Saturday, December 01, 2007

Older adults can hold their liquer just as well as their kids.

Despite US recommendations that elderly people curb their drinking more than young people, an article in the Journal of the American Geriatric Society from January of this year reports that elderly people actually have no more difficulty managing activities of daily living or on cognitive tests when drinking than their younger counterparts.
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Older age is associated with increased sensitivity to alcohol. Because of this,
some nations (e.g., the United States) have lower recommendations for safe
alcohol limits in persons 65 years or older.
pooled analysis using data from HRS and ELSA included 5,759 men and 7,574
women; a longitudinal analysis using HRS data included 2,338 men and 3,698
women; and a longitudinal analysis using ELSA data included 1,152 men and 1,471
women. Over a four-year period, there were no statistically significant
differences in any outcome measures related to a rise in drinking level
There did not appear to be any statistically significant health or mortality
risk increase in older persons consuming greater than one to two drinks of
alcohol per day. The benefits of moderate alcohol consumption on disability and
mortality probably occur through cardiovascular risk reduction.
guidelines for older adults need not be overly restrictive
relative to recommendations for younger adults.
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Child safety seats more effective than shoulder belts.

Although common practice, and for many of us common sense, the use of child safety seats had been recently called into question for children 2 to 6 years of age. A recent article in the Archives of Pediatric Adolescent Medicine reviewed this topic. They found (big surprise) that safety seats do indeed save lives.
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Studies have shown that safety seats are more
effective than lap-shoulder seat belts in reducing the risk of injuries and
death in children. However, one study by researchers at the National Bureau of
Economic Research found that lap-shoulder seat belts were as protective as
child safety seats in children two to six years of age, and that they were
significantly less expensive.
Data were collected from the Crashworthiness Data
System of the National Highway Traffic Safety Administration from January 1,
1998, to December 31, 2004.
A total of 463 children were included in the
analysis, with 409 children being restrained by child safety seat and 54 by
lap-shoulder seat belts.
Unadjusted injury
probability for children in severe crashes was 46 percent lower in the safety
seat group compared with the lap-shoulder seat belt group.
Child safety seats appear to be more effective
than lap-shoulder seat belts in reducing the risk of nonfatal injuries in
chil-dren two to three years of age.
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Friday, November 30, 2007

Invasive treatment not better than medical management for non-ST MI.

A randomized controlled trial published in the Lancet showed no benefit from early invasive treatment for non-ST elevation MI. Although it's true that they experienced fewer symptoms of angina, they did experience more MI's than their piers. This study seems to indicate that early invasive treatment in these cases is not indicated.
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Initial data indicated that routine invasive therapy was more effective than selective invasive treatment in reducing subsequent major cardiovascular events. More recently, large trials with up to five years' follow-up have had contrasting results.
The researchers enrolled 1,200 patients 18 to 80 years of age between 2001 and
Patients were randomly assigned to receive early invasive therapy or initial medical management with intervention only if clinically indicated...cumulative three-year results for the primary composite end point (death, recurrent myocardial infarction, or hospitalization) were 30 percent in the early invasive group and 26 percent in the selective intervention group (P = .09).
The authors conclude that early invasive treatment did not provide better outcomes over four years than the selective strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin.

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Monday, November 26, 2007

Sunday, November 11, 2007

Free clinics may help fill the gap

While the medical system has come under fire recently, thousands of free clinics around the country have been working to fill the holes. Seen as an acute stop-gap for something that is essentially a chronic problem, the cost of these clinics to their providers is generally a tiny fraction of the true value of care received by patients.

No potential medical system can successfully deliver universal coverage while at the same time controlling costs if it does not stimulate the delivery of low cost and free basic services to those most in need.
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The Free Clinic movement is living embodiment of many conservative principles: the principles of subsidiarity and voluntarism, the spirit of enterprise and of community self-reliance. As health care becomes more and more of a national concern, if people are truly concerned about the less fortunate, there should be a population explosion in the number of free clinics around the country.

All the good intentions in the world would not make a free clinic possible in our litigious society. But that problem has been solved in Virginia, whose example could easily be followed.

the help of the Virginia Association of Free Clinics, the state recently established the "VaRISK2" liability risk management program. Operating under the Division of Risk Management of the Department of the Treasury, of the Commonwealth of Virginia, the program indemnifies Directors, Officers, employees, and volunteers in a Free Clinic.

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Wednesday, September 12, 2007

The wrong direction for healthcare?

With the presidential campaigns pushing universal health care back into the forefront of our collective consciousness, the industry itself has gotten into the debate. Unfortunately, it seems to have come in on the wrong side. An article from the New York Post, which appeared on the Cato Institute web page, reports that The American Cancer Society is devoting it's entire advertising budget to the promotion of government-run health care.

Unfortunately for their patients, getting their way will undoubtedly mean worse outcomes. Although free markets often create greater variation in outcomes than bureaucratically managed systems, they are also the only way to guarantee consistent quality care to the majority of customers.

The article, quoted below, elaborates.
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The American Cancer Society announced recently that it will spend its entire advertising budget next year
on campaigning for a government takeover of the U.S. health-care system. This is perverse: It's hard to imagine anything worse for cancer patients than government-run health care.
Cancer patients understand this. The overall five-year survival rate for all types of cancer for men in America is 66.3 percent, and 62.9 percent for women, the best outcome in the world.
free-market U.S. medicine provides the incentives that lead to innovative breakthroughs in new drugs and other medical technologies. U.S. companies have developed half of all the major new medicines introduced worldwide over the last 20 years.
Take prostate cancer, for example.
we are less likely to die from the disease. Fewer than 20 percent of American men with prostate cancer will die from it, against 57 percent of British men and nearly half of French and German men.
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Tuesday, June 12, 2007

Job's tries to keep his winning streak alive.

Apple's trend of "can do no wrong" will likely get another dose of adrenaline this week, as Jobs makes more pronouncements to wow the faithfull, and catch the attention of some of the rest of us...
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Chief executive Steve Jobs said Apple "dream big" and wanted to expand the 4.9% market share Safari enjoys.
He said Safari was "the fastest browser on Windows", saying it was twice as fast as Internet Explorer.
Mr Jobs used the conference to lift the lid on new features of its forthcoming operating system (OS) for Macs, called Leopard.
He said the OS has 300 new features and demoed 10, including a new organisational system for the desktop called Stacks and a new folder system which lets users browse files and applications visually, just as music lovers can browse album covers in iTunes.
Mr Jobs also gave the greenlight to third-party development of new applications for its forthcoming iPhone mobile phone.
Instead of having to test each and every new application themselves, Apple will allow developers to build web applications for the phone which run inside the device's web browser Safari and which were built on existing web standards.
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I can't believe Scotland's that bad...

This article reflects the inherent shortcoming of our western society's propensity for quantifying all things. The assertion that Scotland is the worst small western European country rests primarily upon it's shorter life expectancy. This relatively minor, 2 year difference takes in to account none of the things which make a life qualitatively better... like enjoying a fine glass of single malt scotch rather than some snooty French wine...
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The Federation of Small Businesses' annual Index of Wealth compared 10 countries on economic performance, employment rates, health and education.
Scotland's life expectancy rate was a major factor in it coming bottom.
The FSB Scotland index examined countries with fewer than nine million people, including Norway, Iceland and the Republic of Ireland.
"The reason why Scotland is stuck at the bottom of the pile is largely due to our poor health and our low life expectancy," he said.
The figures were 74.2 for men and 79.3 for women, compared to the UK average of 76.6 and 81 years.
However, Mr McLaren added that even if health was taken out of the equation Scotland would still be "fairly low" on the table, in about fifth or sixth place.
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New 1st line tx. for hepatocellular ca.

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orafenib (Nexavar) is the first effective systemic treatment for advanced liver cancer.
researchers showed that the targeted multikinase inhibitor extends survival by 44%.
There is currently no widely accepted standard of care for advanced liver cancer. Doxorubicin is reportedly the most widely used agent, despite the fact that only 1 randomized controlled trial of 60 patients has supported its use and the drug is said to have a 25% rate of fatal complications. Mitoxantrone is licensed for hepatocellular carcinoma but is not considered a gold standard
double blind, randomized, placebo-controlled trial, investigators studied 602 patients. The trial, known as the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP), looked at the primary end points of overall survival and time to symptomatic progression. Patients received oral sorafenib 400 mg twice daily or placebo for 6 months, but the trial was stopped early because the findings were so positive
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Monday, May 28, 2007

Blind Faith: a review of Stephen Prothero's "Religious Literacy"

For those of us who have at some time lamented the our peers' inability or unwillingness to engage in serious religious discussion, a new book is out which appears to quantify the problem. By creating a culture which is hostile to religious discourse, what we have actually suppressed is our own critical thinking. As social animals, humans require consistent, positive reinforcement in order to develop a skill or interest. Americans (and likely most other cultures) have pushed religion back to the nether-regions of our sunday-school services.

What it boils down to is this: Americans aren't doing their homework when it comes to religion. This new book appears to catalogue that phenomenon. A clip from a Washington Post review is below:
The United States is the most religious nation in the developed world
Americans are also the most religiously ignorant people in the Western world. Fewer than half of us can identify Genesis as the first book of the Bible, and only one third know that Jesus delivered the Sermon on the Mount.
Prothero sees America's religious illiteracy as even more dangerous than general cultural illiteracy "because religion is the most volatile constituent of culture
the author combines a lively history of the rise and fall of American religious literacy with a set of proposed remedies based on his hope that "the Fall into religious ignorance is reversible."
The condition Prothero describes in Religious Literacy is unquestionably one manifestation of a more general decline in the public's cultural and civic knowledge.
How can citizens know what creationism means, or make an informed decision about whether it belongs in classrooms, if fewer than half can identify Genesis?
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Thursday, May 24, 2007

Debating the use of Guiafenesin in Fibromyalgia.

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Dr. Robert Bennett, a recognized expert in the fibromyalgia field, agreed to do a study on guaifenesin, with Dr. St. Amand
The results of this long term study showed that guaifenesin had no effect on fibromyalgia.
much of Dr. St. Amand's success with guaifenesin, could be attributed to the placebo effect.
Additionally, any worsening of fibromyalgia symptoms during the treatment, is also a good sign, since these symptoms are attributed to guaifenesin's reversal process, that rids the body of "metabolic debris".
Not to mention, that guaifenesin often causes a change of smell or color in the urine. Many people attribute these changes to toxins being released from the body, when in all likelihood, this is simply due to the fact that the guaifenesin is metabolized by the liver, resulting in a form of lactic acid, that is then excreted in the urine.
guaifenesin has a skeletal muscle relaxant property,
It likely also has an analgesic, or pain relieving capability
Amongst the many "alternative" treatments in existence today, is the use of guiafenesin, a common over-the-counter mucolytic, in the treatment of fibromyalgia. The most influential proponent of this treatment, one Dr. St. Armond, has written a book on the topic entitled, "What Your Doctor May Not Tell You About Fibromyalgia : The Revolutionary Treatment That Can Reverse The Disease."

Reading the book, as a new physician, several aspects of Dr. St. Armond's case raised immediate red flags in my mind. First, Dr. St, Armond has (admittedly) failed to show any clinical evidence that the treatment works, relying instead on extensive anecdotal evidence. Second, the proposed mechanism of action in the treatment of the fibromyalgia simplifies for the laymen to the all-to-common "ridding the body of metabolic toxins." Third, fibromyalgia itself, and this treatment regimen in particular, lends itself to significant percentages of placebo affected patients. And finally, his line follows the all-to-common theme of the underdog treatment, conspired against by the likes of Big Medical and Big Pharm.

A wonderful response to this theory has been written by Mark London (presumably) at MIT. His response addresses all of the aforementioned points, but most extensively covers the dubious mechanism of action. Some of the basic points in his article are quoted below.

Saturday, April 21, 2007

A rare textual blog of the scriptures

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Like many lax but well-educated Jews (and Christians), I have long assumed I knew what was in the Bible—more or less.
I absorbed other bits of Bible everywhere—from stories I heard in churches and synagogues, movies and TV shows, tidbits my parents and teachers told me. All this left me with a general sense that I knew the Good Book well enough, and that it was a font of crackling stories, Jewish heroes, and moral lessons.
o, the tale of Dinah unsettled me, to say the least. If this story was strutting cheerfully through the back half of Genesis, what else had I forgotten or never learned? I decided I would, for the first time as an adult, read the Bible. And I would blog about it as I went along.
My goal is pretty simple. I want to find out what happens when an ignorant person actually reads the book on which his religion is based.
David Katz, a writer for Slate magazine, has undertaken a surprisingly rare task in the blogosphere. He has decided to actually read the bible and engage his readers in a discussion of the text. As a believer in the pursuit of truth and wisdom, as well as a believer in the scriptures as a source of truth, I had assumed that this type of blog would be easy to come by. Alas, I was mistaken. The longer one searches the blogosphere, and for that matter, the internet at large, the more obvious it becomes what many of us had suspected all along. Almost nobody actually reads that thing. For all the preachers waving their bibles around in church, and all the thousands of people listening intently every week, no one's actually doing their homework.

So leave it to the newly invigorated liberal media to get some religion and fill the gap. The fellows over at Slate may fill volumes with their mockery of the religious right, but in this column they're also one-uping them by studying what the other side claims to own. Keep up this honest search for truth, and the liberals might win over some converts. One thing though, they've certainly captured a reader.

Wednesday, April 18, 2007

Daily Show IQ?

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A study by the Pew Research Center for the People and the Press found that viewers of Jon Stewart and Steven Colbert are among the most politically savvy news watchers. Shit, we even beat out those robo-geeks who watch Jim Lehrer on PBS! The average Fox News viewer, by contrast, bombed the political pop quiz, placing that audience just slightly above the early morning talk show crowd.

it seems safe to conclude that my so-called “slacker” generation takes more of an explicit interest in politics than our ancestors. The other thing to note about this segment of the population is that it skews decidedly liberal.
I think it’s quite simple. My generation (*cough*) grew very wary at an early age with propagandist style lies about everything from the War on Drugs to sex education; with racism, homophobia, immigrant paranoia; and with blind faith in both God and country.
Interesting post. I disagree with his analysis of the data though. Our (*cough*) generation is likely left-leaning just because they're twenty-something, not because we've been alienated by the right. That feeling of alienation we might feel from the right may be predominantly because we're not their target audience. Young people typically seem to be more liberal, and as they age, swing more toward the right. I don't have sources to sight on that, it just seems self-evident.

I would speculate that this age gap also explains why the Daily Show viewers did better on the quiz. My father, for example, used to watch McNeal-Lehr religiously, and as a Mayo clinic physician and information junkie, I suspect he was pretty well informed on things. Now, in his 60's, he leaves the TV on FoxNews "because PBS just got too damn-liberal nowadays."

Monday, April 16, 2007

Greenspan needs to shut up.

Ever known someone who knew everything, but didn't know when to keep quiet about it? Alan Greenspan was that guy this month. It's true when he says that increased competition in any industry invariably leads to innovation and progress. It's true that competition leads to lower costs, and a healthier economy. But as an aspiring doctor with 10's of thousands of dollars of debt, I'm not too happy about him pointing out the inflated salaries of my medical colleagues.

As members of a civilized society however, we cannot draw lines when it affects us personally. We cannot condemn the moral incongruity of other protectionists while at the same time defending our own turf. Still, it would be nice if some truths took a little longer to come to light.

Perhaps while he's on the subject of perceived income inequality, he might suggest some international competition for the Christmas bonuses of friends at Goldman's Sachs. Or better yet, stop by Cato and check how much incomes are really diverging. Or best, next time he has an epiphany like this one, keep it to himself...
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Greenspan's solution to America's wage disparity is thus: "Our skilled wages are higher than anywhere in the world. If we open up a significant window for skilled workers, that would suppress the skilled-wage level and end the concentration of income."
After all, less-skilled and less-educated workers, primarily in the manufacturing industry, have been subjected to direct competition with lower-paid workers overseas. In return, the United States has received less-expensive goods at big box stores like Wal-Mart and Costco.
In 1997, Congress tightened the licensing rules for foreign doctors entering the country because of concerns by the American Medical Association and other doctors' organizations that the inflow of foreign doctors was driving down their salaries. As a result, the number of foreign medical residents allowed to enter the country each year was cut in half.

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Friday, March 23, 2007

Multiple options available for treatment of MRSA

Management of Staphylococcus aureus Infections - December 15, 2005 -- American Family Physician

More than half of all patients who develop S. aureus infections while in the hospital are found to have MRSA (methicillin resistant Staph. aureus). Vancomycin is the drug of choice in the treatment of MRSA. With the development of vancomycin resistant strains, it is important for physicians and patients to be aware of alternatives to vancomycin. Luckily, there are several alternatives available.

A fairly recent review article from American Family Physician (AFP), summarizes these alternatives. Linezolid (Zyvox) can be used for all types of MRSA infections, but is especially useful in treating hospital acquired MRSA pneumonia. One article found that it was actually superior to Vancomycin in this setting. Daptomycin (Cubicin) can be used for all complicated MRSA infections EXCEPT pneumonia.

Patients who develop simple MRSA skin infections outside of the hospital can usually be treated with trimethoprim/sulfamethoxazole (Bactrim), doxycycline,
or possibly a fluoroquinolone such as gati- or levofloxicin.

In patients found to have methacillin susceptible S. aureus (MSSA), the treatment should be easier. Oral dicloxacillin or IV nafcillin or oxacillin (known as semi-synthetic penicillins) are preferred. Oral cephalexin (Keflex) or IV cefazolin (Ancef) (known as 1st generation cephalosporins) are a good alternative. In this setting, Vancomycin should be reserved for patients who are allergic to penicillins.

The article goes on to describe aspects of treatment specific to the various body systems that may be infected by S. aureus. ...very good reading.

Friday, March 02, 2007

Multifactorial approach effective for treatment of IBS

Treatment of Irritable Bowel Syndrome - December 15, 2005 -- American Family Physician

Using an algorithm adapted from a New England Journal of Medicine article, a recent review in AFP promotes a multi factorial approach to the treatment of Irritable Bowel Syndrome (IBS). In addition to relaxation, stress reduction, education, and exercise, patients with mild IBS usually respond to dicyclomine (an antispasmodic) and peppermint. Patients with constipation do especially well with the addition of guar gum, fiber, exercise, and/or laxatives. Those who suffer from diarrhea or pain usually respond to the addition of immodium and TCAs (tricyclic antidepressants). Other treatments, including, 5-HT3 antagonists (Alosetron), 5-HT4 agonists (Tegaserod, or Zelnorm), Cisapride, probiotics, or cognitive-behavioral therapy, can be tried if other therapies fail.

Peppermint is especially interesting because it works well in several ways. It is an antispasmodic, anesthetic, and relieves nausea. As an herbal, it can be given over the counter or as a tea. Importantly, it may be acceptable to many patients who are hesitant to start a new 'medication'.

For those with constipation, guar gum is interesting for much the same reason as pepperment. It too can be given over the counter, and, importantly, patients tend to actually like it better than fiber.

Patients with diarrhea have two very good choices. We all know immodium, but it is important to know that it does suprisingly well in the treatment of IBS. In addition, TCAs such as desipramine (my favorate), amitryptyline, and clomipramine, work very well in low doses. Patients should know that the mechanism of action for TCA's is likely seperate from that which is involved in the antidepressant quality of the drugs (and thus you are NOT saying that they are crazy when prescribing the medication).

In short, patients with IBS have no reason to go untreated. There exist multiple good therapies, and good understanding and treatment of the illness is achievable.

Thursday, March 01, 2007

Dipstick sufficient, no imaging necessary for uncomplicated childhood UTI's

Urinary Tract Infection in Children - December 15, 2005 -- American Family Physician

A review article in American Family Physician reports that children with uncomplicated UTI's show no benefit from imaging work-ups. While it may be true that imaging may reveal relatively common vesicourethral reflux or, less commonly, subsequent renal scarring leading to potential adult hypertension, effective treatments for these conditions are wonting, and clinical efficacy for the tests has not been shown. Older children with classic symptoms of UTI were best served by initial urine cultures and empiric antibiotics, while infants with unexplained fever and older children with nonclassic symptoms did best with initial dipstick testing.

A negative dipstick result can effectively rule out UTI. Physicians are free to treat positive cultures for as long as they want, as long as it lasts more than one day. Cranberry juice has not been shown to be effective in preventing UTI's. Although circumcision has been shown to reduce the incidence of UTI's, the benefit (from this aspect alone) is clearly insufficient to warrant the procedure.

Tuesday, February 20, 2007

Washington's addiction to money

The "Beltway Cut"

A good article from Cato org. breaks down Bush's latest budget proposal. The short of it is that Washington still stubbornly refuses to actually reduce spending, choosing instead to rely on empty statistical manipulation. What is clear from this is that, this administration at least, is still incapable of cutting the cord with pet projects and special interest groups. Their analysis has clearly lead them to the belief that by continually increasing the cost of programs, they gain tighter control of the nation's purse strings and, thus, more influence on the levers of power. And though this equation that is almost ubiquitous amongst world leaders, it is clearly unhealthy for a nation and economy.

Sunday, February 18, 2007

Digital Memories

Science & Technology at Scientific A Digital Life -- [ INFORMATION TECHNOLOGY ] -- New systems may allow people to record everything they see and hear--and even things they c

The sign of a truly great idea is often it's uncanny ability to make the rest of us think, "I already thought of that!" Thus, the MyLifeBits project, which records the activities and experiences of an ordinary person and makes them searchable, strikes many of us as something we all have been striving for. And what an idea! In this manner, we may all achieve immortality! We can organize and review our life in a way never before seen, and link it up to share with others long after we have gone. Wow.

Sunday, February 11, 2007

How Wal-mart may save us all

Coverage & Access | Wal-Mart, SEIU Outline Themes To Meet Health Coverage Goal by 2012 -

One of the more intriguing unusual developments in the evolving health care reform debate is Walmart's push to extend care to all workers. Of course no one is under the illusion that Wal-mart has suddenly developed a heart. The company is clearly still feeling the sting of continued assaults by various labor and left-wing critics. But in case anyone felt that Wal-mart had finally become too big to come up with new and creative solutions to it's problems, they have once again placed themselves in a leading role.

The above article, cited on NPR, PBS, and FoxNews today says that Wal-mart has teamed up with a leading union organization to develop a plan of universal health care reform. At any other time, and by any other author, such a report would likely deserve no attention at all. But Wal-mart, by virtue of it's shear size, can reshape the field of play with such moves. One can look at the effect of Walmarts policy shifts on various other industries for perspective (Wal-mart's decision, for instance, to install solar panels on their stores is reportedly expected to place the solar industry on several year's back order).

In addition, the timing, coming on the heals of moves by several states' (Massachusetts and California most notably) decision to extend health care to all citizens, may just be the push congress needs to finally get off their ass. Our nation's uninsured, the working/nonworking poor, and most of all, those debt laden 20-somethings among us, can only dream...

Saturday, February 10, 2007

Louisiana charity health care stays ahead of the curve - Louisiana Offers Cervical Cancer Vaccination Order to Protect Girls From HPV - Politics | Republican Party | Democratic Party | Political Spectrum

Louisiana is providing free vaccinations to girls in it's charity healthcare system. The system, which replaces the county hospital system of many other states, is an odd mixture of aging infrastructure and underinvestment, combined with well thought out public health initiatives. This latest campaign, vaccinating girls against HPV infections will ensure that, at least on this matter, being poor in a poor state doesn't mean you get substandard healthcare. More importantly, it will save lives.

Setting up a google reader feed in your blogger... and getting the 2 to work together peacefully

How to Kill Your Blogroll with Google Reader’s Clips - from The Zero Boss by Jay Andrew Allen

For those of us just getting started in the blogging world, this is a great article explaining how to connect your blogger and google reader so that you can keep a continuous scroll of feeds on your site. I know it helped me a lot.

...and the rest of this guy's posts are pretty crazy too...

A tome on bloggers of personal finance, one of USNews' better articles Laying Bare Their Money Secrets, Bloggers Trade Strategies for Retirement. Many Are Young. A Few Even Make a Buck; All Money Talk, All the Time

I was excited to find this recent article in USNews. It's a great starting point for those looking for an interactive discussion of personal finances on the web. They list the following links as a reference: A financial planner discusses 401(k)'s, IRAs, asset allocation, and portfolio management. To hold himself accountable for spending money, a man keeps a public record of his net worth. This blogger dispenses practical advice on maximizing income, curbing expenses, and amassing wealth. Pledging to save $2 million by age 45, a 30-year-old chronicles his journey toward financial freedom. Six popular personal finance bloggers join forces in trying to improve their bottom lines. This 20-something strives to make more money, spend less, and manage his finances. A librarian muses about money matters within relationships and families. Child rearing, elder care, and retirement planning have Tuna on Rye's author "sandwiched." A baby boomer discusses ideas and plans for a financially sound retirement.