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<item rdf:about="http://www.docnotes.com/2011/12/12-years-of-bloggin-about-medicine-technology-and-the-intersection.html">
<title>12 years of blogging .. about medicine, technology and their intersection ...</title>
<link>http://www.docnotes.com/2011/12/12-years-of-bloggin-about-medicine-technology-and-the-intersection.html</link>
<description><![CDATA[This post from November 26th, 1999 - was the first on this blog. There were a few months of previous posts, but due to several platform changes back then - these seem to be lost. No matter. 12 years is...]]></description>
</item>

<item rdf:about="http://www.docnotes.com/2011/10/on-platforms-.html">
<title>On Platforms .. </title>
<link>http://www.docnotes.com/2011/10/on-platforms-.html</link>
<description><![CDATA[This is one of the best essays on software product definition/ direction etc. that I've read in a very long time.]]></description>
</item>

<item rdf:about="http://www.docnotes.com/2011/09/prevent-spam-marathon-fundraising.html">
<title>PREVENT SPAM! - Marathon Fundraising</title>
<link>http://www.docnotes.com/2011/09/prevent-spam-marathon-fundraising.html</link>
<description><![CDATA[I'm sending out the following e-mail to my friends and family on Monday. You can prevent this spam .. (I'm learning from Public Radio!) .. but only if you make a generous donation TODAY! Don't put it off! .. -----------...]]></description>
</item>

<item rdf:about="http://www.docnotes.com/2011/08/oesh-running-shoe-review.html">
<title>Oesh Running Shoe Review</title>
<link>http://www.docnotes.com/2011/08/oesh-running-shoe-review.html</link>
<description><![CDATA[Oesh (shoe spelled sideways and backwards) had gotten some good press lately. I've read a handful of Casey Kerrigan's papers on gait and movement - so my interest was piqued when I learned that she and her husband had created...]]></description>
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<item rdf:about="http://www.docnotes.com/2011/08/google.html">
<title>Google+</title>
<link>http://www.docnotes.com/2011/08/google.html</link>
<description><![CDATA[So I'm trying out google+ for blog posting today. Today's post]]></description>
</item>

<item rdf:about="http://www.docnotes.com/2011/07/health-it-workforce-curriculum-initial-impression-c.html">
<title>Health IT Workforce Curriculum - initial impression</title>
<link>http://www.docnotes.com/2011/07/health-it-workforce-curriculum-initial-impression-c.html</link>
<description><![CDATA[I've spent a number of hours today reviewing the ONC HIT Workforce Curriculum materials, and since I've seen many tweets referencing them .. I've seen little substantive narrative on their value - so I'll offer a bit here - with...]]></description>
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<item rdf:about="http://www.docnotes.com/2011/07/compliance.html">
<title>&#x22;compliance&#x22;</title>
<link>http://www.docnotes.com/2011/07/compliance.html</link>
<description><![CDATA[This post on the-blog-that-used-to-be-kevin's-blog (alas, Kevin Pho writes rather few posts these days) ... is accurate, but I wish that the medical community was saying the same thing. In general - we are not. Patients who have guts will say...]]></description>
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<item rdf:about="http://www.docnotes.com/2011/06/google-health-was-a-dumb-idea-anyway-.html">
<title>Google Health Was a Dumb Idea Anyway ...</title>
<link>http://www.docnotes.com/2011/06/google-health-was-a-dumb-idea-anyway-.html</link>
<description><![CDATA[It's been nearly a week since the big announcement and I've read a herd of thoughtful reviews of why google decided to shutter their health experiment. But I've not yet seen anyone say what was obvious from the outset: It...]]></description>
</item>

<item rdf:about="http://www.docnotes.com/2011/06/health-it-tweeting-blogging.html">
<title>Health IT Tweeting &#x26; Blogging</title>
<link>http://www.docnotes.com/2011/06/health-it-tweeting-blogging.html</link>
<description><![CDATA[I've been blogging for a very long time. Tweeting since before Twitter had an "e" .. (it was called twittr) .. Blogging since Blogger was just a little feature of a long-dead product called Pyra. Raise your hand if you...]]></description>
</item>

<item rdf:about="http://www.docnotes.com/2011/06/inbox-management-the-healthcare-version-1.html">
<title>Inbox Management:  The Healthcare Version</title>
<link>http://www.docnotes.com/2011/06/inbox-management-the-healthcare-version-1.html</link>
<description><![CDATA[Mitch Joel's posting: "5 Ways to survive your inbox" describes a set of habits one might use to maintain control: Create folders. Create rules. Get it done. Create a hierarchy of response. Tell people - in your emails - how...]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2008/01/years-end-blogs-end-ive-been-making-my.html">
<title></title>
<link>http://medpundit.blogspot.com/2008/01/years-end-blogs-end-ive-been-making-my.html</link>
<description><![CDATA[Year's End, Blog's End: I've been making my annual year end inventory - deciding what to keep and what to toss. It's become obvious in the past several months that this blog is one of the things that it's time to toss. This will be the last post for Medpundit.  Truly.  Wishing you all the best in 2008 and the years beyond.Click to enlarge]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2007/11/pilgrim-medicine.html">
<title>Pilgrim Medicine</title>
<link>http://medpundit.blogspot.com/2007/11/pilgrim-medicine.html</link>
<description><![CDATA[Thanksgiving Remembrance: Mayflower Medicine.]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2007/11/genetic-prejudice.html">
<title>Genetic Prejudice</title>
<link>http://medpundit.blogspot.com/2007/11/genetic-prejudice.html</link>
<description><![CDATA[Any Excuse Will Do: Any excuse to justifying prejudice, or to stir up fear mongering of what may come: At the same time, genetic information is slipping out of the laboratory and into everyday life, carrying with it the inescapable message that people of different races have different DNA. Ancestry tests tell customers what percentage of their genes are from Asia, Europe, Africa and the Americas. The heart-disease drug BiDil is marketed exclusively to African-Americans, who seem genetically predisposed to respond to it. Jews are offered prenatal tests for genetic disorders rarely found in other ethnic groups.Such developments are providing some of the first tangible benefits of the genetic revolution. Yet some social critics fear they may also be giving long-discredited racial prejudices a new potency. The notion that race is more than skin deep, they fear, could undermine principles of equal treatment and opportunity that have relied on the presumption that we are all fundamentally equal."We are living through an era of the ascendance of biology, and we have to be very careful," said Henry Louis Gates Jr., director of the W. E. B. Du Bois Institute for African and African American Research at Harvard University. "We will all be walking a fine line between using biology and allowing it to be abused."We have been living in an era of ascendant biology since Darwin. Remember eugenics? Jews have been offered prenatal testing long before the mapping of the human genome, as have African-Americans. But prenatal screening is not quite the same as the eugenics movement heyday. So why the hyperventilating? It turns out that the Times is taking its cue from blogs commenting on studies studies like this. Well, if the blogs say that genetics justifies prejudice, it must be true! I never thought I would see the day that the New York Times took that attitude on its front pages. It must be part of their plan to join the internet age. Here's the part that's gotten the Times convinced that genetics is going to bring back the days of institutionalized prejudice:There exists a publicly available gene database, The HapMap Project, that contains random samples of genetic sequences from people in China, Japan, Nigeria, and people in the United States with European ancestry. It’s now possible to search the HapMap database for genes that have been linked with intelligence in published scientific studies. In this manner, we can determine if high intelligence genes occur with greater or lesser frequency in the various races.Now, here’s an interesting point. If even a single gene correlated with intelligence occurs with different frequencies in the different races, this alone proves that there are racial differences in intelligence. How is that? Well, the egalitarian theory holds that every race has identical intelligence. Therefore, whatever genes there are that affect intelligence, they must be distributed exactly equally in all human races. Once even a small race difference is proven, the egalitarian theory is proven false. At that point, it’s only a matter of determining which race has the higher average intelligence based on the genetic evidence.Oh, please. Here's a take home lesson for everyone on the science of genetics, and one that should never be forgotten - these studies are about associations of genes with traits, not the concrete coding of a trait by a given gene. Just because a locus on a chromosome can be found more often in people with schizophrenia than in the general population doesn't mean that everyone with that genetic code in that spot will have schizophrenia, anymore than it means that every sibling of a schizophrenic will have the disease. Ditto with intelligence. Ditto, too, with cancer risks and most other traits and diseases human genome mapping is linking to genes. The essence of a man is not written into his DNA. Here's another important point to remember - our science is still young and uncertain:These genomewide association studies have been able to examine interpatient differences in inherited genetic variability at an unprecedented level of resolution, thanks to the development of microarrays, or chips, capable of assessing more than 500,000 single-nucleotide polymorphisms (SNPs) in a single sample. This "SNP-chip" technology capitalizes on a catalogue of common human genetic variations that is provided by the HapMap Project, which was made possible by the completion of the consensus human-genome sequence.......The main problem with this strategy is that, because of the high cost of SNP chips, most studies are somewhat constrained in terms of the number of samples and thus have limited power to generate P values as small as 10–7. In addition, most variants identified recently have been associated with modest relative risks (e.g., 1.3 for heterozygotes and 1.6 for homozygotes), and many true associations are not likely to exceed P values as extreme as 10–7 in an initial study. On the other hand, a "statistically significant" finding in an underpowered study is more likely to be a false positive result due to chance than is such a finding in an adequately powered study, and "statistically significant" associations could be attributable to systematic bias (e.g., from confounding due to ethnic ancestry, also known as population stratification). Thus, the sine qua non for belief in any specific result from a genomewide association study is not the strength of the P value in the initial study, but the consistency and strength of the association across one or more large-scale replication studies. Robust replication should permit the identification of true positive results and the weeding out of false positive results.In other words, take these genome studies that link intelligence and race just as about as seriously as you would take studies linking intelligence to sex, or that predict elections with brain scans.UPDATE: Best of the Web draws an important distinction:Note that "the presumption that we are all fundamentally equal" is quite different from the notion "that all races are equal." The former is a moral principle, a premise about the basic dignity of every individual; the latter is an empirical presumption about group averages in measurable traits. Someone with an IQ of 80 is as human as someone with an IQ of 120; and this is so regardless of whether the average IQ of one race is different from that of another.What worries people like those in the Times story is that racial differences in IQ or other traits seem to lend empirical support to racist theories. But those theories are qualitatively wrong, so that no empirical evidence could make them right. If all individuals are of equal dignity and worth regardless of IQ, then a group is not fundamentally superior or inferior to another group by virtue of differences in average IQ.It seems that some very smart people mistakenly think that intelligence is a measure of fundamental worth. Maybe they're a little too impressed with their own brilliance.]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2007/11/in-remembrance-winged-victory-veterans.html">
<title>Veteran&#x27;s Day Remembrance</title>
<link>http://medpundit.blogspot.com/2007/11/in-remembrance-winged-victory-veterans.html</link>
<description><![CDATA[In Remembrance: Winged VictoryVeteran's Day movie recommendation - Wooden Crosses.Veteran's Day medical reading - the influence of World War I on heart surgery.]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2007/11/word-about-mrsa.html">
<title>A Word About MRSA</title>
<link>http://medpundit.blogspot.com/2007/11/word-about-mrsa.html</link>
<description><![CDATA[A Word About MRSA: I've been fielding a lot of doorknob questions about MRSA lately. (Doorknob questions= questions thrown out just as my hand reaches the doorknob to leave the room.) Little wonder. It's been in the news again and again, and has even prompted the closing of schools and cancelling of football games. Despite what some editorialists say, it is being framed as a threat to our children. Here's an example of the typical coverage: A 16-year-old Springfield High School junior remained in serious condition Friday in the intensive-care unit of Akron Children's Hospital with a drug-resistant staph infection.  Michael Forester of Lakemore was hospitalized Oct. 24 and was to undergo surgery Friday, said his mother, Mary Baxter.  "The more prayers I can get, the better," Baxter said Friday at the hospital.  On Wednesday, Springfield School Superintendent William Stauffer, in a letter sent to parents, acknowledged that a student had become ill and was admitted to the hospital.  The superintendent said rumors that the student has a contagious disease that puts other students at risk and that the high school has an ongoing problem with staph infections are not true.  Stauffer could not be reached for comment Friday.What is this MRSA? A better question might be "What is SA"? The "SA" in MRSA is Staphylococcus aureus, a bacteria that resides in our nasal passages and skin. That is its habitat. Normally, it causes us no problem, but if conditions are right, it can make us quite ill. It's often the culprit behind boils and styes and cellulitis and urinary tract infections. It can also cause more serious infections such as pneumonia (as in the case of the young man in the linked to article above), meningitis, sepsis, endocartditis, and osteomyelitis. It is one of the most common causes of sepsis. Penicillin conquered Staph infections for a little while, but the bacteria acquired resistance within a few years of the antibiotic's introduction. When penicillin became widely used in the community, the population of Staph aureus living in noses and on skin shifted toward those containing an enzyme that could cut the betalactam ring on penicillin, rendering it ineffective.  New antibiotics were developed to get around this. One of those antibiotics was methicillin, which brings us to the "MR" part of "MRSA". We don't use methicillin any longer. We use drugs like Augmentin instead. But, when we say that a Staph aureus infection is "methicillin resistant" we mean that it's resistant to all penicillins, even those that were developed to get around the betalactam-eating defenses of the Staph aureus population. This doesn't mean that it's resistant to all antibiotics, however, just the ones that we typically use for a Staph infections. In the hospital, we often use vancomycin for MRSA infections. In the outpatient setting, we use drugs like Bactrim and clindamycin. In most cases, the infections respond nicely to these drugs. There is, however, concern that the bacteria may one day develop resistance to these, too, as we use them more to treat the growing resistant population of Staph. So here are the take home points about MRSA:1) It isn't running amok in our schools like the blob or killer tomatoes. It's living on our skin and nasal passages just as it always has before it developed resistance to penicillin and its cousins.2) One of the reasons bacteria acquire resistance is because we expose them to antibiotics when we don't need to. Don't insist on an antibiotic for every runny nose, even if the snot is yellow. And don't insist on one of the special antibiotics for MRSA for every pimple or pustule or red scratch. If we overuse our remaining effective antibiotics, we'll only end up with a population of Staph aureus that is resistant to those, too.3) Don't freak out if you or your child develops a skin infection. Most staph infections are easily treatable. Even most MRSA infections are easily treatable.4) When you read the newspaper, always remember that they lean to the dramatic in all things. It makes for more entertaining reading.]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2007/11/trusty-dentist.html">
<title>Trusty Dentist</title>
<link>http://medpundit.blogspot.com/2007/11/trusty-dentist.html</link>
<description><![CDATA[Trusty Dentist: Not so trusty with music and a drill.]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2007/11/all-saints-medical.html">
<title>All Saints Medical</title>
<link>http://medpundit.blogspot.com/2007/11/all-saints-medical.html</link>
<description><![CDATA[All Saints' Day: A list of medical saints - albeit an incomplete one.]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2007/11/lipo-etching.html">
<title>Lipo-Etching</title>
<link>http://medpundit.blogspot.com/2007/11/lipo-etching.html</link>
<description><![CDATA[Forever Young, Forever Firm: Lipo-etching- maybe not all it's cracked up to be.]]></description>
</item>

<item rdf:about="http://medpundit.blogspot.com/2007/11/statistics-politics-and-medicine.html">
<title>Statistics, Politics, and Medicine</title>
<link>http://medpundit.blogspot.com/2007/11/statistics-politics-and-medicine.html</link>
<description><![CDATA[Lies, Damned Lies, and, Well, You Know: The New York Times is parsing Rudy Guiliani's prostate cancer statitistics:"I had prostate cancer five, six years ago," Mr. Giuliani, a Republican presidential candidate, said in a speech that has been turned into the radio commercial. "My chance of surviving prostate cancer — and, thank God, I was cured of it — in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44 percent under socialized medicine.".... The Office for National Statistics in Britain says the five-year survival rate from prostate cancer there is 74.4 percent. And doctors also say it is unfair to compare prostate cancer statistics in Britain with those in the United States because in the United States the cancer is more likely to be diagnosed in its early stages."Certainly, if you intensively screen for prostate cancer, you will find early disease,” said Dr. Ian M. Thompson, chairman of the department of urology at the University of Texas at San Antonio. "And simply because you find it earlier, you will always have longer survival after the disease is diagnosed."One reason that prostate cancer is diagnosed earlier in the United States than in Britain is that they don't screen for it at all in Britain - at least not at the expense of the NHS. (Which is one of the reasons they spend less on healthcare than the United States. They don't indulge in as much screening as we do.) At any rate, his statistics don't appear to be all that far off the mark, at least for men in their 80's. But even the NHS admits that prostate cancer survival is increasing because more people are starting to have their PSA checked - meaning that slow growing early cancers are being added to the mix, just as happens here in the US. As it happens, even back in 2002, the five year survival rate for prostate cancer in the US was 99% - still a much better figure than the UK's 71%. But, as the astute bloggers point out, prostate cancer isn't the best example of the benefits of screening. Prostate cancer is, in most cases, slow growing - and although our screening policies detect many early cancers that would never do harm if left undetected, we also end up spending a lot more money treating these same cancers. When given the choice between watchful waiting and removal, many choose removal. (Another reason why we end up spending more and
