Below is an excerpt from the full conversation, which is available on epmonthly.com. Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online.
A Llama Antibody Could be the Key to Universal Flu Vaccine
https://www.biospace.com/article/a-llama-antibody-could-be-the-key-to-a-universal-flu-vaccine/
Good news: Study using llama antibodies shows promise in creating influenza vaccine for humans.
Bad news: Study participants developed this inexplicable tendency to spit in other people’s faces.
– William Sullivan, DO, JD
Well folks…it looks like size doesn’t matter. Although llamas are large and fluffy, it turns out their antibodies aren’t. Due to the smaller size of their antibodies it is hypothesized that they can latch onto parts of the hemagglutin influenza protein that are less prone to mutation, at least in mice. Sixty percent of the time, it works every time.
– Salim R. Rezaie, MD
I had no idea that llamas, alpacas and indeed all camelids have antibodies composed only of heavy chains — and their single binding site is about 1/10 the size of a typical human antigen binding fragment. Beyond flu, there’s work on using these special antibodies for cancer, coagulopathies and more. These creatures are strange, but we’re glad to have them.
– Nicholas Genes, MD, PhD
A San Antonio Strip Club goes by the name Emergency Room
I don’t think there is any risk of confusion, as exotic dancers and bartenders are not exactly standard hospital staff. Could you imagine having dyspnea and walking into that environment? Also, don’t worry…if you don’t have cash, I am sure they can just run your health insurance card to cover the visit and just bill you later.
– Salim R. Rezaie, MD
A bar wants to call itself the “Emergency Room Gentleman’s Lounge” and the article says that there is concern from citizens that “some may confuse it from an actual emergency room.” The sign for the building has outlines of women pole dancers next to the “Emergency Room” moniker. If people really think that this place is an actual emergency room, they have more problems than their emergency medical condition if they go there. The legitimate problem that I see is one person telling another person “I’m going to the Emergency Room.” Uhh. Which one? Back in college, there was a bar called “The Library.” When parents called and wanted to speak to roommates, we could legitimately say “they’re going to be at The Library all night.” Was great until parents came out to visit, then wised up and asked “WHICH library” on subsequent calls.
– William Sullivan, DO, JD
Hmm… How to spot the difference between a real ED and this “Emergency Room?” It’s true, both have special rules for VIPs. Both have problems with surprise billing and acquired infections. The difference is, most of us prefer the term “Emergency Department”… but I don’t think you’ll hear the term “ED” mentioned at a strip club.
– Nicholas Genes, MD, PhD
Zuckerberg hospital rolls back $20,243 emergency room bill
https://www.vox.com/health-care/2019/1/24/18195686/vox-zuckerberg-hospital-emergency-room-bill
A series of stories, in Vox and other sites, seems to be moving the needle on the arbitrary cruelty of out-of-network billing for ED visits (perhaps better called “surprised lack of coverage”). Trauma patients don’t have much say in what ED they’re taken to, and have no way of checking if their ED doctor fits their insurance plan. It’s a victory for journalism that some of these outrageous bills have been reduced, and that elected officials are looking into the billing practices of some of the worst offenders, like Zuckerberg General Hospital. It’s the kind of thing I wish we had taken the lead on! Last month, ACEP finally advanced a framework for tackling this issue (link: http://newsroom.acep.org/2019-01-28-ACEP-Presents-Framework-To-Protect-Emergency-Patients-From-Out-Of-Network-Billing-Issues ) and Vox’s Sarah Kliff noted similarities between the ACEP proposal and some bills floating around in Congress, and seems to think ACEP’s timing and content is strategic. I’m all for smart strategy and coordination to get legislation passed, but would feel better as an ED physician if ACEP used its bully pulpit more, to raise awareness about this terrible risk to patients.
– Nicholas Genes, MD, PhD
What a hopeless quagmire. On one hand, federal laws require screening exams and treatment for any emergencies for all patients without any consideration for payment. The amount of charitable care and medical care provided at less than cost by emergency physicians is immense. A Kaiser Family Foundation study pegged the amount of charitable care in the US at $75 billion in 2013 and a 2005 study pegged the amount of uncompensated care by emergency physicians between 25% and 80%. On the other hand, a patient on a bicycle gets hit by a car, suffers a broken arm and despite insurance, is billed $24,074 for treatment. Then, when the story goes viral, the bill is discounted to $200. Transparency in billing is a good first step. If a hospital is embarrassed by its charges to the point that it discounts those charges more than 99% when the charges are made public, then the hospital shouldn’t be charging those prices to begin with. I agree with Nick that ACEP could be doing a much better job of addressing these issues. Right now, public animus is wrongly directed at emergency physicians for this mess. We’re the good guys trying to save your lives, remember?
– William Sullivan, DO, JD