Tuesday, June 27, 2006

Alternative Murder

Here's one from the heart, folks. Hold on to your hats.

I'm going to lose two of my relatives to cancer. That is sad, of course, but what is really unfortunate is that they could have been cured at early stages of their disease. What happened? They became enmeshed in the folly of "alternative medicine", and they are going to die because of that.

I won't name names or give any identifying information. One relative had cancer of the tongue that could have been excised and eliminated when it was quite small. He refused conventional therapy proposed by one of the leading cancer centers of the world, and instead used diet and supplements to treat himself, on the advice of a "practitioner" with barely a high-school education. Three years later, the disease advanced to the point that he had to seek conventional therapy, and he underwent a glossectomy. That's a nice word for having your tongue cut out of your mouth. He "eats" through a tube in his stomach these days.

The other relative has breast cancer. She and her husband, very smart and well-educated people, decided that nutrition and other alternative methods were the only treatment for her. A year later, this formerly healthy woman is an orange, jaundiced skeleton. She just had a biliary stent placed, and she can't even consider chemotherapy until she builds up her strength. Which she can't because she had starved herself trying to follow various cancer diets. My wife and I made an emergency trip to see this relative over the weekend, and she still doesn't realize what has happened to her. She fears most that the cancer has spread to her brain, because the local practitioner of ElectroDermal Screening told her it had done so.

People, I don't know whether to cry, scream, or what. How did this happen?

In the short space of one post, I can't properly cover the entire topic of alternative medicine. I strongly refer you to http://www.quackwatch.org. Dr. Stephen Barrett has spent the last 30 years examining the phenomena, and his articles are mandatory reading on this sad subject.

There is no single reason for people to suspend reason and go for the alternative therapies. Victims include rich, poor, educated, illiterate, black, white, Jewish, Christian, Muslim. No one is immune. The only common thread is that most people will be vulnerable at some point in their lives to the ministrations of charlatains, and those with a chronic or recently diagnosed illness are right at the top of the list. Why go through painful and debilitating chemotherapy when nutrition and electrotherapy can cure you of your cancer?

The "practitioners" usually have no scientific background, and learned their trade by weekend seminar, or perhaps right here on the Internet. Their idols, the inventors of the wonderous therapies, assure them with false testimonials and bogus science that their therapy works. Why are these miracles not accepted by the mainstream medical community? My relative with the tongue cancer was quite convinced that there is a conspiracy amongst all physicians, insurance companies, and pharmaceutical manufacturers to keep these "cures" away from the public, so we, the conspirators, can keep raking in the cash. Just take a look at this "infomercial" from Kevin Trudeau, who is revered among the alternative believers. He has since been banned from making such blatantly false statements. He was interviewed on TV recently, along with someone from mainstream medicine, and someone else from the alternative community. The mainstream doc lambasted him, and the alternative "doc" praised him. My relatives believed the latter.

In some cases, the victims of this deceit really do distrust the traditional medical community, and many are prone to believe conspiracy theories anyway. There is a very simple counter argument: Doctors and their families get cancer as often as any other group, and they live and die in the same percentages as everyone else. If there were some "secret" cancer cure, don't you think somebody would "break ranks" and reveal it to the public after all this time? Perhaps the greatest irony is that we are accused hiding and suppressing this stuff so we can make money. The quacks, however, are very quick to charge as much as much as they possibly can for unproven, untested, ineffective, and often harmful products.

Human beings are well known for believing what they want to believe, even when faced with heaps of evidence to the contrary. Throughout history, quacks, charlatains, witch-doctors, and all of their ilk have misled those who get caught up in their lies. It is no different in the 21st century, I am sorry to report.

Not being bound by the conventions of political correctness, I am going to call this what it is: MURDER. These criminals convince the naive to shirk medical treatments in favor of their patent medicine and snake oil. Many of the victims will die needlessly, and often horribly. That constitutes murder in my book.

Don't think for a moment that I am cannonizing the medical community. As you have noted in the pieces on self-referral, I think we need to fix a few things ourselves. M.D.'s are not above trying to make an extra buck, and I don't excuse them for it. But the methods we use for diagnosis and treatment have evolved via the scientific method. We do not think we possess the Absolute Truth, and we are constantly testing and retesting our diagnostic and therapeutic approaches. I am not ashamed to charge for what we do; we know we are offering the best we have, not something mired in secrecy and obscurity, and "proven" by handwaving and innuendo.

Again, I keep creeping toward more governmental intervention. The government MUST step in and stop this madness. People that make bogus claims need to be prosecuted. Those that have led their victims to their deaths should be up for murder. Because that's what their lies and deceit accomplished, the death of innocents whose only crime was believing the sales pitch. Perhaps there is a greater punishment awaiting these false practitioners, but for the moment, I'd rather trust the government to take care of these murderers. That's what they are.

Fifteen Thousand And Counting!

Image courtesy of http://aes.iupui.edu/
I thought it might be better to note visitation milestones a bit less frequently, and so we're now on the Q5000 scale.
Visitor 15K comes from London, Ontario, Canada, via Huron Telecommunication Cooperative, Limited. I will tell you that he (or she) was perusing an AuntMinnie.com thread, but I won't tell you which one. Believe me, we leave really huge tracks behind us on the web.
Thanks to all my visitors! You've made me what I am today...whatever that is!

Sunday, June 18, 2006

The Da Vinci Code
...or Opus Dei and the Knights (Templar)


I finally got around to taking my son to see The Da Vinci Code. At 12, he is a voracious (dare I say precocious?) reader, and after reading the book, he was quite anxious to see the movie.

Now, I don't want to spoil it for anyone, so both of you out there who haven't seen the movie or read the book STOP READING NOW!

OK. To summarize, the story involves several threads revolving around the premise that Jesus was married to Mary Magdaline, and she bore Him a daughter after the crucifixion. This certainly interferes with the concept of Jesus' divinity, and so the Vatican has tried mightily over the years to suppress this, whilst the Priory of Sion and the Knights Templar attempted to protect Jesus' descendants. Got all that? I'm really simplifying things here. The movie goes on to implicate a strict Catholic order, the Opus Dei, in several murders designed to quash the Priory once and for all.

There are probably a thousand web sites out there that dissect the arguments, and the "facts" of the movie in tremendous detail, and I won't even try it here. Suffice it to say that the movie is enjoyable in a plodding, mystery-story fashion, and it was fairly true to Dan Brown's book. I would recommend you read the book first to be able to follow the plot-twists.

The book and movie have caused great consternation, or at least a lot of discussion in the Christian community, and I can understand that. Coming from the Jewish viewpoint, I don't find the concepts particularly offensive. Judaism does not accept the divinity of Jesus in the first place; rather most of us consider Him to have been a great rabbi, perhaps the first Reform rabbi, and possibly a Prophet in His own right. You will notice very few bachelors among the Jewish characters of the Old Testament; it was tradition for the best and brightest to marry and have lots of children (be fruitful and multiply, as they say), and so it would not be surprising for a rabbi or great teacher to have done so. Think of this as the world's first eugenics program: you want to breed your best stock. I can only speculate as to why the Catholic Church took the exact opposite approach with their clergy.

I guess I can't comment with any great passion on how the "truth" as concocted in the Da Vinci Code would affect Christianity. Much evil has been done in the name of Christianity (the Inquisition, the Crusades, for example), but I would be so bold as to say that overall the good deeds over history outweigh the bad. Nobody is keeping score as far as I know. I realize that the divinity of Jesus is a fundamental tennant of modern Christianity, but even if it were not the case, His teachings would probably still be relevant. Basically, they were a softening of the fairly harsh version of Orthodox Judaism practiced in His day, and one could almost say that we Reform Jews are closer in spirit to what Jesus taught than anyone else. How about that?

I have tried and tried to tie this whole thing into PACS, and I'm coming up short. Maybe we could use the Cryptex to enter our passwords?

Sunday, June 11, 2006

Lessons from the Vasa, and Other Baltic Musings

The Vasa, courtesy of the Vasa Museum, http://www.vasamuseet.se
I'm back from Europe, and jet-lag is setting in to a significant extent. Before I drop, I wanted to post about some of the places we saw on our Baltic cruise.

Oslo seems clean, and modern in a timeless, Frank Lloyd Wright fashion, although the focal point of the city is the Akershaus Fortress, built in the 1300's. For some reason, I find the place very intriguing. Copenhagen had the feel of a much older city, with a feeling of age that we simply don't have in the much younger United States. Stockholm is somewhere between the two, and I found it my favorite of all the places we visited. Helsinki was rather stark, though it still has much of beauty, including a Lutheran church blasted from a stone hillock. Our time in St. Petersburg was rather surreal; a visit to Russia is still uncomfortable, even though the Russian Republic is now a democracy. Our guide spoke almost whistfully of the old Soviet era: it was hard, but the State took care of its people. I fear the old generation will have to pass on before freedom is totally accepted. The Russians are well on their way, however; there were many more Lexuses on their roads than I see here at home! Talinn, Estonia, was a surprise; there is a beautiful medieval city adjacent to a very modern metropolis. The Estonians recovered their freedom and statehood only 15 years ago, and they are fiercely proud of their new/old democracy. If only their weather was better! We ended our trip with a few days in London. We saw the major sites (Buckingham Palace, the Tower of London, Madamme Tussaud's, Harrod's), although we certainly didn't even begin to scratch the surface. London is horrendously expensive...at first glance, the prices are similar to ours here in the US, but those numbers are Pounds Sterling, not Dollars, and therefore everything is roughly double in price.

Oh, yes, before I forget...gasoline everywhere we went was going for about $7-8 per gallon. It was only about $2 or so in Russia, but our guide told us that salaries were commensurately low as well.

Our ship and the cruise line delivered us safely, and very well fed, but there were a few (but significant) glitches that I'll discuss in a later post directed at Royal Caribbean. Get out your bashing clubs, folks!

Delta flew on time, and they didn't lose any of our luggage.

Now, the story of the Vasa. The ship was built in 1628 on the order of King Gustavus Adolphus. On it's maiden voyage, it sailed into Stockholm harbor, listed over to one side, drew water in through open gunports, and promptly sank. The good news is that it was encased in clay at the bottom of the bay, and was nicely preserved for 333 years until it was rediscovered and raised from the depths. It is on display today in a huge museum built around it, a ghost ship returned from the dead. What happened? Here an analysis from the Vasa Museum's website:

In the 17th century there were no scientific methods of calculating a ship's stability. It was not uncommon that warships heeled over and sank. Their cargo - the guns - were placed relatively high up in theship, whereas merchant-vessels stored their cargo in the hold, ie inthe bottom of the ship. Instead of using calculations, the 17th century shipbuilders used so called reckonings, which recorded certain ship-measurements. However, the reckonings used in building the Vasa were intended for smaller ships with only one gundeck. The Vasa was built differently. She had two gundecks with heavy artillery (when the norm was to place lighter guns on the upper gundeck). The standard rules obviously did not apply here. Deep down in the Vasa several tons of stone were stored as ballast. They were meant to give the ship stability. However, the main reason for the Vasa capsizing was that the ballast was not enough as counterweight to the guns, the upper hull, masts and sails of the ship. In the inquiries after the Vasa disaster it was revealed that a stability test had been performed prior to the maiden voyage. Thirty men had run back and forth across the Vasa's deck when she was moored at the quay. The men had to stop after three runs, well before the test could be completed - otherwise, the ship would have capsized. Present was Admiral Klas Fleming, one of the most influential men in the Navy. His only comment to the failed stability test was "If only His Majesty were at home!" After that he let the Vasa make her maiden voyage.Who, then, were to blame for the disaster?

Admiral Fleming. Partly. He could have stopped the ship after the stability test. On the other hand, the ship was already complete and the king was waiting impatiently in Polish Prussia.

King Gustavus Adolphus. Partly. He was anxious to acquire a ship with as many heavy guns as possible. He had also approved the Vasa's dimensions and was keen to have her completed rapidly.

The shipbuilder Henrik Hybertsson. Partly. Although he built the hulltoo narrow, he was a skilled shipbuilder who had previously built manygood ships. His unexpected death the previous year just complicated matters.

The captain Söfring Hansson. According to a new theory the capsizing of the Vasa may be blamed on the captain. He sailed a brand new ship with open gunports. The Vasa sank when water gushed in through the lower gunports! It would have been wiser to test the new ship on her maiden voyage with closed gunports.However, the inquiries showed that no one could really be blamed for the disaster. The main reason being the insufficient theoretical knowhow of the period. The Vasa was something new - a military experiment. After the Vasa, many successful ships were built with two,three and even four gundecks. The shipbuilders learned from their mistakes with the Vasa and improved later designs.

Facinating stuff. In some ways, we can today be very thankful that the Vasa met its doom in this manner, because it otherwise would not have been preserved for us today.
So, what lessons do we learn, and how in the world does this apply to PACS? Well, the Vasa website was a little more conciliatory toward the king than our guide; apparently it is commonly felt in Sweden that the whole mess was the King's fault. Gustavus declared that the Vasa was to be built with too many gun-decks, which made it very top-heavy and unstable, and the Admirals and Captains, and everybody else had to go along. The King is the King, after all. So, this is what happens when someone bulldozes ahead, convinced that his (or her) way is the right way, and the experts and critics be damned. I'll grant you that it is unlikely that lives will be lost if one picks the wrong PACS system, but the point is that the building of a ship, or the assembly of a PACS system, should not hinge on the whims of one group that "knows what's best" for everyone else. Rather, such decisions need to be made by acquiring as much knowledge and expertise as possible. The ship, or the PACS, needs to perform its duties, but it cannot be weighed down by bells, whistles, or guns that would jeopardize its functions, even if the King, or the radiologist, or the IT folks demand it. Compromise, folks. And listen. Or somebody might be digging up the remnants of your PACS in 300 years.

Dr. Dalai Promises.....


A few months ago, I signed up to be a beta-tester for Intelerad's new IntelePacs InteleViewer, hoping they would consider me InteleGent enough to help them out. I guess I've been doing a little too much muckraking lately, as I received this letter from Rick Rubin, Intelerad's Executive VP for R&D:
I see you’ve signed up for our Beta program. I think that’s great, with one proviso (can you guess?). I wouldn’t be comfortable giving you an advanced copy of the InteleViewer if you’re going to write about all its flaws on your blog. Our goal for the Beta release is to get exposure and experience with different PACS systems and users out there but with limited exposure so that we can find out and resolve any major issues before releasing the product. So, it kind of defeats the point if you publicize those problems.

Once we’re in general release, you’re obviously free to do whatever you want, and hopefully we can live up to your scrutiny. But for the Beta program, do you agree not to publish information on the viewer?

OK, Rick, here it is in print (well, if you hit Ctrl-P, you'll have it in print): I promise to behave, and I will not reveal any details of your beta product. I have little more than my crediblity, since my rogueish good looks have long since left me, and no one has ever accused me of being the best radiologist in the world. So, yes, you can trust me.

Blogging is a little like being a real author, but I don't have to answer to anyone. Therefore, I have to be my own editor and publisher, but I get to say whatever I want to say. The major joy of this exercise is knowing that someone is actually reading my illustrious prose, but even so, my goal is to be more like the Today Show than the Jerry Springer Show. I would like to entertain and inform, but I'm not out to ruin anybody or any company. However, I am not going to sugar-coat a bad product. When I bash a product, it is out of frustration borne of using something that wasn't ready for primetime (or was poorly designed in the firstplace) but was released as a full production model anyway.

Don't worry, Rick, I realize that a beta test is a beta test, and I am gratified that YOU understand it as well. There are those who use paying customers to work the kinks out of their software (actually, Microsoft comes to mind on that one), and I don't have time for that when I'm trying to do my work. I cannot think of any other major PACS vendor that has taken this bold step of allowing a large number of interested users to help test and shape a new product, although Rick mentioned something to me about eFilm back in the good old days doing something like this.

I'm expecting great things out of Intelerad. I'll report on this product when Rick gives the OK.

Tuesday, May 30, 2006

PACS, the WIKIpedia, and other musings from the Baltic Sea

At this very moment, I am on a ship traveling up the east coast of Sweden en route to Stockholm. This trip required my son to miss his championship baseball game, but one of the other dads was kind enough to email us the results. (My son’s team lost, unfortunately.) The communications link went something like this: My friend emailed the play-by-play from the field via his Blackberry. The messages went to the Internet, which I picked up in my cabin, where my laptop is also connected to the Internet via satellite. Now my connection is running at dial-up speeds, which gets really frustrating, but, on the other hand, I’m really tickled that I can be on a ship (at that time headed toward Oslo) and get email from someone at a baseball field in South Carolina. Oh, Brave New World.

The Internet probably has done more to unite humanity than any other single factor in history, as illustrated by my little vignette. A more practical and useful example would perhaps be the Wikipedia. This is a collaborative effort, basically involving anyone who wants to participate, to catalogue the world’s knowledge. Anyone can write an article, and anyone can edit the Wikipedia. You do have to be prepared to back up your contribution with facts, and you must credit any photos you submit. I have made my mark on the Wiki by altering the paragraph on PACS architecture to include to concept of Web-based PACS. No doubt it will be edited further, but I feel I have had my 15 minutes of fame.

So far, we have been to Oslo and to Copenhagen. Both are spectacular cities. Oslo is a little more stark in some ways, but I found it to be more compelling. It seems to be overall a more peaceful place, but it’s hard to get much more than just a subjective feeling in a few hours.

Norway has a great deal of oil money from the North Sea fields, and it taxes its citizens quite heavily. Still, the Norwegians enjoy numerous benefits, including socialized medicine. They do have a co-pay for doctor visits, but there is then a major-medical plan that takes over if necessary. There is apparently a growing wait for some non-emergency services, but no one in Norway goes without health care. Period.

I have been a very loud opponent of socialized medicine for most of my career, but I am at the very early stages of thinking it inevitable. I look at the American system, and I see how it is being gutted and deformed and derailed by greed and fear, by self-referral on the part of some doctors, and by gluttony for unneeded services on the part of some patients. We cannot go on forever like this. When I hear about how well a system like that in Norway is working, I have to wonder if theirs is the right way after all.

Forgive my melancholy. It’s a beautiful night on calm seas. I’m going to enjoy it. Thanks for listening. Oh, and by the way, thanks for your ever-increasing readership of this blog. May isn’t even over, and it has topped all previous months for numbers of visitors and page-hits. Maybe I’m at least keeping you guys amused, huh? I’m very grateful for your interest, and I hope you feel your time here is well-spent.

Monday, May 22, 2006

Showdown at the PACS Corral

The second-place winners of the shoot-out at the OK Corral
A rather unusual event took place at the SCBT/MR (the Society of Computed Body Tomography and Magnetic Resonance if you didn't know) meeting last month. Six PACS vendors, Agfa, Amicas, Fuji, GE, McKesson, and Philips were pitted against each other in the first-ever PACS showdown. This is really a mighty feat in and of itself; getting six PACS stations and associated servers to all work at the same time is quite a miracle. I wonder who paid the electric bill.
Several vendors had engineering/apps types running their demonstrations, which consisted of performing a set of typical PACS tasks whilst under the gun. Amicas sent a physician who was very well acquainted with their product, and probably the best choice to show the world how their system works for its intended end users.
According the the Diagnostic Imaging article, there was no clear winner to this little exercise. Sadly, while some vendors (Amicas rep Barry Gutwillig was quoted in particular) wanted the results released, ". . . The vendors with more sensitive concerns. . .won this debate. To ensure a healthy participation at the next showdown, the SCBT/MR will not publish how the audience ranked each vendor." (Italics and implied disgust are mine.)
DI interviewed some of the attendees, and received various responses. Here's one from Dr. Dennis Foley, chief of Digital Imaging at MCW: "Dr. Foley. . . said that Philips, McKesson, and Fuji performed reasonably well in handling large data sets and doing relatively routine daily work. None of these companies, however, had well-integrated 3D solutions in their packages, he said. His nod went to GE for its hanging protocols, exam comparison, access to prior reports, and recovery from interruption." Ahem. It's clear that Dr. Foley hasn't used Centricity in the real world.
I am very disturbed about the "coverup" of the results of the showdown. Let's run an Olympic race and only report the results if the US wins. Obviously, one of the biG vEndors had a problem with how things turned out. Perhaps the small fry were more confident, or at least felt they had nothing to lose. Barry said it best:
“The society asked us if we wanted the results released, and we said yes,” said Barry Gutwillig, executive director of marketing and business development for Amicas. “We wouldn’t be here if we didn’t feel we could rank. I think it’s a testament to the vendors who are here and maybe more so to the ones who are not.”
With all this in mind, here is my advice for prospective PACS buyers: Do your OWN showdown. Either get a bunch of vendors to set up demos at your place all at once (or fairly close in time to each other so the details remain fresh), or get access to a web-based demo that will let you pound on their system at your leisure. I really favor the latter, as you can get a much better idea of how things work in your own hands. Vendors? Can you make this happen?
PACS interface preference is a very subjective thing. I like this approach, you like that approach. In this game, the second-place winner is in no immediate danger of extinction. Perhaps future showdowns can work from some additional metrics, such as: Does the damn thing work? Does it get in my way? Is the interface clean and usable? On second thought, those metrics are pretty hard to, um, meter, aren't they?
ADDENDUM
I received this comment, which is worthy of being moved into the post itself:
As one of the "big vendors" who was present at the show, we were also actually extremely irritated that the results were not disclosed, wherever we placed. This change in policy occured after we went on site. We may not participate again if that is going to be the way the showdown is run as it seems kind of pointless.We also thought the demonstration script was watered down from the original proposal and would have liked to have seen some of the original more challenging scenarios tackled.BTW: You have a minor inaccuracy in your article. You wrote that "Several vendors had engineering/apps types running their demonstrations". Actually, all of the vendors had a customer radiologist running their workstation. Some just seemed geekier than others.
I'm thinking this is from HBO/McKesson, by the way...
Now I wonder which vendor limited the tasks and then Got Excited about the results and as near as I can tell had them quashed? GEe, who could it have been?
OK, enough innuendo. If the folks at Centricity Central want to comment, I will publish their words here verbatim, just as I have for the Anonymous other Big Vendor. Well?

Sunday, May 21, 2006

Cool is for Losers!

My daughter just graduated from high school this weekend, and she will head to college in the fall, departing my sphere of influence. My son is finishing sixth grade, and will hang on to the Dad payroll for quite a while longer. It is his contemporaries that are starting to really worry me, the little 11 and 12 year-olds that shouldn't have a care in the world. Sadly, there are young kids in my son's class, boys as well as girls, that are incredibly concerned with what others think and say about them. It is very important to be "cool". These days, being "cool" involves not eating, not studying, not listening, showing no respect, and generally not doing anything they should be doing. The consequences of all this for these children's health are the most frightening aspect of the whole mess. When I hear a 12-year-old boy say that he can't drink a glass of milk because it might make him fat, I throw up my hands in horror. Enough is enough, people!

I propose a new campaign to fight this horrible trend, "Cool is for Losers!" When you get right down to it, being "cool" just means that you are doing stuff that makes you popular, but might not necessarily be smart or good for you. Starving yourself, smoking whatever, drinking, doing drugs, piercing various body parts, dressing like a prostitute, dressing like a convict (the droopy drawers look originated with prisoners who wanted to, ummmm, advertise their backside wares to fellow inmates), and so on and so on and so on. A real classy way to act, huh?

Why is it so important to be cool anyway? We've all been teenagers recently (ha!) and we all know the insecurities involved in that age group. To be accepted is more important than being healthy, or looking like a human being. But those whose entire goal in life is to be "cool" are more likely than not those who are petrified that they won't fit in with the "in" crowd. While they might make themselves popular with one tiny subset of society, they ruin their reputation with everyone else, and may cause irreparable physical or psychological harm to themselves. To put it quite bluntly, it is the "losers" that try so terribly hard to be cool, and conversely, the attempt to be "cool" can make these kids losers.

I'm no psychiatrist, and I can't begin to find the solution for all of this. However, sometimes just a catchy phrase will get things started. So, spread the word among the young folks in your lives: "Cool is for Losers!" It might actually make them think about the weird things they're doing, which is at least a step in the right direction.

Wednesday, May 17, 2006

Dalai Busts a Junk Faxer!
Well, Almost....



My fax line at home rang at 3AM the other day, naturally the night before I had to take call. It was a message from my friendly Junk Faxer, and I had received the very same fax about 10 times already. But when someone wakes me at 3AM unnecessarily, watch out!

Some rather brief research on the Junk Faxer's fax-back number disclosed that he is using Global Crossing, and that the long distance provider is a little Seattle company called Threshold Communications. I called Threshold, and was able to speak to Karen, one of their VP's. She was very kind and helpful, and promised to get my number removed from the Junk Faxer's list. But, no, she could not disclose the name of the faxer. And she had been receiving numerous calls from disgruntled members of the public such as myself.

Junk Faxing is illegal, as it turns out, mainly because unlike email spam, it costs money to receive a fax. Paper, toner, ribbon, they all add uup, you know. But some of these guys just ignore the law and keep on faxing. We, the victims have very little recourse. There are some services, such as FaxRecoverySystems, that will handle the prosecution for you. Send them a dozen or so junk faxes, they will do the research, file the claims for the illegal activity, and send you a check for $100 or so. It's probably a good deal, as the footwork gets complicated, but keep in mind that the fine for each illegal fax is about $1500. FaxRecovery is recovering more than faxes! As an aside, they had a message posted asking for information about the rather ubiquitous fax, and I supplied them with Threshold's number. Hopefully, I'll get some sort of reward, although not having the phone ring at 3AM is reward in and of itself.

I am no lawyer, thank Heavens, but I have to wonder if the other companies involved in Junk Faxing have some legal liability. The people at Threshold obviously know that they are providing services to a company that is doing something illegal, as well as distasteful. Why don't they refuse to do so? Karen gave me the clue: the junk faxer has about 300 numbers through their service, "but we only get complaints about 3 of them." Money talks, eh?

It would be unethical for me to suggest that anyone contact Threshold and tell them the error of their ways, or to put the fax number of the Junk Faxer on speed-dial and help tie up his lines, so forget that I said anything about that. But if there are any Threshold customers out there reading this, perhaps they could mention the situation the next time they pay their bill? Just a thought.

Saturday, May 06, 2006

Walk the Line (Placement)

Courtesy of ClinicalCases

Of the many and varied annoyances we endure on call, the CXR for line-placement at odd hours is becoming more common. When a surgeon or internist places a catheter in a large vein, there are some potential complications that should be excluded with a radiograph of the area. These problems include a pneumothorax, hematoma, and aberrant course of the line. All well and good. However, some of our clinicians have gotten into the habit of placing the line, and then telling the nurse to get Radiology to "OK the line" as they walk out the door.

Now, I can exclude the complications outlined above, although if I'm working from home at 3AM, I don't have high-res monitors at my disposal, and I can't really confirm that there isn't a tiny pneumo. But even a Sony Jumbotron would not tell me if the line is "OK", in other words usable. That is a clinical determination. If there was good return of blood through the line at the time it was placed, then it should be usable from a hemodynamic (plumbing) standpoint. For this reason, I am now placing the following sentence in the impression of each and every study I read for line placement:

Function of the line cannot be evaluated radiographically. This must be determined by the presence or absence of blood flow at the time of insertion.

Now, the question becomes: is the clinician who placed the line responsible for looking at the post-procedure radiograph? I posted this question on AuntMinnie, and while there was some debate, the majority felt that yes, the clinician IS responsible. He/she placed the line, and will collect the fees for doing so. Line placement has known possible complications, and the clinicians are perfectly able to see these on the radiograph. Are we selling our birthright if we ask them to look themselves? I don't think so. Dr. "Sofa King" posted this on the AuntMinnie thread:

Part of the procedure for line placement in confirmation of positioning and excluding the presence of a pneumothorax. If you have not done this the procedure is not over. If you cannot do this you should not be performing the procedure. If you cant see the cathether traversing up the neck, you shouldn't be performing the procedure.


The ONLY purpose of these rediculous follow-up xrays for placement of anything in a patient is to spread or turn over liability. Don't kid yourself that it is for anything else.


That said, we are not asking them to interpret an xray. Like a stethescope and ultrasound (both of which most of these guys have in their offices) the xray is just another tool of the procedure. Don't think that the idea that you won't let these guys read things in the hospital will stop them from taking anything from you when they want. They have xrays in their office and they can easily take a one week course in anything and get credentialled.

Couldn't have said it better myself. We'll see how much trouble my little canned statement causes. For me, that is.

Teens’ Speech Patterns Often Fail to, Like, Demonstrate Intelligence



The "LIKE" phenomenon is taking over the nation. Kids today, mine included, cannot utter a sentence that doesn't include the word "LIKE". Fortunately, my kids respond to yelling, screaming, threats, and ultimately beatings, and their abuse of this four-letter word has abated somewhat. Sadly, "LIKE" spews forth as every other word from some of their friends, and that is NOT an exaggeration. I am at the point of not being able to understand these poor kids.

Somehow, I thought this was a new problem, but it seems that is not the case. Here is an article from the Columbus Dispatch dated 4/1/1998, written by William L. Bainbridge, who is Distinguished Research Professor at the University of Dayton and is President & Chief Executive Officer of SchoolMatch®, a Columbus based educational auditing, research, data firm:

One of our country's many talk show celebrities is CNN monarch Larry King. King has used his outstanding listening, questioning and communication skills to catapault himself into an exciting career as a premier television and radio interviewer.
In his spare time, the King of primetime question-and-answer shows has published several books focused on his communication secrets. In How to Talk to Anyone, Anytime, Anywhere, King advises his disciples not to rely on "nothing filler words." Words and phrases such as "you know," "as I said," "basically," "actually," "hopefully," and "whatever" are condemned by King as only slightly worse than "uh" and "um" in spoiling interpersonal communication.
Despite the best efforts of teachers and parents, the nothing filler word of the 1990's has been, and continues to be, the dreaded word LIKE. It must have started somewhere in a cheerleading camp and spread with rapid-fire speed through our schools with the help of the media beginning with the early 1980's song and movie, Valley Girl. The movie Clueless and its television adaptation currently being run ad nauseum on cable channels everywhere, unfortunately, presents an accurate picture of the misuse and overuse of this word.
Recently, our organization was conducting an "effectiveness audit" in an affluent suburban school district. The school system recorded incredibly high achievement in virtually all areas of the curriculum. During our team's site visit, we met with a group of community leaders including elected student leaders. The president of the senior class is an outstanding young lady with impeccable scholastic credentials. She has high scholarship examination scores and terrific grades. Her achievements and activities are most impressive.
After the session, several adults clustered in a private corner discussing this young person's "communication flaw," or what Larry King would call a "speaking tic." She seemed unable to speak more than five words without one of them being LIKE.
The session was videotaped. We reviewed the tape and, to no surprise, found sixty-four instances by actual count of this bright person cluttering her sentence with the word LIKE in less than four minutes: "You know LIKE I feel LIKE students LIKE have trouble LIKE selecting LIKE career awareness LIKE experiences." This student was given an opportunity to demonstrate her verbal skills before leaders of the community. In the minds of those in a position to help promote her aspirations, she undermined the serious concepts she was putting forward with a nothing word sentence splice. Moreover, her speech pattern seriously interfered with her attempts to discuss the issues and persuade the audience. What was she trying to accomplish? Had this tic been developed in the process of trying to be trendy with her peers? Some teenagers can turn this brainless language on and off at will. Others apparently have difficulty adjusting to the audience. Most are completely unaware of the extent to which listeners are irritated by this drivel.
Teens need to be encouraged to express themselves. But sentence fillers and splices, however, taken to an extreme, are not well-received in public presentations and interviews for employment, scholarships or college admissions.
If there is a parent or teacher of a teenager reading this who hasn't heard the LIKE phenomenon, consider yourself fortunate. For the rest of us, let's throw it out with the oral crutch "uh", "you know" and "like I said" of an older generation and try to promote better language skills and communication.

So, can we like stop this horrible like bad habit before we like kill somebody? Like DoctorDalai? Let's all like declare our homes like-free zones, so we can have some intelligent conversation, like we used to. You know?

Friday, May 05, 2006

California Legislature To Tom Cruise:
NO MORE ULTRASOUND!

AuntMinnie.com reports today on a bill in the California Assembly designed to thwart private individuals from buying their own ultrasound scanners for home use:


The bill (A.B. 2360) was introduced by Lieu in March. An amended version of the bill, dated May 1, states that violation of the proposed law would carry a criminal misdemeanor charge. The bill was slated for its third reading on the Assembly floor on Thursday.
"If someone sees Tom Cruise buy one, they think this is the thing to do. This is a public safety measure. There's really no medical reason for an untrained person to use this machine," according to Lieu (
E!Online, May 4, 2006).


Personally, I'm not sure how many private folks out there are going to cough up $100,000-$300,000 for their own private sonography suite. I also have to wonder whether the California legislature has anything better to do.

Now, we all know that Tom is really into Scientology, which spurns much of conventional medicine. I am glad to see him embrace some of our technology. You may know that Scientology uses a device called an Electropsychometer, or E-meter for short, to perform Auditing. Here is an image of the L. Ron Hubbard Mark-VII Super Electropsychometer:


Very impressive. From the Scientology website, we learn that:

When the person holding the E-Meter electrodes thinks a thought, looks at a picture, reexperiences an incident or shifts some part of the reactive mind, he is moving and changing actual mental mass and energy. These changes in the mind influence the tiny flow of electrical energy generated by the E-Meter, causing the needle on its dial to move. The needle reactions on the E-Meter tell the auditor where the charge lies, and that it should be addressed through auditing.

Couldn't Tom and Katie have just looked in on little Suri with one of these instead?

A Blast From The Past...
Vital Images Comes A-Callin'


Mark, our PACS guru, phoned me this morning with some interesting news: Carrie from Vital Images was on the line, and wanted to ask about updating our software licenses. Mark was rather confused, a very rare state for him, because he didn't know we even had any of Vital's products. I clasped my hands together in a sinister manner and slobbered with glee....

You see, we do own three Vitreas, dating from the mid 1990's. All are Silicon Graphics computers, two running IRIX (SG's flavor of UNIX), and one running Windows NT. These represent an investment of something like $150,000 to $200,000 or so. I wasn't involved with their purchase. Actually, if memory serves, the NT was a trade-in or something. But I digress.

About three or four years ago, one of the computers blew a hard-drive. I tried to nurse it back to health, but to no avail. So I called Vital Images. TEN TIMES! And I emailed them ten more times. Nothing. I posted nasty things about them on AuntMinnie.com. Nothing. We chalked up our losses, and went on to bigger and better things, like GE AW's and Siemens Leonardos, and various installs of Voxar 3D, all of which have done the job nicely.

I returned Carrie's call, and as nicely as I could for someone out $200,000 on non-working equipment, explained the situation. She had only just joined the service force, and was not happy to hear of our plight. I suggested she elevate the complaint to the president of the company, although that would be mainly for their benefit. Given this incredible service faux pas, I would not even accept a freebie at this point. If Vital wishes to donate a Vitrea to a third-world country in my name to assuage their collective conscience, that would be fine. But do tell them not to expect stellar service if it breaks.

Carrie promised to figure out what had happened, and to keep such a thing from happening again. I wish she had been with Vital a few years ago....

Addendum: The Vital rep for our area did indeed contact me, and we had a very good conversation. I do wish this new generation had been around when our problems started. Anyone want to buy a first or second generation Vitrea?

Sunday, April 30, 2006

The Case of the Missing Hole...
A Doctor Dalai Mystery

I'm on call tonight, and I've read about 200 studies since 8AM. Does wonders for the attitude. Imagine my joy (or lack thereof), when I received the following call from one of our hospitals:

"Uh, Dr. Dalai? This is Joe Tech from NorthSouth Hospital. I have another CT PA gram for you, and also a renal stone CT. Oh, and Dr. Feckless in the ER wants to know if we should scan a chest without or with contrast. Why does he want it? Well, he sees a hole in the lung on a chest X-ray, and he wants to scan it......"

Only the names have been changed to protect the innocent (ME!!!). The chest X-ray in question is anonymously reproduced below:

See the "hole"? It's in the region of the left axilla, and it is a bloody artifact caused by crossing of breast and arm shadows. Hole, indeed.

My response to Joe Tech was at first angry and then practical..."Is Dr. Feckless going to call in the surgeons based on the CT finding? No, don't repeat that....repeat the chest X-ray with the arms out of the way, and if the, ummm, hole is still there, THEN we'll do a CT." The repeat is found below. Voila! No hole!

This sad tale is wonderfully illustrative of how the ER thinks. Or doesn't as the case may be. The slightest twinge deserves the full court press. The slightest question is to be answered with a $1000 CT scan. In the middle of the night, of course. So, I have to get off my anti-self-referral bandwagon and get on my anti-scan-for-no-good-reason bandwagon. Hey, maybe they are the same bandwagon? Anyway, this knee-jerk ordering of a very expensive test is yet another reason imaging costs have skyrocketed out of sight. One of my partners very seriously states that the ER depends on us because we provide the diagnosis for them, because we have become so good at reading CT's, and because CT's have become so much better with multi-slice technique. Balderdash. The ER is just palming off their triage duties onto us. Order a scan of the affected area and see a few more victims while it's being done. And order scans on the new victims while we're at it.

This practice has got to stop, just as much as self-referral must be curbed. I keep backing into the conclusion that socialized medicine is going to do that for us, whether we like it or not. Hope I'm wrong. In the meantime, let me read the next 10 negative CT's.

Thursday, April 27, 2006

SCAR Capitulates to Estonian Pressure!


Big news in the PACS world, folks! SCAR, the Society for Computer Applications in Medicine has changed its name to Siim. Now, in theory, this stands for the Society for Imaging Informatics in Medicine. However, Dalai, your intrepid reporter, did a little digging and discovered the following: The Prime Minister of Estonia is, you guessed it, Siim Kallas! Coincidence? I think not. Notice in the photo below how Mr. Kallas (the one on your left) is looking quite pleased with himself, having just convinced Mr. Bush to move SCAR, I mean SiiM, headquarters to Estonia. I will actually be in Estonia later this year (really!) and I will check this out personally.

In the meantime, if you go to http://www.siim.com, you will reach the site of a plastics manufacturer with these featured products:


Looks like they are in the PACS business, too! Do you sense any takeover plans? Hmmmmm?

United 93


Dalai's Note: David Beamer is the father of Todd Beamer, one of the heros of United Flight 93. His words are so eloquent and poignant, I have copied his statement from today's Wall Street Journal for the benefit of my readers. America needs to hear this, and we need to see this movie.

By DAVID BEAMER Wall Street Journal,April 27, 2006; Page A18

The calendar says it's April 25, 2006. At noon, my wife, Peggy, and I are walking around Battery Park -- near the Tribeca area -- in New York. It is our first time. The flowers are blooming; kids are fishing; people boarding the ferry to Ellis Island and the Statue of Liberty. Kids are laughing and noisy. The sun is shining. The vendors are hawking T-shirts, pretzels and some "designer" wares. And just up the street there is a hole in the skyline and in the ground.
In the park, there is a memorial with walls standing tall. Walls filled with so many names of those who gave their all in the Atlantic in World War II. How fitting that the names are here to honor those who gave their lives to enable this fun, this laughter -- on this sunny day. The sights and sounds of freedom continue.
Fast forward -- it is 10:30 p.m., April 25. We have just seen a movie premiere at the fifth annual Tribeca Film Festival. A film festival that has done so much to energize and revitalize the city, its people and especially the area that has that hole in the skyline and in the ground. This year the movie that had its worldwide premiere at the festival is titled "United 93." It is about the day when the hole in the skyline of New York was made -- the day when a hole was made in the side of the Pentagon near Washington, D.C. -- the day when a hole was made in a quiet mountain meadow in Pennsylvania. The day that our nation was attacked; the day when the war came home -- Sept. 11, 2001. The day our son Todd boarded United 93.
Paul Greengrass and Universal set out to tell the story of United Flight 93 on that terrible day in our nation's history. They set about the task of telling this story with a genuine intent to get it right -- the actions of those on board and honor their memory. Their extensive research included reaching out to all the families who had lost loved ones on United Flight 93 as the first casualties of this war. And Paul and his team got it right.
There are those who question the timing of this project and the painful memories it evokes. Clearly, the film portrays the reality of the attack on our homeland and its terrible consequences. Often we attend movies to escape reality and fantasize a bit. In this case and at this time, it is appropriate to get a dose of reality about this war and the real enemy we face. It is not too soon for this story to be told, seen and heard. But it is too soon for us to become complacent. It is too soon for us to think of this war in only national terms. We need to be mindful that this enemy, who made those holes in our landscape and caused the deaths of some 3,000 of our fellow free people, has a vision to personally kill or convert each and every one of us. This film reminds us that this war is personal. This enemy is on a fanatical mission to take away our lives and liberty -- the liberty that has been secured for us by those whose names are on those walls in Battery Park and so many other walls and stones throughout this nation. This enemy seeks to take away the free will that our Creator has endowed in us. Patrick Henry got it right some 231 years ago. Living without liberty is not living at all.
The passengers and crew of United 93 had the blessed opportunity to understand the nature of the attack and to launch a counterattack against the enemy. This was our first successful counterattack in our homeland in this new global war -- World War III.
This film further reminds us of the nature of the enemy we face. An enemy who will stop at nothing to achieve world domination and force a life devoid of freedom upon all. Their methods are inhumane and their targets are the innocent and unsuspecting. We call this conflict the "War on Terror." This film is a wake-up call. And although we abhor terrorism as a tactic, we are at war with a real enemy and it is personal.
There are those who would hope to escape the pain of war. Can't we just live and let live and pretend every thing is OK? Let's discuss, negotiate, reason together. The film accurately shows an enemy who will stop at nothing in a quest for control. This enemy does not seek our resources, our land or our materials, but rather to alter our very way of life.
I encourage my fellow Americans and free people everywhere to see "United 93."
Be reminded of our very real enemy. Be inspired by a true story of heroic actions taken by ordinary people with victorious consequences. Be thankful for each precious day of life with a loved one and make the most of it. Resolve to take the right action in the situations of life, whatever they may be. Resolve to give thanks and support to those men, women, leaders and commanders who to this day (1,687 days since Sept. 11, 2001) continue the counterattacks on our enemy and in so doing keep us safe and our freedoms intact.
May the taste of freedom for people of the Middle East hasten victory. The enemy we face does not have the word "surrender" in their dictionary. We must not have the word "retreat" in ours. We surely want our troops home as soon as possible. That said, they cannot come home in retreat. They must come home victoriously. Pray for them.

Wednesday, April 19, 2006

Happy Birthday, Dr. K!



Nobody escapes the Spanish Inquisition, or Doctor Dalai when he has photos!

Dr. K celebrated his 40th birthday by trucking into the hospital at 4AM to do a lumbar puncture on a 350 pound lady who wouldn't hold still. The day did improve significantly, and we had a chance to celebrate a little. Dr. K is an avid biker, occasionally riding all the way to the hospital from home. We thought he needed something a little snazzier......

8G SCAM!
A Public Service Announcment from Doctor Dalai

From the "if it's too good to be true it probably isn't" department.....
I troll around eBay periodically, looking for bargains and whatnot. I stumbled across a listing for a "Sony Micro Vault 8GB USB Flash Drive," going for only about $40. I immediately bid on it. Fortunately, a kind soul informed me by email that Sony doesn't make any drives that large in that form-factor, and what I was bidding on was likely a fake. I was able to withdraw my bid in the nick of time. Yes, it would look like an 8GB drive to my computer, until I actually tried to write something to it and read it back. Then its real size of 64 MB would become apparent.
In the interests of Karma, I am passing this information on to my loyal readers. For more information, please see this notice on eBay.
This has been a public service announcement brought to you by Doctordalai.com. Thank you for your attention.

Sunday, April 16, 2006

Happy Easter from Doctor Dalai!




I swear this has not been retouched save to eliminate the name of the store manager. I have always been one to promote good relations between peoples of all faiths. We purchased some Easter Chocolate for some friends, but we didn't realize until we left the store just how ecumenical our selection really was. I wonder if my friends will go for the ears first......

Saturday, April 08, 2006

The X-Ray Man



It’s 2 AM on a Saturday
The regular crowd is all here
There’s an old man yelling out at me
With dementia he’s had for three years

He says, “Doc will you give me an enema?
You know where the barium goes
I got cramps and the trots
Which I didn’t have lots
When I had a younger man’s hose…”

Oh La La La De De Da
La La, De De Da Da Dum

Read us a film, You’re the X-Ray Man
Read us our film TONIGHT
‘Cause we’re all in the mood for a malady
And CT will make us alright

Now John down in Nukes is a friend of mine
He tries not to wake me ‘till 3
And he’s quick with his V/Q
And then he won’t seek you
Till the ER just won’t let him be
He says, “Doc, they just ordered another one”
“I tried not to do it till 10…
But the patient is dusky and comatose
And probably won’t live until then.

Oh La La La De De Da
La La, De De Da Da Dum

Read us a film, You’re the X-Ray Man
Read us our film TONIGHT
‘Cause we’re all in the mood for a malady
And CT will make us alright

Paul is our CT Technologist
Who scans like he’s been there for days
And he’s talking with Davy whose CR’s are wavy
But they all pass QC anyway.
And the ward-clerk is practicing medicine
As the waiting-room slowly gets mean
Yes, they’re sharing a drink they call Thunderbird
Which does wonders for liver and spleen

It’s a really slow night for a Saturday,
I’m 63 studies behind
It takes more than my best
To read neck, head, and chest
And abdomen, pelvis, and spine

And the PACS system smokes like a chimney
And the Dictaphone squawks in my ear
And I sit in my chair and stare off in the air
And say, “Man, what am I doin’ here?”

Oh La La La De De Da
La La, De De Da Da Dum

Read us a film, You’re the X-Ray Man
Read us our film TONIGHT
‘Cause we’re all in the mood for a malady
And CT will make us alright