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.
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.