Online mortality calculator could change healthcare

The Daily Beast reports: When a team of researchers at University of California, San Francisco, started collecting tools for predicting the likelihood of death, they thought their work would be used primarily by physicians. But the project ended up as an interactive tool that would be of interest to medical professionals, elderly patients—and the morbidly curious alike.

The site, ePrognosis.org, displays 16 different methods for determining a person’s chances of dying in the near future. The team designed the site so that doctors could have something better to go on than average life expectancy and intuition when deciding what treatments to recommend for elderly patients. The hope is that a better understanding of life expectancy will help patients and doctors decide on treatments—for instance, sparing a patient with advanced cancer from an invasive procedure for an ailment that likely will never have the chance to become a problem.

The tools aren’t new. Many were publicly available before, or kept behind medical-journal paywalls. But this is the first time so many have been assembled in one place, ranked according to their accuracy, and made so user friendly. A doctor—or anyone who clicks a button saying she’s a doctor—can plug in the relevant medical information and get a prognosis: 59 percent chance of dying within four years for an elderly diabetic male smoker with a history of congestive heart failure, for example.

The hazards of treating loved ones

It was a busy day for the cardiologist. Between juggling patients, he received a phone call from his mother. She said she had heartburn and complained that none of the usual over-the-counter medications had helped.

So the cardiologist quickly called in a prescription for her for an acid blocker and went back to seeing patients. Later that afternoon, his mother called again -- this time from an emergency department. The doctors there said she had a heart attack.

It's a story that Humayun Chaudhry, DO, president of the Federation of State Medical Boards, told medical students during his teaching days. The cardiologist, a former colleague of Dr. Chaudhry's who was well-respected in the field, couldn't believe he had missed the diagnosis in his own mother.

Interesting story in American Medical News.

Texas readies a new weapon against 'doctor shopping'

In today's Austin American Statesman:

As prescription drug abuse increases, Texas is readying a new weapon to catch patients who "doctor shop" for multiple prescriptions and physicians who prescribe too many painkillers.

The Texas Department of Public Safety has been collecting prescription histories of Texans for years, but by this summer the data are expected to be online so doctors, pharmacists and law enforcement officials can more quickly identify the patients abusing pain medications and the medical establishments profiting from the drug trade.

The Legislature last year made "doctor shopping" a felony in most cases and has tried to curb so-called pill mills that supply popular painkillers. Next year, the Legislature will consider whether to make it mandatory for doctors and pharmacists to check the state database before writing or filling a prescription....

"Prescription drug abuse is an epidemic in our state and the nation," said Sen. Tommy Williams, R-The Woodlands, who has authored several laws addressing the issue.

He said last year were 188 overdose deaths attributed to prescription drugs in Harris County alone. He said the problem with pill mills in Texas spiked after Louisiana cracked down.

"They've run a lot of this business into Texas," Williams said.

Click here to read the full article.

Ear Doctors Performing Face-Lifts?

That's not going as far afield as some might think. As one Texas physician points out,

Most otolaryngology training includes significant facial cosmetic training, including face lifts, rhinoplasty eyes etc, probably at least as much as plastics.The tummy tuck, not so much.

Here's an excerpt from a recent New York Times story:

After moving from New York to Los Angeles in 2010 to take a job with a financial services firm, Joan, now 59, believed she needed to freshen her look. So she got a face-lift and tummy tuck from a board-certified doctor in Beverly Hills.

What she did not realize was that his certification was in otolaryngology — ear, nose and throat — not plastic surgery. The outcome was less than ideal: thick scars on her temples and a wavy abdomen.

“I had to use all my savings to get a real plastic surgeon to fix what he did to me,” said Joan, who asked that her last name be withheld to protect her privacy. “I have an M.B.A. I’m not stupid. But when the doctor has a nice clinic and all those diplomas and certifications on the wall, you think he knows what he’s doing.”

With declining insurance reimbursements, more doctors, regardless of specialty, are expanding their practices to include lucrative cosmetic procedures paid for out of pocket by patients.

You can easily check a doctor's board certification on TMB's website. On the upper left side of the homepage, click on "Look Up a Doctor." Accept the useage terms, enter the physician's name, then click on the name to reach the doctor's full profile. Scroll down to the section titled "Specialty Board Certification."

For the NYT story, click here: http://www.nytimes.com/2012/01/31/health/non-specialists-expand-into-lucrative-cosmetic-surgery-procedures.html

Tick tally reveals Lyme risk locations

For four years, researchers combed through hundreds of state parks and bushy areas looking for the culprit responsible for Lyme disease. The blacklegged tick, also known as a deer tick, transmits the disease through a bite.

About 20 percent of the 5,332 ticks collected in the Eastern half of the country were infected with the bacterium that causes Lyme disease.

Lead author Maria Diuk-Wasser says her suspicion about where her team would find infected ticks — and the subsequent risk for the disease — was confirmed when she mapped the data.

"We suspected strongly that we wouldn't find [infected ticks] in the South," the Yale epidemiologist tells Shots. "The tick is found in the South, but it's not infected and it doesn't feed on humans, but on lizards." Researchers found the highest risk of infection for humans in the Northeast, Mid-Atlantic and Upper Midwest.

Read the story on Minnesota Public Radio's website:
http://minnesota.publicradio.org/features/npr.php?id=146211699

Screen teens for HIV: American Academy of Pediatrics

From Reuters Health:

All sexually active adolescents should be screened for HIV, the American Academy of Pediatrics said Monday (Oct. 31) in a new policy statement that broadens earlier recommendations.

And in areas with higher rates of the infection, all teens over 16 should get the test, the group added in its statement.

More than 1.1 million Americans are infected with HIV, and 55,000 of them are between 13 and 24 years old.

"Forty-eight percent of the youth who are infected don't know they are infected," said Dr. Jaime Martinez of the University of Illinois in Chicago, who helped write the new report, published in the journal Pediatrics.
"It's important to realize that those who don't know they are infected drive the epidemic," he told Reuters Health.

HIV usually proceeds to AIDS in the absence of treatment, but newer drugs can keep that from happening for many years. And knowing you're infected may also help stem transmission of the disease to others -- a benefit that isn't seen with cancer screening, for instance.

Today, many doctors only offer testing to patients they deem at risk, such as prostitutes, drug addicts and homosexual men. But since 2006, the U.S. Centers for Disease Control and Prevention have urged everybody older than 13 to get an HIV test regardless of risk factors in areas with many undiagnosed cases.

The new statement is a bit more conservative, said Martinez, lest pediatricians be uncomfortable testing younger teenagers. He added that in 12th grade, more than 60 percent of adolescents say they are sexually active -- and that often they're having sex while under the influence.

An HIV test costs about $14, according to Martinez, and is accurate more than 99 percent of the time.

Standard of care: People skills

From the New York Times:

Doctors save lives, but they can sometimes be insufferable know-it-alls who bully nurses and do not listen to patients. Medical schools have traditionally done little to screen out such flawed applicants or to train them to behave better, but that is changing.

At Virginia Tech Carilion, the nation’s newest medical school, administrators decided against relying solely on grades, test scores and hourlong interviews to determine who got in. Instead, the school invited candidates to the admissions equivalent of speed-dating: nine brief interviews that forced candidates to show they had the social skills to navigate a health care system in which good communication has become critical.

 Read more about it here.

No. 1 prescriber of Hydrocodone nabbed in pill mill bust: DEA

KHOU reports:
     HOUSTON – A Houston doctor and 18 co-conspirators have been arrested in connection with illegal pain-management clinics in the area, the DEA announced Wednesday.
     According to the DEA, Dr. Gerald Ratinov -- a licensed and registered Texas physician – was the No. 1 prescriber of Hydrocodone in the state.
     Hydrocodone is a prescription painkiller that’s sometimes taken with Alprazolam and Carisoprodol – a combination popularly described as the "Houston Cocktail."
     Investigators said Ratinov acted as the medical director of at least three pain clinics in Harris County without proper certification and while he was under judicial review by the Texas Medical Board.
     The clinics – Hobby Medical Clinic on Reveille Street, Abundant Life and Weight Loss Center on Hillcroft and Astrodome Pain Clinic on Westridge – were used, along with select pharmacies, to fill fraudulent, medically unnecessary prescriptions for clients, the DEA said.
     Thanks to the arrests, the clinics and their four related pharmacies can no longer dispense illegal pharmaceuticals on the streets of Houston.
     Harris County District Attorney Pat Lykos applauded the efforts leading to the arrests.
     "This is an example of the superb cooperation between federal and local authorities to protect our citizens." Lykos said. "The DEA conducted a brilliant investigation and has stopped a dirty doctor and his cohorts from continuing to profit from the wretchedness of addiction. We will do our part to vigorously prosecute Ratinov and his co-defendants."
     The multi-agency investigation was led by the DEA and the Harris County DA’s Office, with participation from the Texas Medical Board, the Texas Pharmacy Board, the Texas DPS, the Fort Bend County and Harris County sheriff’s offices, HISD, HPD, Pasadena police, Harris County Precinct 2, Harris County Precinct 6 and the National Insurance Crime Bureau.
     "Doctors and pharmacies have an obligation to comply and operate within the parameters of the law. Dr. Ratinov chose not to do so, which lead to an investigation by DEA and our law enforcement counterparts, resulting in the arrest of Dr. Ratinov and others who blatantly violated the law," Thomas E. Hinojosa, Acting Special Agent-in-Charge of the Drug Enforcement Administration, said.

TMB to begin selling data through website

Watch our homepage for a new link that will let you purchase TMB data products online! The products are the same as before -- new physicians, complete listing of TMB licensees and disciplinary actions, etc. But now, instead of sending an email and a check to us, you can complete your transaction electronically.

Launch is expected this Friday, March 4 .....

From the Houston Chronicle

15 Texas doctors cited in illegal drug sales

7 physicians from the Houston area disciplined in ongoing crackdown

By CINDY HORSWELL
HOUSTON CHRONICLE

Feb. 26, 2011, 7:14AM

The Texas Medical Board this month disciplined 15 doctors — including seven from the Houston area — for improperly dispensing dangerous drugs, part of an ongoing crackdown of a burgeoning illicit industry of doctors and pharmacists illegally dispensing prescription medicine.

Houston in particular has become a national hub for the illegal sale of prescription drugs, especially a narcotic known by such brand names as Vicodin, anti-anxiety drugs and muscle relaxants.

"These numbers just show how pervasive the pill problem has become. Both the appetite for the drugs and the willingness to prescribe," said medical board spokeswoman Leigh Hopper. "The crackdown on the prescription drug problem is one of our big priorities. We are taking full advantage of our new authority to investigate pain clinics that was granted in the new law that took effect in September."

The new law mandates stricter regulations such as requiring all pain management clinics be doctor-owned.