Here we address interesting and important issues affecting the delivery of medical care and related topics from 2022.
We cover additional, related issues and discuss them in more depth on our blog.
November 30, 2022
A number of studies are suggesting that consuming higher amounts of foods containing flavonols slows memory loss associated with aging and may offer some protection against Alzheimer’s and dementia. Flavonols are a class of anti-oxidant compounds found in dark leafy greens, green tea, red wine, broccoli, beans, tomatoes, and leeks. Surely you can find something in there that you like.
November 29, 2022
Patients over 65 undergo 40% of all major surgeries in the United States. One in every seven of them is likely to die within the year following surgery. This is a finding from a study which appeared in JAMA Surgery recently. The conclusion is that many of these surgeries do not provide much benefit to the patient and are greatly outweighed by the risks of the surgery. We spend a great deal of our health care dollars on patients nearing the end of life. If a surgery is not likely to improve the life of an older patient, then only the surgeon and the hospital are benefiting from the procedure. Time to consider the patient in this equation.
November 28, 2022
We are still in the Medicare open enrollment time period. You are still seeing ads encouraging you to switch over to a Medicare advantage plan. Over 50% of Medicare beneficiaries are enrolled in Medicare advantage plans. As I have mentioned before concerning these plans, they make money by taking more from Medicare for treating their enrollees than they spend on actual care for their enrollees. When a plan offers you benefits that are not covered by traditional Medicare, the money to pay for these extra benefits has to come from somewhere. That money comes from limiting the care the enrollees receive. That fact helps explain why you are more likely to die after major cancer surgery if you are in a Medicare advantage plan than if you are covered by traditional Medicare. Here is a link to the article in the Journal of Clinical Oncology explaining the problem and its roots in the Medicare advantage plans. Remember, there is no free lunch.
November 16, 2022
In the recent election, South Dakota became the seventh state to expand Medicaid coverage through the ballot box as opposed to through the legislative process. These states were almost all run by conservatives in the legislature opposed to social programs such as Medicaid. If South Dakota is anything like the other conservative states in which the voters had to take this matter into their own hands to get it done, the change will be a long time coming. Unhappy and hostile legislatures in previous states have slow walked Medicaid expansion approved by the voters. These attitudes by the legislatures are one good reason why these states have some of the least healthy populations in the country.
November 15, 2022
In good news that I hope many of you saw, Congress capped insulin prices for seniors. The change came too late in the year for it to be included in the government’s Medicare plan finding tool. As a result, Medicare will allow seniors to make a change in the coming year without having to wait until the next open enrollment period. So, if you are an insulin using Medicare recipient, contact your local SHIP office. This is the agency that assists Medicare enrollees in each of the states. Here is a link to the SHIP website.
November 8. 2022
On Monday, I posted on our blog about the Medicare open enrollment period and Medicare Advantage plans. Here is a timely story that fits right in about the misleading advertising used by some advantage plans to lure new members. Beware and be careful.
November 7, 2022
Have high levels of LDL, the bad cholesterol, and taking over-the-counter supplements to reduce those levels? According to a new study, you are wasting your money. Popular supplements such as fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice, did nothing to lower LDL levels in the study, and, in some cases, raised them. On the other hand, according to researchers, statins were incredibly effective at lowering LDL levels. If you have bad LDL levels, save your money and go see a doctor for a prescription for a statin.
November 3, 2022
Here is a new idea that may be a win-win for everyone but high priced, low quality health care providers. Colorado has some of the highest health care costs in the country. Some employers are banding together to address the issue. They are providing each of their employees with an on line tool that rates health care providers by the quality of care and the cost of that care. The highest quality providers, the top 25%, are in the green range. The bottom 25% are in the red range and everyone else is in the yellow range. Health care costs are similarly divided up. If an employee chooses a green quality and green cost provider, she or he will receive a check from the employer. The amount will vary but can be substantial. When employees choose high quality, low cost providers, the employer saves money and this program shares some of that savings with the employee. Sounds great on paper. Let’s hope it works and injects a dose of sanity into the pricing of health care services.
November 2, 2022
Tis the season! Not yet Christmas but it is the open enrollment season for both Medicare plans and for people looking to buy health insurance for the coming year. I have written about the Medicare issues and have a blog post ready to go for next week. Today comes another warning about insurance plans. If it looks too good to be true, it probably is.
There are lots of people out there selling “insurance” plans. Some have very low premiums that can look very attractive until you read the fine print. Low premiums and good coverage don’t go together. The lower the premium, the more the company has to cut benefits to make the numbers add up. You may find that you have lots of coverage but have to pay a large deductible before the company begins to pay. Or you may find that there is a large co-pay and that you are on the hook for a big portion of the bill. Don’t wait until you have a large medical expense to find out what your insurance covers.
Another problem is people selling plans that are not insurance at all. They may be co-operative groups in which all the participants pay into a pool and the pool pays out on medical bills what it can afford to pay. Here is a story about a poor lady who thought she was buying insurance and ended up with a $40,000 bill to pay on her own. Don’t let this be you.
October 26, 2022
PSA testing is controversial. Many urologists and oncologists believe that there are too many elevated PSA levels that are not the result of significant prostate cancer. This, they believe, has resulted in too many biopsies and overtreatment. The controversy is based upon conflicting European and American studies of PSA testing. The largest European study found that higher levels of PSA testing were associated with lower levels of metastatic prostate cancer and fewer deaths due to prostate cancer. The largest American test found that higher levels of PSA testing made no difference to the rates of metastatic disease or death. As a result of the controversy, rates of PSA testing declined in the United States. According to an article in JAMA Oncology, the decline in the rate of PSA testing has resulted in an increase in the rate of metastatic prostate cancer. In retrospect, the American study may have been flawed. Doctors who treat men are now reconsidering their position on PSA testing.
October 25, 2022
There are two interesting stories in the news today about Covid vaccinations. The first one reports that if you feel sick after a Covid shot, that is a good thing because it means that your immune system has been strongly activated by the shot. The second story reports that people who are fit get better and stronger immune system responses to Covid vaccinations than those who are couch potatoes. If you are on the couch, get off and, while you are up, get a Covid shot and a flu shot.
October 24, 2022
One of the issues that has troubled many organizations and many researchers is the conflict of interest. When we listen to a physician speak or when we read about a medical study or when we hear advice from a health-related organization, we expect that we are receiving unbiased information. We expect that we are receiving the honest opinions of these people and that they have no financial or other interest in telling us only one side of the story. A recent report casts doubt on the Academy of Nutrition and Dietetics, an important group that speaks on the issue of healthy food and that represents many registered dieticians. According to the report, the Academy itself owns or owned stock in processed food companies and drug companies and accepted corporate financial contributions. If true, and there appears to be documentary support for the claims, this represents a huge conflict of interest. The Academy denies the charges and claims that the information was taken out of context. I guess we will see. In the meantime, as always, be appropriately skeptical of information you receive and always consider the source.
October 21, 2022
According to the Wall Street Journal, Big Pharma is feeling the heat. The recently passed Inflation Reduction Act finally gave Medicare the authority to negotiate prices on certain drugs and to demand rebates when certain drug price increases exceed the rate of inflation. The changes have not yet taken effect but Big Pharma is already sweating about the effect these limitations may have on its huge profit margins. The drug companies are trying to rally their usual allies to stop or blunt these threats. It will be interesting to see what happens.
October 20, 2022
All hospital rooms are not created equal. A new study has found that certain hospital room features are associated with better post-surgical outcomes. Not surprisingly, those rooms that are closest to the nursing station or that have a line of sight view of the nursing station are associated with better outcomes. If the nurses can see you or see you more frequently, they can better respond to your needs. It also helps to be in a room by yourself as opposed to having a roommate, who may keep you awake at night and who may have visitors, who can infect you or disturb you. Just another thing to worry about.
October 18, 2022
I have been writing for years about our inefficient and broken health care delivery system. Here is a nice piece offering the suggestions of six experts for how to fix, or at least improve, the system. Some of the suggestions look pretty sound, but, since they threaten the income streams of some pretty big players in health care delivery, expect them to be vigorously opposed.
October 17, 2022
The scientists whose research in mRNA technology led to the creation of the first Covid vaccines believe that their research can be repurposed to arm the immune system to fight cancer cells. It won’t be quick but they believe that within ten years they will be successful in this effort. A vaccine for cancer would be a big game changer.
October 13, 2022
The latest in hospitals trying to wring every last dollar out of patients and their insurance companies is something called the Obstetrics Emergency Department. When a pregnant woman in labor goes to the hospital to deliver her baby, someone, often a Labor and Delivery nurse, gives her a quick examination to make sure she is actually in labor and, if so, far enough along to be admitted to the Labor and Delivery unit at the hospital. Now, however, many hospitals are requiring that these short, screening examinations be performed by a doctor. This slight change is the excuse the hospital uses to justify billing an extra $1,000 to $1,500 for what it calls a visit to its Obstetrics Emergency Department. Please make the greed stop.
October 12, 2022
Things are looking bleak in the nation’s emergency departments. Some of the problems are rooted in the emergency departments themselves while some are rooted in the hospitals to which the emergency departments send their patients. In the emergency departments, there are not enough beds and not enough nurses. The shortage of beds is aggravated by the fact that the hospitals to which the emergency departments are attached don’t have enough beds to accept patients, who need to be admitted from the emergency department. Patients who are awaiting a bed in the hospital take up beds in the ED that are needed for new arrivals. Recent statistics show that, as wait times in the ED have increased, so has the number of patients who just give up and leave before being seen. We need an emergency department system that is able to provide timely care to people with emergency medical conditions and to move out of the ED those patients who have been seen and who need to be admitted to the hospital.
October 11, 2022
Of all the things you don’t want to think about or read about, this one may top the list. A neonatal intensive care nurse in Great Britain has been charged in the murders of seven babies and the attempted murder of ten more. The crime was so unthinkable that it took a while for authorities to even realize that the baby deaths were not natural. Once authorities concluded that the babies did not die naturally, they were able to find this woman based on her presence during each of the critical shifts when the babies suddenly deteriorated. The nurse’s trial has just begun in Northwest Britain. It is expected to last months.
October 10, 2022
Today’s blog post is on the subject of Medicare Advantage plans. By coincidence, the New York Times just ran a piece on practices by Medicare Advantage plans that are costing Medicare billions. Most of these practices involve some form of fraud, either in overbilling Medicare or in mining patient records for evidence to make them look sicker than they really are so as to justify higher reimbursement by Medicare. Advantage plans are the result of the belief held by some politicians that private enterprise can always do a better job than the government. The theory was that private insurers could provide Medicare’s benefits to eligible beneficiaries cheaper and more efficiently than Medicare. However, according to the Times, the looting by the insurance companies has now made Medicare Advantage plans more expensive for the federal government than traditional Medicare. Never underestimate the greed of corporations when faced with a complex program dispensing billions of dollars each year.
October 7, 2022
Another reason to get up off the couch. An article in the recent edition of JAMA Neurology described a study of dementia risks. It found that taking about 10,000 steps a day reduced a person’s risk of developing dementia by half. Sound like too many steps? Even 4,000 steps a day was found to reduce the risk of dementia by 25%. So get moving, America.
October 5, 2022
The benefits of attempts to lose weight vary depending on where you start. People who are obese when they begin weight loss attempts benefit more from them and gain less weight over time than people who are leaner when they begin. These are the findings of recent research into weight loss methods and body mass index (BMI). The conclusion of the authors is that there are not-yet-understood metabolic reasons for the differing responses to weight loss strategies. The story is worth a read.
October 4, 2022
According to the Wall Street Journal, a company called Bluebird Bio is about to put on the market the most expensive drug in the world. It will sell for $3,000,000 per treatment. While you might expect that a company selling a drug that expensive would be flush with cash, that is not the case here. Bluebird is in danger of running out of money. The condition treated by its new medication is a rare one. There are only about 1,300 people in the United States who would benefit from it. Even with its sky high price, the drug may be a bargain since, in the absence of the drug, the people with the condition need a blood transfusion every few weeks and those are expensive. The plight of Bluebird Bio demonstrates the difficulties of researching and developing drugs to treat rare illnesses. As with so many other parts of our health care delivery system, we need to do a better job.
October 3, 2022
According to the Arizona Hospital and Healthcare Association, a trade group representing Arizona’s hospitals, the financial situation for its members is bleak. The tight job market and inflation are combining to reduce profit margins. We have discussed some of the staffing problems faced by hospitals in Arizona and elsewhere due to issues such as staff burnout, poor working conditions, pandemic fatigue, poor pay and the lure of much higher pay for traveling nurses. Hospitals in Arizona report a 15% increase salaries and wages in the last year. Inflation has also raised the cost of the medical supplies hospitals must purchase.
September 29, 2022
By now you have surely heard that we have lots of bacteria, viruses and fungi living inside out bodies and helping to keep us healthy, or maybe not so healthy depending on which bacteria, viruses and fungi are dominant. This is called our gut biome. Turns out we aren’t the only ones with a biome.
Recently, cancer researchers have discovered that cancer tumors also have biomes that contain bacteria and fungi. This is a startling new discovery and there is much to learn, but already there are two important potential implications arising from this discovery. The first is that these bacteria and fungi will almost certainly be shedding some DNA into the bloodstream. If doctors can detect this DNA, it may allow them to discover cancer tumors before they become symptomatic and before it is too late to treat them. Think pancreatic cancer here, for example. The other potential consequence is that the bacteria may be essential to the successful growth of the cancer tumor and, if so, killing off those bacteria or otherwise disrupting them may offer another way to treat cancer tumors. Good news indeed.
September 9, 2022
Flu shots may offer a double benefit for older people who receive them. In addition to lowering the risk of getting the flu and making it less severe, if you do get it, researchers in Spain found in a large study that the flu shot also reduced the risk of having an ischemic stroke in the year following the immunization for people middle aged and older. The risk reduction was only about 12%, but every little bit helps when it comes to something as significant as a stroke. The researchers have no idea how the flu shot reduces the risk of stroke just that there is an association between the flu shot and the reduced incidence of stroke. Roll up your sleeve and get that flu shot.
September 7, 2022
I hate it when this happens. Another study shows that sugar is bad for us. This time it is related to the microbiome that resides in our intestines. These bacteria and fungi are responsible for many aspects of our health. Researchers have now discovered that a large part of our immune system is based in the gut and dependent on the health of the microbiome. This is where sugar comes in. Too much sugar in the diet affects the population of the microbiome. It kills off some of the beneficial bacteria and encourages the growth of those bacteria that are less helpful and which increase the risk of cardiometabolic disease and diabetes. As usual, Mom was right. Too much sugar is bad for you.
September 6, 2022
The wife of a California Congressman recently died suddenly and unexpectedly after drinking an herbal tea promoted as producing weight loss and lowering blood sugar in diabetics. She was thought to be in generally good health. Herbal remedies are not subject to regulation by the FDA and may not be subject to much in the way of quality control. Unintended and unexpected ingredients may find their way into herbal supplements or remedies. Patients may delay traditional medical treatment by trying a more “natural” remedy first. Toxic effects from herbal remedies may manifest themselves suddenly or slowly and quietly over time. Most herbal remedies are probably harmless as long as you don’t overdo them but remember that you are placing your life in the hands of someone else when you take one of these remedies. Watch for side effects and don’t delay seeking regular medical treatment.
September 2, 2022
From the good news bad news file comes this story about the successful treatment of cancer patients. We are learning more and more about cancer every day and are saving the lives of more and more cancer patients. That is the good news part. The bad news part is that, even with good health insurance, successful cancer treatment can leave you with medical bills that will bankrupt you. It is to the advantage of the big hospital chains, Big Pharma, and the health insurance industry to keep this dysfunctional system in place. Americans, elect someone who will make a change.
August 31, 2022
I learned a new word today: senelytics. It refers to a class of experimental drugs intended to reduce the presence of senescent cells in the body. Senescent cells are cells which have aged but which do not die off as cells are supposed to do when they reach the end of their useful lives. When we are young, cells at the end of their useful lives essentially commit suicide to make room for the new cells we create. Senescent cells, on the other hand, sit around and emit molecules that tend to interfere with the operation of neighboring cells. Researchers have reason to believe that the elimination of senescent cells will improve the function of the neighboring cells and keep those cells acting more like they did when we were young. Not a fountain of youth, but a promise that we might be able to stay active and healthy longer into our later years. There are many clinical trials underway addressing the use of senelytics in various parts of the body. We will see how they turn out.
August 30, 2022
Finally there has been some progress on the price of insulin. Under the Inflation Reduction Act Congress placed a cap on the price of insulin of $35. While this is a great victory for consumers, right now it only applies to Medicare beneficiaries. A proposal to limit the cost of insulin for all comers was stripped out of the final bill. There are also a number of other initiatives out there to make insulin less costly for everyone. Let’s hope this progress continues.
March 18, 2022
What to do about the shortage of nurses? Nurses have been leaving the profession due to burnout, low pay, high expectations and many other reasons just as the need for nurses is skyrocketing due to the pandemic and the ageing of society. Two general approaches have developed. Not surprisingly, they are divided along red and blue lines. Democratic states favor spending more money to train nurses. Many Republican states, on the other hand, say the solution is to require less education and training. As a consumer of health care services, I don’t think dumbing down the requirements to be a nurse is the best path to effective and competent health care.
March 11, 2022
Pancreatic cancer is deadly. It is deadly because it is almost never detected until late in its development by which time it has usually grown large and spread to other organs. Some European researchers have found a promising link between certain fecal microbes and the likelihood of pancreatic cancer. According to their work, if these 27 microbes are present in a person’s fecal material, there is an 84% chance that they have pancreatic cancer. The researchers are applying for a patent to develop a testing kit. Let’s all hope this pans out.
March 9, 2022
Stay in school. Researchers have found that in people who develop mild cognitive impairment (MCI), those with college degrees or who speak more than one language are less likely to progress to actual dementia. Researchers believe that these people have more “cognitive reserve,” which allows them to function even in the face of the process which leads to dementia.
March 8, 2022
I hope you don’t need to have your aortic valve replaced but, if you do, there is good news. Cardiac surgeons can now replace aortic valves without opening your chest and performing open heart surgery. The procedure called Transcatheter Aortic Valve Replacement (TAVR) has been approved for use in the United States since 2011. Its use has increased greatly since its initial approval by the Food and Drug Administration. In 2020, the last year for which there are figures, over 80,000 TAVR’s were performed. The number of open heart aortic valve replacements has been dropping in tandem as more and more surgeons choose to use the new procedure. Being less invasive, the TAVR procedure has a much quicker recovery time and a greatly reduced price tag. Medical progress marches on.
March 7, 2022
An ophthalmologist/ocular surgeon in New York state, Dr. Ameet Goyal, has been sentenced to 96 months in prison for fraud on his patients, their insurance companies and Medicare. In addition to the prison time, he will have to pay restitution of $3.6 million and forfeit another $3.6 million. He perpetrated the fraud by “upcoding” medical procedures he performed. This fraud involves claiming that a procedure was more complicated than it was so that the physician can charge a higher price for it. He made phony entries in patient charts, which misrepresented their medical history and which will make it more difficult for their new doctors to figure out exactly what has happened with them and what treatment they need. The upcoding not only required insurers to pay more, it often required patients to pay more for deductibles and co-pays. When patients could not pay the increased amounts necessitated by the upcoding, the doctor sent them to collections and ruined their credit ratings. When employees in his medical practice were reluctant to go along with his fraud, he threatened them.
One more corrupt doctor taken off the streets but there are plenty more where he came from.
March 3, 2022
A promising new cancer treatment for solid tumors may be going to human trials soon after proving successful in mice. The treatment involves the placement next to a solid tumor of beads, which emit a controlled amount of an immune system protein that summons immune system killer cells to the area where, at least in mice, they attack and destroy the tumor. Not all treatments that are successful in mice transfer successfully to human beings but only a human trial will tell. Human trials may begin as soon as the end of the year.
March 1, 2022
A recent study has revealed a potential problem for people with pacemakers or implanted cardiac defibrillators. These devices are designed to be programmed through the use of strong magnetic signals from outside the body. Some high tech products such, as the Apple AirPods Pro, the Microsoft Surface Pen and the Apple Pencil, can interfere with pacemakers or defibrillators, if held too close to the body. Users take care.
February 9, 2022
The Feds are cracking down on the manufacturers of hardware used in spinal surgeries whom they contend are bribing surgeons to use their products. The amounts paid by these manufacturers to surgeons has been a bone of contention for many years. A number of studies have found that surgeons who receive these payments, which are usually cast as consulting or speaking fees, are more likely to use the manufacturer’s products than surgeons who do not receive the payments. The surgeons receiving the payments argue they have done nothing wrong and that all their decisions are based on what is best for their patients. The facts would suggest there is at a minimum a strong conflict of interest.
February 2, 2022
Here is an excellent article on the best and most effective way to use rapid Covid tests. It also discusses the limitations of this type of test and cautions against assuming that a negative test means that you are free of the virus and cannot transmit it.
January 12, 2022
On a number of occasions I have discussed the qualities one should look for in a surgeon, one of the most important being how often he or she performs the surgery you need. Recent research has added another interesting qualification: gender. It turns out that female surgeons have lower complication rates, fewer hospital readmissions and lower death rates than their male counterparts. This difference is even more pronounced if the patient is a female as well. Female patients needing surgery should take note.
January 10, 2022
The Covid scammers are back. Actually they never left. They do have a new scam, however. Now they are selling fake at home test kits on line. Don’t get taken. Make sure you are purchasing from a reputable seller and that the test kit is approved by the FDA. Obviously, you can avoid the on line scammers, if you can find a test kit at Walgreens’ or CVS or some similar retailer, but they are in short supply, if available at all.