A chair is a mystical thing

… everything in life, directly or indirectly, has a great degree of mystery. To paraphrase Warren Zevon, “Some days I feel like my shadow’s casting me.” Persons, places, things … time itself is a mystery. You know, like, who can explain it? It’s really difficult to define anything. What’s slow can speed up. Love can turn into hate. Peace can turn into war. Pride can turn into humility. Anger to grief.

How would you define a simple thing like a chair, for instance—something you sit on? Well, it’s more than that. You can sit on a curb, or a fence. But they are not chairs. So what makes a chair a chair? Maybe it’s got arms? A cross has arms, so has a person. Maybe the chair doesn’t have arms? Okay, so it’s a post or a flagpole. But those aren’t chairs. A chair has four legs. So does a table. So does a dog. But they’re not chairs either. So a chair is a mystical thing. It’s got a divine presence.

There’s a gloomy veil of chaos that surrounds it. And “chaos” in Greek means “air.” So we live in chaos and we breathe it. Is it any wonder why some people snap and go crazy? Mystery is ancient. It’s the essence of everything. It violates all conventions of beauty and understanding. It was there before the beginning, and it will be there beyond the end. We were created in it.

The Mississippi Sheiks recorded a song called “Stop and Listen.” To most music aficionados, it’s but a ragtime blues. But to me, it’s words of wisdom. Saint Paul said we see through the glass darkly. There’s plenty of mystery in nature and contemporary life. For some people, it’s too harsh to deal with. But I don’t see it that way.

Bob Dylan, on painting

HHS removes public access to National Practitioner Data Bank

The National Practitioner Data Bank has shut down public access to anonymized information about physicians after a reporter was able to identify an individual doctor’s record for a news article.

The move to protect physician confidentiality has drawn objections from consumer advocacy groups and journalists who say it marks a shift from the Obama administration’s promises of transparency.

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AMA group sets new framework for patient outcome measures

The American Medical Association-convened Physician Consortium for Performance Improvement in August adopted principles on developing outcome-based measures of doctors’ quality.

The recommendations will guide the consortium’s measure-development work groups as they generate metrics on patient outcomes such as mortality, morbidity, symptoms, functional health status and satisfaction with care.

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Face transplants starting to gain acceptance

Facial transplantation once spawned science fiction-fed visions of cosmetic surgery run amok but is becoming more common as many fears about the operation prove unfounded.

There have been at least 17 facial transplants worldwide since the first was performed in 2005 for Frenchwoman Isabelle Dinoire, experts say. Three transplants have been done this year at Brigham and Women’s Hospital in Boston, the most recent one in May for Charla Nash, a Connecticut woman mauled by a chimpanzee in 2009. The hospital’s efforts are being supported by a $3.4 million Defense Dept. grant, with hopes that wounded veterans will benefit.

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Temporary health workers double risk of harmful drug mix-ups

Health professionals working on a temporary basis in emergency departments are twice as likely to make medication errors that harm patients, says a study of nearly 24,000 drug mix-ups at 592 U.S. hospitals.

Most of the temp workers’ mistakes were administration mix-ups made by nursing staff, who accounted for 76% of the errors. Physicians were responsible for 21% of the mix-ups, and other health professionals accounted for the rest.

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As CME funding shifts from industry, others foot the bill

Drug- and device-makers’ financial support for continuing medical education fell for the third straight year in 2010, reaching its lowest level since 2002.

With industry support falling to $830 million — 31% lower than the high-water mark of $1.2 billion in 2007 — CME providers are relying more heavily on the fees they charge physicians. Those fees are $20 to $50 per credit hour. Annual CME requirements range from 15 to 50 credit hours, depending on the state.

Payments from doctors, hospitals, medical schools and other sources rose 9% from 2009 to 2010 and now account for more than half of accredited CME providers’ revenue. Commercial support made up 37% of the $2.2 billion in 2010 CME funding, down from 47% in 2007, according to data released in August by the Accreditation Council for Continuing Medical Education.

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Elected coroners report fewer suicides than appointed counterparts

More than 1,500 counties in America elect their coroners, and that voting may play a role in their decisions on whether to classify deaths as suicides.

Elected coroners report 12% fewer suicides among females and 6% fewer among males than appointed medical examiners, even after controlling for other factors that affect suicide rates, according to a study presented in August at the American Sociological Assn.’s annual meeting.

Because people who commit suicide usually do not leave notes or other explanations for their actions, it is often left to coroners to determine based on the evidence available whether a death is due to suicide, accident or some other cause. A lot rides on the decision, as many families and survivors fear the stigma associated with suicide or may lose out on insurance benefits if the death is ruled a suicide.

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NQF endorses pediatric quality measures

The National Quality Forum in August endorsed 41 new measures of pediatric quality covering areas such as asthma, prevention and screening, and patient safety in the hospital.

None of the new standards measures patient outcomes. Instead, they measure how well physicians, hospitals and the health system are doing on processes such as the percentage of children who receive blood pressure screening by age 13.

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HHS bolsters scrutiny of researchers’ drug industry ties

Physician researchers receiving federal grants will have stricter conflict-of-interest rules to follow starting in August 2012.

The first change to Dept. of Health and Human Services regulations in this area since 1995 comes in response to widely reported cases of federally funded researchers failing to disclose millions in pay from medical industry firms. Researchers soon must publicly disclose any industry payments, stock holdings and equity interests of more than $5,000 during the previous year. Their academic institutions will have to file plans with the funding agency explaining how they are managing conflicts of interest posed by such financial relationships.

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