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November 22, 2004

Cargo Daily Gloss

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What's this?

No, not a new rival for USA Today put out by UPS; rather, it's a clever repackaging of lip gloss.

Taking its cue from Prada's throwaway line, Cargo's taken its lip gloss and packaged it in individual tear-away bubble pouches.

Each sealed bubble (3 shades/10 bubbles each) is good for one application.

$10 here.

November 22, 2004 at 04:01 PM | Permalink | Comments (2) | TrackBack

Pinar Yolacan is 'The Tripe Artist'

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The 23-year-old design student turned artist makes clothing out of tripe.

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Yes, the real thing - the lining of a cow's stomach.

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Cathy Horyn wrote a story about Yolacan's work (pictured above and below) in last Tuesday's New York Times Fashion section.

A showing of her photographs, "Perishables," opens at the Rivington Arms gallery on New York's Lower East Side on December 10.

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The Turkish-born artist, asked about why she chose to work in her strange medium, replied, "I've always been interested in the impermanence of things."


November 22, 2004 at 03:01 PM | Permalink | Comments (1) | TrackBack

BehindTheMedspeak: New CT technique threatens to break cardiologists' rice bowl

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Last Wednesday Gina Kolata wrote a front-page story for the New York Times about a revolution in the diagnosis of coronary artery disease.

It threatens to sharply limit the lucrative angiography/stent implantation bread-and-butter practice of today's invasive cardiologists.

The new procedure's called "Multi-detector CT scanning."

It's faster (taking seconds, and allowing the patient to leave immediately, as opposed to hours on the angiography table, the need for sedation, and an overnight stay in the hospital).

It's cheaper ($700, as opposed to $4,000 for an angiogram).

It's safer (no anesthetic overdoses, no bleeding, no perforation of the coronary arteries requiring emergency open-heart surgery).

It's more detailed (provides a clearer picture of the coronary arteries both inside and out).

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Here's the article.

    Heart Scanner Stirs New Hope and a Debate

    What if doctors had a new way to diagnose heart disease that took only seconds and provided pictures so clear it showed every clogged artery, so detailed that it was like holding a living heart in your hand?

    In fact, that new way exists and is coming into use in scattered areas of the country, and there is wide agreement that it will revolutionize cardiology.

    The scans can largely replace diagnostic angiograms, the expensive, onerous way of looking for blockages in arteries, and can make diagnosis so easy that doctors would not hesitate to use them.

    They are expected to cost about $700, compared with about $4,000 for an angiogram.

    Moreover, the scans take seconds to conduct and require no recuperation time; angiograms take nearly an hour and patients must stay in the hospital for a day.

    The new scans can see not just the outline of blood vessels but every detail inside and out.

    Even so, there is hardly wide agreement over whether this new technique, known as multidetector CT scans of the heart, is entirely a good thing.

    Indeed, critics say, the technology is ripe for overuse, with doctors scanning people who do not need to be scanned and finding - and fixing - medical problems that do not need to be fixed.

    Even within one institution, cardiologists differ.

    The scans "will completely revolutionize medicine," said Dr. Mario J. Garcia, director of the echocardiography lab at the Cleveland Clinic.

    Diagnosis of heart disease, he argued, will be transformed, and lives saved.

    Dr. Garcia gave an example: Most people who come to an emergency room with chest pains have a pulled muscle and are not having a heart attack.

    Yet many are admitted to the hospital and observed for 24 hours.

    "That's very expensive," he said.

    "You have to do blood tests and monitor the heart for a day and maybe do a stress test before they let you go home.''

    If the tests look suspicious, the patient is sent for an angiogram.

    But, Dr. Garcia said, "this CT machine in an emergency room could take a picture and very quickly tell" whether the pain is from a blocked artery, or not.

    He added: "That's a phenomenal potential. I am convinced it will change the practice of medicine.''

    Dr. Garcia's colleague, Dr. Steven Nissen, head of clinical cardiology at the Cleveland Clinic, has a very different opinion.

    "To me, it's a nightmare waiting to happen," said Dr. Nissen, who is calling for strict guidelines overseeing use of the new machines.

    "I am concerned that it is going to be difficult to control and it could bust the health care system in terms of cost."

    It is, medical experts agree, an extraordinary time in cardiology.

    Depending on which way the scanning market goes, the nation could save a fortune on diagnostic tests, and medical care could be improved.

    Or expenses could soar and patients could be harmed. The question is, how, if at all, can the technology be controlled?

    With the new scans, most patients with chest pains or other symptoms will no longer need angiograms to see if a coronary artery is narrowed or blocked by atherosclerosis.

    That procedure typically takes 45 minutes and requires sedating the patient, threading a catheter from the groin to the heart, injecting a dye and taking X-ray pictures that show outlines of the arteries.

    It is about four times as expensive as the new CT scans are expected to cost.

    Excited by the scans' potential, companies including General Electric, Siemens, Philips and Toshiba are competing to make the machines.

    They say they could save the health care system money by replacing diagnostic angiograms and be lucrative for doctors and hospitals - as well as for the manufacturers.

    Hundreds of medical centers have scanners that can show the heart and its arteries, but companies are only now installing their most recently developed machines, ones with as many as 64 detectors, as compared with old machines that had at most four detectors and could not provide clear images of a beating heart.

    In a CT scan, X-rays pass through the heart and are picked up by detectors that send information to a computer that constructs an image.

    The more detectors, the greater the resolution.

    G.E., for example, says it will install several of its 64-detector machines in medical centers by the end of the year and several hundred by the end of 2005.

    The Cleveland Clinic just got a 40-detector machine, made by Philips. Siemens has already installed 20 of its newest machines in the United States, including one at the New York University Medical Center.

    Mount Sinai Medical Center in Manhattan has several new machines made by different companies, "to encourage competition," said Dr. Valentin Fuster, a cardiologist there.

    Yet some heart experts see trouble ahead.

    For example, the scans identify narrowed coronary arteries in people with no symptoms of heart disease, like chest pains.

    Once a narrowing is detected, many doctors and most patients want to fix it, inserting a stent or doing bypass surgery - even though research shows such actions will not prevent heart attacks in such patients.

    Patients might think such a procedure reasonable, just in case. But "you have a lot to lose," said Dr. Geoffrey Rubin, the chief of cardiovascular imaging at Stanford University Medical Center.

    "All these procedures are risky," and with no demonstrated benefit, there is no justification for the risk, he said.

    For example, putting a catheter in an artery in preparation to insert a stent can accidentally separate layers of the coronary artery.

    "It can create disease where none existed before," Dr. Rubin said.

    "There also is a small but very real risk of stroke when the catheter comes along the aorta, and something can flick off and go to the head," Dr. Rubin said.

    The scans also show the lungs, and often reveal little spots, almost all of which are harmless.

    But once the spots are seen, many patients have extensive testing, even surgery, to find out whether they are cancers.

    Even if a cancer is found, patients may not be helped, said Dr. H. Gilbert Welch, an expert on early diagnosis at the Veterans Affairs Medical Center in White River Junction, Vt.

    Cancers do not always spread and cause harm; most simply stay small and inconsequential, but no one knows which early cancer is dangerous and which is not.

    And no one knows whether operating on early cancers saves lives or whether the deadly cancers have already spread by the time they are found.

    By incidentally scanning the lungs of symptomless people, Dr. Welch said, doctors will find these small spots, frighten many patients and lead many to have biopsies and other procedures for tiny, harmless lumps.

    "We can cause more problems than we can solve," Dr. Welch said.

    Yet researchers say the new heart scans also hold immense promise.

    "This is a technology that has the potential to revolutionize the way we practice cardiology in this country," said Dr. Joao Lima, a cardiovascular imaging specialist at Johns Hopkins University School of Medicine.

    Unlike angiograms, scans can show dangerous areas of fatty deposits in arteries that are not blocking blood vessels but that could rupture and cause a heart attack, said Dr. William O'Neill, the corporate director of cardiology at William Beaumont Hospital in Royal Oaks, Mich.

    That could let doctors scan smokers and middle-aged and elderly people, find those at risk of a heart attack, and treat them with drugs, potentially saving lives.

    The scans have some limitations.

    They cannot penetrate extensive areas of old, calcified plaque, they do not work well when patients are obese or have abnormal heart rhythms, and they use high doses of radiation, similar to the doses used in angiography.

    Heart disease researchers say that now is the time, while medical centers evaluate the scanners, to make sure they are used only when they will be truly beneficial.

    But that may not be so easy.

    "It's very, very, very hard to control a technology," said Dr. Mark Hlatky, a professor of health research and policy and of medicine at Stanford University.

    The machines cost $1.5 million to $2 million each. But G.E., for one, says the expense is not much more than what it costs to build an angiography suite and argues that the scans can soon pay for themselves.

    Four to six patients can be seen an hour, the company notes, compared with one patient an hour getting an angiogram in a coronary catheterization laboratory.

    And while the scans are expected to cost less, "the payback to the institution is typically much sooner" with CT than with a coronary catheterization laboratory, said Sholom Ackelsberg, general manager for global CT and functional imaging research at G.E.'s health care division.

    It may not be just the institution that collects money, said Dr. Eric Topol, a cardiologist at the Cleveland Clinic.

    Coronary catheterization is conducted in a hospital, and insurers make one payment, a "facilities fee," to the hospital and another to the cardiologist who does the test.

    Cardiologists, radiologists and others could buy their own CT scanners, though, so all the payments could go to them.

    The customary amount that insurers will eventually pay for CT scans is not yet known, but "obviously, there's a potential for being financially remunerated at a high level," Dr. Topol said.

    Radiologists also say they could do the CT scans, assuming much of the business of cardiologists, who had angiography all to themselves.

    "Cardiologists made a lot of money with stress tests and coronary catheterization," said Dr. David Dowe, a radiologist who is medical director and chief operating officer of Atlantic Medical Imaging in Galloway, N.J.

    "Now radiologists are capable of doing this test without a cardiologist's involvement."

    Some who have had CT heart scans are delighted.

    At Beaumont Hospital, which has a new Siemens scanner, Dr. O'Neill had a scan himself.

    He has also had an angiogram.

    With a strong history of heart disease in his family, he wanted to check his arteries, even though he had no symptoms.

    "The difference was just amazing," he said of the two scans.

    "With the angiogram, I was in the cath lab, lying on the table, unclothed, with a catheter in my groin, and then I had to lie down for eight hours of recuperation.

    "With the CT, I went downstairs, they put an I.V. in my arm, I took off my shirt, lay down, and within 15 minutes I was back at work," Dr. O'Neill said.

    His blood vessels, he added, were fine.

    Dr. O'Neill said he too is concerned about overuse.

    But his experience - having a CT scan though he had no symptoms of heart disease - is exactly what worries doctors who fear it will lead to unneeded treatments.

    If scans were used for people at risk for heart disease, almost everyone would be a candidate, Dr. Topol said.

    About 75% of adult Americans have risk factors for heart disease.

    Most middle-aged people have narrowed areas in their arteries.

    "Coronary narrowings are pervasive, endemic in our society," Dr. Topol said.

    But even as the scans are being evaluated at major medical centers, doctors in private practice are offering them to patients.

    Dr. Dowe, the radiologist, conducts such tests.

    He said he had done about 1,000, many on people with no symptoms of heart disease but who are at risk.

    Insurers, including Medicare, pay him $700 a scan for patients with symptoms, he said. As the insurers instructed, he bills for a CT angiogram of the chest.

    When Dr. Dowe sees plaque that is growing in the artery wall, a sign of developing heart disease, but no narrowings, he advises medical management for the patient, like cholesterol-lowering drugs or drugs to control blood pressure.

    The scan can be a real impetus to start a treatment, or stick with one, he said.

    Dr. Topol said there was no justification for scanning people at risk of heart disease, but with no symptoms.

    "I wouldn't have imagined that this could have gone so far already in the wrong direction," he said.

    He and others hope that professional medical societies can set guidelines for appropriate use, and insurers can enforce them.

    Dr. Nissen wants guidelines, too.

    "I am vice president of the American College of Cardiology and in 2006 I will be president," he said. "I will press for an appropriateness standard," to guide the use of the scans.

    Such guidelines have not stopped overuse in the past, he acknowledged.

    And, in this case, he said, "I am afraid the genie is already out of the bottle."

November 22, 2004 at 02:01 PM | Permalink | Comments (0) | TrackBack

Real Thumb Drive

Vial

I did a double-take when this baby popped up on my screen.

Looked pretty damn real to me.

It's a USB 2.0 flash drive in the shape and color of a human thumb.

Each one's hand-made in a prosthetics laboratory.

128 MB, 256 MB, 512 MB, or 1 GB.

PC or Mac.

Prices start at $39.95 for 128 MB.

Like the website says, "Sure to be the one thing that the TECH person on your Christmas list doesn't have but would love."

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Weird and wonderful.

[via luzsombra]

November 22, 2004 at 01:01 PM | Permalink | Comments (0) | TrackBack

Monkey Shakespeare Simulator

Monkey

"If you have enough monkeys banging randomly on typewriters, they will eventually type the works of William Shakespeare."

We've all heard the old saw, but someone decided to see if it were really true.

This website's been up since July 1, 2003, and so far the best the monkey-equivalent's been able to do is the first 22 letters of "Cymbeline."

William

But be patient: we've got all the time - literally - in the world.

November 22, 2004 at 12:01 PM | Permalink | Comments (2) | TrackBack

FacesOnTime.com

Home_watches

What's this?

"Have your favorite photo set in a quality timepiece."

Sounds good to me.

For $89, facesontime.com will create a high-resolution, distortion-free reproduction of any picture you send them, then set it between the watch dial and the crystal.

This lets the whole image be clearly displayed, unobstructed by the watch's hands and center pin, yet lets you see the time at a glance.

The trick is the company's proprietary image suspension system.

They'll also inscribe your watch free.

Takes 2-3 weeks from your online or snail mail order until you get your watch, so if you're gonna do it for Christmas, better get on the stick.

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Should you choose to use an old-fashioned snapshot or other picture, they'll return it unharmed along with your cool new watch.

November 22, 2004 at 11:01 AM | Permalink | Comments (0) | TrackBack

MorphWorld: Pat Conroy into Don Zimmer

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The superb author, whose latest book, "My Losing Season," revolves around basketball, is looking more and more like the legendary gerbil, aka Zim.

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November 22, 2004 at 10:01 AM | Permalink | Comments (0) | TrackBack

KidSafe™ Stove - The best idea I've had this year

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Back when I was on the anesthesia faculty at the University of Virginia Medical School, Jessica Lange and Sam Shepard's little boy, about three or years old, was admitted to the hospital with extensive third-degree burns.

How did he get burned?

He was in the kitchen, reached up and grabbed the handle of a frying pan filled with hot oil, and tipped it over onto himself.

Horrible.

This kind of thing happens every day, many times, all over the world.

Last night, while musing about my rather lazy nature - more on that in a minute - an idea for an invention to end such nightmares occurred to me.

Let me back up a bit first, though, to the subject of my sloth.

You may find it hard it hard to believe I'm lazy.

Most people think I'm kidding.

But I am.

Lazy - not kidding.

My laziness, however, takes a peculiar form: it revolves around thinking about how I can do things with the very least effort possible.

Anyway.

One of the two front burners on my electric stove is broken: specifically, one of the two coils that spiral around each other is out.

It's the large burner; the one next to it is a smaller one.

So the large burner still works, but half as fast as it should.

So when I want to cook something with maximum heat, I use the large burner of the two in the back row.

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I've been doing this for over a year.

I called my electrical repair company and they never called back.

Then I thought maybe I could replace it myself, but it turns out not to be plug-and-play at all, but rather requires tools and stuff.

Not my cuppa, not with electricity, no way José.

Wait a minute - I'm José.

Never mind.

I've gotten used to using the back burner, not really an issue.

Last night, it occurred to me: using the burners in the back row means the pot and frying pan handles are always over the stove, and never extend out into the space in front.

The space where a little kid, seeing a handle, might reach up and grab it.

So my first thought was, have the stove makers offer a cut-off switch for the front burners, for families with kids.

But then the far better, more obvious solution occurred to me: put all the burners in the back row.

What a great idea: no more handles to pull down on and cause massive third-degree burns.

Tons of working space right up on the stove, where you're cooking.

Take this idea and get rich.

Patent it first, though.

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If you don't, someone else will.

November 22, 2004 at 09:01 AM | Permalink | Comments (2) | TrackBack

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