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Posts Tagged ‘medicine’

1000-year-old-recipeA writer friend posted a blog about Ancient Remedies Resurrected. He blogs mostly to help other writers use medicine correctly in their fictional murders. This particular post discusses the surprising success of a medieval recipe in killing specific troubling antibiotic resistant bacteria.

  • Who would suspect that a thousand-year-old Anglo-Saxon recipe to vanquish an infected eyelash follicle could do that?
  • Who even tried the recipe on something different than its original documented purpose?
  • Why was the recipe still around?
  • Who could read it?

Babylon-recipeThe first two questions are relatively easy. Some ancient remedies actually work. They were created over hundreds or even thousands of years of experimentation in the real world. Many experiments failed, with the expected unpleasantotherresults. Some worked and were passed down orally from “doctor” to “doctor,” often from parent to child. Often the “doctor” was closely associated with the local religion. One recipe for curing fever occurring in the brain is on an eight century BC tablet. The particular poultice is attributed to oral medical lore dating back to around 1860 BC. The tablet itself cites “mythological sages from before the Flood.” It is hard to argue with such authority. Enough of these old recipes work that it is well worth the effort to test them. Government agencies, pharmaceutical companies and universities all spend some effort searching ancient texts and experimenting. Looking at what the recipe does from a scientific viewpoint may point out some other possible uses of the drug.

The last two questions are the really important ones.

The survival of any particular ancient text is more due to luck than good data management. There is so much that can go wrong. The document first of all has to avoid being broken into a thousand pieces, sunk in the middle of the ocean, cleaned and reused, or being damaged by the ravages of nature with floods, fire, mold, or rot. But perhaps the most danger to old documents is man. Opened in the third century BC, the Library of Alexandria was one of the largest and most significant libraries in the world of its time. The library was destroyed, first by Julius Caesar when he conquered Egypt in 30 AD, and finally by Coptic Pope Theophilus in 391. Pope Theophilus was very thorough. Not only did he complete the destruction of the main library, but also a smaller version, the Serapeum, located elsewhere in Alexandria. Perhaps the first recorded case of a backup failure.

Maya-CodexMaybe as significant for the preservation of possible ancient medicinal cures was the destruction of all but four of the thousands of Maya codices by Spanish conquistadors and Catholic priests. Why were they destroyed? According to Bishop Diego de Landa in July 1562, because “they contained nothing but … superstition and lies of the devil.”

Unfortunately, this organized destruction of the past continues to this day as the result of conquest and religious fanaticism.

We recently visited one such ancient document, and it was only 800 years old. If was both surprisingly readable and very hard to read, and it was a language we had some rusty familiarity with. Image the difficulty of even deciphering an ancient text and then determining its meaning. We do not have a Rosetta Stone for most ancient languages. I am referring to the multi-language stone found in Egypt during Napoleon’s conquest, not the language instruction company – although the statement applies to both. Often even the structure of the language as well as the meaning of individual characters or symbols had to be coaxed out of many documents by many people over many years. Only after that can other researchers begin to search for specific snippets of interest, like medical recipes.

In trying to recreate the recipe that began this post, researchers had to figure out what the ingredients really were, and hope that modern garlic is similar enough to 1,000 year old garlic to actually work. In most cases an ancient text will not describe exactly how hot or long to cook something, or even how much of each component was to be used.

As a discussed earlier, it is perhaps as difficult to keep data for the long term in today’s electronic age as it was in ancient times.

The last word:

Save the data, especially if you have no idea what value it might have in the future. Pictures, movies, personal history stories whether written or currently only oral could be important. Talk to older relatives and friends and get their stories saved. Do it now while you still can.

If you save oral recordings, go back and make transcripts that can also be saved. A hundred years from now there may be no one who can understand what was said.

If your family knows a language that is little used, work to preserve it so its oral and written legacy can be saved.

Even mundane business records can have historical value in a distant future. Kyle Harper used ancient purchase records to reinterpret the end of Roman slavery by determining what slaves were eating in Rome around 300 AD. This kind of information can help fill in the gaps about a civilization and the well-being of its people, whether wealthy citizens or slaves.

As I have said before, keeping data on paper only is not the best idea.

Comments solicited.

Keep your sense of humor.

Walt.

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AnthemOnce again a company that we trust with our health and personal information has betrayed that trust. Cybercriminals were able to hack into an Anthem database that contained up to 80 million records of current and former customers and company employees. The information now in the hands of criminals includes names, Social Security numbers, birthdays, postal and email addresses, and employment information including income data.

Anthem stated that no credit card or medical information was compromised, but the information that was stolen is sufficient to launch successful identify theft attacks against every one of the tens of millions of compromised individuals.

Anthem noted the intrusion on January 29, but based on analysis of the cybercriminal infrastructure likely used suggests that the attackers first gained a foothold into Anthem’s servers in April 2014, nine months before Anthem noticed the attack. One link in the chain of establishing the Malware at Anthem went through China. Whether that is a significant fact is unknown at this time. Anthem immediately notified the FBI.

Since admitting the attack, Anthem has been sharing information about the attack including IOCs (indicators of compromise) with HITRUST, the Health Information Trust Alliance, and NH-ISAC, the National Health Information Sharing and Analysis Center. These groups disseminate information about cyber threats to the healthcare industry. So far, these IOCs have not been discovered by other health care organizations. It appears that this attack was focused against Anthem.

Clearly, Anthem is not paying attention to the security of their customers’ data. None of this data was encrypted. Anthem has contracted with Mandiant, a cybersecurity firm, to evaluate their security systems and identify solutions. Seems to me they are a year late with this kind of analysis.

The brands impacted by this breach: Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross and Blue Shield, Amerigroup, Caremore, Unicare, and Healthlink. It can also impact anyone holding a BlueCard. A BlueCard enables members of one Blue Cross / Blue Shield plan to obtain healthcare sevices while traveling or living in another service area. Blue Cross / Blue Shield Federal Employee Programs are also impacted. This information is linked through a single electronic network throughout the US and 200 other countries and territories.

What should you as an individual do if you think you were impacted?

  • You may receive an email apparently from Anthem. These emails are not from Anthem and are scams attempting to get your personal information. Do not click on any link in such an email.
  • You may also receive a phone call apparently from Anthem about the attack. These calls are also not from Anthem. As always, do not give out credit card or Social Security numbers over the phone on any call you did not initiate. Hang up.
  • According to Anthem you should receive a letter in the mail “in the coming weeks.” That letter will advise you of the protection(s) being offered.
  • Take whatever identity theft services they offer.
  • Continue to monitor all of your financial accounts, including mortgage, investment, and loan accounts.
  • Consider putting a security freeze on your credit reports at each of the three reporting companies, Equifax, Experian, and TransUnion. Since most businesses will not open a new account without first checking your credit history, if they can’t access your credit history they are quite likely to deny someone getting credit in your name. It may cost you a few dollars, but it really does stop most identity theft. Availability and cost vary by state. If you want to request credit, you can lift the freeze enough to let a specific request be accepted.

If you are responsible for the personal information of your customers, employees or contractors, how vulnerable are you? You should not guess the answer. Find out, before you become the next Anthem.

Anthem will have some very stiff fines as a result of this breach. Between 2009 and 2013, HIPAA has levied fines of more than $25 million for data breaches. But this attack impacts more than twice as many people as all of the 2009-2013 breaches involving fines combined.

In 2014, Columbia Medical Center was fined $4.8 million for a data reach involving less than 10,000 people.

The last word:

Sometimes personal data is “released” on paper. Hundreds of documents from the Philadelphia Adult Probation and Parole Department were found in early February strewn across several streets in part of Philadelphia. These documents contained names, addresses, birthdates, Social Security numbers and signatures. The best guess as of this writing is that one or more boxes of information fell of a truck on the way to a nearby recycling center. The documents were not shredded.

Comments solicited.

Keep your sense of humor.

Walt.

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I recently wrote about some of the impacts that government regulations around the Affordable Care Act are having on small medical practices. One of those differences has to do with coding. These codes are established by the World Health Organization, part of the United Nations, in a medical classification list called the International Statistical Classification of Diseases and Related Health Problems, usually just called “ICD.” This is really two lists: a list of diagnosis codes and a separate list of procedure codes.

The current set, ICD-9, has about 13,000 diagnosis codes and 3,000 procedure codes. The 30-year old ICD-9 suffers from several problems: it lacks detail, uses generic terms, is based on outdated technology,and has limited capability to add new codes.

The new set, ICD-10, addresses those problems. It provides for up to 68,000 diagnosis codes and 87,000 procedure codes.

In a recent one-week nation-wide test involving over 127,000 claims from 2,600 health care providers, suppliers, billing companies and clearinghouses, only 89% of the claims were accepted without issues. This test involved claims from only about 5% of potential claim submitters, and only included those who agreed to be part of the test and had been working on this conversion for years. After October 1, 2015, claims that do not use ICD-10 or have issues with the ICD-10 codes will not be processed, and claims not processed will not be paid. The official position: physicians are urged to set up a line of credit to mitigate any cash flow interruptions that may occur.

As you can imagine, there are some fairly unusual codes. One that has made the NPR circuit is V91.07: burn due to water-skis on fire. But NPR did not get the story correct. V91.07 is an invalid code; you must use one of the three subservient codes to describe the diagnosis in greater detail:

  • V91.07XA – initial encounter
  • V91.07XD – subsequent encounter
  • V91.07XS — sequela

A “sequela” is a chronic condition that is a complication of an initial event.

Before you scoff at this diagnosis, check out these guys.

For some reason, there are different sets of ICD-10 for different countries, so for those of us who travel to foreign countries, there is likely to be some confusion with your insurance provider and local healthcare facility if you are injured or sick outside your home country.

Many organizations have already been working on this conversion for a few years. There are also lots of companies out there to help medical staffs make the transition. For example, Find-A-Code has search solutions for small practices ($300/year) and larger facilities ($950/year).

Like a lot of things in the Affordable Care Act, the end result of the convesion will be beneficial to patients. Getting there will be a really interesting ride, and will contibute to the loss of small medical practices with potentially a significant negative impact in rural areas.

The real concern will be the significant number of coding errors during the transition. Each diagnosis coding error can lead to health workers adminstering the wrong procedures, especially as patients are shifted between doctors and other care providers in larger medical organizations.

The last word:

Considering the large number of people who have access to your health care information, and the number of breaches in personal health care data, you should be concerned over misuse of your data. Certainly the government will have access. Expect companies, perhaps legally, to offer your health care information to your current or potential employer, and certainly to your insurance providers.

Read carefully the fine print around any job or insurance application you submit. You may be granting them access to all of your medical data as well as your financial data as part of a “background check.” HIPAA actually treats much of your medical information as a valid part of your employment record. This includes anything related to drug testing, Family and Medical Leave Act, Americans with Disabilities Act, Occupational Safety and Health Administration, workers’ compensation records, sick leave or return to work documents, and anything related to a drug or alcohol free workplace.

There are legal restrictions on what a company can access or ask for, but if you say “yes” in a job application all bets are off.

Comments solicited.

Keep your sense of humor.

Walt.

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The entire Health Care industry is impacted by existing legislation requiring the adoption of electronic medical records (EMR). This adoption is absolutely necessary in order to improve patient care, reduce medical accidents, and in the end reduce total cost to provide care. The Cloud is a key enabler, allowing insurance companies, pharmacies, doctors and hospitals to share information about a patient allowing for quicker and more accurate treatment. Getting there can be a very expensive pain, especially for those organizations with only paper-based patient records. These companies are not just moving their existing IT to the Cloud, they are moving to an automated computer-managed environment, actions that most older companies took decades ago, and a phase newer companies never went through at all. Most small rural medical practices fit into the “paper-based” category. In many rural areas, small medical practices with an aging physician are the norm. For them, the move to EMR to meet the current ObamaCare requirements can be a heavy and long-term burden.

These doctors are faced with four choices:

  1. Bite the bullet, and spend tens of thousands of dollars and at least a year to comply. While EMR is a federal mandate, the government provides no financial assistance in the conversation.
  2. Ignore the law and carry on as they have for, in some cases, several decades. In this case the government punishes the doctor by withholding part of their Medicare pay. Most small practices are running fairly close to the edge financially due to ever-increasing malpractice insurance rates, the need for more expensive equipment, and declining insurance payments to the practice.
  3. Merge into a larger regional organization. The larger organization probably has implemented a compliant EMR and will help the small practice migrate. The doctor loses a lot of control over the hours they work, possibly work location, and even patient selection. They become an employee of a large bureaucracy.
  4. Retire.

The Medicare reimbursement penalties are significant. Lose 1% for not having a qualified EMR. Lose another 1.5% for failing to enroll in PQRS, a federally mandated program the collects quality data.

For many doctors, especially those over 50, the last option is the one they are selecting, forcing many rural patients to find a new doctor, often many miles away from where they live and work.

To further complicate the migration to EMR, the government is changing, again, the classification codes used to identify diagnoses and diseases within an EMR and in exchanging data with insurers and government organizations. ICD-10 is required by every medical practice in the US by October 1, 2015. This changes how doctors and other medical staff code everything about patient care. Again, when the conversion is complete nationwide it should improve health care significantly, but the path is not easy and not free to the medical organizations. Several state medical associates and the National Physicians’ Council for Healthcare Policy have urged Congress to delay implementation of ICD-10 for two years. At the same time, other groups are pressing for no more delays citing the cost in time, effort and money as they try to meet disjointed deadlines for multiple federal mandates.

The last word:

The impact on you, your family and your business will depend on where you live and your financial situation. One impact we will all face is, at least over the next few years, is the increased cost of medical care and thus for medical insurance while everyone involved in the medical industry tries to keep up with constantly changing government regulations.

All of this confusion also negatively impacts the security of health care data, making us all more vulnerable.

Comments solicited.

Keep your sense of humor.

Walt.

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(This is another special posting by Suzy. I hope you enjoy it.)

Walt’s Mother has been ill for quite awhile so we have become acquainted with various facets of the health care industry as we’ve learned to care for her changing condition.  The other day we were talking to one of the people we interact with when it dawned on me just how much health care has changed during my life.  Injections, how they are given and for what illnesses, are one aspect that has changed quite a bit.

My mother became a registered nurse at the beginning of World War II when it was a two-year program at Presbyterian Hospital, which then, as now, is associated with the University of Pennsylvania in Philadelphia.  Throughout my growing up I first looked at all the diagrams and black and white photos in her textbooks, and later read much of them.  When she began there were no antibiotics; a nurse owned her own syringes that she sharpened and made sure were cleaned in the autoclave.  Mom described hours of practicing her injection technique with an orange.  Her goal was to slip the needle under the rind in such a way that she didn’t puncture a segment.  She prided herself on sharpening her syringe needles after each use so she would cause as little discomfort as possible.  She admired the ability of a nurse, or corpsman, who could administer an injection without leaving a bruise or sore spot, and taught me to do the same.  Today the needles are disposable and much thinner.  To be “poked” with something of comparable size one needs to have blood drawn or have an IV.

HUP, home of Presby’s nurses training, has always been a forward-looking teaching hospital.  Mom lived their philosophy her entire life.  She believed in the concept of “First, do no harm,” as well as exploring all that was new in medicine.  While in her twenties she contracted what was then called yellow jaundice and we now know as hepatitis.  At the time, penicillin was a brand new miracle drug that doctors wanted to try on many maladies even though they were unsure how large a dose was needed to be effective.  So they suggested to Mom a course of injections coming every four hours.  The song “Five-foot two, Eyes of Blue” described my mother, so she soon had more penicillin than her body could absorb.  She said that it got to the point where she felt like a pincushion and that as the nurse would push the serum in the new entry point some would exit a previous injection sight.  She recovered rapidly and always credited the treatment with preventing her from contracting colds for the rest of her life.

One of the critical health problems in the first half of the twentieth century was poliomyelitis.  This had caused Franklin Roosevelt’s paralysis.  Most of us knew at least one child in our class who walked with the characteristic limp of those who were fortunate enough to recover from the virus.  Frequently, that person would “disappear” all summer for a follow-up operation.  Military and their dependents are an ideal sample group for medical tests because they can be tracked.  So when Dr. Jonas Salk wanted to begin field trials inoculating children with anti-polio vaccine Mom saw that I was in one of the first groups.  We were living in San Diego at the time.  I can remember being driven to a near-by high school where large numbers of us were to get our “shot.”  As I was in elementary school, being on a high school campus was exciting, getting an inoculation not so much so.  It became even less exciting when I learned that it was a three-dose vaccination.  Mom was a firm believer in vaccinations against various diseases so I had had many shots by then.  The first injection was interesting because it was my first experience with an inoculation air gun, a wonderful device that eliminated needles.  The second was an annoying interruption to my play.  The morning after the second shot I woke up thinking my back was breaking.  Then I really began to panic when I couldn’t inhale.  I had a fever and ached all over.  Dr. Salk’s vaccine was to have been manufactured with dead virus.  The batch I had gotten had had some live virus in it.  Dad, of course, was on a carrier somewhere in the Pacific Ocean.   So Mom had to take care of business on her own.  She rolled me in the blankets on my bed and put me across the back seat of the car.  She couldn’t leave my baby brother by himself and didn’t want to take the time to find a neighbor so she put him in the front seat.  This was all wrong all around.  I am not a good patient.  I detest being sick.  I was the eldest by six years.  If anyone should have been in the front seat it was me.  I didn’t even have the breath to protest.  Mom drove across Claremont Mesa, down the hill to Pacific Highway, around the bay to the foot of Broadway and the ferry across to Coronado and the Naval Hospital on North Island.  After we saw the doctor I felt Mom begin to relax.  I felt let down.  After all the excitement all I got was some cough syrup that was cherry flavored with a horribly strong, bitter after taste.  Turns out I only had lumbar pneumonia, not polio.  I don’t remember getting the third injection, but I believe Mom followed through after I got over the pneumonia.

She didn’t give up on polio vaccines.  When I was in high school and my brother was in elementary we were living in Naples, Italy.  The Navy medical wing decided that all dependent minors would take Dr. Sabin’s oral version.  It was a pink liquid dropped on sugar cubes that we both got.  Those administering it told us we would enjoy the sugar cubes.  It had a bit of a bitter after taste as well.

In the early 60’s when we were living in Naples, a person wasn’t allowed back into the US if their smallpox vaccine was more than six months old.  There were still epidemics of smallpox, especially in Africa, which had a lot of economic contact with Southern Europe.  Since Dad’s orders were usually for early fall travel, we all got vaccinated every summer we were overseas.  At that point our government was also vigilant about those visiting, or in our case living, in areas that had cases of typhoid, typhus, cholera and a couple of others.  I filled more than one little yellow injection record card with all the initial series and boosters.  During the time we were in Naples there was an especially virulent epidemic in Ethiopia that spread across Northern Africa.  The air gun to be used in mass inoculation settings was very popular.  Navy corpsman were to be sent to the affected areas in an attempt to halt the spread of whichever disease it was.  Before they were deployed they were to inoculate all Americans in the Neapolitan area. However, as with any tool, the operator needs to know how to use it.  The air power behind the “shooting” of the serum is a setting.  The corpsman at one table had left his set for grown men and the first undersize child, rather than having a mist pushed through the skin, lost some of his skin.  It was somewhat painful as the kid yelled loudly enough to get everyone’s attention, and it was messy.  They told us that it wasn’t serious nor permanently disfiguring.  I don’t hear anything about inoculation air guns anymore.  I sometimes wonder what happened to them.

As our sons were growing I saw that they got all of the vaccines scheduled for children at that time.  By then, small pox vaccinations were no longer necessary, as the virus only existed in a few labs.  Their polio shots were given when they were babies.  In the few places in our world where it still exists polio, or the program to vaccinate against it, is more a political issue than a health one.  When they were given their MMR vaccines against measles it was thought to be a lifelong protection.  However while they were in school a measles breakout occurred in the San Diego area and boosters were given.  That, in part, is due to parents who do not have their children vaccinated because they fear a bad outcome.  This is a truly sad thing as it not only leaves their children susceptible to whichever disease they choose not to prevent, but they also turn their children into possible disease vectors for any other people these children come in contact with.

Now as Walt and I are ageing we are back into getting vaccines.  We get our flu shots every year.  We keep our pneumonia vaccines up to date, and, yes, we have had our anti-shingles virus vaccines.

I really appreciate preventative medicine and its ability to eradicate various strains of disease.  I hate to be sick.

The last word:

One of the side effects of age is that I get to have blood work done every 6-9 months.  Since I need to fast for 12 hours prior to the “donation,” I get the blood drawn when the lab first opens at 7 AM.  Any day that starts with the poke of a sharp stick can only get better.

200px-Ped-O-Jet-TearyChild-cropIn the 1920s, diesel engines were being made in large quantities, and one risk when working on them was accidental injection by the fuel injectors.  In 1960, Aaron Ismach invented and patented the Jet Injector Gun, probably the gun Suzy experienced.  There was both an electric powered version and, for remote operation, a foot-powered injection gun.  In 1976, the air gun was instrumental in eradicating smallpox in Africa and Asia.  However, sometimes the injection process dislodged infected matter from a patient onto the nozzle thus risking cross-infection.  In 1997 the US Department of Defense, the largest user of injection guns, announced it would no longer use them due to those concerns.

Comments solicited.

Keep your sense of humor.

Walt.

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