HealthBlawg

Carnivalia at the intersection of law and medicine

Blawg Review is up at Family Lore, across the pond.  Grand Rounds is up at ACP Internist.  Enjoy!

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Health Care Reform edition of Health Wonk Review is up

Joe Paduda does a great job pulling together the best of recent policy posts from the health blogosphere -- and tops it off with some insightful wonkishness of his own -- in today's edition of Health Wonk Review at Managed Care Matters.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Grand Rounds Vol. 5, No. 37: The June Is Bustin' Out All Over Edition

June is bustin' out all over . . . .  Lord knows my nose knows it, thanks to all the pollen in the air these days.  Check out the classic movie rendition of this set piece (well worth the eight-minute investment), let your coffee and/or antihistamines kick in, and then let's dive into the past week's medblogging, loosely categorized into insights of patient bloggers, provider bloggers, bloggers I've met in real life (the number keeps growing), bloggers following the money trail through the health care thicket, and bloggers who are or should be dancing and/or shirtless (watch the whole movie clip . . . on second thought, let's leave it at dancing).

  

Last time I hosted Grand Rounds, we delved into the origins of Valentine's Day, so even though we're a couple weeks shy of the vernal equinox, since June is bustin' out all over, the historian in me feels the need to touch on an ur-Spring nugget or two before we get going.  Where do these celebrations of Spring come from?

Attis was a Phrygian god, whose annual death and resurrection were mourned and celebrated at a Spring festival.  (On the other hand, the death and rebirth of the Sumerian Tammuz was a summer solstice thing rather than a vernal equinox thing.)  James Fraser, in The Golden Bough, wrote:

The annual death and revival of vegetation is a conception which readily presents itself to men in every stage of savagery and civilisation: and the vastness of the scale on which this ever-recurring decay and regeneration takes place, together with man's most intimate dependence on it for subsistence, combine to render it the most impressive annual occurrence in nature, at least within the temperate zones. It is no wonder that a phenomenon so important, so striking, and so universal should, by suggesting similar ideas, have given rise to similar rites in many lands.

What I best remember from The Golden Bough, though, is the tale of the king-for-a-year, who ascends the throne as a result of a cultic regicide, and ends his term the same way.  Great stuff.

For further reading linking The Golden Bough, The Holy Grail, Wagner's Parsifal, and T.S. Eliot's The Waste Land, check out Derrick Everett's article on The Waste Land.

I'm not certain that Rogers and Hammerstein had these themes in mind when writing Carousel.  Heck, who knows what they had in mind; they threw in a happy ending that wasn't in their source material (but hey, that's show business).  You, dear reader, certainly didn't have these themes in mind when you tuned in to today's edition of Grand Rounds.  Nevertheless, on with today's show.

Provider Bloggers

At Musings of a Distractible Mind, Dr. Rob discusses Atul Gawande's recent New Yorker piece on health care cost variations across the country (a good read, well worth the time), which focuses on McAllen, TX, a small border town that consumes far more than the average annual per capita amount of health care services.  Gawande loops in the Dartmouth Health Atlas folks, asks the hard questions about physician-owned facilities and financial incentives, and concludes that outfits like Geisinger, Intermountain, Kaiser Permanente and Mayo -- not-for-profit integrated delivery systems with salaried docs -- have the model we should strive to emulate systemwide.  Dr. Rob recounts his own experience with physician-owned facilities.  His conclusion is a folksy twist on Gawande's:

How do we fix it?  There are lots of good answers, and lots of dumb ones as well.  The bottom line is the bottom line, though.  How you pay docs will determine what happens.  It’s America, after all.  It’s what makes us great.  Right?

Right.  The thing is, guys, we've known this for at least forty years.

ACP Hospitalist reports on Sid Wolfe's new Public Citizen campaign to get hospitals to step up reporting of physician wrongdoing.  Bob Wachter, at Wachter's World, delves deeper into the problem, and says:

I’m proud to say that over the past five years, my hospital (UCSF Medical Center) has taken Leape’s challenge to heart, withdrawing clinical privileges (and filing accompanying NPDB reports) in several cases for behavior that, I’m quite confident, would have been tolerated a decade ago. This is progress. As Kissinger once said, “weakness is provocative.” As more hospitals take this tougher stance, I think we’ll see the boundaries of acceptable behavior shift everywhere. And patients will be safer for it.

Bongi, at other things amanzi, recalls a suboptimal experience in his training, when the "see one, do one, teach one" approach was reduced to "read an article about one, do one immediately afterwards."

At Providentia, Romeo Vitelli looks at the historical precursors to Jenny McCarthy and the current crop of anti-vaccinationists. 

Ken Cohn, a physician and consultant (who I know in real life [IRL]), recounts a (positive) experience in asking health care administrators to consider ethics in physician-hospital relationships.

I take a baby aspirin a day, and Doc Gurley says I should keep on doing so, because I'm better off puking up blood than having a heart attack.

Seizures and how they have been misunderstood (epilepsy vs. demonic possession) is the subject of this week's selection from Mind, Soul and Body.

Suddenly becoming a first responder at 35,000 feet? On Your Meds' Barbara Olson takes you there.  (The blog is part of Medscape, so free registration is required).

NurseAusmed recounts difficulties in handling patient communications and managing patient expectations at Nursing Handover.

How to Cope With Pain takes a page from a book offering guidance to those who have lost their spiritual way and turns the advice to use for those facing physical, rather than spiritual, pain.

Web 2.0 meets the health care establishment, and KevinMD [IRL] observes that since health care is largely a business, this should not be surprising.  For a window into social media use by health care provider organizations, check out healthsocmed.

The anonymous author of Notes of an Anesthesoboist says it's hard for women doctors to make friends . . . perhaps they should introduce themselves as drug pushers instead?

John Crippen wants to, but the NHS Blog Doctor just can't look away from the kids pushed onto TV talent shows by 21st century stage mothers.

Paul Levy [IRL] goes another round with SEIU Local 1199 at Running a Hospital.

At UDM Solutions, David Siwicki provides a clinical perspective on deciding whether to prescribe opioids for chronic pain patients who use marijuana.

Nancy Brown offers sound advice on talking to teens about alcohol at Healthline's Teen Health 411.

Follow the Money

DrRich, at the Covert Rationing Blog, always follows the money, and this week the trail leads to the following unlikely destination: the American College of Surgeons encouraging malpractice suits -- against overseas surgeons offering services to medical tourists.

Big Pharma also always follows the money, and David Williams, at the Health Business Blog, remains perplexed over Pharma's failure to engage with the public via twitter.  (GSK has already responded to David's post, but in a way that doesn't exactly undercut his point.)  For a window into Pharma's engagement with social media, look no further than Shwen Gwee, who organized the Social Pharmer unconference in conjunction with the HealthCamp Boston unconference I co-organized in late April.  Speaking of social media, feel free to follow me on twitter: @healthblawg.  

Last week, I took a look at the proposed Medicare Inpatient Prospective Payment System (IPPS) updates for FFY 2010.  Among other things in the rule (including payments cut to the bone), I was surprised to see tucked away in there a tacit acknowledgement that the whole "no pay for never events" thing isn't really saving anybody that much money.

Lots of hospitals are touting new private rooms these days.  Seems to help patient care (lower infection rates, better sleep, more privacy), but despite the benefits, Jeffrey Seguritan at nuts for healthcare observes that the private room is being pushed by the AIA, and wonders whether health care dollars really ought to be spent these days on capital projects such as these.  (My brief response: these days, they really aren't, given the tight financial markets).

In a medblogosphere first, The Happy Hospitalist has publicly described an entry in the $10 million X Prize competition:

How do you [reduce health care costs dramatically]?  Here's my theory.  You can do more to affect health care costs by getting 10,000 people to change their lifestyle habits than you can by getting a few hundred docs to change how they document and collect data and prescribe some pills.

So here's what you do.  You bribe the public.  People are inherently lazy, but they respond well to piles of money.

For a fuller introduction to the X Prize competition: Scott Shreve [IRL] posted his twitterview on the X Prize with Bertalan Mesko (@berci) at Crossover Health.  Learn more about it there.

The big HITECH Act pot of money that everyone in health IT is itching to get their hands on is going to have some strings attached: chief among them are going to be definitions of "meaningful use" and "certified EHR."  Them that are likely to be certifying -- CCHIT -- have been the target of some possibly well-deserved pot-shots, and the gloves have come off.  See Gilles Frydman's [almost met IRL at the Health 2.0 conference in Boston a month or so ago] framing of the debate at e-patients.net and John Moore's [IRL] take at Chilmark Research.  

Health technology research and development yielded two bits of news this week: FDA approval of a handheld ultrasound unit, via Vijay Sadasivam's scan man's notes, and Ves Dimov's post at Clinical Cases and Images on the Rovio - a WiFi-enabled mobile webcam, which may be more attractive to medical users given the recent study that found patient satisfaction, physician satisfaction and diagnostic agreement (measured both between face-to-face and virtual vists, and between two face-to-face visits) to be similar for face-to-face and virtual visits.  (Yesterday's Boston Globe took a closer look at this study, virtual visits in general, and American Well in particular.)    

The health IT crowd is working on interoperability and portability of health information.  Google Health is one of the platforms that may enable folks to reach this holy grail.  Brian Dolan at mobihealthnews says that Google Wave, an open-source tool for communication and collaboration, looks like a killer tool for enabling Google Health to do more in terms of provider-provider and patient-provider collaboration.

Evan Falchuk's observation at See First on prevention: it ain't cheap; treatment of preventable disease is more expensive than the savings from avoided disease and complications, so we need to be talking about more than cost-effectiveness.  [Supposed to meet IRL soon.]

Patient Bloggers

For some reason, diabetics are very well-represented among Grand Rounds' usual suspects.  This week, they're turning into media critics as well, following President Obama's nomination of Sonia Sotomayor to the Supremes.  Amy Tenderich [who I also almost met IRL at Health 2.0] touched on the media frenzy regarding the nominee's Type 1 diabetes at The Diabetes Mine, as did Six Until Me's Kerri Morrone Sparling.  Not to leave Type 2 diabetes unattended, Rachel Baumgartel offers tips for the newly diagnosed Type 2 diabetic at Diabetes Daily.  (For those who care to immerse themselves in The Politics of the Sotomayor Nomination, the good folks at SCOTUSblog say come on in, the water is fine.)  For a taste of the difficulties faced by some diabetics traveling through airports with needles and curious liquids, head on over to Tim Brown's post at Shoot Up or Put Up. 

At Getting Closer to Myself, Leslie offers her reflections as a twentysomething with auto-immune disease, specifically a feeling of how she can't go home again to an idealized summer retreat.

Barbara Kivowitz describes a good day at In Sickness and In Health, and invites all of us to do the same.

Bloggers Who Are or Should Be Dancing

Val Jones [IRL] is pretty pleased with her high-deductible health plan (HDHP) - cash-only PCP combo.  I hope her husband is dancing after the office procedure scheduled on a dime last weekend . . . and I hope Dr. Val has all the releases for those photos stashed away somewhere.  It's a good solution for those with no chronic conditions, young kids, or other sources of regular interactions with the medical-industrial complex.  And no less a luminary than Clay Christensen says we're 5-6 years away from the tipping point (to mix metaphors) on HSA/HDHP combos, at which time we're likely to see a significant change in the economics of healthcare (with or without significant movement in DC).  For one example of where this may play out, see my recent post on retail health clinics.

No dancing for you if you're susceptible to one of the side effects of Cipro and its relatives (fluoroquinolones): tendon rupture.  There's a black-box warning regarding this, but many clinicians and patients are unaware, says Paul Auerbach at Healthline's Medicine for the Outdoors.

InsureBlog's Bob Vineyard shares good news for Cuba's pre-op transsexual population: coverage is here.  Surely cause for someone (patients, if not bloggers) to dance.

Well, that's the last dance . . . for this week.  See you around the medblogosphere, and next week at the next edition of Grand Rounds. 

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Health Wonk Review is up

Fellow Bostonian Tinker Ready hosts the current edition of Health Wonk Review at Boston Health News.  Her nod to The Boss reminds me that I'll inevitably be heading to the Jersey shore this summer.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Grand Rounds is up at See First; next week's edition right here at HealthBlawg

This week's edition of Grand Rounds is up at Evan Falchuk's See First.  Welcome to the party, Evan. 

Next week's "June Is Busting Out All Over" edition will be right here at HealthBlawg.  Please write your post's URL on the back of a twenty-dollar bill and mail it to the address on my home page (apologies to Click and Clack) or send it to me via email at david AT harlowgroup DOT net with "Grand Rounds" or "Twenty Bucks" in the subject line.  Please include the post title, blog title and URL, and your name or nom de blog (or that of the author if not you) as well.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Health Wonk Review is up

Have a helping or two of wonkish goodness at the Health Wonk Review smorgasbord, tastefully hosted this week by Julie Ferguson at Workers' Comp Insider.  And, not to cause indigestion or anything, but ... did you hear the one about the $2 trillion in savings ... ?

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Blawg Review #211

See Cartoons by John Darkow - Courtesy of Politicalcartoons.com - Email this Cartoon

President Barack Obama has completed his first 100 days in office, and while we passed that marker a week or so ago, now it's time for a Blawg Review roundup and analysis of all that has happened in, or grown out of, that time (as blogged about in the past week, of course).  If we were to ask FOX News about Obama's first 100 days, all we'd hear about is Socialism.  (Those FOX anchors and analysts seem to be playing a 21st Century neocon version of "Hi, Bob.")  When the President spoke about the first 100 days himself, he reflected on issues faced to date -- swine flu (I mean H1N1), the federal budget, foreign policy (involving Iraq, Pakistan and Afghanistan), Gitmo -- and issues coming up in the near future: health care reform, new rules of the road for Wall Street, credit card consumer protection, federal budget savings, and federal contracting reform.  All that, and questions on the auto industry, torture, Arlen Specter and abortion, followed by a poetic reflection (prompted by a reporter's question) on what made him feel surprised, troubled, enchanted and humbled in his first 100 days in office. 

At the White House correspondents' dinner this past weekend, Obama noted that he's ready for his term to continue: "I believe my next hundred days will be so successful that I will be able to complete them in 72 days," he said. "And on my 73rd day, I will rest."  

Now, while POTUS is just getting his sea legs, the HealthBlawger is a seasoned pro (well, at hosting Blawg Review, anyway: see Blawg Review #88, Blawg Review #129 and Blawg Review #154).  As the ship of state steams on, we will now delve into some of the issues touched on by Obama in his recent address, and other legal and policy issues of note that are at the forefront of concern in the blawgiverse this past week.

But first, since this is Blawg Review #211:  One quick PSA for the "other" 211 (no, not that kind of PSA): Dial 2-1-1 for human services referrals and resources.

And now we're off to the races, looking at the news roughly by Cabinet secretariat, and Cabinet-rank agencies, in order of succession to the Presidency.

Vice President of the United States

The what-he-meant-to-say crew snapped into action after Joe Biden overreacted on the swine flu front.  And then from the frying pan into the fire: this linguistic "teachable moment" was replaced by a moment with Barack and Joe at a burger joint in Arlington, VA that had been cited for health code violations, though we can't tell how recently from the linked post on Bill Marler's Marler Blog.  Now, the Veep is putting together a short list of potential nominees for the Supreme Court seat vacated by Justice Souter.  (More on that below.) 

Department of State

State's getting a lawyer, Harold Koh (Dean of Yale Law School), though opponents of his nomination have been doing the equivalent of yelling "socialism" on FOX.  Anupam Chander works to set the record straight.  (By the way, Harold's brother Howard, former commissioner of the Massachusetts Department of Public Health -- my old stomping grounds -- is also headed to Washington, nominated to be assistant HHS secretary for health.)

Department of the Treasury

From The Conglomerate comes a call to hold off on restructuring the SEC until after the markets have recovered a bit more.  Meanwhile, Professor Bainbridge highlights some of the finer points underpinning insider trading regulation.  James Maul, at Mauled Again, supports proposed tax law changes that would eliminate some corporate/international tax boondoggles.  And Larry Ribstein unburdens himself on the banks' recent stress test at Ideoblog, in one of a series of "Dismantling Capitalism" posts.
 
Department of Defense

The "don't ask, don't tell" era may be coming to an end, according to Mother Jones; the question is whether Obama will insist on waiting for legislative change or if he will go the quicker route and just go ahead and sign an executive order suspending enforcement of the rule.

Department of Justice

While the Supremes aren't within the DOJ, there's certainly a close relationship, and the vacancy in the highest court in the land has prompted all sorts of speculation, grousing and counter-grousing.  This includes Scott Greenfield's review of Sonia Sotomayor's former law clerks' comments, made anonymously (cowardly, in his book) and otherwise at Simple Justice.  While playing the appointment guessing game, consider Jack Balkin's proposal for revamping the appointment system at Balkinization: a new Justice appointed every two years, with the nine most junior doing the heavy lifting, and senior justices hearing individual justice matters and stepping in among The Nine when a junior justice cannot hear a case.

Also tangentially related to DOJ is the same-sex marriage question, being taken up in state courtrooms and legislatures across the nation.  My Constitutional Law professor, Ira Lupu (Hi, Chip!) wrote this week at Concurring Opinions that political compromise through legislation is the way to go when it comes to recognition of same-sex marriage.  He notes with disapproval the Massachusetts rule that all adoption agencies treat heterosexual and gay couples equally in their placement processes, which led Catholic Charities to turn in its adoption agency license.

Department of the Interior

Interior has been getting mixed reviews on its handling of endangered species matters recently. Learn more at the joint UCBerkeley/UCLA Legal Planet blog.

Department of Commerce

We rely on commercial shipping for transport of goods around the world, but U.S. law seems to restrict merchant marine vessels to high pressure water hoses in the fight against pirates, according to Export Law Blog.
 
Department of Labor

Here we veer off-topic for a bit.  With Chrysler headed for ownership in part by the company that used to be run by the fashionable Italian guy who never buttoned down his button-down shirt, let's focus the labor segment of this review on the legal labor pool -- see Adrian Dayton's post on Generation Y at Marketing Strategy and the Law.  In the interests of lessening the labor required of attorneys, ABA TECHSHOW runs a program offering online resources for easing the trials of practice, called 60 Sites in 60 Minutes, featured this week on Jim Calloway's Law Practice Tips Blog.  I had the pleasure of meeting Jim at another iteration of this program in Boston, when the ABA cosponsored a TECHSHOW Roadshow with the Massachsuetts Bar Association Law Practice Management Section (I serve on the Section Council with a dedicated crew of colleagues).  Another set of law practice tips is presented by Matthew Homann of The [Non]billable Hour as a collection of tweets in e-book form.  Speaking of twitter, a number of the blawgers featured in this week's edition of Blawg Review also tweet.  Check out directories at Legal Birds and LexTweet, and follow @healthblawg on twitter.  For a glimpse of a tweetstream in and about a conference, accompanied by a first step towards an analysis of said tweetstream, consider the Health 2.0 example.
 
Department of Health and Human Services

So Secretary Kathleen Sebelius has finally been confirmed, after a week or so of questions regarding whether the country's response to the flu pandemic could have been better organized had her post and a couple dozen others been filled already.  Over at the Becker-Posner Blog, there are point-counterpoint posts on the economics of the flu pandemic, and Posner considers, among other things, the prospect of weaponization of flu virus. 

Moving quickly past swine flu -- and the obligatory joke: "They said we'd have a black president when pigs fly.  Well, swine flu!" (groan) -- There is a whole heck of a lot going on these days in the health care arena.  I hope readers will indulge me in a closer examination of some of these issues, as this is my "home turf." 

One of the "hot" debates in the past week or so has been over two key phrases in ARRA (the recovery act) pertaining to electronic health records ("EHRs"): "meaningful use" and "certified EHR."  These terms are used in the HITECH Act part of ARRA in laying out the requirements for a $19 billion bonanza: physicians and hospitals are eligible to participate in a net pool of $19 billion to cover the cost of implementing EHRs, so long as they are engaged in "meaningful use" of "certified EHRs."  The National Committee on Vital and Health Statistics held two days of hearings on "meaningful use" and "certified EHRs"; transcripts and audio recordings are available on line.  John Moore at Chilmark Research pulls it all together in his post, Making "Meaningful Use" Well ... Meaningful.

If all of our health records end up on line, then more and more of us will be concerned about hackers breaking in, misusing personal information, and potentially holding our records for ransom.  This is exactly what happened recently in Virginia.  Bob Coffield lays it all out at his Health Care Law Blog, and I posted my thoughts on lessons learned from the Virginia data security breach here at HealthBlawg.

Obama has a lot riding on health reform.  At the end of the White House health care summit a couple months ago, in a political masterstroke, he rose above the fray and told Congressional leaders that they knew what he was looking for in a health reform bill, and he would be looking to them to send him something he could sign.  In the time since that heady moment, when everyone was all gung ho for health reform -- from Ted Kennedy to Karen Ignani (her managed care industry association sponsored the Harry and Louise ads that helped tank HillaryCare, but now seems to want to be at the table rather than throwing stones from outside) -- prospects for progress have dimmed, principally due to the question of how we will pay for all this health care goodness.  If Congress can't put aside political expediency and be intellectually honest about this question, it just won't happen.  See two of Bob Laszewski's recent posts on the subject at his excellent Health Care Policy and Marketplace Review here and here.    

Office of Management & Budget

OMB Director Peter Orszag blogs at the OMB Blog (in his spare time); when the White House released its budget proposal last week, Orszag focused on the $17 billion in cuts -- programs that pay for things like cleaning up abandoned mines that have already been cleaned up, an early childhood program called Even Start that apparently doesn't do as good a job as Head Start, etc.

United States Trade Representative

Obama has had to walk a fine line on trade through the primaries and general elections, but as he's hitting his stride (when not preoccupied with the crisis du jour) he's been coming down in favor of free trade.  See the International Economic Law and Policy Blog for more on this topic.  The USTR is named Ronald Kirk -- a name I nearly mistook for Rahsaan Roland Kirk, a tremendous multi-instrumentalist famous for multi-tasking, and from whom his near-doppelganger may learn a few things.
 
United States Ambassador to the United Nations

While the United Nations is often a disappointing organization, the United Federation of Planets seems to have its heart in the right place.  Coming full circle to the start of this post, The Volokh Conspiracy considers whether Star Trek's Federation is socialist.  (That blog's title always seemed to have a Klingon ring to it, anyway.)

There are a handful of other cabinet-level agencies without blawg posts from the past week at hand to illustrate their relationship to today's theme (and please excuse the free-associative nature of the Labor section, above), so I will simply list them here and invite readers to add additional first hundred days issues relating to their jurisdictions in the comments section: 

Between Interior and Commerce in the line of succession comes the Department of Agriculture; between HHS and OMB come:

Department of Housing and Urban Development
Department of Transportation
Department of Energy  (I can' t resist a quick reference to Donklephant which, true to its name, seems to find more common ground than most between Dems and the GOP on energy policy.
Department of Education
Department of Veterans Affairs
Department of Homeland Security
Council of Economic Advisers
Environmental Protection Agency

White House Chief of Staff

Finally, we come to the chief of staff.  I like Rahm Emanuel's comment that the President has an open hand but a firm handshake.  Sort of fits the gentleman-who-takes-no-prisoners image.  But he does have quite a mouth on him.  At the correspondents' dinner Saturday night, Obama observed that Rahm Emanuel always has a hard time on Mother's Day: "He's not used to saying the word 'day' after 'mother.'"

Blawg Review has information about next week's host, and instructions on how to get your blawg posts reviewed in upcoming issues.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Blawg Review is up at China Law Blog; Next week's First 100 Days edition will be here at HealthBlawg

China's May 4th movement is marked today by Blawg Review # 210, up at China Law Blog.  Dan Harris tried to bring on world peace through his last outing as BR host, but it didn't work, so he's fired up the cynicism in the current edition. 

Whether you're a starry-eyed idealist or hard-bitten cynic, I welcome your blawg post submissions for next week's First Hundred Days edition, now that we've had a week or so to mull it all over.  (I've tried a lot of things, but not bringing on world peace, in my prior outings as Blawg Review host.)  Send in the cream of the crop of commentary and analysis regarding the Obama Administration's start, through the usual Blawg Review channels.  See you all back here at HealthBlawg then if not before.

Oh, and May the Fourth be with you. (Groan.)

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Health Wonk Review is up

Bob Laszewski hosts the current edition of Health Wonk Review at Health Care Policy and Marketplace Review -- check it out if you're ready for a dive into all things health care: health care reform, IT, payment, congressional jockeying, social media and related wonkery.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Blawg Review goes green

Today's edition of Blawg Review at Green Patent Blog celebrates Earth Day by examining the EPA's stance on greenhouse gases, the carbon footprint of spam, a lawsuit involving the appropriation of Woody Allen's image (dressed as a hasid in Annie Hall), a trademark case about silver birch that sounds more like slippery elm, the HealthBlawger's post about the controlled environment of the hospital operating room, and going camping in the great outdoors.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting