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Latest news
Book of condolence opens for Nelson Mandela
Published: Tuesday 10th December 2013
A Book of Condolence is now open at The John Gray Centre in Haddington for anyone wishing to pay their respects to Nelson Mandela.
Gritmaster takes to the road
Published: Tuesday 10th December 2013
'Name that Gritter' competition winners meet their gritter
The Open delivers £70m to East Lothian and Edinburgh
Published: Thursday 5th December 2013
Independent research has confirmed that this year's Open Championship at Muirfield delivered a near £70 million benefit to East Lothian and Edinburgh.
Coastal / Tidal Flood Risk
Published: Wednesday 4th December 2013
There is a medium likelihood of significant impacts during Thursday afternoon and into Friday morning for south east coastal areas giving a medium flood risk.
John Gray Centre website workshop
Published: Monday 2nd December 2013
Find out about new features to help with your history research.
Air Quality Management Order
Published: Monday 2nd December 2013
An order declaring an air quality management area came into effect on 13 November 2013
New bus services providing commuter connections
Published: Thursday 28th November 2013
Improved connections for commuters in east of county
Council signs Green Network concordat
Published: Wednesday 27th November 2013
New agreement with Europe's largest greenspace initiative
Christmas comes to East Lothian museums
Published: Wednesday 27th November 2013
Events for all the family at local museums
Council Switchboard is now available 24/7
Published: Wednesday 27th November 2013
As part of our continuing improvements to the Council's telephone switchboard, the 'virtual operator' system is now available for use 24 hours a day, every day of the year.
The Travelling Museum of British Invention comes to East Lothian!
Published: Friday 22nd November 2013
100 British inventions and discoveries all packed into a single bus
Council and Scottish Fire and Rescue Service discuss Gullane college proposals
Published: Friday 22nd November 2013
Following decision to close fire training school
East Lothian Council backs NHS Lothian anti-bullying campaign
Published: Tuesday 19th November 2013
New online help for young people on how to deal with cyberbullying and sexting requests
East Lothian, have you pledged to listen?
Published: Tuesday 19th November 2013
Provost urges people of East Lothian to show that they care for children in care by taking the pledge
Drop-in for East Lothian Council tenants
Published: Monday 18th November 2013
Find out about the rent increase and how your rent money is spent at our event at the Brunton this Thursday
Top marks for civic architecture in East Lothian
Published: Monday 18th November 2013
George Johnstone and John Gray Centres receive commendations at UK SCALA Awards
Living Newspaper Winter 2013
Published: Friday 15th November 2013
The winter 2013 issue of the Council's Living newspaper is out now.
Have your say on polling place proposals
Published: Tuesday 12th November 2013
We are still consulting on plans for polling places and it's not too late to have your say. Talk to us by 29 November ...
Sleeping Beauty – a beauty of a panto
Published: Tuesday 12th November 2013
The cast of Sleeping Beauty, including 24 young performers from across East Lothian, are being put through their paces this fortnight as rehearsals are under way at The Brunton in Musselburgh.
Book Week Scotland
Published: Tuesday 12th November 2013
25th November to 1st of December at East Lothian Libraries.
The best little adoption service in East Lothian
Published: Monday 11th November 2013
East Lothian Council's adoption service does very well in Care Commission national rankings
Musselburgh man receives ASBO
Published: Friday 8th November 2013
Council takes court action after series of complaints
More Law and licensing news.
Walking Football
Published: Thursday 7th November 2013
You're never too old to play the beautiful game.
Tidy rewards for Ross High students
Published: Wednesday 6th November 2013
Joint initiative means clean sweep on Tranent High Street
tellmescotland Apps Launch
Published: Wednesday 6th November 2013
tellmescotland has launched two stand-alone Apps on the iPhone and Android platforms to help citizens search for public information notices in Scotland, at their convenience, whilst on the move.
Drop in to East Lothian Adoption Week 2013
Published: Saturday 2nd November 2013
If you want to find out more about any aspect of adoption, join one of our drop-ins this Monday
First anniversary of the Haddington Joint Campus
Published: Wednesday 30th October 2013
Pupils and parents plant 1000s of spring bulbs in celebration
Attention East Lothian business owners
Published: Wednesday 30th October 2013
21 April 2014 will mark the opening of the new John Muir Way.
More articles in the news archive.


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Hotel Campanile BARCELONA SUD - Cornella My husband and I have been customers at the hotel in Cornella for three years now. We have always enjoyed our stay and our experience at this particular hotel. In fact, last summer I booked four rooms for a week when we took family to visit in Barcelona. When we decided to visit family... More
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subset: commoncrawl


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August 21, 2011
Ryan Bartow TigerIllustrated.com
Rick Ray and Phillip Nolan go way back. Could that connection prove to be ultimately vital for the four-star power forward? ...More... To continue reading this article you must be a member. Sign Up Now for a FREE Trial
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This is a 2001 Pontiac Trans Am Convertible one, owner with 17095 miles. Car has an SLT exhaust, car is in excellent condition. Original... More
This fabulous 2001 Pontiac Trans Am WS-6 convertible features the hard to find 6 speed manual transmission which sets it apart from the crowd.... More
2001 Pontiac Trans Am Ram Air WS-6, Black on Black leather, Factory Hurst shifter, GoodYear F-1 steel tires, 26,670 miles, all original. Immaculate! Almost... More
2001 Pontiac Trans Am WS-6, Original owner,you will search long and hard to find a more factory complete Trans Am than this one.It has... More


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Third quarter shipments of graphics processors jumped an amazing 21.2% over Q2, which was already a great quarter clearly signaling the holidays will be robust for PCs and the industry in general. AMD showed the biggest jump in quarter-to-quarter growth at 30% followed by Intel at 21%. Intel shipped the most parts at 63 million, over twice as many as its nearest competitor NVIDIA. "A total of 119.45 million units were shipped in the third quarter, exceeding the record 111 million units that shipped in Q3, 2008," said Dr. Jon Peddie, president of Jon Peddie Research in Tiburon, California. "So the market has caught up with, and exceeded, last year's highs. The crash of fall 2008 is now behind us." Portables lead the way Notebook shipments led the market again topping out at almost 56 million units with discrete graphics processors jumping more than 36% over Q2 indicating what the OEMs think will be the hot sellers in Q4. Peddie notes that, "Integrated graphics in notebooks, which includes the popular netbooks, increased 27% over Q2 - a great gain but less than discrete. Netbooks will remain popular but they will not have the high market share they had during the recession when they were just introduced. Rather, consumers are expected to "buy up" in the next quarter. "The channel is full and the products in it will have to be sold off before the OEMs and their resellers take a chance of seeing the channel becoming overstuffed. That suggests that while Q4 is typically a good quarter for PCs, the quarter-to-quarter growth in Q4 may not be as robust as Q3. Graphics are a great leading indicator," Peddie said, "The graphics go in before the PC is built or shipped.
Via and S3 have grown almost five fold for one year? Would be great if we could also see some numbers next to those percent
5-fold of next-to-nothing still isn't much, sadly enough. :shadedshu That being said, I'm glad that companies like S3, Via, and Matrox are still in business, at least. That Intel market growth has got to be from Netbooks, right?
AMD and Nvidia received a nice boost as well. I expect more increase, especially for AMD, with their newest gpu releases.
Market Share and total profits are not the same thing. You can make more money while losing market share if EVERYONE'S selling more stuff.
I dont see profits being based upon if everyone is selling more stuff but rather how much you are selling and at what ASP everyone else selling more just means there is healthy competition
The value for money these days is absolutely insane, sub 200$ gets you a FRIKKEN' powerful card by anyone's standards.
The quarter-to-quarter growth is of net sales, so the numbers are correct. nVidia is bleeding quite a bit of market share, likely due to a drop in their mobile chipset sales. Most of the high-end Intel-based notebooks hitting retail are running either Intel integrated or ATi discrete, while more and more AMD-based designs are switching over to M7XX chips either due to manufacturing concerns with the old 6XXX nVidia chips or simply the lack of a quality platform from the green team.
Via shipped 1.8 million units. That's pretty nice considering they only sell IGP's for their own cpu's and S3's. Last time i checked (beginning this year), they were selling less than a million cpu's a quarter. So, or they are selling much more cpu's or S3 Chrome's are selling pretty good (all things considered). SIS' growth must be related to the fact that many vendors are bundeling the 672 with the Atom.
Well they also make firewire chips, network chips, IDE controllers, SATA controllers, cardreader controllers, ARM SOC's, Super I/O chips, TV encoders, .... and a lot more but just like sound chips, they have nothing to do with the PC Graphics Market nor this thread.


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The biggest move he can make to change his image is via an eye-catching pick for the number two slot on the presidential ticket.
A CNN/ORC poll from last week asked Republicans and Republican-leaning independents to pick their preference for Romney's running mate. At the top was a surprise choice: Former Secretary of State Condoleezza Rice. She attracted 26 percent support. Rick Santorum won second place with 21 percent support. New Jersey Gov. Chris Christie and Florida Sen. Marco Rubio were tied for third place with 14 percent each. At the meeting of state GOP chairmen in Arizona last week half of them told a National Journal reporter they wanted Romney to pick Rice.
Rice would be a political game changer for the 2012 race.
Yes, she would be the first African-American woman to be on a major party's presidential ticket, at a time when the GOP is losing ground with minority and female voters.
But she is more than that because — unlike some other prospects — her selection can never be dismissed as racial tokenism. She is an experienced political player who has scars from previous battles; former Vice President Dick Cheney and former Defense Secretary Donald Rumsfeld are still taking shots at her in their latest books.
And her expertise on foreign policy, as a former secretary of state, would compensate for Romney's lack of international experience. As a governor and a businessman, Romney dealt almost exclusively with domestic policy.
Read more: http://www.foxnews.com/opinion/2012/05/01/why-condoleezza-rice-could-change-everything-for-romney/#ixzz1tfHJG6tQ
Why Condoleezza Rice could change everything for Romney
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Posted by Albert Fuchs, M.D.
Hepatitis A is an illness which affects the liver and is caused by a virus. (You'll be shocked to learn it's called the hepatitis A virus.) It is usually transmitted through food and water contaminated by human feces, even in microscopic amounts. In the US outbreaks have frequently been linked to food workers who have hepatitis A and contaminate food with their hands. The disease typically causes fatigue, abdominal pain, jaundice (yellowing of the skin and eyes), and dark urine. Patients typically recover completely without lasting damage to the liver. Unlike other forms of viral hepatitis, hepatitis A does not cause chronic infection. After the patient has recovered, the virus is cleared from the body and the patient is no longer infectious. Recovery is followed by lifelong immunity.
An outbreak caused by a negligent restaurant worker is bad enough, but we live in an interconnected international food marketplace. Contamination of the food supply can happen anywhere from the farm to the consumer's hands; the farther upstream the contamination, the more people may be affected.
The most recent food-borne hepatitis A outbreak has been sickening people since March. This week the Centers for Disease Control and Prevention (CDC) updated their findings from their ongoing investigation. The outbreak has been linked to Townsend Farms Organic Anti-Oxidant Blend frozen berry and pomegranate mix. As of Wednesday 97 people have become ill in eight states including California. About half of those affected have been hospitalized. There have been no deaths. The berry and pomegranate mix is sold at both Costco and Harris Teeter, though all the affected people who recall eating the berry mix bought it at Costco.
The product has obviously been removed from store shelves. If you have any, discard it immediately. If you have eaten this product in the past two weeks and have never been vaccinated against hepatitis A, contact your doctor immediately. Vaccination may lower your chance of becoming ill.
I've written previously about food-borne illness, about the lack of evidence that anti-oxidants have health benefits, and about the lack of evidence that organic food is healthier than food grown with industrial fertilizer and pesticides. This is an unfortunate story in which these topics intersect. The recent media coverage of the outbreak included an interview with the wife of one of the people sickened with hepatitis A. She expressed surprise that organic food could become contaminated. But there has never been any suggestion that organic food is less likely to bear infectious diseases than food grown with pesticides. Even organic food producers have never made such a claim. If anything, the withholding of industrial fertilizers may increase the likelihood of food contamination if animal waste is used instead and if it is not cleaned off the food.
So please wash all uncooked fruits and vegetables before eating them, even frozen produce. Please wash your hands after using the bathroom. And please feel free to buy organic food because you think it tastes better, or because you'd like to spend more money on food, or because you know it will impress the intriguing hipster checking out your shopping cart. But don't do it for health benefits.
Learn more:
Multistate outbreak of Hepatitis A infections potentially associated with "Townsend Farms Organic Antioxidant Blend" frozen berry and pomegranate mix (CDC)
Advice to Consumers (CDC)
CDC: 87 Now Sickened in Hepatitis A Outbreak (WebMD)
Hepatitis A victim shocked organic berries almost led to liver transplant (CBS News)
Hepatitis A (review article by the Mayo Clinic)
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor's advice. Anything that I write is no exception. I'm a doctor, but I'm not your doctor.
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June 7, 2013 | 6:35 am
Posted by Albert Fuchs, M.D.
The bacterium Staphylococcus aureus can live on our skin and in our noses without causing disease. Such a condition is called bacterial colonization, to contrast it from infection in which the bacteria causes illness. When the skin is broken or when host immunity is weakened Staph. aureus can enter the blood stream or other body spaces and cause life-threatening infection. Because medical procedures frequently involve puncturing or cutting the skin, Staph. aureus accounts for more health care-associated infections than any other germ.
That would be bad enough, but one strain of Staph. aureus, called methicillin-resistant Staph. aureus (MRSA), has developed resistance to many of the antibiotics most commonly used against Staph. infections, making it particularly difficult to treat. Controlling the spread of MRSA in health-care settings has become a national priority. Many hospitals have implemented programs to remind staff to wash their hands before and after contact with patients and to identify and isolate patients colonized with MRSA. Hospital-acquired MRSA infections have actually declined in recent years, perhaps due to these efforts, but in 2011 they still affected 62,500 patients and killed more than 9,000.
ICU patients are especially vulnerable to life-threatening hospital-acquired infections, for two reasons. First, they are the sickest patients in the hospital and their immune system is frequently not working well. Second, they undergo many invasive procedures that cause potential portals of entry for infection. Some hospitals screen all patients (or all ICU patients) for MRSA by swabbing their nose. Those who test positive are then placed under contact isolation – they are moved to a private room and all staff must don gloves and a disposable gown prior to coming into contact with them. Nine states have mandated by law such MRSA screening and isolation procedures.
But is this the best way to protect hospitalized patients from MRSA infection?
Other hospitals have stepped up their MRSA efforts even further. They screen all patients for MRSA. Those who test positive are isolated and also undergo decolonization – an attempt to kill the MRSA on their skin and in their nose. This is usually done with an antibiotic gel that is placed in the nostrils and antibacterial wipes that are used to clean the patient's skin.
Last week the New England Journal of Medicine published a very clever experiment that tried to elucidate the best way to minimize ICU-acquired MRSA infections.
Rather than randomize patients, they randomized whole hospitals. 43 hospitals were randomized to three different MRSA strategies for their ICU patients. Hospitals in the first group employed the traditional screen-and-isolate strategy. All ICU patients were screened for MRSA and those who were found to be colonized were placed under contact isolation. The second group used a screen-and-decolonize strategy. All ICU Patients were screened for MRSA and those who tested positive were placed under contact isolation but also underwent decolonization with the antibiotic nasal gel and the antibacterial skin wipes. The third group had the simplest strategy – universal decolonization. Their ICU patients did not get tested for MRSA. Instead, all the patients were decolonized with the antibiotic nasal gel and the antibacterial skin wipes.
Hospitals in the third group had the fewest MRSA infections. They also had the fewest blood-borne infections from any germ. That makes sense given that the antibacterial wipes would be expected to kill many pathogens, not just MRSA. The authors calculated that 181 patients would need to undergo decolonization to prevent one MRSA infection, and 54 patients would need to undergo decolonization to prevent one bloodstream infection from any pathogen.
Besides being the most effective, universal decolonization had another important advantage; it eliminated the need for swabbing everyone's nose. This eliminated the expense of doing all those tests for MRSA and also eliminated the delay of waiting for the test result, since decolonization could proceed immediately.
Occasionally fortune smiles on us and the simplest solution turns out to be the most effective. The practicality of this approach makes it possible to implement it in virtually any hospital immediately.
There are some possible drawbacks. The most serious is that universal use of the antibiotic nasal gel and the antibacterial skin wipes could eventually lead to bacterial resistance to either of them. If they were to be used universally, some program to test for resistance should be also implemented. But a more immediate hurdle is that eliminating screening for MRSA would run afoul of state law in nine states.
An editorial in the same issue of NEJM states
[T]he folly of pursuing legislative mandates when evidence is lacking has been shown, and laws mandating MRSA screening should be repealed.
That is indeed a worthy goal. If this were generalized to the repeal of all "legislative mandates when evidence is lacking", the effects of this study would be revolutionary.
Learn more:
Winning the MRSA Battle in Hospitals (Well, NY Times health blog)
New Tack in Preventing Hospital Infections (Wall Street Journal)
Disinfect All ICU Patients To Reduce 'Superbug' Infections (Shots, NPR health blog)
Targeted versus Universal Decolonization to Prevent ICU Infection (NEJM article, by subscription)
Screening Inpatients for MRSA — Case Closed (NEJM editorial, by subscription)
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor's advice. Anything that I write is no exception. I'm a doctor, but I'm not your doctor.
May 24, 2013 | 3:34 pm
Posted by Albert Fuchs, M.D.
We know that people with high cholesterol have a higher risk for strokes and heart attacks than people with low cholesterol. So if a medicine lowers cholesterol it should also lower the frequency of strokes and heart attacks too. Right? Not necessarily. Estrogen lowers cholesterol and doesn't lower stroke or heart attack risk. We also know that people with high blood pressure have a higher risk for strokes and heart attacks. Does that mean that a food that elevates blood pressure increases stroke and heart attack risk? Again, not necessarily.
The confusion here is a misunderstanding of the difference between clinical outcomes and intermediate outcomes. A clinical outcome is something that a patient notices herself and that impacts her life directly – like a stroke, a heart attack, or a bone fracture. An intermediate outcome is something that is measured by the doctor and that doesn't cause symptoms directly – for example, elevated blood pressure, elevated cholesterol, or low bone density. Intermediate outcomes can be risk factors for clinical outcomes but shouldn't be confused with them.
What does this have to do with salt?
Lots of evidence shows that eating more salt raises blood pressure, so doctors have always made the assumption that eating more salt also increases the risk of strokes and heart attacks. But as we've seen with estrogen and many other examples, guessing the effects on clinical outcomes from intermediate outcomes is frequently incorrect. In 2005 the USDA and Department of Health and Human Services wanted to revise their dietary recommendations for salt intake. Given the very little scientific evidence they had, what they did was both simple and presumptuous. They knew that 1,500 mg of sodium intake daily was the minimum needed for adequate nutrition. They also knew that at daily intake levels above 2,300 mg of sodium (which is about a teaspoon of salt) blood pressure begins to increase. So the US recommendations since 2005 have been that everyone should eat no more than 2,300 mg of sodium daily, and that people at very high risk of stroke and heart attack should ingest no more than 1,500 mg.
How are we doing? Well, on average Americans ingest 3,400 mg of sodium daily, well above the recommendations. A host of policy initiatives has been spawned by the recommendations in an effort to educate consumers, clarify food labels, and coerce restaurants to lower sodium.
But did anyone test the effects on the clinical endpoints?
The institute of Medicine (IOM) was commissioned to review all the studies relating to the health effects of sodium intake. Their report (which is over 150 pages) was released last week. A major conclusion of the IOM paper is that the quality of the current evidence linking salt to health outcomes is very poor. There are virtually no randomized studies and the rest of the studies suffer from important methodological flaws (like imprecisely measuring salt intake or using self-reported food diaries to estimate salt intake). The surprising and worrisome finding was that some of the randomized trials actually found worse outcomes with very low salt intakes. This isn't as preposterous as it may sound. We have no solid understanding on salt's effect on the body beyond that on blood pressure, so there could be many mechanisms that could explain worse cardiovascular outcomes with a very low salt diet.
The IOM endorsed the current belief that there is very likely a quantity of daily salt intake above which the risk of cardiovascular disease increases. The current evidence is simply insufficient to figure out what that limit is.
I'm always impressed when science comes up with the answer "We have no idea" because that's very likely to be honest. Those who are more committed to enacting policy than to figuring out the truth are less likely to confess ignorance and to wait for better studies before making up their minds. The American Heart Association issued a press report criticizing the IOM paper and arguing essentially "But salt increases blood pressure!" which no one disputes.
So for now add me to the list of salt agnostics. I frequently ask patients to cut down on salt in the short term to avoid fluid retention, for example when traveling. But we should have the honesty to admit that in terms of long term outcomes we don't know how much salt is too much.
And if you're not going to eat that pickle, can I have it?
Learn more:
No Benefit Seen in Sharp Limits on Salt in Diet (New York Times)
Low-Salt Benefits Questioned (Wall Street Journal)
Is Eating Too Little Salt Risky? New Report Raises Questions (NPR)
Sodium Intake in Populations: Assessment of Evidence (Institute of Medicine)
Shaking the Salt Habit (American Heart Association)
New IOM report an incomplete review of sodium's impact, says American Heart Association (American Heart Association Media Alert)
Merck Knows More about Zetia than They're Telling Us (my post in 2007 explaining the difference between clinical outcomes and intermediate outcomes)
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor's advice. Anything that I write is no exception. I'm a doctor, but I'm not your doctor.
May 17, 2013 | 2:55 pm
Posted by Albert Fuchs, M.D.
This week actress Angelina Jolie revealed in a New York Times op-ed that she underwent preventive double mastectomy. As would be expected of a personal revelation of such a well-known celebrity, it drew intense media attention. Her disclosure was brave and selfless and may save the lives of women in a similar situation, but is likely to be misunderstood by her myriad fans.
Jolie's mother died at the age of 56 of cancer. (We are not told what kind of cancer.) This lead Jolie to pursue genetic testing which found that she had a harmful mutation in a gene called BRCA1. This mutation greatly increases her risk of breast and ovarian cancer. It was this finding that led her ultimately to choose preventive double mastectomy in an attempt to minimize her future breast cancer risk. Her description of her decision and ordeal is poignant. If you haven't, please read it.
In this story of empowerment and survival, where is the potential for misunderstanding? Women are likely to misunderstand two issues – who should seek genetic testing for cancer causing mutations, and who should be considering preventive double mastectomies.
Let's unpack the decision to get genetic testing first. Mutations in two genes called BRCA1 and BRCA2 are linked with very high risks of breast and ovarian cancer. But these mutations are quite rare in the general population, and these mutations are estimated to be responsible for only 5 to 10% of breast cancers and 10 to 15% of ovarian cancers. So genetic testing is not recommended for everyone. The National Cancer Institute lists the following groups of women as having a higher likelihood of a harmful BRCA1 or BRCA2 mutation.
Women without these family history patterns are very unlikely of having a harmful BRCA1 or BRCA2 mutation. If you believe you might be in one of these groups the best way to get tested is to first consult a geneticist. A geneticist will evaluate your family and personal history and help you select the relevant genetic tests to order.
The other issue that women may misinterpret is Jolie's decision to have a double mastectomy. This decision is entirely reasonable in a woman with a harmful BRCA1 or BRCA2 mutation, because of her very high lifetime risk of breast cancer. Unfortunately in recent years women have increasingly asked surgeons for mastectomies in situations in which mastectomies are not indicated. In an excellent and sobering article about how the drive to increase breast cancer awareness has unduly frightened hundreds of thousands of women, miscommunicated the benefits of mammograms, and failed to communicate the frequent harms of screening, Peggy Orenstein states that thousands of women consider double mastectomies after being diagnosed with low-grade breast cancer. In most women with localized breast cancer lumpectomies have been proven to be as effective as mastectomy in preventing recurrence, and the risk of breast cancer in the other breast is very low, so the decision to have a double mastectomy is driven purely by fear and a misunderstanding of the risk. It's also important to know that bilateral mastectomies do not decrease the risk of breast cancer to zero because some breast tissue always remains. So preventive mastectomies are only helpful for women at very high risk of breast cancer, and even for them, preventive surgery isn't the only option.
So I applaud Ms. Jolie for her courage in telling her story in the hopes that other high-risk women seek genetic counseling. And I hope that her fans understand that her decision and advice do not apply to the vast majority of women who are at average risk of breast cancer.
Learn more:
My Medical Choice (New York Times Op-Ed)
BRCA1 and BRCA2: Cancer Risk and Genetic Testing (National Cancer Institute)
Jolie's Disclosure of Preventive Mastectomy Highlights Dilemma (New York Times)
Actress's Move Shines Light on Preventive Mastectomy (Wall Street Journal)
Angelina Jolie, Breast Cancer Game-Changer (Wall Street Journal)
Our Feel-Good War on Breast Cancer (New York Times Magazine)
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor's advice. Anything that I write is no exception. I'm a doctor, but I'm not your doctor.
May 10, 2013 | 9:23 am
Posted by Albert Fuchs, M.D.
Every primary care doctor has had the experience of listening to a very depressed patient explain that things are hopeless, that chronic medical problems or financial setbacks or family conflicts have pushed the patient past his ability to cope, that he can't imagine how things could ever get better, that he would be better off dead.
Unfortunately, suicide in the United States is increasingly common. An article in the CDC's Morbidity and Mortality Weekly Report earlier this month reviewed the suicide statistics between 1999 and 2010. The number of suicides increased by almost a third over that decade, from 29,181 in 1999 to 38,364 in 2010. In 2009 the numbers of suicides surpassed the deaths due to motor vehicle crashes for the first time. Though previously suicide was a problem predominantly among teens and senior citizens, the increase over the last decade has been largely in middle-aged adults. This trend is worrisome to public health officials since current attempts at suicide prevention are not targeted to working age adults.
The cause of this increase in suicides isn't known. In an attached editorial CDC officials speculate about three possible causes. The recent economic downturn certainly may be contributing, as previous difficult economic times have correlated with increases in suicide rates. Another possible cause may relate to the generation of baby boomers themselves. Statisticians call this a cohort effect. Baby boomers had a higher rate of suicide in their teens than prior generations. Perhaps something unique about baby boomers and the times in which they came of age increases their risk of suicide. They certainly were disproportionately involved in the idealism (and radicalism) of the 1960s. It is certainly possible that many of them expected to build a very different world than the one they find themselves in. Finally, prescription pain medications are being prescribed and misused in unprecedented quantities. The authors speculate that the widespread addiction to opiates might be contributing to the increasing frequency of suicide.
Two years ago Freakonomics Radio, the series of podcasts inspired by the bestselling economics book, had a fascinating podcast about suicide. When you have an hour, I highly recommend listening. The podcast mentions that after media reports of suicide, especially in which the victim is famous or portrayed in a positive or sympathetic light, the frequency of suicides increases. Apparently even songs about suicide have been known to trigger "contagions" of suicide. So the media slowly learned to highlight in their stories the grief of loved ones, the disfigurement of the victim's body, the missed opportunities to get help, in an attempt to make suicide less inviting to those who are contemplating it.
So with that in mind, allow me to offer a few personal observations gleaned from caring for many depressed patients during 15 years of practice.
So while every primary care doctor has cared for a patient at the depths of depression, we've all also seen them months later after the medications and the talk therapy have started to work. They may still be suffering, but they're glad they're alive and are relieved that they didn't do anything irreversible before. Perhaps now that we know about this trend we can focus more attention on depressed baby boomers and convince them that hope is not lost.
Get help:
National Suicide Prevention Lifeline
Learn more:
Suicide Rates Rise Sharply in U.S. (New York Times)
Suicides Soar in Past Decade (Wall Street Journal)
Suicide Rate Climbs For Middle-Aged Americans (NPR Shots)
Economic downturn cited as suicide rate jumps for those between 35 and 64 (Daily News)
Suicide Among Adults Aged 35–64 Years — United States, 1999–2010 (Morbidity and Mortality Weekly Report)
The Suicide Paradox (Freakonomics Radio podcast)
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor's advice. Anything that I write is no exception. I'm a doctor, but I'm not your doctor.
April 26, 2013 | 4:53 pm
Posted by Albert Fuchs, M.D.
Do you remember the H1N1 swine flu that made tens of millions sick and killed thousands of people in 2009? Well, one if its cousins, a bird flu with the name H7N9, is causing some death and consternation in China.
This strain has long been circulating among birds, but since earlier this year people have become ill with this respiratory virus, all so far in China. This week's issue of the New England Journal of Medicine (NEJM) published a review of the public health findings thus far.
The review stated that up to now 82 people have been confirmed to have H7N9 in 6 different regions of China. Most of them were extremely ill, but that is largely because of the way in which they were identified – patients with severe respiratory illness were tested for the virus. Of these 82 patients, 17 have died (21%) and 60 remain critically ill. The incubation period ranged from 1 to 10 days, and those who died were ill for a median of 11 days.
Four of the patients were poultry workers and 77% had known exposure to live animals, mostly chickens. This suggests that the majority of the cases are due to transmission from birds to humans. There were no confirmed cases of human to human transmission but in two families human to human transmission could not be ruled out.
The concern is that eventually, through random mutations, H7N9 will get better at human to human transmission. Then, as in the swine flu epidemic of 2009, since the entire human population has never been exposed to H7N9, we will be a very large non-immune target. Like the first spark in a forest that hasn't burned in many decades, very rapid spread would be likely.
Yesterday the first case in Taiwan was reported, so the virus has spilled out of mainland China.
Is it time to panic? No. Not unless you frequent live poultry markets in China. H7N9 has not been detected in people or birds in the US. American health officials are keeping a close eye on the spread of the virus. They are trying to determine how many people have mild disease from H7N9 to better calculate how lethal it is. (People with mild illness may not be seeking medical attention. If hundreds of people have had undiagnosed mild illness then the virus is much less deadly than if the only people who got the virus are the 80-or-so we know about.) They are also waiting for the first confirmed transmission from person to person. That's when all the measures that we saw in 2009 will be revisited – a new vaccine, reminders for people to stay home when sick, and despite official reassurances everybody freaking out.
Learn more:
Preliminary Report: Epidemiology of the Avian Influenza A (H7N9) Outbreak in China (NEJM)
Avian Influenza A (H7N9) Virus (Centers for Disease Control and Prevention)
China's H7N9 bird flu death toll likely to rise (Los Angeles Times)
China Reports Three New H7N9 Bird Flu Cases; Jiangxi Has 1st Suspected Illness (Forbes)
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor's advice. Anything that I write is no exception. I'm a doctor, but I'm not your doctor.
April 19, 2013 | 6:48 am
Posted by Albert Fuchs, M.D.
My regular readers have been following the controversy about prostate cancer screening for some time. The controversy boils down to the following question. Should healthy men be routinely tested for prostate cancer? The most recent chapter in the controversy was written last year when the US Preventive Services Task Force (USPSTF) recommended against prostate cancer screening for men of any age. If this is news to you, or sounds absolutely preposterous, follow the previous link to read about the rationale of the USPSTF recommendation. The bottom line is that the benefits of screening have been shown to be very small or nonexistent, while the harms are proven and significant.
But where does that leave physicians? If you're a man between 50 and 70 and you've seen me for an annual exam in the last year, you know that the recommendations have led to very difficult discussions without very clear guidance. Many men are used to annual screening and are distressed at the idea that suddenly we would do nothing to detect a potential cancer. Younger healthier men are especially puzzled about what to do since they would be most likely to die from an undiagnosed prostate cancer, though they would be least likely to develop prostate cancer.
To clarify our current understanding, and provide direction that is somewhat more useful to primary care physicians, last week the American College of Physicians released guidance statements that crystallize their recommendations.
Guidance Statement 1: ACP recommends that clinicians inform men between the age of 50 and 69 years about the limited potential benefits and substantial harms of screening for prostate cancer. ACP recommends that clinicians base the decision to screen for prostate cancer using the prostate-specific antigen test on the risk for prostate cancer, a discussion of the benefits and harms of screening, the patient's general health and life expectancy, and patient preferences. ACP recommends that clinicians should not screen for prostate cancer using the prostate-specific antigen test in patients who do not express a clear preference for screening.
Guidance Statement 2: ACP recommends that clinicians should not screen for prostate cancer using the prostate-specific antigen test in average-risk men under the age of 50 years, men over the age of 69 years, or men with a life expectancy of less than 10 to 15 years.
I find this very helpful, and it will help guide my conversations with men who are 50 to 69. It incorporates our current understanding while acknowledging that patients have unique values, anxieties, and preferences that should inform their care. If you're a man between 50 and 69 give Guidance Statement 1 a close reading and tell your doctor what you think. If you love a man of that age, send him this post.
Learn more:
Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of the American College of Physicians (Annals of Internal Medicine)
Doctors group questions prostate cancer screening (Reuters)
Some of my previous posts about prostate cancer:
Many with Prostate Cancer Do Not Benefit From Surgery
Why I Won't Have a PSA Test When I Turn 50
Tangential Miscellany
The images and stories from Boston are terrifying and heartbreaking. I believe there is a fascinating story to be written about the medical aspects of the minutes, hours, and days after the explosions. I hope we eventually read that story. By all accounts the first responders, the emergency department staffs, and the surgical teams did extraordinary work very quickly. The newspaper stories suggest that many of the wounded have survived life-threatening injuries because of the fast and organized work of many dedicated professionals. I know that all of you join me in wishing physical and emotional recovery to the injured, calm and focus to the medical teams, and deep condolences to the bereaved.
This Sunday is Ciclavia, a citywide event in which 15 miles of streets are closed to traffic and open for strolling, biking, and exploring the city. It's a perfect opportunity to demonstrate that we will still gather in large groups, have fun, get some exercise, and wear Red Sox hats.
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor's advice. Anything that I write is no exception. I'm a doctor, but I'm not your doctor.
April 12, 2013 | 6:39 pm
Posted by Albert Fuchs, M.D.
Greetings from San Francisco, where I am attending the American College of Physicians 2013 Scientific Program, their annual conference covering the latest progress in internal medicine. Though the conference is obviously geared for physicians, I've compiled below a half dozen points from the various lectures that I think might be of interest to patients. Feel free to skim, and if you want to learn more about any point, follow the links.
Finally, I was pleasantly surprised to find that many of the studies that were highlighted by the professors were ones I wrote about over the year. Reviewing the literature has helped me understand the studies, and composing the posts in non-technical language has helped me remember the key points. There is no better way to learn than to teach. Thank you for reading.
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor's advice. Anything that I write is no exception. I'm a doctor, but I'm not your doctor.
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You're watching...
Obama polls better than Romney in popularity
Gov. John Sununu on the President's popularity being better than Obama's
Jul 26, 2012
You're watching...
Gov. John Sununu on the President's popularity being better than Obama's
Jul 26, 2012
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And -- the impact segment tonight present Obama's job approval rating hovers around the mid forties in many polls but most folks still -- -- personally.
A new USA today Gallup poll says in the like ability category mr.
Obama scoring 60%.
While Mitt Romney just 30% to be fair.
-- is much better known then governor Romney.
The joining us now from Manchester, New Hampshire the former governor that stating current Romney supported John Sununu so does it surprise you that 60% of Americans like Barack Obama.
He he started out with a high rating -- and he's maintained it but he's had a really rough couple weeks here and I think you're gonna see that begin to change.
He is you build you didn't build that moment I think is really.
Resonating around the country.
And I know he's trying to walk away from it saying it's out of context but when he look at the context.
But context is -- and even worse than the context is the tone and the and the really arrogant and insulting way he's he's addressing people who have had success.
But the way I see this is is George W.
Bush had almost the same thing that that people -- Bush the younger even when his policies on Iraq in the economy we're going -- they still separated his job performance from the man.
And it seems like -- -- in the same thing with Barack Obama you know he comes across.
As very -- bowl in.
Kind of and he's certainly not an intimidating man.
He he keeps his composure almost always so while you're saying -- out that his policy and his view of what American.
Capitalism should be and I agree with I think -- -- an enormous mistake.
Saying that.
You know entrepreneur who were -- weren't responsible for their own success.
I think that the folks are separating the policy from the dock you do so they.
Always do they always do that to the president as you said George Bush had high ratings until the last maybe five or six weeks and I think that's happening -- the president.
And as he tries to walk away from what he just said I think he's gonna hurt himself even more.
At -- and you know he's -- he didn't mean what he said but the fact is that's consistent with what you would get.
Out of a community organizer handbook it's it's his communal way of thinking about these things.
And it's reflected in in just about everything he's done for the last few years that I really -- that's going to hurt his pop.
Clarity may be his personal popularity I'm not sure whether it will but it mind what about Mitt Romney at 30% like ability I know the governor for a long time.
He's a nice guy I I never saw him.
Even when he was getting pounded in in the primaries I -- a got a little nasty.
He was always fairly composed the when he ran Massachusetts.
And he's -- -- let's -- surprised by that well you don't look -- you didn't mean where where what they call hot personality I don't know we get.
How to get riled up when we call it the way it is -- the way we see it.
But -- more of a political calm placid guy and only 30% like ability that surprised me.
Look he's a very disciplined guy and and and and -- Settings that that dozen -- that come across as warm but you get governor Romney.
In with a bunch of about thirty people and -- today he really is extremely likable warm guy funny guy.
Smart guy guy who knows how to take tough decisions guy with a backbone.
They can make the tough decisions this country needs and and frankly.
What do they what does he you have to do what is he does you have to sing and Al Green song to to get people didn't like them better what does it what does he have to do you're an advisor of his.
I don't wanna go into election would have 30% like ability wanna get that opted.
This company can do -- Wohlers gave play miniature golf Missouri and he's saying.
Just let the people Salem you know all -- -- another speedboat that cost 300000 I don't think that's the right way to go all he's -- gets a kayak.
Bill look.
It half the country hasn't seen Mitt Romney even in a political situation they ignored the you know half the country nor the primaries.
This election really starts a couple weeks before the that the national convection and conventions and in those two and a half months Mitt Romney knows he's gonna have to communicate his personality and his policies.
2008 was an election of style over substance.
I think word in big enough trouble with over 8% unemployment and the 24 million folks that -- suffering.
Either unemployed or or underemployed.
And and does a -- I'm gonna read this substance I have this.
-- I'm excited since election I agree but I must say that I've known governor Romney and I psalm one time at Fenway Park in Boston.
And he was he was a really.
Guy and and that's it wasn't an act and I and I don't know this I am surprised that that the most people haven't caught on yet that he says is that guy I am very happy to call my friend I I think you're looking good guys because pres Obama.
Didn't -- was very very polite to me and my daughter.
I think they're both good guys tonight and I have to say that that's -- public officials most public officials as as people.
On a person to person basis of very very warm and I don't know about that govern how we may be going only -- not announced guy is.
Nobody and nobody.
95% of them fallen that at all I had no idea our governor thanks very -- you -- me yes.
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If you love to camp, bring all the fun of a camping trip to a backyard party. Pop up a tent, grab a sleeping bag, and build a campfire!
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