Rats, Man . . .

Comments on the article by Richter entitled "Rats, Man, and the Welfare State" (see record 1960-02810-001). The commenter notes that in his article Richter did not indicate how hereditary and environmental factors were controlled. In comparing the hereditary survival characteristics of wild versus domesticated rats, it would be essential that the environmental influences on the survival characteristics of the wild rats should be ruled out. Another factor to be considered is that the wild state may offer a diet and other environmental influences, which in the life of a single individual would produce organic changes, accounting for some of the differences between wild and domestic rats. It would seem that the most effective way to determine the hereditary differences between wild and domestic rats would be to create a wild group, composed solely of the offspring of wild rats. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Summary of penile cancer: relation of extent of nodal metastasis to survival (by Sri V. Srinivas, MD, M.J. Morse, MD, H.W. Herr, MD, P.C. Sogani, MD, and W.F. Whitmore, Jr, MD). 1987

BACKGROUND: Two major flaws have been previously identified in the resource-based relative value scale (RBRVS): (1) inaccurate estimation of physician work effort; and (2) RBRVS compression, which results in undervaluation of major surgical procedures. The impact of RBRVS for physicians treating patients with ruptured abdominal aortic aneurysms (RAAAs) has not been previously reported and is important owing to the severity of the illness, the potential to quantitate actual work effort, and the high percentage of these patients covered by Medicare. PATIENTS AND METHODS: All patients were studied who underwent surgery for RAAAs during a 5-year period encompassing the implementation of RBRVS. Analysis included all physician services including vascular surgeons, anesthesiologists, and all other medical specialists. Total work effort was quantitated for each specialty in minutes/patient. The financial data were obtained by reviewing all professional bills and reimbursements. Cost of service was calculated to include physician compensation, practice overhead costs, and malpractice expenses. RESULTS: In all, 84 patients underwent repair of a RAAA with a mortality rate of 42%. Medicare was the primary insurance for 87% of patients. The cost of service exceeded the reimbursement by 50% for vascular surgeons, resulting in an average loss of $1,593/patient. Actual operative time represented only 24% of total surgical work effort. Early death and a length of stay (LOS) < or = 1 day for 24 patients resulted in a reimbursement rate of $5.98/minute for surgeons. This gain was significantly offset by 30 patients with a LOS > or = 14 days, resulting in a reimbursement rate of $1.94/minute for vascular surgeons. Over the 5-year period there was a trend of decreasing reimbursement for vascular surgeons (P <0.005) but not other physicians. Vascular surgeons incurred a 28% decrease in reimbursement over the study period. CONCLUSIONS: Physician reimbursement under RBRVS for the treatment of patients with RAAAs is inadequate to cover the costs of providing this care. Reimbursement trends and potential changes to the practice component of the RBRVS will further aggravate the losses involved in caring for these very ill patients. Vascular surgeons must continue to provide input to the Health Care Financing Administration to help correct inequities built into RBRVS.     

The J.I.M. interview. James M. Wilson, MD, PhD

Simplicity of concept lies behind the widespread appeal of human gene therapy. A missing or defective gene is safely replaced by a gene that functions normally. Alternatively genes might be used in the laboratory to manufacture essential proteins and enzymes to create gene-based drugs. The idea of using genes to cure genetic diseases is equally appealing to researchers and the public at large precisely because it holds the promise of a real cure. However, as with so many things in clinical research, turning a simple idea into useful medicine has proved to be remarkably difficult. Nonetheless, the opportunity that gene therapy represents remains very real and, within the past decade, hundreds of scientists have become putative gene therapists. Research in gene therapy is booming in academia and industry, with mixed results. James M. Wilson directs the Institute for Human Gene Therapy at the University of Pennsylvania School of Medicine and is president of the 1500 member American Society of Gene Therapy. In an interview with Investigative Medicine, Wilson discusses the state of the art.     

Thyroid cancers. II. Medullary, anaplastic, lymphoma, sarcoma, squamous cell

Medullary thyroid carcinoma in both sporadic and familial forms is a curable disease if detected early and treated by the proper surgery. The advent of genetic screening for the RET protooncogene portends great promise in the earlier diagnosis and treatment of familial forms of MTC. New chemotherapy protocols have produced some tumor regression in patients with metastatic MTC. Improved use of Adriamycin and hyper-fractionated radiotherapy combined with debulking procedures has prolonged survival in anaplastic thyroid cancer. Thyroid gland lymphoma, if diagnosed early and treated by combined chemoradiotherapy, carries a good prognosis for survival. The best treatment for thyroid sarcomas and SCC of the thyroid is early diagnosis and aggressive surgery combined with radiotherapy.