Editorial BMJ: American Med. Assn lobbying costs $16.5m

But in the ensuing days the BMJ published this data briefing looking at federal lobbying costs (doi:10.1136/bmj.f7366), and it portrays a scene in which doctors are far from absent. The single biggest spend on lobbying by a drug company in 2012 was Eli Lilly and Co’s $11.1m ({euro}8.1m, £6.8m). This was closely followed by Pfizer Inc at $10.2m and Merck and Co at $9.5m. But none even comes close to the $16.5m spent by the American Medical Association on influencing government to the benefit, often financial, of its members. And although it is by far the biggest spender of the professional representative organizations, the American Colleges of Radiology, Emergency Physicians, and Cardiology all counted their lobbying spends in millions of dollars in 2012, and are far from alone in doing so. There’s no doubt that self-interested lobbying represents a challenge in the battle against rising costs in US healthcare. What is less clear is whether doctors are part of the problem or the solution, and what they are willing to do to change the status quo. Cite this as: BMJ 2014;348:g135 Follow BMJ Editor Fiona Godlee on Twitter @fgodlee and the BMJ @bmj_latest

U.Toronto FACULTY MEDICINE Graduating Class 2013 Demographics

From U.Tor Magazine MMAMATTERS Winter 2013 pp 10-11 Illustrated with 225 pics. MALE:102 FEMALE:113 Ethnic Asian names: 50 Ethnic Ashkenazi names:16 Ethnic African names: 2

Lawyers Weekly: New Queen's Counsels

Donning the silks Posted: 03 Jan 2014 08:39 AM PST More than 180 lawyers across the country welcomed 2014 with a Queen’s Counsel designation to add to their title. Although Ontario and Manitoba no longer bestow the centuries-old honour upon lawyers, most other provinces still do. (COMMENT) OMA members selecting Lawyers have difficulty knowing which lawyers are best. A "QC" used to help. Left-wing Socialist Ontario dislikes UK-based honours. Many of the major law firms have branches across Canada. Unlike MDs, a lawyer can practice 90 days in any Province. A Doctor is reported to have retained a lawyer from the firm of LENCZNER,SLAGHT,ROYCE,SMITH,GRIFFIN LLP who attended a pre-CPSO tribunal conference in his office with a bare foot and ice-bag -after running. He also failed to attend the Tribunal when the MD was being Cross-examined. A timid Junior took his place, never once objecting to the "legal tricks" of the CPSO female "Prosecutor" (now working for TD bank)who asked multiple clause questions to which it was impossible to give "yes/no" answers.)

BLOOMBERG BUSINESSWEEK:: DOCTORS ON DEMAND.

In his various professional incarnations, Phillip “Dr. Phil” McGraw has been a practicing psychologist, bestselling author, television personality, and spokesman for weight-loss products of dubious efficacy. Now he’s got a part-time gig as an adviser to a startup called Doctor On Demand, which is announcing itself to the public today. The service will try to increase online access to doctors, which could have far-reaching effects on health care. McGraw helped conceive the San Francisco-based startup with his son Jay McGraw, a reality TV producer. The company has raised $3 million from investors including Google Ventures (GOOG), Andreessen Horowitz, Venrock, and Shasta Ventures. (Bloomberg LP, the parent of Bloomberg Businessweek, is an investor in Andreessen.) The startup seeks to help people bypass costly in-person visits to crowded medical offices and emergency rooms by letting them use mobile devices to set up video chats with doctors. “There are 1.2 billion ambulatory care visits every year, and the vast majority of people are walking in for something like colds or urinary tract infections that are very amenable to an initial consult over video,” says Adam Jackson, the company’s co-founder and chief executive officer. Each online consultation costs $40. Doctors who enlist in the company’s network will collect $30 per session. They can diagnose illnesses, prescribe medicine, or refer a case to a caregiver if it seems like an emergency or requires lab work or an in-person examination. “It’s the bane of my existence, but everyone has a smartphone, which means everyone has a video camera. Everyone is paparazzi,” says McGraw, a shareholder and adviser to Doctor on Demand. “There are also many good things to come from this change in technology and telemedicine is one of them. It’s a giant step forward and a great opportunity to help people live healthier lives.” The service goes live today in 15 states, including California, Florida, New Jersey, New York, Ohio, and Texas. (Many states have laws preventing Doctor on Demand from setting up shop.) The company says it has enlisted more than 1,000 doctors to offer video consults a day or two per week. The company trains physicians to use its service, and it handles all the extras, including patient questionnaires, pharmacy networks, and malpractice insurance.

USA CDC: HISTOPLASMOSIS-infected house in St.-Eustache, PQ.

Morbidity and Mortality Weekly Report (MMWR) Histoplasmosis Outbreak Associated with the Renovation of an Old House — Quebec, Canada, 2013 Weekly January 3, 2014 / 62(51);1041-1044 On May 19, 2013, a consulting physician contacted the Laurentian Regional Department of Public Health (Direction de santé publique des Laurentides [DSP]) in Quebec, Canada, to report that two masons employed by the same company to do demolition work were experiencing cough and dyspnea accompanied by fever. Other workers also were said to be ill. DSP initiated a joint infectious disease, environmental health, and occupational health investigation to determine the extent and cause of the outbreak. The investigation identified 14 persons with respiratory symptoms among 30 potentially exposed persons. A strong correlation was found between exposure to demolition dust containing bat or bird droppings and a diagnosis of histoplasmosis. Temporary suspension of construction work at the demolition site in Saint-Eustache, Quebec, northwest from Montreal, and transport of the old masonry elements to a secure site for burial were ordered, and information about the disease was provided to workers and residents. To prevent future outbreaks, recommendations included disinfection of any contaminated material, disposal of waste material with proper control of aerosolized dust, and mandatory use of personal protective equipment such as gloves, protective clothing, and adequate respirators.

USA NIH: KLINEFELTER SYNDROME 1:500 males.

Because XXY males do not really appear different from other males and because they may not have any or have mild symptoms, XXY males often don't know they have KS.1,2 In other cases, males with KS may have mild or severe symptoms. Whether or not a male with KS has visible symptoms depends on many factors, including how much testosterone his body makes, if he is mosaic (with both XY and XXY cells), and his age when the condition is diagnosed and treated. KS symptoms fall into these main categories: Physical Symptoms Language and Learning Symptoms Social and Behavioral Symptoms Symptoms of Poly-X KS Physical Symptoms Many physical symptoms of KS result from low testosterone levels in the body. The degree of symptoms differs based on the amount of testosterone needed for a specific age or developmental stage and the amount of testosterone the body makes or has available. During the first few years of life, when the need for testosterone is low, most XXY males do not show any obvious differences from typical male infants and young boys. Some may have slightly weaker muscles, meaning they might sit up, crawl, and walk slightly later than average. For example, on average, baby boys with KS do not start walking until age 18 months.3 After age 5 years, when compared to typically developing boys, boys with KS may be slightly: Taller Fatter around the belly Clumsier Slower in developing motor skills, coordination, speed, and muscle strength Puberty for boys with KS usually starts normally. But because their bodies make less testosterone than non-KS boys, their pubertal development may be disrupted or slow. In addition to being tall, KS boys may have: Smaller testes and penis Breast growth (about one-third of teens with KS have breast growth) Less facial and body hair Reduced muscle tone Narrower shoulders and wider hips Weaker bones, greater risk for bone fractures Decreased sexual interest Lower energy Reduced sperm production An adult male with KS may have these features: Infertility: Nearly all men with KS are unable to father a biologically-related child without help from a fertility specialist.4 Small testes, with the possibility of testes shrinking slightly after the teen years5 Lower testosterone levels, which lead to less muscle, hair, and sexual interest and function Breasts or breast growth (called gynecomastia, pronounced GUY-nuh-kow-mast-ee-uh). In some cases, breast growth can be permanent, and about 10% of XXY males need breast-reduction surgery.6 [top] Language and Learning Symptoms Most males with KS have normal intelligence quotients (IQs)7,8 and successfully complete education at all levels. (IQ is a frequently used intelligence measure, but does not include emotional, creative, or other types of intelligence.) Between 25% and 85% of all males with KS have some kind of learning or language-related problem, which makes it more likely that they will need some extra help in school. Without this help or intervention, KS males might fall behind their classmates as schoolwork becomes harder. KS males may experience some of the following learning and language-related challenges:9 A delay in learning to talk. Infants with KS tend to make only a few different vocal sounds. As they grow older, they may have difficulty saying words clearly. It might be hard for them to distinguish differences between similar sounds. Trouble using language to express their thoughts and needs. Boys with KS might have problems putting their thoughts, ideas, and emotions into words. Some may find it hard to learn and remember some words, such as the names of common objects. Trouble processing what they hear. Although most boys with KS can understand what is being said to them, they might take longer to process multiple or complex sentences. In some cases, they might fidget or "tune out" because they take longer to process the information. It might also be difficult for KS males to concentrate in noisy settings. They might also be less able to understand a speaker's feelings from just speech alone. Reading difficulties. Many boys with KS have difficulty understanding what they read (called poor reading comprehension). They might also read more slowly than other boys. By adulthood, most males with KS learn to speak and converse normally, although they may have a harder time doing work that involves extensive reading and writing. [top] Social and Behavioral Symptoms Many of the social and behavioral symptoms in KS may result from the language and learning difficulties. For instance, boys with KS who have language difficulties might hold back socially and could use help building social relationships. Boys with KS, compared to typically developing boys, tend to be: Quieter Less assertive or self-confident More anxious or restless Less physically active More helpful and eager to please More obedient or more ready to follow directions In the teenage years, boys with KS may feel their differences more strongly. As a result, these teen boys are at higher risk of depression, substance abuse, and behavioral disorders. Some teens might withdraw, feel sad, or act out their frustration and anger. As adults, most men with KS have lives similar to those of men without KS. They successfully complete high school, college, and other levels of education. They have successful and meaningful careers and professions. They have friends and families. Contrary to research findings published several decades ago, males with KS are no more likely to have serious psychiatric disorders or to get into trouble with the law.10 (Comment: Easy to diagnose: no male-type baldness; infertile (may be married).

Brand: DOCTOR of MEDICINE

Brand "DOCTOR of MEDICINE" Image important. Court Lawyers and Judges look the part and are paid accordingly . Trend of (male) Physicians to look "working class" by avoiding ties and white coats. Fashion of draping "shorty" stethoscope around the neck looks absurd. Better to wear Doppler and Pulse-Oximeter. Or ELECTRONIC STETHOSCOPE to visually separate MDs from Nursing assistants.(e.g. LITTMANN # 3200) A profitable 2014 to the Blog's World Readers. Comments welcome. NB: NO ADs. Canada 4188 United States 3926 Russia 1910 Germany 1383 France 1342 Ukraine 1196 Poland 331 United Kingdom 276 China 237 Latvia 210