Grand Rounds

This week's Grand Rounds editor's pick is one of my favorite blogs.

Storm Dog

It was Sunday night, Aug. 28, and the storm was due to hit on Monday morning. We were at the Superdome in this absolutely pouring down, squalling rain. The winds had already started to pick up. Most of the thousands of people who were trying to get into the Superdome had already managed to get in. They were just about to close the doors and lock down for the night.

That's when I saw a man walking down and talking to cop cars and National Guard people all along the way in the pouring rain. He had a puppy in his arms. They said to him, "you can go in, but you can't take your dog with you."

He kept saying, "Look man, it's a puppy. If I left him at home, he would just die."

So I looked at Tom Baer, our satellite truck operator, and I said, "Tom, we gotta do it."
He nodded. So I went out into the rain and I said, "We'll look after your dog for you."

In the pouring rain, he gave me his name, Joe Torres, and I gave him our numbers, and he went into the Superdome and we took the puppy.

Walking to the park this morning, I met Storm and Tom Baer. I am happy to report that Storm is doing well, and that he is a.do.ra.ble! Mr. Baer is nice, too. It was quite funny to see Mr. Baer, an imposing figure, sitting in the middle of the small dogs group, doting over Storm.

Since leaving New Orleans, Storm has traveled to Baton Rouge, Toronto (where the NBC crew had to go for repairs to their satellite truck), and, as of last night, the City.

I have no doubt that Mr. Torres misses his dog, but the good new is that he can rest assured his dog is very well taken care of. Let's hope they will soon be reunited.

Unfortunately, the bad news is that Mr. Baer did confirm reports of New Orleans officials shooting dogs. I'm not sure what to do to address this problem; if you have any suggestions, please let me know.

President Bush Trims Government Spending

In a courageous move, President Bush declines to spend $34 million Congress had appropriated as funding for the U.N. Population Fund. Finally, some fiscal responsibility:

For the fourth consecutive year, the Bush administration has decided to withhold funding from the U.N. Population Fund, saying the agency contributes to China's "coercive abortion" program.

The administration decision was disclosed in a letter from Under Secretary of State Nicholas Burns to key senators. Congress had appropriated $34 million for the program, but gave President Bush the authority to decline to spend the money.

China has denied using any coercive measures in its population control efforts.

The fund's executive director, Thoraya Ahmed Obaid, called the decision disheartening and said one goal of the fund is to get women to use voluntary family planning to avoid abortion.

Going one step further, the President also encouraged China to deal with its "abortion problem" by following America's brilliant example: less vaginal sex, more pretend abstinence. [After all, fantasy is the new reality.]

And, in a totally unrelated development, President Bush this week nominates* a 72-day-old gestating fetus as his nominee to fill the Supreme Court seat that opened following the death of Chief Justice William Rehnquist.


*I found this link on another blog, but cannot recall which one; sorry about that.

Exponential Potential

Not sure yet what to make of this new blog I found--the writing style is "government bureaucrat", and the blogger has yet to embrace the concept of links to sources. Still, I thought you might find this post interesting.

Implanon

Here's a very good primer on the single-rod implant, Implanon. You never know; any time now the FDA might just decide to flip a coin and approve it for use in the U.S.



Some highlights:

About the size of a matchstick (40 mm long and 2 mm wide), Implanon is a flexible rod that contains ethylene vinyl acetate (EVA) impregnated with 68 mg of etonogestrel (the same drug used in the contraceptive vaginal ring). On average, the rod releases 40 μg of etonogestrel every day, inhibiting ovulation and thickening cervical mucus. The rod is typically inserted in the inside portion of the upper arm during a brief office procedure.

High efficacy.

Rapid return to fertility.

Key [noncontraceptive] advantages of the single-rod implant include no decrease in bone mineral density and no effect on breast milk. But, research on dysmenorrhea [painful period] and acne demonstrate variable effects. For example, a study of 635 women who used Implanon found that 85% of them with dysmenorrhea noted an improvement, while 4% noted new or worsened symptoms. In a study of 231 women with acne at baseline, 16% had less acne, 70% had no change, and 14% had increased acne with the implant. In those without acne at baseline, 16% reported having developed it.

The main reason women discontinue the single-rod implant is due to irregular and unpredictable bleeding patterns. During the first 3 months following insertion, up to 40% of women are amenorrheic, 50% have infrequent bleeding (dropping to 30% by 6 months), and 30% have prolonged bleeding (eventually falling to between 10% and 20%).

Contraindications: known or suspected pregnancy; active venous thromboembolic [clot] disorder; active or history of severe hepatic [liver] disease; progestogen-dependent tumors; undiagnosed vaginal bleeding; hypersensitivity to implant's components. Also, women with diabetes need to be carefully observed.

The average times for insertion and removal are 30 seconds and 3½ minutes, respectively.

For women who cannot take estrogen and who desire long-term protection yet rapid reversibility, Implanon may be an attractive choice. But choosing the implant is just one step; being satisfied with the choice and adhering to it is another.

Calling All Attorney Generals Busy Bodies

When it comes to gyn care, even for young patients, confidentiality matters (emphasis mine):

The interval between sexual debut and initiation of gynecologic health care was substantial in a recent study of urban adolescent girls, but access to confidential care predicted more timely gynecologic care, M. Diane McKee, M.D., reported at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

More than 800 high school girls participated in the anonymous, self-administered, computer- based survey. Nearly 45% reported that they were at some point sexually active, and of these, 45% had received gynecologic care, which for the purposes of this study was defined as a pelvic examination.

The mean interval between sexual debut and gynecologic care was 11 months, but the
range was 6 months before sexual debut up to 6 years after sexual debut. Only about 4% had a pelvic examination before sexual debut, and for the remaining sexually active girls, a negative consequence (such as pregnancy or a sexually transmitted infection) was strongly associated with seeking care.

The interval between sexual debut and gynecologic care was more than 2 years when no negative consequence occurred and slightly more than 1 year when such a consequence did occur.

"Gynecologic care in adolescents is largely reactive," said Dr. McKee of Albert Einstein College of Medicine, New York.

After negative consequences were controlled for, three other factors emerged as predictors of the interval between sexual debut and gynecologic care: access to confidential care (odds ratio 3.1), high self-efficacy for accessing confidential care (odds ratio 2.1), and disclosure of sexual activity to any clinician (odds ratio 1.7).

Confidential care was defined as having at least part of routine visits conducted without parents present.

In the absence of these factors, the median interval between sexual debut and gynecologic care was approximately 3 years.

Other findings from the survey underscore the need for better patient education. Nearly 80% of respondents said they have a regular source of care, and 60% said they had an opportunity for confidential care for at least part of their last clinical visit. But only 52% said they received safe sex counseling. Of the 45% of respondents who were sexually active, only 27% had informed any clinician of that fact.

More than 25% of the sexually active girls had been pregnant or had a sexually transmitted infection in the past year.

ObGyn News. Volume 40, Issue 17, Page 26 (September 1, 2005)

Testosterone and Libido

Q: Do androgen levels help diagnose low libido?

A: No. Clinical measures of circulating androgens are not useful in the diagnosis of low libido and other forms of female sexual dysfunction.

The Pill and Depression

From a small study, another example of a noncontraceptive benefit of using the birth control pill: for depressed women who already take antidepressants, using the Pill appears to decrease the premenstrual worsening of depressive symptoms.

The use of oral contraceptives appears to decrease the premenstrual worsening of depressive symptoms, Hadine Joffe, M.D., said at the annual meeting of the American Psychiatric Association.

In preliminary research, the use of augmentation with oral contraceptive pills was evaluated in women who already take antidepressants but experience worsening symptoms during the luteal phase of the menstrual cycle, said Dr. Joffe, a psychiatrist at Massachusetts General Hospital, Boston.

The 17 women who completed the study reduced their depression scores during the premenstrual phase on the Daily Record of Severity of Problems Scale from a median score of 58 to a median score of 35.3. In addition, their Montgomery-Asberg Depression Rating Scale scores improved from a median of 20 to a median of 4.

A total of 26 women, aged 18-45 years, were randomized to a double-blind treatment with an oral contraceptive containing drospirenone and ethinyl estradiol (Yasmin). One group received additional ethinyl estradiol on days 22-28, which is the typical placebo week of the oral contraceptive pills.

To be eligible for the 2-month study, women had to have regular 25- to 35-day menstrual cycles, a depressive disorder, and stable use of an antidepressant for 2 months or more. In addition, all participants completed a run-in tracking month before starting the oral contraceptive pill. Depressive symptoms were found to be present only during the premenstrual phase.

Of the women included in the study, 82% had major depression, 12% had minor depression, and 6% had dysthymia.

The oral contraceptive pills were well tolerated, and there appeared to be no difference between women who received the additional ethinyl estradiol during days 22-28 of their cycles and those who received placebo during that time.

The study was sponsored by the National Alliance for Research on Schizophrenia and Depression, and product support was provided by Berlex, which manufactures Yasmin.

ObGyn News. Volume 40, Issue 17, Page 24 (September 1, 2005)

Ortho Evra Lawsuit

They're heeere:

Johnson and Johnson's Ortho-McNeil Pharmaceutical Inc. unit is being sued on behalf of a woman who had been using the company's Ortho Evra contraceptive patch.

The suit, filed by Parker & Waichman LLP, alleges the woman suffered a pulmonary embolism after using the patch for seven months.

The law firm said Monday, after the financial markets had closed, that recent reports have indicated that the risk of developing blood clots, pulmonary embolism, heart attack and stroke may be significantly higher with the Ortho Evra patch than with oral-contraceptive use.

The firm alleges that Ortho-McNeill was aware of the increased medical risk and failed to adequately warn patients.

It's not clear what "recent reports" the law firm is referring to. I do hope it's not this [mis]report from last year. Nor this more recent article, AP finds more fatalities from birth control patch than expected (via feministing).

Briefly, from the article:

... since the patch came on the market in 2002 ... the AP found 23 different deaths associated with the patch. The primary cause of death in those reports isn't always clear -- some mention suicide, others abortion. Doctors who reviewed the 23 cases found about 17 that appeared to be clot-related, including 12 from last year.

So, the AP review found:

23 total deaths from 2002-2004

17 clot-related deaths in patch users from 2002-2004

12 of which occurred in 2004

AP's analysis [if you can call it that]: out of all the reported deaths (23), it's not clear six are at all related to patch use (suicide, termination, etc.). [It's quite possible they're referring to these six cases. No way to tell for sure.]

This leaves us with 17 cases, over two years. For these cases, we don't know what the cause of death was. [It's unclear why AP's reviewers were unable to determine cause of death--were the records incomplete, or were they inconclusive? Unfortunately, AP doesn't link to the reports they obtained from the FDA.] However, because most of these cases appear to be clot-related, we assume they are. Moreover, based on this assumption, we go one step further and assume the blood clots were caused by using the patch. Since, in 2004, there were 12 clot-related deaths, the rate of deaths appears to be 3 out of 200,000.

So, does the birth control patch cause more fatalities than expected? This is one question you won't find the answer to by reading the AP article.

Bottom line:

Case reports of deaths need to be fully investigated by formal epidemiological studies. Until this is done, a casual relationship remains questionable. At the present time, no evidence suggests that the transdermal patch is associated with an increased risk of death compared with combination oral contraceptives.*

Not that a lack of evidence should in any way stop lawyers from filling lawsuits.


*Grimes DA, Mishell DR Jr. Assessing Rare Event Reports: A Numerator in Search of a Denominator. Dialogues in Contraception. Fall 2004;8(7):7.

Grand Rounds

This week's Grand Rounds is up.

Doctors Killing Patients in NO?

Amanda links to an extraordinary story of a New Orleans doctor deliberately killing her patients:

Doctors working in hurricane-ravaged New Orleans killed critically ill patients rather than leaving them to die in agony as they evacuated hospitals, The Mail on Sunday can reveal.

With gangs of rapists and looters rampaging through wards in the flooded city, senior doctors took the harrowing decision to give massive overdoses of morphine to those they believed could not make it out alive.

In an extraordinary interview with The Mail on Sunday, one New Orleans doctor told how she 'prayed for God to have mercy on her soul' after she ignored every tenet of medical ethics and ended the lives of patients she had earlier fought to save.

Her heart-rending account has been corroborated by a hospital orderly and by local government officials. One emergency official, William 'Forest' McQueen, said: "Those who had no chance of making it were given a lot of morphine and lain down in a dark place to die."

I don't have any first-hand experience with evacuating patients, but this account just doesn't ring true to me.

For one thing, I can't imagine how one MD can get her hands on all those extra doses of morphine. I mean, in L&D, under normal conditions, the charge nurse practically strip searches you if the counts are off by one dose. In a hospital under a state of emergency, with the pharmacy in lockdown, extra morphine is available for the asking or taking? In any case, I find the corroborating sources--an orderly, and William 'Forest' McQueen, a utility manager--a bit iffy.

Not only that, but, even in the aftermath of a hurricane, unless you have totally snapped, you don't administer lethal doses of morphine to patients because [t]hey would have been dead within hours, if not days, anyway. Maybe the doctor was talking about pain meds for cancer patients, and slow codes on DNR patients, and the reporters somehow misunderstood.

Your thoughts on this story?

Micromanaging Sperm Placement

Taiwanese authorities have extracted sperm from the body of a dead army officer some 57 hours after he died to enable his fiance to bear his child through artificial insemination.

Late Saturday a doctor from a military hospital extracted sperm from the body of Sun Chi-hsiang, an army captain who was killed last Wednesday in a military accident.

Defence Minister Lee Jye subsequently met with Sun's fiancee Lee Hsing-yu to express his condolences over the accident, during which Lee Hsing-yu said she wanted to bear the child of her dead lover.

Her request was turned down by the minister, who cited Taiwanese laws that forbid the harvesting of sperm from the deceased.

Saturday's retrieval of sperm from Sun was only made possible after Premier Frank Hsieh consented to the operation following a series of emotional public pleas by Lee Hsing-yu.

However, she may have to travel overseas to receive the artificial insemination as it is illegal in Taiwan for unmarried women to have such treatment.

I, for one, am moved by the plight of Taiwanese government officials.

Obviously Ms. Hsing-yu, a woman, cannot be trusted to decide, all by her little, infantile self, if she should, or should not, be inseminated with her lover's sperm. The country's Defence Minister and Premier are needed to make this decision for her. But who will make the decisions involved in Ms. Hsing-yu's carrying a pregnancy to term, delivering, and raising a child? Since all these are far more high-risk, and complex endeavors than an insemination, clearly the rank of the decision-making official has to supersede that of those involved in the insemination decision. Does Taiwan have an Emperor? No matter; I have a proposal.

Let us create an International Department of Making Decisions for Minors and Women, so as to free high-ranking government officials everywhere form having to spend their most precious time micromanaging sperm placement.

Katrina: Lessons Learned

My lessons learned from watching the post Hurricane Katrina debacle unfold:

1. Communications: Assume they will fail and plan accordingly.

2. Provisions: There's just no way around this unpleasant task. [All this time since Sept. 11 and I still don't have a complete emergency kit prepared; for shame!] At a minimum, have a 3-4 days supply of food, water, and wet wipes packed and ready to go. And, if you're like me, you also have to figure out how to evacuate your pet [in my case, a 70 lbs dog; the one time I envy people who have small, frou-frou, dogs who fit in a handbag].

3. Leadership: Take for granted that officials won't be able to offer any help. [Quite frankly, after reading some of the accounts from New Orleans, I'd be inclined to avoid/ignore them altogether.] Not only that; go one step further. Assume you will have leadership responsibilities for a small group of people (family, friends, neighbors, etc.). Figure out in advance how you will lead these people to safety, and how you can best contribute to providing for the group's basic needs. Best to focus on, and leverage, your area of expertise. For example, if you are a medical professional, plan on having enough supplies to be able to start at least a few IVs, or have a few suture kits/clamp cords/inhalers, etc. handy.

Finally, a few concluding thoughts, after reading this (via Instapundit):

As New Orleans descended into chaos last week and Louisiana's governor asked for 40,000 soldiers, President Bush's senior advisers debated whether the president should speed the arrival of active-duty troops by seizing control of the hurricane relief mission from the governor.

...

The debate began after officials realized that Hurricane Katrina had exposed a critical flaw in the national disaster response plans created after the Sept. 11 attacks. According to the administration's senior domestic security officials, the plan failed to recognize that local police, fire and medical personnel might be incapacitated.

...

After the hurricane passed New Orleans and the levees broke, flooding the city, it became increasingly evident that disaster-response efforts were badly bogged down.

Justice Department lawyers, who were receiving harrowing reports from the area, considered whether active-duty military units could be brought into relief operations even if state authorities gave their consent - or even if they refused.

The issue of federalizing the response was one of several legal issues considered in a flurry of meetings at the Justice Department, the White House and other agencies, administration officials said.

Attorney General Alberto R. Gonzales urged Justice Department lawyers to interpret the federal law creatively to help local authorities, those officials said. For example, federal prosecutors prepared to expand their enforcement of some criminal statutes like anti-carjacking laws that can be prosecuted by either state or federal authorities.

Politicians, at all levels, are frightfully incompetent and wasteful. Lawyers are a menace. Last, but not least, the current administration has yet to realize that certain departments, like the FDA, FEMA, and the Department of Homeland Security, are reality-based.

Four years after Sept. 11, it is daunting to realize how vulnerable we, as a nation, are.

Medlogs

Currently, there are 103 physician, 14 nurse, and 66 resident/student medbloggers on Medlogs.

In Memoriam

What Makes a Drug "OTC"?

A practicing physician asks, and answers, the question:

The answer to this question begins with a little history. Our current regulation of drugs was established in 3 major pieces of legislation.[2,3] The Food, Drug & Cosmetic Act of 1938 required that the Food and Drug Administration approve all drugs used on humans. The legislation was concerned principally with making sure that drugs were safe and were accurately labeled. At the time, the distinction between OTC and prescription drugs was largely in the hands of the states. This changed in 1951 when the Durham-Humphrey amendments created federal criteria to distinguish OTC and prescription drugs. Prescription drugs were limited to those that were habit-forming and to those whose use required supervision by a licensed health practitioner. In 1962, the Kefauver-Harris amendments required that all drugs be not only safe, but also effective.

Thus, an OTC drug must satisfy 3 criteria: (1) it must be safe, (2) it must be effective, and (3) it must be for a condition that the patient can manage without supervision by a licensed health professional.

Grand Rounds

Today is a good time to catch up on this week's Grand Rounds reading.

And just in case you might have missed it, one of my favorite medbloggers is now a published author.

[ETA: I had to remove the book's cover picture; it was distorting the template. Dr. Charles, if you have a smaller one, I'd be happy to post it.]

Your Brain On Orgasm

A break from the mismanagement of Katrina's aftermath: Researchers scanning women's brain activity during orgasm share some interesting findings.

For example, by studying paralyzed women who can still experience orgasm, they discovered that for women, the vagus nerve appears to be quite important, and therefore may be a promising target for drugs. This nerve — which is outside the spinal cord — carries information to areas of the brain that control mood.

...

The scans reveal something else about women — during orgasms, the pain centers in their brains shut down, and pleasure centers — the same ones that become active when people ingest cocaine — light up.

...

Among other results, Holstege found that the part of the brain thought to control fear and anxiety — the amygdala — deactivated during orgasm for both women and men.

He acknowledged that his data for men is a little suspect — however — because they don't orgasm long enough to take a proper brain scan.

The Blind Leading the Blind

Is Secretary Chertoff incompetent, or worst?

Question: Mr. Secretary, two questions. One is, are you satisfied that you have enough Guard forces there? And secondly, how long do you think it will take to evacuate --

Secretary Chertoff: I'm satisfied that we have not only more than enough forces there and on the way. And frankly, what we're doing is we are putting probably more than we need in order to send an unambiguous message that we will not tolerate lawlessness or violence or interference with the evacuation.

...

Let me say, by the way, that I know there are hospitals that have patients who need care. We have been very focused on evacuating them. We do prioritize, meaning that we go to hospitals and take the most critically needy out first, and then work our way down as -- we get the people who are sick, but perhaps not in a life-threatening situation.

And, in fact, yesterday, I happened to see on TV someone was calling from a hospital and complaining they weren't being picked up. And I called the operation center and I said, are you guys on top of this, and they said they were, and they made it clear that they, again, have a process in place which sets priorities and they're following that process.

Let me see if I understand this correctly. The Secretary of the Department of Homeland Security: 1) knows that there are hospitals in the affected areas, 2) knows these hospitals have patients in need of transport, and 3) knows there's a focus on evacuating them.

And how does Secretary Chertoff know all of this? By watching TV and calling a guy to get some third-hand (hopefully) information. Incredible!

[Update: Good news. All patients and staff from Charity and University hospitals have finally been evacuate, according to Don Smithburg, head of the Louisiana State University hospital system.]

Question: Do you think that FEMA should have had buses available for the evacuation at the time the evacuation order was first declared? And secondly, obviously here and now in retrospect, but did DHS and FEMA under estimate this and not have sufficient resources on the ground?

Secretary Chertoff: Actually, I think there was an extraordinary effort to put resources on the ground and pre-position them. As I said, the President declared states of emergency before the hurricane made landfall. So that enabled us not only to put large quantities of water and food and tarpaulins and generators in place, but it also allowed us to actually start flowing that out in advance.

So are we to understand that supplies weren't put in place in advance *on purpose* at the Superdome and the Convention Center (you know, the spots where tens of thousands of people were told to go)?

Clearly, this is not the time for finger pointing. But neither is this the time to play slick politics with people's unimaginable suffering and lives. If the current situation in New Orleans doesn't merit an honest response, and a constructive assessment from people like Secretary Chertoff, I don't know what does.

On a related note. When I heard* this morning that the President had suspended Posse Comitatus to allow 7,000 active duty troops to come to New Orleans, I wasn't sure this was such a good idea. However, after watching the evacuation efforts by the Texas National Guard at the Superdome, I must say: our military's efficiency and professionalism are impressive.


*I heard that on either MSNBC or CNN, but haven't found anything online confirming it. If I do, I'll update with a link.

Doctors Needed

From Medscape:

The Louisiana Office of Public Health has listed numbers that physicians can call if they would like to offer assistance. Please keep in mind that some lines will be overloaded.

Carl Maddox Field House 225.219.0821
Pete Maravich Assembly Center 225.578.0377
OLOL Medical Staff Office 225.765.8871

Emergency room doctors are needed for the Temporary Medical Operations Staging Areas in Baton Rouge at the LSU Pete Maravich Assembly Center and at Nichols State University in Thibodaux. Physicians are also needed for triage and medical care services for patients who require oxygen treatment, tube feeding, or mental health care in Alexandria, Lake Charles, Lafayette, and Thibodaux. Contact Dr. Jean Takenaka, Office of Public Health, Emergency Operations Center, at 225.763.5751 or jtakenak@dhh.la.gov.

Update: Amanda has more helpful links.

For Shame

Here are some people who truly understand the needs of women and families affected by hurricane Katrina and its aftermath.

Because nothing says "I understand" more than depriving needy people of basic medicines.

Because, after days in the sweltering heat without food, water, and basic hygiene, suffering from cramps, heavy bleeding, anemia, weakness, and facing the possibility of an unintended pregnancy [possibly as a result of being raped] are not pressing concerns.



(via commenter Jesurgislac at Alas, a blog)

Katrina Aid

The federal government declared a public health emergency for the Gulf Coast region, promising 40 medical centers with up to 10,000 beds and thousands of doctors and nurses for the hurricane-ravaged area.

In a stunning example of how desperate the situation has become, 25 babies who had been in a makeshift neonatal intensive care unit at New Orleans' Ochsner Clinic were flown Wednesday to hospitals in Houston, Baton Rouge, La., and Birmingham, Ala. Many were hooked up to battery-operated breathing machines keeping them alive.

Their parents had been forced to evacuate and leave the infants behind. By late in the day, most if not all parents had been contacted and told where their babies were being taken, hospital spokeswoman Katherine Voss said.

"We actually encouraged them to leave. It would just be more people to evacuate if there was a problem," said Dr. Vince Adolph, a pediatric surgeon.

Helicopters had to land on the roof of the parking garage to get the babies because water covered the helipad at the hospital, one of the few in the area that had been operating almost normally.

"We're getting kind of at the end of our rope," with a skeleton staff of doctors and nurses who have been on duty nonstop since Sunday, Voss said.

Officials were trying to evacuate 10,000 people out of nine hospitals battling floodwaters or using generators running low on fuel. About 300 people were stranded on the roof of a two-story hospital in the New Orleans suburb of Chalmette.

Yet even as they tried to evacuate, many hospitals faced an onslaught of new patients — people with injuries and infections caused by the storm, dehydrated people plucked from rooftops, dialysis and cancer patients in need of their regular chemotherapy or radiation treatments.

By day's end, Coast Guard air and boat crews had rescued 2,000 people across the region and recovery teams were delivering food, water, medical equipment and other supplies, said Lt. Cmdr. Jeff Carter.

I just heard an interview with medical personnel from one of the local hospitals. They're working without water; they're taking care of patients without the benefit of labs. They have no idea if, and when they will be evacuated.

Please consider lending a helping hand. The AMA recommends:

American Red Cross: (800) HELP NOW (435-7669) in English, (800) 257-7575 in Spanish

CDC Foundation Emergency Preparedness & Response Fund: (888) 880-4232

Update: Instapundit has more places to donate.

Via feministing:

Liberal Blogosphere for Hurricane Relief



"There's nothing wrong with America that can't be fixed by what's right with America." - Bill Clinton.

Hurricane Katrina destroyed thousands of lives. Together, we're raising $1 million for the Red Cross and prove that the liberal blogosphere can help our fellow citizens.

Please donate now.

Plan B and Your Ob/Gyn

ACOG comments on the FDA's "decision" on availability of Plan B OTC:

The American College of Obstetricians and Gynecologists (ACOG), the nation's leading organization of physicians specializing in women's health care, reiterates its support for making emergency contraception (EC) available without a physician's prescription to all women of reproductive age.

The medical evidence regarding the safety and effectiveness of emergency contraceptive pills (ECPs) is scientifically sound. Not only does the medical community advocate wider access to Plan B, but the US Food and Drug Administration's (FDA) advisory committees on non-prescription and reproductive-health drugs and the agency's own medical-review staff support the switch to over-the-counter.

In May 2004 the FDA rejected the application from Barr Pharmaceuticals, Inc. to make Plan BTM available without a prescription on the basis of insufficient data related to safety. Though now acknowledging that women age 17 and older can safely use Plan BTM as an over-the-counter drug, the FDA nonetheless has introduced new excuses as reasons to continue its delay in making a decision.

"What this amounts to is a quintessential shell game, in which women are the losers. Unplanned pregnancy remains a major public health issue in the US. Emergency contraception offers a safe and effective way to prevent unplanned pregnancy and reduce the number of abortions in this country," says ACOG President Michael T. Mennuti, MD.