The Health News Digest has devoted most of its articles today (new stories are posted every Monday) to healthcare. Specifically, the great opportunities in healthcare.

Some of the articles are good, some are spamish, such as one from a recruiter that reads slightly better than an advertisement for her agency. Still, it is interesting because even with hospital closures and layoffs, healthcare will continue to evolve and be a vital industry. Here is a quote from one article:

In January, 2009 a Careerbuilder.com survey reported that 17% of health care companies would be hiring this year. Perhaps the hottest niche within that giant, troubled industry is something often called “consumer driven health care” (CDH), or “consumer directed health care” (CDHC). Workers with skills ranging from technology, to business management, to financial analysis, are jumping on board with these small to even tiny companies, riding a wave of change that will hopefully begin to solve the problems facing health care in the U.S. today.

It is obvious that this article series is focused on the positive, and is pulling out the optimistic news surrounding jobs in healthcare. Nothing is mentioned about nurses being unable to find work in many areas of the country, or that working conditions continue to suck big time in many places, but oh well. I’m sure that more than one nurse is going to be rolling his or her eyes when she sees that same stats on instant replay once again, as is mentioned by one of the columnists:

There are openings across the entire spectrum of the healthcare industry right now. The nursing shortage is well known with a severe shortage of RNs and LVNs. According to the Bureau of Labor Statistics, the number of nursing positions is expected to increase by 587,000 between 2006 and 2016, adding to the more than 2.5 million nursing jobs already in the industry right now.

Perhaps he might like to direct some jobless nurses to those positions? It’s nice to see optimistic news, and certainly, there are a lot of jobs in healthcare, but those stats about the nursing shortage really get old. I’m sure that the biostatisticians are busy sharpening their pencils and crunching numbers, but the fact remains that right now, today, a new grad trying to get a job in NYC, New Jersey, Northern California, and other locations is not having a good time.  There is obviously a disconnect somewhere along the line.

Complementary medicine, also known as alternative medicine, and which I will affectionately refer to as Cammy Care, has become very popular. But even though its use is growing and becoming increasingly “legitimized” as in insurers picking up the tab and medical centers begin to offer integrative services, there are still vehement attacks against it.

I have inadvertently found myself on a few of these blogs, and the narrow mindedness is incredible. I was silly enough to post a few intelligent comments on one or two of them, but it was sort of like posting a comment about Civil Rights on a KKK website.

What is more amazing is that some of these blogs are authored by doctors, and some of the commentators also said that they are doctors. How frightening to be a patient, having such a dinosaur take care of you. No wonder so many patients are afraid to discuss using alternative medicine with their doctors. They don’t necessarily want their doctors to agree with it, but they would like some advice, maybe a referral to a licensed practitioner, or would like to discuss possible drug/herbal interactions. But if you have a Tyrannosaurus Rex yelling in your face, about how dumb Cammy Care is, and how the effect is only placebo, well, that ends the conversation. The patient will continue to use it, but without physician guidance, knowledge or input. And that is not a good thing.

Or maybe they will go and find a different doctor, one who understands that it is the patient’s body and health, and at the very least, even if he doesn’t approve of Cammy Care or thinks its stupid, can at least give the patient information about drug/herb/supplement interactions; find out what the patient is using/doing; refer patient to a licensed practitioner or online resources that are legitimate. Something, anything. You have to keep the dialog open.

At any rate, there is one thing that I’ve noticed in my limited strolls around these websites—none of them discuss the reasons why patients are turning away from conventional medicine. I haven’t seen one post. Granted, I don’t read these on a daily basis, but from what I can see, all they do is rant and rave about how Cammy Care doesn’t work, its all placebo, its not scientific, no studies, its a scam, its dangerous, and on and on.

So what about posting something a little more useful, instead of the proverbial preaching to the choir?

The reality is that most people in the US seek out alternatives because of dissatisfaction, on many levels, with regular healthcare.  Despite the very chi chi names of some of these blogs, which make it sound like conventional medicine is oh-so-science-based and based on powerful evidence, and so effective, there is obviously a gap between the theory and reality.

I will write more about the drug approval process in another post, but for now, I just want to get to the point of this post.

People are dissatisfied with conventional healthcare because:

1) it offers nothing for their symptoms/disease–as in no wonder drugs to cure them or even provide symptom relief

2) The drugs prescribed are only minimally effective and the physician has nothing else to offer them except to “learn to live with it.”

3) Drugs may work but side effects are too toxic.

4) Doctor can’t figure out what’s wrong and finally tells patient that it is all in their head

5) Healthcare is too expensive, can’t afford the drugs or tests or surgery. Patient has no insurance, or underinsured.

6) Physician doesn’t seem interested in them, and is too rushed (unfortunately, in our era of managed care and crunching the clock, this is a growing problem and often distresses the physician as much as the patient. The physician may want to spend more time with the patient, but can’t due to time constraints. It’s a whole different world from Dr. Welby)

7) Treatment just masks symptoms and doesn’t get to root of problem. As time goes on, more prescriptions may be needed, disease progresses.

While all conventional physicians are not dweebs, and all alternative practitioners are not Gandhi incarnates, those practicing Cammy Care are often perceived as being more caring and attentive. And many do have more time to spend with the patient, since their offices generally operate on a different type of system.

So my point is that instead of ranting and raving and ridiculing Cammy Care, the naysayers on their fancy blogs might instead honestly explore the problems confronting healthcare and what is driving patients away and into the arms of those Cammy Care quacks. Maybe they might offer up some solutions to the problems and situations faced by physicians.

Now here is an example, and it is a true one. A guy named Bobby, type 1 diabetic since age 9, went into kidney failure. Not that unusual for a long term diabetic. Lucky for him that he was able to get both a pancreatic and kidney transplant. So now he’s off dialysis, and to boot, no more diabetes. Both his transplants are very successfull, and he is very happy.

But…his diabetes caused extensive neuropathy in his hands, to the point where he had to go on disability. There is no cure for it and no standard treatment for it, except to slow the progression of the disease and thus slow down neuropathy; treat with anti-seizure meds or anti-depressants; or painkillers. Not a great choice, and none very effective, at least not for most. Plus the drugs can cause side effects which can outweigh any benefit, as they did for Bobby.

His girlfriend convinced him to try acupuncture, and he did, with much skepticism. To his surprise, it worked. It has restored enough function to allow him to return to part time work, and has diminished the pain.  But according to Skeptics Choir, it is all placebo effect. The acupuncture did nothing, and the relief is all in his head.

Well, all I can say is that even if it is placebo, and the acupuncture is worthless, it certainly stimulated a powerful mind-body response.  Would it have been better for Bobby to sit around in pain, and not be able to work, or pop a few painkillers every day? Is that a better route? Would he have been better off not getting acupuncture, especially since it causes no toxic side effects and the worst case scenario would have been that it didn’t work and he’d be out a few bucks?

This is the situation that has to be considered, when patients show a remarkable improvement after Cammy Care. Placebo effect or not, the patient is better, so should that be ignored? Or should we just say, “it’s not evidence based and toss it out the door?” Or tell the patient that even if conventional medicine has nothing to offer, they shouldn’t try anything else and but just sit and suffer and pray for a miracle (oops, sorry, prayer is also considered bogus so scratch that).

Or JAMA juice, as the case may be. Seems like the AMA has upset a nonprofit organization, and the allegations are serious. I mean, you have to have some ethics if you are publishing a medical journal that you would like the professional world to consider prestigious.

From the Wall Street Journal:

A nonprofit group that monitors industry links to medical research called for the suspension of the top two editors of the Journal of the American Medical Association, and an investigation into allegations that they threatened a researcher who criticized a study published in the journal.

The Alliance for Human Research Protection, which is often critical of industry-academic ties, made the requests in a letter it sent Wednesday to the AMA and the journal, known as JAMA.

This has been a topic of conversation on some health/journalism list servs, but I see that it now made it to prime time. In a nutshell, a doctor named Jonathan Leo wrote a letter to the British Medical Journal, in which he criticized how results were reported in a JAMA study last year.  He also said that  JAMA didn’t report the study’s author had a financial relationship with the manufacturer of the drug in the study.

The publication of the BMJ letter upset JAMA’s editor in chief, Catherine DeAngelis, who acknowledges contacting Dr. Leo’s dean in an effort to get Dr. Leo to retract the letter. Dr. Leo says JAMA’s executive deputy editor, Phil Fontanarosa, also called him to request a retraction. Dr. Leo has said Dr. Fontanarosa told him, “You are banned from JAMA for life. You will be sorry.” Dr. Fontanarosa, through a spokeswoman, has said Dr. Leo’s version of the conversation is “inaccurate.”

Nothing like docs duking it out, but this does raise serious ethical questions. Was the study that JAMA published flawed enough that it should have undergone a better review? Should they be more efficient at making sure authors report conflicts of interest? And should someone be banned simply for criticism? Is that a Soviet mentality or what? Maybe they should send Dr. Leo to the physician’s Gulag…

16:08: This is an update to my original post. A link to the Economist, which has a nice article (well, not nice for JAMA) about this scenario. It sounds like JAMA is more interested in preserving its “reputation” at the cost of burying serious infractions, and this is only going to boomerany in its face. The AMA is already rapidly losing membership, and it may be that JAMA’s readership will be waning as well–this type of behavior is quite detrimental and I wouldn’t be at all surprised if the outcome is that it deters researchers from publishing in JAMA.

There was an interesting article that was just published in New York Magazine about Cara Mulhaln, the midwife to end all midwives. In a nutshell, she does homebirths and home birth only, and judging from this article, seems a little on the fanatic side. To the point of being dangerous.

Again, I know nothing about this woman, other than the article, but several readers posted personal experiences with this woman–some good and some bad–very bad. And even in the article, the author describes a case where the woman was in labor for 72 hours, was not progressing, but Mulhaln thought that was okay.  She told the couple that the body knows what its doing, or some nonsense like that. But this woman was not dilating, and her water broke, making her vulnerable to an infection. The couple intelligently decided to go to the hospital, where Mom soon spiked a high fever (indicating an infection). She ultimately had a section and baby ended up in the NICU. And Mulhaln still didn’t think she did anything wrong.

“How do you feel about having a C-section?” Muhlhahn asked the couple at a follow-up appointment to discuss what had happened. It was the first they’d spoken to her since she’d dropped them off at the hospital. Garcia felt the question was barbed with the implication that if she’d only had more patience—tried harder—she could have had a vaginal birth. “I had a plan the whole time,” Muhlhahn told them, “and you just didn’t trust me.”

Is this woman playing with a full deck or what? Didn’t trust her? And she had a “plan” the whole time? What, to wait until Mom and baby had overwhelming sepsis?

The scary thing about Mulhaln is that she doesn’t seem to have a back-up. Midwives delivering at home will generally have a physician as back up in case something goes wrong, or have an agreement with a hospital. Something, anything. But Mulhaln has nothing. She doesn’t have a signed practice agreement with a physician, which she is required by NY State law to have (where she practices). She also doesn’t carry malpractice insurance.  And judging from these stories, she also delivers high risk pregnancies at home, and doesn’t seem to have good judgment when to quit and get help. I wonder what kind of equipment she has with her–does she have sufficient tools to resusciate a baby? Does she know what she’s doing?

I have nothing against home births, but the midwife delivering should have a back-up, should always err on the side of caution, and should be adept at handling an emergency.

What do you all think of home births?

Forbes magazine online has a nice slide show about TV Medical Missteps. Yes, I’m not the only one who’s noticed Dr. Jollywood “jollywoodizing” health and medical care. How hard is it to have a medical adviser read a script, and in most cases, making changes to remove the idiocy and make it more authentic will not cost more money and will probably make viewers happier.

One misstep that they mention is the reality of nursing. Yes, in Dr. Jollywoodland, physicians often do the work of nurses, particularly if they happen to be the star of the show. On ER, patients are often handed off for treatment by paramedics without the help of any nurses. Yup, that’s just how it is. The physician is standing around and waiting for the ambulance, and does the blood draws, hooks the patients up to a monitor, does all the triage, puts the chart together. La la la….

Another idiocy is that physicians often hire and fire nurses on TV shows. The only time I can imagine that happening is if the nurse is working in a private physician’s office, and he or she would then be the boss. Otherwise, physicians have absolutely nothing to do with staffing in a hospital. A nurse cannot be fired by a doctor, just like the doctor can’t be fired by the nurse.

Another TV plague is the super intern syndrome.

On shows such as ER, medical interns often end up alone with a patient who crashes and needs a dramatic, difficult procedure in order to survive. In reality, it’s very rare that an intern would be left alone to do something beyond his or her capability, Safirstein says. In most cases, senior physicians are on hand to guide them through their work step by step

Then there’s ER Drama! Most shows do their best to convince the audience that daily life in the ER is one of gunshots, stabbings, riots, mentally ill patients gone haywire, fires, bombings, terrorist attacks…basically, the excitement that just won’t quit. While violent incidents occasionally happen, most times the ER is just busy and monotonous, filled with patients with non-descript pains and fevers, some broken bones, maybe an out of control asthma case. And the ER staff, especially the docs, do not provide a full service menu. I know, in the world of Dr. Jollywood, patients basically move into the ER and receive all their care in there by the same dedicated physician who never goes home. ER docs on TV can do everything–brain surgery, organ transplants, diagnose a complicated case of Lhassa fever without even doing any labs, and they do it all themselves without the help of pesky nurses or techs.

In reality, patients are triaged and stabilized in the ER, and then either admitted to the hospital and transferred to the appropriate unit or sent home. That’s not very exciting, but that’s how it goes.

Remember the day and time. March 28, 2009, at 8:30-9:30pm local time.

That’s when the lights go out.

I never heard of Earth Hour before, embarrassing to say. But its an uber world wide movement to cut off the lights, save energy and see the stars.

If you really want to go greener than green, turn off all of your electric power. No lights, no TV, no microwave, no oven (if electric), no computer except on battery…amazing how dependent we are on power. But I think for one hour, it can be managed for a lot of us.

Eat dinner before or afterwards, or have a romantic dinner by candlelight, even if you live alone.

Invite friends over for an “Earth Hour” party. Make it a community thing.

Do some star gazing. If its a clear night, and enough lights are out, you may even see a star or two. In my neighborhood, it won’t make much of a difference since there aren’t any streetlights to begin with.

It is only an hour. Surely you can live without TV for an hour. And its a good experience if you have kids. Just explain it to them what’s going on, and how they personally, are helping the planet.

Earth Hour

Putting money into training healthcare professionals is not a bad thing, but it shouldn’t be looked at a cure all. It is far from it, and funding for education is not the cause of many of the personnel shortages seen in healthcare–far from it.  For example, one of the greatest shortages is in attracting and keeping certified nurses aides in long term care. In some places, the turnover rate is about 80% at one year. This has nothing to do with education funding—rather, it is pathetic pay for doing a very hard job. And often being treated very poorly.

And nursing, well, that is like a vinyl record that keeps skipping. Putting all the focus on education funding is safe. No toes stepped on, no angry hospital execs, no real changes needed. In fact, hospital execs would love it if 10 times the number of nurses were churned out of the education assembly line. That would raise competition and they can lower wages and make working conditions even worse than they are. Nurses would lose all leverage.

From Advance for Nurses:

The legislation, signed into law by President Obama Feb. 16, includes $500 million for health professions training. During the 2009 and 2010 fiscal years, $300 million of this funding will go to the National Health Service Corps. The remaining $200 million will be divided between Nursing Workforce Development Programs (Title VIII programs) and Health Professions Training Programs (Title VII programs).

That’s good, that more than half the money is going to the National Health Services Corps. I have no problem with that and these programs need more funding. So that gets a checkmark from me (not that Obama asked). But its the other money that’s problematic.

How much money is nursing going to get out of the $200 million? And who are the “others?” What other health professions are they talking about? Is money going to go to train pharmacists, pay for doctoral degrees for physical therapists, pay for tech education, pay for certification of CNAs, or what?

Now the good part, although it is difficult to say how accurate this is. They are also only quoting a nurse faculty member from one school, rather than someone who be more intimately involved with distributing and allocating the funding.

Funding also may be used to support nursing diversity scholarships, as well as nurse faculty scholarships. Walker said lack of nursing faculty continues to be an obstacle in addressing the current nursing shortage. “Thirty percent of nursing faculty positions in the U.S. are not filled,” she said.

The funding also will support grants for clinical educational equipment. Walker said this would include clinical simulation equipment that allows for the expansion of some nursing educational capacity without the need for more faculty.

Yes, that’s great. Nursing diversity scholarships, what a cool and oh-so politically correct idea. True, most nurses are still white females, but really, are most minority men and women not going into nursing because they don’t have the money to go to school? Or is it because its just not that much of an attractive profession. And if the latter is the case, they will take the scholarship money, get an education, and then use nursing as jumping board to where they really want to be.  Plus I find these kinds of scholarships discriminatory, but that’s another story.

And what are “faculty scholarships?” Is that a scholarship to increase the pay of a faculty member, or money to pay for an education–and the nurse swears on the life of her firstborn that she will teach for 2 years? I think the idea of paying for graduate education in exchange for devoting XX number of years to teaching is a good idea, but it is, like most of these great ideas, simply a bandaid. Chances are, the nurse with a graduate level education is going to fly the coop into a much higher paying job. There’s a reason why there’s a faculty shortage, and the primary one is pay. The secondary one is that the academic world can be very unfriendly, very political, and a nurse had hordes of other opportunities.

My favorite use of the money is “clinical simulation equipment.” I think that is great to give nursing students more clinical time, but not to be used in lieu of actual clinical time==like with real patients and an instructor. However, the person quoted here seems to think that this is the miracle that can help stretch teachers. Sorry, not a good idea. Nurses have limited time in the clinic as is, and simulation is not a viable solution.

All in all, a very depressing article. Full of the usual band-aid approaches and politically correct solutions, and vagueness so typical of this type of reporting.

Not my words.  It’s the headline of a news story, and we know how that often goes.

This headline appears jumbled together with news stories about how dire the nursing shortage is, another about how there are less jobs for nurses at Massachusetts General Hospital but still 400 available (the spokesperson didn’t specify if they would hire new grads or why there are so many jobs open considering the trouble that Boston area nurses are having in finding a job), and some of the usual press release-ish stories about shortages of nursing teachers and if only we can just mass produce nurses everything will be peachy and sweet in healthcare.

Now, the article at hand. This one is a mix and match of quotes and stats, but doesn’t seem to have a direction. In other words, is it talking about a nursing shortage, nurses having trouble finding a job, Obama’s healthcare plan, or what? And some newspapers are wondering why they fail to meet the needs of the public, and why no one with a working brain wants to read them.

From the Daily Pennsylvanian:

If the Obama administration succeeds in extending health care to all U.S. citizens, the system will be under enormous strain, said Nursing professor Matthew McHugh, whose research focuses on nursing workforce policy and the current deficit of nurses in particular.

There “simply won’t be enough” infrastructure to care for the newly insured, he said. “We need to make sure we have a health care workforce that is able to meet the demands of a reformed health care system.”

True, I have to agree. More insured people mean that more wil probably seek medical care. That means more workers needed.

McHugh predicts a shortfall of 300,000 to 800,000 nurses by 2020, but he said, “there hasn’t been significant focus by the administration … on the infrastructure problem of providing a nursing workforce.”

For nursing students, the shortage would seem to be beneficial.

“The nursing shortage makes nursing students at Penn feel more secure,” said Nursing senior Katie Heaberlin.

“The combination of a good school and there being a shortage makes me confident that I’m going to get a job.”

Now these three paragraphs, basically one sentence quotes, tell us nothing. First, the usual quotes about the shortage. But what does he mean that there hasn’t been enough focus on the infastructure problem. Perhaps the article might have concentrated on that one area, and explained it. What should the administration be doing? What should they be focusing on? That might have made a good article.

But no, as usual, it skips over to some silly meaningless comment from a nursing student. Yes, we’re all glad that you feel secure and hope you get a great job. But what has that got to do with an important issue that was just raised.

Now it gets even dumber. We move to student #2, who feels less secure and is worried about a job despite the so-called shortage.

Nursing senior Alexa Nickeson, has found the job market much more challenging in this economy, the shortage notwithstanding. She said hospitals are delaying start dates, and there are fewer positions available this year.

“Research shows a correlation between a higher nurse-to-patient ratio and higher patient mortality,” she said.

Even with the clear benefits of an increased number of nurses, hospitals are still hiring less this year, a number of nursing students said.

So now Alexa says its harder to find a job. Another mixed opportunity–the article could have discussed the difficulty nurses are having in finding a job, despite the dire predictions of a shortage. But it gives no reason why jobs are tighter, what percentage of nurses can’t find jobs, if it is national or just in this state or metro areas, etc.

Instead, they some mumbo jumbo quote about the benefits of smaller nurse to patient ratio, and that this still hasn’t convinced hospitas to hire more nurses. Well, are the hospitals that aren’t hiring working very short staffed? Is the situation dangerous? Are they not hiring because they’re using the economy as an excuse? Are they purposely working short staffed even though they can afford more nurses or at least, temps?

Of course, no info whatsoever. Another lost opportunity.

The last part of the article is something about socialized medicine…I can’t even go there. Is it asking too much for decent reporting, for a news story that has a focus and gives the reader actual information?

And of course it rained today. It wasn’t cold out, but got a little stormy at one point. I managed to trim back the dead leaves and branches from the strawberry plant that have been sitting on my deck all winter, and amazing, two of them have fresh new baby leaves and are coming back to life.

I must be one of the last holdouts, but I am now officially on twitter, to tweet about nurses, health, dorks of the healthcare world, and all that jazz. I will be putting up my logo, but for now, you can tweet me @nabeep.

I’ve only just started, and I’m getting the hang of it, but it looks like fun. I only hope that its not too much of a time suck–I’ve got enough of those.

See you on twitter.

But where is it going? And how beneficial is it going to be for nurses in general?

Those are my questions, Barack. Do tell.

A Reuters article that I found the other day (I don’t know what I did with the link–but I had copied it to send to my editor), says that:

“The economic stimulus bill Obama signed last month included $500 million to address shortages of health workers. About $100 million of this could go to tackling the nursing shortage. There are about 2.5 million working U.S. registered nurses.”

So what does this mean, exactly? How do “we tackle” the shortage of healthcare workers without addressing the root causes of shortages in the first place. Yeah, I know, get out the violins and let’s here that the nursing shortage is caused by not enough schools or teachers, and has absolutely nothing to do with working conditions, or the fact that there are more desirable jobs out there. There are certainly a lot desirable jobs in healthcare than being a nurse. I think even scrub techs get more respect, or radiology techs.

What is the money going to be spent on? More studies to tell us that we have a shortage of healthcare workers, which is tempered a little now due to economic conditions, but which will flare up as soon as the economy starts pumping away again? More studies to look at the causes of the nursing shortage?

“Separately, Senator Dick Durbin and Representative Nita Lowey, both Democrats, have introduced a measure to increase federal grants to help nursing colleges.” Now, what is a “nursing college?” I don’t know of any college that specializes in nursing, do you? Do they mean nursing programs? And how is the money going to help? Are nursing instructors going to get more money than instructors in other subject areas–that will go over real well, I’m sure.

I can’t stand these vague statements which are nothing more than gobbly-gook. A good reporter, like in the olden days, would actually inquire what they plan on spending the money on, and how they assume it will help the shortage. The whole article is just sound bytes from experts, and doesn’t touch on where the money will be siphoned.

You know what? I am going to write to the White House. Barack says he wants to hear from us? Well, he will hear from me.

And a happy St. Paddy’s Day to you all. I bought a beautiful little live shamrock at Trader Joe’s a few days ago, and its little white flowers are blooming. That’s my preference. I also do like cabbage, and some today shredded into my salad, but I’ll pass on the corned beef. And Guiness? I won’t even go there. Beer is not my favorite passion in life.

I guess I could have worn green, but that would be overkill, since there is so much green out the window (thanks to the endless rain), and green inside my house (my little seedlings that have sprouted and that are going like gangbusters).

When you visit an overseas dentist, you cannot be sure what type of materials they might be using. Some may in fact do a great job, but you can’t be sure and definitely would not have the same level of recourse that you might by receiving care by the hard-working dentists right here in the USA.

A report of lead in a dental prosthesis produced in an overseas dental laboratory from an overseas dental lab got everyone’s knickers in a twist, but it is unclear how widespread this is, or if there is a real danger to consumers.

That said, most people never ask about the materials used in a dental prosthesis that they may get in the US, or even read the labels on food items that they buy. Regulation of the dental profession, plus regulation of medical devices, will vary dramatically from country to country, as will views on safety. For example, bovine growth hormone is permitted to be given to cows in the U.S. to increase milk supply (another reason to buy organic milk and dairy products), but yet is banned virtually everywhere else in the world including our neighbor Canada. The reason? Lack of evidence proving its safety, plus evidence strongly suggesting that it may not be safe. So you can’t always blindly trust products born in the U.S. either.

If it’s at all possible, you can ask about the materials being used in a dental prosthesis that you may be contemplating from an overseas dentist. They may be quite willing to give you a list, if its a reputable dentist and they feel they have nothing to hide. And then do some research, like finding out how a comparable product is made in the U.S., and take it from there.

Well, suppose being a traveling shrink might be an interesting profession. Sort of like the itinerant preachers, who set up their tents and hold revivials, and then go off on their way.

But that’s not the type of therapist I’m talking about. This is about the therapists with the words “respiratory” “occupational” “physical” and so on in front.

Apparently, travel jobs are not just for nurses. According to an article at American Traveler, therapist can take the road in much the same way that nurses do.

This is a travel professional staffing agency, so everything they say must be looked upon with that in mind. Anecdotally, some nurses have been complaining the travel assignments have dried up and I imagine that some have. But with hiring freezes and layoffs, hospitals still need staff. Some are making a big fuss and using the economic situation as an excuse to cut benefits, salary and jobs. But when they did the same thing in the early/mid 1990s, they turned around and used travelers and per diems to fill in the slots vacated by full time staff. True, it is more expensive upfront, but a lot cheaper than an employee who demands health insurance and who they may have to eventually provide with a pension.

American Traveler claims to have a lot of jobs waiting, for assorted therapists as well as nurses. I imagine the truth is somewhere in-between no jobs and abundance of jobs.

But for allied health professionals, they claim to have travel jobs for respiratory therapists, occupational therapists, surgical technicians, speech pathologists, and physical therapists. It would make sense, as these jobs can be packed up and carried around the country, much as nursing can.

Factor in all the benefits, bonuses and perks of traveling and travel therapists can make up to $110,000 per year.

Not bad, but of course, that does depend on your location, the type of therapist you are, the pay at the moment, etc. But it is something to consider, especially if you’ve been laid off and can manage to temporarily relocate.

Another mangled medical interpretation brought to you by Dr. Jollywood. On a big budget show, how difficult is it to get something right?

First, I have to say that I love the show Fringe, and am addicted to it. I get it on iTunes and play it on a 30 inch computer screen, so it is easy to stop, start, move back, etc. I think the show is innovative, clever, creative, and the actors are perfect in their roles. That said, there is a lot of “real” medical stuff in this program, and they certainly can do a better job of it–do a better job of it without adding any extra cost or minutes to the show. It’s just called accuracy.

In the second episode, a woman with a quasi-sort of pregnancy was dumped at the ER entrance, screaming and in obvious pain. Of course, everyone thought she was about to deliver a baby, even though she said that wasn’t pregnant. But due to what they perceived as the urgency of the situation, and a quick check of vital signs, they decided to do an emergency C-section.

Now here’s the first flaw. Why were they going to do a section, and in fact, they were “so rushed” that they said they didn’t have time to put her under? It just seemed from their point of view, that the woman was in labor. They showed a flash of monitors and someone said that the heartrate was 60. If that was the baby’s heartrate, then yes, the kid was trouble. But it had to be mother’s monitor they were looking at, because they hadn’t hooked her up to an internal fetal probe, and she didn’t have any sort of external fetal monitoring device around her abdomen. So how on earth could they have been monitoring the baby? And so again, why the need for a C-section?

Okay, move along. Mom is screaming, and then suddenly becomes a flatliner. Again, we see the same monitor, but now the EKG is a flatline. Mom has died, suddenly and inexplicably. No one in that operating room seems to be surprised that this woman, very much alive and vital only seconds before, and seeming healthy except for having a huge abdomen (assumed to be carrying a fetus), suddenly dies.

So what do they do?

Nothing.

One guy says, “She’s gone.” No curiosity or shock that this woman who they assume to be in labor has suddenly died. And then someone says, “we’ve got to get the baby out now!”

Uh yeah, but what about the woman? In real life, I certainly hope that part of the team would be instantly “upfront at the woman’s head and chest” intubating her, pouring in drugs, doing CPR. In other words, she would be a full code. Another person would call for help, and the OB doc would get the baby out. They would not just stand there, stare, and mutter that “she’s gone.”

I can just imagine attorneys who watched this show, moaning and groaning that this wasn’t real life because what a plum lawsuit that would be. And maybe in George W. Bush’s world, the mother should always be sacrificed for the baby (especially if its a boy), and that they were doing the right thing by ignoring the dead slut (yes, she was unmarried and had just had an illicit affair) and saving the sacred child, but this is not how in works in real life.

Grade F- for this scene

A second blunder was the use of paralytic agents that the “bad guy” used to capture his unsuspecting victims. To my knowledge, all paralytics are neuromuscular blocking agents, meaning that that paralyze all voluntary muscle movement. This includes respiration. Because of this side effect, which is why they are used in the first place, all patients receiving these drugs must be on some type of life support–if the intention is to keep them alive.

But yet, the bad man was able to paralyze his victims but not suppress their breathing. Interesting. Since this show is about fringe science, and has a lot of weird stuff in it, this point should have been raised. It only would have taken one sentence from Dr. Bishop or his brilliant son to say that “wow, this guy must be using some avant-garde paralytic that bypasses the respiratory muscles.” Something like that. It would added a little credibility and offered an explanation–granted, most people don’t know how these drugs work, but still, make it as real as possible. Yes, this show was about a heinous scientific experiment that should have ended decades ago, so it would have been believable that a new form of paralytic was available.

Other than that, it was a great show. It would just really help to have medical advisers on the set, and to follow their advice.

It would be overly optimistic to imagine that the FDA might get their brains out of their pants, and their hands out of the pockets of the industries that they are supposed to be regulating, and do the job for which they were created.

But President Obama has selected a new boss of the FDA. She sounds promising, and that she might actually care about public health.

From the NY Times:

President Obama intends to nominate Dr. Margaret A. Hamburg, a former New York City health commissioner, to lead the Food and Drug Administration, sidestepping a battle between drug safety advocates and the drug industry, according to people briefed on the decision.

The latest on President Obama, the new administration and other news from Washington and around the nation. Join the discussion.

The administration is likely to announce the decision this week, these people said. Dr. Joshua Sharfstein, the health commissioner of Baltimore, who led the Obama administration’s transition team for the F.D.A., will become Dr. Hamburg’s chief deputy, these people said.

Dr. Hamburg, 53, succeeds Dr. Andrew C. von Eschenbach, who led the beleaguered agency from 2005 until last January and often had to deflect critics who accused the Bush administration of letting politics play too forceful a role in science policy.

Her selection, first reported Wednesday on the The Wall Street Journal’s Web site, was hailed by top public health officials and experts.

And please note, the onion is smiling because it seems that we might finally be getting an FDA commissioner who cares about food. And that’s enough to bring a smile to the face of any onion.

I am surprised that I didn’t get any nasty comments in relation to my post yesterday about the Obama stance on embryonic stem cell research. This seems to be a hot button topic with some people, especially when accused of caring only about the not-quite-living, as opposed to homo sapiens already inhabiting the earth.

But maybe other issues have taken priority, some related to current economic woes and some not.

I am curious though, and I use nursing as an analogy. I have met a number of die-hard martyr type nurses who declare that they would “never go on strike.” Unions? Bleech, who needs them. But somehow, these nurses forget how to speak whenever I’ve asked them if they also are willing to turn down the benefits, pay increases, or whatever, that result from labor disputes. That since they are unwilling to go out on strike (how immoral for a saintly nurse to even think such a thing), they also would never accept such tainted money.

But not a peep from them, or a mumbled incoherent response that would put even Sarah Palin to shame.

So does the same hold true for embryonic stem cell research? Would a person who is opposed to using embryonic stem cells for scientific research, turn down a treatment derived from these stem cells? If they had fatal disease? A debilitating degenerative disease that slowly eats away the mind and body?

What about for their child? A stem cell treatment that will halt their child’s disease? One that will allow him to walk again? To see again? To live past age 2 years?

Bunny courtesy of stock.xchng

President Barack Obama is reversing yet another Bushism–the ban on federal funding for stem cell research. Now, not to sound like a broken record, but I would have had some respect for Bush’s lofty goal of preserving life in the pre-embryo stage if he really did give a hoot about preserving life in general. But as we all know, the planet is littered with dead and mangled bodies, due directly and indirectly to Bush policies. One of my favorites was cutting funding to the VA, so that our veterans, many with significant physical and mental injuries, would receive less care.

Anyway, here is Barack, announcing yet another step forward:

Oh yes, there are plenty of whiners and moaners about how this is “legalizing” murder, and about the holocaust of pre-embryos that this is going to create. And a lot of these people support the Iraq war, capitol punishment, cutting funding to social services that help care for the babies and children that they feel so passionately about in the embryonic stage….the same story, life is only sacred before it is born.

The second question is what to do about pre-embryos chilling out in limbo. Some of them have been in deep freeze for over a decade, and may not even be viable. So, it is better to destroy the pre-embryo than use it for stem cells? Because that is going to be the choice in most cases. Unless “you” want to implant it into your body, give birth and raise, the fate of the hundreds of thousands of pre-embryos (leftovers from in-vitro procedures mostly) is the toilet (literally). Or sitting forever in deep freeze. I would love to hear some input on that problem from those who are opposed to stem cell research.

Personally, I think that there do need to be better regulations and guidelines, when it comes to creating embryos that will never be used. This is a whole topic in and of itself, but the fertility industry has behaved much like the wild west, and I think its time to take a close look at what’s going on–whether its some cowboy doctor who thinks its cool to implant 8 embryos at a time into a young woman who already had given birth to 6 children, or parents who are keeping 10 pre-embryos on ice and refuse to put them up for adoption but also who have no intention of ever seeing them become babies.

Is the nursing shortage suddenly over? Have RNs clutching their newly minted licenses overrun the healthcare system to such a degree that no one is hiring anymore? Have we reached the point where it is no longer politically correct to say to nurses and would-be nurses, “You’ll always have a job?”

But there’s been a lot of chitchat that new grads are having trouble finding work, especially in northern California, NYC, Boston, and New Jersey. There have been scattered news stories about layoffs in Tuscon, AZ and the Philly area. Some new nurses have reported that not only can’t they find a job, but they can’t even get an interview. Many have been searching for several months.

Is this an instant replay of the early-mid 1990s?

Just when you think you’ve heard it all, along comes the candidate for moron of the year. Sen. David Schultheis, R-Colorado Springs, who voted against a bill requiring pregnant women to be tested for HIV because, he said, it would wrongly protect women and their unborn children from the consequences of “sexual promiscuity.”

Yes, you heard it right. And wait, there’s more. The best is yet to come:

From the Rocky Mountain News

SEN. DAVE SCHULTHEIS, R-Colorado Springs, on Wednesday voted against Senate Bill 179, which requires health care providers treating pregnant women to test those women for HIV unless they opt out[4]. This provision is intended to ensure that steps can be taken to prevent mother to child transmission of the disease if the mother is infected.

* What he said during the debate: “This stems from sexual promiscuity for the most part and I just can’t go there. We do things continually to remove the consequences of poor behavior, unacceptable behavior, quite frankly. I’m not convinced that part of the role of government should be to protect individuals from the negative consequences of their actions.”

* What he said afterward: “What I’m hoping is that yes, that person may have AIDS, have it seriously as a baby and when they grow up, but the mother will begin to feel guilt as a result of that. The family will see the negative consequences of that promiscuity and it may make a number of people over the coming years … begin to realize that there are negative consequences and maybe they should adjust their behavior. We can’t keep people from being raped. We can’t keep people from shooting each other. We can’t keep people from jumping off bridges. People drink and drive, and they crash and kill people. Poor behavior has its consequences.”

Yes, you don’t need glasses. You are reading this correctly. Schultheis really said he is “hoping” people “have AIDS, have it seriously as a baby …” He is hoping that a woman who is HIV positive will pass on the infection to her baby, and that will “teach her a lession” about her promiscuous behavior. And gee, maybe the baby will die a horrible death from AIDS, and won’t that bring a smile to Schultheis’s ugly face (and he is ugly).

And let me guess. The man who hopes and even wants an innocent baby to contract AIDS calls himself pro-life. And I bet he’s even opposed to embryonic stem cell research–you know, fighting for the lives of pre-embryos chilling out in petri dishes. While at the same time wishing an HIV infection on a baby, just to help control “negative” behaviors.

The man is a Republican, and while I am hopeful that there are Republicans with brains and some degree of compassion left in this country, I am waiting to hear the outrage. The silence is deafening. Where are the intelligent Republicans who want to keep their party from completely imploding? Why aren’t they voicing outrage over this moron’s comments? Why are they afraid to speak up and condemn this idiocy?

The dork is free to say whatever he wants, but his fellow party members in Colorado and elsewhere should be waiting in line to say that this is not party policy–that they do not fervently pray that those evil slutty women pass lethal viruses onto their babies. The condemnation should have been quick and loud.

But there’s been nary a peep from the party.

And where is the outrage from the medical and nursing community?

I think that Senator Schultheis needs to be locked up for a few days and undergo a psychologic evaluation. And I’m sure that he considers himself to be a good Christian. I’m sure that’s exactly what Jesus would say, and if Jesus was here on Earth now, I’m sure that he’d be inviting Dave Dickhead out for a beer and slapping him on the back. Way to go, Dickhead. Let those sluts pay for their actions.

And then Jesus would tell David Schultheis that God has a special place in Heaven for good Christian men like himself. It’s called hell. And I imagine that good old Dave is going to be sentenced to having AIDS for all eternity. The same sentence that he’s wishing on an innocent baby.

I’d better stop writing now before I go into V-fib….