OCEANSIDE, N.Y. — American Medical Alert Corp. (NASDAQ: AMAC) a provider of healthcare communication services and advanced telehealth monitoring technologies, today announced operating results for the quarter and six months ended June 30, 2006.

Revenues for the quarter ended June 30, 2006, consisting primarily of monthly recurring revenues (MRR), increased 44% to $7,796,317 as compared to $5,427,324 for the same period in 2005. Net income for the quarter ended June 30, 2006 was $244,776 or $.03 per diluted share as compared to $275,781 or $.03 per diluted share for the same period in 2005.

Revenues for the six months ended June 30, 2006 increased 40% to $14,946,528, as compared to $10,665,894 for the same period in 2005. Net income was $524,543 or $0.06 per diluted share as compared to a net income of $502,280 or $0.06 per diluted share for the previous year. Net Income for the trailing twelve months ended June 30, 2006 and 2005 was $954,699 and $532,564, respectively.

Earnings before interest, taxes and depreciation and amortization (”EBITDA”) for the six months ended June 30, 2006 increased 14% to $2,769,774 as compared to $2,437,533 for the same period in 2005. EBITDA for the trailing twelve months ended June 30, 2006 and 2005 was $5,244,983 and $4,129,536, respectively, a 27% increase.

The Company affirms its guidance issued on March 30, 2006 that gross revenues, consisting primarily of monthly recurring revenue (MRR), will increase by 34% to $30,000,000 while also projecting a 29% increase in earnings to $1,200,000 for the year ending December 31, 2006. This projection does not assume any contribution to anticipated results from future acquisitions.

Howard M. Siegel, Chairman and Chief Executive Officer commented, “The value of the Company’s diversified business model provides the opportunity to invest in our business, allowing us to maintain and grow our market position in each business unit. The TBCS division is making significant progress to integrate technologies to foster company-wide cross platform expansion in support of our primary goal to become the dominant provider of medically oriented, call center solutions. The second quarter also marked the completion of management’s consolidation of our HSMS engineering and fulfillment capability to the Long Island City operations hub from which additional efficiencies are anticipated. We further believe ongoing developments in technology will create new opportunities to increase traction within the HSMS division.”

About American Medical Alert Corp.

AMAC is a healthcare communications company dedicated to the provision of support services to the healthcare community. AMAC’s product and service portfolio includes Personal Emergency Response Systems (PERS) and emergency response monitoring, electronic medication reminder devices, disease management monitoring appliances and healthcare communication solutions services. AMAC operates seven communication centers under local trade names: HLINK OnCall, Long Island City, NY, North Shore TAS, Port Jefferson, NY, Live Message America, Audubon, NJ, ACT Teleservice, Newington, CT and Springfield, MA, MD OnCall, Cranston RI and Capitol Medical Bureau Rockville, MD to support the delivery of high quality, healthcare communications.

Use of Non-GAAP Financial Information

In addition to the results reported in accordance with accounting principles generally accepted in the United States (”GAAP”) included in this press release, the Company has provided information regarding certain non-GAAP financial measure. This measure is “earnings before interest, taxes and depreciation and amortization (”EBITDA”)”. Such information is reconciled to its closest GAAP measure in accordance with the Securities and Exchange Commission rules and is included in the attached supplemental data.

Management believes that the non-GAAP financial measure used in this press release is useful to both management and investors in their analysis of the Company’s financial position and results of operations. Management believes that EBITDA is a useful measure of the Company’s financial performance as it is an indicator of the Company’s ability to generate cash flow to make acquisitions, reinvest in new telehealth products and liquidate liabilities. Management also uses EBITDA for planning purposes to determine appropriate levels of operating and capital investments.

EBITDA is a non-GAAP financial measure and although management and some members of the investment community utilize it to measure financial performance, EBITDA should not be viewed as a substitute for financial data prepared in accordance with GAAP or as a measure of profitability. Additionally, the non-GAAP financial measure as presented by AMAC may not be comparable to similarly titled measures reported by other companies.

Forward Looking Statements

This press release contains forward-looking statements that involve a number of risks and uncertainties. Forward-looking statements may be identified by the use of forward-looking terminology such as “may,” “will,” “expect,” “believe,” “estimate,” “anticipate,” “continue,” or similar terms, variations of those terms or the negative of those terms. Important factors that could cause actual results to differ materially from those indicated by such forward-looking statements are set forth in the Company’s filings with the Securities and Exchange Commission (SEC), including the Company’s Annual Report on Form 10-KSB, the Company’s Quarterly Reports on Forms 10-Q, and other filings and releases. These include uncertainties relating to government regulation, technological changes, costs relating to ongoing FCC remediation efforts, our expansion plans, our contract with the City of New York and product liability risks.

Confusion often rules about which insurance to bill for a service.

Q Are “routine” and “annual” exams covered?

By law, Medicare doesn’t pay for routine vision exams. Medicare beneficiaries may choose to have an “annual exam,” but they are responsible for payment. Some beneficiaries may have vision insurance that covers the exam. Private major medical insurance plans sometimes include a routine eyecare benefit. Check your individual plans.

Q If a patient has both medical and vision insurance, which is primary?

This depends on the reason for the visit, from the patient’s perspective. Bill exams for medical care, evaluation of a complaint or to follow an existing medical condition to the medical plan. Alternately, bill examinations that check vision, screen for disease, or update eyeglasses or contact lenses to the patient or to the patient’s vision plan.

Q When a patient presents for a routine vision exam and you find a pathology, can you bill the medical plan?

No, the chief complaint should relate to the primary diagnosis and determine coverage. In this case, the chart may read, “here for routine eye exam and new glasses” with a corresponding diagnosis of refractive error, including myopia, astigmatism or presbyopia. Address the incidental finding of pathology on a return visit. Bill the subsequent exams to monitor or treat the pathology to Medicare or to the major medical plan.

In the event of an urgent or emergent medical condition, consider the medical plan as primary and the vision plan as out of the picture. Carefully explain the circumstances and gravity of the situation to the patient to avoid later recriminations or questions.

Q Is it ever possible to bill both medical and vision insurance on the same date?

It may be, depending on the patient’s vision plan. Some plans will cover a refraction even when the medical plan covers the visit. If the vision plan allows it, submit the claim with the appropriate medical diagnosis associated with the visit and a refractive diagnosis mated to the refraction.

Q What happened to the local codes that described a routine eye exam?

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 includes rules for “standard code sets,” which eliminated payers’ ability to create and use their own codes to describe services provided. Some payers replaced their routine eye exam codes with HCPCS codes.

HCPCS codes S0620 (routine ophthalmological examination including refraction; new patient) and S0621 (…; established patient) specifically describe routine eye exams, including refraction. These codes are appropriate for healthy patients who come in for a regular check up and for new eyeglasses or contact lenses. Medicare doesn’t accept these codes, although other plans may.

Q How can we reduce confusion with patients on this subject?

Start by determining coverage on the phone during the initial call for the appointment. When the patient arrives for the appointment, confirm the reason for the visit. Some practices use stamps or stickers in the chart to alert the doctor to the reason for the visit and the limitations of coverage.

Keep in mind that patients frequently do not understand their insurance coverage and may be disconcerted to find that it doesn’t pay for some service they want.

One of the more interesting things we’ve learned from our research in the computer and consumer electronics markets is that with technology, one size does not fit all. Dell discovered this early on, letting customers “build” their own computers—a highly personal experience, thanks to its online direct-marketing programs. The company’s credo was to give the customer only what he or she really wanted. That’s key to satisfying customers, but equally as important, perhaps, is understanding who is buying your products. In other words, people of different ages are likely to use technology quite differently.

In our company’s research, we look at four key demographics: “silver surfers” (folks over 65), baby boomers (people born between 1946 and 1964), Gen Xers (those born between 1965 and 1982) and “millennials” (young people between 14 and 24). Of these four groups, millennials are perhaps the most important for technology, since they are the most tech-savvy and strongly influence what their friends, parents, and grandparents buy.

The group with the most purchasing power and cash available to spend on technology, however, is the baby boomers. I recently ran across a report from a job-recruiting firm called J. Kent Staffing that shared some data points gleaned from a book called the The Boomer Century 1946-2046 by Richard Croker.

The report pointed out the following:

1. The number of baby boomers in America is estimated at 78.2 million. 2. Approximately 7,900 Americans turn 60 each day. That’s about 330 every hour, or more than 4 million a year. 3. Within 20 years, the age profile of America will match that of Florida: About one in five Americans will be older than 65. 4. Boomers who reach age 65 in 2011 can expect to live, on average, at least another 18 years. 5. Four out of ten boomers have less than $10,000 in retirement savings. 6. Today, four out of ten boomers’ households have at least $100,000 in investable assets. 7. Only about one-third of baby boomers think they will have enough money to live comfortably once they retire. 8. Four out of five boomers intend to keep working and earning in retirement. Half plan to start an entirely new job or career in retirement. 9. Only one in seven baby boomers says they plan to collect Social Security benefits at age 62. 10. The unpredictable cost of illness and health care is by far boomers’ biggest concern. They are three times more worried about a major illness, their ability to pay for health care, or winding up in a nursing home, than they are about dying.

Although boomers have discovered the value of the Internet, we have found that they use it much differently than their children or grandchildren do. They rate communication as highly essential, but the whole idea behind MySpace or Second Life escapes them. Their grandkids might be lost without 24/7 connectivity, but the concept of being connected 24 hours a day scares boomers. They do love to use the Internet to research things they are passionate about, such as quilting or fishing, and even shopping sites get their attention. But things like online communities don’t really interest them.—next: The Most Important Point >

I consider the last point in this list from Croker’s book to be the most important. Baby boomers’ concerns over their health and the costs of health care are big issues for them, and they will be investing a lot of their money in information and biotech-based technology in the future.

This has not escaped the drug and medical industries, which see boomers as their next cash machines. But tech companies have realized this as well. In fact, Intel was one of the first to place an emphasis on this. When it recently reorganized, it created an entire division devoted to technology related to health care. Philips has also made health-care technology a cornerstone of its business, creating personal defibrillators and other personal heart and health-care monitoring devices, as well as hospital-class monitoring and diagnostic equipment. Here in Silicon Valley, I am beginning to see more garage-shop start-ups taking aim at health-related tech issues, as well as focusing on their use by silver surfers and boomers.

Interestingly, personal monitoring technology is not just a U.S. or European phenomenon. During my last trip to Japan, I saw a Wi-Fi–based teakettle. What does this have to do with monitoring people? I thought the whole thing was crazy, and then my hosts explained. You see, in Japan, tea is a daily ceremonial act. It’s part of the culture. So, Japanese Boomers and Gen Xers buy these Wi-Fi teakettles and install Wi-Fi networks in their parents’ or grandparents’ homes. They know that at certain times of the day, around 11:00 a.m. and 3:00 p.m., their elders will have tea. So, when the kettle is lifted to pour the tea, it sends a Wi-Fi signal to the network, and the network then sends an alert to their cell phones. It’s a signal that things are “normal”—an unconventional monitoring technology, but one that works.

The American Diabetes Association annually
designates the fourth Tuesday of March as a
one-day call-to-action for people to find out
if they’re at risk for diabetes. There are 20.8
million Americans, or 7 percent of the
population, who have diabetes. While an
estimated 14.6 million have been diagnosed,
unfortunately, 6.2 million people (or nearly
one-third) are unaware they have the disease.
The Alert’s goal is to raise the awareness that
diabetes is serious, that you can have diabetes
and not even know it, and that early detection
is important.

SMMC Activities: Health Fair, which will
include blood glucose screenings, foot
screenings, and diabetes counseling. This FREE
event, March 28, from 11 a.m. to 1 p.m. at the
St. Mary’s Medical Center cafeteria at 450
Stanyan Street, San Francisco, is open to
everyone.

Weekly Diabetes Classes, which cover all
aspects of taking care of diabetes, are FREE
and open to everyone.

SMMC Expert: Elissa Hallen, a registered
nurse/certified diabetes educator (RN/CDE) and
Coordinator of Diabetes Services at St Mary’s.
Her areas of expertise include the diagnosis of
diabetes, development of diabetes, living well
with diabetes.

Other Observances  National Nutrition Month
SMMC Expert: Tracy Dalton, Registered
Dietician/Certified Diabetes Coordinator. Her
specialties include Cholesterol Know-How,
Diabetes and Heart Healthy Eating.

About SMMC         For nearly 150 years, St. Mary’s Medical Center
has provided the Bay Area with compassionate,
personalized care combined with the latest
advances in medical care and cutting-edge
technology. St. Mary’s is a full-service acute
care facility with more than 575 physicians and
1500 employees who provide high-quality and
affordable health care services to the Bay Area
community and patients from around the world.
Home to advanced medical practices, such as the
nation’s first digital cardiac catheterization
laboratory, pioneering spine surgery and
comprehensive rehabilitation, St. Mary’s
Medical Center is one of San Francisco’s
leading hospitals, offering patients a full
range of outpatient and inpatient services
delivered with the human touch.

Eagle’s syndrome represents a group of symptoms that includes recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. The medical history and physical and radiologic examinations are the main guides to the precise diagnosis. The radiologic diagnostic modality of choice is three-dimensional computed tomography (3-D CT). We describe a case of bilaterally symptomatic Eagle’s syndrome that was diagnosed by 3-D CT of the styloid processes and successfully treated with surgery via a transoral approach.

Symptoms of Eagle’s syndrome include recurrent throat pain, globus pharyngeus, dysphagia, referred otalgia, and neck pain. Two possible causes of the syndrome are elongation of the styloid process and ossification of the stylohyoid or stylomandibular ligaments. (1-3) Eagle considered any styloid process greater than 25 mm–the approximate length of the normal styloid process in adults–to be elongated. (1-4) The reported prevalence of elongated styloid process ranges between 1.4 and 30%. (5-8)

The diagnosis is guided by the medical history, findings on physical examination (palpation of the lateral tonsillar fossa and infiltration of local anesthetics to the tonsillar fossa), and radiologic investigation. (7,8) X-rays are still used to diagnose Eagle’s syndrome, but a new and preferred modality is three-dimensional computed tomography (3-D CT), which can definitively measure the length of the styloid process. (9,10)

The primary treatment modality for Eagle’s syndrome is surgery. The elongated styloid process can be resected surgically via a transoral or extraoral approach. (11-13) The choice of surgical approach is usually based on the surgeon’s experience.

In this article, we present a case of Eagle’s syndrome that was caused by bilaterally elongated styloid processes. We describe our use of 3-D CT and surgery via the transoral approach.

Case report

A 46-year-old woman presented to us with a chief symptom of a foreign-body sensation in her throat. She also reported a sore throat and bilateral pain in the neck that was aggravated by swallowing. Earlier, she had been prescribed corticosteroid and analgesic treatment by a neurologist, and she had been subsequently referred to a gastroenterologist and a psychiatrist. Because a detailed gastroenterologic examination, including 24-hour pH monitoring, had detected no evidence of a gastrointestinal disease (gastroesophageal reflux or laryngopharyngeal reflux in particular), no medication had been recommended. The psychiatrist had prescribed an antidepressant drug, but the patient’s symptoms persisted.

The patient’s medical history was negative for recurrent tonsillitis, true foreign bodies, coexisting systemic diseases, and surgery, and her family history was negative for craniofacial syndromes. On routine physical examination, no otologic or rhinologic abnormality was found. No visible mass or true foreign body was observed during endoscopic examination of the nasopharynx, hypopharynx, larynx, and tongue base. No palpable mass was present in the neck. Suspecting an elongated styloid process, we palpated the tonsillar fossa bilaterally at the level of the anterior pillar, which elicited a very painful response. Lateral neck rotations to both sides also caused severe pain in the neck. The pain was relieved bilaterally by application of 1% lidocaine to both tonsillar fossae, a finding that suggested a diagnosis of Eagle’s syndrome.

Findings on a laboratory work-up–which included a complete blood count, measurements of the erythrocyte sedimentation rate and anti-streptolysin O titer, and hepatic and renal function tests–were all normal. No microorganism was demonstrated in cultures of sputum. However, a panoramic radiograph demonstrated bilateral radiopaque bodies extending from the origin of the styloid process to the angle of the mandible. We established a presumptive diagnosis of Eagle’s syndrome and initiated conservative treatment with the application of heat to the neck and analgesic and myorelaxant therapy. However, the patient’s symptoms failed to respond. We then obtained 3-D CT, which revealed that both styloid processes were elongated. The styloid process on the left was 41.5 mm (figure 1, A), and the styloid process on the right was 42.5 mm (figure 1, B). Based on these findings, the patient was scheduled for resection of the styloid processes via a transoral approach.

[FIGURE 1 OMITTED]

Following the administration of general anesthesia and intravenous antibiotics, we performed a bilateral tonsillectomy. Next, we located by digital palpation the protuberance of the styloid process at the superolateral corner of the tonsillar fossa. The styloid process was skeletonized, and the attaching ligaments were separated from it (figure 2). The naked and free styloid process was removed from the temporal bone at its origin. The same procedure was then performed on the other side. Intraoperatively, the length of both styloid processes was 40 mm.

* Number of wrong-site surgeries conducted on limbs or organs other than the spine occurred once in every 112,994 operations.

* Degree of harm was low in the instances found in the study.

* Hospitals seem to be confused about processes JCAHO is recommending.

Wrong-site surgery is extremely rare and major injury from it even rarer, according to a study supported by the Agency for Healthcare Research and Quality and published in the April 2006 issue of Archives of Surgery. (1)

Researchers led by Mary R. Kwaan, MD, MPH, of Brigham and Women’s Hospital and Harvard School of Public Health in Boston, estimate that a wrong-site surgery serious enough to result in a report to insurance risk managers or in a lawsuit would occur approximately once every five to 10 years at a single large hospital.

The study assessed all wrong-site surgeries reported to a large medical malpractice insurer between 1985 and 2004 and found that the number of wrong-site surgeries conducted on limbs or organs other than the spine occurred once in every 112,994 operations. In addition, 40 cases of wrong-site surgery were identified among 1,153 malpractice claims and 259 instances of insurance loss related to surgical care. Of that total, 25 of the cases were non-spine wrong-site surgeries, with the remainder involving surgery of the spine.

Another interesting finding involved the universal protocols from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), which went into effect in July 2004. According to the researchers, available medical records for 13 of the 25 non-spine wrong-site surgery cases show that injury was temporary and minor in 10 of the cases, but that JCAHO’s “Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery” might have prevented eight of the cases.

An ‘uncommon’ event

“Our interest was in wrong-site surgery, how it happens, and what kinds of cases are at risk for wrong-site surgery events,” says Kwaan, a surgical research fellow at the Brigham & Women’s Center for Surgery & Public Health. “We also had some interest in finding out how hospitals reacted to the site verification protocol.”

The main point Kwaan would like to emphasize is that based on her findings, wrong-site surgery “is not a common adverse event.” Previously, she says, there had not been much data on the problem. “A lot of the discussion on this problem is based on case reports, so we do not have denominators,” she explains. “Also, we wanted to compare [the rate of wrong-site surgeries] with lots of other well-known errors, like a retained foreign body. We now have a number: one in 10,000. That is far more uncommon than leaving a sponge in the abdomen.”

The other key issue, says Kwaan, is degree of harm, which was low in the instances found in her study. “Retained foreign bodies mostly result in pretty serious harm,” she observes. “In our cases, most involved a scar requiring a second operation, but not a major disability–and none of the cases resulted in death,” she adds.

Structured protocols

“The final point it’s important to cite is that when we reviewed the medical records, the events appeared not to have been preventable by the [JCAHO] site preparation protocol,” adds Kwaan. “This is a very important finding: Despite this protocol being fairly extensive, unfortunately it is not expected to prevent every single case of wrong-site surgery. We found it prevented 62% with diligent enforcement.”

Kwaan describes the protocols as “fairly structured,” with three main components. “One is pre-op verification, with recommendations to check things like the consent document or having the histories and physical documents in the medical record,” she explains. “The second is marking the site, which has gotten a lot of attention, and the third is a time-out.”

While these are “fairly specific” components of what JCAHO would like a hospital to do, she says they don’t specify exactly how you actually bring these about.

“It seems [from discussions with hospitals] like there was some confusion about what procedures should be done,” Kwaan notes. “Even though the requirements are not rocket science, they could be quite cumbersome if not planned correctly.”

Given the fact that the protocols are not foolproof, what does Kwaan recommend? “For now, one of the things we think is important is to have a site verification protocol in your hospital that is simple; this will promote compliance,” she says. “Avoid cumbersome protocols and redundant checks, where everybody knows they are checking the same thing three other people checked. Although there is no data on this, we don’t feel it will increase compliance–in fact, we feel it will make it easier to violate the protocols.”

The pre-op verification process, she continues, should involve two health care professionals–and one should be the surgeon. The other should be the nurse or anesthesiologist, who will verify the documents. “The most relevant is the informed consent,” says Kwaan. “We also advocate that hospital policy have a very clear protocol for inconsistencies, so if something comes along that is not matching the OR schedule, a lot of emphasis should be placed on how that will be resolved.”

Bruce Bartlow writes out of decades of experience as a nephrologist and critical care physician. He begins with two thought-provoking statements to alert us that this book is about every person’s spiritual challenge to live and die as a person whose core self, or soul, knew and answered life’s essential questions.

His unsettling opening sentence states: “All of us will come to the end of our lives, but few of us will die well.” This is not what we expect a medical doctor to write about the American way of dying in an age of ever-increasing medical technological achievements!

His second statement is that, “Nearly everyone who reads this book will someday care for a friend or family member as they die. Some of us will even make it a profession. Though we offer our help out of love, I believe we will also hope to be nourished by the transcendent experience of participating in the life well lived and released with grace.”

Bartlow maintains that illness and death, if we permit them, can teach us to reshape our lives. They can turn us, if we are willing, toward answering the meaning of life questions we were born to ask about who we are as a unique person, what is or ought to have been my primary goal in life? To what degree did I achieve it? What remains to be done? How can I use this illness and whatever time I have left in my life to achieve this goal?

Examining these questions, he believes, is crucial to every person in order to live and die well. For many of us, however, it is only illness or the approach of death that causes us to put aside other life events and to seriously reflect.

To lead us to do this reflection before or during an illness or as death approaches, Bartlow uses a metaphor of life as a river that is moving serenely through a forest of beauty. Suddenly the waters encounter a large stone and the peaceful flow is disrupted perhaps never to become again the gentle river it was. New adaptations to the environment must be made. However, though the river is different it need not cease to be what it was meant to be.

Bartlow sees our lives moving joyfully, with purpose through events as the original serene river. Unexpectedly, illness — perhaps terminal illness — enters and as the stone has changed the river, challenging it to adapt to a new environment and perhaps purposes.

In a similar way, illness becomes our teacher. As dashing against the stone causes the water to become murky and turbulent, so our illness causes us to ask questions we had long silenced within us. How will I live the remaining years of my life? What will I be able to do? How will my family and loved ones relate to me? Will I die peacefully or tied to machines, not being able to communicate my needs and/or desires?

Looking back over the river of his own medical career, Bartlow discovered that the questions he asked patients changed as he found that the medical technology he provided often failed to enable a patient to die well. Rather, 30 years of trying to “save” critically ill patients deprived them of the opportunity to complete the unfinished life goals that our core self needed to pursue in order to die healed.

His experiences taught him he could provide the opportunity for people to die well only if he moved from the technologically centered world into the post-modern world. He learned that rather than being a medical technician with answers about how to heal physical ills, he needed to become a healer, asking the patient to guide him to an understanding of what the patient in his/her deepest self needed so that he/she could die well.

As a technician, he had approached a patient thinking, “What do I need to do to offer this patient a physical cure?”

Today, as a healer, his queries are about the patient’s life goals, his/her hopes for the remainder of her/his life, the quality of life that would be acceptable if cure cannot be achieved.

Knowing the patient’s answers to these questions, as a healer he then outlines whether or not or to what degree the available medical procedures can provide sufficient time and energy for the patient to achieve these goals.

The essential questions become: What is your core self seeking to understand about itself through this illness? Are there unresolved issues that need to be addressed? Are there broken relationships that need to be healed if you are to die well?

The subtitle of this book, A Practical And Healing Guide to End-of-Life Issues for Families, Patients, and Healthcare Providers, can be misleading. A reader may expect a medical ethics book about how to use today’s techniques of medical science, such as pain medication and legal documents such as advance directives to provide for a dignified death.

Rather, the challenge of the book is either to use an existing illness or to imagine one’s dying days to ask questions about the type of person I want to be remembered as being. What have I achieved? What are the life goals that I have not yet accomplished? What is it that I was created to be? How can I achieve that in my remaining years?

Most medical research is empirical based on evidence rather than hunches or preferences. It follows a series of specific steps. There are no short cuts. Collection of evidence and its analysis should follow a carefully drawn protocol. Most of the modern medical research requires biostatistical tools to reach to a valid and reliable conclusion. Researcher must have an adequate knowledge and skill to be really effective. The endeavours should be consistent with the accepted medical and research ethics. Medical research can provide immense satisfaction when conducted on scientific lines, and can be occasionally frustrating when years of efforts fail to produce expected results. This article focuses on aspects that can increase the credibility of research. It is addressed to all interested in medical research, and seeking answers to questions such as what actually is research, what are its types, what specific steps should be followed, what a research protocol should contain, and what makes research credible etc.

Research is a foray into the unknown. It is search for new information and knowledge. Research is either discovery of new facts, enunciation of new principles, or fresh interpretation of the known facts or principles. It is an attempt to reveal to the world something that was either never thought of, or was in the domain of the conjectures-at best being looked at with suspicion. It is a systematic investigation to develop or contribute to generalizable knowledge. The basic function of research is to answer why and how of a phenomenon, but searching answers to what, when, how much, etc., is also part of research efforts. all these questions have relevance to any discipline but medicine seems to have special appetite for such enquiries. The goal of medical research is to improve health, and the purpose is to learn how various systems in human body work, why we get sick, and how to get back to health and stay fit. Research is the very foundation of improved medical care. It can also provide evidence for policies and decisions on health and development.

Much of human biology is still speculative, and its interaction with environment is intricate. Thus medical science has enormous potential for useful research. At the same time it has its own risks as well. This is evident from some of the studies published in 2002. Popular breast cancer therapy tamoxifen was found to carry increased risk of endometrial cancer1. Menopausal women who took estrogen for long time were also found to be at higher risk of getting ovarian cancer2. Arthroscopic surgery for osteoarthritis of knee was found no better than placebo3.

Medicine is a delicate science. It is concerned with vitalities of life such as health, disease and death. Thus, it brooks no error. Ironically, no theories are available that can make it infalliable. There are no lemmas and no theorems. It must per force depend on evidence provided by observations and experience. Medicine is largely an inductive science and has very little space, if any, for deductive methods. The past experience and present evidence provide an insight in to the future. This empiricism is the backbone of medical science. Very often it works wonderfully well but sometimes it does not. There is no assurance. Miscues reported in the year 20021″3 are examples of such errors.

Empiricism has no conflict with rationalism. The observations must stand up to the reason, and should have adequate rational explanation. After all it is the logic of reasoning that separates humans from other species. Research results are more acceptable when the accompanying evidence is compelling and inspiring.

All scientific results are susceptible to error but uncertainty is an integral part of medical framework because of its empirical nature. The realization of enormity of uncertainty in medicine may be recent but the fact is age-old. No two biological entities have ever been exactly alike; neither would they be so in future (How about cloning!). Also our knowledge about biological processes still is extremely limited. These two aspects-first variation, and second limitation of knowledge-throw an apparently indomitable challenge. But the medical science has not only survived but is ticking with full vigour. The silver lining is the ability of some experts to learn quickly from their own and other’s experience, and to discern signals from noise, waves from turbulence, trend from chaos. Biostatistical methods play a key role in this endeavour. It is due to this learning that death rates have steeply declined and life expectancy is showing a relentless rise in almost all countries around the world. Burden of disease is steadily but surely declining across the nations per thousand population4.

Types of medical research

Medical research encompasses a whole gamut of endeavours that ultimately help to improve the health of people. Functionally, it can be divided into basic and applied types. Basic, also termed as ‘pure1, research involves advancing the knowledge base without any specific focus on its application. The results of such research are utilized somewhere in future when that new knowledge is required. Applied research, on the other hand, is problem-oriented, and is specifically directed to solve an existing problem. In medicine, basic research is generally at the cellular level for studying various biological processes. Applied medical research could be on the diagnostic and therapeutic modalities, on agent-host-environment interactions, or health assessments.

A private REIT is shopping a 1.7 million-square-foot portfolio of medical-office buildings valued at about $275 million.

The package consists of 24 buildings in nine clusters, each leased primarily to hospitals or doctors affiliated with hospitals.

The average occupancy rate is 90%. Given the nature of their tenants, medical offices are considered more stable than traditional office buildings, with about a 90% lease renewal rate.

The REIT, Lillibridge Health of Chicago, is backed by Prudential Financial, AEW Capital Management and private-equity player J.P. Morgan Partners. Granite Partners is handling the marketing, with assistance from Cain Brothers, a New York investment bank that specializes in the health-care industry.

At a $165/sf price tag, the buyer’s initial annual yield would be less than 8%.

The portfolio includes the 135,000-sf Saddleback Valley Medical Center in Laguna Hills, Calif., and four San Antonio buildings, encompassing 424,000 sf, that are closely tied to Santa Rosa Hospital/Medical Center. Lillibridge bought Saddleback from Lehman Brothers in 2002 for $30.5 million and bought the San Antonio buildings in 2001 for $22.5 million.

Other properties are located in Atlanta (351,000 sf), Daytona Beach, Fla. (91,000 sf), Indianapolis (95,000 sf), Knoxville, Tenn. (235,000 sf), Miami (148,000 sf), and Minneapolis (97,000 sf). There is also an 88,000-sf Phoenix development, called Banner Desert Medical Pavilion, that is 66% pre-leased.

Except for six of the 10 Knoxville buildings, all of the properties are located on hospital campuses. Many are connected to the hospitals via sky bridges, walkways or underground corridors.

Six of the properties are leasehold interests. The ground leases run through 2041 to 2056, with renewal options of at least 25 years. The portfolio includes six garages that can hold 2,300 cars.

The offering comes on the heels of Orlando-based CNL Retirement Properties’ $256 million acquisition last month of a 1.3 million-sf portfolio from Medical Office Properties of Chevy Chase, Md.

Lillibridge was founded some 25 years ago by Todd Lillibridge, who still heads the firm, which owns or manages some 9 million sf in 20 markets. The company buys, develops and manages medical-office buildings and outpatient healthcare facilities.

Hong Kong’s health authorities said Tuesday that they are on high alert and have taken necessary preventive measures against severe acute respiratory syndrome (SARS) following Singapore’s report of its first probable case in four months.

The Hong Kong government said it has enhanced health checks on incoming travelers from Singapore at Hong Kong International Airport.

”Existing health screening measures, including health declaration and temperature screening at border control points, will remain in place. It is imperative that everybody, the community and the visitors alike, must be put on high alert,” Secretary for Health, Welfare and Food Yeoh Eng-kiong said.

The territory’s public hospitals, private hospitals and private medical practitioners have been alerted of the Singapore incident and told to be prepared for any possible reemergence of SARS.

Hong Kong was one of the areas hit worst by the highly contagious disease, which originated in southern China and triggered off a global health alarm early this year.

SARS infected 1,755 people in the former British colony with 300 deaths.

Hong Kong was removed from the World Health Organization’s (WHO) list of SARS-affected areas in late June.

Hong Kong’s Health Department said it has contacted Singapore’s Health Ministry and the WHO to learn more about the background of the case in the city-state.

The territory has also established a mechanism with neighboring Guangdong Province in mainland China for alerting each other on unusual infections.

”Certainly, we are much better prepared now than we were at the start of the previous outbreak. We should have sufficient facilities and manpower to deal with any possible outbreak. We are all on high alert,” Yeoh said.

He called on the public to continue with the good hygiene practices developed during the SARS epidemic.

Various government departments have also been told to continue preventive measures including requiring students to take their temperature every day before attending school, providing enhanced outreach support to elderly homes, strictly enforcing temperature checking of passengers at border control points, and maintaining active surveillance at clinics, schools, childcare centers and elderly homes.