New additions to the medical blogroll

I have added 2 blogs to my medical blogroll (in the left column).

Living with diabetes is a patient’s ongoing journey to live with her diabetes. She writes well, and does her research. She is a frequent and intelligent commenter on this site.

Medical Weblogs should become a daily visit for all readers.

Medlogs is now much more than a list of medical weblogs — it’s a weblog aggregator. On the right, you can see the familiar list of medical weblogs. Below this post is an excerpt from the last five weblog posts from all of the medical weblogs that I can find. If you know of one that I’m not listing .. please post a comment below and I’ll add it (the weblog must support RSS for this to work)

I am sure that I am leaving out other important sites – drop me a note and I should correct it.

More on the epidemiology of SARS

The news becomes more frightening and more puzzling. How easily does SARS spread? Could the syndrome depend on a dual infection – two viruses? Casual SARS transmission?

IN RECENT weeks the disease has spread beyond Hong Kong hospitals, where dozens of health care workers became infected, to schools, with at least four schools closed for several days.

Hong Kong officials also said Tuesday that nine tourists apparently came down with the deadly disease after a mainland Chinese man infected them on a March 15 Air China flight to Beijing.

If severe acute respiratory syndrome, or SARS, can be more easily spread through the air – rather than through close contact with infected people – it could force travel and other restrictions to contain the disease.

“We would want to be sure that it was people sitting next to that person and not the ventilation system in the airplane which was spreading the disease,” said Dr. David Heymann, head of communicable diseases at WHO.

So the epidemiologists continue to work on the mode of communication. We cannot control an epidemic unless we understand transmission.

Meanwhile on the virology front things become even more confusing.

MORE THAN ONE MICROBE?

“We are a bit puzzled because we are not only dealing apparently with one pathogen but with two. The reason why we believe that both pathogens should be given equal attention is that there is consistent finding of both pathogens in individual patients or of either of the pathogens in other patients,” he said.

“What we are seeing actually are three hypotheses.”

SARS might be caused by one of those two viruses or “these two pathogens have to come together to cause this very severe outbreak.”

The latter theory is that the coronavirus – which Stohr said lives in immune cells that fight off disease – destroys or weakens the immunity in the patient so the second virus “has practically an open door to go in and to sicken the patient beyond what this virus would be able to do normally.

“But more research is being done to verify that.”

I find this very interesting speculation and also very concerning. If we need to address two viral infections simulataneously, then we have a much more complex situation.

Will we have a major epidemic? This is the big question. I remain very concerned. Until we really understand both the transmission and the etiology, we can only guess at treatment and containment strategies.

On China and SARS – ABSURD!!!!

This is ridiculous. We need protesters in the streets. We need a UN resolution. But will anyone notice? Please spread this outrageous story throughout the blogosphere. China Bars W.H.O. Experts From Origin Site of Illness

We are trying to understand and contain a severe respiratory infection from which around 4% of the patients die. This is an astonishing death rate. Investigators are making great progress, but China will not cooperate.

Chinese officials have reported 305 cases in Guangdong from November to Feb. 1, 5 of them fatal. They say the disease died out on its own.

But because outside experts have been stalled in their efforts to go to Guangdong, there has been no independent verification of the number of SARS cases in China, whether cases have occurred elsewhere in the country and whether transmission has stopped. Epidemiologists investigating SARS elsewhere say they suspect the number of cases in China may be much higher than 305.

The team also wants to interview patients who became ill, doctors and other health workers who cared for them and laboratory scientists to find out what they found in specimens from patients with the ailment. The cause of SARS is still unknown, though scientists suspect either or both of two viruses.

The experts also want to be certain that the illness in Guangdong is in fact SARS, which the world organization says has caused at least 487 cases in 13 countries since Feb. 1, including 17 deaths. The symptoms include high fever, cough, shortness of breath and difficulty breathing.

Chinese health officials have said, most recently when a delegation of them visited Hong Kong on Saturday, that they are working on the disease and want to be cooperative with the international community. But they have declined to provide any details other than to say that they believe the problem is under control.

Dr. David L. Heymann, executive director in charge of communicable diseases for the world organization expressed hope yesterday that the team would be invited to visit Guangdong. “Certainly our wish would be that the government will permit us to work with them in all aspects of this outbreak,” he said at a news conference.

Ridiculous! I am speechless.

Medicare spending up – patients will pay more – doctors receive less

Medicare Recipients Face 12.4% Rise in Premiums

Medicare beneficiaries face a large increase in premiums next year, and doctors’ fees will probably be cut because Medicare spending surged unexpectedly last year, federal officials said today.

Richard S. Foster, chief actuary of the Medicare program, estimated that the Medicare premium would rise to $66 a month, an increase of $7.30, or 12.4 percent, the largest increase in 11 years.
Medicare officials said they now estimated that the fees paid to doctors for treating Medicare patients would be cut 4.2 percent next year.

Premiums charged to the elderly and the amounts paid to doctors are computed according to complex formulas set by law.

Once again both patients and doctors are scheduled to financially suffer – because we are providing more (and better) care for patients. We have a significantly flawed formula for calculating premiums and physician reimbursement.

Dr. Yank D. Coble Jr., president of the American Medical Association, said the impending cut showed that Medicare’s formula for paying doctors was severely flawed.

“Under the formula,” Dr. Coble said, “physicians are penalized if services to Medicare patients grow more rapidly than the gross domestic product. At times of slow economic growth, it is likely that Medicare spending on physician services will exceed the target and trigger cuts in physician payments. But the health care needs of America’s seniors don’t change with the ups and downs of the economy.”

This finally starts to become clear. The Congress developed a formula based on the economy rather on the costs of the services. They pass laws requiring more administrative overhead, yet they link payment to the economy. But overhead is not linked. I think they will quickly hear that a crisis is imminent.

Medicare spent $45 billion on doctors’ services last year, an increase of $3 billion, or 7 percent, from 2001, even though the average fee for each service was reduced.

Thomas A. Scully, administrator of the Medicare program, said the fee cut was offset by “a stunning 8 percent increase in the volume” of doctors’ services to Medicare patients last year.

Medicare pays doctors under a fee schedule that sets payment rates for more than 7,000 procedures.

Thomas L. Grissom, director of the federal Center for Medicare Management, said, “The estimated reduction in physician fee schedule rates for 2004 is due, in large part, to substantial growth in 2002 in the volume and intensity of physicians’ services.”
In other words, doctors are performing more procedures and tests.

And every quality measure that Medicare uses is improving. Perhaps this care has good indications. Perhaps some testing occurs in response to the malpractice crisis. Should we not ask why rather than have a formula that just reacts to numbers? As I say repeatedly, improvements in technology and pharmacotherapeutics may lead to an increased percentage of GNP going to medical care. Why should we try to fix that percentage? We should strive to provide the best possible care. Or should we just try to control costs?

So where is the money going? Medicare has broken the data down into categories.

Mr. Foster, the chief actuary, itemized some of the increases in Medicare spending last year:

�Inpatient hospital care, up 10 percent, to $104.9 billion.

�Outpatient hospital services, up 10 percent, to $15.4 billion.

�Skilled nursing homes, up 9 percent, to $14.6 billion.

�Home health care, up 14 percent, to $10.5 billion.

�Durable medical equipment, including wheelchairs, up 20 percent, to $6.5 billion.

�Hospice, up 24 percent, to $4.6 billion.

All good reasons for doctors’ fees to decrease. (I only hope that my sarcasm bleeds through!)