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Latest Posts

Robot Performs Surgery For Obstructive Sleep Apnea: Is It Over The Top?

I came across this article the other day regarding use of the daVinci robot to perform base of tongue surgery for obstructive sleep apnea.

For those who don’t know, the daVinci robot system made by Intuitive Surgical is a robotic system whereby the surgeon directs the arms of the robot to perform surgery in difficult-to-access areas of the body.

My feeling is that using a robot to perform sleep apnea surgery is way overkill akin to using a $50,000 sniper rifle to kill an ant on the wall.

Everything the daVinci robot can do can also be done without the robot with equivalent patient outcomes. In fact, Read more »

*This blog post was originally published at Fauquier ENT Blog*

New Jersey Attempts To Outlaw Cosmetic Botox For Minors: Will The Legislation Work?

TRENTON — Minors in New Jersey wouldn’t be able to get Botox injections unless a doctor says it’s medically necessary and documents the reason, under a bill moving through the Assembly. The Assembly Health and Senior Services Committee approved legislation Thursday to clamp down on doctors injecting people under 18 with botulinum toxin for cosmetic purposes. The Federal Drug Administration already bars anyone under 18 from getting Botox for cosmetic reasons. The new state legislation would go further by requiring doctors to document in a patient’s chart the noncosmetic medical reason for performing the procedure on a minor. Botox is used widely to smooth out facial wrinkles, but also can be used to treat headaches and spasms.

This prospective law in New Jersey would make Botox injections illegal in minors without a doctor’s statement that it is medically necessary. Unfortunately this is not to say such a law would have the desired effect. There are docs who will write those “permit slips.” Watch how many of these Botox-using minors get headaches.

I am not really a fan of laws restricting the flow of medicines. I do not believe they work well. Then again Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

Nurse Anesthetists: Allowed To Work Without Doctor Supervision?

New Jersey’s state health department is considering a rule that would allow nurse anesthetists to work without a doctor’s supervision, as long as there’s a plan to reach one in case of an emergency. New Jersey would join the 30 states that allow nurse anesthetists to work without direct supervision.

On the other end of the country, a California court upheld the state’s decision to opt out of a Medicare requirement that doctors be present while a nurse anesthetist works in order to be reimbursed. The Centers for Medicare and Medicaid Services have allowed states to opt out of that requirement since 2001.

Since then, there has been no evidence of increased inpatient deaths or complications, researchers reported in the August 2010 issue of Health Affairs. Earlier this month, the Institute of Medicine reported that nurses should have a larger role in medical care, including anesthesiology.

*This blog post was originally published at ACP Internist*

Funding Tobacco Control Programs: A Dollar Well Spent

The Centers for Disease Control (CDC) identified tobacco use as the single biggest cause of premature death in every state in the U.S. They recommended in 2007 that New Jersey state government should spend $120 million per year on tobacco control ($13.75 per person per year, and 12% of total tobacco-related revenue to the state).

Here in New Jersey, our Comprehensive Tobacco Control Program (CTCP) started in 2000, with annual funding of just over $30 million via the Master Settlement Agreement (MSA). The program was set up to follow CDC guidelines to have components for media, evaluation, community activities, youth prevention, and smoking cessation. With the post 9/11 recession causing severe budget problems for the state, funding was drastically cut by 66% to $11 million in 2004 and then in 2009 it was cut again to around $8m. The state brings in approximately $1 billion per year from tobacco sources (MSA plus tobacco taxes) and so New Jersey has recently been spending around 1% of tobacco revenues on tobacco control. Despite being drastically underfunded, the New Jersey CTCP has had many noteable achievements. Here’s just a few. Read more »

This post, Funding Tobacco Control Programs: A Dollar Well Spent, was originally published on by Jonathan Foulds, Ph.D..

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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