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Cathy Rose, the nonsmoking woman I wrote about who was dying of lung cancer and spent her last weeks advocating for more spending on lung cancer research, died this morning. My condolences to her family.

Maggie Mahar at The Health Care Blog writes about physicians who no longer accept any kind of health insurance.

How does it work? From the physician's standpoint, it means less time and resources devoted to insurance paperwork, which in turn means more time with patients. The down side? It's likely that fewer people will get health care because they can't afford it. Still, for certain types of practices (primarily primary care) it might work. Take a look at her post and tell me what you think.

Also: Do you know of any physicians locally who aren't taking any insurance? Please let me know.

The Wall Street Journal's health blog reports that the Joint Commission, the group that accredits hospitals, is requiring hospitals to come up by Jan. 1 with policies dictating "unacceptable behavior" and how it will be dealt with.

This goes beyond lying/stealing/malpractice/sexual harassment to get into more day-to-day interpersonal relationships. Why? Various kinds of miscommunications are behind about 70% of "sentinel events" -- preventable serious injuries or deaths of patients, the blog says. And if, say, a doctor routinely yells at and otherwise verbally abuses nurses, the chance that a miscommunication will occur increases.

So the requirement sounds good until you realize that the Joint Commission doesn't define "unacceptable behavior" or lay out what the consequences might be for tolerating it.

It seems plausible that bad behavior of this type could lead to potentially serious miscommunications. But it's far from clear how big a problem this is, let alone what will happen to hospitals where it goes on.

One of the phrases currently in vogue in medicine is "never events," which refers to things, particularly mistakes, that are so preventable that they should never happen. Insurance companies are even threatening to refuse to reimburse hospitals for costs incurred when a "never event" occurs.

Here's a Boston Globe blog post about one such "never event" that took place this week at Beth Israel Deaconess Medical Center there. The nature of the procedure hasn't been disclosed, but in general what happened was that the wrong side of a patient was operated on. Fortunately, the patient is recovering and will suffer no lasting damage.

The Health Care Blog republishes a memo sent to hospital staff that is remarkable for its openness. It says two important things: 1) There are procedures in place to prevent this type of mistake from happening, and 2) in this case those procedures were not followed.

Medical professionals and patients alike can learn from this. The pros are reminded that these procedures exist for a reason and must be followed without exception. Patients are reminded that they need to ask questions of those who care for them to ensure that "right patient, right procedure, right side" is where the operation goes. (When I underwent shoulder surgery several years ago, the surgeon put a big X on the appropriate shoulder before surgery. I asked if that was to make sure the wrong shoulder didn't get operated on, and his response was something along the lines of, "You're darned right."

Some patients have taken it upon themselves to mark or label the wrong side with phrases like "Other side, please" or "Not this one." Some do it as a joke, but as this incident shows, it ain't funny. If the patient in question had been, say, having a cancerous kidney removed, he'd be in serious trouble.

I should stress that these events are very rare. But the potential consequences could be deadly. Procedures are in place for a reason. Docs, nurses and patients need to know about them and make sure they're followed.

The New England Journal of Medicine, whose concerns about striking down the District of Columbia's 1976 gun-control law I noted here and here, is now saying that in the wake of the Supreme Court's June ruling in District of Columbia v. Heller that barring certain exceptions, individuals do, indeed, have a Second Amendment right to bear arms.

That ruling, the journal says in an editorial, now embarks the nation on a de facto experiment in seeing what effect the lack of strict gun control has on the numbers/rates of gun deaths of all types. The journal is not optimistic:

If there is a widespread loosening of gun regulations, we will learn over the next few years — in a before-and-after experiment — whether the laws we had in place had a significant impact in mitigating death and injury from handguns. In our opinion, there is little reason to expect an optimistic result; research has shown and logic would dictate that fewer restrictions on handguns will result in a substantial increase in injury and death. ...

So, do you think there are, or will be, public-health ramifications from this ruling? Why or why not?

That's what this article at NewScientist.com is saying.

OK, strictly speaking, it's saying that global warming = more cases of dehydration, with dehydration being a known cause of kidney stones. But even as a lay person, I've got a problem with this claim, that being this: Even if overall global temps are going up, that doesn't mean they'll necessarily increase significantly enough to cause increased numbers of dehydration cases sufficient to cause the kind of increase in kidney-stone incidence that the writers are claiming (an additional 2.5 million cases per year).

But I could be wrong. What do you think?

It has become conventional wisdom that women should examine their breasts regularly to feel for lumps or other irregularities that could be, or become, cancerous. But is this really an effective approach?

Some researchers say no, and Al Tompkins at the Poynter Institute for Media Studies has compiled a lengthy list of links to articles and resources on the subject. (You might also want to read the comments on t Tompkins' post. There are two as I write this, both defending breast self-exams.)

Coincidentally and quasi-relatedly, my article on how the local nonprofit Friends for an Earlier Breast Cancer Test's grant kicked off some research into breast-cancer detection at the Mayo Clinic ran here today.

Is serious reform of our health-care system dead before it's even introduced in Congress next year? Yeah, probably, writes Brian Klepper at The Health Care Blog.

Why? Well, as the songwriter Randy Newman once pointed out, it's money that matters. Industry lobbyists have spent tens of millions of dollars in contributions to congresscritters. It's a lot of money to you and me, but negligible to the industry when hundreds of millions, or even billions, in revenue may be on the line for them.

That system's ramifications affect not just the health-care system but also people's health, as Klepper notes in his analysis of the U.S. obesity epidemic (31% of Americans are obese, compared with distant runners-up Mexico (24%) and Britain (23%). There are a lot of reasons for that, but money is the predominant one, Klepper writes. And here's the most depressing part:

... since weight is important to fitness, fitness is important to overall health, health is an important component of productivity, and productivity drives competitiveness, the US' future prospects are already lousy and headed south. In terms of our health AND our competitiveness, we're committing slow suicide.

Anyone looking for cheaper or better health care will find the post depressing. Klepper offers a couple of solutions but says they're both improbable.

Is he missing something? Is the situation as dire as he says? Are solutions as few in number and as unlikely to be achieved as he says?

The Kaiser Family Foundation has scheduled a seminar on the rise of health-care blogging for 1 p.m. Eastern today. The keynote address will be delivered by Michael Leavitt, Secretary of Health and Human Services, followed by a roundtable discussion that will include these folks:

• Vicky Rideout (moderator), Vice President, Kaiser Family Foundation and
  Director, Program for the Study of Media and Health


• Jacob Goldstein, Wall Street Journal


• Michael Cannon, Cato Institute


• Ezra Klein, American Prospect Magazine


• John McDonough, Office of Senator Edward Kennedy and formerly of Health Care for All in Massachusetts


• Tom Rosenstiel, Center for Excellence in Journalism

It's being webcast here if you want to listen in.

Right on the heels of Wednesday's U.S. House vote to let the Food and Drug Administration regulate tobacco comes an opinion piece in the New England Journal of Medicine examining several aspects of that issue. It both stresses the need for such regulation and warns that too-lenient legislation has been used effectively in the past by tobacco companies in such areas as shielding themselves from product-liability lawsuits. Take a look and see what you think.

WSJ.com's Health Blog says bills are going to be introduced in both houses of Congress, perhaps as soon as today, that would "impartial experts to visit doctors to talk about the safety, effectiveness and cost of prescription drugs and other treatments." The idea, which is backed by the Prescription Project, is to counteract the drug company sales reps' presentations with information from a disinterested professional.

I've got a number of questions about this.

First, the bill seems predicated on the notion that the reps may be exercising undue influence over physicians' decisions on whether or not to prescribe certain drugs. Perhaps that's true, but is there any evidence to that effect, let alone enough evidence to justify this practice? (If so, by all means provide a link.)

Second, in this era of record-setting budget deficits, where would the money come from?

And third, the pharmaceutical industry has a lot of influence in Washington. How likely is it that any measure perceived as in any way limiting the industry could make it through Congress, even if the Democrats enlarge their majorities in this year's elections?

Purely as an element of chance, couples who conceive a child should have as much of a chance of conceiving a boy as a girl. And vice versa, of course.

But do some families really produce more boys than girls, or vice versa? If so, why?

This question arose during a discussion on one of my listservs about the odds on certain birthdays. I won't get into that here except to link to an article linked by one of the listserv members that takes a look at that question. If it intrigues you, go read it.