Video available in HD:

My favorite lyrics from the song (sung to the tune of Total Eclipse of the Heart) are:

’cause we sometimes check the screen
and every now and then, we write stuff!
And if we have to intervene,
we inject a bit of white stuff!
And we offer to alter the lights,
or the height of the bed,
or fiddle with the radio, change the CD,
we even check the patient, occasionally!!

And if they move, we turn up the vapor,
and then we go back, to reading the paper!

Hat tip to Dr. Latte at Medical Marginalia for showcasing this hilarious song!

You can also see the Amateur Transplants perform this live here!

Nick

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Back in the early 90s, before 19-year-old girl “pharmacy technicians” were the norm, and most medications were prepared by actual licensed pharmacists, we had a serious mix-up with a medicine involving my younger brother.

He was still a baby then, about six years old, and was taking antibiotics (in liquid form). Just in time, we realized the label was papering over the REAL label, which identified it as a powerful anti-seizure sedative that likely would have killed my brother.

Mislabeling kills people. My mom went down to the pharmacy and hit the roof.

Turns out that pharmacist was crazy overworked for weeks and fatigued to the max. Why? the pharmacist shortage, the shortage that would soon force them to delegate much of the work to 19-year-old girls.

That pharmacist was put on forced leave for several weeks.

Because of this pharmacist shortage, much of the work of handling and passing out medications is now done by 19-year-old girl “pharmacy technicians.” Is this safe? In Cleveland, it wasn’t.

Emily Jerry, the 2-year-old daughter of Christopher and Kelly Jerry, suffered an agonizing death after a pharmacy technician gave her a solution containing 23 percent salt at Rainbow Babies & Children’s Hospital on Feb. 26, 2006.

The solution was supposed to be about 1 percent salt. The child was undergoing her final treatment for cancer.

Ohio governor signs ‘Emily’s Law’ forcing standards for pharmacy technicians

The supervising pharmacist, Eric Cropp, was recently convicted of involuntary manslaughter because he didn’t catch the mixing mistake. The young girl pharmacy technician, Katie Dudash, was not charged with a crime after agreeing to testify against Mr. Cropp, who she said approved the IV bag mixture even after she told him she wasn’t sure it was right.

As a result of this high-profile FAIL, Ohio passed “Emily’s Law,” which requires the Ohio Board of Pharmacy to test and certify pharmacy technicians. Emily’s Act, introduced in the U.S. Congress by Rep. Steve LaTourette (OH – 14th) would also require some sort of college training for pharmacy technicians, and I support that idea even more.

Please comment. Are you comfortable with 19 year-old girls with minimal training mixing and arranging your medications? If not, do you see Emily’s Act as a good solution? What should be done?

Nick

(hat tip to Buckeye Surgeon for bringing the Cleveland pharmacy technician fail story to my attention)

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Don’t get me wrong, this story is not black and white; there’s plenty of value in much of what “Happy” writes, I’ve gained a lot from his posts explaining the medical payment system and have learned about how government is skewing the incentives toward procedures and the many other failures of government health policy. So, I’ve found it informative,

"THAT'S 15 UNCOMPENSATED MINUTES!"

I may have been too strident in my initial response; I’m sorry for that. And you know what they say about fighting on the internet…. But my point was, you can’t expect me to buy into the “poor uncompensated doctor” shtick, nor can you expect the American people to support loan forgiveness or payment reform, right after showing “Drive Your Lexus To Work Day.” For most laymen, a lot full of Lexuses = doctors at that hospital are doing JUST FINE with the current system, and don’t need us increasing the fee schedule or other government help. Pleading poverty after that is going to go over like a lead balloon. If docs are really united in trying to convince the public to support their agenda, ostentatious six-Lexus-in-a-row displays should probably be avoided.

Not that some doctors shouldn’t complain; primary care physicians are grossly underpaid by our notoriously bad reimbursement system, to the extent it’s reached crisis levels. But primary care docs are mostly objecting to how they only have 10 minutes with patients, how the system harms patient care, how it hurts doctors and their patients; I don’t see many family doctors bitching about being “uncompensated” as they’re sauntering to their BMW and filing their nails. But “Happy”’s no family practice doctor, and plenty of his posts give off that vibe.

Reading “Happy” complain is more akin to seeing the insurance companies claim poverty. I was accused of jealousy and hating the rich, but that was not my point. My point was that when (relative to most people) you’re swimming in a vault of gold, don’t whine about how unfortunate and enslaved you are! It’s too much, and sticks in my craw. And though there’s a lot I respect about the man (including how he’s built such a popular blog through sheer persistence to post 2-3 times a day) I couldn’t help but speak up on this one.

Nick

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I couldn’t think of a better candidate for Surgeon General than Dr. Benjamin, and I was surprised and pleased that someone from my old hometown that I am familiar with hit the big-time!

President Obama announces Regina Benjamin as his nominee for Surgeon General

Dr. Benjamin works in a clinic in Bayou La Batre just south of Mobile, Alabama (where I’m from). As far as I know, she’s the first Surgeon General to come directly from the trenches caring for the poor, not a hot-shot surgeon who never sees the outside of a hospital, a public health administrator, or a leading health care CEO well-known among country club political donors. ALL Surgeons General should be from the hands-on world, with experience with the hard realities of getting appropriate health care for America’s poor majority.

No one knows these tough realities better than Regina Benjamin, who is one of the only doctors in the small shrimping town of Bayou la Batre along the Gulf of Mexico, where old French Catholic and old Anglo Catholic families have fished and shrimped for centuries, and South Vietnamese (Catholic) shrimpers fled as war refugees after the Vietnam war ended. Bayou la Batre attracted many Vietnamese families because it’s one of the only rural shoreside shrimping villages in America similar to theirs back home, where they can live in a similar environment and work with fishing nets in the ways their families have for millennia, no need to re-train for a new job. The Vietnamese shrimpers and fishermen have increasingly edged the old shrimping families out of the business with their willingness to live on their boats all season, and a seemingly infinite capacity for thrift, bartering fish for gasoline to run their boats and other clever ways of lowering costs. I once knew an ex-army medic and LPN who’s a direct descendant of Joesph Bosarge, the French-born guy who founded Bayou la Batre with a land grant from Spain in 1786, and he told me a lot about the area. I’ve visited Bayou la Batre a few times. I’ve also talked to several Vietnamese kids about it (some of them I went to high school with; despite being poor they were always #1 in the year-end academic rankings, way ahead of me, though I was high up there). My point is, I know exactly where Regina Benjamin is coming from, and it ain’t the same board rooms and government offices where they found most of the previous Surgeons General. She runs a free clinic, and treats poor whites, poor blacks and poor Asians (often by having one of the English-speaking schoolkids translateinterpret her medical instructions into Vietnamese). Like an early 20th century country doctor, Dr. Benjamin does house calls, and accepts whatever patients can pay, even if they can’t, or even if all they can do is barter her part of their catch. This is a doctor who has risen to the top not through the usual cutthroat tactics, not through being the best at what everyone else is doing, but by charting a different path, advocating for and caring for the most needy, showing us what the focus of the medical world should be, public service.

I first became familiar with Regina Benjamin when I was fighting my famous two-year campaign to get Alabama Medicaid to stop stripping home care coverage for people like me just because we turn 21 (full story here). Local WPMI TV news interviewed her about my fight (as she then was director-designate of the Alabama State Medical Association) and she made supportive comments and said of course Alabama Medicaid should cover those who really need it, and that they’re obviously overlooking some gaps.

Regina Benjamin advocating for Nick's Crusade, August 2001

I don’t know of any other doctor who would stick her neck out for justice for kids she’s never met. Dr. Benjamin is a special person, exactly the kind of person who should be put in a powerful position to affect change. This nomination is one thing President Obama is doing RIGHT.

Bayou la Batre is one of the few remaining Catholic fishing communities that still does the annual Blessing of the Fleet in hopes of a bountiful catch that year. Dr. Benjamin is Catholic also, and likely has strong moral convictions that have led her to devote her career to the poor. Her clinic, along with all of Bayou la Batre and much of Mobile (including our backyard), was wrecked by Hurricane Katrina. She rebuilt the clinic, only for it to burn to the ground the night before its grand reopening. Then she rebuilt again. Like a heroine in a Biblical fable or something, each crushing tragedy made her stronger, gained her more support and attention, only pushed her higher. She was awarded the papal cross Pro Ecclesia et Pontifice by Pope Benedict XVI for exceptional service to the people of her diocese.

Incredibly, now Dr. Benjamin has the far-right fringe calling her “baby killer” because she’s never taken a hard-line against abortion (which is understandable from a doctor in an impoverished community that sees too many rapes and pregnancies endangering the mother). Even dumber, people are attacking her for her weight! These critics have probably never been to the Deep South; she is svelte by Alabama standards! And they’re also clueless about the expectations black men have for the women in their community re: size (maybe I should do a post about the differences in cultural expectations).

Anyhow, the haters need to get a grip. This nomination is going to sail through faster than a shrimp boat in a hurricane!

Regina Benjamin is probably Obama’s best nomination yet.

Nick

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Recently, the FDA advisory committee met to issue some recommendations

Picture of Acetaminophen with Codeine generic meds

Question 7: Do you recommend eliminating the prescription acetaminophen combination products?
Vote: 20 yes (10 saying this was a high priority); 17 no

(Source)

This has been interpreted and widely reported as “FDA advisers vote to take Vicodin, Percocet off market.” Thanks for the misleading reporting CNN! You’ve freaked out patients and raised serious concerns among doctors. Yes, Percocet and Vicodin (the most commonly prescribed drug in the United States) are narcotic-acetaminophen combinations, but that doesn’t mean they’ll be gone; they could re-introduce them without the useless acetaminophen, perhaps renamed. There will always be effective narcotics available for chronic pain patients.

This recommendation won’t take Hydrocodone, Codeine and Oxycodone “off the shelves,” it’ll just remove the acetaminophen from them. For severe pain, the acetaminophen is like trying to defeat Godzilla with a biplane, pretty pointless to begin with! Why has the FDA required that drugmakers compound any opioid medications with other drugs anyhow? Chris at stationstops.com explains it thusly:

Up until now, the FDA has prohibited Hydrocodone (the opiate in Vicodin), from being sold in the United States *unless* it is combined with another drug as a compound – far and away, Acetaminophen being the most popular (and most dangerous).

The question is why did the government insist that, unlike the more powerful opiate Oxycodone (which is available standalone, as Oxycontin), Hydrocodone not be prescribed by itself?

From my amateur research around the net, the answer seems to be some unusually sinister legislation originating from The War On Drugs.

In some patients, Hydrocodone can be habit-forming, and its a popular drug of abuse. The FDA wanted to make sure there was something else in the drug that people *wouldn’t* want to take too much of to discourage abuse.

Introducing Acetaminophen.

Its been known since 1970’s that too much Acetaminophen causes the unwanted side effects such as stomach upset and liver damage. So the FDA figured if that was in there too, people wouldn’t want to take too much of it.

Basically, for all intents and purposes, the FDA made an important and popular drug more harmful to discourage abuse.

Besides the fact that this was completely unethical and has probably resulted in the unnecessary liver damage and deaths of countless Americans (the vast majority legitimately ill patients to begin with), there is yet one more irony to this approach:

Many Vicodin users and addicts likely have no idea whatsoever that the government put Acetaminophen in there in the first place, nor what the reason and consequences of the Acetaminophen component are.

In other words, instead of being dissuaded from abusing the drug as intended, most Vicodin users were likely just thoughtlessly destroying their liver.

Source: stationstops.com: Why the FDA Deliberately Poisoned Vicodin With Acetaminophen

The government needs to rethink this absurd and harmful policy. The large amounts of acetaminophen consumed incidentally by chronic pain patients like me who take a lot of “compound” medication has (at best) marginal clinical value, and carries unreasonable risks. I’ve never benefited from mass quantities of acetaminophen. It’s easy enough to strip the acetaminophen from these meds, leaving only the opioids, and doing so won’t harm anyone. In my opinion, that’s seriously overdue. The FDA should act, though the narrow vote on this particular recommendation leaves that uncertain.

Nick

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I did some research on how this burden can be alleviated. Here’s what I learned: no generic Lexapros are available because Forest Laboratories, Inc. got a judge to extend their patent (I wonder how they’d defend that). No generic versions will be able to compete on the market until March 14, 2012.

Further, I learned the entire Lexapro franchise is A HUGE

A Picture of Lexapro tablets

BY MARY CLARE JALONICK, Associated Press Writer
– Sun Jun 14, 7:39 pm ET

CROW AGENCY, Mont. – Ta’Shon Rain Little Light, a happy little girl who loved to dance and dress up in traditional American Indian clothes, had stopped eating and walking. She complained constantly to her mother that her stomach hurt.

When Stephanie Little Light took her daughter to the Indian Health Service clinic in this wind-swept and remote corner of Montana, they told her the 5-year-old was depressed.

This little girl from the Crow Nation, Ta'Shon Little Light, died after the IHS told her family that abdominal pain was "all in her head."

Ta’Shon’s pain rapidly worsened and she visited the clinic about 10 more times over several months before her lung collapsed and she was airlifted to a children’s hospital in Denver. There she was diagnosed with terminal cancer, confirming the suspicions of family members.

A few weeks later, a charity sent the whole family to Disney World so Ta’Shon could see Cinderella’s Castle, her biggest dream. She never got to see the castle, though. She died in her hotel bed soon after the family arrived in Florida.

“Maybe it would have been treatable,” says her great-aunt, Ada White, as she stoically recounts the last few months of Ta’Shon’s short life. Stephanie Little Light cries as she recalls how she once forced her daughter to walk when she was in pain because the doctors told her it was all in the little girl’s head.

Ta’Shon’s story is not unique in the Indian Health Service system, which serves almost 2 million American Indians in 35 states.

On some reservations, the oft-quoted refrain is “don’t get sick after June,” when the federal dollars run out. It’s a sick joke, and a sad one, because it’s sometimes true, especially on the poorest reservations where residents cannot afford health insurance. Officials say they have about half of what they need to operate, and patients know they must be dying or about to lose a limb to get serious care.

Wealthier tribes can supplement the federal health service budget with their own money. But poorer tribes, often those on the most remote reservations, far away from city hospitals, are stuck with grossly substandard care. The agency itself describes a “rationed health care system.”

The sad fact is an old fact, too.

The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. But that promise has not been kept. About one-third more is spent per capita on health care for felons in federal prison, according to 2005 data from the health service.

This photo from the Little Light family shows Thea Little Light, 13, left, and Tia Little Light, 10, with their 5 year-old sister Ta'Shon Little Light, on the Crow Indian Reservation

In Washington, a few lawmakers have tried to bring attention to the broken system as Congress attempts to improve health care for millions of other Americans. But tightening budgets and the relatively small size of the American Indian population have worked against them.

“It is heartbreaking to imagine that our leaders in Washington do not care, so I must believe that they do not know,” Joe Garcia, president of the National Congress of American Indians, said in his annual state of Indian nations’ address in February.

___

When it comes to health and disease in Indian country, the statistics are staggering.

American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease.

American Indians have disproportionately high death rates from unintentional injuries and suicide, and a high prevalence of risk factors for obesity, substance abuse, sudden infant death syndrome, teenage pregnancy, liver disease and hepatitis.

May 19, 2008, Obama becomes the first presidential candidate in American history to visit the Crow Nation.

While campaigning on Indian reservations, presidential candidate Barack Obama cited this statistic: After Haiti, men on the impoverished Pine Ridge and Rosebud Reservations in South Dakota have the lowest life expectancy in the Western Hemisphere.

Those on reservations qualify for Medicare and Medicaid coverage. But a report by the Government Accountability Office last year found that many American Indians have not applied for those programs because of lack of access to the sign-up process; they often live far away or lack computers. The report said that some do not sign up because they believe the government already has a duty to provide them with health care.

The office of minority health at the U.S. Department of Health and Human Services, which oversees the Indian Health Service, notes on its Web site that American Indians “frequently contend with issues that prevent them from receiving quality medical care. These issues include cultural barriers, geographic isolation, inadequate sewage disposal and low income.”

Indeed, Indian health clinics often are ill-equipped to deal with such high rates of disease, and poor clinics do not have enough money to focus on preventive care. The main problem is a lack of federal money. American Indian programs are not a priority for Congress, which provided the health service with $3.6 billion this budget year.

Officials at the health service say they can’t legally comment on specific cases such as Ta’Shon’s. But they say they are doing the best they can with the money they have — about 54 cents on the dollar they need.

Full story: AP: PROMISES, PROMISES: Indian health care needs unmet (worth the read)

It’s their land we all live on, all of it; there should really be acknowledgment of that and the appropriate payments made. The least we can do is PAY THE RENT so tragedies like this don’t have to happen.

Just as Australian band Midnight Oil sang about the Aborigines they got all their land from:

The time has come, to say fair’s fair
to pay the rent, now, to pay our share

Beds Are Burning – Midnight Oil

Nick

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First, Eric:

While I agree with the content of this article, I disagree with the intent. Wearing a mask may not be very helpful in keeping you from catching a disease, but it is quite effective at helping others from catching whatever disease that you may have.

Unfortunately, Americans are too selfish to bother with masks if all it does it helps others from getting sick, so the best way to get them to wear masks is to let them believe the lie that it helps them from getting sick as well.

Of course, some may argue that the propounding such a lie is worse than the help it causes in keeping diseases from spreading as easily. But as a utilitarian, I have to say that I’d prefer the lie to exist if it meant people would wear masks when they’re sick.

Originally posted as a comment by Eric_Herboso on Nick’s Crusade using Disqus.

Eric, I disagree, first off, with the claim that surgical masks prevent the wearer from spreading the flu. As noted here, flu can pass through the masks easily, and, for blocking germ-carrying mucous particles, is no more effective than covering your mouth when you cough.

Everyone should remember that surgical masks are designed to prevent patients’ bodily fluids (blood, mucous, etc.) from splashing onto the nose and mouth of doctors and nurses in hospital situations. Wearing a mask is worth it, to avert even a minuscule chance of contact with HIV-infected blood. But surgical masks aren’t really designed to block airborne viruses, in either direction.

Secondly, you’re crossing over into Strauss’ “the noble lie,” theory, and that’s creepy, especially given its recent implementation (see WMD, Iraq). Isn’t there a human right to the truth? I’m not a utilitarian because it too often leads to crushing the rights of the individual to produce “the greatest good for the greatest number of people.” This leads to absurdities, like a utilitarian I met at Spring Hill, who told me he wouldn’t eat fish because of the suffering it may cause, but, when I pressed him on the Iraq war, wouldn’t condemn it, because “it may well lead to better lives for more people in the long-term.” Once someone puts fish above the deaths of millions and Iraqis’ immeasurable suffering, they lose me. I’m digressing here; the debate over utilitarianism belongs in its own posts. I’d love debating utilitarianism and Peter Singer with you in a series of posts, if you’re amenable (I wanted to do this back at SHC).

Regarding Len’s comment:

While I agree on the silliness of the masks, I would not take the threat so lightly. The general population is likely to have greater immunity to the run of the mill flu that goes around each season. This is more foreign to the average immune system. For that reason, it could be very dangerous if it really took hold.

Originally posted as a comment by Len on Nick’s Crusade using Disqus.

Yes, swine flu (the H1N1 virus) is foreign to the human immune system, but so is the totally new strain of “normal” influenza that requires a new vaccine each year. That flu kills 36,000 Americans a year, and swine flu has killed 1 so far. The toll has been so small because, as the National Foundation for Infectious Diseases is saying, swine flu is no worse than seasonal flu. Even in Mexico City, the epidemic has waned enough that officials have now lowered their alert level. We’re even starting to see some precious few in the media doubt the hysteria, like in this article, TIME: Was the Alarm over Swine Flu Justified?

New York City’s Department of Health is reporting that swine flu is “not causing unexpectedly severe illness” among the 73 confirmed cases in the city (of those 73, 69 of them are from St. Francis Prep School in Queens, where two students recently returned from vacationing in Mexico). This particular flu virus appears to spread as easily as seasonal flu, but is no more deadly.

Yes, it COULD get worse, mutate into something as lethal as avian flu (H5N1), which killed half of those it it infected.

This chart from Wikipedia shows a side-by-side graphical comparison of the H1N1 and H5N1 influenza viruses. H5N1 (avian flu) spreads very slowly (it has difficulty passing from bird to human) but is very deadly, attacking the lungs. H1N1 (swine flu) spreads quickly, like seasonal flu, but mostly only effects the upper airways (nose, throat, etc.) and is rarely fatal.

Yes, IF it mutates into something worse, that would be bad. But that’s a BIG “IF” and hasn’t happened yet. And if it does mutate (the CDC predicts it to surge again in the fall) there’s not a lot we can do to protect ourselves aside from the vigilant hand-washing.

See Cartoons by Cartoon by Steve Greenberg – Courtesy of Politicalcartoons.com – Email this Cartoon

But what we CAN do, is reject the hysteria that’s still as virulent as ever. Outside my friend’s synagogue, some dude is selling surgical masks for $4 each. The masks have become so prevalent in airports that Jamie Lee Curtis had the idea to sell ad space on them (lol). And the media. OMG the media…

The old media, in their death throes, flailing for anything to sell papers and keep themselves afloat, are milking pig flu as much as they can, generating panic.

This Newsweek cover exemplifies the print media exploiting this story:

Yes, this is the real cover of Newsweek. It's all black, the color of fear and death, and bold white letters title the cover "FEAR & THE FLU" and under it, it says "THE NEW AGE OF PANDEMICS." In the lower left corner of the cover, a pig's snout looms beyond cage bars.

This Newsweek cover, and the story inside it that says mutant flu strains could kill us all in the future, doesn’t leave you with the truth, that there are only 245 confirmed cases of swine flu in the US, and your chances of catching it are comparable to being struck twice by lighting and run over by a freight train while skate-boarding on a national holiday. It doesn’t tell you that the 1976 swine flu panic (and accompanying government scare ads) turned out to be much about nothing. It just tells you how vulnerable you are, that more viruses will mutate and kill, with the subtext being, “buy this magazine and understand the coming menace.”

Please get the whole story and innoculate yourself against all this media fearmongering. That will actually make the world a better place.

Nick

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A Mexican soldier hands out masks inside the subway at the Pino Suarez station in Mexico City, on April 26. AFP / Getty Images / Alfredo Estrella

Masked mariachi!! in a square at the Coyoacan neighborhood in Mexico City, Sunday, April 26. AP / Enric Marti

Nuns wear face masks during a closed door mass at the Metropolitan Cathedral in Mexico City, Sunday, April 26. AP / Dario Lopez-Mills

A couple wearing masks kisses in Mexico City on April 25. AFP / Getty Images / Alfredo Estrella

People awaiting care at a Mexico City hospital Wednesday. AP / Eduardo Verdugo

The problem is, SURGICAL MASKS DON’T PREVENT TRANSMISSION OF SWINE FLU! All this ubiquitous masking is pointless; the flu virus is small enough to pass through the pores of a surgical mask with ease.

In 2003, Jon Cohen wrote that the SARS virus, which is just 100 nanometers in size, can easily pass through such barriers. And there’s every reason to believe that swine flu, at 80 to 120 nanometers, can, too.

Slate: Do Surgical Masks Stop Swine Flu?

People feel the urge to mask-up most strongly outdoors, when airborne material is dispersed and least likely to hit you. You’re more likely to be exposed to viruses in a small enclosed space. And even a N-95 respirator can’t provide protection against viruses, which are usually .1 or .2 microns in diameter. To achieve total protection against swine flu, you’d need a full-faced mask with a high-efficiency particle air (HEPA) filter respirator system. Like this:

Dustin Hoffman in the 1995 movie "Outbreak"

But masks like that are hot as hell, breathing through a HEPA filter is mad uncomfortable, and this kind of getup is expensive and rarely available outside of emergency response agencies. And would we really need to go these lengths for a virus with symptoms no worse than regular flu? Remember that regular flu kills 36,000 and hospitalizes 200,000 in America each year, and Swine Flu has killed 1 in America.

Drop the mask. You’re doing it wrong.

Nick

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