The Knights of the Round Table

Charge Given to the Knights by King Google*

God make you a good men and women and fail not of beauty. The Round Table was founded in patience, humility, and meekness. Thou art never to do outrageousity, nor murder, and always to flee treason, by no means to be cruel, and always to do patients, the elderly, and gentle children succour. Also, to take no battles in a wrongful quarrel for no law nor for no world's goods, except for fee for clicks.

Thous shouldst be for all nurses, doctors and patients and fight for their quarrels, and ever be courteous and never refuse mercy to them that asketh mercy, for a knight that is courteous and kind and gentle has favor in every place. Thou shouldst never hold a medical record, patient, nurse or gentle caregiver against their will.

Thou must keep thy word to all and not be feeble of good believeth and faith. Right (and privacy) must be defended against might and distress must be protected. Thou must know good from evil and the vain glory and profit motives of the world, because great pride and bobance maketh great sorrow. Should anyone require ye of any quest so that it is not to thy shame, thou shouldst fulfil the desire by asking medical bloggers and patients themselves.

Ever it is a worshipful knight’s deed to help another worshipful patient with search engines when he seeth him a great danger, for ever a worshipful man should loath to see a patient misinformed, for it is only he that is of no knowledge and who faireth with cowardice that shall never show gentleness or no manner of goodness where he seeth a patient in any danger, but always a good man will do another man as he would have done to himself.

Do not, nor slay not, anything that will in any way dishonor the fair name of the US Healthcare System for only by stainless and honorable lives and not by prowess, conflicts of interest, and courage shall the final goal be reached. Therefore be a good knight and so I pray to God so ye may be, and if ye be of prowess and of worthiness then ye shall be a Knight of the Table Round.

-Wes

* With apologies to kingauthursknights.com.

Hat tip: Kevin, MD.

Dr. Charles Bids Farewell

Without doubt one of the most eloquent writers in the medical blog-o-sphere, Dr. Charles is taking an extended break to pursue his passion.

-Wes

Do Residency Restrictions Limit Clinical Competencies?

“Good judgment comes from experience. Experience comes from bad judgment.”
-- Anonymous

“I have missed more than 9,000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot, and I missed. And I have failed over and over and over again in my life. And that is precisely why I succeed.”
-- Michael Jordan

Ask any doctor in practice today what they think about residency programs, and most will tell you they do not represent medical reality. But then, residency should not represent independent practice, should it? This week, the New England Journal of Medicine has two articles describing the dilemma faced by the residency training programs: residents’ work hours and continuity of care. Residents want shorter work hours by sharing care of patients with other residents, but frequent handoffs of care may result in as many medical errors as created by an exhausted resident.

Kevin Volpp, an assistant professor of medicine and health care systems at the University of Pennsylvania, is conducting a large national study of patient outcomes that attempts to examine the impact of the (Accreditation Council for Graduate Medical Education) rules, using data on millions of patients in the Medicare and Veterans Affairs systems. "We're basically looking at the net effect of reduction in sleep deprivation versus reduction in continuity of care," he said. "One of the big challenges is figuring out how to tease this apart and examine the tradeoffs." Volpp said the evidence is compelling that assigning residents to shorter shifts reduces errors caused by fatigue. However, shortening residents' shifts requires adding staff such as physician assistants, nurse practitioners, and hospitalists, and he noted that despite receiving Medicare subsidies for residency training, teaching hospitals operate on slim financial margins and have recently seen substantial reductions in Medicare funding. Considering the cost of further reducing duty hours, Volpp asked, "Is this the best use of resources that could be targeted to reducing medical errors?"

But is reducing errors really what we should be striving for in residency programs? Will further reducing work hours limit exposure to eduational experiences? Will residents have enough opportunities to stumble, trip and fall in a protected environment like residency so they can later succeed as attending physicians? Or is achieving a residency utopia in training with no medical errors more important than later clinical competency as an attending physician?

Certainly worth pondering…

...especially when good judgment comes from lots of experience.

-Wes

MedBlog Power

Thanks to Kevin, MD, with his amazing ability to stay abreast of the latest news and commentary in medicine while working as a practicing internist, for his mention as a member of the his weekly MedBlog Power 8.

-Wes

Who Needs Minute Clinics?

...especially when you can order your own blood tests for heart screening online yourself?

HeathCheckUSA is proud to offer a heart check profile, which is essential for anyone concerned about their cardiovascular health. Even if you have no immediate concerns, a heart check profile is a good way to gauge your baseline levels for future comparisons. Our heart check profile combines many different of the following tests, which combined give you a good measure of your overall heart health. The combination of homocysteine, highly sensitive C-reactive protein, Chem-26, and the revolutionary VAP (Vertical Auto Profile) cholesterol profile makes our Heart Check Profile the most comprehensive cardiovascular disease assessment HealthCheckUSA offers.

Yee hah! Can't wait to see all those people who've gotten false positive results in my clinic! I mean with over 30 blood tests being performed, what are the odds someone will have one abnormal test if we estimate there's is a 2% false positive or false negative rate? About 60%!!! Yee hah! Better than even odds!

But their "comprehensive cardiovascular disease assessment" misses what's really needed - a good history and physical. From the Third report of the National Cholesterol Education Program Expert Panel's report (ATP-III):

"The identification of cholesterol disorders in the setting of a medical examination has the advantage that other cardiovascular risk factors—including prior CHD, PVD (peripheral vascular disease), stroke, age, gender, family history, cigarette smoking, high blood pressure, diabetes mellitus, obesity, physical inactivity—co-morbidities, and other factors can be assessed and considered prior to treatment. At the time of physician evaluation, the person’s overall risk status is assessed. Thus, detection and evaluation of cholesterol and lipoprotein problems should proceed in parallel with risk assessment for CHD."

And the "VAP®" test they claim is so superior for detecting cholesterol? It's not recommended as a screening test for the general population. Period. From Atherotech's own website:

When used judiciously, the improved LDL-C accuracy and additional ATP III information provided by the VAP cholesterol test can be used to better identify and manage individuals at elevated risk for CHD. (i.e., not as a screening test) The conventional Friedewald calculated profile is recommended for patient screening.

So save your money. And if you're really concerned about your health, see your doctor.

-Wes

It's Sicko, Alright

Michael Moore, health care policy expert, hit Washington DC yesterday to the applause of many of our nations' politicians. But his morning's Tribune commentary from Helen Evans, discusses what he may have left on the cutting room floor.

-Wes

World Record Treadmill Runner

Shouldn't this guy be promoting heart health rather than prostate cancer research?

Ultramarathoner Dean Karnazes will attempt to break the world record by running more than 153.76 miles in 24 hours on a treadmill in Times Square. He'll start running at midnight Thursday and be suspended between two billboards. One billboard will run live video for viewers, along with a clock and mileage counter.

Karnazes plans to raise $1 million for the Athletes for a Cure Foundation, with the money going to prostate cancer research.

Sheesh! But who's going to follow his EKG?

-Wes

Clipboards or Care?

It seems health care is going from bad to worse.

Now we have "lean manufacturing" from the manufacturing industry on which to improve healthcare:

Michael Roberto, an associate professor of management at Bryant University, says the trend will continue as hospitals face increasing pressure to control costs while improving patients' safety and satisfaction.

Much of the demand for factory veterans stems from hospitals' embrace of lean manufacturing techniques. Pioneered by Toyota Motor Corp., lean manufacturing aims to cut waste and reduce defects by speeding up the production cycle, shrinking inventories and implementing just-in-time supply delivery. On hospital wards, lean tactics are used to reduce patient waiting times or prepare operating rooms faster. ThedaCare was among the first to adopt these techniques in 2002.

Ted Stiles, whose recruiting firm specializes in placing managers with backgrounds in lean manufacturing techniques, says demand among health-care providers is up tenfold this year from last year.

Once again, "health-care providers" is a term confused with doctors. Sorry, this doctor does not agree.

"Lean manufacturing" seems to me to be nothing but a euphemism for "lean staffing." Do more with less. Once again, it appears that hospital administrators would rather turn to non-medical auto-industry "efficiency" and "safety" experts, rather than asking health care professionals to recommend the best way to improve care. Instead, they turn to these "experts" to squeeze any amount of remaining professionalism from their medical staff in order to squeeze every health care dime out of the staff they have.

Why? Because nurses and doctors are "expensive" to hospitals.

But what, exactly, is the cost of these hired-gun administrators? Do we really need yet another company or administrator to tell us how to do our job? Is it all about safety and efficacy? Or might providing a better nurse-to-patient ratio be far better at improving care?

And regarding "patient satisfaction?" Ask any patient - is sitting in a dirty bed after soiling yourself and not being able to get a nurse to help you in a time of need what patients want because they've cut back on nursing staff to become more "efficient" and "safe" or "satisfying." Will these clib-board carrying types be on call at 3AM to help answer a call button?

Certainly it is important to provide a safe environment for our patients. No doctor or nurse would argue that fact. But using "safety" and "efficacy" and "patient satisfaction" as a ruse to provide less frontline care in the name of "improving efficiency" is not only potentially dangerous, but expensive too.

-Wes

Addendum: NHS Blog Doctor adds his not-so-subtle pithy bit about this trend as well.

ACLS Recertification Issues

I recently recertified in Advanced Cardiac Life Support, and really wasn't doing to say much, but then, I blog.

Sooooo, I thought it might be informative to discuss a few issues I had with my ACLS recertification process this year.

The American Heart Association provides a course for health care professionals to learn the latest techniques for Advanced Cardiac Life Support in the event an individual collapses of cardiac or respiratory arrest. The certification process is partially performed by company called CardioConcepts (although now it looks like its called 'Scitent') based in Virginia. The recertification process demands a fee for their course and includes an online registration where doctors must now surrender their most personal information (address, phone number, e-mail) to their website on an electronic registration form. You can bet this information is sold, but I digress...

I have some constructive (I hope) criticisms.

If a company is going to teach ACLS instead of doctors, then either the members of this company must first learn EKG's - especially is I have to PAY for the priviledge of undertaking this experience every two years - or else the American Heart Association needs to do a better job proofing the work for hire for which they have contracted.

For the student's pre-test (available on a CD within the ACLS provider book), we find this tracing:

Click to enlarge

So what is this rhythm? The publishers of the student pre-test for ACLS would have you believe it was "Reentry Supraventricular Tachycardia." I wonder if these guys know basic medical terminology. The correct term should be "reentrant supraventricular tachycardia." *Sigh*

But that's not the real problem with this tracing. My guess this tracing is not even reentrant. (I'm open to what other cardiology and EP docs think, here). Look carefully at how this arrhythmia initiates - a slightly premature beat that looks quite similar to the sinus beat - followed in rapid succession by other P waves with a sudden onset with a "warm-up" phenomenon. See the small indentations in the T wave? These suggest a superimposed P wave. I have placed lines above the P waves below:


These findings seem most consistent with an atrial tachycardia to me. Atrial tachycardias usually have an automatic mechanism, not a reentrant one.

And don't get be started about this tracing of Torsade de Pointes which appears on the Student pre-test:


The correct answer (according to their student pre-test) was "Coarse Ventricular Fibrillation." Wrong again. Most texts and online resources I've seen have classified this as arrhythmia as one form of "Polymorphic Ventricular Tachycardia," not coarse ventricular fibrillation. Certainly the treatment for Torsades is very different (consider magnesium, pacing, isuprel, lidocaine, etc.) than for "coarse ventricular fibrillation" (shock, drugs and shock again) and should be recognized by everyone who cares for heart patients.

And I was surprised procainamide was removed from the Tachycardia with Pulses algorithm, especially for irregular, wide tachycardia algorithms as well. I've already discussed my preference for this drug (and why) in an earlier post (See Part I and Part II). Instead, they've decided a "Phone a Friend" option (actually, it says, "expert consultation advised") works best. But sometimes experts aren't there right away...

I do appreciate the folks at the American Heart Association's efforts. I can't imagine what an undertaking organizing the training of the nation's doctors must be like. But we must assure that we train folks correctly and give good examples.

After all, people's lives are at stake.

-Wes

Image credit.

One Expensive Domain Name

Man, they paid $550,000 at auction for Cardiology.com. I mean, I guess it's a good subspecialty name, but it seems the be a high price to me.

But then then again, it might pay for itself if it helps sell about 28 defibrillators or 275 drug-eluting stents...

-Wes

Proving Our Worth

I just don’t get it.

Here’s how we attempt to control the costs of healthcare in America.

First, we must prove to the medical consumer that we have good healthcare in the US and that Medicare is getting their money’s worth, so we assemble TONS of people in the form of associations including: the American Hospital Association (AHA), Federation of American Hospitals (FAH), Association of American Medical Colleges (AAMC), Centers for Medicare and Medicaid Services (CMS), the Joint Commission, the American Medical Association, the American Nurses Association, the National Association of Children’s Hospitals and Related Organizations, American Association of Retired People, American Federation of Labor and Council of Industrial Organizations, the Consumer-Purchaser Disclosure Project, the Agency for Healthcare Research and Quality, the National Quality Forum, the Blue Cross and Blue Shield Association, the National Business Coalition on Health, General Electric, and the U.S. Chamber of Commerce.

Next, we give them a nice marketing name like the “Hospital Quality Alliance.”

Then, they then make sure the hospitals and care providers know the “74 answers” to the tests that they’ll be tested on.

Next, they collect scads of information on every patient admitted to nearly 5000 hospitals across the country.

They spend countless hours of personnel time, intellectual energy, and human resources.

Then they crunch the data.

They spit this data out on a website paid for by the consumer by tax dollars on yet another government department database owned by the Department of Health and Human Services.

And when they reviewed heart disease care statistics, they only find that 17 centers (0.4%) provided exceptional care and 35 (0.8%) provided “substandard” care. Gratefully, they can now justify to those lackluster performers that they will withhold some of their Medicare reimbursements to them and save the government (and taxpayers) a bit of money.

After all, 99.2% of hospitals, they found, are doing a “good” job (at least when it comes to heart disease) by upholding their measures of “good” care.

So what have we learned?

We have now learned that there are millions and millions and millions of dollars of health care and association resources being expended to collect data that might mean something to 0.8% of the hospitals in America and to a tiny fraction of the medical consumers out there.

And will these data really effect care outcomes? For instance, should the ambulance carrying a person with chest pain bypass a hospital with a poor door-to-balloon time in favor of one that meets the standard? Or might this delay care further? Who will decide?

The real outcome question I’d pose is this: Is all of this retrospective review of health care delivery in America worth its cost to gather and process the data when we find it changes how only 0.8% of the hospitals in America will be reimbursed?

Or might our time, energy, and efforts be better expended improving health care facilities, providing programs for the poor, and taking care of patients?

But then, think of all the administrators who might become unemployed, eh?

-Wes

Thankless Dummies

I just saved three people's lives - but I never heard a word from them.

The NERVE!

Could the fact that they were plastic have had anything to do with it?

Ah well, at least I passed ACLS. I'm set for another two years...

-Wes

The MRI-Safe Pacemaker

Magnetic resonance imaging (MRI) scanners are one of the most effective ways to follow soft-tissue and vascular diseases in the body. Unfortunately, sometimes these patients also have heart disease that requires that a permanent pacemaker or implantable defibrillator be installed for control of heart rhythm abnormalities. For these patients, follow-up of their soft tissue tumors is impaired because MRI-safe pacemakers and defibrillators are not available on the market, especially for patients who are dependent on their pacemaker for their heart to beat at all. Fortunately, some investigators (in the US and Europe) have devised special protocols for non-pacemaker dependent patients to undergo MRI scans when they are clinically required. The FDA still frowns on this practice, however.

Studies presented by Sommer et al and Nazarian et al in this issue of Circulation offer further promising evidence in this regard. As with the previous studies, however, the authors acknowledge a multitude of limitations that prevent broad applicability of the results. Furthermore, one of these studies was not entirely free from concerning outcomes with the potential for serious clinical events. We view these results as consistent with our previous message that, on a case-by-case basis, the diagnostic benefit from MRI outweighs the presumed risks for some pacemaker and ICD patients. However, the FDA remains firm in its belief that those risks have not yet been characterized and mitigated sufficiently to justify the routine use of MRI in those populations.

In February of this year, Medtronic began a trial overseas with a new MRI-safe pacemaker called Enrhythm MRI. The was trial recently announced in Canada as well. It will probably be a bit longer before we see the trial spread to the United States, although it looks like the centers have been selected that will participate.

There are several issues with MRI's that can cause problems with conventional pacemaker and defibrillator systems:

• Usually the most common is interference with sensing the patient's underlying rhythm (oversensing, usually of noise, causes the pacemaker to inhibit its output, or undersensing causes the pacemaker or defibrillator to not be able to see the underlying rhythm and may cause pacing at inappropriate times)


• Alteration in programming (like reverting to a power-on reset mode of pacing or actual damage to the circuitry)


• Changes in pacing thresholds, perhaps due to lead movement (torque) or local heating.

A short review of these issues (with references) can be found from this piece from the University of Utah.

Medgadget also has a an even better overview of Medtronic's study and the technology in place to counteract these issues.

I just hope that someday MRI-safe capabilities will eventually become a standard feature in all cardiac devices marketed. After all, patients may have their pacemakers for years before the need for an MRI arises.

-Wes

Taking the Fall With Reduced Risk Cigarettes

Try this experiment some time. It was shown to me in medical school.

Take a brand new box of pristine sticks of chalk - you know - the kind your teachers always used on a blackboard in school. Open the top and be sure all of the pieces of chalk are in one piece but do not remove them from the box. Close the top of the box again.

Now, hold the box of chalk really high over a solid concrete surface (a tile floor usually works well, too).

Now, drop the box and observe it hitting the floor.

Open the box and examine the contents. No doubt you will find many, many shattered sticks of chalk. But almost as certainly, there will be one or two sticks that are still pristine, whole pieces of chalk that survived the fall.

Now why would this have been shown to our medical school class?

Because the speaker was explaining how to counteract this excuse posed to doctors when they attempt to ask a patient to stop moking: "But my mother smoked all her life and she never got cancer!" Statistically, you see, some survive even after they were subjected to the risks of smoking. Just like some pieces of chalk survive when their box is dropped to the floor.

So when I read that Phillip Morris wants to produce a "reduced risk" cigarette or new tobacco products with a "reduced risk" of cancer, I can't help but think that their efforts will be just like dropping a box of chalk from a little lower altitude, hoping that a few more sticks of chalk will survive.

Wouldn't it be better not to drop the box at all?

-Wes

Another Great Grand Rounds

Codeblog does a great job hosting this week's medical blogging grand rounds. Her creativity is remarkable. Be sure to check it out.

-Wes

Another Example of HIPAA Futility

Todd Stroger, the elected Cook County Commissioner here in Chicago, never wanted the public to know that he needed surgery for prostate cancer. He made it clear his health issues were a "personal matter." But the public wanted to know, so the public found out.

Is there any backbone to HIPAA? Does holding public office imply that individuals forfeit their rights to protection under this law?

Interesting questions, eh? What do you think?

-Wes

The Price of Safety

Don't look for drug and medical device prices to come down anytime soon.

(WSJ) Showing that legislation to overhaul drug-safety laws has strong bipartisan support, members of the House Energy and Commerce health subcommittee approved the nine bills on voice votes. The legislation, which also would renew programs that let the FDA charge fees to drug and medical-device companies that help fund the agency, is similar to many provisions contained in a single FDA bill that swept the Senate last month 93-1. The full House Energy and Commerce Committee takes up the legislation tomorrow, and a full House vote is likely in July.

Who do we think is going to pay these fees?

The FDA had proposed collecting $393 million from drug companies next year. Drug companies would pay an additional $50 million under the Senate bill and an additional $225 under the House bill over five years. Much of the extra money would be used to fund drug-safety monitoring programs. Both the House and Senate bills would also authorize the FDA to collect about $287 million in fees over the next five years from medical-device firms.

I assure you, with profit incentives, it won't be the drug and device companies.

-Wes

On Radiation Risks and What's Appropriate

Although I've commented on this before, it's good to see that others are taking notice about the potential problems with excessive use of diagnostic imaging.

But I take issue with this part of the article:

There are several steps patients can take to protect themselves, and they should not be shy about asking questions, doctors and other experts say.

“They can always inquire of the referring physician, ‘Is this test necessary?’ ” said Richard Morin, chairman of the radiology college’s quality and safety committee, adding that “exams are often done for reasons that are not quite appropriate.”

Doctors should be familiar with the radiology college index of appropriateness criteria, which rates the imaging procedures for some 200 medical conditions. Dr. Morin suggests asking the doctor ordering the test about its rating for a given condition.

Scores range from 1 to 9, he said, and “if the number turns out to be 1 or 2, you should look for some other exam.”

Whaaa? Wow, I learned something new... I now have to remember the contents of a 22-page document to see if a test is appropriate or not. I even learned there's a downloadable PDA version of the software, just to make it easy! So watch out docs, patients now might be asking you to consult your PDA while writhing in pain from an acute abdomen: "Gosh, is it acute appendicitis or a kidney stone? Let me check my handy PDA to see if I need to order this CT scan. Gee, there it is! Hot damn, he's a 9 on my handy-dandy xray scale! Okay, Wilma, take him away!"

But "appropriateness" for a test is in the eyes of the beholder. Just ask any emergency room doctor versus the obstetrician selecting a screening test for a preganant mother - each have a different take on the short- and long-term liability risks of such tests. And just for the record, I've never seen an ER doctor whip out his PDA to make such a decision about the "appropriateness" of a radiological test - especially when he's under an ever-mounting pressure to see more patients in less time while trying to never miss a diagnosis for fears of significant liability retribution.

-Wes

Alli's Treatment Effects

The new diet drug, Alli, has some interesting "treatment effects." Here they are:

• You may feel an urgent need to go to the bathroom. Until you have a sense of any treatment effects, it's probably a smart idea to wear dark pants, and bring a change of clothes with you to work
• You may not usually get gassy, but it's a possibility when you take alli. The bathroom is really the best place to go when that happens
• You can use a food journal to recognize what foods can lead to treatment effects. For example, writing down what you eat may help you learn that marinara sauce is a better option than Alfredo sauce

Amazing how the pharmaceutical industry spins side effects as "treatment effects." Bada bing bada boom.

-Wes

Patient-Laundered Direct-to-Consumer Advertising

Direct-to-consumer advertising took a new turn today.

I received this press release for a new website, called StopAfib.org. I follow atrial fibrillation therapies and developments pretty closely, I think, for obvious reason: it's what I do. So when I saw this site I decided to check it out.

The website is nicely executed. It seems to have been sponsored by a patient who experienced what sounds like a transient ischemic attack, or stroke, seven months after having emergency heart surgery. She was, the site says, "intrigued by the potential of pulmonary vein isolation to eliminate her atrial fibrillation, and especially fascinated that the removal of the left atrial appendage could eliminate her stroke risk." Really? Would Ms. Hill even know what a left atrial appendage is?

A closer inspection to the press release confirms that the site is being marketed by a website developer and marketer to the elective healthcare industry:

Founded in 2002, and based in San Luis Obispo, California, Etna Interactive provides Web marketing services to the elective healthcare industry (including medical device manufacturers, plastic surgeons, cosmetic surgeons, surgeons and medical day spas); to physicians and surgeons offering new or novel treatments; and to professional service providers including lawyers, architects and builders. Etna Interactive services clients from Hawaii to upstate New York.

What is interesting is that this company recognized the need to skirt the provisions of Section 650 of the Medical Board of California Business and Professions Code that forbids "fees for referrals."

And yet, close inspection of the one and only advertiser on this website is Atricure, Inc., the company interested in marketing their equipment for open-chest pulmonary vein isolation for atrial fibrillation. Further more, look at Ms. Mellanie Hill's story carefully.

On September 13, 2005, Mellanie had Mini-Maze surgery with the AtriCure bipolar (RF) device and says, "Though it was surgery, with risks and anesthesia, and was in an area that is very delicate for women, I have no regrets." She had been grounded from flying for two years, and was now able to fly again and travel by herself. She says, "You can't put a price on getting your freedom back."

Would a patient really know (or care) that her surgery was performed with the "Atricure bipolar (RF) device?" Does the patient know what "bipolar" means? Or what "(RF)" means?

It is clear this site has been developed by a marketing department of a medical device company. Like industry-paid ghost writers in medical journals, this new tactic is disturbing. Has Atricure has used a website developer and gullible patient to ghost write the marketing of their medical devices? Worse still, could this patient who has had a stroke (or transient ischemic attack) and might be at high risk of recurrent stroke, even after her ablation, be making potenially dangerous recommendations (that stopping warfarin is OK), all in the interest of marketing? And when does a patient testimonial platform that is funded by a company become a "fee for referral" for that company's devices?

While I have nothing against patients standing up for a cause they believe in, I just wish they'd do it themselves. If the StopAfib.org site wants to accomplish this goal:

We're not pushing products or services, or selling anything. We want this site to be as unbiased and informational as possible.

...then they'd better develop their site themselves.

-Wes

15:15PM CST Addendum: I contacted Ms. Hill regarding this post and she was very nice to respond. She did confirm that Atricure contacted her first and had a particular interest in her skills as an "author, writer, and speaker," and they shared ideas and it was her idea to provide a forum for patients to explain options for atrial fibrillation therapies and ways to prevent strokes. Hence they provided a grant to her. She states Atricure was "very careful" to remain detached from the project. She also noted the "EP's had a vested interest" in performing catheter-based afib ablation procedures and often refused to refer patients for surgical procedures. She is continuing to seek other sponsors for her website.