Medical News Week

President Bush’s boyhood home was severely damaged by a fire.I nvestigators in Odessa now believe an arsonist is to blame.

[source]

Burning Bush Home

Source: Burning Bush Home [Greg Laden’s Blog]

Astrology. Classic woo. Not much to say about it other than the fact that for some very strange reason a lot of people still believe in it, at least a little. Maybe it’s because almost every newspaper in the country still has an astrology column. I don’t know. For the sake of my students, several years ago I wrote a little analysis on astrology and why it’s utter bullshit. You can find it here. To be blunt, no one should put any stock in astrology.

Today I stumbled across an explanation of why astrology is to be ignored, but from a completely different perspective, namely that of the fundamentalist Christian nut-job. This delicious bit of woo reaches essentially the same conclusion (ignore astrology) but does so in a most bizarre fashion. The basic argument is that the purpose of astrology is to gain knowledge of the future. According to the author, god and the bible declare that information to be off limits for humans. Consequently, “good Christians” should not make use of astrology. The argument has nothing to do with the efficacy of astrology or its supposed mechanism. In other words, even if it works, you shouldn’t do it because it will upset god’s plan. Interesting logic, eh?

See? Who says science and religion can’t agree on some things?

Source: The Wrong Way to the Correct Conclusion [Dr. Joan Bushwell’s Chimpanzee Refuge]

Two papers in 2007 weighed in on this debate. First was this study from the Archives of Internal Medicine showing a statistically significant reduction in length of stay (5.01 vs 5.87 days) associated with an academic hospitalist model in comparison with non-hospitalist care at Albert Einstein College of Medicine.

Just out is this paper from NEJM comparing hospitalitalist care with that of non-hospitalist internists and family practitioners. Hospitalist care was associated with a shorter length of stay than traditional care by internists and FPs (0.4 days for both comparisons), a reduction in cost per case of $268 compared with traditional internal medicine care and no significant difference with family practice care. (Maybe that means family practitioners order fewer or less expensive tests than internists).

How can we interpret these results in light of what was already known? There have been too many papers for me to link here, so I’ll offer an oversimplified timeline. Early in the movement, small studies suggested that the hospitalist care model was associated with reduced charges and length of stay. A study presented at the 2005 meeting of the Society of Hospital Medicine, however, burst the bubble. That largest to date study showed no superiority of hospitalist care in terms of outcomes or efficiency. To my knowledge that was the largest study conducted until the NEJM study linked above. Bob Wachter, commenting on the Archives paper, said there were more than 20 studies with results favoring the hospitalist model. (I didn’t know there were that many!).

From the varied blog reactions to the NEJM paper it seems there are a gazillion ways to interpret the evidence. Dr. Wes is skeptical of the results, seems to question the meaning of $268 per case and laments the discontinuity of care that is built into the hospitalist model. The Happy Hospitalist has a happier spin, doing a little math to suggest how $268 per case translates into real money over multiple admissions and comments on some intangible benefits of hospitalist care. Retired Doc offers a nice summary of the blog reactions here and concludes with perhaps the only statement we can all agree on: the hospitalist movement is here to stay. Bob Wachter weighed in here (did I miss anybody?).

Wachter has some interesting observations on how the fallout from this study may affect the hospitalist looking for a job or jockeying for better compensation. As I see it, it could play out in any number of ways. Wachter suggests that this study, which shows a smaller resource saving than some older studies, could prompt hospital administrators to tighten their budgets for hospitalist compensation:

Since most hospitalist groups get (and require) hospital support, and much of that support has been predicated on a Return-on-Investment drawn from earlier findings of 15 percent LOS and cost reductions, expect some skirmishes at budget time, with hospitals trying to tighten the screws on their hospitalist groups (“why should we raise your support – you only save us $200 per patient!”).

But I could see it play out another way. Given that the economic value of the hospitalist model was in dispute at least in the minds of some, administrators who look at this paper as having settled the issue once and for all may now say “Hospitalist care is supposed to save money. Why aren’t you doing better than your non-hospitalist peers?”

No matter how you slice it, you’re better off if you can convince folks that there are non-economic and intangible benefits of hospitalist care. As Wachter said,

The hospitalist group that has not convinced its CFO that the true ROI doesn’t hinge on pure cost reduction – but rather on systems improvement, QI, patient safety, and more – may be in for a bumpy ride.

Source: Top ten issues in hospital medicine for 2007, issue 3: does the hospitalist model of care improve efficiency and outcomes?

Waltham, Mass. ? Sept. 16, 2003 ? Massachusetts physicians and their families will fan out across the state on Saturday, October 25, as they volunteer to help those affected by domestic violence.
   

The Massachusetts Medical Society Alliance and the Massachusetts Medical Society & Alliance Charitable Foundation are sponsoring the first annual ?Physicians and Their Families Make a Difference Day,? conducted as part of the national ?Make a Difference Day? coordinated by USA Weekend Magazine and the Points of Light Foundation.
   

The statewide effort will focus on securing comfort items for families in local shelters for domestic violence.
   

Vanessa P. Kenealy, president of the Massachusetts Medical Society Alliance, said that a great need persists for items that most of us take for granted.
   

?Survivors of domestic violence often flee their homes on a moment?s notice,? said Kenealy. ?They leave a lot behind, and our effort is to try to make their time at the shelter more comfortable.?
   

An attorney and Hopkinton resident, Kenealy is enlisting volunteers to distribute and pick up donation bags in communities and neighborhoods across the state. The volunteers will distribute the bags during the first week in October, and then return on or about October 25 to pick up the filled bags, which will then be delivered to shelters across the state
   

The physicians and their families seek personal care and comfort items such as combs, shampoo, toothpaste and toothbrushes, baby food and formula, disposable diapers, socks and undergarments for adults and children, children?s books and magazines, feminine products, and small luxuries such as nail polish and lip gloss.
   

Kenealy, noting that most guests at shelters are women and children, encourages everyone to make a donation to the cause, saying ?every gift, large or small, does indeed make a difference to those forced to stay in a shelter.?
   

For more information on ?Physicians and Their Families Make a Difference Day,? contact Jennifer Day, program manager, at 781-434-7044 or jday@mms.org.
   

For information on the Medical Society?s Campaign Against Domestic Violence, with listings for hotlines and services available, visit www.massmed.org/pages/dv_campaign.asp
   

The Massachusetts Medical Society Alliance is the organization of physicians? spouses committed to advancing the health and well being of the medical family. In conjunction with the Massachusetts Medical Society, the Alliance advocates and promotes good health among the citizens of the Commonwealth of Massachusetts
   

The Massachusetts Medical Society and Alliance Charitable Foundation is a supporting organization of the Massachusetts Medical Society and the MMS Alliance. Since its inception, the Foundation has made more than $330,000 in allotments, supporting such services as medical care for the uninsured and underserved, childhood injury prevention, and rape crisis and services for battered women.
   

The Massachusetts Medical Society, with more than 18,000 physicians and student members is dedicated to educating and advocating for the physicians and patients of Massachusetts. Founded in 1781, the MMS is the oldest continuously operating medical society in the country. The Society owns and publishes The New England Journal of Medicine, the Journal Watch family of professional newsletters, AIDS Clinical Care, and produces HealthNews, a consumer health publication. For more information, visit www.massmed.org.

Source: Massachusetts physicians, families to ?Make a Difference? on October 25

This is one odd video. This French Orangina TV ad has furries wearing kinky lingerie and an octopus giving a lap dance to a bear.

Check it out:

I guess I shouldn’t be surprised after this previous post about a French set of ads on safe sex practices.

-Via BoingBoing-

Source: Weird Furry Orangina Advertisement [Omni Brain]

Another great product from Despair, Inc.

Source: This Shirt Is Awesome [Shifting Baselines]

Greg Laden is reporting that Rwanda is taxing companies that use gorillas in their advertising, in order to pay for their conservation. Unfortunately, or fortunately if you are an albino silverback in Australia, this only applies to Rwandan companies. Or maybe I would happily pay a tax to the Rwandan government for the use of my avatar if asked. It depends on whether I have enough money for beer that month.

Source: A tax on gorilla iconography? Oh noes… [Evolving Thoughts]