Why Wonder Woman Matters

Since her debut in All Star Comics #8 released in 1941, Wonder Woman has become the most famous and recognizable female superhero in the world. This feminist icon is a warrior princess and a United Nations Ambassador. She displays extreme intellect and compassion. Princess Diana of Themyscira has also become a part of pop culture. She has been featured on countless merchandise, toys, comics, animated movies and television shows. For some reason (and Im still scratching my head on this one), it took DC Comics 75 years to bring her to the big screen. Wonder Woman starring Gal Gadot is currently filming and slated for a 2017 release. We will get our first look at Gal as Diana in Batman VS Superman: Dawn of Justice, March 25, 2016.







Wonder Woman has had a huge impact on men, women and children for 75 years. But why? What is it about her that we connect to? Why do we love her so much? This article of the Confessions of a Cosplay Girl Blog explores those questions and answers. Before I get to my thoughts and personal experiences, I want to share the thoughts of a fellow Wonder Woman fan. Cosplayer Candy Keane is also the owner of the Three Muses Clothing Boutique in Jacksonville, FL.


"I want to share My first memory of dressing up like Wonder Woman was around 4 years old, in my Underoos. Even then I dressed up my outfit with a lasso and paper tiara and cuffs. That could possibly count as my first “homemade” cosplay. The Wonder Woman TV show was my introduction to strong super hero women and I’m thankful for that role model. My love of Wonder Woman has stayed with me through the years and grown to include all of WW’s various incarnations, but my true love of all things wonder will always start and end with Lynda Carter."   ~Candy Keane (Visit her Official Facebook Page)

I want to say my first exposure to Wonder Woman was the Lynda Carter series but as of late, I find my memory to be a bit jumbled. Im not quite sure if it was the Wonder Woman live action series or the cartoon show Superfriends. In any case, I always found the character to be fascinating. She was beautiful, independent and strong. She was graceful  yet a fierce warrior. She was the most brave and powerful woman I had ever seen. She could hold her own, defend herself and fight along the side of heroes such as Superman. And she had black hair like me! LOL When I was a child I had a collection of Wonder Woman items such as action figures and pajamas. She was important to me because she was teaching me that a girl could be strong and change the world. Women were just as capable as men  and can make a difference.  Wonder Woman didnt just do good in costume. Diana Prince had a job, supported herself and took time out to help others.

Ive been a Wonder Woman fan literally my whole life. Whats great is that both of my parents and my youngest niece are fans too. Its awesome that we can share our love for the Amazon Princess. Witnessing Wonder Woman evolve over the years in media and pop culture has been amazing. I look forward to what the future brings.

Visit me on my Official Facebook Page

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Why Parental Supervision of Minors Cons is Important

Youve all heard the story of the 17 year old girl who was found bloody and unconscious at the 2014 San Diego Comic-Con. At first reports stated that she was attacked and sexually assaulted but it was later confirmed by  the San Diego Police Department that no such thing had occurred. She had in fact fell while attempting to climb a 6 foot gate and was discovered by the pool of the Marriott Hotel at around 1am. Throughout this entire ordeal I have repeatedly asked myself the same question: where were her parents?



Ive noticed an increasing trend throughout the years as conventions have become more popular. Parents drop their kids off and leave. When did a Comic-Con become a Day Care Center? Do parents not realize that the organizers of these shows are not legally responsible for their children? Arent they the least bit curious as to where their kids are going and whom they are spending time with? Arent they concerned for their safety? Your child is a minor and a minor requires adult supervision. As someone who has completed several certified courses in Early Childhood Development and was in Early Childhood Education for 10 years, this boggles my mind.

Because the underage Roger Rabbit cosplayer at this years San Diego Comic-Con was not properly supervised, her evening ended with a suspicious 29 year old male (its not okay for a man that age to spend time alone with a minor ever) and suffering from a  6 foot fall. Her injuries include eye socket and skull fractures and bleeding from the brain. She also had drugs in her system. Shes lucky she wasnt killed.

Where were her parents?

Everyone needs to learn from this horrible situation. Comic-Cons, shows and events are not a "get out of parenting for the afternoon" card. If your child is a minor, you need to provide them with adult supervision. If you cant do it, find someone else who can. And if your child doesnt like it, thats tough. End of story, No excuse. Failing to do so can have deadly consequences.


                                                Visit me on my Official Facebook Page

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New Clickbank Product Reviews by Marc Charles

10:11

Hi Gang:

Check out my new reviews of Clickbank products.....

These were selected out of more than 500 products.

Have fun!

Marc

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NEW Clickbank Product Reviews

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eft: 0i"

paul’s,secret,for,making,more,money,per,square,foot,by,marc,charles

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Importing Fortunes is for Real by Marc Charles

7:01 AM

Greetings:

Ive enclosed another article I wrote for International Living.

Its about a new overseas income opportunity and my program Importing Fortunes.

Youll like it.....

Marc

---------------

New Overseas Income Opportunity

By Marc Charles

Date

Dear Fund Your Life Overseas Reader,

Finding reliable income opportunities is not easy. But I have one for you today.

I was a guest on a webinar recently that focused on legitimate business and income opportunities that required little or no startup capital.

I revealed a business that surprised a lot of people.

I’ve dedicated more than 30 years to researching, dissecting, testing and teaching people about legitimate business and income opportunities. So this webinar was right up my alley and a lot of fun.

I explained how one “work-from-anywhere” income opportunity might be a good fit for people like you who like to travel or live overseas.

You could start dabbling in this business to see if it’s right for you with very little investment. I completed my first “deal” for under $250. But you could start with even less than I did and be on the right track.  

My friends Kevin and Lisa Hickey started doing deals from a spare bedroom. That was eight years ago. Today they have an online business that can be run from almost anywhere with a laptop.

Caroline Lau loves scrapbooking. She found an overseas supplier for high quality scrapbooks and then she sold them online for a nice profit. The best part is she doesn’t even handle the products; she outsourced this to Amazon (for a small fee).

I’ve developed a comprehensive program with step-by-step instructions for this income opportunity.

You’ll also learn about an incredible website where buyers, sellers and suppliers from 240 different countries meet to discuss products and make deals. That’s where Caroline and the Hickeys found their products.

Jane Ivanov knew there was a market for lingerie for expectant mums. She found a manufacturer on this website that could make them for her, and ship them to her fulfillment center. She has a thriving business that can be run from anywhere!

Did you know that you can sell products on Amazon without ever having to deal with the product physically in your home or office?

Forget about the hassle of storing products in your basement, garage, or home office. Those days are gone.

Today, companies like Amazon have huge storehouses specifically for this purpose. They will store your products for you and only charge a small fee when you make a sale. This is like an ultimate, no stress business with super low startup costs and risks.

I share all of my “insider tips” for this business, plus real life examples, and simple step by step coaching and instruction.

Check it out here

Once you see how it works, you can decide how much time you want to give it.

And when you see the income you can plan the overseas move with the security of knowing you can continue to earn on a regular basis.

In other words, it’s a step in the direction of your dreams…..before you make the big leap.

Sign up now. URL

 

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What is an acceptable rate of VTE prophylaxis

According to the paper “Hospital Performance for Pharmacologic Venous Thromboembolism Prophylaxis and Rate of Venous Thromboembolism: A Cohort Study” that appeared online in JAMA Internal Medicine last month, a rate of 70% for all eligible patients is good enough.

The retrospective study looked at rates of prophylaxis for VTE at 35 Michigan hospitals.

Of the 20,794 eligible patients included in the analysis, 1,658 either died or were transferred to higher or lower levels of care leaving 19,136 evaluable patients, 226 (1.2%) of whom suffered a VTE during either the hospitalization or the 90-day follow-up period.

Based on rates of prophylaxis administered, the hospitals were divided into three groups with 85.8% of patients receiving adequate prophylaxis in high-performance hospitals, 72.6% in moderate-performance hospitals, and 55.5% in low-performance hospitals.

From the results section of the paper: "Compared with patients at hospitals in the highest-performance tertile, the hazard of VTE in patients at hospitals in moderate-performance (hazard ratio, 1.10; 95% CI, 0.74-1.62) and low-performance (hazard ratio, 0.96, 95% CI, 0.63-1.45) tertiles did not differ after adjusting for potential confounders."

The authors concluded that "Efforts to increase rates of pharmacologic VTE prophylaxis in hospitalized medical patients may not substantively reduce this adverse outcome."

Heres the problem. They defined adequate rates as patients receiving pharmacologic prophylaxis during 80% or more of hospital-days such as "1 of 1 dose for daily regimens, 2 of 2 doses for twice daily regimens, or 2 of 3 doses for 3 times daily regimens.”

This means that patients could be classified as receiving appropriate prophylaxis but miss nearly half of their doses. For example, a patient in hospital for 5 days who got 2 of 3 doses for 4 days and missed all 3 on one day would be classified as having received appropriate prophylaxis. Why do the authors give full credit for delivering such low quality care? Why is missing any doses acceptable?

Does missing doses matter?

"Yes," at least in surgical patients, says this JAMA Surgery paper "Correlation of Missed Doses of Enoxaparin with Increased Incidence of Deep Vein Thrombosis in Trauma and General Surgery Patients."

Missing more than one dose of enoxaparin increased DVT risk significantly, and the more doses that were missed, the more DVTs occurred.

Of the 202 patients studied, 119 (58.9%) missed at least one dose of prophylactic enoxaparin. The overall incidence of DVT was 15.8%, but 23.5% of the patients who missed at least one dose developed a DVT compared to 4.8% of patients whose prophylaxis was never interrupted. Patients were aggressively screened for DVT accounting for a higher incidence than most centers report.

Missing 2-4 doses increased the odds ratio of suffering a DVT to 8.49, missing 5 to 8 doses raised it to 10.13, and the odds ratio rose to 14.73 if 9-17 doses were missed.

Among all 35 hospitals in the internal medicine paper, the rate of DVT prophylaxis for eligible patients was only 70%. The authors of that paper seem to think that is not worth improving. Wouldnt 100% compliance be a better goal?

What do you think?

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A “shallow water blackout” is a silent killer

In Jacksonville, Florida, a 50-year-old woman was found at the bottom of her backyard swimming pool. She was an experienced scuba diver who “often stayed at the bottom of the 9-foot deep end without oxygen to increase [her] lung capacity for future dives.”

Despite receiving CPR from her son, she could not be revived.

The Associated Press story about this tragic incident did not explain why a swimmer with her background drowned.

It appears to be a classic case of “shallow water blackout.” This phenomenon occurs when people hyperventilate before diving.

An increasing level of carbon dioxide (CO2) is what triggers the urge to breathe. Hyperventilating causes hypocapnia, a reduced amount of CO2 in the blood. If a swimmer uses up enough oxygen to pass out before the CO2 trigger point for breathing is reached, drowning will occur without notice. Victims are usually found at the bottom of the pool.

Here’s what it looks like in a diagram from Wikipedia:

A physician who lost her son to this little-known phenomenon started a websiteto heighten awareness of the problem. The site contains more information and stories about other drownings caused by shallow water blackouts.

Here is a video of a woman swimming laps of a pool underwater. Advance to the 0:50 point and watch what happens as she begins to slow down. [Addendum 8/13/15 12:50 pm: Warning. The video is graphic. It shows the unconscious swimmer being pulled from the water.]
 

A shallow water blackout may have been responsible for the death of Natalia Molchanova, the world’s foremost freediver, who went missing a few days ago.

Hyperventilating prior to diving is not recommended. Tell your friends.

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Can a surgeon who is sitting perform abdominal operations

A loyal reader alerted me to news of a lawsuit brought by an obstetrician in South Carolina who is suing a hospital for suspending his privileges. He had performed a cesarean section while sitting on a stool because he had a foot fracture secondary to diabetes. Several witnesses said that the doctor "had been unable to properly view the surgical field, unable to properly handle the baby and unable to address hemorrhaging." The patient later developed a serious infection.

A seated surgeon can operate on the hand and arm. In fact, thats the way everyone does it. The surgeons knees easily fit under the small table holding the outstretched arm. Certain anorectal operations and gynecologic procedures done through the vagina can be done by a surgeon who is sitting, but abdominal and pelvic operations done via laparotomy cant be safely done that way.

The problem is that when a surgeon is sitting, she cant get close enough to the OR table and the patient to see way down into the abdomen and pelvis. If bleeding occurs deep in the wound, controlling it would be challenging to a surgeon who is sitting. Tying a secure knot in the pelvis while sitting might even be impossible.

With the exception of robot-assisted surgery where the surgeon sits a console remote from the operating table, a seated surgeon would have trouble doing both open and laparoscopic procedures. Even with a robotic operation, there can be problems. If the surgeon cant stand, an assistant would have to help insert the robotic ports. What if something went wrong and the abdomen had to be opened?

In a laparoscopic case, the video monitor could be seen by a sitting surgeon, but manipulating the rigid instruments would be difficult because of the angles created by the locations of the ports through which the instruments are passed.

As a retired surgeon, I sympathize with anyone who might be forced to quit operating because of illness or disability, but the safety of the patient comes first.

I hope that the suit is resolved quickly and we learn what the outcome is.

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CPR in space is possible maybe

Last summer I wrote about the many problems associated with performing surgery in outer space. [Link here.]  Not surprisingly, I was highly skeptical about such issues as training astronauts to operate on each other and the difficulties in taking along enough supplies to deal with unexpected trauma and surgical diseases.

At least one commentor on that post felt that NASA had all the answers. But another said, “What NASA never wants to discuss publicly is the scenario: If X happens then you die.”

Not to be outdone, the European Space Agency recently released a YouTube video illustrating how cardiopulmonary resuscitation could be carried out in a weightless environment.



You can see that the technique is rather awkward and questionably effective. To my knowledge, the rescuer falling on the victim is not currently recommended in the latest CPR guidelines.

Assuming that by some miracle the victim survives CPR, what would happen to him? Would he be transferred to the intensive care unit on the spaceship? Would there be a ventilator? What about an endotracheal tube and someone to insert it? Who would monitor the patient? Would that person be subject to work hours limits?

Here’s what I think.

If you have a cardiac arrest on the way to Mars, you’re not only in deep space, you’re in deep doodoo.

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Is this the most beautiful photo of Olajumoke yet

Pic shared by make-up artist, Bimpe Onakoya. Stunning!

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The robot is here to draw your blood

A company has produced prototype robots that can draw blood from human arms. Here is a 48 second video showing one of them in action.



Using an infrared camera, the robot identifies a suitable vein and accesses the vein with ultrasound guidance.

A second video, not embedded in this post, explains that the robot is about 83% successful at drawing blood which compares favorably to the success rate of experienced human phlebotomists. The robots inventor hopes to refine the procedure to get the success rate up to 90%.

It also says that there are 9 billion blood draws per year in the United States suggesting that a market is certainly there.

The second video also mentions the discomfort patients experience when a phlebotomist misses or damages the vein.

However, the robot needs quite a bit of help from a human phlebotomist both before and after the actual blood draw takes place.

The robot cant apply a tourniquet, cant wipe the skin with alcohol, can’t take the cover off the needle, once the vein is accessed cant actually remove the blood from the vein with a syringe, cant take off the tourniquet [the human assistant didn’t do it correctly either*], can’t apply pressure to the puncture site, cant put a Band-Aid on the skin, and can’t safely dispose of the needle.

It’s not clear what the robot would do if a patient flinches or withdraws his arm. Patients have been known to do those things.

For the foreseeable future, the robot would have to be accompanied by a human. So whatever the cost of the robot, personnel would not be eliminated.

Its a clever idea, but I don’t think a robot will be drawing your blood any time soon. ________________________________________________________
*One must undo the tourniquet before taking the needle out of the arm or the back-pressure will cause bleeding and/or a hematoma

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My top seven posts of 2015

I’ve been blogging since July of 2010. Here is a list of my most viewed posts of 2015. Thank you for reading and commenting.

“How much money do journal publishers make? A lot,” a look at the highly profitable world of journal publication, was number 1. Profit margins of the top for medical publishers range from 32% to nearly 42%. It’s a good business to be in.

Next was “A shallow water blackout is a silent killer.” What can happen if you hyperventilate before swimming underwater? You might die.

“How to pick the leading physicians of the world” was a humorous take on an “honor” bestowed upon me by a company that is a little careless about choosing its candidates.

In “Narcotics addicts can sue doctors and pharmacies for ‘enabling’ them,” we learned of a ruling by West Virginia’s highest court that spells trouble for both patients and physicians.

“Antibiotics for appendicitis? No thanks” was a critique of a Finnish randomized prospective trial of antibiotics vs. surgery in uncomplicated appendicitis. I had some serious concerns about the way the study was done and interpreted.

“Do surgeons still do postop care?” was a guest post by a medical hospitalist who felt that surgeons were no longer interested in taking care of their patients after operating. It drew a number of comments.

The seventh most-read post was “So you want to be a radiologist,” written by a radiologist who I asked to respond to an email I received from a pre-med student. It was a nice discussion of the pros and cons of the specialty.

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How to get the answers you want from a survey

This isnt about religion or politics, two subjects I tend to avoid. This is about surveys and how they can mislead.

I received this survey in the mail last week. It is from CatholicVote.org and is touted as the "largest survey of Catholics ever conducted on the issue of ObamaCare."

CatholicVote.org promises that the results will "send a strong and clear message to every politician running for election or reelection in the 2014 midterm congressional elections, that the overwhelming majority of Catholic voters demand ObamaCare be repealed."

Judging from the way the questions are framed, I think the message will be clear.

Here are a few examples:

From Section B "ObamaCares War on Christianity and Morality"

Question #2: Do you think ObamaCare is violating the Constitutions First Amendment protections for freedom of religion and freedom of conscience by forcing pro-life Americans to purchase health coverage that includes abortion inducing drugs?

A) Yes, this is certainly a violation of the Constitutions First Amendment protections.
B) No, this is not a violation of the Constitution
C) Not Sure
D) Other

Question #4: As a state lawmaker in Illinois, Barack Obama voted twice to deny lifesaving medical care to babies born in botched abortions. What is your reaction to this fact?

A) I support President Obama on this.
B) I am horrified and angered by this.
C) Not Sure
D) Other

From Section C "ObamaCares War on Freedom"

Question #5: Do you think President Obama knew about the crushing cost of ObamaCare for families across America, and was just lying about the cost to get ObamaCare passed into law? Or do you think he shares our shock and dismay at the staggering cost of ObamaCare?

A) I believe President Obama knew about the crushing cost of ObamaCare for families across America, and was just lying about the cost to get ObamaCare passed into law.
B) I think he shares our shock at the staggering cost of ObamaCare and was just unaware of it.
C) Not Sure
D) Other

Question #6: How do you think the mass exodus of doctors from medicine will impact your ability to see a doctor and get the medical treatments you need?

A) A doctor shortage on this scale will certainly drive healthcare costs up dramatically and make it far more difficult for me to see a doctor and get the medical care I need.
B) I dont think well see much impact from this doctor shortage.
C) Not Sure
D) Other

Had enough?

I look forward to seeing the results.

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Is the surgeon still captain of the ship

A Kentucky appeals court ruled that a surgeon was not responsible for a burn caused by an instrument that had been removed from an autoclave and placed on an anesthetized patients abdomen.

According to an article in Outpatient Surgery, the surgeon was not in the room when the injury occurred and only discovered it when he was about to begin the procedure.

An insufflator valve had been sterilized and was apparently still hot when an unknown hospital staff member put it down on the patients exposed skin. [An insufflator is a machine that is used to pump CO2 through tubing into the abdomen for laparoscopic surgery.] When the doctor saw the mild second-degree burn, he asked what happened, but "but no one in the OR claimed any knowledge or responsibility."

The hospital had settled the suit on behalf of its staff, but the surgeon, who as a private practitioner had his own malpractice insurance, held out. The original lower court ruling dismissing the suit against him had been based on the plaintiffs lawyers failure to prove that the surgeon was responsible for the actions of the hospital staff.

In December 2012, I wrote a post stating my opinion that activities such as counting the sponges during an operation were not the responsibility of the surgeon. Many who commented on the post were highly indignant that I could suggest such a thing.

I wrote another post last year on the subject in response to another surgeons blog entitled "Everythings my fault: How a surgeon says Im sorry." I felt that many things that happened to patients were beyond the control of the surgeon. Most of the comments agreed with me.

I keep hearing that medical care has become a team sport. If thats true, then the surgeon, like everyone else, is simply a member of the team. People on teams have different roles and must execute properly for the team to succeed.

One of the most interesting things about the case in question was that none of the OR team members had any idea how that hot insufflator valve found its way to the patients abdomen.

One thing we know for sure, at least in Kentucky, is that a surgeon is not legally responsible for everything that happens to a patient in the operating room, particularly when he is not even present.

Is this decision the first nail in the coffin of the "captain of the ship" doctrine?

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Questions about antibiotics vs surgery for acute appendicitis

A study from Finland suggesting that antibiotics may be a viable alternative to surgery for acute appendicitis has created a stir. As you might have expected, I had some concerns about the paper which you can read in my blog post here.

On Twitter, many surgeons have commented on both the paper and my post. Several interesting questions come to mind.

Based on this and other similar studies, is the treatment of acute appendicitis with antibiotics now a mainstream alternative to surgery?

Should surgeons now mention the Finnish study results during their informed consent discussions with patients?

Is CT scanning accurate enough to differentiate a reasonable percentage of uncomplicated appendicitis from more complex cases? Previous papers have reported conflicting data on this topic. Will this lead to more CT scanning (if that is even possible)?

What do patients want? In an effort to avoid surgery, are they willing to take a 25-30% chance of a recurrence of appendicitis?

Will patients be able to understand the distinction between complicated and uncomplicated appendicitis?

We all agreed that ertapenem is not a first-choice antibiotic in the United States. In fact, the real questions may be is a three-day hospitalization for intravenous antibiotics really necessary, or as is the case with acute sigmoid diverticulitis, would a course of oral antibiotics as an outpatient be sufficient to deal with an attack of uncomplicated appendicitis?

How will it work if antibiotics and surgery are considered equivalent treatments? Although I am retired, I think I am qualified to say that I would not have enjoyed going to an emergency department at 10 o’clock at night to see a patient with acute appendicitis who after a discussion, chooses to be treated with antibiotics. Should these medically-treated patients be admitted to surgery or another service? Should the emergency physician have the discussion with the patient and only call the surgeon if the patient elects to have an operation?

Is it appropriate for an anonymous blogger to be questioning the methods and results of a paper published in a top-tier journal such as JAMA?

What do you think about all of these questions?

Many thanks to the following for their input. If I omitted someone, I apologize. @jdimick1, @NirajGusani, @TomVargheseJr, @ChrisFriese_RN, @LVSelbs, @NatalieBlencowe, @JBMatthews, @ehldallas, @zuckerbraun, @SarahB_MD, @docaggarwal, @aneelbhangu, @smootholdfart, @DRSoup34, @hswapnil, @qdtrinh, @TimLaheyMD, @jonessurgery, @RogueRad, @DrKathyHughes, @putrescine, @krchhabra, @Apathetic_Cynic, @SimonRBarron

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More evidence that the manuscript peer review process is broken

To the surprise of almost no one, asking authors of research papers to submit names of potential peer reviewers for their manuscripts turns out to be a bad idea.

According to a recent New England Journal of Medicine article by Dr. Charlotte J. Haug, a number of research papers have been retracted because reviews were fabricated. Email addresses of suggested peer reviewers were not legitimate. The bogus email addresses were almost all created by authors of papers who then reviewed their own work favorably using fake identities. 

More about the problem can be found on the blog Retraction Watch.

This type of fraud is simple to do because anyone can set up an email address on Gmail or Yahoo mail using any name. Unless a reviewer has an academic email address, proving legitimacy is impossible.

However even if a reviewer has an “edu” address, how would an editor know that a suggested reviewer is not the author’s sister-in-law or a former mentor?

Every medical student who applies for residency knows that you don’t ask someone for a letter of recommendation unless you are sure that it will be favorable. Why would an author take a chance on recommending someone to review a paper without knowing that the review would be a good one?

I agree with the Dr. Haug that soliciting the names of possible reviewers from authors can save editors time and bother. Having spent three years as an associate journal editor, I have experienced the frustration of trying to find high quality reviewers or even a warm body of any quality to do the job.

I also agree with her that a root cause of this problem is the pressure on faculty to publish.

Another problem is that there are too many journals. In 2014, well over 5000 journals and 760,000 papers were included in Medline. The combination of “publish or perish” and superfluous journals leads to the proliferation of marginal papers.

The problem is not simply fake reviews. Since journal reviewers are not paid and have many other responsibilities, they may not thoroughly read papers or provide useful comments about manuscripts.

Some have suggested paying peer reviewers, but who would pay them? Certainly not publishers, even though they make tons of money. And paying might attract unqualified people looking to make a little extra cash.

What about post-publication peer review? It is already happening on blogs, on sites like PubPeer, and even on PubMed. However, the volume of papers published in medicine alone certainly precludes post-publication review of all of them.

Maybe it doesn’t matter. New journals are appearing every day. Most are “open access” and the charge authors “processing fees.” For many of these publications, processing fees do not include even a cursory manuscripts peer review.

With so many journals publishing just about anything for the right price, readers will have to do their own peer reviewing. Be skeptical my friends. 

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OBGYN Practice for Sale Marc Charles Update

9:22 AM

Hey Gang:

I like the Merger Network. They offer businesses for sale without the hype, deception and games most brokerages play.

I prefer to buy businesses direct from sellers, and advise my consulting clients to do the same thing.

Plus, when you come into a deal youll have either "strong" or "weak" hands. That means you have the funds, business savvy and ability to close deals in your favor, or you have no funding, no business experience in the given field and therefore usually get taken.

Granted, I think the good deal is profitable for both parties. This is why most of the deals and business sales Ive put together do not come undone. I try to make sure everyone is happy.

Anyway.....heres a OBGYN practice for sale. This is a high demand market and service.

http://www.mergernetwork.com/clikthru/businesses-for-sale/369920

Post your thoughts.

Marc

PS Check out my two new programs for making money in 2015.

Importing Fortunes

MicroGig Riches

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Follow up Meaningful Use Stage 3 is coming

Yesterday, I posted "Meaningful Use Stage 3 Is Coming: Should Be Fun" which discussed some onerous new rules that Stage 3 will impose including this one:

More than 25% of patients seen by an eligible professional (EP) or discharged from a hospital or emergency department (ED) must "actively engage" with their electronic health records (EHRs).

I said that in my experience most of the patients I took care of would have been unlikely to engage their EHRs and expressed concern that physicians would be penalized for their patients not reaching the 25% threshold.

A reader commented that the VA has had a patient portal called the Blue Button since 2010. He pointed out that in May of 2012, more than 500,000 unique patients had accessed their EMR. He meant this as a rebuttal to my opinion about the potential level of engagement.

However, it turns out that in 2012 over 6.3 million patients were treated by the VA system.  [See page 4 of this link.] If you divide 1 million by 6.3 million, you get 15.9%.

It seems like they have quite a way to go to get to 25%

I rest my case.

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Do doctors charge too much

We all know that some doctors’ fees are excessive. I have blogged about this myself citing a neurosurgeon’s $117,000 charge for assisting on a case.

We also know that doctor bashing is a popular sport right now.

In an otherwise reasonable article about high-deductible health insurance on Vox.com, reporter Sarah Kliff’s second paragraph read as follows:

The bolded text was hyperlinked to a Washington Post piece about a study that showed wide variations in hospital charges for appendectomies in California. The study was not about physician fees. No matter how difficult the case was, no surgeon would ever have been paid $186,955 for performing an appendectomy.

Yesterday, I twice asked Ms. Kliff to please correct this grossly misleading paragraph. She acknowledged my request that evening, but as of 9 AM today, nothing had been changed.

Even if Ms. Kliff had correctly identified the hospitals as the culprits, using appendectomy as an example of why patients should shop for the lowest prices was a poor choice.

Nearly every patient with appendicitis does not know he has it until he has gone to an emergency room, seen an ED physician, and had some tests. I doubt most people in this situation would A) ask how much it’s going to cost to have an appendectomy and B) decide to go to another hospital for care. The fact is, hospitals are so secretive about their charges that a patient would be unable to comparison shop especially if the emergency department visit occurred outside of normal working hours.

Even trying to find out the charges for elective surgery remains difficult in 2015.

Physicians—particularly surgeons—have taken a lot of heat recently. We don’t need articles like this to inflame patients (and journalists) even more than they already are.

ADDENDUM 9:45 AM 10/15/15

The article was just changed. The bolded mistaken passage was corrected, but the next sentence (underlined in red) remains the same. Still blaming those "really expensive doctors."

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Narcotic addicts can sue doctors and pharmacies for enabling them

In a 3-2 decision, the Supreme Court of West Virginia ruled that narcotic addicts may sue pharmacies and physicians for facilitating their addictions.

A suit was brought on behalf of 29 pain center patients who had been treated with narcotics for various injuries and became addicted. One article quoted the Chief Justices explanation: "A plaintiff’s wrongful or immoral conduct does not prohibit them from seeking damages as the result of the actions of others."

The court recognized that most of the plaintiffs "admitted their abuse of controlled substances occurred before they sought help "at the pain clinic.

Another story said, "The justices paved the way for people to claim damages for allegedly causing or contributing to their addictions of controlled substances—even if they broke the law by doctor shopping."

In a dissenting opinion, one justice wrote that the decision “requires hardworking West Virginians to immerse themselves in the sordid details of the parties’ enterprise in an attempt to determine who is the least culpable—a drug addict or his dealer.”

In response to the ruling, the West Virginia Medical Association issued a statement: "It may cause some physicians to curb or stop treating pain altogether for fear of retribution should treatment lead to patient addiction and/or criminal behavior. It may create additional barriers for patients seeking treatment for legitimate chronic pain due to reduced access to physicians. It would allow criminals to potentially profit for their wrongful conduct by taking doctors and pharmacists to court."

A post on the American Pharmacists Association website explained that pharmacists were included in the ruling "because they were aware of the pill mill activities of the medical providers. The plaintiffs said these pharmacies refilled the controlled substances too early, refilled them for excessive periods of time, filled contraindicated controlled substances, and filled synergistic controlled substances."

One newspaper summarized the public reaction to the ruling in an editorial stating, "Those who are illegally abusing prescription narcotics should be prosecuted to the fullest extent of the law. The same goes for medical professionals who are found guilty of committing a criminal act. But telling a drug addict or someone who is illegally abusing prescription narcotics that it is OK to go to court and file what could very well be a frivolous lawsuit is both baffling and shameful. This ruling by the Supreme Court justices is a clear back eye for West Virginia. And it does nothing to help West Virginia’s rampant drug problem."

As I wrote last year, I think the prescription drug abuse epidemic all stems from a 15-year campaign that declared pain is the fifth vital sign—a concept which is both untrue and as we have come to learn, harmful.

I agree with the WVMA. If I were practicing in West Virginia, I would be very reluctant to prescribe narcotic pain medication to any patient.

What do you think?

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