Desperate Times. Desperate Solutions.
Michael Pence, Governor of Indiana, signed a bill allowing people who are battling life-threatening conditions, to gain access to experimental medicines. Known as a “right to try” law, the intent is to leapfrog a drug-development process that may take years before new treatments become available. The move is a reflection of the frustration with a Food and Drug Administration program called expanded access. People who are seriously ill can obtain a drug under development, even though they aren't enrolled in a clinical trial. Whether the “right to try” rallying cry will make a difference is unknown, but 11 states have a similar statute. Facing a very serious or potentially fatal illness, one is driven to seek help, irrespective of the risk.
Status Quo. Latin for the Mess We're In.
Despite the complexity of separating 15,000 FAA air traffic control employees, the House Aviation sub-committee endorsed the concept of either privatizing ATC or creating a government corporation. Six of seven people who were asked to testify agreed with the committee's recommendation. The panelists who backed the change included Paul Rinaldi, president of the air traffic controllers union and Douglas Parker, CEO of American Airlines, spokesman for the coalition of major airlines. John Engler, president of the Business Roundtable, noted the efficiency of private modern ATC in Australia, Canada, Germany and the United Kingdom. The major difficulty will be moving inbred inertia at the FAA, and unseating a stubborn collection of bureaucrats. Good luck with that.
The MCAT Joins the 21st Century.
For the first time in 25 years the MCAT (Medical College Admission Test) was changed this April. The Association of American Medical Colleges (AAMC) that develops and administers the MCAT, eliminated the essay portion and introduced a large new section. One-fourth of the test covers psychology, sociology and the biological foundations of behavior. AAMC said the revised exam is the product of prodigious planning by the review committee that held 90 outreach events, surveyed 2700 medical school faculty, students, and residents, and consulted with pre-med advisors. The 8200 applicants had to prepare for 11 suggested prerequisite courses compared to 8 in past exams. They were scheduled for a test time of 7 ½ hours not 4 hours 10 minutes, 230 questions rather than 144, and 4 sections not 3. Students must demonstrate what they know and how to apply it. The changes are designed to mirror the evolution of health care delivery. AAMC committee considered making MCAT pass/fail, but it was ultimately decided that reporting scores gives admission committees more flexibility in deciding selections. Buckle up, pre-meds. The road to medical school just got steeper and rockier.
The American Academy of Pediatrics vs The NRA.
For reasons of public safety the American Academy of Pediatrics advised its members to inquire about the presence of firearms in the home. Florida and three other states have passed laws with National Rifle Association support limiting such inquiry, apparently believing it is not a matter for conversation in the doctor/patient-parent relationship. At least 14 other states across the country have considered similar legislation. Florida physicians fear that patients (parents) who believe the doctor is violating the law can be reported to the state medical board. Physicians argue that a gag would be a violation of free speech. The issue has arrived at the US Court of Appeals that will either uphold the statute or not. “Lay that pistol down, Babe, lay that pistol down…”
Making Health Care Available in the Sticks.
In many rural areas in America, medical care is often sketchy or non-existent. Nebraska became the 20th state to provide a change in medical practice to allow nurses with most advanced degrees to provide medical care without physician oversight. Maryland's governor recently signed a similar law and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Not surprisingly, the American Medical Association is opposed to the change, stating nurses lack the knowledge and skills to diagnose complex illnesses. In all, nurse practitioners constitute a quarter of the primary care work force, according to the Institute of Medicine which called on states to lift barriers to their full practice.
Demands of the ACA Can Lead to Burnout.
Meantime, in Minnesota physician burnout is emphasizing an already compromised medical work force. Long hours and emotionally straining cases are compounded by patient record reforms and a digital reimbursement system that judges doctors by their patient's health. A series of influential studies by researchers suggest that burnout could aggravate the state's shortage of primary care doctors and drive some into early retirement. Does Minnesota law permit nurse practitioners?
Breaking Up is So Hard to Do.
According to police records released in April, the 24 year-old woman (awaiting trial for manslaughter) was texting sarcastic insults to her ex-boyfriend while bar hopping (her blood alcohol content later measured 0.178). According to the police report her last text to the ex-boyfriend was “driving drunk woo…. I'll be dead thanks to you.” Sadly, she got that wrong as well. She ran a red light and smashed into a pickup truck. She suffered serious injuries but survived while her passenger was killed.
Air Bags and Safety — A Double Edged Sword for 17 Million Vehicles.
Ten automakers are involved in a massive recall of 17 million vehicles each equipped with two Takata airbags. More than 100 injuries, including serious eye damage, and 6 deaths have been directly tied to the exploding airbags. While the exact mechanism has yet to be determined, a strong suspicion centers around ammonium nitrate, the primary explosive compound that opens the airbag. Ammonium nitrate is the main ingredient in some bombs and becomes unstable at temperatures over 100 degrees Fahrenheit. A closed car can reach 140 deg. parked in the summer sun. Timothy McVeigh used ammonium nitrate to ignite the bomb that destroyed the Oklahoma City federal building with 168 deaths and hundreds injured. Other less volatile compounds are available, but are more expensive. It may not be as simple as just one root cause according to former administrator of the National Highway Traffic Safety Administration, David Kelly, who has been hired to lead the investigation. Between exploding airbags (Takata) and faulty ignition systems (General Motors), driving to the store is not risk free.
Addenda
The color combination with the most visual impact? Black on yellow.
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“You'd be surprised how much it costs to look this cheap.”
Dolly Parton
Never try to keep up with the Joneses. Drag them down to your level.
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Men always scratch their asses when they're thinking.
Maybe that's where their brains are.
People who think they know everything are very irritating to those of us who do.
Aloha and keep the faith rts
(Editorial comment is strictly that of the writer.)