Blawg Review #88: Tickling The Ivories

Monday 18 December 2006
Blawg Review #88 is up at David Harlow's HealthBlawg with a mention and link to the Healthcare Blogging Summit.

David, very nicely composed. In keeping with the theme -- you know the "key" to good health care isn't "black and white." Although the Healthcare Blogging Summit was a small but diverse group I was encouraged by the words of Richard G. Petty, MD who reminded during one of the panel discussions that the Age of Enlightenment was the creation of no more than 1,000 people.

Time's Person of the Year: The Power of the Information Age Public

Sunday 17 December 2006
Time Magazine's recognizes the power of those who now create, control and collaborate with content online and the incredible influence that it is having around the world. This year's Time Magazine's person of the year is "you."

Over the last couple of years since beginning my Health Care Law Blog in 2004 I've gained a good understanding of the "online content creating community" and it has changed the way that I communicate, work and learn. If it hasn't already -- I predict it will change you too.

Some interesting stats for a perspective on where all this might be headed. The Pew Internet & American Life Project found in 2004 that 44% Internet users were creating content for the online world. The November 2005 Pew Internet Report, "Teen Content Creators and Consumers," found that 57% of teens now create content for the the internet. The new generation will create continued demand (and content) that will influence us all.

One statistic that I mentioned earlier this year (courtesy of Denise Howell) was that "Among 21 year olds, 61% of web content created by someone they know." I'm not sure where this stat comes from and whether it was from the Pew report -- but if accurate it goes to show that the public is not only creating content but using and relying on content by those who they personally know. Along these same lines, this past week I attended the Healthcare Blogging Summit and Steve Rubel commented that 68% agreed that the people we trust is "a person like me."

The HealthTrain: The Open Healthcare Manifesto (full Report Version 0.1) discussed at the Healthcare Blogging Summit provides some interesting material for discussion of what impact open published media will have on the health care industry. The Manifesto presents the idea that understanding and learning is grounded in human conversation and that these new technologies allow this to happen easier and with more impact. Time's article recognizes what the Manifesto refers to as the change from "traditional command and control" forms of communication. The Manifesto outlines a set of principles to guide those in health care as we move forward with this online social experiment.

My favorite section of Time's online article on the Person of the Year:

. . . The answer is, you do. And for seizing the reins of the global media, for founding and framing the new digital democracy, for working for nothing and beating the pros at their own game, Time's Person of the Year for 2006 is you.

Sure, it's a mistake to romanticize all this any more than is strictly necessary. Web 2.0 harnesses the stupidity of crowds as well as its wisdom. Some of the comments on YouTube make you weep for the future of humanity just for the spelling alone, never mind the obscenity and the naked hatred.

But that's what makes all this interesting. Web 2.0 is a massive social experiment, and like any experiment worth trying, it could fail. There's no road map for how an organism that's not a bacterium lives and works together on this planet in numbers in excess of 6 billion. But 2006 gave us some ideas. This is an opportunity to build a new kind of international understanding, not politician to politician, great man to great man, but citizen to citizen, person to person. It's a chance for people to look at a computer screen and really, genuinely wonder who's out there looking back at them. Go on. Tell us you're not just a little bit curious.
I do agree with ProBlogger's comments that Time gets the linkbaiter of the year award (brilliant PR move if Time factored this into its decision). Watch the stats on this Technorati graph. The article is already topping Techmeme.

UPDATE: Fard Johnmar at HealthcareVox also looks at Time's "Person of the Year" announcement from a health care perspective.

Healthcare Blogging Summit 2006

Washington DC is the place to be for health care bloggers. Tomorrow the first Healthcare Blogging Summit is being held in conjunction with the Consumer Health World expo. I'll be participating as a panel member on the "Facts and Issues" session. I'm looking forward to meeting in person a number of health care bloggers that I regularly follow though RSS.

My family and I arrived over the weekend for a short holiday weekend before the conference. We took the kids to the National Zoo on Saturday with friends who came into the city from Martinsburg (don't miss the PandaCAM - we watched it for weeks before we came) . Today we spent time along the Mall at the Smithsonian where 6 year olds (and 2 year old sisters and adult parents) are in heaven - dinosaurs, mummies, rockets, airplanes, etc.

While reviewing information form the conference I thought it would be helpful to aggregate a few of the pre-conference (and post-conference) posts and interesting posts/topics that might come up at the conference. If you have one that you would like added please email me. Heck, I might even try out some live blogging during the event. (REMEMBER: If you blog about the event tag it as Healthcare Blogging Summit or HBS2006.)

Preconference Discussion:
  • Carol Kirshner at Driving In Traffic and Josh Hallett at Hyku comment on a recent Florida story about a disgruntled patient and the impact it might have on the Florida hospital involved. I'd like to pose a hypothetical to Nick Jacob and ask him how he'd respond to this on his blog. Nick's response during his panel session was to point out Windber current infection rate is 1% while the national average is 8%.
  • Fard Johnmar at Envision Solutions has released highlights from the "Taking the Pulse of the Healthcare Blogsphere" survey conducted this past summer. The press release includes the following highlight information (download the survey results here):
    • 214 healthcare bloggers took at least a portion of the survey, which was fielded between July 31 and September 29, 2006. 171 answered every question in the poll.
    • 61% of respondents write about their personal experiences.
    • 39% of those surveyed hide their identity to protect their privacy, patient confidentiality or themselves. (As a health lawyer interested in privacy issues this stat interests me)
    • Nearly 40% of healthcare bloggers report that the most important reason they decided to start their blog was to share their opinions or educate others.
  • Business Blogs Now highlights the Summit and the growing number of health professional bloggers.
  • Spare Change talks about the conference location and the "Taking the Pulse of the Healthcare Blogosphere." I agree that the Omni is a great location with wonderful services and I'm interested to see the results of the survey being unveiled tomorrow.
  • Unity Stoakes of Organized Wisdom will be attending and bring the perspective of one of the new Web 2.0 health companies.
Conference Thoughts:

Enjoyed Steve Rubel's presentation which looked at the Galaxy, Stars, Planets, Shooting Stars, etc. of health care bloggers. I was especially struck by the statistics he provided on "who do you trust" and the fact that 68% are "persons like yourself." He also had a great slide showing the shift from 1992-2002 corporate built web to todays 2002 and beyond web built by individuals. He used information from Comscore Media Metrix and a chart from Washington Post article, "New Trends in Online Traffic."

Steve also pointed out that he believes that blogging as an activity has peaked as a result of statistics he provided using Technorati. The chart showed the leveling off of post volume over the last few months. It will be interesting to see if this trend continues.

More to come . . .

Post Conference Discussion:

Note:
If you are going to be in Washington Monday evening don't miss the Blogger Wonk starting at 7pm at Open City. I'm sorry I'll have to pass because we have to be back in Charleston WV Tuesday a.m. and plan to leave right after the conference. So fare on the RSVP list are: Katya Andresen, Leslie Jump, Debbie Weil, Josh Hallett, Marianne Richmond, TrisGrier, CK (Christina Kerley), Dmitriy Kruglyak, Fard Johnmar, Carol Kirshner, Shahid N. Shah, Craig Lefebvre and I'm sure many more . . .

Swiss Army Knife: Lost and Found

Monday 4 December 2006
A simple example of today's live web from fellow Charleston blogger and friend, Rick Lee.

This would not and could not have happened a few years ago. Change is happening as the web becomes the way we create content, share information, communicate, collaborate, network, learn, buy anything, distribute content and even find your swiss army knife.

Next week I am attending and participating as a panelist at the first Healthcare Blogging Summit in DC. You can bet I plan to use the swiss army knife example to show the utility of today's online world and what it may bring to health care.

Note: Learn something everyday -- before this post I had never used Searchbug which was mentioned in the comments to Rick's post. Frightening how much it knows.

End of Life Care - Science and Religion

Running A Hospital has an interesting look at the legal and ethical issues faced by health care providers these days. The post, When is Death? points to a story from the Boston Globe involving a current case at Beth Israel Deaconess Medical Center.

As medical science and genetic issues continue to progress our society will have to address more of these types of legal, moral and social (and religious) issues.

More discussion and commentary over at Kevin, M.D. and TailRank.

The Flattening of Health Care

Thursday 2 November 2006
More on the flattening of health care. U.S. businesses and health insurers continue to look at the option of outsourcing health care services oversees.

The article appearing in the Las Vegas Sun discusses a VP of BlueCross BlueShield of South Carolina recent visit to Bumrungrad in Bangkok along with Delegate Canterbury's efforts here in West Virginia to propose legislation giving state employees the option of traveling abroad for health care services in return for certain incentives.

Cost Of Living In Charleston, Martinsburg, Morgantown and Vienna

Monday 30 October 2006
Does it cost more (or less) to live in West Virginia? Numerous times this question has either come up or been posed to me. The Charleston Daily Mail had a blurb today on a recent report issued by the WVU College of Business & Economics examining cost of living.

The report looks at 4 cities in West Virginia: Charleston, Morgantown, Martinsburg and Vienna. All come in below the national average for cost of living. Vienna (91.1%), Charleston (92.8%), Martinsburg (97.7%) and Morgantown (99.7%). The report also has a snapshot of prices for milk, new home, pizza, boy's jeans and a movie. Interesting info.

The West Virginia Business & Economic Review, Fall 2006 covers the topic in its report, "Cost of Living in West Virginia Cities: Second Quarter 2006."

Go Mountaineers!

Sunday 29 October 2006

I have to agree with ESPN.com, "IF IT'S PANDEMONIUM YOU WANT . . . No. 3 USC lost. No. 5 Texas struggled. No. 7 Auburn struggled. This may have been the greatest Saturday in West Virginia history."

USC's loss sets up a great Thursday night game between the Mountaineers and the Cardinals. Let the hype begin for the "Battle in the Bluegrass."

Some inspiration for Mountaineer fans.


CAB 11.7: Election Day Event

Friday 27 October 2006
The Charleston Area Bloggers (CAB) are planning to meet at Capitol Roasters on November 11 around 7am to 9am. Come early, late or anytime in between. Wi-fi is available.

If you can't make it the group is setting aside Wednesday, December 6 @ 7am for the December get-together. Mark your calendar and plan to attend.

Rick Lee and Oncee have posted about the upcoming event. As Rick says, everyone is welcome especially West Virginia bloggers.

Looking forward to seeing old and new bloggers.

HHS designates CCHIT as RCB

CCHIT is the first group to be designated by HHS as a RCB. How's that for health care acronyms!

The Certification Commission for Healthcare Information Technlogy's (CCHIT) designation as as a Recognized Certification Body (RCB) will allow for those marketing health IT products to move forward for approval as a certified interoperable product. The article indicates that CCHIT as a RCB will be able to evaluate health information technology products to ensure that they meet base-line requirements for functionality, interoperability and security.

The importance of RCB approval also plays into gaining the benefits of the new safe harbors for Anti-kickback and Stark law allowing electronic health information systems to be donated to physicians by hospitals, health plans and others.

A summary is also provided in the HHS Press Release.

UPDATE: Tax-exempt hospitals should be cautious and examine the tax implications of donating health information technology equipment to physicians and other for-profit health care providers. Non-profits have to examine whether the donation is a public vs. private benefit and I would think that most attorneys would recommended seeking a private letter ruling from the IRS prior to donating equipment.

SCOTUS Trivia!

Thursday 26 October 2006
What current U.S. Supreme Court Justice has roots in West Virginia? Answer.

Tip to SW Virginia Law Blog.

Vonage Comes To West Virginia

The Charleston Daily Mail reports today that Vonage has finally entered the West Virginia market. I've been waiting for Vongage to come to West Virginia after having used the service in North Carolina at my brother in law's house. Based on my experience it's a great service.

Those of you who aren't famililar with Vonage and voice over internet service providers you can read this. Basically, it is phone service over your high speed internet service. One of the nice features is that your phone number is portable.

According to the article, Vonage prices will be $24.99 per month and a $14.99 per month basic residential service. There is a draw back if you live here in Charleston. You can't get a local Charleston number yet and instead have to sign up using a Wheeling, Huntington, Parkersburg or Beckley exchange number. This is a draw back for me -- since I would want local Charleston calls from my family and friends to not be charged a long distance call for calling me local via a landline.

Wondering when Vonage will get a Charleston exchange? Maybe someone from Vonage will see my post and provide a response.

UPDATE: A few weeks ago I checked in to see if Vonage was now available in Charleston. At that time it still wasn't available. However, today (2/4/07) I checked again after a conversation with my neighbor about the service and it now appears to be available in Charleston. Although I haven't switched yet -- I plan to switch our home phone the coming days, especially after a recent failure by Verizon to come out and check out lines after we had been having trouble with a garbling line. When we called Verizon they told us that we had to first go out and check the line ourself on the outside box by plugging in a phone and see if it still has problems. I guess this would help to diagnose whether the problem was an outside line problem or problem with the lines in our house.

The following areas are listed as available for West Virginia (area code 304).

304 is available
Available Towns:
BeckleyBridgeportCharleston Zone 1
ClarksburgFairmontGrafton
Huntington Zone 1HurricaneLogan
MartinsburgParkersburg Zone 1Philippi
PrincetonRavenswoodScott Depot
SpencerWheeling Zone 1


Welcome to West Virginia Vonage!

Health Care Blogging Summit 2006

The first Healthcare Blogging Summit will be held on December 11, 2006, at the Omni Shoreham Hotel in Washington, DC, co-located at Consumer Health World.

I've been invited by Dmitriy Kruglyak, the organizer of the summit to participate as a panel member of the session on Healthcare Blogging - Facts & Issues. The panel members include:
The focus of the panel will be on:
Whether or not you are ready to participate directly, there are some things about blogging you need to know. As you are reading these lines bloggers may be writing about your organization and shaping the public opinion! How do blogs work? How many are out there? What is the source of bloggers’ trust, credibility and influence? What options does an organization have for responding to the activities of independent bloggers? What about the legal and ethical considerations?
For more information about the conference or how to register visit the The Medical Blog Network.

120 Days then new National Coordinator for Health Information Technology?

Healtcare IT News reports that Robert Kolodner, Interim National Coordinator for Health Information Technology will only be in the position thru January 2007 and will then return to his position at the VA.

To maintain momentum the health care industry need a charismatic national leader on health information technology to help guide and coordinate a uniform and practical national policy on health information. The focus must remain on adopting technology that provides better, more efficient care and treatment.

Who that person should be (or will be) remains a mystery. If you've got any suggestions -- please post in the comments. I'd be interested to hear of potential candidates.

Hospital Patient Data Lost

Wednesday 25 October 2006
A lesson on losing hospital patient data.

260,000 patient records were accidentally left in a new computer bag by a medical billing contractor who had copied the records onto CDs to work from home. The employee had decided the new recently purchased computer bag was too small and exchanged it at the store leaving the CDs inside. The person who later bought the bag three days later returned the CDs to the hospital system.

According to the article, the hospital system did not believe the data was improperly accessed, but as a precaution, notified patients urging them to monitor their credit.

HIPAA: All Bark, No Bite

Tuesday 24 October 2006
The Red Tape Chronicles highlights HIPAA (un)enforcement in Health Care Privacy Law: All Bark, No Bite?

The post provides an update on the number of HIPAA complaints filed with OCR (22,664 since 2004) and the fact that no fines have been levied for violating the HIPAA Privacy Rule. The article also cites that 332 criminal cases have been referred to the DOJ resulting in three prosecutions.

The aricle provides some good back and forth discussion between privacy advocates, those responsible for implementing compliance/monitoring in the industry and officials at DHHR.

Thanks to my colleague, Dustin Dillard, for tipping me about the article.

Grand Rounds 3.5: A Visual Tour

Monday 23 October 2006
Ohhhhh . . . Tuesday Morning . . . feels like a hangover. I'm finally coming down from the caffeine buzz of last weeks Grand Rounds hosted by Kim at Emergiblog. I'm in withdraw after a week of working on the incredible submissions for this week's edition of the best from the medical blogosphere. Actually, I'm looking more like Ground Round! I should have heded Kim's advice - but you know it's difficult for lawyers to take advice.

Lawyers are known for their written and verbal communication but any good defense trial lawyer knows that a photo is worth a thousand words. Hmmm . . . photos . . . theme? Photos tell a story. Photos enhance the story. Social interaction adds value to content. Social networking is content. Using Flickr within a theme? How will online social networking change the landscape of medicine and health? Just some thoughts.

It's a fascinating time to watch the evolution of online social interaction these days and discuss its impact on the health care industry. Not long ago we were all using the internet as a static place to obtain information. Listserves, bulletin boards and early individual blogs became the first generation of social networking. Soon came the growth of more blogs on specialized topics, more interaction, community blogs and carnivals, like Grand Rounds -- all mediums that allow sharing of information and knowledge in a decentralized process, providing a forum for feedback, comments, discussion and disagreement. Lately we are seeing the next generation develop. Two health care examples are Organized Wisdom, a collaborative health information resource, which allows patients and professionals to share health experiences in a learning environment, and Sermo, which allows physicians to consult with colleagues, share clinical observations, challenge or corroborate each other's opinions (for pay) and accelerate the emergence of trends and new insights on medications, devices and treatments, building open, collaborative health care. What next? It's Your World, Your Imagination. What about Second Life Medical? or Project Virtual Hospital?

Flickr , an online social photo sharing service was one of the early web 2.0 success stories. As an experiment to add value to content I've used "keyword" links for each submission. For example, check out alzheimers, new drug or insulin pump. I urge you to drill down and explore some the photo links, comments on the photos and consider how the photos change your impression of the written posts. On with the rounds . . .

First the Host's Favorites . . .

BREAD: From the don't always believe what you see department comes a post at Unbounded Medicine about a Thai student who bakes human being parts out of bread. Yum . . . .

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

FISH: A fishy topic is on the line at DiseaseProof. In Gone Fishing Again, Gerald Pugliese contemplates a recent article in The Los Angeles Times, pointing out that even the EPA acknowledges the confusion over fish consumption. Mr. Pugliese utilizes Dr. Fuhrman's past comments to add more to the fish tale. Dr. Emer at Parallel Universes is also fishing around this controversy with To Eat or Not To Eat Fish.

DEATH: From The Differential: Medscape Med Students, Ali Tabatabaey, an Iranian medical student, confronts death in The First Patient Death Leaves Its Mark. At why am i still here? a third year medical student confronts whether she would want extravagant measures taken if it were her 16-year-old daughter.

COMPETITION: Dmitriy Kruglyak, at the Medical Blog Network, takes a close look at what's left for hospitals in the current competitive environment in The Shifting Basis of Hospital Competition.

FOOD: I've got the rumblies in my tumblies. May I take your order please? Emergiblog covers the etiquette of ordering food in the ER in Here to Save Your Derrieere, Not Feed It.

The Best of the Rest . . .

FEET: From the foot bone is connected to the ankle bone comes The Foot Blog. A new community blog started this month covering everything for the podiatry community, a great example of a community blog modeling the long tail toe theory.

DIABETES: Amy Tenderich at Diabetes Mine announces the ultimate diabetic "extreme (medical) makeover" in her post Pimp Your Diabetes. A D-Dream Team has been put together and the progress of the individuals will be tracked at Diabetes Mine. Amy also provides a one blog mini-seminar on the thyroid in Hello, Mr. Thyroid and questions all the buzz on the new wireless monitoring devices for diabetes in Remote Control Diabetes? Not.

SPINE: The Science Creative Quarterly by Prashant Nair covers spinal injuries in Spinal Injuries: So many ways to strike a chord. The article made this lawyer confront the altered existence lived by victims of spinal injuries and their hopes for the future. But consider Mark Zupan and don't miss Murderball.

HIPAA: The HIPAA Blog covers the latest recommendations by the National Committee on Vital and Health Statistics . HIPAA may no longer just apply to "covered entities." All that hard work of creating business associate agreements might be for not.

CATHOLIC: Dr. Lei at Genetics Health interviews Catholic genetics blogger, Rebecca Taylor. Ms. Taylor, a clinical laboratory technologist in molecular biology at a Catholic hospital blogs at Mary Meet Dolly, where the world of genetics and genetic engineering (Dolly) meets the teachings of the Catholic Church on the sanctity of life (Mary). Mary Meets Dolly resonates with many people feeling alienated because most science and medicine bloggers are largely atheist or agnostic.

SHOPPING: Comparision shopping, Canada vs. Israel, comes your way via InsureBlog's post titled Isrameds. Canada isn't the only "foreign" country offering discount medications. If you've got a hankerin' for strictly kosher meds, Bob Vineyard has your source. The InsureBlog also has some surprising stats on "What Bothers People About Their Own Health Care" and a followup post poll.

INTUBATED: Homeschooledmedstudent confronts her own sadness and helplessness in Lingering, about an intubated, terminally ill patient.

POLICY: Matthew Holt covers the Six Dirty Little Health Care Secrets of health care.

AUTISM: Dr. Deborah Serani posts Gene Mutation Linked to Risk of Autism highlights further genetic underpinnings for Autism in a study coming out of Vanderbilt University that will be featured in the upcoming Proceedings of the National Academy of Sciences.

DIAGNOSIS: From the "What's Your Diagnosis?" category comes Failure to thrive in a 20-month-old from Rural Pediatrics. The case report involves a 20-month-old toddler with a one-year history of poor weight gain and large, mushy, smelly stools. Turns out the diagnosis was chronic Giardia infection due to likely becoming infected from playing in a mountain stream while his parents gold-panned. The full article can be obtained from Infectionus Disease in Children.

NEW DRUG: Straightfromthedoc discusses Duke University researchers' efforts to significantly prolong the effects of an anti-inflammatory drug by modifying a drug called interleukin-1 receptor antagonist. The engineered drug is potentially useful for providing longer-lasting treatment for osteoarthritis. Gloria Garnat also writes about the recently USFDA-approved drug, ARICEPT, for the treatment of Alzheimer's disease, at The Pharm Voice.

WELLNESS : Musing about the (un)balanced nature of Wellness is Dr. Rob Lamberts' post at Musings of a Distractible Mind. Dr. Lamberts asks the question "does wellness really exist?" and concludes that the physician's role is to "relate to our patients as they go through life and not treat them as a project to complete."

ALZHEIMERS: Mona Johnson at The Tangled Neuron highlights current studies of those diagnosed with mild cognitive impairment and the ongoing efforts to better understand the early stages of dementia and Alzheimers. Why be tested for Alzheimer's when there is no effective treatment? Contribution to research and ultimately finding a cure for the disease. Ms. Johnson, who went through testing at the Wisconsin Registry for Alzheimer's Prevention, recommends participating in testing at a memory clinic, university, or Alzeimer's Disease Research Center so that the results can be used in future studies. West Virginia's own Blanchette Rockefeller Neurosciences Center is leading a shift from laboratory tests to clinical trials.

WIKIPEDIA: Mnmonics Guy (MG) brings us CLMAA and a link to a Wikipedia page that includes volumes of medical acronyms and abbreviations. MG's post speculates that medical acronyms may be a dying art with the introduction of EHRs. MG also highlights the difference between acronyms and abbreviations. My favorite misspelled acronym is HIPPA.

HOSPITAL STORIES: Hospital Impact, authored by Tony Chen, shares the 2nd edition of Friday's Great Patient Stories with Great Patient Stories - Harry Potter, Hamburgers and Hemmorroids. Chen's initial post, along with my Pre-Rounds interview by Nick Genes,inspired me to start a new series of regular posts called The West Virginia Doctor.

STRETCHING: With advice on how not to over-stretch your back comes The Stretch You Need The Least from Dr. Jolie Bookspan at Healthline: The Fitness Fixer. Thanks, Doctor. Your submission was much needed advice after spending hours bent over my laptop working on Grand Rounds.

ODOR: A volunteer ER chaplain writes about wonderful ER odors in The Olfactory Tour at Rickety Contrivances of Doing Good.

BREAST CANCER AWARENESS: In recognition that October is National Breast Cancer Awareness Month, Dr. Emer at Parallel Universes posts about statistics on breast cancer in the Phillipines, catching breast cancer early, and the importance of regular breast self-examination.

PEG Tubes: This week, Dr. Marcucci at Inside Surgery covers the surgical facts and details of Percutaneous Endoscopic Gastrostomy Tubes.

FDA: From the California Medicine Man comes the "story" behind Lester Crawford's departure as the commissioner of the Food and Drug Administration (FDA) and the importance of the FDA maintaining integrity.

MEDICAL SCHOOL: Vitum Medicinus, who is journaling his experiences as he goes through medical school, reminds us of the excitement of practical learning and experience in the post Back in the Hospital: ER Shadowing.

CEO: At Running A Hospital the CEO asks, "How am I doing?" to which Kevin, M.D. responds pretty good job. Congratulations go out to the other blogging hospital CEO who details his trip to Northern Virginia to see Little Lucy for the first time.

VACCINES: Two posts on vaccines from PediatricsInfo . First, the FDA approved the rotavirus vaccine in Febuary 2006. Second, the MMR vaccine has been cleared from causing autistic disorders according to a trial published in the October 2006 issue of Pediatrics.

PERSONA: GruntDoc takes a look at his Work Persona.

BLOOD PRESSURE: South African medical student Karin Little, who blogs at Just Up The Dose, nostalgically remembers her first diagnosis in Thump-thump-thump as she winds down on her degree. Along the same vein comes Hypertension-Silent Killer with a hypertension quiz.

TUNNEL VISION: Wandering Vistor muses about viewing the tunnel from the outside in Are You Suffering from Tunnel Vision?

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

STINGRAY: Dr. Paul Auerbach, at Medicine for the Outdoors, blogs about Another Stingray Attack reported last week in Florida which follows the tragic death of the Crocidile Hunter, Steve Erwin, in a similar unlikely incident.

CALIFORNIA: Nancy L. Brown, PhD, at Teen Health 411, provides insight into the confidentiality laws related to reproductive health care in California for minors and points out the practical issues related to information leaking through the billing process when the minor seeks care covered under her parent's insurance.

POVETRY: Borneo Breezes recognizes the contributions of Mohammed Yunus, a Bangaladeshi economist and founder of Grameem Bank, who will be awarded the Nobel Peace Prize for his effort at ending poverty through providing credit to the poorest of the poor.

INSULIN PUMP: Kerrie Morrone, a twenty-something type 1 diabetic, contemplates incorporating her insulin pump into the tangles of daily dressing in Insulin Pumping, After a Fashion.

JEFF GOLDBLUM: A Caribbean medical student blogging at the rumors were true explores his own science role model. Jeff Goldblum?

HORMONES: A four-part post on Hormone Replacement Therapy at The Blog That Ate Manhattan.

FLU: In his post, Pediatric Flu Vaccine Supply Delayed, Not a Shortage, Dr. Choi at Tech Medicine helps this lawyer understand why his two-year-old can't get her flu shot -- there is only one FDA-approved flu vaccine for children under three.

NFL: The NFL's Punitive Substance Abuse Policy covers Brett Farve's standing up to the NFL and its substance abuse policy after the suspension of Packer's wide receiver Koren Robinson.

RANT: Citing one of my all time favorite movies, Terry Gilliam's "Brazil," Digital Doorway rants about healthcare bureaucracy in Bureaucracy Now! --- A Rant. Is it Buttle or Tuttle? Also, ranting about medblog ranting comes Pointing The Finger from Medblogopathy.

INFORMATION: David Williams at The Health Business Blog provides us a link to the original piece titled, "Information Is The Answer," used by ABC News in its week-long series, Prescription for Change.

HALLOWEEN: The Family Fork: Feeding the Kids and You provides timely advice for choosing healthly alternatives as you prepare to make the Grand Rounds with the kids next Tuesday Night.

The question remains whether Dr. Hebert's Medical Gumbo will be cooking up tricks or treats as the host of Grand Rounds 3.6.

As the first health care lawyer to host Grand Rounds, I just want to say thanks to Nick Genes for giving me the opportunity to host from the hills of West Virginia. Thanks to the contributors who make Grand Rounds what it is -- a wonderfully eclectic collaboration of individuals and health professionals who share a breadth and depth of knowledge unmatched anywhere.

Grand Rounds 3.5

Ohhhhh . . . Tuesday Morning . . . feels like a hangover. I'm finally coming down from the caffeine buzz of last weeks Grand Rounds hosted by Kim at Emergiblog. I'm in withdraw after a week of working on the incredible submissions for this week's edition of the best from the medical blogosphere. Actually, I'm looking more like Ground Round! I should have heded Kim's advice - but you know it's difficult for lawyers to take advice.

Lawyers are known for their written and verbal communication but any good defense trial lawyer knows that a photo is worth a thousand words. Hmmm . . . photos . . . theme? Photos tell a story. Photos enhance the story. Social interaction adds value to content. Social networking is content. Using Flickr within a theme? How will online social networking change the landscape of medicine and health? Just some thoughts.

It's a fascinating time to watch the evolution of online social interaction these days and discuss its impact on the health care industry. Not long ago we were all using the internet as a static place to obtain information. Listserves, bulletin boards and early individual blogs became the first generation of social networking. Soon came the growth of more blogs on specialized topics, more interaction, community blogs and carnivals, like Grand Rounds -- all mediums that allow sharing of information and knowledge in a decentralized process, providing a forum for feedback, comments, discussion and disagreement. Lately we are seeing the next generation develop. Two health care examples are Organized Wisdom, a collaborative health information resource, which allows patients and professionals to share health experiences in a learning environment, and Sermo, which allows physicians to consult with colleagues, share clinical observations, challenge or corroborate each other's opinions (for pay) and accelerate the emergence of trends and new insights on medications, devices and treatments, building open, collaborative health care. What next? It's Your World, Your Imagination. What about Second Life Medical? or Project Virtual Hospital?

Flickr , an online social photo sharing service was one of the early web 2.0 success stories. As an experiment to add value to content I've used "keyword" links for each submission. For example, check out alzheimers, new drug or insulin pump. I urge you to drill down and explore some the photo links, comments on the photos and consider how the photos change your impression of the written posts. On with the rounds . . .

First the Host's Favorites . . .

BREAD: From the don't always believe what you see department comes a post at Unbounded Medicine about a Thai student who bakes human being parts out of bread. Yum . . . .

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

FISH: A fishy topic is on the line at DiseaseProof. In Gone Fishing Again, Gerald Pugliese contemplates a recent article in The Los Angeles Times, pointing out that even the EPA acknowledges the confusion over fish consumption. Mr. Pugliese utilizes Dr. Fuhrman's past comments to add more to the fish tale. Dr. Emer at Parallel Universes is also fishing around this controversy with To Eat or Not To Eat Fish.

DEATH: From The Differential: Medscape Med Students, Ali Tabatabaey, an Iranian medical student, confronts death in The First Patient Death Leaves Its Mark. At why am i still here? a third year medical student confronts whether she would want extravagant measures taken if it were her 16-year-old daughter.

COMPETITION: Dmitriy Kruglyak, at the Medical Blog Network, takes a close look at what's left for hospitals in the current competitive environment in The Shifting Basis of Hospital Competition.

FOOD: I've got the rumblies in my tumblies. May I take your order please? Emergiblog covers the etiquette of ordering food in the ER in Here to Save Your Derrieere, Not Feed It.

The Best of the Rest . . .

FEET: From the foot bone is connected to the ankle bone comes The Foot Blog. A new community blog started this month covering everything for the podiatry community, a great example of a community blog modeling the long tail toe theory.

DIABETES: Amy Tenderich at Diabetes Mine announces the ultimate diabetic "extreme (medical) makeover" in her post Pimp Your Diabetes. A D-Dream Team has been put together and the progress of the individuals will be tracked at Diabetes Mine. Amy also provides a one blog mini-seminar on the thyroid in Hello, Mr. Thyroid and questions all the buzz on the new wireless monitoring devices for diabetes in Remote Control Diabetes? Not.

SPINE: The Science Creative Quarterly by Prashant Nair covers spinal injuries in Spinal Injuries: So many ways to strike a chord. The article made this lawyer confront the altered existence lived by victims of spinal injuries and their hopes for the future. But consider Mark Zupan and don't miss Murderball.

HIPAA: The HIPAA Blog covers the latest recommendations by the National Committee on Vital and Health Statistics . HIPAA may no longer just apply to "covered entities." All that hard work of creating business associate agreements might be for not.

CATHOLIC: Dr. Lei at Genetics Health interviews Catholic genetics blogger, Rebecca Taylor. Ms. Taylor, a clinical laboratory technologist in molecular biology at a Catholic hospital blogs at Mary Meet Dolly, where the world of genetics and genetic engineering (Dolly) meets the teachings of the Catholic Church on the sanctity of life (Mary). Mary Meets Dolly resonates with many people feeling alienated because most science and medicine bloggers are largely atheist or agnostic.

SHOPPING: Comparision shopping, Canada vs. Israel, comes your way via InsureBlog's post titled Isrameds. Canada isn't the only "foreign" country offering discount medications. If you've got a hankerin' for strictly kosher meds, Bob Vineyard has your source. The InsureBlog also has some surprising stats on "What Bothers People About Their Own Health Care" and a followup post poll.

INTUBATED: Homeschooledmedstudent confronts her own sadness and helplessness in Lingering, about an intubated, terminally ill patient.

POLICY: Matthew Holt covers the Six Dirty Little Health Care Secrets of health care.

AUTISM: Dr. Deborah Serani posts Gene Mutation Linked to Risk of Autism highlights further genetic underpinnings for Autism in a study coming out of Vanderbilt University that will be featured in the upcoming Proceedings of the National Academy of Sciences.

DIAGNOSIS: From the "What's Your Diagnosis?" category comes Failure to thrive in a 20-month-old from Rural Pediatrics. The case report involves a 20-month-old toddler with a one-year history of poor weight gain and large, mushy, smelly stools. Turns out the diagnosis was chronic Giardia infection due to likely becoming infected from playing in a mountain stream while his parents gold-panned. The full article can be obtained from Infectionus Disease in Children.

NEW DRUG: Straightfromthedoc discusses Duke University researchers' efforts to significantly prolong the effects of an anti-inflammatory drug by modifying a drug called interleukin-1 receptor antagonist. The engineered drug is potentially useful for providing longer-lasting treatment for osteoarthritis. Gloria Garnat also writes about the recently USFDA-approved drug, ARICEPT, for the treatment of Alzheimer's disease, at The Pharm Voice.

WELLNESS : Musing about the (un)balanced nature of Wellness is Dr. Rob Lamberts' post at Musings of a Distractible Mind. Dr. Lamberts asks the question "does wellness really exist?" and concludes that the physician's role is to "relate to our patients as they go through life and not treat them as a project to complete."

ALZHEIMERS: Mona Johnson at The Tangled Neuron highlights current studies of those diagnosed with mild cognitive impairment and the ongoing efforts to better understand the early stages of dementia and Alzheimers. Why be tested for Alzheimer's when there is no effective treatment? Contribution to research and ultimately finding a cure for the disease. Ms. Johnson, who went through testing at the Wisconsin Registry for Alzheimer's Prevention, recommends participating in testing at a memory clinic, university, or Alzeimer's Disease Research Center so that the results can be used in future studies. West Virginia's own Blanchette Rockefeller Neurosciences Center is leading a shift from laboratory tests to clinical trials.

WIKIPEDIA: Mnmonics Guy (MG) brings us CLMAA and a link to a Wikipedia page that includes volumes of medical acronyms and abbreviations. MG's post speculates that medical acronyms may be a dying art with the introduction of EHRs. MG also highlights the difference between acronyms and abbreviations. My favorite misspelled acronym is HIPPA.

HOSPITAL STORIES: Hospital Impact, authored by Tony Chen, shares the 2nd edition of Friday's Great Patient Stories with Great Patient Stories - Harry Potter, Hamburgers and Hemmorroids. Chen's initial post, along with my Pre-Rounds interview by Nick Genes,inspired me to start a new series of regular posts called The West Virginia Doctor.

STRETCHING: With advice on how not to over-stretch your back comes The Stretch You Need The Least from Dr. Jolie Bookspan at Healthline: The Fitness Fixer. Thanks, Doctor. Your submission was much needed advice after spending hours bent over my laptop working on Grand Rounds.

ODOR: A volunteer ER chaplain writes about wonderful ER odors in The Olfactory Tour at Rickety Contrivances of Doing Good.

BREAST CANCER AWARENESS: In recognition that October is National Breast Cancer Awareness Month, Dr. Emer at Parallel Universes posts about statistics on breast cancer in the Phillipines, catching breast cancer early, and the importance of regular breast self-examination.

PEG Tubes: This week, Dr. Marcucci at Inside Surgery covers the surgical facts and details of Percutaneous Endoscopic Gastrostomy Tubes.

FDA: From the California Medicine Man comes the "story" behind Lester Crawford's departure as the commissioner of the Food and Drug Administration (FDA) and the importance of the FDA maintaining integrity.

MEDICAL SCHOOL: Vitum Medicinus, who is journaling his experiences as he goes through medical school, reminds us of the excitement of practical learning and experience in the post Back in the Hospital: ER Shadowing.

CEO: At Running A Hospital the CEO asks, "How am I doing?" to which Kevin, M.D. responds pretty good job. Congratulations go out to the other blogging hospital CEO who details his trip to Northern Virginia to see Little Lucy for the first time.

VACCINES: Two posts on vaccines from PediatricsInfo . First, the FDA approved the rotavirus vaccine in Febuary 2006. Second, the MMR vaccine has been cleared from causing autistic disorders according to a trial published in the October 2006 issue of Pediatrics.

PERSONA: GruntDoc takes a look at his Work Persona.

BLOOD PRESSURE: South African medical student Karin Little, who blogs at Just Up The Dose, nostalgically remembers her first diagnosis in Thump-thump-thump as she winds down on her degree. Along the same vein comes Hypertension-Silent Killer with a hypertension quiz.

TUNNEL VISION: Wandering Vistor muses about viewing the tunnel from the outside in Are You Suffering from Tunnel Vision?

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

STINGRAY: Dr. Paul Auerbach, at Medicine for the Outdoors, blogs about Another Stingray Attack reported last week in Florida which follows the tragic death of the Crocidile Hunter, Steve Erwin, in a similar unlikely incident.

CALIFORNIA: Nancy L. Brown, PhD, at Teen Health 411, provides insight into the confidentiality laws related to reproductive health care in California for minors and points out the practical issues related to information leaking through the billing process when the minor seeks care covered under her parent's insurance.

POVETRY: Borneo Breezes recognizes the contributions of Mohammed Yunus, a Bangaladeshi economist and founder of Grameem Bank, who will be awarded the Nobel Peace Prize for his effort at ending poverty through providing credit to the poorest of the poor.

INSULIN PUMP: Kerrie Morrone, a twenty-something type 1 diabetic, contemplates incorporating her insulin pump into the tangles of daily dressing in Insulin Pumping, After a Fashion.

JEFF GOLDBLUM: A Caribbean medical student blogging at the rumors were true explores his own science role model. Jeff Goldblum?

HORMONES: A four-part post on Hormone Replacement Therapy at The Blog That Ate Manhattan.

FLU: In his post, Pediatric Flu Vaccine Supply Delayed, Not a Shortage, Dr. Choi at Tech Medicine helps this lawyer understand why his two-year-old can't get her flu shot -- there is only one FDA-approved flu vaccine for children under three.

NFL: The NFL's Punitive Substance Abuse Policy covers Brett Farve's standing up to the NFL and its substance abuse policy after the suspension of Packer's wide receiver Koren Robinson.

RANT: Citing one of my all time favorite movies, Terry Gilliam's "Brazil," Digital Doorway rants about healthcare bureaucracy in Bureaucracy Now! --- A Rant. Is it Buttle or Tuttle? Also, ranting about medblog ranting comes Pointing The Finger from Medblogopathy.

INFORMATION: David Williams at The Health Business Blog provides us a link to the original piece titled, "Information Is The Answer," used by ABC News in its week-long series, Prescription for Change.

HALLOWEEN: The Family Fork: Feeding the Kids and You provides timely advice for choosing healthly alternatives as you prepare to make the Grand Rounds with the kids next Tuesday Night.

The question remains whether Dr. Hebert's Medical Gumbo will be cooking up tricks or treats as the host of Grand Rounds 3.6.

As the first health care lawyer to host Grand Rounds, I just want to say thanks to Nick Genes for giving me the opportunity to host from the hills of West Virginia. Thanks to the contributors who make Grand Rounds what it is -- a wonderfully eclectic collaboration of individuals and health professionals who share a breadth and depth of knowledge unmatched anywhere.

NOTE: I accidentally change the title of the Grand Rounds post which then automatically changed the permalink that was used in the Pre-Rounds Interview on Medscape. This created a dead link for all of these visitors coming from Medscape. To correct the problem I created a duplicate post of Grand Rounds here. You can read comments posted on the duplicate post here.