This has been going around the interwebs for a week or more but I keep coming back to it, what great insight in such a humorous post.  This is what happens when lawyers run the way medicine is delivered…

To familiarize lawyers with the new coding scheme requested by the USPDA, a small sample for the complaint of “Spilling” is shown below:

  • Spilling 200
    • Spilling, Water – 210
      • Spilling, Water, Hot – 211
        • with blisters 211.1
        • without blisters 211
      • Spilling, Water, Warm – 212
      • Spilling, Water, Cold – 213
  • Spilling, Coffee – 240.1
    • Spilling, Coffee, Hot – 240.11
        • with blisters – 240.121
        • without blisters 240.122
      • Spilling, Coffee, Hot, With Cream only – 240.12

      • Spilling, Coffee, Hot, With Regular Milk only – 240.13
      • Spilling, Coffee, Hot, With 2% milk only – 240.14
      • Spilling, Coffee, Hot, With Skim Milk – 240.15
      • Spilling, Coffee, Hot, With Soy milk only 240.16
      • Spilling, Coffee, Hot, With Sugar only – 240.17
      • Spilling, Coffee, Hot, With Artificial Sweetner (of any type, including, but not limited to Nutrasweet, Spenda, Sweet ‘n Low) – 240.18

    • Spilling, Coffee, Hot, With Cream and Sugar 240.16

To see the whole post head on over to Dr. Wes, always good writing and insightful views from the inside of medicine.


The reactions to the soft drink tax that has been bandied about are about what I expected.  Half telling about the good it could do for American diets and waistbands while filling state tax coffers while the other half are asking if this is too 1984ish where Big Brother is watching down on our perceived well-being. No surprises really and there have been some highly nuanced discussions about the merits and fears of the possible tax. It is worth noting that this tax has not been proposed by healthcare legislation (it shows up nowhere in the forming healthcare bill), the President, or any official legislative body. This is simply an idea that has some heavyweights in the medical community supporting it and the President has said it is an issue that may be worth considering.

While in New York you can see some of the funniest signs, one that says “you’re too stupid to make good personal decisions about food and beverages,” which would be a good indictment of this tax if it weren’t true. The issue isn’t really whether people are smart enough or not to make these decisions (in practice we’ve shown not to be) but rather that there is a powerful lobby and marketing campaign behind the soft drink industry that can cause confusion over health issues. And truly a large percentage of our population is not smart enough to make healthy decisions, how many kids can resist the pull of sweets especially in the face of heavily marketed products?

On the other hand there really is no concrete evidence that a tax on soft drinks will lower the obesity rate.  Two states that have levied heavy taxes on soft drinks are Arkansas and West Virginia, which happen to fall at #3 and #10 on the most obese states in the union.  Does this tell us the tax doesn’t work?  No, considering the other major factors of weight (full range of diet and exercise) there is no way to isolate the effects of a soft drink tax without serious study, so don’t believe the cannard that this simple presentation is all you need to know about the situation.

In fact, about 40 states have very minimal taxes on soft drinks, not enough of one that makes a choice difference but one that does add a bit to state tax revenue.  In fact, looking at the history of state taxes on soft drinks it seems that North Carolina repealed their tax program which was the state Arkansas based their soft drink tax on.

Overall this is a sticky issue.  Do soft drinks fall into a category like cigarettes and alcohol? I don’t know that it is an apples to apples comparison as young people don’t have access to those products but can go buy a soft drink without their parents consent at one of the multitude of places they are sold.  Most likely the prices of soft drinks are very elastic with this age group but it’s possible that even younger kids, to those who aren’t used to the ‘at least one coke a day’ routine this could make a difference as they could spend their money on something else.  My bet is that the “something else” would be unhealthy snack food and calorie loaded fast food so it is a matter of pass the buck.

Honestly I don’t know how much the government cares about curbing the purchase of soft drinks as much as generating tax revenue off of their purchase.  I think they realize that if consumers are priced out of soft drink purchase they will simply spend that money on other food and beverage choices that are just as unhealthy and found at the same locations.  This won’t affect health or obesity but if the tax is set at a golden level it could generate a significant amount of tax revenue.

What do you think of the idea of taxing soft drinks? Will it curb soft drink consumption? If so, will other unhealthy foods and drinks see an increase in consumption? Will the tax generated revenue be enough to hold up struggling health care policies? Please comment and let me know what you think!

Maybe we’re taking this a little too far…

H/T to WhiteCoat

In what can be considered a minor victory for medicine and public health Dr. Christine Daniel was brought up on fraud charges.  Daniel pushed crazy remedies on those who were in the most desperate phase of life.  Facing life-threatening cancers these patients were looking for any answers they could get and Daniel was willing to provide them with very expensive advice.  Too bad none of that advice was based on any sort of science or evidence based medicine and ended any chance that these people had of living.

Take Minna Shakespeare, who contacted Daniel in December 2002 after seeing her on TBN’s “Praise the Lord” TV program espousing the effectiveness of her herbal treatment.  Daniel told Shakespeare to stop her chemotherapy “because it doesn’t work” and to pay her $13,000 for her herbal cancer treatment.  Shakespeare told Daniel she didn’t feel that the treatment was working so Daniel told her to go back on the chemotherapy.  But I thought that chemotherapy was ineffective Dr. Daniel?  I don’t understand the change of heart.  Of course what Daniel doesn’t want to say is that she knows the chemo is effective and had a chance to keep Shakespeare alive longer. If Shakespeare stays alive longer then Daniel can charge for her herbal treatment longer and continue raking in the profit.

This is absolutely despicable and a good example of what happens with cancer quackery and all types of medical woo.  Daniel even claimed that her herbal medicine could treat and cure multiple sclerosis, hepatitis, and Alzheimer’s and Parkinson’s disease.  There is absolutely no feasible biochemical mechanism that could explain how an herbal extract, even one that contains tons of different chemicals, could cure that many different mechanisms.  In fact, there is no single medication, herbal or otherwise, that can cure “cancer” as it is hugely wide range of diseases that fall under one category of cancer.

I’m glad to see this type of action taken against a quack as these people offer hope that is not there and cost desperate people tons of money for treatments that don’t work.  True, conventional treatments cost a lot of money as well, but there is proven science behind them that they may cure your disease, or at least extend your life.  The report says Daniels made $1.1 million from 55 families, a fortune for any person.  This is pretty sick, but it will not stop many of the quacks out there and the patients that seek them out.  I hope that this sets a precedent of prosecuting fraudulent activity and actively spreading medical lies.  I’m sure it won’t set off a firestorm of prosecutions, but one can always hope.

Today the Wall Street Journal published an open letter by Coke CEO Muhtar Kent (read here) titled “Coke Didn’t Make America Fat.”  While that is not an untrue statement, it belies the contribution coke (soda for you Yankees) does make to the rising obesity rate. As Le nutritionniste puts it (google translation here), this is a PR move by the Coke corporation in the face of a possible tax on sugary drinks (for my thoughts on the tax, see here), and one that is presented pretty well.

I agree with many of the points made in the piece, such as this one; “If we’re genuinely interested in curbing obesity, we need to take a hard look in the mirror and acknowledge that it’s not just about calories in. It’s also about calories out.”  This statement is very true, we are a sedentary people now and we need to recognize the benefits of exercise, not only on our weight but on all aspects of health.  There are very few conditions (DMD is one of the few I can think of at the moment) that aren’t benefitted by healthy diet and exercise.

But this doesn’t get the companies who provide us with socially unhealthy products off of the hook. Take alcohol and cigarettes for example.  We have recognized that although there is nothing wrong with someone individually consuming these products there is a social cost of widespread use.  We see these costs both in the healthcare sector as well as the criminal justice system (DUI, DWI, etc), where time and money are spent to curb the problem.  Taxes have managed to bring down the use of these products, especially cigarettes.

I won’t mess with the tax/no tax issue but will say that Arkansas has implemented a tax system on cokes that funds pieces of their medicare pie.  There don’t seem to be any uprisings over this although I’m sure it was a fight to pass.

The big problem I have with Kent’s letter is in the first paragraph. “We at the Coca-Cola company are committed to working with government and health organizations to implement effective solutions.” It seems that you would have then volunteered to take all of your products out of public schools and gathering areas where the majority of attendees are children.  Unfortunately my home state of Texas had to take matters into their own hands to mandate that your drinks be taken out of our schools.  I wish they would do the same with food in the lunchroom, but I shall be pleased with small steps.

Overall I don’t like the tone that Kent takes, he shrugs off the responsibility his products bear on rising obesity rates while putting the blame on the public by saying we don’t exercise enough.  He presents percentages which can truly be confusing to the public rather than absolute values, blames the food industries and takes credit for employing over 200,000 Americans.  All of this does not absolve the products he sells and he should step up to the plate and admit the health consequences of overconsumption of his products.  This smells of the tobacco industry parroting their (intentional lies) beliefs that tobacco wasn’t addictive years after the medical community was trying to spread the truth.

I think this was a pretty smooth move on the part of St. Vincent Health System.  Instead of mandating their workers to get the seasonal flu vaccine or letting them have full discretion of whether or not to get it they gave the workers a choice.  Either get the vaccine or wear a mask while you’re at work.  Only 6 employees opted for the mask while all others got the stick.

This was a really innovative way to incentivize the vaccination decision as well as meeting an ethical standard of minimizing exposure of both patients and staff that are in the hospital.  I think that the healthcare industry does have an obligation to protect their patients from all potential exposures and the flu is no different.

Another obligation of the hospital is to have enough healthy staff to serve their patients, this is a step in that direction for the coming flu season and considering the population of hospitals (old, sick, and very young) it seems a good idea to put these measures into practice.

This idea is a great way to maintain the autonomy of the healthcare workers while putting a leading foot forward for the patients and other staff that are at the hospital.

Hattip to Effect Measure

A little late on this as I’ve spent all weekend slogging through the mud at ACL Fest (which was amazing btw, I was hesitant at the lineup but by far the best time I’ve had in the last 4 years).

Anyway, the Nobel Foundation has begun awarding prizes this year giving out the Physiology or Medicine award and the Physics award already.  I happened to win $30 on the Medicine award, the odds were on for the telomerase work but am clueless about the other awards.  I enjoy watching everything unfurl and if you are the same you can check here for the updates.

Up next is Chemistry followed by Literature on Thursday, Peace on Friday and Economic Sciences on Monday.  Happy watching!