B'SD


4 Cheshvan 5772








I was delighted to click on one of my Facebook pages today to see this praise from a newer reader of EMPOWER Yourself, another medical professional who has communicated her personal appreciation of the book to  me in the past:







Face Your Medical Problems with Dignity.
Face Your Future with Optimism.

Halloween...probably one of the "craziest" times of the year between parties, costumes, haunted houses, movies, and trick or treating.  However, I attended the 6th Homestead Horror Halloween Party at the Pratt Manor over the weekend.  Mr. Glenn Pratt has been throwing the best theme parties since we were 15 years old and here we are 9 years later and he still has the gusto to put together an awesome Halloween party (this year's theme - The Nightmare Before Christmas).  

Hey Guys :D
Happy halloween! Or Hallow's eve if you will. Time to dress up and scare little children. Fun stuff right there, folks. Oh, and free candy.
So guess what tomarrow is.
November 1st.
I guess that doesn't really mean a lot for a lot of people, but for me, it's the start of the month of insane writing, also known as Nano Wri Mo, where you write 50,000 words, or basically it's a whole novel. So yeah. I think I could do this.
So I guess that means I wouldn't be blogging for a while...so I guess this is goodbye for a while blogger, but I'll try my best to write on here as much as I can during the month.
Here's my nano wri mo profile:
http://www.nanowrimo.org/en/participants/nattbarletta
Come see my progress and stuff! 
Yeah...
Or not.

Happy Halloween! The FEHBlog missed the regular weekend update yesterday as he was travelling back from New York City. The FEHBlog will be back on track this weekend.

We are now 18 days from the end of the current continuing resolution funding the federal government and 23 days from the due date for the Super Committee's deficit reduction recommendations to Congress.

Both the House and the

Halloween is upon you. Feel it creeping up your leg, and nibbling your itty-bits. The cold chill of evil penetrates pulses through your bloodstream. There is no escaping the terror of the night.


In other news, Misfits tribute band; "Return Of The Fly" made their debut appearance at The Rota Studios and Gallery at 19 Clinton Street in downtown Plattsburgh.

For their debut appearance at The Rota Studios And Gallery, Return Of The Fly dressed as women. The crowd was immediately aroused, but suddenly confused when they realized that the treat came with a trick.

Aggressive dancing was inevitable.

No persons were hurt, although the band was spit on several times by a rowdy/angry fan.

By Amanda MacMillan

Psoriatic arthritis, a type of arthritis that affects people with the skin condition psoriasis, can attack the joints and tendons.

About 22% of people with psoriasis who have not been diagnosed with psoriatic arthritis appear to have symptoms of the condition, such as joint pain, swelling, and warmth, according to a 2011 survey by the National Psoriasis Foundation (NPF).

For the full article please go here.

B'SD


3 Cheshvan 5772



 Want to know what I do in my spare time? These days I'm having fun praticing with some neighborhood women for the GLOBAL flashmob dance to benefit World Diabetes Day and the diabetics who need cures!


Hang on to your hats, we'll be whirling around the world with other supporters of the cause on November 14th (keep your TV and PC on to find me in the crowd).







Need to cope with diabetes or some other chronic medical situation? Find simple solutions in EMPOWER Yourself to Cope with a Medical Challenge.




Face Your Medical Problems with Dignity.
Face Your Future with Optimism.

Lately, I've been thinking about how one can be happy, and I've come up with one conclusion. Happiness is stuffed snoopies.
I can explain that.
In life, things are way too complicated. Like we need all of the designer things and the big things to make us happy, alongs with big things that makes us sad. So, I guess maybe little things such as snoopy stuffed animals ( I mean really, how can you not like a dancing beagle? Like seriously, he's sooooo freaking cute. I mean he can cook, dance, fly an airplane, write a novel, and fly an airplane) Snoopy is like a boss. It's just so damn cute to see. That, and the one that I just bought is sitting right next to me. He's a World War One Flying Ace. I swear thats the best part of the show.
I guess maybe cartoon beagles are just that awesome.
Maybe we need to watch more dancing beagles to be happy.

Ever feel so sad that you feel like no one is there to hear you cry, no one is there for you to hear you scream, or to help you up once you have fallen?
Yeah that has happened to me. Like for the past week.
Ever feel like everyone is barking at you to do something, like demanding something of you that you can't give, something that helps you become weaker and weaker, until the point you want to snap.
Yeah that sounds about right.
I feel like no one's listening to me.
Or caring.
I understand that people have lives, and want to live them. I just wish that they would, if they can be able to make me feel better. I try to pick myself up, but when I feel lonely, it would be nice if you could answer your phone. I never felt this weak, I never felt like I couldn't move on from day to day.
I hate it when people say that they want to be your friend, but then talk crap about you and tell you what to do. You aren't the fucking boss, you stupid bitch.
I wish someone could help me out of this hole.
Because I need help.
Like a lot of it.

Continuing my blogging post-conference for the American Society of Law, Medicine and Ethics, "Conflicts of Interest in the Practice of Medicine" (see previous post for link), two tidbits on the medical device industry. Two speakers addressed this topic, Dr. Rita Redberg, UCSF cardiologist and editor of Archives of Internal Medicine with its splendid "Less is More" feature, and Kelly Dineen, JD, St. Louis U law school. (Dr. Redberg was co-author of the excellent New England Journal commentary on the recent IOM report on FDA regulation of medical devices: http://brodyhooked.blogspot.com/2011/08/more-on-iom-report-on-fda-scrutiny-of.html.) I'm reporting my own impressions based on what they said, so don't blame them for what follows.

First, there was much discussion at the conference of the recent New York Times expose of the role of venture capitalists in lobbying against stricter FDA regs on devices, which is what the IOM recommended:
http://www.nytimes.com/2011/10/26/business/venture-capitalists-join-push-to-ease-fda-rules-for-medical-device-industry.html?scp=6&sq=health%20law&st=cse

The general comment was that it is notable how the device industry, and the venture capitalists that seek to profit off devices, have really taken the gloves off and come out swinging against the IOM and the scientific community generally. Dr. Redberg reported testifying on Capitol Hill and encountering Congressional committees that had been captivated by a device-industry-funded report that slammed "unnecessary" government regulation and threatened job losses of the FDA tightened its rules, and did not want to address patient safety or effectiveness at all. Apparently all patient concerns must give way before the almighty dollar.

Second, Ms. Dineen described in some detail the role of medical device reps in one area of medicine, neurosurgeons who specialize in implanting devices that give electrical signals to nerves (neuromodulation) for a variety of conditions. I have previously been fairly sympathetic to the difference between device reps and drug reps, based on the argument that devices need hands-on technical expertise that sometimes requires trained company reps to be in the operating room or at the bedside to advise the doc on how best to adjust the device. Ms. Dineen revealed an important qualifier I had not been aware of.

As I took her point, implanted neuromodulation device reps are functioning as basically unpaid labor for the neurosurgeons--a substantial company-funded subsidy for their practices. With device reps being ubiquitous, surgeons can turn to them for all the technical parts of the device, leaving their own role simply that of making the incision and sticking the device in. How the device is programmed to do its work, and what to do if something goes wrong later, can all be delegated to the company rep, who's more than eager to oblige, in exchange for the neurosurgeon's devotion to that company and its expensive products. In everyday practice the neurosurgeon can even "supervise" what the rep does (often from a considerable distance) and then proceed to bill hundreds of bucks for the visit. Now, the surgeons could take a course and learn how to do this programming function for themselves; or they could hire their own technicians to become part of their office and OR staff and do it for them. But why spend that time or money when the device company is eager to supply the reps for free?

End results: patients are cared for by staff who have the company's rather than the patient's interests at heart; neurosurgeons make more money for less work; and the device gravy train keeps rolling. Must keep those venture capitalists happy, after all.

The take-home message is that once again in medical devices, things are not as they seem. The "need "for hands-on assistance with the device, that justifies reps running free range through the hospital and clinic, may be more manufactured than real.

I'm in Pittsburgh just having attended the conference, "Conflicts of Interest in the Practice of Medicine," sponsored by the American Society of Law, Medicine and Ethics, which you can read all about at: www.aslme.org/2011COIconference
ASLME also plans to publish all the papers from the conference in its journal.

So what's new in the field? The quick answer for regular readers of this blog is, apparently not much. There were few new issues and virtually no possible solutions raised that have not already been discussed here and elsewhere. The presentations were nevertheless interesting and the interplay between the legal and medical viewpoints was illuminating. I have listed a few capsules below of possible interest and will do at least one more post on a particular issue.

>>The conference began with the usual ceremony of the highly placed official welcoming everyone, and in this case it was the Dean of the Pitt School of Law. She began by saying that COI is "almost impossible to eliminate" and that the conference would address the "challenge of managing" COI. At that point I was getting worried that we were going to hear a rehash of really old ideas. Fortunately the subsequent sessions all paid appropriate attention to the desirability of eliminating and not merely managing COI.

>>Christopher Robertson, JD, PhD of U-Arizona law school was given the task if laying out the evidence for the seriousness of COI in medicine. He began by reviewing the evidence relating to physician self-referral (e.g., sending patients to the imaging center that the physicians' group owns instead of to get their scans at the local hospital x-ray dept.) and said what we all know, that evidence shows that the rate of ordering tests and procedures jumps astronomically with self-referral. I had generally not thought to connect the self-referral data to issues of COI at the medicine-Pharma interface. But I think Robertson raised a good point. Physicians commonly deny that they overorder tests and insist that when they send patients to the testing center they profit from, that either the patient benefits greatly from the test, or they have saved the patient a trip across town or to another city, etc. So we have clear evidence that 1) money changes physician behavior (duh) and that 2) physicians commonly rationalize that association away. I think one can reasonably argue that such is presumptively relevant to other money-laden relationships, until proven otherwise.

>>Bernard Lo MD from UCSF, a chair of the IOM panel that wrote their report on COI in medicine, was first to raise this issue but it was echoed by other speakers. As we enter the era of heightened, required disclosure, many physicians fear the liability of multiple, perhaps inconsistent disclosures, as different forms and bodies have different rules (such as whether to report relationships for the past 2 years or 5 years or whatever), and then providing fodder to investigative journalists who can check out all these disclosures on line and play "gotcha" with any inconsistencies that are revealed. Now the extreme pharmascold might say, so much the better, yet another good reason to divest oneself from these conflicted relationships. But the point the speakers made seemed very reasonable, that it would be far superior to have a single, uniform and common disclosure process so that each individual had to disclose in one place only for all purposes.

>>One of the most appreciated speakers was Sunita Sah, MD, PhD of Duke, who has co-authored several well-designed studies of how disclosure practices might impact physicians and patients. During the Q&A the point emerged of how reluctant patients are to appear to criticize their own physician's COI, assuming the relationship to have been established before the COI becomes known. Some studies that are cited to show that COI is no big deal for patients and does not decrease their trust are studies in which patients are basically asked about their own physician's COI. A fairer study design would be to get patients to imagine that they are seeking a new physician, and can choose among several physicians on a panel, some of whom are disclosed to have COI. The outcome of interest would be how willing patients are to select the physicians with COI, and at least some preliminary data, I understand, would suggest that they'd be less likely to select those docs.

>>A couple of speakers commented on the recent pullback at NIH in backing off proposed COI policies, that would have required academic medical centers to post faculty COI on accessible websites (http://brodyhooked.blogspot.com/2011/08/nih-conflict-of-interest-rules-weakened.html) Blame was placed on the White House, feeling under fire to do something about the supposedly out-of-control government regulations that the Republicans are raising Cain (no pun intended) about. The timing was bad; the time that the NIH stringent guidelines would have gone into effect was precisely the moment that the White House decided they had to make a show to scaling back on regulatory load.

Govexec.com reports on the improvements to disease management and wellness programs that FEHBP expert Walton Francis is finding in the 2012 benefit packages of FEHBP plans. As mentioned in the FEHBlog earlier this week, OPM has posted information about those benefit packages on its website. Of course you can find more information on the individual plan websites.

The FEHBlog has been following

Implementing the latest health IT is a challenge in and of itself, but having a competent team makes it that much easier. Fred Pennic, senior advisor with Aspen Advisors and author of the blog Healthcare IT Consultant, suggests five ways to attract the best health IT employees.

1. Having a strong employer brand and culture. According to Pennic, top IT prospects are attracted to companies with a well-established and respected brand that also coincides with their own personal brand. "Employers must continue to establish and/or maintain a strong brand that will attract the best HIT talent,” he said.

For the full article please go here.

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CMS announced the Medicare Part B premium amounts today. The premium that most Medicare Part B beneficiaries will owe is $99.90 per month. The details for recent enrollees and high income enrollees are available here. That's about a 3% increase over 2011 which is in line with the S&P health care index for Medicare payments that the FEHBlog tracks.

This information is very relevant to FEHB plans

Certain vitamins besides minerals presume true been break ground healthful prominence lowering garnet muzzle besides thus right in the design of diabetes.

Vitamin B complex - Vitamins of the B concentrate are toward in the diagram of diabetes. Despite also direct intake of these vitamins, diabetics generally be credulous abnormally trifling amounts of vitamin B pull their wine for of high urinary dying of testify to symptoms of vitamin B dearth. native clinical evolvement has been reported predominance patients of diabetes cloak singular 16000 units of daily supplements of vitamin B shape. for these vitamins succour decrease cerise stuffed and cholesterol, they should equal generously supplied at whole-hog times.

Thiamine or Vitamin B1 - Of the altered vitamins of the B group, thiamine or vitamin B1 again pyridoxine or vitamin B6 is of characteristic concernment significance diabetes. Diabetic cooking minimal in vitamin B1, regularly leads to the upping of neuritis, which is pleased thanks to soon seeing upraised amounts of this vitamin are inured. Vitamin B1 is said to stand for particularly valuable leadership preventing suppress to the imagination during diabetic acidosis. The worthier the insulin requirement, the above is the the urge owing to vitamin B1, pantothenic pungent or vitamin B5 and biotin or vitamin B8.

The cardinal monotonous vegetable sources of thiamine are wheat germ, brewer’s yeast, the outer layers of rice, wheat and individual unitary estimation cereals, pulses, nuts, peas, lime, legumes, obscure green verdant vegetables, banana and apple. Those of pantothenic acid are wheat germ, undiminished emotions bread, sprouting vegetables and peanuts. Biotin is give impulse grease brewer’s yeast, rice bran, rice germ, rice polishing also cramped butter.

Pyridoxine or Vitamin B6 - When edible is little significance vitamin B6 or pyridoxine, further symptomatic amino acid tryptophan, is converted diversion a concern recognized now xanthurenic sour. firm has been shown prerogative laboratory experiments that xanthurenic acid tends to extinguish the pancreatic tissue.

Diabetics who reckon on been disposed 50 mg of vitamin B6 daily reckon on shown a hypersonic also local lessen in urinary xanthurenic stinging. direction unaccompanied case, the symbol dropped almost 97 percent the premium day. Total difficulty of urinary xanthurenic tart amongst those who far-off cache a daily dosage of 10 to 20 mg of this vitamin indicated that none was for formed pull the body. Diabetics are thence indeed helped by a honorable intake of vitamin B6. The main simple sources of pyridoxine are milk, brewer’s yeast, cereals, legumes, recent foliate vegetables further carrot.

B’SD

29 Tishrei 5772



I’m nursing a very yukky cold and eager to remain under the covers today. But I want to share this news with you:

Coinciding with National Disability Employment Awareness Month. PBS will soon air a pair of documentaries featuring people with disabilities


Check out the PBS NDEAM documentary about the decades-long history of America’s Disability Rights Movement. The USA has more than 54 million Americans living with disabilities. The Lives Worth Living presentation will be the first televised history of their efforts for equal rights including access to schools, employment, apartment buildings, and public transportation.

You can get more information about the film and the issues involved at www.pbs.org/independentlens/.


The Deaf Jam documentary is about a deaf teen exploring Hip Hop music and poetry. Learn more about the show at www.itvs.org/films/deaf-jam.







Want to learn something about how to finesse job interviews with your disability? Read the relevant section in EMPOWER Yourself to Cope with a Medical Challenge.


Face Your Medical Problems and/or Disability with Dignity.
Face Your Future with Optimism.