Archive for August 20th, 2008

Do quiet cars hurt the visually-impaired?

by Paul Rega, MD — published on August 20th, 2008

Intro:  The CA legislature thinks so. Yet, there are apparently no statistics to back up this new bill.  So, a committee will see what it can do.  I have some ideas:

1)  Equip the culprit cars with sensors that honk whenever there is a white cane within a 2-block radius.

2)  The culprit cars are allowed on the streets from 6AM-11PM and the visually impaired are allowed on the streets from 11PM -6AM.

3)  Only stupid people can drive these cars so that the visually impaired can hear the noise from the drivers’ brains rattling.

4)  Have the drivers yell, “Quiet car, quiet car,” out the window every 1/4 mile.

5)  Put marbles in the hubcaps.

6)  Make the bumpers out of a marshmallow-goose-feather composite.

7)  Put “Flubber”  in the gas tank so that the cars can drive 10 feet above the ground.

8)  Evacuate all visually impaired people to Nevada.

9)  Tie an angry duck to the hood of the car.

10)  Let’s just say, “Screw it.  You can’t solve every problem in the world.”

AP, 8/20/08:  (http://edition.cnn.com/2008/US/08/20/quiet.cars.ap/index.html)
Electric and hybrid vehicles may be better for the environment, but the California Legislature says they’re bad for the blind.

It has passed a bill to ensure that the vehicles make enough noise to be heard by visually impaired people about to cross a street.

The measure would establish a committee to study the issue and recommend ways the vehicles could make more noise.

The state Department of Motor Vehicles says more than 300,000 of the vehicles are on state roads. Officials say they don’t keep statistics on pedestrian accidents involving those vehicles.

The bill has been sent to Gov. Arnold Schwarzenegger, who has not taken a position.

 

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categories: Emergency Medicine

OMNI Posting of 8/20/08

by Paul Rega, MD — published on August 20th, 2008

 

On this date in 1794, Gen Mad Anthony Wayne defeated the Indians at Fallen Timbers Ohio.  As a result of this humiliating defeat, the Indians have not been allowed to open up a gambling casino in the new mall  down therel.
But I digress…
Why are injured older people (50 and over) not being taken to trauma hospitals like younger people.  Age bias?  This study suggests that.
Any of you injecting intra-articular lidocaine to reduce a shoulder?  This study concludes that it is as effective as the manual techniques lifted from the pages of the Inquisition.  However, using the lidocaine resulted in fewer complications, like the cessation of breathing, and reduced the time spent in the ER.
This news story reports on a California Supreme Court decision that doctors cannot discriminate against gays and lesbians in medical treatment, even if the procedures being sought conflict with physicians’ religious beliefs
This is a MedScape article torn from the pages of the J Emerg Med on spinal headaches: what , when, why, and how to avoid.  Did you know the incidence of a spinal headache can be as high as 40% in some series studying diagnostic LPs?  Did you also know about a test to help to see if it really is a spinal headache.  Firm continuous abdominal pressure is applied with the examiner’s hand while the headache is present. This is the SHRS test (Spinal Headache-Ruptured Spleen test).  A spinal headache will usually be significantly relieved within 30 seconds and return when pressure is released. This is thought to be due to an increase in pressure relieving CSF hypotension.The second link contains a couple of tables and shows an illustration about why some needles are better in preventing a spinal headache.
Fake Botox is causing some bad results.  People are getting paralyzed all over their bodies, but they never looked better.  In any case, the FDA is taking a dim view of this practice.  As of July 2008, there have been 68 arrests and 29 convictions of individuals who purposely injected an unapproved, cheaper substitute toxin for FDA-approved Botox Cosmetic into nearly 1,000 unknowing patients..

FDA & Botox Scam

by Paul Rega, MD — published on August 20th, 2008

Consumers Affairs, 8/19/08 

(http://www.consumeraffairs.com/news04/2008/08/botox_investigation.html)

In November 2004, when four people became paralyzed after purportedly receiving Botox Cosmetic injections at a medical clinic in Oakland Park, Fla., the Food and Drug Administration’s Office of Criminal Investigations (OCI) was called to investigate.

The four victims were hospitalized with severe botulism poisoning. The paralysis was temporary — a result of being injected with potent, unapproved botulinum toxin. The doctor who injected the toxin had passed it off as Botox Cosmetic, an FDA-approved drug to treat forehead wrinkles.

What began as one OCI investigation of a Florida medical clinic escalated into 210 investigations of health care professionals throughout the United States. As of July 2008, there have been 68 arrests and 29 convictions of individuals who purposely injected an unapproved, cheaper substitute toxin for FDA-approved Botox Cosmetic into nearly 1,000 unknowing patients.

Under federal law, no form of botulinum toxin may be commercially distributed for use on humans unless it has been approved by FDA. At this time, Botox Cosmetic, made by Allergan Inc. of Irvine, Calif., is the only type of botulinum toxin approved by FDA to temporarily soften the frown lines between the eyebrows.

Botox Cosmetic is a sterile, purified version of the same toxin that causes botulism, a severe form of foodborne illness. When used in small doses, it locally affects the muscles’ ability to contract, smoothing out frown lines to make them nearly invisible.

OCI agents traced the fake Botox Cosmetic used in the Florida clinic to a California laboratory that sold botulinum toxin for research purposes. The agents found more of the laboratory’s research product at Toxin Research International Inc. in Tucson, Arizona.

TRI was selling the unapproved toxin to health care professionals as a cheaper alternative to Botox Cosmetic. In December 2004, OCI agents seized vials of the botulinum toxin from TRI, along with numerous marketing materials targeted to physicians.

FDA says the vials were clearly labeled, “For Research Purposes Only, Not For Human Use.” Invoices and product information sheets carried the same warning. Physicians who bought the cheaper, unapproved product from TRI increased their profits on each treatment by charging their patients the same fee as if they were using the FDA-approved Botox Cosmetic, the agency charged.

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categories: Emergency Medicine