Tuesday, October 30, 2007
The New England Journal of Medicine published a commentary recently concerning the emotional toll of medical mistakes - both on family members of the loved ones injured by the mistake and by the doctors. The New York Times ran a brief piece on the commentary and an upcoming documentary about medical mistakes this past weekend.
The New England Journal of Medicine tackled the [emotional toll of medical mistakes] issue yesterday in a moving commentary called “Guilty, Afraid and Alone: Struggling with Medical Error.’’ The writers, Dr. Tom Delbanco and Dr. Sigall K. Bell of the Harvard Medical School, note that while the medical community has focused largely on reducing error rates, hospitals also need to address the “human dimensions” of treatment blunders and to assist in the emotional recovery of patients and families.
The doctors, who are making a documentary film on the subject, talked to numerous patients and families affected by medical errors. The authors found that family members often feel guilty for not having protected loved ones from the caregivers’ mistakes and that many feared retribution if they did complain. And Dr. Delbanco and Dr. Bell note that physicians who err often shut out patients and their families, “isolating them just when they are most in need.’’
When mistakes happen, relatives often berate themselves for not keeping close watch on their loved ones. In one case cited in the commentary, the family of a man with sickle cell anemia repeatedly warned health care workers not to administer morphine. But somehow it happened anyway, sending the man into kidney failure and a coma. “The feeling was impotence, because you can’t stay with a patient 24 hours a day,’’ said his sister. “That’s why you rely on hospitals — you rely on nurses. You feel like you failed your family in terms of ‘I should have been there.’ That’s a guilt that everyone shares.” . . . .
Several family members said that they simply wanted their doctors to talk to them and to explain how the mistake had happened. “What we needed was for someone to reach out and connect with us in human terms,” said one. “The sense that somebody could empathize and know what I was feeling . . . that was almost totally lacking.”
The authors note that honest and direct communication are often the “best antidote” to flawed treatment. Patients and families also want to know that some good has come out of these mistakes, and that the event has taught both caregivers and their institutions.
The Wall Street Journal's Health Blog reports on a recent development in the area of advanced directives:
Psychiatric advance directives, or PADs, are legal documents that patients can prepare to state in advance of an acute psychiatric crisis what medications, hospitals and other treatments they would prefer or like to avoid.
Twenty-five states have laws allowing PADs. In North Carolina, a sample form includes such items as preferences about electroconvulsive therapy, or ECT, and tips for medical personnel on how to minimize the use of restraints or seclusion. A model form in Texas lays out details on a patient’s consent, or lack of it, for specific medications. A Michigan form guides a patient in legally designating a personal advocate in case of crisis.
But how are PADs actually used? And what happens if, in the breach, a doctor’s judgment clashes with the stated wishes of the patient? The Health Blog asked medical sociologist Jeff Swanson (pictured) from Duke University, who’s been active in research on mental health policy and treatment options for people with serious mental illness.
First, Swanson laid out a key difference between the advance directives for psychiatry and those typical for medical care. A living will focuses primarily on “forgoing unwanted treatment,” Swanson said. “The goal of the psychiatric advanced directive is to [help you] recover. You’re trying, in a way, to protect yourself from decisions you might make when you’re ill.” . . . .
Though PADs are legal documents, most state laws on the subject contain override clauses, Swanson said. In a crisis, a doctor can invoke his or her clinical judgment to act in the best interest of the patient, essentially ignoring the PAD. Empirical data are hard to come by. But “clinical experience and anecdotal reports suggest that overrides occur with some frequency,” according to a commentary Swanson published last year in the Journal of the American Academy of Psychiatry and Law.
Monday, October 29, 2007
ThinkProgress reports that President Bush's surgeon general nominee, Dr. James Holsinger may receive his position through a recess appointment.
President Bush’s Surgeon General nominee James Holsinger appeared before the Senate health committee on July 12, forced to defend his controversial positions on homosexuality. Yet three months later, Holsinger is “no closer to becoming the nation’s next surgeon general.”
ThinkProgress today spoke with a spokesperson for chairman Edward Kennedy (D-MA) who said the committee still has not received a response to a follow-up questionnaire it sent Holsinger three months ago:
We sent out the questions on 7/26 and requested that they be returned by COB on 8/10. We have not received the answers and there is no Committee action scheduled at this time.
Holsinger’s lengthy delay indicates that Bush may be angling to recess appoint Holsinger. The Louisville Courier-Journal reports:
The committee must vote before the full Senate can consider the nomination, and senators are hoping to adjourn for the year by mid-November.
The delay leaves open the possibility that Holsinger will either have to wait until next year for a confirmation vote or get the job through a “recess appointment” by Bush. […]
A recess appointment would allow Holsinger to serve as surgeon general until the end of the current Congress late next year. . . . .
Holsinger has come under intense criticism for his long history of prejudice toward gays and lesbians. He founded a church that “ministers to people who no longer wish to be gay or lesbian” and “opposed a decision to allow a practicing lesbian to be an associate pastor” in the United Methodist Church. In 1991, he also authored a graphic document arguing that gay sex is “intuitively” unnatural and can lead to “lacerations, perforations and deaths.”
The Associated Press reports that the American Academy of Pediatrics is recommending that all children be screened for autism twice by age 2. The AP reports,
The advice is meant to help both parents and doctors spot autism sooner. There is no cure for the disorder, but experts say that early therapy can lessen its severity.
Symptoms to watch for and the call for early screening come in two new reports. They are being released by the American Academy of Pediatrics on Monday at its annual meeting in San Francisco and will appear in the November issue of the journal Pediatrics and on the group’s Web site. . . . .
The academy’s renewed effort reflects growing awareness since its first autism guidelines in 2001. A 2006 policy statement urged autism screening for all children at their regular doctor visits at age 18 months and 24 months. . . . .
“With awareness comes concern when there doesn’t always need to be,” he said. “These resources will help educate the reader as to which things you really need to be concerned about.”
Another educational tool, a Web site that debuted in mid-October, offers dozens of video clips of autistic kids contrasted with unaffected children’s behavior. That Web site is sponsored by two nonprofit advocacy groups: Autism Speaks and First Signs. They hope the site will promote early diagnosis and treatment to help children with autism lead more normal lives.
The two new reports say children with suspected autism should start treatment even before a formal diagnosis. They also warn parents about the special diets and alternative treatments endorsed by celebrities, saying there’s no proof those work.
Concurring Opinions' Daniel Solove has a great piece on how to prepare and give a terrific job talk. Here is some of his advice:
The first thing is to understand your audience. Here's my perspective as a member of your audience. Your job talk is taking place during the middle of my day. I'm busy. I've got a ton of things to do, classes to teach, papers to work on, emails to respond to. I'm not coming in eager and excited to give my valuable hour to some unknown person plucked off the street after a 30-minute interview at the meat market. So you've got to work to get my interest and make that hour an interesting part of my day. That involves getting out your thesis quickly, making an interesting argument, and then having a good discussion with the faculty.
Sounds easy, right? You wouldn't believe how many fail at doing these basic things. I've seen countless candidates crash and burn during their job talk. It's like reading a Kafka novel -- things start out bad, and then they get much worse, and then you die.
Here is what I'm looking for in a job talk:
1. Were you able to articulate a coherent thesis? Your talk must have a point, and the point of your talk should be stated towards the beginning.
2. Was the thesis of your talk original and not an obvious point? I should not be saying "duh" to myself throughout your talk.
3. Were you able to defend your thesis?
4. Did you recognize the arguments on the other side of your thesis?
5. Was your talk interesting and engaging?
6. Were you articulate and clear? If not, I might have doubts about the clarity of your thinking as well as about your ability to explain concepts to students in a class.
7. In the Q&A, did you respond well to the faculty's questions?
8. If a question posed a severe challenge to your thesis, were you prepared to address it?
9. Did you demonstrate adequate command of your topic? I expect you to be familiar with the literature and cases on your topic.
Professor Solove provides further helpful tips as well.
Friday, October 26, 2007
GREENWALL FELLOWSHIP PROGRAM IN BIOETHICS AND HEALTH POLICY Johns Hopkins and Georgetown Universities Fellowships The Greenwall Fellowship Program in Bioethics and Health Policy, an interdisciplinary program sponsored jointly by Johns Hopkins and Georgetown Universities, is offering interdisciplinary, two-year Fellowships for early-career legal scholars with outstanding potential. Appointments will begin in September 2008.
FELLOWSHIP DESCRIPTION: The Greenwall Fellowship in Law uniquely combines opportunities for in-depth, mentored research and high- impact public service. Each Fellow will undertake an individualized program of independent research and writing, complemented by a public-service experience in a health policy setting of the Fellow's choosing. Fellows will also enjoy ample opportunity for scholarly interaction (including participation in faculty research workshops) with a broad range of faculty at Georgetown (in the Law Center, the Kennedy Institute of Ethics, and the Philosophy Department) and at Johns Hopkins (in the Berman Institute of Bioethics, the Philosophy Department, the School of Medicine, and the Bloomberg School of Public Health), as well as with scholars at leading Washington "think tanks." Past Fellows have moved on to faculty appointments at leading law schools, as well as high-profile positions in government (including a White House Fellowship and Congressional staff positions). The stipend will be approximately $57,000 per year. No prior health law or bioethics experience is required.
APPLICATION PROCEDURE: For consideration, please send a curriculum vitae, three letters of reference, a writing sample, undergraduate and graduate transcripts, and a personal statement to:
CONTACT: Dr. Ruth Faden Greenwall Fellowship Program c/o Berman Institute of Bioethics Johns Hopkins University 100 N. Charles St., Suite 740 Baltimore, MD 21201 The personal statement should include a proposed agenda for scholarship or research (this need not be detailed, but you should articulate the core idea you would like to develop or the research question you want to investigate). It should also address: (1) unique dimensions of your background, (2) the evolution of your research and other professional interests, and (3) how the Greenwall Fellowship might contribute to your ability to fulfill your career aspirations. The deadline for receipt of applications is December 14, 2007.
For further information, please visit the Academic Training section of: http://www.bioethicsinstitute.org Additional questions may be addressed to: Email: MAILTO:[email protected]
ThinkProgress reports on the House passage of a revised SCHIP bill. It reports on yesterday's vote:
The House just voted 265-142 to approve revised SCHIP expansion legislation, but fell short of the two-thirds needed to uphold a veto by President Bush. Twenty-seven members didn’t vote. The bill would “add $35 billionto the State Children’s Health Insurance Program” and “addressed critics’ concerns about participation by adults, illegal immigrants and families able to afford health insurance.”
NPR's Morning Edition has further commentary.
Thursday, October 25, 2007
Firedoglake has the news on the revised SCHIP vote occurring in the House:
Last night Speaker Pelosi announced she would bring a slightly revised SCHIP funding bill to the House floor for a vote — today. The revised bill still provides $35 billion in additional funds and health coverage for 10 million children, but it makes a few changes to counter the Bush Administration’s misrepresentations and opponent’s alleged concerns.
As Pelosi promised last week, the plan is to enact the full SCHIP funding again, and if the President is foolish and heartless enough to veto it again, attempt another override, with the opposition having even fewer excuses to vote no. This type of strategy is exactly what many progressives have been hoping from the Democratic leadership when they know the public is solidly behind them against an out-of-touch, unpopular President. It’s not just good politics; it’s good public policy, because this program deserves passage and has the overwhelming support of the American people.
The changes include clarification that coverage does not extend to families with annual incomes at $83,000 (a confusion left over from New York’s request that the Administration had already denied); it apparently won’t cover those not legally in the US for five years; and it further limits coverage for adults who do not have covered children.
Harvard School of Public Health Department of Health Policy and Management seeks
Assistant or Associate Professor of Law and Public Health
The Department of Health Policy and Management at the Harvard School of Public Health seeks candidates for the position of assistant or associate professor of law and public health. This is a tenure-ladder position, with the academic rank to be determined in accordance with the successful candidate’s experience and productivity. The successful candidate will play a central role in the department’s program of teaching and research.
Candidates should possess the following qualifications: a law degree and a doctoral degree in health policy (or a related social science discipline) preferred, but candidates with an MD or MPH and evidence of advanced quantitative research skills will be considered; a broad knowledge of legal issues in health care and public health policy and of ethics; and experience in conducting empirical research employing statistical and econometric methods. Additional qualifications include evidence of the ability or the potential to manage national and international projects, to collaborate with professionals in other disciplines, and to teach health law at the graduate level.
Please send a letter of application, including a statement of current and future research interests, curriculum vitae, sample publications, and the names of three referees to the following address. Applicants should ask their three referees to write independently to this address.
Chair, Search Committee for Law and Public Health
c/o Mindy Starmer, Search Administrator
Department of Health Policy and Management
Harvard School of Public Health
677 Huntington Avenue
Boston, MA 02115
Harvard University is committed to increasing representation of women and minority members among its faculty, and particularly encourages applications from such candidates.
Thinkprogress provides more information on the administration's response to its censoring of CDC director's Dr. Julie Gerberding's global warming health remarks. Here is a brief excerpt from the White House Press Secretary Dana Perino:
In her press briefing yesterday, White House Press Secretary Dana Perino responded to reports that the White House “eviscerated” Center for Disease Control director Dr. Julie Gerberding’s Senate testimony on the “Human Impacts of Global Warming.” She claimed that “the decision” was “to focus that testimony on public health benefits” of climate change.” “There are public health benefits to climate change,” asserted Perino.
Asked to explain what some of those benefits are, Perino said that climate change “would help those individuals” who die from cold-related deaths every winter“:
Q: And one more. You mentioned that there are health benefits to climate change. Could you describe some of those?
MS. PERINO: Sure. In some cases, there are — look, this is an issue where I’m sure lots of people would love to ridicule me when I say this, but it is true that many people die from cold-related deaths every winter. And there are studies that say that climate change in certain areas of the world would help those individuals. There are also concerns that it would increase tropical diseases and that’s — again, I’m not an expert in that, I’m going to let Julie Gerberding testify in regards to that, but there are many studies about this that you can look into.
Science Progress has the unredacted version of Dr. Gerberding's remarks.
Wednesday, October 24, 2007
TalkLeft gives us the money quote from Presidential candidate Michael Huckabee on Health Care:
During the Republican debate last night, after attacking Hillary, contender Mike Huckabee had this to say:
"We don't have a health care system. We have a health care maze. And we don't have a health care crisis. We have a health crisis. Eighty percent of the $2 trillion we spend on health care in this country is spent on chronic disease. If we don't change the health of this nation by focusing on prevention, we're never going to catch up with the costs no matter what plan we have. ... And we've got a situation with 10,000 baby boomers a day signing up for Social Security, going into the Medicare system. And I just want to remind everybody when all the old hippies find out that they get free drugs, just wait until what that's going to cost out there."
Something similar is visible on many discussions about health issues. An illness is seen as “deserved” if the patient ever engaged in any activity which is now known to be correlated with that illness, and the illness itself is now viewed as punishment for evil deeds. Illness becomes a moral condition and the search for its epidemiology becomes a court case where the jury looks for that one decision where the patient went wrong, the one sin for which the current pain and suffering might be a just punishment.
In some ways we have stepped out of the framework where illnesses were caused by demons and into the scientifically medical one. But in other ways we have brought those demons with us, transformed into a different type of an ethical judgment or into a search of a different type of causal explanation, and that little hidden demon is what allows us now to judge other people without feeling any embarrassment over doing so. After all, if medical science tells us that some patients “caused” their own illnesses, then it is simply natural that we, too, point out that causal mechanism in all sorts of daily interactions.
Amanda at Pandagon adds,
This kind of discourse on illness is on the rise lately, because conservatives who are opposed to universal health care are rapidly trying to redefine pretty much all illness as a matter of personal responsibility to avoid taking collective responsibility for the health and well-being of citizens. Even the horrible and surely unintended car accident of the Frost family became an attempt to talk about “responsibility”, as if all misfortune could be attributed to a failure of will. . . . .
This pity-then-acceptance curve puts fat activists in a quandary, because it’s widely accepted that being fat is in fact something you can help and therefore the onus is on the fat people to lose weight and not on the rest of us to treat them with decency. And understanding the arch of pity-to-acceptance, fat activists have put a lot of work into arguing that dieting doesn’t work, and that obesity is genetic. That tactic might work, but then again, it might not. One issue that’s going to keep coming up is that people successfully lose and keep off 10, 15, 20 pounds all the time, and erroneously think that a 20 pound loss for me can means a 150 pound loss for you. If you can disabuse people of that notion, then quite possibly the pity-than-acceptance route might work for fat activists.
Tuesday, October 23, 2007
ABC news reports on Senator Fred Thompson's view on the "right-to-die." He doesn't believe that state or federal government should be involved in the end-of-life decisions that a family may have to make.
In a moving, pointed and rare response to a question about the Terri Schiavo controversy, former Sen. Fred Thompson of Tennessee Monday afternoon described details of the death of his own daughter, Elizabeth "Betsy" Thompson Panici, and said that neither federal nor local governments should play any role in making a family's end-of-life decisions.
"I had to make those decisions with the rest of my family," Thompson said. "And I will assure you one thing: No matter which decision you make, you will never know whether or not you made exactly the right decision."
GOP hopeful Thompson said that "making this into a political football is something that I don't welcome, and this will probably be the last time I ever address it. It should be decided by the family. The federal government -- and the state government too, except for the court system -- should stay out of these matters, as far as I'm concerned."
Ezra Klein has an interesting post on the Washington Post story concerning the number one cause of homelessness - untreated chronic disease.
. . . The #1 cause of death among the homeless is untreated chronic disease. It's also a major cause of homelessness. The Washington Post tells the story of Vaughn Bell -- he had a solid job at a teen rehab clinic, an apartment, a good life. "The sickness stripped it all away. Everything. Bell fell ill with kidney disease. Because he was sick, he couldn't work and lost the job. Because he lost the job, he lost his apartment and had to go to a homeless shelter. Because he lived in a homeless shelter, he had to take two trains and a bus to get to dialysis treatments. He fell behind, stopped caring for himself, then just stopped caring."
This isn't a policy post, necessarily. I don't know how to holistically end the ravages of chronic disease. A universal health care system could ensure treatment, but it can't keep you from losing your job, or from having to travel too far for care, or from falling into depression and giving up, or from lacking the money to purchase the sort of food your body needs. But it's worth thinking about.
Our local paper, the Cincinnati Enquirer, is not the best but they carry Jim Borgman's cartoons and they are usually quite funny. Here is one that ran this weekend in response to the consideration of a new law in Ohio to require that women see an ultra-sound of their fetus before receiving an abortion. .
Friday, October 19, 2007
Cold and cough medicines don’t work in children and shouldn’t be used in those younger than 6, federal health advisers recommended Friday.
The over-the-counter medicines should be studied further, even after decades in which children have received billions of doses a year, the outside experts told the Food and Drug Administration. The FDA isn’t required to follow the advice of its panels of outside experts but does so most of the time.
“The data that we have now is they don’t seem to work,” said Sean Hennessy, a University of Pennsylvania epidemiologist, one of the FDA experts gathered to examine the medicines sold to treat common cold symptoms. The recommendation applies to medicines containing one or more of the following ingredients: decongestants, expectorants, antihistamines and antitussives.
The nonbinding recommendation is likely to lead to a shake up in how the medicines — which have long escaped much scrutiny — are labeled, marketed and used. Just how and how quickly wasn’t immediately clear.
In two separate votes, the panelists said the medicines shouldn’t be used in children younger than 2 or in those younger than 6. A third vote, to recommend against use in children 6 to 11, failed.
Earlier, the panelists voted unanimously to recommend the medicines be studied in children to determine whether they work. That recommendation would require the FDA to undertake a rule-making process to reclassify the medicines, since the ingredients they include are now generally recognized as safe and effective, which doesn’t require testing. The process could take years, even before any studies themselves get under way. . . . .
Oops - yet another unsettling side effect of impotence drugs - CNN.com reports,
Men taking any of three erectile dysfunction drugs -- Viagra, Levitra or Cialis -- may be at increased risk for sudden hearing loss, prompting Food and Drug Administration officials to require label changes for the medications.
The FDA is requiring label changes for drugs that may increase the risk of sudden hearing loss. The FDA said manufacturers must change the labels "to display more prominently the potential risk of sudden hearing loss," according to the agency's Web site.
Labeling must also be changed for the blood pressure medication Revatio, which has the same active ingredient as the other drugs. Men taking any of the ED drugs and experiencing hearing loss should immediately stop taking the drug and see their physician, the FDA said. . .
The FDA is requiring the label change for the entire class of drugs -- called Phosphodiesterase Type 5 Inhibitor, or PD-5 inhibitors.
I cannot wait for the new commercials . . .
Thursday, October 18, 2007
The House of Representatives failed to obtain the necessary votes to override President Bush's veto of the SCHIP program. TPM election central reports,
It's over: The House just voted on the SCHIP bill moments ago, and failed to override President Bush's veto.
The vote was 273-156, falling short of the two-thirds vote needed to overturn Bush's veto.
Incredibly, despite polls showing strong majority support for a veto override, and an aggressive ad campaign targeting Republicans on SCHIP, the GOP was remarkably successful in holding the line and sustaining Bush's veto. Only forty-four Republicans voted for the bill -- almost exactly the same as last time, save for GOP Rep. Pete King, a bill supporter who was absent this time. One-hundred and fifty-four GOPers voted against it.
The roll call is here.
Wednesday, October 17, 2007
President Bush appointed Dr. Susan Orr, formerly Associate Commissioner of the Children's Bureau in the Administration for Children and Families, as the Acting Deputy Assistant Secretary for Population Affairs at the Office of Public Health and Science (OPHS). There is just one small drawback with her appointments as RHrealitycheck reports
The Office of Population Affairs advises the Secretary and the Assistant Secretary for Health on "a wide range of reproductive health topics, including adolescent pregnancy, family planning, and sterilization, as well as other population issues," says the OPHS website. Sounds like you might want to count contraception as one of your areas of expertise in that post, right? Not Dr. Orr! In 2001, when President Bush proposed eliminating the requirement that federal employees' health insurance offer a range of options for birth control coverage, Dr. Orr, then the senior director for marriage and families at the Family Research Council, told the Washington Post, "We're quite pleased because fertility is not a disease. It's not a medical necessity that you have [contraception]."
Clearly, Dr. Orr's definition of "medical necessity" does not recognize that women in the world over consider controlling their bodies and the number and spacing of their children foundational to their well-being. If that's not a medical necessity, what is?
Mary Jane Gallagher, president of the National Family Planning and Reproductive Health Association, said in a statement that her organization was "appalled" at Orr's appointment and observed that "While her resume suggests a commitment to child welfare and children her professional credentials fail to demonstrate a commitment to comprehensive family planning services for all men and women in need." . . . .
And ThinkProgress chimes in with some further thoughts from Dr. Orr about the value of contraceptive devices:
In a 2000 Weekly Standard article, Orr railed against requiring health insurance plans to cover contraceptives. “It’s not about choice,” said Orr. “It’s not about health care. It’s about making everyone collaborators with the culture of death.”
Wow, yet another great appointment - I am sure women everywhere feel better about their reproductive health already. How did President Bush find someone so outstandingly qualified for this job - well - let us look at her credentials: According to ThinkProgress, "Before joining HHS, Orr served as senior director for marriage and family care at the conservative Family Research Council and was an adjunct professor at Pat Robertson’s Regent University."
As you are probably well aware, last week several manufacturers of cold medicines for toddlers recalled their products from the market. This Thursday, the FDA will hold hearings on the safety of these cold medicines.
On Thursday, the Food and Drug Administration will meet to discuss whether over-the-counter cold medicines are safe and effective in children age 6 and under. Earlier this year, the FDA completed a review that found between 1969 and the fall of 2006 there were 54 reported child deaths from decongestants and 69 from antihistamines. Most of the deaths occurred in children under 2. Baltimore Health Commissioner Dr. Joshua Sharfstein headed the push that led to the FDA hearing. He became alarmed when four Baltimore children died after their parents gave them excessive doses of cold medicines. "I didn't quite realize that it could potentially be a life-and-death issue," says Sharfstein.
In August, federal health officials recommended the "consult your physician" advice to parents on the labels of cold and cough medicines aimed at young children be replaced by a warning not to use the medications in children under 2 unless directed to do so by a health care provider.
Last week, in advance of the hearings, some of the leading manufacturers of cold and cough medicines announced a voluntary recall of more than a dozen cold medicines for infants. The Consumer Healthcare Products Association said the products were being pulled "out of an abundance of caution."
Potential misuse of the medications, not product safety, is driving the voluntary withdrawal, the group said. In a written statement, the group's president, Linda Suydam said, "It is important to point out that these medicines are safe and effective when used as directed, and most parents are using them appropriately." The recall "in no way affects our taking this issue to the advisory committee meeting," said Dr. Joel Schiffenbauer, deputy director for the FDA's Division of Nonprescription Clinical Evaluation, Office of Nonprescription Products, Center for Drug Evaluation and Research. "All potential actions are on the table," he said.
I wonder if some parents will hoard this drugs and continue to use them anyway - as a close friend has predicted. I am not so sure that I agree about the potential for hoarding but I admit when the doctor informs me that my son, who is coughing and snuffling and quite unhappy, has a virus and all he needs is some TLC, I feel like asking for drugs for myself.