Digital Pathology Blog

Cancer misdiagnosis leads to breast removed, doctor sued

Perhaps another case making the case for need for second opinions in pathology either internal or external prior to major surgical procedures or medical therapy. 

Have seen this story on a number of sites and with 2.0 technologies others are going to add their opinions such as here.

The stories are short on details as suit just filed but emphasizes importance of pathology and need for public to understand what pathologists do and for us in pathology to realize our patients expect no less than 100% from us if in fact there was an error made here.  Some may act without questioning the diagnosis or obtaining other opinions prior to initiating therapy.

Why it’s Best to Trust Your Doctor and Not the Internet (Guest post)

My best friend is a doctor and she hates the Internet, or to be more accurate, she hates the fact that people believe everything they read on it. She has patients who contradict her opinion and diagnosis and question her methods of treatment. Their argument is that they saw something different on the Internet. 

The problem with getting information off the net is that you’re not too sure about its accuracy. We live in the age of information – it’s available at our fingertips 24 hours a day, 7 days a week, 4 weeks a month, and 12 months a year. It’s all around us, it’s pervasive, it comes to us even when we don’t want it to. And if you’re thinking that there’s too much of it, you’re right. The problem with too much is that you tend to get buried under it; you don’t know what’s true and what isn’t; and you’re in a dilemma as to what to believe and what to ignore.

That’s because information today is no longer unbiased; the source has a strong opinion, and this preference comes across in the news that they deliver. And that’s one major problem with the Internet; the plethora of information out there is simply too much to figure out. Even if you do find a reliable source, there’s no way to check the authenticity of the source because the Web is anonymity’s best friend.

When it comes to a matter of your health, you can’t be too careful. The advice on a website may have worked for a friend, but that’s no guarantee that it will work for you. It’s dangerous to diagnose yourself using guidelines from the net and take medication that you think is best for this condition you perceive yourself to have. It could have adverse consequences on your health, and more importantly, it could make you ignore what is really wrong with you.

Your doctor on the other hand, has access to a host of diagnostic tools and has years of experience in diagnosing and treating diseases. And this makes it a wiser proposition to put your trust in your medical practitioner rather than on a generic webpage.

Yes, for those of you who may point this out, this is just my point of view – that you must take what you read on the Internet with a pinch of salt. It may be true or it may not, but finally, it’s your gut instinct that you must trust. And either way, whether you rely on your doctor or the World Wide Web, you need to be prepared to accept the consequences of your decision.

 

This article is written by Kat Sanders, who regularly blogs on the topic of surgical technologist schools at her blog iScrub. She welcomes your comments and questions at her email address: katsanders25@gmail.com

CMS rejects Medicare coverage for virtual colonoscopy

In the past I have blogged about virtual colonoscopy and concern over how in the future this may diminish the number of colon biopsies done to be reviewed.  Others have argued this might actually increase the number of colonoscopies performed and subsequent biopsies, citing a number of reasons, including more people getting at least virtual colonoscopy when age appropriate rather than putting off the more invasive procedure or not getting one at all.  Yesterday CMS rejected the latest proposal to pay for this sevice claiming it wasn't ready for "prime time", as the radiology community has felt. 

So, for the time being it looks like this is not an immediate threat to GI pathologists (if you believe as I do), although I can see the arguments for reimbursement and how this technology may cost costs and save lives. Gastroenterologists are safe from the CT scan as well for now.

As the digital pathology community advances the technology, garners FDA clearances for clinical use and promotes reimbursement for these services, I wonder how CMS will address the issue. 

CPT codes are in place for image assisted IHC interpretation, providing a driver to use the technology with appropriate validation perhaps but will scanned archives, image-linked or enhanced reports, image repositories for data mining or content based image retrieval or enterprise wide PACS image uploads be"compensated".  I think there will be some opportunities to have these services paid for to pathologists and laboratories but will require a tremendous amount of validation of the technologies and will not likely occur for many years to come, particularly if virtual colonoscopy is any indicator.

By Eric Barnes AuntMinnie.com staff writer May 12, 2009

The U.S. Centers for Medicare and Medicaid Services (CMS) today rejected a proposal to pay for virtual colonoscopy (also known as CT colonography or CTC) for routine colon cancer screening of Medicare patients in the U.S., saying that VC, while promising for detecting colorectal polyps and cancer, is "not yet ready for widespread screening use."

"The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under §1861(pp)(1) of the Social Security Act. CT colonography for colorectal cancer screening remains noncovered," the May 12 memo states.

The decision comes as a blow to advocates of CTC, who held out hope that the agency would reverse its proposed February 11 decision to deny reimbursement for screening CTC based on the body of evidence presented to it since the analysis of CTC as a screening tool began last year.

Advocates for virtual colonoscopy were quick to criticize the decision.

"The news is obviously disappointing, but not unexpected, given the inseparable politics and purse strings involved," said Dr. Perry Pickhardt, associate professor of radiology at the University of Wisconsin in Madison. "In the end, CTC will ultimately prevail as a highly effective screening test -- it's simply too good to hold down for much longer."

Dr. James Thrall, chair of the American College of Radiology Board of Chancellors, was even more emphatic.

“Make no mistake: If it stands, this CMS decision not to pay for CT colonography will cost lives. More than 140,000 Americans are diagnosed with colorectal cancer each year. Nearly 50,000 of them die due to late detection. How can CMS ignore the fact that people are dying because they do not want to have the tests that are currently covered?” Thrall said in a statement to the American College of Radiology.

“For CMS to turn its back to a technology that can attract more patients to be screened and save countless lives is deeply concerning," he continued. "CMS should reverse this determination immediately, or Congress should step in and vote to mandate coverage of CTC."

"The decision is understandable in these tough economic times," said Dr. Judy Yee, professor and vice chair of radiology and biomedical imaging at the University of California, San Francisco. "The decision is unacceptable when considering the large body of scientific evidence clearly documenting that CTC has been proven to be as effective as colonoscopy for the detection of clinically significant polyps in adults."

While CMS states that the evidence is insufficient to conclude that CTC improves health outcomes, "the same can be stated for other colorectal cancer screening tests that are currently covered by CMS," Yee told AuntMinnie.com in an e-mail. "We know that colorectal cancer is preventable. We know that a very large percentage of the American public remains unscreened for colorectal cancer. A positive decision from CMS could have helped to change this."

Dr. Abraham Dachman, professor and chair of radiology at the University of Chicago, told AuntMinnie.com that VC utilization is inseparable from efforts to cut healthcare costs.

"CTC experts strongly believe that current data support use of screening CTC in the Medicare aged population as do a large bipartisan group of members of Congress who signed a letter urging CMS to approve coverage of CTC for screening," Dachman wrote in an e-mail. "Even as the nation discusses ways to reign in the cost of healthcare, CTC screening makes sense. Use of CTC for colorectal cancer screening is consistent with President Obama's push for prevention and use of new technology to benefit patients. The public and the medical community at large should work to get this decision reversed."

Radiologists should work to publish data focused on individuals ages 65 and older, he said, and third-party payors should encourage CTC use as radiologists continue to attend courses to ensure that CTC providers continue to offer high-quality services.

"The public and the medical community at large should work to get this decision reversed," Dachman wrote. ... I am confident that CTC will eventually achieve full reimbursement status."

Urgency of screening

Colorectal cancer is the third most commonly diagnosed cancer and the second most common cause of cancer deaths in the U.S. The U.S. Centers for Disease Control and Prevention (CDC) estimates that as many as 60% of deaths caused by colorectal cancer could be prevented if all Americans older than 50 years of age underwent regular screening.

The issue is particularly critical for older patients. Of the approximately 75 million Americans older than 50 who are eligible for colorectal cancer screening, fewer than 50% present for screening due to myriad factors that include, for some, a fear of invasive examination with a colonoscope, which virtual colonoscopy avoids.

Yet patient surveys also suggest that it is the purgative bowel preparation, generally required for virtual colonoscopy and always needed for conventional optical colonoscopy, that patients most dislike about colorectal cancer screening.

Some adults eligible for screening refuse to be examined with optical colonoscopy or cannot undergo the procedure due to contraindications. Virtual colonoscopy advocates believe that Medicare access to VC would improve screening compliance and reduce the death toll from colorectal cancer. Because 90% of colon cancers are diagnosed in people older than 50, they note, colorectal cancer screening is critical for Medicare recipients, who are denied the noninvasive screening option as a result of today's decision.

Private insurance more promising

Although national Medicare coverage may be off the table for now, VC has fared better among private payors. Twenty-six states already mandate that patients with private healthcare coverage are ensured access to virtual colonoscopy. Many regions also cover virtual colonoscopy exams under Medicare local coverage decisions.

Based on early results of the multicenter ACRIN 6664 trial that found equivalent sensitivities for virtual and optical colonoscopy exams, the American Cancer Society (ACS) added CTC to its five-year colon screening guidelines in March 2008.

Other ACS-approved screening exams include optical colonoscopy (every 10 years), flexible sigmoidoscopy (every five years), double contrast barium enema (every five years), annual guaiac fecal occult blood testing (gFOBT), annual fecal immunochemical testing (FIT), and stool DNA testing.

Of these, only virtual colonoscopy remains ineligible for Medicare reimbursement following today's decision. In addition to many physicians and public health advocates, Medicare coverage for CTC is supported by the American College of Radiology, the American Gastroenterological Association, and the U.S. Multisociety Task Force on Colorectal Cancer.

Detractors argue that the evidence remains insufficient to recommend VC screening as a cost-effective alternative to colonoscopy.

In March, the U.S. House of Representatives passed Congressional Resolution 60, calling for increased support for colorectal cancer screening for Americans ages 50 and older. Forty-two representatives also signed a letter to CMS expressing their concerns with CMS' proposed denial of coverage for routine screening with CTC.

The lobbying group CTC Coalition, which includes the Colon Cancer Alliance, the American College of Radiology, and the Medical Imaging and Technology Alliance, argued that Medicare coverage for VC screening would break down barriers to screening for the populations most at risk of the disease.

Observers of all persuasions have complained that a protracted tug-of-war between radiology and gastroenterology interests is more about who will make a living from colorectal cancer screening than the adequacy of CTC. For now, at least, the gastroenterology interests appear to have the upper hand.

Related Reading

Pressure builds on CMS to pay for VC, April 2, 2009

CMS rejects case for virtual colonoscopy reimbursement, February 12, 2009

MedCAC panel members question VC's effectiveness, November 25, 2008

CMS announces VC evidence meeting, September 26, 2008

Animated flu virus

I do not know what to make of all the recent news and stories about the Swine/North American/Newly mutated flu virus and how virulent it actually is. 

Nonetheless, The 1x Objective has some nice videos and other links on the proposed pathogenesis for the mutated strain.

"Telemedicine" doctor gets 9 months in jail

A few months ago I mentioned a case involving a Colorado physician who prescribed medication over the Internet (see: Telemedicine and the Law) to a patient who later committed suicide.

That physican has now been sentenced to nine months in jail.  The story reports this case is "is one of the first criminal prosecutions of a practitioner of "telemedicine," the furnishing of medical advice by phone or the Internet, for failing to have a license in the patient's state." 

The physician's attorney remarked that "telemedicine is now dead" and goes on to say "no doctor in his or her right mind would now pursue telemedicine unless licensed in all 50 states." 

I couldn't disagree more.  The case seems to stem from the fact that the physician did not have a license in any state to write prescriptions, let alone to someone who clearly needed help and received the prescription after completing a questionnaire alone without an examination or direct contact.  The drugs were "ordered" by the patient through a website who relayed the order through a supplier to the physician convicted in this case. 

As I wrote in my previous note, "While we do not know all the facts of the above case, simply diagnosing and treating, or in our case, diagnosing and affecting potential treatment or management seems a stretch without knowing more than allegedly this physician did before prescribing treatment.  Whichever way this case goes, I presume we are going to see more like it but can help ourselves if we practice telemedicine much like we practice medicine."

I think this case speaks to the need for appropriate regulation, licensure and controls in place to ensure a patient-physician relationship so that practice of telemedicine is analagous to the practice of medicine. 

The Anxiety of the Biopsy from NY Times Health Blog

Came across this post from NY Times Health blog this week.  Couple of thoughts:

Biopsies required to fix for certain time should need for certain IHC (i.e. HER2) required.  Formal guidelines coming on ER/PR as well just as we know have ASCO/CAP guidelines for HER2 testing.  Despite the time requirement, processing can and often occurs in 1 day and can be signed out the following day.  I would gather most laboratories will complete majority of sign-outs in one day.  We do it routinely here otherwise get calls from clinicians by mid-day asking for results.  Of course some require additional levels, review, consultation and/or IHC but the exception, not the rule.  2.5 day turn around time seems excessive.  5 days for 73 of 126 women not to have a result seems protracted. I would have hoped the patients' clinician explained reason for delay but this did not seem to occur either. 

Nonetheless, in the laboratory industry the goals are to have high diagnostic accuracy, rapid turnaround time and cost control; said another way, you can have it right, fast or cheap, pick any two.  If given a choice, I gather all of us would choose the right answer in a timely fashion at a reasonable cost. Nonetheless, it sometimes takes a little longer to ensure the right answer & may involve more tests increasing costs.  Having been on both sides of this equation I would rather have the right answer even if it costs more and takes longer.  I wonder what happens to cortisol levels with misdiagnoses and inappropriate, unnecessary or unindicated therapy...

Post and abstract from paper published below.

Waiting days for the results of a breast biopsy appears to affect stress hormone levels just as much as finding out you have cancer does, a new study shows.

Harvard researchers tracked 126 women who were undergoing breast biopsy, monitoring their levels of the stress hormone cortisol while they waited.

One of the most surprising findings, researchers said, was how long many women had to wait before receiving their results. While the average wait time was 2.5 days, many women had to wait five days or longer. By the fifth day, 37 women learned their biopsy was benign, 16 learned they had cancer and 73 still did not have a result, according to the report, which appeared in the medical journal Radiology. Most of the women who did not have a diagnosis had not received any information or explanation for the delay.

Women who were still uncertain about their diagnosis had abnormal cortisol levels that were “essentially indistinguishable’’ from the cortisol profiles of the women who were told they had cancer. And women without a diagnosis had significantly worse cortisol profiles compared to women who had received benign test results.

“If you talk to any woman who has had a biopsy who has had to wait for results, she will tell you it’s a horrible roller coaster,’’ said Dr. Elvira V. Lang, associate professor of radiology at Harvard Medical School and Beth Israel Deaconess Medical Center. “Even when patients hear they have a cancer, they can start doing something. But if you hang in there for five days and you still don’t know what direction it goes, it’s just very stressful.’’

The concern, Dr. Lang said, is that cortisol levels can influence wound healing and immune response, raising a woman’s potential health risks if she ultimately needs to be treated for cancer. And the stress and anxiety of waiting also affects the quality of life of a woman, her family and her ability to function well at work, she said.

Dr. Lang said the research should spur hospitals to focus not only on speeding up test results, but on improving communication and possibly offering psychological services to women who are waiting for a diagnosis. The study was funded by the Department of Defense breast cancer research program. Dr. Lang has a financial interest in a consulting firm that trains medical personnel how to improve communication with patients.

“We have to work much faster to get results to women,’’ Dr. Lang said. “You want to keep stressors as profound as this as short as possible.’’

Large-Core Breast Biopsy: Abnormal Salivary Cortisol Profiles Associated with Uncertainty of Diagnosis

Elvira V. Lang, MD, FSIR, FSCEH, Kevin S. Berbaum, PhD, and Susan K. Lutgendorf, PhD

From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115 (E.V.L.); and Departments of Radiology (K.S.B.) and Psychology (S.K.L.), University of Iowa, Iowa City, Iowa. Received June 19, 2008; revision requested July 22; revision received July 31; accepted August 27; final version accepted September 16. Supported by the U.S. Army Research and Materiel Command DAMD 17-01-01. E-mail: elang@bidmc.harvard.edu.

Purpose: To determine whether uncertainty of the diagnosis after large-core breast biopsy (LCBB) adversely affects biochemical stress levels.

Materials and Methods: This study was institutional review board approved and HIPAA compliant, and all patients gave written informed consent. One hundred fifty women aged 18–86 years collected four salivary cortisol samples per day for 5 days after LCBB. t Tests were used to compare diurnal cortisol slopes among three groups: patients who did not have a final diagnosis (uncertain group), patients who knew they had cancer (known malignant group), and patients who knew they had benign disease (known benign group).

Results: Women learned their diagnosis on days 1–6 (mean, day 2.4) after LCBB. Analysis was truncated at day 5, when the data from a sufficient number of patients from each group were available for meaningful analysis: 16 patients from the known malignant group, 37 from the known benign group, and 73 from the uncertain group, which totaled 126 patients. The mean cortisol slope for the women with an uncertain diagnosis (–0.092 ln [µg/dL]/hr; 95% confidence interval [CI]: –0.113 ln [µg/dL]/hr, –0.072 ln [µg/dL]/hr) was significantly flatter (less desirable) than that for the women who learned that they had benign disease (–0.154 ln [µg/dL]/hr; 95% CI: –0.197 ln [µg/dL]/hr, –0.111 ln [µg/dL]/hr; P = .014) but not significantly different from that for the women who learned that they had malignant disease (–0.110 ln [µg/dL]/hr; 95% CI: –0.147 ln [µg/dL]/hr, –0.073 ln [µg/dL]/hr; P = .421).

Conclusion: Uncertainty about the final diagnosis after LCBB is associated with substantial biochemical distress, which may have adverse effects on immune defense and wound healing. Results indicate the need for more rapid communication of biopsy results.

© RSNA, 2009

CAP News

TOP STORIES CAP Electronic Cancer Checklists Now Available in XML Format The College of American Pathologists electronic Cancer Checklists are now even easier to use! The checklists, which assist pathologists in reporting over 60 common and uncommon forms of cancer, are now available in eXtensible Markup Language (XML) format. The new format was chosen for its universal acceptance, its ease of use, and its ability to facilitate the sharing of structure data across different information systems, particularly via the Internet. The new XML format will replace the Microsoft Access database and should result in identical implementations, content-wise. Later in the year, these checklists will be enhanced further. New versions of over 70 checklists will be released, which will include revised and new content from the American Joint Committee on Cancer Staging Manual, 7th edition (currently, the checklists reference the 6th edition). CAP STS offers educational programs and consulting services to licensees for seamless implementation and customization of the checklists. Dennis D. Reinke, MD, FCAP, receives congratulations from Yvonne Hearn, MD, FCAP, and Robert L. Breckenridge, MD, MBA, FCAP. College Names First Recipient of CAP Pathologist Spotlight Service Award Dennis D. Reinke, MD, FCAP, was recognized as the first recipient of the College's Pathologist Spotlight Service Award at the Council on Membership and Professional Development luncheon in Austin, Texas, on January, 17, 2009. He was nominated by colleague Yvonne Hearn, MD, FCAP. When presented with the award, Dr. Reinke said, "I never imagined being recognized for the work I do everyday." Read about Dr. Reinke's recognition. Learn more about the CAP Pathologist Spotlight Service Award at cap.org or send your nominations to publicaffairs@cap.org. Second Laboratory in the United States Becomes Accredited to CAP 15189SM Program Avera McKennan Medical Laboratory of Sioux Falls, South Dakota, recently became the second laboratory in the United States to earn CAP 15189SM Accreditation. This accreditation is based on the ISO 15189:2007 Standard as published by the International Organization for Standardization (ISO) for laboratory technical competence and continual quality management, which focuses on improved patient safety and risk reduction and outlines standards for quality and competence particular to medical laboratories. For additional information on the CAP 15189SM Accreditation Program, e-mail CAP15189@cap.org. Learn more.

YOUR COLLEGE NEWS 2009 CAP Meritorious Service Awards Program—Call for Nominations Members are invited to nominate recipients for the following CAP Meritorious Awards: CAP Distinguished Patient Care Award CAP Distinguished Service Award CAP Lifetime Achievement Award CAP Outstanding Communicator Award CAP Public Service Award Award criteria as well as instructions and a nomination form are available on the CAP Web site in either Microsoft Word or PDF formats. Nominations are due on or before March 9, 2009. Recipients will be invited to accept their awards in person during CAP '09 – THE Pathologists' Meeting™, which will take place October 11-14 at the Gaylord National Resort in Washington, DC. Learn more. Download the February NewsPath® Podcast and Latest Article February NewsPath® podcast on "Diagnosing Genital Herpes Simplex Virus Infections," which is based on the NewsPath® article by Zsolt Jobbagy, MD, PhD, FCAP, and presented by CAP Spokesperson Noel A. Brownlee, MD, PhD, FCAP. Read the February article on the "Use of Quantitative PCR in the Monitoring of Patients with Chronic Myelogenous Leukemia," written by Jason D. Merker, MD, PhD. NEW Additions to the CAP Transformation Web Site Don't miss the latest pathologist story of Yvonne Hearn, MD, FCAP, whose recent vacation to the South Pacific gave a child a much—needed diagnosis. Now available—Mara Aspinal's CAP '08 presentation on Personalized Medicine. Also, read about the latest trend in on-line auctions for radiologist services. CAP Spokesperson Patricia A. Thomas, MD, FCAP, Featured on FOX for Black History Month in February Patricia A. Thomas, MD, FCAP, was featured on the award-winning show, Americans in Focus, which ran on the FOX Sports Network during Black History Month in February. Emphasizing the importance of overcoming obstacles and how her hard work helped her become a Harvard graduate and a pathologist, Dr. Thomas' message is a great example of transformative behavior, highlighting the success one can achieve by setting one's mind to the goal. Watch the 90-second segment, which appeared on the FOX Sports Network television programming throughout February as well as on the national FOX Sports Network Web site. Dr. Thomas is identified as a pathologist, and she is in great company! Attend Futurescape III June 12–14 in Rosemont, Illinois. Just Added—Pre-Conference Workshop Personalized medicine focuses on using new tools that will enable pathologists to generate new information for improved patient care. The advent of biomarkers, their correct interpretation, and the integration of data from disparate information systems are essential to getting the right treatment to the right patient at the right time. The CAP Foundation invites you to attend Futurescape III, Transforming Pathology: Information as a Disruptive Technology. For more information, please contact Arlene Strong at 800-323-4040 ext. 7324 or visit futurescape.cap.org. Learn more. Renew Your 2009 Membership Dues Renewing your 2009 CAP membership online is quick and easy. You can pay by credit card or check. Plus, you will receive a detailed receipt suitable for reimbursement or processing by your institution. Learn more. Sign Up for CAP '09 and Take Advantage of the Early Bird Savings Sign up now for CAP '09 – THE Pathologists' Meeting™, October 11–14, at the Gaylord National Resort in Washington, DC, and receive the best price guaranteed! Pay $899 and save 20% off the $1,125 global fee. No deposit required. Visit cap2009.org today and save.

EDUCATION OPPORTUNITIES CAP ’09 Abstracts Program Consider submitting an abstract or case study. The CAP '09 Abstracts Program is a competitive program that is designed to promote a broad range of research in pathology. The program provides a unique opportunity to enhance research skills and contribute to the literature and advancement of pathology. Everyone is encouraged to submit abstracts, and CAP Junior Members are eligible for cash awards for their presentations. Submissions to the Abstracts Program will be accepted Monday, February 2, through Friday, March 27, 2009. Visit cap2009.org for more information.

PRACTICE MANAGEMENT CMS Announces Internet-Based Medicare Enrollment Available in All States and in the District of Columbia The Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will allow pathologist to initiate, change, view, and check the status of their Medicare enrollment via the Internet. This new system is designed to be faster, easier to use, and secure. Physicians need their National Provider Identification (NPI) National Plan and Provider Enumeration System (NPPES) User ID and password to use the PECOS system. More information is available on the CMS Web site. View the New and Updated Practice Management Resources The following is a list of new and updated practice management resources at cap.org/practicemanagement, and each resource is listed by practice management topic area. Coding and Reimbursement CMS NCDs - Laboratory National Coverage Determinations ICD9Data.com - A free Web site to lookup ICD-9-CM codes ICD-10 - World Health Organization's ICD-10 listing Compliance and Risk Management Compliance Issues for Pathologists – A November 2008 Practice Managers Forum audioconference. Finance/Governance/Business Operations Consolidation of Physician Practices – A paper covering issues to consider when consolidating practices.

RESIDENTS SECTION Attend Residents Forum Meeting in Boston on March 7 You can still register to attend the Residents Forum. It's easy to do by sending an e-mail to RF staff. Join your resident colleagues for the Welcome Reception on Friday evening and for the all-day Saturday session, which includes continental breakfast and lunch! For more information, visit CAP for Residents at www.cap.org. If you have any questions or comments, contact Jan Glas.

SPOKESPERSONS NETWORK IN THE MEDIA AND IN THE COMMUNITY Forensic Pathologist Stresses Importance of Recognizing Signs of Depression in Children Stephen J. Cina, MD, FCAP, spoke with reporter Bob Roberts of WBBM News Radio, a CBS news station in Chicago, Illinois, about what a forensic pathologist looks for to determine if a death is a suicide—this after a fifth grader was found dead in a Chicago-area school. Dr. Cina offered tips to help parents and teachers recognize signs of depression, even in grade school children, to prevent future tragedies. Listen to the interview on WBBM's Web site, which became available as a news story download on February 4, 2009. Learn more.

A Doctor Takes His Cut

Medicare frauds are nothing new and I can't say I am too surprised about this one featured on "American Greed" on CNBC. A Mohs surgeon in Sarasota, FL milked millions out of Medicare for thousands of "skin cancer" surgeries.  During the investigation experts claimed nearly 2000 slides prepared by this physician were "unreadable". 

Check out CNBC.com for an overview on the story and American Greed Episode #21 for the full version.

Patience Lost - Lines from a Hospital Trench

Dr. Lucien E. Nochomovitz, Vice-Chairman of the Department of Pathology from North Shore-Long Island Jewish Health Care System (Manhasset campus) has an interesting monolgoue about his experiences in academic surgical pathology at www.yourbiopsyandmore.com. 

He offers "a short trip through a somewhat arcane yet crucial piece of medical landscape onto which the tide of baby boomers is already stumbling.

He speaks his mind and discusses a number of interesting issues concerning academia, pathology & medicine. 

Medical and non-medical professionals will enjoy his insight.

Here are some excerpts from the introduction:

"I have tried to describe an obscure corner of the medical world, one that intrudes unexpectedly and rudely into the lives of millions of Americans.

I write from a position well below the radar of the average columnist, and beyond the discernment of even the average clinician.

The general application in Medicine of an efficiency model, however, feeds impatience with things that take long to accomplish, and discourages the idea that it may be wise and mature to wait."

Help our medical technology colleagues with your books

Galveston Medical Technology Students Need Your Used Books

Nearly 50% of the medical technology students at the University of Texas Medical Branch at Galveston (UTMB) lost most of their belongings in their rooms on Galveston Island when hurricane Ike struck. These students need your help to get their textbooks replaced.

Below are the numbers of students enrolled in each class offered this semester.

• Hematology and Coagulation I - 26 students
• Basic Methods and Introduction to Lab Operations - 30 students
• Biochemistry - 43 students
• Intermediate Pathogenic Microbiology - 46 students
• Clinical Chemistry II - 62 students
• Immuno/Immunoheme - 64 students
• Clinical Laboratory Methods – 60 PA students

If you are interested in donating books, please contact Vicki Freeman, PhD, MT(ASCP)SC at 281.338.9912or vfreeman@utmb.edu. The UTMB has created a hurricane relief fund. For more information, go to www.utmb.edu.

Please consider donating textbooks from their fall textbook list (even older editions would be great):

• Linne, J.J. & Ringsrud, K.M. (1999). Clinical Laboratory Sciences: The Basics, 5th ed. Mosby. ISBN: 0323007597.
• Mahon and Manuselis (2007). Textbook of Diagnostic Microbiology, 3rd ed. W.B. Saunders Company. ISBN: 1416025812.
• McKee and McKee (2008). Biochemistry: The Molecular Basis of Life, 4th ed. McGraw-Hill. ISBN: 13-9780195305753.
• Shirley B. McKenzie (2004). Clinical Laboratory Hematology Prentice Hall Clinical Lab Science Series. ISBN: 0-13-019996-6.
• Carr J.H., Rodak, B.F. (2009) Clinical Hematology Atlas Third Edition. Elsevier Saunders. St. Louis MO (2009)
• Arneson & Brickell (2007). Clinical Chemistry: A Laboratory Perspective, Latest ed. F. A. Davis Company. ISBN: 978-0-8036-1498-7.
• Stevens, Christine Clinical Immunology and Serology, 2nd Edition.
• Harmening, D.M. Modern Blood Banking and Transfusion Practices, 5th Edition
• Mary Louise Turgeon, EdD, MT(ASCP), CLS(NCA) (2007). Linne & Ringsrud's Clinical Laboratory Science, 5th Edition - The Basics and Routine Techniques, 5th ed. Mosby. ISBN: 978-0-323-03412-8. (Used by PA students)