Sonspot

The February issue of JAMA has a review of the Book "Marijuana and Madness: Psychiatry and Neurobiology".

The authors make this conclusion:

USNews is carrying an article called "Mysteries of the mind". I found this part interesting:

But in a stunning study published this month in the journal Neurology, researchers used functional magnetic resonance imaging to study the brains of two minimally conscious patients and compared them with the brains of seven healthy men and woman. The scans revealed that the minimally conscious patients had less than half of the brain activity of the others. But then all the subjects were played a tape made by a family member or friend, recounting happy memories and shared experiences. One minimally conscious man listened to his sister reminiscing about her wedding and about the toast that he made. The result was astonishing: All those who were scanned, including the minimally conscious patients, shared similar brain activity, some with activation in the visual cortex. "This shows that there is a life of the mind beyond what is apparent," says Joseph Fins, chief of the medical ethics division of New York-Presbyterian Hospital-Weill Cornell Medical Center. But Fins, who was not involved in the study, points out that philosophical questions also emerge. "Does this mean that they are seeing words? Visualizing semantic concepts? Does this in some way conceptualize consciousness?" As Zaltman points out, language is only the narrowest determination of our thoughts. This study shows that our brains, even damaged brains, are exquisitely attuned to that fact.

So maybe the right to die crowd is incorrect and Mrs. Schiavo has brain function like the rest of us. Of course they can still argue that she has no quality of life. Sure, but do they really want to starve to death a living, breathing and THINKING woman just because they believe death would be a relief for her?

What precedent would that be setting?

(Thanks for the heads-up Steve)

I believe that all God's creatures serve a purpose. From the lowly sea urchin to the majestic bald Eagle to the guy down the street that's always trying to get me to buy whole life insurance from him (although I'm less sure of that one).

However, my yard has been laid siege to by moles. I don't mean an occasional burrow trail behind the shed, but a subterranean interstate complex complete with exit ramps and secondary roads. How did this happen? I don't know.

Initially I was high-minded about the whole thing, "live and let live" I said. Surely they would go away once their supply of grub or worm or whatever ran out. But alas no, I fear they are here to stay. With that I have decided to fight back against the scourge, to defend my property and my dignity (I think my neighbors are laughing at me).

I have set traps and I have planted poison. I would even sit outside and shoot anything that moves, but they would haul me away for that. The road ahead will be long, dark and dirty. The ending, unknown. But I will prevail against this invasion. They have the superior numbers, but I have the superior intellect, right?

It amazes me how small the world community is. Due to advancements in mass media we're all just one big neighborhood, for better or worse.

Take the Terri Schiavo case for instance. This is an unfortunate woman who may, or may not, be in a PVS. Her husband (and POA) wants her tube feeding stopped because he says she has no "quality of life". However, her parents are fighting this and it has sparked much controversy on the net.

I'm a nurse practitioner that works with these types of situations a lot, where life and death choices are having to be made by POA's regarding their loved one's care.

The Schiavo case has had it's repercussions. Right now I have a gentleman who has had an acute, and likely reversible, delirium that has affected his swallowing. In fact, he is currently recovering from an aspiration pneumonia. Usually in these cases a feeding tube would be placed until the delirium improves and the patient is able to swallow normally again.

However, due to the Shiavo litigation his POA won't agree to have a feeding tube placed for fear that his swallowing won't improve and the tube will end-up being his only source of nutrition. The POA doesn't want this to wind-up in court with other family members. So now we're feeding this man by mouth who is grossly dysphagic, risking another aspiration (and possible death).

Fun stuff.

Interesting article here.

Imagine being in a vehicle accident in the middle of the night in a small Minnesota town. You are taken to a hospital whose resources are not suited to analyze your injuries. You need a radiologist and that hospital cannot afford to have one on call at 2 a.m. Luckily, they are able to send your X rays to someone overseas who is on call for that very purpose. They are board certified for Minnesota, look at your injuries, and make the necessary medical recommendations. This is the 24-hour way of doing business and providing service that Subramani envisions with outsourcing.

This is how my hospital handles after hours emergency radiological reports now. Before we had this, much of our diagnoses were made with educated guesses by non-radiologically trained clinicians. Sometimes things were missed, which affected quality.

I know there are downsides to Outsourcing, as reflected in these numbers: Forrester Research estimates that the current number (of outsourced jobs) ranges anywhere from 12,000 to 20,000 jobs a month. However, there should be some discernment made between what is helpful or harmful outsourcing.

My son is sick with the flu. My wife and I have had exactly 6.5 hours of sleep over the past two days. Due to this, posting will continue to be light or non-existent for a while.

Hunter S. Thompson was found dead from a self-inflicted gun shot wound.

Say what you will about the man, and there was plenty to not like, but he was one of the most creative writers of the last 50 years. I "discovered" Thompson in my teens, and even though I didn't agree with much of his politics or lifestyle, I loved the reality he created with his words. It was like the written-word equivalent of a Salvador Dali painting. Or a Beat poet on an hallucinogen, instead of the heroin and Dexedrine they so often preferred.

I quit following Thompson by the early 90's, but I recall his interview with then Democratic Presidential Nominee Bill Clinton that he did for Rolling Stone. Thompson sat down across a table from Clinton and pulled out a wind-up skipping toy in the shape of a male phallic. He let it hop across the table between he and Clinton during the interview. Apparently Thompson knew something about Mr. Clinton early on, that the rest of us would come to realize only years later.

In a biography of his life, Thompson's brother related the story of when he told his older sibling that he had AIDS. Hunter, he said, looked-up at him with deep sadness and said something to the effect of "At least your not in the shape I'm in."

In the end, Thompson's fear and loathing was more directed at himself than anything. And if it is any consolation, when Thompson committed suicide, he took his worst enemy with him.

...the USS Jimmy Carter, what will the USS Bill Clinton look like?

...just don't know when to stop.

I found this interesting:

George W. Bush: 1206 (566 on the verbal)

Al Gore: 1335 (He invented the SAT's, you know)

Sen. Bill Bradley: 485 verbal (Mr. Eloquent himself did worse than Bush?)

Bill Cosby: High 400's combined (Looks like I wasn't the only one asleep that day)

Stephen King: 1300's (the same number as his books that got turned into terrible movies)

Sun Microsystems CEO Scott McNealy: 1420 (No surprise)

Bill Gates: 1590 (yawn)

Microsoft co-founder Paul Allen: 1600 (Yeah, but Steve Allen was funnier)

John Kerry: Refused to release his SAT scores (along with the DD180 form)

Oprah Winfrey: Refused to release (But likely higher than 90% of the authors in her book club)

Beautiful thing? (Spotlight: Moxie)

While doing research on another matter, I came across the Office of National Drug Control Policy's report: The Economic Costs of Drug Abuse in the United States. 1992-1998.

I found this part striking:

...the overall cost of drug abuse in the United States from 1992 to 1998 showed that the overall cost of drug abuse to society increased at a rate of 5.9% annually with healthcare costs of 14.9 billion in 2000.

I have had many conversations with libertarian minded folks that believe the best action to take in regards to illicit drug use is to legalize all drugs. From what I can gather, this point of view comes down to basically two arguments:

-The war on drugs has failed, we might as well legalize and tax it to make some money.

-It's a free country and adults have a right to choose how they want to live.

My argument has always been this; if we legalize drugs then it will send a message to our kids that drugs are okay to use. Some drugs unlike alcohol, but more like Tobacco, are highly addictive. Exposing our children (and legalization will increase exposure) to these addictive drugs will produce an ever increasing amount of addicts that society will have to care for. Some will say that my above quote of numbers proves that legal restriction isn't working. I believe however, that it proves we have a drug problem in this country and the last thing that needs to be done is for us to enable present, a future, addicts by opening the flood gates on narcotics.

Since theological/philosophical arguments haven't worked. I will now plead to the wallets of my Libertarian friends. Do you want to shell out even more money to care for an ever growing group of sick people? Even if we were to legalize drugs, we will still have to care for the physical and psychological needs of these people:

Ramped-up on methamphetamine, her hair a sweat-drenched mop, the woman wrestled a demon only she could see. Through the cell's thick glass, King heard her shriek at the invisible beast, "Go away in the name of Jesus."

The group that put this sign up in Hollywood right before the Oscars, or the uncreative bandits that besmirched its image. (spotlight: Southern Appeal)

Once upon a time there was a good man who decided to help his fellow Christians out of the ghetto by starting a Godblog roll. It was a smashing success, many jumped on board and the rising waters lifted a lot of ecosystem ships.

Suddenly there began to be complaints from some on the blogroll about the "others". Those who did not fit their criteria as providing good theology, or not providing theology only. Now this wasn't an issue when everyone was piling into the blogroll, but once on the blogroll certain people decided it was time to become discriminating.

There are blogs on my roll who I don't always agree with. But so what? Now would usually come the part were I quote a little Jesus and a lot of Paul, but what's the use. No minds are going to be changed.

With that, I have a suggestion for everyone. Each person added themselves to the blogroll to increase their links and their traffic. So if you're going to kick someone off your blogroll, make sure to let them know so that they can decide if they want to keep you on theirs. It's rather unfair to drop a blog and not tell them, but continue to have your blog linked to them, and continue to receive some of their traffic.

Howard Fineman (Spotlight: RCP)

As for the Democrats, there’s no reason they can’t make the Ten Commandments, and the Bible, their own. These days everyone wants to talk about values. But there is plenty in the Old and New Testaments—and in the commandments themselves—for them to cite. End Social Security as we know it? How does that “honor thy father and thy mother”? If the Lord wanted to honor His own creation—and wanted us to do so, too—by observing the Sabbath, what should that say about our respect for His handiwork (a k a the environment)? And of course there is a whole party platform in the social ministry of Jesus—if the Democrats would only get over their reluctance to talk about it.

Forget Fineman's silly remarks that privatizing SS is the same as ending it. And also forget Fineman's automatic association of Republicans with environmental destruction. The left calling the right hypocritical is like Scott Peterson calling Ward Clever a bad father. You can't stand for the things the Dems. stand for then try to battle the religious right on their turf, you will get slaughtered.

Listen, I like some things about the Democratic party (I'm a sucker for populist talk), I was a Democrat for most of my life. But, until the party ejects it's fringe and gets some sane domestic and foreign policies, I (and many like me) will continue to remain (mostly) happy transplants in the Republican party.

...with a two cent message.

Nothing to prove! It has nothing but something to prove, and something that Hollywood proves so routinely that it has by now become rather a bore for me, at least, to see proved again -- namely that our lives are our own to do with as we please. God and any of God's putative "laws" don't come into it.

here

The US food and drug administration has given the go-ahead for the soldiers to be included in an experiment to see if MDMA, the active ingredient in ecstasy, can treat post-traumatic stress disorder.

It's worth a try, I guess.

The March issue of Esquire has a puff piece on Ronnie Earle, the district attorney that has indicted Tom Delay for illegal fund raising activities.

I must admit that I have paid little attention to this issue, but the article was too ridiculous to simply let pass without a word.

As velvet gloved as this article was, it hit right at the heart of the matter, which must've been accidental.

Hell, he thought, everyone knows there's a law in Texas against using corporate contributions in elections. Passed to stop the railroad barons of the Gilded Age from using their wealth to rob local ranchers, that law had stood up for a solid hundred years. And not only did the Republicans succeed spectacularly-sweeping the state and taking control of Texas legislature for the first time in a century, but now they were bragging about it...

Bragging I say!

...So Earle gathered his political-corruption team and started studying the law-and it quickly all seemed clear as mud. According to a 1976 Supreme Court decision called Buckley vs Valeo, money spent on elections is a form of free speech that must be regulated. That means that corporations can spend money on political campaigns as long as they don't practice "express advocacy" by using "magic words" like Elect John Smith or Vote for John Smith. But at that moment the new Mcain-Feingold campaign finance law was going into effect and there were other rulings working their way through the system, like a decision out in California that suggested replacing the magic-words test with a "reasonable person" test-if something looked like a campaign ad and sounded like a campaign ad then it probably was a campaign ad.
So the law was in flux, his team in doubt. "We were reading all these Supreme Court cases," recalls his chief deputy, Rosemary Lehmberg." And that's when people said, Gosh, maybe this is legal.
So it came down to him, Ronnie Earle, and to one man's sense of right and wrong."

Good gravy! So Delay was indicted because of one man's sense of right and wrong?
This must be so, even this very Earle-friendly article makes it clear that the law was not on his side, in 9 out of 10 interpretations of it.

There is a new study out from the Archives of Internal Medicine suggesting that giving flu shots to the elderly has not saved lives.

The researches had this to say:

We attribute the decline in influenza-related mortality among people aged 65 to 74 years in the decade after the 1968 pandemic to the acquisition of immunity to the emerging A(H3N2) virus. We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10% of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.

I have some observations regarding the researchers' conclusions

-There are more elderly people now. Along with more elderly, there are more elderly living with chronic diseases that affect the immune system (transplant recipients, Chronic renal failure, RA, DM etc.). Wouldn't this affect the mortality rates? If you took 10 elderly people 30 years ago maybe only two were living with chronic immunosuppresive diseases (because the morbidity/mortality rates were not as good then). The flu vaccines would likely have been more effective because the patient population was healthier.

If you took 10 patients now, five or six would likely be dealing with a chonic disease that affects the immune system so the vaccines would be less effective because your patient population is sicker as a whole.

-The turning point appears around 1980. This is the same time the DRG system of payment to hospitals by Medicare started (1982). It would seem possible that the two are linked. Medicare began to pay depending on the principle diagnosis carried by the physician. The hospital and physician would've started listing diagnoses more correctly since so much was riding on them. For example, a physician would've been more likely to have started listing, as the principle diagnosis, the reason for presentation to the hospital, and dropped the simple "Influenza" diagnosis. What one would see is a dehydration, pneumonia, or sepsis diagnosis instead. They might've been caused by the Influenza virus but they, not the influenza, caused admission and death.




Freaky!

Just follow the directions, press and hold down the left mouse button. Move the mouse up to go forward or down to go back, very cool stuff.

My father worked his entire adult life, until his retirement 2 years ago, as a guard at the Florida State Prison. The last 30 years were spent guarding death row inmates. I grew-up listening to his stories about the more famous ones such as Ted Bundy and others. No big secrets, just things like their favorite foods, if they were quite or talkative etc. But to a kid that was really neat stuff to hear, it was like getting a glimpse at the inside of a dragon's lair.

Dad was one of the guards that would transport the inmates to "old sparky" their euphemism for the electric chair. He would stand outside the door until death was pronounced and the body removed. My father is a very religious man, but he never saw any conflict in his faith and his job. Dad's view was that these men had done terrible things the state deemed were worthy of death. He was simply carrying out the will of the people of the state of Florida.

I myself have always been conflicted regarding capital punishment, but over the years I have relegated it to the "necessary evil" category.

A few months ago I came across this man on the radio who was explaining his conversion experience. It didn't take long to figure out that this was no normal conversion, what with his admission to the murder of a number of people, and ultimately I found out the guy was David Berkowitz (Son of Sam). Apparently some years after his conviction as a serial killer he gave his life to Christ, and has since been going about trying to heal the damage he has caused.

This is nothing new in a prison setting, many convicts "convert" in hopes of a timely parole. However, Berkowitz has declined any parole hearings regarding his case, even though he has been a model prisoner for more than 20 years. Now some might say he knows there is no hope of release anyway, so denying a hearing is really no loss. To that I agree, but none the less believe he is sincere in his repentance and conversion.

If Berkowitz would've committed his crimes in Florida, he would've fried a long time ago and no one would've missed him. But New York has no death penalty, and he will spend the rest of his life in prison.

So it begs the question; is capital punishment the right answer? I do know that these people are monsters and few ever become sincerely reformed like Berkowitz (if this is indeed the case). But even if only one out of every hundred come to repentance, wouldn't this be enough to end capital punishment? Personally, I don't know the answer, but I'm more comfortable erring on the side of not killing than I am of doing something that ends any hope of repentance.

The February issue of "THE WEEK" has a little blurb about the Clint Eastwood movie "Million Dollar Baby". (Warning: Plot spoiler coming). Apparently the movie details the friendship between a female boxer (Hilary Swank) and her coach (Clint Eastwood). As the movie progresses Mrs. Swank's character becomes paralyzed by a "sucker-punch" and ends up bedridden. Swank's character then begs Eastwood's character to pull-the-plug so that she can die. In the end, he not only pulls the plug but gives her a lethal injection of a drug to insure her death.

Sweet, ain't it?

Well the "critics", or the ones that matter anyway, love the movie. It shows the heart of the right to die advocates, they say. Life is complicated, who knows what's the right answer in these difficult cases, they prattle. Hey, I got a suggestion, why don't we treat her depression and show her that her life is just as valuable as any of us who can walk. But of course, who am I to tell another they have quality of life simply because they are alive.?

Now we come to Roger Ebert, the critic's critic, who attempts to for-shame all us low brows with this statement:

We should also condemn all of Shakespeare-indeed, most of our greatest plays, films, and novels, since characters often fail to live up to society's highest ideals. A work of art must be true to its characters and to the complexities of human existence-not to a political or religious agenda. Attacking a movie because Maggie doesn't get sufficient counseling is absurd. We might as well say Hamlet needed a psychiatrist.

If a group were to take up a cause for Danish Prince poisoning, based on Hamlet, then I would be focusing on Hamlet. As it is, the right to die advocates are using this movie's message in an attempt to promote their agenda. So let's cast away Mr. Ebert's strawman and talk about the real issue.

Everyone is looking for that line. The one that Eastwood's character crossed and went from murderer into humanitarian. Well, they won't find it because there is no line. What they will find, as they continue to define-down life deciding what quality thresholds need to be crossed (if there are any) before a life can be extinguished, is that everyone's life gets cheapened.

Harvard professor Elizabeth Warren has a piece in the Houston Chronicle regarding Medical Bankruptcy.

Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs until illness struck.

To our surprise, half said that illness or medical bills drove them to bankruptcy. So each year, 2 million Americans those who file and their dependents face the double disaster of illness and bankruptcy.

Now the money shot:

...Comprehensive health insurance is the only real solution, for poor and middle-class Americans alike.

People are always surprised when they find out, I not only think universal governmental healthcare won't help, I think it would make healthcare much worse. I deal with Medicaid and Medicare on a nearly daily basis and they are a wreck. Only a Harvard Professor would think expanding those broken systems would be a good thing.

First off, it's no surprise that the majority of bankruptcies due to medical bills are from the middle class. The poor have Medicaid and the rich have money. Why were they surprised by these findings? What did they expect to find?

Secondly, if I'm living paycheck to paycheck, up to my neck in debt, and along comes a fractured leg or pneumonia (or worse), yeah I'm going to tell you it's medical bills that drove me to bankruptcy. Even though it was only the straw that broke the financially over-burdened camel's back.

The plastic elephant in the room is the amount of debt Americans are comfortable carrying. Between credit card debt (avg. $2,627), student loan debt (avg. $18,000), car loan debt (avg. $24,157) and home loan debt (avg. $69,227) there is no room left for sunshine between swimming and sinking. God forbid there is a rainy day, and there are always rainy days.

Instead of destroying the best healthcare in the world by throwing it down the governmental bureaucracy hole, let's try something a little crazy. let's not treat Americans like they are spoiled children that need the government to hold their hands as they stumble through life. Why don't we begin to teach people how to balance a check book and develop a budget? I know it sounds nuts and all, but it just might work.

Like the old saying goes "give a man a fish and he'll eat for a day, teach him to fish and the government won't come and take your hard won fish to divvy out as they see fit", or something like that.

3-point turn? We don't need no stinking 3-point turn!

...or a razor to the wrist?

Our hospital's last OBGYN has announced that he's throwing in the towel. Unable to pay for the ever increasing malpractice costs, he has decided to only do GYN and ER coverage. 10 years ago our small hospital (less than 50 beds) had four physicians that delivered, this was not unusual at the time. Over the years, all of the small hospitals around us had stopped delivering babies, we were the last hold-outs.

Now patients will have to commute over 40 miles in order to deliver. The malpractice attorneys love to point out how they are improving care by "weeding-out" the bad physicians. They have just increased the risks for expecting mothers in this area because of the long distance from a delivering hospital. It reminds me of when airlines were forced to make parents purchase separate seating for their children because it slightly increased the child's chances for survival in a crash. However, what it did was force more parents to travel by car because of the increased seating costs, and since car travel is much less safe than air travel, total accidental child deaths increased due to car crashes.

But this is about money, not poorly thought out policy. Large hospitals can stay open because they can absorb the malpractice costs for the physician, and their patient population tend to be paying customers. In the rural areas, most mothers are Medicaid, and Medicaid is a loser for a hospital. They don't pay enough to cover costs. However, most rural hospitals continued to deliver because they knew that if delivery was lost, pediatrics would be next and then adult care. Ultimately all healthcare would be centralized to the large urban areas, just the way the government (and the large hospital Lobby) wanted.

So the poor suffer out of this, like they always do.

I have faith that this will come to light one day, and the rot will be addressed. But how many will have to suffer first?

Terry Michael of Real Clear Politics has a post today entitled "A Return to Liberalism's Jeffersonian Roots". I'm always interested to read about my old party's latest attempts at changing without really changing. They remind me of a bourbon drunk suddenly switching to whiskey and calling it progress.

Anyway, as I meandered through the piece, I came across this:

From our Jeffersonian roots, we have the glue to make the brand sticky again. The new desktop-empowered generation, turned on by Republican economic choice, but turned off by the social-cultural intolerance of the GOP Taliban wing, could embrace Democrats if we return to our founder's philosophy -- a back-to-the-future Jeffersonian liberalism.

Man those social conservative are evil aren't they? Against abortion AND gay marriage! Yeah, I see the similarities between them and a masochistic/homicidal group of Islamic extremists so clearly now. Sheesh! Since they are able to caricature social conservatives that way, then they should not get upset when someone might call them a bunch of America hating, baby killing, pinko-commies. See, words can be devastating. I understand, that to capture the center in politics, it helps to paint the otherside as extremist wackos. But both sides should take note that all this accomplishes in the end, is add to an ever increasing shrillness that makes both sides appear untrustworthy.

We need a new story. Here's rough cut: "Government: Assure liberty by staying as far away as possible from our bank accounts, our bedrooms and our bodies..."

It's funny to me that liberals don't see any irony in defending a "right" obtained by judicial fiat (abortion) while blasting the denial of a "right" by every states' voters that have had the option on the ballot (gay marriage). Not allowing same-sex couples to marry is not the same as placing sodomy police under every bed, so let's ratchet down the rhetoric. Also, you have every right to your body except when you happen to be housing another body, then that body should have the same rights as you.

Here.

I scored 90%, average error 16 miles (freaking Connecticut).

Since it's a slow news day, I think it's time to post some more about my favorite bureaucratic institution, Medicare (My earlier Medicare posts are here and here).

When a patient, with Medicare as their principle payer, is admitted to the hospital they are either placed in 23 hour observation or inpatient status depending on the reason for the admission.

23 hour observation is (supposed to be) used to determine if a patient requires inpatient admission. This determination is to be made within 24 hours (hence the name). For example, a person with a history of asthma presents with wheezing and some shortness of breath with activity. At that point they don't meet inpatient criteria (clinical/laboratory/radiological findings considered significant enough by the government to warrant IP admission). The patient can be placed in observation, given some respiratory treatments, respiratory testing, and monitoring for any potential progression of the disease/symptoms that would warrant more intensive treatment and inpatient admission.

Now that's the way it's supposed to work, but like many things regarding Medicare, that's not how it's followed. Medicare pays a smaller amount to the hospital for 23 hour observation care than inpatient care because the care is usually less intense. But this fact is being used to cut costs.

As I stated earlier, the government sets what criteria must be met in order to admit a person to inpatient status. Since inpatient status is generally more expensive for Medicare, it's becoming harder to meet admission criteria. For example, in many states (because the criteria vary some depending on the state) for a person with vomiting, diarrhea and subsequent dehydration to be admitted IP they have to be NPO (meaning not allowed to have any fluids/food by mouth). This makes no sense, but it works wonders for Medicare because they can then deny the entire inpatient stay if this order isn't followed.

Another tactic used by Medicare is to perform a retro review after the patient was discharged and force the hospital to bill the admission as 23 hour instead of the original inpatient bill. For example, a person is admitted inpatient with chest pain in order to rule out a myocardial infarction. Chest pain with a cardiac care unit placement meet inpatient criteria. The Medicare Gestapo ( physician review organization or their new name of quality improvement organization) will review the chart after discharge. If the patient turned out to have no acute cardiac event the PRO will, many times, deny the stay on the grounds that the patient never needed admission.

Of course the physician has no way of knowing that the chest pain was not cardiac in nature at admission and the grounds for the denial directly oppose Medicare's own rules of not using evidence after admission to deny an inpatient stay. However, the PRO knows that most physicians don't have the time, and most hospital don't have the guts, to fight back.

Hospitals know that if they push back too hard they could be in for a full-out audit of all their records. And since the government sets the rules, and the interpretation of those rules, the hospitals are at a significant disadvantage. Hospitals (especially small rural ones) only have a limited amount of money for legal defense whereas the government has an unending supply of funds in which they can carry on an unending legal assault.

Mark Byron has a quiz, of sorts, if you're not sure.

I guess I'd call myself a small "e" evangelical if I had to supply a label.

This past Sunday our pastor preached about Christians making an effort to not be, or even appear, "worldly" i.e. one should be able to see a difference in a Christian and the society they're a part of, that the Christian should strive for a higher moral standard.

Our pastor made the statement that it was becoming harder and harder to see a difference between Christians and non-Christians. His conclusion, of course, was that this was a bad thing. However, it got me to thinking about why Christians seem to melt into the scenery now instead of sticking out like they apparently did in the past. Although I'm probably the last person on the planet to have noticed this, I want to share my thinking anyway.

When Christianity first appeared on the scene the world was a very different place. Humans have always been, and still are, cruel but the world of the first centuries A.D. was particularly ugly. No one could vote, slavery was the norm, there were no civil rights, women's rights, child labor laws, OSHO, no concept of cruel and unusual punishment, and no real charities.

Suddenly you have this group of people show-up, who by no means are perfect, but who are dedicated to following the teachings of Christ. The suddenly active philosophies of "Loving your Neighbor" and "treating others as you would have them treat you" must have been quite unusual to the pagans of the time. Add the adherence to the biblical moral codes (commandments) and you have yourself a whole new creature walking around.

Fast-forward 2,000 years and ask yourself, "what has changed?" Are Christians really that much worse, or has the world changed around us?

Now instead of an angel and a devil, I have an atheist and a fundamentalist on my shoulders. The atheist points to the inquisitions, the crusades, the Christians the supported slavery, the Christians that didn't support civil rights/women's rights and concludes that, far from being a positive, Christians are part of the problem in the world. But this is like describing Achilles as "a guy with a bum foot." Sure, some Christians have done evil things, but over all we have transformed the world for the better.

The fundamentalist disagrees for a different set of reasons. He points to the high Christian divorce rate, decreasing church attendance, abortion, the outlawing of prayer in schools, removal of the 10 commandments from public arenas and concludes that both Christians and the world are "slouching towards Gomorrah." But this is like burning down your house because the roof leaks and the fridge is on the blink. Sure, there are problems, some quite severe, but it's far from a hopeless situation.

So yeah, we seem to be moving in the right direction. Certainly, there is still much work to be done, but look at where we came from. Now if we can just keep from blowing ourselves up, we'll be cooking with gas.

M. Scott Peck author of "The Road Less Traveled" has a new Book out called "Glimpses of the Devil" (a review is here). In it he talks about modern day demon possession. Mr. Peck claims to have performed 2 exorcisms himself and had this to say regarding evil:

"There are a great many evil people, I estimate 2 percent. But most people don't need the devil to recruit them to evil. They are capable of recruiting themselves..."

"The subject of Satan is esoteric indeed, but then, I am not so sure how seriously most people take God either, beyond a touch of superficial piety. In our culture, anything you can't see and touch and measure is deemed not worth serious consideration."
(excerpts of interview with Rebecca Trainer of Salon.com)

I have always avoided this topic because it is not something I understand, or at least, don't want to. I agree there is evil in this world, who wouldn't? Are there Demons who force us against our will to perform evil acts? That's harder to swallow since the person could hardly be held accountable for their actions if this is true.

I believe the Demons of such things as addiction can make it appear to the addict that they have no choice but to do whatever evil they need in order to get a fix. I can go that far with it.

Weapons of Warfare has a wonderful post regarding apologetics.

"In the end, all the evidences and proofs of the existence of God will come to naught if God himself does not work in the heart of the person hearing. No argument, however logical, will suffice to bring anyone to salvation."

I want to link this statement to the current post at Evangelical Underground regarding gay marriage and polygamy, because the two are connected.

As Paul said in Corinthians, the foolishness of God is wiser than the wisdom of men and that it pleased God through the folly of what we preach to save those who believe. What an odd concept. Why not simply plead to the intellect of men regarding salvation or even to what is godly living?

Well, remember the Sinai experience? God came down from heaven onto Mt. Sinai in full majesty (as seen in the face of Moses) and power (thunder, earth shaking) and the people feared, but did not believe. The people saw the law as repressive, as being handed out by a terrible God and his blinding mediator. Their fear sparked rebellion, not submission.

The law was obviously meant to keep the people from harm, and what is more logical than the 10 commandments? But the people loved sin and hated the law for what it exposed in them. So much for pleading to the intellect of man!

So what do you do as a deity with a bunch of people who won't listen to reason? That deity pleads, not to the carnal mind, but to the heart, the eternal spirit. After all, God is a spirit. No wonder the Gospel seems like so much crazy talk to the non-believer, it's not rational to them. The spirit must be made ready by God's power to accept what the mind says is foolishness. How is that spirit made ready? By the grace of God. The grace that holds-up all the universe.

We should see Jesus and him only. We should only view God through the prism of Christ and leave the rest to the "wise". So when someone asks if gay marriage is right or if polygamy should be legal I think it's best to return with something like "all is naught, all is emptiness, vanity and chasing after the wind without the cleansing blood of Christ". They will think you're a fool, but you'll be in good company.

...at least I picked the right team. The defenses played better than I thought, and the offenses played much worse (what a stinker of a first half!).

Lame commercials. Now well all get to see them over and over for the next 6 months. They've already shown the convertable mustang with frozen guy five times, once back-to-back.

The half-time show was great, and hey, no boobs.

Patriots: 34
Eagles: 24

Everyone will keep their clothes on at half-time.

I grew-up in Jacksonville and it has to be the biggest football city in the biggest football state. There are some excited folks walking around that city today, their dream has finally come true.

My earlier post about heresies got me to thinking about modern day heresies. This, somehow, brought me back to Joel Osteen. I've already given my opinion about the man (see here, here, and here) but many other blogs have been giving their opinions as well (here, here,).

I had decided not to do a complete blog review of his book. After 3 posts I realized I was just saying the same things over and over again. Also, I wasn't completely sure that what I was doing was a good thing. So what if the guy had his own unique interpretation of scripture, at least he was teaching the bible. Did it really matter if he rarely, if ever, preached, spoke, grunted, hinted at, or pantomimed the Gospel of Christ? Surely he was getting around to it at some point. After all, he's the pastor of the fastest growing church in America. Who cares if he makes wild statements about carnal riches given to the believer by God as a reward for their faith. Used car salesmen are Gods children too, they have a place in the kingdom,right?

No, none of that is right. Osteenism is just another plague of the modern man.

Want to be big and strong, but not work hard for it? Hello steroids
Want to be thin, but not diet for it? Hello bulemia
Want to live, but not feel pain? Hello narcotics
Want sex, but without intimacy? Hello pornography, prostitution
Want in the kingdom of God, but without the cross of Christ? Hello Osteenism

He Lives has a great summary of early Christian heresies. The funny thing is how these heresies get so close to being right, but miss completely on the most important part. Close just doesn't count in these particular matters.

-16-17 year-old driver doubles his chances of having an accident by taking two teen passengers in the car, insurance stats show. He quadruples them by having three or more teen passengers.

This is likely due to the radio being turned up to airline-jet decibels, Chinese fire drills, and "Dukes of hazzard" re-enactments.

-The word "blog" is now in the Oxford English Dictionary-but a new survey has found that 62 percent of Americans have never heard the word, and don't know what a blog is.

I bet at least 62% of people have never heard the word "pisiform" and don't know what it means. That doesn't make it unworthy of being in a dictionary though.

The number of fatal accidents involving motorcyclists above the age of 40 has tripled over the last decade, to about 1,700 a year. Safety officials blame the increase on baby boomers who are coping with midlife crises by buying bikes with big, powerful engines.

Well, killing yourself with a machine you have no business being on is one way to deal with a midlife crises. Whatever happened to buying a corvette and growing a pony-tail?

Since 1923, 44 women have won seats in the House or Senate following the death of a husband in office. "Very few spouses ever lose" said Debbie Walsh of the Center for American Women and Politics at Rutgers University. "There's a huge advantage to being the widow."

Do you think Bill Clinton might be a little nervous about now?

The February 4th issue of "THE WEEK" has a piece regarding a fossil find by paleontologists digging in China:

"Paleontologists in China have found the perfectly preserved remains of a dinosaur in the belly of a 130 million-year-old doglike mammal known as Repenomamus robustus...

...The researchers were startled by their find, because until now, it was assumed that mammals that lived in the age of the dinosaurs were small, ratlike creatures that subsisted on bugs...

"...This changes the picture quite a bit," said researcher Jin Meng..."Nobody thought that a mammal could eat a dinosaur.""

I guess this will push the age of the earth back some more to account for the higher evolution of mammals at an earlier time period. No doubt this find will be assimilated into the silly-putty-like Darwinian evolutionary model without any real fanfare.

Earlier this week a Catholic (Sacred Heart of Mary) church in Boulder, Colorado held a burial service for 500 aborted fetuses. The church obtained the ashes of the cremated babies from the local mortuary.

The Abortion clinic director had this to say in response to the burial service:

"These fanatics simply cannot leave other people alone with their most intimate sorrow."

Intimate sorrow over what? If no life was destroyed, why is there any sadness?

I have removed hundreds skin tags and ingrown toenails in my day, and not once did the patient suffer sorrow over the destruction of those particular collection of cells. So why all the private grief with this procedure?

What would be helpful in this discussion is a bit more honesty. If the abortionists would just concede that what a abortion does is kill an unborn human being, but that the rights of that human is trumped by the rights of the mother, their argument would make much more sense. They would still be wrong, but at least their thinking could be followed.

...I started this blog. It feels like I've been doing this for years already. It's very hard work for me to sit, collect my thoughts, and produce something (mostly) coherent.

I started this blog with the idea that it would be a beacon for the light of the Gospel on the net. What has been a pleasent surprise is the amount of light that I discovered was already there. I have encountered wonderful Christians speaking the truth with love and power. But isn't that like the father? No matter how much we try to give in order to glorify his name, he always gives back more.

The January 26th issue of JAMA has a review of the book "Physician-Assisted Dying: The Case for palliative Care and Patient Choice."

The 2 editors of the book are both advocates for physician-assisted dying and the book is slanted in support of their cause.

An excerpt:

A substantial majority of citizens believe that competent, terminally ill patients should have the option of receiving medication that patients could self-administer to bring about a humane and peaceful death if pain and suffering becomes intolerable...

The authors go on to conclude that physicians also support assisting patients in dying and, in fact, do already in an "underneath the table" way. The authors believe that laws should be changed to legitimize this practice.

I am a nurse practitioner that specializes in the care of the elderly. I have worked in this capacity for the past 10 years and I am very familiar with the issues surrounding the dying patient. I would like to give my opinion about the euthanasia craze that is sweeping the nation(s).

Dying is a difficult (obviously) process for everyone involved. There is no manual that lays out the various points to be met for a proper death. Most of the time what happens is that patient is no longer competent to make their own healthcare decisions. At that point a "Power of Attorney" is designated (usually a family member) and the POA makes the medical decisions.

Suddenly there comes a point when there is a choice to be made that will affect whether the patient continues to live or not. For example, a confused patient is no longer able to swallow. What is usually done is that a tube is placed in the stomach in which to feed the patient. Some POA's (and sometimes the patients themselves) refuse to have the tube placed. At that point there are some other options:

-They can continue to eat until they aspirate food/fluid into the lungs and get pneumonia ,which may or may not be treated depending on the POA's decision.

-They don't eat but have I.V. fluids administered to maintain hydration status until the effects of malnutrition (again, usually infection) cause death.

-No food or fluids are given and the patient thirsts to death (though acute renal failure is usually the real cause of death). Proper pain control is given when needed to keep the patient comfortable throughout.

Now none of these are euthanasia. In each case a decision is being made to extended care in some way, or not. No where is a drug given to end life. BTW I do not like option #3 and lobby against this to the POA. Thankfully that option is, by far, the most rare, and no patient making their own healthcare decisions has ever decided for that option either, which is telling.

Are most physicians practicing euthanasia? Not that I've witnessed. If a physician was found to be outright administering drugs to kill patients, whether the patient/POA was for it or not, they would be thrown in jail. The assertion by the authors is ludicrous.

Some may ask what is the difference between the above processes and simply killing the patient with a lethal dose of a drug. There are some stark differences:

-Not stopping the dying process when something could be done, and actually killing the patient by an active intervention is as different as flying a plane and falling out of one. We are all going to die. I believe a person should have the power to say "enough!" when it comes to interventions to prolong life. I don't believe a person has the right to say "I want to die now, you make it so!" That is a different creature altogether. If a person cannot see this then I don't no how to frame it so they will.

-This idea is considered quaint today, but the Healthcare industry is founded on the principle of life. If healthcare is again annexed into being also a vehicle for the extinction of life (like with abortion) it moves further from it's roots, it's reason for being. This will affect all parts of the industry. I see it now. Many little Gods running around deciding independently who has quality of life and should receive care, and who doesn't. Life is viewed on a continuum from least to most quality. Very dangerous stuff!

This post is getting too long, so I'll stop here.