Hanging On Too Tightly

For some women, being attached to your purse is being taken literally.

In Lawrenceville, Ga. a man tore a woman's finger off during a drive-by purse snatching.

Caesare R. Pinkins, 21 was charged with multiple felony counts of robbery, aggravated battery and burglary and is being held in Gwinnett County Jail without bond.

He reportedly drove by a 55-year-old woman at about 2 p.m., swiped her purse and stepped on the gas, but one of her fingers was caught in the purse and was ripped off during the escape.
Surgeons were unable to reattach the severed finger.

The perpetrator also faces charges for an alleged purse snatching outside a Target store earlier in the month but there were no injuries reported in that incident.

I guess the moral is not to hang on too tightly to your personal belongings.

Medical School Stats for 2007-2008

Medical School statistics for the 2007-2008 year have been published. Some of the highlights are as follows:

• First-time applications reached and unprecedented level growing more than 8% over last year to 31,946 applicants
• MCAT scores were the highest ever with the mean of 28
• The GPA mean was also higher at 3.5 up from 3.4 last year
• Nationally, the entering students reached nearly 17,800 and increase of 2.3 percent
• Osteopathic school enrollment followed a similar pattern

One associate dean stated “millennial student’s want to help others. They are smart and have a lot of time studying math and science in primary and secondary school. They feel they can improve society and what better way to do that then medicine”

It is good to know that we continue to have high caliber students choosing the field of Medicine.

Drug advertising

It is a very rare event, but I actually may agree with one idea from democratic presidential candidate John Edwards.

He recently unveiled a plan to put controls on drug advertising, which he said were misleading patients and driving up health care costs. This I do agree with and believe that patients are motivated by advertising which is not always in their best interest.

Prescription drug costs are straining family budgets and contributing to increased health care costs.

Aggressive and often misleading drug company marketing makes it too easy for advertising to influence families' health decisions rather than physicians advice and recommendations.

It is reported that drug advertising revenues had quadrupled to over $4 billion a year in the 10 years since rules were relaxed to allow firms to advertise medicines directly to consumers.

Somehow limiting the advertising would be helpful, but this is probably the only part of his healthcare plan I agree with. The rest of the Edward’s plan would cost in excess of $120 billion dollars a year and is government mandated and would never work.

Older docs opting for early out

The results of a new survey conducted by Merritt Hawkins & Associates, a Texas-based physician search and consulting firm, suggests that many older physicians are unhappy with the changes that have taken place in medicine over the years.

The results indicate that 48% of physicians between 50 and 65 years of age are planning to reduce or end their clinical practice in the next 1 to 3 years and in addition, many older physicians believe that their younger counterparts do not have the work ethic they do. This correlates to many other fields besides medicine.

The American work ethic is different than it was 20 years ago and it is going to affect the healthcare field as well as many others.

In medicine, when Baby Boomer doctors entered medicine they had control over how they practiced and the fee they charged. But the rules changed in mid-stream and now many are looking for a ticket out.

How, or if, these physician choose to practice in coming years will have a significant impact on overall physician supply in the US and could dramatically change the way healthcare is delivered.

With the U.S. already facing a widespread shortage of physicians, the decline in work of these older, 'workhorse' physicians will potentially restrict access to medical services for more and more individuals.

The Democratic Dilemma

The Hollywood strike that has been going on for some time now is being relatively subdued in the media and in the democratic campaign talks. If this corporate entity was any other private business, you can bet the democratic front runners would be condemning the corporate entity unrelentingly.

So why the difference?

Could it be that the Democrat front-runners are corrupted by big-corporate money and barely standing by a union composed of upper-middle-class liberal writers. Does this not represent a giant income disparity and economic unfairness that the democrats usually thrust themselves on to point out the injustice? But for now, they are being extremely quiet and reserved in their remarks.

Aren’t these writers part of the overclass in the Democrats' vision of the "two Americas."?

These writers are guaranteed a minimum of $106,000 for a screenplay; and the TV networks must pay at least $20,956 for a 22-minute sitcom script and $30,823 for a 44-minute show.

In reality, these numbers are usually doubled since the writer gets a large payoff for the first rerun. The studios and networks report that the average working writer makes $200,000 a year; the average worker in Los Angeles County makes $52,572.

So for now, the democrats are struggling between standing up for unions or going against their sugar-daddy in corporate Hollywood.

Don’t you just feel sorry for the predicament they are in?

Remember the "Thanks" in Thanksgiving

Thanksgiving is another wonderful holiday and yes it is another Holiday with a very strong Christian background.

Hopefully people will remember who should be receiving the thanks!

The Pilgrims, even after losing about half of all those who braved the harsh elements to arrive on the shores of the new world by their first spring, relied heavily on their faith and Divine Providence of God to overcome the many hardships.

On December 11, just before disembarking at Plymouth Rock, they signed the "Mayflower Compact" which was America's first document of civil government and the first to introduce self-governance in the New World.

Persevering in prayer, and assisted by helpful Indians, the Pilgrims reaped a bountiful harvest the following summer and declared a three-day feast, starting on December 13, 1621, to thank God and to celebrate with their Indian friends.

Pilgrim Edward Winslow described the Pilgrims' Thanksgiving in these words:

"Our harvest being gotten in, our Governor sent four men on fowling [bird hunting] so that we might, after a special manner, rejoice together after we had gathered the fruit of our labors. They four in one day killed as much fowl as... served the company almost a week... Many of the Indians [came] amongst us and... their greatest King, Massasoit, with some ninety men, whom for three days we entertained and feasted; and they went out and killed five deer, which they brought... And although it be not always so plentiful as it was at this time with us, yet BY THE GOODNESS OF GOD WE ARE... FAR FROM WANT."

In 1789, following a proclamation issued by President George Washington, America celebrated its first Day of Thanksgiving to God under its new constitution.

It was Mrs. Sarah Joseph Hale who contacted president after president promoting the idea of a national holiday. President Abraham Lincoln responded in 1863 by setting aside the last Thursday of November as a national Day of Thanksgiving.

In 1941, Congress permanently established the fourth Thursday of each November as a national holiday.

Lincoln's original 1863 Thanksgiving Proclamation came, spiritually speaking, at a pivotal point in his life and as he explained to a friend:

When I left Springfield [to assume the Presidency] I asked the people to pray for me. I was not a Christian. When I buried my son, the severest trial of my life, I was not a Christian. But when I went to Gettysburg and saw the graves of thousands of our soldiers, I then and there consecrated myself to Christ.

As we celebrate Thanksgiving this year and every year, I hope we will retain the original gratefulness to God displayed by the Pilgrims and many other founding fathers.

I hope we remember that it is to those early and courageous Pilgrims that we owe not only the traditional Thanksgiving holiday but also the concepts of self-government, the "hard-work" ethic, self-reliant communities, and devout religious faith.

Have a great Thanksgiving holiday.

As the pilgrims and Indians did before me, I’ll be out deer hunting this weekend trying to bag the big one.

Foreign Bodies

A common problem in primary care offices relates to visits where a foreign body is unable to be removed by the patient or family.

Most patients with ear, nose, and throat foreign bodies are children; intellectually challenged or mentally ill adults.

Many family physicians are able to remove the foreign body in the office but it depends on several factors, including location of the foreign body, type of material, whether the material is graspable (i.e., soft and irregular) or nongraspable (i.e., hard and spherical), physician dexterity, and patient cooperation.

Some children are very compliant with the attempt while others are not and occasionally have to be sedated or restrained.

Recent information on these include:

Foreign bodies in the ear:

o 75% occur in children younger than 8 years.
o These objects are usually asymptomatic and are often an incidental finding in children.
o The most common foreign bodies are beads, plastic toys, pebbles, and popcorn kernels; insects are more common in children older than 10 years.
o In 30% of children younger than 7 years, the object requires removal with the child under general anesthesia.
o Graspable foreign bodies (foam rubber, paper) have higher rates of success for removal under direct visualization.
o Options for removal include water irrigation, forceps, cerumen loops, right-angle ball hooks, and suction catheters.
o Live insects can be rapidly killed before removal by instilling alcohol, 2% lidocaine, or mineral oil into the ear canal, but this should not be done if the tympanic membrane is perforated.
o Irrigation should be avoided in patients with button batteries because of the risk for liquefaction tissue necrosis.
o Acetone may be used to dissolve Styrofoam foreign bodies or to loosen cyanoacrylate (eg, Super Glue adhesive).
o After the first failed attempt at removal, complications increase and success rate falls.
o ENT referral should be made for patients requiring general anesthesia.
o After removal of a foreign body, all orifices should be examined for other objects.
o Ear antibiotic drops are required for concurrent infections of the canal or when trauma is present.

Foreign bodies in the nose:

o Nasal foreign bodies tend to be located on the floor of the nasal passage, and most can easily be removed in the office or emergency department.
o Patients often present with foul-smelling unilateral nasal discharge.
o Before removal, 0.5% phenylephrine should be used to reduce edema, and topical lidocaine should be used to provide analgesia.
o Techniques include forceps, curved hooks, cerumen loops, or suction catheters.
o In addition, a thin, lubricated, balloon-tip catheter (5- or 6-French Foley) can be passed past the foreign body, the balloon inflated, and removal completed by pulling the inflated catheter balloon forward.
o Button batteries must be removed from the nose immediately because of the danger of liquefaction necrosis of the surrounding tissue.
o Sedation is discouraged for removal because of the risk for increased complications from reducing the gag and cough reflex.
o Patients may be able to expel the foreign body by blowing their nose while blocking the other nostril.
o If this fails in a young child, positive pressure ventilation can be delivered through the child's mouth, with the rare potential complication of barotraumas to the ear.
o Appropriate infection control should be exercised as the foreign body will be expelled through the cheek.

Foreign bodies in the throat:

o All pharyngeal foreign bodies are medical emergencies that require airway protection.
o Common obstructing objects in children include balloons, soft plastic, and food particles or boluses.
o Patients with nonobstructing or partially obstructing foreign bodies present with choking, dysphagia, odynophagia, or dysphonia, whereas those with complete airway obstruction present with immediate respiratory distress, and emergency intervention is essential.
o Other presentations include undiagnosed coughing, stridor, or hoarseness.
o Doctors must have a high index of suspicion in patients with unexplained upper airway symptoms, especially in children with a history of choking.
o Early consultation with an ENT doctor is advisable because foreign bodies are difficult to visualize without endoscopy.
o Sedation is required for endoscopic removal.

Adult Vaccines

There are new recommendations from the Advisory Committee on Immunization Practices (ACIP) for routine adult immunizations.

This schedule has also been approved by the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Physicians.

Changes in the 2007-2008 schedule from the previous one are as follows:

• 
  Chickenpox (Varicella) vaccine is recommended for all adults without evidence of immunity to chickenpox.


• 
  Shingles (Zoster) vaccine has been added to the age-based schedule and is recommended for persons 60 years of age or older. Zoster vaccine is specifically contraindicated for pregnancy, immunocompromising conditions, and HIV infection with CD4+ T lymphocyte count less than 200 cells/µL.
• 
  There were several wording changes from the report last year.


• 
  In the medical and other indications schedule, indications for influenza vaccination of healthcare personnel now note that healthcare workers can receive either trivalent inactivated influenza vaccine (TIV) or live, attenuated influenza vaccine (LAIV).


• 
  In the medical and other indications schedule, indications for meningococcal vaccine have been revised to note that 1 or more doses of vaccine may be needed.

General information about adult vaccinations, including recommendations on vaccination of persons with HIV and other immunosuppressive conditions is available from state and local health departments and at www.cdc.gov/vaccines/default.htm.

Vaccine information statements are available at www.cdc.gov/vaccines/pubs/vis/default.htm.

Persons can view, download, and print ACIP statements for each recommended vaccine and provisional vaccine recommendations at www.cdc.gov/vaccines/pubs/acip-list.htm."

Forcing EMR's on Physicians

More bad news for doctors related to the ever increasing demands by third party payers.

The report coming out of the Boston area states that Partners Health Care, a large health care system, is demanding all primary-care physicians in its contracting network to implement or sign a contract for an electronic health record by Jan. 1, 2008.

Those physicians refusing to invest the tens of thousands of dollars for this will be expelled from the network. By 2009, the same requirement will be applied to the bulk of Partners’ specialists.

Physicians can choose between one of two systems and if they already have a system, they will only qualify if it has specified decision-support features demanded by the network.

There are roughly 1,100 primary-care doctors in the network and about 700 are in private practice. This demand from the network is noteworthy because it’s believed to be the first U.S. health-care system to, in effect, force private-practice doctors to get EHRs.

There is no guarantee of any increase in reimbursement for these physicians and it is unfortunately a huge mandatory increase in expenses for the practices.

Big brother is not only watching, he is now kicking you around as well!

Political Spin

Subject: Hilary's Family Tree

Judy Wallman, a professional genealogical researcher, discovered that Hillary Clinton's great-great uncle, Remus Rodham, was hanged for horse stealing and train robbery in Montana in 1889.

The only known photograph of Remus shows him standing on the gallows. On the back of the picture is this inscription:

'Remus Rodham; horse thief, sent to Montana Territorial Prison 1885, escaped 1887, robbed the Montana Flyer six times. Caught by Pinkerton detectives, convicted and hanged in 1889.'

Judy e-mailed Hillary Clinton for comments ; Hillary's staff of 'professional image adjusters' sent back the following biographical sketch:

Remus Rodham was a famous cowboy in the Montana Territory. His business empire grew to include acquisition of valuable equestrian assets and intimate dealings with the Montana railroad.

Beginning in 1883, he devoted several years of his life to service at a government facility, finally taking leave to resume his dealings with the railroad.

In 1887, he was a key player in a vital investigation run by the renowned Pinkerton Detective Agency.

In 1889, Remus passed away during an important civic function held in his honor when the platform upon which he was standing collapsed.

.........and THAT is how it's done folks !

****And for all the critics, yes I am aware this is another urban legend and "not true". It is however funny and does demonstrate the political spin that so many politicians succeed at.

Half of US voters say never to Hillary

The question to ponder seems to be; Is America ready for a female president and if so, is America ready for that person to be Hillary Clinton?

I believe we have progressed to the point that electing a woman is possible, but I do not believe we are ready for this particular woman!

Hillary Clinton, seen here 20 October 2007, may be the Democratic Party's 2008 presidential front-runner but she also tops the list when voters are asked for whom they would never, ever cast a ballot, a poll out Monday found.

From Google news (AFP), a recent article read:

Hillary Clinton may be the Democratic Party's 2008 presidential front-runner but she also tops the list when voters are asked for whom they would never, ever cast a ballot, a poll out Monday found.

Fully 50 percent of US voters say that when it comes to Clinton, she can campaign all she likes but there is no way in the world she can win their support, with her negative rating up slightly from 46 percent in March, the Zogby poll said.

Older voters were the most hostile to the attorney and former first lady-turned US senator, who is seeking to become the first woman US president. Fifty-nine percent of those over 65 said they would never vote for Clinton, according to the survey which ranked leading Democratic and Republican hopefuls.

Clinton's Democratic rival Barack Obama drew a 37 percent rating of those who would never back him.

On the Republican side, front-runner Rudy Giuliani also drew a great deal of negative responses: 43 percent said they would never vote for him, and 42 percent said Massachusetts Governor Mitt Romney was their choice for never.

This Internet survey of 9718 people with a one percent margin of error was done October 11-15.

Child support and custody information

We receive a lot of questions from parents about child custody and visitation related to single parents, divorced parents, and children from out of wedlock situations etc.

Indiana as well as most other states has specific rules and guidelines that are used to help facilitate mutually agreeable terms. At times, the court will make decisions that one or the other parent isn’t happy about, but the underlying motivation of the court is the welfare of the child and reunification when possible.

For people living in and around Floyd County, the web site Floyd County Indiana has most of the common information needed.

This site has links to Access Indiana | Local Civil Rules | Local Criminal Rules Local Family Rules | Parenting Time Guidelines Child Support Guidelines | Child Support Calculator and Indiana Department of Correction

Through the above links, you can obtain spreadsheets and calculators to determine child support payments and many other useful tools.

Overall, this is a very helpful site for the most common types of custody questions and answers.

Media Fear or Awareness??

In a recent Courier Journal article, the media is heightening awareness of the bacteria referred to as the “super bug”. 14 school-related staph cases found

The bacteria is MRSA (Methicillin Resistant Staph Aureus). This is not a new bacteria and we have known about it for years. We are beginning to see it more frequently, but it is still not at an epidemic proportion or something that should instill unwarranted fear.

There are actually two strains. One is community acquired strain and it still responds to several common antibiotics and the second strain is considered hospital acquired and it is much more difficult to treat because of its resistance to most oral antibiotics. We still have IV antibiotics which treat it effectively in most cases.

The mainstays of treatment for individuals and school aged children are good hand washing and bandaging any open wounds.

The most relevant comment from the article came from Dr. Christopher Belcher, a pediatric infectious disease specialist with Peyton Manning Children's Hospital at St. Vincent in Indianapolis who said "There's really not much new, this has been a problem that's been increasing in prevalence over the last seven to 10 years, and what's new here is the public awareness of it."

Need to Organize

The article in a recent Courier Journal http://www.courier-journal.com/apps/pbcs.dll/article?AID=2007711080428 shows once again the ongoing battle between physicians and insurance companies.

The Northern Indiana communities described here have the best chance to negotiate with Anthem because they have a unified group of physicians.

We are in a unique position in southern Indiana and if we could develop a primary care network of physicians who practice only in Southern Indiana, we could significantly improve our contracts with third party payers.

There is currently not a single insurance company that could legitimately offer a plan to any major company in the Louisville metropolitan area if they did not have primary care physicians in their network from Southern Indiana.

The goal for primary care physicians over the next few years is to integrate into a health network that is able to negotiate for all of the physicians in the network.

If Floyd and Clark County hospitals would assist in this endeavor, it would help facilitate a stable patient base for their hospitals and build better relationships with the doctors who bring them patients.

Independent practices and physicians are continuously being picked apart by these large 3rd party payers.

Access for patients will become a bigger problem if we do not become proactive amongst ourselves and establish our own Southern Indiana Health Network

New to the Menu

There was an unexpected surprise for customers at a Chicago McDonald’s earlier this month.

Around 5 a.m., a disheveled man walked in to the 24-hour McDonald’s and tried to enter the restroom. Since it was out of order the man walked toward the soda fountain machine and defecated on the floor.

He reportedly said ‘I have to go to the bathroom’ and then just took a dump on the floor.

Surprisingly, he took a napkin and cleaned it up and placed it on the counter where patrons can put your food and get your condiments.

When workers threatened to call police, the disheveled man left.

One customer wasn’t really happy with the events that morning, but he said he did finish his sausage McMuffin before leaving.

I am not sure but the E.coli risk was probably a little higher at this particular McDonalds.

Pizza recall

With the recent outbreak in our area of E. coli infections, November is already bringing bad news for pizza lovers.

General Mills, the maker of Totino's and Jeno's brand frozen pizzas, announced a voluntary recall of millions of its pepperoni-containing products in the wake of a multi-state outbreak of Escherichia coli O157:H7 infections.

Public health officials along with company officials are asking consumers to throw away any of the following affected pizzas they may have purchased:

Totino's Original Crisp Crust Party Pizza, Pepperoni, 10.2 oz.;
Totino's Original Crisp Crust Party Pizza, Classic Pepperoni, 10.2 oz.;
Totino's Original Crisp Crust Party Pizza, Pepperoni Trio, 10.2 oz.;
Totino's Original Crisp Crust Party Pizza, Three Meat Sausage, Canadian Style Bacon & Pepperoni, 10.5 oz.;
Totino's Original Crisp Crust Party Pizza, Combination Sausage & Pepperoni, 10.7 oz.;
Totino's Original Crisp Crust Party Pizza, Supreme Sausage & Pepperoni with Green Peppers & Onions, 10.9 oz.;
Jeno's Crisp 'n Tasty Pizza, Pepperoni, 6.8 oz.;
Jeno's Crisp 'n Tasty Pizza, Combination Sausage and Pepperoni, 7.0 oz.; and
Jeno's Crisp 'n Tasty Pizza, Supreme Sausage and Pepperoni With Green Peppers and Onion, 7.2 oz.

According to a Nov. 2 General Mills news release, the company has recalled all frozen pepperoni pizzas produced at its Wellston, Ohio, plant. This includes more than 120 million pizzas that have been distributed since the beginning of July.

Public health investigators in Tennessee and elsewhere have linked a growing number of people infected with E. coli O157:H7 to pizzas produced at the Ohio plant.

The U.S. Department of Agriculture as well as other agencies are working with General Mills to identify the source of the problem.

As of last week, at least 21 lab-confirmed cases of E. coli infection have been identified in 10 states: Illinois, Kentucky, Missouri, New York, Ohio, Pennsylvania, South Dakota, Tennessee, Virginia and Wisconsin.

If your pizza craving is huge, consumers can request a product replacement by clipping the universal product code, or UPC, symbol from each pizza box and sending those UPCs, along with their name and address information to:

Totino's/Jeno's
P.O. Box 200 - Pizza
Minneapolis, MN 55440-0200

Other questions about the recall can directed to General Mills at (800) 949-9055. I am not sure this includes attorneys.

Heartbreak

Do your personal relationships affect your health?

A new ongoing study shows that negative aspects of a close relationship--such as not confiding and not getting emotional support--can increase the risk of heart related events and the results are published in the October 8, 2007 issue of the Archives of Internal Medicine.

The researches believe there is more and more evidence that shows being exposed to negative relationships that increase worry, anxiety, and feelings of low self-esteem can in the long term produce emotional effects that may trigger biological changes in the body and lead to bad outcomes.

One researcher said poor marital quality has previously been reported as an important prognostic factor for MI, heart failure, and metabolic syndrome and that women seem to be more affected by the negative aspects of a close relationship than men.

The findings in this study expand and corroborate the previous research by showing that negative interactions in close relationships are contributing factors of coronary events.

This study examined 9011 British civil servants (6114 men and 2897 women) and assessed negative aspects of close relationships and other social-support measures with a questionnaire and 80% cited marriage or a partnership as their closest relationship.

The link between negative aspects of relationships and coronary events were determined during an average of 12.2 years of follow-up.

Adjustments were made for sociodemographic, biological (obesity, hypertension, diabetes, and cholesterol levels), and health behaviors (smoking, alcohol intake, exercise, and fruit and vegetable consumption) and they found that people who experienced negative aspects of a close relationship had a 34% higher risk of incident coronary events.

Contrary to their prior reports, they found that although women and people in a lower employment grade were more likely to be exposed to negative aspects of a close relationship, sex and social position had no significant interaction effects.

This study shows that negative interactions in close relationships produce similar effects on heart disease regardless of sex and social position.

Researches think that emotional effects may trigger changes in the neuroendocrine, inflammatory, and immunomodulatory systems and this sounds like a whole new strategy for lawyers to find fault.

The bottom line to take away:

People just need to be nicer to each other!!

Physicians need to Call

Senator Lugar and Senator Bayh are telling us that they are not hearing from Indiana physicians about the looming Medicare physician payment cuts. So let's make sure they get the message: now is the time to include positive Medicare physician payment updates in the Medicare bill that is being put together!

The American Medical Association, multiple national specialty medical societies, and state medical societies are orchestrating a nationwide physician call-in campaign to the Senate!

We urge you and your staff to call
Senator Lugar and Senator Bayh
on November 6, 7, or 8.

Use the AMA's toll-free Grassroots Hotline at
(800) 833-6354 to connect to your senators.

Members of the Senate Finance Committee are meeting to discuss ways to avert the pending Medicare physician payment cuts. However, they have yet to reach a consensus regarding how to proceed.

The Finance Committee is gridlocked because certain rules require that any new spending increases be offset by corresponding spending decreases or increases in revenue. To date, members of the committee have been unable to agree upon offsets. Reducing over-payments to Medicare Advantage plans is viewed as a possible offset for spending to avert physician payment cuts.

The Senate needs to hear directly from physicians now, as the Medicare package is being crafted, how important it is that the Senate takes action to stop the pending Medicare physician payment cuts.

Ask Senator Lugar and Senator Bayh to speak with Senators Max Baucus, D-Mont., and Charles Grassley, R-Iowa, the chairman and ranking member of the Senate Finance Committee, and urge them to include positive Medicare physician payment updates for the next two years in the Medicare bill that they are drafting. Use the AMA's Toll-Free Grass Roots Hotline at (800) 833-6354 and tell them Congress must dedicate new funding to the update and not use the same old funding gimmicks.

Overuse of Antibiotics

As physicians, we all have probably ordered a medicine or test that we know really wasn’t needed for a variety of reasons. It may be purely defensive in nature, patient request or to just confirm a suspicion. But a recent study defines which physicians are more likely to prescribe unnecessary antibiotics.

According to the results of a study reported in the October 9 issue of the Canadian Medical Association Journal, physicians who have been in practice longer, who have high-volume practices, and who were trained outside Canada are more likely to prescribe unneeded antibiotics and to prescribe the wrong antibiotics. I am sure this Canadian journal had no underlying bias.

We all know that inappropriate use of antibiotics promotes antibiotic resistance and this study was to assess whether physician knowledge, time in practice, place of training and practice volume explain the differences in antibiotic prescribing among physicians.

Inappropriate antibiotic use was defined as prescription of antibiotics for viral infections, and prescription of second- or third-line antibiotics given orally for bacterial infections.

The study included 104,230 patients diagnosed with viral infection and 65,304 diagnosed with bacterial infection.

They reported the outcomes to show that compared with University of Montréal graduates, international medical graduates were more likely to prescribe antibiotics for viral respiratory infections and physicians with increased time in practice had higher rates of inappropriate antibiotic prescribing.

Physicians with a high practice volume were more likely to prescribe antibiotics for viral respiratory infections and to prescribe second- and third-line antibiotics as first-line treatment more often than those in low volume practices.

They did admit there were limitations in the study as well as classification of illnesses, antibiotic resistance in certain areas which may cause selection of different drugs and several others.

Physicians responding to this study had several objections to the study and one notes that physicians and patients may be unwilling to tolerate the low risk of missing a bacterial diagnosis and therefore prescribe antibiotics to err on the side of caution.

Scary Indeed

In a poll from Oct. 16-18 the associated press did telephone interviews with 1,013 adults and found once again, Hillary Rodham Clinton leads.

She was top choice when people were asked which major 2008 presidential candidate would make the scariest Halloween costume.

Clinton more than doubled former New York Mayor Rudy Giuliani. She garnered 37 percent compared to 14 percent for Giuliani.

No other candidate exceeded 6 percent.

Selling Body Parts

More information is coming out of Philadelphia about the three Philadelphia funeral directors who led a scheme in which more than 1,000 cadavers were dismembered in unsanitary conditions and the parts sold and implanted them in patients.

Some may wonder if this is a lucrative business. We hear about the black market in other less developed countries, but the grand jury's report here alleges the men made $3.8 million from the sale of body parts. The scheme involved Pennsylvania, New York and New Jersey between February 2004 and September 2005.

The accused are Louis Garzone, his brother Gerald Garzone and James McCafferty who ran a funeral and crematory business and who then allowed Michael Mastromarino and his “cutters” to remove body parts such as bones, skin and tendons in an unsanitary embalming room.

There is still question about whether any diseases were transmitted through the tissue.

The men did not admit wrongdoing but have relinquished their licenses.

The grand jury report says some bodies at the funeral homes often sat for days without refrigeration before the tissue was harvested.

No word on the trial date or potential punishment and there are already plans to consider some measures like banning funeral homes from performing tissue recovery, making the theft of body parts a felony crime and requiring all tissue agencies to be licensed by the state.