Docnotes

VPN Outlawed in Michigan?

Some of the nerds on Slashdot are saying that this Michigan law would make VPNs illegal.  The source of the /. posting is from freedom to tinker .. a technology weblog ...

Expert opinions

From :RangelMD.com  ... Chris responds to an article in the Boston Globe that revies this article in BMJ.

He's right: while consultands often change care ... we don't know that they always improve care.

Fussy Baby

From the AAFP's website:  ICD-9 Changes for 2002-2003 - Family Practice Management

Two codes that I will find useful:

780.91 Fussy infant (baby)

780.92 Excessive crying of infant (baby)

Blogshares

Kinda funny  - "blogshares" .. a stock market game for weblogs ..

Lindane Warning

FDA Issues Health Advisory Regarding Labeling Changes for Lindane Products

Labeling for Lindane products has been changed to include a boxed warning which highlights the most important safety issues associated with use of these products. The boxed warning contains information to better inform both healthcare professionals and patients regarding the potential risks associated with the use and misuse of Lindane. The warning emphasizes that Lindane products have been, and continue to be, indicated as a second-line therapy for the treatment of scabies and lice. While FDA believes that the benefits of Lindane outweigh the risks when used as directed, given the potential for neurotoxicity, patients should only be treated with these medications if other treatments are not tolerable or other approved therapies have failed.

This is an important warning .. since many sources (such as this "tip" in American Family Physician) list Lindane as one of many treatment options - without advice about which product should be considered first-line and which should be reserved for resistant cases.

 

SARS - Inside Story

Bruce sent me this Wall Street Journal Article on SARS.  It's an incredible view of the genesis of the outbreak in Hong Kong.

 

Substance Abuse Treatment

SUBSTANCE ABUSE TREATMENT FACILITY LOCATOR:

"Your search has found 361 facilities within 100 miles of your starting point. The map shows the location of the 10 closest. For more information about each one, scroll down below the map."

From the DHHS - This website provides information on substance abuse treatment facilities in your area.  The link above is to my zip code ... try yours.

"The Substance Abuse and Mental Health Services Administration (SAMHSA) is pleased to provide this on-line resource for locating drug and alcohol abuse treatment programs. The Substance Abuse Treatment Facility Locator lists:

• Private and public facilities that are licensed, certified, or otherwise approved for inclusion by their State substance abuse agency

• Treatment facilities administered by the Department of Veterans Affairs, the Indian Health Service and the Department of Defense.

SAMHSA endeavors to keep the Locator current. All information in the Locator is completely updated each year, based on facility responses to SAMHSA's National Survey of Substance Abuse Treatment Services. The most recent complete update occurred in October, 2001. New facilities are added monthly. Updates to facility names, addresses, and telephone numbers are made monthly, if facilities inform SAMHSA of changes."

Contraceptive options

In this month's American Family Physician, there is a good article on Counseling Issues in Tubal Sterilization. 

It's more than just a discussion of tubal ligation.  There's a good table which lists some of the pros and cons of many contraceptive options - including newer options like Nuvaring and Evra.

I wonder if the pharmaceutical companies are choosing the names of their medications based on whether the domain names remain available ...

Autism

From DB's Medical Rants: an article in the NY times about Autism and vaccines.

The article is well written, and provides an overview of the issue of Thimerosal in vaccines.  Nonetheless, I'm troubled by the author's lack of understanding of the definition(s) of Autism.  She cites figures that depict a significant increase in the prevalence of Autism over the last 30 years, but fails to mention that the diagnostic criteria have changed - so many more kids "qualify" as Autistic who would not have in the 1970's - especially those with Asperger syndrome.  I wonder if there is an increasing prevalence of Autism in the kids of NY times reporters ... as they seem to have an especially strong interest in this topic . as it's the third article (1,2) on this topic in the last 4 months.

As we read in this recent paper:

Increased recognition, the broadening of the diagnostic concept over time and methodological differences across studies may account for most or all of the apparent increase in prevalence, although this cannot be quantified

Some other references:

Prevalence study (JAMA - 2003)

Increasing Prevalence? (Review - Journal of Pediatric Child Health 3/2003)

Migraines & Celiac

Medscape: Migraine Linked to Celiac Disease

About 4% of migraine sufferers may have celiac disease and symptom control may be improved with a gluten-free diet, according to the results of a study published in the March issue of the American Journal of Gastroenterology.

Celiac disease is certainly the disease of 2003.  I think I've diagnosed 5 patients this year already!  Though I think that over time we'll learn that there are varying levels of wheat and/or gluten sensitivity ...