Currently browsing: Physician/Surgeon

SHEMA97 face mask assessment

2/1/21: Looking into the effectiveness of this popular face mask seen on TV with sports figures. Wrong Approach: This is the text accompanying this good looking mask. Maybe good for dust, but not liquid droplets. “’s SHEMA97 Functional Active Mask uses nano fabric technology to protect the respiratory system from harmful substances and infectious sources. The micro dust proof fabric helps prevent the inhalation of airborne dust and potential virus-laden particles with a 97.1% fine dust filter rate. Its special purpose fabric filters particles down to one micron for superior protection. Error: The virus is not dust. It is not a dry substance. It does not travel alone. It travels in water droplet which easily goes through this mask. Proof it for yourself. Put the mask on and place a mirror in front of the mask. Cough. You will see the moisture on the surface of the mirror. Then put some tap water on the outside of the mask and inhale with your mouth open. You will sense the water come into your mouth. Good for dust. Not likely good for virus.

Mask Controversy?

1/31/2021: If face masks were perfect, the compliance is so low they would not be effective. The evidence is obvious when watching college basketball; especially the coaches on and off with the masks. So mask wearing remains controversial. See: I tested the latest and greatest popularized by college coaches: SHEMA97. It is a see through and breath through mask. Cough and moisture goes out. Breath deep and water on outside comes in. Bottom line: if you can bring air through, you can bring droplets with virus through the mask. The solution for any mask is at

NEJM; Flush it!

The once prestigious New England Journal of Medicine recent publication on July 23, 2020 is misleading to say the least. “Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19 from study in Brazil resulted in news reports that this medication was not effective in mild to moderate cases of Covid-19. The news reporter likely read the title and not the manuscript. A reader of the news article would justifiably presume these were early cases of mild to moderated magnitude. However, the news report read by more people than the manuscript was misleading to say the least. There was no mention about the patient cohort studied in this news publication. The inclusion criteria for the patient population in the NEJM study was a magnitude of infection such that it required hospitalization. Furthermore, some of the hospitalized patient’s conditions were such they required supplemental oxygen. Then the NEJM accepted the hospitalized patient as designated; mild to moderate classification. I read the news report as mild to moderate condition of the patients studied being early cases. If I read only the NEJM title I would have come to a similar conclusion. The patients studied had mild to moderate condition, presumptively of early onset and not a group reported upon that were so sick they were hospitalized and some on oxygen. In addition, follow up reports on clinical studies by reputable journals require at least a one to two years. The term of this study was just 15 days before gaining headlines. It is unlikely to find a competing world record short term report published by NEJM citing information to the contrary. I am not privileged to the NEJM’s publication policies, bias or political agenda. I do not know if the news reporter read beyond the journal headline. I do not know their policies or agenda. Whatever the reality, this is an all-time low in medical and news journalism. Flush it! 7/26/2020

Coronavirus in perspective.

7/9/2020: To date there have been 544,739 deaths due to the coronavirus. To put this in perspective see the following from: Influenza A is one of the deadliest infectious diseases in human history, and it can be ranked equally with the bubonic plague in the ability to create large-scale fear and terror despite the great effort of humans to control it.1-3 From the first outbreak in 1918, called the “Spanish flu” and caused by the H1N1 strain, influenza A has killed 4 to 5 times more people than the number of casualties in World War I. The following site estimated 50 million died, one-third of the world’s population at that time. In 1957, the Asian flu, caused by influenza A H2N2, began in China and spread around the world, killing 1.1 million people in total.3 Ten years later, a new strain of H3N2 lead to the eruption of a new pandemic called the “Hong Kong flu” that caused the death of 1 million people.3 In 2009, the strain that caused a deadly pandemic in World War I returned with a new type called H1N1pdm09; the result was approximately 575,000 deaths.3 Along with the deadly strains that infect humans, other strains, like H5N1, cause problems that can indirectly and catastrophically effect humans.4 The H5N1 outbreak appeared in Vietnam in 2003 when a massive avian infection led to the forcible killing of poultries, crippling the agriculture industry.4 Le KP, Do PC, Amaro RE, Le L. Molecular Docking of Broad-Spectrum Antibodies on Hemagglutinins of Influenza A Virus. Evol Bioinform Online. 2019;15:1176934319876938. Published 2019 Sep 16. doi:10.1177/1176934319876938.

Jerry Sloan; one of my first famous athlete patients

5/22/2020: I saw in the press that Jerry Sloan, famous basketball player passed away. He was one of my first famous athlete patients to undergo arthroscopy in the mid 70’s. I remember it well as I was lecturing at a meeting in Chicago suburb and his agent arranged for me to come down town and perform a diagnostic arthroscopy under local anesthesia. I did not tell anyone where I went and as my custom I created no publicity. I forgot about it until today.

Incomplete data analysis on Coronavirus Incidence

5/20/2020: The incidence of coronavirus cases are increasing because the frequency of testing is increasing. That should not be surprising nor unexpected. The magnitude of the condition is not reported; asymptomatic or symptomatic patient, just positive or negative test. The incidence of coronavirus cases with hospital admissions are high perhaps for this contributing reason. Reimbursement has always been the name of the game in medical economics. Now there is bonus money for coding as COVID-19 for billing purposes. Medicare will pay hospitals a 20% “add-on” to the regular DRG payment for a billing coding of a patient with the new government COVID-19 billing codes. Medicare has determined that a hospital gets paid $13,000 more if a COVID-19 patient on Medicare is admitted and $39,000 more if the patient goes on a ventilator with the coronavirus diagnosis. This is in addition to the base reimbursement. What you incentivize you will get more of. Ever wonder why the high incidence of COVID-19 patients? The real numbers may never be known.

Malaria drug evaluation: some facts

5/8/2020: There are many factors to be considered in evaluation of a drug. The first issue is safety. Hydroxychloroquine has met that standard for 50 years in treatment of malaria, lupus and rheumatoid arthritis. The main potential side effect is adverse effect on the heart and that is infrequent. A prescription for any treatment selects the intended patient based upon certain criteria. Is the patient without the disease? In this case the treatment is called preventative or prophylactic. The treatment should be disease specific and in this case the physicians considering the use of hydroxychlorquine for the coronavirus symptoms is called “off label (not FDA approved for this use). It is not being proposed as virilcidal for SARS CoV 2. There is no such certified drug at present. It is being prescribed to affect the symptoms of a specific patient. The next consideration for a use of a drug is for those presently affected by the disease is the disease stage at time of onset. Did it just start or is the disease progressive? The magnitude of the disease in the patient is the next factor. So why all the controversy concerning reports of hydroxychloroquine? So far the answer appears simple and logical. There is a difference in severity of the condition and the amount of the drug given. The success reports have a patient population that are at the early stage of the disease and treated with low dose. The failure reports are the use of those advanced to hospitalization and/or very high doses known to be toxic. The complication in the negative reports are related to the amount of the dose. Those taking 200 mg twice day are not as sick and have fewer complications than those taking greater amounts. There also is the caveat that those getting the higher dose are those most severely effected and with other conditions. For emphasis, the patients not likely to get a benefit are those in the hospitalized group. They are those (recent New England Journal Medicine) who are the sickest and those with most comorbidity (other disease conditions) and on the highest doses. This is not unexpected adverse result. The two opposing views, may be agenda driven, but both have credible logical medical rationale. However, but each is based upon different patient selection and treatment parameters. Bottom Line: It is legal for a patient and their doctor to decide on the individual’s treatment and/or prescription. You may decide with the advice of your physician.