!)
Gordon, Ellie and Aimee.

http://www.ism-london.org.uk/2792/

The Photographs and Journal Entries of Tom Hurndall Released

tom hurndall‘The Only House Left Standing – The Middle East Journals of Tom Hurndall’ has been released on Trolley Books. Robert Fisk wrote the following review in the Independent newspaper.
I don’t know if I met Tom Hurndall. He was one of a bunch of ‘human shields’ who turned up in Baghdad just before the Anglo-American invasion in 2003, the kind of folk we professional reporters make fun of. Tree huggers, that kind of thing. Now I wish I had met him because – looking back over the history of that terrible war – Hurndall’s journals show a remarkable man of remarkable principle. “I may not be a human shield,” he wrote on 17 March from his Amman hotel. “And I may not adhere to the beliefs of those I have travelled with, but the way Britain and America plan to take Iraq is unnecessary and puts soldiers’ lives above those of civilians. For that I hope that Bush and Blair stand trial for war crimes.”
Hurndall got it about right, didn’t he? It wasn’t so simple as war/no war, black and white, he wrote. “Things I’ve heard and seen over the past few weeks prove what I already knew; neither the Iraqi regime, nor the American or British, are clean. Maybe Saddam needs to go but… the air war that’s proposed is largely unnecessary and doesn’t discriminate between civilians and armed soldiers. Tens of thousands will die, maybe hundreds of thousands, just to save thousands of American soldiers having to fight honestly, hand to hand. It is wrong.” Oh, how many of my professional colleagues wrote like this on the eve of war? Not many.
We pooh-poohed the Hurndalls and their friends as groupies, even when they did briefly enter the South Baghdad electricity station and met one engineer, Attiah Bakir, who had been horrifyingly wounded 11 years earlier when an American bomb blew a fragment of metal into his brain. “You can see now where it struck,” Hurndall wrote, “caving in the central third of his forehead and removing the bone totally. Above the bridge of his broken nose, there is only a cavity with scarred skin covering the prominent gap…”
Hurndall’s picture of Attiah Bakir shows him as a distinguished, brave man who refused to leave his place of work as the next war approached. He was silenced only when one of Hurndall’s friends made the mistake of asking what he thought of Saddam’s government. I cringed for the poor man. ‘Minders’ were everywhere in those early days. Talking to any civilian was almost criminally foolish. Iraqis were forbidden from talking to foreigners. Hence all those bloody minders (many of whom, of course, ended up working for Baghdad journalists after Saddam’s overthrow).
Hurndall had a dispassionate eye. “Nowhere in the world have I ever seen so many stars as now in the western deserts of Iraq,” he wrote on 22 February. “How can somewhere so beautiful be so wrought with terror and war as it is soon to be?” In answer to the questions asked of them by the BBC, ITV, WBO, CNN, Al Jazeera and others, Hurndall had no single reply. “I don’t think there could be one, two or 100 responses,” he wrote. “To each of us our own, but not one of us wants to die.” Prophetic words for Tom to have written.
You can see him smiling selflessly in several of his snapshots. He went to cover the refugee complex at Al-Rweished and moved inexorably towards Gaza where he was confronted by the massive tragedy of the Palestinians. “I woke up at about eight in my bed in Jerusalem and lay in until 9.30,” he wrote. “We left at 10… Since then, I have been shot at, gassed, chased by soldiers, had sound grenades thrown within metres of me, been hit by falling debris…”
Hurndall was trying to save Palestinian homes and infrastructure but frequently came under Israeli fire and seemed to have lost his fear of death. “While approaching the area, they (the Israelis) continually fired one- to two-second bursts from what I could see was a Bradley fighting vehicle… It was strange that as we approached and the guns were firing, it sent shivers down my spine, but nothing more than that. We walked down the middle of the street, wearing bright orange, and one of us shouted through a loudspeaker, ‘We are international volunteers. Don’t shoot!’. That was followed by another volley of fire, though I can’t be sure where from…”
Tom Hurndall had stayed in Rafah. He was only 21 when – in his mother’s words – he lost his life through a single, selfless, human act.
“Tom was shot in the head as he carried a single Palestinian child out of the range of an Israeli army sniper.” He was a brave man who stood alone and showed more courage than most of us have dreamed of. Forget tree huggers. Hurndall was one good man and true.
A gallery of images from the book can be viewed here
To pick up your copy, and for further information please visit the Trolley Books website.