Web Victory for Dissatisfied Patients

It took over 5 years but one dissatisfied, legally-blind LASIK patient has successfully defended his right to host a website that publicizes his plight and identifies his surgeon.

Remember, Lady Justice is blindfolded!

Legal wonks can savor the full court decision.

Back in 2002 the surgeons claimed the website was defamatory and they threatened legal action. The host initially sanitized the website but subsequently reloaded it with clear documentation of the patient's claims. The doctors filed suit claiming that the initial removal of the website criticisms to avoid suit constituted an agreement never to mention their names on the Internet.

The Pennsylvania Superior Court in Philadelphia disagreed. According to the advocacy group Public Citizen:

Companies routinely threaten consumers and Internet hosting companies with libel, defamation or trademark infringement litigation in response to legitimate criticism. With a short deadline for compliance, consumers are often pressured into removing criticism from Web sites and censoring their speech to avoid costly and time-consuming litigation.

"This is another victory for consumers who use the Internet to criticize companies," said Paul Levy, the Public Citizen attorney who filed the appeal. "Free speech and consumer rights would be seriously endangered if the temporary removal of criticisms from a Web site could be construed as an 'agreement' not to say anything about the company in the future."

Caveat emptor? From now on the sign should read "Let both the Buyer and Seller Beware!"

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Technorati Tags: eye surgery, LASIK, vision, health-and-wellness

Cyberbullying: Crossing the Limits

The blogosphere is abuzz due to several well-publicized episodes of cyberbullying. Nancy Willard, an attorney with the Center for Safe and Responsible Internet Use (CSRIU) defines cyberbullying this way:

Being cruel to others by sending or posting harmful material or engaging in other forms of social aggression using the Internet.

Cyberbullying includes flaming, harassment, denigration, impersonation, trickery, and cyberstalking.

Most of us have brushed-up against some kind of online hostility.

Having read and replied to thousands of member inquiries at the WebMD Eye & Vision Disorder Message Board I have had a few run-ins with cyberbullies. You can really feel the hostility, the anger. Some visitors are disproportionately upset about a possible health problem and are impatient for a response. They probably overlook their rudeness, and so do I. I've been flamed for not providing precise diagnostic information or treatment recommendations, even though publishing such information would be reckless and unethical!

For some bloggers the cyberbully problem has progressed from obnoxious name-calling to specific threats of violence. The (supposed) anonymity of the Internet likely encourages these spineless acts. Some justify such antisocial acts as an exercise of 'free speech', demonstrating a dual ignorance of civilized behavior and our Constitution. Even though hostile posts can be deleted, harm has already been inflicted, and those who have been violated remain scared and scarred.

The first step in effective problem-solving is awareness. You can't fix what you don't know. Share these 3 valuable resources with your family and friends:

• Stop cyberbullying network
• Cyberbully.org website
• CSRUI website

Okay, maybe you didn't invent the Internet, but you can take responsibility for keeping it a safe and enjoyable environment for all who visit!

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• Bullying Increasing: First Boys, Now Girls
• WebMD Video: Bullying Survivor

Editor's Note: PBS Teachers have declared Friday, March 30th "Stop Cyberbullying Day" - a day to take action by blogging, sharing video, resources and ideas about ways to take a stand against cyberbullying.

Technorati Tags: stopycyberbullying, CSRIU

USA: Unequal Healthcare for All

While traveling this past week I had time to catch up on some reading. Instead of the usual mix of People magazine and prestigious medical journals (can you guess which I usually read FIRST?) I opened a hardcover book about health policy.

Yawwwnnn? Hardly!

The Health Care Mess is an extraordinary analysis that attempts to explain why the richest nation in the world spends the greatest amount of money for health care and yet 45+ millions Americans are uninsured. How can it be?

Do not expect some partisan, politicallly-motivated hatchet job. The authors are renowned experts in the field and have served many different presidents. They objectively recap how America has resisted national health insurance and the consequences of such attitudes.

Bottom line is we all pay, every day, healthy or not. The longer we wait to reform our health care system the worse it will get.

Here's what's really important: nothing will change until voters summon the collective will to demand change. Once that happens the politicians and bureaucrats will put away the band-aids and get to work rebuilding a health care system that is accessible, efficient and accountable.

I'm eager to hear what others have to say. One favor -- read the book first and see if you don't agree with the authors' recommendations.

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Technorati Tags: healthcare, health policy, medicare, The Health Care Mess

Video-Gamers Make Better Surgeons

Twenty years passes quickly!

Maybe buying my son that Atari, then that Sega Genesis, then a Nintendo, then that PlayStation, followed that XBox weren't such bad ideas after all.

A new report recently published in the Archives of Surgery suggests that physicians perform faster and more accurate laparoscopic surgery if they have played lots of video games.

The authors of the study recruited 33 resident and attending surgeons as voluntary participants.

Participants tracked their video game playing time over a four month period before beginning laparoscopic training which used realistic computer aided simulator. This seems like a reasonable "surrogate experience" since real-world laparoscopic surgeons use fingertip controls and watch the instruments via a color monitor. Think of it like using a joystick to remove a gallbladder.

To nobody's surprise, laparoscopic performance among beginners correlated with past experiences playing video games. Here is a modified excerpt from the published paper:

Past video game play in excess of 3 hours per week correlated with 37% fewer errors and 27% faster completion. Overall procedure score (time and errors) was 33% better for video game players and 42% better if they played more than 3 hours per week. Current video game players made 32% fewer errors, performed 24% faster, and scored 26% better overall (time and errors) than their nonplaying colleagues. When comparing demonstrated video gaming skills, those in the top third made 47% fewer errors, performed 39% faster, and scored 41% better on the overall procedure score. Statistical analysis also indicated that video game skill and past video game experience are significant predictors of demonstrated laparoscopic skills.

Perhaps patients contemplating surgery ought to add a new question to the familiar preoperative discussion: Where did you train? How many of these procedures have you previously performed? What was your highest score on Legend of Zelda?

REFERENCE: Rosser JC, Lynch PJ: The Impact of Video Games on Training Surgeons in the 21st Century. Archives of Surgery 2007; 142:181-186.

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Technorati Tags: vision, video games, health-and-wellness

Project ORBIS: Spring Break in China

Is it spring break yet in your area?

This year my wife and daughter are doing something different for spring break, something very different.

You may not know it but my spouse is also an ophthalmologist. She specializes in pediatric ophthalmology. She has been invited to participate in Project ORBIS a nonprofit humanitarian organization. ORBIS strives to eliminate avoidable blindness and restore sight in the developing world. ORBIS works closely with local communities, governments and hospitals to design programs that increase local skills, improve health care facilities and foster awareness of eye health. Enormously successful, this year ORBIS celebrates its 25th anniversary.

There are many wonderful medical charities. What's really different about ORBIS is that, unlike most other international medical organizations, ORBIS does not arrive, perform 500 operations, and fly away. ORBIS is actually a flying eye hospital (a converted DC-10 with operating rooms and classrooms). At each faraway destination ORBIS' volunteer eye surgeons teach clinical and surgical skills to the local doctors. This is an enduring gift that persists long after the two-week visit concludes.

This weekend my wife and older daughter travel to the Peoples Republic of China with ORBIS to share knowledge and experiences regarding the care of pediatric eye surgery patients. I am extremely proud of both of them for choosing to make a positive difference in the world.

My spring break? I get to stay home and finish preparing our taxes!

Learn more about Project ORBIS.

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Technorati Tags: pediatric eye surgery, spring break, Project ORBIS, health-and-wellness

Competing Viewpoints

Did you know that your two eyes do not see the same image? Cover one eye at a time and you'll see the difference. It's subtle but important. The similar-yet-distinct images are integrated in the brain and this visual fusion is responsible for depth perception and stereopsis.

Vision researchers from UC San Diego are studying why the brain can't fuse dissimilar images. For example, wearing glasses with one yellow lens and one blue lens will not create a green world. At any instant the brain decides to accept one image or the other, never both.

Retinal rivalry is the explanation for the brain's inability to fuse two different visual images.

This phenomenon also occurs in the tangible world. If you hold an apple with both hands you don't feel two apples, do you?

Here's a neat visual experiment for students scratching for science fair ideas. Prepare two 8"x8" cards with diagonal stripe patterns as seen above. Tape them onto a wall or other vertical surface 3 inches apart. Then insert a third plain card perpendicular to the wall between the two cards as a dividing barrier.

Bring your face close so that the eyes can only see each card separately. Intuitively you might suspect that the two patterns would fuse to create a diamond grid. Not so! Instead most viewers appreciate either one diagonal pattern or an alternating, wiggling mosaic.

Understanding the phenomenon of retinal rivalry has provided great insights (yes, a horrid pun) regarding visual changes in stroke victims and for patients with crooked eyes.

Want to learn more? Direct both of your eyes to the recent issue of Scientific American Mind cited below.

REFERENCE: Scientific American Mind (Dec06/Jan07) 'When the Two Eyes Clash'. pages 16-18.

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Technorati Tags: vision, eyes, retinal rivalry, amblyopia, lazy eye, double vision, stroke vision, health-and wellness

Anti-Antioxidants?

Surprising new information about the long-term effects of antioxidants has recently been published in the Journal of the American Medical Association.

Antioxidants are naturally-occuring substances that protect cells from oxidative damage caused by unstable molecules called free radicals. Vitamins A, C, E, beta carotene, selenium, and lycopene are among the most popular antioxidants.

Free radicals are implicated in the destructive pathway that leads to age related macular degeneration. In theory, consuming supplemental antioxidants will provide added protection to the retina. Antioxidants may also play a role in preventing heart disease, cancer, and neurodegenerative conditions like Alzheimer's disease. This latest report says, "Not so fast!"

Doctors analyzed data from 68 different randomized clinical studies involving 232,000 adult volunteers. Surprisingly, adults who consumed supplemental Vitamin A, E or beta carotene actually lived shorter lives compared to groups who took a placebo - an average 5% increased death risk. Can you imagine? Health-conscious individuals who take lots of antioxidants actually die sooner?

It's too early to start condemning beta carotene and other antioxidants. Far more work needs to be done to clarify what genuine contribution or legitimate risk can be assigned to nutritional supplements. For example, nearly all of the AREDS research demonstrates that a diet rich in antioxidants can help prevent or delay the onset of macular degeneration and cataract.

There is some consensus. Nearly every expert agrees that folks choosing to consume supplemental antioxidants are wise to get them from natural sources like fresh fruit and vegetables rather than the expensive synthetic pill form. Oh, as far as I know, red wine is natural, too!

REFERENCE: JAMA 2007; 297:842-857.

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Technorati Tags: vision, antioxidants, macular degeneration, health-and-wellness, cataract, eyesight